Degenerative Cervical Spondylosis Research Articles

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.

ZERO-PROFILE DEVICE IMPLANTATION IN ANTERIOR CERVICAL DISCECTOMY AND FUSION: A SINGLE INSTITUTE EXPERIENCE

Background: A surgical procedure, anterior cervical discectomy and fusion (ACDF), is used for neural decompression in degenerative cervical disk disease and cervical spondylosis. A new type of cervical interbody cage, the Zero-profile device (ZPD), has been developed which could reduce postoperative complications among patients.&#x0D; Objectives: The study aimed to examine the effect of ZPD on clinical outcomes and cervical spine alignment of enrolled patients at 1-year follow-up in the management of ADCF.&#x0D; Methods: This study retrospectively evaluated the clinical and radiographic outcomes using the Zero-profile device (ZPD) in the anterior cervical discectomy and fusion (ACDF). All patients who underwent ACDF at Vajira Hospital between May 2017 and June 2021 were included in this study. Radiographic images obtained from picture archiving and communication systems (PACS) were used to evaluate the device-level Cobb angle (DLCA), segmental Cobb angle (SCA), global Cobb angle (GCA), sagittal vertical axis (SVA), and intervertebral disk height. The Japanese Orthopaedic Association (JOA) scores and visual analog scale (VAS) were obtained from the patients’ medical records. The preoperative DLCA, SCA, GCA, SVA, and intervertebral disk height measurements were compared with the postoperative measurements at 1 year.&#x0D; Results: A total of 31 patients (45 disks) who underwent ACDF with the ZPD were included in this study. A significant improvement was found in JOA, VAS, DLCA, SCA, GCA, SVA, and intervertebral disk height after ACDF with ZPD (p&lt;0.001). Immediate postoperative dysphagia occurred in two patients (6.5%), which resolved after 3 months. No subsidence was reported at 1-year follow-up. Age, BMI as well as the preoperative cervical alignment did not affect outcomes in this study.&#x0D; Conclusion: The use of the ZPD in ACDF improved clinical and radiographic outcomes in the correction of cervical spine alignment, and minimized postoperative complications of dysphagia. No device-related failure occurred, and favorable outcomes persisted at 1-year follow-up.

Intervertebral-spreader-assisted anterior cervical discectomy and fusion prevents postoperative axial pain by alleviating facet joint pressure

ObjectiveTo evaluate the relationship of postoperative cervical axial pain with different vertebral distraction methods used during ACDF procedures in cervical spondylosis patients.MethodsNinety-four single-level cervical spondylotic myelopathy patients with significantly loss of intervertebral disc height who underwent ACDF surgery in our institute between January 2018 and January 2020 were enrolled. Cervical spine lateral radiographs were taken preoperatively, 3 days, 1-month, 2-month and 6-month after the surgery. The intervertebral disc height (IDH), interfacet distance (IFD), JOA (Japanese Orthopaedic Association) score, NDI (Neck Disability Index) score, nVAS (Neck Visual Analogue Scale) score and aVAS (Arm Visual Analogue Scale) score were measured. The correlation of clinical parameters and intervertebral disc height was evaluated. Then the correlation of clinical outcomes and different distraction method was evaluated. The patients were randomly divided into two groups, one uses Casper pin distractor system alone for distraction (Caspar alone group) and the other uses spreader assisted distraction method (Casper + spreader group). In biomechanical study, four cervical spine cadavers were selected for facet pressure measurements under different vertebral distraction methods, and the facet joint pressure was measured using force sensors.ResultsSatisfactory cervical fusion and neurological recovery were achieved in all patients. No significant correlation of IDH, IFD, JOA, NDI or aVAS with nVAS score was found. No significant difference between the change in disc height and clinical outcomes was found. However, by comparing the clinical parameters of patients in different vertebral distraction groups, we found significant changes in the early nVAS and NDI scores (P = 0.11, P = 0.48) of the Casper + spreader group (3 days postoperation), and was associated with a better nVAS score at 2 months postoperation (P < 0.05). The biomechanical study in cervical cadavers also showed significantly and continuously decreased facet joint pressure in the spreader assisted vertebral distraction group (P < 0.01).ConclusionsSpreader-assisted vertebral distraction method effectively alleviates postoperative neck pain in degenerative cervical spondylosis patients treated with ACDF. The mechanism may be related to the transient relief of facet joint pressure during the vertebral distraction procedure in ACDF.

