Postoperative Neck Disability Index Scores Research Articles

Comparison of surgical outcomes for cervical radiculopathy by nerve root level

Cervical radiculopathy might affect finger movement and dexterity. Postoperative features and clinical outcomes comparing C8 radiculopathies with other radiculopathies are unknown. This prospective multicenter study analyzed 359 patients undergoing single-level surgery for pure cervical radiculopathy (C5, 48; C6, 132; C7, 149; C8, 30). Background data and pre- and 1-year postoperative neck disability index (NDI) and numerical rating scale (NRS) scores were collected. The C5–7 and C8 radiculopathy groups were compared after propensity score matching, with clinical significance determined by minimal clinically important differences (MCID). Postoperative arm numbness was significantly higher than upper back or neck numbness, and arm pain was reduced the most (3.4 points) after surgery among the C5–8 radiculopathy groups. The C8 radiculopathy group had worse postoperative NDI scores (p = 0.026), upper back pain (p = 0.042), change in arm pain NRS scores (p = 0.021), and upper back numbness (p = 0.028) than the C5–7 group. NDI achieved MCID in both groups, but neck and arm pain NRS did not achieve MCID in the C8 group. In conclusion, although arm numbness persisted, arm pain was relieved after surgery for cervical radiculopathy. Patients with C8 radiculopathy exhibited worse NDI and change in NRS arm pain score than those with C5–7 radiculopathy.

Comparison of fusion, arthroplasty and hybrid surgery outcomes in patients with two-level cervical disc disease.

The study aims to explore the management of two-level cervical disc disease and to compare outcomes of anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty (CDA), and hybrid surgery (HS). Between December 2011 and December 2021, a total of 120 patients (76 males, 44 females; mean age: 44.8±8.1 years; range, 18 to 68 years) who were diagnosed as two-level cervical disc disease and underwent anterior cervical surgery were retrospectively analyzed. The patients were randomly divided into three groups as ACDF, CDA, and HS each consisting of 40 patients. The Neck Disability Index (NDI), Visual Analog Scale (VAS), clinical and radiological findings, and range of motion (ROM) data were evaluated. All of the groups showed a significant improvement according to clinical and radiological outcomes (p=0.01). The mean follow-up was 27.5±6.1 months for ACDF, 20.0±4.7 months for CDA, and 21.1±5.0 months for HS, showing consistency in monitoring post-surgery outcomes. The mean postoperative NDI scores were 13.4±5.6, 14.8±5.2 and 15.0±5.5 in the ACDF, CDA and HS groups, respectively (p=0.056). The mean postoperative ROM values were 20.82±5.66, 32.45±11.21 and 27.18±10.89, respectively (p=0.045). All three surgical techniques, ACDF, CDA, and HS, are safe and successful in the treatment of two-level cervical disc disease. However, HS and CDA may be more preferable over ACDF attributed to their motion-preserving benefits and effectively combining fusion and motion preservation techniques, with comparable clinical and radiological outcomes.

Clinical Impact and Correlations of Odontoid Parameters Following Multilevel Posterior Cervical Fusion Surgery.

C2 slope (C2S), a cervical parameter mathematically approximated as T1 slope minus cervical lordosis (T1S-CL), predicts functional improvement in cervical deformity patients. Nonetheless, C2S is a positional parameter based only on the horizontal axis. The current study aims to introduce novel odontoid parameters and establish their relationships with patient-reported health-related quality of life (HRQoL). Lateral plain radiographs of 32 adults who underwent multilevel posterior cervical fusion were analyzed. The odontoid parameters included odontoid incidence (OI), C2S, odontoid tilt (OT), and gravity line-C2 distance (GL-C2), while the cervical parameters were the Cobb angle at C0-1, C1-2, C0-2, C2-7, C2-7 sagittal vertical axis (cSVA), T1 slope, and T1S-CL. The range of motion (ROM) of the occipito-atlantoaxial complex was measured in flexion and extension plain radiographs. Scores on the Neck Disability Index (NDI) and visual analogue scale (VAS) for axial neck (VASn) and arm pain were measured. Compared to asymptomatic subjects, patients had larger C2S, cSVA, and T1S-CL, and smaller OT. Preoperatively, OI was significantly correlated with the ROM of C1-2 (r = 0.37, p < 0.05) and C0-2 (r = 0.46, p < 0.01). OT and C2S had significant correlations with the C0-1, C1-2, and C0-2 angles, GL-C2, and T1S-CL. Postoperative NDI scores were significantly correlated with OI (r = -0.40, p < 0.05) and OT (ρ = -0.37, p < 0.05). VASn was significantly correlated with GL-C2 (r = -0.35, p < 0.05). The odontoid parameters were significantly correlated with established cervical parameters and HRQoL measures. OI is a constant parameter representing the individual's compensatory reservoir at the upper cervical spine.

