Cervical Disc Surgery Research Articles

Which criterion guarantees successful cervical disc surgery? A report of a 20-year academic experience

Which criterion guarantees successful cervical disc surgery? A report of a 20-year academic experience

Hypotension as a first presentation of myasthenia gravis in an elderly patient scheduled for cervical disc surgery: a case report

Myasthenia gravis presents with progressive skeletal muscle weakness. The disease can affect any group of muscles, along with the proximal limb and neck musculature. Elderly patients, especially those over 60 y of age, frequently face extensive delays in diagnosis, or are misdiagnosed, as the symptoms may be erroneously attributed to different other causes frequently seen in this age group, such as degenerative joint disease, disk herniation, osteoporotic vertebral fractures, or metastases. We present a case of a 61-year-old male patient with significant medical records of hypertension, who presented with neck pain for a few months, posted for cervical disc surgery at C6-7 with cage fixation. Two attempts for general anesthesia induction were complicated by severe hypotension. He was evaluated with low-frequency repetitive stimulation, Acetyl-choline receptor antibody, and P/Q calcium channel antibodies. The low-frequency Repetitive Nerve Stimulation (RNS) showed a severe reduced response that was corrected after rest, which was consistent with the diagnosis of myasthenia gravis.
 Key words: Myasthenia; Pain, Neck; Hypotension; Weakness
 Citation: Seyam SH, Ali MA, Razein H, Elkousy I, Schandran SB. Hypotension as a first presentation of myasthenia gravis in an elderly patient scheduled for cervical disc surgery: a case report. Anaesth. pain intensive care 2023;27(6):763−767; DOI: 10.35975/apic.v27i6.2351
 Received: July 08, 2023; Revised: September 16, 2023; Accepted: October 09, 2023

Biomechanical properties of a novel cervical spine implant with elastic deformation: a cadaveric study.

Introduction: Anterior cervical discectomy and fusion (ACDF) is a most frequently used surgical procedure for treating cervical radiculopathy and myelopathy. However, there is concern about the high adjacent segment degeneration (ASD) rate after ACDF surgery. We creatively designed an elastically deformable cervical implant to reduce the postoperative stress concentration. In this study, we aimed to investigate the biomechanical performance of this novel cervical implant and compare it with the commonly used cervical devices. Methods: Biomechanical test was conducted on twelve fresh-frozen human cadaveric cervical spines (C2-C7) and randomly divided into four groups according to implant types: intact group, Zero-P VA fusion (ACDF) group, the novel cervical implant group and Pretic-I artificial cervical disc (ACDR) group. An optical tracking system was used to evaluate the segmental range of motion (ROM) of the C4/C5, C5/C6, and C6/C7 segments and micro pressure sensor was used to record the maximum facet joint pressure (FJP), maximum intradiscal pressure (IDP) at the C4-5 and C6-7 segments. Results: There were no significant differences in the ROM of adjacent segments between the groups. Compared with the intact group, the ACDR group essentially retained the ROM of the operated segment. The novel cervical implant decrease some ROM of the operated segment, but it was still significantly higher than in the fusion group; The maximum FJP and IDP at the adjacent segments in the ACDF group were significantly higher than those values in the other groups, and there were no differences in the other groups. Conclusion: While the newly developed elastically deformable cervical implant does not completely maintain ROM like the artificial cervical disc, it surpasses the fusion device with regards to biomechanical attributes. After further refinement, this novel implant may be suitable for patients who are prone to severe adjacent segment degeneration after fusion surgery but no indication for artificial cervical disc surgery.

Radiological and Clinical Follow-up of Alpha-D Cervical Disk Prosthesis.

