Cervical Degenerative Disc Disease Research Articles

Characteristics of Cervical Sagittal Alignment at Different C0–C2 Correcting Angles in Fusion Treatment of Atlantoaxial Dislocations

To explore the appropriate range of C0-C2 correction angles by analyzing cervical sagittal alignment parameters and evaluating clinical outcomes. The preoperative and postoperative radiographs, visual analogue scale, Japanese Orthopedic Association score, and neck disability index of 65 atlantoaxial dislocation patients were retrospectively collected. The C0-C2 angle, C2-C7 angle, and cervical sagittal vertical axis (cSVA) were measured from the radiographs, and an assessment of cervical degenerative disc disease was made. According to the 2-year postoperative C0-C2 angles, all patients were categorized into a <10° subgroup, 10°-20° subgroup, and >20° subgroups. The postoperative C2-C7 angles and cSVA of the 10°-20° subgroup were significantly different from those of the <10° subgroup. The Japanese Orthopedic Association score of the 10°-20° subgroup was significantly different from those of the <10° and >20° subgroups. All patients (26/26) in the 10°-20° subgroup exhibited a cSVA 0-40 mm, 25% of patients (6/24) in the >20° subgroup exhibited a cSVA >40 mm, and 40% of patients (6/15) in the <10° subgroup showed a cSVA <0 mm. The postoperative incidence of cervical degenerative disc disease did not increase in the 10°-20° subgroup. Atlantoaxial dislocation patients with different C0-C2 postoperative angles had different cervical sagittal alignments and clinical outcomes. In our study, the patients within the C0-C2 10°-20° subgroup exhibited superior clinical outcomes and cervical sagittal alignment.

Differential diagnosis of patients with cubital tunnel syndrome and concurrent diseases

The main groups of peripheral nerve disorders - cubital tunnel neuropathy, peripheral nerve sheath tumors and cervical degenerative disc disease are reviewed in this article. The main clinical courses of these disorders are presented in this article. We met some problems during the treatment of these disorders. The differential diagnosis of these disorders is associated with some difficulties. Basing on these problems, we attempt to describe advances and limitations of diagnostic methods used for differential diagnostic of abovementioned disorders in this article. (For citation: Orlov AYu, Jigania R, Nasarov AS, et al. Differential diagnosis of patients with cubital tunnel syndrome and concurrent diseases. Herald of North-Western State Medical University named after I.I. Mechnikov. 2018;10(2):5-11. doi: 10.17816/mechnikov20181025-11).

Cost-Effectiveness Analysis of Cervical Anterior Fusion and Cervical Artificial Disc Replacement in the Korean Medical System.

ObjectiveThis study is a retrospective cost-benefit analysis of cervical anterior interbody fusion and cervical artificial disc replacement, which are the main surgical methods to treat degenerative cervical disc disease. MethodsWe analyzed 156 patients who underwent anterior cervical disc fusion and cervical artificial disc replacement from January 1, 2008 to December 31, 2009, diagnosed with degenerative cervical disc disorder. In this study, the costs and benefits were analyzed by using quality adjusted life year (QALY) as the outcome index for patients undergoing surgery, and a Markov model was used for the analysis. Only direct medical costs were included in the analysis; indirect medical costs were excluded. Data were analyzed with TreeAge Pro 2015™ (TreeAge Software, Inc, Williamstown, MA, USA). ResultsPatients who underwent cervical anterior fusion had a total cost of KRW 2501807/USD 2357 over 5 years and obtained a utility of 3.72 QALY. Patients who underwent cervical artificial disc replacement received 4.18 QALY for a total of KRW 3685949/USD 3473 over 5 years. The cumulative cost-effectiveness ratio of cervical spine replacement surgery was KRW 2549511/QALY (USD 2402/QALY), which was lower than the general Korean payment standard. ConclusionBoth cervical anterior fusion and cervical artificial disc replacement are cost-effective treatments for patients with degenerative cervical disc disease. Cervical artificial disc replacement may be an effective alternative to obtain more benefits.

