Cervical Degenerative Disc Disease Research Articles

Is Cervical Disc Replacement Valuable in 3-Level Hybrid Surgery Compared with 3-Level Anterior Cervical Discectomy and Fusion?

Cervical degenerative disc disease is common in clinical practice. Surgery is among the most effective treatments for patients with cervical radiculopathy, myelopathy, or stenosis. Which treatment is the best option for multilevel cervical degenerative disc disease is controversial. Hybrid surgery, combined cervical disc replacement and anterior cervical discectomy and fusion, may be an alternative treatment for multilevel cervical degenerative disc disease. Sixty-four patients with 3-level hybrid surgery and 37 patients with 3-level anterior cervical discectomy and fusion were reviewed retrospectively. Clinical outcomes were based on visual analog scale, Neck Disability Index, 36-Item Short Form Survey, and Japanese Orthopaedic Association scores and Japanese Orthopaedic Association recovery rate. Radiologic assessments included range of motion (ROM) of C2-C7 and adjacent level and cervical lordosis of C2-C7. Perioperative parameters, fusion condition, and complications were assessed. There were no statistical differences observed between the 2 groups for Japanese Orthopaedic Association, Neck Disability Index, or visual analog scale scores. The hybrid surgery group had better physical and mental 36-Item Short Form Survey scores than the fusion group at 1-year follow-up (physical component summary: 49.34 vs. 46.70, P= 0.012; mental component summary: 45.67 vs. 43.95, P= 0.004). ROM of C2-C7 and adjacent levels was less compromised in the hybrid group compared with baseline (64.60% vs. 51.34%, P < 0.001). Cervical lordosis was decreased with time in both groups but was acceptable at final follow-up, and both groups showed solid fusion. Normal ROM and solid fusion were achieved at both arthroplasty and arthrodesis levels. ROM of replacement levels in different locations of the 3-level construct was acceptable.

Motion preservation after cervical total disc replacement surgery-fact or fiction?

Cervical disc replacement surgery aims to preserve cervical motion in younger patients who present with symptomatic degenerative cervical disc herniation and mobile facet joints. We aimed to determine the demographics, pre-operative range of motion, operative parameters, post-operative parameters, range of motion at 2-years post-operatively, in 27 patients who presented to our unit over a 6-year period who underwent cervical total disc replacement surgery. Materials and methodsWe performed a retrospective chart review of 27 patients who presented to our unit with degenerative cervical disc disease, from 01 January 2014 – 31 December 2019, who underwent cervical disc replacement surgery. The data collected included patient age; gender; mechanism of injury; clinical presentation; cervical level/s involved; description and site of the disc herniation; length of preoperative symptomatology; pre-operative cervical range of motion; length of operative procedure; volume of intra-operative blood loss; amount of immediate post-operative radiculopathy pain assessed by the visual analogue scale; complications; length of hospital stay; and cervical range of motion at 2-year follow-up. ResultsThe mean age of our subjects was 45.5 (+/-6.5) years. Regarding gender 11/27 (41%) subjects were female and 16/27 (59%) subjects were male. In terms of number of levels 21/27 (78%) subjects had single level surgery and 6/27 (22%) subjects had double level surgery. Considering age categories, patients in the 4th decade demonstrated a statistically significant increase between their pre-operative segmental range of cervical flexion and their post-operative segmental range of cervical flexion (p = 0.02). ConclusionThrough the results of our study we report that in our 27 subjects cervical total disc replacement surgery was motion preserving in 100% of our subjects at a 2-year study end point. We further report that all our subjects demonstrated some degree of increase in their segmental ranges of motion in all planes, although this was largely insignificant.

