3-Tesla Kinematic MRI of the Cervical Spine for Evaluation of Adjacent Level Disease After Monosegmental Anterior Cervical Discectomy and Arthroplasty

Spine ◽  
2017 ◽  
Vol 42 (4) ◽  
pp. 224-231
Author(s):  
Steffen K. Fleck ◽  
Soenke Langner ◽  
Christian Rosenstengel ◽  
Rebecca Kessler ◽  
Marc Matthes ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Anterior Cervical Discectomy ◽  
3 Tesla ◽  
Adjacent Level ◽  
Cervical Discectomy

scholarly journals Adjacent-Level Ossification Development in Single-Level Standalone Anterior Cervical Discectomy and Fusion Versus Anterior Cervical Discectomy and Fusion With Plate

2020 ◽  
pp. 219256822090274
Author(s):  
Christopher Huang ◽  
Ralph Mobbs ◽  
Michael Selby ◽  
Kevin Phan ◽  
Prashanth Rao
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Case Control Study ◽  
Case Control ◽  
Anterior Cervical Discectomy ◽  
Adjacent Level ◽  
Retrospective Case ◽  
Cervical Discectomy ◽  
Surgical Data ◽  
Control Study

Study Design: Retrospective case control study. Objectives: Adjacent-level ossification development (ALOD) is a distinct form of adjacent segmental degeneration that has been recognized to occur after anterior cervical discectomy and fusion (ACDF). It is unclear whether ACDF with plate versus standalone has an effect on rates of ALOD. This retrospective case-control study aims to assess the rate of ALOD in a large series of patients undergoing ACDF with and without plate and factors causing ALOD. Methods: Data was collected for patients undergoing ACDF from January 2009 to July 2016. Data collected was from multiple centers and included demographic data, surgical data, radiological imaging at time of surgery, and serial follow-up imaging. The radiology for ALOD was independently reviewed. Cohorts were divided into ACDF with plate (Group P = plate) and ACDF without plate (Groups S = standalone) and outcomes were compared. Results: There were 260 patients with 138 (53%) in Group P and 122 (47%) in Group S. ALOD was observed in 15.3% of patients overall, 29% in group P and 2.8% in group S ( P < .001). Following multivariate adjustment, statistically significant association was found between use of plate and ALOD (odds ratio = 12.8, 95% confidence interval = 3.52-45.45, P < .001). Plate-to-disc distance <5 mm was significantly associated with ALOD (odds ratio = 13.5, 95% confidence interval = 3.83-47.62, P < .001). Conclusion: The use of anterior plate with ACDF was associated with ALOD. Plate-to-disc distance <5 mm was significantly associated with ALOD even after adjustment for confounding factors. We conclude utilization of standalone cages or cages with plate with more than 5 mm distance from adjacent disc to minimize ALOD.

scholarly journals Late deep cervical infection after anterior cervical discectomy and fusion: a case report and literature review

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Ying-Chun Chen ◽  
Lin Zhang ◽  
Er-Nan Li ◽  
Li-Xiang Ding ◽  
Gen-Ai Zhang ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Esophageal Perforation ◽  
Radical Neck Dissection ◽  
Titanium Implant ◽  
Anterior Cervical Discectomy ◽  
Antibiotic Administration ◽  
Cervical Discectomy ◽  
Cervical Infection ◽  
Unstable Cervical Spine ◽  
Degenerative Cervical Spine

Abstract Background Anterior cervical discectomy and fusion (ACDF) is often performed for the treatment of degenerative cervical spine. While this procedure is highly successful, 0.1–1.6% of early and late postoperative infection have been reported although the rate of late infection is very low. Case presentation Here, we report a case of 59-year-old male patient who developed deep cervical abscess 30 days after anterior cervical discectomy and titanium cage bone graft fusion (autologous bone) at C3/4 and C4/5. The patient did not have esophageal perforation. The abscess was managed through radical neck dissection approach with repated washing and removal of the titanium implant. Staphylococcus aureus was positively cultured from the abscess drainage, for which appropriate antibiotics including cefoxitin, vancomycin, levofloxacin, and cefoperazone were administered postoperatively. In addition, an external Hallo frame was used to support unstable cervical spine. The patient’s deep cervical infection was healed 3 months after debridement and antibiotic administration. His cervial spine was stablized 11 months after the surgery with support of external Hallo Frame. Conclusions This case suggested that deep cervical infection should be considered if a patient had history of ACDF even in the absence of esophageal perforation.