A Comparison of Cervical Disc Arthroplasty and Anterior Cervical Discectomy and Fusion in Patients with Two-Level Cervical Degenerative Disc Disease: 5-Year Follow-Up Results

To present a long-term clinical and radiographic comparison between the Prestige LP cervical disc replacement and the Zero-P spacer cervical disc fusion in the treatment of patients with symptomatic 2-level cervical degenerative disease. In total, 36 patients in the anterior cervical discectomy and fusion (ACDF) group and 24 patients in the cervical disc arthroplasty (CDA) group were analyzed before surgery and at 1 week and 3, 6, 12, 24, and 60 months after surgery. Clinical assessments included the Japanese Orthopaedic Association score, visual analog scale, and Neck Disability Index scores. Radiographic assessments included cervical lordosis, range of motion (ROM) of the total cervical spine, functional spinal unit (FSU), and superior and inferior adjacent segments. Complications including heterotopic ossification and adjacent-segment degeneration (ASD) at 5-year follow-up were collected as well. Mean follow-up period was 65.6 months. Both the ACDF and CDA groups showed significant clinical improvements in terms of Japanese Orthopaedic Association score, visual analog scale, and Neck Disability Index (P<0.05), but there was no significant difference between groups at the last follow-up period. A significant increase of cervical lordosis was observed in the CDA group after surgery whereas a significant difference was not observed between groups. ROM of the total cervical spine and FSU were maintained during the follow-up, and a significant decrease was observed in the ACDF group after surgery (P< 0.05). The ROM of the superior adjacent segment did not show any difference whereas the ROM of the inferior adjacent segment in the ACDF group presented a significant increase at 6 months and 1 year after surgery and a significant decrease at the last follow-up period. A total of 8 (33.3%) patients in the CDA group had an occurrence of heterotopic ossification. ASD was observed in 2 (8.3%) patients who underwent CDA surgery and 8 (22.2%) patients who underwent ACDF surgery. The use of the Prestige-LP and ZERO-P Spacer implantations is safe and effective. At 5 years after surgery, CDA with Prestige-LP is superior in terms of ROM of the total cervical spine, FSU, and inferior adjacent segment. It also has a relatively low occurrence rate of ASD. This procedure may be a suitable choice for the treatment of contiguous 2-level CDDD.

Clinical outcomes of locking stand-alone cage versus anterior plate construct in two-level anterior cervical discectomy and fusion: a systematic review and meta-analysis

Two-level cervical degenerative disc disease (cDDD) can be effectively treated by anterior cervical discectomy and fusion (ACDF) similarly to single-level cDDD. Traditionally an anterior plate construct (APC) approach has been utilized, but ACDF without plate with a locking stand-alone cage (LSC) approach has emerged as an alternative option. The aim of this study was to compare the clinical outcome of LSC and APC in contiguous two-level ACDF used to treat cDDD the current literature. Searches of seven electronic databases from inception to March 2018 were conducted following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Extracted data were analysed using meta-analysis of proportions. The nine observational studies that satisfied all criteria described a pooled cohort of 687 contiguous two-level cDDD cases managed by ACDF, with 302 (44%) and 385 (56%) managed by LSC and APC approaches, respectively. When compared with APC, LSC was associated with significantly increased subsidence likelihood (OR 2.75; p < 0.001), greater disc height (MD 0.60mm; p = 0.04) and reduced cervical lordosis (MD - 2.52°; p = 0.04) at last follow-up. Operative outcomes, fusion rates, functional scores and postoperative dysphagia rates were comparable. Although significant radiological differences were most evident, the comparability between LSC and APC in contiguous two-level ACDF with respect to all other clinical outcomes does not implicate one approach as clearly superior to the other in two-level ACDF. Larger, randomized studies with longer follow-up are required to delineate outcomes further to validate the findings of this study. These slides can be retrieved under Electronic Supplementary Material.

Outcome Evaluation of Zero-Profile Device Used for Single-Level Anterior Cervical Discectomy and Fusion with Osteoporosis Compared without Osteoporosis: A Minimum Three-Year Follow-Up Study

We compared the mid-term efficacy and safety of anterior cervical discectomy and fusion (ACDF) using a Zero-Profile device for cervical degenerative disc disease (CDDD) with and without osteoporosis. We performed a retrospective study of elderly patients with CDDD treated by single-level ACDF with a Zero-Profile device. The patients were divided into group A (osteoporosis) and group B (no osteoporosis) according to the bone mineral density. The clinical outcomes (Japanese Orthopaedic Association, neck disability index, visual analog scale, and short-form 36 scores), radiological outcomes (cervical lordosis and fusion rate), and complications were reviewed at each follow-up examination. All procedures were successfully performed in all patients. The Japanese Orthopaedic Association, neck disability index, visual analog scale, and short-form 36 scores and cervical lordosis were significantly improved postoperatively in both groups (P < 0.05). However, no significant difference was found between the 2 groups at each follow-up point (P > 0.05). No significant difference was found in the fusion rate at 3 months postoperatively (group A, 88.9%; group B, 90.0%), dysphagia rate at 1 month postoperatively (group A, 11.1%; group B, 15.0%), or cage subsidence rate at the final follow-up visit (group A, 11.1%; group B, 10.0%; P > 0.05). All patients achieved solid fusion, and no patient had dysphagia at the final follow-up examination. ACDF with the Zero-Profile device can be used as an effective and reliable treatment for single-level CDDD with osteoporosis.

