Cervical Degenerative Disease Research Articles

Effect of degenerative factors on cervical spinal cord during flexion and extension: a dynamic finite element analysis.

Spinal cord injury (SCI) is a global problem that brings a heavy burden to both patients and society. Recent investigations indicated degenerative disease is taking an increasing part in SCI with the growth of the aging population. However, little insight has been gained about the effect of cervical degenerative disease on the spinal cord during dynamic activities. In this work, a dynamic fluid-structure interaction model was developed and validated to investigate the effect of anterior and posterior encroachment caused by degenerative disease on the spinal cord during normal extension and flexion. Maximum von-Mises stress and maximum principal strain were observed at the end of extension and flexion. The abnormal stress distribution caused by degenerative factors was concentrated in the descending tracts of the spinal cord. Our finding indicates that the excessive motion of the cervical spine could potentially exacerbate spinal cord injury and enlarge injury areas. Stress and strain remained low compared to extension during moderate flexion. This suggests that patients with cervical degenerative disease should avoid frequent or excessive flexion and extension which could result in motor function impairment, whereas moderate flexion is safe. Besides, encroachment caused by degenerative factors that are not significant in static imaging could also cause cord compression during normal activities.

Flexion/Extension Cervical Magnetic Resonance Imaging: A Potentially Useful Tool for Decision-Making in Patients with Symptomatic Degenerative Cervical Spine

To evaluate the reliability and usefulness of cervical flexion/extension magnetic resonance imaging (MRI) as a tool for decision-making regarding treatment of symptomatic cervical spondylosis. We prospectively collected demographic, clinical, and flexion/neutral/extension MRI data for consecutive 24 patients who had presented with symptomatic cervical degenerative disease. From the survey responses, we analyzed the agreement between clinical interpretation and judgment when neutral MRI (nMRI) versus flexion/extension MRI (fMRI/eMRI) had been provided. Additionally, the mean cervical canal diameter (MCCD), as measured by 2 independent radiologists, was tested for intra- and interobserver reliability. The differences in MCCD between nMRI, fMRI, and eMRI and the correlation with the qualitative assessment by spine surgeons were also evaluated. Using nMRI only, 16.7%-33.3% of the surgical candidates were missed. Neurosurgeons were significantly more likely to use a posterior approach and instrumentation when fMRI/eMRI studies were available compared with nMRI studies alone. More levels had undergone surgery when the providers had been presented with the fMRI/eMRI studies. The raters expressed a preference for the use of fMRI/eMRI in their future practice. The MCCD was significantly different when measured on the nMRI studies compared with the fMRI/eMRI studies and correlated with the qualitative assessments. Flexion/extension MRI studies were useful for assessing patients with cervical degenerative spine disorders regarding the surgical indication, direction of the approach, and use of multilevel instrumentation, especially for patients with early cervical myelopathy.

Operative Technique for Resection of a Ventral Transdural Retro-Odontoid Pannus: A 2-Dimensional Operative Video

Retro-odontoid pseudotumors are rare inflammatory complications of atlantoaxial instability often associated with cervical degenerative disease and rheumatoid arthritis. While propagation of these lesions has been shown to cause spinal cord compression and cervical myelopathy, intradural extension has rarely been reported. In this manuscript and 2-dimensional illustrative intraoperative video, we demonstrate cervical decompression, removal of the intradural component, and stabilization with C1-2 instrumentation using a posterior approach. A 71-year-old patient presented with progressive cervical myelopathy. Preoperative imaging demonstrated a large retro-odontoid pannus causing severe spinal cord compression and an associated contrast-enhancing intradural lesion, in the absence of obvious C1-2 instability or fractures on computed tomography scan. C1-2 posterior decompression and fusion were performed with maximally safe intradural pannus resection and ventral dural reconstruction. Postoperatively, the patient experienced significant improvement in myelopathic symptoms. Imaging demonstrated good spinal cord decompression with complete intradural pannus resection and debulking of the extradural component. Our outcome in this rare complication suggests a posterior approach may be effective in treating similar patients.

