Degenerative Cervical Spondylosis Research Articles

Biomechanical Comparison of Different Surgical Strategies for Skip-level Cervical Degenerative Disc Disease: A Finite Element Study.

We constructed finite element (FE) models of the cervical spine consisting of C2-C7 and predicted the biomechanical effects of different surgical procedures and instruments on adjacent segments, internal fixation systems, and the overall cervical spine through FE analysis. To compare the biomechanical effects between zero-profile device and cage-plate device in skip-level multistage anterior cervical discectomy and fusion (ACDF). ACDF is often considered as the standard treatment for degenerative cervical spondylosis. However, the selection of surgical methods and instruments in cases of skip-level cervical degenerative disc disease is still controversial. Three FE models were constructed, which used noncontiguous 2-level Zero-P (NCZP) devices for C3/4 and C5/6, a noncontiguous 2-level cage-plate (NCCP) for C3/4 and C5/6, and a contiguous 3-level cage-plate (CCP) for C3/6. Simulate daily activities in ABAQUS. The range of motion (ROM), von Mises stress distribution of the endplate and internal fixation system, and intervertebral disc pressure (IDP) of each model were recorded and compared. Similar to the stress of the cortical bone, the maximum stress of the Zero-P device was higher than that of the CP device for most activities. The ROM increments of the superior, inferior, and intermediate segments of the NCZP model were lower than those of the NCCP and CCP models in many actions. In terms of the IDP, the increment value of stress for the NCZP model was the smallest, whereas those of the NCCP and CCP models were larger. Similarly, the increment value of stress on the endplate also shows the minimum in the NCZP model. Noncontiguous ACDF with zero-profile can reduce the stress on adjacent intervertebral discs and endplates, resulting in a reduced risk of adjacent segment disease development. However, the high cortical bone stress caused by the Zero-P device may influence the risk of fractures.

A novel MRI-based Cervical-Endplate Bone Quality score independently predicts cage subsidence after Anterior Cervical Discectomy and Fusion.

Postoperative cage subsidence after Anterior Cervical Discectomy and Fusion (ACDF) often has adverse clinical consequences and is closely related to Bone Mineral Density (BMD). Previous studies have shown that cage subsidence can be better predicted by measuring site-specific bone density. MRI-based Endplate Bone Quality (EBQ) scoring effectively predicts cage subsidence after lumbar interbody fusion. However, there is still a lack of studies on the practical application of EBQ scoring in the cervical spine. To create a similar MRI-based scoring system for Cervical-EBQ (C-EBQ) and to assess the correlation of the C-EBQ with endplate Computed Tomography (CT)-Hounsfield Units (HU) and the ability of this scoring system to independently predict cage subsidence after ACDF, comparing the predictive ability of the C-EBQ with the Cervical-Vertebral Bone Quality (C-VBQ) score. A total of 161 patients who underwent single-level ACDF for degenerative cervical spondylosis at our institution from 2012 to 2022 were included. Demographics, procedure-related data, and radiological data were collected, and Pearson correlation test was used to determine the correlation between C-EBQ and endplate HU values. Cage subsidence was defined as fusion segment height loss of ≥ 3mm. Receiver operating characteristic analysis and area-under-the-curve values were used to assess the predictive ability of C-EBQ and C-VBQ. A multivariate logistic regression model was developed to identify potential risk factors associated with subsidence. Cage subsidence was present in 65 (40.4%) of 161 patients. The mean C-EBQ score was 1.81 ± 0.35 in the group without subsidence and 2.59 ± 0.58 in the group with subsidence (P < 0.001). Multivariate analysis showed that a higher C-EBQ score was significantly associated with subsidence (OR = 5.700; 95%CI = 3.435-8.193; P<0.001), was the only independent predictor of cage subsidence after ACDF, had a predictive accuracy of 93.7%, which was superior to the C-VBQ score (89.2%), and was significantly negatively correlated with the endplate HU value (r = -0.58, P < 0.001). Higher C-EBQ scores were significantly associated with postoperative cage subsidence after ACDF. There was a significant negative correlation between C-EBQ and endplate HU values. The C-EBQ score may be a promising tool for assessing preoperative bone quality and postoperative cage subsidence and is superior to the C-VBQ.