Anchored Spacers Versus Standalone Cages in Two Levels Anterior Cervical Discectomy for Treatment of Degenerative Cervical Disc Disease; A Comparative Study

Background Data: Anterior cervical discectomy and fusion (ACDF) has been standard procedure in treatment of degenerative cervical disc disease. In order to reduce risks associated with traditional methods of anterior cervical discectomy with fusion a new zero profile cage with screws has been introduced and widely used.Purpose: To compare the clinical and radiological outcomes of two levels ACDF using stand-alone peek cage and zero profile anchored cage with screws.Study Design: Two groups of patients were enrolled in this study; Group A involving 30 consecutive patients that underwent two levels ACDF using standalone peek cages, and Group B including 30 patients that underwent two levels ACDF with zero-profile anchored cage with screws.Patients and Methods: Both surgical groups were assessed clinically involving neck and arm pain Visual Analogue Score (VAS), neck disability index and Nurick score. Radiological evaluation involved the changes in vertebral heights (VH), both segmental (Cobb-s) and global (Cobb-c) Cobb angle and fusion rates via plain X-ray cervical spine that was done pre-operative, immediate post-operative and at 24 months post-operative.Results: The neck disability index and the Nurick score together with both VAS for neck and arm pain were significantly improved after surgery with no statistical difference between both groups. All patients in both groups showed satisfactory fusion rates except two patients in Group A. Both groups showed early marked increase in the VH followed later by cage subsidence that was significantly higher in Group A patients. In both groups; Cobb-c, and Cobb-s angles were significantly increased in the immediate postoperative compared to the preoperative measures. Terminal measures for both Cobb-c and Cobb-s, at 24 months follow up images, in both groups worsened but to a statistically significant lesser extent in Group B compared to Group A.Conclusion: The zero-profile anchored cage with screws compared to stand-alone peek cage was effective treatment for cervical disc disorders in two levels cervical discectomy and fusion and their results showed better result regarding the incidence of cage subsidence and maintaining cervical lordosis. (2018ESJ169)

Motion analysis of dynamic cervical implant stabilization versus anterior discectomy and fusion: a retrospective analysis of 70 cases.

Retrospective kinematic analysis of treated level, adjacent levels, and overall cervical spine after single-level dynamic cervical implant (DCI) stabilization versus anterior cervical discectomy and fusion (ACDF). Between June 2009 and March 2013, 70 consecutive patients with a symptomatic single-level cervical degenerative disk disease (DDD) were enrolled in this study and divided into DCI (n = 35) group and ACDF (n = 35) group. All cases were followed up for more than 5years. The study compared perioperative parameters; clinical outcomes; and radiological parameters. Kinematic analysis included range of motion (ROM) of treated level and adjacent level, overall ROM (C2-C7), and changes in adjacent disk spaces. There were no significant differences between the DCI group and ACDF group in terms of improvement in the SF-36, VAS, NDI, and JOA scores. DCI stabilization resulted in better ROM of C2-C7 and the treated level than ACDF did. The ROM of treated level decreased significantly at 24months after surgery and last follow-up in the DCI group, and the C2-C7 ROM showed different degrees of reduction after the 24months after surgery. Radiological evidence of adjacent segment degeneration (ASD) at last follow-up was observed in 4/22 patients (18.2%) in the DCI group and 5/23 patients (21.7%) in the ACDF group which was not a significant difference between groups (p > 0.05). DCI stabilization for the treatment of cervical DDD cannot preserve the normal kinematics of the cervical spine for a long time, especially the treated level. DCI stabilization cannot decrease the risk of ASD compared with ACDF. These slides can be retrieved under Electronic Supplementary Material.

Can the Zero-Profile Implant Be Used for Anterior Cervical Discectomy and Fusion in Traumatic Subaxial Disc Injury? A Preliminary, Retrospective Study

ObjectiveThe zero-profile implant (Zero-P) is accepted for use in anterior cervical fusion for the treatment of degenerative cervical disease. However, evidence pertaining to its efficiency and safety in traumatic cervical injury is largely insufficient. This study aimed to compare the overall outcomes of patients who underwent Zero-P for traumatic cervical disc injury. MethodsData from a total of 53 consecutive patients who underwent surgery for traumatic or degenerative cervical disc disease using the Zero-P were reviewed. Seventeen patients (group A) had traumatic cervical disc injury and the remaining 36 (group B) had degenerative cervical disc herniation. The fusion and subsidence rates and Cobb angle were measured retrospectively from plain radiographs. The patients’ clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score and Odom’s criteria. ResultsThe C2–7 Cobb and operative segmental angles increased by 3.45±7.61 and 2.94±4.59 in group A; and 2.46±7.31 and 2.88±5.49 in group B over 12 postoperative months, respectively. The subsidence and fusion rate was 35.0% and 95.0% in group A; and 36.6% and 95.1% in group B, respectively. None of the parameters differed significantly between groups. The clinical outcomes were similar in both groups in terms of increasing the JOA score and producing a grade higher than “good” using Odom’s criteria. ConclusionThe application of Zero-P in patients with traumatic cervical disc injury was found to be acceptable when compared with the clinical and radiological outcomes of degenerative cervical spondylosis.

