Single-level Anterior Cervical Discectomy Research Articles

Single-level cervical disc arthroplasty in the spine with reversible kyphosis: A finite element study.

BackgroundOur previous studies found the single‐level cervical disc arthroplasty (CDA) might be a feasible treatment for the patients with reversible kyphosis (RK). Theoretically, the change of cervical alignment from lordosis to RK comes with the biomechanical alteration of prostheses and cervical spine. However, the biomechanical data of CDA in the spine with RK have not been reported. This study aimed at establishing finite element (FE) models to (1) explore the effects of RK on the biomechanics of artificial cervical disc; (2) investigate the biomechanical differences of single‐level anterior cervical discectomy and fusion (ACDF) and CDA in the cervical spine with RK.MethodsThe FE models of the cervical spine with lordosis and RK were constructed, then three single‐level surgical models were developed: (1) RK + ACDF; (2) RK + CDA; (3) lordosis + CDA. A 73.6‐N follower load combined with 1 N·m moment was applied at the C2 vertebra to produce cervical motion.ResultsAt the surgical level, “lordosis + CDA” had the greatest ROM (except for flexion) while “RK + ACDF” had the minimum ROM. However, at adjacent levels, the ROM of “RK + ACDF” increased by 4.05% to 38.04% in comparison to “RK + CDA.” “RK + ACDF” had the greatest prosthesis interface stress, while the maximum prosthesis interface stress of “RK + CDA” was at least 2.15 times higher than “lordosis + CDA.” Similarly, “RK + ACDF” had the greatest intradiscal pressure (IDP) at adjacent levels, while the IDP of “RK + CDA” was 1.6 to 6.7 times higher than “lordosis + CDA.” At the surgical level, “RK + CDA” had the greatest facet joint stress (except for extension), which was 1.9 to 11.2 times higher than “lordosis + CDA.” At the adjacent levels, “RK + CDA” had the greatest facet joint stress (except for extension), followed by “RK + ACDF” and “lordosis + CDA” in descending order.ConclusionsRK significantly changed the biomechanics of CDA, which is demonstrated by the decreased ROM and the significantly increased prosthesis interface stress, IDP, and facet joint stress in the “RK + CDA” model. Compared with ACDF, CDA overall exhibited a better biomechanical performance in the cervical spine with RK, with the increased ROM of surgical level and facet joint stress and the decreased ROM of adjacent levels, prosthesis interface stress, and IDP.

Influence of Predominant Neck versus Arm Pain on Anterior Cervical Discectomy and Fusion Outcomes: A Follow-Up Study

To assess differences in postoperative patient-reported outcome measures (PROMs) and minimal clinically important difference (MCID) attainment following single-level anterior cervical discectomy and fusion based on predominant preoperative pain symptom. Patients undergoing primary, single-level anterior cervical discectomy and fusion were identified. PROMs included visual analog scale (VAS) arm and neck, 12-item short-form physical component summary (SF-12 PCS), Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), and Neck Disability Index, collected preoperatively and postoperatively. Patients were placed in preoperative predominant arm pain (pAP) and preoperative predominant neck pain groups. χ2 test compared demographic and perioperative characteristics, and MCID attainment rates. Student t test evaluated change from preoperative to postoperative PROM values and compared PROMs between groups. There were 110 patients assessed (52 neck pain, 58 arm pain). Patients with preoperative predominant neck pain improved significantly from preoperative to postoperative at 12 weeks to 1 year for PROMIS-PF, 6 months and 1 year for SF-12 PCS, 6 weeks to 1 year for VAS neck, 6 weeks to 6 months for VAS arm, and 6 weeks to 2 years for Neck Disability Index (all P ≤ 0.035). Patients with pAP improved significantly from preoperative to all postoperative time points for PROMIS-PF, 6 months to 2 years for SF-12 PCS, 6 weeks to 1 year for VAS neck, 6 weeks to 1 year for VAS arm, and 6 weeks to 6 months for Neck Disability Index (all P ≤ 0.040). Mean PROMIS-PF was higher at 6 weeks, preoperative VAS neck was lower, and preoperative VAS arm was higher for pAP patients (all P ≤ 0.013). MCID attainment was significantly higher in pAP patients for PROMIS-PF from 6 weeks to 6 months, SF-12 PCS 6 weeks, and VAS arm 12 weeks. Predominant pain symptom demonstrated little effect on perioperative characteristics and postoperative PROMs. Anterior cervical discectomy and fusion candidates will likely experience similar clinically meaningful postoperative improvements in physical function, disability, and pain.

