Science.gov

Sample records for cervical anterior transpedicular

  1. Construction and Accuracy Assessment of Patient-Specific Biocompatible Drill Template for Cervical Anterior Transpedicular Screw (ATPS) Insertion: An In Vitro Study

    PubMed Central

    Kong, Xiangxue; Zhao, Weidong; Tang, Lei; Li, Jianyi; Ouyang, Jun

    2013-01-01

    Background With the properties of three-column fixation and anterior-approach-only procedure, anterior transpedicular screw (ATPS) is ideal for severe multilevel traumatic cervical instabilities. However, the accurate insertion of ATPS remains challenging. Here we constructed a patient-specific biocompatible drill template and evaluated its accuracy in assisting ATPS insertion. Methods After ethical approval, 24 formalin-preserved cervical vertebrae (C2–C7) were CT scanned. 3D reconstruction models of cervical vertebra were obtained with 2-mm-diameter virtual pin tracts at the central pedicles. The 3D models were used for rapid prototyping (RP) printing. A 2-mm-diameter Kirschner wire was then inserted into the pin tract of the RP model before polymethylmethacrylate was used to construct the patient-specific biocompatible drill template. After removal of the anterior soft tissue, a 2-mm-diameter Kirschner wire was inserted into the cervical pedicle with the assistance of drill template. Cadaveric cervical spines with pin tracts were subsequently scanned using the same CT scanner. A 3D reconstruction was performed of the scanned spines to get 3D models of the vertebrae containing the actual pin tracts. The deviations were calculated between 3D models with virtual and actual pin tracts at the middle point of the cervical pedicle. 3D models of 3.5 mm-diameter screws were used in simulated insertion to grade the screw positions. Findings The patient-specific biocompatible drill template was constructed to assist ATPS insertion successfully. There were no significant differences between medial/lateral deviations (P = 0.797) or between superior/inferior deviations (P = 0.741). The absolute deviation values were 0.82±0.75 mm and 1.10±0.96 mm in axial and sagittal planes, respectively. In the simulated insertion, the screws in non-critical position were 44/48 (91.7%). Conclusions The patient-specific drill template is biocompatible, easy-to-apply and accurate

  2. Cervical anterior transpedicular screw fixation (ATPS)—Part II. Accuracy of manual insertion and pull-out strength of ATPS

    PubMed Central

    Acosta, Frank; Tauber, Mark; Fox, Michael; Martin, Hudelmaier; Forstner, Rosmarie; Augat, Peter; Penzkofer, Rainer; Pirich, Christian; Kässmann, H.; Resch, Herbert; Hitzl, Wolfgang

    2008-01-01

    Reconstruction after multilevel decompression of the cervical spine, especially in the weakened osteoporotic, neoplastic or infectious spine often requires circumferential stabilization and fusion. To avoid the additional posterior surgery in these cases while increasing rigidity of anterior-only screw-plate constructs, the authors introduce the concept of anterior transpedicular screw (ATPS) fixation. We demonstrated its morphological feasibility as well as its indications in a previous study in Part I of our project. Consequently, the objectives of the current study were to assess the ex vivo accuracy of placing ATPS into the cervical vertebra as well as the biomechanical performance of ATPS in comparison to traditional vertebral body screws (VBS) in terms of pull-out strength (POS). Twenty-three ATPS were inserted alternately to two screws into the pedicles and vertebral bodies, respectively, of six cadaveric specimens from C3–T1. For insertion of ATPS, a manual fluoroscopically assisted technique was used. Pre- and post insertional CT-scans were used to assess accuracy of ATPS insertion in the axial and sagittal planes. A newly designed grading system and accuracy score were used to delineate accuracy of ATPS insertion. Following insertion of screws, 23 ATPS and 22 VBS were subjected to pull-out testing (POT). The bone mineral density (BMD) of each specimen was assessed prior to POT. Statistical analysis showed that the incidence of correctly placed screws and non-critical pedicles breaches in axial plane was 78.3%, and 95.7% in sagittal plane. Hence, according to our definition of “critical” pedicle breach that exposes neurovascular structures at risk, 21.7% (n = 5) of all ATPS inserted showed a critical pedicle breach in axial plane. Notably, no critical pedicle perforation occurred at the C6 to T1 levels. Pull-out testing of ATPS and VBS revealed that pull-out resistance of ATPS was 2.5-fold that of VBS. Mean POS of 23 ATPS with a mean BMD of 0.566

  3. An RCT study on the feasibility of anterior transpedicular screw fixation in the cervicothoracic junction.

    PubMed

    Zhao, Liujun; Hong, Jinjiong; Wandtke, Meghan E; Xu, Rongming; Ma, Weihu; Jiang, Weiyu; Gu, Yongjie; Chen, Jianqing; Wang, Liran; Liu, Jiayong; Ebraheim, Nabil A

    2016-06-01

    We evaluated the trajectory and the entry points of anterior transpedicular screws (ATPS) in the cervicothoracic junction (CTJ). This study aimed at investigating the feasibility of ATPS fixation in the CTJ. Application of an ATPS in the lower cervical spine has been reported; however, there were no reports exploring the feasibility of anterior transpedicular screw fixation in the CTJ. CT scans were performed in 50 cases and multiplanar reformation was used to measure the related parameters on pedicle axis view at C6-T2. Transverse pedicle angle, outer pedicle width, pedicle axis length, distance transverse intersection point (DtIP), sagittal pedicle angle, anterior vertebral body height, outer pedicle height, and distance sagittal intersection point (DsIP) were measured. The prozone of CTJ was divided into three different regions, which were named as the "manubrium region", the region "above" and "below" the manubrium. The distribution of the trajectory of sagittal pedicle axes was recorded in the three regions and the related data were statistically analyzed. There was no statistical difference in gender (P > 0.05). The transverse pedicle angle decreased from C6 (46.77° ± 2.72°) to T2 (20.62° ± 5.04°). DtIP increased from C6 to T2. DsIP was an average of 7.17 mm. The sagittal pedicle axis lines of the C6 and C7 were located in the region above the manubrium. T1 was mainly in the manubrium region followed by the region above the manubrium. T2 was mainly located in the manubrium region followed by the region below the manubrium. Implantation of ATPS at C6, C7, and some T1 is feasible through the low anterior cervical approach, while it is almost impossible to approach T2 that way.

  4. [Isolated anterior cervical hypertrichosis].

    PubMed

    Monteagudo, B; Cabanillas, M; de las Heras, C; Cacharrón, J M

    2009-01-01

    Anterior cervical hypertrichosis was described by Trattner and coworkers in 1991. It consists of a of hair at the anterior cervical level just above the laryngeal prominence. To date, only 28 cases of anterior cervical hypertrichosis have been reported. Although it is normally an isolated finding, it may be associated with mental retardation, hallux valgus, retinal disorders, other hair disorders, facial dysmorphism, or sensory and motor peripheral neuropathy. We report the case of a 27-year-old woman who presented with this condition as an isolated finding.

  5. [Anterior cervical hypertrichosis: case report].

    PubMed

    Orozco-Gutiérrez, Mario H; Sánchez-Corona, José; García-Ortiz, José E; Castañeda-Cisneros, Gema; Dávalos-Rodríguez, Nory O; Corona-Rivera, Jorge R; García-Cruz, Diana

    2016-10-01

    The non-syndromic anterior cervical hypertrichosis (OMIM N° 600457) is a genetic disorder characterized by a patch of hair at the level of the laryngeal prominence. We present a 12-year-old boy with anterior cervical hypertrichosis and mild generalized hypertrichosis. He has no neurological, ophthalmological or skeletal anomalies. The clinical follow up is 10 years.

  6. Anterior cervical hypertrichosis: a sporadic case

    PubMed Central

    Bostan, Sezen; Yaşar, Şirin; Serdar, Zehra Aşiran; Gizlenti, Sevda

    2016-01-01

    Anterior cervical hypertrichosis is a very rare form of primary localized hypertrichosis. It consists of a tuft of terminal hair on the anterior neck just above the laryngeal prominence. The etiology is still unknown. In this article, we reported a 15-year-old female patient who presented to our clinic with a complaint of hypertrichosis on the anterior aspect of the neck for the last five years. Her past medical history revealed no pathology except for vesicoureteral reflux. On the basis of clinical presentation, our patient was diagnosed with anterior cervical hypertrichosis and she was considered to be a sporadic case due to lack of other similar cases in familial history. To date, 33 patients with anterior cervical hypertrichosis have been reported. Anterior cervical hypertrichosis can be associated with other abnormalities, but it frequently presents as an isolated defect (70%). The association of vesicoureteral reflux and anterior cervical hypertrichosis which was observed in our patient might be coincidental. So far, no case of anterior cervical hypertrichosis associated with vesicoureteral reflux has been reported in the literature. PMID:27103865

  7. Anterior cervical hypertrichosis: a sporadic case.

    PubMed

    Bostan, Sezen; Yaşar, Şirin; Serdar, Zehra Aşiran; Gizlenti, Sevda

    2016-03-01

    Anterior cervical hypertrichosis is a very rare form of primary localized hypertrichosis. It consists of a tuft of terminal hair on the anterior neck just above the laryngeal prominence. The etiology is still unknown. In this article, we reported a 15-year-old female patient who presented to our clinic with a complaint of hypertrichosis on the anterior aspect of the neck for the last five years. Her past medical history revealed no pathology except for vesicoureteral reflux. On the basis of clinical presentation, our patient was diagnosed with anterior cervical hypertrichosis and she was considered to be a sporadic case due to lack of other similar cases in familial history. To date, 33 patients with anterior cervical hypertrichosis have been reported. Anterior cervical hypertrichosis can be associated with other abnormalities, but it frequently presents as an isolated defect (70%). The association of vesicoureteral reflux and anterior cervical hypertrichosis which was observed in our patient might be coincidental. So far, no case of anterior cervical hypertrichosis associated with vesicoureteral reflux has been reported in the literature.

  8. Giant anterior cervical osteophyte leading to Dysphagia.

    PubMed

    Hwang, Jin Seop; Chough, Chung Kee; Joo, Won Il

    2013-09-01

    Large anterior cervical osteophytes can occur in degeneration of the cervical spine or in diffuse idiopathic skeletal hyperostosis(DISH). Large osteophytes can produce otolaryngological symptoms such as dysphagia, dysphonia, and foreign body sensation. We describe a DISH patient with giant anterior cervical osteophyte causing chronic dysphagia and dysphonia. A 56-year-old man presented with increasing dysphagia, dysphonia, neck pain and neck stiffness. Physical examination of the neck showed a non-tender and hard mass on the left side at the level of C4-5. Radiography showed extensive ossification of anterior longitudinal ligament along the left anterolateral aspect of vertebral bodies from C2 to T1. The ossification was espe cially prominent at the level of C4-5 and linear breakage was noted at same level. Esophagogram revealed a filling defect along the pharynx and lateral displacement of the esophagus. Giant anterior cervical osteophyte was removed through the leftsided anterolateral cervical approach to the spine. Anterior cervical interbody fusion at C4-5 was followed by posterior cervical fixation using lateral mass screws from C3 to C6. After surgery, dysphagia and dysphonia improved immediately. One year later, cervical CT showed bone fusion at C4-5 bodies and no recurrence of osteophyte. DISH is a common cause of anterior cervical osteophyte leading to progressive dysphagia. Keeping this clinical entity in the differential diagnosis is important in patients with progressive neck stiffness, dysphagia or dysphonia. And surgical treatment of symptomatic anterior cervical osteophyte due to DISH should be considered with a solid fusion procedure preventing postoperative instability or osteophyte progress.

  9. Cervical vertebral fusion with anterior meningocele

    PubMed Central

    Chavredakis, Emmanuel; Carter, David; Bhojak, Manesh; Jenkinson, Michael D; Clark, Simon R

    2015-01-01

    We present the first described case of cervical vertebral fusion associated with anterior meningocele and syringomyelia. A 45-year-old woman presented with minor trauma, and plain cervical spine radiographs highlighted a congenital deformity of the cervical vertebral bodies. She had a normal neurological examination; however, further imaging revealed a meningocele and syringomyelia. This case highlights the importance of thorough imaging investigation when presented with a congenital deformity in order to detect and prevent development of degenerative spinal cord pathologies. PMID:25923673

  10. Anterior Cervical Spine Surgery for Degenerative Disease: A Review

    PubMed Central

    SUGAWARA, Taku

    Anterior cervical spine surgery is an established surgical intervention for cervical degenerative disease and high success rate with excellent long-term outcomes have been reported. However, indications of surgical procedures for certain conditions are still controversial and severe complications to cause neurological dysfunction or deaths may occur. This review is focused mainly on five widely performed procedures by anterior approach for cervical degenerative disease; anterior cervical discectomy, anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, anterior cervical foraminotomy, and arthroplasty. Indications, procedures, outcomes, and complications of these surgeries are discussed. PMID:26119899

  11. Two cases of isolated anterior cervical hypertrichosis.

    PubMed

    Reddy, Swapna; Antaya, Richard J

    2010-01-01

    Two unrelated Hispanic females, ages 4 and 3 years, respectively, each presented with a solitary patch of excessive terminal hair growth in the midline of the neck. This rare form of congenital localized hypertrichosis, known as anterior cervical hypertrichosis, is reported here as an isolated defect with no other underlying abnormalities.

  12. Anterior cervical discectomy with arthroplasty versus anterior cervical discectomy and fusion for cervical spondylosis.

    PubMed

    Li, Gao-Ling; Hu, Jian-Zhong; Lu, Hong-Bin; Qu, Jin; Guo, Li-Yun; Zai, Feng-Lei

    2015-03-01

    This meta-analysis aims to estimate the benefits and drawbacks associated with anterior cervical discectomy with arthroplasty (ACDA) versus anterior cervical discectomy and fusion (ACDF) for cervical spondylosis. Of 3651 identified citations, 10 randomised controlled studies involving 2380 participants were included. Moderate quality evidence supports that patients in the ACDA group had: (1) a higher Neck Disability Index (NDI) success rate at 3 month (relative risk [RR]=0.85, 95% confidence interval [CI] 0.78 to 0.93, p=0.0002) and 2 year follow-up (RR=0.95, 95%CI 0.91 to 1.00, p=0.04); (2) greater neurological success at 2 year follow-up (RR=0.95, 95%CI 0.92 to 0.98); and (3) were more likely to be employed within 6 weeks after surgery (RR=0.80 95%CI 0.66 to 0.96). In summary, the current evidence indicates that ACDA is associated with a higher NDI success rate in the short and long-term as well as a higher neurological success rate. Patients who undergo ACDA may also have a greater likelihood of being employed in the short-term. However, all of the evidence reviewed is of moderate or low quality and the clinical significance often marginal or unclear. Additional data are needed to compare the benefits and limitations of ACDA and ACDF.

  13. Impact of Isometric Contraction of Anterior Cervical Muscles on Cervical Lordosis.

    PubMed

    Fedorchuk, Curtis A; McCoy, Matthew; Lightstone, Douglas F; Bak, David A; Moser, Jacque; Kubricht, Brett; Packer, John; Walton, Dustin; Binongo, Jose

    2016-09-01

    This study investigates the impact of isometric contraction of anterior cervical muscles on cervical lordosis. 29 volunteers were randomly assigned to an anterior head translation (n=15) or anterior head flexion (n=14) group. Resting neutral lateral cervical x-rays were compared to x-rays of sustained isometric contraction of the anterior cervical muscles producing anterior head translation or anterior head flexion. Paired sample t-tests indicate no significant difference between pre and post anterior head translation or anterior head flexion. Analysis of variance suggests that gender and peak force were not associated with change in cervical lordosis. Chamberlain's to atlas plane line angle difference was significantly associated with cervical lordosis difference during anterior head translation (p=0.01). This study shows no evidence that hypertonicity, as seen in muscle spasms, of the muscles responsible for anterior head translation and anterior head flexion have a significant impact on cervical lordosis.

  14. Impact of Isometric Contraction of Anterior Cervical Muscles on Cervical Lordosis

    PubMed Central

    Fedorchuk, Curtis A; McCoy, Matthew; Lightstone, Douglas F; Bak, David A; Moser, Jacque; Kubricht, Brett; Packer, John; Walton, Dustin; Binongo, Jose

    2016-01-01

    Objective This study investigates the impact of isometric contraction of anterior cervical muscles on cervical lordosis. Methods 29 volunteers were randomly assigned to an anterior head translation (n=15) or anterior head flexion (n=14) group. Resting neutral lateral cervical x-rays were compared to x-rays of sustained isometric contraction of the anterior cervical muscles producing anterior head translation or anterior head flexion. Results Paired sample t-tests indicate no significant difference between pre and post anterior head translation or anterior head flexion. Analysis of variance suggests that gender and peak force were not associated with change in cervical lordosis. Chamberlain’s to atlas plane line angle difference was significantly associated with cervical lordosis difference during anterior head translation (p=0.01). Conclusion This study shows no evidence that hypertonicity, as seen in muscle spasms, of the muscles responsible for anterior head translation and anterior head flexion have a significant impact on cervical lordosis. PMID:27761195

  15. Adjacent Segment Pathology after Anterior Cervical Fusion

    PubMed Central

    Chung, Jae Yoon; Park, Jong-Beom; Seo, Hyoung-Yeon

    2016-01-01

    Anterior cervical fusion has become a standard of care for numerous pathologic conditions of the cervical spine. However, subsequent development of clinically significant disc disease at levels adjacent to fused discs is a serious long-term complication of this procedure. As more patients live longer after surgery, it is foreseeable that adjacent segment pathology (ASP) will develop in increasing numbers of patients. Also, ASP has been studied more intensively with the recent popularity of motion preservation technologies like total disc arthroplasty. The true nature and scope of ASP remains poorly understood. The etiology of ASP is most likely multifactorial. Various factors including altered biomechanical stresses, surgical disruption of soft tissue and the natural history of cervical disc disease contribute to the development of ASP. General factors associated with disc degeneration including gender, age, smoking and sports may play a role in the development of ASP. Postoperative sagittal alignment and type of surgery are also considered potential causes of ASP. Therefore, a spine surgeon must be particularly careful to avoid unnecessary disruption of the musculoligamentous structures, reduced risk of direct injury to the disc during dissection and maintain a safe margin between the plate edge and adjacent vertebrae during anterior cervical fusion. PMID:27340541

  16. Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in multilevel cervical spondylotic myelopathy

    PubMed Central

    Wang, Tao; Wang, Hui; Liu, Sen; An, Huang-Da; Liu, Huan; Ding, Wen-Yuan

    2016-01-01

    Abstract Background: Both anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are used to treat multilevel cervical spondylotic myelopathy (mCSM); however, which one is better treatment for mCSM remains considerable controversy. A meta-analysis was performed to compare clinical outcomes, radiographic outcomes, and surgical outcomes between ACDF and ACCF in treatment for mCSM. Methods: An extensive search of literature was performed in Pubmed/MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG databases on ACDF versus ACCF treatment for mCSM from January 2011 to August 2016. The following variables were extracted: length of hospital stay, blood loss, operation time, Japanese Orthopedic Association (JOA) scores, Neck Disability Index (NDI) score, fusion rate, Cobb angles of C2 to C7, dysphagia, hoarseness, C5 palsy, infection, cerebral fluid leakage, donor site pain, epidural hematoma, graft subsidence, graft dislodgment, pseudoarthrosis, and total complications. Data analysis was conducted with RevMan 5.3 and STATA 12.0. Results: A total of 8 studies containing 878 patients were included in our study. The results showed that ACDF is better than ACCF in the angle of C2 to C7 at the final follow-up (P < 0.00001, standardized mean difference = 4.76 [3.48, 6.03]; heterogeneity: P = 0.17, I2 = 43%), C5 plasy (P = 0.02, odds ratio [OR] 0.42, 95% confidence interval [CI] 0.21, 0.86; heterogeneity: P = 0.52, I2 = 0%), blood loss (P < 0.00001, standardized mean difference = −53.12, 95% CI −64.61, −41.64; heterogeneity: P = 0.29, I2 = 20%), fusion rate (P = 0.04, OR 2.54, 95% CI 1.05, 6.11; heterogeneity: P = 0.29, I2 = 20%), graft subsidence (P = 0.004, OR 0.11, 95% CI 0.02, 0.48; heterogeneity: P = 0.94, I2 = 0%), and total complications (P = 0.0009, OR 0.56, 95% CI 0.40, 0.79; heterogeneity: P = 0.29, I2 = 18%).However, there are no significant differences in length of hospital stay, operation time, JOA

  17. Cervical spine metastases: techniques for anterior reconstruction and stabilization.

    PubMed

    Sayama, Christina M; Schmidt, Meic H; Bisson, Erica F

    2012-10-01

    The surgical management of cervical spine metastases continues to evolve and improve. The authors provide an overview of the various techniques for anterior reconstruction and stabilization of the subaxial cervical spine after corpectomy for spinal metastases. Vertebral body reconstruction can be accomplished using a variety of materials such as bone autograft/allograft, polymethylmethacrylate, interbody spacers, and/or cages with or without supplemental anterior cervical plating. In some instances, posterior instrumentation is needed for additional stabilization.

  18. Successful anterior fusion following posterior cervical fusion for revision of anterior cervical discectomy and fusion pseudarthrosis.

    PubMed

    Elder, Benjamin D; Sankey, Eric W; Theodros, Debebe; Bydon, Mohamad; Goodwin, C Rory; Lo, Sheng-Fu; Kosztowski, Thomas A; Belzberg, Allen J; Wolinsky, Jean-Paul; Sciubba, Daniel M; Gokaslan, Ziya L; Bydon, Ali; Witham, Timothy F

    2016-02-01

    Pseudarthrosis occurs after approximately 2-20% of anterior cervical discectomy and fusion (ACDF) procedures; it is unclear if posterior or anterior revision should be pursued. In this study, we retrospectively evaluate the outcomes in 22 patients with pseudarthrosis following ACDF and revision via posterior cervical fusion (PCF). Baseline demographics, preoperative symptoms, operative data, time to fusion failure, symptoms of pseudarthrosis, and revision method were assessed. Fusion outcome and clinical outcome were determined at last follow-up (LFU). Thirteen females (59%) and 9 (41%) males experienced pseudarthrosis at a median of 11 (range: 3-151)months after ACDF. Median age at index surgery was 51 (range: 33-67)years. All patients with pseudarthrosis presented with progressive neck pain, with median visual analog scale (VAS) score of 8 (range: 0-10), and/or myeloradiculopathy. Patients with pseudarthrosis <12 months compared to >12 months after index surgery were older (p=0.013), had more frequent preoperative neurological deficits (p=0.064), and lower baseline VAS scores (p=0.006). Fusion was successful after PCF in all patients, with median time to fusion of 10 (range: 2-14)months. Eighteen patients fused both anteriorly and posteriorly, two patients fused anteriorly only, and two patients fused posteriorly only. Median VAS neck score at LFU significantly improved from the time of pseudarthrosis (p=0.012). While uncommon, pseudarthrosis may occur after ACDF. All patients achieved successful fusion after subsequent posterior cervical fusion, with 91% fusing a previous anterior pseudarthrosis after posterior stabilization. Neck pain significantly improved by LFU in the majority of patients in this study.

  19. Late prevertebral abscess following anterior cervical plating: the missing screw.

    PubMed

    Martínez-Lage, J F; Felipe-Murcia, M; Martínez-Lage Azorín, L

    2007-04-01

    A 51-year-old man underwent a C5-C7 anterior decompression and fusion. Six years later the patient complained of dysphagia caused by displacement of the cervical plate. One week after the scheduled removal of the implanted material, the patient developed a painful cervical swelling and fever. His cervical radiographs showed that a screw was missing compared to previous studies. Computerized tomography showed a large prevertebral abscess anterior to C4-C7. He underwent emergency surgical drainage of the abscess that was followed by total recovery. This report is aimed at describing this unusual complication of cervical instrumentation and to briefly review its pathogenesis and management options.

  20. Alternative grafts in anterior cervical fusion.

    PubMed

    Chen, Fangxiang; He, Wenzhuan; Mahaney, Kelly; Noeller, Jennifer; Mhanna, Nakhle; Viljoen, Stephen; Torner, James; Hitchon, Patrick

    2013-10-01

    The present retrospective study was conducted to compare the clinical and radiographic outcomes in patients undergoing anterior cervical discectomy with fusion (ACDF) using carbon fiber reinforced polymer (CFRP) cages, or allograft. We retrospectively reviewed cases of ACDF using allograft in 20 patients, and CFRP in 19 who had sequential radiographs before and after surgery, and at 1 year. There were no apparent significant differences between the 2 groups in age (p=0.057), gender (p=0.635), or complications (p=0.648). At 12 months, there were no cases of construct failure, and fusion appeared to have been achieved in patients of both groups. Lordosis was increased significantly in both groups after surgery (p<0.001 in allograft and p=0.025 in CFRP), and was maintained up until 1 year (p<0.018 in allograft and p=0.05 in CFRP) without a difference between groups (p=0.721). Anterior interbody height was significantly increased (p<0.001 in both groups at each time points) after surgery, without a significant difference between groups (p>0.21). This increase in height was greatest in magnitude immediately after surgery, and declined with the passage of time. There was no detectable health-related quality of life difference between allograft and CFRP group after surgery (p>0.05). The present study demonstrates that CFRP cages appear to have comparable fusion rates, restoration of lordosis and disc space height, and complication rates to patients who undergo ACDF with allograft. Copyright © 2013 Elsevier B.V. All rights reserved.

  1. Dysphonia and dysphagia after anterior cervical decompression.

    PubMed

    Tervonen, Hanna; Niemelä, Mika; Lauri, Eija-Riitta; Back, Leif; Juvas, Anja; Räsänen, Pirjo; Roine, Risto P; Sintonen, Harri; Salmi, Tapani; Vilkman, S Erkki; Aaltonen, Leena-Maija

    2007-08-01

    In this paper, the authors investigate the effects of anterior cervical decompression (ACD) on swallowing and vocal function. The study comprised 114 patients who underwent ACD. The early group (50 patients) was examined immediately pre- and postoperatively, and the late group (64 patients) was examined at only 3 to 9 months postoperatively. Fifty age- and sex-matched patients from the Department of Otorhinolaryngology-Head and Neck Surgery who had not been intubated in the previous 5 years were used as a control group. All patients in the early and control groups were examined by a laryngologist; patients in the late group were examined by a laryngologist and a neurosurgeon. Videolaryngostroboscopy was performed in all members of the patient and control groups, and the function of the ninth through 12th cranial nerves were clinically evaluated. Data were collected concerning swallowing, voice quality, surgery results, and health-related quality of life. Patients with persistent dysphonia were referred for phoniatric evaluation and laryngeal electromyography (EMG). Those with persistent dysphagia underwent transoral endoscopic evaluation of swallowing function and videofluorography. Sixty percent of patients in the early group reported dysphonia and 69% reported dysphagia at the immediate postoperative visit. Unilateral vocal fold paresis occurred in 12%. The prevalence of both dysphonia and dysphagia decreased in both groups 3 to 9 months postoperatively. All six patients with vocal fold paresis in the early group recovered, and in the late group there were two cases of vocal fold paresis. The results of laryngeal EMG were abnormal in 14 of 16 patients with persistent dysphonia. Neither intraoperative factors nor age or sex had any effect on the occurrence of dysphonia, dysphagia, or vocal fold paresis. Most patients were satisfied with the surgical outcome. Dysphonia, dysphagia, and vocal fold paresis are common but usually transient complications of ACD

  2. Acute Cervical Epidural Hematoma, Screw Pullout, and Esophageal Perforation After Anterior Cervical Corpectomy Surgery: Report of a Case

    PubMed Central

    Li, Ye; Zhu, Qing-San; Liu, Jing-Chen; Wu, Yun-Tao

    2015-01-01

    To report a series of complications related to anterior cervical surgery in the same patient. There have been many reports of complications related to anterior cervical surgeries. These include cervical hematoma, instrumentation extrusion, or esophageal injury after anterior cervical decompression. However, there have been no reports of all these complications occurring in 1 patient. This is our report of a patient who experienced all 3 of these complications. The patient was a 73-year-old man suffering from cervical spondylotic myelopathy who was treated with C5 anterior cervical corpectomy and fusion with titanium mesh and bone graft. The patient successively experienced cervical hematoma, screw pullout, and esophageal perforation, and was treated accordingly. Although the patient suffered a series of complications after anterior cervical corpectomy, all the complications were treated successfully. It serves as a caution that a first complication such as hematoma in anterior cervical corpectomy with fusion should be given enough attention to prevent further complications. PMID:25692439

  3. Missing Screw as a Rare Complication of Anterior Cervical Instrumentation

    PubMed Central

    Duransoy, Yusuf Kurtuluş; Mete, Mesut; Zengel, Baha; Selçukı, Mehmet

    2013-01-01

    Although anterior cervical arthrodesis is an effective procedure for the treatment of cervical disorders, the method has some complications. Here, we describe this rare complication of cervical instrumentation with a literature review. A 23-year-old male patient was operated for a C6-C7 dislocation. At postoperative month 10, he presented with hemoptysis and dysphagia. Cervical roentgenograms showed anterior migrations of one broken screw and a plate-locking screw at the C6 corpus. One screw was missing. We concluded that the missing screw had perforated the esophagus and had been eliminated spontaneously through the gastrointestinal tract. No screw should migrate. Even loose screws should be noted in follow-up X-ray studies. If such findings are detected, a second operation for revision should be considered as soon as possible to prevent potentially fatal complications. PMID:23634313

  4. Missing screw as a rare complication of anterior cervical instrumentation.

    PubMed

    Duransoy, Yusuf Kurtuluş; Mete, Mesut; Zengel, Baha; Selçukı, Mehmet

    2013-01-01

    Although anterior cervical arthrodesis is an effective procedure for the treatment of cervical disorders, the method has some complications. Here, we describe this rare complication of cervical instrumentation with a literature review. A 23-year-old male patient was operated for a C6-C7 dislocation. At postoperative month 10, he presented with hemoptysis and dysphagia. Cervical roentgenograms showed anterior migrations of one broken screw and a plate-locking screw at the C6 corpus. One screw was missing. We concluded that the missing screw had perforated the esophagus and had been eliminated spontaneously through the gastrointestinal tract. No screw should migrate. Even loose screws should be noted in follow-up X-ray studies. If such findings are detected, a second operation for revision should be considered as soon as possible to prevent potentially fatal complications.

  5. Complications of Anterior and Posterior Cervical Spine Surgery

    PubMed Central

    Cheung, Jason Pui Yin

    2016-01-01

    Cervical spine surgery performed for the correct indications yields good results. However, surgeons need to be mindful of the many possible pitfalls. Complications may occur starting from the anaesthestic procedure and patient positioning to dura exposure and instrumentation. This review examines specific complications related to anterior and posterior cervical spine surgery, discusses their causes and considers methods to prevent or treat them. In general, avoiding complications is best achieved with meticulous preoperative analysis of the pathology, good patient selection for a specific procedure and careful execution of the surgery. Cervical spine surgery is usually effective in treating most pathologies and only a reasonable complication rate exists. PMID:27114784

  6. Anterior cervical distraction and screw elevating–pulling reduction for traumatic cervical spine fractures and dislocations

    PubMed Central

    Li, Haoxi; Yong, Zhiyao; Chen, Zhaoxiong; Huang, Yufeng; Lin, Zhoudan; Wu, Desheng

    2017-01-01

    Abstract Treatment of cervical fracture and dislocation by improving the anterior cervical technique. Anterior cervical approach has been extensively used in treating cervical spine fractures and dislocations. However, when this approach is used in the treatment of locked facet joints, an unsatisfactory intraoperative reduction and prying reduction increases the risk of secondary spinal cord injury. Thus, herein, the cervical anterior approach was improved. With distractor and screw elevation therapy during surgery, the restoration rate is increased, and secondary injury to the spinal cord is avoided. To discuss the feasibility of the surgical method of treating traumatic cervical spine fractures and dislocations and the clinical application. This retrospective study included the duration of patients’ hospitalization from January 2005 to June 2015. The potential risks of surgery (including death and other surgical complications) were explained clearly, and written consents were obtained from all patients before surgery. The study was conducted on 86 patients (54 males and 32 females, average age of 40.1 ± 5.6 years) with traumatic cervical spine fractures and dislocations, who underwent one-stage anterior approach treatment. The effective methods were evaluated by postoperative follow-up. The healing of the surgical incision was monitored in 86 patients. The follow-up duration was 18 to 36 (average 26.4 ± 7.1) months. The patients achieved bones grafted fusion and restored spine stability in 3 to 9 (average 6) months after the surgery. Statistically, significant improvement was observed by Frankel score, visual analog scale score, Japanese Orthopedic Association score, and correction rate of the cervical spine dislocation pre- and postoperative (P < .01). The modified anterior cervical approach is simple with a low risk but a good effect in reduction. In addition, it can reduce the risk of iatrogenic secondary spinal cord injury and maintain optimal

  7. Cervical disc replacement - emerging equivalency to anterior cervical discectomy and fusion.

    PubMed

    Buckland, Aaron J; Baker, Joseph F; Roach, Ryan P; Spivak, Jeffrey M

    2016-06-01

    Cervical disc replacement has become an acceptable alternative to anterior cervical fusion for the surgical treatment of cervical spine spondylosis resulting in radiculopathy or myelopathy following anterior discectomy and decompression. This concise overview considers the current state of knowledge regarding the continued debate of the role of cervical disc replacement with an update in light of the latest clinical trial results. A literature review was performed identifying clinical trials pertaining to the use of cervical disc replacement compared to cervical discectomy and fusion. Single level disease and two level disease were considered. Outcome data from the major clinical trials was reviewed and salient points identified. With lengthier follow-up data becoming available, the equivalence of CDR in appropriately selected cases is becoming clear. This is chiefly manifested by reduced re-operation rates and reduced incidence of adjacent level disease in those treated with arthroplasty. Cervical disc replacement shows emerging equivalence in outcomes compared to the gold standard anterior cervical discectomy and fusion. Further longer term results are anticipated to confirm this trend.

  8. Anterior cervical discectomy: to graft or not to graft?

    PubMed

    Konduru, S; Findlay, G

    2009-02-01

    The debate regarding whether to perform an interbody fusion after anterior cervical discectomy (ACD) has been going on for the last 50 years. Several prospective randomized clinical trials have been performed to evaluate the clinical outcome following anterior cervical discectomy with and without interbody fusion. None of these studies show a significant difference between the two techniques in terms of relief of arm pain or neck pain. The operative time, in-hospital stay and time for return to work seem to be slightly longer following anterior cervical discectomy with interbody grafting (ACDF) compared to ACD alone. However a temporary increase in postoperative axial pain seems to be a common complication following ACD. There is also no difference in the clinical outcomes between ACD and ACDF with plating and ACDF with interbody spacers. However, if a fusion procedure is undertaken, the use of interbody spacers does have the advantage of avoiding donor site complications. There is also some evidence to suggest that plate fixation can lead to increased fusion rates. There is a significant risk of a degree of segmental kyphosis following ACD. These radiological features, however, do not correlate with the clinical outcome. Radiological and clinical studies fail to show a significant difference in recurrence of foraminal narrowing or the rates of reoperation following ACD or ACDF. The available body of evidence suggests that the addition of a fusion procedure following anterior cervical decompression may give improved radiological results but does not necessarily result in improved clinical outcomes.

  9. The effect of multilevel anterior cervical fusion on neck motion.

    PubMed

    Wu, Xiao-Dong; Wang, Xin-Wei; Yuan, Wen; Liu, Yang; Tsai, Nicholas; Peng, Yu-Cheng; Chen, Yu; Wang, Cong; Gu, Shi-Yi; Chen, Hua-Jiang; Zhou, Xu-Hui; He, Hai-Long; Chen, Yuan-Yuan

    2012-07-01

    Anterior cervical decompression and fusion (ACDF) procedures are successful in treating multilevel cervical radiculopathy and cervical myelopathy. It was reported that this procedure would result in a loss of cervical range of motion. However, few studies have focused on the exact impact of multilevel (more than 3 levels) ACDF on cervical range of motion. 29 patients underwent a 3-level or 4-level ACDF. In all the patients, preoperative active cervical ROM measurement was performed, and postoperative measurement was performed at 1-year follow-up by a CROM device. The pre- and postoperative data were compared to each other using paired t tests (α = 0.05). The patients had significantly less ROM after the surgery in all planes of motion. Major reduction was observed in flexion (39.5%), left and right lateral flexion (25.7 and 25.9%), with relatively minor impact on extension (18.3%), left and right rotation (14.0 and 14.4%) observed. In the three cardinal planes, major reduction was observed in the sagittal plane (28.2%) and coronal plane (25.8%), while minor impact observed in the horizontal plane (14.1%). The patients of cervical spondylotic myelopathy had an obvious reduction in active cervical ROM following multilevel ACDF. However, patients might not experience great difficulties in performing daily activities with regard to the loss of neck motion after fusion.

  10. Risk factors for dysphagia after anterior cervical spine surgery

    PubMed Central

    Liu, Feng-Yu; Yang, Da-Long; Huang, Wen-Zheng; Huo, Li-Shuang; Ma, Lei; Wang, Hui; Yang, Si-Dong; Ding, Wen-Yuan

    2017-01-01

    Abstract Background: Dysphagia is a well-known complication following anterior cervical spine surgery. Although risk factors for dysphagia have been reported in the literature, they still remain controversial. This study aims to investigate the risk factors associated with dysphagia following anterior cervical spinal surgery. Methods: PubMed, EMBASE, and The Cochrane Library were searched up to June 2016 for studies examining dysphagia following anterior cervical spinal surgery. Risk factors associated with dysphagia were extracted. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for outcomes. Data analysis was conducted with RevMan 5.3 and STATA 12.0. Results: The final analysis includes a total of 18 distinct studies. The pooled analysis reveals that there are significant differences in female gender (OR = 2.30, 95% CI: 1.76–2.99, P < 0.001), the use of anterior cervical plate (OR = 1.66, 95% CI: 1.05–2.62, P = 0.03), more than 1 surgical level (OR = 2.07, 95% CI: 1.62–2.66, P < 0.001), the upper surgical level at C3/4 (OR = 3.08, 95% CI: 1.44–6.55, P = 0.004), and the use of bone morphogenetic protein-2 (rhBMP-2) (OR = 5.52, 95% CI: 2.16–14.10, P < 0.001). However, no significant difference is found in revision surgery (OR = 1.67, 95% CI: 0.60–4.68, P = 0.33), the type of fusion (OR = 1.02, 95% CI: 0.62–1.67, P = 0.95), and cervical disc arthroplasty (OR = 1.37, 95% CI: 0.75–2.51, P = 0.30). Conclusion: Female gender, the use of anterior cervical plate, more than 1 surgical level, the upper surgical level at C3/4, and the use of rhBMP-2 are the risk factors for dysphagia following anterior cervical spinal surgery. However, revision surgery, the type of fusion, and cervical disc arthroplasty are unassociated with dysphagia. Considering the limited number of studies, this conclusion should be interpreted cautiously, and larger scale studies are required. PMID

  11. Application of Piezosurgery in Anterior Cervical Corpectomy and Fusion.

    PubMed

    Pan, Sheng-Fa; Sun, Yu

    2016-05-01

    Anterior cervical corpectomy and fusion (ACCF) is frequently used to decompress the cervical spine; however, this procedure is risky when dealing with a hard disc or ossification of the posterior longitudinal ligament (OPLL). Piezosurgery offers a useful tool for performing this procedure. In this article, we present a 50 years old man who had cervical spondylotic myelopathy with OPLL at the C 6 level and segmental stenosis of the cervical spinal canal. When removing the posterior wall of his C 6 vertebral body and OPLL, piezosurgery was used to selectively cut hard structures piece by piece without injuring delicate soft tissues like the nerve roots and spinal cord. Because there is no bleeding from the bone surface with piezosurgery, it provides a clean operative field. © 2016 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

  12. Early results using the Atlantis anterior cervical plate system.

    PubMed

    Barnes, Bryan; Haid, Regis W; Rodts, Gerald E; Subach, Brian R; Kaiser, Michael

    2002-01-15

    The authors present a retrospective review of 77 patients in whom they performed anterior cervical discectomy and fusion (ACDF) in the treatment of radiculopathy and/or myelopathy. In all cases anterior interbody fusion was performed using the Atlantis locking plate system to treat the degenerative disease. There were 41 men and 36 women (mean age 53.8 years), and 24 active cigarette smokers (31%) in the group. All patients presented with signs and symptoms of cervical radiculopathy and/or myelopathy, and magnetic resonance imaging or computerized tomography myelography demonstrated evidence of radicular and/or spinal cord compression at one or more cervical levels. Thirty-one patients underwent single-level ACDF, 20 patients underwent multilevel ACDF without posterior instrumentation, in eight patients one- to four-level corpectomies were supplemented with posterior fixation, 12 patients underwent single-level corpectomy, and six patients underwent multilevel corpectomy with no posterior instrumentation. The mean follow-up period was 15.33 months; overall good-to-excellent outcome was seen in 75% of patients; osseous fusion was demonstrated in 93.5%. In all patients except three, fibular allograft was used as graft material. The degree of overall cervical lordosis was measured at the last follow up and was compared with normal values obtained in age-matched individuals. In addition, the degree of cervical lordosis at fusion levels was compared with overall cervical lordosis. In patients in all five of the aforementioned categories significantly less lordosis was demonstrated than in age-matched controls. In patients who underwent single-level ACDF, single-level corpectomy, and multilevel ACDF significantly less lordosis was observed at the fusion segment than that in the overall cervical spine. Complications included one episode of chronic anterior wound drainage treated with intravenous antibiotic medication and one postoperative posterior wound infection, which

  13. Enhancement of stability following anterior cervical corpectomy: a biomechanical study.

    PubMed

    Singh, Kern; Vaccaro, Alexander R; Kim, Jesse; Lorenz, Eric P; Lim, Tae-Hong; An, Howard S

    2004-04-15

    An in vitro biomechanical study of various reconstructive techniques following decompression of the spondylotic cervical spine. OBJECTIVE.: To evaluate the biomechanical stability of anterior cervical plate fixation following three strategies of decompression for multilevel cervical spondylosis (three levels) of the cervical spine: three level discectomy, single corpectomy and discectomy, and a two-level corpectomy. The main goals of surgical treatment for cervical myelopathy include adequate decompression and stabilization while maintaining or restoring cervical lordosis. Cervical decompression is often performed through a corpectomy followed by strut-graft reconstruction. An anterior cervical plate with end-fixation (two points of fixation) is then used to span the construct. The authors propose an alternative to multilevel corpectomy and long-segment end construct plate fixation. Often times, the cervical stenosis is confined to the area of the degenerative discs. As a result, the authors feel that either multilevel discectomy or a corpectomy combined with discectomy followed by segmental plate fixation may provide adequate decompression with increased biomechanical rigidity as compared to cervical plate-constructs with end-fixation only. Seven human cadaveric fresh-frozen cervical spines from C1-T1 were utilized. Three-dimensional motion analysis with an optical tracking device was used to determine motion following various reconstruction methods. All seven cervical spines underwent testing in a randomized order. The end construct model consisted of a corpectomy at C4 and C5 with a polymethyl methacrylate strut graft and an anterior cervical PEAK (DePuy-AcroMed) plate. The two segmental constructs also utilized the PEAK plate with one construct undergoing discectomies at C3-C4, C4-C5, and C5-C6 with polymethyl methacrylate interbody grafts and the other segmental construct undergoing a discectomy at C3-C4 and a corpectomy of C5. All specimens underwent a pure

  14. Negative Pressure Pulmonary Edema Associated with Anterior Cervical Spine Surgery

    PubMed Central

    Yoneda, Masana; Tanaka, Yasuhito

    2014-01-01

    We report a very rare case of negative pressure pulmonary edema (NPPE) that occurred immediately after anterior cervical discectomy and fusion (ACDF). The patient was a 25-year-old man who sustained a facet fracture-dislocation of C5 during a traffic accident. After ACDF, he developed NPPE and needed mechanical ventilation. Fortunately, he recovered fully within 24 hours. NPPE is a rare postoperative complication that may occur after cervical spine surgery. The aims of this report are to present information regarding the diagnosis and emergent treatment of NPPE, and to review the previous literature regarding this serious complication. PMID:25558327

  15. Airway complications associated with surgery on the anterior cervical spine.

    PubMed

    Sagi, H Claude; Beutler, William; Carroll, Eben; Connolly, Patrick J

    2002-05-01

    Retrospective chart review of 311 anterior cervical procedures. To assess the incidence and variables that predispose to an airway complication in a large series of anterior cervical surgical procedures. A rare but potentially lethal complication after anterior cervical spine surgery is respiratory compromise and airway obstruction. Some risk factors are thought to include two-level corpectomy in myelopathic patients with a history of heavy smoking and asthma. No previous study in the literature has been directed at examining the factors specifically related to airway complications after anterior cervical spine surgery. Each chart was examined for patient characteristics and pathology, anesthetic parameters and problems, operative procedure, and postoperative course and management. Statistical analysis was performed. Nineteen patients (6.1%) had an airway complication and six (1.9%) required reintubation. One patient died. Symptoms developed on average 36 hours postoperatively. All complications except for two were attributable to pharyngeal edema. Variables that were found to be statistically associated with an airway complication (P < 0.05) were exposing more than three vertebral bodies, a blood loss >300 mL, exposures involving C2, C3, or C4, and an operative time >5 hours. A history of myelopathy, spinal cord injury, pulmonary problems, smoking, anesthetic risk factors, and the absence of a drain did not correlate with an airway complication. Patients with prolonged procedures (i.e., >5 hours) exposing more than three vertebral levels that include C2, C3, or C4 with more than 300-mL blood loss should be watched carefully for respiratory insufficiency.

  16. Correlation between cervical lordosis and adjacent segment pathology after anterior cervical spinal surgery.

    PubMed

    Lee, Soo Eon; Jahng, Tae-Ahn; Kim, Hyun Jib

    2015-12-01

    To evaluate the incidence and risk factors for adjacent segment pathology (ASP) after anterior cervical spinal surgery. Fourteen patients (12 male, mean age 47.1 years) who underwent single-level cervical disk arthroplasty (CDA group) and 28 case-matched patients (24 male, mean age 53.6 years) who underwent single-level anterior cervical discectomy and fusion (ACDF group) were included. Presence of radiologic ASP (RASP) was based on observed changes in anterior osteophytes, disks, and calcification of the anterior longitudinal ligament on lateral radiographs. The mean follow-up period was 43.4 months in the CDA group and 44.6 months in the ACDF group. At final follow-up, ASP was observed in 5 (35.7%) CDA patients and 16 (57.1%) ACDF patients (p = 0.272). The interval between surgery and ASP development was 33.8 months in the CDA group and 16.3 months in the ACDF group (p = 0.046). The ASP risk factor analysis indicated postoperative cervical angle at C3-7 being more lordotic in non-ASP patients in both groups. Restoration of lordosis occurred in the CDA group regardless of the presence of ASP, but heterotopic ossification development was associated with the presence of ASP in the CDA group. And the CDA group had significantly greater clinical improvements than those in the ACDF group when ASP was present. In both CDA and ACDF patients, RASP developed, but CDA was associated with a delay in ASP development. A good clinical outcome was expected in CDA group, even when ASP developed. Restoration of cervical lordosis was an important factor in anterior cervical spine surgery.

  17. Complications of tracheostomy after anterior cervical spine fixation surgery.

    PubMed

    Romero-Ganuza, Javier; Gambarrutta, Claudia; Merlo-Gonzalez, Victoria Eugenia; Marin-Ruiz, Maria Ángeles; Diez De La Lastra-Buigues, Elena; Oliviero, Antonio

    2011-01-01

    Cervical traumatic spinal cord-injured patients often way require both anterior cervical spine stabilization and tracheostomy in the first few days after the injury. The infectious complication of tracheostomy can interfere with the evolution of the fixation surgery. The aim of our study was to evaluate the safety of tracheostomy performed early after anterior cervical spine stabilization. We reviewed the clinical records of 28 patients admitted to our hospital intensive care unit. In all cases, percutaneous tracheostomy was performed using the percutaneous dilation technique. The average time interval between the fixation surgery and tracheostomy was 8.25 ± 5.57 days. We had complications in tracheostomy in only 3 cases: minor bleeding occurred in 1 patient and stomal infection, not propagated to the fixation surgery wound, was observed in 2 patients. Two patients died without causal relation to these interventions. The early performance of tracheostomy after cervical spinal fixation surgery is safe, still realized early and nearly this, at least if the tracheostomy is performed by percutaneous method. Copyright © 2011 Elsevier Inc. All rights reserved.

  18. Anterior Surgical Fixation for Cervical Spine Flexion-Distraction Injuries.

    PubMed

    Jack, Andrew; Hardy-St-Pierre, Godefroy; Wilson, Mitchell; Choy, Godwin; Fox, Richard; Nataraj, Andrew

    2017-05-01

    Optimal surgical management for flexion-distraction cervical spine injuries remains controversial with current guidelines recommending anterior, posterior, and circumferential approaches. Here, we determined the incidence of and examined risk factors for clinical and radiographic failure in patients with 1-segment cervical distraction injuries having undergone anterior surgical fixation. A retrospective review of 57 consecutive patients undergoing anterior fixation for subaxial flexion-distraction cervical injuries between 2008 and 2012 at our institution was performed. The primary outcome was the number of patients requiring additional surgical stabilization and/or radiographic failure. Data collected included age, gender, mechanism and level of injury, facet pattern injury, and vertebral end plate fracture. A total of 6 patients failed clinically and/or radiographically (11%). Four patients (7%) required additional posterior fixation. Although 2 other patients identified met radiographic failure criteria, at follow-up they had fused radiographically, were stable clinically, and no further treatment was pursued. Progressive kyphosis and translation were found to be significantly correlated with need for revision (P < 0.05 and P = 0.02, respectively). No differences were identified for all other clinical and radiologic factors assessed, including unilateral or bilateral facet injury, facet fracture, and end plate fracture. This study contributes to the growing body of evidence supporting anterior fixation alone for flexion-distraction injuries. Findings suggest that current measurements of radiographic failure including segmental translation and kyphosis may predict radiographic failure and need for further surgical stabilization in some patients. Future follow-up studies assessing for independent risk factors for anterior approach failure with a validated predictive scoring model should be considered. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Minimally Invasive Anterior Cervical Discectomy Without Fusion to Treat Cervical Disc Herniations in Patients with Previous Cervical Fusions.

    PubMed

    Jacobson, Robert E; Granville, Michelle; Berti, Aldo

    2017-04-03

    Adjacent level cervical disc disease and secondarily progressive disc space degeneration that develops years after previously successful anterior cervical fusion at one or more levels is a common, but potentially complex problem to manage. The patient is faced with the option of further open surgery which involves adding another level of disc removal with fusion, posterior decompression, and stabilization, or possibly replacing the degenerated disc with an artificial disc construct. These three cases demonstrate that some patients, especially after minor trauma, may have small herniated discs as the cause for their new symptoms rather than progressive segmental degeneration. Each patient became symptomatic after minor trauma three to six years after the original fusion and had no or minimal radiologic changes of narrowing of the disc or spur formation commonly seen in adjacent level disease, but rather had magnetic resonance imaging (MRI) findings typical of small herniated discs. After failing multiple months of conservative treatment they were offered surgery as an option. Subsequently, all three were successfully treated with minimal anterior discectomy without fusion. There are no reports in the literature of using minimal anterior cervical discectomy without fusion in previous fused patients. This report reviews the background of adjacent level cervical disease, the various biomechanical explanations for developing a new disc herniation rather than progressive segmental degeneration, and how anterior cervical discectomy without fusion can be an option in these patients.

  20. C2-C3 Anterior Cervical Fusion: Technical Report.

    PubMed

    Finn, Michael A; MacDonald, Joel D

    2016-12-01

    Retrospective review of patients at a university hospital. To describe the anterior approach for cervical discectomy and fusion (ACDF) at C2-C3 level and evaluate its suitability for treatment of instability and degenerative disease in this region. The anterior approach is commonly used for ACDF in the lower cervical spine but is used less often in the high cervical spine. We retrospectively reviewed a database of consecutive cervical spine surgeries performed at our institution to identify patients who underwent ACDF at the C2-C3 level during a 10-year period. Demographic data, clinical indications, surgical technique, complications, and immediate results were evaluated. Of the 11 patients (7 female, 4 male; mean age 46 y) identified, 7 were treated for traumatic fractures and 4 for degenerative disk disease. Three patients treated for myelopathy showed improvement in mean Nurick grade from 3.6 to 1.3. Pain was significantly improved in all patients who had preoperative pain. Solid bony fusion was achieved in 5 of 7 patients at 3-month follow-up. Complications included dysphagia in 4 patients (which resolved in 3), aspiration pneumonia, mild persistent dysphonia, and construct failure at C2 requiring posterior fusion. One patient died of a pulmonary embolism 2 weeks postoperatively. ACDF at the C2-C3 level is an option for the treatment of high cervical disease or trauma but is associated with a higher rate of approach-related morbidity. Familiarity with local anatomy may help to reduce complications. ACDF at C2-C3 appears to have a fusion rate similar to ACDF performed at other levels.

  1. Pharyngoesophageal perforation 3 years after anterior cervical spine surgery: a rare case report and literature review.

    PubMed

    Yin, Dan-Hui; Yang, Xin-Ming; Huang, Qi; Yang, Mi; Tang, Qin-Lai; Wang, Shu-Hui; Wang, Shuang; Liu, Jia-Jia; Yang, Tao; Li, Shi-Sheng

    2015-08-01

    Pharyngoesophageal perforation after anterior cervical spine surgery is rare and the delayed cases were more rarely reported but potentially life-threatening. We report a case of pharyngoesophageal perforation 3 years after anterior cervical spine surgery. The patient presented with dysphagia, fever, left cervical mass and developing dyspnea 3 years after cervical spine surgery for trauma. After careful examinations, he underwent an emergency tracheostomy, neck exploration, hardware removal, abscess drainage and infected tissue debridement. 14 days after surgery, CT of the neck with oral contrast demonstrated no contrast extravasation from the esophagus. Upon review of literature, only 14 cases of pharyngoesophageal perforation more than 1 year after anterior cervical spine surgery were found. We discussed possible etiology, diagnosis and management and concluded that in cases of dysphagia, dyspnea, cervical pain, swelling and edema of the cervical area even long time after anterior cervical spine surgery, potential pharyngoesophageal damage should be considered.

  2. Extreme multi-level anterior cervical discectomy and fusion.

    PubMed

    Morgan, Jeremy P; Asfora, Wilson T

    2013-07-01

    The use of anterior cervical discectomy and fusion (ACDF) is a common procedure used to treat those who suffer from degenerative disc disease (DDD) of the cervical spine which may result in spondylolisthesis, spinal stenosis, disc herniation, nerve root and/or cord compression. ACDF is regularly used for the fusion of one to four cervical spine levels; however, the literature documenting the fusion of 5 or 6 levels is surprisingly lacking. In this retrospective review of our case series, we document two 5-level and two 6-level ACDF in elderly patients using custom made titanium fusion plates and patellar allograft bone for interbody placement without posterior fixation. The documentation of these long anterior constructs without supplemental posterior fixation or the use of a halo vest apparatus, but a simple neck collar for three months, is an important contribution to the literature illustrating that with utilization of appropriate technique, a high number of levels can be safely fused in the elderly patients necessitating this particular procedure.

  3. Regression of anterior disc-osteophyte complex following cervical laminectomy and fusion for cervical spondylotic myelopathy

    PubMed Central

    Ashana, Adedayo O.; Cohen, Jeremiah R.; Evans, Brandon; Holly, Langston T.

    2014-01-01

    Study Design Retrospective case control study Objective To investigate whether posterior cervical laminectomy and fusion modifies the natural course of anterior disc-osteophyte complex in patients with multilevel CSM Summary of Background Data Dorsal migration of the spinal cord is the main purported mechanism of spinal cord decompression following cervical laminectomy and fusion but other potential mechanisms have received scant attention in the literature. This study was conducted to investigate whether cervical laminectomy and fusion affects the size of anterior disc osteophyte complex. Methods The medical records and radiographical imaging of 44 patients that underwent cervical laminectomy and fusion for CSM between 2006 and 2013 were analyzed. The size of the anterior disc osteophyte complex was measured pre and postoperatively on MR images taken at an interval of > 3 months apart. A control group consisted of 20 non-operatively treated advanced cervical spondylosis patients. Patients in the control met the same inclusion and exclusion criteria and also had sequential MRI taken at an interval of > 3 months apart. Results The nonoperative and operative groups were statistically similar in the pertinent patient demographics and characteristics including gender, age, time to second MRI, size of anterior disc-osteophyte complex on baseline MRI, mean number of levels affected, and percentage of patients with T2 signal change. As expected the mJOA scores were significantly lower in the operative versus nonoperative cohort (13.6 vs. 16.5, P<0.01). A significant decrease in the size of anterior disc osteophyte was observed in the operative group postoperatively (P<0.01). In comparison, there was no statistically significant change in the size of the anterior disc osteophyte complex in the control group (P > 0.05). The magnitude of the change in disc size between the two groups was statistically significant (P <0.01). Conclusion The findings of this study suggest that

  4. A Matched Cohort Analysis Comparing Stand-Alone Cages and Anterior Cervical Plates Used for Anterior Cervical Discectomy and Fusion.

    PubMed

    Overley, Samuel C; Merrill, Robert K; Leven, Dante M; Meaike, Joshua J; Kumar, Abhishek; Qureshi, Sheeraz A

    2017-08-01

    Retrospective cohort study. To compare perioperative characteristics of stand-alone cages and anterior cervical plates used for anterior cervical discectomy and fusion (ACDF). We reviewed 40 adult patients who received a stand-alone cage for elective ACDF and matched them with 40 patients who received an anterior cervical plate. We statistically compared operative time, length of stay, proportion of ambulatory cases, overall complications necessitating a trip to the ED, readmission, or reoperation related to index procedure. There were 21 women and 19 men in the plate cohort with average ages of 53 years ± 12 and 20 women and 20 men in the stand-alone group with an average age of 52 years ± 11. With no statistical difference in total number, the plate group experienced 4 short-term (within 90 days of discharge) complications, including 3 patients who visited the emergency department for dysphagia and 1 who visited the emergency department for severe back pain, while the stand-alone group experienced 0 complications. There was no significant difference in operative time between the stand-alone group (75.35 min) and the plate group (81.35 min; P = .37). There was a significant difference between the proportion of ambulatory cases in the stand-alone group (25) and the plate group (6; P < .0001). Our results demonstrate that stand-alone cages have fewer complications compared to anterior plating, with a lower trend of incidence of postoperative dysphagia. Stand-alone cages may offer the advantage of sending patients home ambulatory after ACDF surgery.

  5. Anterior cervical arthrodesis using a vertebral body autograft.

    PubMed

    Ferrete-Barroso, A M; González-Díaz, R; Losada-Viñas, J I

    2015-01-01

    To assess fusion rates and functional outcomes in patients undergoing anterior cervical discectomy and fusion by using a vertebral body autograft for interbody filling and anterior cervical plate fixation. The study included a total of 102 patients, 54 men and 48 women, who underwent surgery between 2006 and 2010 patients with degenerative disease, cervical disc herniation and radiculopathy, and who had failed standard conservative treatment (3 months). The study was limited to patients with fusion levels 1-3. The mean patient follow-up was 44 (24-96) months. Their mean age was 48.8 years. The clinical variables analyzed were: duration of symptoms (> 12 months), smoking (31% smokers), employment status (76% active), average days of hospitalization (2.2 days), operation time (62 min), etiology (100%, degenerative disease), notable comorbidities (28%), fusion levels (42% 1, 49% 2, 9% 3), symptoms (radiculalgia or axial pain). The functional variables analyzed (score pre-and post-operative scores) were: VAS (8.6-1.32), Neck Disability Index (37.7-5.8), and Odom criteria (76% reflected excellent results after surgery). Finally, radiological variables were also analyzed: anterior reactive osteophytosis (16%), significant collapse (0%), and fusion rate (98%). There were 4 cases of acute postoperative complications, and 4 chronic, none of them were related to the surgical technique. The use of autograft bone of the vertebral body itself reduces comorbidities associated with the use of the iliac crest of the patient. Our results using the technique described are comparable to those in the literature, with a fusion rate of 98% and a mean of 62 min duration of the procedure. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  6. The kinematics of anterior cervical discectomy and fusion versus artificial cervical disc: a pilot study.

    PubMed

    Rabin, Doron; Pickett, Gwynedd E; Bisnaire, Lynn; Duggal, Neil

    2007-09-01

    Anterior cervical discectomy and fusion (ACDF) for the management of cervical spondylosis may contribute to further degenerative changes at adjacent levels secondary to abnormal spinal motion. Insertion of a Bryan Cervical Disc (AD) (Medtronic Sofamor Danek, Memphis, TN) may prevent this accelerated degeneration. This retrospective study compares the in vivo x-ray cervical spine kinematics in patients with ACDF and AD. Ten patients with single-level AD were matched to 10 patients with single-level ACDF based on age and sex. Lateral neutral, flexion and extension cervical x-rays were obtained preoperatively and at regular intervals up to 24 months postoperatively. Kinematic parameters, including range of motion, anteroposterior translation, and disc height, were assessed for all cervical functional spinal units using quantitative motion analysis software. Changes in these parameters were compared between matched patients from both groups using paired Student's t tests. The range of motion at the operated level was greater in the AD group compared with the ACDF group at early (6.9 versus 0.89 degrees, P < 0.01) and late (8.4 versus 0.53 degrees, P < 0.01) follow-up evaluations. Translation was greater at the operated level in patients with AD at late follow-up (6.8 versus 0.8%, P < 0.03) evaluation. No significant between-group kinematic differences were seen at adjacent levels. Patients with AD and those with ACDF demonstrated similar in vivo adjacent level kinematics within the first 24 months after anterior cervical decompression.

  7. Hybrid Surgery Versus Anterior Cervical Discectomy and Fusion in Multilevel Cervical Disc Diseases

    PubMed Central

    Zhang, Jianfeng; Meng, Fanxin; Ding, Yan; Li, Jie; Han, Jian; Zhang, Xintao; Dong, Wei

    2016-01-01

    Abstract To investigate the outcomes and reliability of hybrid surgery (HS) versus anterior cervical discectomy and fusion (ACDF) for the treatment of multilevel cervical spondylosis and disc diseases. Hybrid surgery, combining cervical disc arthroplasty (CDA) with fusion, is a novel treatment to multilevel cervical degenerated disc disease in recent years. However, the effect and reliability of HS are still unclear compared with ACDF. To investigate the studies of HS versus ACDF in patients with multilevel cervical disease, electronic databases (Medline, Embase, Pubmed, Cochrane library, and Cochrane Central Register of Controlled Trials) were searched. Studies were included when they compared HS with ACDF and reported at least one of the following outcomes: functionality, neck pain, arm pain, cervical range of motion (ROM), quality of life, and incidence of complications. No language restrictions were used. Two authors independently assessed the methodological quality of included studies and extracted the relevant data. Seven clinical controlled trials were included in this study. Two trials were prospective and the other 5 were retrospective. The results of the meta-analysis indicated that HS achieved better recovery of NDI score (P = 0.038) and similar recovery of VAS score (P = 0.058) compared with ACDF at 2 years follow-up. Moreover, the total cervical ROM (C2–C7) after HS was preserved significantly more than the cervical ROM after ACDF (P = 0.000) at 2 years follow-up. Notably, the compensatory increase of the ROM of superior and inferior adjacent segments was significant in ACDF groups at 2-year follow-up (P < 0.01), compared with HS. The results demonstrate that HS provides equivalent outcomes and functional recovery for cervical disc diseases, and significantly better preservation of cervical ROM compared with ACDF in 2-year follow-up. This suggests the HS is an effective alternative invention for the treatment of multilevel cervical

  8. Evolution and function of anterior cervical vertebral fusion in tetrapods.

    PubMed

    VanBuren, Collin S; Evans, David C

    2017-02-01

    The evolution of vertebral fusion is a poorly understood phenomenon that results in the loss of mobility between sequential vertebrae. Non-pathological fusion of the anterior cervical vertebrae has evolved independently in numerous extant and extinct mammals and reptiles, suggesting that the formation of a 'syncervical' is an adaptation that arose to confer biomechanical advantage(s) in these lineages. We review syncervical anatomy and evolution in a broad phylogenetic context for the first time and provide a comprehensive summary of proposed adaptive hypotheses. The syncervical generally consists of two vertebrae (e.g. hornbills, porcupines, dolphins) but can include fusion of seven cervical vertebrae in some cetaceans. Based on the ecologies of taxa with this trait, cervical fusion most often occurs in fossorial and pelagic taxa. In fossorial taxa, the syncervical likely increases the out-lever force during head-lift digging. In cetaceans and ricochetal rodents, the syncervical may stabilize the head and neck during locomotion, although considerable variation exists in its composition without apparent variability in locomotion. Alternatively, the highly reduced cervical vertebral centra may require fusion to prevent mechanical failure of the vertebrae. In birds, the syncervical of hornbills may have evolved in response to their unique casque-butting behaviour, or due to increased head mass. The general correlation between ecological traits and the presence of a syncervical in extant taxa allows more accurate interpretation of extinct animals that also exhibit this unique trait. For example, syncervicals evolved independently in several groups of marine reptiles and may have functioned to stabilize the head at the craniocervical joint during pelagic locomotion, as in cetaceans. Overall, the origin and function of fused cervical vertebrae is poorly understood, emphasizing the need for future comparative biomechanical studies interpreted in an evolutionary context.

  9. Cervical radiographic parameters in 1- and 2-level anterior cervical discectomy and fusion.

    PubMed

    Gillis, Christopher C; Kaszuba, Megan C; Traynelis, Vincent C

    2016-10-01

    OBJECTIVE Anterior cervical discectomy and fusion (ACDF) is one of the most commonly performed spine procedures. It can be used to correct cervical kyphotic deformity, which is the most common cervical deformity, and is often performed using lordotic interbody devices. Worsening of the cervical sagittal parameters is associated with decreased health-related quality of life. The study hypothesis is that through the use of machined lordotic allografts in ACDF, segmental and overall cervical lordosis can be maintained or increased, which will have a positive impact on overall cervical sagittal alignment. METHODS Seventy-four cases of 1-level ACDF (ACDF1) and 2-level ACDF (ACDF2) (40 ACDF1 and 34 ACDF2 procedures) were retrospectively reviewed. Upright neutral lateral radiographs were assessed preoperatively and at 6 weeks and 1 year postoperatively. The measured radiographic parameters included focal lordosis, disc height, C2-7 lordosis, C1-7 lordosis, T-1 slope, and C2-7 sagittal vertical axis. Correlation coefficients were calculated to determine the relationships between these radiographic measurements. RESULTS The mean values were as follows: preoperative focal lordosis was 0.574°, disc height was 4.48 mm, C2-7 lordosis was 9.66°, C1-7 lordosis was 42.5°, cervical sagittal vertebral axis (SVA) was 26.9 mm, and the T-1 slope was 33.2°. Cervical segmental lordosis significantly increased by 6.31° at 6 weeks and 6.45° at 1 year. C2-7 lordosis significantly improved by 1 year with a mean improvement of 3.46°. There was a significant positive correlation between the improvement in segmental lordosis and overall cervical lordosis. Overall cervical lordosis was significantly negatively correlated with cervical SVA. Improved segmental lordosis was not correlated with cervical SVA in ACDF1 patients but was significantly negatively correlated in ACDF2 patients. There was also a significant positive correlation between the T-1 slope and cervical SVA. CONCLUSIONS In

  10. Management of the cervical esophagus and hypofarinx perforations complicating anterior cervical spine surgery.

    PubMed

    Orlando, Epimenio Ramundo; Caroli, Emanuela; Ferrante, Luigi

    2003-08-01

    Five cases of esophageal or pharyngeal perforation diagnosed during or after anterior cervical spine surgery are presented. To outline a protocol for the early diagnosis and treatment of iatrogenic pharyngoesophageal perforations. Pharyngoesophageal perforations after anterior cervical spine surgery are uncommon or rarely reported complications. They may have serious functional consequences, including death, if they are not diagnosed promptly and treated effectively. These potentially fatal conditions require a surgical and medical therapy. Clinical course, diagnostic tools and guidelines for the management of five patients presenting esophagopharingeal perforations are illustrated. These five cases resulted in definitive healing of the laceration without functional consequences. We believe that awareness of these complications and their causes, prompt recognition of the symptoms and immediate and multimodality therapies are essential tools to achieve successful results.

  11. C2 prosthesis: anterior upper cervical fixation device to reconstruct the second cervical vertebra

    PubMed Central

    Fekete, Tamás Fülöp; Melcher, Robert; Harms, Jürgen

    2007-01-01

    Destruction of the second cervical vertebra leads to a highly unstable situation. Reconstruction is difficult because the axis plays a central role in rotatory movements and has a unique function in redistributing axial loads. The axis transfers the axial load of the two lateral masses of the atlas to three surfaces on the third cervical vertebra: the two articular facets and the vertebral body. As reconstruction is difficult and the instability in this region is life threatening, pathological processes are often treated less radically compared to other areas of the cervical spine. However, this more moderate approach may result in worse outcomes and prognoses. This paper presents the development of a new implant (C2 prosthesis) and two illustrative cases describing the implementation of this new implant. The C2 prosthesis provides anterior support and therefore allows a more radical surgical approach. PMID:17632736

  12. [Anterior spinal artery syndrome due to cervical spondylosis presenting as cervical angina].

    PubMed

    Odaka, Masaaki; Hirata, Koichi

    2004-11-01

    A 54-year-old woman developed acute progressive paraparesis after repeated precordial pain. Neurological examination revealed bilateral four-limb weakness predominant in the distal part of the upper limbs, upper limbs brisk tendon reflexes, superficial sensory impairment below the C8 level, and atonic bladder. T2-weighted cervical MRI disclosed hyperintense lesion with disc herniation in gray matter of spinal cord between C5 and C7. No vertebral artery abnormalities were detected. We hypothesized that she developed anterior spinal artery syndrome after cervical angina caused by cervical spondylosis. We conclude that physicians need to be aware of patients who experience chest pain without evidence of cardiac disease and that they take into consideration spinal cord infarction.

  13. Effect of Anterior Cervical Discectomy and Fusion on Patients with Atypical Symptoms Related to Cervical Spondylosis.

    PubMed

    Muheremu, Aikeremujiang; Sun, Yuqing; Yan, Kai; Yu, Jie; Zheng, Shan; Tian, Wei

    2016-09-01

    Background A considerable number of patients with cervical spondylosis complain about one or multiple atypical symptoms such as vertigo, palpitations, headache, blurred vision, hypomnesia, and/or nausea. It remains unclear whether surgical intervention for cervical spondylosis can also effectively alleviate those symptoms. The current study was performed to see if anterior cervical diskectomy and fusion (ACDF) offers such an extra benefit for patients with cervical spondylosis. Objective To investigate if patients who received ACDF for the treatment of cervical spondylotic myelopathy and/or radiculopathy can also achieve alleviation of certain atypical symptoms associated with cervical spondylosis after the surgery in the long run. Methods Sixty-seven patients who underwent ACDF for the treatment of cervical spondylotic myelopathy and/or radiculopathy were involved in this study. All these patients also complained about various associated atypical symptoms. They were followed up for 26 to 145 months after the surgery. Severity and frequency scores of the atypical symptoms before the surgery and at last follow-up were compared by paired t tests. Results Most patients reported significantly alleviated symptoms at the last follow-up compared with before the surgery. The severity of vertigo, headache, nausea, and palpitations were significantly alleviated at the last follow-up (with p values of p < 0.001, p = 0.001, p = 0.022, p = 0.004, respectively). There were no significant changes in the severity of tinnitus (p = 0.182), blurred vision (p = 0.260), and hypomnesia (p = 0.821). Conclusion ACDF can significantly alleviate vertigo, headache, nausea, and palpitations in most patients with cervical spondylotic myelopathy and/or radiculopathy, but it is not effective in alleviating symptoms such as tinnitus, blurred vision, and hypomnesia. It can be considered for alleviating atypical symptoms when other treatment options prove

  14. Reoperation Rates After Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Radiculopathy and Myelopathy: A National Population-based Study.

    PubMed

    Park, Moon Soo; Ju, Young-Su; Moon, Seong-Hwan; Kim, Tae-Hwan; Oh, Jae Keun; Makhni, Melvin C; Riew, K Daniel

    2016-10-15

    National population-based cohort study. To compare the reoperation rates between cervical spondylotic radiculopathy and myelopathy in a national population of patients. There is an inherently low incidence of reoperation after surgery for cervical degenerative disease. Therefore, it is difficult to sufficiently power studies to detect differences between reoperation rates of different cervical diagnoses. National population-based databases provide large, longitudinally followed cohorts that may help overcome this challenge. We used the Korean Health Insurance Review and Assessment Service national database to select our study population. We included patients with the diagnosis of cervical spondylotic radiculopathy or myelopathy who underwent anterior cervical discectomy and fusion from January 2009 to June 2014. We separated patients into two groups based on diagnosis codes: cervical spondylotic radiculopathy or cervical spondylotic myelopathy. Age, sex, presence of diabetes, osteoporosis, associated comorbidities, number of operated cervical disc levels, and hospital types were considered potential confounding factors. The overall reoperation rate was 2.45%. The reoperation rate was significantly higher in patients with cervical spondylotic myelopathy than in patients with cervical radiculopathy (myelopathy: P = 0.0293, hazard ratio = 1.433, 95% confidence interval 1.037-1.981). Male sex, presence of diabetes or associated comorbidities, and hospital type were noted to be risk factors for reoperation. The reoperation rate after anterior cervical discectomy and fusion was higher for cervical spondylotic myelopathy than for cervical spondylotic radiculopathy in a national population of patients. 3.

  15. Comparison of cervical disc arthroplasty with anterior cervical discectomy and fusion for the treatment of cervical spondylotic myelopathy.

    PubMed

    Ding, Chen; Hong, Ying; Liu, Hao; Shi, Rui; Song, Yueming; Li, Tao

    2013-06-01

    The clinical outcome of cervical disc arthroplasty for cervical spondylotic myelopathy (CSM) is still controversial. The authors retrospectively compared the intermediate term clinical outcome of cervical disc arthroplasty and traditional anterior cervical discectomy and fusion (ACDF). Seventy-six cases of single-level CSM with a minimum follow-up of two years were retrospectively analyzed. Thirty-seven patients underwent single-level cervical disc arthroplasty (Bryan disc: 12 cases; Prestige LP disc: 25 cases), while the other 39 patients underwent single-level ACDF. Significant improvement in SF-36 physical/ mental component scores and NDI score was found in both groups (p < 0.05); however, the arthroplasty group had significantly greater score improvement at each follow-up time point (p < 0.05). The JOA score and Nurick grade improved significantly at each time point in both groups (p < 0.05), but there were no significant differences between the groups (p > 0.05). The range of motion (surgical level and C2C7) remained unchanged in the arthroplasty group (p > 0.05), whereas it decreased significantly in the ACDF group (p < 0.05). The arthroplasty group had a lower incidence of complications than the ACDF group. The intermediate outcomes of cervical disc arthroplasty compared favourably to those of ACDF. Arthroplasty avoids complications from spinal fusion by preserving mobility.

  16. Morphologic evaluation of cervical spine anatomy with computed tomography: anterior cervical plate fixation considerations.

    PubMed

    Kwon, Brian K; Song, Frederick; Morrison, William B; Grauer, Jonathan N; Beiner, John M; Vaccaro, Alexander R; Hilibrand, Alan S; Albert, Todd J

    2004-04-01

    The computed tomography (CT) studies of the cervical spine from 50 males and 50 females were reviewed to provide morphometric data on a variety of anatomic parameters relevant to anterior cervical reconstruction and fixation. Measurements were made of the vertebral body width and midsagittal anteroposterior (AP) diameter and the distance between the medial borders of the longus coli muscles. Distances between adjacent endplates were also measured, both at their midpoint and at the anterior margin. Widths of the vertebral bodies measure 24.6 +/- 2.4 and 23.0 +/- 2.4 mm in males and females, respectively, with the narrowest measuring 17 and 14, respectively. The average midsagittal AP diameter of each vertebral body in males was approximately 17-18 mm, with the smallest AP diameter measured to be 13 mm. The average midsagittal AP diameter of each vertebral body in females was approximately 15-16 mm, with the smallest being 10 mm. CT scanning provides excellent osseous detail for the measurement of such parameters, and with its widespread use in the evaluation of cervical disorders, large numbers of patients can be reviewed.

  17. Gelfoam-induced Swallowing Difficulty after Anterior Cervical Spine Surgery.

    PubMed

    Yang, Joo Chul; Kim, Tae Wan; Park, Kwan Ho

    2013-06-01

    Symptomatic diffuse idiopathic skeletal hyperostosis (DISH) is not common. Gelfoam is one of the most commonly used topical hemostatic agents. But, in the partially moistened state, air retained in its pores may result in excessive expansion on contact with liquid. The onset of swallowing difficulty after anterior cervical spine surgery due to appling gelfoam is a rare complication. A 77-year-old man with swallowing difficulty was admitted to our hospital and we diagnosed him as DISH confirmed by radiological study. After removing the DISH, patient's symptom was relieved gradually. However, on postoperative day (POD) 7, the symptom recurred but lesser than the preoperative state. We confirmed no hematoma and esophageal perforation on the operation site. We observed him closely and controlled the diet. Three months later, he had no symptom of swallowing difficulty, and was able to be back on a regular diet, including solid foods. We present a complication case of swallowing difficulty occurring by gelfoam application.

