Cervical Disc Disease Research Articles

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)

Anterior Cervical Discectomy fusion: Cervical PEEK Cage vs Dynamic Cervical Implant

Background: There are wide treatment modalities for degenerative disc diseases of cervical spines. However, surgery is indicated when conservative treatment fails, and each procedure had its limitation. Aim of the work: to compare the outcome between cervical peek cage and dynamic cervical implant for anterior cervical discectomy fusion (ACDF) for patients with degenerated cervical disc disease. Patients and methods: Fifty patients with degenerative disk disease (DDD) were treated by cervical poly- etherether-ketone (PEEK) cage (25 patients) and another 25 with dynamic cervical implant (DCI). All patients assessed pre- and post-operatively by clinical and radiological examinations, with pain assessment by visual analogue scale and calculation of the range of motion. Any neurological deficits were documented in both pre-and post-operative periods. Results: Both groups were comparable regarding patient characteristics, preoperative pain and preoperative range of motion. The mean percentage of pain reduction was significantly higher among PEEK when compared to DCI group (81.93±7.07 vs 66.23±11.48 respectively). In DCI group, preoperative mean range of motion at the operated level was 7.56, changed to 6.64 postoperatively, which is statistically significant. Similarly, in PEEK cage group, preoperative mean range of motion at operated level was 7.60 Changed to 7.52 which is statistically non-significant. Complications were mild and treated conservatively. Conclusion: PEEK cage is associated with better alleviation of pain either at the neck or arm pain. On the other side, DCI is associated with slightly better range of motion. However, global range of motion is comparable between both groups.

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.

Effect of Changes in Postoperative Intervertebral Space Height on Clinical and Radiological Outcomes After Cervical Disc Replacement

Narrowing of intervertebral space height (ISH) is an important pathological change in degenerative spinal disease, and ideal intraoperative distraction and postoperative intervertebral space maintenance is one of the most expectant goals pursued by spinal surgeons. The effect of postoperative ISH changing on the clinical and radiological outcomes after cervical disc replacement is not fully understood, however. In this study, the height variation and general trend of postoperative ISH in all patients were analyzed. The patients were divided into 3 groups based on the change of postoperative intervertebral space height (ISH)-group A (ISH <2 mm), group B (ISH 2-4 mm), and group C (ISH >4mm)-and the clinical and radiographic results compared among the 3 groups. A total of 120 consecutive patients with symptomatic cervical disc disease were included in this study. The results showed that the mean ISH increased significantly from 0.729 mm before surgery to 1.143 mm at 1 week, then gradually decreased to 1.032 mm at 3 months, 0.980 mm at 6 months, 0.760 mm at one year, and 0.750 mm at the final follow-up. The average postoperative Neck Disability Index (NDI) was 19.73 ± 0.81, 13.74 ± 4.94, 17.19 ± 4.22, respectively, in the 3 groups at 1 year after surgery and the average range of motion (ROM) was 5.44° ± 3.85° in group A, 9.34° ± 4.38° in group B, and 6.51° ± 4.38° in group C. The mean diameter of the intervertebral foramen was 6.54 ± 1.86 mm in group A, 9.63 ± 2.38 mm in group B, and 9.31 ± 1.68 mm in group C. Degeneration at the superiorly adjacent disc level was observed in 13.51% patients in group A, 9.37% in group B, and 21.05% in group C. Degeneration at the inferiorly adjacent level was radiographically identified in 21.62% in group A, 14.06% in group B, and 26.32% in group C. This study revealed that cervical disc replacement cannot maintain the intervertebral disc height obtained immediately after surgery. There is no obvious correlation between the change in intervertebral space height and clinical efficacy in the early postoperative stage. Nonetheless, the intervertebral disc height may affect the NDI index 1 year after surgery. If the postoperative intervertebral space height change can be maintained at 2-4 mm at 1 year, satisfactory ROM, intervertebral foramen diameter, and relatively low adjacent segment degeneration may be obtained after cervical disc replacement.

Evaluation of sodium valproate low dose efficacy in radicular pain management and it's relation with pharmacokinetics parameters.

BackgroundRadiculopathy due to lumbar or cervical disc disease is the most common chronic neuropathic pain in adults. The aim of present study was evaluation of low dose of sodium valproate (VPA) on radicular pain and determining VPA pharmacokinetics.Materials and MethodsIn this double blind randomized placebo control clinical study, 80 patients with established lumbar or cervical radicular pain, have been randomly allocated into two study groups: 40 have received sodium valproate 200 mg/day and Celecoxib 100 mg/day and acetaminophen 500 mg PRN as rescue medication, and second group has received placebo, Celecoxib and acetaminophen. Quantitative assessment of pain was done by visual analogue scale (VAS) prior to perform the intervention and after ten days (treatment duration). Blood sample has been taken for determining mean through concentration after five half-lives. Evaluation of plasma concentration of VPA and that of efficacy on pain score relationship by comparing VAS before and after the therapy was done.ResultsGroup A and B have demonstrated significant alleviation in mean VAS score; −21.97 ± 25.41, −14.39 ± 23.03 respectively (P < 0.001). The mean plasma concentration of VPA in group A was: 26.9 ± 13.5 mg/L. Moreover, no significant correlation was seen between pain score with age, gender, and weight (p > 0.05).ConclusionLow dose of sodium valproate especially together with NSAIDs demonstrated good efficacy in lumbar and cervical radicular pain management.

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.

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.

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.

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”

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.

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.

Clinical Outcomes of Cervical Hybrid Reconstructions: A Prospective Study.