Cervical degenerative espondilopathy in post-menopausal women

Cervical syndromes comprise a set of clinical conditions that have pain (cervicalgia) in common, to which are added muscular, articular, neurological and even vascular manifestations, with cephalic (cervical cephalic syndrome) and brachial (cervical brachialgic syndrome) irradiations, whose The origin is degenerative spondylodiscopathy or cervical spondylosis. It is a very common entity with an incidence of 85% in people over 60 years of age and onset at an early age, with a high incidence in women. The most common etiology is degenerative: spondylo-disc-uncus-arthrosis constituting 90% of cases, the rest would be inflammatory, tumorous, septic and traumatic, being rare.

Safety and efficacy of day anterior cervical discectomy and fusion procedure for degenerative cervical spondylosis: a retrospective analysis

ObjectiveOur study aimed to develop a day anterior cervical discectomy and fusion (ACDF) procedure to treat degenerative cervical spondylosis (DCS). The goal was to analyze its clinical implications, safety, and early effects to provide a better surgical option for eligible DCS patients.MethodsA retrospective analysis was performed to identify DCS patients who underwent day ACDF from September 2022 to August 2023. The operative time, intraoperative blood loss, postoperative drainage, preoperative and postoperative visual analog scale (VAS) scores, neck disability index (NDI) scores, Japanese Orthopedic Association (JOA) scores, JOA recovery rate (RR), incidence of dysphagia-related symptoms, 30-day hospital readmission rate, and incidence of other complications were recorded to evaluate early clinical outcomes. Radiography was performed to assess the location of the implants, neurological decompression, and cervical physiological curvature.ResultsAll 33 patients (23 women and 10 men) underwent successful surgery and experienced significant symptomatic and neurological improvements. Among them, 26 patients underwent one-segment ACDF, 5 underwent two-segment ACDF, and 2 underwent three-segment ACDF. The average operative time was 71.1 ± 20.2 min, intraoperative blood loss was 19.1 ± 6.2 mL, and postoperative drainage was 9.6 ± 5.8 mL. The preoperative VAS and NDI scores improved postoperatively (7.1 ± 1.2 vs. 3.1 ± 1.3 and 66.7% ± 4.8% vs. 24.1% ± 2.5%, respectively), with a significant difference (P < 0.01). Moreover, the preoperative JOA scores improved significantly postoperatively (7.7 ± 1.3 vs. 14.2 ± 1.4; P < 0.01) with an RR of 93.9% in good or excellent. Postoperative dysphagia-related symptoms occurred in one patient (3.0%). During the follow-up period, no patient was readmitted within 30 days after discharge; however, an incisional hematoma was reported in one patient on the 6th day after discharge, which was cured by pressure dressing. The postoperative radiographs revealed perfect implant positions and sufficient nerve decompression in all patients. Furthermore, the preoperative cervical physiological curvature improved significantly after the operation (14.5° ± 4.0° vs. 26.3° ± 5.4°; P < 0.01).ConclusionsDay ACDF has good safety and early clinical efficacy, and it could be an appropriate choice for eligible DCS patients.

The influence of anterior cervical discectomy and fusion surgery on cervical muscles and the correlation between related muscle changes and surgical efficacy

BackgroundAnterior cervical discectomy and fusion surgery (ACDF) is a common technique in treating degenerative cervical spondylosis. This study is to evaluate the changes of cervical muscles after ACDF and analyze the correlation between related muscle changes and clinical efficacy.MethodsSixty-five postoperative patients (single-level ACDF) with cervical spondylotic myelopathy from January 2013 to December 2022 were analyzed. The measured parameters include: the axial section of longus colli cross-sectional area (AxCSA), the volume of cervical longus, the ratio of long and short diameter line (RLS), the cervical extensor cross-sectional area (CESA), the vertebral body area (VBA), and the CESA/VBA. The visual analog scale (VAS), modified Japanese Orthopedic Association score (mJOA), and neck disability index (NDI) were evaluated. The changes in muscle morphology were analyzed, and the correlation analysis was conducted between morphological changes and function scores.ResultsThe postoperative AxCSA of surgical segment (3rd month, 12th month, and the last follow-up) was decreased compared to preoperative (141.62 ± 19.78), and the differences were significant (P < 0.05). The corresponding data reduced to (119.42 ± 20.08) mm2, (117.59 ± 19.69) mm2, and (117.41 ± 19.19) mm2, respectively (P < 0.05). The RLS increased, and the volume of cervical longus decreased significantly after surgery (P < 0.05). Negative correlation was found between postoperative volume of cervical longus and VAS at the 3rd month (r = − 0.412), 12th month (r = − 0.272), and last follow-up (r = − 0.391) (P < 0.05). Negative correlation existed between postoperative volume of cervical longus and NDI at the 3rd month (r = − 0.552), 12th month (r = − 0.293), and last follow-up (r = − 0.459) (P < 0.05).ConclusionThe volume of cervical longus decreased and its morphology changed after ACDF surgery. The mainly affected muscle was the cervical longus closing to the surgical segment. Negative correlation was found between the postoperative volume of cervical longus and function scores (VAS and NDI).