Short-Term Outcomes and Clinical Features Analysis of Anterior Cervical Discectomy; Effect of Non-Instrumented Vs. Instrumented Fusion

Aim: To investigate the impact of instrumental and non-instrumental anterior cervical decompression and fusion procedures on various cervical degenerative diseases in terms of reducing pain and disability. Study Design: A prospective case series. Place and Duration: The study was conducted in the Neurosurgery Ward of Ayub Medical Complex, Abbottabad and Neurosurgery department of Hayatabad Medical Complex, Peshawar for duration 1 year from 1st Jan 2021 to 31st Dec 2021. Material and Methods: A total of 40 patients who underwent surgery for cervical degenerative diseases were selected and patients with more than one level segment were excluded from the study. Clinical symptoms and preoperative pain and disability were recorded using the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) and the Nurick grading. Post-operative score was recorded with improvement or deterioration in VAS, JOA score, and Odom criteria. Results: 40 patients, 24 (60%) men and 16 (40%) women were enrolled in the analysis. The mean age was 56.6 years ± 6.7 SD. Mean length of symptoms was 12.05 months with 5.65 SD. The total mean span of stay in the postoperative period was 4.55 days ± 1.05 SD. 24 (62.5%) patients reported neck pain, 18 (45%) patients with symptoms of radiculopathy, and 12 (30%) sensory deficits. In the study, 13 (32.5%) patients had features of cervical myelopathy. There was hand weakness in 11 (27.5%) cases and reduced range of neck motion in 15 (37.5%) cases. Anterior cervical decompression and fusion (ACDF) were performed in 24 (60%) patients, and anterior cervical discectomy (ACD) was performed in only 16 (40%) patients. The median of pre-operative VAS was 7.9 (mean 7.2) ± 1.35 SD, and the median of post-operative VAS after 2 weeks of follow-up was 3.00 (mean 3.04) ± 0.64 SD and 2.00 (mean 1.91) ± 0.94 SD after 3-month follow-up. Similarly, the median pre-operative JOA score was 15.20 (mean: 12.7) ± 3.30 SD, and after 3 months of follow-up, it was 16.00 (mean: 15.5) ± 1.01 SD. The reduction of the median VAS (Z = -4.46) and JOA (Z = -4.22) scores for both intervention groups was statistically significant after 3 months of follow-up (p <0.001). Conclusions: Anterior cervical procedures are associated with excellent short-term outcomes in reducing pain and disability. ACDF requires longer operative time, but the length of postoperative stay was comparable in both groups. Keywords: Anterior cervical discectomy and fusion, Cervical spondylosis and Surgical result

PEEK versus titanium-coated PEEK cervical cages: fusion rate.

Anterior cervical discectomy and fusion (ACDF) is one of the most commonly performed procedures for degenerative cervical disease. The evaluation of fusion status is still not fully standardized, and a variety of measurement methods are used. This study presents our own evaluation of fusion by comparing two types of implants. A total of 170 disc spaces were operated on in 104 patients using PEEK (polyetheretherketone) cages and titanium-coated (TC) PEEK cages. Patients were assigned to a specific implant using a randomisation table. Fusion status was evaluated based on functional radiographs and CT scans obtained at 12months post-surgery. Multivariate mixed-effects logistic regression models were performed to assess the association of type of implant with different fusion rates. At 12months post-surgery, CT scans were performed in 86 patients (a total of 144 disc spaces) and conventional radiographs were obtained in 102 (a total of 166 disc spaces). Complete fusion was demonstrated in 101 cases (71.1%), partial fusion in 43 cases (29.9%). There were no cases of absence of fusion. A total of 85 PEEK cages (59%) and 59 TC-PEEK cages (41%) were implanted. For PEEK cages, complete fusion was seen in 75 (88.2%) disc spaces, compared to 26 (44.1%) achieved with TC-PEEK cages. A significantly higher proportion of complete fusions (B = 15.58; P < 0.0001) after 12months was observed with PEEK implants compared to TC-PEEK implants. Complete fusion was noted at 12months post-surgery significantly more frequently with PEEK implants compared to TC-PEEK implants.

Quality assessment of systematic reviews of surgical treatment of cervical spine degenerative diseases: an overview.

