A Long-Term Control Study of the Treatment of Cervical Radiculopathy by Percutaneous Endoscopic Posterior Cervical Discectomy and Anterior Cervical Decompression, Bone Graft Fusion and Internal Fixation

Abstract Background: Cervical spondylotic radiculopathy (CSR) is very common all over the world. However, there are only a few reports about the efficacy of percutaneous endoscopic posterior cervical discectomy (PEPCD) in the treatment of CSR. Anterior cervical decompression and fusion (ACDF) and PEPCD which is a better way to treat CSR need further study.Methods：From January 2015 to December 2016. A retrospective study of 70 patients undergoing surgery for CSR (33 using PEPCD and 37 using ACDF). The intra-operative parameters, neck disability index (NDI), neck and arm visual analog scale (VAS) score were used to assessed clinical outcome. Radiological outcomes were assessed by measuring cervical 2-7 (C2-7) lordosis, disc height index (DHI), and degree of degenerative changes at the corresponding level.Results: The mean follow-up period was 48.5 month (36 –66 months). Two groups can significantly improve the clinical symptoms. There was no significant difference between the two groups in clinical results (VAS, NDI). Compared with preoperative, the lordosis of C2-7 increased significantly at the last follow-up. At the last follow-up, C2-7 lordosis in the ACDF group was significantly higher than that in the PEPCD group. In PEPCD, compared with preoperative, there was no significant difference in the DHI, but the degree of disc degeneration was significantly increased at the last follow-up.Conclusion: For patients with CSR, PEPCD had similar clinical early and intermediate outcomes when compared with ACDF, with the advantages of minimally invasive. PEPCD is a sufficient and safe supplement and alternative to conventional surgery.

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A Long-Term Control Study of the Treatment of Cervical Radiculopathy by Percutaneous Endoscopic Posterior Cervical Discectomy and Anterior Cervical Decompression, Bone Graft Fusion and Internal Fixation

10.21203/rs.3.rs-78852/v1 ◽

2020 ◽

Author(s):

Xiaodong Huang ◽

Weiheng Wang ◽

Qingxi Meng ◽

Jiangming Yu ◽

Xiaojian Ye

Keyword(s):

Clinical Symptoms ◽

Neck Disability Index ◽

Cervical Radiculopathy ◽

Clinical Results ◽

Cervical Discectomy ◽

Anterior Cervical Decompression ◽

Intermediate Outcomes ◽

Significant Difference ◽

Neck Disability

Abstract BackgroundCervical spondylotic radiculopathy (CSR) is very common all over the world. However, there are only a few reports about the efficacy of percutaneous endoscopic posterior cervical discectomy (PEPCD) in the treatment of CSR. Anterior cervical decompression and fusion (ACDF) and PEPCD which is a better way to treat CSR need further study.MethodsFrom January 2015 to December 2016. A retrospective study of 70 patients undergoing surgery for CSR (33 using PEPCD and 37 using ACDF). The intra-operative parameters, neck disability index (NDI), neck and arm visual analog scale (VAS) score were used to assessed clinical outcome. Radiological outcomes were assessed by measuring cervical 2-7 (C2-7) lordosis, disc height index (DHI), and degree of degenerative changes at the corresponding level.ResultsThe mean follow-up period was 48.5 month (36 –66 months). Two groups can significantly improve the clinical symptoms. There was no significant difference between the two groups in clinical results (VAS, NDI). Compared with preoperative, the lordosis of C2-7 increased significantly at the last follow-up. At the last follow-up, C2-7 lordosis in the ACDF group was significantly higher than that in the PEPCD group. In PEPCD, compared with preoperative, there was no significant difference in the DHI, but the degree of disc degeneration was significantly increased at the last follow-up.ConclusionFor patients with CSR, PEPCD had similar clinical early and intermediate outcomes when compared with ACDF, with the advantages of minimally invasive. PEPCD is a sufficient and safe supplement and alternative to conventional surgery.

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Deep Learning-Based Cervical Spine Posterior Percutaneous Endoscopic Disc Nucleus Resection for the Treatment of Cervical Spondylotic Radiculopathy

Journal of Healthcare Engineering ◽

10.1155/2021/7245566 ◽

2021 ◽

Vol 2021 ◽

pp. 1-12

Author(s):

Yang Zhang ◽

Hengjie Zhu ◽

Zheng Zhou ◽

Yinming Sun ◽

Xiang Shen ◽

...