Ayurvedic Management of Cervical Myelopathy

Cervical Myelopathy is a condition causing compression of the spinal cord at the cervical level of the spinal cord. It is mostly due to degenerative cervical spondylosis and is hence called Cervical Spondylotic Myelopathy. The spinal cord may directly experience compressive and ischemic dysfunction as a result of age-related spondylotic alterations. A 63-year-old male with complaints of gradually progressive weakness in the arms and hands along with numbness, tingling sensation, neck stiffness and pain around the neck region for the last 10 years came to the OPD of our hospital. The management offered by contemporary medicine is not satisfactory. Cervical myelopathy and Greevastambha can be co-related in this case, based on signs and symptoms. This case report demonstrates how the clinical and radiological symptoms of cervical spondylotic myelopathy were alleviated by an Ayurvedic intervention. To confirm these results and incorporate Ayurveda into conventional medicine for spinal cord injuries, more investigation and controlled trials are necessary.

Relationship between C2 slope with sagittal parameters and clinical function of degenerative cervical kyphosis

PurposeTo explore the relationship between C2 slope with sagittal parameters and clinical function of degenerative cervical kyphosis (DCK).MethodsA retrospective analysis of 127 patients with degenerative cervical spondylosis treated in our spinal deformity center from January 2019 to June 2022. Patients were categorized into two groups and compared based on C2-7 angle (C2-7 ≥ 5° as kyphosis group, C2-7 < 5° as lordosis group). Pearson correlation or Spearman correlation was used to analyze the relationship between C2S and conventional radiological parameters and health -related quality-of-life (HRQOL) outcomes as measured by the EuroQol 5 dimension questionnaire (EQ5D), NRS, and the neck disability index (NDI). The cutoff value of C2S was determined by a receiver operating characteristic (ROC) curve.ResultsThere were 127 patients who met inclusion criteria (79 men and 48 women). Average 56.00 ± 10.27 years old (range 31–81 years old). C2S of kyphosis group is higher than non-kyphosis group. Aggravating cervical kyphosis increases cSVA positively. For all patients, C2S demonstrated a significant correlation with the O-C2 angle, C2-7 angle, cSVA, and TS-CL (p < 0.05). NRS, NDI and EQ5D-VAS scores revealed a significant correlation with C2S and cSVA (p < 0.01). For the subgroup of patients presenting with DCK, ROC curves demonstrated the cutoff values of C2S as 26.3°, and 30.5°, according to a cSVA of 40 mm, and severe disability expressed by NDI, respectively.ConclusionOn the basis of retaining the consistency of cranio-cervical and cervico-thoracic structure, C2S can better analyze the sagittal alignment of DCK patients than TS-CL and has good practicability in clinical application and HRQOL evaluation.

Postoperative Rehabilitation to Improve Outcomes After Cervical Spine Fusion for Degenerative Cervical Spondylosis: A Systematic Review.

