Surgery For Cervical Disc Herniation Research Articles

Evaluation of the efficacy and safety of day surgery for cervical disc herniation treated with low temperature plasma radiofrequency ablation.

The purpose of this study was to evaluate and compare the clinical efficacy of patients with cervical disc herniation (CDH) treated by low-temperature plasma radiofrequency ablation (LTP-RFA) as day surgery with traditional inpatients. According to the selection criteria, single-segment mild to moderate CDH patients who received LTP-RFA from January 2020 to December 2021 were divided into day surgery procedure (DSP) group anda traditional inpatient procedure (TIP) group. The visual analogue score (VAS) and modified Japanese Orthopedic Association score (mJOA) of neurological function of patients in the two groups were recorded at the time of preoperative, and one day, three months, six months after surgery and the last follow-up respectively. The gender, age, responsible segment, surgical complications, hospitalization time, hospitalization expenses, and patient satisfaction were recorded and analyzed for both groups. The modified Macnab standard was used to evaluate the postoperative efficacy at one month and six months after operation. A total of 127 patients (75 in DSP;52 in TIP) with complete data were enrolled and completed sixmonth follow-up. There were no statistically significant pre-treatment VAS scores and mJOA scores in the two groups (P>0.05). The postoperative VAS and mJOA scores in both groups were improved after surgery (P<0.05). However, there was no significant difference in VAS scores and mJOA scores between the two groups in the same postoperative period (all P > 0.05). The efficacy of MacNab was similar one month and sixmonths after operation (P > 0.05). The hospitalization time and hospitalization cost were significantly lower in DSP group (all P<0.05). As the treatment effects were comparable, patients in both groups were similarly satisfied at discharge. LTP-RFA is an effective method for the treatment of mild to moderate CDH. We suggest that the application of LTP-RFA in DSP for mild to moderate CDH is worthy of wide application.

Clinical and Radiological Outcomes of a Comparative Study of Anterior Cervical Decompression and Fusion with Partial Pediculotomy, Partial Vertebrotomy (PPPV) Posterior Endoscopic Cervical Decompression (PECD) for Cervical Foraminal Pathology.

Background and Objectives: The purpose was to compaSre medium-term clinical and radiological outcomes of Partial Pediculotomy, Partial Vertebrotomy (PPPV) Posterior Endoscopic Cervical Decompression (PECD) surgery versus Anterior Cervical Discectomy and Fusion (ACDF) for patients with cervical disc herniations and foraminal pathologies. Materials and Methods: A prospective registry of patients who had undergone either PPPV PECD surgery or ACDF surgery for cervical disc herniation or foraminal pathologies under a single fellowship-trained spine surgeon was performed. The baseline characteristics and operative details including complications were recorded for all included patients. The clinical outcomes evaluated include VAS, MJOA, motor score, and NDI and MacNab's score. The radiological parameters in neutral-measured facet length, facet area, disc height, C2-C7 angle, neck tilt angle, T1 slope and thoracic inlet angle were also evaluated. Results: A total of 55 patients (29 PPPV PECD, 26 ACDF) were included, with mean follow-up periods of 21.9 and 32.3 months, respectively. Each cohort was noted to have a single case of surgical complication. Statistically significant changes of facet area (49.05 ± 14.50%) and facet length (52.71 ± 15.11%) were noted in the PPPV PECD group. At neutral alignment of the neck on a lateral X-ray, compared to ACDF, PPPV PECD had a statistically significant change in neck tilt angle (-11.68 ± 17.35°) and T1 slope angle (-11.69 ± 19.58°). Whilst both PPPV PECD and ACDF had significant improvements in VAS, MJOA and NDI postoperatively, PPPV PECD was found to be superior across all above scores at various follow-up timepoints compared to its ACDF counterparts. Conclusions: PPPV PECD surgery achieved a satisfactory radiological correction of neck alignment and significantly improved clinical outcomes at medium-term follow-up for our cohort of patients, highlighting its feasibility in treating patients with cervical disc herniations and foraminal pathologies.

Posterior percutaneous endoscopic versus traditional surgery for cervical disc herniation: A protocol for systematic review and meta analysis.

Background:Posterior percutaneous endoscopic cervical diskectomy (P-PECD) can be used posterior microdiscectomy for cervical disc herniation. But only some small sample sizes of clinical studies have evaluated the efficacy and safety of P-PECD. This study aim to evaluated the efficacy and safety of P-PECD compared with traditional open surgery.Methods:We will search the following seven electronic databases from their initiation to the May 1, 2020: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM) and Wanfang database. All randomized controlled trials, non-randomized controlled trials and retrospective case controls that compared the efficacy and safety of P-PECD and traditional open surgery in the treatment of cervical disc herniation will be included. The pooled odds ratio with 95% credible intervals (CIs) was used for the dichotomous variables. The mean difference with 95% CIs was used for the continuous variables. All analyses were conducted by Comprehensive Meta Analysis 2.0. A 2-tailed P value < 0.05 is considered statistically significant.Results:The results of systematic review and meta-analysis will be submitted to a peer-reviewed journal.Conclusion:Our study will provide clarity regarding for clinicians to choices best surgical approach for patients with cervical disc herniation. Any changes that need to be made during the process of this study will be explained in the final full-text publication.Protocol registration number:CRD42020164011.

