scholarly journals Operative Techniques for Cervical Radiculopathy and Myelopathy

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
C. Moran ◽  
C. Bolger
Keyword(s):  
Cervical Spine ◽  
Cervical Spondylosis ◽  
Cervical Radiculopathy ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Past Century ◽  
Operative Techniques ◽  
Disc Arthroplasty ◽  
The Past ◽  
Surgical Options

The surgical treatment of cervical spondylosis and resulting cervical radiculopathy or myelopathy has evolved over the past century. Surgical options for dorsal decompression of the cervical spine includes the traditional laminectomy and laminoplasty, first described in Asia in the 1970's. More recently the dorsal approch has been explored in terms of minimally invasive options including foraminotomies for nerve root descompression. Ventral decompression and fusion techniques are also described in the article, including traditional anterior cervical discectomy and fusion, strut grafting and cervical disc arthroplasty. Overall, the outcome from surgery is determined by choosing the correct surgery for the correct patient and pathology and this is what we hope to explain in this brief review.

scholarly journals The Option of Motion Preservation in Cervical Spondylosis: Cervical Disc Arthroplasty Update

Neurospine ◽  
2018 ◽  
Vol 15 (4) ◽  
pp. 296-305 ◽  
Author(s):  
Chih-Chang Chang ◽  
Wen-Cheng Huang ◽  
Jau-Ching Wu ◽  
Praveen V. Mummaneni
Keyword(s):  
Cervical Spondylosis ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Disc Arthroplasty ◽  
Motion Preservation

scholarly journals Differences between C3–4 and other subaxial levels of cervical disc arthroplasty: more heterotopic ossification at the 5-year follow-up

2016 ◽  
Vol 24 (5) ◽  
pp. 752-759 ◽  
Author(s):  
Peng-Yuan Chang ◽  
Hsuan-Kan Chang ◽  
Jau-Ching Wu ◽  
Wen-Cheng Huang ◽  
Li-Yu Fay ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Heterotopic Ossification ◽  
Clinical Outcomes ◽  
Large Scale ◽  
Japanese Orthopaedic Association ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Disc Arthroplasty ◽  
Arm Pain

OBJECTIVE Several large-scale clinical trials demonstrate the efficacy of 1- and 2-level cervical disc arthroplasty (CDA) for degenerative disc disease (DDD) in the subaxial cervical spine, while other studies reveal that during physiological neck flexion, the C4–5 and C5–6 discs account for more motion than the C3–4 level, causing more DDD. This study aimed to compare the results of CDA at different levels. METHODS After a review of the medical records, 94 consecutive patients who underwent single-level CDA were divided into the C3–4 and non-C3–4 CDA groups (i.e., those including C4–5, C5–6, and C6–7). Clinical outcomes were measured using the visual analog scale for neck and arm pain and by the Japanese Orthopaedic Association scores. Postoperative range of motion (ROM) and heterotopic ossification (HO) were determined by radiography and CT, respectively. RESULTS Eighty-eight patients (93.6%; mean age 45.62 ± 10.91 years), including 41 (46.6%) female patients, underwent a mean follow-up of 4.90 ± 1.13 years. There were 11 patients in the C3–4 CDA group and 77 in the non-C3–4 CDA group. Both groups had significantly improved clinical outcomes at each time point after the surgery. The mean preoperative (7.75° vs 7.03°; p = 0.58) and postoperative (8.18° vs 8.45°; p = 0.59) ROMs were similar in both groups. The C3–4 CDA group had significantly greater prevalence (90.9% vs 58.44%; p = 0.02) and higher severity grades (2.27 ± 0.3 vs 0.97 ± 0.99; p = 0.0001) of HO. CONCLUSIONS Although CDA at C3–4 was infrequent, the improved clinical outcomes of CDA were similar at C3–4 to that in the other subaxial levels of the cervical spine at the approximately 5-year follow-ups. In this Asian population, who had a propensity to have ossification of the posterior longitudinal ligament, there was more HO formation in patients who received CDA at the C3–4 level than in other subaxial levels of the cervical spine. While the type of artificial discs could have confounded the issue, future studies with more patients are required to corroborate the phenomenon.