Postoperative rehabilitation has recently been identified as a high-priority research topic for improving surgical outcomes for degenerative cervical spondylosis (DCS). However, there remains no consensus on specific rehabilitation strategies. Thus, the objective of this study was to evaluate the effectiveness of postoperative rehabilitation strategies for short-term and long-term outcomes after cervical spine fusion forDCS. A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines using the PubMed, Scopus, and Ovid Medline databases. All level I-IV therapeutic studies in the English language investigating the outcomes of postoperative rehabilitation strategies after cervical spine fusion for DCS were included. Nine studies with 895 patients with DCS (747 anterior-only fusion, 55 patients with posterior-only fusion, 93 patients with physiotherapy alone) were included in this analysis, with 446 (49.8%) patients receiving physiotherapy alone or standard postoperative therapyand 449 (50.2%) patients receiving standard postoperative therapy with additional intervention or augmentation. These interventions included pulsed electromagnetic field (PEMF) stimulation, telephone-supported home exercise program (HEP), early cervical spine stabilizer training, structured postoperative therapy, and a postoperative cervical collar. One level II study demonstrated that PEMF led to increased fusion rates at six months postoperatively compared to standard therapy alone, one level II study demonstrated that postoperative cervical therapy in addition to standard therapy was better than standard therapy alone in the improvement of neck pain intensity, one level IV study demonstrated home exercise therapy led to an improvement in neck pain, arm pain, and disability, and six level II studies reported no difference in clinical outcome measures between augmented or targeted therapy and standard postoperative therapy for DCS. In conclusion, there is moderate evidence to suggest that there is no significant difference in clinical and surgical outcomes between standard postoperative therapy and augmented or targeted postoperative therapy for cervical fusion in the setting of cervical spondylosis. However, there is some evidence to support that certain therapeutic modalities, such as PEMF stimulation, may lead to improved fusion rates, clinical outcomes, and patient satisfaction when compared to standard postoperative therapy protocols. There is no evidence to support a difference in effectiveness with different types of postoperative rehabilitation strategies between anterior and posterior fusions for DCS.

Prevalence of incidental thyroid abnormalities in patients with degenerative cervical spondylosis: a retrospective cross-sectional magnetic resonance imaging study.

Incidental thyroid abnormalities found on magnetic resonance imaging (MRI) of the neck are not uncommon. This study aimed to investigate the prevalence of incidental thyroid abnormalities in the cervical spine MRI of the degenerative cervical spondylosis (DCS) population indicated for surgery and to identify patients who require additional workup based on the recommendations of the American College of Radiology (ACR). All consecutive patients with DCS and indications for cervical spine surgery from October 2014 to May 2019 in the Affiliated Hospital of Xuzhou Medical University were reviewed. All MRI scans of the cervical spine routinely include the thyroid. Cervical spine MRI scans were retrospectively evaluated for the prevalence, size, morphologic characteristics, and location of incidental thyroid abnormalities. A total of 1,313 patients were included in the analysis, 98 (7.5%) of whom were found to have incidental thyroid abnormalities. The most frequent thyroid abnormality was thyroid nodules (5.3%), followed by goiters (1.4%). Other thyroid abnormalities included Hashimoto thyroiditis (0.4%) and thyroid cancer (0.5%). There was a statistically significant difference in age and sex between patients with DCS with and without incidental thyroid abnormalities (P=0.018 and P=0.007). Stratified by age, the results showed that the highest incidence of incidental thyroid abnormalities was found in patients aged 71 to 80 years (12.4%). Eighteen patients (1.4%) needed further ultrasound (US) and relevant workups. Incidental thyroid abnormalities are common in cervical MRI, with a prevalence of 7.5% identified in patients with DCS. Incidental thyroid abnormalities are large or have suspicious imaging features, and further evaluation with a dedicated thyroid US examination should be completed before cervical spine surgery is undertaken.

AYURVEDIC MANAGEMENT OF CERVICAL MYELOPATHY- A CASE REPORT

Introduction: Cervical Myelopathy is a neurological impairment caused by compression of the cervical spinal cord mostly due to degenerative cervical spondylosis. Axial imaging is the modality for diagnosis which shows myelomalacia and focal cord atrophy. Main clinical findings:A58 years old female with complaints of weakness of both legs since 6 months which aggravated past 2 months, associated with numbness of both soles and palms came to OPD of our hospital. Diagnosis: She was diagnosed and treated for cervical myelopathy. Depending on the clinical signs and symptoms of the patient the condition can be correlated to Khalli (Kaphavrutha vyana and raktavritavata). Intervention:The patient was managed with internal and external medications including ksharavasthi. Outcome: The treatment showed marked improvement in gait, pain, numbness in both extremities and urinary incontinence. Conclusion: This article is an attempt to shed light on the management of cervical myelopathy and to explore the scope of further study

Is 3D-printed Titanium cage a reliable option for 3-level anterior cervical discectomy and fusion in treating degenerative cervical spondylosis?

