Treatment Of Cervical Degenerative Disease Research Articles

Increased Change in Cervical Lordosis is Associated With Decreased Rate of Recovery in Patients With C5 Palsy.

A retrospective chart review. The authors aim to investigate the role of clinical and radiographic parameters in patients who underwent posterior cervical surgery, and their association with C5 palsy severity and time to recovery. Postoperative C5 palsy affects 1%-30% of patients undergoing posterior decompression, with or without fusion. Causation and avoidance of this complication remain widely debated. A single institution review of patients who underwent posterior cervical spine surgery was focused on using specific Common Procedural Technology codes associated with the patient population of interest. Patients were excluded if they had inadequate pre and postoperative imaging, as well as a history of prior cervical spine surgery, concurrent anterior surgery, intradural pathology, spinal tumor, or spinal trauma. Radiographic measurements of the pre and postoperative images were completed with subsequent intraclass correlation coefficient analysis to confirm the precision of measurements. Out of 105 total patients, 35 (33%) patients developed a C5 palsy. Twenty-four (69%) of those palsies completely resolved, with a median time to recovery of 8 months. Preoperative demographics and radiographic parameters demonstrated heterogeneity among those patients who did and did not have a resolution of palsy. Patients with increased change in C2-C7 lordosis (P = 0.011) after surgery were associated with decreased likelihood of recovery. Patients without a smoking history (P = 0.009) had an increased likelihood of recovering from C5 palsy. The degree of increased lordosis in the treatment of degenerative cervical disease plays a role in the rate of recovery from C5 palsy. This should be considered during preoperative planning in determining the amount of lordosis desired. In addition, patients without a smoking history were associated with a higher rate of recovery. Level IV.

Titanium-Coated Polyetheretherketone Cages Vs Full Titanium Cages for Stand-Alone 1- or 2-Level Anterior Cervical Discectomy and Fusion: A Comparative Study.

Anterior cervical discectomy and fusion (ACDF) for the surgical treatment of cervical degenerative disease often includes an intervertebral cage, which restores disc height and lordosis while promoting fusion . Cage materials include titanium (TTN) or polyetheretherketone (PEEK). Controversy in material selection stems from higher fusion rates with TNN, despite a higher subsidence rate, while PEEK cages demonstrate superior preservation of interspace height. Combining the advantages of both materials, TTN-coated PEEK (TCPEEK) cages were developed, featuring a PEEK core with similar stiffness to the bone, enveloped with a TTN coat, improving osteointegration. However, the potential superiority of TCPEEK over TTN cages has not been investigated. This study aimed to compare clinical and radiographic outcomes following single- or double-level ACDF using either TTN or TCPEEK cages. This retrospective single-center study included patients undergoing single- or double-level ACDF between 2017 and 2019. Clinical outcomes included the Neck Disability Index and revision surgery incidence. Radiographic parameters included cervical and segmental lordosis, C2 to C7 sagittal vertical axis, fusion, subsidence, and adjacent segment degeneration at a minimum 12-month follow-up. A total of 45 patients (16 TTN; 29 TCPEEK) and 58 cervical levels (21 TTN; 37 TCPEEK) were included. Both cages significantly improved Neck Disability Index scores (TTN -10.0; TCPEEK -14.1) without significant differences. Two single-level TCPEEK patients required revision surgery due to non-union. In the radiological assessments, no significant difference was found for subsidence rates (TTN 52.4%; TCPEEK 56.8%), adjacent segment degeneration, cervical and segmental lordosis, and changes in C2 to C7 sagittal vertical axis. Though not statistically significant, fusion rates trended slightly higher with TTN (90.5%) vs TCPEEK cages (86.5%). TTN and TCPEEK cages achieve satisfactory clinical and radiological outcomes in single- or double-level ACDF. This finding suggests that the choice between them can be based on other factors, such as surgeon preference or availability, rather than specific material properties. This study found that the selection of ACDF cage material did not affect clinical outcomes.

Systematic Review and Meta-Analysis of the Effect of Osteoporosis on Fusion Rates and Complications Following Surgery for Degenerative Cervical Spine Pathology.