Fusion surgery is applied to prevent segmental instability after surgery for cervical disk herniation. Motion-sparing surgeries have been developed to prevent adjacent segment disease after fusion surgery. Total disk replacement, one of these methods, has been applied in the cervical region for more than 20years. We aimed to investigate the medium-term radiological and clinical outcomes of patients who had received Alpha-D disk prosthesis after cervical disk surgery, in terms of incidence of heterotopic ossification (HO) and other complications. We included 33 patients (17 women and 16 men) diagnosed with single-level cervical disk herniation and who had received prosthesis after anterior discectomy. The average follow-up period was 36 (18-78) months. The patients were followed up postoperatively at month 4, year 1, and annually thereafter. Patients, who had Alpha-D cervical disk prosthesis (CDP) (Medikon, Turkey), were monitored via radiological (standard and dynamic X-ray) and clinical (visual analog scale [VAS] and neck disability index [NDI]) modalities. Dynamic X-ray images were evaluated by an independent radiologist for HO and prosthesis movement. Mean patient age was 40 ± 6.88years. HO was observed in 7 (21.21%) patients, 6 of which were men. Significant intersex differences were noted for HO and movement rates (p = 0.039). Clinically, the mean preoperative and post-operative NDI levels were 35.4 ± 3.9 and 4 ± 2, respectively, whereas the mean pre- and post-operative VAS levels were 7 ± 1 and 1 ± 1, respectively. There was a clinically significant postoperative improvement in all the patients. However, there was no significant difference between the patients with and without HO in terms of age, operation level, and mean pre- and postoperative VAS, and postoperative NDI levels (p > 0.05). Despite the fact that there was a significant difference (p = 0.038) in favor of patients without HO in terms of mean preoperative NDI levels, this was not considered clinically significant. In the present study, all the patients demonstrated clinically significant improvement following CDP surgery. HO rate after CDP surgery was 21.21% in the medium term, and movement was preserved in 5 of the 7 patients with partial HO. The fact that the CDP design was based on the one-to-one reproduction of the movement segment in the cervical spine, might account for the underlying cause of success. However, these good results in the medium term may change in cases with long-term clinical follow-up.

Management of Postoperative Intra-Abdominal Hypertension in a Dog Undergoing Cervical Disc Surgery

Management of Postoperative Intra-Abdominal Hypertension in a Dog Undergoing Cervical Disc Surgery

Evaluating Intervertebral Foramen Measurements for Patients with Anterior Cervical Disc Surgery in Oblique CT

Objective: It is particularly difficult to determine the level of radiculopathy pain. Because radicular pain usually doesn't fit the dermatomal map. unlike the foramen lumbar vertebrae, where the cervical nerve root is exerted, it has a slope of approximately 45 degrees to the vertebrae in the axical plane and 10-15 degrees in the horizontal plane. Due to this structure of cervical foremen, the evaluation of conventional ct results in incorrect or incomplete diagnosis. In our study, we compared the change in cervical foramen patients with anterior cervical discectomy and cage (fusion) to oblique ct reconstructive and preop and postop. Methods: CT images were acquired in a 64 slice CT system (60–80 mAs, 120 kVp, FC86 reconstruction core and 2.0 mm slice thickness at 2.0 mm intervals). Oblique sagittal images were created with OsiriX Lite v. 12.0.1 version and measurements were performed. For each level, the area has been measured in addition to the short and long axle length of the neural foramens from the pre-op and post-op oblique sagittal images.Results: In our study, 98 cervical intervertebral foramen oblique CT de preop-postop, long axle, short axle and field measurements were evaluated with 43 patients from 16/01/2019 to 03/02/2020, 3 patients with two levels of anterior ceral discectomy + interbody cage. Right side, long axle, short axle, and area respectively; 13,37%, 5,99%, 16,87% increase. Left side, long axle, short axle, and area respectively, increased by 14,27%, 7,11%, 23,20%Conclusion: The cage, which is placed on the intervertebral level, will increase the area of the foramen, increase the space of the foramen, and allow the nerve to decompression. This is why it is necessary to insert the material with the highest height of the intervertebral disk level that can be placed during surgery.

Cervical spine injury and tracheal intubation: are we protecting patients or physicians?

