Outcome Of Anterior Cervical Discectomy Research Articles

A Systematic Review Comparing Fusion Rates and Cage Subsidence in ACDF by Cage Alone vs Cage and Plate in Multilevel Cervical Disc Prolapse

Abstract Background Anterior cervical discectomy and interbody fusion (ACDF) has become the standard procedure for treating degenerative cervical disc disease. Multiple techniques and modalities of fixation are used in ACDF, each with its merits and demerits. Aim of the Work The objective of this study is to compare the outcome of anterior cervical discectomy and fusion by cage alone versus surgical fusion by cage and plate in terms of morbidity, mortality, fusion rates, cage subsidence and quality of life estimates in treatment of multilevel cervical disc prolapse. Patients and Methods Our search strategy identified a total of 235 citations. Search was done for studies conducted or published within 2010 – 2022. After removal of 58 duplicate studies, eligibility criteria was applied to the titles of 177 articles with the exclusion of non-appropriate study design. This yielded 21 studies that underwent full text analysis of which 13 did not meet the inclusion criteria for having only single level ACDF or short follow up period. Results Our study included 8 observational studies (6 retroscpective and 2 prospective) comparing multilevel ACDF with cage alone vs cage and plate regarding fusion rate and cage subsidence, the results showed that while the cage plate group had lower rate of cage subsidence, there was no significant difference in the rate of fusion. Conclusion Our study included 8 observational studies (6 retroscpective and 2 prospective) comparing multilevel ACDF with cage alone vs cage and plate regarding fusion rate and cage subsidence, the results showed that while the cage plate group had lower rate of cage subsidence, there was no significant difference in the rate of fusion.

Cervical alignment and clinical outcome of anterior cervical discectomy and fusion vs. anterior cervical corpectomy and fusion in local kyphotic cervical spondylotic myelopathy

BackgroundCervical local kyphosis (CLK) is a common degenerative disorder with a potentially debilitating and intractable condition. Currently, there is still debate on the optimal treatment of local kyphotic cervical spondylotic myelopathy (LKCSM) via different anterior approaches. ObjectiveThe objective of this study was to evaluate the surgical efficacy of anterior cervical discectomy and fusion (ACDF) vs. anterior cervical corpectomy and fusion (ACCF) for the treatment of LKCSM. In addition, the cervical sagittal alignment parameters and axial symptoms (AS) severity after CLK correction were analyzed. Materials and methodsFrom January 2016 and December 2020, 104 patients who suffered LKCSM were retrospectively reviewed. These patients underwent ACDF (n = 53) and ACCF (n = 51). Pre- and postoperatively, cervical sagittal alignment parameters were measured on the lateral X-rays, including local kyphotic angles (LKA), C2-7 Cobb angle, T1 slope, and C2-7 sagittal vertical axis (C2-7 SVA). The neurological recovery rate was calculated according to the Japanese Orthopedic Association (JOA) score. The AS severity was evaluated using Neck Disability Index (NDI). ResultsSignificant differences (P < 0.05) were demonstrated between ACDF and ACCF groups regarding LKA, LKA correction, C2-7 Cobb angle, T1 slope, C2-7 SVA, NDI, NDI recovery and NDI ranking system. However, no significant differences (P > 0.05) existed in JOA score, recovery rate, and neurological recovery rate grade. In both groups, significant differences (P < 0.05) were demonstrated between pre- and postoperative LKA, T1 slope, C2-7 Cobb angle, C2-7 SVA, JOA score, and NDI. LKA correction showed the positive correlations with the recovery rate (r = 0.48, P < 0.001), and with the NDI recovery in ACDF group (r = 0.49, P < 0.001) and in ACCF group (r = 0.55, P < 0.001). ConclusionsLKCSM with ≤3 segments of spinal cord compression can be improved with either ACDF or ACCF, resulting in satisfactory neurological outcomes. CLK correction can significantly improve the neurological function and AS, and increase the T1 slope and C2-7 SVA. However, ACDF was more favorable than ACCF in the CLK correction.