As the elderly population grows, the increasing prevalence of osteoporosis presents a unique challenge for surgeons. Decreased bone strength and quality are associated with hardware failure and impaired bone healing, which may increase the rate of revision surgery and the development of complications. The purpose of this review is to determine the impact of osteoporosis on postoperative outcomes for patients with cervical degenerative disease or deformity. A systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Medical Subject Headings terms involving spine surgery for cervical degenerative disease and osteoporosis were performed. This review focused on radiographic outcomes, as well as surgical and medical complications. There were 16 studies included in the degenerative group and 9 in the deformity group. Across degenerative studies, lower bone mineral density was associated with increased rates of cage subsidence in osteoporotic patients undergoing operative treatment for cervical degenerative disease. Most studies reported varied results on the relationship between osteoporosis and other outcomes such as revision and readmission rates, costs, and perioperative complications. Our meta-analysis suggests that osteoporotic patients carry a greater risk of reduced fusion rates at 6 months and 1 year postoperatively. With respect to cervical deformity correction, although individual complication rates were unchanged with osteoporosis, the collective risk of incurring any complication may be increased in patients with poor bone stock. Overall, the literature suggests that outcomes for osteoporotic patients after cervical spine surgery are multifactorial. Osteoporosis seems to be a significant risk factor for developing cage subsidence and pseudarthrosis postoperatively, whereas reports on medical and hospital-related metrics were inconclusive. Our findings highlight the challenges of caring for osteoporotic patients and underline the need for adequately powered studies to understand how osteoporosis changes the risk index of patients undergoing cervical spine surgery. In patients undergoing cervical spine surgery for degenerative disease, osteoporosis is a significant risk factor for long-term postoperative complications-notably cage subsidence and pseudarthrosis. Given the elective nature of these procedures, interdisciplinary collaboration between providers should be routinely implemented to enable medical optimization of patients prior to cervical spine surgery.

Is Cervical Disc Arthroplasty an Effective Treatment for Cervical Degenerative Disease With Osteopenia?

Retrospective case-control study. To evaluate postoperative outcomes of single-level cervical disc arthroplasty (CDA) in patients with osteopenia and compare these results with a matched cohort of normal bone mineral density (BMD). Patients who had undergone single-level CDA were collected and screened. Included patients were divided into the osteopenia group and the normal group. 38 eligible patients with osteopenia were included in the final analysis. Subsequently, a 1:1 match was utilized. Clinical, radiographic data, and complications were recorded. Appropriate statistical methods were applied to conduct analysis using SPSS version 24.0. The mean follow-up time was 30.5 ± 27.3months. The osteopenia group achieved satisfactory clinical outcomes, with no significant intergroup differences. Additionally, there were no significant differences between groups in any of the radiological parameters, either in cervical alignment or segmental height, or range of motion. The radiological incidence rate of adjacent segmental degeneration and heterotopic ossification (HO) was comparable in both groups, respectively, with a similar composition of ROM-limiting HO. However, the osteopenia group had a tendency of more implant subsidence (2.7% vs 15.2%). The logistic regression analysis showed the osteopenia group had a significantly higher incidence rate of anterior bone loss (ABL) (OR = 5.37, 95% CI: 1.50 - 19.22). Single-level CDA for patients with osteopenia achieved similar satisfactory clinical outcomes compared with the normal BMD group. Meanwhile, the osteopenia group maintained adequate sagittal balance and segmental height. Based on this observation, this option may be feasible for selected patients with osteopenia.

Thorough Comparative Analysis of Stand-Alone Cage and Anterior Cervical Plate for Anterior Cervical Discectomy and Fusion in the Treatment of Cervical Degenerative Disease: A Systematic Review and Meta-analysis.

In this systematic review and meta-analysis, we aim to thoroughly describe and objectively compare the efficacy of anterior cervical plate (ACP) and stand-alone cage (SAC). Although recognized as an effective procedure for cervical degenerative disease (CDD), a debate between the methods of anterior cervical discectomy and fusion exists. ACP provides stability to the fusion construct; however, some complications have been reported, such as dysphagia, adjacent disc disease, and soft tissue injury. To overcome these complications, a SAC was later introduced. A systematic search was conducted on the basis of PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines to identify relevant studies through PubMed, Google Scholar, and Cochrane database. A total of 14 studies (960 patients) were included in the meta-analysis. Twenty outcomes were clinically and radiologically compared between the two procedures. ACP and SAC were comparable in terms of dysphasia rate, loss of segmental angle, loss of disc height, the Odom criteria, Robinson's criteria, hospital stay, Japanese Orthopaedic Association score, Neck Disability Index, Visual Analog Scale, and fusion time. However, SAC was superior in terms of shorter operation time, less blood loss, lower dysphagia rate, and lower rate of adjacent level disease, whereas ACP was advantageous in terms of lower subsidence rate, better maintenance of the cervical global and segmental angles and disc height, and higher fusion rate. Both procedures can be used in patients with CDD, although it might be more beneficial to choose ACP in patients with multi-level pathologies, wherein better mechanical stability is provided. However, SAC may be more beneficial to use in patients with comorbidities, anemia, or swelling problems because it offers lower complication rates.