Impact of cervical and global spine sagittal alignment on cervical curvature changes after posterior cervical laminoplasty

ObjectiveTo analyze the correlation between the changes in cervical curvature and the sagittal parameters of spino-pelvic and clinical efficacy after posterior laminoplasty (LP).MethodsThe patients with cervical spondylosis treated with LP from June 2018 to December 2020 were reviewed. The preoperative and follow-up spine full-length films were measured. The measured data included C2–C7 Cobb angle, C2–7 sagittal vertical axis (SVA), T1 slope (T1S), pelvic incidence, sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), and C7-SVA. Japanese Orthopaedic Association (JOA) score and neck disability index (NDI) score were recorded before surgery and follow-up.ResultsThere were 56 patients in this study. There were no significant differences in spino-pelvic sagittal parameters before and after surgery; however, the JOA score significantly improved. The changes in postoperative cervical lordosis correlated with SS, PT, LL, T1S, and C7-SVA (P < 0.05). Regression analysis showed that T1S and C7-SVA were associated with reducing cervical lordosis (P = 0.021 and P = 0.001, respectively). Patients with larger T1S combined with larger C7-SVA had more cervical lordosis loss, poor JOA improvement, and high postoperative NDI scores (P < 0.001, P = 0.018, and P < 0.001, respectively).ConclusionPatients should be examined with full-length spine film before surgery to evaluate the cervical and spino-pelvic sagittal balance. T1S and C7-SVA correlated with changes in cervical sagittal alignment after LP.Level of evidenceIII.

Does T1 slope minus cervical lordosis mismatch affect surgical outcomes of cervical laminoplasty in the absence of preoperative severe kyphosis?

BackgroundThe impact of the T1 slope minus cervical lordosis (T1S-CL) on surgical outcomes in patients with degenerative cervical myelopathy undergoing laminoplasty (LP) remain uncertain.MethodsOne hundred patients who underwent cervical LP were retrospectively reviewed. Radiographic measurements included C2–C7 lordosis (CL), T1 slope (T1S), and C2–C7 sagittal vertical axis (SVA). Additionally, pain numeric rating scale, neck disability index (NDI), 12-Item Short-Form Health Survey, Euro QOL 5 dimensions (EQ5D), and Japanese Orthopedic Association score were investigated. According to past reports, T1S–CL > 20° was defined as mismatched. Then, based on T1S-CL mismatching, patients were divided into 2 groups.ResultsThis research understudied 67 males and 33 females with a mean age of 67 y. Preoperatively, only eight patients showed a T1S-CL mismatch. While the C2–7 Cobb angles did not change significantly after surgery, the T1 slope (T1S) angle increased, increasing the T1S-CL as a result. As we compared the clinical outcomes based on the preoperative T1S-CL mismatching, there were no significant differences between the two groups. On the other hand, the number of patients in the mismatched group increased to 21 patients postoperatively. As we compared clinical outcomes based on the postoperative T1S-CL mismatching, the postoperative NDI score and preop/postop EQ5D score were significantly worse in the mismatch group.ConclusionsAlthough cervical LP showed inferior outcomes in patients with postoperative T1S-CL mismatch even in the absence of severe preoperative kyphosis (> 10°), preoperative T1S-CL mismatch was not adversely prognostic.