  18. Are External Cervical Orthoses Necessary after Anterior Cervical Discectomy and Fusion: A Review of the Literature

    PubMed Central

    Ajayi, Olaide O; Asgarzadie, Farbod

    2016-01-01

    Introduction & Background: The use of external cervical orthosis (ECO) after anterior cervical discectomy and fusion (ACDF) varies from physician to physician due to an absence of clear guidelines. Our purpose is to evaluate and present evidence answering the question, “Does ECO after ACDF improve fusion rates?” through a literature review of current evidence for and against ECO after ACDF.  Review: A PubMed database search was conducted using specific ECO and ACDF related keywords. Our search yielded a total of 1,267 abstracts and seven relevant articles. In summary, one study provided low quality of evidence results supporting the conclusion that external bracing is not associated with improved fusion rates after ACDF.  The remaining six studies provide very low quality of evidence results; two studies concluded that external bracing after cervical procedures is not associated with improved fusion rates, one study concluded that external bracing after cervical procedures is associated with improved fusion rates, and the remaining three studies lacked sufficient evidence to draw an association between external bracing after ACDF and improved fusion rates. Conclusion: We recommend against the routine use of ECO after ACDF due to a lack of improved fusion rates associated with external bracing after surgery. PMID:27555986

  19. Management of cervical fractures in ankylosing spondylitis: anterior, posterior or combined approach?

    PubMed

    Longo, Umile Giuseppe; Loppini, Mattia; Petrillo, Stefano; Berton, Alessandra; Maffulli, Nicola; Denaro, Vincenzo

    2015-09-01

    Ankylosing spondylitis (AS) can lead to an increased risk of cervical fractures. A systematic review was undertaken using the keywords 'ankylosing spondylitis', 'spine fractures', 'cervical fractures', 'surgery' and 'postoperative outcomes' on Medline, Pubmed, Google Scholar, Ovid and Embase, and the quality of the studies included was evaluated according to the Coleman Methodology Score. Surgery ameliorates neurological function in patients with unstable AS-related cervical fractures. The combined anterior/posterior and the posterior approaches are more effective than the anterior approach. The optimal approach, anterior, posterior or combined anterior/posterior, for the management of AS related cervical fractures has not been defined. Open reduction and internal fixation allows avoiding worsening and enhances neurological function in AS patients with cervical fractures. Adequately powered randomized trials with appropriate subjective and objective outcome measures are necessary to reach definitive conclusions. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. Anterior Cervical Discectomy and Fusion Using a Double Cylindrical Cage versus an Anterior Cervical Plating System with Iliac Crest Autografts for the Treatment of Cervical Degenerative Disc Disease

    PubMed Central

    Kim, Seong Joon

    2014-01-01

    Objective Anterior cervical discectomy and fusion (ACDF) is often complicated by subsidence, pseudoarthrosis, kyphosis, and graft donor site morbidities. To decrease the occurrence of these complications, various types of cages have been developed. We designed this retrospective study to analyze and compare the efficacy and outcomes of ACDF using double cylindrical cages (DCC) (BK Medical, Seoul, Korea) versus an anterior cervical plating system with autogenous iliac crest grafts. Methods Forty-eight patients were treated with autograft and plating (plate group), and 48 with DCC group from October 2007 to October 2011. We analyzed construct length, cervical lordotic curvarture, the thickness of the prevertebral soft tissue, segmental instability, and clinical outcomes. Results There were no significant differences between the two groups with regard to the decrease in construct length or cervical lodortic curvature at the 3-, 6-, and 12-month follow-ups. The prevertebral soft tissue was thinner in the DCC group than the plate group immediately after surgery and at the 3-, 6-, and 12-month follow-ups. The difference in interspinous distance on flexion-extension was shorter in the plate group than the DCC group at the 3- and 6-month follow-ups. However, there was no significant difference in this distance between the two groups at the 12-month follow-up. Conclusion A double cylindrical cage is a good alternative for fusion in patients with cervical degenerative diseases; the surgical method is relatively simple, allows good synostosis, has less associated prevertebral soft tissue swelling, and complications associated with autografting can be avoided. PMID:24570812

  1. Intrinsic Vertebral Markers for Spinal Level Localization in Anterior Cervical Spine Surgery: A Preliminary Report

    PubMed Central

    Thakur, Anil; Jain, Mukul; Arya, Arvind; Tripathi, Chandrabhushan; Kumari, Rima; Kushwaha, Suman

    2016-01-01

    Study Design Prospective clinical study. Purpose To observe the usefulness of anterior cervical osteophytes as intrinsic markers for spinal level localization (SLL) during sub-axial cervical spinal surgery via the anterior approach. Overview of Literature Various landmarks, such as the mandibular angle, hyoid bone, thyroid cartilage, first cricoid ring, and C6 carotid tubercle, are used for gross cervical SLL; however, none are used during cervical spinal surgery via the anterior approach. We present our preliminary assessment of SLL over anterior vertebral surfaces (i.e., intrinsic markers) in 48 consecutive cases of anterior cervical spinal surgeries for the disc-osteophyte complex (DOC) in degenerative diseases and granulation or tumor tissue associated with infectious or neoplastic diseases, respectively, at an ill-equipped center. Methods This prospective study on patients undergoing anterior cervical surgery for various sub-axial cervical spinal pathologies aimed to evaluate the feasibility and accuracy of SLL via intraoperative palpation of disease-related morphological changes on anterior vertebral surfaces visible on preoperative midline sagittal T1/2-weighted magnetic resonance images. Results During a 3-year period, 48 patients (38 males,10 females; average age, 43.58 years) who underwent surgery via the anterior approach for various sub-axial cervical spinal pathologies, including degenerative disease (n= 42), tubercular infection (Pott's disease; n=3), traumatic prolapsed disc (n=2), and a metastatic lesion from thyroid carcinoma (n=1), comprised the study group. Intrinsic marker palpation yielded accurate SLL in 79% of patients (n=38). Among those with degenerative diseases (n=42), intrinsic marker palpation yielded accurate SLL in 76% of patients (n=32). Conclusions Intrinsic marker palpation is an attractive potential adjunct for SLL during cervical spinal surgeries via the anterior approach in well-selected patients at ill-equipped centers (e

  2. Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in the treatment of multilevel cervical spondylotic myelopathy: systematic review and a meta-analysis

    PubMed Central

    Wen, Zhi-qiang; Du, Jing-yu; Ling, Zhi-heng; Xu, Hai-dong; Lin, Xiang-jin

    2015-01-01

    Background To date, the decision to treat multilevel cervical spondylotic myelopathy (CSM) with anterior cervical discectomy and fusion (ACDF) or anterior cervical corpectomy and fusion (ACCF) remains controversial. Therefore, we conducted a meta-analysis to quantitatively determine the efficacy of ACDF and ACCF in the treatment of multilevel CSM. Methods We searched several databases for related research articles published in English or Chinese. We extracted and assessed the data independently. We determined the pooled data, data heterogeneity, and overall effect, respectively. Results We identified 15 eligible studies with 1,368 patients. We found that blood loss and numbers of complications during surgery in ACDF were significantly less that in ACCF; however, other clinical outcomes, such as operation time, bone fusion failure, post Japanese Orthopedic Association scores, recovery rates, and visual analog scale scores between ACDF and ACCF with multilevel CSM were not significantly different. Conclusion Our results strongly suggest that surgical treatments of multilevel CSM are similar in terms of most clinical outcomes using ACDF or ACCF. PMID:25673996

  3. Efficacy and safety of the use of titanium mesh cages and anterior cervical plates for interbody fusion after anterior cervical corpectomy.

    PubMed

    Chuang, Hao-Che; Cho, Der-Yang; Chang, Cheng-Siu; Lee, Wen-Yuen; Jung-Chung, Chen; Lee, Han-Chung; Chen, Chun-Chung

    2006-05-01

    To determine the safety and effectiveness of the use of titanium mesh cages (TMCs) and anterior cervical plates (ACPs) for interbody fusion after anterior cervical corpectomy. From June 2001 to June 2003, 15 patients underwent reconstruction with TMCs and ACPs for interbody fusion after anterior cervical corpectomy in our hospital. The mean follow-up is 13.6 months (range, 9-24 months). Subjects included those with cervical degenerative, traumatic, or pathological diseases. Titanium mesh cages were filled with autologous bone grafts taken from the corpectomy and iliac crest bone chips and were all filled with triosite (calcium phosphate ceramics). The patients' observable signs, neurological reconstruction results, and complications were fully and explicitly recorded throughout the procedure. Radiological imaging studies for measurements of coronal and sagittal angles, sagittal displacements, and settling ratio changes were performed to evaluate spinal stability. We used axial cervical computed tomography (CT) and reconstructive sagittal cervical CT to demonstrate interbody fusion within titanium mesh. The alleviation and frequent disappearance of the subjects' original symptoms and the significant neurological recovery obvious in most patients indicated that postoperative spinal stability could be well maintained. No significant differences in mean cage height-related settling rates, mean sagittal displacements, and mean coronal and sagittal angle changes were observed between 1-level and multilevel corpectomy. All patients who received axial and reconstructive sagittal cervical CT scan could demonstrate true interbody fusion within TMC, and no nonunions were present. Cage malplacement was observed in one subject who had neck pain and neck stiffness, rather than from radiculopathy or myelopathy. One subject died of acute myocardial infarction. There were no ceramic-related complications. Based on preliminary findings from this study, reconstruction involving TMC

  4. Discover cervical disc arthroplasty versus anterior cervical discectomy and fusion in symptomatic cervical disc diseases: A meta-analysis

    PubMed Central

    Shangguan, Lei; Ning, Guang-Zhi; Tang, Yu; Wang, Zhe; Luo, Zhuo-Jing; Zhou, Yue

    2017-01-01

    Objective Symptomatic cervical disc disease (SCDD) is a common degenerative disease, and Discover artificial cervical disc, a new-generation nonconstrained artificial disk, has been developed and performed gradually to treat it. We performed this meta-analysis to compare the efficacy and safety between Discover cervical disc arthroplasty (DCDA) and anterior cervical discectomy and fusion (ACDF) for SCDD. Methods An exhaustive literature search of PubMed, EMBASE, and the Cochrane Library was conducted to identify randomized controlled trials that compared DCDA with ACDF for patients suffering SCDD. A random-effect model was used. Results were reported as standardized mean difference or risk ratio with 95% confidence interval. Results Of 33 articles identified, six studies were included. Compared with ACDF, DCDA demonstrated shorter operation time (P < 0.0001), and better range of motion (ROM) at the operative level (P < 0.00001). But no significant differences were observed in blood loss, neck disability index (NDI) scores, neck and arm pain scores, Japanese orthopaedic association (JOA) scores, secondary surgery procedures and adverse events (P > 0.05). Subgroup analyses did not demonstrated significant differences. Conclusion In conclusion, DCDA presented shorter operation time, and better ROM at the operative level. However, no significant differences were observed in blood loss, NDI scores, neck and arm pain scores, JOA scores, secondary surgery procedures and adverse events between the two groups. Additionally, more studies of high quality with mid- to long-term follow-up are required in future. PMID:28358860

  5. Neurologic recovery after anterior cervical discectomy and fusion.

    PubMed

    Lehmann, Charles L; Buchowski, Jacob M; Stoker, Geoffrey E; Riew, K Daniel

    2014-02-01

    Study Design Retrospective review. Objective The objective of this study is to describe the natural history of neurologic recovery after anterior cervical discectomy and fusion (ACDF). Methods Patients between 18 and 80 years of age, diagnosed with cervical radiculopathy, who underwent single-level ACDF and were followed for a minimum of 2 years were identified from a single-center database. Sensory and motor deficits were documented and graded based on physical examination findings at preoperative and postoperative visits, and used to calculate deficit rates. Results One hundred eighteen patients were included in the study. Mean age was 46 ± 9.2 years and mean follow-up time was 3.8 ± 2.1 years. At the time of surgery, 66% had a sensory deficit. Recovery of sensory function was seen in 85% of patients within 1 year. At final follow-up, new sensory deficits had developed in 30% of patients, 60% of whom had adjacent-level sensory deficits. Patients with preoperative sensory deficits tended to be more likely to develop a new deficit postoperatively (p = 0.05). At the time of surgery, 55% had a motor deficit. Recovery of motor function was seen in 95% of patients within 1 year, and 14% developed new postoperative motor deficits by final follow-up. Of those patients who developed a new motor deficit postoperatively, 76% did so at an adjacent level. Conclusions In our series, a high percentage of patients recovered neurologic function during the first year after ACDF. Adjacent-level and remote-level degeneration were large contributors to neurologic deficits that occurred in subsequent years.

  6. Plate augmentation in anterior cervical discectomy and fusion with cage for degenerative cervical spinal disorders

    PubMed Central

    Song, Kyung-Jin; Taghavi, Cyrus E.; Hsu, Margaret S.; Kim, Gyu-Hyung; Song, Ji-Hoon

    2010-01-01

    Anterior cervical discectomy and fusion (ACDF) with cage alone (ACDF-C) is associated with a significant incidence of subsidence, local kyphosis, and migration. The use of concurrent plate augmentation may decrease the incidence of these complications while improving the fusion rate. The purpose of the study is to present our results with ACDF with cage and plate augmentation (ACDF-CPA) and to compare these results to previous reports of outcomes following ACDF-C. We evaluated the radiologic and clinical parameters of 83 patients (266 fusion sites) who had an ACDF-CPA between March 2002 and May 2006. Radiologic parameters included fusion rate, fusion time, fusion type, site of pseudoarthrosis and rate and degree of subsidence. Clinical parameters included complications and overall outcomes assessed with Robinson’s criteria; 79 of 83 patients showed bony fusion (95.1%) at last follow-up postoperatively, and there was no significant difference in fusion rate between the number of fusion levels. Type I (pseudoarthrosis) was noticed in 9 patients (12 fusion sites), type II in 14 (19 fusion sites), and type III in 60 (235 fusion sites). Five type I and all type II fusions converged into type III by the last follow-up; 76 of 83 patients (91.6%) experienced good clinical outcomes. Pseudoarthrosis occurred more commonly in more proximal locations, and the subsidence rate was significantly greater in two-level fusions when compared with single-level fusions (P = 0.046). There were four metal-related complications. Plate augmentation in one- or two-level anterior cervical fusions for degenerative cervical spine disorders may improve fusion rates and reduce subsidence and complication rates, resulting in improved clinical outcomes. PMID:20376680

  7. Remote Cervical Pseudomeningocele Following Anterior Cervical Corpectomy and Fusion: Report of a Case and Review of the Literature

    PubMed Central

    Soufiani, Housain; Rahimizadeh, Shaghayegh

    2016-01-01

    Iatrogenic cervical pseudomeningocele is a rare event and majority are located posteriorly as a delayed complication of inadvertent dural tear after decompressive laminectomy. However, iatrogenic anterior cervical pseudomeningocele subsequent to discectomy or corpectomy is a rare pathology. The time necessary for formation of pseudomeningocele varies and depend on the width of the dural tear and the flow of cerebrospinal fluid leakage. Large tears with high CSF flow usually result in early collection of the cerebrospinal fluid in anterior compartment of the neck designated acute pseudomeningoceles. Micro-tears of dura mater, with low flow of cerebrospinal fluid may lead to late formation of a pseudomeningocele known as chronic ones. Herein a 49- year-old woman in whom cervical pseudomeningocele appeared clinically as a mass on the anterior aspect of the neck, six months after anterior cervical corpectomy for cervical spondylotic myelopathy is presented. Otherwise, she was neurologically stable. Cystoperitoneal shunt was proposed which she refused. Surprisingly, at 2-year follow-up, the cyst had remained of the same size. To the best of our knowledge, this is the first example of post-operative chronic cervical pseudomeningocele in the literature, the event that might propose the self-limited natural course of this rare pathology in chronic cases. PMID:27909657

  8. Multiple cervical levels: increased risk of dysphagia and dysphonia during anterior cervical discectomy.

    PubMed

    Danto, Joseph; DiCapua, John; Nardi, Dominic; Pekmezaris, Renee; Moise, Gregory; Lesser, Martin; Dimarzio, Paola

    2012-10-01

    Anterior cervical discectomy (ACD) is widely used for symptomatic cervical spine pathologies. The most common complications associated with this type of surgery are dysphagia and dysphonia; however, the risk factors associated with them have not been adequately elucidated. The purpose of this study is to assess the incidence of self-reported dysphagia and dysphonia and the associated risk factors after ACD. This study used a retrospective chart review of 149 patients who underwent ACD at a tertiary care facility operating in the New York metropolitan area over a period of 2½ years. Charts for ACD patients were reviewed by 6 trained researchers. Incidence rates for self-reported dysphagia and dysphonia were calculated using 95% exact confidence intervals (CI). Risk factors such as age, sex, surgical hours, number of disc levels, airway class, American Society of Anesthesiologists class, fiberoptic intubation, and intubation difficulty were assessed using logistic regression. The incidence of self-reported dysphagia was 12.1% (95% exact CI, 7.3%-18.4%); for dysphonia the self-reported incidence was 5.4% (95% exact CI, 2.3%-10.3%). Patients who underwent surgery at ≥4 cervical levels had a significant 4-fold increased risk (odds ratio=4; 95% CI, 1.1-13.8) of developing dysphonia and/or dysphagia compared with patients who underwent surgery at a single surgical level. This study confirms previous findings that the risk of developing dysphagia and/or dysphonia increases with the number of surgical levels, with multiple cervical levels representing a significantly higher postoperative risk, as compared with surgery at 1 level.

  9. Anterior cervical corpectomy and fusion for blastomycosis causing destruction of C6 vertebra: a case report.

    PubMed

    Patel, Kushal R; Szczodry, Michal; Neckrysh, Sergey; Siemionow, Krzysztof

    2015-11-25

    We describe a patient who had cervical spine osteomyelitis caused by Blastomyces dermatitidis that resulted in cord compression and cervical spine instability. A 25-year-old Hispanic woman presented with fever, sweats, neck pain, and an enlarging neck mass with purulent discharge after sustaining a C6 vertebral body fracture. Magnetic resonance imaging confirmed C6 vertebral osteomyelitis, demonstrated by vertebral body destruction, cervical spine instability, prevertebral abscess, and spinal cord compression. She underwent C6 anterior cervical corpectomy and fusion, with fungal cultures confirming Blastomyces dermatitidis. Anterior cervical corpectomy and fusion successful debrided, decompressed, and restored cervical spine stability in a patient with vertebral osteomyelitis caused by Blastomyces dermatitidis. The patient was subsequently treated with a 1-year course of itraconazole and had no recurrence of infection 4 years postoperatively.

  10. Long-term outcome after anterior cervical discectomy without fusion

    PubMed Central

    Bartels, Ronald H. M. A.

    2007-01-01

    To retrospectively study the long-term outcome of patients after anterior cervical discectomy without fusion (ACD) compared to results published on the long-term outcome after ACD with fusion (ACDF). We reviewed the charts of all patients receiving ACD surgery between 1985 and 2000 to analyze the direct post-operative results as well as complications of the surgery. Moreover, 102 patients, randomly selected, were interviewed with the neck disability index to study possible persisting complaints up to 18 years after ACD surgery. A total of 551 Patients were identified. Two months post-operative follow up at the outpatient clinic revealed that 90.1% of patients were satisfied with the result of ACD surgery. At the time of the survey, this percentage had dropped to 67.6%. In addition, 20.6% and 11.8% had obtained moderate to severe complaints, respectively, in daily-life activities. Complaints were mainly localized in the neck region and occasionally provoked radiating pain in the arm. On the short term, ACD leads to a satisfied outcome. Over the longer term, patients report increasing complaints. The increase in complaints at the time of the survey may be the result of ongoing degenerative effects. Compared to published data on ACDF, there is no superiority of any fusion technique compared to ACD alone. PMID:17262184

  11. Delayed cerebral infarct following anterior cervical diskectomy and fusion

    PubMed Central

    Graffeo, Christopher S.; Puffer, Ross C.; Wijdicks, Eelco F. M.; Krauss, William E.

    2016-01-01

    Background: Ischemic stroke following anterior cervical diskectomy and fusion (ACDF) is an exceedingly rare complication. There are only three previous cases focusing on this problem in the literature; here, we present the fourth case. Case Description: A patient, cared for at an outside institution, developed a delayed ischemic stroke 3 days following an ACDF. This complication was attributed to carotid manipulation precipitating vascular injury in the setting of multiple comorbid vascular and coagulopathic risk factors, including previously undiagnosed carotid atherosclerosis, a prior history of pulmonary embolus requiring Warfarin anticoagulation (held perioperatively), acute dehydration, and atrial fibrillation. Conclusions: This case demonstrates the importance of focused history and examination in appropriate patients prior to ACDF, with special consideration given to the significance of age, comorbidities including coagulopathy and arrhythmia, and potential underlying vascular disease as markers for increased risk of perioperative thrombotic stroke associated with carotid manipulation. Patients at higher risk warrant comprehensive preoperative assessment, including medical evaluation, carotid imaging, and consideration for alternative surgical approaches. PMID:27713852

  12. Mental retardation in a boy with anterior cervical hypertrichosis.

    PubMed

    Corona-Rivera, J Román; González-Abarca, Sergio; Hernández-Rocha, Juan; García-Cruz, Diana; Corona-Rivera, Alfredo

    2005-05-15

    Anterior cervical hypertrichosis (ACH) is a rare form of localized hypertrichosis with 15 previously reported cases. ACH has been considered to be a dominant phenotype, either X-linked or autosomal [OMIM 600457]. ACH was associated with hereditary motor and sensory neuropathy (HMSN) in one family, in which the proband also exhibited severe chorioretinal degeneration and optic atrophy, probably as a different entity [OMIM 239840]. A Mexican boy with congenital ACH associated with moderate mental retardation, abnormal EEG, mild microcephaly, hypertrichosis on the back, and hallux valgus is presented here. An equal sex ratio found in 16 reported cases as well as the suggestion of a paternal age effect in one report appear most consistent with an autosomal dominant mode of inheritance for this trait. It remains unclear if isolated ACH, ACH-HMSN, or other associated findings reported in patients with ACH, including unusual features found in our case, are part of ACH or fortuitous associations, due to the small number of affected patients and different ascertainment biases present in previous reports.

  13. Comparison between anterior cervical discectomy with fusion and anterior cervical corpectomy with fusion for the treatment of cervical spondylotic myelopathy: a meta-analysis

    PubMed Central

    Fei, Qi; Li, Jinjun; Su, Nan; Wang, Bingqiang; Li, Dong; Meng, Hai; Wang, Qi; Lin, Jisheng; Ma, Zhao; Yang, Yong

    2015-01-01

    Background Whether anterior cervical discectomy with fusion (ACDF) or anterior cervical corpectomy with fusion (ACCF) is superior in the treatment of cervical spondylotic myelopathy remains controversial. Therefore, we conducted a meta-analysis to quantitatively compare the efficacy and safety of ACDF and ACCF in the treatment of cervical spondylotic myelopathy. Methods PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, People’s Republic of China), and CNKI (China National Knowledge Infrastructure, People’s Republic of China) were systematically searched to identify all available studies comparing efficacy and safety between patients receiving ACDF and ACCF. The weighted mean difference (WMD) was pooled to compare the Japanese Orthopaedic Association scores, visual analog scale scores, hospital stay, operation time, and blood loss. The risk ratio was pooled to compare the incidence of complications and fusion rate. Pooled estimates were calculated by using a fixed-effects model or a random-effects model according to the heterogeneity among studies. Results Eighteen studies (17 observational studies and one randomized controlled trial) were included in this meta-analysis. Our results suggest that hospital stay (WMD =−1.33, 95% confidence interval [CI]: −2.29, −0.27; P=0.014), operation time (WMD =−26.9, 95% CI: −46.13, −7.67; P=0.006), blood loss (WMD =−119.36, 95% CI: −166.94, −71.77; P=0.000), and incidence of complications (risk ratio =0.51, 95% CI: 0.33, 0.80; P=0.003) in the ACDF group were significantly less than that in the ACCF group. However, other clinical outcomes, including post-Japanese Orthopaedic Association score (WMD =−0.27, 95% CI: −0.57, 0.03; P=0.075), visual analog scale score (WMD =0.03, 95% CI: −1.44, 1.50; P=0.970), and fusion rate (risk ratio =1.04, 95% CI: 0.99, 1.09; P=0.158), between the two groups were not significantly different. Conclusion Evidence from the meta

  14. Sporadic nonsyndromal anterior cervical hypertrichosis: case report and review of the literature.

    PubMed

    Heitink, Martijn V; Quaedvlieg, Patricia J F; van Neer, Francoise J M A; Frank, Jorge

    2007-11-01

    A 13-year-old girl presented with cosmetically disturbing excessive hair growth in the anterior cervical region that had been present since birth. An X-ray of the cervical and lumbosacral spine did not show any ossal changes. Based on the clinical findings, the diagnosis of anterior cervical hypertrichosis was made. We successfully treated the patient with an intense pulsed light source. Here, we briefly discuss and review the clinical presentation and causes of localized and generalized hypertrichosis as well as possible treatment modalities.

  15. Effect of posterior subsidence on cervical alignment after anterior cervical corpectomy and reconstruction using titanium mesh cages in degenerative cervical disease.

    PubMed

    Jang, Jae-Won; Lee, Jung-Kil; Lee, Jung-Heon; Hur, Hyuk; Kim, Tae-Wan; Kim, Soo-Han

    2014-10-01

    Subsidence after anterior cervical reconstruction using a titanium mesh cage (TMC) has been a matter of debate. The authors investigated and analyzed subsidence and its effect on clinical and radiologic parameters after cervical reconstruction using a TMC for degenerative cervical disease. Thirty consecutive patients with degenerative cervical spine disorders underwent anterior cervical corpectomy followed by reconstruction with TMC. Twenty-four patients underwent a single-level corpectomy, and six patients underwent a two-level corpectomy. Clinical outcomes were assessed using a Visual Analogue Scale (VAS), the Japanese Orthopedic Association (JOA) score and the Neck Disability Index (NDI). Fusion status, anterior and posterior subsidence of the TMC, segmental angle (SA) and cervical sagittal angle (CSA) were assessed by lateral and flexion-extension radiographs of the neck. The mean follow-up period was 27.6 months (range, 24 to 49 months). The VAS, NDI and JOA scores were all significantly improved at the last follow-up. No instances of radiolucency or motion-related pseudoarthrosis were detected on radiographic analysis, yielding a fusion rate of 100%. Subsidence occurred in 28 of 30 patients (93.3%). The average anterior subsidence of the cage was 1.4 ± 0.9 mm, and the average posterior subsidence was 2.9 ± 1.2 mm. The SA and CSA at the final follow-up were significantly increased toward a lordotic angle. Anterior cervical reconstruction using TMC and plating in patients with cervical degenerative disease provides good clinical and radiologic outcomes. Cage subsidence occurred frequently, especially at the posterior part of the cage. Despite the prominent posterior subsidence of the TMC, SA and CSA were improved on final follow-up radiographs, suggesting that posterior subsidence may contribute to cervical lordosis.

  16. Outcomes of single-level cervical disc arthroplasty versus anterior cervical discectomy and fusion.

    PubMed

    Tracey, Robert W; Kang, Daniel G; Cody, John P; Wagner, Scott C; Rosner, Michael K; Lehman, Ronald A

    2014-11-01

    Several studies have established the short-term safety and efficacy of cervical disc arthroplasty (CDA) as compared to anterior cervical discectomy and fusion (ACDF). However, few single-center comparative trials have been performed, and current studies do not contain large numbers of patients. We retrospectively reviewed all patients from a single military tertiary medical center between August 2008 to August 2012 who underwent single-level CDA or single-level ACDF and compared their clinical outcomes and complications. A total of 259 consecutive patients were included in the study, 171 patients in the CDA group with an average follow-up of 9.8 (±9.9)months and 88 patients in the ACDF group with an average follow-up of 11.8 (±9.6)months. Relief of pre-operative symptoms was 90.1% in the CDA group and 86.4% in the ACDF group with rates of return to full pre-operative activity of 93.0% and 88.6%, respectively. Patients who underwent CDA had a higher rate of persistent posterior neck pain (15.8% versus 12.5%), and patients who underwent ACDF were at risk for symptomatic pseudarthrosis at a rate of 3.4%. Reoperation rates were higher in the ACDF group (5.7% versus 3.5%). To our knowledge, this review is the largest, non-funded, comparison study between single-level CDA and single-level ACDF. This study demonstrates that CDA is a safe and reliable alternative to ACDF in the treatment of cervical radiculopathy and myelopathy resulting from spondylosis and acute disc herniation.

  17. Anterior cervical discectomy and fusion using a porous hydroxyapatite bone graft substitute.

    PubMed

    Zdeblick, T A; Cooke, M E; Kunz, D N; Wilson, D; McCabe, R P

    1994-10-15

    This study analyzed the use of a coral hydroxyapatite bone substitute for use in ACDF both with and without an anterior cervical plate. The healing of multilevel anterior cervical fusions was tested using a goat model. Comparisons were drawn with histologic, radiographic, and biomechanical test data. Forty-nine mature alpine goats had three-level anterior discectomies performed. Seven treatment groups of seven goats each were used; Group I with no fusion, Group IIa having tricortical iliac crest autograft, Group IIb having autograft plus an anterior plate, Group IIIa having tricortical iliac crest fresh-frozen allograft, Group IIIb having allograft plus an anterior plate, Group IVa having rectangular-shaped implants of porous hydroxyapatite, and Group IVb having ProOsteon 500 implants with an anterior cervical plate. Histologically, at 12 weeks 48% of the ProOsteon (Interpore, Irvine, CA) implants were rated as incorporated, 10% as possessing a fibrous gap, 29% as collapsed, and 14% as extruded. Anterior cervical plating improved the results with 71% of the implants showing good incorporation, 24% with collapse, and 5% with a fibrous gap. These histologic results compare favorably with autogenous bone and are improved over allograft bone. Fluorochrome analysis showed that none of the implants had complete turnover with host bone, but that all possessed peripheral creeping substitution with cutting cones of new bone formation at 12 weeks. Biomechanically, the spines using the ProOsteon implant were less stiff in torsion than autograft, but equal in stiffness to allograft. Flexion-extension neutral zone stiffness was lower in the ProOsteon implant group than either allograft or autograft. The use of a coral-based hydroxyapatite bone graft substitute for anterior cervical fusions led to significant rates of implant collapse at 12 weeks but showed excellent biologic compatibility with good early creeping substitution of the implant by host bone. The concomitant use of

  18. Endoscopic Anatomy and Features of Anterior Cervical Foraminotomy by Destandau Technique

    PubMed Central

    Mostofi, Keyvan; Khouzani, Reza Karimi

    2016-01-01

    BACKGROUND: Minimally invasive spine surgery limits surgical trauma and avoids traditional open surgery so in the majority of cases, recovery is much quicker and patients have less pain after surgery. AIM: The authors describe an endoscopic approach to anterior cervical foraminotomy (ACF) by Destandau’s method. MATERIAL AND METHODS: Anterior cervical foraminotomy by Destandau’s method is carried out under general anaesthesia. A 3 cm transverse skin incision is used just slightly past the anterior border of the sternocleidomastoid’s muscle laterally. After exposing and dissecting superficial cervical fascia, platysma muscle, and deep cervical fascia, Endospine material designed by Destandau will be inserted. As from this moment, the procedure will continue using endoscopy. RESULTS: the Endoscopic approach to anterior cervical foraminotomy by Destandau’s method offers a convenient access to the cervical foraminal stenosis with fewer complications and negligible morbidity and gives maximum exposure to discal space with the goal of minimising cutaneous incision. CONCLUSION: Contrary to the other minimally invasive approaches, the visual field in foraminotomy by Destandau technique is broad and depending on the workability of Endospine an adequate access to cervical disc is possible. PMID:28028407

  19. Utility of Computed Tomography following Anterior Cervical Diskectomy and Fusion

    PubMed Central

    Derakhshan, Adeeb; Lubelski, Daniel; Steinmetz, Michael P.; Benzel, Edward C.; Mroz, Thomas E.

    2015-01-01

    Study Design Retrospective case series. Objective To assess the utility of postoperative computed tomography (CT) following anterior cervical diskectomy and fusion (ACDF) and to determine the clinical circumstances most likely to lead to an abnormal CT scan. Methods Patients who underwent ACDF at a tertiary center over a span of 5 years were investigated. Only patients who had a minimum of 6 months' postoperative follow-up and a CT within 2 years after the surgery were included in the study group. All the postoperative notes were reviewed to determine indications for the CT, abnormalities identified, and whether the scan led to an alteration in the treatment course. Results The charts of 690 patients who underwent ACDF were reviewed. Of the 690 patients, 45 (7%) had postoperative CTs. These patients accounted for 53 postoperative CT scans, 45 (85%) of which were taken for patients who expressed persistent postoperative symptoms and/or had abnormal imaging. There were no indications for 8 (15%) of the CTs. Patients who had a CT for persistent symptoms and/or abnormal preliminary imaging were significantly more likely to have an abnormal CT (p = 0.03) and/or an alteration in treatment course (p = 0.04) compared with those with no symptomatic or radiologic indication for CT. Conclusions CT is associated with minimal utility regarding the alteration of treatment course when employed in asymptomatic patients. Postoperative CT should be ordered solely for symptomatic patients or those with other abnormal preliminary imaging. Judicious use of postoperative CT will limit the radiation exposure and cost. PMID:26430596

  20. Laminoplasty after anterior spinal fusion for cervical spondylotic myelopathy.

    PubMed

    Pang, Chun-Hong; Leung, Hon-Bong; Yen, Chi-Hung

    2009-12-01

    To review outcomes of laminoplasty after anterior spinal fusion (ASF) in 8 patients with cervical spondylotic myelopathy (CSM). Records of 3 men and 5 women aged 49 to 80 (mean, 60) years who underwent laminoplasty after ASF for CSM were reviewed. Before and after ASF and laminoplasty, the causes of CSM, mechanical instability, the Pavlov Torg ratio, the numbers of levels of stenosis, myelomalacia, ASF, and laminoplasty, the modified Japanese Orthopaedic Association (JOA) score, and the Hirabayashi recovery rate were recorded in all the patients. After ASF, the mean modified JOA score improved to 9.6 from 8.3 (p=0.05), with a mean Hirabayashi recovery rate of 12.5% at the 12-month follow-up. However, it deteriorated to 9 after a mean of 25 (range, 3-54) months follow-up. Indications for a secondary laminoplasty included inadequate decompression (n=5), progression of prolapsed discs (n=4), osteophytes (n=3), ossification of the posterior longitudinal ligament (n=1), and hypertrophy of the ligamentum flavum (n=4). The mean interval between ASF and laminoplasty was 30 (range, 14-55) months. The mean number of levels of laminoplasty was 4.5 (range, 4-5). After laminoplasty, all patients had adequate spinal decompression with no cord compromise, neck pain or stiffness, despite the signal change remaining the same. Two patients improved, 2 deteriorated, and 4 remained unchanged with respect to walking status. The mean modified JOA scores improved to 9.7 from 9 (p=0.38); the mean Hirabayashi recovery rate was -1.5%. All patients had persistent myelomalacia, which was not reflected in the improved modified JOA score. Initial surgery (such as ASF) is more effective in relieving cord compromise and myelopathy. Inadequate decompression and progression of disease may necessitate secondary laminoplasty, which conferred additional benefits that 5 of our 8 patients enjoyed despite persistence of myelomalacia.

  1. Tantalum trabecular metal implants in anterior cervical corpectomy and fusion: 2-year prospective analysis.

    PubMed

    King, V; Swart, A; Winder, M J

    2016-10-01

    Anterior cervical decompression for two or more cervical spondylotic levels can be performed using either multiple anterior cervical discectomies and fusion or anterior cervical corpectomy and fusion (ACCF). A variety of options for ACCF implants exist but to our knowledge, there is no clinical data for the use of tantalum trabecular metal implants (TTMI) for ACCF. A retrospective review was performed of prospectively collected data for ten patients undergoing ACCF with TTMI between 2011 and 2012. Radiological outcome was assessed by measuring the change in cervical (C) lordosis (fusion Cobb and C2-C7 Cobb), graft subsidence (anterior/posterior, determined by the subsidence of anterior/posterior body height of fused segments; cranial/caudal, determined by the cranial/caudal plate-to-disc distances) and rate of fusion using lateral cervical X-rays of patients at 0, 6, 12 and 24months post-operatively. The Neck Disability Index (NDI) assessed clinical outcome pre-operatively and at 6, 12 and 24months post-operatively. Cervical lordosis (Cobb angle of fused segment) was 5.2° (± 4.2°) at 0months and 6.0° (± 5.7°) at 24months post-operatively. Graft subsidence was observed to occur at 6months post-operatively and continued throughout follow-up. Anterior, posterior and caudal subsidence occurred more in the first 12months post-operatively than in the following 12months (p<0.05). Average pre-operative NDI was 45%. Average NDIs were 18%, 13% and 10% at 6, 12 and 24months post-operatively, respectively. ACCF patients treated with TTMI demonstrated stable cervical lordosis over 2years of follow-up and 100% fusion rates after 2years. Measures of subsidence appeared to decrease with time. Patients experienced improved clinical outcomes over the 2-year period. Copyright © 2016. Published by Elsevier Ltd.

  2. Anterior Cervical Corpectomy with free vascularized fibular graft versus multilevel discectomy and grafting for Cervical Spondylotic Myelopathy

    PubMed Central

    Addosooki, Ahmad I; El-deen, Mohamed Alam

    2015-01-01

    Purpose A retrospective study to compare the radiologic and clinical outcomes of 2 different anterior approaches, multilevel anterior cervical discectomy with fusion (ACDF) using autologus ticortical bone graft versus anterior cervical corpectomy with fusion (ACCF) using free vascularized fibular graft (FVFG) for the management of cervical spondylotic myelopathy(CSM). Methods A total of 15 patients who underwent ACDF or ACCF using FVFG for multilevel CSM were divided into two groups. Group A (n = 7) underwent ACDF and group B (n = 8) ACCF. Clinical outcomes using Japanese Orthopaedic Association (JOA) score, perioperative parameters including operation time and hospital stay, radiological parameters including fusion rate and cervical lordosis, and complications were compared. Results Both group A and group B demonstrated significant increases in JOA scores. Patients who underwent ACDF experienced significantly shorter operation times and hospital stay. Both groups showed significant increases in postoperative cervical lordosis and achieved the same fusion rate (100 %). No major complications were encountered in both groups. Conclusion Both ACDF and ACCF using FVFG provide satisfactory clinical outcomes and fusion rates for multilevel CSM. However, multilevel ACDF is associated with better radiologic parameters, shorter hospital stay and shorter operative times. PMID:26767152

  3. Multilevel Corpectomy With Anterior Column Reconstruction and Plating for Subaxial Cervical Osteomyelitis.

    PubMed

    Theologis, Alexander A; Lansdown, Drew; McClellan, R Trigg; Chou, Dean; Pekmezci, Murat

    2016-09-15

    A retrospective case series. The aim of this study was to evaluate patients with cervical spine osteomyelitis who underwent multilevel (≥2) subaxial corpectomies and anterior column reconstruction and plating. Neglected multilevel subaxial cervical osteomyelitis is a potentially dangerous disease. As it is rare, early radiographic and clinical outcomes after multilevel anterior corpectomy and reconstruction for subaxial cervical osteomyelitis are incompletely defined. Adults who underwent multilevel corpectomy and anterior plating/reconstruction for subaxial cervical osteomyelitis at two institutions were reviewed. Analysis of patient demographics, operative details, and radiographic cervical alignment parameters [segmental kyphosis, cervical lordosis, C2-7 sagittal vertical axis (SVA)] was performed. Nineteen patients [15 males, four females; average age 48 years (20-81 yrs)] met inclusion criteria. The majority had pre-operative neurologic deficits or was immunosuppressed. All were treated with ≥6 weeks of intravenous antibiotics following operation. All had anterior plating/reconstruction with titanium cages (expandable-6; mesh-6) or structural bone graft (fibular allogaft-6; tricortical iliac crest-1). The average number of corpectomies was 2.4 (2-4). The average numbers of levels fused anteriorly was 4.4 (4-6) and posteriorly was 6.3 (4-9). The majority of patients (74%) was treated with an anterior/posterior approach. Average follow-up was 16 ± 9 months. There was significant improvement in all cervical alignment parameters (segmental kyphosis, C2-7 SVA, cervical lordosis). No intraoperative complications occurred and no patient deteriorated neurologically postoperatively. Postoperative complications included anterior cage/graft dislodgement (n = 2), recurrent neck hematomas requiring revision (n = 1), epidural hematoma (n = 1), and wound infection (n = 1). Sixty percent of patients had persistent neurologic dysfunction at final

  4. Clinical and radiographic analysis of c5 palsy after anterior cervical decompression and fusion for cervical degenerative disease.

    PubMed

    Kim, Sungjin; Lee, Sun-Ho; Kim, Eun-Sang; Eoh, Whan

    2014-12-01

    A retrospective cohort study. To present the cases of 6 patients who developed C5 palsy after anterior decompression and discuss the mechanism of C5 palsy development, especially with respect to radiographic change. C5 palsy has been reported to be a major complication of both anterior and posterior decompression procedures. Although several mechanisms of injury have been proposed, few reports have been issued on C5 palsy after anterior decompression surgery. A retrospective medical record review was performed on 134 patients who underwent anterior decompression and fusion in our hospital from 2008 to 2011. C5 paralysis was defined as deterioration in muscle power of the deltoid or biceps brachii by at least 1 grade by manual muscle testing. Clinical features and radiologic parameters were evaluated to identify predisposing factors. Six patients (4.3%) suffered postoperative paralysis in the upper extremities (C5 radiculopathy). C5 palsy did not occur in 30 patients with radiculopathy. Excluding patients with cervical radiculopathy, the rate of C5 palsies was 5.8% for myelopathy patients. Three of 76 (3.95'%) cervical spondylotic myelopathy cases, one of 6 (16.7%) cervical spondylotic radiculomyelopathy patients, and 2 of 22 (9%) patients with ossification of the posterior longitudinal ligament showed C5 palsy. In 2 of the 6, C5 palsy developed after anterior cervical corpectomy, in 3 patients after anterior cervical discectomy and plate fusion, and in 1 after a standalone cage. Two patients underwent reoperation for foraminal decompression. Of the 4 treated conservatively, 3 fully recovered and the other almost fully improved (grade 4). Of 2 patients treated surgically, 1 showed full improvements. The other had no improvement. Radiographic measurements of these 6 patients showed that lordosis at operated segments increased postoperatively (mean, 6 degrees), and that overall sagittal alignments of the cervical spine (C3-C7) also increased (mean, 8.2 degrees). This

  5. Esophageal Perforation Following Anterior Cervical Spine Surgery: Case Report and Review of the Literature.

    PubMed

    Hershman, Stuart H; Kunkle, William A; Kelly, Michael P; Buchowski, Jacob M; Ray, Wilson Z; Bumpass, David B; Gum, Jeffrey L; Peters, Colleen M; Singhatanadgige, Weerasak; Kim, Jin Young; Smith, Zachary A; Hsu, Wellington K; Nassr, Ahmad; Currier, Bradford L; Rahman, Ra'Kerry K; Isaacs, Robert E; Smith, Justin S; Shaffrey, Christopher; Thompson, Sara E; Wang, Jeffrey C; Lord, Elizabeth L; Buser, Zorica; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    Multicenter retrospective case series and review of the literature. To determine the rate of esophageal perforations following anterior cervical spine surgery. As part of an AOSpine series on rare complications, a retrospective cohort study was conducted among 21 high-volume surgical centers to identify esophageal perforations following anterior cervical spine surgery. Staff at each center abstracted data from patients' charts and created case report forms for each event identified. Case report forms were then sent to the AOSpine North America Clinical Research Network Methodological Core for data processing and analysis. The records of 9591 patients who underwent anterior cervical spine surgery were reviewed. Two (0.02%) were found to have esophageal perforations following anterior cervical spine surgery. Both cases were detected and treated in the acute postoperative period. One patient was successfully treated with primary repair and debridement. One patient underwent multiple debridement attempts and expired. Esophageal perforation following anterior cervical spine surgery is a relatively rare occurrence. Prompt recognition and treatment of these injuries is critical to minimizing morbidity and mortality.

  6. Esophageal Perforation Following Anterior Cervical Spine Surgery: Case Report and Review of the Literature

    PubMed Central

    Hershman, Stuart H.; Kunkle, William A.; Kelly, Michael P.; Buchowski, Jacob M.; Ray, Wilson Z.; Bumpass, David B.; Gum, Jeffrey L.; Peters, Colleen M.; Singhatanadgige, Weerasak; Kim, Jin Young; Smith, Zachary A.; Hsu, Wellington K.; Nassr, Ahmad; Currier, Bradford L.; Rahman, Ra’Kerry K.; Isaacs, Robert E.; Smith, Justin S.; Shaffrey, Christopher; Thompson, Sara E.; Wang, Jeffrey C.; Lord, Elizabeth L.; Buser, Zorica; Arnold, Paul M.; Fehlings, Michael G.; Mroz, Thomas E.

    2017-01-01

    Study Design: Multicenter retrospective case series and review of the literature. Objective: To determine the rate of esophageal perforations following anterior cervical spine surgery. Methods: As part of an AOSpine series on rare complications, a retrospective cohort study was conducted among 21 high-volume surgical centers to identify esophageal perforations following anterior cervical spine surgery. Staff at each center abstracted data from patients’ charts and created case report forms for each event identified. Case report forms were then sent to the AOSpine North America Clinical Research Network Methodological Core for data processing and analysis. Results: The records of 9591 patients who underwent anterior cervical spine surgery were reviewed. Two (0.02%) were found to have esophageal perforations following anterior cervical spine surgery. Both cases were detected and treated in the acute postoperative period. One patient was successfully treated with primary repair and debridement. One patient underwent multiple debridement attempts and expired. Conclusions: Esophageal perforation following anterior cervical spine surgery is a relatively rare occurrence. Prompt recognition and treatment of these injuries is critical to minimizing morbidity and mortality. PMID:28451488

  7. A Meta-Analysis Comparing the Results of Cervical Disc Arthroplasty with Anterior Cervical Discectomy and Fusion (ACDF) for the Treatment of Symptomatic Cervical Disc Disease

    PubMed Central

    Gao, Yu; Liu, Ming; Li, Tao; Huang, Fuguo; Tang, Tingting; Xiang, Zhou

    2013-01-01

    Background: Anterior cervical discectomy and fusion is a standard treatment for symptomatic cervical disc disease, but pseudarthrosis and accelerated adjacent-level disc degeneration may develop. Cervical disc arthroplasty was developed to preserve the kinematics of the functional spinal unit. Trials comparing arthroplasty with anterior cervical discectomy and fusion have shown unclear benefits in terms of clinical results, neck motion at the operated level, adverse events, and the need for secondary surgical procedures. Methods: Only randomized clinical trials were included in this meta-analysis, and the search strategy followed the requirements of the Cochrane Library Handbook. Two reviewers independently assessed the methodological quality of each included study and extracted the relevant data. Results: Twenty-seven randomized clinical trials were included; twelve studies were Level I and fifteen were Level II. The results of the meta-analysis indicated longer operative times, more blood loss, lower neck and arm pain scores reported on a visual analog scale, better neurological success, greater motion at the operated level, fewer secondary surgical procedures, and fewer such procedures that involved supplemental fixation or revision in the arthroplasty group compared with the anterior cervical discectomy and fusion group. These differences were significant (p < 0.05). The two groups had similar lengths of hospital stay, Neck Disability Index scores, and rates of adverse events, removals, and reoperations (p > 0.05). Conclusions: The meta-analysis revealed that anterior cervical discectomy and fusion was associated with shorter operative times and less blood loss compared with arthroplasty. Other outcomes after arthroplasty (length of hospital stay, clinical indices, range of motion at the operated level, adverse events, and secondary surgical procedures) were superior or equivalent to the outcomes after anterior cervical discectomy and fusion. Level of Evidence

  8. Long Term Societal Costs of Anterior Discectomy and Fusion (ACDF) versus Cervical Disc Arthroplasty (CDA) for Treatment of Cervical Radiculopathy

    PubMed Central

    Ghori, Ahmer; Konopka, Joseph F.; Cha, Thomas D.; Bono, Christopher M.

    2016-01-01

    Background Current literature suggests that anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) have comparable clinical outcomes for the treatment of cervical radiculopathy. Given similar outcomes, an understanding of differences in long-term societal costs can help guide resource utilization. The purpose of this study was to compare the relative long-term societal costs of anterior cervical discectomy and fusion (ACDF) to cervical disc arthroplasty (CDA) for the treatment of single level cervical disc disease by considering upfront surgical costs, lost productivity, and risk of subsequent revision surgery. Methods We completed an economic and decision analysis using a Markov model to evaluate the long-term societal costs of ACDF and CDA in a theoretical cohort of 45-65 year old patients with single level cervical disc disease who have failed nonoperative treatment. Results The long-term societal costs for a 45-year old patient undergoing ACDF are $31,178 while long-term costs for CDA are $24,119. Long-term costs for CDA remain less expensive throughout the modeled age range of 45 to 65 years old. Sensitivity analysis demonstrated that CDA remains less expensive than ACDF as long as annual reoperation rate remains below 10.5% annually. Conclusions Based on current data, CDA has lower long-term societal costs than ACDF for patients 45-65 years old by a substantial margin. Given reported reoperation rates of 2.5% for CDA, it is the preferred treatment for cervical radiculopathy from an economic perspective. PMID:26913221

  9. A Prospective Study of the Functional Outcome of Anterior Cervical Discectomy With Fusion in Single Level Degenerative Cervical Disc Prolapse

    PubMed Central

    Kamani, Mayur M; Shetty, Vikram; Rai, H. Ravindranath; Hegde, Deepak

    2016-01-01

    Introduction Cervical spondylotic myelo-radiculopathy is a form of spinal cord dysfunction syndrome and usually accompanies age related degeneration of the spine. Aim To determine the functional outcome of anterior cervical discectomy with fusion and plating in single level degenerative cervical disc prolapse. Materials and Methods A total of 20 patients diagnosed with degenerative single level cervical disc prolapse who presented to the Department of Orthopaedic Surgery, Justice KS Hegde Charitable Hospital, Mangalore from the period of November 2012 to May 2014 were enrolled in the study. Complete clinical and radiological evaluation of the patients was done. A trial of conservative management was tried in all these patients for a period of two months. They were taken up for surgery only when conservative management had failed. Scoring of neck function before the surgery was done as per the Modified Japanese Orthopaedic Association (MJOA) score. All patients underwent anterior cervical discectomy and fusion (ACDF) with tricortical iliac crest bone grafting. Fixation was performed with titanium locking cervical plates. All patients were reviewed at 6 weeks and 6 months postoperatively. Assessment of neck function was done as per the MJOA scoring during all the reviews. Radiographic assessment was also done during all the reviews. The complications noted were documented. The statistical analysis was done using percentages; the arithmetic mean was calculated using SPSS software (version 16.0). Results Amongst the 20 patients included in the study, 1 patient died postoperatively due to oesophageal rupture. of the remaining 19 patients reviewed and followed up, all of them had improvement of symptoms and were reported to be in the ‘mild category’ as per the MJOA score. One patient developed dysphonia, in the immediate postoperative period due to recurrent laryngeal nerve palsy which recovered in a period of three months postoperative. Conclusion Single level

  10. Fishbone-associated actinomycosis of the anterior cervical space: a diagnostic dilemma.

    PubMed

    Lee, Sang Kwon; Kim, Mi Jeong; Kwon, Sun Young

    2010-01-01

    We report the imaging and pathologic findings of fishbone-associated actinomycosis of the anterior cervical space in a 57-year-old man, misdiagnosed preoperatively as a malignancy originating from thyroglossal duct cyst. CT revealed an enhancing mass containing a small abscess pocket and two sharp linear calcifications within it, which infiltrated into the strap muscle. Pathologic examination demonstrated two fishbones within the actinomycotic abscess. Fishbone-associated actinomycosis should be considered when a cervical mass contains sharp linear calcifications.

  11. Successful repair of esophageal perforation after anterior cervical fusion for cervical spine fracture.

    PubMed

    Ahn, Song-Ho; Lee, Sun-Ho; Kim, Eun Sang; Eoh, Whan

    2011-10-01

    Esophageal injury after anterior cervical discectomy and fusion (ACDF) is a rare complication that can be life threatening. The sternocleidomastoid (SCM) pedicled muscle flap has emerged as an effective and versatile tool for selected esophageal perforations. The authors report their surgical experience in three patients with an esophageal perforation after ACDF, and the steps taken to achieve successful repair using a SCM muscle flap. All three patients underwent ACDF at another hospital. Postoperatively, patients complained of severe dysphagia, neck swelling, fever, and alimentary fluid leakage. They were later referred to the author's hospital for diagnostic evaluation and surgical treatment of an esophageal perforation. Esophageal perforation was diagnosed on esophagoscopy and esophagography, and treated by primary closure using an SCM muscle flap. Postoperatively, all patients had a good result. Surgery-related complications occurred in one patient with dysfunction of the recurrent laryngeal nerve. This study shows that esophagoscopic diagnosis and surgical treatment using a SCM muscle flap is highly effective in patients with an esophageal perforation related to ACDF.

  12. Women's experiences of daily life after anterior cervical decompression and fusion surgery: A qualitative interview study.

    PubMed

    Hermansen, Anna; Peolsson, Anneli; Kammerlind, Ann-Sofi; Hjelm, Katarina

    2016-04-01

    To explore and describe women's experiences of daily life after anterior cervical decompression and fusion surgery. Qualitative explorative design. Fourteen women aged 39-62 years (median 52 years) were included 1.5-3 years after anterior cervical decompression and fusion for cervical disc disease. Individual semi-structured interviews were analysed by qualitative content analysis with an inductive approach. The women described their experiences of daily life in 5 different ways: being recovered to various extents; impact of remaining symptoms on thoughts and feelings; making daily life work; receiving support from social and occupational networks; and physical and behavioural changes due to interventions and encounters with healthcare professionals. This interview study provides insight into women's daily life after anterior cervical decompression and fusion. Whilst the subjects improved after surgery, they also experienced remaining symptoms and limitations in daily life. A variety of mostly active coping strategies were used to manage daily life. Social support from family, friends, occupational networks and healthcare professionals positively influenced daily life. These findings provide knowledge about aspects of daily life that should be considered in individualized postoperative care and rehabilitation in an attempt to provide better outcomes in women after anterior cervical decompression and fusion.

  13. Carotid Artery Injury in Anterior Cervical Spine Surgery: Multicenter Cohort Study and Literature Review.

    PubMed

    Härtl, Roger; Alimi, Marjan; Abdelatif Boukebir, Mohamed; Berlin, Connor D; Navarro-Ramirez, Rodrigo; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    Retrospective study and literature review. To provide more comprehensive data about carotid artery injury (CAI) or cerebrovascular accident (CVA) related to anterior cervical spine surgery. We conducted a retrospective, multicenter, case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records of 17 625 patients who went through cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were analyzed. Also, we performed a literature review using Medline and PubMed databases. The following terms were used alone, and in combination, to search for relevant articles: cervical, spine, surgery, complication, iatrogenic, carotid artery, injury, cerebrovascular accident, CVA, and carotid stenosis. Among 17 625 patients that were analyzed, no cases were reported to experienced CAI or CVA after cervical spine surgery. Nevertheless, in our PubMed search we found 157 articles, but only 5 articles matched our study objective criteria; 2 cases were reported to present CAI and 3 cases presented CVA. CAI and CVA related to anterior cervical spine surgeries are extremely rare. We were not able to find neither in our retrospective study nor in our literature research a correlation between the type or length of anterior cervical spine procedure with CVA or CAI complications. However, surgeons should be aware of the possibility of vascular complications and minimize intraoperative direct vascular manipulations or retraction. Preoperative screening for underlying vascular pathology and risk factors is also important.

  14. Current Concepts of Anterior Cervical Discectomy and Fusion: A Review of Literature

    PubMed Central

    Song, Kyung-Jin

    2014-01-01

    Anterior cervical discectomy and fusion (ACDF) is a safe and effective procedure for degenerative cervical spinal disease unresponsive to conservative management and its outstanding results have been reported. To increase fusion rates and decrease complications, numerous graft materials, cage, anterior plating and total disc replacement have been developed, and better results were reported from those, but still there are areas that have not been established. Therefore, we are going to analyze the treatment outcome with the various procedure through the literature review and determine the efficacy of ACDF. PMID:25187874

  15. Comparative Analysis of Interbody Cages Versus Tricortical Graft with Anterior Plate Fixation for Anterior Cervical Discectomy and Fusion in Degenerative Cervical Disc Disease

    PubMed Central

    Singh, Pritish; Shekhawat, Vishal

    2016-01-01

    Introduction Multiple techniques and modalities of fixation are used in Anterior Cervical Discectomy and interbody Fusion (ACDF), each with some merit and demerit against others. Such pool of techniques reflects lack of a consensus method conducive to uniformly good results. Aim A prospective study was done to analyse safety and efficacy of tricortical autograft and anterior cervical plate (Group A) with cylindrical titanium cage filled with cancellous bone (Group B) in procedure of ACDF for single level degenerative cervical disc disease. Materials and Methods Twenty patients with degenerative cervical disc disease were included in study for ACDF. After a computer generated randomisation, ten patients (10 segments) were operated with anterior locking plating and tricortical iliac crest graft (Group A, Tricortical graft group), while ten patients(10 segments) were operated with standalone cylindrical titanium cages filled with cancellous bone harvested using minimally invasive methods (Group B, Cage group) from April 2012 to May 2015. Odoms’s criteria, visual pain analogue score and sequential plain radiographs were obtained to assess for clinic-radiological outcome. Results According to Odom’s system of functional assessment, 9 patients from each group (90%) experienced good to excellent functional recovery and 9 of 10 (90%) patients of each groups were satisfied with outcome. In both groups, relief in neck pain or arm pain was similar without any statistical difference as assessed by visual analogue score. Fusion was present in 10 of 10 (100%) patients in tricortical graft group and 10 of 10 (100%) in cage group at the end of 6 months. There was no implant related complications in cage group. Transient postoperative dysphagia was recorded in 3 patients (2 in Group A and 1 in group B), which resolved within 3 days. In tricortical graft group, graft collapse and partial extrusion was detected in one patient, which did not correspond with good results obtained

  16. Enterobacter cloacae infection after anterior cervical decompression and fusion: case study and literature review

    PubMed Central

    Wang, Hongli; Wang, Lixun; Yang, Yong; Lu, Feizhou; Ma, Xiaosheng; Xia, Xinlei; Jiang, Jianyuan

    2015-01-01

    Wound infection after anterior cervical decompression and fusion can lead to disastrous consequences despite a low incidence rate. Although Gram-positive bacteria such as Staphylococcus aureus are the most common pathogenic bacteria, some rare bacteria such as conditional pathogenic bacteria may also result in such a condition. To the best of our knowledge, E. cloacae-caused acute infection after anterior cervical decompression and fusion has not been reported. Here, we report an E. cloacae-caused acute infection after anterior vertical decompression and fusion. This infection was eventually controlled by virtue of an early diagnosis and the correspondingly-adopted anti-infection, internal fixation removal, and drainage treatments. Exploring the reasons underlying acute infection after anterior cervical decompression and fusion caused by rare bacteria, particularly E. cloacae, by analyzing this case was the basic therapeutic principle in this study. We believe that the therapeutic principle for E. cloacae-caused wound infection after anterior cervical internal fixation is basically consistent with that for other bacterium-caused wound infections after spinal internal fixation. Sufficient drainage, the adoption of sensitive antibacterials, and internal fixation removal as early as possible when necessary are the essential measures in infection control. PMID:26064234

  17. Cervical plexus anesthesia versus general anesthesia for anterior cervical discectomy and fusion surgery

    PubMed Central

    Wang, Hui; Ma, Lei; Yang, Dalong; Wang, Tao; Wang, Qian; Zhang, Lijun; Ding, Wenyuan

    2017-01-01

    Abstract Both general anesthesia (GA) and cervical plexus anesthesia (CPA) can be used for anterior cervical discectomy and fusion (ACDF) surgery. The aim of this study was to evaluate the influence of anesthetic techniques on perioperative mortality and morbidity in patients undergoing cervical surgery. From January 2008 to December 2015, 356 patients who underwent 1-level ACDF for cervical spinal myelopathy were prospectively reviewed. They were assigned to receive GA (group A) and CPA (group B). The analgesic efficacy of the block was assessed by anesthesia preparation time, the maximum heart rate, and mean arterial blood pressure changes compared with the baseline, time of postoperative revival, and duration of recovery stay. Duration of surgery, blood loss, and anesthesia medical cost were also recorded. Numerical rating scale (NRS) was used to evaluate pain at different time points. Postoperative nausea and vomiting (PONV) was assessed, and postoperative average administered dosages of meperidine and metoclopramide were also recorded. The spinal surgeon satisfaction, anesthetist satisfaction, and patient satisfaction were assessed. Both the anesthesia induction time and postoperative revival time were longer in group A than that in group B; both the duration of surgery and recovery stay were also longer in group A than that in group B, whereas there was no difference in blood loss between the 2 groups. The average dosage of both meperidine and metoclopramide was more in group A than that in group B, and the anesthesia medical cost was greater in group A than that in group B. There were no significant differences in baseline data of systolic blood pressure, diastolic blood pressure, and heart rate between the 2 groups. But the intraoperative data of systolic blood pressure, diastolic blood pressure, and heart rate were higher/larger in group B than that in group A. In group A, there was no complaint of pain in the surgery procedure, but the pain increased

  18. Anterior Cervical Discectomy and Fusion Alters Whole-Spine Sagittal Alignment.

    PubMed

    Kim, Jang Hoon; Park, Jeong Yoon; Yi, Seong; Kim, Kyung Hyun; Kuh, Sung Uk; Chin, Dong Kyu; Kim, Keun Su; Cho, Yong Eun

    2015-07-01

    Anterior cervical discectomy and fusion (ACDF) has become a common spine procedure, however, there have been no previous studies on whole spine alignment changes after cervical fusion. Our purpose in this study was to determine whole spine sagittal alignment and pelvic alignment changes after ACDF. Forty-eight patients who had undergone ACDF from January 2011 to December 2012 were enrolled in this study. Cervical lordosis, thoracic kyphosis, lumbar lordosis, sagittal vertical axis (SVA), and pelvic parameters were measured preoperatively and at 1, 3, 6, and 12 months postoperatively. Clinical outcomes were assessed using Visual Analog Scale (VAS) scores and Neck Disability Index (NDI) values. Forty-eight patients were grouped according to operative method (cage only, cage & plate), operative level (upper level: C3/4 & C4/5; lower level: C5/6 & C6/7), and cervical lordosis (high lordosis, low lordosis). All patients experienced significant improvements in VAS scores and NDI values after surgery. Among the radiologic parameters, pelvic tilt increased and sacral slope decreased at 12 months postoperatively. Only the high cervical lordosis group showed significantly-decreased cervical lordosis and a shortened SVA postoperatively. Correlation tests revealed that cervical lordosis was significantly correlated with SVA and that SVA was significantly correlated with pelvic tilt and sacral slope. ACDF affects whole spine sagittal alignment, especially in patients with high cervical lordosis. In these patients, alteration of cervical lordosis to a normal angle shortened the SVA and resulted in reciprocal changes in pelvic tilt and sacral slope.

  19. Hybrid Surgery Versus Anterior Cervical Discectomy and Fusion in Multilevel Cervical Disc Diseases: A Meta-Analysis.

    PubMed

    Zhang, Jianfeng; Meng, Fanxin; Ding, Yan; Li, Jie; Han, Jian; Zhang, Xintao; Dong, Wei

    2016-05-01

    To investigate the outcomes and reliability of hybrid surgery (HS) versus anterior cervical discectomy and fusion (ACDF) for the treatment of multilevel cervical spondylosis and disc diseases.Hybrid surgery, combining cervical disc arthroplasty (CDA) with fusion, is a novel treatment to multilevel cervical degenerated disc disease in recent years. However, the effect and reliability of HS are still unclear compared with ACDF.To investigate the studies of HS versus ACDF in patients with multilevel cervical disease, electronic databases (Medline, Embase, Pubmed, Cochrane library, and Cochrane Central Register of Controlled Trials) were searched. Studies were included when they compared HS with ACDF and reported at least one of the following outcomes: functionality, neck pain, arm pain, cervical range of motion (ROM), quality of life, and incidence of complications. No language restrictions were used. Two authors independently assessed the methodological quality of included studies and extracted the relevant data.Seven clinical controlled trials were included in this study. Two trials were prospective and the other 5 were retrospective. The results of the meta-analysis indicated that HS achieved better recovery of NDI score (P = 0.038) and similar recovery of VAS score (P = 0.058) compared with ACDF at 2 years follow-up. Moreover, the total cervical ROM (C2-C7) after HS was preserved significantly more than the cervical ROM after ACDF (P = 0.000) at 2 years follow-up. Notably, the compensatory increase of the ROM of superior and inferior adjacent segments was significant in ACDF groups at 2-year follow-up (P < 0.01), compared with HS.The results demonstrate that HS provides equivalent outcomes and functional recovery for cervical disc diseases, and significantly better preservation of cervical ROM compared with ACDF in 2-year follow-up. This suggests the HS is an effective alternative invention for the treatment of multilevel cervical spondylosis to

  20. Freeze-dried fibular allograft in anterior spinal surgery: cervical and lumbar applications.

    PubMed Central

    Wetzel, F. T.; Hoffman, M. A.; Arcieri, R. R.

    1993-01-01

    Fifty-six patients who underwent anterior fusion utilizing fibular allograft are reviewed. Thirty-two patients underwent multiple-level anterior cervical discectomy and fusion utilizing fibular strut allograft, and 24 underwent anterior lumbar discectomy and fusion using fibular strut allograft. Cervical surgery was performed via the strut technique of Whitecloud and LaRocca and lumbar surgery was performed via a transperitoneal or retroperitoneal approach. Postoperatively, patients were assigned a clinical grade based on symptomatic relief and medication usage. X-rays were visually inspected, and quantitatively digitized for Cobb angle and translation in order to assess the status of arthrodesis. In the cervical group, the rate of clinical success (87.5%) exceeded the arthrodesis rate. By inspection, 65% fused, at a mean time of 23.5 months postoperatively. In the lumbar group, the overall clinical success rate was 68%. This correlated quite strongly with a fusion rate of 58%. Smoking was a negative correlate with arthrodesis. Patients receiving Workers' Compensation were also more likely to have an unsatisfactory clinical outcome. The results of this study highlight the difference between anterior arthrodesis in the cervical and lumbar spine. The biomechanical stability afforded by the fibular strut in the cervical spine appears to outweigh the disadvantages of delayed time to union. The rate of posterior cervical fusion to salvage symptomatic pseudoarthrosis was quite low (9.3%), thus suggesting that additional posterior surgery in this particular group of patients should not be considered for a minimum of two years postoperatively. In the lumbar group, status of arthrodesis correlated closely with clinical outcome. Fusion rate in this group was disappointing, corresponding to other reports in the literature. Based on these data, primary anterior body fusion without allograft in the lumbar spine cannot be recommended, as a viable alternative to conventional

  1. Dysphagia after anterior cervical spine surgery: a systematic review of potential preventative measures.

    PubMed

    Joaquim, Andrei F; Murar, Jozef; Savage, Jason W; Patel, Alpesh A

    2014-09-01

    Anterior cervical spine surgery is one of the most common spinal procedures performed around the world, but dysphagia is a frequent postoperative complication. Many factors have been associated with an increased risk of swallowing difficulties, including multilevel surgery, revision surgery, and female gender. The objective of this study was to review and define potential preventative measures that can decrease the incidence of dysphagia after anterior cervical spine surgery. This was a systematic literature review. A systematic review in the Medline database was performed. Articles related to dysphagia after anterior cervical spine surgery and potential preventative measures were included. Twenty articles met all inclusion and exclusion criteria. These articles reported several potential preventative measures to avoid postoperative dysphagia. Preoperative measures include performing tracheal exercises before the surgical procedure. Intraoperative measures can be summarized as avoiding a prolonged operative time and the use of recombinant human bone morphogenetic protein in routine anterior cervical spine surgery, using small and smoother cervical plates, using anchored spacers instead of plates, application of steroid before wound closure, performing arthroplasty instead of anterior cervical fusion for one-level disease, decreasing tracheal cuff pressure during medial retraction, using specific retractors, and changing the dissection plan. Current literature supports several preventative measures that may decrease the incidence of postoperative dysphagia. Although the evidence is limited and weak, most of these measures did not appear to increase other complications and can be easily incorporated into a surgical practice, especially in patients who are at high risk for postoperative dysphagia. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Anterior cervical discectomy and fusion: analysis of surgical outcome with and without plating.

    PubMed

    Mobbs, Ralph J; Rao, Prakash; Chandran, Nadana K

    2007-07-01

    The aim of this study is to analyse the differences in clinical and radiological outcome of anterior cervical discectomy and fusion for cervical degenerative disease, with and without the addition of an anterior cervical locking plate. Although disc arthoplasty is gaining popularity, the anterior cervical decompression and fusion procedure remains the gold standard. The outcome of 242 cases operated between 1991 to 1998 were analysed. Two groups of patients were operated on by the same surgeon. The only difference in technique between the two groups was the addition of an anterior cervical plate, with all other technical details matching, including the use of iliac crest autograft. The indications for surgery for both groups was identical. We made an attempt to study radiological fusion, clinical outcome and complications between the non-plated and plated groups. Our main finding is that the addition of an anterior plate reduces the number of poor clinical outcomes, but does not increase the number of excellent outcomes. Anterior discectomy and fusion with plating in our series had a significantly higher fusion rate; 98% fusion was noted in the plating group as compared to 93.5% in the non-plating group (Fisher's exact test, p=0.029). Union was faster in the plated group with no significant increase in surgical complications. Although clinical outcomes were superior in the plated group for the radiculopathy cohort, excellent outcomes were not significantly higher as compared to the non-plated group. The non-plated group had a significantly higher rate of poor outcomes, with 10% of patients requiring revision surgery for non-union, kyphosis, graft extrusion and graft collapse with foraminal stenosis. 1.8% of the plated group required revision surgery.

  3. Comparison of the intervertebral disc spaces between axial and anterior lean cervical traction

    PubMed Central

    Chung, Chin-Teng; Tsai, Sen-Wei; Chen, Chun-Jung; Wu, Ting-Chung; Wang, David; Lan, Haw-Chang H.

    2009-01-01

    The insufficient investigations on the changes of spinal structures during traction prevent further exploring the possible therapeutic mechanism of cervical traction. A blind randomized crossover-design study was conducted to quantitatively compare the intervertebral disc spaces between axial and anterior lean cervical traction in sitting position. A total of 96 radiographic images from the baseline measurements, axial and anterior lean tractions in 32 asymptomatic subjects were digitized for further analysis. The intra- and inter-examiner reliabilities for measuring the intervertebral disc spaces were in good ranges (ICCs = 0.928–0.942). With the application of anterior lean traction, the statistical increases were detected both in anterior and in posterior disc spaces compared to the baseline (0.29 mm and 0.24 mm; both P < 0.01) and axial traction (0.16 mm and 0.35 mm; both P < 0.01). The greater intervertebral disc spaces obtained during anterior lean traction might be associated with the more even distribution of traction forces over the anterior and posterior neck structures. The neck extension moment through mandible that generally occurred in the axial traction could be counteracted by the downward force of head weight during anterior lean traction. This study quantitatively demonstrated that anterior lean traction in sitting position provided more intervertebral disc space enlargements in both anterior and posterior aspects than axial traction did. These findings may serve as a therapeutic reference when cervical traction is suggested. PMID:19533177

  4. Vertebral autograft used as bone transplant for anterior cervical corpectomy: technical note.

    PubMed

    Rieger, Andreas; Holz, Carsten; Marx, Thomas; Sanchin, Lhagva; Menzel, Matthias

    2003-02-01

    In this prospective patient study, we used a surgical technique for autograft bone fusion during anterior cervical corpectomy (ACC) in patients experiencing cervical spondylotic myelopathy. We packed the resected bone material of the corpectomy into a titanium mesh cage. To evaluate the efficacy of our autograft technique, we analyzed the results according to neurological outcome, radiological outcome, and complications. Between 1995 and 1998, 27 ACC operations were performed for cervical spondylotic myelopathy caused by multisegmental cervical spondylosis. In all patients, decompression of the cervical canal and/or spinal nerve roots was performed by a median cervical corpectomy by an anterior approach. After the ACC was completed, a titanium mesh cage, which was variable in diameter and length, was filled with morselized and impacted bone material from the cervical corpectomy and was then implanted. An anterior cervical plate was placed in all patients to achieve primary stability of the cervical vertebral column. Age, sex, pre- and postoperative myelopathy, number of decompressed levels, radiological results, and complications were assessed. The severity of myelopathy was graded according to the scoring system of the Japanese Orthopaedic Association. Symptomatic improvement of neurological deficits was achieved in 80% of the patients. The mean preoperative Japanese Orthopaedic Association score improved from 13.1 to 15.2 postoperatively (P < 0.05). No patient demonstrated worsening of myelopathic symptoms. Radiological follow-up studies demonstrated complete bony fusion in all patients. A vertical movement of 2.25 +/- 0.43 mm of the titanium cage into the adjacent vertebral bodies was observed in 24 patients. In patients with either a lordotic or neutral cervical spinal axis postoperatively, the axis remained unchanged during the entire follow-up period. The results of this study demonstrate that transplantation of autograft bone material harvested during the

  5. Anterior cervical discectomy, fusion and stabilization by plate and screw--early experience.

    PubMed

    Islam, M A; Islam, M A; Habib, M A; Sakeb, N

    2012-08-01

    Anterior cervical plating is commonly performed to stabilize anterior cervical fusion. The aim of the study was to evaluate the clinical and functional outcome, radiological fusion and operative complications in cases of cervical spondylotic myelopathy and radiculopathy who underwent Anterior Cervical Discectomy and Fusion (ACDF) by autograft and stabilized with plate and screw. We evaluated 16 consecutive patients (M: F = 10:6) from January 2008 to December 2010 in Bangabandhu Sheikh Mujib Medical University (BSMMU) and different private hospitals in Dhaka, in cases where adequate conservative treatment failed. Single level ACDF by autograft and stabilization by plate and screw was done in 10 patients and 06 patients had two levels fusion. The mean follow up period was 18 months. The patients improved significantly (p < 0.05) and the recovery rate was 87.50%. All patients showed radiological fusion (p < 0.001). There was no hardware failure, graft extrusion or plate breakage. ACDF with plate and screw is fairly safe and effective therapy for cervical disc degeneration leading to myelo-radiculopathy where major post operative complications are uncommon.

  6. Anterior surgical management of single-level cervical disc disease: a cost-effectiveness analysis.

    PubMed

    Lewis, Daniel J; Attiah, Mark A; Malhotra, Neil R; Burnett, Mark G; Stein, Sherman C

    2014-12-01

    Cost-effectiveness analysis with decision analysis and meta-analysis. To determine the relative cost-effectiveness of anterior cervical discectomy with fusion (with autograft, allograft, or spacers), anterior cervical discectomy without fusion (ACD), and cervical disc replacement (CDR) for the treatment of 1-level cervical disc disease. There is debate as to the optimal anterior surgical strategy to treat single-level cervical disc disease. Surgical strategies include 3 techniques of anterior cervical discectomy with fusion (autograft, allograft, or spacer-assisted fusion), ACD, and CDR. Several controlled trials have compared these treatments but have yielded mixed results. Decision analysis provides a structure for making a quantitative comparison of the costs and outcomes of each treatment. A literature search was performed and yielded 156 case series that fulfilled our search criteria describing nearly 17,000 cases. Data were abstracted from these publications and pooled meta-analytically to estimate the incidence of various outcomes, including index-level and adjacent-level reoperation. A decision analytic model calculated the expected costs in US dollars and outcomes in quality-adjusted life years for a typical adult patient with 1-level cervical radiculopathy subjected to each of the 5 approaches. At 5 years postoperatively, patients who had undergone ACD alone had significantly (P < 0.001) more quality-adjusted life years (4.885 ± 0.041) than those receiving other treatments. Patients with ACD also exhibited highly significant (P < 0.001) differences in costs, incurring the lowest societal costs ($16,558 ± $539). Follow-up data were inadequate for comparison beyond 5 years. The results of our decision analytic model indicate advantages for ACD, both in effectiveness and costs, over other strategies. Thus, ACD is a cost-effective alternative to anterior cervical discectomy with fusion and CDR in patients with single-level cervical disc disease. Definitive

  7. Acute cervical cord infarction in anterior spinal artery territory with acute swelling mimicking myelitis.

    PubMed

    Abou Al-Shaar, Hussam; AbouAl-Shaar, Iyad; Al-Kawi, Mohammed Z

    2015-10-01

    Acute infarction of the cervical segment of the spinal cord is extremely uncommon. Patients may present with signs and symptoms mimicking that of acute myelitis. On imaging, both conditions may present as a hyperintense area on T-2 weighted MRI. History of sudden onset is essential in establishing the diagnosis. We report a case of cervical spinal cord infarction in a 40-year-old man who was diagnosed with acute transverse myelitis, and was treated with high dose intravenous corticosteroids followed by 5 sessions of plasma exchange. An MRI of the spine revealed abnormal high T2 signal intensity extending from the C2 to C7 level involving the anterior two-thirds of the cord with more central involvement. The findings were consistent with anterior spinal artery territory cervical cord infarction.

  8. Acute cervical cord infarction in anterior spinal artery territory with acute swelling mimicking myelitis

    PubMed Central

    Al-Shaar, Hussam Abou; AbouAl-Shaar, Iyad; Al-Kawi, Mohammed Z.

    2015-01-01

    Acute infarction of the cervical segment of the spinal cord is extremely uncommon. Patients may present with signs and symptoms mimicking that of acute myelitis. On imaging, both conditions may present as a hyperintense area on T-2 weighted MRI. History of sudden onset is essential in establishing the diagnosis. We report a case of cervical spinal cord infarction in a 40-year-old man who was diagnosed with acute transverse myelitis, and was treated with high dose intravenous corticosteroids followed by 5 sessions of plasma exchange. An MRI of the spine revealed abnormal high T2 signal intensity extending from the C2 to C7 level involving the anterior two-thirds of the cord with more central involvement. The findings were consistent with anterior spinal artery territory cervical cord infarction. PMID:26492118

  9. Stand-Alone Cages for Anterior Cervical Fusion: Are There No Problems?

    PubMed Central

    Han, Sang Youp; Lee, Cheol Young; Kim, Hong Rye; Park, Dong Ho

    2016-01-01

    Objective There are complications in stand-alone cage assisted anterior cervical discectomy and fusion (ACDF), such as cage subsidence and kyphosis. Here we report our clinical result on ACDF, comparing with stand-alone cages and with cervical plate system for degenerative cervical spine diseases. Methods Patients with degenerative cervical disease who were diagnosed and treated in Konyang University Hospital between January 2004 and December 2014 were included in this study. Patients who had operation in single level ACDF were selected. Patients scored the degree of pain using visual analog scale before and after the surgery. Subsidence was defined as ≥3-mm decrease of the segmental height, and cervical kyphosis was defined as progression of ≥5° at 12 months after postoperative follow-up compared to that measured at the immediate postoperative period. Results A total of 81 patients were enrolled for this study. Forty-five patients were included in a cervical plate group and the others were in stand-alone cage group. There was no statistical difference in pain score between the 2 groups. Segmental subsidence was observed in 7 patients (15.6%) in plate-assisted cervical fusion group, and 13 patients (36.1%) in stand-alone cage group. Segmental kyphosis was observed in 4 patients (8.9%) in plate-assisted cervical fusion group, and 10 patients (27.8%) in stand-alone cage group. There was statistical difference between the 2 groups. Conclusion There was no difference in pain between 2 groups. But stand-alone case group showed higher incidence rate than plate-assisted cervical fusion group in segmental subsidence and cervical kyphosis. When designing cervical fusion, more attention should be given selecting the surgical technique. PMID:27123025

  10. Anatomic Study of Anterior Transdiscal Axial Screw Fixation for Subaxial Cervical Spine Injuries.

    PubMed

    Ji, Wei; Zheng, Minghui; Qu, Dongbin; Zou, Lin; Chen, Yongquan; Chen, Jianting; Zhu, Qingan

    2016-08-01

    Anterior transdiscal axial screw (ATAS) fixation is an alternative or supplement to the plate and screw constructs for the upper cervical spine injury. However, no existing literatures clarified the anatomic feasibility of this technique for subaxial cervical spine. Therefore, the objective of this study was to evaluate the anatomical feasibility and to establish guidelines for the use of the ATAS fixation for the subaxial cervical spine injury.Fifty normal cervical spines had radiographs to determine the proposed screw trajectory (the screw length and insertion angle) and the interbody graft-related parameters (the disc height and depth, and the distance between anterior vertebral margin and the screw) for all levels of the subaxial cervical spine. Following screw insertion in 8 preserved human cadaver specimens, surgical simulation and dissection verified the feasibility and safety of the ATAS fixation.Radiographic measurements showed the mean axial screw length and cephalic incline angle of all levels were 41.2 mm and 25.2°, respectively. The suitable depth of the interbody graft was >11.7 mm (the distance between anterior vertebral margin and the screw), but <17.1 mm (disc depth). Except the axial screw length, increase in all the measurements was seen with level up to C5-C6 segment. Simulated procedure in the preserved specimens demonstrated that ATAS fixation could be successfully performed at C2-C3, C3-C4, C4-C5, and C5-C6 levels, but impossible at C6-C7 due to the obstacle of the sternum. All screws were placed accurately. None of the screws penetrated into the spinal canal and caused fractures determined by dissecting the specimens.The anterior transdiscal axial screw fixation, as an alternative or supplementary instrumentation for subaxial cervical spine injuries, is feasible and safe with meticulous surgical planning.

