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

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.

T1 slope minus cervical lordosis in multilevel anterior cervical discectomy and fusion with or without plate: a mean 6-year follow up

2020 ◽  
Author(s):  
Rile Ge ◽  
Peng Yang ◽  
Xin Liu ◽  
Bingtao Wen
Keyword(s):  
Neck Disability Index ◽  
Anterior Cervical Discectomy ◽  
Adjacent Segment ◽  
Cervical Lordosis ◽  
Sagittal Vertical Axis ◽  
Cervical Discectomy ◽  
Cervical Alignment ◽  
Japanese Orthopedic Association ◽  
T1 Slope

Abstract Purpose Cervical alignment between self-locked cage (SLC) and anterior cage-with-plate (ACP) system was debatable, especially in multilevel anterior cervical discectomy and fusion (ACDF). T1 slope minus C2-C7 cervical lordosis (T1S-CL) was critical for cervical-balance while without identified threshold. Thus the study was to compare sagittal alignment between SLC and ACP on 3-level ACDF and to identify the threshold of T1S-CL in 3-level ACDF. Methods 45 patients of 3-level SLC and 28 cases of 3-level ACP with well-matched demographics were retrospectively enrolled with 6.1-year follow-up. Cervical alignment paramters were CL, C2-C7 sagittal vertical axis (C2-C7 SVA), T1S and T1S-CL, as well as adjacent segment degeneration (ASD), obtained on X-ray. Neck disability index (NDI) and Japanese Orthopedic Association (JOA) score were recorded for evaluating quality of life (QOL). NDI of 20 was difined as the cutoff of QOL. Threshold of T1S-CL was determined by both linear and logistic regression model. Result CL, C2-C7 SVA and T1S were insignificant at baseline and all parameters were indifferent at last (P ˃0.05). CL and T1S improved at last in both groups (P < 0.05). The incidence of ASD was comparable between groups (P ˃0.05). Both groups acquired inprovement on NDI and JOA (P < 0.001). There were close correlation among alignment paramters and between parameters and NDI at final follow-up. C2-C7 SVA was independent risk factor for NDI and two regression models predicted C2-C7 SVA with a cutoff of 29.2 mm, corresponded to the threshold on T1S-CL of 20.7°. Conclusions It is comparable on alignment reconstruction between SLC and ACP system. The cutoff on C2-C7 SVA with 29.2 mm corresponds to a thershold of T1S-CL with 20.7° in multilevel ACDF.

scholarly journals Cellular allograft for multilevel stand-alone anterior cervical discectomy and fusion

2021 ◽  
Vol 50 (6) ◽  
pp. E7
Author(s):  
Alec W. Gibson ◽  
Abdullah H. Feroze ◽  
Madeline E. Greil ◽  
Margaret E. McGrath ◽  
Sananthan Sivakanthan ◽  
...  
Keyword(s):  
Neck Disability Index ◽  
Bone Allograft ◽  
Cervical Radiculopathy ◽  
Anterior Cervical Discectomy ◽  
High Rate ◽  
Cervical Discectomy ◽  
Arm Pain ◽  
Scale Scores ◽  
Neck Disability

