Degenerative Cervical Spine Disease Research Articles

Quantification of cervical spinal stenosis by automated 3D MRI segmentation of spinal cord and cerebrospinal fluid space.

Prospective diagnostic study. Anatomical evaluation and graduation of the severity of spinal stenosis is essential in degenerative cervical spine disease. In clinical practice, this is subjectively categorized on cervical MRI lacking an objective and reliable classification. We implemented a fully-automated quantification of spinal canal compromise through 3D T2-weighted MRI segmentation. Medical Center - University of Freiburg, Germany. Evaluation of 202 participants receiving 3D T2-weighted MRI of the cervical spine. Segments C2/3 to C6/7 were analyzed for spinal cord and cerebrospinal fluid space volume through a fully-automated segmentation based on a trained deep convolutional neural network. Spinal canal narrowing was characterized by relative values, across sever segments as adapted Maximal Canal Compromise (aMCC), and within the index segment as adapted Spinal Cord Occupation Ratio (aSCOR). Additionally, all segments were subjectively categorized by three observers as "no", "relative" or "absolute" stenosis. Computed scores were applied on the subjective categorization. 798 (79.0%) segments were subjectively categorized as "no" stenosis, 85 (8.4%) as "relative" stenosis, and 127 (12.6%) as "absolute" stenosis. The calculated scores revealed significant differences between each category (p ≤ 0.001). Youden's Index analysis of ROC curves revealed optimal cut-offs to distinguish between "no" and "relative" stenosis for aMCC = 1.18 and aSCOR = 36.9%, and between "relative" and "absolute" stenosis for aMCC = 1.54 and aSCOR = 49.3%. The presented fully-automated segmentation algorithm provides high diagnostic accuracy and objective classification of cervical spinal stenosis. The calculated cut-offs can be used for convenient radiological quantification of the severity of spinal canal compromise in clinical routine.

Factors Affecting the Risk of Developing Cervical Cage Malposition in Patients with Cervical Discectomy

Aim: Cervical discectomy followed by cage placement for fusion is nowadays a commonly used method for the treatment of degenerative cervical spine diseases. One of the complications that can be observed during postoperative follow-up is cervical cage subsidence. At this point, it is investigated in this study the relationship between the loss of endplate brightness observed on early postoperative cervical radiographs and the development of cervical cage subsidence during follow-up. Methods: 100 patients who underwent single-level cervical disc herniation surgery between 2013 and 2023 were selected. The patients were divided into two groups based on the presence or absence of cage subsidence in cervical radiographs taken at the 60-day postoperative follow-up. In all patients included in the study, the presence of endplate brightness loss in the cervical radiographs taken within the day 1 of post-surgery period in the vertebrae adjacent to the cage was evaluated and compared between groups. Results: Cage subsidence was detected in 11 patients (11%), while it was not observed in 89 patients (89%). Among the 11 patients with cage subsidence, endplate brightness loss was identified in 8 patients (72.7%), whereas it was found in 10 patients (11.2%) among the 89 patients without cage subsidence. These results indicate a significant relationship between the loss of endplate brightness observed on early radiographs and the occurrence of cervical cage subsidence during later follow-up (p

Paper on role of cervical disc replacement surgery in cervical pivd patients in both elderly and young population and it’s comparison with anterior cervical dissectomy and fusion

For more than fifty years, anterior cervical discectomy and fusion (ACDF) has been a widely accepted operation for cervical spine degenerative diseases, including disc herniation and spondylosis, that are refractory to medical management. The high rates of success and patients’ satisfaction with ACDF has made the operation a standard of care in common neurosurgical practice, however, the advantages of cervical disc arthroplasty (CDA) over fusion including maintaining normal neck motion and reducing degeneration of adjacent segments of the cervical spineTo study the role of cervical disc replacement surgery in cervical pivd patients in both elderly and young population and it’s comparison with anterior cervical dissectomy and fusion with age variability taken into consideration. The inclusion and exclusion criteria used, The operative procedure for both ACDF and CDA, The further follow up studies considering clinical as well as radiological outcome The most commonly indexed levels of CDA were C4–5 and C5–6, accounting for 85%of the entire series.The clinical outcomes, including VAS of neck and arm pain, NDI, and JOA scores were all similarly satisfactory after the surgery, during the follow-up. CDAs has been demonstrated to preserve segmental motion at long-term followup and to decrease the incidence of adjacent-level surgery, as compared to ACDF. Cervical global alignment and the segmental angle at rest improves after cervical arthroplasty

A meta-analysis of the implementation of enhanced recovery after surgery pathways in anterior cervical spine surgery for degenerative cervical spine diseases.

