Four-Level Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy

Purpose To review the outcome of 32 consecutive patients who underwent 4-level anterior cervical discectomy and fusion (ACDF) with cages and plates and were followed up for at least 5 years. Methods Records of 19 men and 13 women aged 48 to 69 years who underwent 4-level ACDF with cages and plates for myelopathy (n=11) or myeloradiculopathy (n=21) at C3 to C7 by a single surgeon and were followed up for a minimum of 5 years were reviewed. Clinical outcome was assessed using the visual analogue scale (VAS), Neck Disability Index (NDI), and modified Japanese Orthopaedic Association (JOA) score for pain or myelopathic symptoms. Radiographic evaluation included fusion rate, range of motion, cervical lordosis (C2-to-C7 Cobb angle), and disc height. Results The mean follow-up was 66 months. All patients had good recovery of muscle strength and resolution of limb sensory disturbance, except for 4 who still had some numbness. The mean VAS for neck and arm pain improved from 14.2 to 6.84 (p=0.012); the mean NDI improved from 31.62 to 12.17 (p<0.01); and the mean JOA score improved from 10.1 to 13.9 (p=0.027). The mean percentage of recovery was 62.9. The mean Cobb angle improved from 10.24° to 1.28° (p=0.019); the mean disc height improved from 4.12 to 6.58 mm (p<0.01). 30 (94%) patients achieved solid fusion. Conclusion Multilevel ACDF using PEEK cages and plates is safe and effective for multilevel cervical spondylotic myelopathy and achieves satisfactory mid-term outcome.

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Can segmental mobility be increased by cervical arthroplasty?

Neurosurgical FOCUS ◽

10.3171/2016.10.focus16411 ◽

2017 ◽

Vol 42 (2) ◽

pp. E3 ◽

Cited By ~ 24

Author(s):

Hsuan-Kan Chang ◽

Chih-Chang Chang ◽

Tsung-Hsi Tu ◽

Jau-Ching Wu ◽

Wen-Cheng Huang ◽

...

Keyword(s):

Cobb Angle ◽

Range Of Motion ◽

Clinical Outcomes ◽

Japanese Orthopaedic Association ◽

Neck Disability Index ◽

Cervical Disc ◽

Segmental Mobility ◽

Arm Pain ◽

The Mean ◽

The Difference

OBJECTIVE Many reports have successfully demonstrated that cervical disc arthroplasty (CDA) can preserve range of motion after 1- or 2-level discectomy. However, few studies have addressed the extent of changes in segmental mobility after CDA or their clinical correlations. METHODS Data from consecutive patients who underwent 1-level CDA were retrospectively reviewed. Indications for surgery were medically intractable degenerative disc disease and spondylosis. Clinical outcomes, including visual analog scale (VAS)–measured neck and arm pain, Neck Disability Index (NDI), and Japanese Orthopaedic Association (JOA) scores, were analyzed. Radiographic outcomes, including C2–7 Cobb angle, the difference between pre- and postoperative C2–7 Cobb angle (ΔC2–7 Cobb angle), sagittal vertical axis (SVA), the difference between pre- and postoperative SVA (ΔSVA), segmental range of motion (ROM), and the difference between pre- and postoperative ROM (ΔROM), were assessed for their association with clinical outcomes. All patients underwent CT scanning, by which the presence and severity of heterotopic ossification (HO) were determined during the follow-up. RESULTS A total of 50 patients (mean age 45.6 ± 9.33 years) underwent a 1-level CDA (Prestige LP disc) and were followed up for a mean duration of 27.7 ± 8.76 months. All clinical outcomes, including VAS, NDI, and JOA scores, improved significantly after surgery. Preoperative and postoperative ROM values were similar (mean 9.5° vs 9.0°, p > 0.05) at each indexed level. The mean changes in segmental mobility (ΔROM) were −0.5° ± 6.13°. Patients with increased segmental mobility after surgery (ΔROM > 0°) had a lower incidence of HO and HO that was less severe (p = 0.048) than those whose ΔROM was < 0°. Segmental mobility (ROM) was significantly lower in patients with higher HO grade (p = 0.012), but it did not affect the clinical outcomes. The preoperative and postoperative C2–7 Cobb angles and SVA remained similar. The postoperative C2–7 Cobb angles, SVA, ΔC2–7 Cobb angles, and ΔSVA were not correlated to clinical outcomes after CDA. CONCLUSIONS Segmental mobility (as reflected by the mean ROM) and overall cervical alignment (i.e., mean SVA and C2–7 Cobb angle) had no significant impact on clinical outcomes after 1-level CDA. Patients with increased segmental mobility (ΔROM > 0°) had significantly less HO and similarly improved clinical outcomes than those with decreased segmental mobility (ΔROM < 0°).

