Visual Analog Scale Neck Pain Scores Research Articles

Atlantoaxial intra-articular cage fusion by posterior intermuscular approach for treating reducible atlantoaxial dislocation: a technique note with case series.

To evaluate the clinical feasibility of atlantoaxial intra-articular cage (AIC) fusion via intermuscular approach for treating reducible atlantoaxial dislocation (AAD). An analysis was conducted on the data of 10 patients who underwent C1-C2 segmental fixation and AIC fusion for AAD by unilateral intermuscular approach and contralateral open approach. Outcome assessments included Japanese Orthopaedic Association score (JOA) and Visual Analog Scale Score for Neck Pain (VASSNP). The duration of surgical exposure, screw insertion and cage insertion, and postoperative drainage volume were also compared between two approaches. Bone fusion was evaluated through computed tomography (CT) reconstruction. Postoperative paravertebral tissue edema was evaluated by paravertebral tissue cross-sectional area (CSA) and signal intensity on T2 weighted sequence of magnetic resonance imaging (MRI) at 3 days postoperatively. The intermuscular approach exhibited a longer exposure time but lower drainage postoperatively compared to the open approach (P < 0.05). After operation, JOA scores significant improved (P < 0.05), while VASSNP scores significantly decreased (P < 0.05). There was no significant difference in preoperative CSA between two approaches (P > 0.05). However, compared to the open approach, the intermuscular approach exhibited less CSA (P < 0.05) and lower T2 signal intensity on MRI postoperatively, indicating less invasive to the paravertebral tissues. AIC fusion by intermuscular approach is an effective and safe technique in the treatment of reducible AAD. Intermuscular approach could reduce the postoperative drainage volume and the extent of paravertebral tissue edema compared to open approach.

Comparison of Anterior Cervical Decompression and Fusion and Posterior Laminoplasty for Four-Segment Cervical Spondylotic Myelopathy: Clinical and Radiographic Outcomes.

Although anterior or posterior surgery for cervical spondylotic myelopathy (CSM) has been extensively studied, the choice of anterior or posterior approach in four-segment CSM remains poorly studied and controversial. We compared the clinical and radiographic outcomes of four-segment CSM by posterior laminoplasty (LAMP) and anterior cervical decompression fusion (ACDF) to further explore the merits and demerits of ACDF and LAMP for four-segment CSM in this study. Patients with four-segment CSM who underwent ACDF or LAMP between January 2016 and June 2019 were retrospectively analyzed. We compared the preoperative and postoperative cervical Japanese Orthopaedic Association (JOA) scores, neck disability index (NDI), neck pain visual analog scale (VAS) score, sagittal vertical axis, cervical lordosis (CL), and range of motion. There were 47 and 79 patients in the ACDF and LAMP groups, respectively. Patients in the ACDF group had a significantly longer surgical time and lower estimated blood loss and length of stay than those in the LAMP group. There was no significant difference in the JOA, NDI, or neck pain VAS scores between the two groups preoperatively, but the NDI and neck pain VAS scores in the ACDF group were significantly lower than those in the LAMP group at the final follow-up. The preoperative C2-C7 Cobb angle of the ACDF group was significantly lower than that of the LAMP group but there was no significant difference between the two groups postoperatively. The improvement of C2-C7 Cobb angle (∆C2-C7 Cobb angle) in the ACDF group was significantly higher than that in the LAMP group. This indicated that ACDF can improve CL better than LAMP. The linear regression analysis revealed the ∆C2-C7 Cobb angle was negatively correlated with the final follow-up neck pain VAS scores and NDI. This indicated that patients with better improvement of CL may have a better prognosis. Although both ACDF and LAMP surgeries are effective for four-segment CSM, ACDF can better improve CL and neck pain. For patients with poor CL, we suggest ACDF when both approaches are feasible.