Effects of Anterior Plating on Achieving Clinically Meaningful Improvement Following Single-Level Anterior Cervical Discectomy and Fusion.

ObjectiveThe clinical utility of anterior cervical plating for anterior cervical discectomy and fusion (ACDF) procedures remains controversial. This study aims to compare the impact of cervical plating on achievement of minimum clinically important difference (MCID) up to 2 years following ACDF. MethodsPatients undergoing primary, single-level ACDF procedures were grouped based on whether their procedure included application of an anterior cervical plate. Demographics, preoperative spinal diagnoses, operative characteristics, and patient-reported outcome measures (PROMs) were compared between plating groups. Achievement of an MCID was assessed using the following previously established thresholds: 12-item Short Form health survey physical component summary (SF-12 PCS) 8.1, visual analogue scale (VAS) neck 2.6, VAS arm 4.1, Neck Disability Index (NDI) 8.5. Rates of MCID achievement were compared between groups. ResultsThe cohort included 192 patients of whom 102 received plating and 90 received no plating. Plating status was significantly associated with Charlson Comorbidity Index and insurance status. Operative duration and estimated blood loss were significantly greater for the plating group. Both groups demonstrated significant improvements at the majority of postoperative timepoints. Significant intergroup differences in PROM improvement were demonstrated for VAS neck and NDI at 6 weeks. Rates of MCID achievement differed significantly between groups for NDI at 6 weeks, and 12 weeks, and SF-12 PCS overall. ConclusionPatients improved significantly in terms of pain, disability and physical function, regardless of plating status, and with the exception of early neck pain and disability, these improvements were similar between groups. Patients that underwent plating as part of their ACDF procedure achieved an MCID for physical function at lower rates overall.

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

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

The Effect of Plating on Adjacent Segments in Anterior Cervical Discectomy and Fusions in Patients with Degenerative Spine Disease: A Retrospective Cohort Study.

Introduction Plate distance is correlated with an increased incidence of adjacent segment pathologies (ASP). However, a correct plate-to-disk distance >5 mm is often not achieved. Therefore, this study aimed to quantify the effect of short plate-to-disk distance on the development of ASP using epidemiological measures in patients with cervical degenerative spine disease undergoing single-level anterior cervical discectomy and fusion (ACDFs). Methods Medical records of all patients with cervical degeneration undergoing single-level ACDF with plating (between January 2015 and December 2017), and a follow-up of at least 1 year, were reviewed retrospectively. Radiologic and clinical outcomes were assessed preoperatively, postoperatively, and at last follow-up. The plate-to-adjacent disk distance was measured, and epidemiological measures were calculated to quantify the risk on adjacent-level ossification development (ALOD) and adjacent segment degeneration (ASD). Results Thirty-eight (47.5%) of the 80 patients developed ALOD, and 12 (15.0%) developed ASD after a 2-year follow-up. The incidence of ALOD was significantly lower if the plate was >5 mm away from the adjacent disk space compared to <5 mm (cranial adjacent segment, 22.5% vs. 51.3% [P=0.010] and caudal, 21.4% vs. 47.8% [P=0.029]). A correct plate-to-disk distance resulted in a relative risk reduction of 57.2% for the cranial segment and 56.0% for the caudal segment, with a number needed to treat of 4. The ASD was only observed in the cranial adjacent segments, and a correct plate-to-disk distance resulted in a relative risk reduction of 32.1% and a number needed to treat of 18. Conclusions Only four patients need to be treated with a correct plate-to-disk distance to avoid one case of ALOD. Therefore, it is advisable to keep the plate at a distance >5 mm away from the adjacent disk.

Characterizing the Effect of Perioperative Narcotic Consumption and Narcotic Prescription Dosing at Discharge on Satisfaction With Pain Control for Patients Undergoing Single-level Anterior Cervical Discectomy and Fusion.