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

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

Comparison of Radiological Outcome in Anterior Cervical Discectomy and Fusion: Cage-Only v/s Cage and Plate Fixation

Aim: A retrospective analysis of the outcome of anterior cervical discectomy and fusion comparing cage-only and cage-and-plate fixation on the basis of radiographic changes. Setting: In the department of Neurosurgery of a tertiary care hospital for two-year duration from January 2019 to December 2020. Methods: 56 patients who endured one-level ACDF (n = 34) and two-level ACDF (n = 22) for cervical disc disease were enrolled in the study and underwent a 12-months follow-up. Patients were separated according to cervical level and divided into cage-only group (ACDF-C) and cage-and-plate fixation group (ACDF-CP). The subsidence and status of fusion were evaluated on the radiography. Results: Comparing the ACDF-C with ACDF-CP at one level, the subsidence was detected in 50% of patients in the former group and in 33.3% of cases in the later at 12 months follow up. The two groups do not have statistically significant variance in terms of occurrence percentage (p = 0.32). In the two levels comparison of ACDF, ACDF-C had significantly more subsidence (75%) than the ACDF-CP group (28.5%; p= 0.046). The rate of fusion in single level ACDF of ACDF-C was not much different on statistics from that in the ACDF-CP group (87.5% and 88.8%, p= 0.43). The fusion was also similar in the two levels ACDF (ACDF-C= 87.5% and ACDF-CP= 92.8%; p= 0.30). Conclusions: This study’s radiological outcome did not exhibit any extra advantage of plate fixation compared to the cage-only in the 1-level ACDF subjects; however in ACDF at 2-level, a subsidence is much more probable without fixation of plate and therefore adding a plate to cage must be taken important. Keywords: cervical plate, cervical discectomy, spinal fusion, subsidence.

84. Surgeon specialty effect on early outcomes of elective anterior cervical discectomy and fusion: an updated propensity matched and subgroup analysis of 10,116 patients

<h3>BACKGROUND CONTEXT</h3> Comparative effectiveness research has a vital role in health reform and policies. Specialty training is one of these provider-side variables and surgeons who were trained in different specialties may have different outcomes upon performing the same procedure. <h3>PURPOSE</h3> To investigate the impact of spine surgeon specialty on early perioperative outcome of anterior cervical discectomy and fusion (ACDF). <h3>STUDY DESIGN/SETTING</h3> Retrospective, 1:1 propensity score-matched cohort study. <h3>PATIENT SAMPLE</h3> A total of 21,211 patients who underwent ACDF between 2016-2018 were reviewed from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. <h3>OUTCOME MEASURES</h3> Outcomes included 30-day perioperative morbidity and mortality measures that are predefined in the ACS-NSQIP database. <h3>METHODS</h3> Patients were stratified by the specialty of surgeon performing the procedure (neurosurgery vs orthopedic surgery), and the number of levels operated on (single- vs multi-level surgery) <h3>RESULTS</h3> Patients operated on by neurosurgeons were more likely to be older, smokers, of Hispanic ethnicity, functionally dependent, and to have higher BMI, an ASA class 3 or more, baseline dyspnea, bleeding disorders, and myelopathy. In both groups (single/multi-level ACDF), cases in the orthopedic surgery cohort were more likely to have shorter operation time (104 vs 133 minutes/ 138 vs 164 minutes), longer total hospital stay (41 vs 24 hours/ 46 vs 25 hours), higher return to operating room rates within the same admission (2.1% vs 0.7%/ 2.4% vs 0.6%), be discharged to destination other than home (4.6% vs 1.2%/ 4.9% vs 1.0%), be discharged after postoperative day 1 (11.9% vs 6.7%/ 18.9% vs 10.1%), higher perioperative blood transfusion rate (2.1% vs 0.4%/ 3.1% vs 0.6%) and higher sepsis rates (0.7% vs 0.2%/ 0.7% vs 0.1%). In the single-level ACDF group, cases in the orthopedic surgery cohort had higher readmission (4.1% vs 1.9%) and unplanned intubation rates (1.1% vs 0.1%). Other outcome measures and mortality rates were similar among the cohorts. <h3>CONCLUSIONS</h3> Significant differences in early perioperative outcomes of patients undergoing ACDF by neurosurgeons and orthopedic surgeons were noted. These differences have significant clinical and cost implications for patients, physicians, payors and health systems. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Functional outcome of anterior cervical discectomy and fusion for degenerative diseases of the cervical spine.