Cervical spine injury occurs in 3–4% of patients who suffer trauma, with approximately 25% of these individuals having associated cervical cord injury.1 Spinal cord injury occurs more frequently in patients who have a lower Glasgow Coma Scale (GCS) and around 25% of patients will have suffered polytrauma with multisystem injuries.1 As a result, this patient population often requires tracheal intubation for airway protection and to allow management of their injuries, either in the operating theatre or intensive care unit. In addition to this emergent patient cohort, patients at risk of cervical spine injury also present for elective surgery. The potential for cervical cord injury may be due to the surgical procedure itself (for example, cervical disc surgery) or pre-existing cervical canal stenosis, which is a common finding in older patients and may be asymptomatic.2

When years of many different diagnosis may turn into one – a case of munchausen syndrome

IntroductionThe term Munchausen syndrome was first used in 1951 after Baron von Münchhausen, a German nobleman known for his exaggerated storytelling. DSM-5 refers to it as factitious disorder imposed on self: “falsification of physical or psychological signs or symptoms, or induction of injury or disease, (…) in the absence of obvious external rewards”.ObjectivesTo report a case of Munchausen syndrome and highlight the impact on its physical and psychiatric approaches.MethodsDescription of a clinical case based on medical records and a brief review on Munchausen syndrome.ResultsA 57-year-old female, with no previous psychiatric history, was evaluated by Psychiatry for complaints of depression with suicidal ideation. She reported family conflicts and a list of medical conditions and surgical interventions. According to the patient she was waiting for a cardiac transplant and said she had type 1 diabetes, myasthenia gravis, hepatic steatoses, dyslipidemia, hyperuricemia, mitral valve prolapse and was submitted to a thymectomy and cervical herniated disc surgery. She was on many different prescription pills. Even though she had blocked the access to her clinical records in other institutions, at our hospital she had multiple admissions to the emergency room, numerous follow-up appointments of different specialties and several allergies documented. She displayed many incoherencies throughout the interview, had a circumstantial speech and exuberant appearance.ConclusionsMunchausen syndrome remains a challenging diagnosis to physicians. This condition is not only associated with significant morbidity and mortality, but also with unnecessary tests and procedures, iatrogenesis, prolonged hospitalizations and increased health costs.DisclosureNo significant relationships.

Patient Reported Outcomes (PROs) - a Tool for Strengthening Patient Involvement and Measuring Outcome in Orthopaedic Outpatient Rehabilitation.

The present study serves to establish Patient Reported Outcomes (PROs) as a tool for strengthening patient involvement and measuring outcomes in orthopaedic outpatient rehabilitation. Assessments by FFbH-R (Hannover Back Function Questionnaire for patients with back problems), Quick-DASH (Disabilities of Arm, Shoulder, and Hand Score for patients with upper extremity lesions), and LEFS (Lower Extremity Function Scale for patients with lower extremity lesions) were employed in 20 outpatient rehabilitation centres over a period of 12 months to evaluate changes in performance and participation from the subjective patient perspective. The following questionnaires were used: FFbH-R status post: lumbar disc surgery; cervical disc surgery; spinal canal decompression; conservative back pain treatment; other; Quick-DASH status post: rotator cuff reconstruction; shoulder arthroplasty; fracture (conservative or osteosynthesis); other; LEFS status post: hip arthroplasty; knee arthroplasty; anterior cruciate ligament repair; osteotomy; fracture (conservative treatment or osteosynthesis); other. Analysis of the 6,751 usable data sets demonstrated significant positive changes in all scores and diagnostic subgroups. The mean difference in score was 14.2 points in the FFbH-R, - 22 points in the Quick-DASH and 18 points in the LEFS. Thus, this study proves the positive effects of orthopaedic rehabilitation in an outpatient setting. PROs were instituted on a permanent basis in seven of the participating institutions.