Association between anterior bone loss and anterior heterotopic ossification in hybrid surgery

BackgroundHybrid surgery (HS) has become an alternative procedure for the treatment of multilevel cervical degenerative disc disease with satisfactory outcomes. However, some adverse outcomes have recently emerged, such as heterotopic ossification (HO) and anterior bone loss (ABL). Furthermore, HO was found mostly located in the posterior and lateral of the cervical intervertebral disc space. The mechanism of anterior heterotopic ossification (AHO) formation may be different, and its relationship with ABL was uncertain.MethodsRadiographical and clinical outcomes of ninety-seven patients who had undergone contiguous two-level HS between December 2010 and December 2017 and with a minimum of 2-year follow-up were analyzed. Postoperative radiographs were evaluated and compared to the initial postoperative films to determine the incidence of ABL and AHO.ResultsThe overall incidence rate of ABL was 44.3% (43/97). It was identified in 70.6% of AHO cases (33.3% mild, 41.7% moderate, 25.0% severe) and 38.8% of non-AHO cases (38.7% mild, 45.2% moderate, 16.1% severe). A significant association between ABL and AHO occurrence was found (P = 0.016). There was no significant difference in prosthesis–endplate depth ratio or disc space angle change between the AHO group and the non-AHO group (P > 0.05). Compared with data preoperatively, clinical outcome scores significantly improved after surgery in both the AHO and non-AHO groups, with no significant differences between the two groups (P > 0.05).ConclusionABL was common in HS, and it related to AHO. The formation of AHO could be an integral part of postoperative bone remodeling, as well as ABL.

Anterior Cervical Discectomy with Fusion in Patients with Degenerative Cervical Disc Disease

Background: Anterior cervical discectomy with fusion (ACDF) is challenging with respect to both patient selection and choice of surgical procedure. Objective: To determine the age of patients with degenerative cervical disc disease undergoing surgery, to determine the clinical and radiological findings of degenerative cervical disc disease, and to find out the rate of success for relieving pain and radiculopathy. Patients and Methods: This is a clinical prospective study of 50 patients (case series of patients with chronic degenerative cervical disease) operated on from October 2015 to October 2018. Their ages ranged from 48-78 years, they were treated with anterior cervical discectomy with fusion, and fusion was achieved with Polyether ether ketene (PEEK) cage. Follow up using visual analog scale (VAS), out of 10 scores, was done for at least one year after the operation (at six months, nine months and one year postoperatively) for both neck pain and shoulder pain (radicular pain). Results: The mean age + SD was 63.8 + 8.4 years, 54% of the patients were females, 92% of the patients had single level ACDF, and 8% had multiple levels ACDF. The most common presentation in both genders was pain & radiculopathy (56%), followed by radiculopathy (28%), and less common presentation was pain alone (16%). The patient who has short history of the symptom (less than 6 months) gave good postoperative results and showed improvement in the symptom, 64% of the patients improved and 4% of them had no change.In the 2nd group (the symptom more than 6 months): 10 patients improved out of 16 (62.5%), four of them had no change and two of them deteriorated & re-operated for adjacent level. Conclusion: ACDF is an effective treatment for pain & radiculopathy in selected patients with chronic degenerative cervical disease (CDCD) after one year of follow up.

The Impact Plate Application on the Sagittal Plane Correction after Anterior Cervical Discectomy and Fusion Compared to Stand Alone Cage.