Improved Sagittal Alignment Is Associated with Early Postoperative Neck Disability and Pain-Related Patient-Reported Outcomes Following Posterior Cervical Decompression and Fusion for Myelopathy

To compare patient-reported outcomes measures (PROMs) following posterior cervical decompression and fusion (PCDF) based on changes in perioperative cervical sagittal alignment. We reviewed patients who underwent PCDF from C2 to T2 between the years 2015 and 2020. C2 sagittal vertical axis (SVA) and C2-C7 lordosis were assessed preoperatively and 1-year postoperatively. Neck Disability Index (NDI) and visual analog scale (VAS) Neck scores were collected preoperatively, 3 months' postoperatively, and 1-year postoperatively. PROMs were compared based on perioperative radiographic parameters. Eighty-five patients were included in this study. Patients with preoperative C2 SVA <40 mm had a larger improvement in VAS Neck pain scores at 3 months' postoperatively (-4.9 vs. -3.0, P= 0.03) and a larger decrease in NDI scores at 1-year postoperatively (7.2 vs. 3.1, P= 0.04) than patients with C2 SVA ≥40 mm. Patients with postoperative C2 SVA <40 mm demonstrated lower VAS Neck pain scores at 3 months' postoperatively (2.0 vs. 3.4, P= 0.049). The cohort of patients with a decrease of C2 SVA by ≥5 mm demonstrated lower NDI at 3 months' postoperatively but not at 1-year postoperatively in comparison with patients whose C2 SVA increased or remained unchanged (11.7 vs. 23.8 vs. 18.2; P < 0.001). Patients in whom both C2 SVA and C2-C7 lordosis improved demonstrated superior NDI (P < 0.001) and VAS Neck (P= 0.007) at 3 months' but not at 1-year postoperatively. In a uniform cohort of patients undergoing PCDF from C2 to T2, improvements in C2 SVA and C2-C7 lordosis were associated with improved early postoperative PROMs.

Direct Internal Fixation for Unstable Atlas Fractures.

PurposeTo investigate the radiologic and clinical outcomes of direct internal fixation for unstable atlas fractures.Materials and MethodsThis retrospective study included 12 patients with unstable atlas fractures surgically treated using C1 lateral mass screws, rods, and transverse connector constructs. Nine lateral mass fractures with transverse atlantal ligament (TAL) avulsion injury and three 4-part fractures with TAL injury (two avulsion injuries, one TAL substance tear) were treated. Radiologic outcomes included the anterior atlantodental interval (AADI) in flexion and extension cervical spine lateral radiographs at 6 months and 1 year after treatment. CT was also performed to visualize bony healing of the atlas at 6 months and 1 year. Visual Analog Scale (VAS) scores for neck pain, Neck Disability Index (NDI) values, and cervical range of motion (flexion, extension, and rotation) were recorded at 6 months after surgery.ResultsThe mean postoperative extension and flexion AADIs were 3.79±1.56 (mean±SD) and 3.13±1.01 mm, respectively. Then mean AADI was 3.42±1.34 and 3.33±1.24 mm at 6 months and 1 year after surgery, respectively. At 1 year after surgery, 11 patients showed bony healing of the atlas on CT images. Only one patient underwent revision surgery 8 months after primary surgery due to nonunion and instability findings. The mean VAS score for neck pain was 0.92±0.99, and the mean NDI value was 8.08±5.70.ConclusionC1 motion-preserving direct internal fixation technique results in good reduction and stabilization of unstable atlas fractures. This technique allows for the preservation of craniocervical and atlantoaxial motion.

Ten-year clinical and radiographic results of computer-assisted cervical pedicle screw fixation combined with laminoplasty

ObjectiveCervical pedicle screw (CPS) fixation is widely used for the treatment of cervical spinal instability from various causes; however, there are few reports on the long-term outcomes of this procedure. The present study evaluated the 10-year results of CPS fixation for cervical instability. MethodsThe medical records of 13 consecutive patients who underwent computer-guided CPS fixation for cervical instability were reviewed. The mean observation period was 153 months. Evaluated items included Japanese Orthopaedic Association (JOA) score and C2-7 lordotic angle before surgery and at 5 and 10 years afterwards. Visual analog scale (VAS) scores for neck pain and radiological evidence of adjacent segment degeneration (ASD) at 10 years of follow-up were also assessed. ResultsMean JOA score significantly improved from 9.4 points before surgery to 13.2 points at 5 years after surgery (p < 0.001), followed next by a slight reduction to 11.6 points at 10 years postoperatively. C2-7 lordotic angle tended to decrease from 7.9° preoperatively to 5.3° at 10 years after surgery. No clinically significant complications, such as neurovascular injury caused by screw misplacement, were observed. The mean VAS score for neck pain was 31.7 points at the study endpoint, and ASD rate was 23.1%. ConclusionsAt 10 years after CPS fixation, mean JOA score was improved without symptoms indicative of cervical myelopathy recurrence. Our long-term results confirm that computer-assisted CPS fixation is useful for treating cervical instability.