OBJECTIVE Anterior cervical discectomy and fusion (ACDF) is the most common treatment for degenerative disease of the cervical spine. Given the high rate of pseudarthrosis in multilevel stand-alone ACDF, there is a need to explore the utility of novel grafting materials. In this study, the authors present a single-institution retrospective study of patients with multilevel degenerative spine disease who underwent multilevel stand-alone ACDF surgery with or without cellular allograft supplementation. METHODS In a prospectively collected database, 28 patients who underwent multilevel ACDF supplemented with cellular allograft (ViviGen) and 25 patients who underwent multilevel ACDF with decellularized allograft between 2014 and 2020 were identified. The primary outcome was radiographic fusion determined by a 1-year follow-up CT scan. Secondary outcomes included change in Neck Disability Index (NDI) scores and change in visual analog scale scores for neck and arm pain. RESULTS The study included 53 patients with a mean age of 53 ± 0.7 years who underwent multilevel stand-alone ACDF encompassing 2.6 ± 0.7 levels on average. Patient demographics were similar between the two cohorts. In the cellular allograft cohort, 2 patients experienced postoperative dysphagia that resolved by the 3-month follow-up. One patient developed cervical radiculopathy due to graft subsidence and required a posterior foraminotomy. At the 1-year CT, successful fusion was achieved in 92.9% (26/28) of patients who underwent ACDF supplemented with cellular allograft, compared with 84.0% (21/25) of patients who underwent ACDF without cellular allograft. The cellular allograft cohort experienced a significantly greater improvement in the mean postoperative NDI score (p < 0.05) compared with the other cohort. CONCLUSIONS Cellular allograft is a low-morbidity bone allograft option for ACDF. In this study, the authors determined favorable arthrodesis rates and functional outcomes in a complex patient cohort following multilevel stand-alone ACDF supplemented with cellular allograft.

scholarly journals First Clinical Experience with a Carbon Fibre Reinforced PEEK Composite Plating System for Anterior Cervical Discectomy and Fusion

2019 ◽  
Vol 10 (3) ◽  
pp. 29 ◽  
Author(s):  
Helena Milavec ◽  
Christoph Kellner ◽  
Nivetha Ravikumar ◽  
Christoph E. Albers ◽  
Till Lerch ◽  
...  
Keyword(s):  
Carbon Fibre ◽  
Disease Free Survival ◽  
Adjacent Segment Degeneration ◽  
Anterior Cervical Discectomy ◽  
Adjacent Segment ◽  
Cervical Lordosis ◽  
Cervical Discectomy ◽  
Suitable Material ◽  
Peek Composite

Carbon fibre reinforced polyether ether ketone (CFR-PEEK) is a suitable material to replace metal implants in orthopaedic surgery. The radiolucency of CFR-PEEK allows an optimal visualisation of the bone and soft tissue structures. We aimed to assess the performance and radiological and clinical outcomes of anterior cervical discectomy and fusion (ACDF) with CFR-PEEK anterior cervical plating (ACP) under first use clinical conditions. We retrospectively studied the prospectively-collected data of 42 patients who underwent ACDF with CFR-PEEK ACP between 2011 and 2016. We assessed clinical outcome (Odom’s criteria, complications) and radiological parameters (global and segmental cervical lordosis, Bridwell score for fusion, adjacent segment degeneration) preoperatively, immediately post-operatively, and after a 12-month follow-up period. Patients’ satisfaction was excellent, good, fair, and poor in 12, 19, 3, and 1 patients, respectively. Two patients developed dysphagia. No hardware failure occurred. Compared with preoperative radiographs, we observed a gain of global cervical lordosis and segmental lordosis (7.4 ± 10.1 and 5.6 ± 7.1 degrees, respectively) at the 12-month follow-up. Bridwell IF grades I, II, and III were observed in 22, 6, and 7 patients, respectively. The 12-month adjacent segment degeneration-free and adjacent segment disease-free survival rates were 93.1% and 96.3%, respectively. We observed a dysphagia rate of 5.7% and a reoperation rate of 4.8%. In conclusion, CFR-PEEK ACP shows positive outcomes in terms of implant safety, restoration of cervical lordosis, and functional recovery, and is suitable for ACDF.

i-Factor™ Bone Graft vs Autograft in Anterior Cervical Discectomy and Fusion: 2-Year Follow-up of the Randomized Single-Blinded Food and Drug Administration Investigational Device Exemption Study