Background Data: Anterior cervical discectomy and fusion (ACDF) is the treatment of choice for cervical degenerative disc disease, which causes neurological symptoms such as radiculopathy and/or myelopathy. Anterior cervical discectomy and fusion with stand-alone cage (ACDF-CA) is a successful option to treat cervical disc disease, but long-term follow-up showed complications like cage subsidence and pseudoarthrosis. Then, anterior cervical decompression and fusion with cage and plate (ACDF-CP) was developed to decrease complications of the stand-alone cage; however, it showed complications like dysphagia. Study Design: This is a retrospective clinical case series. Purpose: To compare the role of anterior plate constructs (ACDF-CP) and stand-alone cage (ACDF-CA) in maintaining sagittal plane correction. Patients and Methods: We retrospectively reviewed the lateral cervical radiographs of all patients who underwent ACDF-CA or ACDF-CP between 2011 and 2015. Radiological findings (cervical lordosis, segmental lordosis, cage subsidence, and disc height) were compared (preoperatively, immediately, and 6 and and 12 months postoperatively). Results: Sixty-five patients underwent ACDF, including 88 operative disc levels, 29 (44.6%) ACDF-CA, and 36 (55.6%) ACDF-CP. There were 41 (63.1%) males and 24 (36.9%) females, with a mean age of 47.7 ± 9.32 years. Forty percent of the procedures were conducted by orthopedic spine surgeons and 60% by neurosurgeons. The most common operated level was C5-C6 followed by C6-C7. Initially, ACDF-CA showed better surgical correction than ACDF-CP in terms of cervical lordosis and segmental lordosis but did not reach the statistically significant value (p = 0.692, CI: [-4.8]-7.28), whereas ACDF-CP maintains these corrections more than ACDF-CA at final follow-up despite being statistically insignificant (p = 0.506, CI: [-7.05]-3.54). No difference was detected in disc height and cage subsides between the two groups. Conclusion: The data in this study may suggest that the ACDF-CA construct was slightly better than ACDF-CP in the surgical correction of the cervical curve, whereas ACDF-CP maintained the correction at final follow-up despite the insignificant statistical value. (2020ESJ216)

Stand-Alone Anterior Cervical Discectomy and Fusion Using an Additive Manufactured Individualized Bioactive Porous Titanium Implant without Bone Graft: Results of a Prospective Clinical Trial.

The purpose of this study was to introduce our patient-specific bioactive porous titanium implant manufactured using selective laser melting (SLM) and to establish the efficacy and safety of the implant for stand-alone anterior cervical discectomy and fusion (ACDF) based on a prospective clinical trial. We designed a customized ACDF implant using patient-specific data and manufactured the implant using SLM. We produced a bioactive surface through a specific chemical and thermal treatment. Using this implant, we surgically treated four patients with cervical degenerative disc disease and evaluated the clinical and radiological results. We achieved successful bony union in all but one patient without autologous bone grafting within 1 year. We observed no implant subsidence during the follow-up period, and all clinical parameters improved significantly after surgery, with no reported implant-related adverse effects. Our customized bioactive porous titanium implant is a safe and promising implant for stand-alone ACDF.

P46. Do diabetics experience more cervical spine degenerative disc disease

BACKGROUND CONTEXT Previous degenerative disc disease (DDD) literature has primarily focused on lumbar DDD. However, biomechanics of the cervical and lumbar spine are different. Cervical spine intervertebral discs (IVDs) are designed to withstand compression forces better than lumbar spine IVDs, but they are less equipped to tolerate bending stresses when compared to the lumbar spine. Therefore, it is unclear if co-morbidities associated with lumbar DDD are also correlated with cervical disc disease, and to our knowledge this has not previously been studied. PURPOSE Our primary objective was to determine if diabetics experience cervical DDD at a higher rate than non-diabetics. Our secondary objectives were to assess: 1) whether glycemic control (insulin use, blood glucose levels >200 and HgA1c levels >8.0%) or 2) other medical comorbidities were associated with cervical DDD. STUDY DESIGN/SETTING Retrospective cohort study in a tertiary care center. PATIENT SAMPLE A total of 308 diabetic and 315 non-diabetic patients. OUTCOME MEASURES Suzuki scoring of cervical spine intervertebral disc on MRI (0-3). METHODS Patients who underwent cervical spine MRI at our university for any reason between 2011-2019 were identified. A random group of 308 diabetic and 315 non-diabetic patients’ health data was extracted from the electronic medical record. Each intervertebral disc graded on MRI was scored from C2-T1 based on the Suzuki intervertebral disc score (0-3) in a blinded fashion. For univariate analysis, a one-sided Mann-Whitney test for non-parametric data was used to assess for an association between diabetes and DDD risk. The chi-square or Fisher's Exact test identified associations between comorbidities and Suzuki scores. All tests were adjusted for multiple comparisons using the Benjamini-Hochberg method. Multivariate data was analyzed using a best fit model. RESULTS Univariate analysis identified age, diabetes, hypertension, hypothyroidism, ASA class, cancer, pulmonary disease (COPD), number of previous cervical spine surgeries, peripheral vascular status, smoking and Medicare insurance as correlating with worse cumulative cervical spine disc disease (p 200 and HgA1c levels >8.0% were not associated with increased DDD in diabetics (p>0.05). On multivariate analysis, age and ASA class showed the highest correlation with cervical DDD. CONCLUSIONS Cervical spine DDD is multifactorial. We found diabetes diagnosis to be strongly correlated with cervical spine DDD. Additionally, multivariate analysis identified age and ASA class as best correlated with cervical DDD. Interestingly, BMI and poor glycemic control was not associated with cervical DDD. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