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Comparison of the ROI-C cage and Zero-P device used in anterior cervical discectomy and fusion: a minimum 2-year follow-up study

10.21203/rs.2.12368/v1 ◽

2019 ◽

Author(s):

Penghuan Wu ◽

Aidong Yuan ◽

Shaoxiong Min ◽

Benchao Shi ◽

Anmin Jin

Keyword(s):

Cobb Angle ◽

Standard Procedure ◽

Japanese Orthopaedic Association ◽

Neck Disability Index ◽

Operation Time ◽

Anterior Cervical Discectomy ◽

Comparable Efficacy ◽

Cervical Discectomy ◽

Cage Subsidence

Abstract Background: Anterior cervical discectomy and fusion (ACDF) has been considered the gold-standard procedure for treating symptomatic cervical spondylosis refractory to conservative management. The aim of this study was to compare the clinical efficacies of anterior cervical discectomy and fusion (ACDF) with Zero-P and ROI-C devices in the treatment of cervical degenerative disc disease (CDDD). Methods: Between July 2014 and December 2014, 56 patients underwent ACDF with Zero-P or ROI-C. Pre-, intra-, and postoperative clinical and radiographic outcomes were compared between groups. Results: The visual analogue scale (VAS) pain score, Japanese Orthopaedic Association (JOA) score, neck disability index (NDI) score, cervical range of motion (CROM) angle, C2-7 Cobb angle, and disc height index (DHI) exhibited significant postoperative improvements in both groups (P<0.05). The successful treatment rates in both groups were 76% (P>0.05). In the Zero-P group, the duration for surgeries involving C3-4 or C6-7 was longer than for other surgeries (135.0±19.0 vs. 105.6±17.5 min, P<0.05). The operative time for surgeries involving C3-4 or C6-7 was significantly shorter for ROI-C than for Zero-P (112.2±20.5 min, P<0.05). There were no significant differences in the dyspepsia or cage subsidence rates between the Zero-P and ROI-C groups (P>0.05). The last follow-up Cobb angle in the Zero-P group (24.4±4.5°) was significantly higher than that in the ROI-C group (18.1±2.3°) (P<0.05). Conclusion: ACDF with ROI-C showed comparable efficacy with the Zero-P device, with a shorter operation time for surgeries involving C3-4 or C6-7. However, ROI-C may cause more Cobb angle loss over time, which may lead to uncomfortable symptoms. Above all, the surgeon should take individual patient context and personal proficiency into consideration when choosing cage devices.

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Two-Year Clinical and Radiological Outcomes in Patients With Diabetes Undergoing Single-Level Anterior Cervical Discectomy and Fusion

Global Spine Journal ◽

10.1177/2192568220914880 ◽

2020 ◽

pp. 219256822091488

Author(s):

Paul M. Arnold ◽

Alexander R. Vaccaro ◽

Rick C. Sasso ◽

Benoit Goulet ◽

Michael G. Fehlings ◽

...

Keyword(s):

Short Form ◽

Secondary Analysis ◽

Neck Disability Index ◽

Cervical Radiculopathy ◽

Anterior Cervical Discectomy ◽

Disc Disease ◽

Cervical Discectomy ◽

Single Level ◽

Arm Pain ◽

Patients With Diabetes

Study Design: Secondary analysis of data from the multicenter, randomized, parallel-controlled Food and Drug Administration (FDA) investigational device exemption study. Objective: Studies on outcomes following anterior cervical discectomy and fusion (ACDF) in individuals with diabetes are scarce. We compared 24-month radiological and clinical outcomes in individuals with and without diabetes undergoing single-level ACDF with either i-FACTOR or local autologous bone. Methods: Between 2006 and 2013, 319 individuals with single-level degenerative disc disease (DDD) and no previous fusion at the index level underwent ACDF. The presence of diabetes determined the 2 cohorts. Data collected included radiological fusion evaluation, neurological outcomes, Neck Disability Index (NDI), Visual Analog Scale (VAS) scores, and the 36-Item Short Form Survey Version 2 (SF-36v2) Physical and Mental component summary scores. Results: There were 35 individuals with diabetes (11.1%; average body mass index [BMI] = 32.99 kg/m2; SD = 5.72) and 284 without (average BMI = 28.32 kg/m2; SD = 5.67). The number of nondiabetic smokers was significantly higher than diabetic smokers: 73 (25.70%) and 3 (8.57%), respectively. Preoperative scores of NDI, VAS arm pain, and SF-36v2 were similar between the diabetic and nondiabetic participants at baseline; however, VAS neck pain differed significantly between the cohorts at baseline ( P = .0089). Maximum improvement for NDI, VAS neck and arm pain, and SF-36v2 PCS and MCS scores was seen at 6 months in both cohorts and remained stable until 24 months. Conclusions: ACDF is effective for cervical radiculopathy in patients with diabetes. Diabetes is not a contraindication for patients requiring single-level surgery for cervical DDD.