Examination of the Effect of Physical Therapy Intervention Aimed at Improving Spinal Alignment for Patients with Degenerative Cervical Spondylosis with Dropped Head Symptoms

Examination of the Effect of Physical Therapy Intervention Aimed at Improving Spinal Alignment for Patients with Degenerative Cervical Spondylosis with Dropped Head Symptoms

Two-Attending Surgeon Teams Improve Outcomes of Single-Level Anterior Cervical Discectomy and Fusion.

Given the shift toward value-based healthcare, strategies that decrease risk in commonly performed procedures such as anterior cervical discectomy and fusion (ACDF) are of interest. The objective of this study was to analyze the effect of a two-attending surgeon team on the outcomes of patients undergoing single-level ACDF. A retrospective matched-cohort study of patients undergoing single-level ACDF for degenerative cervical spondylosis, with minimum 2-year follow-up was performed. Patients were subdivided into two cohorts: cases with procedures performed by one attending surgeon assisted by a resident physician and cases with procedures performed by an attending surgeon with another attending surgeon as first-assist. Patients were matched by age, sex, body mass index, smoking status, American Society of Anesthesia grade and Charlson Comorbidity Index. Perioperative data and complications were compared. Standard binomial and categorical comparative analysis were performed. Forty-two patients were included (21 in each group). There were 22 males and 20 females, with a mean age of 47.7 years and mean follow-up of 43.4 months. There were no differences in any demographic variable between groups, indicating successful matching. Cohort B had decreased anesthesia time (114.9 vs. 157.1 minutes, P < 0.001), operative time (58.1 vs. 98.9 minutes, P < 0.001) and blood loss (14.8 vs. 24.3 mL, P = 0.012). There were no significant differences in terms of post-operative complications including dysphagia, wound infection, neurologic or cardiovascular related complications. A two-attending surgeon team significantly reduces anesthesia time, surgical time, and blood loss in single-level ACDF procedures without an increase in complications or a decrease in fusion rates.

Grip Strength as a Screening Index for Severe Degenerative Cervical Myelopathy in Primary Care: Development of Cutoff Values Using Receiver Operating Curve Analysis.

PurposeEarly diagnosis of degenerative cervical spondylosis (DCM) is desirable because late treatment can lead to irreversible sequelae. No screening method has yet been established. Grip strength is commonly used in primary care settings to evaluate disease activity and diagnose sarcopenia. This single-center, cross-sectional study aimed to determine the diagnostic accuracy of grip strength for cervical myelopathy (DCM) and cutoff values for primary care DCM screening using area under the curve (AUC) and sensitivity values.Patients and MethodsThe DCM group comprised 249 consecutive participants (165 males, 84 females; mean age, 65.1 years) with DCM who had undergone surgery at the affiliated hospital. The control group comprised 735 (280 males, 455 females; mean age, 65.8 years) participants undertaking a local government health checkup. Stratifying by age and sex, receiver operating characteristic (ROC) analyses were constructed for each group using minimum grip strength values for both hands. Based on ROC analysis, cut-off values were established so that the screening sensitivity would be 90% for either sex or age group, respectively.ResultsAccording to age group and sex (males/females [M/F]), AUC values for a diagnosis of DCM in M/F were as follows: 40–59 years, 0.92/0.87; 60–69 years, 0.94/0.89; 70–79 years, 0.89/0.91; and 80–89 years, 0.97/0.97. Calculated M/F cutoff values were 41/24.5, 27/16, 27/15, and 20/10 kg, which were similar to cutoff scores for sarcopenia in M/F patients aged 60–69 and 70–79 years. M/F sensitivities in each age groups were 0.94/0.91, 0.92/0.90, 0.95/0.96, and 0.92/0.93. M/F specificities were 0.62/0.59, 0.84/0.83, 0.61/0.71, and 0.83/0.88.ConclusionGrip strength had moderate-to-high diagnostic accuracy for DCM between participants in the control and DCM groups. We developed easily applicable cutoff values for primary care DCM screening with ≥90% sensitivity. In patients with sarcopenia, DCM should be differentially diagnosed in primary care.