Background &amp; Objectives: Discectomy followed by the fusion in the cervical spine is done for herniated cervical intervertebral disc causing neurologic symptoms when conservative management has failed. In our study, we assessed clinical presentation and functional outcomes after surgery through an anterior cervical approach.&#x0D; Materials and Methods: This retrospective cohort study was conducted in the Neurosurgery division, Lady reading hospital Peshawar. We included 42 consecutive patients who underwent single-level anterior cervical discectomy and fusion for the herniated cervical disc. The mean follow-up was 14 months. Anterior cervical discectomy and fusion (ACDF) was done in all patients using standalone titanium or PEEK cage. Z scores and associated p values were calculated to see the difference of significance between preoperative reported symptoms and their improvements postoperatively.&#x0D; Results: There were 37 male and 5 female patients. The mean age was 43 ± 9.8 years. Disc herniation mostly occurred at C4 – 5 and C5 – 6 levels (76.16%). Preoperatively, the Neck pain was present in 36 (85.7%), upper limb weakness in 20 (47.6%), numbness/paresthesias in 25 (59.5%), upper limb pain in 18 (42.84%), lower limbs spasticity in 14 (33.32%) and bladder involvement in 3 (7.14%) patients. Statistical significant postoperative improvements in (90-100%) were reported in symptoms. Postoperative complications were observed in 5 patients. Most reported complication, the dysphagia was noted in 9.52% patients.&#x0D; Conclusions: A significant proportion of patients with herniated cervical disc showed an excellent recovery after anterior cervical discectomy and fusion (ACDF).

Outcome of Anterior Cervical Discectomy with PEEK Cage Fixation for Single Level Cervical Disc Disease

Objective: To assess the outcome of anterior cervical discectomy and fusion (ACDF) with PEEK cage.&#x0D; Material and Methods: This prospective study was conducted in the Departments of Neurosurgery Prime Teaching Hospital and Irfan General Hospital Peshawar. Patients undergoing one level ACDF with PEEK cage fixation were enrolled in the study. Patients who needed multiple level ACDF or corpectomy with plating and redo cases were excluded from the study. A proforma, which included age, gender, address, level of prolapsed disc, sign and symptoms, pain score, MRI findings were filled. All patients were assessed on day of discharge and on follow-up visit after one month. Data was analyzed with SPSS version 22.&#x0D; Results: Total 95 patients were included out of which 58 (61%) were male and 37 (39%) were female. Range of patients` Age was from 27 years to 64 years with 50.4 years mean age. Most patients (65%) had C6 radiculopathy. 58 patients (61%) had right sided radicular pain. 5 patients (5.26%) had radiculomyelopathy. C5 – C6 was the most common level operated (68 patients). Excellent results were achieved in 75 patients (79%) while satisfactory results in the rest of patients using Odom’s criteria. Bony fusion occurred in 92% of patients at 6 months.&#x0D; Conclusion: ACDF with PEEK cage fixation is a safe and beneficial procedure in one level cervical prolapse disc disease

Functional outcome of Anterior Cervical Discectomy and Fusion with Anterior Cervical Plating Among Patients of Cervical Disc Disease at a Tertiary Health Care Centre

Introduction: Cervical spondylosis means osteoarthritis of cervical spinal column. The degenerative process mainly affects the vertebrae, neural foramina and the facet joints. It leads to compression of the spinal cord resulting in progressive neural cell loss and neurological deterioration in 40 to 60 % of patients. Cervical myelopathy is a constellation of symptoms and physical findings including motor and sensory abnormalities. Spasticity and paresis are frequently seen. The patient often complaints of gait disturbance due to abnormalities incorticospinal tract and spinal spinocerebellar tracts. There is also associated loss of grip strength and finger movements. Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure to remove a herniated or degenerative disc. An incision is made in the anterior cervical region and the disc is then removed. A graft is then placed to fuse the vertebrae above and below the disc. ACDF was first described by Cloward, Smith and Robinson in 1958 and shortly later by Hirsch in 1960 who described anterior cervical decompression and debated the necessity for inter body fusion. Anterior cervical discectomy and fusion has been widely performed since the late 1950s and is currently recommended in patients in whom the nonoperative modalities for single level or multilevel disease have failed. Objectives: To study the functional outcome of cervical discectomy and fusion with anterior cervical plating among patients of cervical disc disease. Materials and Methods: 46 patients treated with ACDF with anterior cervical plating were considered in this study. Results and Conclusion: All the patients showed significant post-operative improvement in their symptoms and diagnostic scores. Thus, we can conclude that ACDF with anterior cervical plating is an efficient procedure in patients with cervical myelopathic symptoms not responding to conservative treatment.