To assess the clinical and radiographical outcomes of 3-level anterior cervical discectomy and fusion (ACDF) with a 3D-printed titanium cage in treating degenerative cervical spondylosis. In this study, 25 patients with degenerative cervical spondylosis who underwent 3-level ACDF using a 3D-printed titanium cage from March 2019 to June 2021 were retrospectively enrolled. The patient-reported outcome measures (PROMs) were evaluated by visual analog scale (VAS) for the neck (VAS-neck) and arm pain (VAS-arm), Neck Disability Index (NDI) score, Japanese Orthopedic Association (JOA) score, SF-12 concise health survey, and the Odom criteria. The radiographical parameters, including C2-C7 lordosis, segmental angle, segmental height, and subsidence, were assessed. The mean duration of follow-up was 25.6 months. Bony fusion was achieved in all patients (100%). In three patients (12%) mild dysphagia was observed during the follow-up. The VAS-neck, VAS-arm, NDI score, JOA score, SF-12 score, C2-C7 lordosis, and segmental angle improved noticeably at the latest follow-up. Based on the Odom criteria, 22 patients (88%) reported satisfactory (excellent or good). The mean loss of C2-C7 lordosis and segmental angle between the immediate postoperative and the latest follow-up values were 1.6° ± 0.5° and 1.1° ± 0.5°, respectively. The mean subsidence was 0.9 ± 0.6 mm. In patients with multi-level degenerative cervical spondylosis, 3-level ACDF using the 3D-printed titanium cage can effectively relieve the symptoms, stabilize the spine, and restore segmental height and cervical curvature. It is proven to be a reliable option for patients with 3-level degenerative cervical spondylosis. However, a future comparative study involving a larger population and longer follow-up time may be required to further evaluate the safety, efficacy and outcomes of our preliminary results.

Update of the Natural History, Pathophysiology, and Treatment Strategies of Degenerative Cervical Myelopathy: A Narrative Review.

Cervical myelopathy is a clinical syndrome resulting in symptoms of neurologic deficits due to prolonged spinal cord compression or ischemia in the cervical spine. Spinal cord compression can be caused by ossification of the posterior longitudinal ligament and hypertrophy of ligamentun flavum in addition to degenerative cervical spondylosis, degenerative disc disease, and progressive cervical kyphosis. Degenerative cervical myelopathy (DCM) is a series of disease entities caused by spinal cord compression by various nontraumatic and non-infectious causes. The pathophysiology of DCM includes spinal cord structure and function abnormalities caused by both static and dynamic factors. Surgical decompression for patients with moderate to severe cervical myelopathy not only inhibits the progression of neurological deterioration, but also improves functional status, pain, and quality of life. However, the role of nonsurgical treatment in patients with mild spinal cord compression is controversial. In general, patients with cervical myelopathies who do not undergo surgery have a poor prognosis. Appropriate surgical treatment is recommended when spinal cord compression is confirmed on image study in patients with reasonable symptoms of cervical myelopathy. The patient's overall health, degree of compression, presence of concurrent cervical radiculopathy, and cervical spine alignment, in addition to lesion location and etiology, should be considered when determining an appropriate surgical procedure. This review covers the updated issues, including pathophysiology, clinical manifestations, differential diagnosis, and available treatments for DCM.

Transcriptome-wide association study identifies new susceptibility genes for degenerative cervical spondylosis

Degenerative cervical spondylosis (DCS) is a common musculoskeletal disease that encompasses a wide range of progressive degenerative changes and affects all components of the cervical spine. DCS imposes very large social and economic burdens. However, its genetic basis remains elusive. Predicted whole-blood and skeletal muscle gene expression and genome-wide association study (GWAS) data from a DCS database were integrated, and functional summary-based imputation (FUSION) software was used on the integrated data. A transcriptome-wide association study (TWAS) was conducted using FUSION software to assess the association between predicted gene expression and DCS risk. The TWAS-identified genes were verified via comparison with differentially expressed genes (DEGs) in DCS RNA expression profiles in the Gene Expression Omnibus (GEO) (Accession Number: GSE153761). The Functional Mapping and Annotation (FUMA) tool for genome-wide association studies and Meta tools were used for gene functional enrichment and annotation analysis. The TWAS detected 420 DCS genes with p < 0.05 in skeletal muscle, such as ribosomal protein S15A (RPS15A) (PTWAS = 0.001), and 110 genes in whole blood, such as selectin L (SELL) (PTWAS = 0.001). Comparison with the DCS RNA expression profile identified 12 common genes, including Apelin Receptor (APLNR) (PTWAS = 0.001, PDEG = 0.025). In total, 148 DCS-enriched Gene Ontology (GO) terms were identified, such as mast cell degranulation (GO:0043303); 15 DCS-enriched Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were identified, such as the sphingolipid signalling pathway (ko04071). Nine terms, such as degradation of the extracellular matrix (R-HSA-1474228), were common to the TWAS enrichment results and the RNA expression profile. Our results identify putative susceptibility genes; these findings provide new ideas for exploration of the genetic mechanism of DCS development and new targets for preclinical intervention and clinical treatment.Cite this article: Bone Joint Res2023;12(1):80-90.