Anterior Cervical Discectomy and Fusion Versus Cervical Disc Replacement in Patients With Significant Cervical Spondylosis.

Retrospective cohort study. The aim was to compare clinical outcomes in patients with significant cervical spondylosis treated with cervical disc replacement (CDR) compared with anterior cervical discectomy and fusion (ACDF). As CDR utilization has increased over the past decade, recent studies have investigated the outcomes of CDR in patients with more significant spondylotic changes and demonstrated improved postoperative patient-reported outcomes (PROs). However, no prior study has investigated clinical outcomes of patients with significant spondylotic changes treated with CDR in comparison to ACDF. Patients who underwent 1-level or 2-level CDR or ACDF with significant cervical spondylosis, quantified using a validated grading scale, were identified, and prospectively collected data was retrospectively reviewed. The following PROs were analyzed: Neck Disability Index (NDI), visual analog scale-Neck, visual analog scale-Arm, and PROMIS Physical Function (PROMIS-PF) Computer Adaptive Test Score. Demographic, operative, and radiographic variables, and achievement of minimum clinically important difference (MCID) for each PRO were compared between the 2 groups. A total of 66 patients were included in the present study, of which 35 (53%) were treated with CDR and 31 (47%) with ACDF. The preoperative cervical spondylotic grade was similar between the 2 groups (1.8 vs. 2.2, P=0.27). At final follow-up, there was no significant difference in the absolute value for each PRO between the 2 groups (P>0.19) and both groups demonstrated significant improvement in each PRO compared with preoperative values (P<0.01). There was no significant difference in the percentage of patients achieving the MCID for each PRO when comparing CDR to ACDF (P>0.09). A similar percentage of patients with significant degenerative cervical spondylosis achieved the MCID across multiple PROs when treated with CDR or ACDF. Patients in both treatment groups demonstrated significant improvement in all PROs assessed when compared with preoperative values. Level III.

Degenerative Cervical Spondylosis: A Cause of Vertigo?

Prospective observational study. Studying the effect of degenerative cervical spondylosis(CS) on blood flow velocity of vertebral artery (VA) during cervical spine rotation in different head positions and its association with vertigo. Vertigo is one of the most common complaints seen in an out-patient clinic. Its association with CS remains an enigma for a treating physician. This study planned to systematically analyze the association between vertigo and CS by evaluating VA blood flow dynamics in different head positions. 100 patients with ages ranging from 20-80 years were recruited. First group of 50 patients with CS with vertigo were compared with second study group of 50 patients having CS without vertigo. Cervical radiographs were used to evaluate CS using cervical degenerative index (CDI). Color doppler was used to measure VA blood flow with head in neutral position and 60° lateral rotation with 30° extension. Same procedure was repeated on opposite side. Measurements performed included peak systolic blood flow velocity(PSV) and end diastolic blood flow velocity (EDV). Among patients with CS, patients having vertigo showed significantly more evident degenerative changes (CDI ≥25) (P=<0.001). High grade CS patients (CDI ≥25) with vertigo had statistically significant lower blood flow parameters with head rotation in the left and right VAs as compared to CS patients without vertigo. This study highlights important pathophysiological mechanism of vertigo observed in patients of CS. The magnitude of reduction in VA blood flow was significantly higher in patients with advanced CS presenting as vertigo.

Anterior hybrid construction of multilevel cervical disc disease and spondylotic spinal stenosis: surgical results and factors affecting adjacent segment problems