Comparative study between outcome of anterior cervical discectomy and fusion with cages only versus cages and plate in cases with cervical spondylosis

Background: The aim of this study is to compare the clinical and radiological outcome of anterior cervical discectomy in two levels or more with cages only versus cages and plate clinically and radiologically and effect of plating on lordosis.Methods : a total of 50 adult patients with two levels or more cervical disc degeneration were at random allocated to different procedures.The patients were classified into 2 groups:Group (A): included 25 patient who were operated by cages only.Group (B): included 25 patient who were operated by cages and plateUpright cervical spine radiographs were obtained. C2_7_cobb_angle, Segmental angle and Segmental height were obtained .Results: after follow up 6 m, the angles in the group of cages were different from that of the group of plating (cervical lordosis is better with plating), but were statistically insignificant.Conclusions : Irrespective of the technique used for anterior cervical discectomy for two levels or more degenerative cervical disc disease whether with cages only or with adding plate, the alignment of the cervical spine is unaltered and the complications are more in plating group.

Outcome of Anterior Cervical Discectomy and Fusion in Single Level Cervical Disc Prolapse

Background: Cervical disc disease and spondylosis is a common pathological entity and is characterised by increasing degeneration of the intervertebral disc with subsequent changes in the bones and soft tissues.&#x0D; Aim: To determine functional outcome of anterior cervical discectomy with fusion and plating in single level degenerative cervical disc prolapse.&#x0D; Methods and Materials: This study was done at the Department of Neurosurgery, Medical Trust Hospital, Kochi over a period of three years after receiving institutional ethical clearance. 60 patients aged between 20 to 60 years, both male and female, who had degenerative disc disease with single level herniation with worsening or non-improving neck pain with radiculopathy, corresponding neurologic deficit, who were admitted in our unit were included in the study. Baseline data like name, age and gender were recorded for all the patients included in the study. Clinical examination consisted of history, thorough neurological examination and corresponding radiological evaluation. A visual analogue scale was used to make a subjective assessment of the patient’s complaints (pre-operative and post-operative).&#x0D; Results: A total of 60 patients were included in the present study, among them 40 were males and 20 were females with male to female ratio of 2:1. All of them showed a significantly better improvement in visual analogue scale score of neck pain and UE radicular pain (p&lt;0.05). The post-operative improvements in the clinical presentation of the patients were also noted.&#x0D; Conclusion: A single level of anterior discectomy and cervical fusion for degenerative cervical disc prolapse with and without radiculo-myelopathy is an effective, successful and safe operation with minimal complication rate. The visual analogue scale following surgery was significantly improved.

Surgical Outcome of Anterior Cervical Discectomy and Fusion (ACDF) with Autologous Bone Graft from Iliac Bone and Miniplate Application Over It

Objectives: To know the surgical outcome of ACDF with autologous bone graft from iliac bone and miniplate application over it.Materials and Methods: This prospective study was conducted in the Department of Neurosurgery, Hayatabad Medical Complex and Lady Reading Hospital Peshawar from 1st June 2017 to 31 December 2018. Only those patients having prolapsed intervertebral cervical discs or cervical stenosis were included while those with multiple level involvement, trauma, fracture and previously operated patients for any cervical pathology were excluded. Pre-op and postoperative data were documented. For all patients, tricortical iliac bone autograft and rigid plate instrumentation was used to optimize fusion cervical collar was not used post op. Acquired data were analyzed with SPSS v20.Results: Total 83 patients fulfilled the inclusion criteria and enrolled in the study. Out of these, 48 patients were males and 35 were females. The age range was from 17 to 63 with a mean age 52 years ± 2.5.The C5 – C6 was the commonest site for fusion C6 – C7, C3 – C4 and C4 – C5 were less common. Odom’s criteria was applied to determine the outcome of the procedure. Excellent results were noted in 70 (82%). Ten (12.05%) patients had good results. Conclusion: The ACDF with the tricortical iliac bone autograft and mini plate application is the choice treatment in appropriately selected patients. It increases chances of fusion and abates the need for post op cervical collar.

