scholarly journals Longitudinal spinous-splitting laminoplasty with coral bone for the treatment of cervical adjacent segment degenerative disease: A 5-year follow-up study

2020 ◽  
Author(s):  
Wei He ◽  
Qilong Wang ◽  
Wei Tian ◽  
Bing Han ◽  
Yumei Wang ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Neck Disability Index ◽  
Degenerative Disease ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Adjacent Segment ◽  
Vas Score ◽  
Cervical Plate ◽  
Anterior Cervical Plate

Abstract Background: To analyze the causes of cervical adjacent segment degenerative disease (ASDis), explore the surgical results of longitudinal spinous-splitting laminoplasty with coral bone (SLAC) during cervical reoperation, and accumulate data on reoperation with SLAC in a primary hospital.Methods: We conducted a retrospective study. From 1998 to 2014, 52 patients underwent cervical reoperation for ASDis using SLAC at our hospital. Among them, 39 were treated with anterior cervical fusion and internal fixation in the first operation (anterior cervical corpectomy with fusion [ACCF], n=24; anterior cervical discectomy and fusion [ACDF], n=11; and cervical disc arthroplasty [CDA], n=4).Results: In patients who underwent an anterior cervical approach in the first instance, ASDis was significantly higher in the C3/4 gap than in other gaps. In the ACCF group, the lateral radiograph of the cervical spine revealed that the distance between the anterior cervical plate and adjacent segment disc in15 cases (62.5%) was <5 mm, and five cases (12.8%) had internal fixation screws that broke into the annulus of the adjacent segment. After the first SLAC, ASDis occurred in C2/3 and C3/4 in four (30.8%) and eight cases (61.5%), respectively. Post-reoperation, all cases were follow-up for >5 (average, 6.2) years. Comparing pre-reoperation and last follow-up values, the mean Japanese Orthopedic Association score was 10.2±1.5 versus15.5±0.7 (P=0.03), neck disability index was 26.2 versus13.6 points (P=0.01), upper-limb visual analog scale (VAS) score was 6.1 versus2.6 points (P=0.04), and neck and shoulder VAS score was 6.6 versus 2.1 points (P=0.03).Conclusions: ASDis was primarily caused by 1) a distance of <5 mm between the anterior cervical plate and adjacent segment disc and 2) the screw breaking through the adjacent segmental annulus. SLAC proved to be a simple technique, with clear local anatomy and satisfactory clinical results.

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.

scholarly journals Effectiveness comparison of Zero-profile interbody fusion implant and anterior cervical plate interbody fusion device: a clinical and radiological study

2020 ◽  
Author(s):  
Jun Zhang ◽  
Xiangyu Tang ◽  
Wei Xiong ◽  
Hua Wu ◽  
Chaoxu Liu ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Neck Disability Index ◽  
Operation Time ◽  
Degenerative Changes ◽  
Adjacent Segment ◽  
Fusion Device ◽  
Cage Group ◽  
Cervical Plate ◽  
Anterior Cervical Plate ◽  
Interbody Fusion Device

Abstract Purpose This study was to compare the clinical outcomes, radiographic parameters, and complications of anterior cervical discectomy and fusion (ACDF) with a Zero-profile implant (Zero-P) and traditional plate and cage. Methods There were 68 patients received ACDF of single level, 35 patients with Zero-profile implant (Zero-p group) and 33 patients with traditional plate and cage (Cage group), from C3–C7 during 2014 to 2016. Collecting and analyzing of clinical and radiological data were performed. Patients were followed-up at least 1 year after surgery. The operation time, blood loss, Japan Department of Orthopedics Association (JOA) score, pain Visual Analogue Score (VAS), Neck Disability Index (NDI) score and dysphagia score were recorded. Additionally, changes in cervical lordosis, fusion rate and adjacent segment degeneration were analyzed as well. Results For neurologic outcomes, the JOA, VAS and NDI were statistically equivalent between the two groups (P>0.05). For radiographic outcomes, there were no significant differences in the C2-7 Cobb angles, segmental Cobb angle and incidence of subsidence at the final follow-up (P>0.05). No degenerative changes was found in the Zero-p group, whereas 5 patients in the Cage group developed degeneration in adjacent segments (P<0.05). Also, the incidence of postoperative dysphagia is higher in Cage group than in Zero-p group at 3 months and 12 months (P<0.05). Conclusions Both Zero-profile implant and anterior cervical plate interbody fusion device were demonstrated to be effective and safe strategies in this study. Considering the lower incidences of dysphagia and degenerative changes, the Zero-profile implant is a good succedaneum.

