scholarly journals Traumatic Cervical Unilateral and Bilateral Facet Dislocations Treated With Anterior Cervical Discectomy and Fusion Has a Low Failure Rate

2017 ◽  
Vol 7 (2) ◽  
pp. 110-115 ◽  
Author(s):  
Alireza K. Anissipour ◽  
Julie Agel ◽  
Matthew Baron ◽  
Erik Magnusson ◽  
Carlo Bellabarba ◽  
...  
Keyword(s):  
Risk Factor ◽  
Treatment Failure ◽  
Anterior Cervical Discectomy ◽  
Cervical Discectomy ◽  
Single Level ◽  
Surgical Data ◽  
Facet Fracture ◽  
The Mean ◽  
Cervical Facet

Study Design: Retrospective radiographic and chart review. Objective: To define the rate and associated risk factors of treatment failure of anterior cervical fusion for treatment of cervical facet dislocations. Methods: Between 2004 and 2014, a retrospective review at a single level 1 trauma center identified 38 patients with unilateral or bilateral dislocated facet(s) treated with anterior cervical discectomy and fusion (ACDF). Two patients were eliminated due to less than 30-day follow-up. Demographic data, initial neurological exams, surgical data, radiographic findings, and follow-up records were reviewed. Results: Of the 36 patients with facet dislocations treated with ACDF using a fixed locking plate, 16 were unilateral and 20 were bilateral. The mean age was 35 years (range 13-58). Mean follow-up was 323 days (range 30-1998). There were 3 treatment failures (8%). Three of 7 (43%) endplate fractures failed ( P < .01), and 1/28 (4%) facet fractures failed ( P = .13). The mean time to failure was 4 weeks (1-7 weeks). One treatment failure had a facet fracture, and all 3 failures had an associated endplate fracture. Conclusion: Treatment failure occurred in 3 out of 36 (8%) patients with facet fracture dislocations treated with anterior cervical discectomy, fusion, and plating. Rates of failure are lower than has been previously reported. Endplate fractures of the inferior level in jumped facets appears to be a major risk factor of biomechanical failure. However, a facet fracture may not be a risk factor for failure. In the absence of an endplate fracture, ACDF is a reasonable treatment option in patients with single-level cervical facet dislocation.

Radiographic and clinical outcomes following single-level anterior cervical discectomy and allograft fusion without plate placement or cervical collar

2008 ◽  
Vol 8 (5) ◽  
pp. 420-428 ◽  
Author(s):  
Jay Jagannathan ◽  
Christopher I. Shaffrey ◽  
Rod J. Oskouian ◽  
Aaron S. Dumont ◽  
Christian Herrold ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Anterior Cervical Discectomy ◽  
Radiographic Evidence ◽  
Disc Space ◽  
Cervical Discectomy ◽  
Single Level ◽  
Flexion Extension ◽  
The Mean ◽  
Graft Migration

Object Although the clinical outcomes following anterior cervical discectomy and fusion (ACDF) surgery are generally good, 2 major complications are graft migration and nonunion. These complications have led some to advocate rigid internal fixation and/or cervical immobilization postoperatively. This paper examines a single-surgeon experience with single-level ACDF without use of plates or hard collars in patients with degenerative spondylosis in whom allograft was used as the fusion material. Methods The authors conducted a retrospective review of a prospective database of (Cloward-type) ACDF operations performed by the senior author (J.A.J.) between July 1996 and June 2005. Radiographic follow-up included static and flexion/extension radiographs obtained to assess fusion, focal and segmental kyphosis, and change in disc space height. At most recent follow-up, the patients' condition was evaluated by an independent physician examiner. The Odom criteria and Neck Disability Index (NDI) were used to assess outcome. Results One hundred seventy patients underwent single-level ACDF for degenerative pathology during the study period. Their most common presenting symptoms were pain, weakness, and radiculopathy; 88% of patients noted ≥ 2 neurological complaints. The mean hospital stay was 1.76 days (range 0–36 days), and 3 patients (2%) had major immediate postoperative complications requiring reoperation. The mean duration of follow-up was 22 months (range 12–124 months). Radiographic evidence of fusion was present in 160 patients (94%). Seven patients (4%) showed radiographic evidence of pseudarthrosis, and graft migration was seen in 3 patients (2%). All patients had increases in focal kyphosis at the operated level on postoperative radiographs (mean −7.4°), although segmental alignment was preserved in 133 patients (78%). Mean change in disc space height was 36.5% (range 28–53%). At most recent clinical follow-up, 122 patients (72%) had no complaints referable to cervical disease and were able to carry out their activities of daily living without impairment. The mean postoperative NDI score was 3.2 (median 3, range 0–31). Conclusions Single-level ACDF without intraoperative plate placement or the use of a postoperative collar is an effective treatment for cervical spondylosis. Although there is evidence of focal kyphosis and loss of disc space height, radiographic evidence of fusion is comparable to that attained with plate fixation, and the rate of clinical improvement is high.