Neurosurgery ◽  
2017 ◽  
Vol 83 (3) ◽  
pp. 377-384 ◽  
Author(s):  
Paul M Arnold ◽  
Rick C Sasso ◽  
Michael E Janssen ◽  
Michael G Fehlings ◽  
Robert F Heary ◽  
...  
Keyword(s):  
Bone Graft ◽  
Visual Analog Scale ◽  
Neck Disability Index ◽  
Anterior Cervical Discectomy ◽  
Analog Scale ◽  
Cervical Discectomy ◽  
Investigational Device Exemption ◽  
I Factor ◽  
Neck Disability

Abstract BACKGROUND i-Factor™ Bone Graft (Cerapedics Inc, Westminster, Colorado) is a composite bone substitute material consisting of P-15 synthetic collagen fragment adsorbed onto anorganic bone mineral suspended in an inert biocompatible hydrogel carrier. A pivotal, noninferiority, US FDA Investigational Device Exemption study demonstrated the benefits of i-Factor™ compared to local autograft bone in single-level anterior cervical discectomy and fusion at 1-yr postoperative. OBJECTIVE To report 2-yr follow-up. METHODS Subjects randomly received either autograft (n = 154) or i-Factor™ (n = 165) in a cortical ring allograft and followed using radiological, clinical, and patient-reported outcomes. RESULTS At 2 yr, the fusion rate was 97.30% and 94.44% in i-Factor™ and autograft subjects, respectively (P = .2513), and neurological success rate was 94.87% (i-Factor™) and 93.79% (autograft; P = .7869). Neck Disability Index improved 28.30 (i-Factor™) and 26.95 (autograft; P = .1448); Visual Analog Scale arm pain improved 5.43 (i-Factor™) and 4.97 (autograft) (p = .2763); Visual Analog Scale neck pain improved 4.78 (i-Factor™) and 4.41 (autograft; P = .1652), Short Form-36 (SF-36v2) Physical Component Score improved 10.23 (i-Factor™) and 10.18 (autograft; P = .4507), and SF36v2 Mental Component Score improved 7.88 (i-FactorTM) and 7.53 (autograft; P = .9872). The composite endpoint of overall success (fusion, Neck Disability Index improvement &gt;15, neurological success, and absence of re-operations) was greater in i-Factor™ subjects compared to autograft subjects (69.83% and 56.35%, respectively, P = .0302). Twelve (7.45%) i-Factor™ subjects and 16 (10.53%) autograft subjects underwent re-operation (P = .3411). There were no allergic reactions associated with i-Factor™. CONCLUSION Use of i-Factor™ in anterior cervical discectomy and fusion is effective and safe, and results in similar outcomes compared to local autograft bone at 2 yr following surgery.

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

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.

Post-Operative Dysphagia in Anterior Cervical Discectomy and Fusion

2021 ◽  
pp. 000348942110155
Author(s):  
Leonard Haller ◽  
Khush Mehul Kharidia ◽  
Caitlin Bertelsen ◽  
Jeffrey Wang ◽  
Karla O’Dell
Keyword(s):  
Risk Factors ◽  
Medical Records ◽  
Assessment Tool ◽  
Demographic Data ◽  
Anterior Cervical Discectomy ◽  
Cervical Discectomy ◽  
Long Term Follow Up

Objective: We sought to identify risk factors associated with long-term dysphagia, characterize changes in dysphagia over time, and evaluate the incidence of otolaryngology referrals for patients with long-term dysphagia following anterior cervical discectomy with fusion (ACDF). Methods: About 56 patients who underwent ACDF between May 2017 to February 2019 were included in the study. All patients were assessed for dysphagia using the Eating Assessment Tool (EAT-10) survey preoperatively and late postoperatively (≥1 year). Additionally, 28 patients were assessed for dysphagia early postoperatively (2 weeks—3 months). Demographic data, medical comorbidities, intraoperative details, and post-operative otolaryngology referral rates were collected from electronic medical records. Results: Of the 56 patients enrolled, 21 patients (38%) had EAT-10 scores of 3 or more at long-term follow-up. None of the demographics, comorbidities, or surgical factors assessed were associated with long-term dysphagia. Patients who reported no long-term dysphagia had a mean EAT-10 score of 6.9 early postoperatively, while patients with long-term symptoms had a mean score of 18.1 ( P = .006). Of the 21 patients who reported persistent dysphagia symptoms, 3 (14%) received dysphagia testing or otolaryngology referrals post-operatively. Conclusion: Dysphagia is a notable side effect of ACDF surgery, but there are no significant demographics, comorbidities, or surgical risk factors that predict long-term dysphagia. Early postoperative characterization of dysphagia using the EAT-10 questionnaire can help predict long-term symptoms. There is inadequate screening and otolaryngology follow-up for patients with post-ACDF dysphagia.