C2 Pedicle Screws Combined With C1 Laminar Hooks for Reducible Atlantoaxial Dislocation: An Ideal Salvage Technique for C1-C2 Pedicle Screws.

A C1 laminar hook can theoretically avoid vertebral artery injury and is less technically demanding. However, only few studies with small samples analyzed the short-term outcomes of C2 pedicle screws combined with C1 laminar hooks (C2PS-C1LH) technique in the treatment of atlantoaxial dislocation. Furthermore, it is not confirmed whether similar clinical outcomes can be achieved with C1-C2 pedicle screw and rod construct (PSRC). To evaluate the outcomes of C2PS-C1LH and C1-C2 PSRC fixation techniques for treating atlantoaxial dislocation. Data of 52 patients with atlantoaxial dislocation treated by C1-C2 PSRC or C2PS-C1LH fixation were retrospectively reviewed. Outcomes evaluated by visual analog scale score for neck pain (VASSNP), Neck Disability Index (NDI), atlantodental interval (ADI), and the perioperative parameters including blood loss and operation time were analyzed and compared between 2 techniques. Patient satisfaction at final follow-up was also investigated. There were no complications related to the surgical approach and instrumentation in either group. The mean bone fusion time was 5.06±1.65 mo for the C2PS-C1LH group and 3.93±0.99 mo for the C1-C2 PSRC group (P > .05). Hundred percent of fusion rates were achieved in both groups at month 12 after operation. The ADI, VAS scores, the NDI scores, and the JOA scores were greatly improved in both the groups (P<.05), but there were no significant differences between the 2 groups. C2PS-C1LH fixation technique was comparable to C1-C2 PSRC in the treatment of reducible atlantoaxial dislocation. C2PS-C1LH fixation was an ideal alternative strategy to C1-C2 PSRC fixation.

Comparison of Two Bone Grafting Techniques Applied During Posterior C1-C2 Screw-Rod Fixation and Fusion for Treating Reducible Atlantoaxial Dislocation

Several bone grafting techniques for posterior atlantoaxial arthrodesis have been reported. The techniques of placing a cancellous morselized bone graft (MBG) on decorticated surfaces of the atlantoaxial complex and securing a structural iliac bone graft (SBG) between C1 and C2 have been used widely. The aim of the present study was to compare the outcomes of these 2 bone grafting techniques for atlantoaxial arthrodesis. The data from 64 patients with reducible atlantoaxial dislocation treated using posterior C1-C2 screw-rod fixation and fusion were retrospectively reviewed. The MBG technique had been used in 32 patients and the SBG technique in 32 patients. The time required for bone fusion was recorded. The outcomes were evaluated using the Japanese Orthopaedic Association scale score, Neck Disability Index, visual analog scale (VAS) score for neck pain, patient satisfaction, and neck stiffness and compared between the 2 groups. The donor site complications were also compared, and donor site pain was assessed using a VAS. At the final follow-up, the bone fusion rate was 100% in both groups. No significant differences were found in the bone fusion time or donor site pain between the 2 groups (P > 0.05). Postoperatively, The Japanese Orthopaedic Association scale scores, Neck Disability Index, and VAS score for neck pain had improved significantly within both groups (P < 0.05), with no statistically significant differences between the 2 groups (P > 0.05). Additionally, no differences were found between the 2 groups in patient satisfaction and neck stiffness postoperatively (P > 0.05). The MBG and SBG techniques were both effective for atlantoaxial arthrodesis, with the advantages of reducing the potential risk of catastrophic bleeding of the epidural venous plexus and C2 nerve root injury.