SeUneter: Channel attentive U-Net for instance segmentation of the cervical spine MRI medical image.

In recent years, cervical spondylosis has become one of the most common chronic diseases and has received much attention from the public. Magnetic resonance imaging (MRI) is the most widely used imaging modality for the diagnosis of degenerative cervical spondylosis. The manual identification and segmentation of the cervical spine on MRI makes it a laborious, time-consuming, and error-prone process. In this work, we collected a new dataset of 300 patients with a total of 600 cervical spine images in the MRI T2-weighted (T2W) modality for the first time, which included the cervical spine, intervertebral discs, spinal cord, and spinal canal information. A new instance segmentation approach called SeUneter was proposed for cervical spine segmentation. SeUneter expanded the depth of the network structure based on the original U-Net and added a channel attention module to the double convolution of the feature extraction. SeUneter could enhance the semantic information of the segmentation and weaken the characteristic information of non-segmentation to the screen for important feature channels in double convolution. In the meantime, to alleviate the over-fitting of the model under insufficient samples, the Cutout was used to crop the pixel information in the original image at random positions of a fixed size, and the number of training samples in the original data was increased. Prior knowledge of the data was used to optimize the segmentation results by a post-process to improve the segmentation performance. The mean of Intersection Over Union (mIOU) was calculated for the different categories, while the mean of the Dice similarity coefficient (mDSC) and mIOU were calculated to compare the segmentation results of different deep learning models for all categories. Compared with multiple models under the same experimental settings, our proposed SeUneter's performance was superior to U-Net, AttU-Net, UNet++, DeepLab-v3+, TransUNet, and Swin-Unet on the spinal cord with mIOU of 86.34% and the spinal canal with mIOU of 73.44%. The SeUneter matched or exceeded the performance of the aforementioned segmentation models when segmenting vertebral bodies or intervertebral discs. Among all models, SeUneter achieved the highest mIOU and mDSC of 82.73% and 90.66%, respectively, for the whole cervical spine.

Utility of intraoperative neuromonitoring for decompression of Chiari type I malformation in 93 adult patients.

There is currently a lack of consensus on the utility of intraoperative neuromonitoring (IONM) for decompression of Chiari type I malformation (CM-I). Commonly used monitoring modalities include somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), and brainstem auditory evoked potentials (BAEPs). The purpose of this study was to evaluate the utility of IONM in preventing neurological injury for CM-I decompression. The authors conducted a retrospective study of a population of adult patients (ages 17-76 years) diagnosed with CM-I between 2013 and 2021. IONM modalities included SSEPs, MEPs, and/or BAEPs. Prepositioning baseline signals and operative alerts of significant signal attenuation were recorded. Ninety-three patients (average age 38.4 ± 14.6 years) underwent a suboccipital craniectomy for CM-I decompression. Eighty-two (88.2%) of 93 patients underwent C1 laminectomy, 8 (8.6%) underwent C1 and C2 laminectomy, and 4 (4.3%) underwent suboccipital craniectomy with concomitant cervical decompression and fusion in the setting of degenerative cervical spondylosis. Radiographically, the average cerebellar tonsillar ectopia/descent was 1.1 ± 0.5 cm and 53 (57.0%) of 93 patients presented with a syrinx. The average number of vertebral levels traversed by the syrinx was 5.3 ± 3.5, and the average maximum width of the syrinx was 5.8 ± 3.3 mm. There was one instance (1/93, 1.1%) of an MEP alert, which resolved spontaneously after 10 minutes in a patient who had concomitant stenosis due to pannus formation at C1-2. No patient developed a permanent neurological complication. There were no permanent complications related to intraoperative neurological injury. Transient fluctuations in IONM signals can be detected without clinical significance. The authors suggest that CM-I suboccipital decompression surgery may be performed safely without IONM. The use of IONM in patients with additional occipitocervical pathology should be left as an option to the performing surgeon on a case-by-case basis.