Limitations of minimally invasive posterior cervical foraminotomy—a decompression method of posteriorly shifting the nerve root—in cases of large anterior osteophytes in cervical radiculopathy: A retrospective multicenter cohort study

BackgroundPosterior cervical foraminotomy against anterior osteophyte is an indirect decompression procedure but less invasive compared to anterior cervical discectomy and fusion. Residual compression to the nerve root may lead to poor surgical outcomes. Although clinical results of posterior cervical foraminotomy for osteophytes are not considered better than those of disk herniation, osteophyte size and the association of the decompression area with poor surgical outcomes remain unclear. This study aimed to identify the limitations of minimally invasive posterior cervical foraminotomy for cervical radiculopathy and discuss the methods to improve surgical outcomes. MethodsWe analyzed 55 consecutive patients with degenerative cervical radiculopathy who underwent minimally invasive posterior cervical foraminotomy. Minimum postoperative follow-up duration was 1 year. We divided the patients into nonimproved and improved groups. The cutoff value between preoperative and postoperative Neck Disability Index scores was 30% improvement. Preoperative imaging data comprised disk height, local kyphosis, spinal cord compression, anterior osteophytes in the foramen, and anterior osteophytes of >50% of the intervertebral foramen diameter. Postoperative imaging data comprised craniocaudal length and lateral width of decompressed lamina, preserved superior facet width, and area of decompressed lamina. ResultsFifty-five patients were divided into two groups: nonimproved (n = 19) and improved (n = 36). The presence of osteophytes itself was not significant; however, the presence of osteophytes of >50% of the foramen diameter increased in the nonimproved group (P = 0.004). Mean lateral width and mean area of decompressed lamina after surgery significantly increased in the improved group (P = 0.001, P = 0.03). ConclusionThe presence of anterior osteophytes >50% of the diameter of the foramen led to poor improvement of clinical outcomes in minimally invasive posterior cervical foraminotomy. However, the larger the lateral width and area of the decompressed lamina, the better the surgical outcome.

Multifidus Sarcopenia Is Associated With Worse Patient-reported Outcomes Following Posterior Cervical Decompression and Fusion.

Retrospective cohort study. The present study is the first to assess the impact of paraspinal sarcopenia on patient-reported outcome measures (PROMs) following posterior cervical decompression and fusion (PCDF). While the impact of sarcopenia on PROMs following lumbar spine surgery is well-established, the impact of sarcopenia on PROMs following PCDF has not been investigated. We performed a retrospective review of patients undergoing PCDF from C2 to T2 at a single institution between the years 2017 and 2020. Two independent reviewers who were blinded to the clinical outcome scores utilized axial cuts of T2-weighted magnetic resonance imaging sequences to assess fatty infiltration of the bilateral multifidus muscles at the C5-C6 level and classify patients according to the Fuchs Modification of the Goutalier grading system. PROMs were then compared between subgroups. We identified 99 patients for inclusion in this study, including 28 patients with mild sarcopenia, 45 patients with moderate sarcopenia, and 26 patients with severe sarcopenia. There was no difference in any preoperative PROM between the subgroups. Mean postoperative Neck Disability Index scores were lower in the mild and moderate sarcopenia subgroups (12.8 and 13.4, respectively) than in the severe sarcopenia subgroup (21.0, P <0.001). A higher percentage of patients with severe multifidus sarcopenia reported postoperative worsening of their Neck Disability Index (10 patients, 38.5%; P =0.003), Visual Analog Scale Neck scores (7 patients, 26.9%; P =0.02), Patient-Reported Outcome Measurement Information System Physical Component Scores (10 patients, 38.5%; P =0.02), and Patient-Reported Outcome Measurement Information System Mental Component Scores (14 patients, 53.8%; P =0.02). Patients with more severe paraspinal sarcopenia demonstrate less improvement in neck disability and physical function postoperatively and are substantially more likely to report worsening PROMs postoperatively. 3.