A single-center, retrospective review of prospectively collected data on patients who underwent single-level anterior cervical discectomy and fusions (ACDFs) between October 2014 and October 2019. To investigate the effect of perioperative narcotic consumption and amount of narcotic prescribed at discharge on patient satisfaction with pain control after single-level ACDF. Prior research has demonstrated that opioid prescription habits may be related to physician desire to produce superior patient satisfaction with pain control. Patients with complete Press-Ganey Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey information were analyzed. Inpatient opioid prescriptions were recorded and converted to milligram morphine equivalents (MME) and tablets of 5 mg oxycodone. HCAHPS scores were converted to a Likert-type 5-point scale. A total of 47 patients met inclusion criteria for this study. Average age was 48.1±10.9 y. Average inpatient opioids prescribed was 102±106 MME. Average opioids prescribed at discharge was 437±342 MME. No statistically significant correlation was found between satisfaction with pain control and opioid consumption while in the hospital [r=-0.106, P=0.483]. Similarly, there was no statistically significant correlation between satisfaction with pain control and opioids prescribed upon discharge [r=-0.185, P=0.219]. No statistically significant correlation was found between date of surgery and inpatient MME consumption [r=-0.113, P=0.450]. Interestingly, more opioids were prescribed at discharge the earlier the date of surgery [r=-0.426, P=0.003]. For every additional month further along in the study period, the odds of a patient reporting a top box score for satisfaction with pain control increased by 5.5% [P=0.025]. Our study found no correlation between patient satisfaction with pain control and inpatient opioid dosage or outpatient prescription dosage after single-level ACDF. Moreover, satisfaction with pain control increased over time despite a decrease in MME prescribed at discharge. This suggests that factors other than narcotic consumption play a more important role in patient satisfaction with pain control. Level III.

The Impact of Single-Level Anterior Cervical Discectomy and Fusion on Cervical Sagittal Parameters and Its Correlation With Pain and Functional Outcome of Patients With Neck Pain.

This study examines the changes in segmental and global cervical sagittal parameters after single-level anterior cervical discectomy and fusion (ACDF) in patients with cervical radiculopathy or myelopathy. We also investigate whether these changes have any relation with postoperative pain and functional outcome of the patients. Sixty patients (37 females and 23 males) with a mean age of 45.9 ± 9.5 years who were candidates of single-level ACDF due to cervical myelopathy or radiculopathy participated in the study. At baseline, 1 month, and 6 months after ACDF, outcomes of the study including sagittal balance parameters, pain intensity, and Neck Disability Index (NDI) were measured among the patients. Intensity of pain and neck disability were measured using the visual analog scale (VAS) and validated version of NDI, respectively. Using a standard lateral cervical radiography, the Cobb angle for occiput-C2, C1-C2, and C2-C7 as well as operation-level angle (OA; Cobb's angle at the level of discopathy), the thoracic inlet angle, and C7 and T1 slope angles were measured. The intensity of pain and neck disability of patients improved significantly during the follow up of the study comparing with baseline measurements (P < .001). There was a significant correlation between the increase of C2-C7 angle, C1-C2 angle, and OA and improvement in neck pain and NDI at 1- and 6-month follow ups. We found that changes at C2-C7 angle, C1-C2 angle, and OA have positive significant correlation with clinical outcome including pain improvement and decrease of disability in patients who undergo ACDF. 3. The results of this study might be beneficial in selection of cervical cages with appropriate size during ACDF surgery, as our findinds showed that larger cages could lead to better functional outcome in patients.

Is only Anterior Stabilization Enough in Three-Column Injury of Subaxial Cervical Spine? - A Long-Term Retrospective Analysis of 78 Patients.