ABSTRACTObjective To gather all systematic reviews of surgical treatment of degenerative cervical diseases and assess their quality, conclusions and outcomes.Methods A literature search for systematic reviews of surgical treatment of degenerative cervical diseases was conducted. Studies should have at least one surgical procedure as an intervention. Included studies were assessed for quality through Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) and Assessment of Multiple Systematic Reviews (AMSTAR) questionnaires. Quality of studies was rated accordingly to their final score as very poor (<30%), poor (30%-50%), fair (50%-70%), good (70%-90%), and excellent (>90%). If an article reported a conclusion addressing its primary objective with supportive statistical evidence for it, they were deemed to have an evidence-based conclusion.Results A total of 65 systematic reviews were included. According to AMSTAR and PRISMA, 1.5% to 6.2% of studies were rated as excellent, while good studies counted for 21.5% to 47.7%. According to AMSTAR, most studies were of fair quality (46.2%), and 6.2% of very poor quality. Mean PRISMA score was 70.2%, meaning studies of good quality. For both tools, performing a meta-analysis significantly increased studies scores and quality. Cervical spondylosis studies reached highest scores among diseases analyzed. Authors stated conclusions for interventions compared in 70.7% of studies, and only two of them were not supported by statistical evidence.Conclusion Systematic reviews of surgical treatment of cervical degenerative diseases present “fair” to “good” quality in their majority, and most of the reported conclusions are supported by statistical evidence. Including a meta-analysis significantly increases the quality of a systematic review.

Catastrophic delayed cervical arthroplasty failure: illustrative case.

BACKGROUNDCervical disc replacement (CDR) is an increasingly used alternative to fusion for symptomatic cervical disc disease. While more studies have suggested favorability of CDR over fusion procedures, limited data exist regarding implant fatigability. Here, the authors present a unique and previously unreported failure of the M6-C prosthesis causing spinal cord injury.OBSERVATIONSA 49-year-old female with history of cervical degenerative disease and prior C4–7 M6-C arthroplasty presented 9 years later after a minor fall from standing. She endorsed bilateral hand numbness ascending to forearms and shoulders, with dysesthesias and weakness. Imaging showed fractured arthroplasty penetrating the spinal cord. Revision surgery found a ruptured arthroplasty annulus with metal piece piercing the spinal cord. Partial C4 and C5 corpectomy was performed to remove the integrated fins of the arthroplasty and inspect the cord and dura. This was reconstructed with a corpectomy cage and plate. The patient made an excellent recovery, with improvement in her weakness and resolution of her sensory symptoms.LESSONSPossibility of fatigue-related failures presenting years after implantation have only been infrequently reported but can be catastrophic for patients. The authors encourage further discussions in this area, increased counseling with patients, and recommend a patient registry to better document adverse events.

Thorough Comparative Analysis of Stand-Alone Cage and Anterior Cervical Plate for Anterior Cervical Discectomy and Fusion in the Treatment of Cervical Degenerative Disease: A Systematic Review and Meta-analysis.

In this systematic review and meta-analysis, we aim to thoroughly describe and objectively compare the efficacy of anterior cervical plate (ACP) and stand-alone cage (SAC). Although recognized as an effective procedure for cervical degenerative disease (CDD), a debate between the methods of anterior cervical discectomy and fusion exists. ACP provides stability to the fusion construct; however, some complications have been reported, such as dysphagia, adjacent disc disease, and soft tissue injury. To overcome these complications, a SAC was later introduced. A systematic search was conducted on the basis of PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines to identify relevant studies through PubMed, Google Scholar, and Cochrane database. A total of 14 studies (960 patients) were included in the meta-analysis. Twenty outcomes were clinically and radiologically compared between the two procedures. ACP and SAC were comparable in terms of dysphasia rate, loss of segmental angle, loss of disc height, the Odom criteria, Robinson's criteria, hospital stay, Japanese Orthopaedic Association score, Neck Disability Index, Visual Analog Scale, and fusion time. However, SAC was superior in terms of shorter operation time, less blood loss, lower dysphagia rate, and lower rate of adjacent level disease, whereas ACP was advantageous in terms of lower subsidence rate, better maintenance of the cervical global and segmental angles and disc height, and higher fusion rate. Both procedures can be used in patients with CDD, although it might be more beneficial to choose ACP in patients with multi-level pathologies, wherein better mechanical stability is provided. However, SAC may be more beneficial to use in patients with comorbidities, anemia, or swelling problems because it offers lower complication rates.

