Anterior Cervical Discectomy With Fusion and Plating for Correction of Degenerative Cervical Kyphosis: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Jeremy M V Guinn ◽  
Brenton Pennicooke ◽  
Joshua Rivera ◽  
Praveen V Mummaneni ◽  
Dean Chou
Keyword(s):  
Spinal Cord ◽  
Informed Consent ◽  
Bone Density ◽  
Surgical Intervention ◽  
Anterior Cervical Discectomy ◽  
Cervical Kyphosis ◽  
Nerve Roots ◽  
Cervical Discectomy ◽  
Cervical Plate ◽  
Sequential Induction

Abstract This surgical video demonstrates the technique for correcting degenerative cervical kyphosis using an anterior cervical discectomy and fusion (ACDF). Degenerative cervical kyphosis can cause radiculopathy, myelopathy, and difficulty holding up one's head. The goal of surgical intervention is to alleviate pain, improve the ability for upright gaze, and decompress the spinal cord or nerve roots. Posterior-only approaches and anterior corpectomies are alternative treatments to address cervical kyphosis. However, an ACDF allows for sequential induction of lordosis via distraction over multiple segments and for further lordosis induction by sequential screw tightening, pulling the spine towards a lordotic cervical plate.1 This video shows 2 cases demonstrating a technique of correcting severe cervical degenerative kyphosis. The video illustrates our initial kyphotic Caspar pin placement coupled with sequential anterior distraction to correct kyphosis. The technique is most useful in patients who have good bone density, nonankylosed facets, and degenerative cervical kyphosis. We have received informed consent of this patient to submit this video.

scholarly journals Magnetic resonance imaging artifact following anterior cervical discectomy and fusion with a trabecular metal cage

2016 ◽  
Vol 24 (3) ◽  
pp. 496-501 ◽  
Author(s):  
Cameron A. Elliott ◽  
Richard Fox ◽  
Robert Ashforth ◽  
Sita Gourishankar ◽  
Andrew Nataraj
Keyword(s):  
Spinal Cord ◽  
Bone Graft ◽  
Nerve Root ◽  
Plate Fixation ◽  
Anterior Cervical Discectomy ◽  
Nerve Root Compression ◽  
Anterior Plate ◽  
Nerve Roots ◽  
Minimal Impact ◽  
Cervical Discectomy

OBJECT 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. METHODS 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. RESULTS 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% (52/96) of cases (p < 0.01). The presence of anterior plate fixation had minimal impact on visualization of the spinal cord (99% [213/216] for plated cases vs 98% [159/162] for nonplated cases; p = 1.0) or nerve roots (79% [170/216] for plated cases vs 77% [124/162] for nonplated cases; p = 0.62). CONCLUSIONS Interbody fusion with tantalum cage following anterior cervical discectomy imparts significant paramagnetic artifact, which significantly decreases visualization and assessment of ongoing surgical level nerve root, but not spinal cord, compression. Anterior plate constructs do not affect visualization of these structures. TSE T2-weighted sequences significantly improve nerve root visualization and should be performed as part of a standard postoperative protocol when imaging the cervical spine following interbody implantation of materials with potential for paramagnetic artifact.

Does smoking have an impact on fusion rate in single-level anterior cervical discectomy and fusion with allograft and rigid plate fixation?

2013 ◽  
Vol 19 (5) ◽  
pp. 527-531 ◽  
Author(s):  
Myles Luszczyk ◽  
Justin S. Smith ◽  
Jeffrey S. Fischgrund ◽  
Steven C. Ludwig ◽  
Rick C. Sasso ◽  
...  
Keyword(s):  
Plate Fixation ◽  
Fusion Rate ◽  
Anterior Cervical Discectomy ◽  
Cervical Disc ◽  
Cervical Discectomy ◽  
Single Level ◽  
Significant Difference ◽  
Solid Fusion ◽  
Cervical Plate ◽  
Anterior Cervical Plate

