Cervical Disc Disease Research Articles

Titanium-interlayer mediated hydroxyapatite coating on polyetheretherketone: a prospective study in patients with single-level cervical degenerative disc disease

BackgroundCurrently, there are limited reports regarding investigation of the biological properties of polyetheretherketone (PEEK) coated with titanium (Ti) and hydroxyapatite (HA) in human. The objective of this study is to evaluate the in vivo response of the PEEK cages coated with Ti and HA versus uncoated PEEK cages after anterior cervical discectomy and fusion (ACDF) in patients with single-level cervical degenerative disc disease (CDDD).MethodsTwenty-four patients with PEEK cages coated with Ti and HA (PEEK/Ti/HA group) were matched one-to-one with patients with uncoated PEEK cages (PEEK group) based on age, gender, and operative segment. All patients had been followed up for more than 2 years. Radiological assessments included intervertebral height (IH), C2-7 angle (C2-7a), segmental alignment (SA), and fusion rate. Clinical parameters included Visual Analogue Scale (VAS) and Japanese Orthopedic Association (JOA) scores.ResultsThere was no statistical difference in SA, IH, and C2-7a between the two groups before and after surgery and all these parameters were restored postoperatively. The fusion rate of PEEK/Ti/HA group was significantly higher than PEEK group at 3-month post-operation (87.5% vs. 62.5%). At the last follow-up, the fusion rate of the both groups achieved 100%. The VAS and JOA scores were comparable between two groups and improved postoperatively.ConclusionsIn patients with single-level ACDF, PEEK cage coated with Ti and HA provided a higher fusion rate than uncoated PEEK cage at 3-month post-operation, while both two cages could achieve solid osseous fusion at the last follow up. Compared with the uncoated PEEK cage, PEEK/Ti/HA cage yielded similar favorable segmental and overall cervical lordosis, IH, and clinical outcomes after the surgery.

Association between cervical disc disease and lesions of multiple sclerosis

Cervical discopathy and demyelinating lesions often co-exist in patients with multiple sclerosis (MS). Our study examines the possible association between these two pathologies. Medical records and cervical magnetic resonance imaging scans of MS patients with cervical discopathy who were seen at our MS clinic during 2018 were retrospectively reviewed. The severity of the disc disease was classified as grade I (no compression), grade II (compression of the dural sac) and grade III (cord compression). The spinal cord in each scan was divided into six segments corresponding to the intervertebral space of the spine (C1-C6). Each segment was defined as containing demyelinating lesion and disc pathology (group 1), demyelinating lesion without disc pathology (group 2), disc pathology without demyelinating lesion (group 3) and no demyelinating lesion or disc pathology (group 4). Fisher's exact test was used to test the association between demyelinating lesions and disc pathology. Thirty-four MS patients with cervical discopathy were included in the study (26 females; average age 42.9 ± 13.7 years; average disease duration 8.4 ± 5.4 years). A total of 204 spinal cord segments were evaluated. Twenty-four segments were classified as group 1, 27 segments as group 2, 52 segments as group 3 and 101 segments as group 4. There was no association between demyelinating lesions and the grade of disc disease (p = 0.1 for grade I, p = 0.3 for grade II and p = 1 for grade III disc disease). Our study did not find any association between cervical disc disease and demyelinating spinal cord lesion.

