Single-level Cervical Disc Herniation Research Articles

Factors Affecting the Risk of Developing Cervical Cage Malposition in Patients with Cervical Discectomy

Aim: Cervical discectomy followed by cage placement for fusion is nowadays a commonly used method for the treatment of degenerative cervical spine diseases. One of the complications that can be observed during postoperative follow-up is cervical cage subsidence. At this point, it is investigated in this study the relationship between the loss of endplate brightness observed on early postoperative cervical radiographs and the development of cervical cage subsidence during follow-up. Methods: 100 patients who underwent single-level cervical disc herniation surgery between 2013 and 2023 were selected. The patients were divided into two groups based on the presence or absence of cage subsidence in cervical radiographs taken at the 60-day postoperative follow-up. In all patients included in the study, the presence of endplate brightness loss in the cervical radiographs taken within the day 1 of post-surgery period in the vertebrae adjacent to the cage was evaluated and compared between groups. Results: Cage subsidence was detected in 11 patients (11%), while it was not observed in 89 patients (89%). Among the 11 patients with cage subsidence, endplate brightness loss was identified in 8 patients (72.7%), whereas it was found in 10 patients (11.2%) among the 89 patients without cage subsidence. These results indicate a significant relationship between the loss of endplate brightness observed on early radiographs and the occurrence of cervical cage subsidence during later follow-up (p

Comparison of Cervical Biportal Endoscopic Spine Surgery and Anterior Cervical Discectomy and Fusion in Patients with Symptomatic Cervical Disc Herniation.

Background: We aimed to analyze the clinical outcomes and effectiveness of cervical biportal endoscopic spine surgery (C-BESS) and anterior cervical discectomy and fusion (ACDF) in patients with symptomatic cervical disc herniation. Methods: This study was a retrospective chart review of four-year clinical data involving 318 cases of symptomatic cervical disc herniation, with 156 patients undergoing the ACDF and 162 patients receiving the C-BESS. Preoperative and postoperative one-year data were collected. Results: The numeric rating scale and neck disability index showed statistically significant improvement for both ACDF and C-BESS groups. While showing a longer operation time and more blood loss during surgery compared to the ACDF group, the C-BESS group demonstrated a learning effect as the surgeon's proficiency increased with more cases. There was no significant difference in the postoperative length of hospitalization between the two methods. The subgroup with predominant arm pain revealed the statistical difference in arm pain intensity changes between the two groups (p < 0.001). The rates of complication were 2.6% for the ACDF group and 1.9% for the C-BESS group. Conclusions: C-BESS and ACDF are effective surgical treatments for patients with symptomatic single-level cervical disc herniation in relieving relevant pain intensities and pain-related disabilities.

The Effects of Rehabilitation Following Anterior Cervical Microdiscectomy and Fusion Surgery.

To determine the effects of physical therapy and exercise programs that was performed after anterior cervical discectomy and fusion (ACDF) surgery on patient?s pain treatment, a retrospective study was designed. Of the 127 patients without neurological deficit who underwent ACDF surgery in our clinic in 2019 and 2020 for single-level cervical disc herniation, 40 patients (including 23 men and 17 women) were enrolled. The mean age of the patients was 45.5 years. The patients were separated into two groups. Group A comprised 20 patients who did not apply for a post-ACDF physical therapy and exercise program. Group B comprised 20 patients who applied for a 6-month post-ACDF physical therapy and exercise program and complied with it. The Oswestry Deficiency Index (ODI), visual analog pain scale (VAS), and C2-7 cervical lordosis angle were evaluated. The C2-7 cervical lordosis angles were individually calibrated and calculated for each patient using Surgimap. The relationships between the results were compared using Wilcoxon biostatistics test. The ODI, VAS, and C2-7 cervical lordosis angle parameters of Groups A and B were statistically compared. No significant differences in the ODI, VAS, and C2-7 cervical lordosis angle 2 days after surgery and C2-7 cervical lordosis angle 6 months after surgery were observed between the two groups; however, significant differences were observed in VAS and ODI values 6 months after physical therapy in Group B and in VAS and ODI values 6 months after surgery in Group A. No significant difference in C2-7 cervical lordosis angle 6 months after surgery was observed between post-physical therapy Group B and postoperative Group A. Physical therapy and exercise program performed early after ACDF enhances and improves pain management and does not cause any changes in the restoration of cervical misalignment.

Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty: A Comparison of National Trends and Outcomes

Anterior cervical discectomy and fusion (ACDF) has been considered the standard treatment for degenerative cervical disc disease; however, recent trials have shown comparable outcomes with cervical disc arthroplasty (CDA). This study aimed to observe disparities in treatment paradigms of single-level cervical disc diseases and compare inpatient outcomes between procedures. A retrospective cohort of patients treated for single-level cervical disc herniation or degeneration without myelopathy was queried from the Nationwide Inpatient Sample spanning 2012-2015. Multivariate logistic regression was performed to assess the effects of demographics, temporality of admission, and hospital characteristics on odds of receiving CDA versus ACDF. Propensity-score matching was performed to compare cost, length of stay (LOS), non-home discharge, and inpatient complications. In total, 1028 CDAs and 44,374 ACDFs were performed for single-level cervical disc disease during 2012-2015. Matched comparison showed that while non-home discharges were not different between CDA and ACDF (P= 0.248), patients who received CDA had a 0.19-day shorter LOS (P < 0.001) and $4694 greater total cost (P < 0.001). There were no statistically significant differences in inpatient complication rates. Multivariate analysis showed that patients in the 26th-50th percentile, 51st-75th percentile, and 76th-100th percentile of median household income had greater odds of CDA compared with patients in the 0-25th percentile (odds ratio [OR] 1.35, P= 0.003; OR 1.31, P= 0.013; OR 1.34, P= 0.011, respectively). Patients with private insurance had greater odds of receiving CDA compared with patients on Medicare (OR 1.91, P < 0.001). CDA was associated with shorter LOS but greater costs compared with ACDF. Patients with greater median income and private insurance were more likely to receive CDA.

Comparative evaluation of posterior percutaneous endoscopy cervical discectomy using a 3.7\u2009mm endoscope and a 6.9\u2009mm endoscope for cervical disc herniation: a retrospective comparative cohort study

BackgroundPosterior percutaneous endoscopy cervical discectomy (p-PECD) is an effective strategy for the treatment of cervical diseases, with a working cannula ranging from 3.7 mm to 6.9 mm in diameter. However, to date, no studies have been performed to compare the clinical outcomes of the use of endoscopes with different diameters in cervical disc herniation (CDH) patients. The purpose of this study was to compare the clinical outcomes of patients with unilateral CDH treated with p-PECD using a 3.7 mm endoscope and a 6.9 mm endoscope.MethodsFrom January 2016 to June 2018, a total of 28 consecutive patients with single-level CDH who received p-PECD using either the 3.7 mm or the 6.9 mm endoscope were enrolled. The clinical results, including the surgical duration, hospitalization, visual analog scale (VAS) score and modified MacNab criteria, were evaluated. Cervical fluoroscopy, CT, and MRI were also performed during follow-up.ResultsTthere was a significant difference in regard to the average identification time of the “V” point (18.608 ± 3.7607 min vs. 11.256 ± 2.7161 min, p < 0.001) and the mean removal time of the overlying tissue (16.650 ± 4.1730 min vs. 12.712 ± 3.3079 min, p < 0.05) for the use of the 3.7 mm endoscope and the 6.9 mm endoscope, respectively. The postoperative VAS and MacNab scores of the two endoscopes were significantly improved compared with those the preoperative scores (p < 0.05).ConclusionThe application of both the 3.7 mm endoscope and 6.9 mm endoscope represent an effective method for the treatment of CDH in selected patients, and no significant difference can be observed in the clinical outcomes of the endoscopes. The 6.9 mm endoscope shows superiority to the 3.7 mm endoscope in terms of the efficiency of “V” point identification, the removal of overlying soft tissue and the prevention of spinal cord injury. However, the 6.9 mm endoscope may be inferior to the 3.7 mm endoscope in regards to anterior foraminal decompression due to its large diameter; this result needs to be further evaluated with the support of a large number of randomized controlled trials.

Is There Any Relationship Between Cervical Disc Herniation and Blood Inflammatory Response?