ObjectiveWe aimed to evaluate reliability, radiological outcomes, and the impacts of anterior cervical hybrid construction on the adjacent segments for the multilevel cervical degenerative disc disease (mCDDD) and spondylotic spinal stenosis (SSS).MethodsA retrospective analysis was performed using data extracted from the medical files of 195 patients (105 males, 90 females; mean age: 47.7 years). From 2008 to 2018, these patients underwent anterior cervical hybrid construction for symptomatic contiguous at least 2-level cervical degenerative disc diseases and cervical spondylosis. Clinical and radiological data including Neck Disability Index (NDI), visual analogue scale (VAS), local cervical degenerative disk disease in adjacent segments on magnetic resonance imaging (MRI) views, and complications were reviewed.ResultsThe mean clinical and radiological follow-up was 45.2 months (range 24 to 102). Radiculopathy and/or myelopathy were the main clinical problems in all patients. The mean VAS scores of HC for arm pain were 7.4 ± 0.8 preoperatively; 2.8 ± 0.6, 1 month after surgery; 2.3 ± 0.6, 6 months after surgery; 1.8 ± 0.6, 12 month after surgery; and 1.6 ± 0.6, 24 months after surgery. The mean NDI scores (mean ± SD) of HC significantly improved after surgery (on admission, 57.2 ± 5.5%; 1 month after surgery, 27.35 ± 5.3%; 6 month after surgery, 21.43 ± 2.8%; 12 months after surgery, 21.9 ± 2.3%; 24 months after surgery, 20.6 ± 2.6%, p = 0.006). Hoarseness and dysphagia were the most common complications and osteophyte formation was the most frequent radiographic change.ConclusionAnterior cervical hybrid construction appears to be an acceptable option in the management of multilevel cervical degenerative disc diseases and spondylotic spinal stenosis.

Vacuum plasma sprayed porous titanium coating on polyetheretherketone for ACDF improves the osteogenic ability: An in vitro and in vivo study.

Cervical degenerative disease is a common and frequently occurring disease, which seriously affects the health and quality of the life of patients worldwide. Anterior cervical decompression and interbody fusion is currently recognized as the gold standard for the treatment of degenerative cervical spondylosis. Polyetheretherketone (PEEK) has become the prevailing material for cervical fusion surgery. Although PEEK has excellent biocompatibility, it is difficult to form bone connection at its bone-implant interface due to its low surface hydrophilicity and conductivity. It is widely accepted that Ti has excellent osteogenic activity and biocompatibility. In this study, a Ti-PEEK composite cage was prepared by coating Ti on the surface of a PEEK cage using a vacuum plasma spraying technique to enhance the osteogenic property of PEEK. The Ti-PEEK samples were evaluated in terms of their in vitro cellular behaviors and in vivo osteointegration, and the results were compared to a pure PEEK substrate. The skeleton staining and MTS assay indicated that the MC3T3-E1 cells spread and grew well on the surface of Ti-PEEK cages. The osteogenic gene expression and western blot analysis of osteogenic protein showed upregulated bone-forming activity of MC3T3-E1 cells in Ti-PEEK cages. Furthermore, a significant increase in new bone formation was demonstrated on Ti-PEEK implants in comparison with PEEK implants at 12weeks in a sheep cervical spine fusion test. These results proved that the Ti-PEEK cage exhibited enhanced osseointegrative properties compared to the PEEK cage both in vitro and in vivo.

Occult Disco-Ligamentous Lesions of the Subaxial c-Spine-A Comparison of Preoperative Imaging Findings and Intraoperative Site Inspection.

Despite the general acceptance of magnetic resonance imaging (MRI) as the gold standard for diagnostics of traumatic disco-ligamentous injuries in the subaxial cervical spine, clinical experience shows cases where no lesion is detected in MRI exams but obtained during surgery. The aim of this study was to compare intraoperative site inspection to preoperative imaging findings and to identify radiological features of patients having a risk for under- or over-estimating disco-ligamentous lesions. We performed a retrospective analysis of our clinical database, considering all patients who underwent surgical treatment of the cervical spine via an anterior approach after trauma between June 2008 and April 2018. Only patients with availability of immediate preoperative computed tomography (CT), 3-Tesla MRI scans, and information about intraoperative findings were considered. Results of preoperative imaging were set in context to intraoperative findings, and receiver operator characteristics (ROC) were calculated. Out of 144 patients receiving anterior cervical surgery after trauma, 83 patients (mean age: 59.4 ± 20.5 years, age range: 12–94 years, 63.9% males) were included in this study. Included patients underwent surgical treatment via anterior cervical discectomy and fusion (ACDF; 79 patients) or anterior cervical corpectomy and fusion (4 patients) with ventral plating. Comparing preoperative imaging findings to intraoperative site inspection, a discrepancy between imaging and surgical findings was revealed in 14 patients, leading to an overall specificity/sensitivity of preoperative imaging to identify disco-ligamentous lesions of the cervical spine of 100%/77.4%. Yet, adding the existence of prevertebral hematoma and/or vertebral fractures according to preoperative imaging improved the sensitivity to 95.2%. Lack of sensitivity was most likely related to severe cervical spondylosis, rendering correct radiological reporting difficult. Thus, the risk of missing a traumatic disco-ligamentous injury of the cervical spine in imaging seems to be a particular threat in patients with preexisting degenerative cervical spondylosis. In conclusion, incorporating the existence of prevertebral hematoma and/or vertebral fractures can significantly improve diagnostic yield.

