Front-Back Cervical Deformity Correction by Anterior Cervical Discectomy and Fusion With Posterior Instrumentation: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Ethan S Srinivasan ◽  
Isaac O Karikari ◽  
Theresa Williamson ◽  
Christopher I Shaffrey ◽  
Khoi D Than
Keyword(s):  
Neck Pain ◽  
Posterior Instrumentation ◽  
Deformity Correction ◽  
Anterior Cervical Discectomy ◽  
Cervical Kyphosis ◽  
Instrumented Fusion ◽  
Cervical Discectomy ◽  
Cervical Deformity ◽  
Posterior Element ◽  
Vertebral Bodies

Abstract Front-back procedures for cervical deformity permit the correction of cervical kyphosis in the setting of unfused facets. Here, we highlight the operative treatment of a 65-yr-old female entailing a 4-level anterior cervical discectomy and fusion (ACDF) at C3-C4, C4-C5, C5-C6, and C6-C7 with hyperlordotic interbody implants, supplemented by a posterior C2-T2 instrumented fusion. The patient initially presented with symptoms of treatment-refractory neck pain while neurologically intact on examination. Her imaging demonstrated significant cervical kyphosis measuring 46° as the Cobb angle between C2 and C7 without neural compression. The patient consented to the procedure and publication of their image. After 2 d of traction, the operation proceeded with the patient initially in a supine position with dissection medial to the sternocleidomastoid muscle down to the vertebral bodies. Discectomies were performed at each level followed by installation of the interbody implants. After closure of this access wound, the patient was turned to a prone position for the posterior element of the operation. The posterior bony elements were exposed and a C2-T2 instrumented fusion performed. Postoperative imaging demonstrated improvement of her sagittal cervical curvature and the patient described improvement in her neck pain.

Nonunion Rates After Anterior Cervical Discectomy and Fusion: Comparison of Polyetheretherketone vs Structural Allograft Implants

Neurosurgery ◽  
2021 ◽  
Author(s):  
Won Hyung A Ryu ◽  
Dominick Richards ◽  
Mena G Kerolus ◽  
Adewale A Bakare ◽  
Ryan Khanna ◽  
...  
Keyword(s):  
Smoking Status ◽  
Posterior Instrumentation ◽  
Patient Reported Outcome ◽  
Anterior Cervical Discectomy ◽  
Successful Outcome ◽  
Cervical Discectomy ◽  
Structural Allograft ◽  
Modifiable Factors ◽  
Patient Reported ◽  
The Impact

Abstract BACKGROUND Although advances in implant materials, such as polyetheretherketone (PEEK), have been developed aimed to improve outcome after anterior cervical discectomy and fusion (ACDF), it is essential to confirm whether these changes translate into clinically important sustained benefits. OBJECTIVE To compare the radiographic and clinical outcomes of patients undergoing up to 3-level ACDF with PEEK vs structural allograft implants. METHODS In this cohort study, radiographic and symptomatic nonunion rates were compared in consecutive patients who underwent 1 to 3 level ACDF with allograft or PEEK implant. Prospectively collected clinical data and patient-reported outcome (PRO) scores were compared between the allograft and PEEK groups. Regression analysis was performed to determine the predictors of nonunion. RESULTS In total, 194 of 404 patients met the inclusion criteria (79% allograft vs 21% PEEK). Preoperative demographic variables were comparable between the 2 groups except for age. The rate of radiographic nonunion was higher with PEEK implants (39% vs 27%, P = .0035). However, a higher proportion of nonunion in the allograft cohort required posterior instrumentation (14% vs 3%, P = .039). Patients with multilevel procedures and PEEK implants had up to 5.8 times the risk of radiographic nonunion, whereas younger patients, active smokers, and multilevel procedures were at higher risk of symptomatic nonunion. CONCLUSION Along with implant material, factors such as younger age, active smoking status, and the number of operated levels were independent predictors of fusion failure. Given the impact of nonunion on PRO, perioperative optimization of modifiable factors and surgical planning are essential to ensure a successful outcome.

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.