Anterior 1-2 Level Cervical Corpectomy and Fusion for Degenerative Cervical Disease: A Retrospective Study With Lordotic Porous Tantalum Cages. Long-Term Changes in Sagittal Alignment and Their Clinical and Radiological Implications After Cage Subsidence.

Despite the advances in anterior cervical corpectomy and fusion (ACCF) as a reconstructive surgical technique, the rate of complications related to artificial implants remains high. The purpose of this study was to investigate the long-term clinical course of ACCF with tantalum trabecular metal (TTM)-lordotic implants. Focus is placed on the relevance and influence of implant subsidence on sagittal alignment and the related clinical implications. Retrospective, observational study of prospectively collected outcomes including 56 consecutive patients with degenerative cervical disc disease (myelopathy and/or radiculopathy). All patients underwent 1-level or 2-level ACCF with TTM-lordotic implants. The mean duration of follow-up was 4.85 years. The fusion rate at the end of follow-up was 98.11% (52/53). Implant subsidence occurred in 44 (83.01%) cases, including slight subsistence (<3 mm) in 37 (69.81%) and severe subsidence (>3 mm) in 7 cases (13.2%). The greatest degree of subsidence developed in the first 3 months postoperatively (P = 0.003). No patients presented a significant increase in implant subsidence beyond the second year of follow-up. The most common site of severe subsidence was the anterior region of the cranial end plate (4/7). At the end of follow-up, C1-C7 lordosis and segmental-Cobb angle of the fused segment increased on average by 5.06 ± 8.26 and 1.98 ± 6.02 degrees, respectively, though this difference failed to reach statistical significance (P > 0.05). Visual analog scale and Neck Disability Index scores improved at the conclusion of follow-up (P < 0.05). ACCF with anterior cervical reconstruction using TTM-lordotic implants and anterior cervical plating for treatment of cervical degenerative disease has high fusion rates and good clinical outcome. The osteoconductive properties of TTM provide immediate stabilization and eliminate the need for bone grafts to ensure solid bone fusion. Before fusion occurs, asymptomatic implant settlement into the vertebral body is inevitable. However, lack of parallelism and reduced contact surface between the implant and the vertebral end plate are major risk factors for severe further subsidence, which may negatively affect the clinical outcomes.

Early efficacy of three dimensional printed anatomical biomimetic cervical artificial disc replacement in the treatment of cervical degenerative diseases

Objective: To investigate the efficacy and safety of a new cervical artificial disc prosthesis in the treatment of cervical degenerative diseases. Methods: The clinical data of 18 patients with single-level cervical degenerative diseases who underwent three dimensional printed anatomical bionic cervical disc replacement at Department of Spinal Surgery,Honghui Hospital,Xi'an Jiaotong University from May 2019 to July 2020 were analyzed retrospectively. There were 7 males and 11 females,aged (45±8) years old(range:28 to 58 years).The surgical segment was located at C3－4 level in 2 cases, C4－5 level in 5 cases, C5－6 level in 9 cases, and C6－7 level in 2 cases.The clinical and radiographic outcomes were recorded and compared at preoperative,postoperative times of one month and twelve months.The clinical assessments contained Japanese orthopedic association (JOA) score,neck disability index (NDI) and visual analogue scale (VAS).Imaging assessments included range of motion (ROM) of cervical spine, prosthesis subsidence and prosthesis anteroposterior migration.Repeated measurement variance analysis was used for comparison between groups,and paired t test was used for pairwise comparison. Results: All patients underwent the operation successfully and were followed up for more than 12 months.Compared with preoperative score,the JOA score,NDI and VAS were significantly improved after surgery (all P<0.01).There was no significant difference in postoperative ROM compared with 1-and 12-month preoperative ROM (t=1.570,P=0.135;t=1.744,P=0.099). The prosthesis subsidence was (0.29±0.13) mm (range: 0.18 to 0.50 mm) at 12-month postoperatively.The migration of prosthesis at 12-months postoperatively were (0.71±0.20) mm (range: 0.44 to 1.08 mm).There was no prosthesis subsidence or migration>2 mm at 12-month postoperatively. Conclusion: Three dimensional printed anatomical biomimetic cervical artificial disc replacement has a good early clinical effect in the treatment of cervical degenerative diseases, good mobility can be obtained while maintaining stability.