251. Location of the fused level does not affect the behavior of disc replacement adjacent to fusion in hybrid surgery

BACKGROUND CONTEXT Hybrid surgery (HS), consisting of cervical disc arthroplasty (CDA) at the mobile level, along with anterior cervical discectomy and fusion (ACDF) 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 utilizes 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. PURPOSE To investigate whether the location of the fusion affected the behavior of the disc replacement and adjacent segments in HS in vivo. STUDY DESIGN/SETTING This is an observational study. PATIENT SAMPLE The numbers of patients in the arthroplasty-fusion (AF) and fusion-arthroplasty (FA) groups were 51 and 24, respectively. OUTCOME MEASURES The Japanese Orthopedic Association (JOA), neck disability index (NDI) and visual analogue scale (VAS) 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. METHODS Between January 2010 and July 2016, 75 patients with cervical DDD at two contiguous levels undergoing 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. Radiological parameters, including global and segmental lordosis, the ROM of C2- C7, the operated and adjacent segments, and complications, were also evaluated RESULTS Although the JOA, NDI and VAS scores were improved in both the AF and 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 CONCLUSIONS In 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. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

P22. Local retropharyngeal space anesthetic for dysphagia reduction after anterior cervical discectomy and fusion surgery: a single-center, prospective, randomized, double-blinded, placebo-controlled clinical trial

BACKGROUND CONTEXT We hypothesized that a local anesthetic, bupivacaine hydrochloride, may facilitate the sympathetic blockade of the intraoperative stimulation, stabilize the hemodynamic profile and therefore reduce postoperative inflammation and swelling of the esophago-pharyngeal area. PURPOSE The main objective of this study was to analyze the ability of local anesthetic instillation into the retropharyngeal space to reduce dysphagia symptoms and occurrence rates in patients undergoing anterior cervical discectomy and fusion (ACDF) procedures. STUDY DESIGN/SETTING A single-center, prospective, randomized, double-blinded, and placebo-controlled clinical study was performed. PATIENT SAMPLE We enrolled 120 patients undergoing one- or two-level ACDF procedures for cervical degenerative disc disease with disc herniation, radiculopathy and/or myelopathy symptoms. OUTCOME MEASURES Swallowing-Quality of Life (SWAL-QOL) survey, occurrence rates, and duration of dysphagia symptoms. METHODS The patients were randomly assigned (1:1 ratio) to receive either 0.5% bupivacaine hydrochloride or 0.9% NaCl solution. RESULTS Twenty-seven (23.7%) patients reported no dysphagia symptoms: 15 (25.9%) in the investigational and 12 (22.6%) in the control groups. There were no statistically significant differences in duration of dysphagia symptoms, Swallowing-Quality of Life (SWAL-QOL) survey or pain scores between the investigational or control patient groups at any of the follow-up time points. Controlling for independent variables, only younger age significantly predicted dysphagia symptoms at discharge, 2-week, and 3-month follow-ups (p -0.038; OR=0.96, 95% CI 0.93 – 0.99. Female gender was associated with lower SWAL-QOL scores at discharge (p=0.046; R=0.87; OR=2.38, 95% CI 1.02-5.56). A total of eight (13.8%) and six (11.3%) patients in the investigational and control groups, respectively, were referred to a specialist or underwent speech therapy for their dysphagia symptoms. There were no adverse reactions to the study drug observed. CONCLUSIONS Local retropharyngeal space anesthetic instillation did not reduce dysphagia symptoms or occurrence rates in patients undergoing anterior discectomy and fusion surgeries. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Osteolysis after cervical disc arthroplasty.