266. Higher paraspinal muscle density effect on outcomes after ACDF

<h3>BACKGROUND CONTEXT</h3> Studies in the lumbar spine suggest a correlation between sarcopenia and worse patient outcomes. To our knowledge, no studies have investigated whether an association exists between fatty degeneration of the cervical paraspinal musculature and cervical disability in the perioperative period. <h3>PURPOSE</h3> The purpose of this study is to determine whether paraspinal Goutalier grade of fat degeneration is associated with patient-reported outcomes in patients undergoing ACDF. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of a prospectively collected cohort of patients who underwent 1 to 3 level ACDF between the years 2011-2014 at a single academic medical center. <h3>PATIENT SAMPLE</h3> Sixty-nine patients who underwent 1-3 level ACDF between the years of 2011-2014. <h3>OUTCOME MEASURES</h3> Goutalier classification, patient-reported outcomes such as neck disability index (NDI), RAND score, and EQ-5D score were measured. <h3>METHODS</h3> We performed a retrospective review of a prospective cohort of patients undergoing 1 to 3 level ACDF at a single institution between the years 2011-2014. We utilized preoperative MRI's to classify patients into Goutalier grades. Patient-reported outcomes including NDI, RAND score and EQ-5D score were collected and analyzed according to patients' Goutalier grade. We utilized Student's t-test and ANOVA to compare all means between groups. The mid-P exact test was used to compare proportional differences between groups. <h3>RESULTS</h3> We identified 69 patients for inclusion. The cohort was 47.3% male. 29 patients were classified as Goutalier 0-1 (Group 1), 29 were Goutalier 1.5-2 (Group 2), and 11 were Goutalier 2.5-4.0 (Group 3). Determination of Goutalier grade by the two reviewers resulted in 82.8% agreement with correlation coefficient of 0.69 (Pearson, r2), demonstrating moderate interrater reliability. All Goutalier groups experienced significant improvement in all three outcome scores. Average postoperative NDI scores were 25.3 in Group 1, 13.9 in Group 2, and 25.1 in Group 3 (p=0.02). The percentage of patients in each group reporting worse disability after surgery was 17.2%, 3.3% and 9.1%, respectively (p=0.05) No statistically significant difference was seen between groups in postoperative EQ-5D (p=0.07) or RAND scores (p>0.05). <h3>CONCLUSIONS</h3> The present study is the first to assess the association between cervical paraspinal muscle Goutalier grade and patient reported outcomes following ACDF. Based upon our study, patients with worse cervical paraspinal degeneration may benefit from improved symptom relief in comparison to patients with a lesser degree of degeneration undergoing ACDF. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Cellular allograft for multilevel stand-alone anterior cervical discectomy and fusion.

Anterior cervical discectomy and fusion (ACDF) is the most common treatment for degenerative disease of the cervical spine. Given the high rate of pseudarthrosis in multilevel stand-alone ACDF, there is a need to explore the utility of novel grafting materials. In this study, the authors present a single-institution retrospective study of patients with multilevel degenerative spine disease who underwent multilevel stand-alone ACDF surgery with or without cellular allograft supplementation. In a prospectively collected database, 28 patients who underwent multilevel ACDF supplemented with cellular allograft (ViviGen) and 25 patients who underwent multilevel ACDF with decellularized allograft between 2014 and 2020 were identified. The primary outcome was radiographic fusion determined by a 1-year follow-up CT scan. Secondary outcomes included change in Neck Disability Index (NDI) scores and change in visual analog scale scores for neck and arm pain. The study included 53 patients with a mean age of 53 ± 0.7 years who underwent multilevel stand-alone ACDF encompassing 2.6 ± 0.7 levels on average. Patient demographics were similar between the two cohorts. In the cellular allograft cohort, 2 patients experienced postoperative dysphagia that resolved by the 3-month follow-up. One patient developed cervical radiculopathy due to graft subsidence and required a posterior foraminotomy. At the 1-year CT, successful fusion was achieved in 92.9% (26/28) of patients who underwent ACDF supplemented with cellular allograft, compared with 84.0% (21/25) of patients who underwent ACDF without cellular allograft. The cellular allograft cohort experienced a significantly greater improvement in the mean postoperative NDI score (p < 0.05) compared with the other cohort. Cellular allograft is a low-morbidity bone allograft option for ACDF. In this study, the authors determined favorable arthrodesis rates and functional outcomes in a complex patient cohort following multilevel stand-alone ACDF supplemented with cellular allograft.

Higher Paraspinal Muscle Density Effect on Outcomes After Anterior Cervical Discectomy and Fusion.