scholarly journals Four-year results of a prospective single-arm study on 200 semi-constrained total cervical disc prostheses: clinical and radiographic outcome

2016 ◽  
Vol 25 (5) ◽  
pp. 556-565 ◽  
Author(s):  
Hans-Jörg Meisel ◽  
Lubomír Jurák ◽  
Jussi Antinheimo ◽  
Ricardo Arregui ◽  
Bernhard Bruchmann ◽  
...  
Keyword(s):  
Total Disc Replacement ◽  
Neck Disability Index ◽  
Disc Replacement ◽  
Cervical Disc ◽  
Adjacent Segment ◽  
Radiographic Outcome ◽  
Cervical Disc Replacement ◽  
Arm Pain ◽  
Facet Joint Degeneration

OBJECTIVE Recent studies have described encouraging outcomes after cervical total disc replacement (cTDR), but there are also critical debates regarding the long-term effects of heterotopic ossification (HO) and the prevalence of adjacent-level degeneration. The aim in this paper was to provide 4-year clinical and radiographic outcome results on the activ C disc prosthesis. METHODS A total of 200 subjects underwent single-level activ C (Aesculap AG) implantation between C-3 and C-7 for the treatment of symptomatic degenerative disc disease. Clinical and radiographic assessments were performed preoperatively, intraoperatively, at discharge, and again at 6 weeks, 6 months, 1 year, 2 years, and 4 years. Radiographic evaluations were done by an independent core laboratory using a specific software for quantitative motion analysis. RESULTS Neck Disability Index (NDI) and visual analog scale (VAS) score for neck and arm pain decreased significantly from baseline to the 4-year follow-up. The mean improvement for NDI was 20, for VAS severity and frequency of neck pain 26.4 and 28, and for VAS severity and frequency of arm pain 30.7 and 35.1, respectively. The neurological situation improved for the majority of patients (86.4%); 76.1% of cases were asymptomatic. Subsequent surgical interventions were reported in 7% of the cases, including device removals in 3%. In 2.5% a subsidence greater than 3 mm was recorded; 1 of these cases also had a migration greater than 3 mm. No device displacement, expulsion, disassembly, loose or fractured device, osteolysis, or facet joint degeneration at the index level was observed. Segmental lordotic alignment changed from −2.4° preoperatively to −6.2° at 4 years, and postoperative height was maintained during the follow-up. Advanced HO (Grade III and IV) was present in 27.1% of the cases; 82.4% showed segmental mobility. A progression of radiographic adjacent-segment degeneration occurred in 28.2%, but only 4.5% required surgical treatment. CONCLUSIONS The activ C is a safe and effective device for cervical disc replacement confirming the encouraging results after cTDR. Clinical trial registration no.: NCT02492724 (clinicaltrials.gov)

Ten-Year Outcomes of 1- and 2-Level Cervical Disc Arthroplasty From the Mobi-C Investigational Device Exemption Clinical Trial

Neurosurgery ◽  
2020 ◽  
Author(s):  
Kee Kim ◽  
Greg Hoffman ◽  
Hyun Bae ◽  
Andy Redmond ◽  
Michael Hisey ◽  
...  
Keyword(s):  
Neck Disability Index ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Adjacent Segment ◽  
Disc Disease ◽  
Cervical Arthroplasty ◽  
Disc Arthroplasty ◽  
Arm Pain ◽  
Pain Outcomes ◽  
Neck Disability