To systematically evaluate the perioperative effects of enhanced recovery after surgery (ERAS) protocol on anterior cervical spine surgery by means of meta-analysis. According to the PRISMA guidelines, the article's search on the China National Knowledge Infrastructure (CNKI), Wanfang data resource system, VIP, PubMed database and Cochrane library was conducted to identify clinical studies investigating the effects of ERAS protocols on anterior cervical spine surgery. A quantitative meta-analysis was performed for the clinical outcomes extracted from the studies that met inclusion criteria. Of the 21 studies identified from the article search, 10 studies met inclusion criteria. The meta-analysis showed shorter length of stay (LOS) (MD = -2.16, 95% CI (-2.57, -1.75), P < 0.00001) and higher patient satisfaction for the ERAS protocols (OR = 3.13, 95% CI (1.97, 4.98), P < 0.00001). Furthermore, ERAS programs led to significant decreases in cost (MD = -0.81, 95% CI (-1.08, -0.53), P < 0.00001) and complication rates (OR = 0.15, 95% CI (0.08, 0.27), P < 0.00001), but no difference in 90-day readmission (OR = 0.63, 95% CI (0.30, 1.35), P = 0.24). The data of this study suggest that the implementation of ERAS protocol decreases LOS, cost and complications rates and improve satisfaction for the patients undergoing anterior cervical spine surgery. To support the practice use of ERAS in anterior cervical spine surgery further, controlled trials will be indispensable.

Association between Cervical Muscle Weakness and Functional Limitations due to Headache in Doctors

Background: Headaches and neck discomfort are prevalent issues, particularly among healthcare professionals, and are often related to muscular weaknesses and postural anomalies. The intricate relationship between cervical muscle strength and the frequency and intensity of headaches necessitates a deeper understanding for effective management and treatment strategies. Objective: The primary objective of this study was to investigate the association between cervical muscle weakness and functional limitations due to headaches in doctors, considering the impact of long working hours and the physical demands of the medical profession. Methods: A cross-sectional study was conducted among doctors working at Akhtar Saeed Trust Hospital, Farooq Hospital, and AMDC in Lahore from June to December 2022. Participants with conditions like fibromyalgia, history of head and neck trauma, or degenerative cervical spine disease were excluded. The strength of cervical muscles was assessed using Manual Muscle Testing, and the intensity of headaches was evaluated using the Headache Impact Test (HIT-6) questionnaire. The sample size was calculated to be approximately 150, with data analysis performed using SPSS version 25. The study employed descriptive statistics, Chi-square tests, and parametric tests to analyze the data. Results: The study found significant correlations between cervical muscle strength and headache impact. Among participants with moderate cervical flexor strength, HIT scoring ranged from 30 in the 36-50 range to 28 in the 60-78 range. For strong cervical flexors, the range was 34 in the 36-50 to 6 in the 60-78 range. Similar patterns were observed in cervical extensors and side flexors. The Chi-square values were significant across all muscle groups (18.45 for flexors, 32.164 for extensors, 50.175 for right side flexors, and 45.30 for left side flexors), all with a p-value of 0.000. Conclusion: The study demonstrates a significant association between cervical muscle strength and the impact of headaches, indicating that weaker cervical muscles are associated with higher headache frequency and severity. These findings suggest the need for targeted muscle strengthening and posture correction interventions among doctors to mitigate the risks of headache and neck discomfort.

Geospatial Evaluation of Disparities in Access to Cervical Spine Fusion in Metropolitan Areas Across the United States.