Management of Acute Unilateral Nondisplaced Subaxial Cervical Facet Fractures

2017 ◽  
Vol 14 (2) ◽  
pp. 104-111 ◽  
Author(s):  
Aditya Vedantam ◽  
Jared Steven Fridley ◽  
Jovany Cruz Navarro ◽  
Shankar P Gopinath
Keyword(s):  
Nonoperative Management ◽  
Exact Test ◽  
Laminar Fracture ◽  
Facet Fracture ◽  
The Mean ◽  
Lateral Mass Fracture ◽  
Fracture Types ◽  
Cervical Facet ◽  
Spine Radiographs

Abstract BACKGROUND Few studies have focused on the management of patients with nondisplaced cervical facet fractures. OBJECTIVE To determine the rate of successful nonoperative management and risk factors for instability in patients with acute traumatic, unilateral, nondisplaced cervical facet fractures. METHODS We reviewed patients with single or multilevel unilateral nondisplaced or minimally displaced subaxial cervical facet fractures between 2008 and 2014. Facet fractures were classified as type A1 fractures: superior facet fracture of caudal vertebra; type A2: inferior facet fracture of rostral vertebral; and type A3: floating lateral mass (fracture of pedicle and vertical laminar fracture). All patients were given a trial of nonoperative management with external immobilization using a hard cervical collar. Follow-up clinical data and cervical spine radiographs were analyzed to determine factors associated with instability. RESULTS Thirty-five patients (34 males, mean age 40.2 ± 2.4 yr) were reviewed. The mean follow-up duration was 2.7 ± 0.4 mo. The distribution of fracture types was type A1 (n = 15), type A2 (n = 4), type A3 (n = 5), type A1 and A2 fractures (n = 10), and type A1 and A3 fractures (n = 1). Nonoperative management was successful in 29 patients (82.9%), and 6 patients developed instability requiring surgery. All patients who failed nonoperative management had associated injuries suggesting a more severe mechanism of injury. No significant association was found between the type of facet fracture and outcome (Fisher's exact test, P = .18). CONCLUSION In our series, more than 80% of the patients with unilateral, nondisplaced cervical facet fractures underwent successful nonoperative management in the short term.

Banked fibula and the locking anterior cervical plate in anterior cervical fusions following cervical discectomy

1996 ◽  
Vol 84 (2) ◽  
pp. 161-165 ◽  
Author(s):  
Scott Shapiro
Keyword(s):  
High Speed ◽  
Iliac Crest ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Cervical Discectomy ◽  
Single Level ◽  
Flexion Extension ◽  
The Mean ◽  
Cervical Plate