PROMIS correlation with NDI and VAS measurements of physical function and pain in surgical patients with cervical disc herniations and radiculopathy.

The aim of this study was to compare the patient-reported outcome measures Neck Disability Index (NDI) and visual analog scale (VAS) with the Patient Reported Outcomes Measurement Information System (PROMIS) physical function (PF) and pain interference (PI) measures, respectively, and to determine their correlations in a surgical population longitudinally.Legacy outcome measures such as NDI and VAS are essential for analyzing treatments in spine surgery for cervical disc herniations with radiculopathy. Despite their usefulness, administrative burdens impose limits on completion of these measures. PROMIS was developed as a patient outcome measure in order to improve reporting of patient symptoms and function and to reduce administrative burden. Despite early positive results of PROMIS in orthopedics, NDI and VAS scores have not been compared with PROMIS scores in patients with cervical disc herniations with radiculopathy. Eighty patients undergoing surgery for cervical disc herniations with radiculopathy were included. All patients were treated at the same tertiary spine center. Patients were seen and PROMIS PF and PI, NDI, and VAS arm and neck pain scores were collected preoperatively and at 1 year postoperatively. Correlations between NDI, VAS, and PROMIS PF and PI were quantified using Pearson correlation coefficients. Two-tailed Student t-tests were used to demonstrate correlation significance, with alpha = 0.05. All 80 (100%) patients completed all preoperative questionnaires. Fifty-seven (72%) and 75 (94%) patients completed all questionnaires at baseline and at the 6-month and 1-year follow-ups, respectively. PROMIS PF and NDI scores demonstrated a strong negative correlation, with Pearson r values of -0.81, -0.77, and -0.75 at baseline, 6 months, and 1 year. PROMIS PI and VAS neck pain scores demonstrated a moderately positive correlation, with Pearson r values of 0.51, 0.61, and 0.6. PROMIS PI and VAS arm pain scores demonstrated a moderately positive correlation, with Pearson r values of 0.46, 0.47, and 0.45. PROMIS PF scores have a strong negative correlation with NDI scores at baseline and in the postoperative course in patients undergoing surgery for cervical disc herniations with radiculopathy. PROMIS PI scores have a moderately positive correlation with VAS neck and arm pain scores at baseline and in the postoperative course. Surgeons may factor these correlation results into the interpretation of patient-reported outcome measures in patients with cervical radiculopathy. Use of PROMIS PF and PI for this patient population may reduce administrative burden while providing reliable outcomes data.

Outcomes of Anterior Cervical Fusion Using Polyetheretherketone Cage with Demineralized Bone Matrix and Plate for Management of Subaxial Cervical Spine Injuries.

ObjectiveWe evaluated the usefulness of a polyetheretherketone (PEEK) cage filled with demineralized bone matrix (DBM) and plate fixation in anterior interbody fusions for subaxial cervical spine injuries.MethodsA retrospective review of 98 patients (58 women, 40 men; mean age, 49.7 years; range, 17–78 years) who underwent single-level anterior cervical discectomy and fusion (ACDF) using a PEEK cage filled with DBM and plate fixation for subaxial cervical spine injuries from March 2005 to June 2018 was conducted. Bone fusion, interbody height (IBH), segmental lordosis, and adjacent segment degeneration (ASD) development were assessed with plain radiographs and computed tomography. Clinical outcomes were assessed using a visual analog scale (VAS) for pain and the Frankel grade for neurologic function.ResultsThe mean follow-up period was 27.6 months (range, 6–142 months). Twenty-one patients (21.4%) had an improvement of at least one Frankel grade. The mean preoperative and final follow-up neck pain VAS scores were 8.3±0.9 and 2.6±1.5 (p<0.05). All patients showed solid fusion at the final follow-up. The mean preoperative and final Cobb's angles were −3.7±7.9° and 1.9±5.1° (p<0.05). The mean preoperative and final IBHs were 36.9±1.7 mm and 38.2±1.8 mm (p<0.05). Five patients (5%) showed ASD.ConclusionACDF using a PEEK cage filled with DBM and plate fixation yielded high fusion rates and satisfactory clinical outcomes without donor-site morbidity. This procedure is safe and effective for single-level subaxial cervical spine injuries.