ASSESSMENT OF OUTCOMES OF PATIENTS UNDERGOING DISC PRESERVING FUNCTIONAL CERVICAL DISC SURGERY

The concept of accelerated degeneration of adjacent disc levels as a consequence of increased stress caused by inter body fusion of cervical spine is widely accepted. These phenomenon supports the hypothesis that reconstruction of an intervertebral disc after discectomy with functional disc prosthesis would offer benefit. Degeneration of an intervertebral disc involves progressive dehydration and fibrosis of the nucleus pulposus. These modifications induce loss of elasticity, loss of intervertebral height, formation of osseous spurs, cracking and bulging of the annulus fibrosus, and eventually, extrusion of nucleus tissue. Hence based on above findings the present study was planned for Assessment of Outcomes of Patients Undergoing Disc Preserving Functional Cervical Disc Surgery.
 The present study was planned in Department of Neurosurgery, SKMCH, Muzaffarpur, Bihar, India. Total 10 cases operated for cervical radiculopathy were enrolled in the present study. Diagnostic evaluation was performed by anterior posterior and lateral standard radiographs of the cervical spine and magnetic resonance imaging (MRI) evaluation of the cervical spine. All patients had follow up X-ray of the cervical spine anterior and posterior view with flexion and extension study, at 4 weeks and at subsequent follow up.
 The data generated from the present study concluded that the major symptoms experienced by the patients were neck and radicular pain. C6-7 cervical root level was affected in majority patients. Majority of the had an excellent surgical results. Post operative follow up X-ray after 6 months revealed adequate motion at the operated site.
 Keywords: Cervical Disc Surgery, Cervical radiculopathy, Disc preserving, Disc Herniation, etc.

Comparing the postoperative results of single-level anterior cervical discectomy and fusion, cervical disc prosthesis and minimal invasive posterior cervical disc surgery

Objective: Comparison of preoperative and postoperative clinical characteristics of patients who underwent single-level anterior cervical discectomy and fusion, cervical discectomy and prosthesis or minimal invasive posterior cervical discectomy.Methods: The preoperative and the postoperative characteristics (0-, 3-, 12- and 24-month results) of patients who had undergone anterior cervical discectomy and fusion (24 patients, 40%), cervical discectomy and prosthesis (21 patients, 35%) or minimal invasive posterior cervical discectomy (15 patients, 25%), for single-level disc hernia of the C3 to C7 region at the İstanbul Yeni Yüzyıl University Gaziosmanpaşa Hospital between February 2015 and December 2017 were evaluated postoperatively using visual pain scales, neck disability index (NDI) values and Odom’s criteria.Results: Postoperative visual analog scale and NDI scores were significantly decreased immediately after surgery in all groups (p < .001). Similarly, these two values at the second year were significantly decreased compared to post-op values (p < .001). When pre-op, post-op, third month, first year and second year scores were compared between the groups, a significant difference was found between the groups (p < .001). It was observed that the minimal invasive posterior cervical discectomy surgery was significantly better than the other two surgeries in all follow-up assessments (p < .001 for all follow-up).Conclusion: The early postoperative values of the visual pain scale and neck disability indicator were found to demonstrate immediate benefits of the surgeries, in addition to the further decrease at the 2-year follow-up in this study.

Assessment of Disk Preserving Functional Cervical Disc Surgery

Assessment of Disk Preserving Functional Cervical Disc Surgery

Evaluation of clinical and radiological outcome of disk preserving functional cervical disk surgery