Retrospective study with epidemiologic analysis of public Medicare data. The purpose of this study is to use geospatial analysis to identify disparities in access to cervical spine fusions in metropolitan Medicare populations. Cervical spine fusion is among the most common elective procedures performed by spine surgeons and is the most common surgical intervention for degenerative cervical spine disease. Although some studies have examined demographic and socioeconomic trends in cervical spine fusion, few have attempted to identify where disparities exist and quantify them at a community level. Center for Medicare and Medicaid Services physician billing and Medicare demographic data sets from 2013 to 2020 were filtered to contain only cervical spine fusion procedures and then combined with US Census socioeconomic data. The Moran Index geospatial clustering algorithm was used to identify statistically significant hotspot and coldspots of cervical spine fusions per 100,000 Medicare members at a county level. Univariate and multivariate analysis was subsequently conducted to identify demographic and socioeconomic factors that are associated with access to care. A total of 285,405 cervical spine fusions were analyzed. Hotspots of cervical spine fusion were located in the South, while coldspots were throughout the Northern Midwest, the Northeast, South Florida, and West Coast. The percent of Medicare patients that were Black was the largest negative predictor of cervical spine fusions per 100,000 Medicare members ( β =-0.13, 95% CI: -0.16, -0.10). Barriers to access can have significant impacts on health outcomes, and these impacts can be disproportionately felt by marginalized groups. Accounting for socioeconomic disadvantage and geography, this analysis found the Black race to be a significant negative predictor of access to cervical spine fusions. Future studies are needed to further explore potential socioeconomic barriers that exist in access to specialized surgical care. Level III-retrospective.

The effect of concurrent cervical spine degenerative disease on the outcome of rotator cuff repair: a national database study

Cervical spine degenerative disease (CSD) can cause shoulder pain, potentially confounding the management of patients with rotator cuff tears. This study aimed to investigate the relationships between CSD and rotator cuff repair (RCR). A national administrative database (PearlDiver) was used to study 4 patient cohorts: (1) RCR only (RCRo), (2) RCR with concurrent CSD (RCRC), (3) RCR after a cervical spine procedure (RCRA), and (4) RCR before a cervical spine procedure (RCRB). The outcomes of RCR were compared using multivariable logistic regression, controlling for age, sex, and Elixhauser Comorbidity Index, as well as preoperative opioid utilization in the analysis of opioid use. Between 2010 and 2021, a total of 889,977 patients underwent RCR. Of these patients, 784,230 (88%) underwent RCRo whereas 105,747 (12%) underwent RCRC, of whom 21,585 (2.4%) underwent cervical spine procedures (RCRA in 9670 [1.1%] and RCRB in 11,915 [1.3%]). At 2 years after RCR, compared with RCRo patients, RCRC patients had an increased risk of surgical-site infection (adjusted odds ratio [aOR]=1.25, P=.0004), deep vein thrombosis (aOR=1.17, P=.0002), respiratory complications (aOR=1.19, P=.0164), and ipsilateral shoulder reoperations (débridement [aOR=1.66, P<.0001], manipulation under anesthesia or arthroscopic lysis of adhesions [aOR=1.23, P<.0001], distal clavicle excision [aOR=1.78, P<.0001], subacromial decompression [aOR=1.72, P<.0001], biceps tenodesis [aOR=1.76, P<.0001], incision and drainage [aOR=1.34, P=.0020], synovectomy [aOR=1.48, P=.0136], conversion to shoulder arthroplasty [aOR=1.62, P<.0001], revision RCR [aOR=1.77, P<.0001], and subsequent contralateral RCR [aOR=1.71, P<.0001]). At 2 years, compared with RCRC patients who did not undergo cervical spine procedures, RCRC patients who underwent cervical spine procedures had an increased risk of incision and drainage (aOR=1.50, P=.0255), conversion to arthroplasty (aOR=1.40, P<.0001), and revision RCR (aOR=1.11, P=.0374), as well as a lower risk of contralateral RCR (aOR=0.89, P=.0469). The sequence of cervical spine procedures did not affect the risk of shoulder reoperations. At 1 year, the risk of opioid use after RCR was less for RCRA patients compared with RCRB patients (aOR=1.71 [95% confidence interval, 1.61-1.80; P<.0001] vs. aOR=2.01 [95% confidence interval, 1.92-2.12; P<.0001]). Concurrent CSD has significant detrimental effects on RCR outcomes. Patients with concurrent CSD undergoing cervical spine procedures have a greater risk of ipsilateral shoulder reoperations but a decreased risk of contralateral RCR. The risk of prolonged opioid use was lower if RCR followed a cervical spine procedure. Concurrent CSD must be considered and possibly treated to optimize the outcomes of RCR.