Anterior Approaches for Two-Level Cervical Degenerative Disease: A Comparative Study of at least 6-Year Follow-Up.

ObjectiveTo compare the clinical and radiogrincaphic results of a hybrid surgery (HS) and cervical artificial disc replacement (ADR) for contiguous two-level cervical spondylosis.MethodsA total of 56 patients with contiguous two-level degenerative cervical spondylosis who underwent cervical HS and ADR via an anterior approach and completed at least 6 years of follow-up were included in this study. Patients were divided into two groups: group I, comprising 22 patients who underwent ADR, and group II, comprising 34 patients who underwent HS combined ADR and anterior cervical discectomy and fusion using a cage. Clinical outcomes were evaluated based on the visual analog scale (VAS) scores for arm pain, neck disability index (NDI), and modified MacNab criteria. Radiological parameters were assessed by measuring the bone fusion status, cervical range of motion (ROM C2-C7), heterotopic ossification (HO), adjacent segment disease (ASD) incidence, and fused segment height (FSH).ResultsThe VAS scores and NDI significantly improved in both groups, without significant differences between the groups. The incidences of HO, ROM C2–C7, and FSH were similar between groups, without significant differences. New osteophyte formation and osteophyte enlargement at adjacent segments were more frequently found in the HS group; however, the difference was not significant.ConclusionClinical results of this study showed that the clinical efficacy and radiological changes in HS were similar to those of ADR. HS can be an alternative procedure for the treatment of two-level cervical spondylosis.

Long-term outcomes of Bryan artificial cervical disc replacement for degenerative cervical spondylosis

Objective: To compare the long-term clinical effect and imaging results of Bryan artificial cervical disc replacement (ACDR) and anterior cervical discectomy and fusion (ACDF) and to explore whether ACDR can reduce the occurrence of postoperative adjacent segment degeneration (ASD) in the treatment of degenerative cervical spondylosis. Methods: It was a retrospective study. Total of 60 patients with degenerative cervical spondylosis, who had received operations by Bryan ACDR (n=27) and ACDF (n=33) in the Third Hospital of Hebei Medical University between January 2005 and December 2009 were enrolled in this study. The Japanese Orthopedic Association (JOA) scores, neck disability index (NDI), visual analogue scale (VAS), Odom's scale, cervical range of motion (ROM), surgical segment ROM, heterotopic ossification (HO) and ASD were used to evaluate the clinical and radiologic results. The indices abovementioned were compared between the two groups. Results: The VAS, NDI and JOA scores at each follow-up node in both ACDR and ACDF group were all significantly improved when compared with those before operation (all P<0.05), but there was no significant differences between the two groups (all P>0.05). Of all, 88.9%(24/27) of patients in ACDR group and 84.8%(28/33) of patients in ACDF group achieved excellent or good results, however, there was no significant difference in Odom's scale between the two groups (P>0.05). At the last follow-up, the cervical ROM in ACDR group was 43.2°±8.8°, which was slightly lower than that before operation (45.7°±10.4°), the difference was not statistically significant (t=0.954, P=0.345); the surgical segment ROM in ACDR group was 5.9°±3.6°, which was significantly reduced when compared with that before operation (8.8°±3.4°, t=3.043, P<0.01). However at the last follow-up, the cervical ROM in ACDF group was 36.4°±8.4°, which was significantly reduced when compared with that before operation (43.9°±11.1°), the difference was statistically significant (t=3.095, P<0.01). Although, there was no significant difference in the cervical ROM between the two groups before operation (t=0.643, P=0.523), and the difference was statistically significant at the last follow-up (t=3.054, P<0.01). At the last follow-up, the incidence of HO in ACDR group was 92.6%, and the high-grade HO was 37.0%. The incidence of ASD in ACDR group was 39.5%, which was much lower than that in ACDF group (61.1%, χ(2)=4.462, P=0.035). Conclusion: At minimum follow-up of 10 years, Bryan ACDR achieves a satisfactory clinical effect consistent with ACDF. In terms of advantages, ACDR could maintain the ROM of cervical and retain the ROM of the surgical segment, which reduces the occurrence of ASD by preserving motion.