High prevalence of heterotopic ossification after cervical disc arthroplasty: outcome and intraoperative findings following explantation of 22 cervical disc prostheses

2012 ◽  
Vol 17 (2) ◽  
pp. 141-146 ◽  
Author(s):  
Christopher Brenke ◽  
Johann Scharf ◽  
Kirsten Schmieder ◽  
Martin Barth
Keyword(s):  
Neck Disability Index ◽  
Adjacent Segment Degeneration ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Adjacent Segment ◽  
Analog Scale ◽  
Osteophyte Formation ◽  
High Prevalence ◽  
The Mean ◽  
Neck Disability

Object Cervical disc arthroplasty (CDA) has been increasingly used for the treatment of cervical disc herniations. However, the impact of CDA on adjacent-segment degeneration and the degree of heterotopic ossification (HO) of the treated segment remain a subject of controversy. Due to a product failure of the Galileo-type disc prosthesis, 22 of these devices were explanted. The radiological and clinical course in each case was investigated in detail with an emphasis on the incidence of HO and facet joint degeneration 18 months following the operation. Intraoperative findings regarding ossification and implant fixation were documented. Thus, the authors were able to describe the true rate of adjacent-segment degeneration and HO following CDA and the clinical relevance thereof. Methods In all 22 patients, functional radiographic imaging was performed prior to surgery, 3 and 12 months after surgery, and prior to disc prosthesis explantation. At all time points, the range of motion (ROM) in the operated and adjacent segments was determined. A motion index was calculated using the preoperative and all postoperative ROMs (preoperative ROM/postoperative ROM). Computed tomography was used preoperatively to measure the height of the index segment, extent of HO, and the degree of the progression of facet arthrosis, and was used postoperatively prior to prosthesis explantation. Patients completed clinical questionnaires that included a visual analog scale and the Neck Disability Index. Results The motion index of the index segment declined gradually from 1.4 at 3 months postoperative to 1.2 prior to explantation, while the motion index of the adjacent upper segment increased from 0.9 to 1.3. The mean ROM of the index segment was 10.4° ± 6.7°, and fusion was observed in 2 (9%) of the 22 patients. Prosthesis migration was present in 3 patients (13.6%). Severe HO (Grades 3 and 4) was present in 17.4%. Computed tomography showed a significant increase of segmental height of the index segment (1.6 ± 1.1 mm, p = 0.035), and a significant increase of left-sided lateral osteophytes (1.7 ± 2.1 mm, p = 0.009). The incidence of severe osteophyte formation (> 2 mm) occurred in 40%. Intraoperative findings reflected the results from CT, with primary lateral proliferation of osteophytes found in approximately 25% of patients. The mean visual analog scale scores were 3.8 ± 2.7 (neck) and 2.4 ± 2.5 (arms), and the mean Neck Disability Index score was 30 ± 22. No correlation was found between radiological and clinical parameters. Conclusions In this study, a higher incidence of HO after CDA could be demonstrated using CT, compared with studies using fluoroscopy only. However, patient selection and/or the operative technique might have contributed to the high prevalence of osteophyte formation. Thus, the exact indication for CDA has to be reconsidered. Because implant migration was detected, using fixation in the present CDA model appears suboptimal.

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