  11. A Tunneled Subcricoid Approach for Anterior Cervical Spine Reoperation: Technical and Safety Results.

    PubMed

    Winkler, Ethan A; Rowland, Nathan C; Yue, John K; Birk, Harjus; Ozpinar, Alp; Tay, Bobby; Ames, Christopher P; Mummaneni, Praveen V; El-Sayed, Ivan H

    2016-02-01

    Anterior cervical spine decompression and fusion are common neurosurgical operations. Reoperation of the anterior cervical spine is associated with increased morbidity. The authors describe a novel subcricoid approach to protect the recurrent laryngeal nerve in a cuff of tissue while facilitating surgical access to the anterior cervical spine. Single institution, consecutive case review of 48 patients undergoing reoperation in the anterior cervical region including the level of C5 and below. Univariable and multivariable regression analysis was used to determine predictors of postoperative morbidity. No intraoperative complications were reported. Estimated blood loss for the approach was 13.6 ± 3.1 mL. Nine of 48 patients developed immediate postoperative complications, including vocal cord paresis (10.4%), moderate-to-severe dysphagia (10.4%), and neck edema requiring intubation (2.1%). No postoperative hematomas or death occurred. All complications occurred with 4 or more levels of exposure (1-3 disc levels, 0%, vs. ≥ 4 disc levels, 31%). Extension of the exposure to the upper thoracic spine was associated with odds for postoperative complications (adjusted odds ratio, 6.50; 95% confidence interval, 1.14-37.03) and prolonged hospital stay (adjusted increase 4.23 days, P < 0.01). The tunneled subcricoid approach is a relatively safe corridor to reapproach the anterior cervical spine at the level of C5 and below. However, caution must be exercised when using this approach to expose 4 or more disc levels and with extension of the exposure to the upper thoracic spine. Future comparative studies are needed to establish patient selection criteria in determining the use of this technique compared with classic approaches. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Postoperative Cervical Haematoma Complicated by Ipsilateral Carotid Thrombosis and Aphasia after Anterior Cervical Fusion: A Case Report

    PubMed Central

    Chin, Kingsley R.; Seale, Jason; Butron, Veronica

    2013-01-01

    Hematoma alone is the most common vascular complication reported after anterior cervical decompression and fusion (ACDF). We present this case to report the occurrence of postoperative cervical hematoma complicated by ipsilateral carotid thrombosis and aphasia after an uncomplicated C4–6 ACDF. This is a case of a 65-year-old woman who underwent revision fusions of the C4-5 and C6-7 levels complicated by postoperative cervical hematoma and carotid thrombosis. The patient's history, clinical examination, imaging findings, and treatment are reported. The revision fusions were performed and deemed routine. Approximately eight hours later 200 mL of blood was evacuated from a postoperative cervical hematoma. The patient became unresponsive and disoriented a few hours after evacuating the hematoma. Computed tomography and magnetic resonance imaging of the brain were normal, but magnetic resonance angiography demonstrated total occlusion of the left carotid artery. Thrombectomy was performed and the patient was discharged without residual deficits. At the latest followup she is fully functional and asymptomatic in her neck. We suggest, after evacuating a cervical hematoma, an evaluation of the carotids be made with MRA or cerebral angiography, as this may demonstrate a clot before the patient develops symptoms. PMID:23533432

  13. Clinical comparison of Zero-profile interbody fusion device and anterior cervical plate interbody fusion in treating cervical spondylosis

    PubMed Central

    Yan, Bin; Nie, Lin

    2015-01-01

    Objective: the aim of the study was to compare the clinical effect of Zero-profile interbody fusion device (Zero-P) with anterior cervical plate interbody fusion system (PCB) in treating cervical spondylosis. Methods: a total of 98 patients with cervical spondylosis (110 segments) in February 2011 to January 2013 were included in our hospital. All participants were randomly divided into observation group and control group with 49 cases in each group. The observation group was treated with Zero-P, while the control group received PCB treatment. Comparison of the two groups in neurological function score (JOA), pain visual analogue scale (VAS), the neck disability index (NDI), quality of life score (SF-36) and cervical curvature (Cobb angle) change were recorded and analyzed before and after treatment. Results: The observation group was found with 90% excellent and good rate, which was higher than that of the control group (80%). Dysphagia rate in observational group was 16.33% (8/49), which was significantly less than that in control group (46.94%). Operation time and bleeding volume in the observation group was less than those in control group. Postoperative improvements of JOA score, VAS score, and NDI in observational group were also significantly better than that in control group (P<0.05). Conclusion: The clinical effect of Zero-P and PCB for the treatment of cervical spondylosis was quite fair, but Zero-P showed a better therapeutic effect with improvement of life quality. PMID:26550337

  14. Dysphagia and soft-tissue swelling after anterior cervical surgery: a radiographic analysis.

    PubMed

    Kepler, Christopher K; Rihn, Jeffrey A; Bennett, Jonathan D; Anderson, David G; Vaccaro, Alexander R; Albert, Todd J; Hilibrand, Alan S

    2012-08-01

    Dysphagia is common in the early postoperative period after anterior cervical discectomy and fusion (ACDF). Several mechanisms, including soft-tissue swelling, have been implicated as a cause of postoperative dysphagia. To determine whether anterior soft-tissue swelling is greater in patients with postoperative dysphagia. Prospective cohort study. Forty-three patients. Validated dysphagia questionnaire, lateral cervical spine radiographs. Patients undergoing one- or two-level ACDF using allograft bone and anterior instrumentation were enrolled. Baseline patient demographic characteristics and history were recorded. A dysphagia questionnaire, including a dysphagia numeric rating scale (DNRS; range, 0-10), was administered preoperatively and 2 and 6 weeks postoperatively. Lateral cervical radiographs were obtained preoperatively and 2 and 6 weeks postoperatively. The anterior cervical soft-tissue shadow width was measured at each level. Patients were divided into groups based on the 2-week dysphagia questionnaire: Group 1 (no symptoms/mild dysphagia) and Group 2 (moderate/severe dysphagia). Anterior soft-tissue shadow width at each level was compared between groups. Correlation was used to assess the relationship between DNRS and anterior soft-tissue swelling. Forty-three patients (24 females; average age, 47.9) were enrolled. Fifteen patients had one-level and 28 patients had two-level ACDF. The anterior soft-tissue shadow width increased significantly from preoperative values at all levels except C1 at 2 and 6 weeks and C2 at 6 weeks. At 2 weeks, 18 patients had no symptoms/mild dysphagia (Group 1) and 25 patients had moderate/severe dysphagia (Group 2). The average DNRS was 1.1 for Group 1 and 5.3 for Group 2 (p<.001). This difference decreased by 6 weeks but remained significant. There were no significant differences in the soft-tissue measurements between groups at any level. There was no significant correlation between the DNRS and anterior soft-tissue swelling

  15. Total Disc Arthroplasty and Anterior Cervical Discectomy and Fusion in Cervical Spine: Competitive or Complimentary? Review of the Literature

    PubMed Central

    Jawahar, Ajay; Nunley, Pierce

    2012-01-01

    Anterior cervical discectomy and arthrodesis has come to represent standard of care for patients with persistent radicular and/or myelopathic symptoms that have failed to improve with conservative treatments. One potential complication of the procedure is the accelerated degeneration of the vertebrae and the intervertebral discs adjacent to the level fused and the effects of fusion on those levels. The concern that fusion may be a contributing factor to accelerated adjacent segment degeneration led to increased interest in cervical disc replacement after anterior decompressive surgery. Several studies analyzing the short-term outcomes of the disc replacement procedure have been published since then, and the pros and cons of both procedures continue to remain a topic of debate among the scientific community. The analysis of published literature and our own experience has convinced us that the overall longer-term clinical outcomes after anterior cervical discectomy and fusion (ACDF) and total disc replacement (TDR) in the general patient population are not significantly different in terms of symptomatic improvement, neurological improvement, and restoration to better quality of life. Age of the patients and number of affected levels may impact the outcomes and hence determine the choice of optimum procedure. To definitely compare the incidence of adjacent segment disease after these procedures, multi-institutional studies with predetermined and unanimously agreed upon clinical and radiological criteria should be undertaken and the results analyzed in an unbiased fashion. Until that time, it is reasonable to assume that ACDF as well as cervical TDR are both safe and effective procedures that may have outcome benefits in specific patient subgroups based upon demographics and clinical/radiological parameters at the time of surgery. PMID:24353966

  16. Cervical anterior fusion with the Williams-Isu method: clinical review.

    PubMed

    Kim, Kyongsong; Isu, Toyohiko; Morimoto, Daijiro; Sugawara, Atsushi; Kobayashi, Shiro; Teramoto, Akira

    2012-01-01

    Anterior decompression and fusion of the cervical spine is a widely accepted treatment for cervical canal disease. The Williams-Isu method involves cervical anterior fusion with autologous bone grafts from cervical vertebral bodies. Its advantages are a wide operative field, excellent graft fusion, the absence of problems related to the iliac donor site, and direct visualization of the nerve root. For detailed decompression of the cervical root, an ultrasonic bone curette (SONOPET, Stryker Japan K.K., Tokyo) may be useful. To prevent graft extrusion, bioabsorbable screws featuring a head are placed in 4 corners of the bone graft and are fixed with a tap on a part of the graft. The screws are visualized on postoperative X-ray, computed tomography, and magnetic resonance imaging studies. In 69 patients reported elsewhere there were no complications attributable to screw insertion, screw or graft extrusion, or surgery-related infections. When adequate bone cannot be harvested, a piece of ceramic hydroxyapatite is placed between the bone grafts. This sandwich method reinforces the graft, and radiological evidence suggests that it yields better results with respect to the angle and height of the fused segment. For the surgical treatment of cervical ossification of the posterior longitudinal ligament, a large vertebral bone window and a large bone graft are needed; this may result in postoperative radiological worsening. Radiological studies have shown that cervical ossification of the posterior longitudinal ligament can, as can cervical spondylosis, be addressed with the Williams-Isu method. Detailed radiological studies in patients treated with the Williams-Isu method have demonstrated that the range of motion and the disc height of the fused segment must be considered to prevent worsening in that segment after anterior fusion. The Williams-Isu method cannot completely correct cervical alignment, and great caution must be exercised in patients with preoperative

  17. A new anterior-posterior surgical approach for the treatment of cervical facet dislocations.

    PubMed

    Wang, Biao; Zhu, Yue; Jiao, Ying; Wang, Feng; Liu, Xinchun; Zhu, Haitao; Tu, Guanjun; Liang, Deyong

    2014-05-01

    The preliminary results from a new anterior-posterior surgical approach are reported. To report a novel surgical approach, which was successfully applied to treat 8 cervical facet dislocation patients. The combined anterior-posterior surgical procedure is used as a common approach in the treatment of cervical facet dislocations. However, some problems may arise during the application of this approach, and as a result, surgeons must change the initial surgical plan to anterior-posterior-anterior approach. Between December 2011 and June 2012, 8 patients had facet dislocations were surgically treated by the new anterior-posterior approach. After anterior discectomy, a peek frame cage containing autologous iliac bone particles or tricalcium phosphate bone substitute was inserted in the interspace and fixed with a peek composite buttress plate screwed into the inferior vertebral body. Then, the anterior wound was closed and the patient was turned prone. Through a posterior midline approach, the posterior elements were exposed and the reduction was gradually achieved by posteriorly translating the superior segment and progressively positioning the patient's neck into extension. Then lateral mass or pedicle screws and titanium rods were placed in a favorable and satisfactory position, which was demonstrated by the intraoperative plain radiographs. A posterolateral fusion was performed and the posterior wound was closed. With the use of this new approach, all the patients had obtained successful reduction and satisfactory anatomic sagittal alignment. No instances of neurological deterioration and instrument failure occurred, no complications were owing to the use of this technique, and 4 patients existed neurological functional recovery at the most recent follow-up visit. This reported surgical approach is an efficient and safe way for the treatment of traumatic cervical facet dislocations.

  18. Surgical treatment of upper, middle and lower cervical injuries and non-unions by anterior procedures

    PubMed Central

    2009-01-01

    The goals of any treatment of cervical spine injuries are: return to maximum functional ability, minimum of residual pain, decrease of any neurological deficit, minimum of residual deformity and prevention of further disability. The advantages of surgical treatment are the ability to reach optimal reduction, immediate stability, direct decompression of the cord and the exiting roots, the need for only minimum external fixation, the possibility for early mobilisation and clearly decreased nursing problems. There are some reasons why those goals can be reached better by anterior surgery. Usually the bony compression of the cord and roots comes from the front therefore anterior decompression is usually the procedure of choice. Also, the anterior stabilisation with a plate is usually simpler than a posterior instrumentation. It needs to be stressed that closed reduction by traction can align the fractured spine and indirectly decompress the neural structures in about 70%. The necessary weight is 2.5 kg per level of injury. In the upper cervical spine, the odontoid fracture type 2 is an indication for anterior surgery by direct screw fixation. Joint C1/C2 dislocations or fractures or certain odontoid fractures can be treated with a fusion of the C1/C2 joint by anterior transarticular screw fixation. In the lower and middle cervical spine, anterior plating combined with iliac crest or fibular strut graft is the procedure of choice, however, a solid graft can also be replaced by filled solid or expandable vertebral cages. The complication of this surgery is low, when properly executed and anterior surgery may only be contra-indicated in case of a significant lesion or locked joints. PMID:19826842

  19. [Our experiences with anterior cervical cages and spacer].

    PubMed

    Szabó, József; Lapis, István; Marik, László; Kondacs, András; Rusznyák, Csaba

    2007-11-30

    Between 2001 and 2005 86 patients were treated for cervical disc herniations and spondylosis at our department. Stabilization was performed with different cervical cages or spacer after discectomy and decompression. The aim of the study was to examine the changes of the patients' pain, quality of life and work ability, fusion rate, the intervertebral disc height, changes of under and upper segments and finally curvature of cervical spine. Patients were followed by the authors, clinical examination, lateral and antero-posterior radiographic examinations were performed. They were asked to fill in a questionnaire, concerning their pre- and postoperative pain, quality of life and work ability. The patients' pain was graded using a 10-point analog scale (VAS) and with a simplified, McGill-Melzak analog scale. The quality of life was measured with a 10-graduated analog scale as well. More than 77% of our patients appeared at follow up examination. The fusion rate was 89.3%, operated spaces were held in 61%. In the upper segment of operated space 7%, and in the under-segment 14% were found increasingly degenerated. The curvature of cervical spine of the patients' were 64.51% lordotic, 27.42% straight and 8.07% kyphotic. On average the patients' pain changed on VAS from 8.179 to 5.015; on McGill-Melzak scale from 3.89 to 2.80; quality of life changed from 8.045 to 5.463. By the advantage of using cages, the operative approach has become smaller than before, consequently the operative pain has become less too. In addition operation time and hospital stay were significantly shorter (p < 0.005) than using traditional operation approach. The majority of the patients, pain was decreased, quality of life got better. Despite this fact only 3 patients continue their original work and 5 patients do easier work. The majority of our patients were disabled before the operation, but from that time many of them became disabled, in some cases the grade of disability increased. There can

  20. Ligamentum Flavum Buckling Causing immediate Post-operative neurologic deterioration after an Anterior Cervical Discectomy: a case report.

    PubMed

    Taghvaei, Mohammad; Tayebi Meybodi, Keyvan; Zeinalizadeh, Mehdi

    2016-05-05

    Neurological injury is a potential complication of anterior cervical discectomy (ACDF). Iatrogenic trauma, hypoxic-ischemic damage during surgery or epidural hematoma could cause neurologic deterioration after surgery. This is the first case being reported of neurologic deterioration after an anterior cervical discectomy due to ligamentum flavum buckling. The case illustrated an uncommon cause of cord compression after ACDF. Therefore, ligamentum flavum buckling should be considered as one of the potential causes for acute neurologic deterioration after an anterior cervical discectomy. While keeping this rare complication in mind, obtaining a quick post-operative imaging seems mandatory in early detection and establishing an appropriate management.

  1. Single anterior approach for cervical spine fractures at C5-T1 complicating ankylosing spondylitis.

    PubMed

    Guo, Qunfeng; Cui, Yidong; Wang, Liang; Lu, Xuhua; Ni, Bin

    2016-08-01

    To evaluate the outcomes of anterior approach for cervical spine fractures at C5-T1 in patients with ankylosing spondylitis (AS) and study the problems encountered in diagnosis and treatment. Ten patients with AS (all males; mean age 43.7±9.4 years) underwent anterior surgeries to treat fractures at C5-T1. Skull tractions were performed on patients with fracture dislocation preoperatively. After operation, all the patients wore a cervical collar for 3 months. Plain radiographs at follow-up were reviewed. If bone fusion could not be confirmed on plain radiograph, CT scan was employed. The pre- and postoperative neurological statuses were evaluated according to the Frankel grading system. Problems encountered in diagnosis and treatments were analyzed. The mean follow-up was 41.2±22.7months. After operation, the displacements of fractures were significantly reduced(P<0.05). Bone fusions were observed in 9 patients at final follow-up. Frankel grades improved by 1.0±0.7 grade (P>0.05). Posterior complications occurred in four patients, including implants failure (n=1), subsidence of cage (n=1), hoarse voice (n=1) and pneumonias (n=2). The patient with implants failure required revision surgery and anterior-posterior fixation. Patient with subsidence of the titanium cage achieved bone fusion with prolonged cervical collar immobilization. The diagnosis and treatment of cervical spine fractures at C5-T1 in AS patients are challenging, with high risk of neurological compromise and postoperative complications. The single anterior approach followed by postoperative immobilization with a cervical collar can yield acceptable results if the cases are properly selected. Copyright © 2016 Elsevier B.V. All rights reserved.

  2. Late prevertebral abscess with sinus following anterior cervical corpectomy and fusion.

    PubMed

    Bhise, Swapnil D; Mathesul, Ambarish A; Deokate, Pravin; Chandanwale, Ajay S; Bartakke, Girish D

    2015-01-01

    Anterior cervical discectomy/corpectomy and fusion is performed in degenerative, traumatic and neoplastic etiologies of the cervical spine. This procedure is highly successful and associated with fewer complications. The rates of early and late postoperative infection have been reported to be between 0.1% and 1.6%, the late infections are being very rare. We report a rare case of a 30-year-old HIV negative, non-diabetic male who developed a late prevertebral cervical abscess with discharging sinus over posterior triangle of neck 3 years after an anterior cervical C6 corpectomy with fibular grafting and buttress screw fixation performed elsewhere for traumatic fracture C6 vertebra. The abscess was drained using radical neck dissection approach with complete excision of sinus track and removal of the infected implant. On culture, the organism was found to be beta-hemolytic streptococci, for which appropriate antibiotics were administered postoperatively. The sinus tract completely healed in 3 months time. Late infection as a complication of anterior cervical spine surgeries is rare and is associated with esophageal perforation, implant migration, seeding of the deep prevertebral space with oropharyngeal flora, or from surgical site/bacteremia or with Zenker's diverticulum. Few cases have been reported till date, but none have presented with a sinus tract. We present a case of delayed prevertebral abscess after cervical spine instrumentation that followed abnormal path causing sinus track to be developed in the site (the posterior triangle of the neck) other than previous incision site. Exploring both triangles of the neck using radical neck dissection approach was essential for complete excision of sinus track, removal of screw and debridement.

  3. Dynamic anterior cervical plating for multi-level spondylosis: Does it help?

    PubMed

    Ragab, Ashraf A; Hodges, F Spain; Hill, Clint P; McGuire, Robert A; Tucci, Michelle

    2010-05-01

     Randomized controlled trial.  To compare fusion rates, time to fusion, complication rates and subsidence between 1) a static, 2) a dynamic angulation, and 3) a dynamic translation plate in anterior cervical discectomy and fusion for symptomatic degenerative cervical disease.  Thirty-six patients with two level, symptomatic cervical degenerative changes requiring surgery were randomized in a blinded fashion to receive a statically locked plate, Cervical Spine Locking Plate (CSLP) (Synthes, Paoli, PN, USA), an Atlantis Vision(®) Anterior Cervical Plate System (Medtronic, Memphis, TN, USA) which allows angular dynamization, or a Premier(®) Anterior Cervical Plate System (Medtronic) which allows translational dynamization. Structured data collection and measurement protocols were used. Intervertebral composite allograft cages were used in all groups. Identical external immobilization and antiinflammatory medication protocols were followed. X-rays were obtained at preset time points postoperatively. Assessment of the primary outcomes was blinded. Rate of and time to fusion, graft/instrumentation complications, subsidence, and reoperation for adjacent level disease were measured. Paired t-test and three-way Analysis of Variance test (ANOVA) were used to assess statistical differences between groups.  The three groups were similar demographically. Fusion rates in the CSLP, Atlantis and Premier plate groups were 100%, 91%, and 92% respectively. Mean time to fusion was 6.1, 8.3 and 6.3 months respectively but differences were not statistically significant. Mean subsidence in the groups was 1.9, 1.6, and 2.6 mm respectively. Subsidence was found even for the static (CSLP) plate, but no statistically significant differences were found.  We found no clinical advantage of dynamic plates over static plates with regards to fusion rates, time to fusion, subsidence, complications, or adjacent-level surgery. Static plating allows for subsidence at similar levels to

  4. Graft Subsidence and Revision Rates Following Anterior Cervical Corpectomy: A Clinical Study Comparing Different Interbody Cages.

    PubMed

    Weber, Michael H; Fortin, Maryse; Shen, Jian; Tay, Bobby; Hu, Serena S; Berven, Sigurd; Burch, Shane; Chou, Dean; Ames, Christopher; Deviren, Vedat

    2016-09-10

    Retrospective cohort study. To assess the subsidence and revision rates associated with different interbody cages following anterior cervical corpectomy and reconstruction. Different interbody cages are currently used for surgical reconstruction of the anterior and middle columns of the spine following anterior cervical corpectomy. However, subsidence and delayed union/nonunion associated with allograft and cage reconstruction are common complications, which may require revision with instrumentation. We reviewed the cases of 75 patients who underwent cervical corpectomy and compared the radiographic graft subsidence and revision rates for fibula allograft, titanium mesh cage, titanium expandable cage, and carbon fiber cages. Subsidence was calculated by comparing the immediate postoperative lateral x-ray films to those obtained during follow-up visits. The average graft subsidence was 3 mm and revision rate was 25% for fibula allograft versus 2.9 mm and 11.1%, 2.9 mm and 18.8% for titanium mesh cages and titanium expandable cages, respectively. The average graft subsidence for carbon fiber cages was 0.7 mm with no revision surgery in this subset. Our findings suggest that subsidence and revision rates following anterior corpectomy and interbody fusion could be minimized with the use of a carbon fiber cage.

  5. Establishing objective volume-outcome measures for anterior and posterior cervical spine fusion.

    PubMed

    Blais, Micah B; Rider, Sean Michael; Sturgeon, Daniel J; Blucher, Justin; Zampini, Jay M; Kang, James D; Schoenfeld, Andrew J

    2017-10-01

    There is a growing literature on the relationship between provider volume and patient outcomes, specifically within joint arthroplasty and lumbar spine surgery. Such benchmarks have yet to be established for many other spinal procedures, including cervical fusion. We sought to determine whether outcomes-based volume measures for both surgeons and hospitals can be established for cervical spine fusion procedures. This was a retrospective review of patient data in the Florida Statewide Inpatient Dataset (SID; 2011-14). Patients identified in the Florida SID who underwent either anterior or posterior cervical fusion were identified along with the operative surgeons and the hospitals where the procedures were performed. Socio-demographic data, as well as medical and surgical characteristics were obtained, as were the development of complications and readmissions up to 90days following hospital discharge. Surgeon and hospital volume were plotted separately against the number of complications and readmissions in an adjusted spline analysis. Multivariable logistic regression analysis was subsequently performed to assess the effect of surgeon and hospital volume on post-operative complications and readmissions. There were 8960 patients with posterior cervical fusion and 57,108 anterior cervical fusions (total=66,068) identified for inclusion in the analysis. The patients of low-volume surgeons were found to have an increased (OR 1.83; 95% CI 1.65, 2.02) likelihood of complications following anterior and posterior (OR 1.45; 95% CI 1.24, 1.69) cervical fusion. Low-volume surgeons demonstrated increased likelihood of readmission, irrespective of anterior (OR 1.37; 95% CI 1.29, 1.47) or posterior (OR 1.31; 95% CI 1.16, 1.48) approach. No clinically meaningful differences in the likelihood of complications or readmissions were detected between high- and low-volume hospitals. This study demonstrates objective volume-outcome measures for surgeons who perform anterior and

  6. Radiographic Evaluation of the Reliability of Neck Anatomic Structures as Anterior Cervical Surgical Landmarks.

    PubMed

    Liu, Jia-Ming; Du, Liu-Xue; Xiong, Xu; Chen, Xuan-Yin; Zhou, Yang; Long, Xin-Hua; Huang, Shan-Hu; Liu, Zhi-Li

    2017-07-01

    Accurate location of the skin incision is helpful to decrease the technical difficulty and save the operative time in anterior cervical spine surgery. Spine surgeons usually use the traditional neck anatomic structures (the hyoid bone, thyroid cartilage, and cricoid cartilage) as landmarks during the surgery. However, the reliability of these landmarks has not been validated in actual practice. To find out which landmark is the most accurate for identifying the cervical levels in anterior cervical spine surgery. The lateral flexion and extension radiographs of cervical spine in standing position from 30 consecutive patients from January 2015 to February 2015 were obtained. The cervical vertebral bodies from C2 to C7 were divided equally into 2 segments. The cervical segments corresponding to each of the surface landmarks were recorded on the flexion and extension radiographs, respectively, and the displacement of corresponding cervical segments from the flexion to extension radiographs for each landmark was calculated. Based on the measurements, the main corresponding cervical levels for the mandibular angle were C2 on both of the flexion and extension films, for the hyoid bone were the C3-C4 interspace on flexion film and C3 on extension film, for the thyroid cartilage C5 on both of flexion and extension films, and for the cricoid cartilage C6 on flexion film and C5-C6 interspace on extension film, respectively. The ratios of displacement within 2 segments from flexion to extension were 83.3% (25/30) for mandibular angle, 56.7% (17/30) for hyoid bone, 66.7% (20/30) for thyroid cartilage, and 56.7% (17/30) for cricoid cartilage, respectively. The mean displacement from flexion to extension films were significantly less than 2 cervical segments for the mandibular angle but greater than 2 segments for the other landmarks. Significant differences were found between mandibular angle and the other 3 landmarks for the displacement from flexion to extension. The angle of

  7. Acquired Pharyngeal Diverticulum after Anterior Cervical Fusion Operation Misdiagnosed as Typical Zenker Diverticulum

    PubMed Central

    Park, Jong Myung; Kim, Chang Wan; Kim, Do Hyung

    2016-01-01

    A pharyngeal diverticulum is a rare complication of an anterior cervical discectomy and fusion (ACDF). We present a case of a pharyngeal diverticulum after an ACDF, which was misdiagnosed as a typical Zenker diverticulum. A 54-year-old woman presented with dysphagia and a sense of irritation in the neck following C5 through C7 cervical fusion 3 years prior. The patient underwent open surgery to resect the diverticulum with concurrent cricopharyngeal myotomy. An ACDF-related diverticulum is difficult to distinguish from a typical Zenker diverticulum. PMID:27525244

  8. Anterior Cervical Discectomy and Fusion Alters Whole-Spine Sagittal Alignment

    PubMed Central

    Kim, Jang Hoon; Yi, Seong; Kim, Kyung Hyun; Kuh, Sung Uk; Chin, Dong Kyu; Kim, Keun Su; Cho, Yong Eun

    2015-01-01

    Purpose Anterior cervical discectomy and fusion (ACDF) has become a common spine procedure, however, there have been no previous studies on whole spine alignment changes after cervical fusion. Our purpose in this study was to determine whole spine sagittal alignment and pelvic alignment changes after ACDF. Materials and Methods Forty-eight patients who had undergone ACDF from January 2011 to December 2012 were enrolled in this study. Cervical lordosis, thoracic kyphosis, lumbar lordosis, sagittal vertical axis (SVA), and pelvic parameters were measured preoperatively and at 1, 3, 6, and 12 months postoperatively. Clinical outcomes were assessed using Visual Analog Scale (VAS) scores and Neck Disability Index (NDI) values. Results Forty-eight patients were grouped according to operative method (cage only, cage & plate), operative level (upper level: C3/4 & C4/5; lower level: C5/6 & C6/7), and cervical lordosis (high lordosis, low lordosis). All patients experienced significant improvements in VAS scores and NDI values after surgery. Among the radiologic parameters, pelvic tilt increased and sacral slope decreased at 12 months postoperatively. Only the high cervical lordosis group showed significantly-decreased cervical lordosis and a shortened SVA postoperatively. Correlation tests revealed that cervical lordosis was significantly correlated with SVA and that SVA was significantly correlated with pelvic tilt and sacral slope. Conclusion ACDF affects whole spine sagittal alignment, especially in patients with high cervical lordosis. In these patients, alteration of cervical lordosis to a normal angle shortened the SVA and resulted in reciprocal changes in pelvic tilt and sacral slope. PMID:26069131

  9. Anterior decompression and fusion versus posterior laminoplasty for multilevel cervical compressive myelopathy.

    PubMed

    Liu, Xuzhou; Wang, Hehui; Zhou, Zhilai; Jin, Anmin

    2014-02-01

    The optimal surgical strategy for anterior or posterior approaches remains controversial for multilevel cervical compressive myelopathy caused by multisegment cervical spondylotic myelopathy (MCSM) or ossification of the posterior longitudinal ligament (OPLL). A systematic review and meta-analysis was conducted evaluating the clinical results of anterior decompression and fusion (ADF) compared with posterior laminoplasty for patients with multilevel cervical compressive myelopathy. PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials and nonrandomized cohort studies conducted from 1990 to May 2013 comparing ADF with posterior laminoplasty for the treatment of multilevel cervical compressive myelopathy due to MCSM or OPLL. The following outcome measures were extracted: Japanese Orthopedic Association (JOA) score, recovery rate, complication rate, reoperation rate, blood loss, and operative time. Subgroup analysis was conducted according to the mean number of surgical segments. Eleven studies were included in the review, all of which were prospective or retrospective cohort studies with relatively low quality indicated by GRADE Working Group assessment. A definitive conclusion could not be reached regarding which surgical approach is more effective for the treatment of multilevel cervical compressive myelopathy. Although ADF was associated with better postoperative neural function than posterior laminoplasty in the treatment of multilevel cervical compressive myelopathy due to MCSM or OPLL, there was no apparent difference in the neural function recovery rate between the 2 approaches. Higher rates of surgery-related complication and reoperation should be taken into consideration when ADF is used for patients with multilevel cervical compressive myelopathy. The surgical trauma associated with corpectomy was significantly higher than that associated with posterior laminoplasty.

  10. Utilization trends of cervical artificial disc replacement during the FDA investigational device exemption clinical trials compared to anterior cervical fusion.

    PubMed

    Qureshi, Sheeraz A; Koehler, Steven M; Lu, Young; Cho, Samuel; Hecht, Andrew C

    2013-12-01

    While anterior cervical discectomy and fusion (ACDF) is the gold standard surgical treatment for cervical disc disease, concerns regarding adjacent segment degeneration lead to the development of cervical disc arthroplasty (CDA). This study compares the utilization trends of CDA versus ACDF during the period of the Food and Drug Administration Investigational Device Exemption clinical trials from 2004 to 2007. The Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was used to identify CDA and ACDF procedures performed in the USA between 2004 and 2007. The prevalence of CDA and ACDF procedures was estimated and stratified by age, sex, diagnosis, census region, payor class, and hospital characteristics. The average length of hospital stay, total charges, and costs were also estimated. The number of CDA surgeries significantly increased annually from 2004 to 2007 and mostly took place at urban non-teaching hospitals. There were no regional differences between CDA and ACDF utilization. There was no difference between sex or admission type between CDA and ACDF patients. ACDF patients were older and had more diabetes, hypertension, and chronic obstructive pulmonary disease. CDA patients were more likely to be discharged home and had shorter hospital stays but had a higher rate of deep venous thrombosis than ACDF patients. Significantly more CDA patients had private insurance while more ACDF patients had Medicare. The average cost was higher for ACDF than CDA. While ACDF dominated surgical intervention for cervical disc disease during the trial period, CDA utilization increased at a significantly greater rate suggesting rapid early adoption.

  11. A case series on the technical use of three-dimensional image guidance in subaxial anterior cervical surgery.

    PubMed

    Pirris, Stephen M; Nottmeier, Eric W

    2015-03-01

    Three dimensional (3D) image guidance has been used to improve the safety of complex spine surgeries, but its use has been limited in anterior cervical spine approaches. Twenty-two patients underwent complex anterior cervical spine surgeries in which 3D image guidance provided intraoperative assistance with the dissection, decompression and implant placement. One of two paired systems, the BrainLAB (BrainLAB, Westchester, Illinois) system, or Stealth (Medtronic Inc., Littleton, Massachusetts) system was used for 3D image guidance in this study. Image guidance was able to reliably locate pertinent anatomical structures in complex anterior cervical spine surgery involving re-exploration, dissection around vertebral arteries or deformity correction. No complications occurred, and no patients required a revision anterior surgery. This technical note describes the setup and technique for the use of cone beam computed tomography (cbCT)-based, 3D image guidance in subaxial anterior cervical surgery. The authors have found this technique to be a useful adjunct in revision anterior cervical procedures, as well as anterior cervical procedures involving corpectomy or tumor removal. Copyright © 2014 John Wiley & Sons, Ltd.

  12. Anterior cervical spine fusion in treatment of cervicobrachialgia.

    PubMed

    Kooijman, M A

    1991-01-01

    Traumatic and degenerative changes in the spine at the level of the neck are frequent causes of pain in the neck, often associated with radiculopathy and sometimes even myelopathic symptoms. The signs and symptoms can generally be attributed to a problem of instability for which there are no specific criteria. If conservative treatment does not help, satisfying results can be achieved by a stable intercorporeal fusion using the modified Robinson technique. An EMG and a cervical myelogram must be carried out before surgical stabilization. In 154 patients followed for an average of 12 years, 75% observed resolution of the pain and paresthesias after surgical stabilization. These results correspond to those described in the literature. The best results are achieved if the signs and symptoms are experienced for no longer than 1 year and if the patient is under age 40.

  13. Health state utility of patients with single-level cervical degenerative disc disease: comparison of anterior cervical discectomy and fusion with cervical disc arthroplasty.

    PubMed

    Qureshi, Sheeraz; Goz, Vadim; McAnany, Steven; Cho, Samuel K; Hecht, Andrew C; Delamarter, Rick B; Fehlings, Michael G

    2014-05-01

    Cost-effectiveness analysis (CEA) of medical interventions has become increasingly relevant to the discussion of optimization of care. The use of utility scales in CEA permits a quantitative assessment of effectiveness of a given intervention. There are no published utility values for degenerative disc disease (DDD) of the cervical spine, anterior cervical discectomy and fusion (ACDF), or cervical disc replacement (CDR). The purpose of this study was to define health utility values for those health states. The 36-Item Short Form Health Survey data from the ProDisc-C investigational device exemption study were obtained for single-level DDD at baseline and 24 months postoperatively after ACDF or CDR procedures. Patients in the original study were randomized to either ACDF or CDR. Utilizing a commercially available Short Form-6 dimensions program, utility scores were calculated for each health state using a set of parametric preference weights obtained from a sample of the general population using the recognized valuation technique of standard gamble. The baseline health state utility (HSU) value for a patient with single-level DDD was 0.54 in both the ACDF and CDR groups. Postoperative changes in HSU values were seen in both intervention groups at 24 months. Cervical disc replacement had a HSU value of 0.72. Anterior cervical discectomy and fusion was found to have a postoperative utility state of 0.71. No statistically significant difference was found in the HSU for ACDF and CDR at 24 months of follow-up. This study represents the first calculated HSU value for a patient with single-level cervical DDD. Additionally, 2 common treatment interventions for this disease state were assessed. Both treatments were found to have significant impact on the HSU values. These values are integral to future CEA of ACDF and CDR.

  14. Subsidence and nonunion after anterior cervical interbody fusion using a stand-alone polyetheretherketone (PEEK) cage.

    PubMed

    Yang, Jae Jun; Yu, Chang Hun; Chang, Bong-Soon; Yeom, Jin Sup; Lee, Jae Hyup; Lee, Choon-Ki

    2011-03-01

    The purposes of the present study are to evaluate the subsidence and nonunion that occurred after anterior cervical discectomy and fusion using a stand-alone intervertebral cage and to analyze the risk factors for the complications. Thirty-eight patients (47 segments) who underwent anterior cervical fusion using a stand-alone polyetheretherketone (PEEK) cage and an autologous cancellous iliac bone graft from June 2003 to August 2008 were enrolled in this study. The anterior and posterior segmental heights and the distance from the anterior edge of the upper vertebra to the anterior margin of the cage were measured on the plain radiographs. Subsidence was defined as ≥ a 2 mm (minor) or 3 mm (major) decrease of the segmental height at the final follow-up compared to that measured at the immediate postoperative period. Nonunion was evaluated according to the instability being ≥ 2 mm in the interspinous distance on the flexion-extension lateral radiographs. The anterior and posterior segmental heights decreased from the immediate postoperative period to the final follow-up at 1.33 ± 1.46 mm and 0.81 ± 1.27 mm, respectively. Subsidence ≥ 2 mm and 3 mm were observed in 12 segments (25.5%) and 7 segments (14.9%), respectively. Among the expected risk factors for subsidence, a smaller anteroposterior (AP) diameter (14 mm vs. 12 mm) of cages (p = 0.034; odds ratio [OR], 0.017) and larger intraoperative distraction (p = 0.041; OR, 3.988) had a significantly higher risk of subsidence. Intervertebral nonunion was observed in 7 segments (7/47, 14.9%). Compared with the union group, the nonunion group had a significantly higher ratio of two-level fusion to one-level fusions (p = 0.001). Anterior cervical fusion using a stand-alone cage with a large AP diameter while preventing anterior intraoperative over-distraction will be helpful to prevent the subsidence of cages. Two-level cervical fusion might require more careful attention for avoiding nonunion.

  15. Subsidence and Nonunion after Anterior Cervical Interbody Fusion Using a Stand-Alone Polyetheretherketone (PEEK) Cage

    PubMed Central

    Yang, Jae Jun; Yu, Chang Hun; Yeom, Jin Sup; Lee, Jae Hyup; Lee, Choon-Ki

    2011-01-01

    Background The purposes of the present study are to evaluate the subsidence and nonunion that occurred after anterior cervical discectomy and fusion using a stand-alone intervertebral cage and to analyze the risk factors for the complications. Methods Thirty-eight patients (47 segments) who underwent anterior cervical fusion using a stand-alone polyetheretherketone (PEEK) cage and an autologous cancellous iliac bone graft from June 2003 to August 2008 were enrolled in this study. The anterior and posterior segmental heights and the distance from the anterior edge of the upper vertebra to the anterior margin of the cage were measured on the plain radiographs. Subsidence was defined as ≥ a 2 mm (minor) or 3 mm (major) decrease of the segmental height at the final follow-up compared to that measured at the immediate postoperative period. Nonunion was evaluated according to the instability being ≥ 2 mm in the interspinous distance on the flexion-extension lateral radiographs. Results The anterior and posterior segmental heights decreased from the immediate postoperative period to the final follow-up at 1.33 ± 1.46 mm and 0.81 ± 1.27 mm, respectively. Subsidence ≥ 2 mm and 3 mm were observed in 12 segments (25.5%) and 7 segments (14.9%), respectively. Among the expected risk factors for subsidence, a smaller anteroposterior (AP) diameter (14 mm vs. 12 mm) of cages (p = 0.034; odds ratio [OR], 0.017) and larger intraoperative distraction (p = 0.041; OR, 3.988) had a significantly higher risk of subsidence. Intervertebral nonunion was observed in 7 segments (7/47, 14.9%). Compared with the union group, the nonunion group had a significantly higher ratio of two-level fusion to one-level fusions (p = 0.001). Conclusions Anterior cervical fusion using a stand-alone cage with a large AP diameter while preventing anterior intraoperative over-distraction will be helpful to prevent the subsidence of cages. Two-level cervical fusion might require more careful attention

  16. Positional change of hyoid bone after anesthesia in anterior surgery of upper cervical spine.

    PubMed

    Lim, Jong-Han; Wang, Seong-Il; Kim, Do-Yeon; Song, Kyung-Jin; Kim, Tae Gyun; Lee, Kwang-Bok

    2014-09-01

    The hyoid bone is used as a landmark in anterior upper cervical spine operations and is supposed to represent the level of C3 body. However, this correspondence between hyoid bone position and cervical level is not static and changes during surgery (extension after anesthesia). To find the cervical level corresponding to the position of hyoid bone before and after anesthesia and to evaluate the adequacy of its usage as a surgical landmark. A retrospective study. One hundred twenty-eight patients with degenerative cervical diseases who had undergone anterior cervical discectomy and fusion. Radiologic measure. For each patient, preanesthesia neutral, preanesthesia extension, and postanesthesia induction extension C-spine lateral image were obtained. The level of cervical vertebra that midline of hyoid bone indicated was measured by radiological method. A cervical vertebra was divided into three segments, consisting of upper half, lower half, and disc space, and each of these segments was considered as one level. The differences between pre- and postanesthesia induction hyoid positions were classified as minimal change (one level or less) and significant change (two levels or greater). Relationship between positional change of hyoid bone to gender, obesity, and age were respectively investigated. There were 20 cases of one-level distal displacement of the hyoid bone, 40 cases of two-level distal displacement, 34 cases of three-level distal displacement, 16 cases of 4-level distal displacement, and two cases of five-level distal displacement. In eight cases, there was no level change, and in the remaining 8 cases, the hyoid bone had been displaced proximally. There were 34 cases of minimal change. The remaining 94 cases (73.4%) had significant changes. No respective relationship was found between sex, obesity, age and pre-and postanesthesia induction positional change of hyoid bone. Among the 128 cases studied, 73.4% hyoid bone positions had changed by more than one

  17. Multilevel anterior cervical discectomy and fusion with plate fixation for juvenile unilateral muscular atrophy of the distal upper extremity accompanied by cervical kyphosis.

    PubMed

    Guo, Xiang; Lu, Ming; Xie, Ning; Guo, Qunfeng; Ni, Bin

    2014-10-01

    A retrospective clinical study was conducted and related literatures were reviewed. This study aimed to evaluate outcome of multilevel anterior cervical discectomy and fusion with plate fixation for juvenile unilateral muscular atrophy of the distal upper extremity accompanied by cervical kyphosis. Juvenile unilateral muscular atrophy of the distal upper extremity is a rare disease. Traditional treatment uses a neck collar to immobilize neck motion. However, if the disease is accompanied by cervical kyphosis, conservative treatment is difficult to correct cervical kyphosis and the prognosis is worsened. Therefore, it is important to initially apply surgical treatment for juvenile unilateral muscular atrophy accompanied with cervical kyphosis. From March 2008 to May 2010, 4 patients were transferred to our spine medical center because of a history of slowly progressive distal weakness and atrophy of their hands and forearms. Four patients were diagnosed with Hirayama disease accompanied with cervical kyphosis based on their clinical representations and radiologic findings. After conservative treatment failed, these patients underwent multilevel anterior cervical discectomy and fusion with plate fixation. The clinical outcomes were retrospectively evaluated with follow-up ranging from 1.5 to 3 years. The clinical and radiologic follow-up indicated satisfactory clinical relief from symptoms, cervical sagittal alignment and cervical spinal canal volume, for all the patients. Within 6 months after surgery, the JOA score improved from a preoperative average of 14 to a postoperative average of 16.3; JOA recovery rates of all patients were more than good level. The muscle strengths of intrinsic muscles, wrist flexors and extensors, and biceps and triceps muscle improved on average by 1 grade. No complications occurred. Hirayama disease is a rare disease, a proper diagnosis of which can be made based on significant clinical symptoms and neurological imaging (dynamic MRI

  18. Fibular Allograft After Anterior Cervical Corpectomy: Long Term Follow-Up

    PubMed Central

    McKoy, Brodie E; Wingate, Jeffrey K; Poletti, Steven C; Johnson, Donald R; Stanley, Mark D; Glaser, John A

    2002-01-01

    The purpose of this study was to provide clinical and radiographic evaluation after a minimum of two years in patients who had an anterior cervical corpectomy and a fibular allograft strut. Nineteen patients returned for a follow-up visit which included independent radiographic evaluation as well as completing a Visual Analogue Scale and Oswestry and Short-Form 36 questionnaires. The categories of fusion were as follows: 1) definitely fused (84%) 2) questionably fused (11%) 3) definitely not fused (5%). The average VAS was 29 mm (range 0-85). The Oswestry Back Scores showed relatively low levels of significant pain with an average score of 29 (range 0-73). Anterior cervical corpectomy followed by an allograft fibular strut provides for relatively high rates of arthrodesis without severe loss of height or sagittal alignment at long term radiographic follow-up. PMID:12180610

  19. Congenital midline cervical cleft: clinical approach to a congenital anterior neck defect.

    PubMed

    Crippa, Beatrice Letizia; Bedeschi, Maria Francesca; Cantarella, Giovanna; Colombo, Lorenzo; Agosti, Viola; Amodeo, Ilaria; Fumagalli, Monica; Mazzola, Isabella; Mosca, Fabio

    2015-05-01

    Numerous malformations can affect the anterior part of the neck presenting at birth as a real diagnostic challenge for the pediatrician or the primary care physician who initially evaluate the baby. Congenital midline cervical cleft represents a rare defect of the midline neck, which is sometimes wrongly diagnosed as a thyroglossal duct anomaly, dermoid cyst, branchial cleft anomaly or "birthmark". A prompt clinical diagnosis and surgical treatment during early infancy are essential to ensure both functional and aesthetic outcome. We report a case of a female neonate with a midline cervical cleft diagnosed immediately after birth. The main features of other congenital anomalies of the anterior neck are also discussed referring to their embryologic origin. © 2014 Japanese Teratology Society.

  20. Oesophageal perforation caused by screw displacement 16 months following anterior cervical spine fixation

    PubMed Central

    Leaver, Nicholas; Colby, Alexandra; Appleton, Nathan; Vimalachandran, Dale

    2015-01-01

    Anterior cervical spine plating is a standard procedure for fixing unstable vertebral fractures. Following surgery, oesophageal perforation has an incidence of 0.25% and this is usually hours following surgery, due to over prominent screws or friction between the oesophagus and the plate. Instrumentation failure of these plates months or years following surgery is very rare but potentially life-threatening. We report a case of microcytic anaemia which was investigated by oesophagogastroduodenoscopy, and subsequently found that a screw from the anterior plate had lifted off and perforated the oesophagus. This is very rare, but emphasises an important lesson. Anyone presenting with gastrointestinal bleeding or infectious signs, with a history of cervical spine plating should be investigated immediately for instrumentation failure as it brings a high mortality. PMID:25796082

  1. A rare case of pharyngeal perforation and expectoration of an entire anterior cervical fixation construct.

    PubMed

    Quadri, Syed A; Capua, John; Ramakrishnan, Vivek; Sweiss, Raed; Cabanne, Marc; Noel, Jerry; Fiani, Brian; Siddiqi, Javed

    2017-02-03

    Anterior cervical discectomy and fusion (ACDF) is a very common surgery performed globally. Although a few cases of expectorating screws or extrusion of screws into the gastrointestinal tract through esophageal perforations have previously been reported, there has not been a case reporting pharyngeal perforation and entire cervical construct extrusion in the literature to date. In this report the authors present the first case involving the extrusion of an entire cervical construct via a tear in the posterior pharyngeal wall. An 81-year-old woman presented to the emergency department (ED) with a complaint of significant cervical pain 5 days after a fall due to a syncopal event. Radiological findings showed severe anterior subluxation of C-2 on C-3 with no spinal cord signal change noted. She underwent ACDF at the C2-3 level utilizing a polyetheretherketone (PEEK) cage, allograft, autograft, and a nontranslational plate with a locking apparatus and expanding screws. The screw placement was satisfactory on postoperative radiography and the Grade II spondylolisthesis of C-2 on C-3 was reduced appropriately with the surgery. The postoperative radiographs obtained demonstrated good instrumentation placement. Three and a half years later the patient returned to the ED having expectorated the entire anterior cervical construct. A CT scan demonstrated the C-2 and C-3 vertebral bodies to be fused posteriorly with an anterior erosive defect within the vertebral bodies and the anterior fusion hardware at the C2-3 level no longer identified. The fiberoptic laryngoscopy demonstrated a 1 × 1 cm area over the importation of the hypopharynx, above the glotic area. The Gastrografin swallowing test ruled out any esophageal tear or fistula and confirmed the presence of a large ulcer on the posterior wall of the oropharynx. To the best of the authors' knowledge, this is the first ever reported case of a tear in the posterior pharyngeal wall along with extrusion of the entire cervical

  2. Cervical vertebral column morphology and head posture in preorthodontic patients with anterior open bite.

    PubMed

    Kim, Phong; Sarauw, Martin Toft; Sonnesen, Liselotte

    2014-03-01

    Cervical vertebral column morphology and head posture were examined and related to craniofacial morphology in preorthodontic children and adolescents with anterior open bite. One hundred eleven patients (ages, 6-18 years) with an anterior open bite of more than 0 mm were divided into 2 groups of skeletal or dentoalveolar open bite. The skeletal open-bite group comprised 38 subjects (19 girls, 19 boys). The dentoalveolar open-bite group comprised 73 subjects (43 girls, 30 boys). Visual assessment of the cervical column and measurements of craniofacial morphology and head posture were made on profile radiographs. Deviations in the cervical vertebral column morphology occurred in 23.7% of the subjects in the skeletal open-bite group and in 19.2% in the dentoalveolar open-bite group, but the difference was not significant. Head posture was significantly more extended in the skeletal open-bite group compared with the dentoalveolar open-bite group (craniovertical angle [Mx/VER], P <0.05; craniocervical angles [Mx/OPT, Mx/CVT], P <0.01. Only head posture was associated with craniofacial morphology: extended posture was associated with a large cranial base angle (P <0.01, P <0.001), large vertical craniofacial dimensions (P <0.05; P <0.01; P <0.001), and retrognathia of the jaws (P <0.001). Cervical column morphology is described for the first time in children and adolescents with open bite. No significant differences in the cervical vertebral column's morphologic deviations were found between the skeletal and the dentoalveolar open-bite groups. Significant differences were found in head posture between the groups and with regard to associations with craniofacial dimensions. This might indicate a respiratory etiologic component in children with anterior open bite. Copyright © 2014 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  3. Long term outcome of anterior cervical discectomy and fusion using coral grafts.

    PubMed

    Ramzi, Najib; Ribeiro-Vaz, Geraldo; Fomekong, Edward; Lecouvet, Frédéric E; Raftopoulos, Christian

    2008-12-01

    To determine the long term efficacy of coral grafts in anterior cervical discectomy and fusion. In this prospective longitudinal study, All patients presenting with myelopathy and/or radiculopathy due to discal hernia or cervical spondylosis underwent anterior cervical microdiscectomy, arthrodesis with coral, and stabilization with anterior cervical locking plates. Clinical and radiological post-operative evaluations were performed at 2 days, 3, 6, and 12 months, and then yearly. The visual analogue scale was used for the evaluation of pain. Fusion was defined as the absence of motion on dynamic imaging combined with the disappearance of radio-lucent lines around the graft. The mean follow-up period was 44 months. In 83.3%, 91.2% and 93.7% of patients there was a satisfactory outcome for neck pain, arm pain, and motor deficit, respectively. The overall complication rate was 17.5%, all of which were transient. Additional surgery was required in nine cases. The occurrence of complications is correlated with less satisfactory outcomes for both neck and arm pain. While 95.5% of patients expressed overall satisfaction with their surgery, 70.5% stated that they had returned to their previous activities. The fusion rate was 45%; which was not correlated with clinical outcome and more likely in patients with of cervical spondylosis and one-level arthrodesis. Despite satisfactory clinical results and a long follow-up period, coral implants yield low fusion rates, particularly in patients with discal hernia of two-level arthrodesis. The use of coral grafts cannot be recommended when fusion is one of the post-operative endpoints.

  4. Cage subsidence after anterior cervical discectomy and fusion using a cage alone or combined with anterior plate fixation.

    PubMed

    Pinder, E M; Sharp, D J

    2016-04-01

    To compare the extent of cage subsidence after anterior cervical discectomy and fusion (ACDF) using a cage alone or combined with anterior plate fixation, and to assess the effect of end plate removal on cage subsidence. Records of 23 men and 13 women aged 32 to 82 (mean, 54) years who underwent ACDF for 61 levels using the Solis cage alone (n=46) or combined with anterior plate fixation (n=15) were reviewed. The extent of cage subsidence was determined by comparing immediately postoperative (within one week) with final follow-up radiographs. Cage subsidence was defined as the sum subsidence of the superior and inferior part of the cage into the vertebral body. Mild and major cage subsidence was defined as ≤2 mm and >2 mm, respectively. Patients who underwent ACDF using a cage alone or combined with anterior plate fixation were comparable in terms of age, gender, follow-up duration, and number of levels decompressed. Cage subsidence occurred in 33 (54%) of the 61 levels decompressed. In the cage alone group, the extent of cage subsidence was greater (1.68 vs. 0.57 mm, p=0.039) and the rate of major cage subsidence was higher (28% vs. 7%, p=0.08). The inferior part of the cage was more vulnerable to subsidence compared with the superior part (median subsidence: 3.0 vs. 1.4 mm, p<0.0001). Cage subsidence occurred more often when the end plate was removed rather than preserved (58% vs. 18%, p<0.002). The extent of cage subsidence was greater after ACDF with cage alone. Cage subsidence occurred more often when the end plate was removed. Additional anterior plate fixation is recommended when the end plate is removed.

  5. Anterior Cervical Discectomy with Arthroplasty versus Arthrodesis for Single-Level Cervical Spondylosis: A Systematic Review and Meta-Analysis

    PubMed Central

    Fallah, Aria; Akl, Elie A.; Ebrahim, Shanil; Ibrahim, George M.; Mansouri, Alireza; Foote, Clary J.; Zhang, Yuqing; Fehlings, Michael G.

    2012-01-01

    Objective To estimate the effectiveness of anterior cervical discectomy with arthroplasty (ACDA) compared to anterior cervical discectomy with fusion (ACDF) for patient-important outcomes for single-level cervical spondylosis. Data sources Electronic databases (MEDLINE, EMBASE, Cochrane Register for Randomized Controlled Trials, BIOSIS and LILACS), archives of spine meetings and bibliographies of relevant articles. Study selection We included RCTs of ACDF versus ACDA in adult patients with single-level cervical spondylosis reporting at least one of the following outcomes: functionality, neurological success, neck pain, arm pain, quality of life, surgery for adjacent level degeneration (ALD), reoperation and dysphonia/dysphagia. We used no language restrictions. We performed title and abstract screening and full text screening independently and in duplicate. Data synthesis We used random-effects model to pool data using mean difference (MD) for continuous outcomes and relative risk (RR) for dichotomous outcomes. We used GRADE to evaluate the quality of evidence for each outcome. Results Of 2804 citations, 9 articles reporting on 9 trials (1778 participants) were eligible. ACDA is associated with a clinically significant lower incidence of neurologic failure (RR  = 0.53, 95% CI  = 0.37–0.75, p = 0.0004) and improvement in the Neck pain visual analogue scale (VAS) (MD  = 6.56, 95% CI  = 3.22–9.90, p = 0.0001; Minimal clinically important difference (MCID)  = 2.5. ACDA is associated with a statistically but not clinically significant improvement in Arm pain VAS and SF-36 physical component summary. ACDA is associated with non-statistically significant higher improvement in the Neck Disability Index Score and lower incidence of ALD requiring surgery, reoperation, and dysphagia/dysphonia. Conclusions There is no strong evidence to support the routine use of ACDA over ACDF in single-level cervical spondylosis. Current trials lack long

  6. Effect of perioperative steroids on dysphagia after anterior cervical spine surgery: A systematic review

    PubMed Central

    Adenikinju, Abidemi S.; Halani, Sameer H.; Rindler, Rima S.; Gary, Matthew F.; Michael, Keith W.

    2017-01-01

    Background Dysphagia following anterior cervical spine surgery is common. Steroids potentially reduce post-operative inflammation that leads to dysphagia; however, the efficacy, optimal dose and route of steroid administration have not been fully elucidated. Objective The purpose of this systematic review is to evaluate the effect of peri-operative steroids on the incidence and severity of dysphagia following anterior cervical spine surgery. Methods A PubMed search adherent to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed to include clinical studies reporting use of steroids in adult patients following anterior cervical spine surgery. Data regarding steroid dose, route and timing of administration were abstracted. Incidence and severity of post-operative dysphagia were pooled across studies. Results Seven of 72 screened articles met inclusion criteria for a total of 246,298 patients that received steroids. Patients that received systemic and local steroids had significant reductions in rate and severity of dysphagia postoperatively. Reduction of dysphagia severity was more pronounced in patients undergoing multilevel procedures in both groups. There was no difference in infectious complications among patients that received steroids compared with controls. There was no difference in fusion rates at long-term follow-up. Conclusions and Clinical Relevance Steroids may reduce dysphagia after anterior cervical spinal procedures in the early post-operative period without increasing complications. This may be especially beneficial in patients undergoing multilevel procedures. Future studies should further define the optimal dose and route of steroid administration, and the specific contraindications for use. PMID:28377867

  7. Fixed vs dynamic plate complications following multilevel anterior cervical corpectomy and fusion with posterior stabilization.

    PubMed

    Epstein, N E

    2003-07-01

    Comparison of fixed vs dynamic plate complications in cervical surgery. : New York, USA. Anterior cervical plate-related complications were evaluated following 66 anterior cervical corpectomy and fusion (ACF) with posterior stabilization (PWF) procedures performed in patients with ossification of the posterior longitudinal ligament (OPLL). Clinical data were comparable for both patient populations. Patients averaged between 52 and 53 years of age. The male to female ratio was approximately 2:1. Surgery addressed MR and CT documented multilevel OPLL in all patients accompanied by spondylosis and stenosis. Preoperatively average Nurick Grades ranged from 3.6 to 3.7. Anterior cervical corpectomies included an average of 2.6-3.0 vertebral bodies, while PWF covered seven levels. Fixed plates were applied in the initial 38 patients, while the latter 28 patients had dynamic plates (ABC, Aesculap, Tuttlingen, Germany) applied. Halo devices were used until fusion was documented on both X-ray and 2D-CT studies. Patients were followed-up for an average of 5.4 years in the fixed-plated groups, and 2.7 years in the dynamic-plated population. CT and dynamic X-ray confirmed that fusion occurred an average of 4.5-4.9 months postoperatively. Five (13%) fixed plates (Medtronic, Sofamor Danek, Memphis, TN, USA) failed warranting secondary surgery, while only one (3.6%) dynamic-plated patient developed a pseudarthrosis and required secondary posterior fusion. Higher failure rates follow multilevel ACF as compared with anterior diskectomy and fusion required to resect multilevel OPLL. Vaccaro et al observed a 9% failure rate following two-level ACFs and 50% failure rate following three-level ACFs performed with fixed plates. In this series, the plate extrusion rate was reduced to 3.6% when dynamic plates were applied.

  8. Reversal of lifelong mutism after anterior cervical discectomy and fusion for myelopathy

    PubMed Central

    Babu, Ranjith; Grunch, Betsy H; Bagley, Carlos A; Gottfried, Oren N

    2011-01-01

    A 34-year-old man with a history of spina bifida occulta, fetal alcohol syndrome and mutism presented with an acute on chronic decline of unsteady gait and right arm and leg weakness over the period of a few months. The patient was non-verbal and communicated using hand gestures. MRI of the cervical spine showed severe stenosis at C4-5 with T2 signal abnormalities. Brain MRI demonstrated mild ventriculomegaly. The patient underwent an anterior cervical discectomy and fusion for severe cervical spine stenosis. Postoperatively the patient’s myelopathic symptoms improved. He also became verbal and engaged in conversation. Ten months after surgery, the patient who had previously been non-verbal had developed a vocabulary of more than 50 words. PMID:22674701

  9. Postoperative Shingles Mimicking Recurrent Radiculopathy after Anterior Cervical Diskectomy and Fusion

    PubMed Central

    Montgomery, Jason T.; Lawrence, Brandon D.; Brodke, Darrel S.; Patel, Alpesh A.

    2015-01-01

    Study Design Case report and review of literature. Objective To report the case of a 67-year-old woman who developed delayed onset (6 months) of symptomatic shingles after cervical nerve root decompression in a previously symptomatic dermatome. Methods The patient's clinic course and outcomes were retrospectively reviewed. The study required no outside funding. The study authors have no financial interest in any of the products or techniques discussed. Results The patient received definitive treatment for shingles once the zoster form rash manifested. The patient, however, developed postherpetic neuralgia and remained symptomatic at her 2-year postoperative visit. Conclusions Although shingles is a common disease state affecting patients in the fifth and sixth decades of life, it is rarely seen in the setting of cervical nerve root decompression. This case demonstrates the need to include shingles on the differential diagnosis of recurrent neurogenic pain after anterior cervical decompression and fusion. PMID:26131388

  10. Analysis of correlative risk factors for C5 palsy after anterior cervical decompression and fusion

    PubMed Central

    Wang, Haiying; Zhang, Xu; Lv, Bing; Ding, Wenyuan; Shen, Yong; Yang, Dalong; Bai, Zhilong

    2015-01-01

    Background: It has been reported that C5 palsy is a potential complication of both anterior and posterior cervical spine surgery, although several mechanisms of C5 palsy following posterior cervical surgery have been proposed, few reports about correlative risk factors have been elaborated on C5 palsy after anterior cervical decompression and fusion (ACDF). Objective: The purpose of this study was to investigate the correlative risk factors of C5 palsy after anterior cervical decompression and fusion. Methods: This is a retrospective study. A total of 161 patients (108 males and 53 females) who underwent ACDF between 2007 and 2012 were included in this study. C5 palsy is characterized by deltoid and/or biceps brachii weakness. The patients were divided into two groups: one that had experienced C5 palsy (group A) and the other one had not (group B). In both groups, the age, gender, duration of disease, diagnosis, No. of surgical levels, cervical curvature correction, occupying rate of spinal canal at C4/5, diameter of the C4/5 foramen, intervertebral height variation, decompression width and preoperative high-signal intensity zone (HIZ) of spinal cord in T2-weighted MRI at C4/5 were measured and evaluated. The risk factors of C5 palsy were detected with logistic regression analysis. Results: There were no significant differences in age, gender, duration of disease, diagnosis, No. of surgical levels, rate of spinal canal at C4/5 and HIZ of spinal cord in T2-weighted MRI at C4/5. Cervical curvature correction, diameter of the C4/5 foramen, intervertebral height variation and decompression width had significant differences between the two groups (P<0.05). Logistic regression analysis revealed that cervical curvature, diameter of the C4/5 foramen, intervertebral height and decompression width were the pivotal risk factors for the incidence of C5 palsy. Conclusion: For patients with ACDF, greater cervical curvature correction, narrow diameter of the C4/5 foramen

  11. Outcomes of Secondary Laminoplasty for Patients with Unsatisfactory Results after Anterior Multilevel Cervical Surgery

    PubMed Central

    Liu, Hong-Wei; Chen, Liang; Xu, Nan-Wei; Yang, Hui-Lin

    2015-01-01

    Objective To investigate the causes for failed anterior cervical surgery and the outcomes of secondary laminoplasty. Methods Seventeen patients failed anterior multilevel cervical surgery and the following conservative treatments between Feb 2003 and May 2011 underwent secondary laminoplasty. Outcomes were evaluated by the Japanese Orthopaedic Association (JOA) Scale and visual analogue scale (VAS) before the secondary surgery, at 1 week, 2 months, 6 months, and the final visit. Cervical alignment, causes for revision and complications were also assessed. Results With a mean follow-up of 29.7±12.1 months, JOA score, recovery rate and excellent to good rate improved significantly at 2 months (p<0.05) and maintained thereafter (p>0.05). Mean VAS score decreased postoperatively (p<0.05). Lordotic angle maintained during the entire follow up (p>0.05). The causes for secondary surgery were inappropriate approach in 3 patients, insufficient decompression in 4 patients, adjacent degeneration in 2 patients, and disease progression in 8 patients. Complications included one case of C5 palsy, axial pain and cerebrospinal fluid leakage, respectively. Conclusion Laminoplasty has satisfactory results in failed multilevel anterior surgery, with a low incidence of complications. PMID:25674342

  12. Transoral robotic-assisted surgery for the approach to anterior cervical spine lesions.

    PubMed

    Molteni, Gabriele; Greco, Marco Giuseppe; Presutti, Livio

    2017-09-01

    The Da Vinci robotic surgical system is increasingly being used by head and neck surgeons in transoral approaches for head and neck cancer. Our experience using the Da Vinci system for transoral robotic-assisted surgery (TORS) is presented. The feasibility of TORS for lesions involving the anterior portion of C1-C2 and the cranio-cervical junction has been evaluated from an anatomical viewpoint in a cadaveric laboratory. Two patients treated using the Da Vinci system to reach C1-C2 benign lesions are presented. The anatomical cadaveric study showed that this approach is safe and feasible. The first two cases which we describe confirmed the advantages of the Da Vinci system in the anterior approach to the cervical spine and allowed the limitations of this procedure to be assessed. TORS may be useful to reach anterior lesions of the cervical spine localized at the level of C1 and C2: first, for removal of small benign and well-delineated lesions; and second, for diagnostic purposes with biopsy of large lesions. Further studies and new instruments are needed to confirm the safety and results of this approach in terms of morbidity.

  13. Comparison of Radiologic Outcomes of Different Methods in Single-Level Anterior Cervical Discectomy and Fusion

    PubMed Central

    Kwon, O Ik; Lee, Sang Weon; Song, Geun Sung

    2016-01-01

    Objective Anterior cervical discectomy and fusion (ACDF) is a choice of surgical procedure for cervical degenerative diseases associated with radiculopathy or myelopathy. However, the patients undergoing ACDF still have problems. The purpose of the present study is to evaluate the radiologic results of 3 different methods in single-level ACDF. Methods We conducted a retrospective collection of radiological data from January 2011 to December 2014. A total of 67 patients were included in this study. The patients were divided into 3 groups by operation procedure: using stand-alone cage (group cage, n=20); polyether-ether-ketone (PEEK)-titanium combined anchored cage (group AC, n=21); and anterior cervical cage-plate (group CP, n=26). Global cervical lordosis (C2-C7 Cobb angle), fused segment height, fusion rate, and cervical range of motion (ROM) were measured and analyzed at serial preoperative, postoperative, 6-month, and final 1-year follow-up. Results Successful bone fusion was achieved in all patients at the final follow-up examination; however, the loss of disc height over 3 mm at the surgical level was observed in 6 patients in group cage. Groups AC and CP yielded significantly better outcomes than group cage in fused segment height and cervical ROM(p=0.01 and p=0.02, respectively). Furthermore, group AC had similar radiologic outcomes to those of group CP. Conclusion The PEEK-titanium combined anchored cage may be a good alternative procedure in terms of reducing complications induced by plate after ACDF. PMID:27799985

  14. Anterior decompression, fusion and plating in cervical spine injury: Early experience in Abuja, Nigeria.

    PubMed

    Ogungbo, Biodun

    2011-01-01

    We present a review of the results of the current surgical management of acute cervical spine injuries in the Federal Capital Territory, Abuja, Nigeria. This is the first detailed retrospective study on the surgical management of patients with cervical spine injuries from Nigeria. The medical reports of patients with traumatic cervical spine and spinal cord injuries undergoing surgery from 1 August 2009 till 30 August 2010 were reviewed. Management and early results of outcome were ascertained and detailed consecutively in a prospective Microsoft Office Access(®) database (Microsoft Group of Companies). Frankel grading was used for pre- and immediate post-operative evaluation (within 48 hours). The Barthel index (BI) was used to classify patients as dependent or independent at follow-up. Twenty consecutive patients presented with acute cervical spine and spinal cord injuries since August 2009. Twenty anterior cervical spine decompression and fixation with an iliac graft and an anterior cervical plate (ACDF) were performed in 18 patients. All operations were performed with general anaesthesia using standard techniques but without a microscope or a high speed drill. Of the 18 patients who were operated, 4 patients died within a short period following surgical intervention. Seven patients have made a full recovery and seven remain fully dependent. Only two of the dependent quadriplegic patients have become reintegrated back into the society. The management of spinal cord injuries in Abuja is evolving. The operations were performed adequately with much limited complement of equipment. Poor intensive care therapy is a major challenge and improvements in this area of care will likely lead to better patient outcomes.

  15. Headache relief after anterior cervical discectomy: post hoc analysis of a randomized investigational device exemption trial: clinical article.

    PubMed

    Schrot, Rudolph J; Mathew, Jesna S; Li, Yueju; Beckett, Laurel; Bae, Hyun W; Kim, Kee D

    2014-08-01

    The authors analyzed headache relief after anterior cervical discectomy. Headache may be relieved after anterior cervical discectomy, but the mechanism is unknown. If headaches were directly referred from upper cervical pathology, more headache relief would be expected from surgery performed at higher cervical levels. If spinal kinesthetics were the mechanism, then headache relief may differ between arthroplasty and fusion. Headache relief after anterior cervical discectomy was quantified by the operated disc level and by the method of operation (arthroplasty vs arthrodesis). The authors performed a post hoc analysis of an artificial disc trial. Data on headache pain were extracted from the Neck Disability Index (NDI) questionnaire. A total of 260 patients underwent single-level arthroplasty or arthodesis. Preoperatively, 52% reported NDI headache scores of 3 or greater, compared with only 13%-17% postoperatively. The model-based mean NDI headache score at baseline was 2.5 (95% CI 2.3-2.7) and was reduced by 1.3 points after surgery (95% CI 1.2-1.4, p < 0.001). Higher cervical levels were associated with a greater degree of preoperative headache, but there was no association with headache relief. There was no significant difference in headache relief between arthroplasty and arthrodesis. Most patients with symptomatic cervical spondylosis have headache as a preoperative symptom (88%). Anterior cervical discectomy with both arthroplasty and arthrodesis is associated with a durable decrease in headache. Headache relief is not related to the level of operation. The mechanism for headache reduction remains unclear.

  16. A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage.

    PubMed

    Hacker, R J; Cauthen, J C; Gilbert, T J; Griffith, S L

    2000-10-15

    A prospective, concurrently controlled, randomized, multicenter trial of an anterior Bagby and Kuslich cervical fusion cage (BAK/C; Sulzer Spine-Tech, Minneapolis, MN) for treatment of degenerative disc disease of the cervical spine. To report clinical results with maximum 24-month follow-up of fusions performed with the BAK/C fusion cage. Threaded lumbar cages have been used during the past decade as a safe and effective surgical solution for chronic disabling low back pain. Threaded cages have now been developed for use in anterior cervical interbody fusions to obviate the need for allografts or autogenous bone grafting procedures while providing initial stability during the fusion process. Patients with symptomatic cervical discogenic radiculopathy were treated with either anterior cervical discectomy with uninstrumented bone-only fusion (ACDF) or BAK/C fusion cage(s). Independent radiographic assessment of fusion was made and patient-based outcome was assessed by visual analog pain scale and a Short Form (SF)-36 Health Status Questionnaire. Data analysis included 344 patients at 1 year and 180 at 2 years. When the two cage groups (hydroxya, patite-coated or noncoated) were compared with the ACDF group, similar outcomes were noted for duration of surgery, hospital stay, improvements in neck pain and radicular pain in the affected limb, improvements in the SF-36 Physical Component subscale and Mental Component subscale, and the patients' perception of overall surgical outcome. Symptom improvements were maintained at 2 years. A greater percentage of patients with ACDF needed an iliac crest bone harvest than did BAK/C patients (67% vs.- 3%). Successful fusion for one-level procedures at 12 months was 97.9% for the BAK/C groups and 89.7% for the ACDF group (P < 0.05). The complication rate for the ACDF group was 20.4% compared with an overall complication rate of 11.8% with BAK/C. There was no difference in complications that necessitated a second operative

  17. Anterior cervical fusion assessment using reconstructed computed tomographic scans: surgical confirmation of 254 segments.

    PubMed

    Song, Kwang-Sup; Chaiwat, Piyaskulkaew; Kim, Han Jo; Mesfin, Addisu; Park, Sang-Min; Riew, K Daniel

    2013-12-01

    Retrospective study developing diagnostic criteria. To validate 2 computed tomography-based findings, extragraft bone bridging (ExGBB) and intragraft bone bridging (InGBB), as diagnostic criteria for anterior cervical fusion using subsequent surgical confirmation and to demonstrate the different diagnostic accuracy on the basis of the graft material used. The accuracy and the methodology for evaluating bone bridging on computed tomographic scans to determine anterior cervical fusion status have not been validated or standardized. One hundred ten patients with 254 surgically explored segments along with reconstructed computed tomographic scans were included. Bone bridging at each cervical level was assessed for ExGBB and InGBB. ExGBB was defined as complete cortical bridging at any peripheral margins (anterior, posterior, left, or right) of the operated disc space, outside of the graft. InGBB was defined as cortical or trabecular bridging within the confines of the graft only. ExGBB and InGBB were serially evaluated on reformatted coronal and sagittal views by 3 independent raters. The reliabilities and validities correlated with surgical exploration were evaluated. Surgical exploration revealed 123 fused and 131 pseudarthrosis segments. The reliability of 3 raters showed near perfect agreement for ExGBB and substantial agreement for InGBB. ExGBB also had higher validity for all raters than did InGBB. The autocortical graft group had the highest accuracy for both InGBB and ExGBB, with both values being nearly identical. The allograft group had the next highest validity values. For the cage group, InGBB had the lowest specificity (53.2%) and positive predictive value (35.5%), whereas ExGBB had 100% sensitivity and negative predictive value. ExGBB seems to be a far more reliable and accurate to determine anterior cervical fusion. The diagnostic criteria using bone bridging should be different based on the intradiscal materials. With cages in particular, InGBB seems

  18. Adverse effects associated with high-dose recombinant human bone morphogenetic protein-2 use in anterior cervical spine fusion.

    PubMed

    Shields, Lisa B E; Raque, George H; Glassman, Steven D; Campbell, Mitchell; Vitaz, Todd; Harpring, John; Shields, Christopher B

    2006-03-01

    A retrospective review of patients who underwent an anterior cervical fusion using recombinant human bone morphogenetic protein (rhBMP)-2 with an absorbable collagen sponge (INFUSE; Medtronic Sofamor Danek, Minneapolis, MN). To ascertain the complication rate after the use of high-dose INFUSE in anterior cervical fusions. The rhBMP-2 has been primarily investigated in lumbar spine fusions, where it has significantly enhanced the fusion rate and decreased the length of surgery, blood loss, and hospital stay. We present 151 patients who underwent either an anterior cervical discectomy and fusion (n = 138) or anterior cervical vertebrectomy and fusion (n = 13) augmented with high-dose INFUSE between July 2003 and March 2004. The rhBMP-2 (up to 2.1 mg/level) was used in the anterior cervical discectomy and fusions. A total of 35 (23.2%) patients had complications after the use of high-dose INFUSE in the cervical spine. There were 15 patients diagnosed with a hematoma, including 11 on postoperative day 4 or 5, of whom 8 were surgically evacuated. Thirteen individuals had either a prolonged hospital stay (> 48 hours) or hospital readmission because of swallowing/breathing difficulties or dramatic swelling without hematoma. A significant rate of complications resulted after the use of a high dose of INFUSE in anterior cervical fusions. We hypothesize that in the cervical area, the putative inflammatory effect that contributes to the effectiveness of INFUSE in inducing fusion may spread to adjacent critical structures and lead to increased postoperative morbidity. A thorough investigation is warranted to determine the optimal dose of rhBMP-2 that will promote cervical fusion and minimize complications.

  19. Anterior cervical interbody fusion using polyetheretherketone cage filled with synthetic bone graft in acute cervical spine injury.