Outcome of Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy

Background: Cervical spondylotic myelopathy (CSM) is a progressive degenerative disease and the most common cause of cervical spinal cord dysfunction (SCD) in older patients. Anterior cervical discectomy andfusion (ACDF) is a common procedure for patients with severe neurological deterioration. The goals of this study were to evaluate the clinical and functional outcome, radiological fusion and operative complications in case of CSM who underwent ACDF by autogeneous-tricortical bone graft and stabilized with plate and screws.&#x0D; Methods: This prospective interventional study was carried out at National Institute of Traumatology and Orthopaedic Rehabilitation ( NITOR) and different private hospitals in Dhaka from January 2012 to December 2014. Within this period total 12 CSM patients were included as study sample. All were surgically treated by ACDF and stabilized by plate and screws. All patients were clinically and radiologically evaluated before and after surgery.&#x0D; Results: Single level ACDF by autograft and stabilization by plate and screws was done in 10 (83.33%) patients and 2 (16.67%) patients had two level fusion. The mean follow up period was 12 months. The satisfactory result was found in 10 (83.33%) patients. Post-operative complications were donor site morbidity in2 (16.67%) patients and transient dysphagia in 1 (8.33%) patient. The fusion rate was 100% in this series.&#x0D; Conclusion: ACDF with anterior plating for CSM is a safe and effective procedure. It results in highest fusion, least complication and relatively lower cost.&#x0D; Birdem Med J 2019; 9(2): 133-137

Functional Outcome of Anterior Cervical Discectomy and Fusion with Taper Titanium Cage for Cervical Spondylosis

Functional Outcome of Anterior Cervical Discectomy and Fusion with Taper Titanium Cage for Cervical Spondylosis

Anterior cervical discectomy and fusion with polyetheretherketone cages in the management of single and double level cervical spondylotic myelopathy-our experiences of 80 cases

Background: Anterior cervical discectomy with fusion (ACDF) is challenging with respect to both patient selection and choice of surgical procedure.Objectives: The aim of this study was to evaluate the clinical outcome of anterior cervical discectomy and fusion with an artificial cage made of polyetheretherketoneMaterials &amp; Methods: From January 2012 to January 2017, 80 consecutive patients referred to the Department of spine surgery, Bangabandhu Shekh Mujib Medical University were recruited for the study. Postoperative Clinical outcome assessed with Nurick scale for myelopathy, Odom's criteria for functional outcome and Visual Analogue Scale (VAS) for both neck and arm pain. Radiological fusion was assessed by X-ray. Operative complications were reported.Results: 36 patients were operated for one level discectomy and fusion with PEEK cages and 44 patients for two levels. There were 48 (60%) males and 32 (40%) females. The age of the patients ranged from 30-72 years, a mean ± SD 45 ± 8.34. At the 2 years clinical follow-up, there were significant post operative improvements of Nurick scale, and VAS comparative to preoperative record. According to Odom's criteria, 72/80 patients (90%) were graded excellent-good.Conclusion: Anterior cervical discectomy and fusion with polyetheretherketone (PEEK) cage is an effective treatment of cervical myelopathy having higher fusion rate and lack of donor site morbidity.KYAMC Journal Vol. 9, No.-1, April 2018, Page 32-34

Outcome of Anterior Cervical Discectomy and Fusion In Degenerative Compressive Myelorediculopathy With Stand-Alone Titanium Cage