Cervical disc arthroplasty (CDA) has become an increasingly popular treatment for cervical degenerative disc disease. One potential complication is osteolysis. However, current literature on this topic appears limited. The purpose of this study is to elucidate the incidence, aetiology, consequence, and subsequent treatment of this complication. A systematic literature review was performed according to the PRISMA guidelines. Studies discussing the causes, incidence and management of osteolysis after a CA were included. A total of nine studies were included. We divided these studies into two groups: (1) large case series in which an active radiological evaluation for osteolysis was performed (total = six studies), (2) case report studies, which discussed symptomatic cases of osteolysis (total = three). The incidence of asymptomatic osteolysis ranged from 8 to 64%; however, only one study reported an incidence of < 10% and when this case was excluded the incidence ranged from 44 to 64%. Severe asymptomatic bone loss (exposure of the implant) was found in less than 4% of patients. Bone loss from osteolysis appeared to occur early (< 1year) after surgery and late (> 1year) as well. Symptomatic patients with osteolysis often required revision surgery. These patients required removal of implant and conversion to fusion in the majority of the cases. Osteolysis after CDA is common; however, the majority of cases have only mild or asymptomatic presentations that do not require revision surgery. The timing of osteolysis varies significantly. This may be due to differences in the aetiology of osteolysis.

Letter to the Editor Regarding “Comparison of Different Hybrid Techniques for the Treatment of Multi-level Cervical Degenerative Disc Disease—Analysis of Prospectively Collected Clinical, Radiological, and Psychological Parameters”

Letter to the Editor Regarding “Comparison of Different Hybrid Techniques for the Treatment of Multi-level Cervical Degenerative Disc Disease—Analysis of Prospectively Collected Clinical, Radiological, and Psychological Parameters”

Letter to the Editor Regarding “Comparison of Different Hybrid Techniques for the Treatment of Multilevel Cervical Degenerative Disc Disease—Analysis of Prospectively Collected Clinical, Radiologic, and Psychological Parameters”

Letter to the Editor Regarding “Comparison of Different Hybrid Techniques for the Treatment of Multilevel Cervical Degenerative Disc Disease—Analysis of Prospectively Collected Clinical, Radiologic, and Psychological Parameters”

Multilevel Cervical Disc Arthroplasty: Long-Term Outcomes at 3 and 4 Levels.

Multilevel cervical degenerative disc disease in 2 or more segments poses treatment challenges. Anterior cervical discectomy and fusion is a viable treatment option, but one with high rates of adjacent segment disease and pseudoarthrosis. Cervical disc arthroplasty (CDA) is approved by the US Food and Drug Administration for the treatment of 1- and 2-level cervical pathology, with established long-term safety and effectiveness. Limited evidence exists for CDA at more than 2 levels. This study investigates the long-term outcomes of 3- and 4-level CDA out to 7 years. In a retrospective review of prospectively collected data, patient demographics and surgical characteristics were collected. Patient-reported outcomes (PROs) were collected preoperatively and at 6 weeks, 3 months, 6 months, and 12 months postoperatively, and annually thereafter, including: Neck Disability Index (NDI), numeric rating scales for neck pain and arm pain, the Veterans Rand 12-item Health Survey physical component summary (PCS) score and mental component summary (MCS) score, and patient satisfaction scores. Secondary surgery data were also collected. Predictive methods using mixed-effects regression models were used to analyze the data. Data for 139 CDAs were available for evaluation (n = 116 three-level and n = 23 four-level). Statistical improvement was shown for all PRO scores at all postoperative intervals (P < .001). From preoperatively to 7 years postoperatively, mean NDI decreased from 57.9 to 31.3 (45.9% improvement), mean neck pain decreased from 15.6 to 7.9 (49.4% improvement), mean arm pain decreased from 12.2 to 5.6 (54.1% improvement), mean PCS increased from 29.2 to 41.4 (41.8% improvement), and mean MCS increased from 37.1 to 44.5 (19.9% improvement). Five (3.6%) 3-level patients underwent secondary surgery. Patient satisfaction exceeded 88% 7 years after surgery. Statistical improvement in PROs, with a low rate of secondary surgeries out to 7 years, demonstrates that 3- and 4-level CDA may be performed safely and effectively in appropriately selected patients. 4.