The Early Effect of Anterior Cervical Discectomy and Fusion on Adjacent Segment Degeneration in Cases of Cervical Degenerative Disease: A Clinical and Retrospective Study

BACKGROUND: The cervical spine is the most mobile part of the spine in the sagittal plane. It is important for surgeons to have reliable, simple, and reproducible parameters to analyze the cervical spine pre-operative and post-operative. Despite anterior cervical discectomy and fusion (ACDF) is a common procedure, adjacent segment failure after surgery is an ongoing clinical concern; adjacent segment disease (ASD) occurs in approximately 3% of patients per year, with an expected incidence of 25% within the first 10 years following fusion. It has been suggested that the increased stress placed on adjacent segments after successful ACDF may increase the rate of symptomatic disc disease at those segments, so our study focuses on how to evaluate ASD using magnetic resonance imaging (MRI) and X-ray. METHODS: The retrospective study conducted on 72 patients in the department of neurosurgery at Kasr Al-Ainy hospitals to evaluate ASD after ACDF for degenerative cervical spondylosis using pre-operative and post-operative cervical spine X-ray lateral view as well as MRI for cervical spine after 2 years from the date of surgery. RESULTS: Among the 72 patients in our study, the follow-up MRI after 2 years showed new pathology in 14 patients (19.4%) while 58 patients (80.6%) showed no new pathology; also 20 patients (27.8%) presented with new complaints while 52 patients (72.2%) had no new complaints and only 3 patients (4.16%) were scheduled for surgery. CONCLUSION: ASD is an ongoing process of degeneration that could be accelerated by ACDF procedures, but not every adjacent segment degeneration or symptomatic disease requires additional surgery. Cervical mal-alignment greatly affects the neck pain rather than development of other new neurological manifestations and plays a role in adjacent segment failure which should be considered during cervical fusion surgeries. ASD must be differentiated from adjacent segment degeneration using clinical examination and imaging to help in patients’ follow-up and decision-making of further intervention.

Clinical and radiological comparison of the zero-profile anchored cage and traditional cage-plate fixation in single-level anterior cervical discectomy and fusion

BackgroundThe aim of this study was to compare the clinical outcomes and radiographic parameters of the zero-profile anchored cage and traditional cage-plate fixation in single-level anterior cervical discectomy and fusion (ACDF).MethodsBetween January 2016 and November 2018, a total of 68 patients with degenerative cervical spondylosis who underwent single-level ACDF were evaluated in this retrospective study. Thirty-five patients were treated with the zero-profile anchored cage (Zero-P group), and 33 patients were treated with the traditional cage-plate fixation (Cage group). The two groups were compared in reference to clinical outcomes and radiographic parameters.ResultsThe mean operation time in the Zero-P group was significantly shorter than that in the Cage group. The incidence of postoperative dysphagia in the Cage group was higher than that in the Zero-P group at 3 months and 12 months postoperatively. No bony spurs were found in the Zero-P group, whereas 5 patients in the Cage group developed bony spurs. There were no statistically significant differences between the two groups in the JOA scores, VAS scores, NDI scores, C2-7 Cobb angles, segmental Cobb angles, total interbody height or fusion rates at 3 months or 12 months postoperatively.ConclusionIn this study, both the zero-profile anchored cage and traditional cage-plate fixation were demonstrated to be effective and safe strategies. Given the lower incidence of dysphagia and degenerative changes, zero-profile anchored cage is a good option.

Comparing Clinical and Radiographic Outcomes Between the Self-locking Stand-alone Cage and Conventional Cage-plate Construct: A Five-year Retrospective Cohort Study.