Disc prosthesis versus fusion with cage in single level cervical degenerative spine disease – A retrospective case-control patient reported outcome study

AimTo compare the clinical outcome of single level cervical degenerative spine disease treated surgically with motion preserving anterior cervical disc arthroplasty versus anterior cervical discectomy and fusion (ACDF). MethodsPatients treated with cervical disc arthroplasty at Aalborg University Hospital and ACDF at Aarhus University Hospital were matched 1:2.Primary outcome measures were Neck Disability Index (NDI), EQ-5D-3 L and Numeric rating scale (NRS) for arm- and neck pain.Data was collected by telephone interviews regarding present and retrospective data. Results50 patients treated with cervical disc arthroplasty were matched to 100 ACDF patients covering November 2011 to December 2018.Mean improvements for NRS neck pain three-months postoperative, and NDI were significantly better in the cervical disc arthroplasty group, with intergroup differences of 1.56 (p = 0.02) and 5.01 (p = 0.01) respectively.A subgroup analysis of the half of the cohort with the longest follow-up (mean 7.6 years) showed, in favour of cervical disc arthroplasty, mean improvements of NDI: 8.80 (p = 0.00), EQ5D: − 0.19 (p = 0.04), NRS neck three months follow-up: 3.70 (p = 0.00) and long follow-up: 2.54 (p = 0.01) and NRS arm three months follow-up: 2.02 (p = 0.01).Radiologic examination indicated preserved mobility in 80% of the implanted protheses at 24-month post-surgical follow-up. ConclusionSurgical treatment of one level degenerative cervical spine disease with cervical disc arthroplasty or anterior cervical discectomy and fusion has a similar good clinical outcome after a mean follow-up of 5.6 years.However, cervical disc arthroplasty displayed long-term superiority in the half of the cohort with the longest follow-up time averaging 7.6 years.

Demographic and Clinical Characteristics of Patients With Cervical Spine Degeneration Reveal Frequent Cervicolumbar Tandem Spinal Stenosis in Mexico.

Limited literature exists regarding the differences in demographics, causes, comorbidities, presentation, and structural changes associated with cervical spine degeneration in patients from distinct geographic regions. The authors aimed to evaluate the demographic and clinical characteristics of patients with cervical spine degeneration admitted to a single center in Mexico. This study enrolled patients with degenerative disease of the cervical spine. Clinical data were retrieved from medical records and retrospectively characterized. A total of 50 patients with cervical spine degeneration were included in the analysis. Of these, 26% were men with a median age of 54 years. Hypertension, depression, anxiety, obesity, and alcohol consumption were presented in about a quarter of the participants. In addition, we observed hypertriglyceridemia and hypercholesterolemia in 72% and 46% of participants, respectively. The median duration of symptoms was 11 months, including radicular arm/neck pain (80%), tingling (80%), reduced muscle strength (48%), and gait disturbances (48%). Forty percent of patients had 2 cervical segments radiologically involved, mainly at C5-C6, with changes such as disc herniation (88%), foraminal stenosis with nerve root compression (67%), reduced spinal canal-to-vertebral body ratio (38%), and ligamentum flavum hypertrophy (24%). Also, 22% of patients showed degenerative cervical myelopathy. Strikingly, 48% of enrolled individuals showed cervicolumbar tandem spinal stenosis, mainly in L4-L5 and L5-S1, who were generally older, had a longer duration of symptoms, and had a higher comorbidity burden, including hyperglycemia, hypertension, and depression. The demographic and clinical characteristics of degenerative cervical spine disease in Mexico differ with respect to other geographical regions by a younger age of diagnosis, a high frequency of cardiovascular, metabolic, and mental health comorbidities, and an increased prevalence of concomitant lumbar spinal stenosis. Our findings reveal a considerably high burden of cervicolumbar tandem spinal stenosis as a distinctive feature of Mexican patients with cervical spine degeneration.