Clinical and radiographic outcomes of cervical disc arthroplasty with Prestige-LP Disc: a minimum 6-year follow-up study

BackgroundCervical disc arthroplasty (CDA) has been considered as an alternative to cervical arthrodesis in the treatment of cervical degenerative disc diseases (CDDD). The aim of this study was to assess the long-term clinical and radiographic outcomes of CDA with Prestige-LP Disc.MethodsA total of 61 patients who underwent single- or two-level CDA with Prestige-LP Disc were retrospectively investigated at a minimum of 6-year follow-up. Clinical assessments included visual analogue scale (VAS) for neck and arm pain, Neck Disability Index (NDI), and Japanese Orthopedic Association (JOA) score. Radiological evaluations included range of motion (ROM) of the index and adjacent levels, segmental angle, cervical sagittal alignment, heterotopic ossification (HO) and adjacent segment degeneration (ASD).ResultsSignificant and maintained improvement in VAS for neck and arm, NDI and JOA were observed after a mean follow-up of 82.3 months (p < 0.001). The preoperative ROM of the index level was 9.7°, which was maintained at 2-and 4-year follow-up (9.3°, p = 0.597; 9.0°, p = 0.297), but was decreased to 8.0° at final follow-up (p = 0.019). Mobility was maintained in 80.5% (62/77) of the implanted prostheses at final follow-up. ROM of the superior and inferior adjacent segments, cervical sagittal alignment and cervical angel were all maintained. The incidence of HO was 42.9% at final follow-up, but it did not influence the clinical outcome. Radiographic ASD were detected in 29.5% of the patients. However, the incidence of symptomatic ASD was only 6.6%.ConclusionCervical disc arthroplasty with Prestige-LP Disc demonstrated a maintained and satisfactory clinical outcome at a minimal of 6-year follow-up, with majority of the prostheses remained mobile. Cervical disc arthroplasty with Prestige-LP Dis can be considered as an effective surgical method in treating CDDD.

Chromium and Nickel Concentrations in Subjects with a Stainless Steel Metal-on-Metal Cervical Disc Arthroplasty: Results from a Prospective Longitudinal Study with 7 Years Follow-Up.

Cervical disc arthroplasty (CDA) has emerged as an alternative to anterior cervical discectomy and fusion for degenerative cervical disc disease. The artificial discs provide intervertebral motion using multicomponent articulation and thus tend to generate particulate debris and soluble metal ions. Limited information is available on the long-term metal concentrations and associated systemic adverse events observed in metal-on-metal CDA. Serum chromium (Cr) and nickel (Ni) concentrations were assessed in patients implanted with ball-in-trough stainless steel-based cervical disc through 7 years. A prospective, nonrandomized longitudinal study was conducted that included 25 patients following rigorous exclusion criteria that included no previous permanent metal implants and no professional exposure to metal particles. Blood serum Cr and Ni concentrations were assayed preoperatively and at 3, 6, 12, 24, 36, 60, and 84 months postoperatively using high-resolution inductively coupled plasma-mass spectrometry. Longitudinal statistical comparisons were made using the Friedman test with statistical significance at P < .05. Median serum concentrations determined preoperatively and at 3, 6, 12, 24, 36, 60, and 84 months postoperatively were 0.074, 0.106, 0.132, 0.170, 0.172, 0.274, 0.192, and 0.203 ng/mL for Cr and 0.085, 0.178, 0.222, 0.175, 0.205, 0.284, 0.181, and 0.194 ng/mL for Ni. The serum Cr concentrations were statistically higher for all postoperative time periods compared to preoperative concentration (Friedman P <.01), whereas serum Ni concentration was statistically higher at the 84-month postoperative time period than the preoperative concentration (Friedman P <.01) and then the concentration at 3, 12, 24, and 60 months postoperatively (Friedman P < .03). The Cr concentrations detected at all postoperative times were statistically higher than preoperative concentrations, whereas Ni concentration was statistically higher than the preoperative concentration only at 84 months.