Keyword(s):

Deep Learning ◽

Cervical Spine ◽

Cervical Radiculopathy ◽

Surgical Instruments ◽

Decompression Surgery ◽

Average Height ◽

Cervical Spondylotic Radiculopathy ◽

Anterior Cervical Decompression ◽

Significant Difference

In the past 10 years, the technology of percutaneous spine endoscopy has been continuously developed. The indications have expanded from simple lumbar disc herniation to various degenerative diseases of the cervical, thoracic, and lumbar spine. Traditional surgery for the treatment of cervical radiculopathy includes anterior cervical decompression surgery, anterior cervical decompression plus fusion surgery, and posterior limited fenestration surgery. This article mainly studies the treatment of cervical spondylosis caused by radiculopathy caused by the nucleus resection of the posterior cervical spine percutaneous spinal endoscopy based on deep learning. In the PPECD group, the height of the intervertebral cavity was measured before the operation and during the final follow-up, and the height change of the intervertebral cavity was evaluated. The relative angle and relative displacement of the sagittal plane of the operation segment in the PPECD group were measured, and the stability was evaluated. Using the cervical spine X-ray Kelvin degeneration evaluation criteria, before and during the final follow-up operation, the degeneration of the adjacent segments of the two groups was evaluated. A retrospective analysis of 26 cases of cervical radiculopathy that met the criteria for diagnosis, inclusion, and exclusion was reviewed. Among them, 11 cases were treated with PPECD surgery; 15 cases were treated with ACDF surgery. According to the evaluation method of Odom, the excellent rate and the good rate of the two groups were compared. According to the location of the lesion, the nerve detection or dull tip device is exposed under the armpit or shoulder of the nerve root, and the protruding nucleus pulposus tissue is explored and removed, and annulus fibrosus is performed as needed. After hemostasis was detected, the surgical instruments were removed and the surgical incision was completely sutured. Before the operation and 3 months after the operation, the final follow-up made no significant difference in the overall average height of the intervertebral cavity (F = 2.586, P > 0.05 ). The results show that posterior foramen expansion is an effective surgical method for the treatment of cervical spondylotic radiculopathy, but surgical adaptation requires strict management. In order to achieve satisfactory results, appropriate cases must be selected.

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Posterior percutaneous full-endoscopic cervical discectomy under local anesthesia for cervical radiculopathy due to soft-disc herniation: a preliminary clinical study

Journal of Neurosurgery Spine ◽

10.3171/2018.1.spine17795 ◽

2018 ◽

Vol 29 (4) ◽

pp. 351-357 ◽

Cited By ~ 8

Author(s):

Quan Wan ◽

Daying Zhang ◽

Shun Li ◽

Wenlong Liu ◽

Xiang Wu ◽

...

Keyword(s):

Local Anesthesia ◽

Disc Herniation ◽

Clinical Success ◽

Neck Disability Index ◽

Cervical Radiculopathy ◽

Functional Improvement ◽

Promising Alternative ◽

Cervical Discectomy ◽

Neck Disability

OBJECTIVETo the authors’ knowledge, posterior percutaneous full-endoscopic cervical discectomy (PPFECD) has not been reported before as a procedure performed with patients under local anesthesia (LA). In this study, the authors report the outcomes of 25 patients treated by this technique, the surgical steps, and the procedure’s potential advantages.METHODSTwenty-five patients diagnosed with cervical radiculopathy due to soft-disc herniation (SDH) were treated by PPFECD. The intensities of arm and neck pain were measured using the visual analog scale (VAS) and the functional status was assessed using the Neck Disability Index (NDI) preoperatively and at 1, 3, 6, and 12 months postoperatively. Global outcome was also assessed using modified Macnab criteria, and outcomes were grouped as clinical success (excellent or good) and clinical failure (fair or poor). Complications were also recorded.RESULTSNo patient was lost to the follow-up. Significant and durable pain relief and cervical functional improvement were achieved postoperatively. Clinical success was achieved in 24 patients (96%), including 22 excellent and 2 good outcomes at the last follow-up. No serious complications occurred.CONCLUSIONSThe authors’ preliminary experience indicates that PPFECD under LA is a feasible and promising alternative for selected cases of cervical radiculopathy due to SDH, though the procedure’s effectiveness and safety still need confirmation from further studies.

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

Neurosurgical FOCUS ◽

10.3171/2021.3.focus2150 ◽

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.

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Coccygectomy for coccygodynia: a cohort study with a long-term follow-up of up to 29 years

European Spine Journal ◽

10.1007/s00586-020-06627-w ◽

2020 ◽

Author(s):

R. Hochgatterer ◽

M. Gahleitner ◽

J. Allerstorfer ◽

J. Maier ◽

M. Luger ◽

...