Study Design:Retrospective cohort study.Objectives:Studies in the lumbar spine suggest a correlation between sarcopenia and worse patient outcomes. The purpose of this study was to determine whether paraspinal Goutalier grade of fat degeneration is associated with patient-reported outcomes in patients undergoing anterior cervical discectomy and fusion (ACDF).Methods:We performed a retrospective review of a prospective cohort of patients undergoing 1- to 3-level ACDF at a single institution between the years 2011-2014. We utilized preoperative magnetic resonance images to classify patients into Goutalier grades. Patient-reported outcomes, including Neck Disability Index (NDI), RAND score, and EQ-5D score were collected and analyzed according to patients’ Goutalier grade.Results:We identified 69 patients for inclusion. A total of 29 patients were classified as Goutalier 0-1 (group 1), 29 were Goutalier 1.5-2 (group 2), and 11 were Goutalier 2.5-4.0 (group 3). All Goutalier groups experienced significant improvement in all 3 outcome scores. Average postoperative NDI scores were 25.3 in group 1, 13.9 in group 2, and 25.1 in group 3 (P = .02). The percentage of patients in each group reporting worse disability after surgery was 17.2%, 3.3%, and 9.1%, respectively (P = .05). No statistically significant difference was seen between groups in postoperative EQ-5D (P = .07) or RAND scores (P > .05).Conclusions:The present study is the first to assess the association between cervical paraspinal muscle Goutalier grade and patient-reported outcomes following ACDF. Based on our study, patients with worse cervical paraspinal degeneration may benefit from improved symptom relief in comparison to patients with a lesser degree of degeneration undergoing ACDF.

Treatment of cervical spondylotic radiculopathy with posterior percutaneous endoscopic cervical discectomy: Short-term outcomes of 24 cases.

To determine the short-term clinical outcomes of single-segment cervical spondylotic radiculopathy treated with posterior percutaneous endoscopic cervical discectomy (PPECD).Data of a total of 24 patients who underwent PPECD and local anesthesia for single-level segmental cervical spondylotic radiculopathy between March 2016 and December 2017 were reviewed. The Japanese Orthopaedic Association, visual analog scale (VAS), and neck disability index scores at preoperative 1 day, postoperative 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year were recorded. The modified MacNab criteria at the last follow-up were re-recorded for the evaluation of clinical effectiveness.All operations were successfully completed under endoscopic guidance. No patient showed spinal cord, nerve root, vascular injuries, dural tears or other complications. The postoperative VAS scores of the arm and neck were significantly reduced compared with the preoperative VAS scores (P < .05), while postoperative the Japanese Orthopaedic Association scores were significantly increased (P < .05). The postoperative neck disability index scores were significantly reduced compared with preoperative scores (P < .05). The modified MacNab criteria at the last follow-up showed 16 excellent cases, 8 good cases, 0 fine cases, and 0 poor cases. Postoperative magnetic resonance imaging and cervical 3-dimensional computed tomography reconstruction showed that the intervertebral disc was adequately resected and the nerve root was not under compression.PPECD is safe and effective for the treatment of single-segment cervical spondylotic radiculopathy.

Is Facet Joint Distraction Associated with Functional Outcome in Patients with Cervical Spondylotic Radiculopathy Treated with Single-Segment Anterior Cervical Discectomy and Fusion?

To explore 1) whether the degree of facet joint distraction during single-segment anterior cervical discectomy and fusion for cervical spondylotic radiculopathy affects functional outcome and 2) whether the degree of facet joint distraction is related to cervical sagittal parameters. This study retrospectively analyzed data from 72 patients with single-segment cervical spondylotic radiculopathy from January 2013 to December 2018. Lateral cervical radiographs were performed preoperatively and 12months postoperatively. Disc height, interfacet distance, and segmental angle were measured from the lateral cervical radiographs to evaluate facet joint distraction, and cervical sagittal parameters were measured. The outcome measures included visual analog scale (VAS) and Neck Disability Index scores. Sixty-eight patients were included. ΔInterfacet distance was statistically significant in relation to ΔVAS score (P < 0.01). In a receiver operating characteristic curve analysis, less than the mean ΔVAS score for all patients was set as a positive result, and the critical value of Δinterfacet distance was 0.7 mm (P= 0.024, area under the curve= 0.659, sensitivity= 46.8%, specificity= 78.8%). According to the critical value determined by the receiver operating characteristic curve, all patients were divided into the appropriate distraction group or the excessive distraction group. There was a significant difference in VAS scores between the 2 groups (P < 0.05). After undergoing single-segment ACDF for the treatment of cervical spondylotic radiculopathy, patients with an interfacet distance of 0.7 mm or more had worse VAS pain scores. However, this was not related to the improvement in postoperative Neck Disability Index scores; changes in the interfacet distance were not associated with changes in the cervical sagittal parameters.

