The Role for Cervical Arthroplasty for Symptomatic Cervical Stenosis: Indicated for a Single-Level Cervical Disc Herniation Causing Stenosis with Myelopathy

Object. Polymethylmethacrylate (PMMA) bone cement has been used as a spacer in the treatment of patients with cervical disc disease with good long-term outcomes, but solid bone fusion has not been demonstrated in all cases. To achieve cervical interbody fusion, the authors designed a modified PMMA cervical cage that they filled with spongy bone for the treatment of single-level cervical disc herniation. Methods. Sixty-three patients underwent anterior cervical microdiscectomy and implantation of a PMMA cervical cage filled with autograft cancellous bone and were followed for a minimum of 2 years. The fusion rates were 90.5 and 100% at the 6- and 12-month follow-up examinations, respectively. The mean intervertebral disc height gain was 3.4 ± 1.9 mm when preoperative and 24-month postoperative values were compared. Neck pain, measured using the Huskissan visual analog scale (0 mm, no pain; 100 mm, worst possible pain), decreased from 71 ± 13 mm at preoperative baseline to 28 ± 17 at 6, 23 ± 19 at 12, and 31 ± 19 mm at 24 months. Based on the same scale, radicular pain decreased from 83 ± 15 mm at preoperative baseline to 24 ± 11 at 6, 27 ± 13 at 12, and 22 ± 11 mm at 24 months. The self-rated clinical outcome was excellent in 45 (71.4%) and good in 18 (28.6%) of the 63 patients. Conclusions. The autograft cancellous bone—filled PMMA cage is safe and effective for cervical interbody fusion in the treatment of single-level cervical disc herniation and monoradiculopathy.

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Subsequent Cervical Disc Herniation following Single-Level ACDF

Global Spine Journal ◽

10.1055/s-0035-1554387 ◽

2015 ◽

Vol 5 (1_suppl) ◽

pp. s-0035-1554387-s-0035-1554387

Author(s):

Ikchan Jeon ◽

Yongeun Cho ◽

Dongkyu Chin

Keyword(s):

Disc Herniation ◽

Cervical Disc Herniation ◽

Cervical Disc ◽

Single Level

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Differences between soft-disc herniation and spondylosis in cervical arthroplasty: CT-documented heterotopic ossification with minimum 2 years of follow-up

Journal of Neurosurgery Spine ◽

10.3171/2011.10.spine11497 ◽

2012 ◽

Vol 16 (2) ◽

pp. 163-171 ◽

Cited By ~ 41

Author(s):

Jau-Ching Wu ◽

Wen-Cheng Huang ◽

Tsung-Hsi Tu ◽

Hsiao-Wen Tsai ◽

Chin-Chu Ko ◽

...

Keyword(s):

Heterotopic Ossification ◽

Clinical Outcomes ◽

Disc Herniation ◽

Cervical Disc ◽

Artificial Disc ◽

Cervical Arthroplasty ◽

Single Level ◽

Arm Pain ◽

Estimated Blood Loss

Object Cervical arthroplasty is a valid option for patients with single-level symptomatic cervical disc diseases causing neural tissue compression, but postoperative heterotopic ossification (HO) can limit the mobility of an artificial disc. In the present study the authors used CT scanning to assess HO formation, and they investigated differences in radiological and clinical outcomes in patients with either a soft-disc herniation or spondylosis who underwent cervical arthroplasty. Methods Medical records, radiographs, and clinical evaluations of consecutive patients who underwent single-level cervical arthroplasty were reviewed. Arthroplasty was performed using the Bryan disc. The patients were divided into a soft-disc herniation group and a spondylosis group. Clinical outcomes were measured using the visual analog scale (VAS) for neck and arm pain and the Neck Disability Index (NDI), whereas HO grading was determined by studying CT scans. Radiological and clinical outcomes were analyzed, and the minimum follow-up duration was 24 months. Results Forty-seven consecutive patients underwent a single-level cervical arthroplasty. Forty patients (85.1%) had complete radiological evaluations and clinical follow-up of more than 2 years. Patients were divided into 1 of 2 groups: soft-disc herniation (16 cases) and the spondylosis group (24 cases). Their mean age was 45.51 ± 11.12 years. Sixteen patients (40%) were female. Patients in the soft-disc herniation group were younger than those in the spondylosis group, but the difference was not statistically significant (42.88 vs 47.26, p = 0.227). The mean follow-up duration was 38.83 ± 9.74 months. Sex, estimated blood loss, implant size, and perioperative NSAID prescription were not significantly different between the groups (p = 0.792, 0.267, 0.581, and 1.000, respectively). The soft-disc herniation group had significantly less HO formation than the spondylosis group (1 HO [6.25%] vs 14 Hos [58.33%], p = 0.001). Almost all artificial discs in both groups remained mobile (100% and 95.8%, p = 0.408). The clinical outcomes were not significantly different between the groups at all postoperative time points of evaluation, and clinical improvements were also similar. Conclusions Clinical outcomes of single-level cervical arthroplasty for soft-disc herniation and spondylosis were similar 3 years after surgery. There was a significantly higher rate of HO formation in patients with spondylosis than in those with a soft-disc herniation. The mobility of the artificial disc is maintained, but the long-term effects of HO and its higher frequency in spondylotic cases warrant further investigation.