Anterior 1-2 Level Cervical Corpectomy and Fusion for Degenerative Cervical Disease: A Retrospective Study With Lordotic Porous Tantalum Cages. Long-Term Changes in Sagittal Alignment and Their Clinical and Radiological Implications After Cage Subsidence.

Despite the advances in anterior cervical corpectomy and fusion (ACCF) as a reconstructive surgical technique, the rate of complications related to artificial implants remains high. The purpose of this study was to investigate the long-term clinical course of ACCF with tantalum trabecular metal (TTM)-lordotic implants. Focus is placed on the relevance and influence of implant subsidence on sagittal alignment and the related clinical implications. Retrospective, observational study of prospectively collected outcomes including 56 consecutive patients with degenerative cervical disc disease (myelopathy and/or radiculopathy). All patients underwent 1-level or 2-level ACCF with TTM-lordotic implants. The mean duration of follow-up was 4.85 years. The fusion rate at the end of follow-up was 98.11% (52/53). Implant subsidence occurred in 44 (83.01%) cases, including slight subsistence (<3 mm) in 37 (69.81%) and severe subsidence (>3 mm) in 7 cases (13.2%). The greatest degree of subsidence developed in the first 3 months postoperatively (P = 0.003). No patients presented a significant increase in implant subsidence beyond the second year of follow-up. The most common site of severe subsidence was the anterior region of the cranial end plate (4/7). At the end of follow-up, C1-C7 lordosis and segmental-Cobb angle of the fused segment increased on average by 5.06 ± 8.26 and 1.98 ± 6.02 degrees, respectively, though this difference failed to reach statistical significance (P > 0.05). Visual analog scale and Neck Disability Index scores improved at the conclusion of follow-up (P < 0.05). ACCF with anterior cervical reconstruction using TTM-lordotic implants and anterior cervical plating for treatment of cervical degenerative disease has high fusion rates and good clinical outcome. The osteoconductive properties of TTM provide immediate stabilization and eliminate the need for bone grafts to ensure solid bone fusion. Before fusion occurs, asymptomatic implant settlement into the vertebral body is inevitable. However, lack of parallelism and reduced contact surface between the implant and the vertebral end plate are major risk factors for severe further subsidence, which may negatively affect the clinical outcomes.

Early efficacy of three dimensional printed anatomical biomimetic cervical artificial disc replacement in the treatment of cervical degenerative diseases

Objective: To investigate the efficacy and safety of a new cervical artificial disc prosthesis in the treatment of cervical degenerative diseases. Methods: The clinical data of 18 patients with single-level cervical degenerative diseases who underwent three dimensional printed anatomical bionic cervical disc replacement at Department of Spinal Surgery,Honghui Hospital,Xi'an Jiaotong University from May 2019 to July 2020 were analyzed retrospectively. There were 7 males and 11 females,aged (45±8) years old(range:28 to 58 years).The surgical segment was located at C3－4 level in 2 cases, C4－5 level in 5 cases, C5－6 level in 9 cases, and C6－7 level in 2 cases.The clinical and radiographic outcomes were recorded and compared at preoperative,postoperative times of one month and twelve months.The clinical assessments contained Japanese orthopedic association (JOA) score,neck disability index (NDI) and visual analogue scale (VAS).Imaging assessments included range of motion (ROM) of cervical spine, prosthesis subsidence and prosthesis anteroposterior migration.Repeated measurement variance analysis was used for comparison between groups,and paired t test was used for pairwise comparison. Results: All patients underwent the operation successfully and were followed up for more than 12 months.Compared with preoperative score,the JOA score,NDI and VAS were significantly improved after surgery (all P<0.01).There was no significant difference in postoperative ROM compared with 1-and 12-month preoperative ROM (t=1.570,P=0.135;t=1.744,P=0.099). The prosthesis subsidence was (0.29±0.13) mm (range: 0.18 to 0.50 mm) at 12-month postoperatively.The migration of prosthesis at 12-months postoperatively were (0.71±0.20) mm (range: 0.44 to 1.08 mm).There was no prosthesis subsidence or migration>2 mm at 12-month postoperatively. Conclusion: Three dimensional printed anatomical biomimetic cervical artificial disc replacement has a good early clinical effect in the treatment of cervical degenerative diseases, good mobility can be obtained while maintaining stability.