scholarly journals Pseudarthrosis rate following anterior cervical discectomy with fusion using an allograft cellular bone matrix: a multi-institutional analysis

2021 ◽  
Vol 50 (6) ◽  
pp. E6
Author(s):  
Stephen M. Bergin ◽  
Timothy Y. Wang ◽  
Christine Park ◽  
Shashank Rajkumar ◽  
C. Rory Goodwin ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Bone Growth ◽  
Bone Matrix ◽  
Anterior Cervical Discectomy ◽  
Cervical Discectomy ◽  
Cervical Spine Surgery ◽  
Single Level ◽  
Flexion Extension ◽  
Index Level ◽  
Instrumentation Failure

OBJECTIVE The use of osteobiologics, engineered materials designed to promote bone healing by enhancing bone growth, is becoming increasingly common for spinal fusion procedures, but the efficacy of some of these products is unclear. The authors performed a retrospective, multi-institutional study to investigate the clinical and radiographic characteristics of patients undergoing single-level anterior cervical discectomy with fusion performed using the osteobiologic agent Osteocel, an allograft mesenchymal stem cell matrix. METHODS The medical records across 3 medical centers and 12 spine surgeons were retrospectively queried for patients undergoing single-level anterior cervical discectomy and fusion (ACDF) with the use of Osteocel. Pseudarthrosis was determined based on CT or radiographic imaging of the cervical spine. Patients were determined to have radiographic pseudarthrosis if they met any of the following criteria: 1) lack of bridging bone on CT obtained > 300 days postoperatively, 2) evidence of instrumentation failure, or 3) motion across the index level as seen on flexion-extension cervical spine radiographs. Univariate and multivariate analyses were then performed to identify independent preoperative or perioperative predictors of pseudarthrosis in this population. RESULTS A total of 326 patients met the inclusion criteria; 43 (13.2%) patients met criteria for pseudarthrosis, of whom 15 (34.9%) underwent revision surgery. There were no significant differences between patients with and those without pseudarthrosis, respectively, for patient age (54.1 vs 53.8 years), sex (34.9% vs 47.4% male), race, prior cervical spine surgery (37.2% vs 33.6%), tobacco abuse (16.3% vs 14.5%), chronic kidney disease (2.3% vs 2.8%), and diabetes (18.6% vs 14.5%) (p > 0.05). Presence of osteopenia or osteoporosis (16.3% vs 3.5%) was associated with pseudarthrosis (p < 0.001). Implant type was also significantly associated with pseudarthrosis, with a 16.4% rate of pseudarthrosis for patients with polyetherethereketone (PEEK) implants versus 8.4% for patients with allograft implants (p = 0.04). Average lengths of follow-up were 27.6 and 23.8 months for patients with and those without pseudarthrosis, respectively. Multivariate analysis demonstrated osteopenia or osteoporosis (OR 4.97, 95% CI 1.51–16.4, p < 0.01) and usage of PEEK implant (OR 2.24, 95% CI 1.04–4.83, p = 0.04) as independent predictors of pseudarthrosis. CONCLUSIONS In patients who underwent single-level ACDF, rates of pseudarthrosis associated with the use of the osteobiologic agent Osteocel are higher than the literature-reported rates associated with the use of alternative osteobiologics. This is especially true when Osteocel is combined with a PEEK implant.

scholarly journals Outcome Study of Anterior Cervical Discectomy and Fusion with Lordotic Cage Insertion