Evaluation of Bone Marrow-derived Stem Cells and Adipose-derived Stem Cells Co-cultured on Human Nucleus Pulposus Cells: A Pilot Study.

ObjectiveWe aimed to determine whether bone marrow-derived mesenchymal stem cells (BDMSCs) effectively attenuate the degeneration of human nucleus pulposus cells (NPCs).MethodsFour NPC lines were obtained from 3 subjects who underwent spinal surgery for cervical disc herniation (n=1) or lumbar disc herniation (n=2). For co-culture wells without contact, BDMSCs and adipose-derived mesenchymal stem cells (ADMSCs) were seeded on tissue culture plates and maintained for 3 days. Senescence-associated β-gal (SA-β-gal) staining was represented as a percentage of the total number of stained cells (%). The cells with intracellular lipid droplets (LDs) were represented as the percentage of the number of cells with LDs. Glycosaminoglycan (GAG) secretion was measured at 450 nm, using a commercial kit, to analyze optical density.ResultsThe ratio of cells stained with SA-β-gal to the total number of cells reduced significantly when co-cultured with BDMSCs and ADMSCs (p<0.001 vs. p<0.001). The proportion of NPCs containing LDs was lower when co-cultured with BDMSCs than with ADMSCs (p<0.001). The optical density related to GAG secretion was lower in BDMSCs and ADMSCs co-cultured with NPCs than in the controls (p<0.001 vs. p<0.001).ConclusionSA-β-gal staining showed significant attenuation of degenerative changes in NPCs co-cultured with BDMSCs. Moreover, the unexpected increase in LDs was significantly higher in NPCs co-cultured with ADMSCs than in those co-cultured with BDMSCs. However, GAG secretion was significantly decreased in NPCs co-cultured with MSCs.

The strategy and results of percutaneous endoscopic surgery for cervical disc herniation

Objective To evaluate the strategy and clinical effects of percutaneous endoscopic surgery for cervical disc herniation. Methods Fifty-one patients with cervical disc herniation were treated with percutaneous endoscopic surgery from June 2015 to March 2017, including 32 men and 19 women, with an average age of 52.2 years (range, 28-66 years). Radicular symptoms were present in all patients, while 23 patients had mild myelopathy (Nurick Grade: 0-3) and 3 patients of multilevel stenosis had severe myelopathy (Nurick Grade: 4-5). According to axial image of preoperative magnetic resonance imaging (MRI), 31 patients had lateral herniation that was located lateral to the edge of spinal cord, 20 patients had central herniation that was located within the lateral edge of spinal cord. Among them, 48 patients had soft herniation and 3 patients had ossified lateral herniation combined with foraminal stenosis. All surgery was carried out under general anesthesia, while posterior and anterior percutaneous endoscopic surgeries were performed for lateral herniation and central herniation respectively. Posterior endoscopic surgery was performed with keyhole fenestration at V point (the junction of lateral edge of lamina space and inner edge of facet). Lateral edge of thecal sac and nerve root were exposed and decompressed, soft herniation was explored and removed. Anterior endoscopic surgery was performed through puncture and 4mm tube between the visceral sheath and vascular sheath. The tube was inserted through disc to the base of herniation under fluoroscopy. The herniation was removed until the dura sac was exposed and relaxed. One stage open-door laminoplasty was performed for 3 patients with severe multiple segmental stenosis and huge central herniation. The operative time and blood loss were recorded, and patients were followed-up (range, 6-18 months, average 12.1 months) to evaluate the clinical efficacy. Results The mean operative time of posterior endoscopic surgery was 90 min (range, 45-150 min). The nerve root was not well exposed, and the fenestration was too lateral in 1 patient, with partial relieve of symptoms; and simple nerve root decompression was performed for 3 patients of ossified herniation combined with foraminal stenosis. Herniated or sequestered nucleus pulposus was removed for 27 patients, one of them had transient paralysis ipsilateral limb and 2 of them had linkage of cerebrospinal fluid. The Visual Analogue Score (VAS) score improved form preoperative 8.9±1.6 to 0.5±0.4, and the Oswestry Disability Index (ODI) score improved form 32.8±4.2 to 2.3±1.9 at final follow-up. For anterior percutaneous endoscopic surgery, the mean operative time was 80 min (range, 45–120 min). Herniated or free nucleus was successfully removed for all patients. The thecal sac was lacerated due to unclear exposure in 1 case. The VAS score improved form preoperative 6.9±2.3 to 0.9±0.8, and the ODI score improved form 40.1±8.6 to 5.6±3.0 at final follow-up, with improvement of myelopathy at least one Nurick Grade. During follow-up, the alignment of cervical spine was well preserved without kyphosis for two groups, while the height of intervertebral space decreased with 0.4±0.3 mm and 0.9±0.6 mm in posterior and anterior surgery respectively. Conclusion Percutaneous endoscopic surgery provides minimally invasive alternatives for some cervical disc herniation with predominant radicular pain. Posterior endoscopic surgery is suitable for lateral herniation, and anterior endoscopic discectomy is suitable for some central soft herniation without obvious collapse and instability. However, the long-term results of disc space collapsed after anterior approach remains unclear. Key words: Cervical vertebrae; Intervertebral disc displacement; Endoscopy; Surgical procedures, minimally invasive