Outcome of Anterior Fusion Technique for Multilevel Cervical Spondylotic Myelopathy

Objective: To asses’ surgical parameters, complications, clinical and radiological outcomes in the treatment of 2-, 3- and 4-levels Cervical Spondylotic Myelopathy .&#x0D; Methods: A total of 90 patients with 2-, 3- or 4-level CSM who underwent anterior decompression and fusion procedures between January 2017 and October 2018 were divided into three different groups, the 2-level group (65 patients), the 3-level group (20 patients) and the 4-level group (5 patients). The clinical and Radiographic outcomes like Neck Disability Index (NDI) score, hospital stay, blood loss, operation time, fusion rate, cervical lordosis, cervical range of motion (ROM), and complications were compared between different procedures.&#x0D; Results: At a minimum of 1-year follow-up, no statistical differences in NDI score, hospital stay, fusion rate and cervical lordosis were found among the 3 groups. However, the mean postoperative NDI score of the 4-level group was significantly higher than that in the other two groups , and in terms of postoperative total ROM, the 3- level group was superior to the 4-level group and inferior to 2-level group (P,0.05). The decrease rate of ROM in the 3-level group was significantly higher than that in the 2-level group, and lower than that in the 4-level group.&#x0D; Conclusions: As the number of involved levels increased, surgical results become worse in terms of operative time, blood loss, NDI score, cervical ROM and complication rates postoperatively. An appropriate surgical procedure for multilevel CSM should be chosen according to comprehensive clinical evaluation before operation, thus reducing fusion and decompression levels if possible.

Posterior Cervical Muscle-Preserving Interspinous Process Approach and Decompression: More Minimally Invasive and Modified Shiraishi's Selective Laminectomy

The cervical extensor musculature is important in cases of neck pain and loss of cervical lordosis after laminoplasty. Therefore, various surgical methods have been developed to preserve the muscle during laminoplasty. We have developed a posterior cervical muscle-preserving interspinous process (MIS) approach and decompression method. We have described the operation details and clinical outcomes of selected patients who have undergone this procedure. The MIS approach and decompression method were performed in 20 consecutive patients who had only required central decompression for cervical stenosis. This procedure includes an approach to the interspinous space that is similar to Shiraishi's method but includes decompression without fracturing the spina bifida. The patients had no complications and did not require conversion to conventional laminoplasty. The mean operative time and mean blood loss was 53.0 minutes and 63.0 mL per level, respectively, and the mean hospital stay was 4.0 days. The mean preoperative and 3-month postoperative modified Japanese Orthopedic Association scores were 12.6 and 16.2, and the mean preoperative and 3-month postoperative neck disability index scores were 15.4 and 2.5, respectively. The postoperative neck visual analog scale score was 0.8. The mean preoperative and postoperative sagittal vertical axis was 1.6 and 1.8 cm, respectively. The mean loss of lordosis was 1.0°, and the mean cervical range of motion did not change from preoperatively to postoperatively. The MIS approach and decompression method was less invasive than both conventional laminoplasty and Shiraishi's selective laminectomy. It is a safe and effective minimally invasive technique for central stenosis caused by cervical spondylotic myelopathy.

Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion

AbstractBackground: The anterior cervical discectomy for cervical disc prolapse has been the work horse for ages and it works fine but the mechanical problems that follows is actually problematic hence the evolution of total disc replacement.Aim of Study: The aim was to compare the efficacy and safety of arthroplasty using the artificial cervical disc with the standard Anterior Cervical Discectomy and Fusion (ACDF) for the management of cervical disc prolapse at single level.Patients and Methods: Sixty patients were included and randomized to one of two groups: Investigational patients (30) underwent arthroplasty using a disc prosthesis, and a control group (30 patients) underwent ACDF with a cervical cage. Patients were assessed pre-operatively, immediate post-operative period and at six weeks, three months, six, twelve, eighteen and-twenty-four months postoperatively. Efficacy and safety outcomes were measured according to the Neck Disability Index (NDI), visual analogue score, gait disturbance, disc height, range of motion (arthroplasty group) or bony fusion (control group), complications, rate of second surgery, and neurological outcome. Overall outcome was considered successful according to four pivot criteria: (1): Improvement of post-operative NDI score more than fifteen points over the preoperative score, (2): Improved neurological presenting symptoms, (3): No serious complications caused by the prosthesis or by the surgical procedure, and (4): No resurgery needed (superimposed fixation, revision, or non-elective implant removal).Results: The one year rate of overall outcome were ninety five percent for the arthroplasty group and eighty six percent for the control group, the arthroplasty group was better than the control group for the NDI score improvement. The per-centage of patients experiencing any adverse effects was six percent in the arthroplasty group and eight percent in the control group, which were not statistically different. Radio-graphic success was achieved in 9 ninety five percent of the arthroplasty group (maintenance of range of motion without bony fusion) and one hundred percent of control patients (fusion).Conclusions: Arthroplasty is as efficient and successful as ACDF for the management of cervical disc pathology.

