Hybrid Constructs in the Surgical Treatment of Degenerative Cervical Disc Disease: Five-Year Clinical and Radiological Follow Up

Object. Anterior cervical foraminotomy has been advocated as a procedure that preserves the motion segment while treating radiculopathy due to degenerative cervical disc disease. Because the medical literature contains no long-term follow up or randomized studies related to this procedure, the authors reviewed their results, specifically examining cases of failure to determine the efficacy of the approach. Methods. The authors identified 23 patients in whom unilateral cervical radiculopathy due to degenerative cervical disc disease was refractory to conservative therapy and in whom anterior cervical foraminotomy was performed between 1998 and 2000. The procedure involves ipsilateral exposure, microsurgical removal of the uncovertebral joint to identify the nerve root, and partial removal of the lateral anulus and or disc fragments. Data in those patients who underwent reoperation(s) were reviewed specifically for the procedure type, interval between index procedure and reoperation, and whether multiple procedures were performed. Of the 23 patients, 30% required at least one additional procedure. A good or excellent outcome at last follow-up examination was achieved in only 12 patients. Conclusions. In the current study the authors found a reoperation rate that is considerably higher than that in most series of anterior cervical surgery for radiculopathy. The presumed benefit of anterior cervical foraminotomy is preservation of the disc interspace; however, in this study, a significant number of patients failed to experience a satisfying outcome. Currently the authors do not recommend anterior cervical foraminotomy as a stand-alone procedure.

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Combination of Fusion and Motion Preservation in the Surgical Treatment of Degenerative Cervical Disc Disease

Global Spine Journal ◽

10.1055/s-0035-1554144 ◽

2015 ◽

Vol 5 (1_suppl) ◽

pp. s-0035-1554144-s-0035-1554144

Author(s):

Andras Bank ◽

Balazs Szollosi ◽

Peter Varga

Keyword(s):

Surgical Treatment ◽

Cervical Disc ◽

Cervical Disc Disease ◽

Disc Disease ◽

Motion Preservation ◽

Degenerative Cervical Disc Disease

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Long-Term Follow-Up Radiologic and Clinical Evaluation of Cylindrical Cage for Anterior Interbody Fusion in Degenerative Cervical Disc Disease

Journal of Korean Neurosurgical Society ◽

10.3340/jkns.2012.52.2.107 ◽

2012 ◽

Vol 52 (2) ◽

pp. 107 ◽

Cited By ~ 2

Author(s):

Suhyeong Kim ◽

Hyoung-Joon Chun ◽

Hyeon-Joong Yi ◽

Koang Hum Bak ◽

Dong Won Kim ◽

...

Keyword(s):

Clinical Evaluation ◽

Interbody Fusion ◽

Cervical Disc ◽

Cervical Disc Disease ◽

Disc Disease ◽

Degenerative Cervical Disc Disease ◽

Anterior Interbody Fusion ◽

Long Term Follow Up

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Adjacent-level arthroplasty following cervical fusion

Neurosurgical FOCUS ◽

10.3171/2016.11.focus16412 ◽

2017 ◽

Vol 42 (2) ◽

pp. E5 ◽

Cited By ~ 7

Author(s):

Deshpande V. Rajakumar ◽

Akshay Hari ◽

Murali Krishna ◽

Subhas Konar ◽

Ankit Sharma

Keyword(s):

Cobb Angle ◽

Anterior Cervical Discectomy ◽

Cervical Disc ◽

Cervical Fusion ◽

Adjacent Level ◽

Cervical Disc Disease ◽

Disc Disease ◽

Cervical Arthroplasty ◽

Arm Pain

OBJECTIVE Adjacent-level disc degeneration following cervical fusion has been well reported. This condition poses a major treatment dilemma when it becomes symptomatic. The potential application of cervical arthroplasty to preserve motion in the affected segment is not well documented, with few studies in the literature. The authors present their initial experience of analyzing clinical and radiological results in such patients who were treated with arthroplasty for new or persistent arm and/or neck symptoms related to neural compression due to adjacent-segment disease after anterior cervical discectomy and fusion (ACDF). METHODS During a 5-year period, 11 patients who had undergone ACDF anterior cervical discectomy and fusion (ACDF) and subsequently developed recurrent neck or arm pain related to adjacent-level cervical disc disease were treated with cervical arthroplasty at the authors' institution. A total of 15 devices were implanted (range of treated levels per patient: 1–3). Clinical evaluation was performed both before and after surgery, using a visual analog scale (VAS) for pain and the Neck Disability Index (NDI). Radiological outcomes were analyzed using pre- and postoperative flexion/extension lateral radiographs measuring Cobb angle (overall C2–7 sagittal alignment), functional spinal unit (FSU) angle, and range of motion (ROM). RESULTS There were no major perioperative complications or device-related failures. Statistically significant results, obtained in all cases, were reflected by an improvement in VAS scores for neck/arm pain and NDI scores for neck pain. Radiologically, statistically significant increases in the overall lordosis (as measured by Cobb angle) and ROM at the treated disc level were observed. Three patients were lost to follow-up within the first year after arthroplasty. In the remaining 8 cases, the duration of follow-up ranged from 1 to 3 years. None of these 8 patients required surgery for the same vertebral level during the follow-up period. CONCLUSIONS Artificial cervical disc replacement in patients who have previously undergone cervical fusion surgery appears to be safe, with encouraging early clinical results based on this small case series, but more data from larger numbers of patients with long-term follow-up are needed. Arthroplasty may provide an additional tool for the management of post-fusion adjacent-level cervical disc disease in carefully selected patients.

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