Posterior Open Reduction and Interlaminae Compression Fusion for Os Odontoideum with Atlantoaxial Dislocation

To evaluate the outcome of posterior open reduction and interlaminae compression fusion using a screw-rod system combined with a structural iliac bone graft in the treatment of atlantoaxial dislocation (AAD) secondary to os odontoideum. A retrospective study was performed on 24 patients with AAD secondary to os odontoideum. All cases were with partial reduction after skeletal traction. Intraoperative open reduction and fixation were performed with a posterior screw-rod system, followed by interlaminae compression of an autologous iliac bone graft for fusion. The modified atlanto-dental interval (MADI) was measured to assess the degree of dislocation before traction, after traction, and postoperatively. Japanese Orthopaedic Association (JOA) score, Nurick scale score, visual analog scale score for neck pain (VASSNP), Neck Disability Index (NDI) score, and neck stiffness were used to evaluate functional outcomes. The mean duration of follow-up was 43.0±24.0 months. All patients achieved relief of symptoms and solid bone fusion. There were no complications associated with instrumentation and operation. At the final follow-up, the average MADI was reduced to 2.0 ± 0.8 mm (pretraction: 9.2 ± 1.1 mm; post-traction: 6.6 ± 0.7 mm; P<0.001). The neck stiffness was significantly relieved (P< 0.001), and function of the spinal cord manifested by the JOA score and Nurick scale score significantly improved (all P < 0.001). The NDI score and VASSNP markedly decreased (all P < 0.001). Intraoperative open reduction and interlaminae compression fusion using a posterior screw-rod system combined with a structural iliac bone graft is a safe and effective procedure for AAD secondary to os odontoideum.

Posterior Cervical Fusion Using Cervical Interfacet Spacers in Patients With Symptomatic Cervical Pseudarthrosis.

Posterior cervical fusion with cervical interfacet spacer (CIS) is a novel allograft technology offering the potential to provide indirect neuroforaminal decompression while simultaneously enhancing fusion by placing the allograft in compression. To analyze the clinical and radiological outcomes after posterior cervical fusion with CIS in patients with symptomatic anterior cervical pseudarthroses. Medical records of patients who underwent posterior cervical fusion with CIS for symptomatic pseudarthrosis after anterior cervical diskectomy and fusion were reviewed. Standardized outcome measures such as visual analog scale (VAS) score for neck and arm pain, Neck Disability Index (NDI), and upright lateral cervical radiographs were reviewed. There were 19 patients with symptomatic cervical pseudarthrosis. Preoperative symptoms included refractory neck or arm pain. The average follow-up was 20 months (range, 12-56 months). There was improvement in VAS score for neck pain (P < .004), radicular arm pain (P < .007), and NDI score (P < .06) after surgery, with 83%, 72%, and 67% of patients showing improvement in their VAS neck pain, VAS arm pain, and NDI scores, respectively. Fusion rate was high, with fusion occurring at all levels treated for pseudarthrosis. There was a small improvement in cervical lordosis (mean difference, 2 ± 5.17°; P = .09) and slight worsening of C2-7 sagittal vertical axis after surgery (mean difference, 1.89 ± 7.87 mm; P = .43). CIS provides an important fusion technique, allowing placement of an allograft in compression for posterior cervical fusion in patients with anterior cervical pseudarthroses. Although there was improvement in clinical outcome measures after surgery, placement of CIS had no clinically significant impact on cervical lordosis and C2-7 sagittal vertical axis.