Does stopping at C7 in long posterior cervical fusion accelerate the symptomatic breakdown of cervicothoracic junction?

ObjectTo compare the clinical and radiological outcomes between patients with long posterior cervical fusion (PCF) in which fusion stopped at C7 versus patients in which fusion crossed the cervicothoracic junction (CTJ).MethodsThe patients were divided into 2 groups on the basis of the lower-most instrumented vertebra (LIV); C7 group patients (n = 25) and upper thoracic (UT) group (n = 21). We analyzed the visual analogue scale of arm/neck pain, Japanese Orthopedic Association (JOA) score, and neck disability index (NDI). And we also measured the following parameters: (1) pseudomotion of fused segments; (2) C2–C7 sagittal vertical axis; (3) T1 slope; and (4) C2–C7 lordosis.ResultsArm and neck pain were similar in both groups pre- and postoperatively. Interestingly, mean postoperative NDI score in the UT group was significant worse when compared with the C7 group (9.7±4.6 vs. 14.2±3.7, p = 0.006). Although UT patients had longer fusion levels, the fusion rates were not significantly different between the C7 and UT groups (96.0% vs. 90.5%; p = 0.577). The radiographic parameters did not show any significant differences between the groups at final follow-up.ConclusionsOur study demonstrates that multi-level PCF stopping at C7 does not negatively affect C7-T1 segment failure, fusion rate, neck pain, neurologic outcomes, and global sagittal alignment of the cervical spine. Hence, it is unnecessary to extend the long PCF levels caudally across the healthy CTJ for fear of development of adjacent segmental disease (ASD) at the C7-T1 segment.

Complications of Poor Cervical Alignment in Patients Undergoing Posterior Cervicothoracic Laminectomy and Fusion

This study sought to determine whether a relationship exists between caudal instrumented level and revision rates, neck disability index scores, and cervical alignment in patients undergoing multilevel posterior cervical fusion. This study examined a dataset of all patients undergoing posterior cervical decompression and fusion at ≥3 levels, terminating between C4 and T4, between January 2010 and December 2015, with at least 12 months of clinical follow-up. Patients were separated into cohorts based on caudal level of the fusion: C6 (or more cranial), C7, T1, or T2 (or more caudal). Revision rate, neck disability index score, sagittal vertical axis, T1 slope, and cervical lordosis were recorded. Linear regression and multivariate analysis were performed to identify independent predictors of patient outcomes and disparities between ending constructs in the cervical and the thoracic spine. The overall revision rate was 10.8% (n= 24). No statistically significant difference in the revision rate was identified between fusions terminating at C6 or cranial, C7, T1, or T2 and caudal (P= 0.74). Revision correlated strongly with increased sagittal vertical axis (P=0.002) and T1 slope (P= 0.04). Increased neck disability index score correlated with revision rate (P=0.01), cervical kyphosis (P < 0.001), and increased sagittal vertical axis (P= 0.04). This study suggests that constructs terminating in the proximal thoracic spine have similar revision rates, postoperative neck disability index scores, and radiographic measurements as those terminating in the cervical spine. Poor cervical alignment, as evidenced by increased sagittal vertical axis, cervical kyphosis and T1 slope, predicts need for revision and of poorer clinical outcomes.

A Novel Technique for Cervical Laminoplasty Fusion: Simultaneously Enhancing Stabilization and Decompression in Various Cervical Myelopathies: A Technical Note and Outcomes.