Introduction: Cervical radiculopathy is a neurological disfunction wherein a nerve root in the cervical spine becomes inflamed with disc herniation and uncovertebral osteophytes accounting for the majority of cases. The standard surgical treatment for this cervical radiculopathy till now is posterior lamino foraminotomy and anterior discectomy with or without fusion. This study describe the outcome of a minimally invasive anterior cervical disc preserving technique of upper vertebral transcorporeal anterior microforaminotomy to treat cervical radiculopathy Cervical. Objective: To Evaluate the clinical and radiological outcome of disk preserving functional cervical disk surgery. Material and Methods: This is a prospective non randomised hospital based study. The study population included 11 patients operated for cervical radiculopathy with the new technique at the department of Neurosurgery, Manipal Hospital, Bangalore during July 2007 to June 2010. The patients were followed up from 8 to 30 months with a mean follow up of 17 months for clinical and radiological outcome. Results: The mean age of the patient was 40.099.71 years. The majority of the patients (five) were in 31-40 age groups. Male patients (63.6%) were more as compared to females. All patients in this study had neck pain, radicular pain and weakness. Clinical symptoms were between 1 to 3months. The mean preoperative visual analogue scale score was 8.55 and postoperative score was 1.18. The VAS score reduced significantly postoperatively and it was statistically significant. There was no significant reduction in the disc height postoperatively. Conclusion: The Disk preserving functional cervical disk surgery is a minimal invasive procedure with the least complications and adequate motion at the operated site. Keywords: Cervical Disk Surgery, Cervical radiculopathy, Disk preserving, Disk Herniation

Our experience of a left-sided approach to anterior cervical discectomy

Objective: To emphasize the advantages of a left-sided approach compared to opening the cervical region from the right side in patients with cervical disc hernia undergoing surgery for any reason. Method: A total of 10 patients with a history of surgery in the right cervical region were operated on with a left-side approach because of disc hernia at a single cervical level between 2013 and 2018. The patients comprised 6 males and 4 females. Of the whole patient group, 5 had previously undergone surgery for cervical disc hernia, 3 for goitre, 1 with hydrocephalus because the shunt traversed the medial of the distal end of the sternocleidomastoid muscle, and 1 patient who had not been operated on but had goitre of giant dimensions extending to the right. Results: All the patients were diagnosed with cervical disc hernia from MRI findings and neurological examination. The operation of single level cervical disc surgery was performed with an approach from the left in all 10 patients avoiding opening from a recurrence area. No complications developed and the complaints were seen to recover. Conclusions: In the light of previous reports in literature, it can be emphasized that to prevent complications in cervical disc surgery, rather than an approach from a previously operated region, it could be more advantageous to open from the opposite side.

Effectiveness of rehabilitation after cervical disk surgery: a systematic review of controlled studies

Objectives: To present a synopsis of evidence on the efficacy of rehabilitation after cervical disk surgery performed for neck pain and radiculopathy. Data sources: The databases of Medline, EMBASE, and Cochrane Central were searched for studies reporting effects of rehabilitation interventions in patients undergoing surgery due to cervical disk disease with pain and radicular syndrome, published before 31 August 2018. Review methods: Project was registered with PROSPERO database (number CRD42018085937). Randomized controlled trials that evaluated the efficacy of rehabilitation interventions versus other, sham, or no treatment were selected. The primary outcomes were disability and pain. Secondary outcomes were other measures assessing biological, psychological or social effect of rehabilitation. Two reviewers independently screened studies for eligibility, assessed risk of bias and extracted data. Evaluation of evidence was performed with the GRADE system. Results: Five papers were included in the review. The eligible studies were heterogeneous in intervention and outcome reporting. There are low- to very-low-quality evidence that some interventions (use of cervical collars after non-plated anterior cervical diskectomy an fusion, structured physiotherapy, and interactive patients’ education) provide some benefit within functioning, pain, and selected psychological variables in patients undergoing cervical disk surgery. Controlled trials addressing comprehensive interdisciplinary rehabilitation, multidisciplinary pain management, occupational therapy, psychotherapy, social and vocational interventions were not identified. Conclusion: There is insufficient evidence with few trials of low quality to allow any conclusion to be drawn about the effectiveness, harms, and general ineffectiveness of rehabilitation for people who have had cervical disk surgery for pain or radiculopathy.

Effect of Social Factors on Surgical Outcomes in Cervical Disc Disease.