ObjectiveInflammation plays an important role in the pathophysiology of disc herniation. The aim of this study was to evaluate blood neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and C-reactive protein (CRP) levels in cervical disc herniation (CDH) patients.Materials and methodsWe retrospectively analyzed the medical records of 126 patients with neck pain who were treated as inpatients at the Neurosurgery Department of Harran University Faculty of Medicine. The NLR, PLR, and CRP levels during hospital admissions were documented.ResultsThe study included 73 patients with CDH and neck pain, 53 patients with normal cervical MR examination and neck pain, and 50 healthy control subjects. The group with cervical disc hernia had a significantly higher mean serum leucocyte count, neutrophil count, NLR, and CRP level compared to those with a normal MR but neck pain and the control group. NLR was significantly higher in the multi-level CDH group compared to the control group, while the single-level CDH and multi-level CDH had no significant difference with respect to mean serum inflammatory parameters.ConclusionHigher NLR and CRP in patients with CDH compared to patients with neck pain but normal cervical MR and the controls may be due to a developing inflammatory response. It may be speculated that among patients with neck pain, those with non-elevated NLR and CRP levels may have normal neck MR imaging, and in patients with elevated NLR and CRP levels, early protective approaches may play a preventive role in disc degeneration and cervical disc hernia development.

Clinical study of single-level cervical disc herniation treated by full-endoscopic decompression via anterior transcorporeal approach

To investigate the clinical feasibility of full-endoscopic decompression for the treatment of single-level cervical disc herniation via anterior transcorporeal approach. According to the inclusion and exclusion criteria, 21 patients with cervical disc herniation who received full-endoscopic decompression via anterior transcorporeal approach between September 2014 and March 2016 were retrospectively analyzed. There were 12 males and 9 females with an age ranged from 32 to 65 years, with an average of 48.5 years. The duration of symptoms ranged from 6 to 18 weeks, with an average of 10.5 weeks. According to the Nurick grading of spinal cord symptoms, there were 2 cases with grade 1, 7 cases with grade 2, and 12 cases with grade 3. Operative segment was C 3, 4 in 2 cases, C 4, 5 in 8 cases, C 5, 6 in 9 cases, and C 6, 7 in 2 cases. The operation time and related complications were recorded. The central vertical height of the vertebral body and the diseased segment space were measured on the cervical X-ray film. The neck and shoulder pain were evaluated by visual analogue scale (VAS) score; Japanese Orthopaedic Association (JOA) score was used to evaluate the improvement of neurological function in patients. The MRI of cervical spine was reexamined at 3 months after operation, and the CT of cervical spine was reexamined at 12 months after operation. The decompression of spinal cord and the healing of bone canal in the vertebral body were further evaluated. Full-endoscopic decompression via anterior transcorporeal approach were achieved at all 21 patients. The operation time was 85-135 minutes, with an average of 96.5 minutes. All patients were followed up 24-27 months, with an average of 24.5 months. There was no complication such as residual nucleus pulposus, spinal cord injury, large esophageal vessels injury, pleural effusion, endplate collapse, intraspinal hematoma, cervical spine instability, protrusion of disc in the same segment, or kyphosis. Both VAS scores of neck and shoulder pain and JOA scores were significantly improved at 12 months after operation ( P<0.05). At 3 months after operation, it was confirmed by the cervical MRI that neural decompression was sufficient and the abnormal signal was also degraded in the patients with intramedullary high signal at T2-weighted image. The cervical CT showed that bone healing were achieved in the surgical vertebral bodies of all patients at 12 months after operation. At 24 months after operation, the central vertical height of the diseased segment space significantly decreased compared with preoperative one ( t=2.043, P=0.035); but there was no significant difference in the central vertical height of the vertebral body between pre- and post-operation ( t=0.881, P=0.421). Full-endoscopic decompression via anterior transcorporeal approach, integrating the advantages of the endoscopic surgery and the transcorporeal approach, provide an ideal and thorough decompression of the ventral spinal cord with satisfactory clinical and radiographic results.

The relationship between facet tropism and cervical disc herniation.