    PubMed

    Hattou, L; Morandi, X; Lefebvre, J; Le Reste, P-J; Riffaud, L; Hénaux, P-L

    2017-02-01

    The aim of this study was to assess the interbody fusion rate for patients treated by anterior cervical interbody fusion (ACIF) using polyetheretherketone (PEEK) cages filled with synthetic bone graft in acute cervical spine injury. Twenty-nine patients (mean age: 49 years) with monosegmental instability due to cervical spine injury were followed. We assessed the rate of and time to interbody fusion at 1-year follow-up. In case of secondary displacement, we analysed its causes and surgical management. The rate of fusion was 86.2%. The mean time to fusion was 7.2 months. Interbody fusion was observed at 3 months in 4 patients, at 6 months in 14 and at 1 year in 7. Four patients had secondary displacement within 3 months. ACIF with a PEEK cage filled with synthetic bone graft seems to be an alternative to iliac crest bone graft with no morbidity related to the harvest site. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  20. Impact of over distraction on occurrence of axial symptom after anterior cervical discectomy and fusion

    PubMed Central

    Bai, Jiayue; Zhang, Xin; Zhang, Di; Ding, Wenyuan; Shen, Yong; Zhang, Wei; Du, Mengzhen

    2015-01-01

    Objective: A retrospective review was undertaken to evaluate the impact of over distraction on cervical axial symptoms (AS) after anterior cervical discectomy and fusion (ACDF). Methods: The retrospective review included 421 patients who underwent ACDF for one or two segments. Of these, 78 patients for whom complete follow-up data were available were selected for inclusion in the analysis. X-rays of the cervical vertebra were performed immediately after the surgery, 3 months postsurgery, and at a final follow up (6-24 months). According to the presence/absence of AS, the patients were divided into a symptom group (Group S) and a nonsymptom group (Group N). The ratio of intervertebral height change, change in the overall cervical curvature, change in the local curvature of the surgical segment, cervical total range of motion (ROM), and Japanese Orthopaedic Association (JOA) recovery rate were compared and analyzed. A linear regression analysis of the ratio of intervertebral height change and the symptom and severity of the AS according to the Visual Analogue Scale (VAS) was carried out. Results: The total incidence of AS was 33.97%. C5 nerve root palsy occurred in one case in Group S after the surgery. The neurologic symptoms of both groups were significantly alleviated after the surgery. The ratio of intervertebral height change in Group S was significantly higher than that in Group N at the last follow-up (P < 0.05). However, the changes in the overall cervical curvature, local curvature of the surgical segment, cervical ROM, and JOA recovery rates were not statistically significant (P > 0.05). In Group S, 37% of the patients had symptoms that occurred in the chest area, and the ratio of intervertebral height change was significantly positively correlated with the VAS score of the AS (r = 0.893). Conclusions: The occurrence of postoperative AS will significantly increase if the ratio of intervertebral height change of the surgical segment after ACDF is over 10

  1. Changes in Swallowing after Anterior Cervical Discectomy and Fusion with Instrumentation: A Presurgical versus Postsurgical Videofluoroscopic Comparison

    ERIC Educational Resources Information Center

    Muss, Lydia; Wilmskoetter, Janina; Richter, Kerstin; Fix, Constanze; Stanschus, Soenke; Pitzen, Tobias; Drumm, Joerg; Molfenter, Sonja

    2017-01-01

    Purpose: The purpose of this study was to explore the impact of anterior cervical discectomy and fusion (ACDF) with anterior instrumentation on swallowing function and physiology as measured on videofluoroscopic swallowing studies. Method: We retrospectively analyzed both functional measures (penetration-aspiration, residue) and…

  2. Can Multilevel Anterior Cervical Discectomy and Fusion Result in Decreased Lifting Capacity of the Shoulder?

    PubMed

    Liu, Baoge; Zhu, Di; Yang, Jiang; Zhang, Yao; VanHoof, Tom; Okito, Jean-Pirre Kalala

    2015-12-01

    To investigate the upper-extremity abduction, and lifting limitations and associated factors after anterior cervical decompression and fusion. A total of 117 patients who underwent anterior cervical decompression and fusion for cervical spondylosis were assessed retrospectively. Their upper-extremity abduction and lifting capacity after operation and manual muscle test grade for deltoid muscle strength and its sensory status were recorded. In addition, spinal cord function (Japanese Orthopaedic Association and Neck Disability Index scores) and C4-5 intervertebral height (radiographs) were assessed. Finally, high signal and ossification of posterior longitudinal ligament were observed by T2 magnetic resonance imaging and computed tomography, respectively. Seven individuals had a decrease in muscle strength, with 2 patients also exhibiting sensory defect. Six individuals had bilateral weakness of deltoid and biceps brachii and 1 of unilateral. After 8-16 months of follow-up, the abduction function and lift capacity were restored. The manual muscle test grade recovered to 5 and 4 degrees, respectively, in 6 and 1 patients. Two patients remained with sensory defect. The mean recovery time 19.7 days on average, and Japanese Orthopaedic Association scores significantly improved. Among the 117 patients, less than 2-level decompression showed upper-extremity function limitations in 1 of 67 (1.5%), whereas more than a 3-level decompression resulted in greater rate in 6 of 50 (12%), a significant difference (P < 0.05). No significant difference was obtained in C4-5 intervertebral heights, as well as for rates of C3-5 high signal area in magnetic resonance imaging. The rate of upper-extremity abduction and lifting limitation after anterior cervical decompression and fusion is low, indicating a good prognosis after active treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Retrospective Evaluation of Efficiency and Safety of an Anterior Percutaneous Approach for Cervical Discectomy

    PubMed Central

    Schubert, Michael

    2014-01-01

    Study Design Retrospective case series. Purpose The purpose of the study was to evaluate the efficiency and complication rate of a percutaneous anterior approach to herniated cervical disks with or without concomitant foraminal stenosis and/or spondylosis. Overview of Literature Recent publications reflect that minimally invasive procedures gain in importance in patients and spine surgeons as they are generally associated with less tissue damage and shorter recovery times. However, for anterior percutaneous cervical discectomy, very little data is available for relevant patient populations. Methods Charts from patients with herniated cervical disc confirmed by magnetic resonance imaging, mainly radicular symptoms and irresponsive to conservative treatment who underwent anterior percutaneous discectomy were evaluated retrospectively. All patients were asked to return questionnaires that included visual analogue scores (VAS), MacNab score as well as subjective satisfaction data 2 years after surgery. Results Ninety-five patients were included. There were no neurological or vascular complications; only one patient suffered from transient hoarseness. During the two years after surgery, 9 patients underwent reoperation. 90.5% of the patients returned the questionnaire at 2 years' follow-up. 87.7% of them reported excellent or good outcome, 11.1% rated results as fair and 1.2% as unsatisfactory. On average, arm and neck pain improved significantly by 6.1 points and 5.8 points respectively on a ten point VAS. 94.5% stated that they would choose the same procedure again. Conclusions This procedure has proved a safe and sufficient option for symptomatic cervical disk herniations with or without concomitant spondylosis and/or foraminal stenosis. PMID:25187857

  4. Pedicled Vascularized Clavicular Graft for Anterior Cervical Arthrodesis: Cadaveric Feasibility Study, Technique Description, and Case Report.

    PubMed

    Bohl, Michael A; Mooney, Michael A; Catapano, Joshua S; Almefty, Kaith K; Preul, Mark C; Chang, Steve W; Kakarla, U Kumar; Reece, Edward M; Turner, Jay D; Porter, Randall W

    2017-03-14

    Cadaveric feasibility study. To assess the anatomic and technical feasibility of rotating a clavicular segment on a sternocleidomastoid muscle (SCM) pedicle into the ventral cervical spine using a cadaveric model and to provide the first clinical case description of performing this procedure. Reconstruction of the anterior cervical spine in patients with a high risk of pseudoarthrosis may require the use of a vascularized bone graft (VBG). A vascularized clavicular graft rotated on an SCM pedicle would afford all the benefits of a VBG without the added morbidity of free-tissue transfer; however, this technique has not been described. A multidisciplinary team hypothesized that it would be anatomically and technically feasible to rotate a pedicled clavicular bone graft from the bottom of C2 to the top of T2 via an anterior approach. Five cadavers underwent bilateral anterior neck dissections for a total of 10 clavicular graft assessments. A case report describes the use of a clavicular VBG in a patient with a 3-level corpectomy defect and a history of failed fusion. Ten clavicles were rotated on an SCM pedicle. The grafts were either harvested as an entire segment or as the superior two-thirds of clavicle, leaving the inferior one-third in situ with pectoralis attachments intact. All grafts reached from the bottom of C2 to the top of T2. When the entire length of exposed clavicle was mobilized, it could cover 5-6 levels. The case report highlights technical challenges of this procedure in a living patient and provides clinical context for its potential utility in reconstruction of the ventral cervical spine. This surgical technique is best suited for patients with long-segment cervical defects and an increased risk of pseudarthrosis. Further clinical experience with this technique is required before definitive conclusions can be made. 5.

  5. Long Term Results of Anterior Corpectomy and Fusion for Cervical Spondylotic Myelopathy

    PubMed Central

    Chen, Huajiang; Liu, Yang; Liang, Lei; Yuan, Wen

    2012-01-01

    Background Results showed good clinical outcomes of anterior corpectomy and fusion (ACCF) for patients with cervical spondylotic myelopathy (CSM) during a short term follow-up; however, studies assessing long term results are relatively scarce. In this study we intended to assess the long term clinical and radiographic outcomes, find out the factors that may affect the long term clinical outcome and evaluate the incidence of adjacent segment disease (ASD). Methods This is a retrospective study of 145 consecutive CSM patients on ACCF treatment with a minimum follow-up of 5 years. Clinical data were collected from medical and operative records. Patients were evaluated by using the Japanese Orthopedic Association (JOA) scoring system preoperatively and during the follow-up. X-rays results of cervical spine were obtained from all patients. Correlations between the long term clinical outcome and various factors were also analyzed. Findings Ninety-three males and fifty-two females completed the follow-up. The mean age at operation was 51.0 years, and the mean follow-up period was 102.1 months. Both postoperative sagittal segmental alignment (SSA) and the sagittal alignment of the whole cervical spine (SACS) increased significantly in terms of cervical lordosis. The mean increase of JOA was 3.8±1.3 postoperatively, and the overall recovery rate was 62.5%. Logistic regression analysis showed that preoperative duration of symptoms >12 months, high-intensity signal in spinal cord and preoperative JOA score ≤9 were important predictors of the fair recovery rate (≤50%). Repeated surgery due to ASD was performed in 7 (4.8%) cases. Conclusions ACCF with anterior plate fixation is a reliable and effective method for treating CSM in terms of JOA score and the recovery rate. The correction of cervical alignment and the repeated surgery rate for ASD are also considered to be satisfactory. PMID:22514669

  6. Effects of decreasing endotracheal tube cuff pressures during neck retraction for anterior cervical spine surgery.

    PubMed

    Ratnaraj, Jebadurai; Todorov, Alexandre; McHugh, Tom; Cheng, Mary Ann; Lauryssen, Carl

    2002-09-01

    The authors' goal was to determine whether the incidence of postoperative sore throat, hoarseness, and dysphagia associated with anterior spine surgery is reduced by maintaining endotracheal tube cuff pressure (ETCP) at 20 mm Hg during the period of neck retraction. Fifty-one patients scheduled for anterior cervical spine surgery were enrolled. After intubation, ETCP was adjusted to 20 mm Hg in all patients. Following placement of neck retractors, ETCP was measured. Patients were randomized to a control (no adjustment) or treatment group (ETCP adjusted to 20 mm Hg). A blinded observer questioned the patients about the presence of sore throat, dysphagia, and hoarseness at 1 hour, 24 hours, and 1 week postoperatively. No differences between groups at 1 hour postoperatively were demonstrated. At 24 hours, 51% of patients in the treatment group complained of sore throat compared with 74% of control patients (p < 0.05). Sixty-five percent of the women experienced sore throat compared with 35% of the men (p < 0.05). At 24 hours, longer retraction time correlated with development of dysphagia (p < 0.05, r2 = 0.61). At 24 hours, hoarseness was present in 65% of women and 20% of men (p < 0.05). The results of this study suggest the following three predictors of postoperative throat discomfort following anterior cervical spine surgery in which neck retraction is performed: increased ETCP during neck retraction (sore throat), neck retraction time (dysphagia), and female sex (sore throat and hoarseness). The simple maneuver of decreasing ETCP to 20 mm Hg may be helpful in improving patient comfort following anterior cervical spine surgery.

  7. Dynamic Cervical Implant versus Anterior Cervical Diskectomy and Fusion: A Prospective Study of Clinical and Radiologic Outcome.

    PubMed

    Richter, Heiko; Seule, Martin; Hildebrandt, Gerhard; Fournier, Jean-Yves

    2016-07-01

    Objective To evaluate clinical and radiologic outcome in patients treated with a dynamic cervical implant (DCI) or anterior cervical diskectomy and fusion (ACDF). Study Design A prospective comparative cohort study. Methods The study included 60 patients with one- or two-level cervical degenerative disk disease (DDD) undergoing treatment with either DCI (n = 30) or ACDF (n = 30). Clinical and radiologic outcomes were assessed 3 and 12 months after surgery. Clinical scoring systems included the Visual Analog Scale for Neck (VAS-N) and Arm pain (VAS-A), the Neck Pain and Disability Scale (NPAD), and the European Quality of Life Scale (EQ-5D). Results Both the DCI and ACDF group showed significant clinical improvement 12 months after surgery using the VAS-N (p = 0.034 and p < 0.001, respectively), VAS-A (p < 0.001 and p < 0.001, respectively), NPAD (p < 0.001 and p < 0.001, respectively), and EQ-5D (p < 0.001 and p < 0.001, respectively). There were no significant differences in clinical outcome comparing both groups at the 3- and 12-month follow-up. The fusion rate at 12 months after surgery was 39.4% and 80.0% in the DCI and ACDF groups, respectively. Radiolucency was found in 90.9% in the DCI group at 12-month follow-up. Conclusion The clinical results for DCI treatment are equivalent to those for ACDF in the treatment of one- and two-level cervical DDD at 12 months after surgery. Further studies are necessary to investigate the high rates of radiolucency and fusion associated with DCI treatment. Georg Thieme Verlag KG Stuttgart · New York.

  8. Single-level anterior cervical discectomy and fusion versus minimally invasive posterior cervical foraminotomy for patients with cervical radiculopathy: a cost analysis.

    PubMed

    Mansfield, Haley E; Canar, W Jeffrey; Gerard, Carter S; O'Toole, John E

    2014-11-01

    Patients suffering from cervical radiculopathy in whom a course of nonoperative treatment has failed are often candidates for a single-level anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF). The objective of this analysis was to identify any significant cost differences between these surgical methods by comparing direct costs to the hospital. Furthermore, patient-specific characteristics were also considered for their effect on component costs. After obtaining approval from the medical center institutional review board, the authors conducted a retrospective cross-sectional comparative cohort study, with a sample of 101 patients diagnosed with cervical radiculopathy and who underwent an initial single-level ACDF or minimally invasive PCF during a 3-year period. Using these data, bivariate analyses were conducted to determine significant differences in direct total procedure and component costs between surgical techniques. Factorial ANOVAs were also conducted to determine any relationship between patient sex and smoking status to the component costs per surgery. The mean total direct cost for an ACDF was $8192, and the mean total direct cost for a PCF was $4320. There were significant differences in the cost components for direct costs and operating room supply costs. It was found that there was no statistically significant difference in component costs with regard to patient sex or smoking status. In the management of single-level cervical radiculopathy, the present analysis has revealed that the average cost of an ACDF is 89% more than a PCF. This increased cost is largely due to the cost of surgical implants. These results do not appear to be dependent on patient sex or smoking status. When combined with results from previous studies highlighting the comparable patient outcomes for either procedure, the authors' findings suggest that from a health care economics standpoint, physicians should consider a minimally invasive PCF

  9. Best Practices for Outpatient Anterior Cervical Surgery: Results From a Delphi Panel.

    PubMed

    Mohandas, Anita; Summa, Chris; Worthington, W Bradley; Lerner, Jason; Foley, Kevin T; Bohinski, Robert J; Lanford, Gregory B; Holden, Carol; Wohns, Richard N W

    2017-06-01

    Delphi Panel expert panel consensus and narrative literature review. To obtain expert consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (anterior cervical disc fusion (ACDF) and cervical total disc replacement (CTDR)). Spine surgery in ambulatory settings is becoming a preferred option for both patients and providers. The transition from traditional inpatient environments has been enabled by innovation in anesthesia protocols and surgical technique, as well as favorable economics. Studies have demonstrated that anterior cervical surgery (ACDF and CTDR) can be performed safely on an outpatient basis. However, practice guidelines and evidence-based protocols to inform best practices for the safe and efficient performance of these procedures in same-day, ambulatory settings are lacking. A panel of five neurosurgeons, three anesthesiologists, one orthopedic spine surgeon, and a registered nurse was convened to comprise a multidisciplinary expert panel. A three-round modified-Delphi method was used to generate best-practice statements. Predetermined consensus was set at 70% for each best-practice statement. A total of 94 consensus statements were reviewed by the panel. After three rounds of review, there was consensus for 83 best-practice statements, while 11 statements failed to achieve consensus. All statements within several perioperative categories (and subcategories) achieved consensus, including preoperative assessment (n = 8), home-care/follow-up (n = 2), second-stage recovery (n = 18), provider economics (n = 8), patient education (n = 14), discharge criteria (n = 4), and hypothermia prevention (n = 6). This study obtained expert-panel consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (ACDF/CTDR). Given a paucity of guidelines and a lack of established care pathways for ACDF/CTDR in same

  10. Magnetic resonance imaging artifact following anterior cervical discectomy and fusion with a trabecular metal cage.

    PubMed

    Elliott, Cameron A; Fox, Richard; Ashforth, Robert; Gourishankar, Sita; Nataraj, Andrew

    2016-03-01

    This study was undertaken to evaluate the impact of postoperative MRI artifact on the assessment of ongoing spinal cord or nerve root compression after anterior cervical discectomy and fusion (ACDF) using a trabecular tantalum cage or bone autograft or allograft. The authors conducted a retrospective review of postoperative MRI studies of patients treated surgically for cervical disc degenerative disease or cervical instability secondary to trauma. Standard ACDF with either a trabecular tantalum cage or interbody bone graft had been performed. Postoperative MR images were shown twice in random order to each of 3 assessors (2 spine surgeons, 1 neuroradiologist) to determine whether the presence of a tantalum interbody cage and/or anterior cervical fixation plate or screws imparted MRI artifact significant enough to prevent reliable postoperative assessment of ongoing spinal cord or nerve root compression. A total of 63 patients were identified. One group of 29 patients received a tantalum interbody cage, with 13 patients (45%) undergoing anterior plate fixation. A second group of 34 patients received bone auto- or allograft, with 23 (68%) undergoing anterior plate fixation. The paramagnetic implant construct artifact had minimal impact on visualization of postoperative surgical level spinal cord compression. In the cage group, 98% (171/174) of the cases were rated as assessable versus 99% in the bone graft group (201/204), with high intraobserver reliability. In contrast, for the assessment of ongoing surgical level nerve root compression, the presence of a tantalum cage significantly decreased visualization of nerve roots to 70% (121/174) in comparison with 85% (173/204) in the bone graft group (p < 0.001). When sequences using turbo spin echo (TSE), a T2-weighted axial sequence, were acquired, nerve roots were rated as assessable in 88% (69/78) of cases; when only axial T2-weighted sequences were available, the nerve roots were rated as assessable in 54% (52

  11. Evaluation of Outcome of Transpedicular Decompression and Instrumented Fusion in Thoracic and Thoracolumbar Tuberculosis

    PubMed Central

    Jain, R.K.; Kiyawat, Vivek

    2017-01-01

    Study Design Retrospective analysis. Purpose We evaluated the functional, neurological, and radiological outcome in patients with thoracic and thoracolumbar tuberculosis operated through the transpedicular approach. Overview of Literature For surgical treatment of thoracic and thoracolumbar tuberculosis, the anterior approach has been the most popular because it allows direct access to the infected tissue, thereby providing good decompression. However, anterior fixation is not strong, and graft failure and loss of correction are frequent complications. The transpedicular approach allows circumferential decompression of neural elements along with three-column fixation attained via pedicle screws by the same approach. Methods A total of 47 patients were diagnosed with tuberculosis of the thoracic or thoracolumbar region from August 2012 to August 2013. Of these, 28 patients had progressive neurological deterioration or increasing back pain despite conservative measures and underwent transpedicular decompression and pedicle screw fixation with posterior fusion. Antituberculosis therapy was given till signs of radiological healing were evident (9–16 months). Functional outcome (visual analog scale [VAS] score for back pain), neurological recovery (Frankel grading), and radiological improvement were evaluated preoperatively, immediate postoperatively, and at 3 months, 6 months, and 1 year. Results Mean VAS score for back pain improved from 8.7 preoperatively to 1.1 at 1 year follow-up. Frankel grading preoperatively was grade B in 7, grade C in 11, and Grade D in 10 patients, which improved to grade D in 6 and grade E in 22 patients at the last follow-up. Radiological healing was evident in the form of reappearance of trabeculae formation, resolution of pus, fatty marrow replacement, and bony fusion in all patients. Mean correction of segmental kyphosis postoperatively was 10.5°. Mean loss of correction at final follow-up was 4.1°. Conclusions Transpedicular

  12. Effects of anterior shear displacement rate on the structural properties of the porcine cervical spine.

    PubMed

    Gallagher, Kaitlin M; Howarth, Samuel J; Callaghan, Jack P

    2010-09-01

    While the individual tissues of the vertebral joint demonstrate viscoelastic properties, the global viscoelastic properties of the lumbar vertebral joint are not well established. This study investigated how changes in displacement rate influenced the mechanical response of the porcine cervical spine (a surrogate or model for the human lumbar spine) exposed to acute anterior shear failure loading. Thirty porcine cervical spine specimens (15 C3-C4 and 15 C5-C6) were placed under a 1600 N compressive load and subsequently loaded in anterior shear to failure at one of three randomly assigned displacement rates (1 mm/s, 4 mm/s, or 16 mm/s). Ultimate anterior shear force, ultimate displacement, average stiffness, and energy stored until failure were calculated. Load rate in the elastic region was also calculated to compare the load rates used in this study to those used in previous studies. Changes in displacement rate affected the C3-C4 and C5-C6 specimens differently. C5-C6 specimens tested at 16 mm/s had an ultimate force that was 28% and 23% higher than at 1 (p=0.0215) and 4 mm/s (p=0.0461), respectively. The average stiffness to failure of the C5-C6 specimens tested at 16 mm/s was 52% higher than at 4 mm/s (p=0.0289). No such differences were found for the C3-C4 specimens. An increase in the anterior shear displacement rate did not necessarily demonstrate viscoelasticity of the vertebral joint. Specimen intervertebral levels were affected differently by changes in anterior shear displacement rate, which may have been a result of anatomical and postural differences between the two levels. Future studies should further investigate the effect of displacement rate on the spine and the inconsistencies between different specimen levels.

  13. Diagnosing Tapia syndrome using a videofluoroscopic swallowing study and electromyography after anterior cervical spine surgery.

    PubMed

    Park, Junbum; Ahn, Ryeok; Weon, Youngcheol; Yang, Dongseok

    2011-11-01

    A couple of the most common complications after anterior cervical spine surgery are dysphagia and hoarseness. This is often related to recurrent laryngeal nerve palsy and it can also be caused by injury to the branches of the lower cranial nerves. In general, Tapia syndrome is combined injuries of the recurrent laryngeal nerve of the vagus and the hypoglossal nerves. There has been no reported case until now of Tapia syndrome after a patient underwent anterior cervical spine surgery. We present here the case of a 42-yr-old man who complained of hoarseness, dysphagia, and right deviation of the tongue with an atrophic change for 2 mos after he underwent C3-4 discectomy and anterior fusion body. We found that he has a diagnosis of a variant of Tapia syndrome, although recurrent laryngeal nerve injury did not seem to be involved according to a videofluoroscopic swallowing study and electromyography. Our case report demonstrates that the combined diagnostic tools of videofluoroscopic swallowing study, electromyography, and laryngoscopy can be very useful in localizing and evaluating the level of lesions in patients with Tapia syndrome.

  14. Esophageal perforation after anterior cervical spine surgery: a systematic review of the literature.

    PubMed

    Halani, Sameer H; Baum, Griffin R; Riley, Jonathan P; Pradilla, Gustavo; Refai, Daniel; Rodts, Gerald E; Ahmad, Faiz U

    2016-09-01

    OBJECTIVE Esophageal perforation is a rare but well-known complication of anterior cervical spine surgery. The authors performed a systematic review of the literature to evaluate symptomatology, direct causes, repair methods, and associated complications of esophageal injury. METHODS A PubMed search that adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines included relevant clinical studies and case reports (articles written in the English language that included humans as subjects) that reported patients who underwent anterior spinal surgery and sustained some form of esophageal perforation. Available data on clinical presentation, the surgical procedure performed, outcome measures, and other individual variables were abstracted from 1980 through 2015. RESULTS The PubMed search yielded 65 articles with 153 patients (mean age 44.7 years; range 14-85 years) who underwent anterior spinal surgery and sustained esophageal perforation, either during surgery or in a delayed fashion. The most common indications for initial anterior cervical spine surgery in these cases were vertebral fracture/dislocation (n = 77), spondylotic myelopathy (n = 15), and nucleus pulposus herniation (n = 10). The most commonly involved spinal levels were C5-6 (n = 51) and C6-7 (n = 39). The most common presenting symptoms included dysphagia (n =63), fever (n = 24), neck swelling (n = 23), and wound leakage (n = 18). The etiology of esophageal perforation included hardware failure (n = 31), hardware erosion (n = 23), and intraoperative injury (n = 14). The imaging modalities used to identify the esophageal perforations included modified contrast dye swallow studies, CT, endoscopy, plain radiography, and MRI. Esophageal repair was most commonly achieved using a modified muscle flap, as well as with primary closure. Outcomes measured in the literature were often defined by the time to oral intake following esophageal repair. Complications included

  15. Cervical intervertebral disc herniation treatment via radiofrequency combined with low-dose collagenase injection into the disc interior using an anterior cervical approach

    PubMed Central

    Wang, Zhi-Jian; Zhu, Meng-Ye; Liu, Xiao-Jian; Zhang, Xue-Xue; Zhang, Da-Ying; Wei, Jian-Mei

    2016-01-01

    Abstract This study aimed to determine the therapeutic effect of radiofrequency combined with low-dose collagenase injected into the disc interior via an anterior cervical approach for cervical intervertebral disc herniation. Forty-three patients (26–62-year old; male/female ratio: 31/12) with cervical intervertebral disc herniation received radiofrequency combined with 60 to 100 U of collagenase, injected via an anterior cervical approach. The degree of nerve function was assessed using the current Japanese Orthopaedic Association (JOA) scoring system at 3 and 12 months postoperation. A visual analogue scale (VAS) was used to evaluate the degree of pain preoperation and 7 days postoperation. The preoperative and 3 month postoperative protrusion areas were measured and compared via magnetic resonance imaging (MRI) and picture archiving and communication systems (PACS). Compared with the preoperative pain scores, the 7-day postoperative pain was significantly reduced (P <0.01). The excellent and good rates of nerve function amelioration were 93.0% and 90.7% at 3 and 12 months postoperation, respectively, which was not significantly different. Twenty-seven cases exhibited a significantly reduced protrusion area (P <0.01) at 3 months postoperation. No serious side effects were noted. To our knowledge, this is the first study to demonstrate that the use of radiofrequency combined with low-dose collagenase injection into the disc interior via an anterior cervical approach is effective and safe for the treatment of cervical intervertebral disc herniation. PMID:27336892

  16. Is tutobone an efficient alternative to other implants used in anterior cervical discectomy and fusion surgeries?

    PubMed

    Prakash, Savithru Kumar; Mukerji, Nitin; Nath, Fredrik Prem

    2017-06-01

    The graft site morbidity following iliac crest harvesting is significant. To overcome this, different bone substitutes like coral dowels, solvent dissolved bovine/human bone substitutes, and carbon fiber/titanium cages have been used. This study was undertaken to assess the postoperative radiological fusion rates and symptom relief in patients who had Tutobone used as an interbody spacer compared to autologous bone graft (ABG), cages, surgibone and coral dowels. This was a retrospective, observational study. Case notes and post-operative cervical spine radiographs done at two subsequent follow-ups were reviewed. Data were derived from all Anterior Cervical Discectomy and fusion (ACDF) surgeries performed at our centre over a 10-year period for degenerative cervical spine disease. We analysed 530 patients. Exclusion criteria included incomplete notes, complex cervical surgery (both anterior and posterior fixation and vertebrectomies). Patients were divided into 3 groups, patients treated with (1) Autologous bone graft, (2) Tutobone and (3) other implants which include cages, surgibone and coral dowels. An analysis of 530 patients who had ACDF with either ABG (n = 328) or tutobone (n = 95) or other implants (n = 90) is presented. A significantly greater number of patients in whom autologous bone was used had more than one level surgery. The median follow-up times were 3 months and 12 months. Rates of fusion and time to fusion with bone substitutes were inferior to ABG in our series, but there was not much to choose amongst them. The use of ABG in ACDF leads to fusion in a shorter duration and greater proportion of patients, when compared to substitutes. Other implants like Tutobone (cheaper alternative), cages, etc can also be used in ACDF procedures with good efficacy with the added advantage of preventing donor site morbidity. There was no association between fusion rates and symptom relief and between use of plating and fusion.

  17. Clinical and radiologic comparison of dynamic cervical implant arthroplasty versus anterior cervical discectomy and fusion for the treatment of cervical degenerative disc disease.

    PubMed

    Li, Zhonghai; Yu, Shunzhi; Zhao, Yantao; Hou, Shuxun; Fu, Qiang; Li, Fengning; Hou, Tiesheng; Zhong, Hongbin

    2014-06-01

    This study compared the clinical and radiological outcomes of dynamic cervical implant (DCI; Scient'x, Villers-Bretonneux, France) arthroplasty versus anterior cervical discectomy and fusion (ACDF) for the treatment of cervical degenerative disc disease. This prospective cohort study enrolled patients with single-level cervical degenerative disc disease who underwent DCI arthroplasty or ACDF between September 2009 and June 2011. Patients were followed up for more than 2years. Clinical evaluation included the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), Neck Disability Index (NDI), Japan Orthopedic Association (JOA) score, and visual analog scale (VAS) scores for neck and arm pain. Radiological assessments included segmental range of motion (ROM), overall ROM (C2-C7), disc height (DHI), and changes in adjacent disc spaces. The VAS, SF-36, JOA, and NDI scores improved significantly after surgery in both the DCI and ACDF groups. The VAS, JOA, and SF-36 scores were not significantly different between the DCI and ACDF groups at the final follow-up. The segmental ROM at the treated level and overall ROM increased significantly after surgery in the DCI group, but the ROM in the adjacent cephalad and caudal segments did not change significantly. The mean DHI at the treated level was significantly restored after surgery in both groups. Five patients (12.8%) in the DCI group showed new signs of adjacent segment degeneration. These results indicate that DCI is an effective, reliable, and safe procedure for the treatment of cervical degenerative disc disease. However, there is no definitive evidence that DCI arthroplasty has better intermediate-term results than ACDF.

  18. Subsidence after single-level anterior cervical fusion with a stand-alone cage.

    PubMed

    Park, Jae-Young; Choi, Ki-Young; Moon, Bong Ju; Hur, Hyuk; Jang, Jae-Won; Lee, Jung-Kil

    2016-11-01

    To investigate the risk factors for subsidence in patients treated with stand-alone anterior cervical discectomy and fusion (ACDF) using polyetheretherketone (PEEK) cages for single-level degenerative cervical disease. Seventy-seven consecutive patients who underwent single-level stand-alone ACDF with a PEEK cage between 2005 and 2012 were included. Subsidence was defined as a decrease in the interbody height of more than 3mm on radiographs at the 1-year follow-up compared with that in the immediate post-operative image. Patients were divided into the subsidence and non-subsidence groups. The following factors were investigated in relation to the occurrence of subsidence: age, pre-operative overall cervical sagittal angle, segmental angle of the operated level, interbody height, cage height, cage devices and cage location (distance between anterior margin of the body endplate and that of the cage). The clinical outcomes were assessed with visual analog scale, modified Japanese Orthopedic Association score and neck disability index. Twenty-six out of the 77 (33.8%) patients had radiological signs of cage subsidence. Solid fusion was achieved in 25 out of the 26 patients (96.2%) in the subsidence group and in 47 out of the 51 patients (92.2%) in the non-subsidence group. More than 3mm distance between anterior margin of the vertebral body and that of the cage was significantly associated with subsidence (p<0.05). However, subsidence did not correlate with fusion rate or clinical outcomes. Cage location was the only significant risk factor. Therefore, cage location should be taken into consideration during stand-alone ACDF using PEEK cages. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Effect of Cervical Collar Removal on the Fracture Load of Anterior Zirconia Crowns.

    PubMed

    Campos, Fernanda; Cardoso, Mayra; de Melo, Renata Marques; Bottino, Marco Antonio; Souza, Rodrigo Oa

    The objective of this study was to assess the influence of the extension of collar and fatigue cycling on the fracture load of anterior zirconia crowns. A total of 60 anterior full-crown preparations (central incisor) were machined in glass fiber-filled epoxy resin. Zirconia copings were designed and milled using computer-aided design/computer-assisted manufacture (thickness: buccal = 0.62 mm, lingual = 0.65 mm, incisal = 0.72 mm). The cervical collars (occlusogingival height = 0.8 mm, buccolingual width = 1.0 mm) were totally or partially (buccal face) removed for modified copings. They were randomly allocated to six groups according to the type of cervical collar design and the presence (or not) of fatigue cycling (n = 10). The veneering ceramic layer was pressed, and the crowns were cemented with resin cement. The samples were tested until fracture in a universal testing machine and analyzed by stereomicroscopy. Data were statistically analyzed by two-way analysis of variance and Tukey test (5%). Removal of the cervical collar significantly affected the fracture strength of zirconia crowns (P = .000), whereas fatigue cycling did not (P = .428). The mean failure load was lower in the groups with no collar. The most frequent failure modes were cracking of the veneer porcelain in collarless crowns and catastrophic failure in the others. The authors concluded that removal of the vestibular collar of zirconia copings in anterior crowns does not reduce the fracture load of the crowns. However, removal of the entire collar reduces the fracture load and cannot be recommended.

  20. Spinal manipulation and anterior headweighting for the correction of forward head posture and cervical hypolordosis: A pilot study

    PubMed Central

    Morningstar, Mark W; Strauchman, Megan N.; Weeks, Darin A

    2003-01-01

    Abstract Objective To evaluate the effectiveness of Pettibon spinal manipulation and anterior headweighting for correct cervical hypolordosis and forward head posture, quantified by measurements taken from pre and post intervention lateral cervical radiographs. Methods A total of 15 subjects were selected for investigation at random. An initial seated lateral cervical radiograph was taken to evaluate forward head posture and the amount of cervical lordosis. A series of 3 manipulative procedures were performed, followed immediately by introduction of an anterior headweight device. This headweight device was worn for 5 minutes while walking on a treadmill. A post intervention seated lateral cervical radiograph was taken while each subject wore the headweight. Measurements of cervical lordosis and forward head posture were again quantified and compared to the initial radiographs. Results The average overall decrease in forward head posture among all subjects was 0.83 inches. The largest reduction in forward head posture was 1.25 inches. One subject failed to show any reduction. The largest and smallest improvements in the cervical lordosis were 23° and 4°, respectively. The average increase in cervical lordosis for all subjects was 9.9°. Conclusions This specific protocol was able to provide measurable improvement in cervical lordosis and reduction of forward head posture after only 1 session. However, it is not known which component, the spinal manipulation or the anterior headweighting, made the biggest impact. This study shows the immediate effects of spinal manipulation and headweighting combined. Future research should focus on the headweighting effects over a longer period of time. Additionally, anterior headweighting alone needs to be tested to evaluate its effectiveness as a sole treatment intervention. PMID:19674595

  1. Outpatient anterior cervical discectomy and fusion for cervical disk disease: a prospective consecutive series of 96 patients.

    PubMed

    Lied, B; Rønning, P A; Halvorsen, C M; Ekseth, K; Helseth, E

    2013-01-01

    To evaluate surgical complications and clinical outcome in a consecutive series of 96 patients undergoing anterior cervical discectomy and fusion (ACDF) for cervical disk degeneration (CDD) in an outpatient setting. Pre-, per-, and postoperative data on patients undergoing single- or two-level outpatient ACDF at the private Oslofjord Clinic were prospectively collected. This study includes 96 consecutive patients with a mean age of 49.1 years. 36/96 had a two-level ACDF. Mean postoperative observation time before discharge was 350 min, and 95/96 were successfully discharged either to their home or to a hotel on the day of surgery. The surgical mortality was 0%, while the surgical morbidity rate was 5.2%. Two (2.1%) patients developed postoperative hematoma, 2 (2.1%) patients experienced postoperative dysphagia, and 1 (1%) experienced deterioration of neurological function. Radicular pain, neck pain, and headache decreased significantly after surgery. 91% of patients were satisfied with the surgery, according to the NASSQ. ACDF in carefully selected patients with CDD appears to be safe in the outpatient setting, provided a sufficient postoperative observation period. The clinical outcome and patient satisfaction of outpatients are comparable to that of inpatients. © 2012 John Wiley & Sons A/S.

  2. Comparison of the more than 5-year clinical outcomes of cervical disc arthroplasty versus anterior cervical discectomy and fusion

    PubMed Central

    Shao, Min-Min; Chen, Chun-Hui; Lin, Zhong-Ke; Wang, Xiang-Yang; Huang, Qi-Shan; Chi, Yong-Long; Wu, Ai-Min

    2016-01-01

    Abstract Background: Anterior cervical discectomy and fusion (ACDF) was almost the “golden standard” technique in treatment of symptomatic cervical degenerative disc disease, however, it cause motion loss of the indexed level, increase the intradiscal pressure and motion of the adjacent levels, and may accelerate the degeneration of adjacent level. Cervical disc arthroplasty (CDA) was designed to preserve the motion of index level, avoid the over-activity of adjacent levels and reduce the degeneration of adjacent disc levels, the process of degeneration of adjacent level is very slowly, long term follow up studies should be conducted, this study aim to compare the more than 5 years’ long-term clinical outcomes and safety between CDA and ACDF. Methods: A systematic review and meta-analysis that will be performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The electric database of Medline, Embase, and Cochrane library will be systematic search. A standard data form will be used to extract the data of included studies. We will assess the studies according to the Cochrane Handbook for Systematic Reviews of Interventions, and perform analysis in software STATA 12.0. Fixed-effects models will be used for homogeneity data, while random-effects will be used for heterogeneity data. The overall effect sizes will be determined as weighted mean difference (WMD) for continuous outcomes and Relative risk (RR) for dichotomous outcomes. Results: The results of study will be disseminated via both international conference and peer-review journal. Conclusion: The conclusion of our study will provide the long-term and updated evidence of clinical outcomes and safety between CDA and ACDF, and help surgeon to change better surgical technique for patients. PMID:28002345

  3. Anterior cervical hypertrichosis: a case report and review of the literature.

    PubMed

    Megna, Matteo; Balato, Nicola; Patruno, Cataldo; Ayala, Fabio

    2015-01-01

    Anterior cervical hypertrichosis (ACH), or "hairy throat," is a rare form of localized hypertrichosis that refers to the presence of a tuft of terminal hair on the anterior neck. Only 40 cases of ACH have been reported in the literature. Although it is usually an isolated finding, it may be associated with systemic disorders such as neurologic abnormalities (peripheral neuropathy, developmental delay, mental retardation), ophthalmologic disorders (optic atrophy, chorioretinal changes), hallux valgus, and dorsal hypertrichosis. Thus it is strongly advised to take a thorough family history and to perform clinical examinations and investigations (neurologic and ophthalmologic examination, electromyography, X-ray of the feet) in all patients with ACH to exclude possible associated abnormalities. We report the case of a 7-year-old Italian girl who presented with this condition as an isolated finding.

  4. Anterior corpectomy versus posterior laminoplasty for multilevel cervical myelopathy: a systematic review and meta-analysis.

    PubMed

    Liu, Xuzhou; Min, Shaoxiong; Zhang, Hui; Zhou, Zhilai; Wang, Hehui; Jin, Anmin

    2014-02-01

    Surgical strategy for multilevel cervical myelopathy resulting from cervical spondylotic myelopathy (CSM) or ossification of posterior longitudinal ligament (OPLL) still remains controversial. There are still questions about the relative benefit and safety of direct decompression by anterior corpectomy (CORP) versus indirect decompression by posterior laminoplasty (LAMP). To perform a systematic review and meta-analysis evaluating the results of anterior CORP compared with posterior LAMP for patients with multilevel cervical myelopathy. Systematic review and meta-analysis of cohort studies comparing anterior CORP with posterior LAMP for the treatment of multilevel cervical myelopathy due to CSM or OPLL from 1990 to December 2012. An extensive search of literature was performed in Pubmed, Embase, and the Cochrane library. The quality of the studies was assessed according to GRADE. The following outcome measures were extracted: pre- and postoperative Japanese orthopedic association (JOA) score, neurological recovery rate (RR), surgical complications, reoperation rate, operation time and blood loss. Two reviewers independently assessed each study for quality and extracted data. Subgroup analysis was conducted according to the mean number of surgical segments. A total of 12 studies were included in this review, all of which were prospective or retrospective cohort studies with relatively low quality. The results indicated that the mean JOA score system for cervical myelopathy and the neurological RR in the CORP group were superior to those in the LAMP group when the mean surgical segments were <3, but were similar between the two groups in the case of the mean surgical segments equal to 3 or more. There was no statistical difference in the surgical complication rate between the two groups when the mean surgical segments <3, but were significantly higher incidences of surgical complications and complication-related reoperation in the CORP group compared with the LAMP

  5. [Complaints and findings at the iliac crest donor site following anterior cervical fusion].

    PubMed

    Pitzen, T; Kränzlein, K; Steudel, W I; Strowitzki, M

    2004-01-01

    A high rate of donor site complications has been described following bone graft harvesting at the anterior iliac crest for anterior cervical fusion. However, no prospective study exists dealing with this topic. The objectives of the study presented were to evaluate minor and major donor site complications following graft harvesting at the anterior iliac crest, to investigate postoperative changes at the donor site using computed tomography and ultrasound imaging and to judge the patients satisfaction. 67 patients were included in a clinical prospective study. All patients underwent anterior cervical discectomy and fusion using an autologous iliac crest graft. Clinical examination was performed three and ten days and two and three months after the operation. Computed tomography and ultrasound imaging of the donor site were performed 10 days after surgery. Complications were classified as "minor" and "major" complications. Minor complications were found in 62.7%. A significant decrease of minor complication rate was seen between the first and second examination after surgery. At the last follow-up, 80.5% of all patients were free from pain concerning the donor site. Haematomas and seromas were detected by ultrasound in 67.2% and donor site fractures in 6% using computed tomography. Major complications were seen in 11.9% of all patients. The current study revealed a high rate of minor complications and haematomas at the graft donor site. However, the majority of all patients is free of pain at the donor site three months after surgery and satisfied with the surgical result. Techniques without the need of bone grafting may help to avoid these complications and to ameliorate the initial postoperative status.

  6. Does anterior plating maintain cervical lordosis versus conventional fusion techniques? A retrospective analysis of patients receiving single-level fusions.

    PubMed

    Troyanovich, Stephan J; Stroink, Ann R; Kattner, Keith A; Dornan, Wayne A; Gubina, Irina

    2002-02-01

    A retrospective review of medical records and radiographs of patients receiving anterior cervical discectomy and fusion (ACDF) without anterior plating and with anterior plating was performed. The objective of the study was to determine whether a difference exists in cervical lordotic alignment between subjects undergoing single-level ACDF with and without anterior cervical plating instrumentation for symptomatic cervical disc disease. Collapse or settling of grafted bone into the vertebral endplates with resulting kyphotic deformity of the cervical spine is a commonly described complication of anterior discectomy and fusion. Despite the increasing use of instrumentation for the treatment of cervical spine injuries and degenerative conditions, little is known regarding lordotic alignment of the cervical spine in patients who receive plating instrumentation compared with conventional fusion without plating. Accumulating evidence suggests that plating is superior to non-plating techniques in patients with multiple level cervical disc lesions in regard to fusion, return to work rates, and complication rates; however, little is known about maintenance of lordotic curve alignment in single- and multiple-level procedures. Neutral lateral cervical radiographs of 57 patients who underwent single-level ACDF between 1994 and 1999 with anterior screw plates (n = 26), and conventional single-level fusion without anterior screw plates (n = 21) were retrospectively assessed. Measurements were made on weight-bearing lateral cervical radiographs to assess overall sagittal spinal alignment and intersegmental sagittal alignment at the surgical site before surgery, immediately after surgery, 4 to 12 weeks after surgery, and 12+ months after surgery. The average magnitude of overall lordosis measured between C2 and C7 decreased 4.2 degrees in the non-plated group, while being preserved in the plated group. This finding did not reach statistical significance in the long-term follow

  7. Posterior cervical fixation with nitinol shape memory loop in the anterior-posterior combined approach for the patients with three column injury of the cervical spine : preliminary report.

    PubMed

    Yu, Dong-Kun; Heo, Dong-Hwa; Cho, Sung-Min; Choi, Jong-Hun; Sheen, Seung-Hun; Cho, Yong-Jun

    2008-11-01

    The authors reviewed clinical and radiological outcomes in patients with three column injury of the cervical spine who had undergone posterior cervical fixation using Nitinol shape memory alloy loop in the anterior-posterior combined approach. Nine patients were surgically treated with anterior cervical fusion using an iliac bone graft and dynamic plate-screw system, and the posterior cervical fixation using Nitinol shape memory loop (Davydovtrade mark) at the same time. A retrospective review was performed. Clinical outcomes were assessed using the Frankel grading method. We reviewed the radiological parameters such as bony fusion rate, height of iliac bone graft strut, graft subsidence, cervical lordotic angle, and instrument related complication. Single-level fusion was performed in five patients, and two-level fusion in four. Solid bone fusion was presented in all cases after surgery. The mean height of graft strut was significantly decreased from 20.46+/-9.97 mm at immediate postoperative state to 18.87+/-8.60 mm at the final follow-up period (p<0.05). The mean cervical lordotic angle decreased from 13.83+/-11.84 degrees to 11.37+/-6.03 degrees at the immediate postoperative state but then, increased to 24.39+/-9.83 degrees at the final follow-up period (p<0.05). There were no instrument related complications. We suggest that the posterior cervical fixation using Nitinol shape memory alloy loop may be a simple and useful method, and be one of treatment options in anterior-posterior combined approach for the patients with the three column injury of the cervical spine.

  8. Is Two-Level Cervical Disc Replacement More Cost-Effective than Anterior Cervical Discectomy and Fusion at 7 Years?

    PubMed

    Merrill, Robert K; McAnany, Steven J; Albert, Todd J; Qureshi, Sheeraz A

    2017-08-14

    Cost-effectiveness analysis. Investigate the 7-year cost-effectiveness of two-level cervical disc replacement (CDR) and anterior cervical discectomy and fusion (ACDF). CDR and ACDF are both effective treatment strategies for managing degenerative conditions of the cervical spine. CDR has been shown to be a more-cost effective intervention in the short term, but the long-term cost-effectiveness has not been established. We analyzed 7-year follow-up data from the two-level Medtronic Prestige LP investigational device exemption study. Short-form 36 (SF-36) data were converted into health utility scores using the SF-6D algorithm. Costs were based on direct costs from the payer perspective, and effectiveness was measured as quality adjusted life years (QALYs). The willingness to pay (WTP) threshold was set to $50,000/QALY. A probabilistic sensitivity analysis was conducted via Monte Carlo simulation. Two-level CDR had a 7-year cost of $176,654.19, generated 4.65 QALYs, and had a cost-effectiveness ratio of $37,993.53/QALY. Two-level ACDF had a 7-year cost of $158,373.48, generated 4.44 QALYs, and had a cost-effectiveness ratio of $35,635.72. CDR was associated with an incremental cost of $18,280.71 and an incremental effectiveness of 0.21 QALYs, resulting in an incremental cost-effectiveness ratio (ICER) of $89,021.04, above the WTP threshold. Our Monte Carlo simulation demonstrated CDR would be chosen 46% of the time based on 10,000 simulations. Two-level CDR and ACDF are both cost-effective procedures at 7-year follow-up for treating degenerative conditions of the cervical spine. Based on an ICER of $89,021.04/QALY, we cannot conclude which treatment is the more cost-effective option at 7-years. CDR would be chosen 46% of the time based on 10,000 iterations of our Monte Carlo probabilistic sensitivity analysis. 3.

  9. Intraoperative technique to define the safe lateral limits of anterior cervical corpectomy: a cadaveric study.

    PubMed

    Friess, Darin M; Yoo, Jung U

    2006-08-01

    We describe a surgical radiographic technique during anterior cervical corpectomy to define the safe lateral limit of dissection. To assess the radiographic technique accuracy using computed tomography (CT) measurements on cadaveric specimens. Two clinical cases are presented. During anterior cervical surgery loss of orientation can lead to eccentric decompression and vertebral artery injury. A two-level corpectomy on 4 cadaveric samples was filled with radioopaque dye. An "introperative" antero-posterior x-ray was used to measure the narrowest distance from dye column to uncovertebral joints. A CT scan confirmed the distance from corpectomy to vertebral arteries. The distance between the x-ray dye column and uncovertebral joints averaged 2.7 mm (range, 0 to 7+/-2.2 mm). A CT scan demonstrated the distance from corpectomy to vertebral artery averaged 4.5 mm (range, 0 to 10+/-4.4 mm). The measured distance underestimated the true distance by an average of 1.8 mm (range, 0 to 8+/-2.2 mm). An intraoperative radiographic technique can estimate the lateral distance between the corpectomy and vertebral arteries by measuring the distance from the dye column to uncovertebral joints. The dye radiographic technique provides the surgeon an additional margin of safety.

  10. Is return to professional rugby union likely after anterior cervical spinal surgery?

    PubMed

    Andrews, J; Jones, A; Davies, P R; Howes, J; Ahuja, S

    2008-05-01

    We have examined the outcome in 19 professional rugby union players who underwent anterior cervical discectomy and fusion between 1998 and 2003. Through a retrospective review of the medical records and telephone interviews of all 19 players, we have attempted to determine the likelihood of improvement, return to professional sport and the long-term consequences. We have also attempted to relate the probability of symptoms in the neck and radicular pain in the arm to the position of play. Neck and radicular pain were improved in 17 patients, with 13 returning to rugby, the majority by six months after operation. Of these, 13 returned to their pre-operative standard of play, one to a lower level and five have not played rugby again. Two of those who returned to the game have subsequently suffered further symptoms in the neck, one of whom was obliged to retire. The majority of the players with problems in the neck were front row forwards. A return to playing rugby union after surgery and fusion of the anterior cervical spine is both likely and safe and need not end a career in the game.

  11. The NEtherlands Cervical Kinematics (NECK) Trial. Cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation; a double-blind randomised multicenter study

    PubMed Central

    2010-01-01

    Background Patients with cervical radicular syndrome due to disc herniation refractory to conservative treatment are offered surgical treatment. Anterior cervical discectomy is the standard procedure, often in combination with interbody fusion. Accelerated adjacent disc degeneration is a known entity on the long term. Recently, cervical disc prostheses are developed to maintain motion and possibly reduce the incidence of adjacent disc degeneration. A comparative cost-effectiveness study focused on adjacent segment degeneration and functional outcome has not been performed yet. We present the design of the NECK trial, a randomised study on cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in patients with cervical disc herniation. Methods/Design Patients (age 18-65 years) presenting with radicular signs due to single level cervical disc herniation lasting more than 8 weeks are included. Patients will be randomised into 3 groups: anterior discectomy only, anterior discectomy with interbody fusion, and anterior discectomy with disc prosthesis. The primary outcome measure is symptomatic adjacent disc degeneration at 2 and 5 years after surgery. Other outcome parameters will be the Neck Disability Index, perceived recovery, arm and neck pain, complications, re-operations, quality of life, job satisfaction, anxiety and depression assessment, medical consumption, absenteeism, and costs. The study is a randomised prospective multicenter trial, in which 3 surgical techniques are compared in a parallel group design. Patients and research nurses will be kept blinded of the allocated treatment for 2 years. The follow-up period is 5 years. Discussion Currently, anterior cervical discectomy with fusion is the golden standard in the surgical treatment of cervical disc herniation. Whether additional interbody fusion or disc prothesis is necessary and cost-effective will be determined by this trial. Trial Registration Netherlands

  12. Cervical Total Disc Replacement is Superior to Anterior Cervical Decompression and Fusion: A Meta-Analysis of Prospective Randomized Controlled Trials

    PubMed Central

    Zhang, Yujie; Liang, Chengzhen; Tao, Yiqing; Zhou, Xiaopeng; Li, Hao; Li, Fangcai; Chen, Qixin

    2015-01-01

    Background Despite being considered the standard surgical procedure for symptomatic cervical disc disease, anterior cervical decompression and fusion invariably accelerates adjacent segment degeneration. Cervical total disc replacement is a motion-preserving procedure developed as a substitute to fusion. Whether cervical total disc replacement is superior to fusion remains unclear. Methods We comprehensively searched PubMed, EMBASE, Medline, and the Cochrane Library in accordance with the inclusion criteria to identify possible studies. The retrieved results were last updated on December 12, 2014. We classified the studies as short-term and midterm follow-up. Results Nineteen randomized controlled trials involving 4516 cases were identified. Compared with anterior cervical decompression and fusion, cervical total disc replacement had better functional outcomes (neck disability index [NDI], NDI success, neurological success, neck pain scores reported on a numerical rating scale [NRS], visual analog scales scores and overall success), greater segmental motion at the index level, fewer adverse events and fewer secondary surgical procedures at the index and adjacent levels in short-term follow-up (P < 0.05). With midterm follow-up, the cervical total disc replacement group indicated superiority in the NDI, neurological success, pain assessment (NRS), and secondary surgical procedures at the index level (P < 0.05). The Short Form 36 (SF-36) and segmental motion at the adjacent level in the short-term follow-up showed no significant difference between the two procedures, as did the secondary surgical procedure rates at the adjacent level with midterm follow-up (P > 0.05). Conclusions Cervical total disc replacement presented favorable functional outcomes, fewer adverse events, and fewer secondary surgical procedures. The efficacy and safety of cervical total disc replacement are superior to those of fusion. Longer-term, multicenter studies are required for a better

  13. The efficacy of the synthetic interbody cage and Grafton for anterior cervical fusion.

    PubMed

    Park, Hyun-Woong; Lee, Jung-Kil; Moon, Sung-Jun; Seo, Seung-Kweon; Lee, Jae-Hyun; Kim, Soo-Han

    2009-08-01

    Prospective study of 31 patients who underwent anterior cervical fusion. To investigate the efficacy of polyetheretherketone (PEEK) cages and demineralized bone matrix (DBM) for anterior cervical discectomy and fusion (ACDF). Although high fusion rates can be achieved with autogenous bone grafts, donor-site morbidity affects the patient's satisfaction with the surgical outcome. Thirty-one consecutive patients treated with ACDF using the PEEK cage with DBM (Grafton, Osteotech, Inc., Shrewsbury, NJ) at 42 levels were prospectively evaluated with a minimum of 12-month follow-up (mean: 16 months). Twenty-one patients underwent a single-level ACDF, 9 patients underwent a 2-level ACDF, and 1 patient had a 3-level ACDF. The affected level was C3-C4 in 7 patients; C4-C5 in 9, C5-C6 in 16, and C6-C7 in 10. The neurologic outcomes were evaluated using the VAS score for neck and arm pain and the Japanese Orthopedic Association scoring system for myelopathy at 3, 6, and 12 months. The cervical lordosis and fusion status were assessed on radiographs including flexion/extension radiographs. At 12 months, the radiographs demonstrated grades I, II, and III new bone formation at 1, 13, and 28 levels, respectively. There was a significant improvement in both the neck and arm pain and a significant improvement in the Japanese Orthopedic Association scores at the last follow-up. There was no case with implant-related complications such as cage failure or migration, and no complications associated with the use of Grafton. ACDF using the Solis cage packed with Grafton demonstrated good clinical and radiologic outcomes. The fusion rate was comparable with the published results of the traditional ACDF using tricortical iliac crest grafts. Therefore, the results of this study suggest that the ongoing use of the PEEK cage packed with DBM and autologous bone chips in ACDF is a safe and effective alternative to the gold standard of autologous iliac bone grafts.

  14. Anterior Cervical Discectomy and Fusion: Practice Patterns Among Greek Spinal Surgeons

    PubMed Central

    Spanos, Savvas L.; Siasios, Ioannis D.; Dimopoulos, Vassilios G.; Fountas, Kostas N.

    2016-01-01

    Background A web-based survey was conducted among Greek spinal surgeons to outline the current practice trends in regard to the surgical management of patients undergoing anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine pathology. Various practice patterns exist in the surgical management of patients undergoing anterior cervical discectomy for degenerative pathology. No consensus exists regarding the type of the employed graft, the necessity of implanting a plate, the prescription of an external orthotic device, and the length of the leave of absence in these patients. Methods A specially designed questionnaire was used for evaluating the criteria for surgical intervention, the frequency of fusion employment, the type of the graft, the frequency of plate implantation, the employment of an external spinal orthosis (ESO), the length of the leave of absence, and the prescription of postoperative physical therapy. Physicians’ demographic factors were assessed including residency and spinal fellowship training, as well as type and length in practice. Results Eighty responses were received. Neurosurgeons represented 70%, and orthopedic surgeons represented 30%. The majority of the participants (91.3%) considered fusion necessary. Allograft was the preferred type of graft. Neurosurgeons used a plate in 42.9% of cases, whereas orthopedic surgeons in 100%. An ESO was recommended for 87.5% of patients without plates, and in 83.3% of patients with plates. The average duration of ESO usage was 4 weeks. Physical therapy was routinely prescribed postoperatively by 75% of the neurosurgeons, and by 83.3% of the orthopedic surgeons. The majority of the participants recommended 4 weeks leave of absence. Conclusions The vast majority of participants considered ACDF a better treatment option than an ACD, and preferred an allograft. The majority of them employed a plate, prescribed an ESO postoperatively, and recommended physical therapy to their

  15. A prospective, randomized, controlled cervical fusion study using recombinant human bone morphogenetic protein-2 with the CORNERSTONE-SR allograft ring and the ATLANTIS anterior cervical plate.

    PubMed

    Baskin, David S; Ryan, Patrick; Sonntag, Volker; Westmark, Richard; Widmayer, Marsha A

    2003-06-15

    A prospective, randomized, pilot clinical trial compared recombinant human bone morphogenetic protein-2 (rhBMP-2) with iliac crest autograft bone for the treatment of human cervical disc disease. To examine the safety and effectiveness of using INFUSE Bone Graft (rhBMP-2 applied to an absorbable collagen sponge), as compared with an autogenous iliac crest bone graft placed inside the CORNERSTONE-SR fibular allograft, in anterior cervical discectomy and interbody fusion. Recombinant human bone morphogenetic protein-2 is an osteoinductive protein that induces a reliable fusion in the lumbar spine, but it has not been studied in patients with degenerative cervical disc disease. For this study, 33 patients with degenerative cervical disc disease were randomly assigned to investigational or control groups. The investigational group received a fibular allograft (CORNERSTONE-SR Allograft Ring) with an rhBMP-2-laden collagen carrier inside the graft along with an ATLANTIS anterior cervical plate. The control group received a fibular allograft with cancellous iliac crest autograft placed inside it, along with an ATLANTIS anterior cervical plate. The patients underwent plain radiographs at 6 weeks, then at 3, 6, 12, and 24 months, and CT scans at 3 and 6 months after surgery. They also completed general health profiles and self-evaluation scales. Adverse events were evaluated for severity, duration, association with the implant, and the need for a second surgical procedure. All the patients evaluated had solid fusions 6, 12, and 24 months after surgery. There were no device-related adverse events. At 24 months, the investigational group had mean improvement superior to that of the control group in neck disability and arm pain scores (P < 0.03 each). This pilot study demonstrates the feasibility of using rhBMP-2 safely and effectively in the cervical spine.

  16. Influence of cervical bone mineral density on cage subsidence in patients following stand-alone anterior cervical discectomy and fusion.

    PubMed

    Brenke, Christopher; Dostal, Martin; Scharf, Johann; Weiß, Christel; Schmieder, Kirsten; Barth, Martin

    2015-12-01

    Anterior cervical discectomy and fusion (ACDF) is a common procedure for the treatment of cervical degenerative diseases. However, cage subsidence remains a frequent problem. We therefore investigated if cage design and site-specific bone mineral density (BMD) contribute to the rate and direction of subsidence following ACDF. Patients were prospectively included and received two different cages (groups 1 and 2) using minimization randomization. The degree and direction of cage subsidence were determined using plain radiographs. Neck pain intensity on the visual analogue scale (VAS), the neck disability index (NDI), and the patient satisfaction index were recorded up to 12 months after surgery. 88 patients were analysed with a mean age of 53.7 ± 11.8 years. BMD values decreased in craniocaudal direction from 302.0 ± 62.2 to 235.5 ± 38.9 mg/cm(3). Both groups showed significant height gain after the operation (both p < 0.001), followed by height loss at 3 months (both p < 0.05) and at 3-12 months after the operation (both p > 0.05). Both groups showed improvement of VAS neck pain intensity (both p < 0.05) and NDI (both p < 0.05). The direction of cage subsidence was similar, no correlations were found between cage subsidence and BMD or various clinical parameters. Implant geometry of both cages and variations of the operative procedure promoted a relatively high degree of cage subsidence. Further studies are necessary to identify a relation of BMD and subsidence using optimized implant geometry and by controlling additional intraoperative variables.

  17. Use of Allogenic Mesenchymal Cellular Bone Matrix in Anterior and Posterior Cervical Spinal Fusion: A Case Series of 21 Patients.

    PubMed

    Divi, Srikanth Naga; Mikhael, Mark M

    2017-06-01

    Retrospective case series. To report our early experience using allogenic mesenchymal cellular bone matrix (CBM) products in cervical spine fusion. Multi-level cervical fusions have historically yielded lower fusion rates than single level fusions, especially in patients with high risk medical comorbidities. At this time, significant literature in cervical fusion outcomes with this cellular allograft technology is lacking. Twenty-one patients underwent either multilevel (3 or 4 level) anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, or posterior cervical fusion. ViviGen (DePuy Synthes Spine, Raynham, MA, USA), an allogenic bone matrix product, was used in addition to standard instrumentation. Radiographic evaluation was performed at 2 weeks, 12 weeks, 24 weeks and 1 year postoperative. Visual analog scale (VAS) and neck disability index (NDI) scores along with return to work and leisure activity were recorded. At 6 months postoperative, all patients had radiographic evidence of bone fusion regardless of age or medical comorbidities. All patients reported subjective improvement with a mean decrease in VAS from 8.3 to 1.5 and a mean decrease in NDI from 40.3% to 6.0% at 1 year. All patients also returned to work and/or regular leisure activity within 3 months. Twenty-one patients undergoing high-risk anterior and posterior cervical spine fusion, with the use of a commercially available mesenchymal CBM product, went on to radiographic fusion and all had improvement in subjective outcomes. While further effort and research is needed to validate its widespread use, this study shows favorable use of CBM in cervical fusion for high-risk cases.

  18. Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

    PubMed Central

    Reynolds, Jeremy; Zenner, Juliane; Forstner, Rosemarie; Hempfing, Axel; Maislinger, Iris; Kolb, Klaus; Tauber, Mark; Resch, Herbert; Mayer, Michael; Hitzl, Wolfgang

    2009-01-01

    The management of patients with subaxial cervical injuries lacks consensus, particularly in regard to the decision which surgical approach or combination of approaches to use and which approach yields the best clinical outcome in the distinct injury. The trauma literature is replete with reports of surgical techniques, complications and gross outcome assessment in heterogeneous samples. However, data on functional and clinical outcome using validated outcome measures are scanty. Therefore, the authors performed a study on plated anterior cervical decompression and fusion for unstable subaxial injuries with focus on clinical outcome. For the purpose of a strongly homogenous subgroup of patients with subaxial injuries without spinal cord injuries, robust criteria were applied that were fulfilled by 28 patients out of an original series of 131 subaxial injuries. Twenty-six patients subjected to 1- and 2-level fusions without having spinal cord injury could be surveyed after a mean of 5.5 years (range 16–128 months). The cervical spine injury severity score averaged 9.6. Cross-sectional outcome assessment included validated outcome measures (Neck pain disability index, Cervical Spine Outcome Questionnaire, SF-36), the investigation of construct failure and successful surgical outcome were defined by strict criteria, the reconstruction and maintenance of local and total cervical lordosis, adjacent-segment degeneration and intervertebral motion, and the fusion-rate using an interobserver assessment. Self-rated clinical outcome was excellent or good in 81% of patients and moderate or poor in 19% that corresponded to the results of the validated outcome measures. Results of the NPDI averaged 12.4 ± 12.7% (0–40). With the SF-36 mean physical and mental component summary scores were 47.0 ± 9.8 (18.2–59.3) and 52.2 ± 12.4 (14.6–75.3), respectively. Using merely non-constrained plates, construct failure was observed in 31% of cases and loss of local lordosis

  19. Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries.

    PubMed

    Koller, Heiko; Reynolds, Jeremy; Zenner, Juliane; Forstner, Rosemarie; Hempfing, Axel; Maislinger, Iris; Kolb, Klaus; Tauber, Mark; Resch, Herbert; Mayer, Michael; Hitzl, Wolfgang

    2009-05-01

    The management of patients with subaxial cervical injuries lacks consensus, particularly in regard to the decision which surgical approach or combination of approaches to use and which approach yields the best clinical outcome in the distinct injury. The trauma literature is replete with reports of surgical techniques, complications and gross outcome assessment in heterogeneous samples. However, data on functional and clinical outcome using validated outcome measures are scanty. Therefore, the authors performed a study on plated anterior cervical decompression and fusion for unstable subaxial injuries with focus on clinical outcome. For the purpose of a strongly homogenous subgroup of patients with subaxial injuries without spinal cord injuries, robust criteria were applied that were fulfilled by 28 patients out of an original series of 131 subaxial injuries. Twenty-six patients subjected to 1- and 2-level fusions without having spinal cord injury could be surveyed after a mean of 5.5 years (range 16-128 months). The cervical spine injury severity score averaged 9.6. Cross-sectional outcome assessment included validated outcome measures (Neck pain disability index, Cervical Spine Outcome Questionnaire, SF-36), the investigation of construct failure and successful surgical outcome were defined by strict criteria, the reconstruction and maintenance of local and total cervical lordosis, adjacent-segment degeneration and intervertebral motion, and the fusion-rate using an interobserver assessment. Self-rated clinical outcome was excellent or good in 81% of patients and moderate or poor in 19% that corresponded to the results of the validated outcome measures. Results of the NPDI averaged 12.4 +/- 12.7% (0-40). With the SF-36 mean physical and mental component summary scores were 47.0 +/- 9.8 (18.2-59.3) and 52.2 +/- 12.4 (14.6-75.3), respectively. Using merely non-constrained plates, construct failure was observed in 31% of cases and loss of local lordosis, expressed

  20. In vivo experimental study of anterior cervical fusion using bioactive polyetheretherketone in a canine model.

    PubMed

    Shimizu, Takayoshi; Fujibayashi, Shunsuke; Yamaguchi, Seiji; Otsuki, Bungo; Okuzu, Yaichiro; Matsushita, Tomiharu; Kokubo, Tadashi; Matsuda, Shuichi

    2017-01-01

    Polyetheretherketone (PEEK) is a widely accepted biomaterial, especially in the field of spinal surgery. However, PEEK is not able to directly integrate with bone tissue, due to its bioinertness. To overcome this drawback, various studies have described surface coating approaches aimed at increasing the bioactivity of PEEK surfaces. Among those, it has been shown that the recently developed sol-gel TiO2 coating could provide PEEK with the ability to bond with bone tissue in vivo without the use of a bone graft. This in vivo experimental study using a canine model determined the efficacy of bioactive TiO2-coated PEEK for anterior cervical fusion. Sol-gel-derived TiO2 coating, which involves sandblasting and acid treatment, was used to give PEEK bone-bonding ability. The cervical interbody spacer, which was designed to fit the disc space of a beagle, was fabricated using bioactive TiO2-coated PEEK. Both uncoated PEEK (control) and TiO2-coated PEEK spacers were implanted into the cervical intervertebral space of beagles (n = 5 for each type). After the 3-month survival period, interbody fusion success was evaluated based on μ-CT imaging, histology, and manual palpation analyses. Manual palpation analyses indicated a 60% (3/5 cases) fusion (no gap between bone and implants) rate for the TiO2-coated PEEK group, indicating clear advantage over the 0% (0/5 cases) fusion rate for the uncoated PEEK group. The bony fusion rate of the TiO2-coated PEEK group was 40% according to μCT imaging; however, it was 0% of for the uncoated PEEK group. Additionally, the bone-implant contact ratio calculated using histomorphometry demonstrated a better contact ratio for the TiO2-coated PEEK group than for the uncoated PEEK group (mean, 32.6% vs 3.2%; p = 0.017). The TiO2-coated bioactive PEEK implant demonstrated better fusion rates and bone-bonding ability than did the uncoated PEEK implant in the canine anterior cervical fusion model. Bioactive PEEK, which has bone-bonding ability

  1. [Repair of middle and lower face scars using alar thin expanded cervical flap with pedicle in anterior neck].

    PubMed

    Xu, Lisi; Li, Yangqun; Tang, Yong; Chen, Wen; Yang, Zhe; Zhao, Muxin; Ma, Ning; Feng, Jun

    2014-04-01

    To explore the application of alar thin expanded cervical flap with pedicle in anterior neck for large scars on middle and lower face. From February 2000 to July 2013, 26 patients with scars on the middle and lower face were treated with the alar thin expanded cervical flaps with pedicle in anterior neck. After the skin of anterior neck was expanded by implanting skin expanders, alar thin expanded cervical flap with pedicle in anterior neck was obtained with size of 163-275 cm(2). Then the scars on the middle and lower face with the size of 135-196 cm(2) were excised, with the area of excision allowing full coverage of the expanded flap. The flap was rotated and advanced to the middle and lower face, and the incision was closed in layers. The 26 patients were followed up for 2 to 24 months. Twenty-one flaps survived, with good appearance and function. Four flaps showed venous retardation at distal part, and only one flap showed necrosis of the right edge. They were healed by free skin grafting. The alar thin expanded cervical flap not only makes maximum use of expanded flap on the premise of ensuring blood supply, but also guarantees good color, texture, and contour of face and neck.

  2. Delayed anterior cervical plate dislodgement with pharyngeal wall perforation and oral extrusion of cervical plate screw after 8 years: A very rare complication

    PubMed Central

    Kapu, Ravindranath; Singh, Manish; Pande, Anil; Vasudevan, Matabushi Chakravarthy; Ramamurthi, Ravi

    2012-01-01

    We report a patient with congenital anomaly of cervical spine, who presented with clinical features suggestive of cervical compressive spondylotic myelopathy. He underwent C3 median corpectomy, graft placement, and stabilization from C2 to C4 vertebral bodies. Postoperative period was uneventful and he improved in his symptoms. Eight years later, he presented with a difficulty in swallowing and occasional regurgitation of feeds of 2 months duration and oral extrusion of screw while having food. On oral examination, there was a defect in the posterior pharyngeal wall through which the upper end of plate with intact self-locking screw and socket of missed fixation screw was seen. This was confirmed on X-ray cervical spine. He underwent removal of the plate system and was fed through nasogastric tube and managed with appropriate antibiotics. This case is presented to report a very rare complication of anterior cervical plate fixation in the form of very late-onset dislodgement, migration of anterior cervical plate, and oral extrusion of screw through perforated posterior pharyngeal wall. PMID:23741125

  3. Reconstruction of an Anterior Cervical Necrotizing Fasciitis Defect Using a Biodegradable Polyurethane Dermal Substitute.

    PubMed

    Wagstaff, Marcus Jd; Caplash, Yugesh; Greenwood, John E

    2017-01-01

    Introduction: Although we have previously described the use of a novel polyurethane biodegradable dermal substitute in the reconstruction of 20 free flap donor sites, and extensive cutaneous defects, including a large area of exposed calvarium secondary to burn injury, our experience with this material now extends to 35 free flap donor site reconstructions and 13 major or complex burns. Methods: The polyurethane material (NovoSorb BTM; PolyNovo Biomaterials Pty Ltd, Port Melbourne, Victoria, Australia) was recently employed in another complex wound scenario, implanted into a large anterior cervical cutaneous and soft-tissue defect remaining after serial radical debridement for necrotizing fasciitis. Results: Implantation, integration, delamination, and split-skin graft application proceeded without complication, mirroring our previous experience in other wounds (including major burns). The result was a robust, supple, mobile, and well-contoured reconstruction over the deep tissues of the neck. The functional and cosmetic outcomes exceeded all expectation. Discussion: The wound environment created after necrotizing fasciitis infection and debridement is austere. In this particular case, reconstructive options were limited to large free flap repair, skin graft alone, and skin graft augmented by commercially available collagen/glycosaminoglycan dermal matrix. Each option was discarded for various reasons. Our previous success with NovoSorb BTM, developed at our center, prompted its use following regulatory approval. The patient was physiologically stronger after the temporization afforded by the biodegradable temporizing matrix over 4 weeks of integration. Conclusion: This is the first description of the successful use of an entirely synthetic biodegradable dermal substitute for the reconstruction of both necrotizing fasciitis and an anterior cervical defect.

  4. Reconstruction of an Anterior Cervical Necrotizing Fasciitis Defect Using a Biodegradable Polyurethane Dermal Substitute

    PubMed Central

    Wagstaff, Marcus JD; Caplash, Yugesh

    2017-01-01

    Introduction: Although we have previously described the use of a novel polyurethane biodegradable dermal substitute in the reconstruction of 20 free flap donor sites, and extensive cutaneous defects, including a large area of exposed calvarium secondary to burn injury, our experience with this material now extends to 35 free flap donor site reconstructions and 13 major or complex burns. Methods: The polyurethane material (NovoSorb BTM; PolyNovo Biomaterials Pty Ltd, Port Melbourne, Victoria, Australia) was recently employed in another complex wound scenario, implanted into a large anterior cervical cutaneous and soft-tissue defect remaining after serial radical debridement for necrotizing fasciitis. Results: Implantation, integration, delamination, and split-skin graft application proceeded without complication, mirroring our previous experience in other wounds (including major burns). The result was a robust, supple, mobile, and well-contoured reconstruction over the deep tissues of the neck. The functional and cosmetic outcomes exceeded all expectation. Discussion: The wound environment created after necrotizing fasciitis infection and debridement is austere. In this particular case, reconstructive options were limited to large free flap repair, skin graft alone, and skin graft augmented by commercially available collagen/glycosaminoglycan dermal matrix. Each option was discarded for various reasons. Our previous success with NovoSorb BTM, developed at our center, prompted its use following regulatory approval. The patient was physiologically stronger after the temporization afforded by the biodegradable temporizing matrix over 4 weeks of integration. Conclusion: This is the first description of the successful use of an entirely synthetic biodegradable dermal substitute for the reconstruction of both necrotizing fasciitis and an anterior cervical defect. PMID:28197297

  5. Early failure of bioabsorbable anterior cervical fusion plates: case report and failure analysis.

    PubMed

    Brkaric, Mario; Baker, Kevin C; Israel, Raj; Harding, Trevor; Montgomery, David M; Herkowitz, Harry N

    2007-05-01

    Case report with forensic failure analysis. To determine the failure modes of 3 explanted 70:30 PLDLA Mystique (Medtronic Sofamor Danek, Memphis, TN) graft containment plates retrieved from revision surgery for early device failure. To reduce the problems of stress-shielding and radiopacity associated with metallic systems, bioabsorbable polymers have been used in anterior cervical discectomy and fusion procedures. Degradation of mechanical properties in vivo is a major concern when using bioabsorbable systems. Three of 6 patients who underwent anterior cervical discectomy with instrumented fusion, using Mystique graft containment systems experienced early failure requiring revision to alternate hardware. Devices were retrieved after failure and analyzed by light microscopy and environmental scanning electron microscopy. Simulations were performed with an unused plating system to induce damage for comparison with the retrieved devices. A detailed case review was performed to identify possible sources of extraordinary loading or damage. One plating system failed at 6 weeks postimplantation due to fatigue fracture of the screws. Crack initiation sites were identified at the interface of the thread root and mold line of the screw. Another plating system failed at 16 weeks postimplantation due to the coalescence of radial microcracking between holes in the plate, leading to catastrophic failure of the plate. The final plating system failed during the implantation surgery, when the screw fractured in torsion. Stress concentrations at the screw head-shaft interface and thread-shaft interface reduce the fatigue performance of bioabsorbable screws. Hydrolysis of the polymer may also play a role in the reduction of resistance to crack initiation and propagation.

  6. Cervical disc arthroplasty with PRESTIGE LP disc versus anterior cervical discectomy and fusion: a prospective, multicenter investigational device exemption study.

    PubMed

    Gornet, Matthew F; Burkus, J Kenneth; Shaffrey, Mark E; Argires, Perry J; Nian, Hui; Harrell, Frank E

    2015-07-31

    OBJECT This study compared the safety and efficacy of treatment with the PRESTIGE LP cervical disc versus a historical control anterior cervical discectomy and fusion (ACDF). METHODS Prospectively collected PRESTIGE LP data from 20 investigational sites were compared with data from 265 historical control ACDF patients in the initial PRESTIGE Cervical Disc IDE study. The 280 investigational patients with single-level cervical disc disease with radiculopathy and/or myelopathy underwent arthroplasty with a low-profile artificial disc. Key safety/efficacy outcomes included Neck Disability Index (NDI), Neck and Arm Pain Numerical Rating Scale scores, 36-Item Short Form Health Survey (SF-36) score, work status, disc height, range of motion, adverse events (AEs), additional surgeries, and neurological status. Clinical and radiographic evaluations were completed preoperatively, intraoperatively, and at 1.5, 3, 6, 12, and 24 months postoperatively. Predefined Bayesian statistical methods with noninformative priors were used, along with the propensity score technique for controlling confounding factors. Analysis by independent statisticians confirmed initial statistical findings. RESULTS The investigational and control groups were mostly similar demographically. There was no significant difference in blood loss (51.0 ml [investigational] vs 57.1 ml [control]) or hospital stay (0.98 days [investigational] vs 0.95 days [control]). The investigational group had a significantly longer operative time (1.49 hours vs 1.38 hours); 95% Bayesian credible interval of the difference was 0.01-0.21 hours. Significant improvements versus preoperative in NDI, neck/arm pain, SF-36, and neurological status were achieved by 1.5 months in both groups and were sustained at 24 months. Patient follow-up at 24 months was 97.1% for the investigational group and 84.0% for the control group. The mean NDI score improvements versus preoperative exceeded 30 points in both groups at 12 and 24 months. SF

  7. Cervical Disc Arthroplasty with Prestige LP Disc Versus Anterior Cervical Discectomy and Fusion: Seven-Year Outcomes

    PubMed Central

    Burkus, J. Kenneth; Shaffrey, Mark E.; Nian, Hui; Harrell, Frank E.

    2016-01-01

    Background Cervical disc arthroplasty (CDA) has emerged as an alternative to anterior cervical discectomy and fusion (ACDF) for the treatment of cervical pathologies. Studies are on-going to assess the long term outcomes of CDA. This study assessed the safety and efficacy of the Prestige® LP Disc at 84-months follow up. Methods Prospective data from 280 CDA patients with single-level cervical disc disease with radiculopathy or myelopathy were compared with 265 historical control ACDF patients. Clinical and radiographic follow up was completed pre-operatively, intraoperatively, and at intervals up to 84 months. Results Follow-up rate was 75.9% for CDA and 70.0% for ACDF patients. Statistical improvements (p < 0.001) in Neck Disability Index (NDI), neck/arm pain, and SF-36 were achieved by 1.5 months in both groups and maintained through 84 months. At 84 months, 86.1% of CDA versus 80.1% of ACDF patients achieved NDI success, (≥15-point improvement over baseline). Mean NDI score improvements exceeded 30 points in both groups. SF-36 PCS/MCS mean improvements were 13.1±11.9/8.2±12.3 points for CDA and 10.7±11.8/8.3±13.6 points for ACDF. Neurological success was 92.8% for CDA and 79.7% for ACDF patients. The rate of Overall Success was 74.9% for CDA and 63.2% for ACDF. At 84 months, 17.5% of CDA and 16.6% of ACDF patients had a possibly implant- or implant-surgical procedure-related adverse event. Eighteen (6.4%) CDA and 29 (10.9%) ACDF patients had a second surgery at the index level. In CDA patients, mean angular motion at the target level was maintained at 24 (7.5°) and 84 (6.9°) months. Bridging bone was reported in 5.9%/9.5%/10.2%/13.0% of CDA patients at 24/36/60/84 months. Change in mean preoperative angulation of the adjacent segment above/below the index level was1.06±4.39/1.25±4.06 for CDA and (-0.23)±5.37/1.25±5.07 for ACDF patients. At 84 months, 90.9% of CDA and 85.6% of ACDF patients were satisfied with the results of their treatment

  8. Cervical plexus anesthesia versus general anesthesia for anterior cervical discectomy and fusion surgery: A randomized clinical trial.