Efficacy of Hybrid anterior cervical spine surgery on range of motion and curvature in the treatment of cervical degenerative diseases

To observe the change of cervical curvature and range of motion (ROM) on imaging at 6 months after Hybrid surgery. A total of 29 patients with cervical degenerative disease who underwent Hybrid surgery from January 2017 to July 2018 were retrospectively analyzed. Also, they all met the inclusion criteria and had complete preoperative and 6 months postoperative imaging data. There were 11 males and 18 females, aged from 34 to 76 (55.86±10.69) years, and the operation time was from 2 to 4(3.03±0.51) hours. The Cobb angle method was used to measure the changes of cervical curvature and ROM of C2-C7, replacement segments, fusion segments, and upper adjacent segments on cervical lateral X-rays before and 6 months after surgery. There was no statistically significant difference in C2-C7 curvature and ROM between 6 months after operation and before operation (P>0.05). The degree of curvature and ROM of the replacement segment increased compared with that before operation (P<0.05). The curvatureof the fusion segment was increased than that before operation (P<0.05). There was no statistically significant difference in ROM of the fusion segment compared with that before operation (P>0.05). There was no statistically significant difference in the curvature and ROM of the upper adjacent segments compared with those before operation (P>0.05). There was no significant difference in the curvature between the replacement and fusion segments before and 6 months after operation (P>0.05);the ROM of the replacement segment was higher than that of the fusion segment at 6 months after operation (P<0.05). Hybrid surgery reconstructs the lordotic curvature of the entire cervical spine and the responsible segment, retains the ROM of the cervical replacement segment, and restores the biomechanical function of cervical spine.

Use of tissue sealant patch (TachoSil) in the management of cerebrospinal fluid leaks after anterior cervical spine discectomy and fusion

Purpose The purpose of this study was to evaluate a fast, sutureless technique to repair anterior cervical dural tears. Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure for the treatment of cervical degenerative diseases. Although uncommon, incidental durotomy with cerebrospinal fluid (CSF) leak during ACDF is a potentially serious complication. Yet, its technical management for the prevention of CSF leak is controversial. Methods Between September 2012 and June 2018 we encountered seven cases (2 female/5 male) presenting with intraoperative CSF leaks secondary to incidental dural tears during ACDF surgery. All the cases were surgically treated using a topical fibrin sealant patch (TachoSil) with high adesive strength and fibrin glue (Tisseel). Intraoperative source of leakage, time to leakage control, quantity of Sealant Sponge used and postoperative complications were evaluated. Results Dural tears were tipically the result of dissection of adherent posterior longitudinal ligament and/or calcified disc from the cervical dural sac to allow full decompression of the spinal cord. Effective repair of dural tear defined as cessation of CSF leak after topical sealant agents application was achieved no later than one minute in all cases. Evident clinical and/or radiological postoperative CSF leak was used to determine the patient’s postoperative result. Postoperative CSF leak was not evident during a minimum 6 months follow up. Conclusions In the present study, we have reported our experience with a new sealing technique to manage CSF leaks from iatrogenic cervical dural lacerations. Tachosil tissue sealant patch is a rapid sutureless technique that may help in repairing introperatively incidental dural tears, thus reducing the risk of postoperative CSF leaks. To our knowledge, this is the first series to report the use of Tachosil adhesive sealant patch for the treatment of incidental dural tears during anterior cervical discectomy.

Clinical observation on the treatment of cervical degenerative diseases with Hybrid surgery

To investigate the clinical effect of anterior cervical Hybrid surgery in the treatment of cervical degenerative diseases (CDD) and observe the incidence of heterotopic ossification of disc replacement segment at 1 year after surgery. From January 2015 to April 2018, 35 patients who received anterior cervical hybrid surgery met the inclusion and exclusion criteria and the complete clinical follow up data were analyzed retrospectively. Complete imaging follow-up data were obtained from 24 patients. There were 15 males and 20 females, aged from 39 to 70(55.57±7.73) years old. The amount of bleeding was for 20 to 100 (40.29±18.39) ml, and the hospitalstay was for 4 to 28(11.03±4.63) days, and the follow-up time was(12.97±1.36) months. Clinical outcomes were assessed by the Tanaka Yasushi cervical spondylitis symptom scale 20 score (YT20), and Japanese Orthopaedic Association (JOA) score. The occurrence of heterotopic ossification after Hybrid surgery was evaluated by X-ray according to McAfee standard one year after operation. Patients with or without heterotopic ossificationwere divided into two groups and their clinical effects were compared. At the final follow up, the mean YT20 score and JOA score were significantly higher than those before operation (P <0.05), and the average improvement rate of JOA was (70.66 ±0.44)%. One year after operation, the heterotopic ossification occurred in 10 of 24 segments, with incidence of 41.70%(10/24), including 29.20% in gradeⅠand 12.50% in gradeⅡ. The results of clinical efficacy comparison between patients with and without heterotopic ossification were as follows:there was no significant difference in JOA score before and after operation (P>0.05);there was no significant difference in YT20 score before operation (P>0.05), and YT20 score in patients with heterotopic ossification was significantly lower than that in patients without heterotopic ossification(P<0.05). The short-term clinical effect of Hybrid surgery is satisfactory for cervical degenerative diseases, and the cause of heterotopic ossification still needs tobe further explored.