Many studies have demonstrated the association between facet tropism and disc herniation in the lumbar spine. Some of them found that lumbar disc herniation was on the side of the more sagittal facet joint interface. However, little is understood about the association of facet tropism with disc herniation in the cervical spine. As the relationship between the facet orientation and the side of cervical disc herniation (CDH) is unclear, the purpose of this study is to investigate that relationship. Ninety-six patients with single-level CDH (C4-C5, C5-C6 or C6-C7) were included in the CDH group of this study. Another 50 age-matched and gender-matched healthy participants who accepted physical examinations were enrolled as the control group. The cervical facet angles of two sides were measured using axial computed tomography (CT). The intersection angle of the midsagittal line of the vertebra to the facet line represents the facet angle. Facet tropism was defined as the angular difference of 7º between the left and the right sides. Facet tropism angle was recorded as the absolute value of the difference of facet angles between two sides. There were 20 herniations at C4-C5 level, 50 herniations at C5-C6 level and 26 herniations at C6-C7 level. The present study showed that more cases in the CDH group had facet tropism than did those in the control group at C4-C5, C5-C6 and C6-C7 level (p=.021, p=.001, p=.015, respectively). The facet tropism angles in the CDH group were significantly bigger than those in the control group at C4-C5, C5-C6 and C6-C7 level (p=.001, p=.002, p=.028, respectively). In the CDH group, the facet angles on the herniated side were found to be significantly bigger than those on the healthy side at C4-C5, C5-C6 and C6-C7 level (p=.000, p=.000, p=.037, respectively). The findings of this present study suggest that facet tropism is associated with the disc herniation in the cervical spine. We also found that cervical disc herniates towards the side of the bigger facet angle with respect to the sagittal plane. There is a need for future studies to verify the biomechanical impact of facet tropism on CDH.

Finite element method to study cervical postoperative stability

A cervical spine model built by means of the finite element method was used to determine the risk of postoperative cervical instability in relation to the type of discectomy, in cervical disc herniation. Furthermore, this model was employed to check whether, at the adjacent levels of the fusion discectomy, the intervertebral translation during cervical movements will maintain the normal amplitude [normal ROM] or its amplitude will decrease.&#x0D; The intervertebral displacement and the tension arising from motion and weight in the cervical vertebral structure were thus determined through computer modelling using the above-mentioned method and the software Abaqus. It resulted in a cervical spine model consisting of 739666 finite elements interacting through 210530 nodes, with biomechanical properties following the vertebral anatomical structures modelled.&#x0D; Two movement situations were studied to determine the behaviour of this model. Firstly, the moment of force for flexion and extension of 1 Nm. Secondly, we aimed to establish the maximum flexion and extension for a normal cervical spine model in order to determine the momentum value of moving forces for each of them.&#x0D; It was showed that both anterior cervical microdiscectomy without fusion and cervical discectomy with cage fusion (used for the surgical treatment of cervical disc herniation at one level), ensure postoperative vertebral stability when performed properly. Both types of surgery reduce the mobility of the cervical spine, although more in the case of fusion discectomy. The intradiscal tension increases in movement in both models, with a higher intensification in the fusion discectomy model.&#x0D; The practical conclusion is that microdiscectomy without fusion is preferable in the case of a single-level cervical disc herniation occurred to a cervical spine without instability.

Anterior Cervical Discectomy with or without Fusion in Non-traumatic Single level Cervical Disc Disorder: Study of 50 Cases

Objectives: The aim of this study is to compare patients undergoing single level anterior cervical discectomy without fusion (ACD) versus anterior cervical discectomy with fusion (ACDF).&#x0D; Methods: A retrospective analysis of 50 patients with degenerative cervical spondylosis of them 25 had undergone ACD without fusion and remaining 25 undergone ACDF at either C4-C5, C5- C6 level or at C6-C7 level.&#x0D; Results: The kinematic analysis included the range of motion, intervertebral angulations, anteroposterior translation and disc height assessed for the cervical functional spinal units at the operated level and adjacent levels. At the operated level of C4-C5, C5-C6 and C6-C7, the range of motion and the translation were minimal in the anterior cervical discectomy without fusion (ACD) group, but absent in the cervical discectomy with fusion (ACDF) group. The superior adjacent levels range of motion and the translation were greater in the ACDF group compared with the ACD group. But both groups had almost similar results in term of hospital stay, mean time for improvement and patient satisfaction.&#x0D; Conclusion: The clinical results of anterior cervical discectomy without fusion (ACD) and anterior cervical discectomy with fusion (ACDF) were comparable. In cervical discectomy without fusion, the elastic fibrous intradiscal scar at the operated level allows a small degree of mobility and the adjacent cervical levels are not overstressed. Fusion is not routinely required in single level cervical disc herniation until it is associated with instability, loss of cervical lordosis, hard disc, osteophytic bar and multi-segmental disease. So ACD is a better option in single level cervical disc disorder than ACDF.&#x0D; J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 29-35

Surgery in cervical disc herniation: anterior cervical discectomy without fusion or with fusion