Keyword(s):

Conservative Treatment ◽

Clinical Symptoms ◽

Clinical Results ◽

Long Term Results ◽

Level Of Evidence ◽

Superficial Infection ◽

Initial Surgery ◽

Significant Difference

Abstract Purpose We aim to critically review the effectiveness and safety of coccygectomy with special regard to long-term outcomes. Methods Coccygectomy was performed in our clinic in 38 patients between 1990 and 2019. All these patients (32 females vs. 6 males) have failed to respond to conservative treatment for at least 6 months prior to surgery. All patients were available for follow-up after mean 12,3 years (2 months to 29 years, 11 patients had a minimum FUP of 24 years). We evaluated all patients clinically and radiologically. Results Nineteen patients reported traumatic and 17 patients reported idiopathic onset of their symptoms; one patient had clinical symptoms after childbirth and another patient had coccygodynia after extensive low back surgery. 36 of our 38 patients were free of pain at least 6 months after surgery and had good or excellent clinical results according to the VAS which improved from 6.37 (SD 1.08) preoperatively to 0.68 (SD 0.99) at the recent follow-up. Two patients showed an ODI > 22 at the recent follow-up (24 and 28) and 32 had an ODI equal or under 4. There was no statistical significant difference in terms of clinical outcome between the different radiological types of the coccyx. Postoperative complications were rare: 1 superficial infection and one re-operation 6 months after initial surgery due to an pre-existing exostosis which had not been removed at the index surgery; no neurological complications and no major bleeding occurred. No patient had recurrent onset of coccygodynia. 37 out of 38 patients would have coccygectomy again. Conclusions Coccygectomy is a safe treatment option in patients with coccygodynia and shows excellent long-term results. We recommend to perform coccygectomy if patients fail to respond to conservative treatment for 6 months. Level of evidence IV

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Clinical efficacy of autogenous vertebrae-filled polyetheretherketone cage in anterior cervical discectomy and fusion with instrumentation

10.21203/rs.3.rs-411395/v1 ◽

2021 ◽

Author(s):

Xusheng Li ◽

Xuehua Zhan ◽

Long Chang ◽

Yongdong Qiao ◽

Huiqiang Ding ◽

...

Keyword(s):

Postoperative Complications ◽

Blood Loss ◽

Clinical Efficacy ◽

Operative Time ◽

Neck Disability Index ◽

Anterior Cervical Discectomy ◽

Peek Cage ◽

Cervical Discectomy ◽

Significant Difference

Abstract Background. Anterior cervical discectomy and fusion with instrumentation (ACDFI) have been widely used in the treatment of the degenerative disease or traumatic instability of the cervical spine. This study aimed to investigate the clinical efficacy of the autologous vertebral-filled polyetheretherketone (PEEK) cage in anterior cervical discectomy and fusion with instrumentation (ACDFI).Material and Methods. The clinical data of 368 patients who received ACDFI from September 2015 to September 2020 were retrospectively analyzed. According to the material that filled PEEK cage during the surgery, the patients were divided into two groups, the autologous vertebrate group (n = 185) and the autologous iliac group (n = 183). The operative time, operative blood loss, postoperative complications in two groups were recorded and analyzed. The bone graft fusion and postoperative functional outcomes, including scores of modified Japanese Orthopedic Association score (mJOA), Neck Disability Index (NDI), and visual analog scale (VAS) were compared.Results. Patients were followed-up for 14.04 ± 0.98 months. At a 6-months follow-up, the rate of spinal fusion was 96.29% (178/185) in the vertebral group and 95.94% (176/183) in the iliac group, there was no statistically significant difference between the two groups (P>0.05). The postoperative VAS, mJOA, and NDI scores were not significantly different between two groups during the follow-up (P>0.05). The operative time and blood loss in the vertebral group were significantly less than that of the iliac group (P<0.01). In the iliac group, all patients suffered pain in the iliac donor site, 65 patients suffered numbness, 12 patients had fat liquefaction in donor incision, while all patients in the vertebral group had no postoperative complications. Conclusion. The autologous vertebrae-filled PEEK cage can achieve the same clinical outcome as the autologous iliac, but the autologous vertebrae filled PEEK cage have the advantage of shorter operative time, less intraoperative blood loss, and postoperative complications.