Background : Anterior Cervical Discectomy and Fusion (ACDF) is widely performed for cervical degenerative disease with autograft or allograft with long term satisfactory outcome. But the complications of autogenous bone grafting cause the spinal surgeons to seek alternative method. This prospective study was conducted to observe the outcome of using stand-alone titanium cage in ACDF. Materials and methods : Total 50 patients (68 levels) with degenerative compressive cervical myelorediculopathy were operated using stand-alone titanium cage from July 2013 to June 2015 in the Department of Neurosurgery, Chittagong Medical College Hospital. All patients were examined and evaluated preoperatively by plain X-ray and MRI and postoperatively by plain X-ray at one, three and 12 months. Clinical and neurological outcome was assessed by Japanese Orthopedic Association (JOA) score. Results: The mean age was 42.04±7.94 years ranged from 30 to 66 years. Maximum patients were in 41-50 years age group. Quadriparesis was found most common symptom (60%) followed by brachialgia (20%). Out of 50 patients, 32 (64%) suffered from single level compression while 18 (36%) patients suffered from two level compression. Among all operated levels, C5-6 (n-30, 44.2%) was most common level followed by C6-7 (n- 20,29.4%) and C4-5 (n-12, 17.6%) level. All patients improved in terms of their neck pain, redicular arm pain, clumsy hand movement and quadriparesis after surgery. Subsidence was observed in 15 (30%) patients and kyphosis was observed in 10 (20%) patients. All patients with subsidence and kyphosis were neurologically stable and no revision was required. Mean preoperative JOA score was 8.38±3.71 and mean post operative JOA score was 12.92±3.39. Among all patients in post operative follow up, 22 (44%) patients showed excellent recovery and 15 (30%) patients showed good recovery. Conclusion: Anterior cervical fusion using a stand-alone titanium cage is a safe and effective procedure allowing excellent to good functional recovery and avoiding donor site morbidity. Titanium cage can be an effective alternative to iliac bone autograft.&#x0D; JCMCTA 2017 ; 28 (2) : 34-38

In Spondylotic Cervical Myelopathy Anterior Cervical Discectomy and Fusion by Peek Cage Without Plate Reinforcement is a Standard Method of Treatment

Background: Anterior cervical discectomy with fusion (ACDF) is challenging with respect to both patient selection and choice of surgical procedure.Objective: The aim of this study was to evaluate the clinical outcome of anterior cervical discectomy and fusion with an artificial cage made of polyetheretherketone .Patients and Methods: From January 2012 to January 2016, 40 consecutive patients referred to the Department of spine surgery, Bangabandhu Shekh Mujib Medical University were recruited for the study.Postoperative Clinical outcome assessd with Nurick scale for myelopathy, Odom’s criteria for functional outcome and Visual Analogue Scale (VAS) for both neck and arm pain. Radiological fusion was assessed by X-ray. Operative complications were reported.Results: 18 patients were operated for one level discectomy and fusion with PEEK cages and 22 patients for two levels. There were 24 (60%) males and 16 (40%) females. The age of the patients ranged from 30-72 years, a mean ± SD 45±8.34. At the 2 years clinical follow-up, there were significant post operative improvements of Nurick scale, and VAS comparative to preoperative record. According to Odom’s criteria, 36/40 patients (90%) were graded excellentgood.Conclusion: Anterior cervical discectomy and fusion with polyetheretherketone (PEEK) cage is an effective treatment of cervical myelopathy having higher fusion rate and lack of donor site morbidity.J Dhaka Medical College, Vol. 25, No.2, October, 2016, Page 110-114

Anterior Cervical Discectomy and Fusion Using an “Oversized” PEEK Cage: Radiological and Clinical Outcome

IntroductionThere has been controversial data about the effect of cage size on radiological and clinical outcome of anterior cervical discectomy and fusion (ACDF). Oversized cages have been linked ...

A Prospective Study of the Functional Outcome of Anterior Cervical Discectomy With Fusion in Single Level Degenerative Cervical Disc Prolapse.