Study Design:This was a retrospective study.Purpose:The purpose was to retrospectively evaluate long-term outcome of anterior stabilization in three-column injury of the subaxial cervical spine.Overview of Literature:Literature shows varied results regarding the approach to be chosen. Most studies prefer a combined approach since biomechanically forms more stable construct. The isolated posterior approach is preferred by many as it is easy to reduce and fix three-column injuries. There are very few studies which show the isolated anterior approach to be better than the other two.Materials and Methods:Seventy-eight patients of three-column injury operated by anterior approach with follow-up of atleast 2 years were included and retrospectively analyzed. Clinical data included age, sex, time to surgery, methods of reduction, postoperative mobilization, and neurological evaluation using the ASIA scale. Radiological data included pre- and postreduction X-ray, computed tomography, and magnetic resonance imaging (MRI). X-rays taken post-operatively at 1,3, 6 months, 1yr and 2yrs. Variables like fracture type (AO Classification), overall alignment, localized kyphosis, time for fusion and grade of fusion mass were noted.Results:Of 78 patients, 61 had bifacetal dislocation and 17 unifacetal. The most common site was C5-6, followed by C3-4 and C6-7. The mean patient age was 35.98 years with 60 males and 18 females. The mean time to surgery was 4.4 days. Forty dislocations were reduced by closed method and 38 by open anterior approach. Fifty-six percent of patients had traumatic disc injury on MRI. All are managed by single-level anterior cervical discectomy and fusion with iliac crest autograft for fusion. The mean preoperative lordosis: 4.44° (range −13.4° to 25°) and mean postoperative lordosis: 28.57° (P < 0.0001) mean loss of alignment: 2.59° by 2 years, 100% fusion with mean time – 22.82 weeks, neurological recovery in 34.6% with atleast one grade improvement in ASIA scale. No neurological worsening or need for revision surgery was observed.Conclusion:The goal of surgery in cervical injury is bony stabilization and fusion using a least morbid approach and one with good long-term outcome. Above study concludes that only anterior stabilization after reduction of three-column injury would suffice with good long-term outcome, thereby obviating need for global fusion.

P51. Differences in charges for elective single level anterior cervical discectomy and fusion across hospital size: A nationwide readmissions database analysis

<h3>BACKGROUND CONTEXT</h3> Rising health care expenditures in the United States place an imperative on providers, payers, and policymakers to more closely evaluate hospital charges. While previous spine surgery studies have compared charges across procedures and in the presence of comorbidities, the association between charges and hospital size in Anterior Cervical Discectomy and Fusion (ACDF) has yet to be understood. <h3>PURPOSE</h3> To assess the differences in charges for elective single-level ACDF procedures across hospitals of different size. <h3>STUDY DESIGN/SETTING</h3> This was a retrospective analysis utilizing elective, single-level ACDF data from January 2016 to September 2016 in the HCUP Nationwide Readmissions Database (NRD). <h3>PATIENT SAMPLE</h3> A total of 13,776 cases of elective, single-level ACDF were identified. Patients who underwent single-level ACDF were identified using the ICD-10 procedural codes for single-level anterior cervical fusion. Patients who underwent cervical disc arthroplasty were excluded from this study. Additional exclusion criteria were death during hospitalization, nonelective surgery, use of emergency services, and age < 18. <h3>OUTCOME MEASURES</h3> Total charges were compared across hospital sizes (small, medium, and large). <h3>METHODS</h3> Elective single-level ACDF cases were stratified into three groups by hospital bedsize (small, medium, and large) as classified by the NRD. As per the NRD, about one-third of the hospitals within a specific teaching status, location, and region grouping are assigned to each bedsize category. Mean total charges were compared across hospital size utilizing one-way analysis of variance (ANOVA) and subsequently the post-hoc Tukey's range test. <h3>RESULTS</h3> There was significant variation in mean total charges across small ($59,010.97 ± $55,211.71), medium ($63,775.99 ± $50,823.21) and large ($63,546.59 ± $54,831.45) hospitals (p=0.002). Post-hoc testing revealed significant differences in charge between small and medium hospitals (p=0.004) and between small and large hospitals (p=0.002). <h3>CONCLUSIONS</h3> Hospital size is a determining factor for cost of elective single-level ACDF. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

P115. Analysis of 90-day readmissions across hospital size: Risk factors for readmission in single level anterior cervical discectomy and fusion

P115. Analysis of 90-day readmissions across hospital size: Risk factors for readmission in single level anterior cervical discectomy and fusion

Cervical Spine Microsurgery with the High-Definition 3D Exoscope: Advantages and Disadvantages