Abstract The study included a group of anterior cervical microdiscectomy without fusion performed at one level (either C5-C6 level or at the C6-C7 level) and a second group of patients with same single-level of anterior cervical discectomy with fusion. The kinematic analysis included the range of motion, anteroposterior translation and disc height assessed for the cervical functional spinal units at the operated level and adjacent levels. At the operated level the range of motion and the translation were minimal in the anterior cervical discectomy without fusion group, both for the C5-C6 and C6-C7 levels, and absent in the cervical discectomy with fusion group. The superior adjacent levels translations were greater in the ACDF group compared with the ACD group. The clinical results of both types of cervical discectomy were comparable. In cervical microdiscectomy without fusion the elastic fibrous intradiscal scar at the operated level allows a small degree of mobility and the adjacent cervical levels are not overstressed. No need for anterior cervical discectomy with fusion to trait a single level cervical disc herniation than in selected cases.

Randomized Controlled Study of Percutaneous Epidural Neuroplasty Using Racz Catheter and Epidural Steroid Injection in Cervical Disc Disease

Background: The efficacy of lumbar percutaneous epidural neuroplasty (PEN) as a minimally invasive technique has been relatively well investigated, but the clinical effectiveness of cervical PEN (C-PEN) has yet to be established. Objective: The purpose of this study was to compare clinical outcomes between C-PEN and cervical epidural steroid injection (C-ESI). Study Design: Randomized control study. Setting: University hospital center. Methods: Eighty patients with neck pain from single level cervical disease with and without radiculopathy were included in this study. Patients were randomly assigned into 2 groups: C-PEN or C-ESI. Clinical outcomes were assessed according to Neck Disability Index (NDI) score and Visual Analog Scale (VAS) score for arm pain until 12 months after treatment. Results: All C-PEN and C-ESI groups showed better NDI recovery and greater reduction in VAS score at postoperative 6 months (P &lt; 0.001). The C-PEN group demonstrated better NDI score at postoperative 6 months than the C-ESI group (P = 0.014), while there were no differences at 2, 4, and 12 months. Additionally, the C-PEN group showed lower VAS scores at all follow-up intervals compared to the C-ESI group (P &lt; 0.050). Symptom relief was sustained for a significantly longer duration in the C-PEN group than in the C-ESI group (23.4 vs. 20.5 weeks, P &lt; 0.001). Limitations: The follow-up period was relatively short with a small sample size, and the grade of cervical disc disease, root compression, and disc degeneration grade were could not considered in this study. Conclusions: C-PEN was superior to C-ESI in terms of better NDI recovery (at 6 months) and greater reduction in VAS score (until 12 months) in treating single level cervical disc herniation. Better outcomes with C-PEN may have been achieved via a more localized selective block in the epidural space closer to the dorsal root ganglion and ventral aspect of the nerve root. Key words: Cervical, cervical disc disease, pain management, percutaneous epidural neuroplasty, percutaneous adhesiolysis, epidural steroid injection

Effect of single-level Discover cervical artificial disc replacement on cervical sagittal alignment

Objective To evaluate the effect of single-level Discover cervical artificial disc replacement on cervical sagittal alignment. Methods Retrospective analysis was conducted on patients who underwent single-level Discover cervical artificial disc replacement in our hospital from February 2012 to September 2014. Sixty-two patients (34 males, 28 females) with an average age of 45.2±8.2 (31-61) who were diagnosed with single-level cervical disc herniation were included (C3-4 3 cases, C4-5 12 cases, C5-6 34 cases, C6-7 13 cases). We measured the cervical sagittal alignment parameters: index level disc angle, functional spinal unit (FSU) angle, C2-C7 angle, anterior disc height (ADH), middle disc height (MDH), posterior disc height (PDH), anterior FSU height (AFH), middle FSU height (MFH), posterior FSU height (PFH) on neutral lateral radiographs before surgery and 3 months after surgery. Results All of the patients were followed up for 3 months. The cervical sagittal alignment parameters before surgery and 3 months after surgery were as follows. Index level disc angle increased from 0.0°±4.2° to 7.3°±3.9°, FSU angle increased from 2.3°±5.0° to 6.9°±4.8°, C2-C7 angle increased from 9.5°±10.8° to 13.1°±9.1°, ADH increased from 4.3±1.0 mm to 7.9±1.1 mm, MDH increased from 5.8±0.9 mm to 8.1±0.9 mm, PDH increased from 3.7±0.9 mm to 5.5±0.9 mm, AFH increased from 34.1±3.5 mm to 36.2±3.4 mm, MFH increased from 32.3±3.5 mm to 33.6±3.3 mm, PFH increased from 33.9±3.5 mm to 34.6±3.2 mm. All changes were statistically significant (P<0.05). Conclusion Single-level Discover cervical artificial disc replacement can improve the disk angle, FSU angle, and disk height effectively in early follow-up period, thereby improving the cervical sagittal alignment. Key words: Cervical vertebrae; Total disc replacement; Treatment outcome