A retrospective cohort study. To evaluate the clinical efficacy of the self-locking stand-alone (SA) cage and conventional cage-plate construct (CPC) in treating degenerative cervical spondylosis with a five-year follow-up. The SA approach was designed to reduce complications associated with traditional anterior cervical discectomy and fusion. These techniques have been shown to have satisfactory short-term clinical outcomes. Literature describing the mid-term clinical outcomes of SA cage is limited. We retrospectively analyzed patients with cervical spondylosis who had received an SA device or CPC between 2014 and 2016 at the Xijing Hospital. Participants were matched for sex, age, and operative level. Differences in clinical and radiographic outcomes and the occurrence of postoperative complications between the two groups were analyzed. In total, 207 patients were included (101 with SA and 106 with CPC), the median follow-up for both groups were 60.2 and 60.9 months. Both groups exhibited significant improvements in all measured values compared with the preoperative values. The SA group had a shorter operation time, less intraoperative blood loss, and a significantly lower incidence of dysphagia after surgery than the CPC group ( P <0.05). At the last visit, cage subsidence was 6.9% and 3.8% in the SA and CPC groups, respectively ( P =0.365). The radiographic adjacent segment degeneration (ASD) was significantly lower in the SA group than in the CPC group (6.9% vs. 27.4%, P <0.01). No symptomatic ASD was observed in the SA group, and six (5.7%) cases occurred in the CPC group ( P =0.029). In this study, the SA cage showed similar efficacy to that of the conventional CPC in treating cervical spondylosis using anterior cervical discectomy and fusion, with a significant reduction in the incidence of immediate postoperative dysphagia and mid-term ASD.

The Effect of Preoperative Mental Health Status on Outcomes After Anterior Cervical Discectomy and Fusion.

The effect of preoperative mental health on outcomes after anterior cervical discectomy and fusion (ACDF) is of increasing interest. The purpose of this study was to utilize patient-reported outcome measures (PROMs) to compare outcomes after ACDF in patients with and without poor mental health. We hypothesized that patients with worse baseline mental health would report worse outcomes after surgery. Patients undergoing ACDF for degenerative cervical spondylosis with at least 12 months of follow-up were included. Outcomes collected before and after surgery included the RAND-36, Neck Disability Index (NDI), EuroQol 5-dimension (EQ-5D), and Single Assessment Numeric Evaluation (SANE) score. Seventy-one patients were included and assigned to the depression or nondepression group based on baseline mental health. The depression group had worse baseline preoperative scores across all PROMs: NDI (44.2 vs 36.8, P = 0.05), RAND (1511.4 vs 2198.18, P < 0.001), EQ-5D (12.55 vs 10.14, P < 0.001), and SANE (56.3 vs 72.9, P < 0.001). Postoperatively, the depression group had worse scores at the final follow-up for RAND (2242.8 vs 2662.2, P = 0.03) and SANE (71.5 vs 80.8, P = 0.02). Both groups experienced improvements with ACDF across all PROMs. The changes in each PROM were not statistically significant between groups. There were no statistically significant differences in the percentage of patients achieving the minimal clinically important difference across PROMs. This study is the first to utilize the RAND-36, EQ-5D, NDI, and SANE scores to assess preoperative mental health and its effect on postoperative outcomes after ACDF. While poor preoperative mental health status yielded significantly worse baseline and postoperative outcomes scores, patients experienced significant improvement in symptoms after ACDF. Clinicians should be aware of the effects of poor mental health status on clinical outcomes in patients undergoing anterior cervical fusion, but can still expect significant clinical improvements after surgery.

Association between Sagittal Cervical Spinal Alignment and Degenerative Cervical Spondylosis: A Retrospective Study Using a New Scoring System.

(1) Background: Prolonged neck flexion is thought to cause harmful loading on the cervical spine. Along with the degenerative process, cervical alignment tends to change toward lordotic curvature. The association between cervical alignment and cervical spondylosis remains unclear. (2) Methods: Three raters retrospectively assessed cervical radiographies of outpatients at a tertiary center in 2019 using degenerative cervical spondylosis score (DCS score; a newly developed scoring system), C2-7 absolute rotational angle (ARA), and C2-7 sagittal vertical axis (SVA). (3) Results: A total of 561 patients were included in the analysis. Multiple regression analysis with adjustments for age and sex revealed that C2-7 ARA, rather than SVA, was a significant parameter for degenerative spondylosis. The interaction between age and C2-7 ARA was significant, indicating that the increase in DCS score with increasing age was more pronounced in patients with kyphotic cervical alignment. The direct effect of age on DCS score was 0.349 (95% CI 0.319 to 0.380, p < 0.001) and the proportion of the mediation effect of C2-7 ARA was −0.125 (p < 0.001). (4) Conclusions: C2-7 ARA was significantly associated with DCS after adjustment for both age and sex. Subjects with more kyphotic cervical alignment showed a greater correlation between increased DCS score and older age.