The aim of this study was to evaluate our experience with a high-definition 3-dimensional (3D) exoscope (EX) for cervical spine surgery versus a binocular operating microscope (OM). A retrospective review of patients undergoing a single-level anterior cervical discectomy and fusion (ACDF) procedure for the treatment of cervical myelopathy from March 2019 to May 2020 was performed. Demographic, perioperative, and clinical outcomes of 50 patients were included, 23 of whom received assistance from the 3D exoscope (EX group) and 27 of whom received assistance from the OM (OM group). Operative baseline and postoperative outcome parameters were evaluated. Periprocedural handling, visualization, and illumination by the EX, as well as surgeons' ergonomics, were scored using a questionnaire and rapid upper limb assessment (RULA). Baseline characteristics were similar between the 2 groups. There were no significant differences between groups in mean operative time, blood loss, duration of admission, or postoperative improvement of symptoms. Both groups showed similar clinical improvements after surgery. There were no intraoperative complications in either group. According to the attending surgeons, the intraoperative handling of instruments for the EX was rated to be comparable to that of the OM. Surgeons rated the comfort level of the intraoperative posture for the EX as very high on the subjective questionnaire and equal to the OM on the objective RULA. When compared with the OM, depth perception, image quality, and illumination for the EX were rated as inferior in ACDF procedures with long approaches. The operative education and training function of the EX was rated to be superior to that of the OM. Overall, our study showed that the EX appears to be a safe alternative for common ACDF with the unique advantage of excellent comfort and also serves a useful educational tool for the surgical team. However, our investigation revealed several important limitations of this system, including slightly inferior visualization and illumination quality compared with the OM.

Effect of Surgical Setting on Cost and Hospital Reported Outcomes for Single-Level Anterior Cervical Discectomy and Fusion.

Hospitals seek to reduce costs and improve patient outcomes by decreasing length of stay (LOS), 30-day all-cause readmissions, and preventable complications. We evaluated hospital-reported outcome measures for elective single-level anterior cervical discectomy and fusions (ACDFs) between tertiary (TH) and community hospitals (CH) to determine location-based differences in complications, LOS, and overall costs. Patients undergoing elective single-level ACDF in a 1-year period were retrospectively reviewed from a physician-driven database from a single medical system consisting of 1 TH and 4 CHs. Adult patients who underwent elective single-level ACDF were included. Patients with trauma, tumor, prior cervical surgery, and infection were excluded. Outcomes measures included all-cause 30-day readmissions, preventable complications, LOS, and hospital costs. A total of 301 patients (60 TH, 241 CH) were included. CHs had longer LOS (1.25 ± 0.50 versus 1.08 ± 0.28 days, P = .01). There were no differences in complication and readmission rates between hospital settings. CH, orthopaedic subspecialty, female sex, and myelopathy were predictors for longer LOS. Overall, costs at the TH were significantly higher than at CHs ($17 171 versus $11 737; Δ$ = 5434 ± 3996; P < .0001). For CHs, the total costs of drugs, rooms, supplies, and therapy were significantly higher than at the TH. TH status, orthopaedic subspecialty, and myelopathy were associated with higher costs. Patients undergoing single-level ACDFs at CHs had longer LOS, but similar complications and readmission rates as those at the TH. However, cost of ACDF was 1.5 times greater in the TH. To improve patient outcomes, optimize value, and reduce hospital costs, modifiable factors for elective ACDFs should be evaluated. 3.

Does Myelopathy Increase the Morbidity and Mortality of Elective Single-Level Anterior Cervical Discectomy and Fusion? An Updated Propensity-Matched Analysis of 3938 Patients From the American College of Surgeons National Surgical Quality Improvement Program Database.