    PubMed

    Wang, Hui; Ma, Lei; Yang, Dalong; Wang, Tao; Wang, Qian; Zhang, Lijun; Ding, Wenyuan

    2017-02-01

    Both general anesthesia (GA) and cervical plexus anesthesia (CPA) can be used for anterior cervical discectomy and fusion (ACDF) surgery. The aim of this study was to evaluate the influence of anesthetic techniques on perioperative mortality and morbidity in patients undergoing cervical surgery.From January 2008 to December 2015, 356 patients who underwent 1-level ACDF for cervical spinal myelopathy were prospectively reviewed. They were assigned to receive GA (group A) and CPA (group B). The analgesic efficacy of the block was assessed by anesthesia preparation time, the maximum heart rate, and mean arterial blood pressure changes compared with the baseline, time of postoperative revival, and duration of recovery stay. Duration of surgery, blood loss, and anesthesia medical cost were also recorded. Numerical rating scale (NRS) was used to evaluate pain at different time points. Postoperative nausea and vomiting (PONV) was assessed, and postoperative average administered dosages of meperidine and metoclopramide were also recorded. The spinal surgeon satisfaction, anesthetist satisfaction, and patient satisfaction were assessed.Both the anesthesia induction time and postoperative revival time were longer in group A than that in group B; both the duration of surgery and recovery stay were also longer in group A than that in group B, whereas there was no difference in blood loss between the 2 groups. The average dosage of both meperidine and metoclopramide was more in group A than that in group B, and the anesthesia medical cost was greater in group A than that in group B. There were no significant differences in baseline data of systolic blood pressure, diastolic blood pressure, and heart rate between the 2 groups. But the intraoperative data of systolic blood pressure, diastolic blood pressure, and heart rate were higher/larger in group B than that in group A. In group A, there was no complaint of pain in the surgery procedure, but the pain increased after GA, with

  9. Cervical Disc Arthroplasty with Prestige LP Disc Versus Anterior Cervical Discectomy and Fusion: Seven-Year Outcomes.

    PubMed

    Gornet, Matthew F; Burkus, J Kenneth; Shaffrey, Mark E; Nian, Hui; Harrell, Frank E

    2016-01-01

    Cervical disc arthroplasty (CDA) has emerged as an alternative to anterior cervical discectomy and fusion (ACDF) for the treatment of cervical pathologies. Studies are on-going to assess the long term outcomes of CDA. This study assessed the safety and efficacy of the Prestige(®) LP Disc at 84-months follow up. Prospective data from 280 CDA patients with single-level cervical disc disease with radiculopathy or myelopathy were compared with 265 historical control ACDF patients. Clinical and radiographic follow up was completed pre-operatively, intraoperatively, and at intervals up to 84 months. Follow-up rate was 75.9% for CDA and 70.0% for ACDF patients. Statistical improvements (p < 0.001) in Neck Disability Index (NDI), neck/arm pain, and SF-36 were achieved by 1.5 months in both groups and maintained through 84 months. At 84 months, 86.1% of CDA versus 80.1% of ACDF patients achieved NDI success, (≥15-point improvement over baseline). Mean NDI score improvements exceeded 30 points in both groups. SF-36 PCS/MCS mean improvements were 13.1±11.9/8.2±12.3 points for CDA and 10.7±11.8/8.3±13.6 points for ACDF. Neurological success was 92.8% for CDA and 79.7% for ACDF patients. The rate of Overall Success was 74.9% for CDA and 63.2% for ACDF. At 84 months, 17.5% of CDA and 16.6% of ACDF patients had a possibly implant- or implant-surgical procedure-related adverse event. Eighteen (6.4%) CDA and 29 (10.9%) ACDF patients had a second surgery at the index level. In CDA patients, mean angular motion at the target level was maintained at 24 (7.5°) and 84 (6.9°) months. Bridging bone was reported in 5.9%/9.5%/10.2%/13.0% of CDA patients at 24/36/60/84 months. Change in mean preoperative angulation of the adjacent segment above/below the index level was1.06±4.39/1.25±4.06 for CDA and (-0.23)±5.37/1.25±5.07 for ACDF patients. At 84 months, 90.9% of CDA and 85.6% of ACDF patients were satisfied with the results of their treatment. Prestige LP maintained

  10. [Wide esophageal wall rupture as iatrogenic complication of anterior cervical spine surgery].

    PubMed

    Wierzbicka, Małgorzata; Pabiszczak, Maciej; Smuszkiewicz, Piotr; Szyfter, Witold

    2005-01-01

    The case of 19-year old men with iatrogenic esophageal wall perforation is presented. The patient underwent anterior cervical stabilization using plate and screw for fracture of the C4 and C5 vertebra followed by an abscess of prevertebral space with discharging pus and food from the wound. The general condition was poor. Symptoms included: pneumonia, pleuritis with effusion, septicemia with mediastinitis, fever up to 40 and quadriplegia on neurological examination. During surgical procedure the implant loose but was still fixed into the esophagus causing a large defect in the posterior wall of the hypopharynx and cervical part of esophagus was found. The patient undergone three step surgery with wide drainage of prevertebral abscess, removing of osteosynthetic plate removal and formation of pedicle flap with sterno-cleido-mastoideus muscule. The finnal fourth procedure with using of pediculed infrahyoid flap gave an excellent result. During 160 days hospitalization the pus culture showed growth of the 11 bacterials species (like Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus faecalis) and 2 species of fungus. He was treated 13 types of antybiotics. This special case we present because of live threatening complication (mediastinitis) and complicated clinical course as well as because of unique technique of the defect closure, i.e. the infrahyoid flap occurred to be successful.

  11. Relationship between depression and clinical outcome following anterior cervical discectomy and fusion

    PubMed Central

    Phan, Kevin; Moran, Dane; Kostowski, Thomas; Xu, Risheng; Goodwin, Rory; Elder, Benjamin; Ramhmdani, Seba

    2017-01-01

    Background Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure for patients with symptomatic degenerative conditions of the cervical spine. The objective is to assess the impact of preoperative depression and other baseline characteristics on patient reported clinical outcomes following ACDF surgery based on the experience at our institution. Methods This was a retrospective cohort study of some patients undergoing ACDF at a single institution from 2012 to 2014. Ninety-three patients that underwent an ACDF procedure were included. The primary outcome measure was post-operative Nurick score. Results Sixteen (17.2%) patients had a formal diagnosis of depression compared to 77 (82.8%) patients without depression. On univariate analysis, patients with depression had statistically significantly higher Nurick scores compared to patients without depression after surgery (coefficient =0.55, 95% CI: 0.21–0.90, P=0.002). On multivariate analysis, there was a trend toward higher postoperative Nurick scores in patients that had depression (coefficient =0.31, 95% CI: −0.01–0.63, P=0.057). Conclusions This small retrospective study reveals an inverse relationship between preoperative depression and functional outcome. Further research should be performed to investigate this relationship and to investigate if treating depression can improve postoperative outcomes. PMID:28744492

  12. [Anterior cervical fusion with tantalum interbody implants. Clinical and radiological results in a prospective study].

    PubMed

    Vicario, C; Lopez-Oliva, F; Sánchez-Lorente, T; Zimmermann, M; Asenjo-Siguero, J J; Ladero, F; Ibarzábal, A

    2006-04-01

    Anterior cervical discectomy and interbody fusion (ACDF) is a widely accepted surgical technique in the treatment of cervical disc disease. Tantalum cages have been recently introduced in spine surgery for interbody fusion because of the advantages of their mechanical properties. We present the results of a prospective clinical and radiological study on 24 consecutive patients who underwent an ACDF with tantalum cages. Clinical evaluation was assessed preoperatively and after surgery by a questionnaire that included a Visual Analogic Scale (VAS) of neck and arm pain, the Oswestry Disability Index and the Zung Depression Scale. Results were classified by Odom's criteria. Radiological evaluation included flexion-extension X-rays, and changes in distance between spinous processes and Cobb angle were measured. Postoperatively patients were reviewed 3 and 12 months after surgery. A statistical significative improvement in all clinical data was reported. According to Odom's criteria in 75% of patients the results were considered like excellent or good. Only one case of radiological and clinical pseudoarthrosis was confirmed. No significative differences were reported 3 and 12 months after surgery. Tantalum cages are a very promising and usefull alternative among implants available for ACDF. Compatibility with MRI postoperative studies and the unnecessariness of autograft are some of their advantages.

  13. Reliability and scientific use of a surgical planning software for anterior cervical discectomy and fusion (ACDF).

    PubMed

    Barth, Martin; Weiß, Christel; Brenke, Christopher; Schmieder, Kirsten

    2017-04-01

    Software-based planning of a spinal implant inheres in the promise of precision and superior results. The purpose of the study was to analyze the measurement reliability, prognostic value, and scientific use of a surgical planning software in patients receiving anterior cervical discectomy and fusion (ACDF). Lateral neutral, flexion, and extension radiographs of patients receiving tailored cages as suggested by the planning software were available for analysis. Differences of vertebral wedging angles and segmental height of all cervical segments were determined at different timepoints using intraclass correlation coefficients (ICC). Cervical lordosis (C2/C7), segmental heights, global, and segmental range of motion (ROM) were determined at different timepoints. Clinical and radiological variables were correlated 12 months after surgery. 282 radiographs of 35 patients with a mean age of 53.1 ± 12.0 years were analyzed. Measurement of segmental height was highly accurate with an ICC near to 1, but angle measurements showed low ICC values. Likewise, the ICCs of the prognosticated values were low. Postoperatively, there was a significant decrease of segmental height (p < 0.0001) and loss of C2/C7 ROM (p = 0.036). ROM of unfused segments also significantly decreased (p = 0.016). High NDI was associated with low subsidence rates. The surgical planning software showed high accuracy in the measurement of height differences and lower accuracy values with angle measurements. Both the prognosticated height and angle values were arbitrary. Global ROM, ROM of the fused and intact segments, is restricted after ACDF.

  14. Use of autologous bone graft in anterior cervical decompression: morbidity & quality of life analysis

    PubMed Central

    2009-01-01

    Background Autologous iliac crest graft has long been the gold standard graft material used in cervical fusion. However its harvest has significant associated morbidity, including protracted postoperative pain scores at the harvest site. Thus its continued practice warrants scrutiny, particularly now that alternatives are available. Our aims were to assess incidence and nature of complications associated with iliac crest harvest when performed in the setting of Anterior Cervical Decompression (ACD). Also, to perform a comparative analysis of patient satisfaction and quality of life scores after ACD surgeries, when performed with and without iliac graft harvest. Methods All patients who underwent consecutive ACD procedures, with and without the use of autologous iliac crest graft, over a 48 month period were included (n = 53). Patients were assessed clinically at a minimum of 12 months postoperatively and administered 2 validated quality of life questionnaires: the SF-36 and Cervical Spine Outcomes Questionnaires (Response rate 96%). Primary composite endpoints included incidence of bone graft donor site morbidity, pain scores, operative duration, and quality of life scores. Results Patients who underwent iliac graft harvest experienced significant peri-operative donor site specific morbidity, including a high incidence of pain at the iliac crest (90%), iliac wound infection (7%), a jejunal perforation, and longer operative duration (285 minutes vs. 238 minutes, p = 0.026). Longer term follow-up demonstrated protracted postoperative pain at the harvest site and significantly lower mental health scores on both quality of life instruments, for those patients who underwent autologous graft harvest Conclusion ACD with iliac crest graft harvest is associated with significant iliac crest donor site morbidity and lower quality of life at greater than 12 months post operatively. This is now avoidable by using alternatives to autologous bone without compromising clinical or

  15. The Role of C2-C7 Angle in the Development of Dysphagia After Anterior and Posterior Cervical Spine Surgery.

    PubMed

    Tian, Wei; Yu, Jie

    2016-12-07

    This is a retrospective clinical study. To analyze the relationship between cervical alignment and the development of dysphagia after anterior and posterior cervical (PC) spine surgery [anterior cervical discectomy and fusion (ACDF), cervical disk replacement (CDR), and PC]. Dysphagia is a known complication of cervical surgery and may be prolonged or occasionally serious. A previous study showed dysphagia after occipitocervical fusion was caused by oropharyneal stenosis resulting from O-C2 (upper cervical lordosis) fixation in a flexed position. However, there have been few reports analyzing the association between the C2-C7 angle (middle-lower cervical lordosis) and postoperative dysphagia. In total, 452 patients were reviewed in this study, including 172 patients who underwent the ACDF procedure, 98 patients who had the CDR procedure, and 182 patients who had the PC procedure between June 2007 and May 2010. The presence and duration of postoperative dysphagia were recorded via face-to-face questioning or telephone interview performed at least 1 year after the procedure. Plain cervical radiographs before and after surgery were collected. The O-C2 angle and C2-C7 angle were measured. The change of O-C2 angle and C2-C7 angle were defined as dO-C2 angle=postoperative O-C2 angle-preoperative O-C2 angle and dC2-C7 angle=postoperative C2-C7 angle-preoperative C2-C7 angle. The association between postoperative dysphagia with dO-C2 angle and dC2-C7 angle was studied. A total of 12.8% ACDF, 5.1% CDR, and 9.4% PC patients reported dysphagia after cervical surgery. The dC2-C7 angle has considerable impact on postoperative dysphagia. When dC2-C7 angle is >5 degrees, the chance of developing postoperative dysphagia of this patient is significantly greater. The dO-C2 angle, age, sex, body mass index, operative time, blood loss, procedure type, revision surgery, most cephalic operative level, and number of operative levels did not significantly influence the incidence of

  16. Effect of steroid use in anterior cervical discectomy and fusion: a randomized controlled trial.

    PubMed

    Jeyamohan, Shiveindra B; Kenning, Tyler J; Petronis, Karen A; Feustel, Paul J; Drazin, Doniel; DiRisio, Darryl J

    2015-08-01

    OBJECT Anterior cervical discectomy and fusion (ACDF) is an effective procedure for the treatment of cervical radiculopathy and/or myelopathy; however, postoperative dysphagia is a significant concern. Dexamethasone, although potentially protective against perioperative dysphagia and airway compromise, could inhibit fusion, a generally proinflammatory process. The authors conducted a prospective, randomized, double-blinded, controlled study of the effects of steroids on swallowing, the airway, and arthrodesis related to multilevel anterior cervical reconstruction in patients who were undergoing ACDF at Albany Medical Center between 2008 and 2012. The objective of this study was to determine if perioperative steroid use improves perioperative dysphagia and airway edema. METHODS A total of 112 patients were enrolled and randomly assigned to receive saline or dexamethasone. Data gathered included demographics, functional status (including modified Japanese Orthopaedic Association myelopathy score, neck disability index, 12-Item Short-Form Health Survey score, and patient-reported visual analog scale score of axial and radiating pain), functional outcome swallowing scale score, interval postoperative imaging, fusion status, and complications/reoperations. Follow-up was performed at 1, 3, 6, 12, and 24 months, and CT was performed 6, 12, and 24 months after surgery for fusion assessment. RESULTS Baseline demographics were not significantly different between the 2 groups, indicating adequate randomization. In terms of patient-reported functional and pain-related outcomes, there were no differences in the steroid and placebo groups. However, the severity of dysphagia in the postoperative period up to 1 month proved to be significantly lower in the steroid group than in the placebo group (p = 0.027). Furthermore, airway difficulty and a need for intubation trended toward significance in the placebo group (p = 0.057). Last, fusion rates at 6 months proved to be

  17. Altered activity of the serratus anterior during unilateral arm elevation in patients with cervical disorders.

    PubMed

    Helgadottir, H; Kristjansson, E; Einarsson, E; Karduna, A; Jonsson, H

    2011-12-01

    Altered activity in the axioscapular muscles is considered to be an important feature in patients with neck pain. The activity of the serratus anterior (SA) and trapezius muscles during arm elevation has not been investigated in these patients. The objectives of this study was to investigate whether there is a pattern of altered activity in the SA and trapezius in patients with insidious onset neck pain (IONP) (n=22) and whiplash associated disorders (WAD) (n=27). An asymptomatic group was selected for baseline measurements (n=23). Surface electromyography was used to measure the onset of muscle activation and duration of muscle activity of the SA as well as the upper, middle, and lower trapezius during unilateral arm elevation in the three subject groups. Both arms were tested. With no interaction, the main effect for the onset of muscle activation and duration of muscle activity for serratus anterior was statistically significant among the groups. Post hoc comparison revealed a significantly delayed onset of muscle activation and less duration of muscle activity in the IONP group, and in the WAD group compared to the asymptomatic group. There were no group main effects or interaction effects for upper, middle and lower trapezius. This finding may have implications for scapular stability in these patients because the altered activity in the SA may reflect inconsistent or poorly coordinated muscle activation that may reduce the quality of neuromuscular performance and induce an increased load on the cervical and the thoracic spine.

  18. Measuring Surgical Outcomes in Cervical Spondylotic Myelopathy Patients Undergoing Anterior Cervical Discectomy and Fusion: Assessment of Minimum Clinically Important Difference

    PubMed Central

    Auffinger, Brenda M.; Lall, Rishi R.; Dahdaleh, Nader S.; Wong, Albert P.; Lam, Sandi K.; Koski, Tyler; Fessler, Richard G.; Smith, Zachary A.

    2013-01-01

    Object The concept of minimum clinically important difference (MCID) has been used to measure the threshold by which the effect of a specific treatment can be considered clinically meaningful. MCID has previously been studied in surgical patients, however few studies have assessed its role in spinal surgery. The goal of this study was to assess the role of MCID in patients undergoing anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy (CSM). Methods Data was collected on 30 patients who underwent ACDF for CSM between 2007 and 2012. Preoperative and 1-year postoperative Neck Disability Index (NDI), Visual-Analog Scale (VAS), and Short Form-36 (SF-36) Physical (PCS) and Mental (MCS) Component Summary PRO scores were collected. Five distribution- and anchor-based approaches were used to calculate MCID threshold values average change, change difference, receiver operating characteristic curve (ROC), minimum detectable change (MDC) and standard error of measurement (SEM). The Health Transition Item of the SF-36 (HTI) was used as an external anchor. Results Patients had a significant improvement in all mean physical PRO scores postoperatively (p<0.01) NDI (29.24 to 14.82), VAS (5.06 to 1.72), and PCS (36.98 to 44.22). The five MCID approaches yielded a range of values for each PRO: 2.00–8.78 for PCS, 2.06–5.73 for MCS, 4.83–13.39 for NDI, and 0.36–3.11 for VAS. PCS was the most representative PRO measure, presenting the greatest area under the ROC curve (0.94). MDC values were not affected by the choice of anchor and their threshold of improvement was statistically greater than the chance of error from unimproved patients. Conclusion SF-36 PCS was the most representative PRO measure. MDC appears to be the most appropriate MCID method. When MDC was applied together with HTI anchor, the MCID thresholds were: 13.39 for NDI, 3.11 for VAS, 5.56 for PCS and 5.73 for MCS. PMID:23826290

  19. Is there a need for cervical collar usage post anterior cervical decompression and fusion using interbody cages? A randomized controlled pilot trial.

    PubMed

    Abbott, Allan; Halvorsen, Marie; Dedering, Asa

    2013-05-01

    Anterior cervical discectomy and fusion (ACDF) is a common surgical intervention for radiculopathy resulting from degenerative cervical spine conditions. Post-surgical cervical collar use is believed to reduce post-operative pain, provide the patient with a sense of security during activities of daily living and even reduce rates of non-fusion. This prospective randomized controlled pilot trial investigates trial design feasibility in relation to prospective physical, functional, and quality of life-related outcomes of patients undergoing ACDF with interbody cage, with (n = 17) and without (n = 16) post-operative cervical collar usage. Results show that the sample provides sufficient statistical power to show that the use of a rigid cervical collar during 6 post-operative weeks is associated with significantly lower levels of neck disability index after 6 weeks and significantly lower levels of prospective neck pain. To investigate causal quality of life or fusion rate outcomes, sample size needs to be increased at least fourfold and optimally sixfold when accounting for data loss in prospective follow-up. The study suggests that post-surgical cervical collar usage may help certain patients cope with initial post-operative pain and disability.

  20. Surgical Outcome of a Zero-profile Device Comparing with Stand-alone Cage and Anterior Cervical Plate with Iliac Bone Graft in the Anterior Cervical Discectomy and Fusion

    PubMed Central

    Shin, Jae Sik; Cho, Pyoung Goo

    2014-01-01

    Objective A Zero-profile device is a cervical stand-alone cage with integrated segmental fixation device. We characteristically evaluated the radiological changes as well as clinical outcomes in the application of Zero-profile devices compared with stand-alone cages and anterior cervical plates with iliac bone grafts for the cervical disease. Methods Retrospectively, total 60 patients at least more than one year follow-up were enrolled. Twenty patients were treated with Zero-profile devices (Group A), twenty patients with stand-alone cages (Group B) and twenty patients with anterior cervical plates and iliac bone grafts (Group C) for a single level cervical disease. The clinical outcomes were evaluated by Odom's criteria and Bazaz-Yoo dysphagia index. The radiologic parameters were by subsidence and the changes of the midpoint interbody height (IBH), the segmental kyphotic angle (SKA), the overall kyphotic angle (OKA) in index level. Results Although there was no significant clinical difference according to the Odom's criteria among them(p=0.766), post-operative dysphagia was significantly decreased in the Group A and B compared with the Group C (p=0.04). From the immediate postoperative to the last follow-up time, the mean change of IBH decrement and SKA increment were significant in the Group B compared with the Group A (p=0.025, p=0.033) and the Group C (p=0.001, p=0.000). The subsidence rate was not significant among all groups (p=0.338). Conclusion This Zero-profile device is a valuable alternative to the anterior cervical discectomy and fusion with a low incidence of postoperative dysphagia and without segmental kyphotic change. PMID:25346764

  1. Long-term magnetic resonance imaging evaluation of bioresorbable anterior cervical plate resorption following fusion for degenerative and traumatic disk disruption.

    PubMed

    Vaccaro, Alexander R; Sahni, Deshdeepak; Pahl, Michael A; Harrop, James S; Sharan, Ashwini D; Venger, Benjamin H; Haid, Regis W; Carrino, John A; Vadera, Sumeet; Hilibrand, Alan S; Albert, Todd J

    2006-08-15

    A retrospective magnetic resonance imaging (MRI) review of a series of patients who underwent a single-level anterior cervical discectomy and fusion followed by anterior plate stabilization using an anterior cervical resorbable mesh plate and screw system. MRI evaluation of the long-term implant resorption properties of a bioresorbable anterior cervical plate and the adjacent peri-implant soft tissue environment. The use of bioresorbable anterior cervical plates for immediate cervical stabilization following an anterior cervical discectomy and fusion presents several distinct advantages over metallic instrumentation. Bioresorbable polymers may diminish, by their resorbability, implant-related complications such as loosening, migration, and failure of instrumentation, as well as stress shielding of the underlying fusion. Information on the intermediate and long-term bony and soft tissue reaction to the resorption byproducts of these biomaterials is limited. There were 9 consecutive patients who underwent single-level anterior cervical decompression and fusion using allograft cortical bone, followed by bioresorbable polylactide anterior mesh plate and screw fixation. Following institutional review board approval, 5 of the 9 patients agreed to postoperative MRI assessment of the peri-implant area. An independent radiologist then characterized implant degradation, and the presence of soft tissue inflammation and swelling during the resorption phase of the bioresorbable plate. At an average follow-up of 32 months, MRI assessment showed no evidence of soft tissue swelling or inflammation related to the resorption of a bioresorbable anterior plate in any of the 5 patients. In addition, none of the patients complained of any dysphagia or phonation difficulties. Based on MRI assessment, these devices, at more than 2-year follow-up, did not indicate any local chronic inflammation or swelling resulting from their degradation. Clinical symptoms of dysphagia or dysarthria, a

  2. [Early and one-stage posterior-anterior surgery for fresh and severe lower cervical spine fracture and dislocation].

    PubMed

    Duan, Chunyue; Hu, Jianzhong; Wang, Xiyang; Wu, Jianhuang

    2016-08-01

    To explore the clinical value of early and one-stage posterior laminectomy decompression, fracture reconstruction and lateral mess screw fixation combined with anterior cervical corpectomy or discectomy for the treatment of fresh and severe lower cervical spine fracture and dislocation.
 A total of 156 consecutive cases of severe fracture and dislocation of lower cervical spine were reviewed from January 2008 to January 2015. Skull traction was installed when the patients were enrolled in the hospital, so the operation was performed as early as possible. Firstly, the posterior procedure was applied to the patients prone on a frame. A standard posterior laminectomy, fixation and fusion were performed with lateral mass screws and rods. The cervical spine reconstruction was achieved by laminecomy, partially facetectomy, leverage and distraction. The technique of rotating rod was applied to recover the sequence of the cervical and keep or increase the zygopophysis and lordosis of the cervical on the sagittal plane. After the skull traction removed, a standard anterior approach to the cervical spine was initiated as the second stage of the procedure. Anterior cervical corpectomy or discectomy, spinal cord decompression, antograft and cervical spine auto-locking plate fixation were carried out. The stability, the fusion rate of the injured segments and spinal cord decompression were observed on the regular postoperative X-ray film and CT scan. The function of the spinal cord was evaluated by American Spinal Injury Association (ASIA) classification.
 A total of 137 cases were followed-up, 19 failed to follow-up and 8 of them were due to death. The follow-up time was from 9.0 months to 35.0 months (mean: 13.7 months). All patients got completely reduction of the cervical spine. The injured segments were stable. There was no patient of bone graft no-fusion. The cervical intervertebral height and lordosis were reconstructed and maintained and all grafts were fused at the

  3. [Bisegmental anterior interbody spondylodesis, using rigid plates, in surgical treatment of cervical vertebral column traumas and diseases].

    PubMed

    Barysh, A E; Kozyrev, S A

    2015-02-01

    Results of surgical treatment of 34 patients, suffering cervical vertebral column traumas and diseases, are analyzed. In all the patients bisegmental anterior interbody spondylodesis was conducted, using cervical rigid plates and vertical cylindrical net implants. The existing and newly obtained information about changes in the radiological indices dynamics while the method application by its authors is presented. The interbody synostosis was achieved in 82.4% patients in 1 yr after the operation. The complications rate while the implants application have constituted 23.3%, and the total rate of complications--29.1%.

  4. Modified transpedicular approach for the surgical treatment of severe thoracolumbar or lumbar burst fractures.

    PubMed

    Kaya, Ramazan Alper; Aydin, Yunus

    2004-01-01

    showed neurological improvement. The percent of ambulatory patients was 71.4% 6 months after the operation. The major complications included pseudarthrosis in five patients (17.8%), epidural hematoma in one (3.5%) and inadequate decompression in one (3.5%). These patients were reoperated on by means of an anterior approach. Of the five pseudarthrosis cases, two were the result of infection. Although anterior vertebrectomy and fusion is generally recommended for burst fractures causing canal compromise, in these patients adequate neural canal decompression can also be achieved by a modified transpedicular approach less invasively.

  5. Use of Piezosurgery for removal of retrovertebral body osteophytes in anterior cervical discectomy.

    PubMed

    Grauvogel, Juergen; Scheiwe, Christian; Kaminsky, Jan

    2014-04-01

    The relatively new technique of Piezosurgery is based on microvibrations, generated by the piezoelectrical effect, which results in selective bone cutting with preservation of adjacent soft tissue. To study the applicability of Piezosurgery in anterior cervical discectomy with fusion (ACDF) surgery. Prospective clinical study at the neurosurgical department of the University of Freiburg, Germany. Nine patients with cervical disc herniation and retrovertebral osteophytes who underwent ACDF surgery. Piezosurgery was evaluated with respect to practicability, safety, preciseness of bone cutting, and preservation of adjacent neurovascular tissue. Pre- and postoperative clinical and radiological data were assessed. Piezosurgery was supportively used in ACDF in nine patients with either radiculopathy or myelopathy from disc herniation or ventral osteophytes. After discectomy, osteophytes were removed with Piezosurgery to decompress the spinal canal and the foramina. Angled inserts were used, allowing for cutting even retrovertebral osteophytes. In all nine cases, Piezosurgery cut bone selectively with no damage to nerve roots, dura, or posterior longitudinal ligament. None of the patients experienced any new neurological deficit after the operation. The handling of the instrument was safe and the cut precise. Osteophytic spurs, even retrovertebral ones that generally only can be approached via corpectomies, could be safely removed because of the angled inserts through the disc space. Currently, a slightly prolonged operation time was observed for Piezosurgery. Furthermore, the design of the handpiece could be further improved to facilitate the intraoperative handling in ACDF. Piezosurgery proved to be a useful and safe technique for selective bone cutting and removal of osteophytes with preservation of neuronal and soft tissue in ACDF. In particular, the angled inserts were effective in cutting bone spurs behind the adjacent vertebra which cannot be reached with

  6. Vertebral Distraction during Anterior Cervical Discectomy and Fusion Causes Postoperative Neck Pain.

    PubMed

    Ha, Seung Man; Kim, Jeong Hoon; Oh, Seung Hun; Song, Ji Hwan; Kim, Hyoung Ihl; Shin, Dong Ah

    2013-05-01

    Vertebral distraction is routinely performed during anterior cervical discectomy and fusion (ACDF). Overdistraction can injure the facet joints and may cause postoperative neck pain consequently. The purpose of this study was to investigate the clinical relevance of distraction force during ACDF. This study included 24 consecutive patients with single level cervical disc disease undergoing single level ACDF. We measure the maximum torque just before the the arm of the Caspar retractor was suspended by the rachet mechanism by turning the lever on the movable arm using a torque meter. In order to turn the lever using the torque driver, we made a linear groove on the top of the lever. We compared the neck disability index (NDI) and visual analogue scale (VAS) scores between the high torque group (distraction force>6 kgf·cm) and the low torque group (distraction force≤6 kgf·cm) at routine postoperative intervals of 1, 3, 5 days and 1, 3, 6 months. The VAS scores for posterior neck pain had a linear correlation with torque at postoperative 1st and 3rd days (y=0.99×-1.1, r(2)=0.82; y=0.77×-0.63, r(2)=0.73, respectively). VAS scores for posterior neck pain were lower in the low torque group than in the high torque group on both 1 and 3 days postoperatively (3.1±1.3, 2.6±1.0 compared with 6.0±0.6, 4.9±0.8, p<0.01). However, the difference in NDI scores was not statistically significant in all postoperative periods. Vertebral distraction may cause posterior neck pain in the immediate postoperative days. We recommend not to distract the intervertebral disc space excessively with a force of more than 6.0 kgf·cm.

  7. Developing an anterior cervical diskectomy and fusion simulator for neurosurgical resident training.

    PubMed

    Ray, Wilson Z; Ganju, Aruna; Harrop, James S; Hoh, Daniel J

    2013-10-01

    Surgical simulators are useful in many surgical disciplines to augment residency training. Duty hour restrictions and increasing emphasis on patient safety and attending oversight have changed neurosurgical education from the traditional apprenticeship model. The Congress of Neurological Surgeons Simulation Committee has been developing neurosurgical simulators for the purpose of enhancing resident education and assessing proficiency. To review the initial experience with an anterior cervical diskectomy and fusion (ACDF) simulator. The first ACDF training module was implemented at the 2012 Congress of Neurological Surgeons Annual Meeting. The 90-minute curriculum included a written pretest, didactics, a practical pretest on the simulator, hands-on training, a written posttest, a practical posttest, and postcourse feedback. Didactic material covered clinical indications for ACDF, comparison with other cervical procedures, surgical anatomy and approach, principles of arthrodesis and spinal fixation, and complication management. Written pretests and posttests were administered to assess baseline knowledge and evidence of improvement after the module. Qualitative evaluation of individual performance on the practical (simulator) portion was included. Three neurosurgery residents, 2 senior medical students, and 1 attending neurosurgeon participated in the course. The pretest scores were an average 9.2 (range, 6-13). Posttest scores improved to 11.0 (range, 9-13; P = .03). Initial experience with the ACDF simulator suggests that it may represent a meaningful training module for residents. Simulation will be an important training modality for residents to practice surgical technique and for teachers to assess competency. Further development of an ACDF simulator and didactic curriculum will require additional verification of simulator validity and reliability.

  8. Investigation of clinically important benefit of anterior cervical decompression and fusion

    PubMed Central

    2006-01-01

    The objectives of the prospective randomized study are to investigate the clinically relevant change after anterior cervical decompression and fusion (ACDF) using measures of pain intensity (visual analog scale, VAS) and neck disability index (NDI). And to determine the number of subjects showing persistent pain and disability at 6-year follow-up. To investigate the possibility of differences in outcome between ACDF with the cervical intervertebral fusion cage (CIFC) and the Cloward procedure (CP). Clinically relevant change and residual, postoperative pain intensity and disability after ACDF have been investigated a little. Ninety-five patients with neck and radicular arm pain lasting for at least 6 months were randomly selected to receive ACDF with the CP or the CIFC. Questionnaires concerning pain and NDI were obtained from 83 patients (87%) at a mean follow-up time of 76 months (range 56–94 months). When evaluating clinical benefits regarding pain intensity 6 years after ACDF, according to different cut-off points and relative percentages, symptoms improved in 46–78% of patients. Improvement in NDI was seen in 18–20% of patients. Approximately 70% of the patients had persistent pain and disability at 6-year follow-up. There was no clinically important difference following CP versus CIFC. Thirty millimeter and 20% in pain intensity and NDI, respectively, are reasonable criteria to suggest a clinically relevant change after ACDF. Before patients undergo ACDF, they should be informed that they have an approximate 50% probability of achieving pain relief and little probability of functional improvement. The findings demonstrate that there is poor evidence for difference between CIFC and CP. PMID:17143633

  9. Vertebral Distraction during Anterior Cervical Discectomy and Fusion Causes Postoperative Neck Pain

    PubMed Central

    Ha, Seung Man; Kim, Jeong Hoon; Oh, Seung Hun; Song, Ji Hwan; Kim, Hyoung Ihl

    2013-01-01

    Objective Vertebral distraction is routinely performed during anterior cervical discectomy and fusion (ACDF). Overdistraction can injure the facet joints and may cause postoperative neck pain consequently. The purpose of this study was to investigate the clinical relevance of distraction force during ACDF. Methods This study included 24 consecutive patients with single level cervical disc disease undergoing single level ACDF. We measure the maximum torque just before the the arm of the Caspar retractor was suspended by the rachet mechanism by turning the lever on the movable arm using a torque meter. In order to turn the lever using the torque driver, we made a linear groove on the top of the lever. We compared the neck disability index (NDI) and visual analogue scale (VAS) scores between the high torque group (distraction force>6 kgf·cm) and the low torque group (distraction force≤6 kgf·cm) at routine postoperative intervals of 1, 3, 5 days and 1, 3, 6 months. Results The VAS scores for posterior neck pain had a linear correlation with torque at postoperative 1st and 3rd days (y=0.99×-1.1, r2=0.82; y=0.77×-0.63, r2=0.73, respectively). VAS scores for posterior neck pain were lower in the low torque group than in the high torque group on both 1 and 3 days postoperatively (3.1±1.3, 2.6±1.0 compared with 6.0±0.6, 4.9±0.8, p<0.01). However, the difference in NDI scores was not statistically significant in all postoperative periods. Conclusion Vertebral distraction may cause posterior neck pain in the immediate postoperative days. We recommend not to distract the intervertebral disc space excessively with a force of more than 6.0 kgf·cm. PMID:23908702

  10. Volume-Outcome Relationship After 1 and 2 Level Anterior Cervical Discectomy and Fusion.

    PubMed

    De la Garza Ramos, Rafael; Nakhla, Jonathan; Nasser, Rani; Jada, Ajit; Bhashyam, Niketh; Kinon, Merritt D; Yassari, Reza

    2017-09-01

    To investigate the effects of surgeon volume on inpatient morbidity after 1- and 2-level anterior cervical discectomy and fusion (ACDF). Data from the Nationwide Inpatient Sample from 2009 were extracted. All adult patients who underwent an elective 1- or 2-level ACDF for degenerative cervical spine disease were identified. Surgeon volume was analyzed as a continuous and categorical variable: very low (<12 procedures per year), low (12-23 procedures per year), medium (24-35 procedures per year), high (36-47 procedures per year), and very high (≥48 procedures per year). A multivariate logistical regression analysis was performed to calculate the adjusted odds ratios of overall in-hospital and surgical complication occurrence in relation to surgeon volume. Eleven thousand two hundred forty-nine admissions were analyzed. The overall complication rate was 4.7%, and the surgical complication rate was 1.2%. Following regression analysis, increasing surgeon volume (evaluated continuously) was independently associated with lower odds of overall complication (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98-0.99; P < 0.001) and surgical complication development (OR, 0.98; 95% CI, 0.97-0.99; P = 0.004). Surgeons with very high volume (performing 48 or more procedures per year; 4 or more per month) showed a significant decrease in overall complications (OR, 0.58; 95% CI, 0.41-0.84; P = 0.003) and surgical complications (OR, 0.52; 95% CI, 0.25-0.99; P = 0.041) when compared to surgeons with very low volume. In this study, increasing surgeon volume was independently associated with significantly lower odds of perioperative complications following 1- and 2-level ACDF. Performing 4 or more procedures per month was associated with the lowest complication rate. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion.

    PubMed

    De la Garza-Ramos, Rafael; Xu, Risheng; Ramhmdani, Seba; Kosztowski, Thomas; Bydon, Mohamad; Sciubba, Daniel M; Wolinsky, Jean-Paul; Witham, Timothy F; Gokaslan, Ziya L; Bydon, Ali

    2016-06-01

    OBJECTIVE The purpose of this study was to report the long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion (ACDF). METHODS A retrospective review of all adult neurosurgical patients undergoing elective ACDF for degenerative disease at a single institution between 1996 and 2013 was performed. Patients who underwent first-time 3- or 4-level ACDF were included; patients with previous cervical spine surgery, those undergoing anterior/posterior approaches, and those with corpectomy were excluded. Outcome measures included perioperative complication rates, fusion rates, need for revision surgery, Nurick Scores, Odom's criteria, symptom resolution, neck visual analog scale (VAS) pain score, and persistent narcotics usage. RESULTS Seventy-one patients who underwent 3-level ACDF and 26 patients who underwent 4-level ACDF were identified and followed for an average of 7.6 ± 4.2 years. There was 1 case (3.9%) of deep wound infection in the 4-level group and 1 case in the 3-level group (1.4%; p = 0.454). Postoperatively, 31% of patients in the 4-level group complained of dysphagia, compared with 12.7% in the 3-level group (p = 0.038). The fusion rate was 84.6% after 4-level ACDF and 94.4% after 3-level ACDF (p = 0.122). At last follow-up, a significantly higher proportion of patients in the 4-level group continued to have axial neck pain (53.8%) than in the 3-level group (31%; p = 0.039); the daily oral morphine equivalent dose was significantly higher in the 4-level group (143 ± 97 mg/day) than in the 3-level group (25 ± 10 mg/day; p = 0.030). Outcomes based on Odom's criteria were also different between cohorts (p = 0.044), with a significantly lower proportion of patients in the 4-level ACDF group experiencing an excellent/good outcome. CONCLUSIONS In this study, patients who underwent 4-level ACDF had significantly higher rates of dysphagia, postoperative neck pain, and postoperative narcotic usage when compared with patients who

  12. Bilateral posterior cervical cages provide biomechanical stability: assessment of stand-alone and supplemental fixation for anterior cervical discectomy and fusion

    PubMed Central

    Voronov, Leonard I; Siemionow, Krzysztof B; Havey, Robert M; Carandang, Gerard; Phillips, Frank M; Patwardhan, Avinash G

    2016-01-01

    Introduction Supplemental posterior instrumentation has been widely used to enhance stability and improve fusion rates in higher risk patients undergoing anterior cervical discectomy and fusion (ACDF). These typically involve posterior lateral mass or pedicle screw fixation with significant inherent risks and morbidities. More recently, cervical cages placed bilaterally between the facet joints (posterior cervical cages) have been used as a less disruptive alternative for posterior fixation. The purpose of this study was to compare the stability achieved by both posterior cages and ACDF at a single motion segment and determine the stability achieved with posterior cervical cages used as an adjunct to single- and multilevel ACDF. Methods Seven cadaveric cervical spine (C2–T1) specimens were tested in the following sequence: intact, C5–C6 bilateral posterior cages, C6–C7 plated ACDF with and without posterior cages, and C3–C5 plated ACDF with and without posterior cages. Range of motion in flexion–extension, lateral bending, and axial rotation was measured for each condition under moment loading up to ±1.5 Nm. Results All fusion constructs significantly reduced the range of motion compared to intact in flexion–extension, lateral bending, and axial rotation (P<0.05). Similar stability was achieved with bilateral posterior cages and plated ACDF at a single level. Posterior cages, when placed as an adjunct to ACDF, further reduced range of motion in both single- and multilevel constructs (P<0.05). Conclusion The biomechanical effectiveness of bilateral posterior cages in limiting cervical segmental motion is comparable to single-level plated ACDF. Furthermore, supplementation of single- and multilevel ACDF with posterior cervical cages provided a significant increase in stability and therefore may be a potential, minimally disruptive option for supplemental fixation for improving ACDF fusion rates. PMID:27471414

  13. Usefulness of polyetheretherketone (PEEK) cage with plate augmentation for anterior arthrodesis in traumatic cervical spine injury.

    PubMed

    Song, Kyung-Jin; Choi, Byung-Wan; Kim, Gyu-Hyung; Song, Ji-Hun

    2010-01-01

    Even though many clinical reports about cages have been documented in patients with degenerative disorders, reports were scarce for traumatic injury cases, and those cases using metal cages were restricted to only one-level injury. To evaluate the usefulness of polyetheretherketone (PEEK) cage and plate construction in anterior interbody fusions (AIF) for traumatic cervical spine injuries by analyzing radiographic changes and clinical outcomes. Retrospective study. Fifty-eight patients (91 levels) underwent cage and plate construction for treatment of traumatic cervical spine injury. The fusion rate, fusion time, changes of Cobb angle, subsidence rate, and adjacent level changes were assessed as a radiographic outcome. Clinical analysis includes the recovery rate on the American Spinal Injury Association (ASIA) impairment scale and the presence of the complications. We evaluated 58 patients (91 levels) who underwent surgery and had at least 24 months in follow-up study. Radiographic evaluation included the assessment of interbody fusion rate, fusion time, changes of Cobb angle, subsidence rate, and adjacent level changes. Clinical assessment was done by analyzing recovery state of ASIA impairment scale from preoperative period to the last follow-up and by evaluating complications. Fifty-four cases showed bony fusion within 3 months after the surgery. The mean Cobb angle between the vertebral bodies was 2.54 degrees before operation, 9.13 degrees after operation, and 8.39 degrees at the latest follow-up. The mean intervertebral disc height was increased by 3.01 mm after the operation, but the mean height was 2.17 mm shorter at the last follow-up than after postoperation. In terms of clinical results, five Grade A cases and one Grade B case as assessed by the ASIA impairment scale were unchanged until the last follow-up. Twenty-three cases of Grade C, 16 cases of Grade D, and 13 cases of Grade E improved to seven cases, 26 cases, and 19 cases, respectively. Three

  14. The Effect of Uncinate Process Resection on Subsidence Following Anterior Cervical Discectomy and Fusion

    PubMed Central

    Lee, Su Hun; Lee, Jun Seok; Sung, Soon Ki; Son, Dong Wuk; Lee, Sang Weon; Song, Geun Sung

    2017-01-01

    Objective Subsidence is a frequent complication of anterior cervical discectomy and fusion. Postoperative segmental micro-motion, thought to be a causative factor of subsidence, has been speculated to increase with uncinate process resection area (UPR). To evaluate the effect of UPR on micro-motion, we designed a method to measure UPR area based on pre- and postoperative computed tomography images and analyzed the relationship between UPR and subsidence as a proxy of micro-motion. Methods We retrospectively collected clinical and radiological data from January 2011 to June 2016. A total of 38 patients (53 segments) were included. All procedures included bilateral UPR and anterior plate fixation. UPR area was evaluated with reformatted coronal computer tomography images. To reduce level-related bias, we converted UPR area to the proportion of UPR to the pre-operative UP area (pUPR). Results Subsidence occurred in 18 segments (34%) and positively correlated with right-side pUPR, left-side pUPR, and the sum of bilateral pUPR (sum pUPR) (R=0.310, 301, 364; p=0.024, 0.029, 0.007, respectively). Multiple linear regression analysis revealed that subsidence could be estimated with the following formula: subsidence=1.522+2.7×sum pUPR (R2=0.133, p=0.007). Receiver-operating characteristic analysis determined that sum pUPR≥0.38 could serve as a threshold for significantly increased risk of subsidence (p=0.005, area under curve=0.737, sensitivity=94%, specificity=51%). This threshold was confirmed by logistic regression analysis for subsidence (p=0.009, odds ratio=8.471). Conclusion The UPR measurement method confirmed that UPR was correlated with subsidence. Particularly when the sum of pUPR is ≥38%, the possibility of subsidence increased. PMID:28881118

  15. The Effect of Uncinate Process Resection on Subsidence Following Anterior Cervical Discectomy and Fusion.

    PubMed

    Lee, Su Hun; Lee, Jun Seok; Sung, Soon Ki; Son, Dong Wuk; Lee, Sang Weon; Song, Geun Sung

    2017-09-01

    Subsidence is a frequent complication of anterior cervical discectomy and fusion. Postoperative segmental micro-motion, thought to be a causative factor of subsidence, has been speculated to increase with uncinate process resection area (UPR). To evaluate the effect of UPR on micro-motion, we designed a method to measure UPR area based on pre- and postoperative computed tomography images and analyzed the relationship between UPR and subsidence as a proxy of micro-motion. We retrospectively collected clinical and radiological data from January 2011 to June 2016. A total of 38 patients (53 segments) were included. All procedures included bilateral UPR and anterior plate fixation. UPR area was evaluated with reformatted coronal computer tomography images. To reduce level-related bias, we converted UPR area to the proportion of UPR to the pre-operative UP area (pUPR). Subsidence occurred in 18 segments (34%) and positively correlated with right-side pUPR, left-side pUPR, and the sum of bilateral pUPR (sum pUPR) (R=0.310, 301, 364; p=0.024, 0.029, 0.007, respectively). Multiple linear regression analysis revealed that subsidence could be estimated with the following formula: subsidence=1.522+2.7×sum pUPR (R2=0.133, p=0.007). Receiver-operating characteristic analysis determined that sum pUPR≥0.38 could serve as a threshold for significantly increased risk of subsidence (p=0.005, area under curve=0.737, sensitivity=94%, specificity=51%). This threshold was confirmed by logistic regression analysis for subsidence (p=0.009, odds ratio=8.471). The UPR measurement method confirmed that UPR was correlated with subsidence. Particularly when the sum of pUPR is ≥38%, the possibility of subsidence increased.

  16. Risk factors for postoperative subsidence of single-level anterior cervical discectomy and fusion: the significance of the preoperative cervical alignment.

    PubMed

    Lee, Young-Seok; Kim, Young-Baeg; Park, Seung-Won

    2014-07-15

    Retrospective cohort study. To investigate and analyze the preoperative risk factors affecting subsidence after anterior cervical discectomy and fusion (ACDF) to reduce subsidence. Subsidence after ACDF may be caused by various risk factors, although the related information is scarce. Seventy-eight patients who underwent single-level ACDF between 2005 and 2011 were included. Patients were categorized into the subsidence (n = 26) and nonsubsidence groups (n = 52). Preoperative factors such as age, sex, operative level, bone mineral density, cervical alignment, segmental sagittal angle, and anterior/posterior disc height were assessed. The use of plates and the anterior/posterior disc height gap were examined as perioperative factors. The clinical outcome was assessed using a visual analogue scale for neck and arm pain. Subsidence occurred in 26 (33.3%) of 78 patients. A significant difference was found in clinical outcomes between the subsidence and nonsubsidence groups (P < 0.05). The fusion rate was 61.5% in the subsidence group. The mean time to subsidence was 4.8 months. Logistic regression analysis revealed that cervical alignment (P = 0.017), age (P = 0.022), and use of plates (P = 0.041) affected subsidence. In patients who received a stand-alone cage, the risk of subsidence was significantly greater in the kyphotic angle group than in the lordotic angle group (odds ratio = 13.56; P < 0.001). After ACDF, the main factors affecting subsidence are cervical alignment, age, and use of plates. Our data suggest that surgeons should consider the kyphotic curvature and/or age when deciding on the use of plates.

  17. A rare cause of dysphagia: compression of the esophagus by an anterior cervical osteophyte due to ankylosing spondylitis.

    PubMed

    Albayrak, Ilknur; Bağcacı, Sinan; Sallı, Ali; Kucuksen, Sami; Uğurlu, Hatice

    2013-09-01

    Ankylosing spondylitis (AS) is a chronic inflammatory rheumatological disease affecting the axial skeleton with various extra-articular complications. Dysphagia due to a giant anterior osteophyte of the cervical spine in AS is extremely rare. We present a 48-year-old male with AS suffering from progressive dysphagia to soft foods and liquids. Esophagography showed an anterior osteophyte at C5-C6 resulting in esophageal compression. The patient refused surgical resection of the osteophyte and received conservative therapy. However, after 6 months there was no improvement in dysphagia. This case illustrates that a large cervical osteophyte may be the cause of dysphagia in patients with AS and should be included in the diagnostic workup in early stages of the disease.

  18. Efficacy of PEEK Cages and Plate Augmentation in Three-Level Anterior Cervical Fusion of Elderly Patients

    PubMed Central

    Song, Kyung Jin; Kim, Gyu Hyung

    2011-01-01

    Background To evaluate the clinical efficacy of three-level anterior cervical arthrodesis with polyethyletherketone (PEEK) cages and plate fixation for aged and osteoporotic patients with degenerative cervical spinal disorders. Methods Twenty one patients, who had undergone three-level anterior cervical arthrodesis with a cage and plate construct for degenerative cervical spinal disorder from November 2001 to April 2007 and were followed up for at least two years, were enrolled in this study. The mean age was 71.7 years and the mean T-score using the bone mineral density was -2.8 SD. The fusion rate, change in cervical lordosis, adjacent segment degeneration were analyzed by plain radiographs and computed tomography, and the complications were assessed by the medical records. The clinical outcomes were analyzed using the SF-36 physical composite score (PCS) and neck disability index (NDI). Results Radiological fusion was observed at a mean of 12.3 weeks (range, 10 to 15 weeks) after surgery. The average angle of cervical lordosis was 5° preoperatively, 17.6° postoperatively and 16.5° at the last follow-up. Degenerative changes in the adjacent segments occurred in 3 patients (14.3%), but revision surgery was unnecessary. In terms of instrument-related complications, there was cage subsidence in 5 patients (23.8%) with an average of 2.8 mm, and loosening of the plate and screw occurred in 3 patients (14.3%) but there were no clinical problems. The SF-36 PCS before surgery, second postoperative week and at the last follow-up was 29.5, 43.1, and 66.2, respectively. The respective NDI was 55.3, 24.6, and 15.9. Conclusions For aged and osteoporotic patients with degenerative cervical spinal disorders, three-level anterior cervical arthrodesis with PEEK cages and plate fixation reduced the pseudarthrosis and adjacent segment degeneration and improved the clinical outcomes. This method is considered to be a relatively safe and effective treatment modality. PMID:21369473

  19. Efficacy of PEEK cages and plate augmentation in three-level anterior cervical fusion of elderly patients.

    PubMed

    Song, Kyung Jin; Kim, Gyu Hyung; Choi, Byeong Yeol

    2011-03-01

    To evaluate the clinical efficacy of three-level anterior cervical arthrodesis with polyethyletherketone (PEEK) cages and plate fixation for aged and osteoporotic patients with degenerative cervical spinal disorders. Twenty one patients, who had undergone three-level anterior cervical arthrodesis with a cage and plate construct for degenerative cervical spinal disorder from November 2001 to April 2007 and were followed up for at least two years, were enrolled in this study. The mean age was 71.7 years and the mean T-score using the bone mineral density was -2.8 SD. The fusion rate, change in cervical lordosis, adjacent segment degeneration were analyzed by plain radiographs and computed tomography, and the complications were assessed by the medical records. The clinical outcomes were analyzed using the SF-36 physical composite score (PCS) and neck disability index (NDI). Radiological fusion was observed at a mean of 12.3 weeks (range, 10 to 15 weeks) after surgery. The average angle of cervical lordosis was 5° preoperatively, 17.6° postoperatively and 16.5° at the last follow-up. Degenerative changes in the adjacent segments occurred in 3 patients (14.3%), but revision surgery was unnecessary. In terms of instrument-related complications, there was cage subsidence in 5 patients (23.8%) with an average of 2.8 mm, and loosening of the plate and screw occurred in 3 patients (14.3%) but there were no clinical problems. The SF-36 PCS before surgery, second postoperative week and at the last follow-up was 29.5, 43.1, and 66.2, respectively. The respective NDI was 55.3, 24.6, and 15.9. For aged and osteoporotic patients with degenerative cervical spinal disorders, three-level anterior cervical arthrodesis with PEEK cages and plate fixation reduced the pseudarthrosis and adjacent segment degeneration and improved the clinical outcomes. This method is considered to be a relatively safe and effective treatment modality.

  20. Surgery for ventral intradural thoracic spinal tumors with a posterolateral transpedicular approach.

    PubMed

    Ito, Kiyoshi; Aoyama, Tatsuro; Miyaoka, Yoshinari; Seguchi, Tatsuya; Horiuchi, Tetsuyoshi; Hongo, Kazuhiro

    2016-08-01

    Surgery for ventrally seated thoracic tumors requires an anatomically specific approach that is distinct from cervical or lumbar spinal cord surgery as the narrower spinal canal of the thoracic spinal cord makes it sensitive to surgical procedures. However, reports describing this operative technique are few. To obtain a wide operative field and minimize thoracic spinal cord retraction, we employed a posterolateral transpedicular approach in ventral-located tumors and investigated the efficacy and limitations of this technique. Eighteen patients with lesions (meningioma or neurinoma) located in the ventral intradural thoracic region were surgically treated between 2009 and 2014. The relationship among the clinical outcome, tumor location, and postoperative spinal alignment was analyzed. Postoperative neurological function improved in all patients, namely those with meningioma (p = 0.012) and schwannoma (p = 0.018). One patient who underwent removal of two facet joints suffered a postoperative compression fracture. Removal of two facet joints and pedicles resulted in a worsening of spinal alignment (p = 0.03), while this was not the case for the removal of one facet joint and pedicle (p = 0.72). This case series clarified the benefits of the posterolateral transpedicular approach for resection of ventral intradural extramedullary tumors. Removal of one pedicle and facet joint seems to be more beneficial.

  1. Impact of subsidence on clinical outcomes and radiographic fusion rates in anterior cervical discectomy and fusion: a systematic review.

    PubMed

    Karikari, Isaac O; Jain, Deeptee; Owens, Timothy Ryan; Gottfried, Oren; Hodges, Tiffany R; Nimjee, Shahid M; Bagley, Carlos A

    2014-02-01

    Systematic review. To provide a systematic review of published literature on the impact of subsidence on clinical outcomes and radiographic fusion rates after anterior cervical discectomy and fusion with plates or without plates. Subsidence of interbody implants is common after anterior cervical spine fusions. The impact of subsidence on fusion rates and clinical outcomes is unknown. Systematic literature review on published articles on anterior cervical discectomy and fusion, which objectively measured graft subsidence, radiographic fusion rates, and clinical outcomes between April 1966 and December 2010. A total of 35 articles that measured subsidence and provided fusion rates and/or clinical outcomes were selected for inclusion. The mean subsidence rate ranged from 19.3% to 42.5%. The rate of subsidence based on the type of implant ranged from 22.8% to 35.9%. The incidence of subsidence was not impacted by the type of implant (P=0.98). The overall fusion rate of the combined studies was 92.8% and was not impacted by subsidence irrespective of subsidence definition or the measurement technique used (P=0.19). Clinical outcomes were evaluated in 27 of 35 studies with all studies reporting an improvement in patient outcomes postoperatively. Subsidence irrespective of the measurement technique or definition does not appear to have an impact on successful fusion and/or clinical outcomes. A validated definition and standard measurement technique for subsidence is needed to determine the actual incidence of subsidence and its impact on radiographic and clinical outcomes.

  2. Subsidence of Cylindrical Cage (AMSLU™ Cage) : Postoperative 1 Year Follow-up of the Cervical Anterior Interbody Fusion

    PubMed Central

    Joung, Young Il; Ko, Yong; Yi, Hyeong Joong; Lee, Seung Ku

    2007-01-01

    Objective There are numerous reports on the primary stabilizing effects of the different cervical cages for cervical radiculopathy. But, little is known about the subsidence which may be clinical problem postoperatively. The goal of this study is to evaluate subsidence of cage and investigate the correlation between radiologic subsidence and clinical outcome. Methods To assess possible subsidence, the authors investigated clinical and radiological results of the one-hundred patients who underwent anterior cervical fusion by using AMSLU™ cage during the period between January 2003 and June 2005. Preoperative and postoperative lateral radiographs were measured for height of intervertebral disc space where cages were placed. Intervertebral disc space was measured by dividing the sum of anterior, posterior, and midpoint interbody distance by 3. Follow-up time was 6 to 12 months. Subsidence was defined as any change in at least one of our parameters of at least 3 mm. Results Subsidence was found in 22 patients (22%). The mean value of subsidence was 2.21 mm, and mean subsidence rate was 22%. There were no cases of the clinical status deterioration during the follow-up period. No posterior or anterior migration was observed. Conclusion The phenomenon of subsidence is seen in substantial number of patients. Nevertheless, clinical and radiological results of the surgery were favorable. An excessive subsidence may result in hardware failure. Endplate preservation may enables us to control subsidence and reduce the number of complications. PMID:19096571

  3. Flap Reconstruction for Esophageal Perforation Complicating Anterior Cervical Spinal Fusion: An 18-year Experience

    PubMed Central

    Hanwright, Philip J.; Purnell, Chad A.

    2015-01-01

    Background: Esophageal injury following anterior cervical discectomy and fusion (ACDF) poses a significant reconstructive challenge. Buttressing flap repairs have proven beneficial; however, there remains a paucity of evidence to guide optimal flap selection. Methods: A retrospective chart review was performed for patients who presented to the senior author with esophageal perforations after ACDF from 1995 until present. Demographic, clinical, and postoperative details were collected. Outcomes of omental flap reconstructions were compared against other flap reconstructions. Results: A total of 13 flap reconstructions were performed in 11 patients with the following distribution: 7 free omental, 1 anterolateral thigh, 1 osteomuscular fibula, 2 radial forearm, and 2 pedicled pectoralis flaps. Patients receiving omental flap reconstructions demonstrated a significantly faster resolution of leak on contrast swallow imaging and earlier return to oral feeding compared with all other flap reconstructions (22.5 versus 268 days, respectively; P < 0.05). This relationship remained evident even when calculations excluded an outlying patient from the nonomental cohort (22.5 versus 111 days, respectively; P < 0.05). Length of hospital stay, complications, and success rates were also more favorable in the omental cohort but failed to reach statistical significance. Conclusions: Esophageal perforation after ACDF is an uncommon but devastating complication. The use of free omentum flap reconstruction is associated with a more rapid functional recovery and may prove beneficial in the management of these challenging cases. PMID:26090290

  4. Bilateral vocal cord edema following anterior cervical discectomy-usefulness of bonfils retromolar fiberscope.

    PubMed

    Kumar, V R Hemanth; Tripathy, D K; Sivashanmugam, T; Ravishankar, M

    2014-01-01

    We present a case of a 40-year-old male patient who presented to us with radicular pain in arm for anterior cervical discectomy with fusion. The preanesthetic checkup including indirect laryngoscopy was normal with routine investigations within normal limits. The patient was induced and intubated with the established routine technique without any obvious airway problems. Prophylactic dexamethasone was administered, and the intraoperative course was uneventful. Immediately after extubation, it was noticed that the patient had inspiratory stridor and whispered voice on the operation theater table itself. Assessment by Bonfils retromolar fiberscope under fentanyl sedation revealed bilateral vocal cord edema. The patient was re intubated and put on T piece with humidified O2. After 72-h, patient was extubated after confirming normal vocal cord movement under flexible fiberscope guidance. This case is presented to alert anesthesiologist about the possibility of vocal cord edema even though other potential airway complications are possible. We would also highlight the importance of Bonfils retromolar fiberscope in awake vocal cord examination and flexible fiberscope use in managing patients presenting with airway problems during extubation.

  5. Swallowing Function Defined by Videofluoroscopic Swallowing Studies after Anterior Cervical Discectomy and Fusion: a Prospective Study

    PubMed Central

    2016-01-01

    This study evaluated factors related to swallowing dysfunction after anterior cervical discectomy and fusion (ACDF) using videofluoroscopic swallowing studies (VFSS). Preoperative and postoperative VFSSs were done with 5 mL diluted barium. Oral transit time, pharyngeal delay time, pharyngeal response time (PRT), and pharyngeal transit time were measured. Hyoid bone movement and upper esophageal sphincter (UES) diameter were measured serially. Thickness of prevertebral soft tissue was measured from digitized VFSS images. In results, 12 of 20 patients showed abnormal postoperative VFSS findings. PRT decreased significantly after surgery. Hyoid bone movement did not change significantly after surgery. The maximal distance of UES opening decreased significantly after surgery, and the higher the level of surgery (C3 > C4 > C5 > C6), the greater the decrease in maximal distance of the UES opening after surgery. The time to widest opening of the UES was prolonged significantly. At the C3 and C4 levels, the change in prevertebral soft tissue thickness of patients with VFSS abnormalities was significantly greater than those without abnormalities. In conclusion, patients after ADCF with their highest surgery level at C3 and C4 showed more abnormal VFSS findings, significantly increased soft tissue thickness, and decreased maximal distance of UES opening. VFSS provided objective data related with swallowing dysfunction after ACDF. PMID:27822944

  6. Combined Anterior-Posterior Decompression and Fusion for Cervical Spondylotic Myelopathy.

    PubMed

    Bram, Richard; Fiore, Susan; Labiak, John J; Davis, Raphael P

    We conducted a study to evaluate the operative details, perioperative complications, and short-term outcomes associated with combined anterior-posterior decompression and fusion (CAPDF) for treating cervical spondylotic myelopathy (CSM). We retrospectively reviewed the charts of 21 patients who underwent CAPDF at our institution. Pertinent information, including demographics, surgery indication, perioperative complications, operative time, levels fused (and number of levels fused) anteriorly and posteriorly, estimated blood loss, and length of stay, was gathered. Outpatient follow-up data were available for 20 of the 21 patients, and postoperative neurologic status was evaluated with Nurick grades as well as by subjective means. Mean age was 62.1 years (range, 44-79 years). Of the 21 patients, 9 were female, and 12 were male. Before surgery, all patients had a diagnosis of CSM of varying degree. Mean number of levels fused was 2 (range, 1-3) anteriorly and 3 (range, 1-4) posteriorly. Mean operative time, which included patient repositioning, was 4 hours 55 minutes (range, 3:04-6:22). Mean estimated blood loss was 131 mL (range, 55-278 mL), and mean length of stay was 5 days (range, 2-10 days). The most commonly encountered complication was dysphagia (28.6%, 6/21). Neither neurologic instability nor mortality was observed after surgery. Neurologic status was subjectively improved for 19 patients and unimproved for 1 patient; no patient's neurologic status was worse. Mean Nurick grade was 1.9 before surgery and 1.1 after surgery (mean difference, 0.80; P < .001), at a mean follow-up of 96 days (range, 51-149 days). When indicated, CAPDF is an efficient and effective treatment for CSM. This study found the procedure to be associated with minor complications, no new neurologic deficits, and high levels of neurologic improvement. The positive short-term outcomes and low rate of long-term complications in our study, combined with data from previous comparative studies

  7. A comparison of minimally invasive posterior cervical decompression and open anterior cervical decompression and instrumented fusion in the surgical management of degenerative cervical myelopathy.

    PubMed

    Abbas, Syed F; Spurgas, Morgan P; Szewczyk, Benjamin S; Yim, Benjamin; Ata, Ashar; German, John W

    2016-06-01

    OBJECTIVE Minimally invasive posterior cervical decompression (miPCD) has been described in several case series with promising preliminary results. The object of the current study was to compare the clinical outcomes between patients undergoing miPCD with anterior cervical discectomy and instrumented fusion (ACDFi). METHODS A retrospective study of 74 patients undergoing surgery (45 using miPCD and 29 using ACDFi) for myelopathy was performed. Outcomes were categorized into short-term, intermediate, and long-term follow-up, corresponding to averages of 1.7, 7.7, and 30.9 months, respectively. Mean scores for the Neck Disability Index (NDI), neck visual analog scale (VAS) score, SF-12 Physical Component Summary (PCS), and SF-12 Mental Component Summary (MCS) were compared for each follow-up period. The percentage of patients meeting substantial clinical benefit (SCB) was also compared for each outcome measure. RESULTS Baseline patient characteristics were well-matched, with the exception that patients undergoing miPCD were older (mean age 57.6 ± 10.0 years [miPCD] vs 51.1 ± 9.2 years [ACDFi]; p = 0.006) and underwent surgery at more levels (mean 2.8 ± 0.9 levels [miPCD] vs 1.5 ± 0.7 levels [ACDFi]; p < 0.0001) while the ACDFi patients reported higher preoperative neck VAS scores (mean 3.8 ± 3.0 [miPCD] vs 5.4 ± 2.6 [ACDFi]; p = 0.047). The mean PCS, NDI, neck VAS, and MCS scores were not significantly different with the exception of the MCS score at the short-term follow-up period (mean 46.8 ± 10.6 [miPCD] vs 41.3 ± 10.7 [ACDFi]; p = 0.033). The percentage of patients reporting SCB based on thresholds derived for PCS, NDI, neck VAS, and MCS scores were not significantly different, with the exception of the PCS score at the intermediate follow-up period (52% [miPCD] vs 80% [ACDFi]; p = 0.011). CONCLUSIONS The current report suggests that the optimal surgical strategy in patients requiring dorsal surgery may be enhanced by the adoption of a minimally invasive

  8. Polyetheretherketone Cage with Demineralized Bone Matrix Can Replace Iliac Crest Autografts for Anterior Cervical Discectomy and Fusion in Subaxial Cervical Spine Injuries

    PubMed Central

    Kim, Soo-Han; Lee, Jung-Kil; Jang, Jae-Won; Park, Hyun-Woong; Hur, Hyuk

    2017-01-01

    Objective This study aimed to compare the clinical and radiologic outcomes of patients with subaxial cervical injury who underwent anterior cervical discectomy and fusion (ACDF) with autologous iliac bone graft or polyetheretherketone (PEEK) cages using demineralized bone matrix (DBM). Methods From January 2005 to December 2010, 70 patients who underwent one-level ACDF with plate fixation for post-traumatic subaxial cervical spinal injury in a single institution were retrospectively investigated. Autologous iliac crest grafts were used in 33 patients (Group I), whereas 37 patients underwent ACDF using a PEEK cage filled with DBM (Group II). Plain radiographs were used to assess bone fusion, interbody height (IBH), segmental angle (SA), overall cervical sagittal alignment (CSA, C2–7 angle), and development of adjacent segmental degeneration (ASD). Clinical outcome was assessed using a visual analog scale (VAS) for pain and Frankel grade. Results The mean follow-up duration for patients in Group I and Group II was 28.9 and 25.4 months, respectively. All patients from both groups achieved solid fusion during the follow-up period. The IBH and SA of the fused segment and CSA in Group II were better maintained during the follow-up period. Nine patients in Group I and two patients in Group II developed radiologic ASD. There were no statistically significant differences in the VAS score and Frankel grade between the groups. Conclusion This study showed that PEEK cage filled with DBM, and plate fixation is at least as safe and effective as ACDF using autograft, with good maintenance of cervical alignment. With advantages such as no donor site morbidity and no graft-related complications, PEEK cage filled with DBM, and plate fixation provide a promising surgical option for treating traumatic subaxial cervical spine injuries. PMID:28264242

  9. Polyetheretherketone Cage with Demineralized Bone Matrix Can Replace Iliac Crest Autografts for Anterior Cervical Discectomy and Fusion in Subaxial Cervical Spine Injuries.

    PubMed

    Kim, Soo-Han; Lee, Jung-Kil; Jang, Jae-Won; Park, Hyun-Woong; Hur, Hyuk

    2017-03-01

    This study aimed to compare the clinical and radiologic outcomes of patients with subaxial cervical injury who underwent anterior cervical discectomy and fusion (ACDF) with autologous iliac bone graft or polyetheretherketone (PEEK) cages using demineralized bone matrix (DBM). From January 2005 to December 2010, 70 patients who underwent one-level ACDF with plate fixation for post-traumatic subaxial cervical spinal injury in a single institution were retrospectively investigated. Autologous iliac crest grafts were used in 33 patients (Group I), whereas 37 patients underwent ACDF using a PEEK cage filled with DBM (Group II). Plain radiographs were used to assess bone fusion, interbody height (IBH), segmental angle (SA), overall cervical sagittal alignment (CSA, C2-7 angle), and development of adjacent segmental degeneration (ASD). Clinical outcome was assessed using a visual analog scale (VAS) for pain and Frankel grade. The mean follow-up duration for patients in Group I and Group II was 28.9 and 25.4 months, respectively. All patients from both groups achieved solid fusion during the follow-up period. The IBH and SA of the fused segment and CSA in Group II were better maintained during the follow-up period. Nine patients in Group I and two patients in Group II developed radiologic ASD. There were no statistically significant differences in the VAS score and Frankel grade between the groups. This study showed that PEEK cage filled with DBM, and plate fixation is at least as safe and effective as ACDF using autograft, with good maintenance of cervical alignment. With advantages such as no donor site morbidity and no graft-related complications, PEEK cage filled with DBM, and plate fixation provide a promising surgical option for treating traumatic subaxial cervical spine injuries.

  10. Differences between Cervical Schwannomas of the Anterior and Posterior Nerve Roots in Relation to the Incidence of Postoperative Radicular Dysfunction

    PubMed Central

    Ohnishi, Yu-Ichiro; Ohkawa, Toshika; Ninomiya, Koshi; Moriwaki, Takashi; Yoshimine, Toshiki

    2015-01-01

    Study Design A retrospective study. Purpose To assess the case files of patients who underwent surgery for cervical dumbbell schwannoma for determining the differences between schwannomas of the anterior and posterior nerve roots with respect to the incidence of postoperative radicular dysfunction. Overview of Literature The spinal roots giving origin to schwannoma are frequently nonfunctional, but there is a risk of postoperative neurological deficit once these roots are resected during surgery. Methods Fifteen patients with cervical dumbbell schwannomas were treated surgically. Ten men and 5 women, who were 35-79 years old (mean age, 61.5 years), presented with neck pain (n=6), radiculopathy (n=10), and myelopathy (n=11). Results Fourteen patients underwent gross total resection and exhibited no recurrence. Follow-ups were performed for a period of 6-66 months (mean, 28 months). Preoperative symptoms resolved in 11 patients (73.3%) but they persisted partially in 4 patients (26.7%). Six patients had tumors of anterior nerve root origin, and 9 patients had tumors of posterior nerve root origin. Two patients who underwent total resection of anterior nerve root tumors (33.3%) displayed minor postoperative motor weakness. One patient who underwent total resection of a posterior nerve root tumor (11.1%) showed postoperative numbness. Conclusions Appropriate tumor removal improved the neurological symptoms. In this study, the incidence of radicular dysfunction was higher in patients who underwent resection of anterior nerve root tumors than in patients who underwent resection of posterior nerve root tumors. PMID:25901239

  11. Cement-augmented screws in a cervical two-level corpectomy with anterior titanium mesh cage reconstruction: a biomechanical study.

    PubMed

    Hartmann, Sebastian; Thomé, Claudius; Tschugg, Anja; Paesold, Johannes; Kavakebi, Pujan; Schmölz, Werner

    2017-04-01

    Biomechanical investigation. Cervical two-level corpectomies with anterior-only instrumentation are associated with a high rate of implant-related complications. These procedures, therefore, often require an additional dorsal instrumentation to prevent screw loosening. Cement augmentation of the anterior screws in two-level corpectomies might stabilize the construct, so that a second dorsal procedure could be avoided. To evaluate the screw anchorage in cervical anterior-only procedures, an ex vivo evaluation of the range of motion (ROM) in two-level corpectomies (C4 and C5), with and without cement augmentation of the anterior screws, was carried out in this study. Twelve human cervical cadaveric spines (C2-T1) were divided into two groups of six specimens each. Corpectomies were performed in C4 and C5, with grafting and anterior instrumentation with and without cement augmentation of the anterior screw-and-plate system (0.3-0.5 mL cement/screw). Flexibility tests with pure moments (1.5 Nm) were carried out before and after three cyclic loading periods of 5000 cycles with increasing eccentric forces (100, 200, and 300 N). After corpectomy and instrumentation, the control group and the augmented group showed a significant reduction in ROM in comparison with the native states with average ROMs of 49% (±17%) and 24% (±10%), respectively (P = 0.006). The ROM in the control group increased significantly in all motion directions in the course of cyclic loading and approached native values after the third cyclic loading period, with an overall ROM of 78% (±22%). In contrast, the augmented group maintained a significantly decreased ROM in all motion directions during cyclic loading, with a final ROM of 32% (±14%) after the third period of cyclic testing. Inter-group comparison demonstrated a significant difference between the two groups in the course of cyclic loading. The cement-augmented group outperformed the control group in all motion directions, with a

  12. Long-term results of anterior cervical corpectomy and fusion with nano-hydroxyapatite/polyamide 66 strut for cervical spondylotic myelopathy

    NASA Astrophysics Data System (ADS)

    Zhang, Yuan; Deng, Xu; Jiang, Dianming; Luo, Xiaoji; Tang, Ke; Zhao, Zenghui; Zhong, Weiyang; Lei, Tao; Quan, Zhengxue

    2016-05-01

    To assess the long-term clinical and radiographic outcomes of anterior cervical corpectomy and fusion (ACCF) with a neotype nano-hydroxyapatite/polyamide 66 (n-HA/PA66) strut in the treatment of cervical spondylotic myelopathy (CSM). Fifty patients with CSM who underwent 1- or 2-level ACCF with n-HA/PA66 struts were retrospectively investigated. With a mean follow-up of 79.6 months, the overall mean JOA score, VAS and cervical alignment were improved significantly. At last follow-up, the fusion rate was 98%, and the subsidence rate of the n-HA/PA66 strut was 8%. The “radiolucent gap” at the interface between the n-HA/PA66 strut and the vertebra was further noted to evaluate the osteoconductivity and osseointegration of the strut, and the incidence of it was 62% at the last follow-up. Three patients suffered symptomatic adjacent segment degeneration (ASD). No significant difference was detected in the outcomes between 1- and 2-level corpectomy at follow-ups. In conclusion, the satisfactory outcomes in this study indicated that the n-HA/PA66 strut was an effective graft for cervical reconstruction. Moreover, the osteoconductivity and osseointegration of the strut is still need to be optimized for future clinical application owing to the notably presence of “radiolucent gap” in present study.

  13. Bilateral internal superior laryngeal nerve palsy of traumatic cervical injury patient who presented as loss of cough reflex after anterior cervical discectomy with fusion.

    PubMed

    Shin, Dong-Uk; Sung, Joo-Kyung; Nam, Kyung-Hun; Cho, Dae-Chul

    2012-09-01

    Injury to the bilateral internal branch of superior laryngeal nerve (ibSLN) brings on an impairment of the laryngeal cough reflex that could potentially result in aspiration pneumonia and other respiratory illnesses. We describe a patient with traumatic cervical injury who underwent bilateral ibSLN palsy after anterior cervical discectomy with fusion (ACDF). An 75-year-old man visited with cervical spine fracture and he underwent ACDF through a right side approach. During the post-operative days, he complained of high pitched tone defect, and occasional coughing during meals. With a suspicion of SLN injury and for the work up for the cause of aspiration, we performed several studies. According to the study results, he was diagnosed as right SLN and left ibSLN palsy. We managed him for protecting from silent aspiration. Swallowing study was repeated and no evidence of aspiration was found. The patient was discharged with incomplete recovery of a high pitched tone and improved state of neurologic status. The SLN is an important structure; therefore, spine surgeons need to be concerned and be cautious about SLN injury during high cervical neck dissection, especially around the level of C3-C4 and a suspicious condition of a contralateral nerve injury.

  14. Long-term results of anterior cervical corpectomy and fusion with nano-hydroxyapatite/polyamide 66 strut for cervical spondylotic myelopathy

    PubMed Central

    Zhang, Yuan; Deng, Xu; Jiang, Dianming; Luo, Xiaoji; Tang, Ke; Zhao, Zenghui; Zhong, Weiyang; Lei, Tao; Quan, Zhengxue

    2016-01-01

    To assess the long-term clinical and radiographic outcomes of anterior cervical corpectomy and fusion (ACCF) with a neotype nano-hydroxyapatite/polyamide 66 (n-HA/PA66) strut in the treatment of cervical spondylotic myelopathy (CSM). Fifty patients with CSM who underwent 1- or 2-level ACCF with n-HA/PA66 struts were retrospectively investigated. With a mean follow-up of 79.6 months, the overall mean JOA score, VAS and cervical alignment were improved significantly. At last follow-up, the fusion rate was 98%, and the subsidence rate of the n-HA/PA66 strut was 8%. The “radiolucent gap” at the interface between the n-HA/PA66 strut and the vertebra was further noted to evaluate the osteoconductivity and osseointegration of the strut, and the incidence of it was 62% at the last follow-up. Three patients suffered symptomatic adjacent segment degeneration (ASD). No significant difference was detected in the outcomes between 1- and 2-level corpectomy at follow-ups. In conclusion, the satisfactory outcomes in this study indicated that the n-HA/PA66 strut was an effective graft for cervical reconstruction. Moreover, the osteoconductivity and osseointegration of the strut is still need to be optimized for future clinical application owing to the notably presence of “radiolucent gap” in present study. PMID:27225189

  15. Cervical anterior hybrid technique with bi-level Bryan artificial disc replacement and adjacent segment fusion for cervical myelopathy over three consecutive segments.

    PubMed

    Chen, Jiang; Xu, Lin; Jia, Yu-Song; Sun, Qi; Li, Jin-Yu; Zheng, Chen-Ying; Bai, Chun-Xiao; Yu, Qin-Sheng

    2016-05-01

    This study aimed to assess the preliminary clinical efficacy and feasibility of the hybrid technique for multilevel cervical myelopathy. Considering the many shortcomings of traditional treatment methods for multilevel cervical degenerative myelopathy, hybrid surgery (bi-level Bryan artificial disc [Medtronic Sofamor Danek, Memphis, TN, USA] replacement and anterior cervical discectomy and fusion) should be considered. Between March 2006 and November 2012, 108 patients (68 men and 40 women, average age 45years) underwent hybrid surgery. Based on the Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), and Odom's criteria, the clinical symptoms and neurological function before and after surgery were evaluated. Mean surgery duration was 90minutes, with average blood loss of 30mL. Mean follow-up duration was 36months. At the final follow-up, the mean JOA (± standard deviation) scores were significantly higher compared with preoperative values (15.08±1.47 versus 9.18±1.22; P<0.01); meanwhile, NDI values were markedly decreased (12.32±1.03 versus 42.68±1.83; P<0.01). Using Odom's criteria, the clinical outcomes were rated as excellent (76 patients), good (22 patients), fair (six patients), and poor (four patients). These findings indicate that the hybrid method provides an effective treatment for cervical myelopathy over three consecutive segments, ensuring a good clinical outcome. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. The management of one-level anterior cervical corpectomy with fusion using Atlantis hybrid plates: preliminary experience.