✓ Eighty-eight consecutive patients underwent anterior cervical discectomy (ACD) with banked fibula fusion and internal fixation using the locking cervical plate. Pathology included cervical spondylotic radiculopathy in 48, cervical spondylotic radiculomyelopathy in 30, cervical facet dislocations with associated disc herniations in six, and autologous iliac crest graft collapse pseudoarthrosis with recurrent symptoms in four patients. Operations were single-level banked fibula fusion with plating in 37, multilevel banked fibula fusion with plating in 45, and combined single-level ACD banked fibula fusion with plating and posterior fusion in six patients. The only perioperative complication was transient hoarseness. There were no transfusions, infections, neurological injuries, or deaths. The mean time in the hospital for the nontraumatic cases was 1.8 days. The mean follow up was 22 months (range 12–30 months). There has been no motion at the fused level on flexion/extension films, no kyphosis, no screw plate backout, and no banked fibula has suffered graft collapse. Following a high-speed motor vehicle accident 6 months after a multilevel fusion, one alcoholic man suffered a fractured plate with transient worsening of neck pain, and the plate has remained in place for an additional 11 months of follow-up care. Compared to 100 consecutive autologous iliac crest fusions performed by the same surgeon, there were significantly fewer graft-related complications (p < 0.001). There was a significantly greater chance of autologous iliac crest collapsing with the passage of time as compared to banked fibula. Time until return to work was shorter by 5 weeks for the plate/banked fibula group (p < 0.05). When fusion is considered following ACD, the combination of banked fibula and locking cervical plates is significantly superior to autologous iliac crest grafts.

scholarly journals A radiographic follow-up study of stand-alone-cage and graft-plate constructs for single-level anterior cervical discectomy and fusion

2017 ◽  
Vol 3 (4) ◽  
pp. 596-600 ◽  
Author(s):  
Joseph F. Baker ◽  
Jaime Gomez ◽  
Kartik Shenoy ◽  
Sarah Kim ◽  
Afshin Razi ◽  
...  
Keyword(s):  
Anterior Cervical Discectomy ◽  
Cervical Discectomy ◽  
Single Level ◽  
Follow Up Study

scholarly journals The Functional outcome following anterior cervical discectomy and fusion for single level cervical degenerative disc disease: a prospective single institutional study

2020 ◽  
Vol 17 (2) ◽  
pp. 42-47
Author(s):  
Somraj Lamichhane ◽  
Sujata Panta ◽  
Devendra Acharya
Keyword(s):  
Degenerative Disc Disease ◽  
Cervical Spondylotic Myelopathy ◽  
Anterior Cervical Discectomy ◽  
Disc Disease ◽  
Cervical Discectomy ◽  
Degenerative Disc ◽  
Single Level ◽  
Cervical Degenerative Disc Disease ◽  
Severe Grade

Introduction: Cervical degenerative disc diseases leading to cervical spondylotic myelopathy (CSM) is one the most common cause of disability in elderly population that progresses with age with continuation of degree of degeneration. Objective: To assess the functional outcome following ACDF in single-level cervical degenerative disc disease in terms of improvement in the mJOA scoring system and postoperative complications. Materials and methods: Eighteen patients with single level cervical degenerative disc diseases who presented at the college of medical sciences from May 2018 to October 2019 fulfilling the inclusion criteria (single-level cervical degenerative disc disease with age between 40 to 70 years with progressive neurological deficits, features of cervical spondylotic myelopathy and patients with mild grade who failed four weeks of conservative treatment and progressed to moderate or severe grades) were included in the study. All patients underwent Anterior Cervical Discectomy and Fusion (ACDF); with tricortical iliac crest graft with cervical plate and screws in 13 patients and polyether ether ketone (PEEK) cage placement in five patients. Patients were assessed using mJOA scoring system and graded into mild, moderate and severe myelopathy. Post-operatively patients were assessed for improvement in terms of mJOA scores at four weeks and three months follow-up. They were also assessed for development of any post-operative complications and documented accordingly. Statistical analysis was done using the Statistical Package for the Social Sciences version 20 software. Results: Out of 18 patients, at the time of presentation 12 were in moderate grade and six were in severe grade. During subsequent follow up at four weeks and three months, patients showed progressive improvement. 15 patients improved to mild grade while two remained in moderate grade and one in severe grade during three months postoperative assessment. One patient each developed dysphagia, hoarseness and superficial wound infection that were managed conservatively. Conclusion: Anterior cervical discectomy and fusion is one of the effective and safe treatments for single-level degenerative cervical disc disease associated with cervical spondylotic myelopathy with minimal complications.

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