Myelopathy is thought to be associated with higher morbidity and mortality after anterior cervical discectomy and fusion (ACDF); however, the literature investigating this association has limitations. To investigate the influence of myelopathy on early perioperative complications of elective single-level ACDF. Patients who underwent ACDF between 2016 and 2018 were reviewed from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Propensity score matching analysis was used. Twenty percent of the cohort was myelopathic. These patients were significantly older, had more comorbidities, more likely to be functionally dependent, and to undergo emergency surgery when compared to the nonmyelopathic cohort. When 1969 myelopathic patients were 1:1 propensity matched with nonmyelopathic patients, there was no difference between the myelopathic and nonmyelopathic patients in incidence of postoperative intensive care unit admission or death. Patients in the myelopathic group were significantly more likely to have a nonhome discharge and less likely to be discharged on the first postoperative day. Myelopathic patients had a higher rate of return to operating room within the same admission (2.2%) as well as a higher unplanned readmission rate (4.2%). The total operation time (143 min) and average length of hospital stay (52 h) were significantly higher in the myelopathic group when compared to the nonmyelopathic group (117 min) and (33 h), respectively. Patients with myelopathy who undergo elective single-level ACDF have higher risks of several perioperative events including longer operative time, longer hospital stay, higher return to operating room, and unplanned readmission rates, when compared to nonmyelopathic patients. On the other hand, myelopathic patients did not exhibit higher mortality rate.

Complications of Peek Cage Following Single Level Anterior Cervical Discectomy and Fusion

Abstract Background: Prospective study of complications related to PEEK cage in fusion following single level anterior cervical discectomy. Aim of Study: To assess the complications related to PEEK cage following single level anterior cervical discectomy and fusion. Patients and Methods: A total of 127 case have been operated, 12 of them developed complications after using PEEK cage after anterior cervical discectomy and fusion. Follow-up at Cairo University Hospital between 2011 to 2013. Outcome assessment was done using visual analogue score (VAS), forearm pain, neck pain as well as neurological assess-ment and radiological follow-up with cervical X-rays. Results: 12 patients from a total of 127 patients following single level anterior cervical discectomy and fusion using PEEK cage had cage related complications. Follow-up ranged from 12 to 27 months, with a mean follow-up of 15 month. There were five cases of cage migration, three cases with subsidence, two cases with adjacent level degeneration, one case with kyphotic deformity and one case pseudoarthrosis. Conclusion: Use of PEEK cage in cervical fusion following single level Anterior Cervical Discectomy is widely used and provide satisfactory results. Complications related to PEEK cage use is relatively low and avoidable through careful attention to technically steps in graft site and choosing an appropriate sized cage.

Comparative Study between Fusion and Non-Fusion Techniques in Anterior Cervical Discectomy: Bone Cement Versus Cervical Cage

Abstract Background: A prospective comparative study between fusion and non-fusion techniques in anterior cervical discec-tomy (ACD) evaluating the results achieved using polymeth-ylmethacrylate (PMMA) as a non-fusion and cervical cage (PEEK) as a fusion following single level ACD. Patients and Methods: A total of 40 patients, divided in to two groups of 20 patients each, group (A); having PMMA used for disc replacement and group (B) cervical (PEEK) cage placement after ACD. Results: Of both groups are evaluated regarding: (1) Clinical outcome according to Odom's criteria (2) Radiological outcome and inter body fusion, (3) Simplicity and postoperative morbidity of each procedure and (4) Complications related to each technique. Patients were followed up for a mean period of 10 months. Group (A) presented excellent and good clinical outcome in 85% at 6 months and 90% at 12 months. Radio-logical none fusion was noticed in 80% of patients and partial fusion occurred in 20% of cases at 12 months postoperative interval cage migration in 5% (one patient) into adjacent vertebral bodies which needed surgical removal and replaced by cage after causing partial collapse of the disc space height. No other graft related complications, progressive deformity or instability were reported. Group (B) achieved 90% excellent and good clinical outcome at 6 and 12 months respectively. Fusion rate of 85% at 6 months and increased to 95% at 12 months. No other cage related complications were reported. Conclusion: Clinical outcome in both group is related to the surgical decompression technique and preoperative neu-rological status of the patients e.g. cervical spondylotic myelopathy (CSM), cervical spondylotic radiculopathy (CSR) or both than to the use of either disc replacement by fusion (PEEK) cage or non fusion by bone cement (PMMA). The use of interbody fusion cage is preferred owing to their ability to function as load-sharing devices and to adequately fix the spine and increase segmental stiffness thus achieve acceptable fusion rate and low complication when compared with PMMA graft.

Pseudarthrosis rate following anterior cervical discectomy with fusion using an allograft cellular bone matrix: a multi-institutional analysis.