Thursday, September 27, 2018 3:35 PM–5:05 PM Section on Motion Technology Abstract Presentations: 134. Ten-year radiographic analysis of one- and two-level cervical disc arthroplasty in a U multicenter study

BACKGROUND CONTEXT Short- and mid-term studies have demonstrated that cervical disc arthroplasty (CDA) can maintain or restore range of motion and sagittal alignment in select patients with cervical disc degeneration. Upon completion of the 7-year Mobi-C FDA study, follow-up continued out to 10 years on a subset of CDA patients from high-enrolling centers in the FDA study. This is an analysis of the radiographic outcomes of the first 98 CDA patients with 10-years follow-up. PURPOSE The purpose of this study is to present preliminary radiographic outcomes of the first 98 (approximately 50%) patients followed for 10-years in a multicenter study of cervical arthroplasty for one- and two-level pathology. STUDY DESIGN/SETTING This was a prospective cohort study of patients treated with cervical disc replacement at one or two contiguous levels using the Mobi-C Cervical Disc. Following completion of the 7-year FDA post approval study, follow-up was extended to 10 years for consenting patients at seven high-enrolling centers. PATIENT SAMPLE The inclusion criteria for this study was adult patients (>18 years) with radiculopathy or myelopathy and cervical spondylosis at one or two contiguous levels and no prior cervical operations. OUTCOME MEASURES All radiographic evaluations were conducted by independent radiologists (Medical Metrics, Inc., Houston, TX, USA). Radiographic endpoints included segmental and global range of motion, sagittal alignment, adjacent level degeneration (ALD) and heterotopic ossification (HO). The Kellgren-Lawrence scale of disc degeneration was used to define radiographic ALD. HO was classified using the system adapted from McAfee and Mehren. HO grades 3 and 4 were classified as clinically relevant due to restricted ROM. METHODS Ten-year radiographic follow-up was obtained from 98 CDA patients (53 2-level; 45 1-level) at seven centers. All radiological endpoints for the study cohort including HO were evaluated at 10 years, and were compared to the 7-year data for the group using statistical tests that were 2-sided, with p values RESULTS There were no significant differences in demographic factors or preoperative patient-reported outcomes between these patients and the original FDA cohort. Both segmental flexion-extension (FE) and lateral bending (LB) range of motion remained significantly greater (p .05). Global (C2-C6) flexion-extension and sagittal alignment also were maintained from 7 to 10 years (p>.05). Clinically relevant ALD (Grades III-IV) at 10 years was not significantly different from the 7-year incidence for one-level (25.0% vs. 26.2%; p=.47) or 2-level (17.0% vs. 13.7%; p=.16) CDA patients. The incidence of clinically relevant HO at 10 years was not significantly different from the 5-year incidence for one-level (28.9% vs. 33.3%; p=.88) or 2-level (35.8% vs. 26.9%; p=.21) CDA patients. From 7 to 10 years, 94% of patients had no progression of HO. Although patients with Grade 3/4 HO had diminished ROM, range of motion at the affected level(s) remained stable in these patients from 7 years (FE 3.7°; LB 2.7°) to 10 years (FE 3.5°; LB 2.6°). CONCLUSIONS We demonstrate continued maintenance of radiographic performance of cervical arthroplasty out to 10 years. At 10-year follow-up, both one- and two-level arthroplasty demonstrate sustained range of motion and sagittal alignment in comparison to baseline values. Progression of ALD and HO was limited from 7 to 10 years in these patients. Our preliminary results through 10 years demonstrate that total disc arthroplasty with Mobi-C continues to be an effective surgical treatment for patients with one- or two-level cervical degenerative disc disease. FDA DEVICE/DRUG STATUS The Mobi-C is approved for this indication.

Total disc replacement versus anterior cervical discectomy and fusion: a systematic review with meta-analysis of data from a total of 3160 patients across 14 randomized controlled trials with both short- and medium- to long-term outcomes.