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

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.2021808 ◽

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.

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Is it Safe and Effective to Treat Complex Cervical Spondylotic Myelopathy Using Piezosurgery in Anterior Cervical Discectomy and Fusion?

10.21203/rs.3.rs-134091/v1 ◽

2021 ◽

Author(s):

Yuwei Li ◽

Shixin Zhao ◽

Haijiao Wang ◽

Peng Zhou ◽

Wei Cui ◽

...

Keyword(s):

Blood Loss ◽

Surgical Complications ◽

Cervical Spondylotic Myelopathy ◽

Japanese Orthopaedic Association ◽

Anterior Cervical Discectomy ◽

Intraoperative Blood Loss ◽

Traditional Group ◽

Improvement Rate ◽

Cervical Discectomy ◽

Operative Duration

Abstract Objective To investigate the safety and efficacy of piezosurgery in anterior cervical discectomy and fusion (ACDF) for treating patients with cervical spondylotic myelopathy (CSM) coincident retrovertebral body osteophytes adjacent to the endplate or a free nucleus pulposus migrated to the vertebral body, posteriorly; known as complex cervical spondylotic myelopathy (cCSM) here.Methods Forty-seven patients with cCSM underwent ACDF surgery from 2014 to 2017. Among these patients, 26 underwent ACDF using piezosurgery (group A) and 21 underwent ACDF by traditional tools such as air drill, bone curet and gun-shaped bone forceps (group B). Average operative duration, intraoperative blood loss, surgical complications, preoperative and postoperative Japanese Orthopaedic Association (JOA) scores and improvement rate were measured.Results Average operative duration and intraoperative blood loss were signiﬁcantly lower in the piezosurgery group than those in the traditional group (P < 0.01). The incidences of surgical complications were 3.8% and 23.8% in the piezosurgery and traditional groups (P < 0.05), respectively. Whereas JOA scores and improvement rate were insigniﬁcantly diﬀerent at each data collection period (P > 0.05); preoperative, postoperative 3 days and postoperative 1 year follow-up were included.Conclusion For treating cCSM, both the piezosurgery and traditional tools led to signiﬁcant neurological improvement. However, the piezosurgery was superior to the traditional tools in terms of operative duration, blood loss, and complication rate. Hence, the piezosurgery was a safe and effective adjunct for ACDF treating cCSM.

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Use of the Solis cage and local autologous bone graft for anterior cervical discectomy and fusion: early technical experience

Journal of Neurosurgery Spine ◽

10.3171/spi.2005.2.2.0116 ◽

2005 ◽

Vol 2 (2) ◽

pp. 116-122 ◽

Cited By ~ 35

Author(s):

Amjad Shad ◽

John C. D. Leach ◽

Peter J. Teddy ◽

Tom A. D. Cadoux-Hudson

Keyword(s):