Effects of Central Sensitivity Syndrome and Psychological Factors on the Clinical Features of Patients with Cervical Degenerative Disease: A Cross-Sectional Study.

Study DesignSingle-center cross-sectional study.PurposeThe present study aimed to clarify the effects of central sensitivity syndrome (CSS) and psychological factors on the clinical features in patients with cervical degenerative disease (CDD).Overview of LiteratureThe presence of CSS and psychological factors can influence the clinical features of patients with musculoskeletal disorders including CDD. However, the precise effects of CSS are unclear.MethodsPatients admitted for surgical treatment of CDD were recruited. The following patient-reported outcome measures were recorded on the day before the surgery: the Numerical Rating Scale (NRS) for neck pain intensity, Neck Disability Index (NDI), EuroQol 5-Dimensions (EQ-5D) survey, Central Sensitization Inventory (CSI), Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and the Hospital Anxiety and Depression Scale were used. We performed three multiple regression analyses to investigate the effects of CSS and psychological factors on the clinical features.ResultsMultiple regression analysis revealed that CSI had a significant effect on NRS (β, 0.50; 95% confidence interval [CI], 0.29 to 0.71), NDI (β, 0.64; 95% CI, 0.45 to 0.82), and EQ-5D (β, −0.55; 95% CI, −0.75 to −0.35). Multiple regression analysis revealed that psychological factors did not exert a significant effect on the clinical features.ConclusionsOur results demonstrated that CSI was able to identify the clinical features in CDD patients, suggesting that CSS does affect the clinical features of such patients.

Anterior or posterior approach in the surgical treatment of cervical radiculopathy; neurosurgeons’ preference in the Netherlands

ObjectivesSeveral surgical techniques are available for the treatment of cervical degenerative disease. For resolving cervical nerve root compression, anterior cervical discectomy with fusion (ACDF) or posterior cervical foraminotomy (PCF) can be applied. Amongst neurosurgeons, there seems to be a tendency to prefer ACDF, even though there are some advantages in favor of PCF. The objective of present study is to evaluate which factors determine the choice for an anterior or posterior surgical approach in patients with cervical radiculopathy based on foraminal pathology. MethodsA web-based survey was sent to all 133 neurosurgeons in the Netherlands. The study followed a mixed methods cross-sectional design. The first part of the survey focused on general perceived (dis)advantages of ACDF and PCF. The second part concerned questions about the choice between the two procedures. Furthermore, it was analyzed if exposure during training, amount of performed surgeries, assumed reoperation and complication rates influenced the choice of procedure by conducting Chi-square tests with post-hoc analysis. ResultsA total of 56 neurosurgeons responded (42%). An overall preference for ACDF was observed, even when differentiating for a pure disc prolapse, a spondylotic or a combined stenosis of the neuroforamen. The most relative important factors for motivating the preference for either ACDF or PCF were: the assumed best decompression of the nerve root (18%), congruence with current literature (16%), exposure during residency (12%), personal comfort (11%) and experience (11%) with the technique. ConclusionIn this survey, there was an overall preference for ACDF above PCF for the surgical treatment of a foraminal cervical radiculopathy. In addition to subjective factors as “experience” and “comfort”, the respondents often motivated their choice as “the best one according to literature”. As there is currently no evidence about the superiority of any of the procedures in literature, this assumption is remarkable.