The aim of this study was to determine how the short- and medium- to long-term outcome measures after total disc replacement (TDR) compare with those of anterior cervical discectomy and fusion (ACDF), using a systematic review and meta-analysis. Databases including Medline, Embase, and Scopus were searched. Inclusion criteria involved prospective randomized control trials (RCTs) reporting the surgical treatment of patients with symptomatic degenerative cervical disc disease. Two independent investigators extracted the data. The strength of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. The primary outcome measures were overall and neurological success, and these were included in the meta-analysis. Standardized patient-reported outcomes, including the incidence of further surgery and adjacent segment disease, were summarized and discussed. A total of 22 papers published from 14 RCTs were included, representing 3160 patients with follow-up of up to ten years. Meta-analysis indicated that TDR is superior to ACDF at two years and between four and seven years. In the short-term, patients who underwent TDR had better patient-reported outcomes than those who underwent ACDF, but at two years this was typically not significant. Results between four and seven years showed significant differences in Neck Disability Index (NDI), 36-Item Short-Form Health Survey (SF-36) physical component scores, dysphagia, and satisfaction, all favouring TDR. Most trials found significantly less adjacent segment disease after TDR at both two years (short-term) and between four and seven years (medium- to long-term). TDR is as effective as ACDF and superior for some outcomes. Disc replacement reduces the risk of adjacent segment disease. Continued uncertainty remains about degeneration of the prosthesis. Long-term surveillance of patients who undergo TDR may allow its routine use. Cite this article: Bone Joint J 2018;100-B:991-1001.

Effects of preoperative mental distress versus surgical modality, arthroplasty, or fusion on long-term outcome in patients with cervical radiculopathy.

Several efforts have been made to investigate the long-term efficacy of artificial disc replacement surgery compared with that of fusion after decompression for the treatment of cervical degenerative disc disease and radiculopathy. However, research on the impact of mental distress on surgical treatment outcome has been sparse. The aim of the authors was to investigate the potential predictive value of preoperative risk factors in determining long-term outcome. A total of 153 patients (mean age 47 years) with single- or double-level cervical degenerative disc disease and radiculopathy were randomly assigned to undergo either anterior cervical discectomy and fusion (n = 70) or artificial disc replacement (n = 83). The primary outcome was the Neck Disability Index (NDI) score, a patient-reported function score that ranges from 0% to 100%; higher scores indicate greater disability. Preoperative variables such as sex, age, smoking status, employment status, having a strenuous job, neck pain duration, arm pain duration, amount of regular exercise, Hospital Anxiety and Depression Scale (HADS) score, NDI score, whether surgery was performed on 1 or 2 levels, and allocated treatment were analyzed in multiple linear regression models with the 5-year NDI score as the outcome. A total of 47 (31%) patients had either a HADS anxiety or HADS depression score of 10 points or higher. High values on the preoperative HADS were a negative predictor of outcome (p = 0.009). Treatment allocation had no effect on 5-year NDI scores (p = 0.32). Preoperative mental distress measured with the HADS affects long-term outcome in surgically treated patients with cervical radiculopathy.

Posterior longitudinal ligament resection in anterior cervical discectomy

BackgroundThe concept of generous decompression, including resection of the posterior longitudinal ligament (PLL) and even partial bilateral uncovertebral joint resection, has been adopted by some authors. This was justified by the need to remove compressive structures hidden underneath and to prevent nerve root impingement during extreme flexion/extension or rotation. This study was designed to assess the benefits of PLL resection as a routine step in anterior cervical discectomy and fusion (ACDF) surgeries and to find out if there is any added risk of such a procedure that overweighs its benefits.MethodsThis is a retrospective study conducted on 50 patients who underwent ACDF for treatment of degenerative cervical intervertebral disc disease with microscopic resection of the posterior longitudinal ligament.ResultsThere were 31 (62%) males and 19 (38%) females. Age ranged from 22 to 69 years with a mean age of 47.32 years. A total of 83 disc levels were operated upon with a mean of 1.66 levels per patient. Analysis of the obtained data showed a statistically significant difference between the preoperative and both early and late postoperative VAS (p value < 0.001 for both). Moreover, there was a statistically significant difference between early and late postoperative VAS with a p value < 0.001. For axial neck pain, similar results could be demonstrated. Regarding motor function of related nerve roots, there was a statistically significant improvement in preoperative motor power grade values that can be demonstrated when compared with both the early and late postoperative grade values (3.96 ± 0.638, 4.34 ± 0.557, and 4.88 ± 0.328 respectively).ConclusionsDespite being an additional step in ACDF surgery, resection of the PLL does not seem to add significant surgical risk. On the other hand, it had a positive impact on outcome regarding axial and radicular pain. So, it may be advisable to attempt resection of the PLL as a routine step in ACDF surgery.