Neck Pain ◽

Donor Site ◽

Japanese Orthopaedic Association ◽

Autologous Bone Graft ◽

Anterior Cervical Discectomy ◽

Anterior Plate ◽

Content Type ◽

Cervical Discectomy ◽

Arm Pain ◽

Fine Print

Object. The authors prospectively evaluated the clinical and radiological outcomes after anterior cervical discectomy and fusion (ACDF) involving placement of a Solis cage and local autograft in patients who presented with symptomatic cervical spondylosis. Methods. Twenty-two consecutive patients underwent ACDF for radiculopathy (13 cases), myeloradiculopathy (eight cases), or myelopathy alone (one case) and were assessed at 3, 6, and 12 months. Plain cervical spine radiography demonstrated a significant change in both local (p < 0.05) and regional (p < 0.05) kyphotic angles as well as an increase in segmental height (p < 0.05). At 12 months, plain radiography demonstrated Grades I, II, and III new bone formation in two, three, and 17 patients, respectively. Clinical outcomes were assessed using a visual analog scale for both neck and arm pain and a modified Japanese Orthopaedic Association (JOA) scale for myelopathy. There was a significant improvement in both arm (p < 0.05) and neck pain (p < 0.05). At 12 months, 16 (84%) of 19 and 19 (86%) of 22 patients reported complete resolution of arm pain and neck pain, respectively. There was a significant improvement in JOA scores following surgery (p < 0.05). There were two complications in the series: one case of deep venous thrombosis and one case of postoperative arm pain that resolved after conservative treatment. There were no technical complications. Conclusions. Early experience with Solis cage—augmented ACDF indicates good clinical and radiological outcomes; additionally, there are the advantages of absent donor site morbidity and anterior plate system—related morbidity.

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Establishing the minimum clinically important difference in Neck Disability Index and modified Japanese Orthopaedic Association scores for adult cervical deformity

Journal of Neurosurgery Spine ◽

10.3171/2020.3.spine191232 ◽

2020 ◽

Vol 33 (4) ◽

pp. 441-445

Author(s):

Alex Soroceanu ◽

Justin S. Smith ◽

Darryl Lau ◽

Michael P. Kelly ◽

Peter G. Passias ◽

...

Keyword(s):

Cobb Angle ◽

Japanese Orthopaedic Association ◽

Neck Disability Index ◽

Deformity Correction ◽

Minimum Clinically Important Difference ◽

Cervical Deformity ◽

Clinically Important Difference ◽

Significant Difference ◽

The Mean ◽

Neck Disability

OBJECTIVEIt is being increasingly recognized that adult cervical deformity (ACD) is correlated with significant pain, myelopathy, and disability, and that patients who undergo deformity correction gain significant benefit. However, there are no defined thresholds of minimum clinically important difference (MCID) in Neck Disability Index (NDI) and modified Japanese Orthopaedic Association (mJOA) scores.METHODSPatients of interest were consecutive patients with ACD who underwent cervical deformity correction. ACD was defined as C2–7 sagittal Cobb angle ≥ 10° (kyphosis), C2–7 coronal Cobb angle ≥ 10° (cervical scoliosis), C2–7 sagittal vertical axis ≥ 4 cm, and/or chin-brow vertical angle ≥ 25°. Data were obtained from a consecutive cohort of patients from a multiinstitutional prospective database maintained across 13 sites. Distribution-based MCID, anchor-based MCID, and minimally detectable measurement difference (MDMD) were calculated.RESULTSA total of 73 patients met inclusion criteria and had sufficient 1-year follow-up. In the cohort, 42 patients (57.5%) were female. The mean age at the time of surgery was 62.23 years, and average body mass index was 29.28. The mean preoperative NDI was 46.49 and mJOA was 13.17. There was significant improvement in NDI at 1 year (46.49 vs 37.04; p = 0.0001). There was no significant difference in preoperative and 1-year mJOA (13.17 vs 13.7; p = 0.12). Using multiple techniques to yield MCID thresholds specific to the ACD population, the authors obtained values of 5.42 to 7.48 for the NDI, and 1.00 to 1.39 for the mJOA. The MDMD was 6.4 for the NDI, and 1.8 for the mJOA. Therefore, based on their results, the authors recommend using an MCID threshold of 1.8 for the mJOA, and 7.0 for the NDI in patients with ACD.CONCLUSIONSThe ACD-specific MCID thresholds for NDI and mJOA are similar to the reported MCID following surgery for degenerative cervical disease. Additional studies are needed to verify these findings. Nonetheless, the findings here will be useful for future studies evaluating the success of surgery for patients with ACD undergoing deformity correction.

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Pseudarthrosis in anterior cervical discectomy and fusion with a self-locking, stand-alone cage filled with hydroxyapatite: a retrospective study with clinical and radiological outcomes of 98 levels with a minimum 2-year follow-up

Journal of Neurosurgery Spine ◽

10.3171/2020.4.spine20357 ◽

2020 ◽

Vol 33 (6) ◽

pp. 717-726

Author(s):

Eduardo A. Iunes ◽

Enrico A. Barletta ◽

Telmo A. B. Belsuzarri ◽

Franz J. Onishi ◽

André Y. Aihara ◽

...