Does Hybrid Surgery Improve Quality of Life in Multilevel Cervical Degenerative Disk Disease? Five-Year Follow-up Study

Patient satisfaction is becoming an increasing factor worthy of consideration when evaluating the surgical quality. The correlation between patient satisfaction and surgical outcomes 5 years after cervical hybrid surgery (HS), which incorporates anterior cervical decompression and fusion and cervical disk arthroplasty techniques in multilevel cervical degenerative disk disease, has not been evaluated. The aim of this study was firstly to analyze prospectively collected data from a sample of patients (n= 50) treated with cervical HS for selected cases of radiculopathy and myelopathy in order to evaluate pain levels of patients, using the Neck and Arm Pain scale as an expression of visual analog scale. Secondly, we aimed to evaluate health-related quality of life, via the short-form 36,Neck Disability Index, and Japanese Orthopedic Association score. Patients were followed up for more than 5 years. Intraoperative parameters, clinical features, and outcome scores were recorded. Radiologic investigations including disk height and changes in adjacent disk spaces were assessed. Clinical improvements were observed in all outcomes; significant improvements on the Neck Disability Index, visual analog scale, short-form 36, and Japanese Orthopedic Association scores were maintained at 5 years (P < 0.05). The mean disk height resulted restored in all the cases. Temporary dysphagia was rarely observed (3%). No surgery for adjacent-level disease was required. There was no significant difference in the outcomes between radiculopathy and myelopathy groups (P > 0.05). HS is an effective and safe procedure for the treatment of multilevel cervical degenerative disk disease. Such a surgical construct offers postoperative improvement on pain levels and health-related quality of life.

Pseudarthrosis in anterior cervical discectomy and fusion with a self-locking, stand-alone cage filled with hydroxyapatite: a retrospective study with clinical and radiological outcomes of 98 levels with a minimum 2-year follow-up.

The goal of this study was to evaluate the incidence of pseudarthrosis after the treatment of cervical degenerative disc disease (CDDD) with anterior cervical discectomy and fusion (ACDF) in which self-locking, stand-alone intervertebral cages filled with hydroxyapatite were used. The authors performed a retrospective cohort study of 49 patients who underwent 1- to 3-level ACDF with self-locking, stand-alone intervertebral cages without plates, with a minimum 2 years of follow-up. The following data were extracted from radiological and clinical charts: age, sex, time and type of pre- and postoperative signs and symptoms, pain status (visual analog scale [VAS]), functional status (Neck Disability Index [NDI]), history of smoking, bone quality (bone densitometry), and complications. Pseudarthrosis was diagnosed by a blinded neuroradiologist using CT scans. Clinical improvement was assessed using pre- and postoperative comparison of VAS and NDI scores. The Wilcoxon test for paired tests was used to evaluate statistical significance using a p value of < 0.05. Three patients (6%) developed symptomatic pseudarthrosis requiring reoperation, with only 1 patient showing clinical worsening due to pseudarthrosis, while the other 2 with pseudarthrosis had associated disc disease at an adjacent level. The rate of symptomatic pseudarthrosis according to the number of operated levels was 0% for 1 level, 8.7% (2/23 patients) for 2 levels, and 7.7% (1/13 patients) for 3 levels. The total pseudarthrosis rate (including both symptomatic and asymptomatic patients) was 16.4%. Considering the clinical outcomes, there was a significant improvement of 75.6% in neck pain and 95.7% in arm pain, as well as a 64.9% improvement in NDI scores. Complications were observed in 18.4% of patients, with adjacent-level degenerative disease being the most prevalent at 14.3%. ACDF with self-locking, stand-alone cages filled with a hydroxyapatite graft can be used for the surgical treatment of 1- to 3-level CDDD with clinical and radiological outcomes significantly improved after a minimum 2-year follow-up period. Comparative studies are necessary.