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Impact of Age and Duration of Symptoms on Surgical Outcome of Single-Level Microscopic Anterior Cervical Discectomy and Fusion in the Patients with Cervical Spondylotic Radiculopathy

Neuroscience Journal ◽

10.1155/2014/808596 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 8

Author(s):

Farzad Omidi-Kashani ◽

Ebrahim Ghayem Hasankhani ◽

Reza Ghandehari

Keyword(s):

Surgical Outcome ◽

Anterior Cervical Discectomy ◽

Symptom Duration ◽

Duration Of Symptoms ◽

Cervical Discectomy ◽

Single Level ◽

Cervical Spondylotic Radiculopathy ◽

Significant Difference ◽

The Impact

We aim to evaluate the impact of age and duration of symptoms on surgical outcome of the patients with cervical spondylotic radiculopathy (CSR) who had been treated by single-level microscopic anterior cervical discectomy and fusion (ACDF). We retrospectively evaluated 68 patients (48 female and 20 male) with a mean age of 41.2±4.3 (ranged from 24 to 72 years old) in our Orthopedic Department, Imam Reza Hospital. They were followed up for 31.25±4.1 months (ranged from 25 to 65 months). Pain and disability were assessed by Visual Analogue Scale (VAS) and Neck Disability Index (NDI) questionnaires in preoperative and last follow-up visits. Functional outcome was eventually evaluated by Odom’s criteria. Surgery could significantly improve pain and disability from preoperative 6.2±1.4 and 22.2±6.2 to 3.5±2.0 and 8.7±5.2 (1–21) at the last follow-up visit, respectively. Satisfactory outcomes were observed in 89.7%. Symptom duration of more and less than six months had no effect on surgical outcome, but the results showed a statistically significant difference in NDI improvement in favor of the patients aged more than 45 years (P=0.032), although pain improvement was similar in the two groups.

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Comparative evaluation of posterior percutaneous endoscopy cervical discectomy using a 3.7 mm endoscope and a 6.9 mm endoscope for cervical disc herniation: a retrospective comparative cohort study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-03980-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Tong Yu ◽

Jiu-Ping Wu ◽

Jun Zhang ◽

Hai-Chi Yu ◽

Qin-Yi Liu

Keyword(s):

Clinical Outcomes ◽

Disc Herniation ◽

Large Diameter ◽

Clinical Results ◽

Cervical Disc Herniation ◽

Cervical Disc ◽

Cervical Discectomy ◽

Significant Difference ◽

Cord Injury ◽

Percutaneous Endoscopy

Abstract Background Posterior percutaneous endoscopy cervical discectomy (p-PECD) is an effective strategy for the treatment of cervical diseases, with a working cannula ranging from 3.7 mm to 6.9 mm in diameter. However, to date, no studies have been performed to compare the clinical outcomes of the use of endoscopes with different diameters in cervical disc herniation (CDH) patients. The purpose of this study was to compare the clinical outcomes of patients with unilateral CDH treated with p-PECD using a 3.7 mm endoscope and a 6.9 mm endoscope. Methods From January 2016 to June 2018, a total of 28 consecutive patients with single-level CDH who received p-PECD using either the 3.7 mm or the 6.9 mm endoscope were enrolled. The clinical results, including the surgical duration, hospitalization, visual analog scale (VAS) score and modified MacNab criteria, were evaluated. Cervical fluoroscopy, CT, and MRI were also performed during follow-up. Results Tthere was a significant difference in regard to the average identification time of the “V” point (18.608 ± 3.7607 min vs. 11.256 ± 2.7161 min, p < 0.001) and the mean removal time of the overlying tissue (16.650 ± 4.1730 min vs. 12.712 ± 3.3079 min, p < 0.05) for the use of the 3.7 mm endoscope and the 6.9 mm endoscope, respectively. The postoperative VAS and MacNab scores of the two endoscopes were significantly improved compared with those the preoperative scores (p < 0.05). Conclusion The application of both the 3.7 mm endoscope and 6.9 mm endoscope represent an effective method for the treatment of CDH in selected patients, and no significant difference can be observed in the clinical outcomes of the endoscopes. The 6.9 mm endoscope shows superiority to the 3.7 mm endoscope in terms of the efficiency of “V” point identification, the removal of overlying soft tissue and the prevention of spinal cord injury. However, the 6.9 mm endoscope may be inferior to the 3.7 mm endoscope in regards to anterior foraminal decompression due to its large diameter; this result needs to be further evaluated with the support of a large number of randomized controlled trials.