Cervical spondylotic myelo-radiculopathy is a form of spinal cord dysfunction syndrome and usually accompanies age related degeneration of the spine. To determine the functional outcome of anterior cervical discectomy with fusion and plating in single level degenerative cervical disc prolapse. A total of 20 patients diagnosed with degenerative single level cervical disc prolapse who presented to the Department of Orthopaedic Surgery, Justice KS Hegde Charitable Hospital, Mangalore from the period of November 2012 to May 2014 were enrolled in the study. Complete clinical and radiological evaluation of the patients was done. A trial of conservative management was tried in all these patients for a period of two months. They were taken up for surgery only when conservative management had failed. Scoring of neck function before the surgery was done as per the Modified Japanese Orthopaedic Association (MJOA) score. All patients underwent anterior cervical discectomy and fusion (ACDF) with tricortical iliac crest bone grafting. Fixation was performed with titanium locking cervical plates. All patients were reviewed at 6 weeks and 6 months postoperatively. Assessment of neck function was done as per the MJOA scoring during all the reviews. Radiographic assessment was also done during all the reviews. The complications noted were documented. The statistical analysis was done using percentages; the arithmetic mean was calculated using SPSS software (version 16.0). Amongst the 20 patients included in the study, 1 patient died postoperatively due to oesophageal rupture. of the remaining 19 patients reviewed and followed up, all of them had improvement of symptoms and were reported to be in the 'mild category' as per the MJOA score. One patient developed dysphonia, in the immediate postoperative period due to recurrent laryngeal nerve palsy which recovered in a period of three months postoperative. Single level anterior cervical discectomy with fusion and anterior cervical plating for degenerative cervical disc prolapse with or without myelo-radiculopathy is an effective and safe surgical procedure with minimal complication rate.

Clinical Outcome of Anterior Cervical Discectomy and Fusion versus Total Disc Replacement – A Meta-Analysis of 2532 Cases

Purpose: Cervical total disc replacement (TDR) has become an alternative to fusion (ACDF) in the surgical treatment of cervical radiculopathy with the promise of preserving motion in the affected segment and of avoiding accelerated degeneration of the adjacent levels. Nowadays there are numerous prospective, randomised and controlled studies comparing the clinical outcome of patients with both therapeutical options. Since cervical prostheses are much more expensive than cages it is crucial to compare the clinical benefit of both implants on the basis of a larger amount of patient data. Methods: A systematic data base search and study review identified 11 prospective, randomized and controlled studies that compared the clinical outcome after ACDF or TDR using at least the scores of NDI, VAS for neck pain and VAS for arm pain after a follow-up of at least 2 years. 2532 cases were included in the statistical analysis that compared the mean values of the clinical scores. Results: There were no statistically significant difference between the ACDF group and the TDR group in the clinical outcome scores (NDI, VAS neck, VAS arm) 2 years after surgery although some of the included studies found differences. Conclusion: ACDF and cervical TDR generate the same clinical results 2 years after surgery in regard to pain relief. Some of the included studies give proof of a better range of motion and less adjacent level degeneration in the TDR group. Thus, this more expensive option is only indicated in younger patients with soft-disc herniation.

Outcome of Anterior Cervical Discectomy and Fusion Using Surgical Loupe

Background Data: ACDF using the surgical microscope is the gold standard treatment for cervical radiculopathy, myelopathy or myeloradiculopathy due to herniated cervical disc and/or uncovertebral spurs, since it was first developed in 1950. Complications of ACDF, reported in the literature, have very low incidence rate except laryngeal and pharyngeal complications (dysphagia, dysphonia) with reported incidence of 5.7% to 93.3%.Purpose: To find out the possibility and safety of use of surgical loupe alone as an alternative to the gold standard surgical microscope. Study Design: observational analytic retrospective study. Patients and Methods: Retrospective evaluation of outcome of 59 cases of surgically treated cervical disc disease done using surgical loupe alone instead of microscope inAin Shams university hospitals. Results: The mean VAS of axial neck pain and radicular pain decreased significantlyimmediately postoperatively (P value 0.001>). Radicular weakness improved immediately postoperatively (P value 0.032). Myelopathy improved significantly after 1 month (P value 0.004).The overall satisfaction of patients was excellent in 47.4% (28 cases) and very good in 37.3% (22 cases) with overall highly satisfactory results 84.7% of patients. The mean interval to return to work after surgery (in months) was 1.98±0.55. The mean of operation time (in minutes) of ACDF was 112.71±44.55. Conclusion: Surgical loupe could be good alternative to microscope in ACDF in resources- limited centers. (2014ESJ075)