Evaluation of a new type of titanium mesh cage versus the traditional titanium mesh cage for single-level, anterior cervical corpectomy and fusion

A retrospective review of prospectively collected data in an academic institution. To evaluate the safety and efficacy of a new type of titanium mesh cage (TMC) in single-level, anterior cervical corpectomy and fusion (ACCF). Fifty-eight patients consecutive with cervical spondylotic myelopathy (CSM) from cervical degenerative spondylosis and isolated ossification of the posterior longitudinal ligament were treated with a single-level ACCF using either a new type of TMC (28 patients, group A) or the traditional TMC (30 patients, group B). We evaluated the patients for TMC subsidence, cervical lordosis (C2-C7 Cobb and Cobb of fused segments) and fusion status for a minimum of 30 months postoperatively based on spine radiographs. In addition, neurologic outcomes were evaluated using the Japanese Orthopedic Association (JOA) scores. Neck pain was evaluated using a 10-point visual analog scale (VAS). The loss of height of the fused segments was less for group A than for group B (0.8 ± 0.3 vs. 2.8 ± 0.4 mm) (p < 0.01); also, there was a lower rate of severe subsidence (≥3 mm) in group A (4 %, 1/28) than in group B (17 %, 5/30) (p < 0.01). There were no differences in the C2-C7 Cobb and Cobb of fused segments between the groups preoperatively or at final follow-up (p > 0.05), but the Cobb of fused segments immediately postoperative were significantly less for group B than for group A (p < 0.01). All patients, however, had successful fusion (100 %, each). Both groups had marked improvement in the JOA score after operation (p < 0.01), with no significant differences in the JOA recovery ratio (p > 0.05). The postoperative VAS neck pain scores for group A were significantly less than that for group B (p < 0.05); severe subsidence was correlated with neck pain. The new type of TMC provides comparable clinical results and fusion rates with the traditional TMC for patients undergoing single-level corpectomy. The new design TMC decreases postoperative subsidence (compared to the traditional TMC); the unique design of the new type of TMC matches the vertebral endplate morphology which appears to decrease the severity of subsidence-related neck pain in follow-up.

Postoperative occipital neuralgia with and without C2 nerve root transection during atlantoaxial screw fixation: a post-hoc comparative outcome study of prospectively collected data

Background contextAlthough routine transection of the C2 nerve root during atlantoaxial segmental screw fixation has been recommended by some surgeons, it remains controversial and to our knowledge no comparative studies have been performed to determine whether transection or preservation of the C2 nerve root affects patient-derived sensory outcomes. PurposeThe purpose of this study is to specifically analyze patient-derived sensory outcomes over time in patients with intentional C2 nerve root transection during atlantoaxial segmental screw fixation compared with those without transection. Study designThis is a post-hoc comparative analysis of prospectively collected patient-derived outcome data. Patient sampleThe sample consists of 24 consecutive patients who underwent intentional bilateral transection of the C2 nerve root during posterior atlantoaxial segmental screw fixation (transection group) and subsequent 41 consecutive patients without transection (preservation group). Outcome measuresA visual analog scale (VAS) score was used for occipital neuralgia as the primary outcome measure and VAS score for neck pain, neck disability index score and Japanese Orthopedic Association score for cervical myelopathy and recovery rate, with bone union rate as the secondary outcome measure. MethodsPatient-derived outcomes including change in VAS score for occipital neuralgia over time were statistically compared between the two groups. This study was not supported by any financial sources and there is no topic-specific conflict of interest related to the authors of this study. ResultsSeven (29%) of the 24 patients in the transection group experienced increased neuralgic pain at 1 month after surgery either because of newly developed occipital neuralgia or aggravation of preexisting occipital neuralgia. Four of the seven patients required almost daily medication even at the final follow-up (44 and 80 months). On the other hand, only four (10%) of 41 patients in the preservation group had increased neuralgic pain at 1 month after surgery, and at ≥1 year, no patients had increased neuralgic pain. The difference in the prevalence of increased neuralgic pain between the two groups was statistically significant at all time points (3, 6, 12, and 24 months postoperatively) except at 1 month postoperatively. The intensity of neuralgic pain, which preoperatively had not been significantly different between the two groups, was significantly higher in the transection group at the final follow-up. ConclusionsC2 nerve root transection is not a benign procedure and, in our experience, more than a quarter of the patients experience increased neuralgic pain following C2 nerve root transection. Because the prevalence and intensity of postoperative neuralgia was significantly higher with C2 nerve root transection than with its preservation, we recommend against routine C2 nerve root transection when performing atlantoaxial segmental screw fixation.