2021 ◽  
Author(s):  
Nattawut Niljianskul
Keyword(s):  
Cervical Spine ◽  
Cobb Angle ◽  
Japanese Orthopaedic Association ◽  
Intervertebral Disk ◽  
Anterior Cervical Discectomy ◽  
P Value ◽  
Sagittal Vertical Axis ◽  
Cervical Discectomy ◽  
Radiographic Outcomes ◽  
Disk Height

Objective: This study retrospectively evaluated the clinical and radiographic outcomes following the use of a lordotic cage in anterior cervical discectomy and fusion (ACDF).Material and Methods: All patients who underwent ACDF, at Vajira Hospital; between May 2017 and May 2020, were included in this study. Radiographic images were used to evaluate the device-level Cobb angle (DLCA), segmental Cobb angle (SCA), global Cobb angle (GCA), sagittal vertical axis (SVA), sagittal alignment (SA), and intervertebral disk height. The visual analog scale (VAS) for neck pain, and the Japanese Orthopaedic Association (JOA) score were reviewed as part of the patient’s medical records. Preoperative DLCA, SCA, GCA, SVA, SA, and intervertebral disk height measurements were compared with postoperative measurements at 1 year.Results: A total of 51 patients (88 disks), having undergone ACDF with lordotic cage insertion were included in this study. The initial curvature of the cervical spine was diagnosed as kyphosis in 30 (58.8%) patients, and as lordosis in 21 (41.2%) patients. There was significant improvement in the VAS, JOA, DLCA, SCA, GCA, SVA, SA, and intervertebral disk height after ACDF (p-value<0.050). In patients with preoperative kyphosis, the greatest changes were observed in the GCA (p-value=0.004).Conclusion: The use of a lordotic cage in ACDF improved both the clinical and radiographic outcomes of all postoperative parameters, regardless of the patient’s preoperative cervical spine curvature; although, patients with preoperative kyphosis had greater improvement in GCA.

scholarly journals Evaluation of clinical profile, radiological and functional outcome following anterior cervical discectomy and fusion for cervical compressive myelopathy

2020 ◽  
Vol 7 (8) ◽  
pp. 2679
Author(s):  
Ranjit Kumar ◽  
Brijesh Kumar Tiwari ◽  
Sanjeev Kumar Pandey
Keyword(s):  
Cervical Spine ◽  
Blood Loss ◽  
Surgical Outcome ◽  
Postoperative Outcome ◽  
Anterior Cervical Discectomy ◽  
Cervical Disc ◽  
Cervical Cord ◽  
Cervical Discectomy ◽  
Cervical Compressive Myelopathy ◽  
Compressive Myelopathy

Background: Symptomatic cervical disc prolapse is best managed with anterior cervical discectomy with or without fusion. We studied the clinical, radiological and surgical profile with postoperative outcome of the patients undergoing anterior cervical discectomy and fusion (ACDF) for cervical compressive myelopathy at one level.Methods: In this retrospective study, data was collected from patients who underwent ACDF for cervical compressive myelopathy in our hospital between 2016 and 2019. Clinical, radiological profile with surgical outcome were studied.Results: A total of 283 patients were recruited. They could be followed up for a period of at least 6 months and so were recruited for the study. Out of these 283 patients (201 males; 82 females; mean age, 48.4 years, range, 22 years to 83 years), magnetic resonance imaging (MRI) cervical spine without contrast and x-ray cervical spine was available for all the patients. Nape of neck pain was the most common presenting symptom followed by tingling sensation in all four limbs and trunk. Average time taken for surgery was 2 hours 10 minutes with an average blood loss of 50 ml. Mean follow up duration was 2.7 years (range 6 months to 4 years).Conclusions: ACDF is the treatment of choice for the patients with clinical and radiological evidence of cervical cord compression. The techniques is associated with minimal blood loss and exceptionally good surgical outcome. Following discectomy, putting an autologous graft or titanium cage improves the spine stability and maintains the cervical lordosis.

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