Assessment of image quality of cervical spine complications using Three Magnetic Resonance Imaging Sequences

Examining and comparing the image quality of degenerative cervical spine diseases through the application of three MRI sequences; the Two-Dimension T2 Weighed Turbo Spin Echo (2D T2W TSE), the Three-Dimension T2 Weighted Turbo Spin Echo (3D T2W TSE), and the T2 Turbo Field Echo (T2_TFE). Thirty-three patients who were diagnosed as having degenerative cervical spine diseases were involved in this study. Their age range was 40-60 years old. The images were produced via a 1.5 Tesla MRI device using (2D T2W TSE, 3D T2W TSE, and T2_TFE) sequences in the sagittal plane. The image quality was examined by objective and subjective assessments. The MRI image characteristics of the cervical spines (C4-C5, C5-C6, C6-C7) showed significant differences among the three sequences used P˂0.05 with the exception of the contrast P˃ 0.05. For the cervical spines (C4-C5), the minimum CNR was noticed with the T2_TFE sequence. For the cervical spines (C5-C6), the CNR and SNR were higher when they were assessed by the 2D T2W TSE sequence as compared to the other sequences. The same findings were observed with the cervical spines (C6-C7). The subjective assessment of the degenerative cervical spine diseases showed that the T2_TFE sequence is excellent in terms of viewing the central stenosis and foraminal stenosis. The best MRI diagnostic imaging can be obtained using the Turbo Field Echo (T2_TFE) and the Three-Dimension T2 Weighted Turbo Spin Echo (3D T2W TSE) sequences to gain detailed diagnostic information regarding the central stenosis and foraminal stenosis of the cervical spines (C4-C5, C5-C6, C6-C7)

Nationwide sample data analysis of additional surgery rate after anterior or posterior cervical spinal surgery

Surgical outcomes of degenerative cervical spinal disease are dependent on the selection of surgical techniques. Although a standardized decision cannot be made in an actual clinical setting, continued education is provided to standardize the medical practice among surgeons. Therefore, it is necessary to supervise and regularly update overall surgical outcomes. This study aimed to compare the rate of additional surgery between anterior and posterior surgeries for degenerative cervical spinal disease using the National Health Insurance Service-National Sample Cohort (NHIS-NSC) nationwide patient database. The NHIS-NSC is a population-based cohort with about a million participants. This retrospective cohort study included 741 adult patients (> 18 years) who underwent their first cervical spinal surgery for degenerative cervical spinal disease. The median follow-up period was 7.3 years. An event was defined as the registration of any type of cervical spinal surgery during the follow-up period. Event-free survival analysis was used for outcome analysis, and the following factors were used as covariates for adjustment: location of disease, sex, age, type of insurance, disability, type of hospital, Charles comorbidity Index, and osteoporosis. Anterior cervical surgery was selected for 75.0% of the patients, and posterior cervical surgery for the remaining 25.0%. Cervical radiculopathy due to foraminal stenosis, hard disc, or soft disc was the primary diagnosis in 78.0% of the patients, and central spinal stenosis was the primary diagnosis in 22.0% of them. Additional surgery was performed for 5.0% of the patients after anterior cervical surgery and 6.5% of the patients after posterior cervical surgery (adjusted subhazard ratio, 0.83; 95% confidence interval, 0.40–1.74). The rates of additional surgery were not different between anterior and posterior cervical surgeries. The results would be helpful in evaluating current practice as a whole and adjusting the health insurance policy.