P105. The influence of standalone cage versus plate-augmented single-level ACDF on global and local cervical sagittal alignment

BACKGROUND CONTEXT Prior studies have demonstrated that the postoperative sagittal alignment parameters of the cervical spine influence clinical outcomes and patient-reported outcome scores. For example, increased C2-C7 sagittal vertical axis (SVA) has been shown to decease neck disability index (NDI) scores. One recent study characterized the influence that different implant choices (particularly standalone versus plate-augmented constructs) had on cervical alignment parameters for 2-level ACDFs, and found that plate-augmented devices were better at restoring cervical lordosis. PURPOSE There is a paucity of literature investigating sagittal alignment parameters for single level constructs, and thus we sought to compare the ACDF-plate and ACDF-cage constructs in terms of their influence on sagittal parameters for single level fusions. STUDY DESIGN/SETTING This is a retrospective cohort study comparing patients who underwent ACDF with a plate-augmented construct to those who underwent ACDF with a standalone interbody device. PATIENT SAMPLE We identified 43 patients who underwent ACDF during the period studied. Of those, 17 underwent ACDF with a standalone device, whereas 26 underwent plate-augmented ACDF. OUTCOME MEASURES Demographic and perioperative factors were collected. Radiographic parameters of C2-C7 SVA, C2-C7 lordosis, segmental cobb angle, T1 slope, and T1 slope minus C2-C7 lordosis were measured on preoperative and postoperative images. METHODS We retrospectively analyzed the preoperative and most recent postoperative radiographs from patients who underwent a single-level ACDF for degenerative cervical spondylosis at our institution between May 2014 and July 2019. The average follow-up time was 10.5 months. Patients were separated into groups based on the construct used (ACDF-cage and ACDF-plate). Demographic and perioperative factors were collected. Radiographic parameters of C2-C7 SVA, C2-C7 lordosis, segmental cobb angle, T1 slope, and T1 slope minus C2-C7 lordosis were measured on preoperative and postoperative images. Patient demographic, perioperative and radiographic factors were compared using Pearson's chi-square test for categorical and independent samples t-test for continuous variables. RESULTS We identified 43 patients who underwent ACDF during the period studied. Of those, 17 underwent ACDF with a standalone device, whereas 26 underwent plate-augmented ACDF. There was no significant difference between groups in terms of age (52.0 vs 48.8, p = >0.05) or which levels were fused (p = 0.615). We did not find a significant difference between groups in the final postoperative sagittal alignment parameters (SVA 28.6 vs 33.7, cervical lordosis 10.2 vs 12.4, segmental angle 4.9 vs 4.3, T1 slope 25.8 vs 27.7, T1 slope minus cervical lordosis 0.83 vs 4.03, p>0.05). We also compared the change from preoperative to postoperative alignment between groups, and again found no significant difference when comparing ACDF-plate to ACDF-cage constructs. CONCLUSIONS Our data has failed to demonstrate a difference in radiologic alignment outcomes between plate-augmented and standalone single-level ACDF constructs. This is not consistent with a prior study comparing these constructs in patients with 2-level ACDFs, which found better postoperative cervical alignment with the use of an ACDF with an anterior plate. However, a recent meta-analysis comparing single-level ACDF-plate to ACDF-cage constructs also found no difference between groups in terms of C2-C7 lordosis or segmental cobb angle, but that study did not examine other parameters such as C2-C7 SVA. Thus, our data, taken in tandem with the existing literature, seem to support the conclusion that the effects of construct on cervical alignment are significant for fusions of at least two levels, but may not reach significance for single level fusions. However, the power of our study to detect small but significant differences between groups is limited due to the number of cases analyzed, and thus further study is still needed to make definitive conclusions regarding ACDF construct choice. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Magnetic Resonance Imaging Research of Thoracic Inlet Parameters in the Cervical and Cervicothoracic Spine in Degenerative Cervical Spondylosis