Effects of shell angle on clinical and radiological outcomes after single-level cervical disc arthroplasty with Prestige LP prosthesis

BackgroundCervical disc arthroplasty (CDA) using Prestige LP disc has been widely used for cervical degenerative disease. Postoperative shell angle (SA) is the angle between the upper and lower prosthesis endplate and previous studies have reported a significant correlation between prosthesis SA with postoperative biomechanical stress. Due to the lack of reference range in SA, a larger discrepancy exists in postoperative SA among the patients after CDA with Prestige LP disc. MethodsA total of 160 patients who had been subjected to single level CDA with Prestige-LP were enrolled. SA was defined the angle between the upper and lower prosthesis endplate and patients were assigned into parallel (SA 0°−3°) and lordotic (SA > 3°) groups according to the immediate postoperative SA. Patients were followed up for a mean duration of 27.78 ± 5.13 months. Clinical, radiographic and complication data were compared among groups. Results90 patients were assigned in the parallel group while 70 patients were included in the lordotic group. The mean immediate postoperative SA in the parallel and lordotic groups were 1.64 ± 0.08° and 4.88 ± 1.20°, respectively (p < 0.05). FSU angle in the parallel group at 1 year and last follow-up were 2.6 ± 2.1° and 2.1 ± 2.0°, respectively, with a change value of − 0.68 ± 2.28°. In the lordotic group, FSU angle at 1 year and last follow-up were 3.3 ± 2.5° and 3.1 ± 2.2°, respectively, with a change value of 0.70 ± 1.43°. At 1 year, the FSU angle in the parallel group was significantly low than in the lordotic group (p < 0.05). Besides, average intervertebral space heights (ISH) at 6 months, 1 year and last follow-up were 6.81 ± 0.38 mm, 6.79 ± 0.3 7 mm, 6.78 ± 0.36 mm in the parallel group and 6.64 ± 0.24 mm, 6.32 ± 0.19 mm, 6.30 ± 0.19 mm in the lordotic group, respectively (all p < 0.05). There were no significant differences in clinical outcomes and complications between the groups (p > 0.05). ConclusionsImmediate postoperative SA has no significant effects on clinical outcomes and complications after CDA with Prestige-LP. However, it has a positive correlation with postoperative FSU angle and a negative correlation with ISH maintenance.

Pharyngoesophageal Damage from Hardware Extrusion at an Average of 7.5 Years After Anterior Cervical Diskectomy and Fusion: A Case Series, Discussion of Risk Factors, and Guide for Management

We present a single-institution case series of patients who experienced pharyngoesophageal damage, specifically from extruded hardware occurring at an average of 7.5 years after anterior cervical diskectomy and fusion (ACDF). A retrospective chart review was conducted of patients who had undergone ACDF with subsequent delayed pharyngoesophageal perforation or erosion from extruded hardware ≥1 year after surgery. A discussion of the literature surrounding this complication, including risk factors and management, is also presented. Nine patients were identified (average age 58 years, 66.7% male) among a total of 4122 ACDF patients (incidence: 0.22%). Average time to injury was 7.5 years. Indications for initial ACDF were degenerative cervical disease (n= 7), ankylosing spondylitis (n= 1), and cervical fracture (n= 1). Eight patients had prior multilevel ACDF spanning 2 (n= 4), 3 (n= 1), or 4 levels (n= 2). Fusion levels for prior ACDF included C5-C7 (n= 3), C3-C7 (n= 2), C4-C7 (n= 1), C4-C6 (n= 1), C2-C5 (n= 1), and C6-C7 (n= 1). Pharyngoesophageal injuries included esophageal perforation (n= 3), pharyngeal perforation (n= 2), esophageal erosion (n= 3), and pharyngoesophageal erosion (n= 1). In most (n= 6) cases, the cause of pharyngoesophageal damage was due to ≥1 extruded screws. Dysphagia (n= 8) was the most common presenting symptom. For perforations (n= 5), 2 repairs used a rotational flap to reinforce a primary closure; the other 3 cases were repaired via primary closure. Pharyngoesophageal damage caused by extruded hardware may occur several years after ACDF. These delayed complications are difficult to predict. Proper screw placement may be the most important factor for minimizing the chances of this potentially devastating complication, particularly with multilevel constructs.

