A comparison study between hybrid surgery and anterior cervical discectomy and fusion for the treatment of multilevel cervical spondylosis

2020 ◽  
Vol 102-B (8) ◽  
pp. 981-996
Author(s):  
Yong-Dong Yang ◽  
He Zhao ◽  
Yi Chai ◽  
Ding-Yan Zhao ◽  
Li-Jun Duan ◽  
...  
Keyword(s):  
Blood Loss ◽  
Japanese Orthopaedic Association ◽  
Anterior Cervical Discectomy ◽  
Sensitivity Analyses ◽  
Cervical Disc ◽  
Symptom Improvement ◽  
Adjacent Segment ◽  
Hybrid Surgery ◽  
Cervical Discectomy ◽  
Hospitalization Time

Aims Whether to perform hybrid surgery (HS) in contrast to anterior cervical discectomy and fusion (ACDF) when treating patients with multilevel cervical disc degeneration remains a controversial subject. To resolve this we have undertaken a meta-analysis comparing the outcomes from HS with ACDF in this condition. Methods Seven databases were searched for studies of HS and ACDF from inception of the study to 1 September 2019. Both random-effects and fixed-effects models were used to evaluate the overall effect of the C2-C7 range of motion (ROM), ROM of superior/inferior adjacent levels, adjacent segment degeneration (ASD), heterotopic ossification (HO), complications, neck disability index (NDI) score, visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, Odom’s criteria, blood loss, and operating and hospitalization time. To obtain more credible results contour-enhanced funnel plots, Egger’s and Begg’s tests, meta-regression, and sensitivity analyses were performed. Results In total, 17 studies involving 861 patients were included in the analysis. HS was found to be superior to ACDF in maintaining C2-C7 ROM and ROM of superior/inferior adjacent levels, but HS did not reduce the incidence of associated level ASD. Also, HS did not cause a higher rate of HO than ACDF. The frequency of complications was similar between the two techniques. HS failed to achieve more favourable outcomes than ACDF using the NDI, VAS, JOA, and Odom’s scores. HS did not show any more advantages in operating or hospitalization time but did show reduction in blood loss. Conclusion Although HS maintained cervical kinetics, it failed to reduce the incidence of ASD. This finding differs from previous reports. Moreover, patients did not show more benefits from HS with respect to symptom improvement, prevention of complications, and clinical outcomes. Cite this article: Bone Joint J 2020;102-B(8):981–996.

scholarly journals Risk factor analysis of axial symptoms after single-segment anterior cervical discectomy and fusion: A retrospective study of 113 patients

2019 ◽  
Vol 47 (12) ◽  
pp. 6100-6108
Author(s):  
Lin-Feng Wang ◽  
Zhen Dong ◽  
De-Chao Miao ◽  
Yong Shen ◽  
Feng Wang
Keyword(s):  
Risk Factor ◽  
Retrospective Study ◽  
Japanese Orthopaedic Association ◽  
Anterior Cervical Discectomy ◽  
Occurrence Rate ◽  
Adjacent Segment ◽  
Disc Space ◽  
Cervical Discectomy ◽  
Single Segment ◽  
Axial Symptoms

Objective This retrospective study was performed to investigate the risk factors for axial symptoms (AS) after single-segment anterior cervical discectomy and fusion (ACDF). Methods One hundred thirteen patients with cervical spondylosis who had undergone single-segment ACDF from January 2012 to December 2015 were divided into those with and without AS (n = 34 and n = 79, respectively). Clinical data and radiological evaluation results were recorded. Results The occurrence rate of AS was 30.1% (34/113), and the average visual analog scale score was 4.5 points. Bony fusion was achieved in all cases during follow-up. There were no differences in age, sex, disease duration, diagnostic categories, operative segment, Japanese Orthopaedic Association score, or adjacent segment degeneration. However, cervical range of motion (CROM), cervical curvature, and disc space enlargement significantly differed between the groups. Logistic regression analysis revealed that CROM, cervical curvature, and disc space enlargement were independently associated with AS. Conclusions AS after single-segment ACDF is not rare. Disc space enlargement is a risk factor for AS, while higher CROM and lordotic cervical curvature are protective factors. Excessive or insufficient disc space enlargement could increase the incidence of AS. Maintaining CROM within the normal range and restoring cervical lordosis might help to prevent AS.

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

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.

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.

Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial

2007 ◽  
Vol 6 (3) ◽  
pp. 198-209 ◽  
Author(s):  
Praveen V. Mummaneni ◽  
J. Kenneth Burkus ◽  
Regis W. Haid ◽  
Vincent C. Traynelis ◽  
Thomas A. Zdeblick
Keyword(s):  
Anterior Cervical Discectomy ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Control Group ◽  
Adjacent Segment ◽  
Segmental Motion ◽  
Disc Arthroplasty ◽  
Cervical Discectomy ◽  
Single Level ◽  
The Prestige

Object The authors report the results of a prospective randomized multicenter study in which the results of cervical disc arthroplasty were compared with anterior cervical discectomy and fusion (ACDF) in patients treated for symptomatic single-level cervical degenerative disc disease (DDD). Methods Five hundred forty-one patients with single-level cervical DDD and radiculopathy were enrolled at 32 sites and randomly assigned to one of two treatment groups: 276 patients in the investigational group underwent anterior cervical discectomy and decompression and arthroplasty with the PRESTIGE ST Cervical Disc System (Medtronic Sofamor Danek); 265 patients in the control group underwent decompressive ACDF. Eighty percent of the arthroplasty-treated patients (223 of 276) and 75% of the control patients (198 of 265) completed clinical and radiographic follow-up examinations at routine intervals for 2 years after surgery. Analysis of all currently available postoperative 12- and 24-month data indicated a two-point greater improvement in the neck disability index score in the investigational group than the control group. The arthroplasty group also had a statistically significant higher rate of neurological success (p = 0.005) as well as a lower rate of secondary revision surgeries (p = 0.0277) and supplemental fixation (p = 0.0031). The mean improvement in the 36-Item Short Form Health Survey Physical Component Summary scores was greater in the investigational group at 12 and 24 months, as was relief of neck pain. The patients in the investigational group returned to work 16 days sooner than those in the control group, and the rate of adjacent-segment reoperation was significantly lower in the investigational group as well (p = 0.0492, log-rank test). The cervical disc implant maintained segmental sagittal angular motion averaging more than 7°. In the investigational group, there were no cases of implant failure or migration. Conclusions The PRESTIGE ST Cervical Disc System maintained physiological segmental motion at 24 months after implantation and was associated with improved neurological success, improved clinical outcomes, and a reduced rate of secondary surgeries compared with ACDF.

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