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Management of fresh odontoid fractures using posterior C1–2 fixation without fusion: a long-term clinical follow-up study

Journal of Neurosurgery Spine ◽

10.3171/2021.9.spine21822 ◽

2021 ◽

pp. 1-11

Keyword(s):

Scale Score ◽

Neck Disability Index ◽

Implant Removal ◽

Odontoid Fractures ◽

Significant Difference ◽

Flexion Extension ◽

Group A ◽

Group B

OBJECTIVE Posterior C1–2 fixation without fusion makes it possible to restore atlantoaxial motion after removing the implant, and it has been used as an alternative technique for odontoid fractures; however, the long-term efficacy of this technique remains uncertain. The purpose of the present study was to explore the long-term follow-up outcomes of patients with odontoid fractures who underwent posterior C1–2 fixation without fusion. METHODS A retrospective study was performed on 62 patients with type II/III fresh odontoid fractures who underwent posterior C1–2 fixation without fusion and were followed up for more than 5 years. The patients were divided into group A (23 patients with implant removal) and group B (39 patients without implant removal) based on whether they underwent a second surgery to remove the implant. The clinical outcomes were recorded and compared between the two groups. In group A, the range of motion (ROM) of C1–2 was calculated, and correlation analysis was performed to explore the factors that influence the ROM of C1–2. RESULTS A solid fracture fusion was found in all patients. At the final follow-up, no significant difference was found in visual analog scale score or American Spinal Injury Association Impairment Scale score between the two groups (p > 0.05), but patients in group A had a lower Neck Disability Index score and milder neck stiffness than did patients in group B (p < 0.05). In group A, 87.0% (20/23) of the patients had atlantoodontoid joint osteoarthritis at the final follow-up. In group A, the C1–2 ROM in rotation was 6.1° ± 4.5° at the final follow-up, whereas the C1–2 ROM in flexion-extension was 1.8° ± 1.2°. A negative correlation was found between the C1–2 ROM in rotation and the severity of tissue injury in the atlantoaxial region (r = –0.403, p = 0.024) and the degeneration of the atlantoodontoid joint (r = –0.586, p = 0.001). CONCLUSIONS Posterior C1–2 fixation without fusion can be used effectively for the management of fresh odontoid fractures. The removal of the implant can further improve the clinical efficacy, but satisfactory atlantoaxial motion cannot be maintained for a long time after implant removal. A surgeon should reconsider the contribution of posterior C1–2 fixation without fusion and secondary implant removal in preserving atlantoaxial mobility for patients with fresh odontoid fractures.

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Patient-Reported Outcomes and Patient-Reported Satisfaction After Surgical Treatment for Cervical Radiculopathy

Global Spine Journal ◽

10.1177/2192568218765398 ◽

2018 ◽

Vol 8 (7) ◽

pp. 703-708 ◽

Cited By ~ 12

Author(s):

Andreas Kiilerich Andresen ◽

Rune Tendal Paulsen ◽

Frederik Busch ◽

Alexander Isenberg-Jørgensen ◽

Leah Y. Carreon ◽

...

Keyword(s):

Short Form ◽

Neck Disability Index ◽

Visual Analogue Score ◽

Cervical Radiculopathy ◽

Strongly Correlated ◽

Anterior Cervical Decompression ◽

Sf 36 ◽

Patient Reported ◽

Neck Disability ◽

Cervical Degenerative Disease

Study Design: Retrospective cohort study. Objectives: It is estimated that 10 000 patients seek medical care due to cervical radiculopathy every year in Denmark. Although the natural course is usually favorable, around 20% undergo surgery for cervical degenerative disease every year in Denmark. We aim to evaluate the patient-reported results and satisfaction of anterior cervical decompression and fusion over a 5-year period from a single Danish center for spine surgery. Methods: This study is a retrospective study based on prospectively collected data from 318 consecutive patients treated with anterior cervical decompression and fusion over 1 to 3 levels. Data in the DaneSpine registry was collected pre- and postoperatively, and at 1 year after surgery. The outcome measures were Neck Disability Index (NDI), European Quality of Life 5D (EQ-5D), visual analogue score (VAS), and Short Form-36 Physical Component Summary (SF-36 PCS). Results: Of 318 cases enrolled, 272 (85.5%) had follow-up data available at a minimum 1-year postoperatively. The mean preoperative NDI was 40.0 and improved to 22.7. Mean EQ-5D was 0.50 and improved to 0.70, and mean VAS arm was 60.4 improved to 26.4. All improvements were statistically significant. A total of 74.3% were back to work 1 year after surgery. Achieving minimal clinically important difference (MCID) in VAS neck and SF-36 PCS was strongly correlated to patient satisfaction. Conclusion: Patients who undergo anterior cervical discectomy and fusion can expect improvement in their pain and disability, with 74.3% of patients reporting a positive change in health status after surgery.

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