EVALUATION OF CLINICAL OUTCOME OF FOUR LEVELS ANTERIOR CERVICAL DISCECTOMY

Background: The modern paradigm for managing cervical disc diseases uses both ventral and dorsal approaches, with ventral procedures being more common. The ventral procedures consist primarily of discectomy, followed by fusion. The symptoms and syndromes of cervical disc diseases can be mimicked by a number of other neurological disorders. Objective: To evaluate the efficacy of polyetheretherketone (PEEK) cage only in four levels anterior cervical discectomy as one of surgical option other than anterior cervical corpectomy, fixation by plat or posterior approach for cervical laminectomy, and assessment of post spinal surgery pain. Patients and Methods: This was a prospective study including twenty adult patients with symptomatic four levels cervical disc disease operated upon by anterior cervical discectomy with inter-body cage fusion in the Neurosurgery Department at Al-Hussein University Hospital and Sednawy Health Insurance Hospital. The study was performed through the period from January 2018 to June 2020, and the follow up period was 24 months. Results: At the time of diagnosis, the most common symptoms presented were neck pain, brachialgia, heaviness of the lower limbs, and urinary incontinence. All patients were managed by anterior cervical discectomy and fusion by stand-alone PEEK cages for four levels. The mean preoperative visual analogue score (VAS) was 6.05± 1.14 and reached 2.15 ± 0.58 by the 24th month postoperative. Conclusion: The procedure of multi-level anterior cervical discectomy with PEEK inter body cage fusion without plate fixation at four levels appeared safe and efficient, with improvement in long-term outcomes for pain and myelopathy, short inpatient hospital stay, and potentially short procedure duration.

Anterior Cervical Microdiscectomy and Fusion using Stand-Alone Polyetheretherketone Cage: A Retrospective Study

Introduction: Anterior Cervical Discectomy and Fusion (ACDF) constitutes the standard mode of treatment for cervical disc herniation due to degeneration. Stand-alone cage can be considered as effective treatment for single and two level disc prolapse. Aim: To examine the clinical outcomes of ACDF using stand- alone Polyetheretherketone (PEEK) cage in a single centre. Materials and Methods: This retrospective study was conducted from July 2015 to Dec 2020 in 224 consecutive patients who underwent successful ACDF using self-locking stand-alone PEEK cage, study was done at Shri Dharmasthala Manjunatheshwara tertiary care hospital, Dharwad, Karnataka, India for radiculopathy or myelopathy due to cervical degenerative disc disease. Data analysis was done upto March 2021. The patients were analysed with Visual Analogue Scale (VAS) pain score for neck and arm pain and Nurick grade preoperatively and at 3 months postoperatively. Patients underwent preoperative and postoperative clinical, neurological evaluation. This study was statistically analysed using the Statistical Package for the Social Sciences (SPSS version 13.0) (IBM, Chicago, IL). Results: Out of 244, (73%)164 patients underwent single level ACDF and sixty (27%) two-level ACDF. The mean age of patients was 45.86±12.07. It included 146 (65.2%) males and 78 (34.8%) female patients. In this study, the mean VAS neck score preoperatively was 4.04 and at 3 months postoperatively was 1.66 which was statistically significant (p<0.001). Even in VAS arm scores, there was a statistical significant difference (p<0.001) between preoperative (7.25) and 3 months postoperative (1.63) scores. The mean Nurick grade preoperatively was 1.46 vs 0.40 postoperatively which was statistically significant (p<0.001). No implant related complications or adjacent level disease was noted. Conclusion: This study demonstrated that treatment of cervical degenerative disc disease by ACDF withstand alone PEEK cage is an effective and safe method.

Adjacent segment disease after anterior cervical decompression surgery for cervical degenerative disc disease: A single center retrospective cohort study with long-term follow-up

Adjacent segment disease after anterior cervical decompression surgery for cervical degenerative disc disease: A single center retrospective cohort study with long-term follow-up

Percutaneous uniportal versus biportal endoscopic posterior cervical foraminotomy for unilateral cervical radiculopathy with cervical foraminal disc disease

Percutaneous uniportal versus biportal endoscopic posterior cervical foraminotomy for unilateral cervical radiculopathy with cervical foraminal disc disease

The Role Of Nasya (Nasal therapy) With Kashaya Paana(Decoction) By RasnaBala-Ashwagandha Sadhita Taila And Kashaya In The Management Of Cervical Degenerative Disc Disease W.S.R To Vishwachi.