    PubMed

    Epstein, N E

    2000-08-01

    To limit high pseudarthrosis rates encountered after cervical procedures for adjacent two-level disease, one-level anterior corpectomy with fusion was performed using the newly available Atlantis hybrid plates (fixed screws placed superiorly and variable screws placed inferiorly). Eight one-level anterior corpectomies with fusion were performed using iliac autografts and Atlantis hybrid plates. Nurick and Medical Outcomes Trust Short Form 36 scores were recorded before operation (Nurick grade 2.3) and 6 months after operation. Fusion status was followed an average of 9 months (range, 8 to 11 months). Fusion was confirmed an average of 6 months after operation in seven patients, when the mean Nurick grade was 0.2 and all had improved on the eight Medical Outcomes Trust Short Form 36 health scales. Atlantis plates contributed to successful fusion in seven of eight patients undergoing one-level anterior corpectomy with fusion using Atlantis hybrid plates.

  17. Pseudoarthrosis rates in anterior cervical discectomy and fusion: a meta-analysis.

    PubMed

    Shriver, Michael F; Lewis, Daniel J; Kshettry, Varun R; Rosenbaum, Benjamin P; Benzel, Edward C; Mroz, Thomas E

    2015-09-01

    Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure for patients presenting with cervical radiculopathy, myelopathy, or deformity. A systematic literature review and meta-analysis of pseudoarthrosis rates associated with ACDF with plate fixation have not been previously performed. The purpose of this study was to identify all prospective studies reporting pseudoarthrosis rates for ACDF with plate fixation. This study is based on a systematic review and meta-analysis. Studies reporting pseudoarthrosis rates in patients who received one-, two-, or three-level ACDF surgeries were included. Outcomes of interest included reported pseudoarthrosis events after ACDF with plate fixation. We conducted a MEDLINE, SCOPUS, Web of Science, and EMBASE search for studies reporting complications for ACDF with plate fixation. We recorded pseudoarthrosis events from all included studies. A meta-analysis was performed to calculate effect summary mean values, 95% confidence intervals (CIs), Q statistics, and I(2) values. Forest plots were constructed for each analysis group. Of the 7,130 retrieved articles, 17 met the inclusion criteria. The overall pseudoarthrosis rate was 2.6% (95% CI: 1.3-3.9). Use of autograft fusion (0.9%, 95% CI: -0.4 to 2.1) resulted in a reduced pseudoarthrosis rate compared with allograft fusion procedures (4.8%, 95% CI: 1.7-7.9). Studies were separated based on the length of follow-up: 12 to 24 and greater than 24 months. These groups reported rates of 3.1% (95% CI: 1.2-5.0) and 2.3% (95% CI: 0.1-4.4), respectively. Studies performing single-level ACDF yielded a rate of 3.7% (95% CI: 1.6-5.7). Additionally, there was a large difference in the rate of pseudoarthrosis in randomized controlled trials (4.8%, 95% CI: 2.6-7.0) versus prospective cohort studies (0.2%, 95% CI: -0.1 to 0.5), indicating that the extent of follow-up criteria affects the rate of pseudoarthrosis. This review represents a comprehensive estimation of the actual

  18. Concurrent Validity and Responsiveness of PROMIS Health Domains Among Patients Presenting for Anterior Cervical Spine Surgery.

    PubMed

    Purvis, Taylor E; Andreou, Elena; Neuman, Brian J; Riley, Lee H; Skolasky, Richard L

    2017-07-24

    Prospective cohort study. To determine validity and responsiveness of Patient-Reported Outcomes Measurement Information System (PROMIS) health domains. PROMIS health domains (anxiety, depression, fatigue, pain, physical function, satisfaction with participation in social roles, sleep disturbance) may measure quality of care and determine minimal important differences (MIDs) after spine surgery. We examined concurrent validity of PROMIS domains before and PROMIS domain MIDs after anterior cervical spine surgery. We included 148 adults undergoing cervical spine surgery from February 2015 through June 2016. We determined concurrent validity by correlations of preoperative PROMIS domains with legacy measures and responsiveness of PROMIS domains using distribution-based and anchor-based criteria (preoperative to postoperative change, within 6 months) anchored to treatment expectations (assessed using North American Spine Society Patient Satisfaction Index criteria). Statistical significance was accepted as p < 0.05. All PROMIS domains showed moderate to strong correlations with Neck Disability Index, Short-Form Health Survey, version 2 (SF-12v2), and Brief Pain Inventory pain interference and weak correlations with intensity of arm/neck pain (except between PROMIS pain and neck pain [r = 0.45, p < 0.001] and PROMIS physical function and SF-12v2 physical [r = -0.14, p = 0.138] and mental [r = 0.39, p < 0.001] components). PROMIS domains were well correlated with Generalized Anxiety Disorder-7 and Patient Health Questionnaire-8 except PROMIS physical function (r = -0.29, p = 0.002). Distribution-based PROMIS MID estimates ranged from 2.3-3.9 points. Incorporating cross-sectional and longitudinal anchor-based criteria, final PROMIS MID estimates were as follows: anxiety, -5.7; depression, -4.6, fatigue, -5.8; pain, -5.2; physical function, 4.5; satisfaction with participation in social roles, 4.4; and sleep disturbance, -7.4. PROMIS

  19. Full-endoscopic technique for anterior cervical discectomy and interbody fusion: 5-year follow-up results of 67 cases.

    PubMed

    Yao, Nuzhao; Wang, Cheng; Wang, Wenjun; Wang, Lushan

    2011-06-01

    With minimally invasive technique becoming more popular, endoscopic operations such as arthroscopy or laparoscopy have become the standard of care in several other areas. In this study, we evaluated the 5-year follow-up outcomes of anterior cervical (Ahn et al. in Photomed Laser Surg 23:362-368, 2005) discectomy and interbody fusion (ACDF) performed via endoscopic approach. Sixty-seven patients who underwent anterior cervical discectomy and cage fusion performed using endoscopic technique were followed for at least 5 years. We reviewed the clinical and radiographic records of these patients. The postoperative radiographic measures accessed were the anterior intervertebral height (AIH) and the lordosis angle (LDA). Clinical outcomes were determined using the previously validated Japanese Orthopaedic Association (JOA) and the pain visual analog scale (VAS). Patients included had a minimal follow-up period of 5 years and based on the outcomes criteria (JOA, VAS), 86.6% of patients reported excellent or good results. The AIH increased on average 18.7% of the original height (p < 0.01), and the LDA were more physiologic at final follow-up. Of the 67 cases, there was no segmental instability, and the bone fusion rate was 100%. One patient required revision open ACDF due to adjacent segment disc herniation 6 years postoperatively. There were no intraoperative complications, dysphasia or esophageal injury in this study group. It indicated endoscopic technique for ACDF can obtain satisfactory results in patients with cervical disc herniation, cervical myelopathy, or radiculopathy. Compared with a traditional approach, this technique may be associated with less morbidity while improving cosmesis and postoperative recovery. Prospective randomized control trials are needed to directly compare these two procedures.

  20. Outcomes of contemporary use of rectangular titanium stand-alone cages in anterior cervical discectomy and fusion: cage subsidence and cervical alignment.

    PubMed

    Yamagata, Toru; Takami, Toshihiro; Uda, Takehiro; Ikeda, Hidetoshi; Nagata, Takashi; Sakamoto, Shinichi; Tsuyuguchi, Naohiro; Ohata, Kenji

    2012-12-01

    Cervical intervertebral disc replacement using a rectangular titanium stand-alone cage has become a standard procedure for anterior cervical discectomy and fusion (ACDF). We examined outcomes resulting from the contemporary use of rectangular titanium stand-alone cages for ACDF, particularly focusing on cage subsidence and subsequent kyphotic malalignment. Patient data were collected prospectively, and a total of 47 consecutive patients who underwent periodic follow-up of at least 1 year's duration after ACDF were studied retrospectively. Sixty-three rectangular titanium cages were implanted during 31 1-level and 16 2-level procedures. None of the patients developed surgery-related complications (including cage displacement or extrusion). Mean Neurosurgical Cervical Spine Scale scores were significantly improved at 1 year after surgery. Twelve of the 63 inserted cages (19.0%) were found to have cage subsidence, occurring in 11 of 47 patients (23.4%). There was no significant difference in functional recovery between patients with and without cage subsidence. Logistic regression analysis indicated that fusion level, cage size and cage position were significantly related to cage subsidence. The distraction ratio among patients with cage subsidence was significantly higher than that among patients without cage subsidence. Cage subsidence resulted in early deterioration of local angle and total alignment of the cervical spine. Although a longer follow-up is warranted, a good surgical outcome with negligible complications appears to justify the use of rectangular titanium stand-alone cages in 1- and 2-level ACDF. Excessive distraction at the fusion level should be avoided, and cage position should be adjusted to the anterior vertical line. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. Prospective, Randomized Comparison of One-level Mobi-C Cervical Total Disc Replacement vs. Anterior Cervical Discectomy and Fusion: Results at 5-year Follow-up

    PubMed Central

    Zigler, Jack E.; Jackson, Robert; Nunley, Pierce D.; Bae, Hyun W.; Kim, Kee D.; Ohnmeiss, Donna D.

    2016-01-01

    Introduction There is increasing interest in the role of cervical total disc replacement (TDR) as an alternative to anterior cervical discectomy and fusion (ACDF). Multiple prospective randomized studies with minimum 2 year follow-up have shown TDR to be at least as safe and effective as ACDF in treating symptomatic degenerative disc disease at a single level. The purpose of this study was to compare outcomes of cervical TDR using the Mobi-C® with ACDF at 5-year follow-up. Methods This prospective, randomized, controlled trial was conducted as a Food and Drug Administration regulated Investigational Device Exemption trial across 23 centers with 245 patients randomized (2:1) to receive TDR with Mobi-C® Cervical Disc Prosthesis or ACDF with anterior plate and allograft. Outcome assessments included a composite overall success score, Neck Disability Index (NDI), visual analog scales (VAS) assessing neck and arm pain, Short Form-12 (SF-12) health survey, patient satisfaction, major complications, subsequent surgery, segmental range of motion, and adjacent segment degeneration. Results The 60-month follow-up rate was 85.5% for the TDR group and 78.9% for the ACDF group. The composite overall success was 61.9% with TDR vs. 52.2% with ACDF, demonstrating statistical non-inferiority. Improvements in NDI, VAS neck and arm pain, and SF-12 scores were similar between groups and were maintained from earlier follow-up through 60 months. There was no significant difference between TDR and ACDF in adverse events or major complications. Range of motion was maintained with TDR through 60 months. Device-related subsequent surgeries (TDR: 3.0%, ACDF: 11.1%, p<0.02) and adjacent segment degeneration at the superior level (TDR: 37.1%, ACDF: 54.7%, p<0.03) were significantly lower for TDR patients. Conclusions Five-year results demonstrate the safety and efficacy of TDR with the Mobi-C as a viable alternative to ACDF with the potential advantage of lower rates of reoperation and

  2. Anterior Cervical Discectomy and Fusion Outcomes over 10 Years: A Prospective Study.

    PubMed

    Buttermann, Glenn R

    2017-06-09

    Prospective cohort study with >10-year follow-up. To assess the long-term, >10-year, clinical outcomes of anterior cervical discectomy and fusion (ACDF) and to compare outcomes based on primary diagnosis of disc herniation; stenosis or advanced degenerative disc disease (DDD); number of levels treated; and preexisting adjacent level degeneration. ACDF is a proven treatment for patients with stenosis and disc herniation and results in significantly improved short- and intermediate-term outcomes. Motion preservation treatments may result in improved long-term outcomes but need to be compared to long-term ACDF outcomes reference. Patients who had disc herniation, stenosis, and DDD and underwent ACDF with or without decompression were prospectively enrolled and followed for a minimum of 10 years with outcome assessment at various intervals. All 159 consecutive patients had autogenous tricortical iliac crest bone graft and plate instrumentation used. Outcomes included visual analog scale (VAS) for neck and arm pain; pain drawing; Oswestry Disability Index (ODI); and self-assessment of procedure success. Preoperative adjacent-level disc degeneration, pseudarthrosis, and secondary operations were analyzed. For all diagnostic groups, significant outcomes improvement was seen at all follow-up periods for all scales relative to preoperative scores. Outcomes were not related to age, gender, number of levels treated, and minimally to pre-existing degeneration at the adjacent level. The use of narcotic pain medication decreased substantially. Neurological deficits almost all resolved. Patient self-reported success ranged from 85% to 95%. Over the long term, additional surgery for pseudarthrosis (10%) occurred in the early follow-up period, and for adjacent segment degeneration (21%) which occurred linearly during the 10+ year follow-up period. ACDF leads to significantly improved outcomes for all primary diagnoses and was sustained for more than 10 years' follow-up. Secondary

  3. Anterior cervical discectomy and fusion: comparison of titanium and polyetheretherketone cages.

    PubMed

    Cabraja, Mario; Oezdemir, Soner; Koeppen, Daniel; Kroppenstedt, Stefan

    2012-09-14

    Titanium (TTN) cages have a higher modulus of elasticity when compared with polyetheretherketone (PEEK) cages. This suggests that TTN-cages could show more frequent cage subsidence after anterior cervical discectomy and fusion (ACDF) and therefore might lead to a higher loss of correction. We compared the long term results of stand-alone PEEK- and TTN-cages in a comparable patient collective that was operated under identical operative settings. From 2002 to 2007 154 patients underwent single-level ACDF for degenerative disc disease (DDD). Clinical and radiological outcome were assessed in 86 eligible patients after a mean of 28.4 months. 44 patients received a TTN- and 42 patients a PEEK-cage. Solid arthrodesis was found in 93.2% of the TTN-group and 88.1% of the PEEK-group. Cage subsidence was observed in 20.5% of the TTN- and 14.3% of the PEEK-group. A significant segmental lordotic correction was achieved by both cage-types. Even though a loss of correction was found at the last follow-up in both groups, it did not reach the level of statistical significance. Statistical analysis of these results revealed no differences between the TTN- and PEEK-group.When assessed with the neck disability index (NDI), the visual analogue scale (VAS) of neck and arm pain and Odom's criteria the clinical data showed no significant differences between the groups. Clinical and radiological outcomes of ACDF with TTN- or PEEK-cages do not appear to be influenced by the chosen synthetic graft. The modulus of elasticity represents only one of many physical properties of a cage. Design, shape, size, surface architecture of a cage as well as bone density, endplate preparation and applied distraction during surgery need to be considered as further important factors.

  4. Iliac crest autograft versus alternative constructs for anterior cervical spine surgery: Pros, cons, and costs

    PubMed Central

    Epstein, Nancy E.

    2012-01-01

    Background: Grafting choices available for performing anterior cervical diskectomy/fusion (ACDF) procedures have become a major concern for spinal surgeons, and their institutions. The “gold standard”, iliac crest autograft, may still be the best and least expensive grafting option; it deserves to be reassessed along with the pros, cons, and costs for alternative grafts/spacers. Methods: Although single or multilevel ACDF have utilized iliac crest autograft for decades, the implant industry now offers multiple alternative grafting and spacer devices; (allografts, cages, polyether-etherketone (PEEK) amongst others). While most studies have focused on fusion rates and clinical outcomes following ACDF, few have analyzed the “value-added” of these various constructs (e.g. safety/efficacy, risks/complications, costs). Results: The majority of studies document 95%-100% fusion rates when iliac crest autograft is utilized to perform single level ACDF (X-ray or CT confirmed at 6-12 postoperative months). Although many allograft studies similarly quote 90%-100% fusion rates (X-ray alone confirmed at 6-12 postoperative months), a recent “post hoc analysis of data from a prospective multicenter trial” (Riew KD et. al., CSRS Abstract Dec. 2011; unpublished) revealed a much higher delayed fusion rate using allografts at one year 55.7%, 2 years 87%, and four years 92%. Conclusion: Iliac crest autograft utilized for single or multilevel ACDF is associated with the highest fusion, lowest complication rates, and significantly lower costs compared with allograft, cages, PEEK, or other grafts. As spinal surgeons and institutions become more cost conscious, we will have to account for the “value added” of these increasingly expensive graft constructs. PMID:22905321

  5. A microsurgical anterior cervical approach and the immediate impact of mechanical retractors: A case control study

    PubMed Central

    Ramos-Zúñiga, Rodrigo; Díaz-Guzmán, Laura Rocío; Velasquez, Shannen; Macías-Ornelas, Ana Magdalena; Rodríguez-Vázquez, Martín

    2015-01-01

    Introduction: A microsurgical anterior cervical approach with discectomy and fusion (MACDF) is one of the most widely used procedures for treating radicular disorders. This approach is highly successful; however, it is not free from complications. These can be associated with soft tissue injuries. Aim of the Study: The recognition of the risks for these complications should be identified for timely prevention and safe treatment. Materials and Methods: Study Design: Retrospective case control study. This study includes a retrospective case series of 37 patients, paying special attention to immediate complications related to the use of mechanical retraction of soft tissue (dysphagia, dysphonia, esophageal lesions and local hematoma); and a comparative analysis of the outcomes after changes in the retraction method. Results: All selected cases had a positive neurological symptom response in relation to neuropathic pain. Dysphagia and dysphonia were found during the first 72 h in 94.1% of the cases in which automatic mechanical retraction was used for more than one hour during the surgical procedure. A radical change was noted in the reduction of the symptoms after the use of only manual protective blades without automatic mechanical retraction: 5.1% dysphagia and 0% dysphonia in the immediate post-operative period, P = 0.001. Conclusions: Soft tissue damage due to the use of automatic retractors in MACDF is not minor and leads to general discomfort in the patient in spite of good neurological results. These problems most often occur when automatic retractors are used continuously for more than 1 hour, as well as when they are used in multiple levels. Dysphagia, dysphonia and local pain decreased with the use of transient manual blades for retraction, and with intermittent release following minimally invasive principles. PMID:26167011

  6. Anterior cervical discectomy and fusion: Comparison of titanium and polyetheretherketone cages

    PubMed Central

    2012-01-01

    Background Titanium (TTN) cages have a higher modulus of elasticity when compared with polyetheretherketone (PEEK) cages. This suggests that TTN-cages could show more frequent cage subsidence after anterior cervical discectomy and fusion (ACDF) and therefore might lead to a higher loss of correction. We compared the long term results of stand-alone PEEK- and TTN-cages in a comparable patient collective that was operated under identical operative settings. Methods From 2002 to 2007 154 patients underwent single-level ACDF for degenerative disc disease (DDD). Clinical and radiological outcome were assessed in 86 eligible patients after a mean of 28.4 months. 44 patients received a TTN- and 42 patients a PEEK-cage. Results Solid arthrodesis was found in 93.2% of the TTN-group and 88.1% of the PEEK-group. Cage subsidence was observed in 20.5% of the TTN- and 14.3% of the PEEK-group. A significant segmental lordotic correction was achieved by both cage-types. Even though a loss of correction was found at the last follow-up in both groups, it did not reach the level of statistical significance. Statistical analysis of these results revealed no differences between the TTN- and PEEK-group. When assessed with the neck disability index (NDI), the visual analogue scale (VAS) of neck and arm pain and Odom’s criteria the clinical data showed no significant differences between the groups. Conclusions Clinical and radiological outcomes of ACDF with TTN- or PEEK-cages do not appear to be influenced by the chosen synthetic graft. The modulus of elasticity represents only one of many physical properties of a cage. Design, shape, size, surface architecture of a cage as well as bone density, endplate preparation and applied distraction during surgery need to be considered as further important factors. PMID:22978810

  7. Impact of smoking on postoperative complications after anterior cervical discectomy and fusion.

    PubMed

    Purvis, Taylor E; Rodriguez, Haroldo J; Ahmed, A Karim; Boone, Christine; De la Garza-Ramos, Rafael; Elder, Benjamin D; Goodwin, C Rory; Sciubba, Daniel M

    2017-04-01

    The relationship between smoking and the risk of postoperative complications among anterior cervical discectomy and fusion (ACDF) patients remains uncertain. We compared the postoperative complication rates following ACDF surgery among non-smokers, current smokers, and ever-smokers. Baseline and outcome data were obtained from the 2005- to 2014 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for patients over the age of 18 who underwent non-emergent ACDF surgery. Information on current smoking and ever-smoking status was extracted. Outcomes included development of at least one complication, development of a major complication, in-hospital mortality, and length of stay. ACDF patients were either current smokers (7847, 30.3%) or not current smokers (18,022, 69.7%); 33.0% of all patients (n=8542) had ever smoked. Current smoking status was not associated with increased odds of any one complication (P=0.584) or any major complication (P=0.138). In addition, using the number of pack-years as the primary independent variable, multivariate logistic regression analysis revealed that the number of pack-years was not significantly associated with greater odds of developing any one complication (P=0.276) or any major complication (P=0.334). However, ever-smoker status did present significantly higher odds of any major complication (OR, 1.333; 95% CI 1.007-1.764; P=0.044) than for non-smokers. These results suggest that any patient with a prior smoking history should be considered a higher risk surgical candidate when attempting ACDF. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Anterior cervical corpectomy: review and comparison of results using titanium mesh cages and carbon fibre reinforced polymer cages.

    PubMed

    Kabir, Syed M R; Alabi, J; Rezajooi, Kia; Casey, Adrian T H

    2010-10-01

    Different types of cages have recently become available for reconstruction following anterior cervical corpectomy. We review the results using titanium mesh cages (TMC) and stackable CFRP (carbon fibre reinforced polymer) cages. Forty-two patients who underwent anterior cervical corpectomy between November 2001 and September 2008 were retrospectively reviewed. Pathologies included cervical spondylotic myelopathy (CSM), cervical radiculopathy, OPLL (ossified posterior longitudinal ligament), metastasis/primary bone tumour, rheumatoid arthritis and deformity correction. All patients were evaluated clinically and radiologically. Outcome was assessed on the basis of the Odom's criteria, neck disability index (NDI) and myelopathy disability index (MDI). Mean age was 60 years and mean follow-up was 1½ years. Majority of the patients had single-level corpectomy. Twenty-three patients had TMC cages while 19 patients had CFRP cages. The mean subsidence noted with TMC cage was 1.91 mm, while with the stackable CFRP cage it was 0.5 mm. This difference was statistically significant (p < 0.05). However, there was no statistically significant correlation noted between subsidence and clinical outcome (p > 0.05) or between subsidence and post-operative sagittal alignment (p > 0.05) in either of the groups. Three patients had significant subsidence (> 3 mm), one of whom was symptomatic. There were no hardware-related complications. On the basis of the Odom's criterion, 9 patients (21.4%) had an excellent outcome, 14 patients (33.3%) had a good outcome, 9 patients (21.4%) had a fair outcome and 5 patients (11.9%) had a poor outcome, i.e. symptoms and signs unchanged or exacerbated. Mean post-operative NDI was 26.27% and mean post-operative MDI was 19.31%. Fusion was noted in all 42 cases. Both TMC and stackable CFRP cages provide solid anterior column reconstruction with good outcome following anterior cervical corpectomy. However, more subsidence is noted with TMC cages though

  9. Comparative Analysis of Cervical Arthroplasty Using Mobi-C® and Anterior Cervical Discectomy and Fusion Using the Solis® -Cage

    PubMed Central

    Park, Jin Hoon; Roh, Kwang Ho; Cho, Ji Young; Ra, Young Shin; Rhim, Seung Chul

    2008-01-01

    Objective Although anterior cervical discectomy and fusion (ACDF) is the standard treatment for degenerative cervical disc disease, concerns regarding adjacent level degeneration and loss of motion have suggested that arthroplasty may be a better alternative. We have compared clinical and radiological results in patients with cervical disc herniations treated with arthroplasty and ACDF. Methods We evaluated 53 patients treated for cervical disc herniations with radiculopathy, 21 of whom underwent arthroplasty and 32 of whom underwent ACDF. Clinical results included the Visual Analogue Scale (VAS) score for upper extremity radiculopathy, neck disability index (NDI), duration of hospital stay and convalescence time. All patients were assessed radiologically by measuring cervical lordosis, segmental lordosis and segmental range-of-movement (ROM) of operated and adjacent disc levels. Results Mean hospital stay (5.62 vs. 6.26 days, p<0.05) and interval between surgery and return to work (1.10 vs. 2.92 weeks, p<0.05) were significantly shorter in the arthroplasty than in the fusion group. Mean NDI and extremity VAS score improved after 12 months in both groups. Although it was not significant, segmental ROM of adjacent levels was higher in the fusion group than in the arthroplasty group. And, segmental motion of operated levels in arthroplasty group maintained more than preoperative value at last follow up. Conclusion Although clinical results were similar in the two groups, postoperative recovery was significantly shorter in the arthroplasty group. Although it was not significant, ROM of adjacent segments was less in the arthroplasty group. Motion of operated levels in arthroplasty group was preserved at last follow up. PMID:19096680

  10. Anterior cervical discectomy and fusion with titanium cages for simple or multilevel herniated discs and spur of the cervical spine: Report of 2 cases and experience in Bali

    PubMed Central

    Mahadewa Tjokorda, G. B.; Nyoman, Golden; Sri, Maliawan; Junichi, Mizuno

    2016-01-01

    This report presents two cases of cervicobrachialgia and radiculopathy due to multiple cervical herniated discs and spur formation that dealt with anterior cervical discectomy and fusion (ACDF) using different titanium interbody cages. The description of the clinical presentation, magnetic resonance imaging (MRI) appearances and management strategy are discussed. Both cases showed chronic neck pain and radiating pain from the shoulder to the arm. They had a history of blurry vision, cluster head ache, weakness, and numbness on the shoulder for 2 years. MRI revealed multiple herniated discs between C4-7 and accompanied by the spur formation leading to the narrowness of the spinal canal and its foramina bilaterally. ACDF were performed and complete decompression of the spinal canal and its foramina were carried out. Twin M-cages (Ammtec Inc.-Japan) were placed in the first case at C5-7 levels and single cage of Smith Robinson (SR) was placed in the second case at C5-6 levels. There were no more blurry vision, cluster headache, weakness, and numbness, immediately after surgery. To our knowledge, this is the first reported cases of ACDF, using twin M-cages and single SR cage in Indonesia, with improvement immediately after surgery. Cervical spondylosis can present with cervicobrachialgia and radiculopathy and surgical treatment produces good functional outcome. PMID:27695567

  11. Anterior cervical discectomy and fusion with titanium cages for simple or multilevel herniated discs and spur of the cervical spine: Report of 2 cases and experience in Bali.

    PubMed

    Mahadewa Tjokorda, G B; Nyoman, Golden; Sri, Maliawan; Junichi, Mizuno

    2016-01-01

    This report presents two cases of cervicobrachialgia and radiculopathy due to multiple cervical herniated discs and spur formation that dealt with anterior cervical discectomy and fusion (ACDF) using different titanium interbody cages. The description of the clinical presentation, magnetic resonance imaging (MRI) appearances and management strategy are discussed. Both cases showed chronic neck pain and radiating pain from the shoulder to the arm. They had a history of blurry vision, cluster head ache, weakness, and numbness on the shoulder for 2 years. MRI revealed multiple herniated discs between C4-7 and accompanied by the spur formation leading to the narrowness of the spinal canal and its foramina bilaterally. ACDF were performed and complete decompression of the spinal canal and its foramina were carried out. Twin M-cages (Ammtec Inc.-Japan) were placed in the first case at C5-7 levels and single cage of Smith Robinson (SR) was placed in the second case at C5-6 levels. There were no more blurry vision, cluster headache, weakness, and numbness, immediately after surgery. To our knowledge, this is the first reported cases of ACDF, using twin M-cages and single SR cage in Indonesia, with improvement immediately after surgery. Cervical spondylosis can present with cervicobrachialgia and radiculopathy and surgical treatment produces good functional outcome.

  12. Biomechanical comparison of a two-level anterior discectomy and a one-level corpectomy, combined with fusion and anterior plate reconstruction in the cervical spine.

    PubMed

    Aghayev, Kamran; Doulgeris, James J; Gonzalez-Blohm, Sabrina A; Eleraky, Mohammed; Lee, William E; Vrionis, Frank D

    2014-01-01

    Common fusion techniques for cervical degenerative diseases include two-level anterior discectomy and fusion and one-level corpectomy and fusion. The aim of the study was to compare via in-vitro biomechanical testing the effects of a two-level anterior discectomy and fusion and a one-level corpectomy and fusion, with anterior plate reconstruction. Seven fresh frozen human cadaveric spines (C3-T1) were dissected from posterior musculature, preserving the integrity of ligaments and intervertebral discs. Initial biomechanical testing consisted of no-axial preload and 2Nm in flexion-extension, lateral bending and axial rotation. Thereafter, discectomies were performed at C4-5 and C5-6 levels, then two interbody cages and an anterior C4-C5-C6 plate was implanted. The flexibility tests were repeated and followed by C5 corpectomy and C4-C6 plate reconstruction. Biomechanical testing was performed again and statistical comparisons among the means of range of motion and axial rotation energy loss were investigated. The two-level cage-plate construct had significantly lower range of motion than the one-level corpectomy-plate construct (P≤0.03). Axial rotation energy loss was significantly (P≤0.03) greater for the corpectomy-plate construct than for the two-level cage-plate construct and the intact condition. A two-level cage-plate construct provides greater stability in flexion, extension and lateral bending motions when compared to a one-level corpectomy-plate construct. A two-level cage-plate is more likely to maintain axial balance by reducing the energy lost in axial rotation. © 2013.

  13. The Change of Range of Motion at Anterior Compression of the Cervical Cord after Laminoplasty in Patients with Cervical Spondylotic Myelopathy

    PubMed Central

    2016-01-01

    Objective Degenerative diseases of the spine, such as cervical spondylotic myelopathy (CSM), are increasing among the old age population, and surgical treatment of CSM is becoming more and more common. The aim of this study was to investigate how functional recovery can be influenced by anterior compression of the spinal cord (ACS) after laminoplasty for treatment of patients with CSM. Methods We retrospectively analyzed 32 patients admitted to Ewha Womans Mok-Dong Hospital with CSM who underwent open-door laminoplasty from January 2012 to December 2014. We divided patients into 2 groups according to whether ACS was or not preoperatively. Each group was analyzed clinical and radiological parameters which were Japanese Orthopedic Association (JOA) scores and its recovery rate, sagittal alignment and range of motion (ROM). Results The mean duration of symptom was 11.2 months (range, 6-22 months). A significant difference in recovery rate of the total JOA score was shown between the 2 groups, especially upper extremity motor function. No difference in preoperative JOA score between the 2 groups, but recovery rate of each group was 20.05%±18.1%, 32.21%±25.4%, statistically significant (p<0.005). Upper motor and sensory function was not significantly different in the 2 groups. Preoperative, postoperative and preservation of ROM was 44.3°±10.1°, 41.8°±15.7°, 87.9%±35.4% each at ACS (-) group. A significant difference in postoperative ROM was identified between ACS (-) and ACS (+) group. Postoperative anterior compression of the spinal cord was recognized 14 cases which were classified from its causes. Conclusion Cervical ROM decreased significantly after laminoplasty, but 85.3% of the preoperative ROM was preserved. The postoperative reduction of ROM in group with anterior compression of spinal cord was identified. PMID:28127374

  14. Dysphagia, short-term outcomes, and cost of care after anterior cervical disc surgery.

    PubMed

    Starmer, Heather M; Riley, Lee H; Hillel, Alexander T; Akst, Lee M; Best, Simon R A; Gourin, Christine G

    2014-02-01

    Dysphonia and dysphagia are common complications of anterior cervical discectomy (ACD). We sought to determine the relationship between dysphagia and in-hospital mortality, complications, speech therapy/dysphagia training, length of hospitalization, and costs associated with ACD. Discharge data from the Nationwide Inpatient Sample for 1,649,871 patients who underwent ACD of fewer than four vertebrae for benign acquired disease between 2001 and 2010 were analyzed using cross-tabulations and multivariate regression modeling. Dysphagia was reported in 32,922 cases (2.0 %). Speech therapy/dysphagia training was reported in less than 0.1 % of all cases and in only 0.2 % of patients with dysphagia. Dysphagia was significantly associated with age ≥65 years (OR = 1.5 [95 % CI 1.4-1.7], P < 0.001), advanced comorbidity (OR = 2.3 [2.0-2.6], P < 0.001), revision surgery (OR = 2.7 [2.3-3.1], P < 0.001), disc prosthesis placement (OR = 1.5 [1.0-2.0], P = 0.029), and vocal cord paralysis (OR = 11.6 [8.3-16.1], P < 0.001). Dysphagia was a significant predictor of aspiration pneumonia (OR = 8.6 [6.7-10.9], P < 0.001), tracheostomy (OR = 2.3 [1.6-3.3], P < 0.001), gastrostomy (OR = 30.9 [25.3-37.8], P < 0.001), and speech therapy/dysphagia training (OR = 32.0 [15.4-66.4], P < 0.001). Aspiration pneumonia was significantly associated with in-hospital mortality (OR = 15.9 [11.0-23.1], P < 0.001). Dysphagia, vocal cord paralysis, and aspiration pneumonia were significant predictors of increased length of hospitalization and hospital-related costs, with aspiration pneumonia having the single largest impact on length of hospitalization and costs. Dysphagia is significantly associated with increased morbidity, length of hospitalization, and hospital-related costs in ACD patients. Despite the known risk of dysphagia in ACD patients and an established role for the speech-language pathologist in dysphagia management, speech-language pathology

  15. Effect of Surgeon Volume on Complications, Length of Stay, and Costs Following Anterior Cervical Fusion.

    PubMed

    Basques, Bryce A; Louie, Philip K; Shifflett, Grant D; Fice, Michael P; Mayo, Benjamin C; Massel, Dustin H; Guzman, Javier Z; Bohl, Daniel D; Singh, Kern

    2017-03-15

    Retrospective cohort. To identify the association between surgeon volume and inpatient complications, length of stay, and costs associated with ACF. Increased surgeon volume may be associated with improved outcomes after surgical procedures. However, there is a lack of information on the effect of surgeon volume on short-term outcomes after anterior cervical fusion (ACF). A retrospective cohort study of ACF patients was performed using the Nationwide Inpatient Sample (NIS) from 2003 to 2009. Surgeon volume was divided into three categories, volume <25th percentile, 25th to 74th percentile, and ≥75th percentile of surgeon volume. Multivariate regression was used to compare the rates of adverse events, hospital length of stay, and total hospital costs between surgeon volume categories. A total of 419,212 ACF patients were identified. The 25th percentile for volume was 5 cases per year, and the 75th percentile for volume was 67 cases per year. Volume <25th percentile was associated with increased rates of any adverse event (odd ratio, OR 3.8, P < 0.001), and multiple individual complications including death (OR 2.5, P=0.014), myocardial infarction (OR4.4, P < 0.001), sepsis (OR 4.1, P < 0.001), and surgical site infection (OR 4.0, P < 0.001). Notably, volume ≥75th percentile was associated with decreased rates of any adverse event (OR 0.7, P < 0.001) and death (OR 0.6, P = 0.028). On multivariate analysis, length of stay was significantly increased by 2.3 days (P < 0.001) for surgeons <25th percentile of volume and was decreased by 0.3 days for surgeons with volume ≥75th percentile. Hospital costs were $4569 more for surgeons with <25th percentile of volume and $1213 less for surgeons with ≥75th percentile volume. In this nationally representative sample, surgeons with volume <25th percentile had significantly increased complications, length of stay, and costs. Conversely, surgeons with ≥75th percentile volume experienced

  16. Relationship Between ASA Scores and 30-Day Readmissions in Patients Undergoing Anterior Cervical Discectomy and Fusion.

    PubMed

    Phan, Kevin; Kim, Jun S; Lee, Nathan J; Kothari, Parth; Cho, Samuel K

    2017-01-15

    Retrospective study of prospectively collected data. To assess the American Society of Anesthesiologists (ASA)score as an independent predictor of 30-readmissions after anterior cervical discectomy and fusion (ACDF). The ASA classification scheme was introduced in 1941 to establish a scoring system to evaluate the overall health status and comorbidities of patients before surgery10-12. Although the score was designed to predict postoperative complications, it may also be used as a predictor of perioperative risk. Data collected for the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database in the period 2005 to 2012 were used in the present analysis. Current Procedural Terminology codes were used to identify elective ACDF cases (CPT codes: 22551, 22554, and 63075). The primary study outcome was 30-day readmission rates after elective ACDF in adults. Univariate and multivariate analysis was used to determine whether any of age, sex, race, body mass index, comorbidities, operative variables, or ASA class were predictors of 30-day readmission rates after ACDF. From the ACS-NSQIP database, 1701 elective ACDF cases were included for analysis, including 92 (5.5%) ASA class 1,955 (56.1%) ASA class 2,618 (36.3%) ASA class 3 and 34 (2.0%) ASA class 4 patients. Using ASA class 1 as a reference, significant independent predictors included being in ASA class 4 [odds ratio (OR) 5.7; 95% confidence interval (CI) 0.58-56.7; P = 0.039], having cardiac comorbidities (OR 2.2; 95% CI 1.2-4.2; P = 0.017), and prior strokes (OR 3.8; 95% CI 1.4-10.1; P = 0.0086). In conclusion, the unplanned readmission rate for patients undergoing ACDF was 3.2%. There was a significant and independent association between a high ASA class (class 4), cardiac comorbidities and prior strokes with 30-day unplanned readmissions after ACDF. The ASA score may be a valuable tool for the preoperative assessment of ACDF patients for risk of unplanned

  17. [Transpedicular intracorporeal hydroxyapatite grafting and pedicle screw fixation via paraspinal approach for thoracolumbar fractures].

    PubMed

    Lin, Da-sheng; Guo, Lin-xin; Ding, Zhen-qi; Chen, Chang-qing; Lian, Ke-jian; Hong, Jia-yuan

    2011-02-01

    To investigate the feasibility and safety of the treatment for thoracolumbar fractures with transpedicular intracorporeal hydroxyapatite grafting and pedicle screw fixation via paraspinal approach. From June 2007 to December 2008, 19 cases of thoracolumbar fractures were treated with transpedicular intracorporeal hydroxyapatite grafting and pedicle screw fixation via paraspinal approach. There were 7 female and 12 male, ranging from 21 to 57 years of age (mean 40.8 years) at surgery. The time from injury to surgery varied from 1 d to 5 d (mean 2.9 d). Nineteen patients all suffered from single thoracolumbar fracture with the distribution of injury level being T(11) in 1, T(12) in 5, L(1) in 9, and L(2) in 4. According to Denis fracture classification, there were 5 compression fractures and 14 burst fractures. The mean preoperative ratio of the anterior height of the body was 57.2%, kyphosis angle was 17.6° and occupation of spinal canal was 27.7%. The mean preoperative load-sharing classification of spine fractures was 5.2. Based on the ASIA neurologic grading system, preoperative neurological function was grade B in 2 cases, C in 9 and D in 8. Median operating time was 83.8 min (range 60-95 min) and median blood loss was 133 ml (range 90 - 200 ml). Infection did not occur in any of the patients and the operative incisions were healing well. Average follow-up time was 19.2 months (range 12 - 36 months). At the latest follow-up, the height of the anterior border was corrected to 88.4%, the kyphosis angle was 6.1°, and the occupation of spinal canal was 8.2% on average. The postoperative neurologic function of all 19 patients was improved with grade D in 2 cases and E in 17. There were no instances of instrumentation failure and no patient had persistent postoperative back pain. Transpedicular intracorporeal hydroxyapatite grafting and pedicle screw fixation via paraspinal approach could provide reliable neurologic improvement in patients with incomplete neurologic

  18. Comparison between cervical total disc replacement and anterior cervical discectomy and fusion of 1 to 2 levels from 2002 to 2009.

    PubMed

    Nandyala, Sreeharsha V; Marquez-Lara, Alejandro; Fineberg, Steven J; Singh, Kern

    2014-01-01

    Retrospective database analysis. To compare the perioperative patient characteristics, early postoperative outcomes, and costs between anterior cervical discectomy and fusion (ACDF) and cervical total disc replacement (TDR) in the United States. Cervical TDR and ACDF are indicated to treat symptomatic cervical degenerative pathology. The epidemiology, complication rates, and the cost differences between the 2 surgical approaches are not well characterized. Data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project was queried from 2002 to 2009. Patients undergoing cervical TDR or ACDF of 1 to 2 levels were identified. Patient demographics, comorbidities, length of stay, costs, and the in-hospital complications were assessed. SPSS (version 20) was used for statistical analysis with χ test for categorical data and independent-samples t test for continuous data. A value of P ≤ 0.001 denoted statistical significance. Multinomial regression analysis was used to identify the independent risk for complications in the TDR cohort compared with the ACDF cohort. There were 141,230 ACDF cases of 1 to 2 levels and 1830 cervical TDR cases identified in the Nationwide Inpatient Sample database. The ACDF cohort was older and demonstrated a greater comorbidity burden than the TDR group (P < 0.001). The ACDF-treated patients demonstrated a significantly greater length of stay than the TDR group (P < 0.001). In contrast, there were no significant differences in the incidence of postoperative complications, mortality, or hospital costs between the surgical cohorts. Multinomial regression did not demonstrate significant differences in the risk for postoperative complications between the surgical techniques. The ACDF cohort was significantly older and demonstrated a greater comorbidity burden that likely contributed to the greater length of stay when than the TDR cohort. Both cohorts demonstrated comparable incidences of early postoperative complications

  19. Biomechanics of Hybrid Anterior Cervical Fusion and Artificial Disc Replacement in 3-Level Constructs: An In Vitro Investigation

    PubMed Central

    Liao, Zhenhua; Fogel, Guy R.; Pu, Ting; Gu, Hongsheng; Liu, Weiqiang

    2015-01-01

    Background The ideal surgical approach for cervical disk disease remains controversial, especially for multilevel cervical disease. The purpose of this study was to investigate the biomechanics of the cervical spine after 3-level hybrid surgery compared with 3-level anterior cervical discectomy and fusion (ACDF). Material/Methods Eighteen human cadaveric spines (C2-T1) were evaluated under displacement-input protocol. After intact testing, a simulated hybrid construct or fusion construct was created between C3 to C6 and tested in the following 3 conditions: 3-level disc plate disc (3DPD), 3-level plate disc plate (3PDP), and 3-level plate (3P). Results Compared to intact, almost 65~80% of motion was successfully restricted at C3-C6 fusion levels (p<0.05). 3DPD construct resulted in slight increase at the 3 instrumented levels (p>0.05). 3PDP construct resulted in significant decrease of ROM at C3-C6 levels less than 3P (p<0.05). Both 3DPD and 3PDP caused significant reduction of ROM at the arthrodesis level and produced motion increase at the arthroplasty level. For adjacent levels, 3P resulted in markedly increased contribution of both upper and lower adjacent levels (p<0.05). Significant motion increases lower than 3P were only noted at partly adjacent levels in some conditions for 3DPD and 3PDP (p<0.05). Conclusions ACDF eliminated motion within the construct and greatly increased adjacent motion. Artificial cervical disc replacement normalized motion of its segment and adjacent segments. While hybrid conditions failed to restore normal motion within the construct, they significantly normalized motion in adjacent segments compared with the 3-level ACDF condition. The artificial disc in 3-level constructs has biomechanical advantages compared to fusion in normalizing motion. PMID:26529430

  20. Difference in canal encroachment by the fusion mass between anterior cervical discectomy and fusion with bone autograft and anterior plating, and stand-alone cage.

    PubMed

    Lee, Soo Eon; Chung, Chun Kee; Kim, Chi Heon

    2016-07-01

    We conducted a prospective randomized study comparing stand-alone cage and bone autograft and plate implants in anterior cervical discectomy and fusion (www.clinicaltrials.gov, NCT01011569). Our interim analysis showed autologous bone graft with plating was superior to a stand-alone cage for segmental lordosis. During this analysis, we noted a difference in canal encroachment by the fusion mass between the two fusion groups. A narrow cervical spinal canal is an important factor in the development of cervical spondylotic myelopathy, therefore this unexpected potential risk of spinal cord compression necessitated another interim analysis to investigate whether there was a difference in canal encroachment by the fusion mass between the two groups. Patients had a minimum 1year of follow-up. The Neck Disability Index, neck and arm pain Visual Analog Scales and lateral radiographs, including bone fusion patterns, were evaluated. Twenty-seven (16 males, 11 females, mean age 54.8years) and 31 (24 males, seven females, mean age 54.5years) patients were in the cage and plate group, respectively. Both groups improved after surgery. Fusion began at 2.6months and 1.3months and finished at 6.7months and 4.0months in 24 (88.9%) and 28 (90.3%) patients in the cage and plate group, respectively. Encroachment into the spinal canal by the fusion mass was significantly different between the fusion types, occuring in 21 (77.8%) patients in the cage group versus six (19.4%) in the plate group (p=0.003). There was a high incidence of spinal canal encroachment by the fusion mass in the stand-alone cage group, possibly limiting use in narrow spinal canals.

  1. [Comparison of the outcomes between anterior cervical discectomy and fusion versus posterior laminectomy and fusion for the treatment of multi-level cervical spondylotic myelopathy combined with cervical kyphosis].

    PubMed

    Shen, Q F; Xu, T T; Xia, Y P

    2016-12-20

    Objective: To compare the outcomes between anterior cervical discectomy and fusion (ACDF) and posterior laminectomy and fusion(LF) for multilevel cervical spondylotic myelopathy combined with cervical kyphosis. Methods: From January 2010 to June 2014, 54 patients with cervical spondylotic myelopathy combined with cervical kyphosis underwent surgical treatment.Among them, 29 patients were underwent ACDF, and 25 patients were underwent LF in Department of spine surgery, Tianjin Union Medical Centre. The operation time, intraoperative blood loss, fusion segments, Japanese Orthopaedic Association (JOA)score, Neck Disability Index (NDI), Visual Analog Scale (VAS), change of cervical curvature, range of motion(ROM)and complications were recorded and compared between the two groups. Results: Mean operative time was (162.7±21.3)min in the anterior approach group versus (176.3±29.8)min in the posterior group(P>0.05). Mean intraoperative blood loss was (135.6±27.8)ml in the anterior approach group and (255.2±32.3)ml in the posterior approach group(P<0.05). Mean fusion levels are (4.1±0.3)in the anterior approach group and (5.3±0.5) in the posterior approach group(P<0.05). The mean preoperative JOA score were(8.3±2.7)in the anterior approach group and( 8.9±2.1) in the posterior approach group (P>0.05). Mean postoperative JOA score were(13.6±2.5) in the anterior approach group and (14.0±1.7)in the posterior approach group at final follow-up(P>0.05). Mean improvement rate was (55.7%±16.3%)in the anterior approach group and (58.3%±15.7%) in the posterior approach group (P>0.05). Mean preoperative NDI score were(33.8±11.0)in the anterior approach group and (34.4±8.7)in the posterior approach group (P>0.05). Mean postoperative NDI score were (16.9±7.5) in the anterior approach group and (15.5±8.1) in the posterior approach group at final follow-up (P>0.05). Mean VAS score were (2.9±1.5) in the anterior approach group and (2.5±1.0) in the posterior approach group

  2. Single-Session Combined Anterior-Posterior Approach for Treatment of Ankylosing Spondylitis with Obvious Displaced Lower Cervical Spine Fractures and Dislocations

    PubMed Central

    Yang, Baohui; Lu, Teng

    2017-01-01

    For patients with AS and lower cervical spine fractures, surgical methods have mainly included the single anterior approach, single posterior approach, and combined anterior-posterior approach. However, various surgical procedures were utilized because the fractures have not been clearly classified according to presence of displacement in these previous studies. Consequently, controversies have been raised regarding the selection of the surgical procedure. This study retrospective analysis was conducted in 12 patients with AS and lower cervical spine fractures and dislocations and explored single-session combined anterior-posterior approach for the treatment of AS with obvious displaced lower cervical spine fractures and dislocations which has demonstrated advantages such as good stabilization, satisfied fracture healing, and easy postoperative cares. However, to some extent, the difficulty and risk of this approach should be considered. Attention should be paid to the prevention of perioperative complications. PMID:28133616

  3. Single-Session Combined Anterior-Posterior Approach for Treatment of Ankylosing Spondylitis with Obvious Displaced Lower Cervical Spine Fractures and Dislocations.

    PubMed

    Yang, Baohui; Lu, Teng; Li, Haopeng

    2017-01-01

    For patients with AS and lower cervical spine fractures, surgical methods have mainly included the single anterior approach, single posterior approach, and combined anterior-posterior approach. However, various surgical procedures were utilized because the fractures have not been clearly classified according to presence of displacement in these previous studies. Consequently, controversies have been raised regarding the selection of the surgical procedure. This study retrospective analysis was conducted in 12 patients with AS and lower cervical spine fractures and dislocations and explored single-session combined anterior-posterior approach for the treatment of AS with obvious displaced lower cervical spine fractures and dislocations which has demonstrated advantages such as good stabilization, satisfied fracture healing, and easy postoperative cares. However, to some extent, the difficulty and risk of this approach should be considered. Attention should be paid to the prevention of perioperative complications.

  4. Factors affecting reoperations after anterior cervical discectomy and fusion within and outside of a Federal Drug Administration investigational device exemption cervical disc replacement trial.

    PubMed

    Singh, Kern; Phillips, Frank M; Park, Dan K; Pelton, Miguel A; An, Howard S; Goldberg, Edward J

    2012-05-01

    The excellent clinical results of five US Federal Drug Administration (FDA) trials approved for cervical total disc replacement (TDR) (Prestige [Medtronic Sofamor Danek, Memphis, TN, USA], Bryan [Medtronic Sofamor Danek], ProDisc-C [Synthes, West Chester, PA, USA], Kineflex|C [SpinalMotion, Mountain View, CA, USA], and Mobi-C [LDR Spine, Austin, TX, USA]) have recently been published. In these prospective randomized studies, superiority or equivalency of TDR was claimed, citing an 8.7% (23/265), 9.5% (21/221), 8.5% (9/106), 12.2% (14/115), and 6.2% (5/81) (mean = 9.02%) rate of additional related cervical surgical procedures within 2 years in control anterior cervical discectomy and fusion (ACDF) patients, respectively, compared with 1.8% (5/276), 5.8% (14/242), 1.9% (2/103), 11% (15/136), and 1.2% (2/164) (mean = 4.34%) in patients receiving the cervical TDR. The rate of reoperation within 2 years after ACDF seems unusually high. To assess the rate of and specific indications for early reoperation after ACDF in a cohort of patients receiving the ACDF as part of their customary care. These results are contrasted with similar patients receiving ACDF as the control arm of five FDA investigational device exemption (IDE) studies. Multisurgeon retrospective clinical series from a single institution. One hundred seventy-six patients with spondylotic radiculopathy or myelopathy underwent ACDF by three surgeons between 2001 and 2005 as part of their clinical practices. All patients had at least 2 years of follow-up with final follow-up within 6 months of completion of this study. Cervical reoperation rates at 2-year follow-up and at 3.5-year follow-up. Review of medical records and telephone conversations were completed to determine the number of patients who had undergone a revision cervical procedure. At final follow-up, complete data were available for 159 ACDF patients. Of the 48 patients who underwent single-level ACDF and met criteria for inclusion in the IDE studies

  5. Anterior Cervical Discectomy and Fusion with Stand-Alone Trabecular Metal Cages as a Surgical Treatment for Cervical Radiculopathy: Mid-Term Outcomes

    PubMed Central

    ElAbed, Khaldoun; Shawky, Ahmad; Ainscow, Donald

    2016-01-01

    Study Design Retrospective case cohort study done between 2002 and 2012. Purpose To assess the mid-term clinical and radiological outcomes of 1-level and 2-level anterior cervical discectomy and fusion (ACDF) with stand-alone trabecular metal cages. Overview of Literature ACDF is the gold standard surgical treatment for cervical degenerative disease. The usual surgical practice is to use an anteriorly placed fusion plate with or without interdiscal cages. Methods Patients between 36 and 64 years of age diagnosed with cervical radiculopathy who underwent ACDF using stand-alone trabecular metal cages with at least 3 years follow-up were included in this study. Recorded clinical outcomes included residual axial neck pain, radicular arm pain, upper extremity weakness, and upper extremity altered sensation. Visual Analogue scores were also recorded. Fusion was assessed by lateral radiographs looking for bone breaching and radiolucent lines around the device at the latest follow-up. Results Ninety patients were included in the study. Fifty-one patients underwent 2-level surgery and 39 patients underwent 1-level surgery. Mean age was 44±10.4 years and mean follow-up time was 4.5±2.6 years. Patients reported excellent or good outcomes (90%), as well as improvements in axial neck pain (80%), radicular arm pain (95%), upper extremity weakness (85%), and upper extremity altered sensation (90%). Most patients (90%) progressed to fusion at the 1-year follow-up. The reoperation rate was 3.6%. There was no reported persistent dysphagia, voice complaints, dural tear, or tracheal or oesophageal perforation in any of the patients. One patient developed a deep methicillin-resistant Staphylococcus aureus infectious infarction of the spinal cord, which was treated with antibiotics. Recovery was complete at the 1-year follow up. Conclusions Mid-term results show that surgical treatment with ACDF with trabecular metal cages is a safe and effective treatment of single and 2-level

  6. The change of adjacent segment after cervical disc arthroplasty compared with anterior cervical discectomy and fusion: a meta-analysis of randomized controlled trials.

    PubMed

    Dong, Liang; Xu, Zhengwei; Chen, Xiujin; Wang, Dongqi; Li, Dichen; Liu, Tuanjing; Hao, Dingjun

    2017-10-01

    Many meta-analyses have been performed to study the efficacy of cervical disc arthroplasty (CDA) compared with anterior cervical discectomy and fusion (ACDF); however, there are few data referring to adjacent segment within these meta-analyses, or investigators are unable to arrive at the same conclusion in the few meta-analyses about adjacent segment. With the increased concerns surrounding adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis) after anterior cervical surgery, it is necessary to perform a comprehensive meta-analysis to analyze adjacent segment parameters. To perform a comprehensive meta-analysis to elaborate adjacent segment motion, degeneration, disease, and reoperation of CDA compared with ACDF. Meta-analysis of randomized controlled trials (RCTs). PubMed, Embase, and Cochrane Library were searched for RCTs comparing CDA and ACDF before May 2016. The analysis parameters included follow-up time, operative segments, adjacent segment motion, ASDeg, ASDis, and adjacent segment reoperation. The risk of bias scale was used to assess the papers. Subgroup analysis and sensitivity analysis were used to analyze the reason for high heterogeneity. Twenty-nine RCTs fulfilled the inclusion criteria. Compared with ACDF, the rate of adjacent segment reoperation in the CDA group was significantly lower (p<.01), and the advantage of that group in reducing adjacent segment reoperation increases with increasing follow-up time by subgroup analysis. There was no statistically significant difference in ASDeg between CDA and ACDF within the 24-month follow-up period; however, the rate of ASDeg in CDA was significantly lower than that of ACDF with the increase in follow-up time (p<.01). There was no statistically significant difference in ASDis between CDA and ACDF (p>.05). Cervical disc arthroplasty provided a lower adjacent segment range of motion (ROM) than did ACDF, but the difference was not statistically significant. Compared with ACDF, the

  7. Transfer of the brachialis to the anterior interosseous nerve as a treatment strategy for cervical spinal cord injury: technical note.

    PubMed

    Hawasli, Ammar H; Chang, Jodie; Reynolds, Matthew R; Ray, Wilson Z

    2015-04-01

    Study Design Technical report. Objective To provide a technical description of the transfer of the brachialis to the anterior interosseous nerve (AIN) for the treatment of tetraplegia after a cervical spinal cord injury (SCI). Methods In this technical report, the authors present a case illustration of an ideal surgical candidate for a brachialis-to-AIN transfer: a 21-year-old patient with a complete C7 spinal cord injury and failure of any hand motor recovery. The authors provide detailed description including images and video showing how to perform the brachialis-to-AIN transfer. Results The brachialis nerve and AIN fascicles can be successfully isolated using visual inspection and motor mapping. Then, careful dissection and microsurgical coaptation can be used for a successful anterior interosseous reinnervation. Conclusion The nerve transfer techniques for reinnervation have been described predominantly for the treatment of brachial plexus injuries. The majority of the nerve transfer techniques have focused on the upper brachial plexus or distal nerves of the lower brachial plexus. More recently, nerve transfers have reemerged as a potential reinnervation strategy for select patients with cervical SCI. The brachialis-to-AIN transfer technique offers a potential means for restoration of intrinsic hand function in patients with SCI.

  8. Transfer of the Brachialis to the Anterior Interosseous Nerve as a Treatment Strategy for Cervical Spinal Cord Injury: Technical Note

    PubMed Central

    Hawasli, Ammar H.; Chang, Jodie; Reynolds, Matthew R.; Ray, Wilson Z.

    2014-01-01

    Study Design Technical report. Objective To provide a technical description of the transfer of the brachialis to the anterior interosseous nerve (AIN) for the treatment of tetraplegia after a cervical spinal cord injury (SCI). Methods In this technical report, the authors present a case illustration of an ideal surgical candidate for a brachialis-to-AIN transfer: a 21-year-old patient with a complete C7 spinal cord injury and failure of any hand motor recovery. The authors provide detailed description including images and video showing how to perform the brachialis-to-AIN transfer. Results The brachialis nerve and AIN fascicles can be successfully isolated using visual inspection and motor mapping. Then, careful dissection and microsurgical coaptation can be used for a successful anterior interosseous reinnervation. Conclusion The nerve transfer techniques for reinnervation have been described predominantly for the treatment of brachial plexus injuries. The majority of the nerve transfer techniques have focused on the upper brachial plexus or distal nerves of the lower brachial plexus. More recently, nerve transfers have reemerged as a potential reinnervation strategy for select patients with cervical SCI. The brachialis-to-AIN transfer technique offers a potential means for restoration of intrinsic hand function in patients with SCI. PMID:25844283

  9. Comparative Study between a Curved and a Wedge PEEK Cage for Single-level Anterior Cervical Discectomy and Interbody Fusion.

    PubMed

    Kim, Hwan Soo; Song, Joon Suk; Heo, Weon; Cha, Jae Hoon; Rhee, Dong Youl

    2012-09-01

    This study evaluated the efficiency of a curved polyetheretherketone (PEEK) cage in comparison with a wedge PEEK cage according to radiologic and clinical outcomes in patients with cervical degenerative disease. A total of 37 patients who suffering from cervical disc disease with radiculopathy or myelopathy were reviewed retrospectively. Seventeen patients were underwent anterior cervical discectomy and interbody fusion with a curved shape PEEK cage (curved cage group), and twenty patients with wedge shape PEEK cage (wedge cage group). Clinical assessment was graded using Odom's criteria, NDI score and VAS score. For radiologic analysis, disc height (DH), segmental angle (SA), subsidence were measured at the preoperative and last follow up. A comparison of the preoperative and postoperative results revealed improvements after the surgery in the DH and SA in both cage groups. The change of postoperative DH between the preoperative and the last follow-up in wedge cage group and curved cage group was 6.85% and 25.5%, respectively. The change of postoperative SA was 1.75° and 0.95°, respectively. There was no statistically significant difference in the DH and SA between the 2 groups. The subsidence rate in the wedge cage group and curved cage group was 20% and 6%, respectively. The 2 different cage groups showed significant improvements in the disc height, segmental angle and clinical outcomes. However, the shape of PEEK Cage influences the tendency for subsidence. Increasing contact surface area and fitting into two adjacent vertebral body prevent significant subsidence.

  10. A Prospective Study of Interbody Fat Graft Application With the Anterior Contralateral Cervical Microdiscectomy to Preserve Segmental Mobility.

    PubMed

    Aydin, Yunus; Çavusoglu, Halit; Yüce, Ismail; Özdilmaç, Ahmet; Kahyaoglu, Okan

    2017-10-01

    Any surgical procedure aims at protecting mobile segments at the operated level, and the sagittal balance of the columna vertebralis. Interbody fusion has become an often applied technique in anterior cervical discectomy. To indicate that a minimally invasive technique in which we use interbody fat graft placement showed great results and effectiveness, especially in patients who were suffering from cervical paramedian disc herniation. In this study, 432 patients were observed from 2000 to 2013. All these consecutive patients had paramedian disc herniation. The initial 239 patients (group 1) underwent microdiscectomy without graft placement, whereas the remaining 193 patients (group 2) had a microdiscectomy with interbody fat graft insertion. The Neck Disability Index (NDI) and Short Form-36 (SF-36) were used to evaluate clinical outcomes. They were followed up for 5.3 years (range 2-13 years). Spontaneous radiological fusion was noticed in 12% of group 1 patients and none of the group 2 patients. It has been observed that the mean overall cervical curvature (C2-7) angles and segmental lordosis did not change significantly in late follow-up findings. During both early and late follow-ups, all patients indicated a decreasing NDI score, but in late follow-up, an improving SF-36 score. This surgical technique provides good direct decompression and preserves mobility at the treated level, while preventing disc collapse.

  11. Anterior cervical discectomy and fusion using a stand-alone polyetheretherketone cage packed with local autobone : assessment of bone fusion and subsidence.

    PubMed

    Park, Jeong-Ill; Cho, Dae-Chul; Kim, Kyoung-Tae; Sung, Joo-Kyung

    2013-09-01

    It remains debatable whether cervical spine fusion cages should be filled with any kind of bone or bone substitute. Cortical and subcortical bone from the anterior and posterior osteophytes of the segment could be used to fill the cage. The purposes of the present study are to evaluate the clinical outcomes and radiological outcomes including bone fusion and subsidence that occurred after anterior cervical discectomy and fusion using a stand-alone cage packed with local autobone graft. Thirty-one patients who underwent anterior cervical fusion using a stand-alone polyetheretherketone (PEEK) cage packed with local autobone graft from July 2009 to december 2011 were enrolled in this study. Bone fusion was assessed by cervical plain radiographs and computed tomographic scan. Nonunion was evaluated according to the absence of bony bridge on computed tomographic scan. Subsidence was defined as a ≥2 mm decrease of the interbody height at the final follow-up compared to that measured at the immediate postoperative period. Subsidence was observed in 7 patients (22.6%). Of 7 patients with subsidence greater 2 mm, nonunion was developed in 3. Three patients with subsidence greater 2 mm were related with endplate damage during intraoperative endplate preparation. Solid bone fusion was achieved in 28 out of 31 patients (90.3%). With proper patient selection and careful endplate preparation, anterior cervical discectomy and fusion (ACDF) using a stand-alone PEEK cage packed with local autobone graft could be a good alternative to the standard ACDF techniques with plating.

  12. [Combined anterior-posterior arthrodesis en patient with athetoid cerebral palsy who developed spondylotic cervical mielopathy. Case report and review of literature].

    PubMed

    Pancucci, G; Miranda-Lloret, P; Plaza-Ramírez, M E; López-González, A; Rovira-Lillo, V; Beltrán-Giner, A

    2011-06-01

    Spondylotic cervical mielopathy is a common complication in young patients with Cerebral Child Palsy with an important dystonic and athetoid component. Its surgical treatment is a challenge, due to elevate incidence of early faliure of the arthrodesis, both in anterior and posterior approaches. We report an historical review about the treatment of cervical mielopathy in this subgroup of patients and a clinical case in which we decided to realize decompression and arthtrodesis by a combined anterior and posterior approach, with lateral-mass screw placement, using botulinium toxin injections in the postoperative period, achieving a good clinical outcome.

  13. Influence of anterior cervical plate design on Dysphagia: a 2-year prospective longitudinal follow-up study.

    PubMed

    Lee, Michael J; Bazaz, Raj; Furey, Christopher G; Yoo, Jung

    2005-10-01

    To compare the incidence, prevalence, and rate of improvement of dysphagia in patients undergoing anterior cervical spine surgery with two different anterior instrumentation designs. The study subjects were 156 consecutive patients undergoing anterior cervical spine surgery with plate fixation. We compared the incidence of dysphagia among the two different plate groups both produced by the same manufacturer (Medtronic Danek); the Atlantis plate has thicker and wider plate dimensions than the Zephir plate. Dysphagia evaluations were performed prospectively by telephone interviews at 1, 2, 6, 12, and 24 months following the procedure. Risk factors such as gender, revision surgery, and number of surgical levels were compared between the groups and were not statistically different. Overall incidences of dysphagia were 49%, 37%, 20%, 15.4%, and 11% at 1, 2, 6, 12, and 24 months, respectively. Severe and disabling dysphagia is reported to be a relatively uncommon complication of anterior cervical surgery. However, a significant number of patients report mild to moderate discomfort including double-swallowing and catching sensation. Except at the 2-month follow-up point, the Atlantis plate group had higher incidences of dysphagia than the Zephir group at all time points (57% vs 50%, 36% vs 4%, 23% vs 14%, 17% vs 7%, 14% vs 0% at 1, 2, 6, 12, and 24 months, respectively). The Atlantis plate group had a 14% incidence of dysphagia at 2 years compared with the Zephir group, which had a 0% incidence at 2 years (P < 0.04). For primary surgeries, there was a higher incidence of dysphagia at all time points in the Atlantis group when compared with the Zephir group (58% vs 43%, 35% vs 30%, 22% vs 10%, 17% vs 0%, and 13% vs 0% at 1, 2, 6, 12, and 24 months, respectively) (P < 0.04 at 1 year). A regression analysis was performed. The resulting formulas predict the permanent rate of dysphagia for the Atlantis group is 13.6% and for the Zephir group is 3.58%. The use of a smaller and

  14. Long-term follow-up results and radiographic findings of anterior surgery with Cloward trephination for cervical spondylotic myelopathy.

    PubMed

    Xu, Bao-Shan; Zhang, Zuo-Lun; Le Huec, Jean-Charles; Xia, Qun; Hu, Yong-Cheng

    2009-04-01

    Serial retrospective long-term follow-up study. To assess the long-term results of anterior surgery with Cloward trephination and iliac strut grafting for cervical spondylotic myelopathy. Anterior surgery remains the most common surgical option and generally gives good results, although early and late deterioration after initial postoperative improvement has been noted. Although anterior decompression with trephination is a variant of the Cloward technique, little information is available concerning the long-term results after this procedure. One hundred sixty-eight consecutive patients treated with this technique by the same author from the years 1978 to 1992 were followed serially. One hundred and seven patients were followed for over 10 years (mean: 14.1 y) (follow-up rate: 71.8%). Clinical results were evaluated according to the Japanese Orthopedic Association system and the results at different postoperative intervals were analyzed. Thirty-six patients returned for the final follow-up. Plain radiographs were taken in neutral and flexion-extension positions and computed tomography scans were taken at fused segments and unfused levels. The mean recovery rate was 56.8% at final follow-up. Deterioration of 2 Japanese Orthopedic Association points or more was experienced in 44 patients at various postoperative periods and was more frequent at over 10 years follow-up. Kyphosis of fused segments was noted frequently on the radiographies of the 36 patients with a mean of 7.8 degrees. A straight or misaligned cervical spine was found in 28 (77.8%) patients and these deformities were more serious in multilevel fusions. Stenosis of the canal at fused segments was found in 15 (41.7%) patients owing to osteogenesis resulting from inadequate decompression or pseudoarthrosis. At unfused levels, the incidence of spondylolisthesis, bony bridge, disc hernia, and thickening or bulging of the ligament flavum was 19.4%, 27.8%, 33.3%, 19.4%, respectively, and these abnormalities

  15. Outpatient Anterior Cervical Discectomy and Fusion: An Analysis of Readmissions from the New Jersey State Ambulatory Services Database

    PubMed Central

    Passias, Peter G; Errico, Thomas J; Bess, R Shay; Protopsaltis, Themistocles S

    2017-01-01

    Background Anterior cervical discectomy and fusion (ACDF) performed as an outpatient has become increasingly common for treating cervical spine pathology. Few reports have attempted to assess readmissions following outpatient ACDF. This study was performed to address this issue using population-based databases. Methods The State Ambulatory Services Database (SASD) for New Jersey (NJ) from 2003-2012 was used for analysis. Patients receiving ACDF (defined as anterior cervical fusion (ICD-0 code=81.02) + excision of intervertebral disc (80.51)) were extracted; those with three or more levels fused (ICD-9 codes 81.63-81.64), cancer (ICD-9 codes 140-239), or trauma (ICD-9 codes=805.0-806.9) were excluded. A series of perioperative complications including durotomy, red blood cell transfusion, acute posthemorrhagic anemia, paraplegia (weakness), and mortality were examined. Propensity score matching (PSM) was used to adjust the analysis for patient age, race, sex, primary payer for care, and number of diagnoses. The NJ SASD defined readmission as admission to the same facility within seven days of initial discharge. Results Two thousand sixteen (2,016) patients were found, 1,528 of whom had readmission data. Of these 1,528 patients, 83 (5.4%) required readmission. PSM was performed prior to comparing readmission versus non-readmission. While there was no difference in perioperative complications between the two groups, the small sample size of the readmission cohort prevented this analysis from having sufficient power. No patient requiring readmission had an initial length of stay greater than one day. Conclusion Based on a 10-year outpatient analysis, fewer than 6% of outpatient 1-2 level ACDFs require readmission. Future studies involving outpatients from several states will be necessary to determine whether these results of outpatient ACDF are applicable nationwide.

  16. Outpatient Anterior Cervical Discectomy and Fusion: An Analysis of Readmissions from the New Jersey State Ambulatory Services Database.

    PubMed

    McClelland, Shearwood; Passias, Peter G; Errico, Thomas J; Bess, R Shay; Protopsaltis, Themistocles S

    2017-01-01

    Anterior cervical discectomy and fusion (ACDF) performed as an outpatient has become increasingly common for treating cervical spine pathology. Few reports have attempted to assess readmissions following outpatient ACDF. This study was performed to address this issue using population-based databases. The State Ambulatory Services Database (SASD) for New Jersey (NJ) from 2003-2012 was used for analysis. Patients receiving ACDF (defined as anterior cervical fusion (ICD-0 code=81.02) + excision of intervertebral disc (80.51)) were extracted; those with three or more levels fused (ICD-9 codes 81.63-81.64), cancer (ICD-9 codes 140-239), or trauma (ICD-9 codes=805.0-806.9) were excluded. A series of perioperative complications including durotomy, red blood cell transfusion, acute posthemorrhagic anemia, paraplegia (weakness), and mortality were examined. Propensity score matching (PSM) was used to adjust the analysis for patient age, race, sex, primary payer for care, and number of diagnoses. The NJ SASD defined readmission as admission to the same facility within seven days of initial discharge. Two thousand sixteen (2,016) patients were found, 1,528 of whom had readmission data. Of these 1,528 patients, 83 (5.4%) required readmission. PSM was performed prior to comparing readmission versus non-readmission. While there was no difference in perioperative complications between the two groups, the small sample size of the readmission cohort prevented this analysis from having sufficient power. No patient requiring readmission had an initial length of stay greater than one day. Based on a 10-year outpatient analysis, fewer than 6% of outpatient 1-2 level ACDFs require readmission. Future studies involving outpatients from several states will be necessary to determine whether these results of outpatient ACDF are applicable nationwide.

  17. Hybrid surgery versus anterior cervical discectomy and fusion for multilevel cervical degenerative disc diseases: a meta-analysis.

    PubMed

    Tian, Peng; Fu, Xin; Li, Zhi-Jun; Sun, Xiao-Lei; Ma, Xin-Long

    2015-08-26

    The objective of this meta-analysis is to compare hybrid surgery (HS) and cervical discectomy and fusion (ACDF) for multilevel cervical degenerative disc diseases (DDD). Systematic searches of all published studies through March 2015 were identified from Cochrane Library, Medline, PubMed, Embase, ScienceDirect, CNKI, WANFANG DATA and CQVIP. Randomized controlled trials (RCTs) and non-RCTs involving HS and ACDF for multilevel DDD were included. All literature was searched and assessed by two independent reviewers according to the standard of Cochrane systematic review. Data of functional and radiological outcomes in two groups were pooled, which was then analyzed by RevMan 5.2 software. One RCT and four non-RCTs encompassing 160 patients met the inclusion criteria. Meta-analysis revealed significant differences in blood loss (p = 0.005), postoperative C2-C7 ROM (p = 0.002), ROM of superior adjacent segment (p < 0.00001) and ROM of inferior adjacent segment (p = 0.0007) between the HS group and the ACDF group. No significant differences were found regarding operation time (p = 0.75), postoperative VAS (p = 0.18) and complications (p = 0.73) between the groups. Hybrid surgery demonstrated excellent clinical efficacy and radiological results. Postoperative C2-C7 ROM was closer to the physiological status. No decrease in the ROM of the adjacent segment was noted in the hybrid surgery group.

  18. 3 Tesla Kinematic MRI of the Cervical Spine for Evaluation of Adjacent Level Disease after Monosegmental Anterior Cervical Discectomy and Arthroplasty: Results of 2-Year Follow-up".

    PubMed

    Fleck, Steffen; Langner, Soenke; Rosenstengel, Christian; Kessler, Rebecca; Matthes, Marc; Müller, Jan-Uwe; Langner, Inga; Marx, Sascha; Schroeder, Henry W S

    2016-05-23

    We prospectively evaluated adjacent disc levels after cervical discectomy and arthroplasty (ACDA) using kinematic magnetic resonance imaging (MRI) and plain functional radiographs. Anterior cervical discectomy and arthroplasty (ACDA) is an established treatment for degenerative cervical disc disease. The objective of this study was to evaluate the use of kinematic magnetic resonance imaging (MRI) for assessing the range of motion (ROM) before and after ACDA compared to plain functional radiographs and to evaluate adjacent degenerative disc disease (aDDD) at mid-term follow-up. Twenty patients (12 females, 8 males; median age 45.6 ± 6.9 years) treated by ACDA (BryanDisc®, Medtronic, Minneapolis, USA) underwent plain functional radiography and kinematic MRI of the cervical spine at 3T before and 6 and 24 months after surgery. A sagittal T2-weighted (T2w) 2D turbo spin echo (TSE) sequence and a 3D T2w dataset with secondary axial reconstruction were acquired. Signal intensity of all nonoperated discs was measured in regions of interest (ROI). Disc heights adjacent to the operated segment were measured. Range of motion (ROM) was evaluated and compared to plain functional radiographs. Clinical outcome was evaluated using the visual analog scale (VAS) for head, neck and radicular pain, and the neck disability index (NDI). Mean ROM of the cervical spine on functional plain radiographs was 21.25 ± 8.19, 22.29 ± 4.82 and 26.0 ± 6.9 degrees preoperatively and at 6-month and 24-month follow-up, respectively. Mean ROM at MRI was 27.1 ± 6.78, 29.45 ± 9.51 and 31.95 ± 9.58 degrees, respectively. There was good correlation between both techniques. Follow-up examinations demonstrated no signs of progressive degenerative disc disease of adjacent levels. All patients had clinical improvement up to 24 months after surgery. After ACDA, kinematic MRI allows evaluation of the ROM with excellent correlation to plain functional radiographs. Mid

  19. The effects of anterior cervical discectomy and fusion with stand-alone cages at two contiguous levels on cervical alignment and outcomes.

    PubMed

    Moon, Hong Joo; Kim, Joo Han; Kim, Jong-Hyun; Kwon, Taek-Hyun; Chung, Hung-Seob; Park, Youn-Kwan

    2011-03-01

    Anterior cervical discectomy and fusion (ACDF) using stand-alone cages is an effective method of treating degenerative disease. However, stand-alone cages are reported to have a relatively high incidence of implant subsidence with secondary kyphotic deformity particularly after multilevel ACDF. The purpose of our article was to investigate clinical and radiological outcomes after ACDF using stand-alone cages, at two contiguous levels, with a particular focus on changes in regional alignment and the correlation between alignment of the operated cervical levels and the entire cervical spine. Twenty-seven patients with 54 levels and a mean age of 50.8 years were enrolled between January 2005 and August 2006. They underwent ACDF using polyetheretherketone cages packed with demineralized bone matrix without plate fixation at two contiguous levels. Mean follow-up period was 25.5 months (range, 13-60). Clinical outcome was evaluated using two Visual Analog Scales and the Neck Disability Index (NDI). We assessed fusion, regional alignment (RA) of the operated levels and cervical global alignment (GA) preoperatively in the immediate 1-week postoperative period and at the final follow-up. An interspinous distance ≥2 mm was used as an indicator of pseudoarthrosis at each level. All patients showed improvements in clinical outcome, with 96% of patients showing mild NDI scores (<14). Radiological solid fusion was obtained at 48 of 54 levels (88.9%) and in 21 of 27 patients (77.8%). Lower cervical levels were significantly more vulnerable to pseudoarthrosis (100%). Fusion rate had no significant correlation with outcome (p > 0.05). RA of the operated levels was improved at the final follow-up compared with preoperatively in 76% of patients, although it had decreased compared with the immediate postoperative period due to subsidence in 84% of patients. In total, 80.8% of patients showed improvements in GA. Furthermore, improvements in RA showed a significant positive

  20. [Markedly dilated cervical carotid arteries in a patient with a ruptured aneurysm of the anterior communicating artery: a case report].

    PubMed

    Nakai, H; Kawata, Y; Tomabechi, M; Aizawa, S; Ohgami, S; Yonemasu, Y; Muraoka, S

    1993-04-01

    We reported a case of ruptured aneurysm of the anterior communicating artery with marked dilatation of bilateral cervical carotid arteries. A 38 year old female suffered a subarachnoid hemorrhage. Angiography on admission revealed markedly dilated cervical carotid arteries with smooth lumen and a few segmental areas with mild constrictions in their entire course up to the carotid canals (their maximal sagittal diameters exceeded those of a cervical vertebral body). A saccular aneurysm was also seen at the junction of right A1, A2, and Acom. External carotid arteries were normal in size. Vertebral arteries were not examined because of failures of selective cannulation. The patient was operated upon and trapping of Acom was performed. During the operation, no definite arteriosclerotic changes were identified in the intracranial arteries. Histopathological examination of the surgical specimens revealed marked hyperplasia of the smooth muscle of the tunica media with intact internal elastic lamina both in a superficial temporal artery and a middle meningeal artery. During the operation, pneumothorax developed due to the rupture of bullae in the right lung. Past history of this patient disclosed hypertension noted a few years previously, and frequent severe bruises following minor trauma. Repeated angiography performed three months after the operation disclosed unchanged dilatation of the cervical carotid arteries as well as mild intraluminal irregularities in the proximal one third of the left renal artery. This patient died of pneumonia one year after the operation, but autopsy was not permitted. Possible diagnosis of this patient was discussed, with particular emphasis on fibromuscular dysplasia and Ehlers-Danlos type IV (arterial, ecchymotic, or Sack-Barabas type).(ABSTRACT TRUNCATED AT 250 WORDS)

  1. Circumferential Reconstruction of Subaxial Cervical and Cervicothoracic Spine by Simultaneously Combined Anterior-posterior Approaches in the Sitting Position.

    PubMed

    Han, Yue; Ma, Xin-Long; Hu, Yong-Cheng; Miao, Jun; Zhang, Ji-Dong; Bai, Jian-Qiang; Xia, Qun

    2017-08-01

    To introduce and analyze the feasibility of a new surgical strategy for circumferential reconstruction of subaxial cervical and cervicothoracic spine by simultaneously combined anterior-posterior approach in the sitting position. A retrospective review was performed for seven patients who underwent the above surgical procedure between July 2011 and January 2015. Among the seven patients, there were six men and one woman, with an average age of 52 years (range, 36-79 years). Six patients were confirmed to have a lower subaxial cervical fracture and dislocation with a locked facet joint, and the other patient had an invasive tumor involving both anterior and posterior parts of vertebrae and lamina, detected by radiological examination. The levels involved for all patients were from C4 to T2 . According to American Spinal Injury Association (ASIA) classification, one case was class A, four were class B, and two were class D. The patients were restricted in the sitting position with traction and a halo in extension to immobilize the head during the operation. The simultaneously combined anterior-posterior operation for reduction, decompression or tumor resection and circumferential reconstruction was carried out. Both anterior and posterior procedures were successfully completed simultaneously in the sitting position in all cases. There were no perioperative complications. The average operative time was 175 ± 32 min (range, 120-240 min), and the mean blood loss was 430 ± 85 mL (range, 200-1100 mL). The patients were followed up for 35.8 months (range, 18-60 months). The symptom of neck pain improved distinctly and no evidence of implant failure was noted in any patients. Neurological status improvement was confirmed in six patients, who had suffered incomplete paralysis. The ASIA grade improved in five patients, and two cases had no change in grade. The "sitting position" simultaneously combined anterior-posterior approach is safe and is

  2. [Transpedicular bone graft for the treatment of thoracolumbar vertebral fractures through Wiltse approach].