The use of osteobiologics, engineered materials designed to promote bone healing by enhancing bone growth, is becoming increasingly common for spinal fusion procedures, but the efficacy of some of these products is unclear. The authors performed a retrospective, multi-institutional study to investigate the clinical and radiographic characteristics of patients undergoing single-level anterior cervical discectomy with fusion performed using the osteobiologic agent Osteocel, an allograft mesenchymal stem cell matrix. The medical records across 3 medical centers and 12 spine surgeons were retrospectively queried for patients undergoing single-level anterior cervical discectomy and fusion (ACDF) with the use of Osteocel. Pseudarthrosis was determined based on CT or radiographic imaging of the cervical spine. Patients were determined to have radiographic pseudarthrosis if they met any of the following criteria: 1) lack of bridging bone on CT obtained > 300 days postoperatively, 2) evidence of instrumentation failure, or 3) motion across the index level as seen on flexion-extension cervical spine radiographs. Univariate and multivariate analyses were then performed to identify independent preoperative or perioperative predictors of pseudarthrosis in this population. A total of 326 patients met the inclusion criteria; 43 (13.2%) patients met criteria for pseudarthrosis, of whom 15 (34.9%) underwent revision surgery. There were no significant differences between patients with and those without pseudarthrosis, respectively, for patient age (54.1 vs 53.8 years), sex (34.9% vs 47.4% male), race, prior cervical spine surgery (37.2% vs 33.6%), tobacco abuse (16.3% vs 14.5%), chronic kidney disease (2.3% vs 2.8%), and diabetes (18.6% vs 14.5%) (p > 0.05). Presence of osteopenia or osteoporosis (16.3% vs 3.5%) was associated with pseudarthrosis (p < 0.001). Implant type was also significantly associated with pseudarthrosis, with a 16.4% rate of pseudarthrosis for patients with polyetherethereketone (PEEK) implants versus 8.4% for patients with allograft implants (p = 0.04). Average lengths of follow-up were 27.6 and 23.8 months for patients with and those without pseudarthrosis, respectively. Multivariate analysis demonstrated osteopenia or osteoporosis (OR 4.97, 95% CI 1.51-16.4, p < 0.01) and usage of PEEK implant (OR 2.24, 95% CI 1.04-4.83, p = 0.04) as independent predictors of pseudarthrosis. In patients who underwent single-level ACDF, rates of pseudarthrosis associated with the use of the osteobiologic agent Osteocel are higher than the literature-reported rates associated with the use of alternative osteobiologics. This is especially true when Osteocel is combined with a PEEK implant.

Longer operative time associated with prolonged length of stay, non-home discharge and transfusion requirement after anterior cervical discectomy and fusion: an analysis of 24,593 cases

BACKGROUNDProlonged operative time of single-level ACDF has been associated with adverse postoperative outcomes. The current literature does not contain a comprehensive quantitative description of these associations PURPOSEThis study characterized the associations between single-level anterior cervical discectomy and fusion(ACDF) operative time and (1)30-day postoperative healthcare utilization, and (2)the incidence of local wound complications, need for transfusion and mechanical ventilation. DESIGN/SETTINGRetrospective database analysis PATIENT SAMPLEThe American College of Surgeons National Surgical Quality Improvement Program(ACS-NSQIP) database was queried for single-level ACDF cases(2012–2018) using current procedural terminology codes. A total of 24,593 cases were included. OUTCOME MEASURESPrimary outcomes included healthcare utilization(lengths of stay[LOS], discharge dispositions, 30-day readmissions, and reoperations) per operative time category. The secondary outcome was the incidence of wound complications, blood transfusion and need for ventilation per operative time category. METHODSMultivariate regression determined operative time categories associated with increased risk while adjusting for patient demographics and comorbidities. Predictive spline regression models visualized the associations. RESULTSCompared to the reference operative time of 81-100-minutes, the 101-120-minute category was associated with higher odds of LOS >2 days(OR:1.36,95%CI(1.18–1.568);p<.001) and non-home discharge(OR:1.341,95%CI(1.081-1.664);p=.008). Three-times greater odds of LOS >2 days(OR:3.367,95%CI(2.719-4.169); p<.001) and twice the odds of non-home discharge(OR:2.174,95%CI(1.563-3.022);p<.001) were detected at 181-200-minutes. The highest operative time category(≥221 minutes) was associated with the highest odds of LOS>2 days(OR:4.838,95%CI(4.032–5.804);p<.001), non-home discharge(OR:2.687,95%CI(2.045–3.531);p<.001) and reoperation(OR:1.794,95%CI(1.094-2.943);p=.021). Patients within the 201-220 and the ≥221-minute categories exhibited a significant association with greater odds of transfusion(OR:8.57,95%CI(2.321-31.639);p<.001, and OR:11.699, 95%CI(4.179–32.749);p=.001, respectively). Spline regression demonstrated that the odds of LOS >2 days, non-home discharge disposition, reoperation and bleeding requiring transfusion events began to rise, starting at 94, 91.6, 91.6, and 93.3 minutes of operative time, respectively. CONCLUSIONThis study demonstrated that prolonged operative time is associated with increased odds of healthcare utilization and transfusion after single-level ACDF. Operative times greater than 91 minutes may carry higher odds of postoperative complications.