The Role Of Nasya (Nasal therapy) With Kashaya Paana(Decoction) By RasnaBala-Ashwagandha Sadhita Taila And Kashaya In The Management Of Cervical Degenerative Disc Disease W.S.R To Vishwachi.

Titanium-interlayer mediated hydroxyapatite coating on polyetheretherketone: A prospective study in patients with single-level cervical degenerative disc disease

Titanium-interlayer mediated hydroxyapatite coating on polyetheretherketone: A prospective study in patients with single-level cervical degenerative disc disease

Clinical adjacent segment pathology after anterior cervical decompression surgery for cervical degenerative disc disease: a single center retrospective cohort study with long-term follow-up

Clinical adjacent segment pathology after anterior cervical decompression surgery for cervical degenerative disc disease: a single center retrospective cohort study with long-term follow-up

Hybrid implants in anterior cervical decompressive surgery for degenerative disease

Background:Anterior cervical discectomy and fusion (ACDF) still represent the mainstream surgical approach in the treatment of degenerative cervical Degenerative Disc Disease (DDD), being a loss of mobility at the treated segment and adjacent segment diseases well-known complications. To overcome those complications, hybrid surgery (HS) incorporating ACDF and cervical disk arthroplasty is increasingly performed for DDD.Methods:We retrospectively reviewed the clinical, surgical, and outcome data of 62 consecutive patients (male/female, 29/37) harboring cervical disk herniation with or without osteophytes, with radiculopathy with or without myelopathy, who underwent a cervical discectomy on two or more levels with the anterior approach with at least one disk prosthesis along with cage and plate or O Profile screwed plate.Results:All the patients improved regardless of the cervical construct used. No significant relationship between different kind of prostheses as well as their surgical level, the number and the site of the cages (screwed and/or plated) was found out concerning immediate stability, dynamic prosthesis effectiveness, and clinical improvement in all the patients up to the maximum follow-up.Conclusions:Although the optimal surgical technique for cervical DDD remains controversial, HS represents a safe and effective procedure in selected patients with multilevel cervical DDD, as demonstrated by biomechanical and clinical studies and the present series. Some technical aspects should be considered when dealing with this procedure, like the drilling of the endplate, and some radiological findings have to be detected because potentially predictive of future misplacement.

The dervan upper limb dermatome syndrome pilot study of high incidence of cervical disc disease in patients presenting with primary shoulder pain & restriction of movements

Introduction: Shoulder pain is among the most common complaints in the orthopedic outpatient department. It can be due to local pathology or a referred pain from cervical disc degeneration. Frequently, neck and shoulder pathologies may co-exist causing a dilemma regarding treatment approach. Although there are many studies published in literature, we think ours is the first published Indian study to make the observation of concomitant cervical disc degeneration in patients with ipsilateral shoulder pain.Materials & Methods: 39 patients with shoulder pain without any history of trauma, attended the OPD of Walawalkar hospital, Dervan. Of the 3 patients 32 agreed to be part of this pilot study. They underwent x rays & MRI of the shoulder as well as cervical spine.Results: All patients who presented in the orthopaedicopd with complaints of atraumatic shoulder pain, showed varying degrees of cervical disc disease. The commonest affected cervical spine pathological segment was C5-C6 i.e 92 % with two patients having C6-C7 disc disease i.e 8 %.Grading of disc disease was 78.1 % grade 28, 6 patients had grade 3 disc disease, 18.75 %, and only 1 patient had a grade 1 disease with typical signs of chemical radiculopathy with shoulder pain & restriction.X Ray of shoulder showed normal acromiohumeral distance of more than 7 mm in more than 70 % of patients and less than 2 mm in only 1 patient who also incidentally had grade 3 disc disease.MRI of shoulder showed 78 % patients with grade 2 or less of Goutallier grading [9] and all patients of Grade 3 disc disease having grade 3 Goutallier grading and a positive Tangent sign [10]. (18.75 %)This may open another vista in investigation of degenerative rotator cuff disease mimicking grading and severity of cervical disc disease although that is not the primary objective of this paper. We aimed to bring to light the concomitant cervical spine pathology in patients presenting with shoulder pain in this original research. Conclusion: This study found an unusually high rate of coexistent shoulder and cervical spine pathologies. Almost all patients had some form of cervical disc disease and on deeper questioning related signs and symptoms of cervical spondylosis concurrently or a few weeks ago. It undermines the need for investigating this important contributor, the cervical spine, to clinically diagnose the enigma of shoulder pain.