BackgroundDaily clinical practice shows us how diametrically different surgical outcomes can occur in particular groups of patients sharing the same diagnosis and being subjected to the same treatment. Patient-reported outcomes appear to be significantly influenced by social factors and patients’ emotional status. Data on such variables were collated and analyzed statistically with the aim of confirming our clinical observations.MethodsWe analyzed a group of 100 patients following cervical disc surgery. The clinical evaluation was based on a visual analog scale (VAS) for pain and the neck disability index (NDI). Non-clinical data comprised education status, employment status, body mass index (BMI), and history of depressive episodes in the period immediately preceding the surgery, which was investigated using the Beck Depression Inventory (BDI).ResultsPatients who had completed university or secondary school education had a significantly lower BMI and lower BDI scores and they reported less pain at 12 months postoperatively than patients with vocational or elementary school education only. Patients who were employed at the time of the study or were retired demonstrated significantly lower NDI scores both before the surgery and at 12 months postoperatively, as well as lower BDI scores compared to those who were unemployed or drew disability pensions. Factors such as age or BMI score did not exert a direct effect on treatment outcomes assessed as changes in the VAS and NDI scores.ConclusionsSurgical treatment for the cervical disc disease decreases pain and improves patients’ quality of life. Treatment outcomes are also influenced by social factors and patients’ emotional status.

Symptomatic Adjacent Segment Disease After Anterior Cervical Discectomy for Single-level Degenerative Disk Disease

A prospective cohort of 142 patients underwent either anterior cervical discectomy alone, anterior cervical discectomy with fusion by cage stand-alone, or anterior cervical discectomy with arthroplasty. We then followed up on their condition for a mean of 9.1±1.9 years (5.6-12.2 y) later. We aimed to evaluate the annual rate of clinically symptomatic adjacent segment disease (ASD) and to analyze predictive factors. Until recent, ASD has been predominantly evaluated radiologically. It is not known whether all patients had complaints. A frequent cited annual rate of ASD is 2.9%, but a growing number of studies report a lower annual rate. Furthermore, maintaining motion to prevent ASD is one reason for implanting a cervical disk prosthesis. However, the results of studies contradict one another. Participants took part in a randomized controlled trial that ended prematurely because of the publication of evidence that did not justify continuation of the trial. The patients were randomly allocated to 3 groups, each of which received one of the abovementioned treatments. We defined symptomatic ASD as signs and symptoms caused by degeneration of an intervertebral disk adjacent to a level of previous anterior cervical disk surgery. At the last follow-up, we were able to ascertain whether clinically symptomatic ASD was present in any of the participants. The overall annual rate of symptomatic ASD was 0.7%. We found no statistically significant correlations between any of the investigated factors and symptomatic ASD except for the surgical method used. Symptomatic ASD was seen less often in anterior cervical discectomy solely or anterior cervical discectomy with arthroplasty than in anterior cervical discectomy with fusion by plate fixation. The annual rate of symptomatic ASD after an anterior cervical discectomy procedure was estimated to be 0.7%. This seems to be related to the procedure, although firm conclusions cannot be drawn. Level 2-prospective cohort.

Efficacy and safety of Mobi-C cervical artificial disc versus anterior discectomy and fusion in patients with symptomatic degenerative disc disease: A meta-analysis.