Keyword(s):

Statistical Significance ◽

Neck Disability Index ◽

Wilcoxon Test ◽

Anterior Cervical Discectomy ◽

Adjacent Level ◽

Disc Disease ◽

Cervical Discectomy ◽

Arm Pain ◽

Pain Status

OBJECTIVEThe goal of this study was to evaluate the incidence of pseudarthrosis after the treatment of cervical degenerative disc disease (CDDD) with anterior cervical discectomy and fusion (ACDF) in which self-locking, stand-alone intervertebral cages filled with hydroxyapatite were used.METHODSThe authors performed a retrospective cohort study of 49 patients who underwent 1- to 3-level ACDF with self-locking, stand-alone intervertebral cages without plates, with a minimum 2 years of follow-up. The following data were extracted from radiological and clinical charts: age, sex, time and type of pre- and postoperative signs and symptoms, pain status (visual analog scale [VAS]), functional status (Neck Disability Index [NDI]), history of smoking, bone quality (bone densitometry), and complications. Pseudarthrosis was diagnosed by a blinded neuroradiologist using CT scans. Clinical improvement was assessed using pre- and postoperative comparison of VAS and NDI scores. The Wilcoxon test for paired tests was used to evaluate statistical significance using a p value of < 0.05.RESULTSThree patients (6%) developed symptomatic pseudarthrosis requiring reoperation, with only 1 patient showing clinical worsening due to pseudarthrosis, while the other 2 with pseudarthrosis had associated disc disease at an adjacent level. The rate of symptomatic pseudarthrosis according to the number of operated levels was 0% for 1 level, 8.7% (2/23 patients) for 2 levels, and 7.7% (1/13 patients) for 3 levels. The total pseudarthrosis rate (including both symptomatic and asymptomatic patients) was 16.4%. Considering the clinical outcomes, there was a significant improvement of 75.6% in neck pain and 95.7% in arm pain, as well as a 64.9% improvement in NDI scores. Complications were observed in 18.4% of patients, with adjacent-level degenerative disease being the most prevalent at 14.3%.CONCLUSIONSACDF with self-locking, stand-alone cages filled with a hydroxyapatite graft can be used for the surgical treatment of 1- to 3-level CDDD with clinical and radiological outcomes significantly improved after a minimum 2-year follow-up period. Comparative studies are necessary.

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Is the improvement of cervical alignment really essential after three-level anterior cervical discectomy and fusion? A minimal 5-year follow-up

10.21203/rs.2.20402/v1 ◽

2020 ◽

Author(s):

Yan Liang ◽

Shuai Xu ◽

Guanjie Yu ◽

Zhenqi Zhu ◽

Haiying Liu

Keyword(s):

Japanese Orthopaedic Association ◽

Neck Disability Index ◽

Adjacent Segment Degeneration ◽

Anterior Cervical Discectomy ◽

Adjacent Segment ◽

Cervical Discectomy ◽

Cervical Alignment ◽

Neck Disability

Abstract Purpose: To identify the importance of sagittal alignment with self-locked stand-alone cage (SSC) and anterior cage-with-plate (ACP) system after 3-level anterior cervical discectomy and fusion (ACDF) on cervical spondylotic myelopathy (CSM) after minimal 5-year follow-up.Methods: 38 patients with SSC system (SSC group) and 26 with ACP system (ACP group) from February 2007 to September 2013 were enrolled. Cervical alignment were C2-7 lordosis (CL), operated-segment CL (OPCL), upper and lower adjacent-segment CL (UCL and LCL) at preoperation (POP), immediate postoperation (IPO) and final follow-up (FFU). Clinical outcomes contained the neck disability index (NDI), the Japanese Orthopaedic Association (JOA) score and adjacent segment degeneration (ASD). Patients were divides into CL improved subgroup (IM subgroup) and non-improved subgroup (NIM subgroup).Results: There were improvements on CL and OPCL in both groups. The change of CL and OPCL larger in ACP group (P<0.05) but UAL and LAL were of no significance. NDI and JOA got improvement in both groups at IPO and FFU while ASD was in no difference between SSC and ACP. A total of 40 patients (18 vs 22) acquired CL improvement with a larger population in ACP group. There were no differences on the rate if ASD, NDI, JOA and their change between IM and NIM subgroup and the change of CL were not correlated with NDI, JOA and their change.Conclusion: SSC and ACP both provide long-term efficacy on OPCL correction with little impact on adjacent segment. The improvement of CL after three-level ACDF seems not so essential.

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