Influence of subsidence after stand-alone anterior cervical discectomy and fusion in patients with degenerative cervical disease: a long-term follow-up study

Influence of subsidence after stand-alone anterior cervical discectomy and fusion in patients with degenerative cervical disease: a long-term follow-up study

The position of the cervical prosthesis in Hybrid Surgery for the two-level cervical degenerative disease and its effect on cervical range of motion

The position of the cervical prosthesis in Hybrid Surgery for the two-level cervical degenerative disease and its effect on cervical range of motion

Comparison of hybrid surgery and anterior cervical discectomy and fusion in two-level cervical degenerative disease (5 year follow-up)

Comparison of hybrid surgery and anterior cervical discectomy and fusion in two-level cervical degenerative disease (5 year follow-up)

Cross-Cultural Adaptation and Psychometric Validation of the Dutch Version of the Core Outcome Measures Index for the Neck in Patients Undergoing Surgery for Degenerative Disease of the Cervical Spine.

ObjectiveTo perform the psychometric validation of the Dutch version of the Core Outcome Measures Index (COMI) for the neck.MethodsA total of 178 patients, who had an indication for surgery due to degenerative cervical spinal disease, were enrolled in the study. They filled in a baseline booklet containing the Dutch version of the COMI-neck, Likert-scales for neck and arm/shoulder pain, the Neck Disability Index (NDI), the EuroQol-5 dimensions (EQ-5D) and the 12-item Short Form health survey (SF-12). Aside from analyzing construct validity using the Spearman correlation test, test-retest reliability, and responsiveness at 3 months were assessed using the intraclass correlation coefficient (ICC) and the receiver-operating characteristic (ROC) curve, respectively. ResultsThe COMI-neck showed good acceptability with missing data ranging from 0% to 4.5% and some floor/ceiling effects for 3 of the domains at baseline. The COMI-summary score showed good to very good correlation with the EQ5D (ρ=-0.43), the physical component summary of the SF-12 (ρ=-0.47) and the NDI (ρ=0.73). Individual domains showed correlations of -0.28 to 0.85 with the reference questionnaires. Test-retest reliability analysis showed an ICC of 0.91 with a minimal detectable change of 1.7. Responsiveness analysis of the COMI-neck showed an area under 0.79 under the ROC-curve. The standardized response mean for a good outcome was 1.24 and for a poor outcome 0.37. ConclusionThe current study shows that the Dutch version of the COMI-neck is a valid, reliable and responsive Patient-Reported Outcome Measure, among patients undergoing surgery for degenerative cervical spinal disorders.

The Effect of Plating on Adjacent Segments in Anterior Cervical Discectomy and Fusions in Patients with Degenerative Spine Disease: A Retrospective Cohort Study.

Introduction Plate distance is correlated with an increased incidence of adjacent segment pathologies (ASP). However, a correct plate-to-disk distance >5 mm is often not achieved. Therefore, this study aimed to quantify the effect of short plate-to-disk distance on the development of ASP using epidemiological measures in patients with cervical degenerative spine disease undergoing single-level anterior cervical discectomy and fusion (ACDFs). Methods Medical records of all patients with cervical degeneration undergoing single-level ACDF with plating (between January 2015 and December 2017), and a follow-up of at least 1 year, were reviewed retrospectively. Radiologic and clinical outcomes were assessed preoperatively, postoperatively, and at last follow-up. The plate-to-adjacent disk distance was measured, and epidemiological measures were calculated to quantify the risk on adjacent-level ossification development (ALOD) and adjacent segment degeneration (ASD). Results Thirty-eight (47.5%) of the 80 patients developed ALOD, and 12 (15.0%) developed ASD after a 2-year follow-up. The incidence of ALOD was significantly lower if the plate was >5 mm away from the adjacent disk space compared to <5 mm (cranial adjacent segment, 22.5% vs. 51.3% [P=0.010] and caudal, 21.4% vs. 47.8% [P=0.029]). A correct plate-to-disk distance resulted in a relative risk reduction of 57.2% for the cranial segment and 56.0% for the caudal segment, with a number needed to treat of 4. The ASD was only observed in the cranial adjacent segments, and a correct plate-to-disk distance resulted in a relative risk reduction of 32.1% and a number needed to treat of 18. Conclusions Only four patients need to be treated with a correct plate-to-disk distance to avoid one case of ALOD. Therefore, it is advisable to keep the plate at a distance >5 mm away from the adjacent disk.