Anterior cervical discectomy and fusion by polyetheretherketon cage in degenerative disc diseases

Background Anterior cervical discectomy has proven to be a safe and effective procedure for the treatment of degenerative disc disease. The anterior approach allows direct visualization of the entire interspace and wide decompression of the anterior aspect of cervical spinal cord and nerve roots; it may be undertaken in cases of multilevel disease and interbody fusion may be performed if required. Patients and methods A total of 20 patients aged from 20 to 65 years, 16 females and four males with symptomatic cervical disc disease, presented in the outpatient clinic, Menoufia University hospital from 2012 to 2014, were examined and followed up prospectively, The mean age was 43.25±9.06 (range: 28–60) years. There were 13 patients (65%) with radiculopathy only, two patients (10%) with mylopathy only, and five patients (10%) with radiculomylopathy; seven cases were affected by mylopathy graded according to Ranawat grading. There were 37 levels affected among the 20 patients. C5,6 was the commonly affected level 1 (40.5%), then C4,5 11 (29.7%), then C6,7 7 (18.9%), and the least one was C3,4 4 (10.8%). Five cases were operated by using a microscope. Anterior cervical discectomy and fusion (ACDF) were performed using polyetheretherketone (PEEK) cages and local bone graft. Results The mean operative time per microscopic level was 64.5 min, the nonmicroscopic level was 47 min.The only intraoperative complication was external jugular-vein ligation that occurred in two cases (nonmicroscopic). The only postoperative complication was difficulty in swallowing, which occurred in 13 cases (11 nonmicroscopic and two microscopic). The mean of preoperative interbody ratio was 1.8±0.2, 12 months postoperatively the mean was 1.9± 0.2.There was a statistically significant difference in the mean of the interbody ratio preoperative and at 12 months. The mean preoperative disc space height was 3.3±0.8 mm, 12 months postoperative was 5.8±0.9. There was a statistically significant difference in the mean disc space height preoperative and 12 months postoperative. Rate of fusion at 12 months: three levels were average fusion, 26 levels were good fusion, and eight levels were excellent fusion. Conclusion Patients receiving ACDF with local bone graft combined with a PEEK cage had significantly shorter operation time, lower perioperative complication rates, and better radiological results comparing with those with an iliac bone graft alone. It seems that the local bone graft with a PEEK cage appears to be a safe alternative to the iliac bone graft for ACDF.

A multicentre prospective randomized controlled trial comparing efficacy and safety of ProDisc-C to anterior cervical discectomy and fusion for treatment of symptomatic cervical disc disease

A multicentre prospective randomized controlled trial comparing efficacy and safety of ProDisc-C to anterior cervical discectomy and fusion for treatment of symptomatic cervical disc disease

Vitamin D Supplementation Improves the Effects of the Rehabilitation Program on Balance and Pressure Distribution in Patients after Anterior Cervical Interbody Fusion-Randomized Control Trial.