    PubMed

    Wang, Xiang-fu; Wang, Xing-sheng

    2013-07-01

    To explore methods and therapeutic effects of transpedicular bone graft in treating thoracolumbar fractures through Wiltse approach. From March 2009 to February 2012,56 patients with thoracolumbar fractures were treated by transpedicular bone graft through Wiltse approach. Among them, there were 36 males and 20 females, ranging in age from 14 to 55 years old (mean, 41 years old). The time from injury to operation from 2 to 15 d (mean,3 d). Twenty-five cases were caused by falling down, 7 cases were caused by slipping, 20 cases were caused by car accident and 4 cases were caused by crush trauma. MRI was performed before operation to exclude pathological fracture. The distance between multifidus muscle and longissimus to midcourt line was measured. Self-made trocar was applied in operation. According to AO classification,there were 33 cases with type A1 compression fracture,5 cases with type A2 cleavage fracture and 18 cases with type A3 burst fracture. Sixteen cases of the 56 cases combined with spinal cord injury. Based on Frankel neurologic grading system, preoperative neurological function was grade B in 5 cases, grade C in 2 cases, gade D in 9 cases. Preoperative Denis gading were P5. Frankel and lumbago Denis clssification were used to evaluate neurological function and lumbago. The imaging data before, after operation and the latest follow-up were used to evaluate correction vision. All patients were followed up over 24 months. At the time of the latest follow-up, Frankel B were 3 cases, Frankel C were 2 cases, Frankel D were 4 cases and Frankel E were 7 cases. According to lumbago Denis clssification, P1 (painlessness) were 32 cases, P2 ( slight pain without treatment) were 18 cases, P3 ( moderate pain and taking medicine occasionally) were 6 cases. The anterior vertebral height improved from preoperative (13.38 +/- 4.72)mm to postoperative (22.18 +/- 1.44)mm. The Cobb's angle decreased from preoperative (28.39 +/- 2.64) degrees to (10.07 +/- 3.05) degrees

  3. Hybrid surgery versus anterior cervical discectomy and fusion for multilevel cervical degenerative disc diseases: a meta-analysis

    PubMed Central

    Tian, Peng; Fu, Xin; Li, Zhi-Jun; Sun, Xiao-Lei; Ma, Xin-Long

    2015-01-01

    The objective of this meta-analysis is to compare hybrid surgery (HS) and cervical discectomy and fusion (ACDF) for multilevel cervical degenerative disc diseases (DDD). Systematic searches of all published studies through March 2015 were identified from Cochrane Library, Medline, PubMed, Embase, ScienceDirect, CNKI, WANFANG DATA and CQVIP. Randomized controlled trials (RCTs) and non-RCTs involving HS and ACDF for multilevel DDD were included. All literature was searched and assessed by two independent reviewers according to the standard of Cochrane systematic review. Data of functional and radiological outcomes in two groups were pooled, which was then analyzed by RevMan 5.2 software. One RCT and four non-RCTs encompassing 160 patients met the inclusion criteria. Meta-analysis revealed significant differences in blood loss (p = 0.005), postoperative C2–C7 ROM (p = 0.002), ROM of superior adjacent segment (p < 0.00001) and ROM of inferior adjacent segment (p = 0.0007) between the HS group and the ACDF group. No significant differences were found regarding operation time (p = 0.75), postoperative VAS (p = 0.18) and complications (p = 0.73) between the groups. Hybrid surgery demonstrated excellent clinical efficacy and radiological results. Postoperative C2–C7 ROM was closer to the physiological status. No decrease in the ROM of the adjacent segment was noted in the hybrid surgery group. PMID:26307360

  4. [Case-control study on Zero-profile implant for anterior cervical discectomy and fusion and conventional cage plate internal fixation for the treatment of single segmental cervical intervertebral disc herniation].

    PubMed

    Shao, Hai-yu; Zhang, Jun; Yang, Di; Chen, Jin-ping; Huang, Ya-zeng

    2016-06-01

    To compare clinical efficacy of Zero-profile implant for anterior cervical discectomy and fusion and conventional titanium plate with cage internal fixation for the treatment of single segmental cervical intervertebral disc herniation. From August 2011 to March 2014, clinical data of 139 patients with single cervical disc herniation treated with anterior cervical discectomy and interbody fusion with internal fixation were retrospectively analyzed. The patients were divided into two groups according to its operation method. There were 63 patients in group A which performed anterior discectomy and interbody fusion with Zero-profile;76 patients in group B which performed anterior cervical discectomy and cage plate internal fixation. JOA score and Odom functional rating between two groups were compared before and after operation. Videofluorographic swallowing study (VFSS) were used to evaluate thickness of prevertebral soft tissue. Bazaz dysphagia score were used to assess incidence of dysphagia. Postoperative AP X-ray and CT of cervical vertebra at 12 months were applied for evaluating bone graft fusion. Postoperative MRI was applied for evaluating the incidence of adjacent segment degeneration. Blood loss,operative time, preoperative and postoperative JOA score, Odom functional rating and VFSS score, Bazaz score, fusion rate between vertebral bodies and incidence of adjacent segment degeneration were compared between two groups. There were no statistical meaning between two groups in JOA score, Odom functional rating before and after operation (P > 0.05); and no significant meaning in VFSS score between two groups before operation (P > 0.05); There were no significant difference in operative time and blood loss. There was statistical meaning in VFSS, Bazaz dysphagia score at 2 days, and 6 months after operation (P < 0.05). All patients obtained bone union at 1 year after operation, and no obvious meaning in fusion rate (P > 0.05). Eight patients (12.7%) in group A

  5. An Outcome Study of Anterior Cervical Discectomy and Fusion among Iranian Population

    PubMed Central

    Haghnegahdar, Ali

    2016-01-01

    Background and Aim. First-line treatment strategy for managing cervical disc herniation is conservative measures. In some cases, surgery is indicated either due to signs/symptoms of severe/progressive neurological deficits, or because of persistence of radicular pain despite 12 weeks of conservative treatment. Success for treatment of cervical disc herniation using ACDF has been successfully reported in the literature. We aim to determine the outcome of ACDF in treatment of cervical disc herniation among Iranians. Methods and Materials/Patients. In a retrospective cohort study, we evaluated 68 patients who had undergone ACDF for cervical disc herniation from March 2006 to March 2011. Outcome tools were as follows: (1) study-designed questionnaire that addressed residual and/or new complaints and subjective satisfaction with the operation; (2) recent (one week prior to the interview) postoperative VAS for neck and upper extremity radicular pain; (3) Japanese Orthopaedic Association Myelopathy Evaluation Questionnaire (JOACMEQ) (standard Persian version); and (4) follow-up cervical Magnetic Resonance Imaging (MRI) and lateral X-ray. Results. With mean follow-up time of 52.93 (months) ± 31.89 SD (range: 13–131 months), we had success rates with regard to ΔVAS for neck and radicular pain of 88.2% and 89.7%, respectively. Except QOL functional score of JOAMEQ, 100% success rate for the other 4 functional scores of JOAMEQ was achieved. Conclusion. ACDF is a successful surgical technique for the management of cervical disc herniation among Iranian population. PMID:27635392

  6. Pelvic Floor Support Defect in Apical Anterior Vaginal Prolapse with Cervical Hypertrophy. Review with Case Report in a 20-year-old Cadaver

    PubMed Central

    2015-01-01

    Apical anterior vaginal wall prolapse (AVWP) with central defect is uncommon in young non hysterectomized patients causing considerable mortality after the fourth decade of life. Its high propensity to recurrence poses the greatest challenge to pelvic reconstructive surgeons. Approximately 40% of women with prolapse have hypertrophic cervical elongation and the extent of elongation increases with greater degrees of prolapse. Women with prolapse either have inherent hypertrophic elongation of the cervix which predisposes them to prolapse or the downward traction in prolapse leads to cervical elongation. The Pelvic Organ Prolapse Quantification (POP-Q) examination includes measurement of the location of the posterior fornix (point D) with the assumption that this measurement is associated with cervical elongation. Multifocal site involvement with apical and perineal descent primarily afflicts elderly, postmenopausal women after the fourth decade while cervical hypertrophic elongation with prolapse is observed in younger women less than 40 years of age. A review of the anatomical implication of the association of cervical hypertrophy in prolapse is carried out in this article. We observed a combination of distension type anterior vaginal prolapse with apical descent and cervical hypertrophy in a 20-year-old cadaver during routine dissection for undergraduate medical students at Sikkim Manipal Institute of Medical Sciences in 2013. Distension type anterior vaginal prolapse with central defect is rarer as most reported cases are of the displacement type, paravaginal defect. Hypertrophic cervical elongation is either the cause or consequence of prolapse and its identification before reconstructive surgery is paramount as uterine suspension in the face of cervical elongation is contraindicated. Inappropriate identification of all support defects and breaking of tissues is the primary cause of failure of laparoscopic pelvic reconstructive surgery. PMID:26557506

  7. Bioresorbable polylactide interbody implants in an ovine anterior cervical discectomy and fusion model: three-year results.

    PubMed

    Thomas, Kevin A; Toth, Jeffrey M; Crawford, Neil R; Seim, Howard B; Shi, Lewis L; Harris, Mitchel B; Turner, A Simon

    2008-04-01

    In vivo study of anterior discectomy and fusion using a bioresorbable 70:30 poly(l-lactide-co-d,l-lactide) interbody implant in an ovine model. To evaluate the efficacy of the polylactide implant to function as an interbody fusion device, and to assess the tissue reaction to the material during the resorption process. The use of polylactide as a cervical interbody implant has several potential advantages when compared with traditional materials. Having an elastic modulus very similar to bone minimizes the potential for stress shielding, and as the material resorbs additional loading is transferred to the developing fusion mass. Although preclinical and clinical studies have demonstrated the suitability of polylactide implants for lumbar interbody fusion, detailed information on cervical anterior cervical discectomy and fusion (ACDF) with polylactide devices is desirable. Single level ACDF was performed in 8 skeletally mature ewes. Bioresorbable 70:30 poly (l-lactide-co-d,l-lactide) interbody implants packed with autograft were used with single-level metallic plates. Radiographs were made every 3 months up to 1 year, and yearly thereafter. The animals were killed at 6 months (3 animals), 12 months (3 animals), and 36 months (2 animals). In addition to the serial plain radiographs, the specimens were evaluated by nondestructive biomechanical testing and undecalcified histologic analysis. The bioresorbable polylactide implants were effective in achieving interbody fusion. The 6-month animals appeared fused radiographically and biomechanically, whereas histologic sections demonstrated partial fusion (in 3 of 3 animals). Radiographic fusion was confirmed histologically and biomechanically at 12 months (3 of 3 animals) and 36 months (2 of 2 animals). A mild chronic inflammatory response to the resorbing polylactide implant was observed at both 6 months and 12 months. At 36 months, the operative levels were solidly fused and the implants were completely resorbed. No

  8. Preoperative opioid strength may not affect outcomes of anterior cervical procedures: a post hoc analysis of 2 prospective, randomized trials

    PubMed Central

    Kelly, Michael P.; Anderson, Paul A.; Sasso, Rick C.; Riew, K. Daniel

    2015-01-01

    Object The aim of this study is to evaluate the relationship between preoperative opioid strength and outcomes of anterior cervical decompressive surgery. Methods A retrospective cohort of 1004 patients enrolled in 1 of 2 investigational device exemption studies comparing cervical total disc arthroplasty (TDA) and anterior cervical discectomy and fusion (ACDF) for single-level cervical disease causing radiculopathy or myelopathy was selected. At a preoperative visit, opioid use data, Neck Disability Index (NDI) scores, 36-ltem Short-Form Health Survey (SF-36) scores, and numeric rating scale scores for neck and arm pain were collected. Patients were divided into strong (oxycodone/morphine/meperidine), weak (codeine/propoxyphene/ hydrocodone), and opioid-naïve groups. Preoperative and postoperative (24 months) outcomes scores were compared within and between groups using the paired t-test and ANCOVA, respectively. Results Patients were categorized as follows: 226 strong, 762 weak, and 16 opioid naïve. The strong and weak groups were similar with respect to age, sex, race, marital status, education level, Worker's Compensation status, litigation status, and alcohol use. At 24-month follow-up, no differences in change in arm or neck pain scores (arm: strong –52.3, weak –50.6, naïve –54.0, p = 0.244; neck: strong –52.7, weak –50.8, naïve –44.6, p = 0.355); NDI scores (strong –36.0, weak –33.3, naïve –32.3, p = 0.181); or SF-36 Physical Component Summary scores (strong: 14.1, weak 13.3, naïve 21.7, p = 0.317) were present. Using a 15-point improvement in NDI to determine success, the authors found no between-groups difference in success rates (strong 80.6%, weak 82.7%, naïve 73.3%, p = 0.134). No difference existed between treatment arms (TDA vs ACDF) for any outcome at any time point. Conclusions Preoperative opioid strength did not adversely affect outcomes in this analysis. Careful patient selection can yield good results in this patient

  9. 3-Tesla Kinematic MRI of the Cervical Spine for Evaluation of Adjacent Level Disease After Monosegmental Anterior Cervical Discectomy and Arthroplasty: Results of 2-Year Follow-Up.

    PubMed

    Fleck, Steffen K; Langner, Soenke; Rosenstengel, Christian; Kessler, Rebecca; Matthes, Marc; Müller, Jan-Uwe; Langner, Inga; Marx, Sascha; Schroeder, Henry W S

    2017-02-15

    We prospectively evaluated adjacent disc levels after anterior cervical discectomy and arthroplasty (ACDA) using kinematic magnetic resonance imaging (MRI) and plain functional radiographs. ACDA is an established treatment for degenerative cervical disc disease. The objective of this study was to evaluate the use of kinematic MRI for assessing the range of motion (ROM) before and after ACDA compared with plain functional radiographs and to evaluate adjacent degenerative disc disease (aDDD) at mid-term follow-up. Twenty patients (12 females, 8 males; median age 45.6 ± 6.9 yrs) treated by ACDA (BryanDisc; Medtronic, MN) underwent plain functional radiography and kinematic MRI of the cervical spine at 3 T before and 6 and 24 months after surgery. A sagittal T2-weighted (T2w) 2D turbo spin echo (TSE) sequence and a 3D T2w dataset with secondary axial reconstruction were acquired. Signal intensity of all nonoperated discs was measured in regions of interest (ROI). Disc heights adjacent to the operated segment were measured. ROM was evaluated and compared with plain functional radiographs. Clinical outcome was evaluated using the visual analog scale (VAS) for head, neck and radicular pain, and the neck disability index (NDI). Mean ROM of the cervical spine on functional plain radiographs was 21.25 ± 8.19°, 22.29 ± 4.82°, and 26.0 ± 6.9° preoperatively and at 6-month and 24-month follow-up, respectively. Mean ROM at MRI was 27.1 ± 6.78°, 29.45 ± 9.51°, and 31.95 ± 9.58°, respectively. There was a good correlation between both techniques. Follow-up examinations demonstrated no signs of progressive degenerative disc disease of adjacent levels. All patients had clinical improvement up to 24 months after surgery. After ACDA, kinematic MRI allows evaluation of the ROM with excellent correlation to plain functional radiographs. Mid-term follow-up after ACDA is without evidence of progressive DDD of adjacent segments. 3.

  10. A 5- to 8-year randomized study on the treatment of cervical radiculopathy: anterior cervical decompression and fusion plus physiotherapy versus physiotherapy alone.

    PubMed

    Engquist, Markus; Löfgren, Håkan; Öberg, Birgitta; Holtz, Anders; Peolsson, Anneli; Söderlund, Anne; Vavruch, Ludek; Lind, Bengt

    2017-01-01

    OBJECTIVE The aim of this study was to evaluate the 5- to 8-year outcome of anterior cervical decompression and fusion (ACDF) combined with a structured physiotherapy program as compared with that following the same physiotherapy program alone in patients with cervical radiculopathy. No previous prospective randomized studies with a follow-up of more than 2 years have compared outcomes of surgical versus nonsurgical intervention for cervical radiculopathy. METHODS Fifty-nine patients were randomized to ACDF surgery with postoperative physiotherapy (30 patients) or to structured physiotherapy alone (29 patients). The physiotherapy program included general and specific exercises as well as pain coping strategies. Outcome measures included neck disability (Neck Disability Index [NDI]), neck and arm pain intensity (visual analog scale [VAS]), health state (EQ-5D questionnaire), and a patient global assessment. Patients were followed up for 5-8 years. RESULTS After 5-8 years, the NDI was reduced by a mean score% of 21 (95% CI 14-28) in the surgical group and 11% (95% CI 4%-18%) in the nonsurgical group (p = 0.03). Neck pain was reduced by a mean score of 39 mm (95% CI 26-53 mm) compared with 19 mm (95% CI 7-30 mm; p = 0.01), and arm pain was reduced by a mean score of 33 mm (95% CI 18-49 mm) compared with 19 mm (95% CI 7-32 mm; p = 0.1), respectively. The EQ-5D had a mean respective increase of 0.29 (95% CI 0.13-0.45) compared with 0.14 (95% CI 0.01-0.27; p = 0.12). Ninety-three percent of patients in the surgical group rated their symptoms as "better" or "much better" compared with 62% in the nonsurgical group (p = 0.005). Both treatment groups experienced significant improvement over baseline for all outcome measures. CONCLUSIONS In this prospective randomized study of 5- to 8-year outcomes of surgical versus nonsurgical treatment in patients with cervical radiculopathy, ACDF combined with physiotherapy reduced neck disability and neck pain more effectively than

  11. DEFECTS IN CERVICAL VERTEBRAE IN BORIC ACID-EXPOSED RAT EMBRYOS ARE ASSOCIATED WITH ANTERIOR SHIFTS OF HOX GENE EXPRESSION DOMAINS

    EPA Science Inventory

    Defects in cervical vertebrae in boric acid-exposed rat embryos are associated with anterior shifts of hox gene expression domains

    Nathalie Wery,1 Michael G. Narotsky,2 Nathalie Pacico,1 Robert J. Kavlock,2 Jacques J. Picard,1 AND Francoise Gofflot,1*
    1Unit of Developme...

  12. DEFECTS IN CERVICAL VERTEBRAE IN BORIC ACID-EXPOSED RAT EMBRYOS ARE ASSOCIATED WITH ANTERIOR SHIFTS OF HOX GENE EXPRESSION DOMAINS

    EPA Science Inventory

    Defects in cervical vertebrae in boric acid-exposed rat embryos are associated with anterior shifts of hox gene expression domains

    Nathalie Wery,1 Michael G. Narotsky,2 Nathalie Pacico,1 Robert J. Kavlock,2 Jacques J. Picard,1 AND Francoise Gofflot,1*
    1Unit of Developme...

  13. Cost-effectiveness analysis: comparing single-level cervical disc replacement and single-level anterior cervical discectomy and fusion: clinical article.

    PubMed

    Qureshi, Sheeraz A; McAnany, Steven; Goz, Vadim; Koehler, Steven M; Hecht, Andrew C

    2013-11-01

    In recent years, there has been increased interest in the use of cervical disc replacement (CDR) as an alternative to anterior cervical discectomy and fusion (ACDF). While ACDF is a proven intervention for patients with myelopathy or radiculopathy, it does have inherent limitations. Cervical disc replacement was designed to preserve motion, avoid the limitations of fusion, and theoretically allow for a quicker return to activity. A number of recently published systematic reviews and randomized controlled trials have demonstrated positive clinical results for CDR, but no studies have revealed which of the 2 treatment strategies is more cost-effective. The purpose of this study was to evaluate the cost-effectiveness of CDR and ACDF by using the power of decision analysis. Additionally, the authors aimed to identify the most critical factors affecting procedural cost and effectiveness and to define thresholds for durability and function to focus and guide future research. The authors created a surgical decision model for the treatment of single-level cervical disc disease with associated radiculopathy. The literature was reviewed to identify possible outcomes and their likelihood following CDR and ACDF. Health state utility factors were determined from the literature and assigned to each possible outcome, and procedural effectiveness was expressed in units of quality-adjusted life years (QALYs). Using ICD-9 procedure codes and data from the Nationwide Inpatient Sample, the authors calculated the median cost of hospitalization by multiplying hospital charges by the hospital-specific cost-to-charge ratio. Gross physician costs were determined from the mean Medicare reimbursement for each current procedural terminology (CPT) code. Uncertainty as regards both cost and effectiveness numbers was assessed using sensitivity analysis. In the reference case, the model assumed a 20-year duration for the CDR prosthesis. Cervical disc replacement led to higher average QALYs gained

  14. Anterior cervical discectomy and fusion (ACDF) autograft versus graft substitutes: what do patients prefer?—A clinical study

    PubMed Central

    Maharaj, Monish M.; Phan, Kevin

    2016-01-01

    Background Patient dissatisfaction with donor site morbidity has led to the search for alternative grafting options and techniques. This report compares patient satisfaction rates between autograft and graft substitutes for anterior cervical discectomy and fusion (ACDF). Methods This study was performed with the approval of the local area health network ethics committee. Over a 9-year period, the author performed 574 ACDF procedures (697 levels). Of these, 22 patients had previous surgery with autograft, with a subsequent ACDF procedure performed using a graft substitute. Patients rated their satisfaction with pain, recovery, and preference of autograft versus a bone graft substitute. Graft substitutes used include: tricalcium phosphate/hydroxyapatite (TCP/HA) composite and iFactor placed within a polyetheretherketone (PEEK) cage. Results Results demonstrated that 21/22 patients achieved a solid fusion with the graft substitute. A total of 20/22 patients rated the autograft incision more painful than the anterior cervical incision, and 21/22 preferred the graft substitute. Three patients had adjacent segment disc replacement performed after autograft/ACDF. All patients reported preference for the total disc replacement (TDR) procedure in terms of recovery and postoperative pain. Conclusions Patient satisfaction with bone graft substitutes is very high compared with autograft with all but one (21/22) preferring the graft substitute option. The author questions the traditional recommendation that autograft is the “gold standard” for ACDF. In modern age of graft substitutes, autograft should not be considered the gold standard, but an index option between other options for comparison. PMID:27683706

  15. Risk-factor analysis of adjacent-segment pathology requiring surgery following anterior, posterior, fusion, and nonfusion cervical spine operations: survivorship analysis of 1358 patients.

    PubMed

    Lee, Jae Chul; Lee, Sang-Hun; Peters, Colleen; Riew, K Daniel

    2014-11-05

    Adjacent-segment pathology is an important issue involving the cervical spine, but there have been few comprehensive studies of this problem. The purpose of the current study was to determine the risk factors for adjacent-segment pathology and to compare the survivorship of adjacent segments in patients who underwent cervical spine operations including arthrodesis and motion-sparing procedures. This was a retrospective analysis of a consecutive series of 1358 patients with radiculopathy, myelopathy, or myeloradiculopathy who underwent cervical spine surgery performed by a single surgeon. We calculated the annual incidence of adjacent-segment pathology requiring surgery and, with use of Kaplan-Meier analysis, determined survivorship. Cox regression analysis was used to identify risk factors. The index surgical procedures included cervical arthrodesis (1095 patients; 1038 anterior, twenty-nine posterior, and twenty-eight combined anterior and posterior), posterior decompression (214 patients; 145 laminoplasty and sixty-nine foraminotomy), arthroplasty (thirty-two patients), and a combination of arthroplasty and anterior arthrodesis (seventeen patients). Secondary surgery on adjacent segments occurred at a relatively constant rate of 2.3% per year (95% confidence interval, 1.9 to 2.9). Kaplan-Meier analysis predicted that 21.9% of patients would need secondary surgery on adjacent segments by ten years postoperatively. Factors increasing the risk were smoking, female sex, and type of procedure. The posterior arthrodesis group (posterior-only or combined anterior and posterior arthrodesis) had a 7.5-times greater risk of adjacent-segment pathology requiring reoperation than posterior decompression, and a 3.0-times greater risk than the anterior arthrodesis group. However, when we compared the anterior cervical arthrodesis group, the arthroplasty group (arthroplasty or hybrid arthroplasty), and the posterior decompression group to each other, there were no significant

  16. [Preliminary application of the fusion cage of biomimetic n-HA/PA66 composites in anterior cervical intervertebral fusion].

    PubMed

    Ou, Yunsheng; Jiang, Dianming; Quan, Zhengxue; An, Hong; Tang, Ke; Li, Jia; Shen, Changhuan

    2010-04-01

    This study was aimed to evaluate the preliminary efficacy and the safety of the fusion cage made of biomimetic nano-hydroxyapatite and polyamide 66 (n-HA/PA66) composites for the structural reconstruction and the restoration of height of vertebral body in the case of cervical spondylosis by anterior surgical procedures. 52 patients with cervical spondylosis, received the therapy by discectomy with or without vertebrae resection and decompression, and the fusion cage of n-HA/PA66 vertebra implant with bone chip, and titanium plate system was fixed. All cases were followed up for 6 to 25 months. All the patients' preoperative symptoms subsided without any serious complication, and no patient complained of lasting soreness. No effusion or flare was found, and no recurrence happened in the follow-up. The preoperative JOA score was 10.4, and post-operative JOA score 15.7. The X-ray films of all cases demonstrated successful fusion with good curvature and height, and there was no sinking or collapse. The stability was satisfactory; the reconstructive height of vertebra was maintained. No complications such as infection and screw broken came into being. The fusion cage of the biomimetic n-HA/PA66 composites can effectively restore the height and structure of vertebra. It may have the potential for use as a satisfactory prosthestic vertebral body replacement.

  17. Comparative Study between a Curved and a Wedge PEEK Cage for Single-level Anterior Cervical Discectomy and Interbody Fusion

    PubMed Central

    Kim, Hwan Soo; Heo, Weon; Cha, Jae Hoon; Rhee, Dong Youl

    2012-01-01

    Objective This study evaluated the efficiency of a curved polyetheretherketone (PEEK) cage in comparison with a wedge PEEK cage according to radiologic and clinical outcomes in patients with cervical degenerative disease. Methods A total of 37 patients who suffering from cervical disc disease with radiculopathy or myelopathy were reviewed retrospectively. Seventeen patients were underwent anterior cervical discectomy and interbody fusion with a curved shape PEEK cage (curved cage group), and twenty patients with wedge shape PEEK cage (wedge cage group). Clinical assessment was graded using Odom's criteria, NDI score and VAS score. For radiologic analysis, disc height (DH), segmental angle (SA), subsidence were measured at the preoperative and last follow up. Results A comparison of the preoperative and postoperative results revealed improvements after the surgery in the DH and SA in both cage groups. The change of postoperative DH between the preoperative and the last follow-up in wedge cage group and curved cage group was 6.85% and 25.5%, respectively. The change of postoperative SA was 1.75° and 0.95°, respectively. There was no statistically significant difference in the DH and SA between the 2 groups. The subsidence rate in the wedge cage group and curved cage group was 20% and 6%, respectively. Conclusion The 2 different cage groups showed significant improvements in the disc height, segmental angle and clinical outcomes. However, the shape of PEEK Cage influences the tendency for subsidence. Increasing contact surface area and fitting into two adjacent vertebral body prevent significant subsidence. PMID:25983812

  18. Cost-Utility Analysis of Anterior Cervical Discectomy and Fusion With Plating (ACDFP) Versus Posterior Cervical Foraminotomy (PCF) for Patients With Single-level Cervical Radiculopathy at 1-Year Follow-up.

    PubMed

    Alvin, Matthew D; Lubelski, Daniel; Abdullah, Kalil G; Whitmore, Robert G; Benzel, Edward C; Mroz, Thomas E

    2016-03-01

    A retrospective 1-year cost-utility analysis. To determine the cost-effectiveness of anterior cervical discectomy and fusion with plating (ACDFP) in comparison with posterior cervical foraminotomy (PCF) for patients with single-level cervical radiculopathy. Cervical radiculopathy due to cervical spondylosis is commonly treated by either PCF or ACDFP for patients who are refractory to nonsurgical treatment. Although some have suggested superior outcomes with ACDFP as compared with PCF, the former is also associated with greater costs. The present study analyzes the cost-effectiveness of ACDFP versus PCF for patients with single-level cervical radiculopathy. Forty-five patients who underwent ACDFP and 25 patients who underwent PCF for single-level cervical radiculopathy were analyzed. One-year postoperative health outcomes were assessed based on Visual Analogue Scale, Pain Disability Questionnaire, Patient Health Questionnaire, and EuroQOL-5 Dimensions questionnaires to analyze the comparative effectiveness of each procedure. Direct medical costs were estimated using Medicare national payment amounts and indirect costs were based on patient missed work days and patient income. Postoperative 1-year cost/utility ratios and the incremental cost-effectiveness ratio (ICER) were calculated to assess for cost-effectiveness using a threshold of $100,000/QALY gained. The 1-year cost-utility ratio for the PCF cohort was significantly lower ($79,856/QALY gained) than that for the ACDFP cohort ($131,951/QALY gained) (P<0.01). In calculating the 1-year ICER, as the ACDFP cohort showed lower QALY gained than the PCF cohort, the ICER was negative and is not reported, meaning that ACDFP was dominated by PCF. Statistically significant and clinically relevant improvements (through minimum clinically important differences) were seen in both cohorts. Although both cohorts showed improved health outcomes, ACDFP was not cost-effective relative to the threshold of $100,000/QALY gained at 1

  19. Application of the cervical subaxial anterior approach at C2 in select patients.

    PubMed

    Zhang, Ying; Zhang, Jing; Wang, Xinwei; Chen, Deyu; Yuan, Wen

    2013-05-01

    The purpose of this study was to assess the feasibility and radiographic indications of using the subaxial anterior approach for decompression and fusion at C2. Anterior exposure at C2 was difficult and associated with increased morbidity. The subaxial anterior approach is easy and familiar to spine surgeons but did not provide satisfying exposure in all patients. This article describes a series of patients undergoing anterior surgery involving C2 through the subaxial anterior approach. Patients were selected based on lateral extension radiographs showing a mandibular angle higher than the C3 upper endplate. Forty-two patients (29 men and 13 women) with average age of 45 years and an average follow-up of 9.7 months were reviewed. Etiologies included Hangman's fracture (n=35), traumatic disk herniation at C2-C3 (n=1), C3 fracture (n=2), ossification of the posterior longitudinal ligament (n=2), and tumor (n=2). Single-level diskectomy (n=36) and corpectomy (n=6) were performed. Exposure was satisfactory, and operations went smoothly in all patients except in 1 man with a muscular neck. One (2.4%) postoperative complication of choking and trouble swallowing liquids was observed and diminished in 3 months with no treatment. Pre- and postoperative Japanese Orthopaedic Association scores were 13.86 ± 2.25 and 16.50 ± 0.76, respectively, with an improvement rate of 85% ± 24% in 14 patients who had preoperative neurological dysfunction. A fusion rate of 100% was achieved. The subaxial anterior approach may be simple and safe for exposure at C2 in select patients. Complicated exposure, such as the transoral or retropharyngeal approach, should be avoided in these patients.

  20. Adjacent segment motion after anterior cervical discectomy and fusion versus Prodisc-c cervical total disk arthroplasty: analysis from a randomized, controlled trial.

    PubMed

    Kelly, Michael P; Mok, James M; Frisch, Richard F; Tay, Bobby K

    2011-07-01

    Post hoc analysis of data acquired in a prospective, randomized, controlled trial. To compare adjacent segment motion after anterior cervical discectomy and fusion (ACDF) versus cervical total disc arthroplasty (TDA). TDA has been designed to be a motion-preserving device, thus theoretically normalizing adjacent segment kinematics. Clinical studies with short-term follow-up have yet to demonstrate a consistent significant difference in the incidence of adjacent segment disease. Two hundred nine patients at 13 sites were treated in a prospective, randomized, controlled trial of ACDF versus TDA for single-level symptomatic cervical degenerative disc disease (SCDD). Flexion and extension radiographs were obtained at all follow-up visits. Changes in ROM were compared using the Wilcoxon signed-rank test and the Mann-Whitney U test. Predictors of postoperative ROM were determined by multivariate analysis using mixed effects linear regression. Data for 199 patients were available with 24-month follow-up. The groups were similar with respect to baseline demographics. A significant increase in motion at the cranial and caudal adjacent segments after surgery was observed in the ACDF group only (cranial: ACDF: +1.4° (0.4, 2.4), P = 0.01; TDA: +0.8°, (-0.1, +1.7), P = 0.166; caudal: ACDF: +2.6° (1.3, 3.9), P < 0.0001; TDA: +1.3, (-0.2, +2.8), P = 0.359). No significant difference in adjacent segment ROM was observed between ACDF and TDA. Only time was a significant predictor of postoperative ROM at both the cranial and caudal adjacent segments. Adjacent segment kinematics may be altered after ACDF and TDA. Multivariate analysis showed time to be a significant predictor of changes in adjacent segment ROM. No association between the treatment chosen (ACDF vs. TDA) and ROM was observed. Furthermore clinical follow-up is needed to determine whether possible differences in adjacent segment motion affect the prevalence of adjacent segment disease in the two groups.

  1. Is anterior cervical fusion with a porous tantalum implant a cost-effective method to treat cervical disc disease with radiculopathy?

    PubMed

    Fernández-Fairen, Mariano; Murcia, Antonio; Torres, Ana; Hernández-Vaquero, Daniel; Menzie, Ann M

    2012-09-15

    Retrospective cost-effectiveness analysis. To determine the relative cost-effectiveness of anterior cervical discectomy with fusion (ACDF) using a porous tantalum implant compared with autograft with plating, for single-level cervical disc disease with radiculopathy. ACDF with autograft as an interbody spacer is a generally accepted method to treat degenerated cervical discs with radiculopathy. Concerns about donor site morbidity and the structural characteristics of autograft stimulated investigations of alternative materials. Techniques may differ in their operative risks, complications, outcomes, and resource use. A retrospective review of clinical outcomes and total cost of illness for 5 years postsurgery was performed for 61 consecutive patients enrolled for this study. Twenty-eight patients were treated with single-level ACDF using either a stand-alone, porous tantalum implant, without graft inside the implant, and 33 patients received autograft and plating. A cost-effectiveness analysis comparing the 2 ACDF treatment methods was conducted. This article reports clinical assessments, quality adjusted life years gained, and an incremental cost-effectiveness ratio analysis. Patients in both cohorts reported improved clinical outcomes, including neck disability index, visual analogue scale, Short-Form 36, Odom's clinical assessment, and patient satisfaction at 5 years postindex surgery. The mean cost of illness for the study period, including preoperative through 5 years postoperative assessments, was 6806 per patient treated with tantalum and 10,143 per patient receiving autograft and plate. Quality-adjusted life years (QALY) gained were 9.41 and 7.14 for the tantalum and control cohorts, respectively. The cost per QALY for the tantalum group was 723 and 1420 for the control group. The incremental cost-effectiveness ratio of ACDF with a porous tantalum implant compared with ACDF with autograft and plate was -1473 per patient per year for the duration of this

  2. The ROI-C zero-profile anchored spacer for anterior cervical discectomy and fusion: biomechanical profile and clinical outcomes

    PubMed Central

    Bucci, Michael N; Oh, Dennis; Cowan, R Scott; Davis, Reginald J; Jackson, Robert J; Tyndall, Dwight S; Nehls, Daniel

    2017-01-01

    Introduction Anterior cervical discectomy and fusion (ACDF) has been the gold standard for treating cervical degenerative disc disease (cDDD). The use of anterior plates in ACDF poses an increased risk of complications such as screw or plate dislodgement, soft tissue injury, esophagus perforation, and dysphagia. The ROI-C™ implant system consists of a zero-profile interbody fusion cage with self-locking plates designed for stand-alone fusion without external plates or screws. Objective The purpose of this report is to describe the ROI-C™ implant system with VerteBRIDGE™ anchor plates, including indications for use, surgical technique, preclinical testing, and clinical study results. The objectives of the clinical study were to assess fusion status, incidence of dysphagia and other device-related complications, and patient reported outcomes. Methods This was a retrospective, multicenter cohort study of 110 patients who underwent ACDF with ROI-C at seven study centers. Patient charts and radiographs were reviewed for any complications or device malfunction. The final follow-up was conducted prospectively and included collection of neck disability index, and visual analog scale (VAS) neck and arm pain scores. Results The mean operation time was 73 minutes, and mean blood loss was 25 mL (range 0–75 mL). Mean follow-up was 20.7 months (range 9.5–42.2). Dysphagia was reported in two patients (1.8%), and 99.1% of patients achieved fusion. One patient had radiographically confirmed pseudarthrosis at 12 months that was asymptomatic and did not require surgery. One patient had subsequent surgery owing to adjacent level degeneration. The mean neck disability index, VAS neck pain, and VAS right and left arm pain scores at final follow-up were 19, 26.5, 12.5, and 15.3, respectively. Conclusion The ROI-C interbody cage with VerteBRIDGE anchor plates achieved a high rate of fusion, with a low incidence of dysphagia. These patients had similar or better outcomes compared

  3. Subsequent surgery rates after cervical total disc replacement using a Mobi-C Cervical Disc Prosthesis versus anterior cervical discectomy and fusion: a prospective randomized clinical trial with 5-year follow-up.

    PubMed

    Jackson, Robert J; Davis, Reginald J; Hoffman, Gregory A; Bae, Hyun W; Hisey, Michael S; Kim, Kee D; Gaede, Steven E; Nunley, Pierce Dalton

    2016-05-01

    OBJECTIVE Cervical total disc replacement (TDR) has been shown in a number of prospective clinical studies to be a viable treatment alternative to anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic degenerative disc disease. In addition to preserving motion, evidence suggests that cervical TDR may result in a lower incidence of subsequent surgical intervention than treatment with fusion. The goal of this study was to evaluate subsequent surgery rates up to 5 years in patients treated with TDR or ACDF at 1 or 2 contiguous levels between C-3 and C-7. METHODS This was a prospective, multicenter, randomized, unblinded clinical trial. Patients with symptomatic degenerative disc disease were enrolled to receive 1- or 2-level treatment with either TDR as the investigational device or ACDF as the control treatment. There were 260 patients in the 1-level study (179 TDR and 81 ACDF patients) and 339 patients in the 2-level study (234 TDR and 105 ACDF patients). RESULTS At 5 years, the occurrence of subsequent surgical intervention was significantly higher among ACDF patients for 1-level (TDR, 4.5% [8/179]; ACDF, 17.3% [14/81]; p = 0.0012) and 2-level (TDR, 7.3% [17/234]; ACDF, 21.0% [22/105], p = 0.0007) treatment. The TDR group demonstrated significantly fewer index- and adjacent-level subsequent surgeries in both the 1- and 2-level cohorts. CONCLUSIONS Five-year results showed treatment with cervical TDR to result in a significantly lower rate of subsequent surgical intervention than treatment with ACDF for both 1 and 2 levels of treatment. Clinical trial registration no.: NCT00389597 ( clinicaltrials.gov ).

  4. PEEK Cages versus PMMA Spacers in Anterior Cervical Discectomy: Comparison of Fusion, Subsidence, Sagittal Alignment, and Clinical Outcome with a Minimum 1-Year Follow-Up

    PubMed Central

    Krüger, Marie T.; Sircar, Ronen; Kogias, Evangelos; Scholz, Christoph; Volz, Florian; Scheiwe, Christian; Hubbe, Ulrich

    2014-01-01

    Purpose. To compare radiographic and clinical outcomes after anterior cervical discectomy in patients with cervical degenerative disc disease using PEEK cages or PMMA spacers with a minimum 1-year follow-up. Methods. Anterior cervical discectomy was performed in 107 patients in one or two levels using empty PEEK cages (51 levels), Sulcem PMMA spacers (49 levels) or Palacos PMMA spacers (41 levels) between January, 2005 and February, 2009. Bony fusion, subsidence, and sagittal alignment were retrospectively assessed in CT scans and radiographs at follow-up. Clinical outcome was measured using the VAS, NDI, and SF-36. Results. Bony fusion was assessed in 65% (PEEK cage), 57% (Sulcem), and 46% (Palacos) after a mean follow-up of 2.5 years. Mean subsidence was 2.3–2.6 mm without significant differences between the groups. The most pronounced loss of lordosis was found in PEEK cages (−4.1°). VAS was 3.1 (PEEK cage), 3.6 (Sulcem), and 2.7 (Palacos) without significant differences. Functional outcome in the PEEK cage and Palacos group was superior to the Sulcem group. Conclusions. The substitute groups showed differing fusion rates. Clinical outcome, however, appears to be generally not correlated with fusion status or subsidence. We could not specify a superior disc substitute for anterior cervical discectomy. This trial is registered with DRKS00003591. PMID:25110734

  5. The application of a zero-profile implant in anterior cervical discectomy and fusion.

    PubMed

    Wang, Zhi-dong; Zhu, Ruo-fu; Yang, Hui-lin; Gan, Min-feng; Zhang, Shi-kai; Shen, Min-jie; Chen, Chao; Yuan, Quan

    2014-03-01

    We analyzed the clinical efficacy of the Zero-P implant (Synthes GmbH Switzerland, Oberdorf, Switzerland) in the treatment of single level cervical spondylotic myelopathy. The clinical data of 47 patients with single level cervical spondylotic myelopathy were retrospectively analyzed. Twenty-two patients were treated with a Zero-P implant (Group A) and 25 with a titanium plate with cage (Group B) between January 2009 and September 2010. Operative time, intraoperative blood loss, preoperative and postoperative Japanese Orthopaedic Association (JOA) scores and JOA recovery rate, dysphagia incidence and adjacent segment degeneration rate were measured. The mean operative time in Group A and Group B was 98.18 minutes and 105.4 minutes, respectively. The average intraoperative blood loss in Group A and Group B was 87.95 ml and 92.4 ml, respectively. There were no statistical differences in operation time and intraoperative blood loss between the two groups (p>0.05). The JOA score was significantly improved in the two groups (p<0.001), and the recovery rate was similar (60.86% for Group A versus 62.95% for Group B, p>0.05). Dysphagia was experienced by one (4.5%) patient in Group A and eight (32%) patients in Group B, which was significantly different (p=0.044). There was no statistical significance found in the adjacent level degeneration rates between Group A and Group B (p=0.330). The Zero-P implant and traditional titanium plate with cage are effective treatments for single level cervical spondylotic myelopathy, but the Zero-P implant has a lower dysphagia incidence.

  6. Anterior Cervical Discectomy and Fusion Using a Stand-Alone Polyetheretherketone Cage Packed with Local Autobone : Assessment of Bone Fusion and Subsidence

    PubMed Central

    Park, Jeong-Ill; Kim, Kyoung-Tae; Sung, Joo-Kyung

    2013-01-01

    Objective It remains debatable whether cervical spine fusion cages should be filled with any kind of bone or bone substitute. Cortical and subcortical bone from the anterior and posterior osteophytes of the segment could be used to fill the cage. The purposes of the present study are to evaluate the clinical outcomes and radiological outcomes including bone fusion and subsidence that occurred after anterior cervical discectomy and fusion using a stand-alone cage packed with local autobone graft. Methods Thirty-one patients who underwent anterior cervical fusion using a stand-alone polyetheretherketone (PEEK) cage packed with local autobone graft from July 2009 to december 2011 were enrolled in this study. Bone fusion was assessed by cervical plain radiographs and computed tomographic scan. Nonunion was evaluated according to the absence of bony bridge on computed tomographic scan. Subsidence was defined as a ≥2 mm decrease of the interbody height at the final follow-up compared to that measured at the immediate postoperative period. Results Subsidence was observed in 7 patients (22.6%). Of 7 patients with subsidence greater 2 mm, nonunion was developed in 3. Three patients with subsidence greater 2 mm were related with endplate damage during intraoperative endplate preparation. Solid bone fusion was achieved in 28 out of 31 patients (90.3%). Conclusion With proper patient selection and careful endplate preparation, anterior cervical discectomy and fusion (ACDF) using a stand-alone PEEK cage packed with local autobone graft could be a good alternative to the standard ACDF techniques with plating. PMID:24278646

  7. Biomechanical stability of a bioabsorbable self-retaining polylactic acid/nano-sized β-tricalcium phosphate cervical spine interbody fusion device in single-level anterior cervical discectomy and fusion sheep models.

    PubMed

    Cao, Lu; Duan, Ping-Guo; Li, Xi-Lei; Yuan, Feng-Lai; Zhao, Ming-Dong; Che, Wu; Wang, Hui-Ren; Dong, Jian

    2012-01-01

    The aim of this study was to investigate the biomechanical stability provided by a novel, polylactic acid/nano-sized, β-tricalcium phosphate, bioabsorbable, self-retaining cervical fusion cage (BCFC). Quasistatic nonconstraining torques (maximum 1.5 NM) induced flexion, extension, lateral bending (±1.5 NM), and axial rotation (±1.5 NM) on 32 sheep cervical spines (C2-C5). The motion segment C3-C4 was first tested intact; the following groups were tested after complete discectomy: autologous tricortical iliac crest bone graft, Medtronic-Wego polyetheretherketone (PEEK) cage, Solis PEEK cage, and BCFC. The autologous bone graft group was tested with an anterior plate. The mean range of motion (ROM) was calculated from the load-displacement curves. BCFC significantly decreased ROM in lateral bending and axial rotation compared to other implants, and no significant difference in ROM between two types of PEEK cages and BCFC could be observed in flexion and extension. Anterior cervical plate (ACP) significantly decreased ROM in flexion and extension, but no significant difference in ROM between BCFC and bone graft plus ACP could be determined in lateral bending and axial rotation. The BCFC device showed better stability to autologous tricortical iliac crest bone graft and PEEK cages in single-level anterior cervical discectomy and fusion models and thus may be a potential alternative to the current PEEK cages.

  8. Biomechanical stability of a bioabsorbable self-retaining polylactic acid/nano-sized β-tricalcium phosphate cervical spine interbody fusion device in single-level anterior cervical discectomy and fusion sheep models

    PubMed Central

    Cao, Lu; Duan, Ping-Guo; Li, Xi-Lei; Yuan, Feng-Lai; Zhao, Ming-Dong; Che, Wu; Wang, Hui-Ren; Dong, Jian

    2012-01-01

    Purpose The aim of this study was to investigate the biomechanical stability provided by a novel, polylactic acid/nano-sized, β-tricalcium phosphate, bioabsorbable, self-retaining cervical fusion cage (BCFC). Methods Quasistatic nonconstraining torques (maximum 1.5 NM) induced flexion, extension, lateral bending (±1.5 NM), and axial rotation (±1.5 NM) on 32 sheep cervical spines (C2–C5). The motion segment C3–C4 was first tested intact; the following groups were tested after complete discectomy: autologous tricortical iliac crest bone graft, Medtronic–Wego polyetheretherketone (PEEK) cage, Solis PEEK cage, and BCFC. The autologous bone graft group was tested with an anterior plate. The mean range of motion (ROM) was calculated from the load-displacement curves. Results BCFC significantly decreased ROM in lateral bending and axial rotation compared to other implants, and no significant difference in ROM between two types of PEEK cages and BCFC could be observed in flexion and extension. Anterior cervical plate (ACP) significantly decreased ROM in flexion and extension, but no significant difference in ROM between BCFC and bone graft plus ACP could be determined in lateral bending and axial rotation. Conclusion The BCFC device showed better stability to autologous tricortical iliac crest bone graft and PEEK cages in single-level anterior cervical discectomy and fusion models and thus may be a potential alternative to the current PEEK cages. PMID:23226018

  9. Squamous cell carcinoma of the anterior tongue: is tumour thickness an indicator for cervical metastasis?

    PubMed

    Loganathan, P; Sayan, A; Hsu, D W K; Paraneetharan, S; Ilankovan, V

    2017-04-01

    The incidence of squamous cell carcinoma (SCC) of the tongue accounts for 90% of all malignancies affecting the oral cavity and oropharynx. The distribution between the anterior and posterior tongue is equal. Nodal metastasis is dependent on various factors including tumour thickness, site, size, differentiation, and perineural and perivascular invasion. There is increasing evidence of a close correlation between tumour thickness and metastasis. A retrospective study covering the 16-year period from 2000 to 2016 was performed. Eighty-one patients with anterior tongue SCC were included. The only primary treatment was surgery. All patients were T1/T2N0M0 stage. Sixty-five patients underwent local excision with simultaneous selective neck dissection; 29 of these patients were confirmed to have occult metastasis. Sixteen patients underwent local excision only as an initial treatment. Four of them subsequently developed neck metastasis within a 6- to 18-month period. The results of this study support recent publications associating tumour thickness with nodal disease. Therefore, it is postulated that prophylactic neck dissection should be considered when the tumour thickness of anterior tongue SCC exceeds 5mm, in order to prevent lymphatic spread and improve the survival rate.

  10. Management of hangman's fracture with percutaneous transpedicular screw fixation.

    PubMed

    Wu, Yao-Sen; Lin, Yan; Zhang, Xiao-Lei; Tian, Nai-Feng; Sun, Liao-Jun; Xu, Hua-Zi; Chi, Yong-Long; Pan, Zhi-Jun

    2013-01-01

    This study describes a percutaneous technique for C2 transpedicular screw fixation and evaluates its safety and efficacy in the treatment of patients with hangman's fracture. Ten patients with hangman's fracture were treated by percutaneous C2 transpedicular screw fixation. There are six males and four females, who were, based on the classification of Levine and Edwards, sorted as follows: type I fracture, three cases; type II, five cases; type IIa, two cases. The causes of injury were road traffic accident in six patients and falling injury in four patients. Other associated lesions included rib fractures (7 patients), head injuries (4 patients), and fractures of extremities (6 patients). The new technique was performed successfully in all cases. The average operation time was 98 min (range 60-130 min) and the estimated blood loss was 25 ml (range 15-40 ml). No complications such as vascular or neural structures injuries were found intraoperatively. Postoperative CT scans demonstrated that 17 (85 %) of 20 screws were placed satisfactorily, and 3 (15 %) screws showed perforations of the pedicle wall (<2 mm). These patients were asymptomatic and no further intervention was required postoperatively. After 8-25 months follow-up (mean 15.3 months), solid fusion was demonstrated by computed tomography. All cases got well-sagittal alignment and no angulation or dislocation was found at the segment of C2-C3. There was no loss of fixation. Clinical examination showed a full range of motion in the neck in all patients. The fluoroscopically assisted percutaneous C2 transpedicular screw fixation method is a technically feasible and minimally invasive technique for hangman's fracture.

  11. Anterior cervical fusion with interbody cage containing beta-tricalcium phosphate augmented with plate fixation: a prospective randomized study with 2-year follow-up.

    PubMed

    Dai, Li-Yang; Jiang, Lei-Sheng

    2008-05-01

    A variety of bone graft substitutes, interbody cages, and anterior plates have been used in cervical interbody fusion, but no controlled study was conducted on the clinical performance of beta-tricalcium phosphate (beta-TCP) and the effect of supplemented anterior plate fixation. The objective of this prospective, randomized clinical study was to evaluate the effectiveness of implanting interbody fusion cage containing beta-TCP for the treatment of cervical radiculopathy and/or myelopathy, and the fusion rates and outcomes in patients with or without randomly assigned plate fixation. Sixty-two patients with cervical radiculopathy and/or myelopathy due to soft disc herniation or spondylosis were treated with one- or two-level discectomy and fusion with interbody cages containing beta-TCP. They were randomly assigned to receive supplemented anterior plate (n = 33) or not (n = 29). The patients were followed up for 2 years postoperatively. The radiological and clinical outcomes were assessed during a 2-year follow-up. The results showed that the fusion rate (75.0%) 3 months after surgery in patients treated without anterior cervical plating was significantly lower than that (97.9%) with plate fixation (P < 0.05), but successful bone fusion was achieved in all patients of both groups at 6-month follow-up assessment. Patients treated without anterior plate fixation had 11 of 52 (19.2%) cage subsidence at last follow-up. No difference (P > 0.05) was found regarding improvement in spinal curvature as well as neck and arm pain, and recovery rate of JOA score at all time intervals between the two groups. Based on the findings of this study, interbody fusion cage containing beta-TCP following one- or two-level discectomy proved to be an effective treatment for cervical spondylotic radiculopathy and/or myelopathy. Supplemented anterior plate fixation can promote interbody fusion and prevent cage subsidence but do not improve the 2-year outcome when compared with those treated

  12. Cervicitis

    MedlinePlus

    ... growth of normal bacteria in the vagina (bacterial vaginosis) can also cause cervicitis. ... a microscope (may show candidiasis , trichomoniasis , or bacterial vaginosis) Pap test Tests for gonorrhea or chlamydia Rarely, ...

  13. Comparison of allograft and polyetheretherketone (PEEK) cage subsidence rates in anterior cervical discectomy and fusion (ACDF).

    PubMed

    Yson, Sharon C; Sembrano, Jonathan N; Santos, Edward Rainier G

    2017-04-01

    Structural allografts and PEEK cages are commonly used interbody fusion devices in ACDF. The subsidence rates of these two spacers have not yet been directly compared. The primary aim of this study was to compare the subsidence rate of allograft and PEEK cage in ACDF. The secondary aim was to determine if the presence of subsidence affects the clinical outcome. We reviewed 67 cases (117 levels) of ACDF with either structural allograft or PEEK cages. There were 85 levels (48 cases) with PEEK and 32 levels (19 cases) with allograft spacers. Anterior and posterior disc heights at each operative level were measured at immediate and 6months post-op. Subsidence was defined as a decrease in anterior or posterior disc heights >2mm. NDI of the subsidence (SG) and non-subsidence group (NSG) were recorded. Chi-square test was used to analyze subsidence rates. T-test was used to analyze clinical outcomes (α=0.05). There was no statistically significant difference between subsidence rates of the PEEK (29%; 25/85) and allograft group (28%; 9/32) (p=0.69). Overall mean subsidence was 2.3±1.7mm anteriorly and 2.6±1.2mm posteriorly. Mean NDI improvement was 11.7 (from 47.1 to 35.4; average follow-up: 12mos) for the SG and 14.0 (from 45.8 to 31.8; average follow-up: 13mos) for the NSG (p=0.74). Subsidence rate does not seem to be affected by the use of either PEEK or allograft as spacers in ACDF. Furthermore, subsidence alone does not seem to be predictive of clinical outcomes of ACDF.

  14. Anterior Migration After Bryan Cervical Disc Arthroplasty: The Relationship Between Hyperlordosis and its Impact on Clinical Outcomes.

    PubMed

    Lei, Tao; Tong, Tong; Miao, Dechao; Gao, Xianda; Xu, Jiaxin; Zhang, Di; Shen, Yong

    2017-05-01

    Various modifications have been tested to prevent kyphosis after Bryan cervical disc arthroplasty (CDA). However, the migration of Bryan prostheses has not been systematically studied. This study investigated the cause of anterior migration (AM) and assessed the effect of AM on clinical and radiographic outcomes. We retrospectively reviewed 46 consecutive patients who underwent modified Bryan CDA between August 2006 and December 2010. We measured functional spinal unit, angle of operative disc space, range of motion, and sagittal alignment of cervical spine preoperatively, postoperatively, and at the final follow-up, and compared these values between the AM and non-AM groups. Clinical outcome was evaluated by scores for Japanese Orthopaedic Association, Neck Disability Index, and visual analog scale. AM occurred in 9/46 (19.6%) patients. Clinical outcomes in both groups were significantly improved compared with the preoperative scores (P < 0.05). However, the postoperative and final follow-up angle of operative disc space was more lordotic and the postoperative functional spinal unit significantly higher in patients in the AM group compared with the non-AM group (P < 0.05). At the final follow-up, patients with AM had significantly higher Neck Disability Index and neck visual analog scale scores (P < 0.05), partially restricted range of motion (4.9° vs. 7.4°; P < 0.05), and adjacent segment degeneration at 6 vertebral levels (46.2%). The intermediate clinical outcomes for patients treated with modified Bryan CDA were satisfactory; however, overcorrection of segmental lordosis may lead to AM of the prosthesis, which could restrict patient range of motion and cause postoperative neck pain. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Predictive factors for long-term outcome of anterior cervical decompression and fusion: a multivariate data analysis

    PubMed Central

    Peolsson, Michael

    2007-01-01

    We conducted a prospective randomized study to investigate predictive factors for short- and long-term outcome of anterior cervical decompression and fusion (ACDF) as measured by current pain intensity on the Visual Analogue Scale (VAS) and by disability using the Neck Disability Index (NDI). Current understanding about how preoperative and short-term outcome data predict long-term outcome is sparse, and there are few studies involving analysis of short-term follow-up using multivariate approaches with quantification of the relative importance of each variable studied. A total of 95 patients were randomly allocated for ACDF with the cervical intervertebral fusion cage or the Cloward procedure. The mean follow-up time was 19 months (range 12–24) for short-term follow-up and 76 months (range 56–94 months) for long-term. Background factors, radiologically detected findings, physiological measurements, treatment type, pain, and disability were used as potential predictors. Multivariate statistical analysis by projection to latent structures was used to investigate predictors of importance for short- and long-term outcome of ACDF. A “preoperative” low disability and pain intensity, non-smoking status, male sex, good hand strength, and an active range of motion (AROM) in the neck were significant predictors for good short- and long-term outcomes. The short-term outcome data were better at predicting long-term outcome than were baseline data. Radiologically detected findings and surgical technique used were mainly insignificant as predictors. We suggest that the inclusion criteria for ACDF should be based on a bio-psycho-social model including NDI. NDI may also be regarded as an important outcome measurement in evaluation of ACDF. PMID:18084782

  16. [The clinical value of end plate rings in preventing subsidence of titanium cage in anterior cervical corpectomy and fusion surgery].

    PubMed

    He, Lei; Qian, Yu; Jin, Yi-Jun; Fan, Liang; Lü, Zuo

    2014-09-01

    To evaluate the clinical results of using end plate rings in preventing subsidence of titanium cage in anterior cervical corpectomy and fusion (ACCF) surgery. The clinical data of 71 patients with cervical spondylotic myelopathy underwent ACCF in single segment from February 2008 to February 2011 were retrospectively analyzed. There were 38 males and 33 females, aged from 39 to 74 years old with a mean of 53.8 years. Thirty-three were used end plate rings and thirty-eight were not used (end plate rings group and no end plate ring group, respectively). The Japanese Orthopaedic Association (JOA) score, Odom's scale, imaging data were used to evaluate the clinical effects. Imaging data including Cobb angle of fusion segment, intervertebral height of anterior border (Da) and posterior border (Dp), the mean intervertebral height (Dm). All patients were followed up from 13 to 34 months with an average of 19.5 months. Between two groups, there was no significant difference in Cobb angle of fusion segment and the mean intervertebral height (Dm) before surgery and one week after surgery. Whereas, one year after surgery, the Cobb angle of end plate ring group was (9.4 ± 3.8) degrees, and contral group was (7.5 ± 3.9) degrees, which was significantly lower than that of end plate ring group. Meanwhile, the Dm of end plate ring group was (57.3 ± 2.2) mm, and no end ring group was (55.2 ± 2.6) mm which was significantly lower than that of end plate ring group. The subsidence in end plate ring group was 57.6%, and was 78.9% in no end plate ring group. There was no significant difference in JOA score before and after surgery between two groups. At 1 year after operation, 90.9% (30/33) got excellent or good results in end plate ring group, 89.5% (33/38) got excellent or good results in contral group. The use of end plate rings could not completely prevent the subsidence of titanium cage, however, which can decrease the occurrence rate of the subsidence and lessen its degree.

  17. Biomechanical evaluation of the impact of various facet joint lesions on the primary stability of anterior plate fixation in cervical dislocation injuries: a cadaver study: Laboratory investigation.

    PubMed

    Oberkircher, Ludwig; Born, Sebastian; Struewer, Johannes; Bliemel, Christopher; Buecking, Benjamin; Wack, Christina; Bergmann, Martin; Ruchholtz, Steffen; Krüger, Antonio

    2014-10-01

    Injuries of the subaxial cervical spine including facet joints and posterior ligaments are common. Potential surgical treatments consist of anterior, posterior, or anterior-posterior fixation. Because each approach has its advantages and disadvantages, the best treatment is debated. This biomechanical cadaver study compared the effect of different facet joint injuries on primary stability following anterior plate fixation. Fractures and plate fixation were performed on 15 fresh-frozen intact cervical spines (C3-T1). To simulate a translation-rotation injury in all groups, complete ligament rupture and facet dislocation were simulated by dissecting the entire posterior and anterior ligament complex between C-4 and C-5. In the first group, the facet joints were left intact. In the second group, one facet joint between C-4 and C-5 was removed and the other side was left intact. In the third group, both facet joints between C-4 and C-5 were removed. The authors next performed single-level anterior discectomy and interbody grafting using bone material from the respective thoracic vertebral bodies. An anterior cervical locking plate was used for fixation. Continuous loading was performed using a servohydraulic test bench at 2 N/sec. The mean load failure was measured when the implant failed. In the group in which both facet joints were intact, the mean load failure was 174.6 ± 46.93 N. The mean load failure in the second group where only one facet joint was removed was 127.8 ± 22.83 N. In the group in which both facet joints were removed, the mean load failure was 73.42 ± 32.51 N. There was a significant difference between the first group (both facet joints intact) and the third group (both facet joints removed) (p < 0.05, Kruskal-Wallis test). In this cadaver study, primary stability of anterior plate fixation for dislocation injuries of the subaxial cervical spine was dependent on the presence of the facet joints. If the bone in one or both facet joints is damaged

  18. Cage subsidence does not, but cervical lordosis improvement does affect the long-term results of anterior cervical fusion with stand-alone cage for degenerative cervical disc disease: a retrospective study.

    PubMed

    Wu, Wen-Jian; Jiang, Lei-Sheng; Liang, Yu; Dai, Li-Yang

    2012-07-01

    Clinical outcomes of the stand-alone cage have been encouraging when used in anterior cervical discectomy and fusion (ACDF), but concerns remain regarding its complications, especially cage subsidence. This retrospective study was undertaken to investigate the long-term radiological and clinical outcomes of the stand-alone titanium cage and to evaluate the incidence of cage subsidence in relation to the clinical outcome in the surgical treatment of degenerative cervical disc disease. A total of 57 consecutive patients (68 levels) who underwent ACDF using a titanium box cage for the treatment of cervical radiculopathy and/or myelopathy were reviewed for the radiological and clinical outcomes. They were followed for at least 5 years. Radiographs were obtained before and after surgery, 3 months postoperatively, and at the final follow-up to determine the presence of fusion and cage subsidence. The Cobb angle of C2-C7 and the vertebral bodies adjacent to the treated disc were measured to evaluate the cervical sagittal alignment and local lordosis. The disc height was measured as well. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score for cervical myelopathy, before and after surgery, and at the final follow-up. The recovery rate of JOA score was also calculated. The Visual Analogue Scale (VAS) score of neck and radicular pain were evaluated as well. The fusion rate was 95.6% (65/68) 3 months after surgery. Successful bone fusion was achieved in all patients at the final follow-up. Cage subsidence occurred in 13 cages (19.1%) at 3-month follow-up; however, there was no relation between fusion and cage subsidence. Cervical and local lordosis improved after surgery, with the improvement preserved at the final follow-up. The preoperative disc height of both subsidence and non-subsidence patients was similar; however, postoperative posterior disc height (PDH) of subsidence group was significantly greater than of non-subsidence group

  19. Internal carotid artery dissection after anterior cervical disc replacement: first case report and literature review of vascular complications of the approach.

    PubMed

    Loret, Jean-Edouard; Francois, Patrick; Papagiannaki, Chrysanthi; Cottier, Jean-Philippe; Terrier, Louis-Marie; Zemmoura, Ilyess

    2013-07-01

    We report the case of a 41-year-old woman who underwent cervical total disc replacement at C4C5 and C5C6 levels and fusion at C6C7 level through an anterior right-side approach. After anesthesia recovery, the patient presented left hemiparesia and facial palsy due to large right hemispheric stroke. Diffusion-weighted magnetic resonance imaging was performed as soon as the patient developed neurologic symptoms of stroke and revealed a right internal carotid artery dissection. Digital substraction angiography, endovascular stenting, angioplasty and thrombectomy were performed. Six months after treatment, clinical examination showed mild left-arm spasticity. To the best of our knowledge, only two cases of internal carotid artery stroke without dissection or thrombosis are reported. In conclusion, although vascular complications are rare after anterior cervical spine procedure, internal carotid artery dissection can occur. Suspected risk factors are prolonged retraction of the carotid artery and neck extension.

  20. [Results to 4-year follow-up of the treatment of the cervical stenosis by corpectomy, titanium mesh cage and anterior plate fixation].

    PubMed

    Reyes Sánchez, Alejandro Antonio; Gameros Castañeda, Luis Alberto; Obil Chavarría, Claudia; Alpizar Aguirre, Armando; Zárate Kalfópulos, Barón; Rosales-Olivares, Luis Miguel

    2017-01-16

    Cervical spondylotic myelopathy is caused by cervical stenosis. Several techniques have been described for the treatment of multilevel disease, such as the anterior corpectomy with titanium mesh cage and anterior cervical plate placement, which has the advantage of performing a wider decompression and using the same bone as graft. However, it has caused controversy since the collapse of the mesh cage continues being a major limitation of this procedure. A prospective 4-year follow-up study was conducted in 7 patients diagnosed with cervical stenosis, who were treated surgically by one level corpectomy with titanium mesh cage and anterior cervical plate placement, evaluating them by radiographs and clinical scales. 7 patients, 5 women and 2 males were studied. The most common level was C5 corpectomy (n=4). The Neck Disability Index (NDI) preoperative average was 30.01±24.32 and 4-year postoperative 16.90±32.05, with p=0.801. The preoperative and 4-year postoperative Nürick was 3.28± 48 and 3.14±1.21 respectively, with p=0.766. Preoperative lordosis was 14.42±8.03 and 4-year postoperative 17±11.67 degrees, with p=0.660. The immediate postoperative and 4-year postoperative subsidence was 2.69±2.8 and 6.11±1.61 millimeters respectively, with p=0.0001. Despite the small sample, the subsidence of the mesh cage is common in this procedure. No statistically significant changes were observed in the lordosis or Nürick scale and NDI. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  1. Antibiotic-impregnated polymethylmethacrylate as an anterior biomechanical device for the treatment of cervical discitis and vertebral osteomyelitis: technical report of two cases.

    PubMed

    Barrett, Ryan J; Sandquist, Lee; Richards, Boyd F; Soo, Teck M

    2014-01-01

    To evaluate the feasibility of this novel surgical approach for treatment of cervical discitis and vertebral osteomyelitis. This is a report of two patients who underwent anterior cervical decompression for discitis and vertebral osteomyelitis (DVO) with cervical spine reconstruction with polymethylmethacrylate impregnated with antibiotics (AI-PMMA). Both patients had successful procedures that were followed by 6 weeks of intravenous antibiotics. Stabilization and eradication of infection was achieved with clinical and radiographic stabilization seen in both. Follow-up is greater than 18 months and both patients remain off antibiotics. The described technique using AI-PMMA offers immediate structural stability and local delivery of high concentration of antibiotics. Use in two patients has demonstrated a cost effective, long-term biomechanically stable construct and infection control.

  2. Accessory articulation of elongated anterior transverse process: a rare anatomical variant of the cervical spine depicted with CT and post-processing techniques.

    PubMed

    Bilreiro, C; Saraiva, J; Duarte Silva, L; Brito, J; Grande, P

    2016-03-01

    There are several described anatomical variants of the cervical spine, ranging from common to extremely rare, which may have different clinical implications. We present the case of an extremely rare anatomical variant of the cervical spine, in a symptomatic patient, consisting of a unilateral accessory articulation between the 5th and 6th cervical vertebrae, due to elongated anterior transverse processes. Our search found only three cases in the English literature describing similar findings to the case here reported. Our case is, to our knowledge, the first report of this anatomical variant imaged with computed tomography including post-processing images (volume rendering technology and multiplanar reformations), which contribute greatly to a better understanding and depiction of the anatomical variant.

  3. Significant relationship between local angle at fused segments and C2-7 angle: Average duration of longer than 20 years after anterior cervical discectomy and fusion

    PubMed Central

    Nagata, T.; Takami, T.; Yamagata, T.; Uda, T.; Naito, K.; Ohata, K.

    2011-01-01

    Background: The authors have focused their attention to the radiological durability of cervical sagittal alignment after anterior cervical discectomy and fusion (ACDF) using autologous bone grafting. Materials and Methods: Among the patients who underwent ACDF with trans-unco-discal (TUD) approach between 1976 and 1997, 22 patients (16 males and 6 females) made return visits for a clinical evaluation. Patients with trauma or previously treated by anterior cervical fusion or by posterior decompression were excluded from the present study. Clinical evaluation included adjacent segment degeneration (ASD), osseous fusion, local angle at the fused segments and C2-7 angle of cervical spine. Results: The duration after ACDF ranged from 13 to 34 years with an average of 21.3 ± 7.0 years. A single level fusion was done on 8 patients, 2 levels on 11 patients, 3 levels on 2 patients, and 4 levels on 1 patient. Imaging studies indicated that 12 of the 22 patients (54.5%) were graded as having symptomatic ASD. Osseous bony fusion at ACDF was recognized in all cases. None of the patients demonstrated kyphotic malalignment of the cervical spine. Average degrees of local angle at the fused segments and the C2-7 angle were 7.06 and 17.6, respectively. Statistical analysis indicated a significant relationship between the local at the fused segments and C2-7 angles. Conclusions: Sagittal alignment of the cervical spine was durable long after ACDF when the local angle at the fused segments was well stabilized. PMID:23125490

  4. Use of thoracic spine thrust manipulation for neck pain and headache in a patient following multiple-level anterior cervical discectomy and fusion: a case report.

    PubMed

    Salvatori, Renata; Rowe, Robert H; Osborne, Raine; Beneciuk, Jason M

    2014-06-01

    Case report. Thoracic spine thrust manipulation has been shown to be an effective intervention for individuals experiencing mechanical neck pain. The patient was a 46-year-old woman referred to outpatient physical therapy 2 months following multiple-level anterior cervical discectomy and fusion. At initial evaluation, primary symptoms consisted of frequent headaches, neck pain, intermittent referred right elbow pain, and muscle fatigue localized to the right cervical and upper thoracic spine regions. Initial examination findings included decreased passive joint mobility of the thoracic spine, limited cervical range of motion, and limited right shoulder strength. Outcome measures consisted of the numeric pain rating scale, the Neck Disability Index, and the global rating of change scale. Treatment consisted of a combination of manual therapy techniques aimed at the thoracic spine, therapeutic exercises for the upper quarter, and patient education, including a home exercise program, over a 6-week episode of care. Immediate reductions in cervical-region pain (mean ± SD, 2.0 ± 1.1) and headache (2.0 ± 1.3) intensity were reported every treatment session immediately following thoracic spine thrust manipulation. At discharge, the patient reported 0/10 cervical pain and headache symptoms during all work-related activities. From initial assessment to discharge, Neck Disability Index scores improved from 46% to 16%, with an associated global rating of change scale score of +7 ("a very great deal better"). This case report describes the immediate and short-term clinical outcomes for a patient presenting with symptoms of neck pain and headache following anterior cervical discectomy and fusion surgical intervention. Clinical rationale and patient preference aided the decision to incorporate thoracic spine thrust manipulation as a treatment for this patient. Level of Evidence Therapy, level 4.

  5. A comparison of a new zero-profile, stand-alone Fidji cervical cage and anterior cervical plate for single and multilevel ACDF: a minimum 2-year follow-up study.

    PubMed

    Li, Zhonghai; Zhao, Yantao; Tang, Jiaguang; Ren, Dongfeng; Guo, Jidong; Wang, Huadong; Li, Li; Hou, Shuxun

    2017-04-01

    To compare perioperative parameters, clinical outcomes, radiographic parameters, and complication rates of the new zero-profile, stand-alone Fidji cervical cage with those of the stand-alone cages with a titanium plate for anterior cervical discectomy and fusion (ACDF) for the surgical treatment of single- and multilevel cervical degenerative disc disease (DDD). Between October 2009 and December 2013, 152 consecutive patients [86 males and 52 females; mean age 51.0 years (range 30-69 years)] with cervical DDD, who underwent surgery and were followed for more than 2 years, were enrolled in this study and divided into the cage group and plate group. The study compared perioperative parameters, surgery-related and implant-related complication rates, clinical outcomes, and radiologic parameters. The clinical and radiologic results in both groups were satisfactory after a minimum 2-year follow-up. No significant differences between the cage group and plate group in terms of improvement in the 36-Item Short Form Health Survey, visual analogue scale, Neck Disability Index, Japanese Orthopedic Association scores, disc height, mean fusion time, fusion rate, adjacent segment degeneration, and restoration of cervical lordosis, but the cage group was associated with a lower risk of postoperative dysphagia, shorter operation time, less blood loss, less cost of index surgery, and relatively greater simplicity than the plate group. The zero-profile, stand-alone Fidji cervical cage for ACDF is an effective, reliable, and safe alternate to the conventional method for the treatment of cervical DDD. However, there is no definitive evidence that Fidji cervical cage has better intermediate-term outcomes than the stand-alone cages with a titanium plate for ACDF.

  6. Thirty-day readmission and reoperation rates after single-level anterior cervical discectomy and fusion versus those after cervical disc replacement.

    PubMed

    Bhashyam, Niketh; De la Garza Ramos, Rafael; Nakhla, Jonathan; Nasser, Rani; Jada, Ajit; Purvis, Taylor E; Sciubba, Daniel M; Kinon, Merritt D; Yassari, Reza

    2017-02-01

    OBJECTIVE The goal of this study was to compare 30-day readmission and reoperation rates after single-level anterior cervical discectomy and fusion (ACDF) versus those after cervical disc replacement (CDR). METHODS The authors used the 2013-2014 American College of Surgeons National Surgical Quality Improvement Program database. Included were adult patients who underwent first-time single-level ACDF or CDR for cervical spondylosis or disc herniation. Primary outcome measures were readmission and/or reoperation within 30 days of the original surgery. Logistic regression analysis was used to assess the independent effect of the procedure (ACDF or CDR) on outcome, and results are presented as odds ratios with 95% confidence intervals. RESULTS A total of 6077 patients met the inclusion criteria; 5590 (92.0%) patients underwent single-level ACDF, and 487 (8.0%) patients underwent CDR. The readmission rates were 2.6% for ACDF and 0.4% for CDR (p = 0.003). When stratified according to age groups, only patients between the ages of 41 and 60 years who underwent ACDF had a significantly higher readmission rate than those who underwent CDR (2.5% vs 0.7%, respectively; p = 0.028). After controlling for patient age, sex, body mass index, smoking status, history of chronic obstructive pulmonary disease (COPD), diabetes, hypertension, steroid use, and American Society of Anesthesiologists (ASA) class, patients who underwent CDR were significantly less likely to undergo readmission within 30 days than patients who underwent ACDF (OR 0.23 [95% CI 0.06-0.95]; p = 0.041). Patients with a history of COPD (OR 1.97 [95% CI 1.08-3.57]; p = 0.026) or hypertension (OR 1.62 [95% CI 1.10-2.38]; p = 0.013) and those at ASA Class IV (OR 14.6 [95% CI 1.69-125.75]; p = 0.015) were significantly more likely to require readmission within 30 days. The reoperation rates were 1.2% for ACDF and 0.4% for CDR (p = 0.086), and multivariate analysis revealed that CDR was not associated with lower odds of

  7. The incidences and risk factors related to early dysphagia after anterior cervical spine surgery: A prospective study

    PubMed Central

    Chen, Xuan-Yin; Zhou, Yang; Chen, Wen-Zhao; Huang, Shan-Hu; Liu, Zhi-Li

    2017-01-01

    Dysphagia is a common complication following anterior cervical spine surgery (ACSS). The incidences of dysphagia were variable and controversial. The purpose of this study was to determine the incidence of early dysphagia after ACSS with a new scoring system, and to identify the risk factors of it. A prospective study was carried out and patients who underwent ACSS from March 2014 to August 2014 in our hospital were included in this study. A self-designed dysphagia questionnaire was delivered to all of the patients from the first day to the fifth day after ACSS. Perioperative characteristics of patients were recorded, and incidences and risk factors of dysphagia were analyzed. A total of 104 patients who underwent ACSS were included and incidences of dysphagia from the first to the fifth day after ACSS was 87.5%, 79.81%, 62.14%, 50% and 44.23%, respectively. There was a good correlation between the new dysphagia scoring system and Bazaz scoring system (P < 0.001). Operative time and body mass index (BMI) were the risk factors for dysphagia during the first to the second day postoperatively. However, the dC2-C7angle was the main risk factor for dysphagia from the third to the fifth day after surgery. There were comparatively high incidences of early dysphagia after ACSS, which may be ascribed to operative time, BMI and the dC2-C7 angle. PMID:28267777

  8. High rate of fusion in sheep cervical spines following anterior interbody surgery with absorbable and nonabsorbable implant devices.

    PubMed

    Slivka, Michael A; Spenciner, David B; Seim, Howard B; Welch, William C; Serhan, Hassan A; Turner, A Simon

    2006-11-15

    Fourteen sheep were fused using anterior interbody implants at C2-C3 and C4-C5 and followed for 6 months. To evaluate the effect of absorbable and nonabsorbable implants on fusion rate, cage migration, and implant integrity. Despite the high clinical success rate with metallic plates and interbody grafting, complications such as dysphagia, imaging artifacts, and revision difficulties exist. Less permanent and lower profile implants could minimize these problems. Four treatments were studied: 1) carbon fiber-reinforced polymer (CFRP) cage alone, 2) CFRP cage with an absorbable tension band, 3) absorbable cage with an absorbable tension band, and 4) absorbable cage with a titanium plate. Fusion was assessed using radiographs, biomechanical testing, and micro-CT analysis. Treatments with the CFRP cage alone had the lowest fusion rate at 3 months (2/6) and 6 months (4/6). The CFRP cage with the absorbable strap treatments had 5/6 fusions at 6 months. The absorbable cage with absorbable strap also had 5/6 fusions, but two of the cages fractured. The absorbable cage with titanium plate had 5/6 fusions, but the one partial fusion was attributed to poor screw and plate placement. Using both absorbable and nonabsorbable implants, high fusion rates were achieved in the challenging sheep cervical spine model. However, the absorbable cages were not able to withstand the mechanical forces during the 6-month survival period.