Surgical Outcomes of Cervical Disc Herniation Causing Deltoid Palsy: Multicenter Study

Introduction In general, deltoid palsy develops in patients with cervical disc herniation (CDH) at the level of C4–5, resulting in compression of the C5 nerve root. Because of duplicate nerve innervation, however, deltoid palsy can also develop when CDH is at the levels of C3–4 and C5–6. To date, little has been known about the surgical outcomes of CDH causing deltoid palsy. We report on by far the largest series of CDH causing deltoid palsy focusing on surgical outcomes in the literature. Patients and Methods A total of 61 patients with CDH causing deltoid palsy (less than grade 3) were identified among 13 surgeons and included in this study. Average age of the patients was 51.4 years (range, 25–69 years), with 49 males and 12 females. Overall, 35 patients were soft disc and 26 patients were hard disc. Overall, 32 patients had single-level CDH (22 C4–5, 9 C5–6 and 1 C3–4), 22 had two-level (19 C4–5-6, 2 C3–4-5 and 1 C5–6-7), 4 had three-level (4 C4–5-6–7), 3 had four-level (3 C3–4-5–6-7). All the patients underwent surgery for deltoid palsy and arm pain not responding to conservative treatment: 57 ACDF, 2 ADR, and 2 foraminotomy and discectomy. Average follow-up was 20.7 months (range, 6–83 months). The severity of deltoid palsy was classified into five grades according to manual motor power test, and the severity of radiculopathy was recorded on a visual analog scale (VAS) of arm pain (0–10 points). The degree of improvement in both the severity of deltoid palsy and arm pain following surgery was evaluated. Patients with accompanying myelopathy, shoulder diseases, or peripheral neuropathy were excluded from the study. Results Average duration of deltoid palsy was 11.9 weeks (range, 1–156 weeks). Both deltoid palsy and radiculopathy improved significantly with surgery (2.4 vs. 4.5 grades, p &lt; 0.001) and (6.4 vs. 2.1 points, p &lt; 0.001), respectively. Of 61 patients, 36 (59%) patients achieved full recovery of deltoid palsy with an average time of 8.4 weeks (range, 1–54 weeks). Longer duration of deltoid palsy negatively affected the degree of improvement of deltoid palsy after surgery (correlation coefficient −0.351; p &lt; 0.01). Severity of preoperative deltoid palsy, type of disc (soft disc or hard disc), and gender did not affect the degree of improvement of deltoid palsy after surgery. Conclusion This study demonstrates that surgical decompression significantly improves the degree of deltoid palsy and radiculopathy because of the CDH irrespective of the type of disc. The longer the duration of deltoid palsy preoperatively, the lower the degree of improvement of deltoid palsy postoperatively. Thus, early surgical decompression is recommended for improvement of deltoid palsy in patients with CDH.

Adjacent segment degeneration after single-level anterior cervical decompression and fusion: Disc space distraction and its impact on clinical outcomes

The purpose of this study was to find whether excessive distraction of the disc space for cage insertion was a risk factor for adjacent segment degeneration (ASD) after anterior cervical decompression and fusion (ACDF). One hundred and sixteen consecutive patients who underwent ACDF for single-level cervical disc herniation between June 2006 and November 2008 were retrospectively reviewed. Preoperative, postoperative and final follow-up disc height (DH), sagittal segmental alignment (SSA), and sagittal alignment of the cervical spine (SACS) were measured and compared between the ASD group and non-ASD group. In 116 patients, ASD was radiographically proven in 28 (24.1%) patients. The clinical outcomes were significantly improved compared to the preoperative scores in both groups. However, the postoperative and final follow-up DH of the ASD group were significantly higher than in the non-ASD group (p<0.05). In addition, the postoperative DH was significantly correlated with the postoperative or final follow-up SSA (p<0.05). However, postoperative DH was not found to significantly correlate with postoperative or final follow-up SACS (p=0.072 and p=0.096, respectively). Multivariate analysis showed that postoperative DH was the most significant risk factor for ASD. The clinical outcomes of ACDF for single-level degenerative cervical disc disease were satisfactory. Postoperative DH (the distracted distance) had the greatest impact on the incidence of ASD. Excessive disc space distraction is a considerable risk factor for the development of radiographic ASD.