Cervical disc arthroplasty for less-mobile discs

2019 ◽  
Vol 31 (3) ◽  
pp. 310-316 ◽  
Author(s):  
Tsung-Hsi Tu ◽  
Chu-Yi Lee ◽  
Chao-Hung Kuo ◽  
Jau-Ching Wu ◽  
Hsuan-Kan Chang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Cervical Radiculopathy ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Segmental Mobility ◽  
Disc Arthroplasty ◽  
Flexion Extension ◽  
Index Level

OBJECTIVEThe published clinical trials of cervical disc arthroplasty (CDA) have unanimously demonstrated the success of preservation of motion (average 7°–9°) at the index level for up to 10 years postoperatively. The inclusion criteria in these trials usually required patients to have evident mobility at the level to be treated (≥ 2° on lateral flexion-extension radiographs) prior to the surgery. Although the mean range of motion (ROM) remained similar after CDA, it was unclear in these trials if patients with less preoperative ROM would have different outcomes than patients with more ROM.METHODSA series of consecutive patients who underwent CDA at the level of C5–6 were followed up and retrospectively reviewed. The indications for surgery were medically refractory cervical radiculopathy, myelopathy, or both, caused by cervical disc herniation or spondylosis. All patients were assigned to 1 of 2 groups: a less-mobile group, which consisted of those patients who had an ROM of ≤ 5° at C5–6 preoperatively, or a more-mobile group, which consisted of patients whose ROM at C5–6 was > 5° preoperatively. Clinical outcomes, including visual analog scale, Neck Disability Index, and Japanese Orthopaedic Association Scale scores, were evaluated at each time point. Radiological outcomes were also assessed.RESULTSA total of 60 patients who had follow-up for more than 2 years were analyzed. There were 27 patients in the less-mobile group (mean preoperative ROM 3.0°) and 33 in the more-mobile group (mean ROM 11.7°). The 2 groups were similar in demographics, including age, sex, diabetes, and cigarette smoking. Both groups had significant improvements in clinical outcomes, with no significant differences between the 2 groups. However, the radiological evaluations demonstrated remarkable differences. The less-mobile group had a greater increase in ΔROM than the more-mobile group (ΔROM 5.5° vs 0.1°, p = 0.001), though the less-mobile group still had less segmental mobility (ROM 8.5° vs 11.7°, p = 0.04). The rates of complications were similar in both groups.CONCLUSIONSPreoperative segmental mobility did not alter the clinical outcomes of CDA. The preoperatively less-mobile (ROM ≤ 5°) discs had similar clinical improvements and greater increase of segmental mobility (ΔROM), but remained less mobile, than the preoperatively more-mobile (ROM > 5°) discs at 2 years postoperatively.

scholarly journals Cervical Total Disc Arthroplasty

2012 ◽  
Vol 2 (2) ◽  
pp. 105-108 ◽  
Author(s):  
Rahul Basho ◽  
Kenneth A. Hood
Keyword(s):  
Cervical Spine ◽  
Surgical Techniques ◽  
Adjacent Segment Degeneration ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Adjacent Segment ◽  
Disc Arthroplasty ◽  
Definitive Answer ◽  
Investigational Device Exemption ◽  
Early Results

Symptomatic adjacent segment degeneration of the cervical spine remains problematic for patients and surgeons alike. Despite advances in surgical techniques and instrumentation, the solution remains elusive. Spurred by the success of total joint arthroplasty in hips and knees, surgeons and industry have turned to motion preservation devices in the cervical spine. By preserving motion at the diseased level, the hope is that adjacent segment degeneration can be prevented. Multiple cervical disc arthroplasty devices have come onto the market and completed Food and Drug Administration Investigational Device Exemption trials. Though some of the early results demonstrate equivalency of arthroplasty to fusion, compelling evidence of benefits in terms of symptomatic adjacent segment degeneration are lacking. In addition, non-industry-sponsored studies indicate that these devices are equivalent to fusion in terms of adjacent segment degeneration. Longer-term studies will eventually provide the definitive answer.

Sign in / Sign up

Export Citation Format

Share Document