Is It Necessary to Cross the Cervicothoracic Junction in Posterior Cervical Decompression and Fusion for Multilevel Degenerative Cervical Spine Disease? A Systematic Review and Meta-Analysis.

Posterior cervical decompression and fusion (PCF) is a common procedure for treating patients with multilevel degenerative cervical spine disease. The selection of lower instrumented vertebra (LIV) relative to the cervicothoracic junction (CTJ) remains controversial. This study aimed to compare the outcomes of PCF construct terminating at the lower cervical spine and crossing the CTJ. A comprehensive literature search was performed for relevant studies in the PubMed, EMBASE, Web of Science, and Cochrane Library database. Complications, rate of reoperation, surgical data, patient-reported outcomes (PROs), and radiographic outcomes were compared between PCF construct terminating at or above C7 (cervical group) and at or below T1 (thoracic group) in patients with multilevel degenerative cervical spine disease. A subgroup analysis based on surgical techniques and indications was performed. Fifteen retrospective cohort studies comprising 2071 patients (1163 in the cervical group and 908 in the thoracic group) were included. The cervical group was associated with a lower incidence of wound-related complications (RR, 0.58; 95% CI 0.36 to 0.92, p = 0.022; 831 patients in cervical group vs. 692 patients in thoracic group), a lower reoperation rate for wound-related complications (RR, 0.55; 95% CI 0.32 to 0.96, p = 0.034; 768 vs. 624 patients), and less neck pain at the final follow-up (WMD, -0.58; 95% CI -0.93 to -0.23, p = 0.001; 327 vs. 268 patients). However the cervical group also developed a higher incidence of overall adjacent segment disease (ASD, including distal ASD and proximal ASD) (RR, 1.87; 95% CI 1.27 to 2.76, p = 0.001; 1079 vs. 860 patients), distal ASD (RR, 2.18; 95% CI 1.36 to 3.51, p = 0.001; 642 vs. 555 patients), overall hardware failure (including hardware failure of LIV and hardware failure occurring at other instrumented vertebra) (RR, 1.48; 95% CI 1.02 to 2.15, p = 0.040; 614 vs. 451 patients), and hardware failure of LIV (RR, 1.89; 95% CI 1.21 to 2.95, p = 0.005; 380 vs. 339 patients). The operating time was reasonably shorter (WMD, -43.47; 95% CI -59.42 to -27.52, p < 0.001; 611 vs. 570 patients) and the estimated blood loss was lower (WMD, -143.77; 95% CI -185.90 to -101.63, p < 0.001; 721 vs. 740 patients) when the PCF construct did not cross the CTJ. PCF construct crossing the CTJ was associated with a lower incidence of ASD and hardware failure but a higher incidence of wound-related complications and a small increase in qualitative neck pain, without difference in neck disability on the NDI. Based on the subgroup analysis for surgical techniques and indications, prophylactic crossing of the CTJ should be considered for patients with concurrent instability, ossification, deformity, or a combination of anterior approach surgeries as well. However, long-term follow-up outcomes and patient selection-related factors such as bone quality, frailty, and nutrition status should be addressed in further studies.

Removal of a Floating and Migrated Plate Screw in a Patient with a Failed Anterior Cervical Discectomy and Fusion

Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure for degenerative cervical spine disease. Rare complications of ACDF surgery include hardware failure, in the form of screw loosening and migration, or rod breakage. We present a case in which we removed a migrated screw lodged in the esophagus from a patient with a failed anterior cervical fusion. To present a surgical technique and considerations to remove a migrated screw. The previous ACDF incision was reopened and exposure was gained under the guidance of a head and neck surgeon. Longus coli were mobilized off the spine bilaterally with electrocautery. After dissection, the screw was found lodged in the longitudinal muscle of the esophageal wall and excised with the use of a 15-blade. The integrity of the esophageal mucosa and submucosa was maintained and subsequently checked with rigid esophagoscopy. Fluoroscopy was used to confirm that all hardware was removed, with the exception of the anterior cages. The dislodged screw, which was embedded in the esophagus, was successfully removed. Failure of an ACDF carries a risk of screw migration, which may be asymptomatic even if the screw is lodged in the esophagus. Additional considerations are required with potential violations of the adjacent viscera.