Object Although smoking has been shown to negatively affect fusion rates in patients undergoing multilevel fusions of the cervical and lumbar spine, the effect of smoking on fusion rates in patients undergoing single-level anterior cervical discectomy and fusion (ACDF) with allograft and plate fixation has yet to be thoroughly investigated. The objective of the present study was to address the effect of smoking on fusion rates in patients undergoing a 1-level ACDF with allograft and a locked anterior cervical plate. Methods This study is composed of patients from the control groups of 5 separate studies evaluating the use of an anterior cervical disc replacement to treat cervical radiculopathy. For each of the 5 studies the control group consisted of patients who underwent a 1-level ACDF with allograft and a locked cervical plate. The authors of the present study reviewed data obtained in a total of 573 patients; 156 patients were smokers and 417 were nonsmokers. A minimum follow-up period of 24 months was required for inclusion in this study. Fusion status was assessed by independent observers using lateral, neutral, and flexion/extension radiographs. Results An overall fusion rate of 91.4% was achieved in all 573 patients. A solid fusion was shown in 382 patients (91.6%) who were nonsmokers. Among patients who were smokers, 142 (91.0%) had radiographic evidence of a solid fusion. A 2-tailed Fisher exact test revealed a p value of 0.867, indicating no difference in the union rates between smokers and nonsmokers. Conclusions The authors found no statistically significant difference in fusion status between smokers and nonsmokers who underwent a single-level ACDF with allograft and a locked anterior cervical plate. Although the authors do not promote tobacco use, it appears that the use of allograft with a locked cervical plate in single-level ACDF among smokers produces similar fusion rates as it does in their nonsmoking counterparts.

scholarly journals Anterior Cervical Discectomy and Fusion (ACDF): Comparison Between Zero Profile Implants and Anterior Cervical Plate and Spacer

Cureus ◽  
2016 ◽  
Author(s):  
Marjan Alimi ◽  
Innocent Njoku ◽  
Christoph P Hofstetter ◽  
Apostolos J Tsiouris ◽  
Kartik Kesavabhotla ◽  
...  
Keyword(s):  
Anterior Cervical Discectomy ◽  
Cervical Discectomy ◽  
Cervical Plate ◽  
Anterior Cervical Plate

scholarly journals The influence of cervical plate fixation with either autologous bone or cage insertion on radiographic and patient-rated outcomes after two-level anterior cervical discectomy and fusion

2014 ◽  
Vol 24 (1) ◽  
pp. 113-119 ◽  
Author(s):  
Jan-Karl Burkhardt ◽  
Anne F. Mannion ◽  
Serge Marbacher ◽  
Frank S. Kleinstück ◽  
Dezsö Jeszenszky ◽  
...  
Keyword(s):  
Plate Fixation ◽  
Anterior Cervical Discectomy ◽  
Cervical Discectomy ◽  
Autologous Bone ◽  
Cervical Plate

scholarly journals Cervical Cord Compression With Lower Limbs Sensory Disturbance Presentation: Three Case Reports and Literature Review

2021 ◽  
Author(s):  
Yafei Cao ◽  
Yihong Wu ◽  
Weiji Yu ◽  
Weidong Liu ◽  
Shufen Sun ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Lower Limb ◽  
Cord Compression ◽  
Lower Limbs ◽  
Anterior Cervical Discectomy ◽  
Cervical Cord ◽  
Sensory Disturbance ◽  
Cervical Discectomy ◽  
Sensory Disturbances

Abstract Background: Lower limb sensory disturbance presentation can be a false localizing cervical cord compressive myelopathy (CSM). It may lead to delayed or missed diagnosis, resulting in the wrong management plan, especially in the presence of concurrent lumbar lesions.Case presentation:Three Asian patients with lower limb sensory disturbances presentation were treated ineffectively in the lumbar. Magnetic resonance imaging (MRI) showed cervical disc herniation and cervical level spinal cord compression. Anterior cervical discectomy surgery and zero-p interbody fusion were performed. After operations, imagings showed that the spinal cord compression were relieved, and the lower limbs sensory disturbances were also relieved. Three-months follow-up after operation showed good recovery.Conclusions:These three cervical cord compression cases of lower limb sensory disturbance presentation were easily misdiagnosed with lumbar spondylosis. Anterior cervical discectomy and fusion operation had a good therapeutic effect. Therefore, cases that present with lower limb sensory disturbance, but in a non-radicular classical pattern, should always alert a suspicion of a possible cord compression cause at a higher level.