P123. Clinically important difference in neck pain and disability with cervical plating for anterior cervical discectomy and fusion

2021 ◽  
Vol 21 (9) ◽  
pp. S200-S201
Author(s):  
Cara Geoghegan ◽  
Elliot Cha ◽  
Conor Lynch ◽  
Caroline Jadczak ◽  
Shruthi Mohan ◽  
...  
Keyword(s):  
Neck Pain ◽  
Anterior Cervical Discectomy ◽  
Cervical Discectomy ◽  
Clinically Important Difference ◽  
Cervical Plating

scholarly journals Cervical radiographic parameters in 1- and 2-level anterior cervical discectomy and fusion

2016 ◽  
Vol 25 (4) ◽  
pp. 421-429 ◽  
Author(s):  
Christopher C. Gillis ◽  
Megan C. Kaszuba ◽  
Vincent C. Traynelis
Keyword(s):  
Significant Positive Correlation ◽  
Disc Height ◽  
Anterior Cervical Discectomy ◽  
Cervical Lordosis ◽  
Cervical Discectomy ◽  
Positive Correlation ◽  
Cervical Deformity ◽  
Radiographic Parameters ◽  
Sagittal Parameters ◽  
Segmental Lordosis

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 the study population, the improvement of focal lordosis was significantly correlated with an improvement in overall lordosis (C1–7 and C2–7), and overall lordosis as measured by the C2–7 Cobb angle was significantly negatively correlated with cervical SVA. Using lordotic cervical allografts, we successfully created and maintained significant improvement in cervical segmental lordosis at the 6-week and 1-year time points with values of 6.31° and 6.45°, respectively. ACDF is able to achieve statistically significant improvement in C2–7 cervical lordosis by the 1-year followup, with a mean improvement of 3.46°. Increasing the number of levels operated on resulted in improved cervical sagittal parameters. This establishes a baseline for further examination into the ability of multilevel ACDF to achieve cervical deformity correction through the intervertebral correction of lordosis.

scholarly journals Vertebral Distraction during Anterior Cervical Discectomy and Fusion Causes Postoperative Neck Pain

2013 ◽  
Vol 53 (5) ◽  
pp. 288 ◽  
Author(s):  
Seung Man Ha ◽  
Jeong Hoon Kim ◽  
Seung Hun Oh ◽  
Ji Hwan Song ◽  
Hyoung Ihl Kim ◽  
...  
Keyword(s):  
Neck Pain ◽  
Anterior Cervical Discectomy ◽  
Cervical Discectomy

scholarly journals Long-Term Results of Multiple Anterior Cervical Discectomy with Cage Fusion Technique: Results of Multiple Centre Study

2019 ◽  
Vol 7 (17) ◽  
pp. 2824-2828 ◽  
Author(s):  
Hamdi Mostafa ◽  
Mohsen Lotfi ◽  
M. Wahid
Keyword(s):  
Neck Pain ◽  
Anterior Cervical Discectomy ◽  
Long Term Results ◽  
Cervical Disc ◽  
Fusion Technique ◽  
Cervical Discectomy ◽  
Cage Subsidence ◽  
Long Term Follow Up

BACKGROUND: Cervical herniation is commonly treated by anterior cervical discectomy and fusion (ACDF) if conservative management has failed in relief of the patient's symptoms. Disc fusion is needed after ACDF as anterior longitudinal ligament will be absent after doing the operation, especially if multiple levels are needed. The occurrence of complications as cage subsidence and adjacent segment failure related to the length of follow up as they are increasing in percentage is directly proportional to the length of follow up. AIM: Analysis of the results for patients who underwent 3 levels of ACDF with cage fusion for short term and long term follow up in multiple centres as the visual analogue score for neck pain & brachialgia. METHODS: This retrospective cohort series of 68 patients selected out of 136 patients suffering from 3 levels of degenerative cervical disc disease who were unresponsive to adequate conservative therapy. All cases were treated at one of the neurosurgery departments of 3 different hospitals (Naser institute for research and treatment hospital, Haram hospital for research and treatment and Misr university for science and technology) by the same surgical team in the period from February 2012 to February 2017. RESULTS: We found in this study;68 patients fulfilling the inclusion criteria, of the 29 patients underwent 3 levels of ACDF starting from C3-4 (42.65%) and 39 patients who underwent 3 levels of ACDF starting from C4-5 (57.35%). Clinical assessment for VAS pain score for both neck pain and radiculopathy were done before the surgery and immediately post-operative and during each time follow up visit and we found statistically significant immediate postoperative improvement. (P ˂ 0.05) CONCLUSION: Stand-alone three levels of an anterior cervical discectomy with cage fusion technique improved the clinical outcomes on long term follow up.

4:2097. Relationship between plate position and neck pain following instrumented anterior cervical discectomy and fusion

2005 ◽  
Vol 5 (4) ◽  
pp. S51
Author(s):  
Brian Ipsen ◽  
David Kim ◽  
Brian Kwon ◽  
Louis Jenis ◽  
Jesse Affonso ◽  
...  
Keyword(s):  
Neck Pain ◽  
Anterior Cervical Discectomy ◽  
Cervical Discectomy
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