A comparison of a self-locking stand-alone cage and anterior cervical plate for ACDF: Minimum 3-year assessment of radiographic and clinical outcomes

ObjectivesThe self-locking stand-alone cage has been clinically applied in treating cervical degenerative disc disease (CDDD). However, no long-term clinical and radiographic studies have been performed so far. This retrospective study was designed to analyze and compare the efficacy and outcomes of anterior cervical discectomy and fusion (ACDF) using self-locking stand-alone cages and cages with the anterior cervical plating system. Patients and methodsA total of 98 consecutive patients were recruited in this study. Patients in the cage group were given stand-alone self-locking cages, and patients in the plate group were treated with cages and anterior plate fixation. The operative time, intraoperative blood loss and complications were recorded. Clinical outcomes were evaluated using the JOA scoring system, Neck Disability Index and Odom’s criteria. The cervical lordosis, subsidence and cervical fusion status were assessed by X-ray and computed tomography. ResultsThe mean follow-up period was 39.7 months in the cage group and 42.2 months in the plate group. The operative time, intraoperative blood loss, postoperative dysphagia, sore throat and adjacent segment degeneration in the cage group were significantly less than those in the plate group (p < 0.05). All the patients in both groups achieved complete interbody fusion. Postoperative JOA and NDI scores in both groups were obviously improved compared with the preoperative ones. The postoperative cervical lordosis was effectively restored in both groups. ConclusionsThe self-locking stand-alone cage for ACDF could effectively restore the cervical physiological curvature, cause few complications, and lead to satisfactory outcomes. Therefore, it could be used as an effective and reliable treatment for the CDDD.

Is the behavior of disc replacement adjacent to fusion affected by the location of the fused level in hybrid surgery?

Background ContextHybrid surgery (HS), consisting of cervical disc arthroplasty (CDA) at the mobile level, along with anterior cervical discectomy and fusion at the spondylotic level, could be a promising treatment for patients with multilevel cervical degenerative disc disease (DDD). An advantage of this technique is that it uses an optimal procedure according to the status of each level. However, information is lacking regarding the influence of the relative location of the replacement and the fusion segment in vivo. PurposeWe conducted the present study to investigate whether the location of the fusion affected the behavior of the disc replacement and adjacent segments in HS in vivo. Study DesignThis is an observational study. Patient SampleThe numbers of patients in the arthroplasty-fusion (AF) and fusion-arthroplasty (FA) groups were 51 and 24, respectively. Outcome MeasuresThe Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and Visual Analog Scale (VAS) scores were evaluated. Global and segmental lordosis, the range of motion (ROM) of C2–C7, and the operated and adjacent segments were measured. Fusion rate and radiological changes at adjacent levels were observed. MethodsBetween January 2010 and July 2016, 75 patients with cervical DDD at two contiguous levels undergoing a two-level HS were retrospectively reviewed. The patients were divided into AF and FA groups according to the locations of the disc replacement. Clinical outcomes were evaluated according to the JOA, NDI, and VAS scores. Radiological parameters, including global and segmental lordosis, the ROM of C2–C7, the operated and adjacent segments, and complications, were also evaluated. ResultsAlthough the JOA, NDI, and VAS scores were improved in both the AF and the FA groups, no significant differences were found between the two groups at any follow-up point. Both groups maintained cervical lordosis, but no difference was found between the groups. Segmental lordosis at the fusion segment was significantly improved postoperatively (p<.001), whereas it was maintained at the arthroplasty segment. The ROM of C2–C7 was significantly decreased in both groups postoperatively (AF p=.001, FA p=.014), but no difference was found between the groups. The FA group exhibited a non-significant improvement in ROM at the arthroplasty segment. The ROM adjacent to the arthroplasty segment was increased, although not significantly, whereas the ROM adjacent to the fusion segment was significantly improved after surgery in both groups (p<.001). Fusion was achieved in all patients. No significant difference in complications was found between the groups. ConclusionsIn HS, cephalic or caudal fusion segments to the arthroplasty segment did not affect the clinical outcomes and the behavior of CDA. However, the ROM of adjacent segments was affected by the location of the fusion segment; segments adjacent to fusion segments had greater ROMs than segments adjacent to arthroplasty segments.

A comparison of zero-profile anchored spacer (ROI-C) and plate fixation in 2-level noncontiguous anterior cervical discectomy and fusion- a retrospective study

BackgroundAnterior cervical discectomy and fusion (ACDF) is the classic surgical treatment for symptomatic cervical degenerative disc disease (CDDD). However, there is controversy over the best surgical management in patients with two noncontiguous symptomatic levels of CDDD.MethodsFrom April 2011 to May 2014, 44 patients with two noncontiguous symptomatic levels of CDDD underwent skip-level ACDFs. In Group NoPlate, 23 cases underwent 2 noncontiguous levels of ACDF using zero-profile anchored spacer; and in Group Plate, 21 cases underwent 2 noncontiguous levels of ACDF using cages and plates. Operation-related paraeters for each group were recorded and compared. Japanese Orthopedic Association (JOA) scores and Neck Disability Index (NDI) scores at preoperation and postoperation were compared with at least a 2-year follow-up. Cervical lordosis was analyzed before surgery, 1 month after surgery, 3 months after surgery, and at final follow-up.ResultsMean follow-up was 35.4 ± 6.5 (range 24–48) months. Significant improvement on the JOA, NDI scores and cervical lordosis was noted in each group (p < 0.05), and there were no significant difference in terms of JOA, NDI scores, cervical lordosis and fusion rate between the two groups (P > 0.05). The operation time in Group NoPlate was significantly shorter than in Group Plate (p < 0.05), and the incidence of dysphagia and adjacent segment degeneration in Group NoPlate was significantly lower than in Group Plate (p < 0.05).ConclusionsROI-C and cages with plate fixation were both effective in two-level noncontiguous ACDF, and there were no significant difference in clinical outcomes, fusion rate, and cervical lordosis. However, ROI-C was associated with shorter operative time, lower incidence of dysphagia and adjacent segment degeneration.