The Functional outcome following anterior cervical discectomy and fusion for single level cervical degenerative disc disease: a prospective single institutional study

Introduction: Cervical degenerative disc diseases leading to cervical spondylotic myelopathy (CSM) is one the most common cause of disability in elderly population that progresses with age with continuation of degree of degeneration.&#x0D; Objective: To assess the functional outcome following ACDF in single-level cervical degenerative disc disease in terms of improvement in the mJOA scoring system and postoperative complications.&#x0D; Materials and methods: Eighteen patients with single level cervical degenerative disc diseases who presented at the college of medical sciences from May 2018 to October 2019 fulfilling the inclusion criteria (single-level cervical degenerative disc disease with age between 40 to 70 years with progressive neurological deficits, features of cervical spondylotic myelopathy and patients with mild grade who failed four weeks of conservative treatment and progressed to moderate or severe grades) were included in the study. All patients underwent Anterior Cervical Discectomy and Fusion (ACDF); with tricortical iliac crest graft with cervical plate and screws in 13 patients and polyether ether ketone (PEEK) cage placement in five patients. Patients were assessed using mJOA scoring system and graded into mild, moderate and severe myelopathy. Post-operatively patients were assessed for improvement in terms of mJOA scores at four weeks and three months follow-up. They were also assessed for development of any post-operative complications and documented accordingly. Statistical analysis was done using the Statistical Package for the Social Sciences version 20 software.&#x0D; Results: Out of 18 patients, at the time of presentation 12 were in moderate grade and six were in severe grade. During subsequent follow up at four weeks and three months, patients showed progressive improvement. 15 patients improved to mild grade while two remained in moderate grade and one in severe grade during three months postoperative assessment. One patient each developed dysphagia, hoarseness and superficial wound infection that were managed conservatively.&#x0D; Conclusion: Anterior cervical discectomy and fusion is one of the effective and safe treatments for single-level degenerative cervical disc disease associated with cervical spondylotic myelopathy with minimal complications.

Could self-locking stand-alone cage reduce adjacent-level ossification development after aneterior cervical discectomy and fusion?

Numerous studies have shown that cervical arthrodesis is associated with the adjacent-segment pathology (ASP), such as adjacent-level ossification development (ALOD). However, it still remains largely unclear whether the self-locking stand-alone implant system can reduce the incidence of ALOD. In the present study, we prospectively recruited 120 patients with cervical degenerative disc disease (CDDD) who were treated by anterior cervical discectomy and fusion (ACDF). These patients were randomly and evenly divided into the ROI-C group and plate group. Clinical and radiologic follow-up was performed at 3, 6, 12, 24 and 36 months after surgery. Clinical evaluation included preoperative and postoperative assessments of Japanese Orthopaedic Association (JOA) score and Neck Disability Index (NDI) score. The presence and severity of ALOD, as well as the C2-7 Cobb angle, were assessed on the lateral cervical films during follow-up. There were no significant differences in JOA and NDI scores at each time point during the follow-up period between the two groups. ALOD occurred in 8.8% of 58 patients and 6.7% of 104 levels in the cage group. Moreover, ALOD occurred in 20.1% of 57 patients and 17.8% of 101 levels in the plate group. The ALOD was more serious in the plate group compared with the cage group. The C2-7 Cobb angle was significantly improved compared with that before the operation and could be maintained during the follow-up in both groups. The self-locking stand-alone cage was efficacious for ACDF, and it could reduce the incidence of ALOD compared with anterior plate and cage.