Clinical Correlation of Change in Sagittal Parameters after Anterior Cervical Microdiscectomy

Objective: Cervical radiculopathy is the syndrome of pain and / or sensorimotor deficit caused by compression of the cervical nerve root. Symptoms of cervical radiculopathy in the upper limb are described as pain, numbness, or weakness. Conservative treatment is recommended initially for degenerative cervical radiculopathy. Surgical treatment is recommended in cases where progressive loss of muscle strength does not respond to conservative therapy. Many radiographic parameters are used to define the sagittal alignment of the cervical spine. This variation contrasts with the assessment of caudal spine segments where there are more established guides for measuring deformity angles. The aim of this study is to evaluate the effect of anterior cervical discectomy and fusion, which are widely used in spinal surgery practice, on cervical sagittal alignment.Methods: We retrospectively evaluated 33 patients who were operated with anterior cervical discectomy and fusion technique with the diagnosis of single level degenerative cervical disc hernia after an average of 3 months of follow-up period. For radiological evaluation, we analyzed the C2-C7 lordosis angles, the anterior and posterior disc heights at the operating level on lateral scoliosis radiographs, preoperatively and at 3rd month postoperatively. Japanese Orthopedic Association scores and visual analog scale scores were examined to evaluate clinical results.Results: A statistically significant difference was found between the preoperative radiological sagittal parameters and the postoperative 3rd month (p = 0.001). When the clinical correlation of the findings was examined, a statistically significant difference was found in the Japanese Orthopedic Association scores and visual analog scale scores of the patients measured preoperatively versus 3 months postoperatively (p &amp;lt; 0.001).Conclusion: Radiological and clinical parameters improve significantly in patients after single level anterior cervical discectomy surgery.

Does Early Postoperative T1 Slope Change Affect Clinical Results of Patients With Single-level ACDF?

This was a retrospective study. The main question of this study is whether the change of postoperative T1 slope will affect the clinical and imaging recovery of patients with single-level anterior cervical discectomy and fusion (ACDF). The T1 slope after ACDF is different from that preoperatively, however, the clinical significance of this change has not been reported. A retrospective analysis was conducted on 87 patients with single-level ACDF. Visual Analogue Scale was used to compare neck and upper limb pain before and after surgery. Neurological improvement was assessed by the Japanese Orthopaedic Association Scores and Neck Disability Index. Preoperative and postoperative T1 slope, occipital-C2 angle, C2-C7 overall curvature and functional spinal unit curvature were measured and analyzed by lateral cervical spine x-ray. All patients were followed up for 23.98±12.17 months. The Japanese Orthopaedic Association, Visual Analogue Scale, and Neck Disability Index scores as well as the overall curvature and change of C2-C7 and functional spinal unit were significantly improved in the last postoperative follow-up. At 12 months after surgery and the last follow-up, patients with increased T1 slope had more severe neck pain symptoms than those with decreased T1 slope (P<0.05). The overall curvature and change of C2-C7 in patients with increased T1 slope were better than those with decreased T1 slope (P<0.05). For patients with increased postoperative T1 slope after single-level ACDF, the degree of postoperative neck pain was more severe, suggesting that some clinical intervention is needed.

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).