Clinical and radiographic outcome of dynamic cervical implant (DCI) arthroplasty for degenerative cervical disc disease: a minimal five-year follow-up

BackgroundTo evaluate the mid- to long-term clinical and radiographic outcomes of anterior cervical discectomy and dynamic cervical implant (DCI) arthroplasty for degenerative cervical disc disease.MethodsFrom April 2010 to October 2010, 38 patients with single- or double-level cervical disc herniation underwent anterior cervical discectomy and DCI arthroplasty. The clinical results and radiographic outcomes of these 38 patients (42 levels) were retrospectively evaluated. The clinical results included the visual analogue scale, Japanese Orthopaedic Association score, Neck Disability Index score, 36-item short form health survey questionnaire, and incidences of complications and neurological deterioration. Radiographic results including cervical alignment, intervertebral height, cervical range of motion (ROM), ROM of the functional spinal unit, adjacent intervertebral ROM, migration, subsidence, and heterotopic ossification (HO) were assessed on plain radiography, three-dimensional computed tomography, and magnetic resonance imaging.ResultsThe mean follow-up period was 72.3 months (range 68–78 months). During follow-up, all patients showed significant improvements in the visual analogue scale score, Japanese Orthopaedic Association score, Neck Disability Index score, 36-item short form health survey physical component summary score and mental component summary score. The ROM of the functional spinal unit was partly reduced. The DCI migrated forward in 10 of 42 (23.8%) cases, and HO was detected in 24 of the 42 (57.1%) DCI segments. Subsidence was observed in 14 of 42 (33.3%) DCI segments. Two patients experienced symptom recurrence, and were treated conservatively.ConclusionsThe clinical efficacy of DCI arthroplasty was maintained during mid- to long-term follow-up. HO formation is a common phenomenon, leading to a substantial decrease in ROM at the index level and recurrence of neurological symptoms. The incidence of implant subsidence and migration is relatively high, leaving a potential risk of symptoms at the index level and adjacent segment degeneration. We consider that the first choice for patients with degenerative cervical disc disease should still be total disc replacement or anterior cervical discectomy and fusion, rather than DCI arthroplasty.

Clinical Outcome Results of Stand Alone Anchored Spacer for Anterior Cervical Discectomy and Fusion

Background Data: Anterior cervical discectomy and fusion (ACDF) became the classic operation in treating degenerative cervical spondylosis. The application of anterior cervical plate helped fusion and stabilization; however, there were many reports of the complications, such as dysphagia and the possibility of adjacent segment degeneration that may develop after anterior cervical approach. Purpose: The aim of this study is to assess the outcome of the standalone anchoredcervical spacers in anterior cervical discectomy and fusion. Study Design: This is a retrospective study included 30 patients suffering from degenerative cervical disc disease. The outcome measures were: the visual analoguescore, Cobb’s angles for sagittal and segmental alignment, the Japanese orthopedic association score, Nurick score for myelopathic patients and the occurrence of postoperative dysphagia.Patients and Methods: 30 patients were included in this study. All these patients had an anterior approach for cervical discectomy. A standalone anchored cervical spacer was used for this purpose. All patients were regularly assessed through the follow up period of two years post surgical intervention. Results: The study included 30 patients, 22 patients had single level, and 8 patients had two levels cervical discectomy. Postoperative improvement of radicular painVAS were statistically significant (9.0 to 1.67) as well as the improvement in Cobb’s angle (1.39±5.69 to 6.78±3.83) were statistically significant (P=0.001). Postoperative improvement in the JOA Score was significant (7.12 to 14.65). Nurick score for myelopathy improvement was statistically significant (2.6 to 0.83). Postoperative improvement in the fused levels’ height was statistically significant (p=0.001) Conclusion: Stand-alone anchored spacer has a good result regarding relief of symptoms, fusion, and is simple to insert with less post-operative dysphagia. (2018ESJ156)