The purpose of this study was to examine the thoracic inlet angle (TIA) and its related parameters in the cervical and cervical-thoracic vertebrae in patients with degenerative cervical spondylosis (DCS) and explore the association of the TIA, tilt angle of the neck, and tilt angle of the first thoracic spine with the cervical degeneration score. Patients with DCS were included from January 2014 to December 2017. The relevant parameters were assessed on T2-weighted magnetic resonance imaging. The association of cervical parameters with the cervical degeneration score was examined by multiple linear regression model. A total of 204 patients (126 men) were eligible and enrolled, with a mean age of 55-56 years. Men had significantly higher thoracic inlet parameters than women (all P < 0.05). Thoracic inlet parameters were positively correlated with age (all P < 0.05). After adjustment for age and sex, the significant association between the TIA and cervical or cervical-thoracic spine degeneration scores was not observed in all vertebrae. Meanwhile, men had higher vertebral height (VH) and intervertebral disk height (IVDH) than women. Only the VHs of C7, T1, and T2 and the IVDHs of C6-7, T1-2, and T2-3 were significantly and positively associated with the TIA (all P < 0.05). Age was positively correlated with thoracic inlet parameters in patients with DCS. Men had significantly higher thoracic inlet parameters than women because the men had higher VHs and IVDHs. However, the TIA was not associated with the level of cervical disk degeneration. The clinical relevance of these findings has not been established.

Clinical efficacy of Raktamokshana by cupping method in the management of chronic cervical spondylosis: A case study

Cervical spondylosis is a common condition affecting the neck. In Ayurveda, several methods such as Snehana (massage), Nasya (nasal insufflation), and Raktamokshana (therapeutic bloodletting) are indicated in the management of Sandhigatvata. The aim of this study was to evaluate the clinical efficacy Raktamokshana in the management of chronic cervical spondylosis. A 47-year-old male patient visited outpatient department (OPD) with the complaint of cervical pain radiating to hand, stiffness, and difficulty in neck movement since 4 years. On Examination, Spurling’s test and Lhermitte’s sign were positive. Along with the support of X-ray and magnetic resonance imaging investigations, the patient was diagnosed with degenerative cervical spondylosis due to cervical stenosis. Considering the cervical spondylosis as Sandhigatvata, the patient was treated with Raktamokshana in two sittings at 15-day interval. Before treatment, the pain score (visual analog scale) and Neck Disability Index percentage were 7% and 67.5%, respectively, and that was reduced to 2% and 12.5% within 1 month after intervention. Hence it concludes that, Raktamokshana plays a major role in the management of pain due to muscular spasm.

Bladed peek cage using the anterior approach in multiple-level degenerative cervical disc herniation: a case series of 156 patients

Purpose: This study aimed to evaluate the efficacy of cervical discectomy with bladed peek cage and differences in clinical outcomes, complication rates, and radiological findings of patients with multiple-level cervical degenerative disc herniation in terms of age, sex, and number of levels.Materials and Methods: The following data were assessed: demographic data, patient complaints, symptoms, neurologic examination and radiologic findings, postoperative outcomes, and complications of surgery. We assessed 156 patients who had level 2, 3, and 4 cervical degenerative disc herniation detected between 2012 and 2018 via radiological examination.Results: Of the patients, 41.6% (n = 65) were men and 58.4% (n = 91) women. The patients were aged 32–76 years, with an average age of 50.68 years. Moreover, 85.2% (n = 133), 13.5% (n = 21), and 1.3% (n = 2) of patients presented with level 2, 3, and 4 cervical degenerative disc herniation, respectively. All patients received medications as a conservative treatment during the preoperative period, and 79.5% (n = 124) underwent physiotherapy. In terms of complications, five patients developed neurological deficit and one developed superficial wound infection during the early postoperative period.Conclusion: The fusion rate may be similar to the stabilization, and cervical region movements may be achieved after performing anterior cervical plaque surgery with cage as well as anterior cervical discectomy and bladed peek cage surgery in patients with level 2 or higher cervical degenerative disc herniation and/or cervical spondylosis.