Background:Total disc replacement (TDR) using Mobi-C cervical artificial disc might be promising to treat symptomatic degenerative disc disease. However, the results remained controversial. We conducted a systematic review and meta-analysis to compare the efficacy and safety of Mobi-C cervical artificial disc and anterior cervical discectomy and fusion (ACDF) in patients with symptomatic degenerative disc disease.Methods:PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of Mobi-C versus ACDF on the treatment of symptomatic degenerative disc disease were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were neck disability index (NDI) score, patient satisfaction, and subsequent surgical intervention. Meta-analysis was performed using the random-effect model.Results:Four RCTs were included in the meta-analysis. Overall, compared with ACDF surgery for symptomatic degenerative disc disease, TDR using Mobi-C was associated with a significantly increased NDI score (Std. mean difference = 0.32; 95% CI = 0.10–0.53; P = .004), patient satisfaction (odds risk [OR] = 2.75; 95% confidence interval [CI] = 1.43–5.27; P = .002), and reduced subsequent surgical intervention (OR = 0.20; 95% CI = 0.11–0.37; P < .001). Mobi-C was found to produce comparable neurological deterioration (OR = 0.77; 95% CI = 0.35–1.72; P = .53), radiographic success (OR = 1.18; 95% CI = 0.39–3.59; P = .77), and overall success (OR = 2.13; 95% CI = 0.80–5.70; P = .13) compared with ACDF treatment.Conclusion:Among the 4 included RCTs, 3 articles were studying patients with 1 surgical level, and 1 article reported 2 surgical levels. When compared with ACDF surgery in symptomatic degenerative disc disease, TDR using Mobi-C cervical artificial disc resulted in a significantly improved NDI score, patient satisfaction, and reduced subsequent surgical intervention. There was no significant difference of neurological deterioration, radiographic success, and overall success between TDR using Mobi-C cervical artificial disc versus ACDF surgery. TDR using Mobi-C cervical artificial disc should be recommended for the treatment of symptomatic degenerative disc disease.

Artificial Disk Replacement Combined With Fusion Versus 2-Level Fusion in Cervical 2-Level Disk Disease With a 5-Year Follow-up.

Prospective study. The purpose of this study was to compare the long-term clinical and radiologic outcomes of hybrid surgery (HS) and 2-level anterior cervical discectomy and fusion (2-ACDF) in patients with 2-level cervical disk disease. In a previous study with a 2-year follow-up, HS was shown to be superior to 2-ACDF, with a better Neck Disability Index (NDI) score, less postoperative neck pain, faster C2-C7 range of motion (ROM) recovery, and less adjacent ROM increase. Between 2004 and 2006, 40 patients undergoing 2-level cervical disk surgery at our hospital were identified as 2-level degenerative disk disease. Forty patients were included in the previous study; 35 patients were followed up for 5 years. Patients completed the NDI and graded their pain intensity before surgery and at routine postoperative until 5 years. Dynamic cervical radiographs were obtained before surgery and at routine postoperative intervals and the angular ROM for C2-C7 and adjacent segments was measured. The HS group had better NDI recovery until 3 years after surgery (P<0.05). Postoperative neck pain was lower in the HS group at 1 and 3 years after surgery (P<0.05), but arm pain relief was not differently relieved. The HS group showed more angular ROM for C2-C7 at 2 and 3 years after surgery. The superior adjacent segment ROM showed hypermobility in the 2-ACDF group and hypomobility in the HS group at all follow-up periods without statistically significance, but the inferior adjacent segment ROM differed significantly (P<0.05). HS is superior to 2-ACDF; it leads to better NDI recovery, less postoperative neck pain, faster C2-C7 ROM recovery, and less adjacent ROM increase over a 2-year follow-up, but these benefits of HS become similar to those of 2-ACDF with 5 years of follow-up.

Servikal disk cerrahisi sonrası şişmiş oksidize rejenere sellüloza bağlı kök basısı

Oxidized regenerated cellulose is a hemostatic material that is frequently used in neurosurgery. While it is often left in place to avoid postoperative hematoma, in rare cases it may cause neural tissue compression. A case with severe radicular pain due to swollen oxidized regenerated cellulose after anterior cervical disc surgery was reported. A 37-year-old female was operated for a C5-6 disc herniation. After anterior microdiscectomy, severe radicular pain developed due to a retained piece of swollen oxidized regenerated cellulose. Complaints resolved completely after removal of the material causing the compression. Neurological deficits may develop with even a small amount of oxidized regenerated cellulose left behind on the surface of the dura after spinal surgery. We need to keep in mind that this is foreign material that should be used in small quantities. If possible, it must be removed after hemostasis has been achieved.