Full-endoscopic posterior foraminotomy surgery for cervical disc herniations.

Surgery for cervical disc herniation with full-endoscopic posterior access. Cervical disc herniation and neuroforaminal pathology with radicular symptoms. Neck pain alone, cervical myelopathy or pathologies with central nervous system symptoms, instabilities requiring correction/instabilities. Introduction of asurgical tube to the facet joint at the level to be operated on. Resection of bony and ligamentous parts of the cervical spinal canal under endoscopic guidance. Visualisation of the disc herniation and decompression of the neural structures. Immediate mobilisation, specific rehabilitative physiotherapy depending on pre-existing neurological deficits. A total of 87patients underwent full-endoscopic posterior surgery and were followed over aperiod of 2years. Significant improvement was observed. No serious complications occurred. In all, 5patients underwent revision in the follow-up period. Of the patients, 93% would undergo the procedure again.

The value of transcranial motor-evoked potentials and free-running electromyography in surgery for cervical disc herniation

The present study prospectively investigated the value of free-running electromyography (EMG) and transcranial motor-evoked potentials (TcMEP) during anterior cervical microdiscectomy and fusion for cervical disc herniation with radiculopathy. Thirty-eight patients were eligible for inclusion in the study. Pain was assessed using the visual analogue scale (VAS) score. Quality of life results were scored according to Odom’s criteria in the postoperative period. Patients with at least a 41% increase in TcMEP amplitude had an excellent postoperative outcome. When the increase of TcMEP amplitude was ⩽ 11% the patient’s outcome was fair. The VAS score decreased from a preoperative mean value of 6.39±2.16 to a 3-month postoperative value of 2.39±1.17. At 12-month follow-up the mean VAS score was 1.65±0.90. TcMEP and free-running EMG are effective for monitoring the spinal cord during surgery and may hold an additional prognostic role.

Percutaneous cervical nucleoplasty in the treatment of cervical disc herniation

Percutaneous disc decompression procedures have been performed in the past. Various percutaneous techniques such as percutaneous discectomy, laser discectomy, and nucleoplasty have been successful. Our prospective study was directly to evaluate the results of percutaneous cervical nucleoplasty (PCN) surgery for cervical disc herniation, and illustrate the effectiveness of PCN in symptomatic patients who had cervical herniated discs. From July of 2002 to June of 2005, 126 consecutive patients with contained cervical disc herniations have presented at the authors' clinic and treated by PCN. The patients' gender distribution for PCN was 65 male, 61 female. The age of patients ranged from 34 to 66 years (mean 51.9 +/- 10.2 years). The levels of involvement were 21 cases at C3-4, 30 cases at C4-5, 40 cases at C5-6, and 35 cases at C6-7. The clinical outcomes, pain reduction and the segment stability were all recorded during this study. A clinical outcome was quantified by the Macnab standard and using VAS. The angular displacement (AD) > or =11 degrees or horizontal displacement (HD) > or =3 mm was considered to be radiographically unstable. In the results of this study, puncture of the needle into the disc space was accurately performed under X-ray guidance in all cases. There was one case where the Perc-D Spine Wand had broken in the disc space during the procedure. The partial Perc-D Spine Wand, which had broken in the disc space could not be removed by the percutaneous cervical discectomy and thus remained there. There were no recurrent cases or complications in our series. Macnab standard results were excellent in 62 cases, good in 41 cases and fair in 23 cases. The rate of excellent and good was 83.73%. The VAS scores demonstrated statistically significant improvement in PCN at the 2-week, 1, 3, 6, and 12-month follow-up visits when compared to preoperational values (P < 0.01). There were no cases of instability following the PCN procedure. There was no significant difference in stability either preoperatively or postoperatively (P > 0.05). Our findings confirm that PCN for the treatment of cervical disc herniation results in a good outcome without any tampering of the stability of the cervical spine. Hence, PCN as a procedure is safe, minimally invasive, less traumatic, requiring less time with an excellent clinical outcome. PCN should be performed for those patients who fail conservative medical management including medication, physical therapy, behavioral management, psychotherapy, and who are unwilling to undergo a more invasive technique such as spinal surgery.