Study Design: A double-blinded, randomized controlled trial. Background: Surgery is effective in reducing pain intensity in patients with cervical disc disease. However, functional measurements demonstrated that the results have been not satisfactory enough. Thus, rehabilitation programs combined with the supplementation of vitamin D could play an essential role. Methods. The study recruited 30 patients, aged 20 to 70 years, selected for anterior cervical interbody fusion (ACIF). The patients were randomly divided into the placebo (Pl) and vitamin D (3200 IU D3/day) supplemented groups. The functional tests limits of stability (LOS), risk of falls (RFT), postural stability (PST), Romberg test, and foot pressure distribution were performed before supplementation (BS—week 0), five weeks after supplementation (AS—week 5), four weeks after surgery (BSVR—week 9), and 10 weeks after supervising rehabilitation (ASVR—week 19). Results. The concentration of 25(OH)D3 in the serum, after five weeks of supplementation, was significantly increased, while the Pl group maintained the same. The RFT was significantly reduced after five weeks of vitamin D supplementation. Moreover, a further significant decrease was observed following rehabilitation. In the Pl group, no changes in the RFT were observed. The overall postural stability index (OSI), LOS, and the outcomes of the Romberg test significantly improved in both groups; however, the effects on the OSI were more pronounced in the D3 group at the end of the rehabilitation program. Conclusions. Our data suggest that vitamin D supplementation positively affected the rehabilitation program in patients implemented four weeks after ACIF by reducing the risk of falls and improving postural stability.

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

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. A single-center, prospective, randomized, double-blinded, and placebo-controlled clinical study was performed. We enrolled patients undergoing one- or two-level ACDF procedures for cervical degenerative disc disease with disc herniation, radiculopathy and/or myelopathy symptoms. The patients were randomly assigned (1:1 ratio) to receive either 0.5% bupivacaine hydrochloride or 0.9% NaCl solution. Forty-three (74%) and 41 (77%) of patients reported dysphagia symptoms at the time of discharge in the investigational and control groups, respectively. There were no statistically significant differences in duration of dysphagia symptoms, Swallowing-Quality of Life (SWAL-QOL) survey or pain scores between the investigational and 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 ≤ 0.03; R ≥ -0.038; OR 0.96, 95% CI 0.93-0.99. Female sex 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 8 (13.8%) and 6 (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. Local retropharyngeal space anesthetic instillation did not reduce dysphagia symptoms or occurrence rates in patients undergoing anterior discectomy and fusion surgeries.

Coagulation Profile as a Significant Risk Factor for Short-Term Complications and Mortality after Anterior Cervical Discectomy and Fusion

Cervical degenerative disc disease is the most common indication for anterior cervical discectomy and fusion. Given the possible complications, patients are stratified before anterior cervical discectomy and fusion by preoperative risk factors to optimize treatment. One preoperative factor is a patient's coagulation profile. The American College of Surgeons-National Surgical Quality Improvement Database was used to identify patient preoperative coagulation profile and postoperative complications. By generating binary logistic regression models, each of the 4 abnormal coagulation categories (bleeding disorder, low platelet count, high partial thromboplastin time, and high international normalized ratio [INR]) were analyzed for their independent impact on increased risk for complications compared with the control cohort. A total of 61,977 patients were assessed. The most common abnormal coagulation was abnormal platelet count (n= 2149). The most common postoperative outcome was an extended length of hospital stay among patients with an abnormal coagulation profile relative to the control cohort. After multivariate analysis, patients with an abnormal INR (odds ratio, 2.2 [1.3-3.8]; P= 0.003) or abnormal platelet count (odds ratio, 1.5 [1.2-2.1]; P= 0.003) had a higher chance of having an extended length of hospital stay relative to patients having a normal coagulation profile. Having an abnormal INR was found to be associated with an increased risk for having "Any complication." Our results show significant differences in the incidence rates of a multitude of complications among the 5 groups based on univariate analysis. Patients with any abnormal coagulation disorder had increased rates of developing any complication or having an extended length of hospital stay.

Comparative Study of Anterior Cervical Discectomy and Fusion by Cages versus Tricortical Bone Graft with Anterior Plate Fixation for Degenerative Cervical Disc Disease

Comparative Study of Anterior Cervical Discectomy and Fusion by Cages versus Tricortical Bone Graft with Anterior Plate Fixation for Degenerative Cervical Disc Disease

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

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

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

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

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

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