P24. Prospective multicenter anterior cervical discectomy and fusion outcome study utilizing a new semi-constrained cervical plate

2005 ◽  
Vol 5 (4) ◽  
pp. S121
Author(s):  
John Finkenberg ◽  
Scot Miller ◽  
Stephen Montgomery ◽  
Philip Orisek ◽  
Anh Le ◽  
...  
Keyword(s):  
Anterior Cervical Discectomy ◽  
Outcome Study ◽  
Cervical Discectomy ◽  
Cervical Plate

High cervical arteriovenous fistulas fed by dural and spinal arteries and draining into a single medullary vein

2014 ◽  
Vol 20 (3) ◽  
pp. 256-264 ◽  
Author(s):  
Kiyoshi Onda ◽  
Yuichi Yoshida ◽  
Kounosuke Watanabe ◽  
Hiroyuki Arai ◽  
Hideo Okada ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Intervention ◽  
Digital Subtraction ◽  
Spinal Root ◽  
Nerve Roots ◽  
Arteriovenous Fistulas ◽  
Posterior Spinal Arteries ◽  
Operative Findings ◽  
High Cervical

Object The authors previously reported a case of complex arteriovenous fistula (AVF) at C-1 with multiple dural and spinal feeders that were linked with a common medullary venous channel. The purpose of the present study was to collect similar cases and analyze their angioarchitecture to gain a better understanding of this malformation. Methods Three such cases, affecting 2 males and 1 female in their 60s who had presented with hematomyelia (2) or progressive myelopathy (1), were treated surgically, and the operative findings from all 3 cases were compared using digital subtraction angiography (DSA) to determine the angioarchitecture. Results The C-1 and C-2 radicular arteries and anterior and posterior spinal arteries supplied feeders to a single medullary draining vein in various combinations and via various routes. The drainage veins ran along the affected ventral nerve roots and lay ventral to the spinal cord. The sites of shunting to the vein were multiple: dural, along the ventral nerve root in the subarachnoid space, and on the spinal cord, showing a vascular structure typical of dural AVF, that is, a direct arteriovenous shunt near the spinal root sleeve fed by one or more dural arteries and ending in a single draining vein, except for intradural shunts fed by feeders from the spinal arteries. In 2 cases with hemorrhagic onset the drainer flowed rostrally, and in 1 case associated with congestive myelopathy the drainer flowed both rostrally and caudally. Preoperative determination of the shunt sites and feeding arteries was difficult because of complex recruitment of the feeders and multiple shunt sites. The angioarchitecture in these cases was clarified postoperatively by meticulous comparison of the DSA images and operative video. Direct surgical intervention led to a favorable outcome in all 3 cases. Conclusions A high cervical complex AVF has unique angioarchitectural characteristics different from those seen in the other spinal regions.

Cervical juxtafacet cyst after anterior cervical discectomy and fusion

2011 ◽  
Vol 31 (4) ◽  
pp. E19 ◽  
Author(s):  
Walavan Sivakumar ◽  
J. Bradley Elder ◽  
Mark H. Bilsky
Keyword(s):  
Neck Pain ◽  
Surgical Intervention ◽  
Neurological Symptoms ◽  
Anterior Cervical Discectomy ◽  
Long Term Outcomes ◽  
Motor Weakness ◽  
Neurosurgical Procedure ◽  
Cervical Discectomy ◽  
Juxtafacet Cyst

Anterior cervical discectomy and fusion (ACDF) is a common neurosurgical procedure, and the benefits, long-term outcomes, and complications are well described in the literature. The development of a juxtafacet joint cyst resulting in radiculopathy is a rare outcome after ACDF and merits further description. The authors describe a patient in whom a juxtafacet joint cyst developed after ACDF procedures, resulting in surgical intervention. When a juxtafacet joint cyst develops after ACDF, symptoms can include radiculopathy, neck pain, and neurological symptoms such as paresthesias and motor weakness. The presence of a juxtafacet joint cyst implies instability in that region of the spine. Patients with this pathological entity may require decompression of neural elements and fusion across the segment involved with the cyst.

scholarly journals 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

2016 ◽  
Vol 24 (5) ◽  
pp. 734-745 ◽  
Author(s):  
Robert J. Jackson ◽  
Reginald J. Davis ◽  
Gregory A. Hoffman ◽  
Hyun W. Bae ◽  
Michael S. Hisey ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Degenerative Disc Disease ◽  
Surgical Intervention ◽  
Total Disc Replacement ◽  
Anterior Cervical Discectomy ◽  
Disc Replacement ◽  
Disc Disease ◽  
Cervical Total Disc Replacement ◽  
Cervical Discectomy ◽  
Surgery Rates

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)

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