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

Romanian Neurosurgery ◽

10.1515/romneu-2017-0008 ◽

2017 ◽

Vol 31 (1) ◽

pp. 54-58

Author(s):

Andrei Stefan Iencean

Keyword(s):

Range Of Motion ◽

Disc Herniation ◽

Clinical Results ◽

Small Degree ◽

Anterior Cervical Discectomy ◽

Cervical Disc Herniation ◽

Cervical Disc ◽

Cervical Discectomy ◽

Single Level ◽

Anteroposterior Translation

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

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Anterior Decompression and Fusion in the Treatment of Single-level Cervical Disc Herniation - Plate Fixation vs Cage -

Journal of Korean Society of Spine Surgery ◽

10.4184/jkss.2008.15.3.140 ◽

2008 ◽

Vol 15 (3) ◽

pp. 140 ◽

Cited By ~ 2

Author(s):

Heui-Jeon Park ◽

Young-Jun Shim ◽

Jae-Hyung Yang

Keyword(s):

Disc Herniation ◽

Plate Fixation ◽

Cervical Disc Herniation ◽

Cervical Disc ◽

Anterior Decompression ◽

Single Level ◽

Anterior Decompression And Fusion

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Implantation of an empty carbon fiber cage or a tricortical iliac crest autograft after cervical discectomy for single-level disc herniation: a prospective comparative study

Journal of Neurosurgery Spine ◽

10.3171/spi.2006.4.4.292 ◽

2006 ◽

Vol 4 (4) ◽

pp. 292-299 ◽

Cited By ~ 16

Author(s):

Frédéric Schils ◽

Benedict Rilliet ◽

Michael Payer

Keyword(s):

Carbon Fiber ◽

Neck Pain ◽

Disc Herniation ◽

Iliac Crest ◽

Radicular Pain ◽

Cervical Disc Herniation ◽

Cervical Disc ◽

Cervical Discectomy ◽

Single Level ◽

Autograft Group

Object The authors conducted a study to evaluate and compare prospectively the implantation of either an empty carbon fiber composite frame cage (CFCFC) or an iliac crest autograft after anterior cervical discectomy (ACD) for cervical disc herniation with monoradiculopathy. Methods Thirty-six consecutive patients with one-level radiculopathy due to single-level cervical disc herniation were treated by ACD, and implantation of either an empty CFCFC (24 patients) or an iliac crest autograft (12 patients). Radiological and clinical assessments were performed preoperatively, immediately postoperatively; and at 3, 6, and 12 months postoperatively. Fusion, at the 12-month follow-up examination was demonstrated in 96% of the patients in the cage group and in 100% of those in the autograft group. The mean anterior intervertebral body height was 3.7 mm preoperatively and 3.9 mm at 12 months in the CFCFC, and 4.1 and 3.8 mm, respectively, in the autograft group. In cage-treated patients, neck pain, as measured using the visual analog scale (VAS) (Score 0 = minimum; 10 = maximum) decreased from 6.4 preoperatively to 2.0 at 12 months, and radicular pain, decreased from 8.4 preoperatively to 1.5 at 12 months. In the autograft group, neck pain changed from a mean preoperative VAS score of 7.2 to 2.5 at 12 months, and radicular pain decreased from a preoperative mean of 7.8 to 1.4 at 12 months. Analysis of the 12-Item Short Form Health Survey domains and the Oswestry Disability Index scores indicated a significant improvement in both the Physical and Mental Component Summary domains in both groups. Conclusions Implantation of an empty CFCFC or a tricortical iliac crest autograft after ACD are safe and reliable options for the treatment of cervical disc herniation causing one-sided radiculopathy. Both procedures produced equally satisfying clinical and radiological results, leading to a high fusion rate and maintaining intervertebral height. Implantation of an empty CFCFC has the advantages of avoiding any donor site morbidity and requiring a significantly shorter operative time.

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