Outcomes following outpatient anterior cervical discectomy and fusion for the treatment of myelopathy

IntroductionAnterior cervical discectomy and fusion (ACDF) is a commonly performed procedure for the treatment of degenerative cervical disease. With continued increase in U.S. healthcare expenditure, surgeons have begun to more closely examine the benefits of performing ACDF in an outpatient setting to increase efficiency, reduce the overall financial burden on patients/providers, and provide streamlined care for these patients. The purpose of this study was to analyze outcomes following outpatient ACDF for the treatment of myelopathy. Methods14,490 patients who had undergone ACDF for myelopathy from 2010 to 2018 were included in this retrospective study, of which 2956 (20.40%) patients were considered to have undergone outpatient surgery. Pearson chi-squared tests and Fischer’s Exact Tests were used to analyze differences in categorical variables of demographics, preoperative comorbidities, and postoperative complications, while Mann-Whitney-U-Tests were used to compare mean values of continuous variables. Coarsened-exact-matching (CEM) was implemented to control for baseline differences in demographics and comorbidities, and post-matching diagnostics included multivariate and univariate imbalance measure assessment. Outcomes were compared between the CEM-matched inpatient and outpatients ACDF cohorts. ResultsUpon CEM-matching (L1-statistic <0.001), the outpatient cohort (n = 2610, 25.13%) demonstrated significantly lower rates of any complication (p < 0.001), minor complications (p = 0.001), urinary tract infections (p = 0.029), blood transfusions (p < 0.001), major complications (p < 0.001), deep incisional surgical site infections (p = 0.017), ventilator dependence (p = 0.027), cardiac arrest (p = 0.028), unplanned reoperations (p = 0.001), and mortality (p = 0.006) in the 30-day postoperative period when compared to inpatient controls (n = 7774, 74.87%). ConclusionACDF has been a target amongst spinal procedures as a prime candidate for outpatient surgery. However, no previous reports have described complication rates and perioperative parameters in the sub-population of outpatient ACDF patients with myelopathy. In addition to shorter times from admission to operating room, operative time, and LOS, our study also demonstrated lower rates of major and overall complications in outpatient ACDF’s for myelopathy in comparison to their inpatient counterparts. Performing ACDF’s for myelopathy in an outpatient setting may help to curb costs, improve outcomes, and serve as a valuable learning resource for graduate medical education with rapid turnovers and shorter operative times.

Identifying the Characteristics of Patients With Cervical Degenerative Disease for Surgical Treatment From 17-Year Real-World Data: Retrospective Study.

BackgroundReal-world data (RWD) play important roles in evaluating treatment effectiveness in clinical research. In recent decades, with the development of more accurate diagnoses and better treatment options, inpatient surgery for cervical degenerative disease (CDD) has become increasingly more common, yet little is known about the variations in patient demographic characteristics associated with surgical treatment.ObjectiveThis study aimed to identify the characteristics of surgical patients with CDD using RWD collected from electronic medical records.MethodsThis study included 20,288 inpatient surgeries registered from January 1, 2000, to December 31, 2016, among patients aged 18 years or older, and demographic data (eg, age, sex, admission time, surgery type, treatment, discharge diagnosis, and discharge time) were collected at baseline. Regression modeling and time series analysis were conducted to analyze the trend in each variable (total number of inpatient surgeries, mean age at surgery, sex, and average length of stay). A P value <.01 was considered statistically significant. The RWD in this study were collected from the Orthopedic Department at Peking University Third Hospital, and the study was approved by the institutional review board.ResultsOver the last 17 years, the number of inpatient surgeries increased annually by an average of 11.13%, with some fluctuations. In total, 76.4% (15,496/20,288) of the surgeries were performed in patients with CDD aged 41 to 65 years, and there was no significant change in the mean age at surgery. More male patients were observed, and the proportions of male and female patients who underwent surgery were 64.7% (13,126/20,288) and 35.3% (7162/20,288), respectively. However, interestingly, the proportion of surgeries performed among female patients showed an increasing trend (P<.001), leading to a narrowing sex gap. The average length of stay for surgical treatment decreased from 21 days to 6 days and showed a steady decline from 2012 onward.ConclusionsThe RWD showed its capability in supporting clinical research. The mean age at surgery for CDD was consistent in the real-world population, the proportion of female patients increased, and the average length of stay decreased over time. These results may be valuable to guide resource allocation for the early prevention and diagnosis, as well as surgical treatment of CDD.