Assessing in vivo flexion-extension quality of motion after cervical disc arthroplasty: a pilot study.

The quality of flexion-extension motion after cervical disc arthroplasty has been a subject of interest due to the number of available devices with different designs and kinematics. Previous studies of motion quality have been limited to measuring the range of motion using two radiographs taken at the extremes of flexion and extension. This is the first study evaluating the in vivo quality of index segment motion using fluoroscopic images collected over the arc of flexion-extension after M6-C cervical disc arthroplasty surgery. Eligible participants had previously undergone a single-level cervical disc arthroplasty surgery for degenerative cervical spine disease performed by the senior author. Study participants underwent dynamic lateral fluoroscopic imaging to capture the C2-C7 motion between maximal flexion and extension. The amount of motion contribution by individual segments to the C2-C7 motion (termed segmental motion fraction) and its variation throughout the arc of flexion-extension were compared between the index and adjacent segments. The shift of centre of rotation during the arc of motion was also assessed. Ten subjects with a mean age of 43.8 years old were recruited, with an average follow-up of 16.2 months at the time of fluoroscopy. The C2-C7 cervical spine had an average flexion-extension range of 66.7 degrees. The contribution of the index segment averaged over the flexion-extension arc of motion was 18.9% (peak contribution 24.4%) for the C5-C6 group; and 15.5% (peak contribution 25.5%) for the C6-C7 group. The mean cranial-caudal location of the centre of rotation progressively shifted in the cranial direction from C2-C3 to C6-C7 motion segment. Our results demonstrated physiologic quality of motion at the index segment and harmony among its neighbouring segments following cervical disc arthroplasty, without gearshift-like intermittent locking of the prosthesis during the arc of flexion-extension motion. This pilot study provides a basis for the design of future long-term studies with larger sample size to compare the quality of motion between different cervical disc prostheses using the concept of segmental motion fraction as a motion-quality metric.

Is it necessary to cross the cervicothoracic junction in posterior cervical decompression and fusion for multilevel degenerative cervical spine disease? A systematic review and meta-analysis

Is it necessary to cross the cervicothoracic junction in posterior cervical decompression and fusion for multilevel degenerative cervical spine disease? A systematic review and meta-analysis

Is it necessary to cross the cervicothoracic junction in posterior cervical decompression and fusion for multilevel degenerative cervical spine disease? A systematic review and meta-analysis

Is it necessary to cross the cervicothoracic junction in posterior cervical decompression and fusion for multilevel degenerative cervical spine disease? A systematic review and meta-analysis

What Is the Evidence Surrounding the Cost-Effectiveness of Osteobiologic Use in ACDF Surgery? A Systematic Review of the Literature.

This study constitutes a systematic review of the literature. The aim of this study was to identify and present all available studies that report on the costs of osteobiologics used in anterior cervical discectomy and fusion (ACDF). The literature was systematically reviewed to identify studies with specific inclusion criteria: (1) randomized controlled trials and observational studies, (2) in adult patients, (3) with herniated disc(s) or degenerative cervical spine disease, (4) reporting on either direct or indirect costs of using specific osteobiologics in an ACDF operation. (5) Only studies in English were included. The quality of the included studies was assessed using the MINORS and RoB 2.0 tools. Overall, 14 articles were included; one randomized controlled trial and 13 observational studies. The most commonly used osteobiologics other than autograft/iliac crest bone graft (ICBG) were allograft and bone morphogenetic protein (BMP). None of the studies was reported to be industry-supported. There was considerable heterogeneity on the reported costs. Overall, most studies reported on surgery-related costs, such as anesthesia, operating room, surgical materials and surgeon's fee. Only two studies, both using allograft, reported the exact cost of the osteobiologic used (450 GBP, $700). Some of the studies reported on the cost of care during hospitalization for the surgical operation, such as radiology studies, emergency room costs, cardiologic evaluation, laboratory studies, pharmacy costs, and room costs. Only a few studies reported on the cost of follow-up, reoperation, and physical therapy and rehabilitation. Based on the data of this current systematic review, no recommendations can be made regarding the cost-effectiveness of using osteobiologics in ACDF. Given the high costs of osteobiologics, this remains a topic of importance. The design of future studies on the subject should include cost effectiveness.