Using the cobweb classification system as a digital location system for the neurologic compression in cervical degenerative disease.

ObjectiveTo provide the cobweb classification system (CCS) for the precise digital location and description of the neurological compression in cervical degenerative disease (CDD), and the reliability and the clinical subgroup analysis of the system were tested and analyzed.MethodsThe CCS consisted of three parts: compression zones (1‐12), degrees (a, b) and ossification (s, m, h). Computerized tomography (CT) and magnetic resonance imaging (MRI) images from 238 CDD patients were reviewed. All compression cases were classified by five independent reviewers with varied clinical experience in spine surgery. The reliability of the CCS was tested by calculating the kappa (κ) statistics value. Finally, 74 patients with anterior cervical surgery treatment were enrolled for the clinical subgroup analysis.ResultsFor the small compression, including single and double compression zones, there was a good interobserver reliability between the reviewers (κ coefficient = .855, P < .001). For the large compression with three or more involved zones, there was a fair reliability between the reviewers (κ coefficient = .696, P < .001). The whole intraobserver reliability was good (κ coefficient = .923, P < .001). For clinical practice, the operative time in the large compression and the m/h group was significantly longer than the small compression and the s group, respectively (P < .05), and the blood loss in the m/h group was significantly increased as well (P < .01). Though the preoperative Japanese Orthopedic Association score in Group b was lower than Group a (P < .05), all patients had achieved significant clinical improvement at last follow‐up.ConclusionsThe CCS can be used to provide detailed and objective descriptions of the location, extent, and severity of neurological compressions in CDD with satisfactory reliability. Surgeons should pay more attention to the patient with large zone, degree b, and ossification compression, because the operation may be more challenging.

Variations in Cervical Degenerative Diseases:What are the Key-points in Diagnosis?

Degenerative cervical spine diseases are caused by age-related changes in the spine and often lead to impairment of neurological function, resulting in reduced quality of life. Multiple cervical spine degenerative diseases are known, such as cervical spondylosis, cervical disc herniation, and ossification of the posterior longitudinal ligament, which often coexist in a single patient. In degenerative cervical spine disease, many lesions are noted on radiographs but are often asymptomatic; hence, caution is required in clinical practice. Therefore, for the treatment of the disease, it is important to diagnose and identify the phenomenon or location causing the disorder. For this purpose, it is important to focus on the type and extent of neurological symptoms; mechanism of nerve compression, radiculopathy or myelopathy; and presence or absence of spinal instability, static or dynamic.

How Subsidence Affects Clinical and Radiological Outcomes after Stand-Alone Anterior Cervical Discectomy and Fusion on Patients with Degenerative Cervical Disease? A Long-Term Follow-Up Study

Objective: We aimed to examine the long-term radiological and clinical outcomes after stand-alone anterior cervical discectomy and fusion (ACDF).Methods: In total, we enrolled 20 patients and 31 treated segments with degenerative cervical disease that underwent stand-alone ACDF with ≥60 months of follow-up. Segmental angle (SA), cervical sagittal alignment (CSA), subsidence, and fusion were evaluated. A visual analogue scale (VAS) and the neck disability index (NDI) were applied pre- and post-operatively and at the last follow-up.Results: Subsidence occurred in 9 (45%) patients and 15 segments (48.4%) at the last follow-up. The mean VAS and NDI scores had improved in both groups with and without subsidence. The mean SA at the last follow-up had significantly increased to 2.3°±8.5° in the subsidence group and to 1.7°± 5.2° degree in the non-subsidence group compared to the post-operative SA (p&lt;0.001). The overall mean CSA at the last follow-up significantly increased overtime in both groups from the postoperative CSA (p=0.003). The fusion rate was 86.7% in the subsidence group and 81.3% in non-subsidence group. However, the difference in SA, CSA and fusion rates between the two groups were not statistically significant (p=0.119, 0.98, and 0.682, respectively).Conclusion: As a result of a long-term follow-up study after stand-alone ACDF, subsidence occurs to some extent. Still, it does not appear to significantly impact radiological and clinical outcomes if the clinician performs sufficient decompression of foramen during surgery. Subsidence seems to have a positive influence on the fusion rate.