Anterior cervical decompression and fusion for a single-level cervical disc herniation

Cervical radiculopathy is a clinical diagnosis consisting of sensory and/or motor symptoms in a nerve root distribution of the upper extremity. Operative management is frequently required to relieve symptoms. Anterior cervical decompression and fusion (ACDF) was originally described by Smith and Robinson and has been shown to be a relatively safe treatment approach to the cervical spine. Modern advances have helped to improve outcomes and decrease complications, including the development of bone grafting techniques, cage constructs, and augmentation of grafting with anterior plating systems. Anterior plating serves to increase fusion rates and maintain sagittal alignment. Despite advancements, complications still exist, including dysphagia, dural tear, adjacent segment disease, esophageal perforation, hardware failure, and recurrence of symptoms. We have reviewed the literature and shown that for single-level radiculopathy of a nerve root in the cervical spine, ACDF with plating is a favorable surgical treatment.

Empty Bladed PEEK Cage for Interbody Fusion after Anterior Cervical Discectomy.

Cervical disc herniation (CDH) can be treated using different anterior and posterior methods. Anterior cervical discectomy and fusion (ACDF) is currently gold standard and provides bony fusion and good clinical outcome. Recently many studies reported good clinical and radiological outcomes in cases who underwent anterior cervical discectomy (ACD) and reconstruction with empty cage. This study aimed to review our results after cervical microdiscectomy reconstructed with empty polyether ether ketone (PEEK) cage. Twenty-five cases with single level CDH who underwent microdiscectomy were included to this study. Reconstruction was performed using empty bladed cervical PEEK cages. Clinical (Visual analogue scale (VAS) and Odom scores) and radiological results (intervertebral disc and foraminal heights, mean cervical spine lordosis angle, and fusion rate) were reviewed one day and one year after surgery. There were 18 males and 7 females, aged between 25 and 54 years (mean: 40.8). Mean neck and arm VAS scores reduced from 2.9 to 1.4, and from 7.2 to 1.8, respectively. Odom scores were found to be 1.6 and 1.4 at 1st day and one year postoperatively, respectively. Subsidence was seen in three cases (12%). There was no significant change in heights of neural foramina and intervertebral discs, and no change in cervical spine lordosis, when compared postoperative 1st day and one year radiographs. Fusion was detected in 92% of cases in one year. Bladed cervical cages are safe with almost no risk of dislocation. Empty cages provide acceptable rates of fusion and subsidence.

Comparison of cervical kinematics between patients with cervical artificial disc replacement and anterior cervical discectomy and fusion for cervical disc herniation

Background contextAlthough anterior cervical discectomy and fusion (ACDF) is an effective treatment option for patients with cervical disc herniation, it limits cervical range of motion, which sometimes causes discomfort and leads to biomechanical stress at neighboring segments. In contrast, cervical artificial disc replacement (ADR) is supposed to preserve normal cervical range of motion than ACDF. A biomechanical measurement is necessary to identify the advantages and clinical implications of ADR. However, literature is scarce about this topic and in those available studies, authors used the static radiological method, which cannot identify three-dimensional motion and coupled movement during motion of one axis. PurposeThe purpose of this study was to compare the clinical parameters and cervical motion by three-dimensional motion analysis between ACDF and ADR and to investigate the ability of ADR to maintain cervical kinematics. Study designThis was a prospective case control study. Patient samplePatients who underwent ADR or ACDF for the treatment of single-level cervical disc herniation. Outcome measuresVisual analog scale (VAS), Korean version of Neck Disability Index (NDI, %), and three-dimensional motion analysis were used. MethodsThe patients were evaluated by VAS and the Korean version of the NDI (%) to assess pain degree and functional status. Cervical motions were assessed by three-dimensional motion analysis in terms of sagittal, coronal, and horizontal planes. Markers of 2.5 cm in diameter were attached at frontal polar (Fpz), center (Cz), and occipital (Oz) of 10–20 system of electroencephalography, C7 spinous process, and both acromions. These evaluations were performed preoperatively and 1 month and 6 months after surgery. ResultsThe ACDF and ADR groups revealed no significant difference in VAS, NDI (%), and cervical range of motion preoperatively. After surgery, both groups showed no significant difference in VAS and NDI (%). In motion analysis, significantly more range of motion was retained in flexion and extension in the ADR group than the ACDF group at 1 month and 6 months. There was no significant difference in lateral tilt and rotation angle. In terms of coupled motion, ADR group exhibited significantly more preserved sagittal plane motion during right and left rotation and also showed significantly more preserved right lateral bending angle during right rotation than ACDF group at 1 month and 6 months. There was no significant difference in other coupled motions. ConclusionThree-dimensional motion analysis could provide useful information in an objective and quantitative way about cervical motion after surgery. In addition, it allowed us to measure not only main motion but also coupled motion in three planes. ADR demonstrated better retained cervical motion mainly in sagittal plane (flexion and extension) and better preserved coupled sagittal and coronal motion during transverse plane motion than ACDF. ADR had the advantage in that it had the ability to preserve more cervical motions after surgery than ACDF.