279. Cervical corpectomy vs 2-level discectomy: a comparative study of 100 patients

BACKGROUND CONTEXT Surgical treatment of cervical spine degenerative pathology involving 2 levels can be performed anteriorly through a double discectomy or through a corpectomy. It is not clear, however, what is the capacity of each technique in the restoration of cervical lordosis and what is its effect over time. PURPOSE Compare the 2 techniques with respect to clinical and radiographic results, namely in the restoration and maintenance of sagittal cervical balance. METHODS Clinical files and radiographs of patients submitted to a 2-level discectomy (Group A) or a 1-level corpectomy (Group B) were evaluated retrospectively in the treatment of degenerative cervical disease between 2010 and 2017. Radiological parameters were measured (C2-C7 sagittal Cobb, regional cervical lordosis and graft collapse) preoperatively, after 3-6 weeks and at the last follow-up. Patient variables, surgery and perioperative parameters (length of stay, blood loss, surgical time and complications) were compared. RESULTS A total of 100 patients (43 men and 57 women) with a mean age of 60.4 years (40-86) were included. Average follow-up of 3.5 years (8 months-7.3 years). Group A: 18 patients, mean age 60.3, 39% (n = 7) with radiculopathy and 61% (n = 11) with myelopathy; Group B: 82 patients, mean age 61.4; 69.5% (n = 56) with myelopathy, 30.5% (n = 25) with radiculopathy. There was no statistically significant difference between the 2 groups regarding length of hospital stay, blood loss or surgical time. Patients submitted to a corpectomy had a lower lordosis than those who underwent discectomy at 2 levels (p = 0.083). However, the gain of lordosis with surgery was similar in both groups, 7.8° in Group B and 6,1° in Group A (p = 0.582). After surgery, there was a progressive loss of lordosis gain mainly in the first 6 weeks but without significant differences between the groups. (p = 0.08 at 6 weeks and p = 0.690 at the last follow-up). CONCLUSIONS In the presence of myelopathy, corpectomy was the preferred surgical option. Preoperatively, these patients had a lower degree of lordosis than those operated by radiculopathy. Both surgical options allowed an equivalent gain in lordosis, which was partially lost during follow-up. There were no advantages of one surgical technique over the other in lordosis gain. Therefore, the decision on the technique to be used must be based on factors other than the concern with the gain of lordosis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Anterior cervical discectomy and fusion can restore cervical sagittal alignment in degenerative cervical disease.

The purpose of this study was to evaluate its effect on the restoration and maintenance of cervical sagittal alignment in usual cervical degenerative diseases without preoperative sagittal malalignment. We retrospectively evaluated 108 patients who were diagnosed with degenerative cervical disease and underwent ACDF (allograft and plating) with > 1-year follow-up. For radiographic evaluation, we analysed segmental and C2-7 cervical lordosis, disc height, C2-7 sagittal vertical axis (SVA), T1 slope, and T1 slope minus C2-7 lordosis (T1S - CL) in lateral X-ray. Clinical assessment was based on arm VAS, neck VAS, and NDI scores. Correlation analysis was performed across the pre-post-changes in radiological parameters. Correlations between the changes in radiological and clinical parameters at final follow-up were also analysed. C2-7 lordosis was 7.13° preoperatively and increased to 13.06° (p < 0.001) and maintained at 10.08° at final follow-up (p = 0.007). Segmental lordosis increased from 0.66° to 8.33° and maintained at 5.19° (p < 0.001). Segmental disc height was 4.67mm preoperatively (increased to 7.13mm postoperatively and decreased to 5.74mm at final follow-up) (p < 0.001). SVA distance (31.53mm to 30.02mm) (p = 0.750) and T1 slope (30.03° to 31.37°) did not show meaningful change after surgery. Increase in segmental lordosis was correlated to an increase in C2-7 lordosis (p < 0.001). C2-7 SVA change correlated with both the T1 slope change (p < 0.001) and T1S - CL (p = 0.012). Change in SVA was correlated to a change in segmental lordosis and T1 slope (p = 0.003, p = 0.014). Clinical outcomes did not correlate with radiological findings. ACDF for the treatment of degenerative cervical disease without preoperative deformity was effective in restoring cervical sagittal alignment. Improvement of segmental lordosis related to an improvement in C2-7 lordosis and SVA. Radiological sagittal alignment did not show any relation with clinical outcomes in usual degenerative cases.

Integrated screws with cage spacer system in the treatment of cervical spine degenerative disease with a minimum follow-up of 2 years

Background: Anterior cervical discectomy and fusion (ACDF) is a widely accepted surgical treatment for cervical degenerative disease.Integrated screws with cage spacer system is a relatively new device designed for patients undergoing ACDF with the dual properties of plating and standalone cage. We are reporting our findings in term of clinico-radiological outcomes following the use of such devices in the treatment of cervical spine degenerative diseases. Materials and Methods: Retrospectively, we studied 18 patients treated with integrated screws and cage spacer system for cervical degenerative diseases with a minimum follow up period of 2 years.We compared the preoperative Visual analogue scale (VAS) pain score both neck and for arm, neck disability index (NDI), overall cervical sagittal alignment (OSA) and segmental sagittal alignment (SSA) with the postoperative data. The final outcome was assessed with Odom's criteria. Paired student t test was used for statistical analysis. Results: The mean age of the patient was 46 years (range: 29-63 years) with the mean follow up period of 28 months (range: 24-47 months). The total operated levels were 19.Out of which 11 were at C5-C6 level. The mean pain VAS score for neck and arm along with NDI improved significantly after surgery at last follow up. The mean OSA and SSA improved from 8.00 ± 5.00 to 10.61 ± 3.50 and 3.50 ± 3.20 to 8.11 ± 4.65 at last follow up. X ray showed 100% fusion rate and majority of the patients had a good outcome. Conclusion: Integrated screws and cage spacer device is a safe and effective alternative for the treatment of cervical degenerative diseases.