Is there any relationship between proinflammatory mediator levels in disc material and myelopathy with cervical disc herniation and spondylosis? A non-randomized, prospective clinical study

The proinflammatory mediator (PIM) levels were assessed in surgically removed samples of herniated cervical intervertebral discs. The objective of this study was to investigate if there is a correlation between the levels of PIMs in disc material and myelopathy associated with cervical intervertebral disc herniation and spondylosis. The role of proinflammatory mediators in the degeneration of intervertebral disc and the inflammatory effects of disc herniations on radicular pain has been previously published. However, the possible relationship between PIMs and myelopathy related to cervical disc herniation and spondylosis has not been investigated before. Thirty-two patients undergoing surgery for cervical disc herniation and spondylosis were investigated. Surgically obtained disc materials, stored at 70 degrees C, were classified into two groups: cervical disc herniation alone or with myelopathy. Biochemical preparation and solid phase enzyme amplified sensitivity immunoassay (ELISIA) analysis of the samples were performed to assess the concentration of mediators in the samples. Very similar values of interleukin-6 were found in both groups whereas the concentrations of mediators were significantly higher in myelopathy group. This study has demonstrated that PIMs are involved in cervical intervertebral disc degeneration with higher concentrations in the samples associated with myelopathy.

The value of neurophysiological and imaging studies in predicting outcome in the surgical treatment of cervical radiculopathy

It is not always easy to predict the degree of symptomatic improvement to be expected in a patient undergoing surgery for cervical disc herniation and radiculopathy. Here we investigate whether preoperative electromyography (EMG) can help select those most likely to benefit from intervention. We prospectively evaluated 20 patients whose required operative level was unclear after clinical examination and MRI scan alone. The surgical procedures was anterior cervical interbody fusion with the AcroMed carbon fibre cage. Clinical assessment employed using validated scoring systems (Prolo functional and economic scoring system). Patients underwent MRI preoperatively, and were assessed pre and postoperatively with neurophysiological studies (NPS) including nerve conduction studies and concentric needle EMG. Patients with preoperative evidence of cervical nerve root involvement on EMG (group A, n = 8) had better outcome (P = 0.001) following discectomy and anterior fusion than patients who had no evidence of nerve root damage on EMG (group B, n = 12). Prolo mean score +/- SEM for group A was 7.375 +/- 0.3750 and for group B was 5.583 +/- 0.2876. Thus, NPS are a valuable tool in selecting patients in this subgroup for cervical surgery.

Cervical brucellosis mimicking cervical disc herniation.

Brucellar spondylitis may be difficult to diagnose. Initial plain radiographs of the spine may show mild degenerative lesions. Although, magnetic resonance imaging of spine is mostly helpful to establish the disease, in some cases, it may lead to misdiagnosis. The aim of this report was to present a case of brucella infection involving the cervical spine that was falsely diagnosed and underwent to surgery for cervical disc herniation. Since the spinal form of brucellosis has no specific symptomatology, a patient has symptoms with mimicking the cervical hernia, with a history of disabling pain more severe than radicular pain, and especially who reside in countries where the disease is endemic, the brucella infection should be kept in mind in the differential diagnosis and specific diagnostic investigations such as brucella agglutination tests should be made before any treatment procedure.

Esophageal Perforation during Surgery on the Cervical Spine

Abstract Esophageal perforation during surgery for cervical disc herniation is a rare complication. Differences in the time of diagnosis of this complication in three patients-no delay and delays of 6 hours and 4 days, respectively-resulted in different symptoms and outcomes. Early detection of the perforation allows prompt treatment. In the early stage, primary suture and, if necessary, interposition of vital tissue are sufficient to complete healing. In later stages, only drainage procedures, sometimes with a diversion of the salivary leakage, are indicated. In the reported patients, the outcome was favorable. On the other hand as an ongoing infection may cause mediastinitis, awareness of this complication and urgent surgical treatment may be lifesaving.

Esophageal perforation during surgery on the cervical spine

Esophageal perforation during surgery for cervical disc herniation is a rare complication. Differences in the time of diagnosis of this complication in three patients--no delay and delays of 6 hours and 4 days, respectively--resulted in different symptoms and outcomes. Early detection of the perforation allows prompt treatment. In the early stage, primary suture and, if necessary, interposition of vital tissue are sufficient to complete healing. In later stages, only drainage procedures, sometimes with a diversion of the salivary leakage, are indicated. In the reported patients, the outcome was favorable. On the other hand as an ongoing infection may cause mediastinitis, awareness of this complication and urgent surgical treatment may be lifesaving.