New Cervical Compressive Staple

In vitro testing and retrospective study. To evaluate the biomechanical and preliminary clinical results of a staple. Anterior cervical discectomy and fusion is currently the most used technique in cervical surgery. Arthrodesis is obtained with a spacer generally secured using a screwed osteosynthesis plate. Implantation of a plate is time consuming and exposes the patient to additional adverse events. The C-JAWS device is a new cervical compressive staple developed to stabilize the spacer. Intact and instrumented behaviors of 6 cervical segments were compared. Instrumentation consisted of a spacer and the staple, fixed at C5-C6 level. The 3-dimensional ranges of motion (ROM) of C5 regarding C6 was tracked. Twenty-three consecutive patients, with single-level cervical disc herniation, were reviewed retrospectively. All patients were treated with anterior cervical discectomy and fusion using a spacer secured by the staple. The Neck Disability Index score and Pain scores were reported; radiographic examinations were used to assess fusion. Mean ROM were 10 degrees, 8 degrees, and 10 degrees for the intact specimens and 4 degrees, 5 degrees, and 8 degrees for the instrumented ones in flexion-extension, lateral bending, and axial torsion, respectively. The mean clinical follow-up was 24.4 months. The mean operating time was 35 minutes. Patients showed sustained clinical improvement, and radiographic fusion was obtained at last follow-up. No clinical complication was reported except 1 hardware breakage for a borderline indication: the patient reported no complaint, and solid fusion was obtained. Experimental results showed reduced ROM of the instrumented spine regarding the intact one. Fusion rate and the occurrence of complication are similar to previous published data. The staple seems to provide a safe and effective new way to stabilize and secure a spacer with a short surgical time. A multicenter prospective clinical study, with more patients, is in progress to confirm these promising results.

Advantages of the Plating for Anterior Cervical Discectomy and fusion: Comparison with Wearing Cervical Collar Without Plate

Objective: Most patients wear cervical braces regardless of any anterior cervical discectomy and fusion (ACDF) technique for cervical disc herniation, even in the plating. We compared clinical and radiological results in patients with cervical disc herniations. The purpose of this study was to evaluate the efficacy of plate insertion during ACDF and determine if this could eliminate the need for external cervical braces after ACDF. Methods: In this study, we evaluated 67 patients treated for single level cervical disc herniation with radiculopathy. The patients were divided into two groups: 30 patients treated with ACDF using a Solis ® cage with plating who did not wear a cervical brace after the operation (Group I: Plated group), and 37 patients treated with ACDF using a Solis ® cage without plating who wore a cervical brace for 3 months (Group II: Non-plated group). Clinical outcomes were assessed using the neck disability index (NDI), and visual analogue scale (VAS) for neck and arm pain at different times after the surgery. In addition, modified MacNab’s grading criteria were used to assess the subjective patients’ outcome at the last follow-up. Fusion was assessed at 6, 12, and 18 months after the surgery using upright AP, lateral, and flexion-extension views. Results: Excellent or good results were achieved in the most patients from both groups. Patients in both groups showed marked pain relief in terms of neck and arm pain scores over all time intervals. The NDI scores in both groups significantly improved when compared to preoperative scores; however, at 1 and 2 months after the surgery, patients in Group I (Plated group) had significantly better NDI scores compared to Group II (Non-plated group). Higher rates of fusion were reported in Group I over all time intervals although none of these were statistically significant. There were two patients who required second surgery for cage subsidence in Group II. Conclusion: Our study demonstrates that anterior cervical fusion with plating for cervical radiculopathy is a safe and effective treatment which can eliminate unnecessary need for an external cervical brace.