A comparison of long-term outcomes of nanohydroxyapatite/polyamide-66 cage and titanium mesh cage in anterior cervical corpectomy and fusion: A clinical follow-up study of least 8 years

ObjectivesThe nanohydroxyapatite/polyamide-66 (n-HA/PA66) cage is a novel biomimetic nonmetal cage device that is now used in some medical centers, while the titanium mesh cage (TMC) is a typical metal cage device that has been widely used for decades. This study was performed to compare the long-term outcomes of these two different cages in patients undergoing anterior cervical corpectomy. Patients and methodsThis retrospective study involved 107 patients who underwent single-level anterior corpectomy using either a TMC (n = 52) or an n-HA/PA66 cage (n = 55) for treatment of cervical degenerative disease with a minimum follow-up of 8 years. Their radiographic data (cage subsidence, fusion status, segmental sagittal alignment, and cervical spine degeneration) and clinical data [visual analog scale (VAS) and Japanese Orthopedic Association (JOA) scores] were evaluated preoperatively, postoperatively, and at the final follow-up. ResultsThe mean duration of follow-up was 103.6 ± 6.3 months in the n-HA/PA66 group and 102.4 ± 4.6 months in the TMC group. The n-HA/PA66 group and the TMC group had similar final fusion rates (97% vs. 94%, respectively). The final n-HA/PA66 cage subsidence was 2.4 ± 1.0 mm with 18.2% subsidence of >3 mm, which was significantly lower than the respective 3.0 ± 0.7 mm and 40.4% for the TMC (p < 0.01). The n-HA/PA66 group also had better JOA scores than the TMC group (p < 0.01). No significant difference in the segmental sagittal alignment, cervical lordosis, or VAS score was observed between the two groups (p = 0.18, 0.42, and 0.17, respectively). ConclusionsThe n-HA/PA66 cage is associated with excellent radiographic fusion, lower subsidence and better clinical outcomes than the TMC within 8 years after single-level anterior cervical corpectomy. With the addtional benefit of radiolucency, the n-HA/PA66 cage could be superior to the TMC in anterior cervical construction.

Is Anterior Cervical Discectomy and Fusion for ≥4 Levels Safe and Effective for the Treatment of Degenerative Cervical Disease?

Is Anterior Cervical Discectomy and Fusion for ≥4 Levels Safe and Effective for the Treatment of Degenerative Cervical Disease?

Can the Zero-Profile Implant Be Used for Anterior Cervical Discectomy and Fusion in Traumatic Subaxial Disc Injury? A Preliminary, Retrospective Study

ObjectiveThe zero-profile implant (Zero-P) is accepted for use in anterior cervical fusion for the treatment of degenerative cervical disease. However, evidence pertaining to its efficiency and safety in traumatic cervical injury is largely insufficient. This study aimed to compare the overall outcomes of patients who underwent Zero-P for traumatic cervical disc injury. MethodsData from a total of 53 consecutive patients who underwent surgery for traumatic or degenerative cervical disc disease using the Zero-P were reviewed. Seventeen patients (group A) had traumatic cervical disc injury and the remaining 36 (group B) had degenerative cervical disc herniation. The fusion and subsidence rates and Cobb angle were measured retrospectively from plain radiographs. The patients’ clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score and Odom’s criteria. ResultsThe C2–7 Cobb and operative segmental angles increased by 3.45±7.61 and 2.94±4.59 in group A; and 2.46±7.31 and 2.88±5.49 in group B over 12 postoperative months, respectively. The subsidence and fusion rate was 35.0% and 95.0% in group A; and 36.6% and 95.1% in group B, respectively. None of the parameters differed significantly between groups. The clinical outcomes were similar in both groups in terms of increasing the JOA score and producing a grade higher than “good” using Odom’s criteria. ConclusionThe application of Zero-P in patients with traumatic cervical disc injury was found to be acceptable when compared with the clinical and radiological outcomes of degenerative cervical spondylosis.