Pedicle Screw Placement Aided byC-Arm Fluoroscopy: A "Nevermore without" Technology to Pursue Optimal Spine Fixation.

The surgical technique and the intraoperative technology that support spinal pedicle screw placement have consistently evolved over the past decades to decrease the misplacement rate of pedicle screws. We retrospectively evaluated our case series by analyzing the period 2016-2020. Patients undergoing pedicle screw fixation for cervical, thoracic, or lumbar spine degenerative diseases have been included. Surgery was carried out with the aid of intraoperative 3D C-arm fluoroscopy to assess and optimize screw placement and/or correct possible mispositioning. Each patient underwent a postoperative CT scan. Our aim was to evaluate the safety and accuracy of pedicle screw placement and estimate the variation in mispositioning rates. We carried out 329 surgical procedures, as follows: 70 cervical, 78 thoracic spine, and 181 lumbar spine surgeries. An excellent overall pedicle screw positioning was obtained, with slight differences between the cervical (98.6%), thoracic (100%), and lumbar (98.9%) tracts. Accordingly, only three patients required a revision surgery owing to mispositioning (0.91%). In particular, intraoperative C-arm fluoroscopy significatively improved the accuracy of thoracic screw positioning, as shown by postoperative CT scans. Our experience proves the crucial role of intraoperative C-arm fluoroscopy in pursuing optimal technical results and improving patient outcomes at follow-up.

Effectiveness of prophylactic bilateral C5 foraminotomy on C5 palsy incidence following combined anterior-posterior cervical instrumentation and decompression surgery for degenerative cervical spine diseases

Effectiveness of prophylactic bilateral C5 foraminotomy on C5 palsy incidence following combined anterior-posterior cervical instrumentation and decompression surgery for degenerative cervical spine diseases

Functional and Radiological Outcome of Anterior Cervical Discectomy and Titanium Cage Fusion in the Management of Patients with Degenerative Cervical Spine Disease

Background: The causes of cervical radiculopathy include trauma, disc herniation, instability, spondylosis and, in rare cases, malignancies. Degenerative spinal disorders are often treated by anterior cervical discectomy. Objective: To assess the functional and radiological outcome of anterior cervical discectomy and titanium cage fusion in the management of patients with degenerative cervical spine disease Methodology: The current study was descriptive study carried out at the orthopedic department, Qazi Hussain Ahmad Medical College, Nowshera from August 2021 to August 2022. All the relevant laboratory and radiological investigations were carried out for the enrolled patients. Cervical radiographs were examined for fusion, cage subsidence, and kyphosis at each visit. The functional outcomes, quality of life and pain level was determined for all the patients. IBM SPSS version 23 was employed for analysis of data. Results: In the current study, totally 50 patients were enrolled. The male participants in this study were 30 (60%) while female patients were 20 (40%). The mean age of the patients was 53 (±5.32). The pre-operative mean NDI, VAS and EQ-5D-5L index was 42 (5.90), 8.11 (2.11) and 0.54 (0.01) respectively while the post-operative mean NDI, VAS and EQ-5D-5L index was 19 (2.81), 2 (1.88) and 0.75(0.01) respectively (p=˂0.05). In all the enrolled patients radiographical fusion was achieve successfully. Segmental subsidence was reported in 2 (4%) patients while kyphosis was not observed in any of our patients. Conclusion: Our study concludes that in patients with symptomatic degenerative cervical spine disease, the anterior cervical discectomy and titanium cage fusion is an effective and safe surgical procedure with excellent functional and radiological outcome. Our study observed minimal complication rate by using this procedure. Keywords: Radiological outcome; Anterior cervical discectomy; titanium cage fusion; degenerative cervical spine disease