Cervical laminectomy has 2 major disadvantages: postlaminectomy adhesion of dural membrane and lack of a fusion bed. The objective of this study was to determine whether simultaneous cervical laminoplasty with fusion (CLPF) might overcome these unwanted outcomes. Patients who underwent CLPF for treating cervical myelopathy with instability who were followed up for at least 12 months were enrolled. Preoperative and postoperative Neck Disability Index (NDI) and Japanese Orthopedic Association (JOA) scores before and after surgery, recovery rates (RRs), C2-C7 lordosis, and fusion success rates were evaluated. The study cohort comprised 50 patients (35males and 15 females; mean age, 60.5 ± 14.0 years) who underwent CLPF. The average duration of clinical follow-up was 24.6 ± 16.1 months. Mean preoperative and postoperative NDI scores were 27.0 ± 10.6 and 17.6 ± 7.2, respectively (P= 0.004). Mean preoperative and postoperative JOA scores were 10.4 ± 4.2 and 13.6 ± 3.0, respectively (P= 0.001). The mean JOA RR was 49.8 ± 42.2%. No significant changes in C2-7 lordosis were noted after surgery (preoperative, 7.0 ± 8.0°; postoperative, 7.3 ± 6.3°; P= 0.789). The fusion success rate was 96% (48 of 50 patients). Fusion mass areas at C5 level were significantly different between the opening side and the hinge side (opening side, 15.8 ± 13.1 mm2; hinge side, 50.8 ± 27.2 mm2; P < 0.001). There was no postoperative restenosis or epidural fibrosis. CLPF might be useful for canal decompression and a good fusion bed while avoiding postoperative epidural fibrosis.

Comparison of the outcomes of cage-stand-alone with cage-with-plate fixation in one level and two levels for treating cervical disk diseases.

Introduction:Anterior cervical discectomy and fusion (ACDF) surgery is an accepted method for many spinal cord abnormalities. The purpose of this study was to evaluate the outcomes of treating patients with spinal cord lesions at one level or two levels through ACDF with cage-stand-alone (ACDF-CA) and ACDF with cage-with-plate fixation (ACDF-CP) surgery and comparing these results with each other.Methods:In this prospective, cross-sectional, descriptive study, eighty patients undergoing ACDF surgery were enrolled according to the inclusion and exclusion criteria. Demographic data, before and after surgery findings, and clinical symptoms were investigated. Data were collected by means of visual analog scale (VAS) and Neck Disability Index (NDI) questionnaires. The adverse effects and surgical outcomes were evaluated based on Odom's criteria and patients’ satisfaction. The collected data of the groups were then compared and assessed.Results:There was no significant difference between the groups in regards of gender, age, duration of surgery to visit, surgical level, preoperative and postoperative VAS and cervical range of motion, preoperative NDI, results based on Odom's criteria, and satisfaction of patients (P > 0.05). The VAS, NDI, and range of motion scores were significantly reduced in the four groups after the operation compared to the preoperative stage. Postoperative NDI scores in the ACDF-CA group at one level were significantly lower than other groups (P < 0.05).Conclusion:Both of the methods revealed acceptable outcomes in comparison to the preoperative stage, and despite some minor differences, there are generally no significant differences in outcomes and complications.

Clinical and radiological results of posterior cervical foraminotomy at two or three levels: a 3-year follow-up.

Single-level unilateral posterior cervical foraminotomy is regarded as a safe method. However, the outcomes of posterior cervical foraminotomy performed on two or three levels are uncertain and debated. We aimed to analyze the long-term clinical and radiological outcomes of posterior cervical foraminotomy at two or three levels. From September 2008 to December 2011, a total of 42 patients who underwent a posterior cervical foraminotomy at two or three levels and were followed for at least 3years were analyzed with retrospective cohort study. Clinical assessments were performed using the visual analog scale (VAS), neck disability index (NDI) and modified MacNab criteria. Radiological evaluation included the assessment of static and dynamic lateral radiographs to identify instability, postlaminectomy kyphotic deformity, adjacent segmental degeneration (ASD), and focal degeneration. The mean VAS improved from preoperative score 8.5±0.3 to postoperative score 1.8±0.5 significantly. The mean presenting NDI score was 32.9±2.0 and the mean postoperative NDI score was 14.2±1.3. Improvement of radiculopathy was displayed in 39 patients (92.9%). During radiological evaluation, no significant change in disc height related to ASD and focal degeneration was noted. However, we confirmed one patient with radiological instability and one patient with radiological postlaminectomy kyphotic deformity. Posterior cervical foraminotomy at two or three levels is fairly effective for treating patients with cervical radiculopathy, and results in long-lasting pain relief and improved quality of life in nearly all patients. However, further studies of three levels that include more patients are needed.