Integrated intervertebral device for anterior cervical fusion: An initial experience

Objective:To analyze the clinical and radiographic results following the use of integrated intervertebral implant in patients with cervical spine degenerative disease.Background:Though excellent results have been reported following anterior cervical discectomy and fusion using iliac crest autograft/allograft with plating, the morbidity associated with autograft harvest and small chances of complications with plating always exists. Recently, there has been development of a cervical stand-alone cage with integrated fixation for cervical fusion and stabilization with a possible low morbidity and optimal clinical outcome.Materials and Methods:A retrospective study of 16 patients who underwent anterior cervical discectomy and fusion using the integrated intervertebral device was performed. Intra-operative parameters, clinical features [Neck Disability Index (NDI), visual analog scale (VAS) score for neck/arm pain], and presence or absence of dysphagia was recorded. Radiographs were evaluated for assessment of implant failure and fusion.Results:Mean age of patients was 54 years (range: 38-84 years) with male: female ratio of 1:3. Follow-up ranged from 6 to 12 months (mean: 10 months). In the early postoperative period, 2 of the 15 patients (13%) patients had mild dysphagia that resolved during follow-up with no patient having complaints of dysphagia at 3-month follow-up. One of the patients with diffuse idiopathic skeletal hyperostosis (DISH) and severe preoperative dysphagia had significant improvement in swallowing function at 3-month follow-up that was stable at 1-year follow-up. There was no evidence of implant failure, with fusion occurring in 95% (19/20) of operated levels. Analysis of follow-up VAS and NDI scores showed significant reduction in VAS score for neck pain (P < 0.019), radicular arm pain (P < 0.003), and NDI score (P < 0.007) in 77, 92, and 77% of patients, respectively, at a mean follow-up of 10 months (6-12 months).Conclusions:Our preliminary results with the use of this cervical stand-alone anterior fusion device with integrated screw fixation show its efficacy in anterior cervical decompression and fusion with stabilization with optimal clinical and radiographic outcome. Lower chances of dysphagia with no device-related complications are appealing, which needs to be verified in larger studies.

Laminoplasty outcomes: is there a difference between patients with degenerative stenosis and those with ossification of the posterior longitudinal ligament?

Two common causes of cervical myelopathy include degenerative stenosis and ossification of the posterior longitudinal ligament (OPLL). It has been postulated that patients with OPLL have more complications and worse outcomes than those with degenerative stenosis. The authors sought to compare the surgical results of laminoplasty in the treatment of cervical stenosis with myelopathy due to either degenerative changes or segmental OPLL. The authors conducted a retrospective review of 40 instrumented laminoplasty cases performed at a single institution over a 4-year period to treat cervical myelopathy without kyphosis. Twelve of these patients had degenerative cervical stenotic myelopathy ([CSM]; degenerative group), and the remaining 28 had segmental OPLL (OPLL group). The 2 groups had statistically similar demographic characteristics and number of treated levels (mean 3.9 surgically treated levels; p > 0.05). The authors collected perioperative and follow-up data, including radiographic results. The overall clinical follow-up rate was 88%, and the mean clinical follow-up duration was 16.4 months. The mean radiographic follow-up rate was 83%, and the mean length of radiographic follow-up was 9.3 months. There were no significant differences in the estimated blood loss (EBL) or length of hospital stay (LOS) between the groups (p > 0.05). The mean EBL and LOS for the degenerative group were 206 ml and 3.7 days, respectively. The mean EBL and LOS for the OPLL group were 155 ml and 4 days, respectively. There was a statistically significant improvement of more than one grade in the Nurick score for both groups following surgery (p < 0.05). The Nurick score improvement was not statistically different between the groups (p > 0.05). The visual analog scale (VAS) neck pain scores were similar between groups pre- and postoperatively (p > 0.05). The complication rates were not statistically different between groups either (p > 0.05). Radiographically, both groups lost extension range of motion (ROM) following laminoplasty, but this change was not statistically significant (p > 0.05). Patients with CSM due to either degenerative disease or segmental OPLL have similar perioperative results and neurological outcomes with laminoplasty. The VAS neck pain scores did not improve significantly with laminoplasty for either group. Laminoplasty may limit extension ROM.