Outcome analysis of upper and lower limb motor functions after anterior cervical discectomy and fusion for degenerative cervical disc disease

Background: Anterior cervical discectomy and fusion (ACDF) is the most commonly performed surgical procedure for symptomatic cervical disc disease. In this study, we analysed the upper and lower limb motor functions after ACDF for disc prolapse in patients with degenerative cervical disc disease.&#x0D; Methods: One hundred consecutive adult patients who underwent ACDF for single or two-level cervical disc prolapse during the study period (October 2015 to October 2017) were included in the study.&#x0D; Results: Preoperative motor deficits in limbs were noted in 73% (73/100) of the patients. Enhance recovery of motor deficits was noted in 72.6% (53/73) of these patients and persisting motor deficits in the remaining patients (20/73- 27.4%). Five patients (5/27- 18.5%) without any preoperative motor deficits developed motor deficits after ACDF. Detailed pre and postoperative (at the time of discharge) motor power (graded by MRC grade) in all 4 limbs (Shoulder abduction/adduction/flexion/extension, elbow flexion/extension, wrist flexion/extension, hip abduction/adduction/flexion/extension, knee flexion/extension, ankle flexion/extension) was recorded. Statistically significant improvement in motor power (as recorded at the time of discharge) was noted in all the tested muscle groups after ACDF.&#x0D; Conclusion: Early improvement in preoperative motor deficits can be expected in the majority of the patients with cervical PIVD following ACDF.

RADIOGRAPHIC OUTCOMES OF ANTERIOR CERVICAL DISCECTOMY AND FUSION SURGERY BY USING CUSHIONED TITANIUM CAGE

Purpose: Anterior cervical discectomy and fusion is considered as a standard procedure for treating cervical degenerative disc disease. This retrospective study aimed to analyze the radiographic outcome of using a novel cushion titanium cage (Baui Z-Brace Dynamic Fusion Cage). Methods: Fifty-seven patients who received either single-, double-, or three-level interbody fusion surgeries were enrolled. Data from initial status after surgery and postoperative follow-ups for five years were obtained. The patients were divided into three groups according to different levels of cage implantation: 1-level ([Formula: see text]), 2-level ([Formula: see text]), and 3-level ([Formula: see text]). Follow-up time and fusion rate of radiographs were subjected to evaluation. Results: The lateral view of plain radiographs manifests no evident cage subsidence ([Formula: see text][Formula: see text]mm) and dislodgment in 1-, 2-, and 3-level cage implantation. The follow-up time is three years in 1-level and two years in 2- and 3-level. The CT scans at the final follow-up among different levels of cage implantation manifested bony fusion. The measurement of the Hounsfield unit indicates the bone growth inside the cage compared with control case, demonstrating solid bony fusion among groups at the final follow-up. Conclusions: The data confirm that the specialized Z-shaped structure of the cushion titanium cage may provide the interfragmentary motion stimulating innate bony fusion for sustained improvement.

Total disc replacement compared with fusion for cervical degenerative disc disease: A systematic review of overlapping meta-analyses.

Study design:The present study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.Objective:The present study aimed to conduct a systematic review of overlapping meta-analyses comparing ACDR with fusion for treating CDDD in order to assist decision makers in their selection among conflicting meta-analyses and to provide treatment recommendations based on the best available evidence.Summary of background data:Although several meta-analyses have been performed to compare total disc replacement (TDR) and fusion for treating cervical degenerative disc disease (CDDD), their findings are inconsistent.Methods:Multiple databases were comprehensively searched for meta-analyses comparing TDR with fusion for treating CDDD. The meta-analyses that comprised only randomized controlled trials (RCTs) were included. Two authors independently assessed the meta-analysis study quality and extracted the data. The Jadad decision algorithm was used to ascertain which meta-analysis studies represented the best evidence.Results:A total of 14 meta-analysis studies were included. All these studies only included RCTs and were determined as Level-II evidence.Conclusions:Cervical disc arthroplasty was superior compared to anterior discectomy and fusion for the treatment of symptomatic cervical disc disease.