The study design was a prospective clinical cohort study. The aim of this study was to assess the patient-reported outcome measures (PROMs), patient satisfaction, as well as complication and reoperation rate of cervical hybrid procedures for symptomatic cervical multilevel degenerative disc disease (MLDDD). Cervical total disc replacement (CTDR) has been shown to be safe and effective for the treatment of degenerative pathologies. However, there is minimal PROMs data on the outcomes of combined CTDR and anterior cervical decompression and fusion procedures, commonly referred to as cervical hybrid surgery. Prospectively collected PROMs were analyzed from patients receiving cervical hybrid surgery for symptomatic cervical MLDDD. Between 2004 and 2016, data were collected preoperatively and postoperatively at 3, 6, and 12 months, then yearly thereafter. Patient reported outcome measures included patient satisfaction, visual analog score for neck and arm, and Neck Disability Index. Complication and reoperation rates were also assessed. A total of 151 patients (80 males, 71 females) who had a minimum of 12 months follow up were included. The mean age was 53 years (range = 24-81), and median follow up was 2 years (range = 1-10). The median number of levels treated was 3, with 29.8%, 49.0%, and 21.2% of patients having 2, 3, and 4 levels treated, respectively. The most common indication for surgery was multilevel cervical spondylotic radiculopathy (52.8%), followed by combined cervical spondylotic radiculomyelopathy (16.7%), axial neck pain (16%), and cervical spondylotic myelopathy (13.9%). Improvement in pain and disability scores were both clinically and statistically significant (P < .001), and these improvements were sustained throughout the course of follow up. There was a 16% incidence of minor adverse events, and 3 (1.9%) reoperations. Cervical hybrid surgery for cervical MLDDD demonstrates favorable and sustained clinical outcomes at short-term to midterm follow up. 4. Statistically and substantial clinical benefits can be achieved by cervical hybrid surgery, in the treatment of cervical pathologies including radiculopathy and myelopathy. The key principles is to follow strict indications, and to match technology with the pathology.

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.

Https://painphysicianjournal.com/current

Background: Chronic neck pain is reportedly considered the fourth leading cause of disability. Cervical interlaminar epidural injections are among the commonly administered nonsurgical interventions for managing chronic neck pain, secondary to disc herniation and radiculitis, spinal stenosis, or chronic neck pain of discogenic origin. Objectives: To systematically review the differences in the effectiveness of cervical epidural injections with local anesthetics with or without steroids for the management of chronic neck pain. Study Design: Systematic review and meta-analysis. Methods: A comprehensive search of the literature of randomized controlled trials (RCTs) that compared epidural injections with local anesthetic with or without steroids was performed, including a search of PubMed, EMBASE, and Cochrane databases for all years up to May 2019. Meta-analysis was done for pain relief based on the Numeric Rating Scale, functional status based on the Neck Disability Index, and opioid intake dosage. Results: Four studies met the inclusion criteria. A total of 370 patients were divided into 2 groups: the experimental group received cervical epidural injection with steroid and local anesthetic, and the control group received injection with local anesthetic only. Regrading pain relief, no significant difference was observed between both groups (weighted mean difference [WMD], –0.006; 95% confidence interval (CI), –0.275 to 0.263; P = 0.963; I2 = 0.0% at 12 months). There was also no significant difference in the improvement of the functional status (WMD, 0.159; 95% CI, –1.231 to 1.549; P = 0.823; I2 = 9.8% at 12 months). Similarly, there was no significant difference in opioid dosage (WMD, –0.093; 95% CI, –5.952 to 5.766; P = 0.975; I2 = 0.0% at 12 months). Limitations: Only a few studies on this premise were found in the literature. There was also a lack of heterogeneity of the included RCT studies. Conclusions: The addition of steroids to anesthetic injectates was not associated with better pain and functional score outcomes compared with anesthetic injectate alone in patients with chronic neck pain. Key words: Chronic neck pain, cervical radiculopathy, cervical disc disease, spinal stenosis, facet joint pathology, cervical epidural injections, steroid injections, local anesthetic injections, systematic review, meta-analysis, randomized control trial

Outcome of Anterior Cervical Discectomy with PEEK Cage Fixation for Single Level Cervical Disc Disease

Objective: To assess the outcome of anterior cervical discectomy and fusion (ACDF) with PEEK cage.&#x0D; Material and Methods: This prospective study was conducted in the Departments of Neurosurgery Prime Teaching Hospital and Irfan General Hospital Peshawar. Patients undergoing one level ACDF with PEEK cage fixation were enrolled in the study. Patients who needed multiple level ACDF or corpectomy with plating and redo cases were excluded from the study. A proforma, which included age, gender, address, level of prolapsed disc, sign and symptoms, pain score, MRI findings were filled. All patients were assessed on day of discharge and on follow-up visit after one month. Data was analyzed with SPSS version 22.&#x0D; Results: Total 95 patients were included out of which 58 (61%) were male and 37 (39%) were female. Range of patients` Age was from 27 years to 64 years with 50.4 years mean age. Most patients (65%) had C6 radiculopathy. 58 patients (61%) had right sided radicular pain. 5 patients (5.26%) had radiculomyelopathy. C5 – C6 was the most common level operated (68 patients). Excellent results were achieved in 75 patients (79%) while satisfactory results in the rest of patients using Odom’s criteria. Bony fusion occurred in 92% of patients at 6 months.&#x0D; Conclusion: ACDF with PEEK cage fixation is a safe and beneficial procedure in one level cervical prolapse disc disease

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.