  9. The natural course of prevertebral soft tissue swelling after anterior cervical spine surgery: how long will it last?

    PubMed

    Kim, Seok Woo; Jang, Chulyoung; Yang, Myung Ho; Lee, Seonjong; Yoo, Je Hyun; Kwak, Yoon Hae; Hwang, Ji Hyo

    2017-09-01

    Prevertebral soft tissue swelling (PSTS) after anterior cervical spine surgery (ACSS) has been regarded as one of the critical complications that cause airway obstruction. Still, however, no research has dealt with how PSTS returns to presurgery status after ACSS; most recommendations are being performed without information about its natural course, focusing on acute-phase swelling after surgery. The study aimed to examine how long postsurgery PSTS lasts and when it returns to its presurgery state, and to analyze the actual influence of a number of factors to observe the natural progress of postsurgery PSTS. This is a prospective observational study. The sample included a total of 160 patients who underwent ACSS, including anterior cervical discectomy and fusion (ACDF) and cervical total disc replacement (TDR). The diameter of PSTS measured at each set time point after surgeries was compared with PSTS measurements before surgery, and analyzed with factors influencing PSTS. Anterior and posterior diameters of the anterior soft tissue of C3 (pharyngeal airway) and C6 (laryngeal airway) were measured using simple lateral radiography before surgery, immediately after surgery, at 2 weeks, 1, 3, 6, and 12 months after surgery. The progress of postsurgery PSTS was analyzed according to patients' individual characteristics, such as age, gender, weight, body mass index (BMI), smoking status, use of antiplatelet therapy, hypertension and diabetes mellitus, complaints of dysphagia, along with surgical factors such as anesthesia time, operation time, numbers of involved operation segments, transfusion, estimated blood loss , and operation method. Multivariable analysis by generalized linear mixed model was used to perform additional univariable analysis on variables found to be related to PSTS. In addition, to find the postsurgery interval at which PSTS naturally stabilizes, repeated measures analysis of variance and Bonferroni method were used to perform post-hoc tests. There

  10. Long-Term Follow-Up Radiologic and Clinical Evaluation of Cylindrical Cage for Anterior Interbody Fusion in Degenerative Cervical Disc Disease

    PubMed Central

    Kim, Suhyeong; Yi, Hyeon-Joong; Bak, Koang Hum; Kim, Dong Won; Lee, Yoon Kyoung

    2012-01-01

    Objective Various procedures have been introduced for anterior interbody fusion in degenerative cervical disc disease including plate systems with autologous iliac bone, carbon cages, and cylindrical cages. However, except for plate systems, the long-term results of other methods have not been established. In the present study, we evaluated radiologic findings for cylindrical cervical cages over long-term follow up periods. Methods During 4 year period, radiologic findings of 138 patients who underwent anterior cervical fusion with cylindrical cage were evaluated at 6, 12, 24, and 36 postoperative months using plain radiographs. We investigated subsidence, osteophyte formation (anterior and posterior margin), cage direction change, kyphotic angle, and bone fusion on each radiograph. Results Among the 138 patients, a minimum of 36 month follow-up was achieved in 99 patients (mean follow-up : 38.61 months) with 115 levels. Mean disc height was 7.32 mm for preoperative evaluations, 9.00 for immediate postoperative evaluations, and 4.87 more than 36 months after surgery. Osteophytes were observed in 107 levels (93%) of the anterior portion and 48 levels (41%) of the posterior margin. The mean kyphotic angle was 9.87° in 35 levels showing cage directional change. There were several significant findings : 1) related subsidence [T-score (p=0.039) and anterior osteophyte (p=0.009)], 2) accompanying posterior osteophyte and outcome (p=0.05). Conclusion Cage subsidence and osteophyte formation were radiologically observed in most cases. Low T-scores may have led to subsidence and kyphosis during bone fusion although severe neurologic aggravation was not found, and therefore cylindrical cages should be used in selected cases. PMID:23091668

  11. Cervical total disc replacement with the Mobi-C cervical artificial disc compared with anterior discectomy and fusion for treatment of 2-level symptomatic degenerative disc disease: a prospective, randomized, controlled multicenter clinical trial: clinical article.

    PubMed

    Davis, Reginald J; Kim, Kee D; Hisey, Michael S; Hoffman, Gregory A; Bae, Hyun W; Gaede, Steven E; Rashbaum, Ralph F; Nunley, Pierce Dalton; Peterson, Daniel L; Stokes, John K

    2013-11-01

    Cervical total disc replacement (TDR) is intended to treat neurological symptoms and neck pain associated with degeneration of intervertebral discs in the cervical spine. Anterior cervical discectomy and fusion (ACDF) has been the standard treatment for these indications since the procedure was first developed in the 1950s. While TDR has been shown to be a safe and effective alternative to ACDF for treatment of patients with degenerative disc disease (DDD) at a single level of the cervical spine, few studies have focused on the safety and efficacy of TDR for treatment of 2 levels of the cervical spine. The primary objective of this study was to rigorously compare the Mobi-C cervical artificial disc to ACDF for treatment of cervical DDD at 2 contiguous levels of the cervical spine. This study was a prospective, randomized, US FDA investigational device exemption pivotal trial of the Mobi-C cervical artificial disc conducted at 24 centers in the US. The primary clinical outcome was a composite measure of study success at 24 months. The comparative control treatment was ACDF using allograft bone and an anterior plate. A total of 330 patients were enrolled, randomized, and received study surgery. All patients were diagnosed with intractable symptomatic cervical DDD at 2 contiguous levels of the cervical spine between C-3 and C-7. Patients were randomized in a 2:1 ratio (TDR patients to ACDF patients). A total of 225 patients received the Mobi-C TDR device and 105 patients received ACDF. At 24 months only 3.0% of patients were lost to follow-up. On average, patients in both groups showed significant improvements in Neck Disability Index (NDI) score, visual analog scale (VAS) neck pain score, and VAS arm pain score from preoperative baseline to each time point. However, the TDR patients experienced significantly greater improvement than ACDF patients in NDI score at all time points and significantly greater improvement in VAS neck pain score at 6 weeks, and at 3, 6, and

  12. [Posterior corpectomy, transpedicular fixation and expandable cage placement in thoracolumbar fractures].

    PubMed

    De la Cruz-Álvarez, S; Canales-Nájera, J A; Hurtado-Padilla, A; Guevara-Villazón, F; Ledezma-Ledezma, J

    2017-01-01

    The objective is to evaluate the outcome of vertebral corpectomy and placement of an expandable cage in patients with thoracolumbar fractures, using a posterior-only approach. A retrospective, case series study in the period from May 2011 to May 2014, in which eight patients with thoracolumbar burst fractures were treated surgically with corpectomy of fractured spinal body, placement of expandable box and fixation with transpedicular system, via posterior-only approach. Neurologic examination was done pre- and postoperatively with the ASIA score in a one year span. The angular deformity correction was also measured. The mean age was 38 years (24 to 58 years); five male and three female patients. All the patients had burst fracture, one of them with aggregate rotational component. Only one vertebral level was worked with corpectomy in all patients. Mean surgical time was 236 minutes (195-330 min). Mean surgical bleeding was 1,731 ml. Patients who underwent posterior approach corpectomy showed favorable clinical results. None presented neurological damage or surgical-related injury. This technique can be a useful option to avoid complications related to anterior vertebral approach or double approach.

  13. Maintaining endotracheal tube cuff pressure at 20 mm Hg to prevent dysphagia after anterior cervical spine surgery; protocol of a double-blind randomised controlled trial

    PubMed Central

    2013-01-01

    Background In anterior cervical spine surgery a retractor is obligatory to approach the spine. Previous studies showed an increase of endotracheal tube cuff pressure after placement of a retractor. It is known that high endotracheal tube cuff pressure increases the incidence of postoperative dysphagia, hoarseness, and sore throat. However, until now no evidence supports the fact whether adjusting the endotracheal tube cuff pressure during anterior cervical spine surgery will prevent this comorbidity. We present the design of a randomized controlled trial to determine whether adjusting endotracheal tube cuff pressure after placement of a retractor during anterior cervical spine surgery will prevent postoperative dysphagia. Methods/design 177 patients (aged 18–90 years) scheduled for anterior cervical spine surgery on 1 or more levels will be included. After intubation, endotracheal tube cuff pressure is manually inflated to 20 mm Hg in all patients. Patients will be randomized into two groups. In the control group endotracheal tube cuff pressure is not adjusted after retractor placement. In the intervention group endotracheal tube cuff pressure after retractor placement is maintained at 20 mm Hg and air is withdrawn when cuff pressure exceeds 20 mm Hg. Endotracheal tube cuff pressure is measured after intubation, before and after placement and removal of the retractor. Again air is inflated if cuff pressure sets below 20 mmHg after removal of the retractor. The primary outcome measure is postoperative dysphagia. Other outcome measures are postoperative hoarseness, postoperative sore throat, degree of dysphagia, length of hospital stay, and pneumonia. The study is a single centre double blind randomized trial in which patients and research nurses will be kept blinded for the allocated treatment during the follow-up period of 2 months. Discussion Postoperative dysphagia occurs frequently after anterior cervical spine surgery. This may be related to high

  14. Maintaining endotracheal tube cuff pressure at 20 mm Hg to prevent dysphagia after anterior cervical spine surgery; protocol of a double-blind randomised controlled trial.

    PubMed

    Arts, Mark P; Rettig, Thijs C D; de Vries, Jessica; Wolfs, Jasper F C; in't Veld, Bas A

    2013-09-25

    In anterior cervical spine surgery a retractor is obligatory to approach the spine. Previous studies showed an increase of endotracheal tube cuff pressure after placement of a retractor. It is known that high endotracheal tube cuff pressure increases the incidence of postoperative dysphagia, hoarseness, and sore throat. However, until now no evidence supports the fact whether adjusting the endotracheal tube cuff pressure during anterior cervical spine surgery will prevent this comorbidity. We present the design of a randomized controlled trial to determine whether adjusting endotracheal tube cuff pressure after placement of a retractor during anterior cervical spine surgery will prevent postoperative dysphagia. 177 patients (aged 18-90 years) scheduled for anterior cervical spine surgery on 1 or more levels will be included. After intubation, endotracheal tube cuff pressure is manually inflated to 20 mm Hg in all patients. Patients will be randomized into two groups. In the control group endotracheal tube cuff pressure is not adjusted after retractor placement. In the intervention group endotracheal tube cuff pressure after retractor placement is maintained at 20 mm Hg and air is withdrawn when cuff pressure exceeds 20 mm Hg. Endotracheal tube cuff pressure is measured after intubation, before and after placement and removal of the retractor. Again air is inflated if cuff pressure sets below 20 mmHg after removal of the retractor. The primary outcome measure is postoperative dysphagia. Other outcome measures are postoperative hoarseness, postoperative sore throat, degree of dysphagia, length of hospital stay, and pneumonia. The study is a single centre double blind randomized trial in which patients and research nurses will be kept blinded for the allocated treatment during the follow-up period of 2 months. Postoperative dysphagia occurs frequently after anterior cervical spine surgery. This may be related to high endotracheal tube cuff pressure. Whether

  15. Cervicitis

    MedlinePlus

    ... uterine lining and the fallopian tubes, resulting in pelvic inflammatory disease (PID), an infection of the female reproductive organs that can cause fertility problems if left untreated. Cervicitis can also ... incidentally during a routine pelvic exam and Pap test and may not require ...

  16. Evaluation of porous biphasic calcium phosphate ceramics for anterior cervical interbody fusion in a caprine model.

    PubMed

    Toth, J M; An, H S; Lim, T H; Ran, Y; Weiss, N G; Lundberg, W R; Xu, R M; Lynch, K L

    1995-10-15

    This study compared the efficacy of characterized 50/50 hydroxyapatite/beta-tricalcium phosphate ceramics of 30%, 50%, and 70% porosity and autograft to promote interbody spinal fusion at C2-C3 and C5-C6 in 24 goats: 12 at 3 months and 12 at 6 months. Radiographs, histology, dual energy x-ray absorptiometry analysis, and biomechanical testing were used to evaluate the ability of the 30%, 50%, and 70% porous 50/50 hydroxyapatite/beta-tricalcium phosphate ceramics and autograft to promote cervical interbody fusion. The conundrum in the use of calcium phosphates for interbody fusion is what porosity is most effective to promote ingrowth yet strong enough to resist compressive stresses found in the spine? It is known that the ability for bone ingrowth increases and the compressive strength decreases as porosity of the ceramic is increased. Dense ceramics remain intact but may be surrounded by fibrous tissue. Porous ceramics have good ingrowth but may fracture. Radiographs were evaluated for fusion and fracture or collapse of the ceramics or autograft. Dual energy x-ray absorptiometry was used to evaluate the fusion mass. Treated motion segments underwent biomechanical testing to quantify the flexibility of the segment. Undecalcified and decalcified histologic analysis were performed to evaluate the presence or absence of a bony union. Thirty percent, 50%, and 70% porous ceramics had better radiographic fusion scores than the autograft at 3 and 6 months. Incidence of ceramic fracture did not increase with porosity and was equivalent to the collapse of autograft, although ceramics maintained disc height when fracture occurred. No statistically significant differences were found between autograft and the porous ceramics with biomechanical testing and peri-implant bone mineral density values as measured by dual energy x-ray absorptiometry. At 3 months, histologic analysis showed a union rate of 0% for autograft and 30% porous ceramic, 67% for 50% porous ceramic, and 83

  17. Factors Affecting the Nonlinear Force Versus Distraction Height Curves in an In Vitro C5-C6 Anterior Cervical Distraction Model.

    PubMed

    Wen, Junxiang; Xu, Jianwei; Li, Lijun; Yang, Mingjie; Pan, Jie; Chen, Deyu; Jia, Lianshun; Tan, Jun

    2017-06-01

    In vitro biomechanical study of cervical intervertebral distraction. To investigate the forces required for distraction to different heights in an in vitro C5-C6 anterior cervical distraction model, focusing on the influence of the intervertebral disk, posterior longitudinal ligament (PLL), and ligamentum flavum (LF). No previous studies have reported on the forces required for distraction to various heights or the factors resisting distraction in anterior cervical discectomy and fusion. Anterior cervical distraction at C5-C6 was performed in 6 cadaveric specimens using a biomechanical testing machine, under 4 conditions: A, before disk removal; B, after disk removal; C, after disk and PLL removal; and D, after disk and PLL removal and cutting of the LF. Distraction was performed from 0 to 10 mm at a constant velocity (5 mm/min). Force and distraction height were recorded automatically. The force required increased with distraction height under all 4 conditions. There was a sudden increase in force required at 6-7 mm under conditions B and C, but not D. Under condition A, distraction to 5 mm required a force of 268.3±38.87 N. Under conditions B and C, distraction to 6 mm required <15 N, and further distraction required dramatically increased force, with distraction to 10 mm requiring 115.4±10.67 and 68.4±9.67 N, respectively. Under condition D, no marked increase in force was recorded. Distraction of the intervertebral space was much easier after disk removal. An intact LF caused a sudden marked increase in the force required for distraction, possibly indicating the point at which the LF was fully stretched. This increase in resistance may help to determine the optimal distraction height to avoid stress to the endplate spacer.

  18. Development of a Remodeled Caspar Retractor and Its Application in the Measurement of Distractive Resistance in an In Vitro Anterior Cervical Distraction Model.

    PubMed

    Wen, Junxiang; Xu, Jianwei; Li, Lijun; Yang, Mingjie; Pan, Jie; Chen, Deyu; Jia, Lianshun; Tan, Jun

    2017-06-01

    In vitro biomechanical study of the cervical intervertebral distraction using a remodeled Caspar retractor. To investigate the torques required for distraction to different heights in an in vitro C3-C4 anterior cervical distraction model using a remodeled Caspar retractor, focusing on the influence of the intervertebral disk, posterior longitudinal ligament (PLL), and ligamentum flavum (LF). No previous studies have reported on the torques required for distraction to various heights or the factors resisting distraction in anterior cervical discectomy and fusion. Anterior cervical distractions at C3-C4 was performed in 6 cadaveric specimens using a remodeled Caspar retractor, under 4 conditions: A, before disk removal; B, after disk removal; C, after disk and PLL removal; and D, after disk and PLL removal and cutting of the LF. Distraction was performed for 5 teeth, and distractive torque of each tooth was recorded. The torque increased with distraction height under all conditions. There was a sudden increase in torque at the fourth tooth under conditions B and C, but not D. Under condition A, distraction to the third tooth required 84.8±13.3 cN m. Under conditions B and C, distraction to the third tooth required <13 cN m, and further distraction required dramatically increased torque. Under condition D, no marked increase in torque was recorded. Distraction of the intervertebral space was much easier after disk removal. An intact LF caused a sudden marked increase in the force required for distraction, possibly indicating the point at which the LF was fully stretched. This increase in resistance may help to determine the optimal distraction height to avoid excessive stress to the endplate spacer. The remodeled Caspar retractor in the present study may provide a feasible and convenient method for intraoperative measurement of distractive resistance.

  19. Total spondylectomy of C2 and circumferential reconstruction via combined anterior and posterior approach to cervical spine for axis tumor surgery.

    PubMed

    Wu, Wei; Li, Feng; Fang, Zhong; Xiong, Wei; Guan, Han-feng; Xiao, Jun; Guo, Feng-jin; Chen, An-min

    2013-02-01

    As a result of the complex anatomy in upper cervical spine, the operative treatment of axis neoplasms is always complicated. Although the procedure for the second cervical vertebra (C2) surgery had been described previously in diverse approaches and reconstruction forms, each has its own limitations and restrictions that usually result in less satisfactory conclusions. The purpose of this study was to evaluate the operation efficacy for axis tumors by using a combined anterior (retropharyngeal) cervical and posterior approach in achieving total resection of C2 and circumferential reconstruction. Eight consecutive C2 tumor patients with mean age of 47.6 years in our institute sequentially underwent vertebra resection and fixation through aforementioned approach from Jan. 2006 to Dec. 2010. No surgical mortality or severe morbidity occurred in our group. In terms of complications, 2 cases developed transient difficulty in swallowing liquids (one of them experienced dysphonia) and 1 developed cerebrospinal fluid leakage (CSFL) that was resolved later. During a mean follow-up period of 31.9 months, the visual analogue scale (VAS) and Japanese orthopedic association (JOA) score revealed that the pain level and neurological function in all patients were improved postoperatively, and there was no evidence of fixation failure and local recurrence. It is concluded that the anterior cervical retropharyngeal approach permits a visible exposure to facilitate the C2 vertebra resection and perform an effective anterior reconstruction at the same time. The custom-made mesh cage applied in our cases can be acted as a firm and convenient implant in circumferential fixation.

  20. Incidence and risk factors for pneumonia following anterior cervical decompression and fusion procedures: an ACS-NSQIP study.

    PubMed

    Bohl, Daniel D; Ahn, Junyoung; Rossi, Vincent J; Tabaraee, Ehsan; Grauer, Jonathan N; Singh, Kern

    2016-03-01

    Postoperative pneumonia has important clinical consequences for both patients and the health-care system. Few studies have examined pneumonia following anterior cervical decompression and fusion (ACDF) procedures. This study aimed to determine the incidence and risk factors for development of pneumonia following ACDF procedures. A retrospective cohort study of data collected prospectively by the American College of Surgeons National Surgical Quality Improvement Program was carried out. This study comprised 11,353 patients undergoing ACDF procedures during 2011-2013. The primary outcome was diagnosis of pneumonia in the first 30 postoperative days. Independent risk factors for the development of pneumonia were identified using multivariate regression. Readmission rates were compared between patients who did and did not develop pneumonia using multivariate regression that adjusted for all demographic, comorbidity, and procedural characteristics. The incidence of pneumonia was 0.45% (95% confidence interval=0.33%-0.57%). In the multivariate analysis, independent risk factors for the development of pneumonia were greater age (p<.001), dependent functional status (relative risk [RR]=5.3, p<.001), chronic obstructive pulmonary disease (RR=4.4, p<.001), and greater operative duration (p=.020). Patients who developed pneumonia following discharge had a higher readmission rate than other patients (72.7% vs. 2.4%, adjusted RR=24.5, p<.001). In total, 10.2% of all readmissions were caused by pneumonia. Pneumonia occurs in approximately 1 in 200 patients following ACDF procedures. Patients who are older, are functionally dependent, or have chronic obstructive pulmonary disease are at greater risk. These patients should be counseled, monitored, and targeted with preventative interventions accordingly. Greater operative duration is also an independent risk factor. Approximately three in four patients who develop pneumonia following hospitalization for ACDF procedures are

  1. Return to Play in Elite Contact Athletes After Anterior Cervical Discectomy and Fusion: A Meta-Analysis.

    PubMed

    McAnany, Steven J; Overley, Samuel; Andelman, Steven; Patterson, Diana C; Cho, Samuel K; Qureshi, Sheeraz; Hsu, Wellington K; Hecht, Andrew C

    2017-09-01

    Systematic literature review and meta-analysis of studies published in English language. Return to play after anterior cervical discectomy and fusion (ACDF) in contact athletes remains a controversial topic with no consensus opinion in the literature. Additional information is needed to properly advise and treat this population of patients. This study is a meta-analysis assessing return to competitive contact sports after undergoing an ACDF. A literature search of Medline, Embase, and Cochrane Reviews was performed to identify investigations reporting return to play following ACDF in professional contact athletes. The pooled results were performed by calculating the effect size based on the logic event rate. Studies were weighted by the inverse of the variance, which included both within and between-study error. Confidence intervals (CIs) were reported at 95%. Heterogeneity was assessed using the Q statistic and I(2). Sensitivity analysis and publication bias calculations were performed. The initial literature search resulted in 166 articles, of which 5 were determined relevant. Overall, return to play data was provided for 48 patients. The pooled clinical success rate for return to play was 73.5% (CI = 56.7%, 85.8%). The logit event rate was calculated to be 1.036 (CI = 0.270, 1.802), which was statistically significant (P = .008). The studies included in this meta-analysis demonstrated minimal heterogeneity with Q value of 4.038 and I(2) value of 0.956. Elite contact athletes return to competition 73.5% of the time after undergoing ACDF. As this is the first study to pool results from existing studies, it provides strong evidence to guide decision making and expectations in this patient population.

  2. Management of Cerebrospinal Fluid Leakage During Anterior Cervical Discectomy and Fusion and Its Effect on Spinal Fusion.

    PubMed

    Elder, Benjamin D; Theodros, Debebe; Sankey, Eric W; Bydon, Mohamad; Goodwin, C Rory; Wolinsky, Jean-Paul; Sciubba, Daniel M; Gokaslan, Ziya L; Bydon, Ali; Witham, Timothy F

    2016-05-01

    Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure. Cerebrospinal fluid (CSF) leaks, although uncommon, may occur and can be a potentially serious complication. Little is known regarding the fusion rate after durotomy in ACDF. This study sought to investigate the clinical outcomes and fusion rates of patients with CSF leak after ACDF. In this single-institution retrospective review, 14 patients who experienced CSF leak after ACDF between 1995 and September 2014 were identified. The median follow-up was 13.1 months. The diagnoses included spondylosis/degenerative disc disease (n = 10), disc herniation with radiculopathy (n = 3), and kyphotic deformity (n = 1). Of ACDFs, 7 were 1-level, 5 were 2-level, and 2 were 3-level procedures. The posterior longitudinal ligament was intentionally opened in all cases, and the microscope was used in 9 cases. Durotomy was discovered intraoperatively in all cases and was generally repaired with a combination of fibrin glue and synthetic dural replacement. Lumbar drainage was used in 5 patients, and 3 patients reported orthostatic headaches, which resolved within 1 month. Two patients reported hoarseness, and 8 patients reported dysphagia; all cases were transient. Follow-up imaging for fusion assessment was available for 12 patients, and a 100% fusion rate was achieved with no postoperative infections. ACDFs with CSF leak had a 100% fusion rate in this series, with generally excellent clinical outcomes, although it is difficult to conclude definitively that there is no effect on fusion rates because of the small sample size. However, given the relative rarity of this complication, this study provides important data in the clinical literature regarding outcomes after CSF leak in ACDFs. Published by Elsevier Inc.

  3. Surgical Outcomes of Anterior Cervical Fusion Using Deminaralized Bone Matrix as Stand-Alone Graft Material: Single Arm, Pilot Study.

    PubMed

    Chung, Ho-Jung; Hur, Jung-Woo; Ryu, Kyeong-Sik; Kim, Jin-Sung; Seong, Ji-Hoon

    2016-09-01

    To investigate the safety and efficacy of demineralized bone matrix (DBM) as a bone graft substitute for anterior cervical discectomy and fusion (ACDF) surgery. Twenty consecutive patients treated with ACDF using stand-alone polyestheretherketone (PEEK) cages (Zero-P) with DBM(CGDBM100) were prospectively evaluated with a minimum of 6 months of follow-up. Radiologic efficacy was evaluated with a 6-point scoring method for osseous fusion using plain radiograph and computed tomogrpahy scans. Clinical efficacy was evaluated using the visual analogue scale (VAS), Owestry disability index (ODI), and short-form health questionnaire-36. The safety of the bone graft substitute was assessed with vital sign monitoring and a survey measuring complications at each follow-up visit. There were significant improvements in VAS and ODI scores at a mean 6-month follow-up. Six months after surgery, solid fusion was achieved in all patients. Mean score on the 6-point scoring system was 5.1, and bony formation was found to score at least 4 points in all patients. There was no case with implant-related complications such as cage failure or migration, and no complications associated with the use of CGDBM100. ACDF using CGDBM100 demonstrated good clinical and radiologic outcomes. The fusion rate was comparable with the published results of traditional ACDF. Therefore, the results of this study suggest that the use of a PEEK cage packed with DBM for ACDF is a safe and effective alternative to the gold standard of autologous iliac bone graft.

  4. Surgical Outcomes of Anterior Cervical Fusion Using Deminaralized Bone Matrix as Stand-Alone Graft Material: Single Arm, Pilot Study

    PubMed Central

    Chung, Ho-Jung; Ryu, Kyeong-Sik; Kim, Jin-Sung; Seong, Ji-Hoon

    2016-01-01

    Objective To investigate the safety and efficacy of demineralized bone matrix (DBM) as a bone graft substitute for anterior cervical discectomy and fusion (ACDF) surgery. Methods Twenty consecutive patients treated with ACDF using stand-alone polyestheretherketone (PEEK) cages (Zero-P) with DBM(CGDBM100) were prospectively evaluated with a minimum of 6 months of follow-up. Radiologic efficacy was evaluated with a 6-point scoring method for osseous fusion using plain radiograph and computed tomogrpahy scans. Clinical efficacy was evaluated using the visual analogue scale (VAS), Owestry disability index (ODI), and short-form health questionnaire-36. The safety of the bone graft substitute was assessed with vital sign monitoring and a survey measuring complications at each follow-up visit. Results There were significant improvements in VAS and ODI scores at a mean 6-month follow-up. Six months after surgery, solid fusion was achieved in all patients. Mean score on the 6-point scoring system was 5.1, and bony formation was found to score at least 4 points in all patients. There was no case with implant-related complications such as cage failure or migration, and no complications associated with the use of CGDBM100. Conclusion ACDF using CGDBM100 demonstrated good clinical and radiologic outcomes. The fusion rate was comparable with the published results of traditional ACDF. Therefore, the results of this study suggest that the use of a PEEK cage packed with DBM for ACDF is a safe and effective alternative to the gold standard of autologous iliac bone graft. PMID:27799989

  5. The management of vertebral artery injury in anterior cervical spine operation: a systematic review of published cases.

    PubMed

    Park, Hyung-Ki; Jho, Hae-Dong

    2012-12-01

    Anterior cervical spine operations (ACSO) are generally considered to be safe and effective, but the vertebral artery (VA) is at risk during the procedure. Because the consequences of VA injury can be catastrophic, properly managing a VA injury is very important. However, due to the rarity of these injuries, there is no agreed upon treatment strategy. Studies were identified for inclusion in the review via sensitive searches of electronic databases through 31 December 2011. All cases included in the review were qualitatively analyzed to explore the relationship between type of VA injury management and neurological complications. Seventeen articles describing 39 cases of VA injury during ACSO were included in this study. Seven patients (17.9 %) had neurological complications followed by VA insufficiency. Two patients (5.1 %) had root damage due to ligation. One case (2.6 %) resulted in intraoperative death due to fatal bleeding. Delayed vascular complications were identified in nine (45.0 %) of the 20 patients that underwent only tamponade or hemostatic agent during the operation. Four patients underwent intraoperative endovascular treatment, and three of these patients had a cerebral infarction. All three patients who underwent clipping also had neurological complications. The five patients treated by direct repair did not have any complications. Our review suggests the management of VA injury should be considered in order listed: (1) performing tamponade with a hemostatic agent, (2) direct repair, (3) postoperative endovascular procedures to prevent delayed complications. If tamponade fails to achieve proper hemostasis, additional procedures as endovascular embolization, clipping and ligation should be considered but carry the risk of neurological complications. Because of the limitations of this review, further studies are recommended with larger sample sizes.

  6. Sporadic lower motor neuron disease with a snake eyes appearance on the cervical anterior horns by MRI.

    PubMed

    Sasaki, Shoichi

    2015-09-01

    Lower motor neuron disease (LMND) is the term generally used to describe diseases in which only lower motor neuron signs are detected. A snake eyes appearance on magnetic resonance imaging (MRI) is associated with a wide spectrum of neurological conditions including LMND. The author reports on three unique LMND patients with upper limb muscle weakness and atrophy who show a snake eyes appearance by MRI. The patients were aged 18, 40 and 52 years, respectively, at the onset of the disease and had a longstanding clinical course (more than 10 years for two patients and 8 years for one patient). They were followed up for more than 6 years. Clinical manifestations were characterized by (1) longstanding slow progression or delayed spontaneous arrest of asymmetric lower motor neuron signs localized exclusively in the upper extremities with unilateral predominance and distal or proximal preponderance; (2) the absence of upper motor neuron signs, bulbar signs, sensory disturbances and respiratory involvement; (3) a snake eyes appearance on the anterior horns of the cervical cord over more than 3 vertebrae by axial T2-weighted MRI and a longitudinal linear-shaped T2-signal hyperintensity by sagittal MRI; (4) neurogenic change with fasciculation and denervation potentials (fibrillation and a positive sharp wave) confined to the affected muscles by needle electromyogram; and (5) normal cerebrospinal fluid and a normal creatine kinase level. These cases did not fall into any existing category of LMND, such as progressive muscular atrophy, flail arm syndrome or Hirayama disease. These patients should be classified as sporadic LMND with snake eyes on MRI with a relatively benign prognosis. Copyright © 2015 Elsevier B.V. All rights reserved.

  7. Fusion and failure following anterior cervical plating with dynamic or rigid plates: 6-months results of a multi-centric, prospective, randomized, controlled study

    PubMed Central

    Stulik, Jan; Chrobok, Jan; Ruffing, Sabine; Drumm, Jörg; Sova, Laurentius; Kucera, Ravel; Vyskocil, Tomas; Steudel, Wolf Ingo

    2007-01-01

    Anterior cervical plate fixation is an approved surgical technique for cervical spine stabilization in the presence of anterior cervical instability. Rigid plate design with screws rigidly locked to the plate is widely used and is thought to provide a better fixation for the treated spinal segment than a dynamic design in which the screws may slide when the graft is settling. Recent biomechanical studies showed that dynamic anterior plates provide a better graft loading possibly leading to accelerated spinal fusion with a lower incidence of implant complications. This, however, was investigated in vitro and does not necessarily mean to be the case in vivo, as well. Thus, the two major aspects of this study were to compare the speed of bone fusion and the rate of implant complications using either rigid- or dynamic plates. The study design is prospective, randomized, controlled, and multi-centric, having been approved by respective ethic committees of all participating sites. One hundred and thirty-two patients were included in this study and randomly assigned to one of the two groups, both undergoing routine level-1- or level-2 anterior cervical discectomy with autograft fusion receiving either a dynamic plate with screws being locked in ap - position (ABC, Aesculap, Germany), or a rigid plate (CSLP, Synthes, Switzerland). Segmental mobility and implant complications were compared after 3- and 6 months, respectively. All measurements were performed by an independent radiologist. Mobility results after 6 months were available for 77 patients (43 ABC/34 CSLP). Mean segmental mobility for the ABC group was 1.7 mm at the time of discharge, 1.4 mm after 3 months, and 0.8 mm after 6 months. For the CSLP- group the measurements were 1.0, 1.8, and 1.7 mm, respectively. The differences of mean segmental mobility were statistically significant between both groups after 6 months (P = 0.02). Four patients of the CSLP-group demonstrated surgical hardware complications

  8. Kinematic Magnetic Resonance Imaging Assessment of the Degenerative Cervical Spine: Changes after Anterior Decompression and Cage Fusion.

    PubMed

    Obradov, Marina; Bénard, Menno R; Janssen, Michiel M A; Anderson, Patricia G; Heesterbeek, Petra J C; Spruit, Maarten

    2016-11-01

    Study Design A prospective cohort study. Objective Decompression and fusion of cervical vertebrae is a combined procedure that has a high success rate in relieving radicular symptoms and stabilizing or improving cervical myelopathy. However, fusion may lead to increased motion of the adjacent vertebrae and cervical deformity. Both have been postulated to lead to adjacent segment pathology (ASP). Kinematic magnetic resonance imaging (MRI) has been increasingly used to evaluate range of motion (ROM) of the cervical spine and ASP. Our objective was to measure ASP, cervical curvature, and ROM of individual segments of the cervical spine using kinematic MRI before and 24 months after monosegmental cage fusion. Methods Eighteen patients who had single-level interbody fusion were included. ROM (using kinematic MRI) and degeneration, spinal stenosis, and cervical curvature were measured preoperatively and 24 months postoperatively. Results Using kinematic MRI, segmental motion of the cervical segments was measured with a precision of less than 3 degrees. The cervical fusion did not affect the ROM of adjacent levels. However, pre- and postoperative ROM was higher at the levels immediately adjacent to the fusion level compared with those further away. In addition, at 24 months postoperatively, the number of cases with ASP was higher at the levels immediately adjacent to fusion level. Conclusions Using kinematic MRI, ROM after spinal fusion can be measured with high precision. Kinematic MRI can be used not only in clinical practice, but also to study intervention and its effect on postoperative biomechanics and ASP of cervical vertebrae.

  9. Cervical Stand-Alone Polyetheretherketone Cage versus Zero-Profile Anchored Spacer in Single-Level Anterior Cervical Discectomy and Fusion : Minimum 2-Year Assessment of Radiographic and Clinical Outcome

    PubMed Central

    Cho, Hyun-Jun; Hur, Junseok W.; Han, Jin-Sol; Cho, Tai-Hyoung; Park, Jung-Yul

    2015-01-01

    Objective We compared the clinical and radiographic outcomes of stand-alone polyetheretherketone (PEEK) cage and Zero-Profile anchored spacer (Zero-P) for single level anterior cervical discectomy and fusion (ACDF). Methods We retrospectively reviewed 121 patients who underwent single level ACDF within 2 years (Jan 2011-Jan 2013) in a single institute. Total 50 patients were included for the analysis who were evaluated more than 2-year follow-up. Twenty-nine patients were allocated to the cage group (m : f=19 : 10) and 21 for Zero-P group (m : f=12 : 9). Clinical (neck disability index, visual analogue scale arm and neck) and radiographic (Cobb angle-segmental and global cervical, disc height, vertebral height) assessments were followed at pre-operative, immediate post-operative, post-3, 6, 12, and 24 month periods. Results Demographic features and the clinical outcome showed no difference between two groups. The change between final follow-up (24 months) and immediate post-op of Cobb-segmental angle (p=0.027), disc height (p=0.002), vertebral body height (p=0.033) showed statistically better outcome for the Zero-P group than the cage group, respectively. Conclusion The Zero-Profile anchored spacer has some advantage after cage for maintaining segmental lordosis and lowering subsidence rate after single level anterior cervical discectomy and fusion. PMID:26361527

  10. Artificial Cervical Vertebra and Intervertebral Complex Replacement through the Anterior Approach in Animal Model: A Biomechanical and In Vivo Evaluation of a Successful Goat Model

    PubMed Central

    Qin, Jie; He, Xijing; Wang, Dong; Qi, Peng; Guo, Lei; Huang, Sihua; Cai, Xuan; Li, Haopeng; Wang, Rui

    2012-01-01

    This was an in vitro and in vivo study to develop a novel artificial cervical vertebra and intervertebral complex (ACVC) joint in a goat model to provide a new method for treating degenerative disc disease in the cervical spine. The objectives of this study were to test the safety, validity, and effectiveness of ACVC by goat model and to provide preclinical data for a clinical trial in humans in future. We designed the ACVC based on the radiological and anatomical data on goat and human cervical spines, established an animal model by implanting the ACVC into goat cervical spines in vitro prior to in vivo implantation through the anterior approach, and evaluated clinical, radiological, biomechanical parameters after implantation. The X-ray radiological data revealed similarities between goat and human intervertebral angles at the levels of C2-3, C3-4, and C4-5, and between goat and human lordosis angles at the levels of C3-4 and C4-5. In the in vivo implantation, the goats successfully endured the entire experimental procedure and recovered well after the surgery. The radiological results showed that there was no dislocation of the ACVC and that the ACVC successfully restored the intervertebral disc height after the surgery. The biomechanical data showed that there was no significant difference in range of motion (ROM) or neural zone (NZ) between the control group and the ACVC group in flexion-extension and lateral bending before or after the fatigue test. The ROM and NZ of the ACVC group were greater than those of the control group for rotation. In conclusion, the goat provides an excellent animal model for the biomechanical study of the cervical spine. The ACVC is able to provide instant stability after surgery and to preserve normal motion in the cervical spine. PMID:23300816

  11. A novel computed method to reconstruct the bilateral digital interarticular channel of atlas and its use on the anterior upper cervical screw fixation.

    PubMed

    Wu, Ai-Min; Wang, Wenhai; Xu, Hui; Lin, Zhong-Ke; Yang, Xin-Dong; Wang, Xiang-Yang; Xu, Hua-Zi; Chi, Yong-Long

    2016-01-01

    Purpose. To investigate a novel computed method to reconstruct the bilateral digital interarticular channel of atlas and its potential use on the anterior upper cervical screw fixation. Methods. We have used the reverse engineering software (image-processing software and computer-aided design software) to create the approximate and optimal digital interarticular channel of atlas for 60 participants. Angles of channels, diameters of inscribed circles, long and short axes of ellipses were measured and recorded, and gender-specific analysis was also performed. Results. The channels provided sufficient space for one or two screws, and the parameters of channels are described. While the channels of females were smaller than that of males, no significant difference of angles between males and females were observed. Conclusion. Our study demonstrates the radiological features of approximate digital interarticular channels, optimal digital interarticular channels of atlas, and provides the reference trajectory of anterior transarticular screws and anterior occiput-to-axis screws. Additionally, we provide a protocol that can help make a pre-operative plan for accurate placement of anterior transarticular screws and anterior occiput-to-axis screws.

  12. A novel computed method to reconstruct the bilateral digital interarticular channel of atlas and its use on the anterior upper cervical screw fixation

    PubMed Central

    Wu, Ai-Min; Wang, Wenhai; Xu, Hui; Lin, Zhong-Ke; Yang, Xin-Dong; Wang, Xiang-Yang; Xu, Hua-Zi

    2016-01-01

    Purpose. To investigate a novel computed method to reconstruct the bilateral digital interarticular channel of atlas and its potential use on the anterior upper cervical screw fixation. Methods. We have used the reverse engineering software (image-processing software and computer-aided design software) to create the approximate and optimal digital interarticular channel of atlas for 60 participants. Angles of channels, diameters of inscribed circles, long and short axes of ellipses were measured and recorded, and gender-specific analysis was also performed. Results. The channels provided sufficient space for one or two screws, and the parameters of channels are described. While the channels of females were smaller than that of males, no significant difference of angles between males and females were observed. Conclusion. Our study demonstrates the radiological features of approximate digital interarticular channels, optimal digital interarticular channels of atlas, and provides the reference trajectory of anterior transarticular screws and anterior occiput-to-axis screws. Additionally, we provide a protocol that can help make a pre-operative plan for accurate placement of anterior transarticular screws and anterior occiput-to-axis screws. PMID:26925345

  13. Cervical Spondylosis and Hypertension

    PubMed Central

    Peng, Baogan; Pang, Xiaodong; Li, Duanming; Yang, Hong

    2015-01-01

    Abstract Cervical spondylosis and hypertension are all common diseases, but the relationship between them has never been studied. Patients with cervical spondylosis are often accompanied with vertigo. Anterior cervical discectomy and fusion is an effective method of treatment for cervical spondylosis with cervical vertigo that is unresponsive to conservative therapy. We report 2 patients of cervical spondylosis with concomitant cervical vertigo and hypertension who were treated successfully with anterior cervical discectomy and fusion. Stimulation of sympathetic nerve fibers in pathologically degenerative disc could produce sympathetic excitation, and induce a sympathetic reflex to cause cervical vertigo and hypertension. In addition, chronic neck pain could contribute to hypertension development through sympathetic arousal and failure of normal homeostatic pain regulatory mechanisms. Cervical spondylosis may be one of the causes of secondary hypertension. Early treatment for resolution of symptoms of cervical spondylosis may have a beneficial impact on cardiovascular disease risk in patients with cervical spondylosis. PMID:25761188

  14. Surgical management of multilevel cervical spinal stenosis and spinal cord injury complicated by cervical spine fracture.

    PubMed

    Xu, Zhao-Wan; Lun, Deng-Xing

    2014-08-22

    There are few reports regarding surgical management of multilevel cervical spinal stenosis with spinal cord injury. Our purpose is to evaluate the safety and feasibility of open-door expansive laminoplasty in combination with transpedicular screw fixation for the treatment of multilevel cervical spinal stenosis and spinal cord injury in the trauma population. This was a retrospective study of 21 patients who had multilevel cervical spinal stenosis and spinal cord injury with unstable fracture. An open-door expansive posterior laminoplasty combined with transpedicular screw fixation was performed under persistent intraoperative skull traction. Outcome measures included postoperative improvement in Japanese Orthopedic Association (JOA) score and incidence of complications. The average operation time was 190 min, with an average blood loss of 437 ml. A total of 120 transpedicular screws were implanted into the cervical vertebrae between vertebral C3 and C7, including 20 into C3, 34 into C4, 36 into C5, 20 into C6, and 10 into C7. The mean preoperative JOA score was 3.67 ± 0.53. The patients were followed for an average of 17.5 months, and the average JOA score improved to 8.17 ± 1.59, significantly higher than the preoperative score (t = 1.798, P < 0.05), with an average improvement of 44.7 ± 11.7%. Postoperative complications in four patients included cerebrospinal fluid leakage, delayed wound healing, pulmonary infection, and urinary system infection. All four patients were responsive to antibiotic treatment; one died from respiratory failure 3 months postoperatively. The open-door expansive laminoplasty combined with posterior transpedicular screw fixation is feasible for treating multilevel cervical spinal stenosis and spinal cord injury complicated by unstable fracture. Its advantages include minimum surgical trauma, less intraoperative blood loss, and satisfactory stable supportive effect for reduction of fracture.

  15. Aortic arch origin of the left vertebral artery: An Anatomical and Radiological Study with Significance for Avoiding Complications with Anterior Approaches to the Cervical Spine.

    PubMed

    Tardieu, Gabrielle G; Edwards, Bryan; Alonso, Fernando; Watanabe, Koichi; Saga, Tsuyoshi; Nakamura, Moriyoshi; Motomura, Mayuko; Sampath, Raghuram; Iwanaga, Joe; Goren, Oded; Monteith, Stephen; Oskouian, Rod J; Loukas, Marios; Tubbs, R Shane

    2017-09-01

    Complications from anterior approaches to the cervical spine are uncommon with normal anatomy. However, variant anatomy might predispose one to an increased incidence of injury during such procedures. We hypothesized that left vertebral arteries that arise from the aortic arch instead of the subclavian artery might take a more medial path in their ascent making them more susceptible to iatrogenic injury. Fifty human adult cadavers were examined for left vertebral arteries having an aortic arch origin and these were dissected along their entire cervical course. Additionally, two radiological databases of CTA and arteriography procedures were retrospectively examined for cases of aberrant left vertebral artery origin from the aortic arch over a two-year period. Two cadaveric specimens (4%) were found to have a left vertebral artery arising from the aortic arch. The retrospective radiological database analysis identified 13 cases (0.87%) of left vertebral artery origin from the aortic arch. Of all cases, vertebral arteries that arose from the aortic arch were much more likely to not only have a more medial course (especially their preforaminal segment) over the cervical vertebral bodies but also to enter a transverse foramen that was more cranially located than the normal C6 entrance of the vertebral artery. Spine surgeons who approach the anterior cervical spine should be aware that an aortic origin of the left vertebral artery is likely to be closer to the midline and less protected above the C6 vertebral level. Clin. Anat. 30:811-816, 2017. © 2017Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  16. Anterior Fusion Technique for Multilevel Cervical Spondylotic Myelopathy: A Retrospective Analysis of Surgical Outcome of Patients with Different Number of Levels Fused

    PubMed Central

    Yu, Shunzhi; Li, Fengning; Yan, Ning; Yuan, Chaoqun; He, Shisheng; Hou, Tiesheng

    2014-01-01

    Objective The anterior approach for multilevel CSM has been developed and obtained favorable outcomes. However, the operation difficulty, invasiveness and operative risks increase when multi-level involved. This study was to assess surgical parameters, complications, clinical and radiological outcomes in the treatment of 2-, 3- and 4-level CSM. Methods A total of 248 patients with 2-, 3- or 4-level CSM who underwent anterior decompression and fusion procedures between October 2005 and June 2011 were divided into three groups, the 2-level group (106 patients), the 3-level group (98 patients) and the 4-level group (44 patients). The clinical and Radiographic outcomes including Japanese Orthopedic Association (JOA) score, Neck Disability Index (NDI) score, Odom's Scale, hospital stay, blood loss, operation time, fusion rate, cervical lordosis, cervical range of motion (ROM), and complications were compared. Results At a minimum of 2-year follow-up, no statistical differences in JOA score, NDI score, Odom's Scale, hospital stay, fusion rate and cervical lordosis were found among the 3 groups. However, the mean postoperative NDI score of the 4-level group was significantly higher than that in the other two groups (P<0.05), and in terms of postoperative total ROM, the 3-level group was superior to the 4-level group and inferior to 2-level group (P<0.05). The decrease rate of ROM in the 3-level group was significantly higher than that in the 2-level group, and lower than that in the 4-level group (P<0.05). Conclusions As the number of involved levels increased, surgical results become worse in terms of operative time, blood loss, NDI score, cervical ROM and complication rates postoperatively. An appropriate surgical procedure for multilevel CSM should be chosen according to comprehensive clinical evaluation before operation, thus reducing fusion and decompression levels if possible. PMID:24618678

  17. Comparison of the incidence of patient-reported post-operative dysphagia between ACDF with a traditional anterior plate and artificial cervical disc replacement.

    PubMed

    Yang, Yi; Ma, Litai; Liu, Hao; Liu, Yilian; Hong, Ying; Wang, Beiyu; Ding, Chen; Deng, Yuxiao; Song, Yueming; Liu, Limin

    2016-09-01

    Compared with anterior cervical discectomy and fusion (ACDF), cervical disc replacement (CDR) has provided satisfactory clinical results. The incidence of post-operative dysphagia between ACDF with a traditional anterior plate and CDR remains controversial. Considering the limited studies and knowledge in this area, a retrospective study focusing on post-operative dysphagia was conducted. The Bazaz grading system was used to assess the severity of dysphagia at post-operative intervals including 1 week, 1 month, 3 months, 6 months, 12 months and 24 months respectively. The Chi-square test, Student t-test, Mann-Whitney U tests and Ordinal Logistic regression were used for data analysis when appropriate. Statistical significance was accepted at a probability value of <0.05. Two hundred and thirty-one patients in the CDR group and one hundred and fifty-eight patients in Plate group were included in this study. The total incidences of dysphagia in the CDR and plate group were 36.58% and 60.43% at one week, 29.27% and 38.85% at one month, 21.95% and 31.65% at three months, 6.83% and 17.99% at six months, 5.85% and 14.39% at 12 months, and 4.39% and 10.07% at the final follow-up respectively (All P<0.05, Mann-Whitney U test). Ordinal Logistic regression analysis showed that female patients, two-level surgery, C4/5 surgery, and anterior cervical plating were significant risk factors for post-operative dysphagia (all P<0.05). Comparing ACDF with a plate, CDR with a Prestige LP can significantly reduce both transient and persistent post-operative dysphagia. Female patients, two-level surgery, C4/5 surgery and anterior cervical plating were associated with a higher incidence of dysphagia. Future prospective, randomized, controlled studies are needed to further validate these findings. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. Analysis of Associating Factors With C2-7 Sagittal Vertical Axis After Two-level Anterior Cervical Fusion: Comparison Between Plate Augmentation and Stand-alone Cages.

    PubMed

    Kwon, Woo-Keun; Kim, Pyeong Soo; Ahn, Seong Yong; Song, Jye Young; Kim, Joo Han; Park, Youn-Kwan; Kwon, Taek-Hyun; Moon, Hong Joo

    2017-03-01

    A retrospective review. We investigated the longitudinal change of cervical alignment parameters including C2-7 lordosis, C2-7 sagittal vertical axis (SVA), T1 slope, and segmental angle (SA) after two-level anterior cervical discectomy and fusion (ACDF). Cervical alignment may influence postoperative clinical outcomes. Several studies have suggested that cervical alignment may serve as a parameter for assessing cervical deformities similar to those used to assess thoracolumbar spine deformities. However, to our knowledge, no studies have investigated the effect of ACDF on cervical sagittal alignment. We enrolled patients whom had ACDF, 23 patients with stand-alone cages and 22 with plate augmentation. Radiologic parameters including C2-7 lordosis, C2-7 SVA, T1 slope, and SA at the operated level were evaluated preoperatively and at 1 week and 6 months postoperatively. The differences between preoperative and 6-month postoperative parameter values were designated as Δvalues. T1S-CL was calculated as the T1 slope minus C2-7 lordosis. Clinical outcome were obtained by the Visual Analog Scale (VAS) and the Neck Disability Index (NDI). ΔC2-7 SVA was significantly correlated with ΔT1S-CL and ΔC2-7 lordosis. ΔC2-7 lordosis was significantly correlated with ΔSA. ΔC2-7 lordosis had a significantly greater impact on ΔT1S-CL than did ΔT1 slope. The ΔSA and ΔC2-7 lordosis in the ACDF-plate were significantly higher than those in the in ACDF-cage. ΔT1S-CL and ΔC2-7 SVA in the ACDF-plate were significantly lower than those in the ACDF-cage. C2-7 SVA after two-level ACDF was affected more significantly by the SA and C2-7 angle than by the T1 slope. Two-level ACDF with plate restored more cervical lordosis by obtaining more segmental lordosis at the operated level and was more effective in terms of cervical alignment compared with ACDF using stand-alone cages. 3.

  19. Efficacy of a Topical Gelatin-Thrombin Matrix Sealant in Reducing Postoperative Drainage Following Anterior Cervical Discectomy and Fusion

    PubMed Central

    Li, Quan You; Lee, Osung; Han, Ho Sung; Kim, Gang-Un; Lee, Chee Kean; Kang, Sung Shik; Lee, Myung Ho; Cho, Hyeon Guk; Kim, Ho-Joong

    2015-01-01

    Study Design Retrospective fusion level(s)-, age-, and gender-matched analysis. Purpose To determine whether the application of a topical gelatin-thrombin matrix sealant (Floseal) at the end of anterior cervical discectomy and fusion (ACDF) can reduce the amount of postoperative hemorrhage. Overview of Literature The effect of the matrix sealant in decreasing postoperative hemorrhage following ACDF has not been reported. Methods Matrix sealant was (n=116, study group) or was not applied (n=58, control group) at the end of ACDF. Patients were selected by 1:2 matching criteria of fusion level(s), age, and gender. Seven parameters described below were compared between the two groups. Results The total drain amount for the first 24 hours (8±9 versus 27±22 mL), total drain amount until the 8-hour drainage decreased to ≤10 mL (8±10 versus 33±26 mL), and the total drain amount until 6 AM on the first postoperative day (7±8 versus 24±20 mL) were significantly lower in the study group than the control group (all p<0.001). The time for the 8-hour drainage to decrease to ≤10 mL was significantly lower in the study group (10±5 versus 26±14 hours, p<0.001). The 8-hour drainage decreased to ≤10 mL on the operation day in most patients (88%) in the study group versus mostly on the first (48%) or second (33%) postoperative day in the control group (p<0.001). The total drain amount until 6 AM on the first postoperative day was 0 mL in 43% of patients in the study group and in 7% in the control group (p<0.001). No patient in either group required hematoma evacuation. Conclusions Application of the topical matrix sealant at the end of ACDF can significantly reduce the amount of postoperative hemorrhage. PMID:26713124

  20. Multi-center, Prospective, Randomized, Controlled Investigational Device Exemption Clinical Trial Comparing Mobi-C Cervical Artificial Disc to Anterior Discectomy and Fusion in the Treatment of Symptomatic Degenerative Disc Disease in the Cervical Spine

    PubMed Central

    Bae, Hyun W.; Davis, Reginald; Gaede, Steven; Hoffman, Greg; Kim, Kee; Nunley, Pierce D.; Peterson, Daniel; Rashbaum, Ralph; Stokes, John

    2014-01-01

    Background Anterior cervical discectomy and fusion (ACDF) is the gold standard for treating symptomatic cervical disc degeneration. Cervical total disc replacements (TDRs) have emerged as an alternative for some patients. The purpose of this study was to evaluate the safety and effectiveness of a new TDR device compared with ACDF for treating single-level cervical disc degeneration. Methods This was a prospective, randomized, controlled, multicenter Food and Drug Administration (FDA) regulated Investigational Device Exemption (IDE) study. A total of 245 patients were treated (164 TDR: 81 ACDF). The primary outcome measure was overall success based on improvement in Neck Disability Index (NDI), no subsequent surgical interventions, and no adverse events (AEs) classified as major complications. Secondary outcome measures included SF-12, visual analog scale (VAS) assessing neck and arm pain, patient satisfaction, radiographic range of motion, and adjacent level degeneration. Patients were evaluated preoperatively and postoperatively at 6 weeks, 3, 6, 12, 18, and 24 months. The hypothesis was that the TDR success rate was non-inferior to ACDF at 24 months. Results Overall success rates were 73.6% for TDR and 65.3% for ACDF, confirming non-inferiority (p < 0.0025). TDR demonstrated earlier improvements with significant differences in NDI scores at 6 weeks and 3 months, and VAS neck pain and SF-12 PCS scores at 6 weeks (p<0.05). Operative level range of motion in the TDR group was maintained throughout follow-up. Radiographic evidence of inferior adjacent segment degeneration was significantly greater with ACDF at 12 and 24 months (p < 0.05). AE rates were similar. Conclusions Mobi-C TDR is a safe and effective treatment for single-level disc degeneration, producing outcomes similar to ACDF with less adjacent segment degeneration. Level of Evidence: Level I. Clinical relevance: This study adds to the literature supporting cervical TDR as a viable option to ACDF in

  1. Single-stage Anterior and Posterior Fusion Surgery for Correction of Cervical Kyphotic Deformity Using Intervertebral Cages and Cervical Lateral Mass Screws: Postoperative Changes in Total Spine Sagittal Alignment in Three Cases with a Minimum Follow-up of Five Years

    PubMed Central

    OGIHARA, Satoshi; KUNOGI, Junichi

    The surgical treatment of cervical kyphotic deformity remains challenging. As a surgical method that is safer and avoids major complications, the authors present a procedure of single-stage anterior and posterior fusion to correct cervical kyphosis using anterior interbody fusion cages without plating, as illustrated by three consecutive cases. Case 1 was a 78-year-old woman who presented with a dropped head caused by degeneration of her cervical spine. Case 2 was a 54-year-old woman with athetoid cerebral palsy. She presented with cervical myelopathy and cervical kyphosis. Case 3 was a 71-year-old woman with cervical kyphotic deformity following a laminectomy. All three patients underwent anterior release and interbody fusion with cages and posterior fusion with cervical lateral mass screw (LMS) fixation. Postoperative radiographs showed that correction of kyphosis was 39° in case 1, 43° in case 2, and 39° in case 3. In all three cases, improvement of symptoms was established without major perioperative complications, solid fusion was achieved, and no loss of correction was observed at a minimum follow-up of 61 months. We also report that preoperative total spine sagittal malalignment was improved after corrective surgery for cervical kyphosis and was maintained at the latest follow-up in all three cases. The combination of anterior fusion cages and LMS is considered a safe and effective procedure in cases of severe cervical kyphotic deformity. Preoperative total spine sagittal malalignment improved, accompanied by correction of cervical kyphosis, and was maintained at last follow-up in all three cases. PMID:26119893

  2. Cone beam computed tomographic evaluation of two access cavity designs and instrumentation on the thickness of peri-cervical dentin in mandibular anterior teeth

    PubMed Central

    Varghese, Vinny Sara; George, John V.; Mathew, Sylvia; Nagaraja, Shruthi; Indiresha, H. N.; Madhu, K. S.

    2016-01-01

    Background and Objectives: The aim of the study was to determine the effect of two access cavity designs on the peri-cervical dentin thickness before and after instrumentation using cone beam computed tomography (CBCT). Materials and Methods: Sixty mandibular anterior teeth were divided into two groups of thirty teeth each: Group I: conventional access cavity preparation, where access was prepared just above the cingulum and Group II: incisal access cavity preparation, where access was prepared in proximity to the incisal edge. CBCT scans were taken preoperatively, following access cavity preparation and post instrumentation. 200 μm thick slices were obtained 4mm apical and coronal to the cemento-enamel junction. The peri-cervical dentin thickness was calculated on the facial, lingual, mesial, and distal for all the three obtained scans. Results: The analysis showed that access cavity preparation and instrumentation resulted in a significant loss of tooth structure in Group I on all surfaces, but in Group II, there was a significant loss of tooth structure only in the mesial, lingual, and distal surfaces (P < 0.05). Conclusion: Incisal access cavity preparation resulted in lesser loss of dentin in the peri-cervical region. PMID:27656065

  3. Osteocel Plus cellular allograft in anterior cervical discectomy and fusion: evaluation of clinical and radiographic outcomes from a prospective multicenter study.

    PubMed

    Eastlack, Robert K; Garfin, Steven R; Brown, Christopher R; Meyer, S Craig

    2014-10-15

    Prospective, multicenter, nonrandomized, institutional review board-approved clinical and radiographic study. To evaluate and summarize the 2-year outcomes of patients treated with Osteocel Plus cellular allograft as part of an anterior cervical discectomy and fusion procedure. Osteocel Plus is an allograft cellular bone matrix containing native mesenchymal stem cells and osteoprogenitor cells that is intended to mimic the performance of iliac crest autograft without the morbidity associated with its harvest. A total of 182 patients were treated with anterior cervical discectomy and fusion using Osteocel Plus in a polyetheretherketone cage and anterior plating at 1 or 2 consecutive levels. Clinical outcomes included visual analogue scale for neck and arm pain, neck disability index, and SF-12 physical and mental component scores. Computed tomography and plain film radiographic measures included assessment of bridging bone, disc height, disc angle, and segmental range of motion. A total of 249 levels were treated in 182 patients. Mean procedure time was 100 minutes, blood loss was less than 50 mL in 93% of patients, and hospital stay was 1 day or less in 84% of patients. Significant (P<0.05) average improvements in clinical outcomes from preoperatively to 24 months included the following: neck disability index: 21.5%; visual analogue scale neck: 34 mm; visual analogue scale arm: 35 mm; SF-12 physical component score: 11.2; SF-12 mental component score: 6.8. At 24 months, 93% of patients were satisfied with their outcome. In patients treated at a single level with a minimum of 24-month follow-up, 92% (79/86) of levels achieved solid bridging and 95% of levels demonstrated range of motion of less than 3°. In combined single- and 2-level procedures, 87% (157/180) of levels achieved solid bridging and 92% (148/161) had range of motion of less than 3° at 24 months. No patient required revision for pseudarthrosis. Improvements in clinical results at 2 years, high

  4. A role for motor and somatosensory evoked potentials during anterior cervical discectomy and fusion for patients without myelopathy: Analysis of 57 consecutive cases

    PubMed Central

    Xu, Risheng; Ritzl, Eva K.; Sait, Mohammed; Sciubba, Daniel M.; Wolinsky, Jean-Paul; Witham, Timothy F.; Gokaslan, Ziya L.; Bydon, Ali

    2011-01-01

    Background: Although the usage of combined motor and sensory intraoperative monitoring has been shown to improve the surgical outcome of patients with cervical myelopathy, the role of transcranial electric motor evoked potentials (tceMEP) used in conjunction with somatosensory evoked potentials (SSEP) in patients presenting with radiculopathy but without myelopathy has been less clear. Methods: We retrospectively reviewed all patients (n = 57) with radiculopathy but without myelopathy, undergoing anterior cervical decompression and fusion at a single institution over the past 3 years, who had intraoperative monitoring with both tceMEPs and SSEPs. Results: Fifty-seven (100%) patients presented with radiculopathy, 53 (93.0%) with mechanical neck pain, 35 (61.4%) with motor dysfunction, and 29 (50.9%) with sensory deficits. Intraoperatively, 3 (5.3%) patients experienced decreases in SSEP signal amplitudes and 4 (6.9%) had tceMEP signal changes. There were three instances where a change in neuromonitoring signal required intraoperative alteration of the surgical procedure: these were deemed clinically significant events/true positives. SSEP monitoring showed two false positives and two false negatives, whereas tceMEP monitoring only had one false positive and no false negatives. Thus, tceMEP monitoring exhibited higher sensitivity (33.3% vs. 100%), specificity (95.6% vs. 98.1%), positive predictive value (33.3% vs. 75.0%), negative predictive value (97.7% vs. 100%), and efficiency (91.7% vs. 98.2%) compared to SSEP monitoring alone. Conclusions: Here, we present a retrospective series of 57 patients where tceMEP/SSEP monitoring likely prevented irreversible neurologic damage. Though further prospective studies are needed, there may be a role for combined tceMEP/SSEP monitoring for patients undergoing anterior cervical decompression without myelopathy. PMID:22059128

  5. Embolization by Direct Puncture with a Transpedicular Approach Using an Isocenter Puncture (ISOP) Method in a Patient with a Type II Endoleak After Endovascular Aortic Repair (EVAR)

    SciTech Connect

    Ogawa, Yukihisa Hamaguchi, Shingo; Nishimaki, Hiroshi; Kon, Yuri; Chiba, Kiyoshi; Sakurai, Yuka; Murakami, Kenji; Arai, Yasunori; Miyairi, Takeshi; Nakajima, Yasuo

    2015-06-15

    BackgroundEndovascular aortic repair (EVAR) requires further intervention in 20-30 % of cases, often due to type II endoleak (T2EL). Management options for T2EL include transarterial embolization, direct puncture (DP), or transcaval embolization. We report the case of an 80-year-old man with T2EL who successfully underwent DP embolization.MethodsEmbolization by DP was performed with a transpedicular approach using an isocenter puncture (ISOP) method. An isocenter marker (ICM) was placed at a site corresponding to the aneurysm sac on fluoroscopy in two directions (frontal and lateral views). A vertebroplasty needle was inserted tangentially to the ICM under fluoroscopy and advanced to the anterior wall of the vertebral body. A 20 cm-length, 20-G-PTCD needle was inserted through the outer needle of the 13-G needle and advanced to the ICM. Sac embolization using 25 % N-buty-2-cyanoacrylate diluted with Lipiodol was performed. After complete embolization, rotational DA confirmed good filling of the sac with Lipiodol. The outer cannula and 13-G needle were removed and the procedure was completed.ResultsThe patient was discharged the next day. Contrast-enhanced computed tomography 1 and 8 months later showed no Lipiodol washout in the aneurysm sac, no endoleak recurrence, and no expansion of the excluded aneurysm.ConclusionDP with a transpedicular approach using ISOP may be useful when translumbar and transabdominal approaches prove difficult.

  6. Embolization by Direct Puncture with a Transpedicular Approach Using an Isocenter Puncture (ISOP) Method in a Patient with a Type II Endoleak After Endovascular Aortic Repair (EVAR).

    PubMed

    Ogawa, Yukihisa; Hamaguchi, Shingo; Nishimaki, Hiroshi; Kon, Yuri; Chiba, Kiyoshi; Sakurai, Yuka; Murakami, Kenji; Arai, Yasunori; Miyairi, Takeshi; Nakajima, Yasuo

    2015-06-01

    Endovascular aortic repair (EVAR) requires further intervention in 20-30 % of cases, often due to type II endoleak (T2EL). Management options for T2EL include transarterial embolization, direct puncture (DP), or transcaval embolization. We report the case of an 80-year-old man with T2EL who successfully underwent DP embolization. Embolization by DP was performed with a transpedicular approach using an isocenter puncture (ISOP) method. An isocenter marker (ICM) was placed at a site corresponding to the aneurysm sac on fluoroscopy in two directions (frontal and lateral views). A vertebroplasty needle was inserted tangentially to the ICM under fluoroscopy and advanced to the anterior wall of the vertebral body. A 20 cm-length, 20-G-PTCD needle was inserted through the outer needle of the 13-G needle and advanced to the ICM. Sac embolization using 25 % N-buty-2-cyanoacrylate diluted with Lipiodol was performed. After complete embolization, rotational DA confirmed good filling of the sac with Lipiodol. The outer cannula and 13-G needle were removed and the procedure was completed. The patient was discharged the next day. Contrast-enhanced computed tomography 1 and 8 months later showed no Lipiodol washout in the aneurysm sac, no endoleak recurrence, and no expansion of the excluded aneurysm. DP with a transpedicular approach using ISOP may be useful when translumbar and transabdominal approaches prove difficult.

  7. Surgical results and complications of anterior decompression and fusion as a revision surgery after initial posterior surgery for cervical myelopathy due to ossification of the posterior longitudinal ligament.

    PubMed

    Odate, Seiichi; Shikata, Jitsuhiko; Soeda, Tsunemitsu; Yamamura, Satoru; Kawaguchi, Shinji

    2017-04-01

    OBJECTIVE Ossification of the posterior longitudinal ligament (OPLL) is a progressive disease. An anterior cervical decompression and fusion (ACDF) procedure for cervical OPLL is theoretically feasible, as the lesion exists anteriorly; however, such a procedure is considered technically demanding and is associated with serious complications. Cervical laminoplasty is reportedly an effective alternative procedure with few complications; it is recognized as a comparatively safe procedure, and has been widely used as an initial surgery for cervical OPLL. After posterior surgery, some patients require revision surgery because of late neurological deterioration due to kyphotic changes in cervical alignment or OPLL progression. Here, the authors retrospectively investigated the surgical results and complications of revision ACDF after initial posterior surgery for OPLL. METHODS This was a single-center, retrospective study. Between 2006 and 2013, 19 consecutive patients with cervical OPLL who underwent revision ACDF at the authors' institution after initial posterior surgery were evaluated. The mean age at the time of revision ACDF was 66 ± 7 years (± SD; range 53-78 years). The mean interval between initial posterior surgery and revision ACDF was 63 ± 53 months (range 3-235 months). RESULTS The mean follow-up period after revision ACDF was 41 ± 26 months (range 24-108 months). Before revision ACDF, the mean maximum thickness of the ossified posterior longitudinal ligament was 7.2 ± 1.5 mm (range 5-10 mm), and the mean C2-7 angle was 1.3° ± 14° (range -40° to 24°). The K-line was plus (OPLL did not exceed the K-line) in 8 patients and minus in 11 (OPLL exceeded the K-line). The mean Japanese Orthopaedic Association score improved from 10 ± 3 (range 3-15) before revision ACDF to 11 ± 4 (range 4-15) at the last follow-up, and the mean improvement rate was 18% ± 18% (range 0%-60%). A total of 16 surgery-related complications developed in 12 patients (63%). The

  8. Three-level and four-level anterior cervical discectomies and titanium cage-augmented fusion with and without plate fixation.

    PubMed

    Hwang, Shiuh-Lin; Lin, Chih-Lung; Lieu, Ann-Shung; Lee, Kung-Shing; Kuo, Tai-Hung; Hwang, Yan-Fen; Su, Yu-Feng; Howng, Shen-Long

    2004-09-01

    Cage-assisted anterior cervical discectomy and fusion (ACDF) has proven to be a safe and effective procedure for the treatment of one- and two-level degenerative disc disease (DDD). To the authors' knowledge, clinical results after three- and four-level interbody cage-augmented ACDF have not been reported in the literature. The authors investigated the safety and effectiveness of titanium cages used in such procedures and evaluated the results in cases with or without plate fixation. Fifty-six patients suffering from cervical DDD were divided into two groups. Group 1 included 32 patients who underwent titanium cage-assisted ACDF; Group 2 included 24 patients who underwent the same procedure, supplemented with plate fixation. The cervical DDD was confirmed by radiography and magnetic resonance imaging. The patients underwent radiographic evaluation to assess cervical lordosis, segmental height of cervical spine, the height of the foramina, and spinal stability. Neurological outcomes were assessed using the Japanese Orthopaedic Association (JOA) scores. Neck pain was graded using a 10-point visual analog scale (VAS). The follow-up period ranged from 13 to 28 months (mean 17.2 months). In both Groups 1 and 2 significant increase (p < 0.001) was demonstrated in the JOA scores (preoperatively 10.7 +/- 2.4 and 11.1 +/- 2, postoperatively 13.9 +/- 2.2 and 14.1 +/- 2.3, respectively) and VAS pain scores (preoperatively 8.8 +/- 0.9 and 8.5 +/- 1, postoperatively 3.1 +/- 2.1 and 2.8 +/- 1.8, respectively); however, there was no significant intergroup difference. A significant increase in the cervical lordosis, foraminal height, and segmental height was observed in both groups. Good stability of cage fusion was obtained in both groups 12 months postoperatively (90.6% in Group 1 and 91.7% in Group 2); however, there were no statistically significant intergroup differences. The complication rate in Group 2 was higher than that in Group 1. The hospital length of stay in Group 1

  9. Results of Single-Staged Posterior Decompression and Circumferential Fusion Using a Transpedicular Approach to Correct a Kyphotic Deformity due to Thoracolumbar Spinal Tuberculosis

    PubMed Central

    Modi, Jayprakash; Soman, Shardul; Patel, Harshil; Dhanani, Shrikant

    2016-01-01

    Study Design This is a prospective study. Purpose The aim of this study was to investigate the results of single-staged posterior decompression and circumferential fusion using a transpedicular approach to correct a kyphotic deformity due to thoracolumbar spinal tuberculosis. Overview of Literature Surgical management is frequently an imperative choice to achieve spinal decompression and deformity correction due to tuberculosis to relieve pain, improve neurology, and reconstruct the spine stability. Since the time anterior radical debridement and noninstrumented fusion was described, it has become apparent that even anterior debridement and bone grafting was often unsatisfactory in correcting or preventing the progression of kyphosis deformity. With the advent of modern segmental spinal instrumentation systems, isolated posterior instrumentation; combined anterior and posterior fusion; and single-staged posterior decompression and circumferential fusion have been described by many authors for correcting angular deformity and stabilizing the spine; however, there is a lack of consensus regarding the most effective means of correcting the deformity due to thoracolumbar spinal tuberculosis. Methods This is a prospective study of 20 patients with thoracolumbar spinal tuberculosis who underwent surgery at our institute. Results Twenty patients who were started on antituberculosis treatment underwent surgery using a single-staged posterior approach involving fixation, decompression, and kyphosis correction. Preoperatively, all patients had varying degrees of neurological deficit and a 27.45° average kyphotic angle, which improved. At the 1-year follow-up, correction was maintained at 6.9°, and 55% of patients showed neurological improvement. None of the patients experienced neurological deterioration. Two patients with lumbar spine tuberculosis underwent revision surgery because of nonunion. Conclusions The procedure of posterior decompression, fixation, and

  10. Cost-utility analysis modeling at 2-year follow-up for cervical disc arthroplasty versus anterior cervical discectomy and fusion: A single-center contribution to the randomized controlled trial

    PubMed Central

    Warren, Daniel; Andres, Tate; Hoelscher, Christian; Ricart-Hoffiz, Pedro; Bendo, John; Goldstein, Jeffrey

    2013-01-01

    Background Patients with cervical disc herniations resulting in radiculopathy or myelopathy from single level disease have traditionally been treated with Anterior Cervical Discectomy and Fusion (ACDF), yet Cervical Disc Arthroplasty (CDA) is a new alternative. Expert suggestion of reduced adjacent segment degeneration is a promising future result of CDA. A cost-utility analysis of these procedures with long-term follow-up has not been previously reported. Methods We reviewed single institution prospective data from a randomized trial comparing single-level ACDF and CDA in cervical disc disease. Both Medicare reimbursement schedules and actual hospital cost data for peri-operative care were separately reviewed and analyzed to estimate the cost of treatment of each patient. QALYs were calculated at 1 and 2 years based on NDI and SF-36 outcome scores, and incremental cost effectiveness ratio (ICER) analysis was performed to determine relative cost-effectiveness. Results Patients of both groups showed improvement in NDI and SF-36 outcome scores. Medicare reimbursement rates to the hospital were $11,747 and $10,015 for ACDF and CDA, respectively; these figures rose to $16,162 and $13,171 when including physician and anesthesiologist reimbursement. The estimated actual cost to the hospital of ACDF averaged $16,108, while CDA averaged $16,004 (p = 0.97); when including estimated physicians fees, total hospital costs came to $19,811 and $18,440, respectively. The cost/QALY analyses therefore varied widely with these discrepancies in cost values. The ICERs of ACDF vs CDA with Medicare reimbursements were $18,593 (NDI) and $19,940 (SF-36), while ICERs based on actual total hospital cost were $13,710 (NDI) and $9,140 (SF-36). Conclusions We confirm the efficacy of ACDF and CDA in the treatment of cervical disc disease, as our results suggest similar clinical outcomes at one and two year follow-up. The ICER suggests that the non-significant added benefit via ACDF comes at a

  11. A Meta-Analysis of the Incidence of Patient-Reported Dysphagia After Anterior Cervical Decompression and Fusion with the Zero-Profile Implant System.

    PubMed

    Yang, Yi; Ma, Litai; Liu, Hao; Xu, MangMang

    2016-04-01

    Dysphagia is a well-known complication following anterior cervical surgery. It has been reported that the Zero-profile Implant System can decrease the incidence of dysphagia following surgery, however, dysphagia after anterior cervical decompression and fusion (ACDF) with the Zero-profile Implant System remains controversial. Previous studies only focus on small sample sizes. The objective of this study was to determine the incidence of dysphagia after ACDF with the Zero-profile Implant System. Studies were collected from PubMed, EMBASE, the Cochrane library and the China Knowledge Resource Integrated Database using the keywords "Zero-profile OR Zero-p) AND (dysphagia OR [swallowing dysfunction]". The software STATA (Version 13.0) was used for statistical analysis. Statistical heterogeneity across the various trials, a test of publication bias and sensitivity analysis was performed. 30 studies with a total of 1062 patients were included in this meta-analysis. The occurrence of post-operative transient dysphagia ranged from 0 to 76 % whilst the pooled incidence was 15.6 % (95 % CI, 12.6, 18.5 %). 23 studies reported no persistent dysphagia whilst seven studies reported persistent dysphagia ranging from 1 to 7 %). In summary, the present study observed a low incidence of both transient and persistent dysphagia after ACDF using the Zero-profile Implant System. Most of the dysphagia was mild and gradually decreased during the following months. Moderate or severe dysphagia was uncommon. Future randomized controlled multi-center studies and those focusing on the mechanisms of dysphagia and methods to reduce its incidence are required.

  12. Comparison of clinical outcomes between laminoplasty, posterior decompression with instrumented fusion, and anterior decompression with fusion for K-line (-) cervical ossification of the posterior longitudinal ligament.

    PubMed

    Koda, Masao; Mochizuki, Makondo; Konishi, Hiroaki; Aiba, Atsuomi; Kadota, Ryo; Inada, Taigo; Kamiya, Koshiro; Ota, Mitsutoshi; Maki, Satoshi; Takahashi, Kazuhisa; Yamazaki, Masashi; Mannoji, Chikato; Furuya, Takeo

    2016-07-01

    The K-line, which is a virtual line that connects the midpoints of the anteroposterior diameter of the spinal canal at C2 and C7 in a plain lateral radiogram, is a useful preoperative predictive indicator for sufficient decompression by laminoplasty (LMP) for ossification of the posterior longitudinal ligament (OPLL). K-line is defined as (+) when the peak of OPLL does not exceed the K-line, and is defined as (-) when the peak of OPLL exceeds the K-line. For patients with K-line (-) OPLL, LMP often results in poor outcome. The aim of the present study was to compare the clinical outcome of LMP, posterior decompression with instrumented fusion (PDF) and anterior decompression and fusion (ADF) for patients with K-line (-) OPLL. The present study included patients who underwent surgical treatment including LMP, PDF and ADF for K-line (-) cervical OPLL. We retrospectively compared the clinical outcome of those patients in terms of Japanese Orthopedic Association score (JOA score) recovery rate. JOA score recovery rate was significantly higher in the ADF group compared with that in the LMP group and the PDF group. The JOA score recovery rate in the PDF group was significantly higher than that in the LMP group. LMP should not be used for K-line (-) cervical OPLL. ADF is one of the suitable surgical treatments for K-line (-) OPLL. Both ADF and PDF are applicable for K-line (-) OPLL according to indications set by each institute and surgical decisions.

  13. Long-term outcome after adjacent two-level anterior cervical discectomy and fusion using stand-alone plasmaphore-covered titanium cages.

    PubMed

    Marbacher, Serge; Hidalgo-Staub, Teresa; Kienzler, Jenny; Wüergler-Hauri, Carola; Landolt, Hans; Fandino, Javier

    2015-05-01

    Reports on long-term outcome of stand-alone contiguous two-level anterior cervical discectomy and fusion (ACDF) using stand-alone Plasmaphore-coated titanium cages (PCTCs) are rare, and data on follow-ups > 3 years are missing. To evaluate the long-term outcome of adjacent two-level microsurgical ACDF using stand-alone PCTC. A total of 33 consecutive patients presented with cervical degenerative disc disease (DDD) underwent contiguous two-level ACDF. Clinical long-term evaluation (mean: 61 ± 14 months) included documentation of neurologic deficits (motor deficits, sensory deficits, reflex status, and gait disturbance), neck pain, and radicular pain. Functional outcome was measured using the Odom criteria, patient-perceived outcome, and evaluation of work status. Radiographs were evaluated to assess intervertebral disc height, subsidence, level of fusion, sagittal balance, and implant position. Surgery was performed at levels C5-C6 and C6-C7 in 30 patients and at C4-C5 and C5-C6 in 3 (mean age: 50.1 ± 7.7 years). Symptoms and neurologic deficits improved as follows: neurologic deficits (pre: 100%; post: 36%), radicular pain (pre: 85%; post: 15%), and neck pain (pre: 94%; post: 33%). Excellent and good functional and subjective outcome was noted in 75%. Cage subsidence was found to be more prominent in the lower (52%) than the upper (36%) mobile cervical segment. Two-level fusion was documented in most patients (n = 29 [88%]). Kyphotic deformity occurred in two cases (n = 2 [6%]). Stand-alone contiguous two-level ACDF using PCPT proved to be effective, yielding good long-term clinical and functional outcomes. The relatively high rate of subsidence did not affect the good clinical and functional long-term outcome. Georg Thieme Verlag KG Stuttgart · New York.

  14. Physical function outcome in cervical radiculopathy patients after physiotherapy alone compared with anterior surgery followed by physiotherapy: a prospective randomized study with a 2-year follow-up.

    PubMed

    Peolsson, Anneli; Söderlund, Anne; Engquist, Markus; Lind, Bengt; Löfgren, H