Abstract BACKGROUND Short- and mid-term studies have shown the effectiveness of cervical disc arthroplasty (CDA) to treat cervical disc degeneration. OBJECTIVE To report the 10-yr outcomes of a multicenter experience with cervical arthroplasty for 1- and 2-level pathology. METHODS This was a prospective study of patients treated with CDA at 1 or 2 contiguous levels using the Mobi-C® Cervical Disc (Zimmer Biomet). Following completion of the 7-yr Food and Drug Administration postapproval study, follow-up continued to 10 yr for consenting patients at 9 high-enrolling centers. Clinical and radiographic endpoints were collected out to 10 yr. RESULTS At 10 yr, patients continued to have significant improvement over baseline Neck Disability Index (NDI), neck and arm pain, neurologic function, and segmental range of motion (ROM). NDI and pain outcomes at 10 yr were significantly improved from 7 yr. Segmental and global ROM and sagittal alignment also were maintained from 7 to 10 yr. Clinically relevant adjacent segment pathology was not significantly different between 7 and 10 yr. The incidence of motion restricting heterotopic ossification at 10 yr was not significantly different from 7 yr for 1-level (30.7% vs 29.6%) or 2-level (41.7% vs 39.2%) patients. Only 2 subsequent surgeries were reported after 7 yr. CONCLUSION Our results through 10 yr were comparable to 7-yr outcomes, demonstrating that CDA with Mobi-C continues to be a safe and effective surgical treatment for patients with 1- or 2-level cervical degenerative disc disease.

scholarly journals Effectiveness comparison of Zero-profile interbody fusion implant and anterior cervical plate interbody fusion device: a clinical and radiological study

2020 ◽  
Author(s):  
Jun Zhang ◽  
Xiangyu Tang ◽  
Wei Xiong ◽  
Hua Wu ◽  
Chaoxu Liu(Former Corresponding Author) ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Neck Disability Index ◽  
Degenerative Changes ◽  
Adjacent Segment ◽  
Postoperative Dysphagia ◽  
Fusion Device ◽  
Cage Group ◽  
Cervical Plate ◽  
Anterior Cervical Plate ◽  
Interbody Fusion Device

Abstract Background Anterior cervical discectomy and fusion (ACDF) is a successful strategy to relieve the symptoms caused by cervical degenerative disease. Postoperative dysphagia is one complication of this kind of surgery. We performed this study to compare the clinical outcomes, radiographic parameters, and complications of　ACDF with a Zero-profile implant (Zero-P) and titanium plate and cage.Methods There were 68 patients received ACDF of single level, 35 patients with Zero-profile implant (Zero-p group) and 33 patients with traditional plate and cage (Cage group), from C3–C7 during 2014 to 2016. Collecting and analyzing of clinical and radiological data were performed. Patients were followed-up at least 1 year after surgery. The operation time, blood loss, Japan Department of Orthopedics Association (JOA) score, pain Visual Analogue Score (VAS), Neck Disability Index (NDI) score and dysphagia score were recorded. Additionally, changes in cervical lordosis, fusion rate and adjacent segment degeneration were analyzed as well.Results For neurologic outcomes, the JOA, VAS and NDI were statistically equivalent between the two groups (P>0.05). For radiographic outcomes, there were no significant differences in the C2-7 Cobb angles, segmental Cobb angle and incidence of subsidence at the final follow-up (P>0.05). No degenerative changes was found in the Zero-p group, whereas 5 patients in the Cage group developed degeneration in adjacent segments (P<0.05). Also, the incidence of postoperative dysphagia is higher in Cage group than in Zero-p group at 3 months and 12 months (P<0.05).Conclusions Both Zero-profile implant and anterior cervical plate interbody fusion device were demonstrated to be effective and safe strategies in this study. Considering the lower incidences of dysphagia and degenerative changes, the Zero-profile implant is a good succedaneum.

Heterotopic ossification and radiographic adjacent-segment disease after cervical disc arthroplasty

2019 ◽  
Vol 31 (5) ◽  
pp. 660-669 ◽  
Author(s):  
Michael M. H. Yang ◽  
Won Hyung A. Ryu ◽  
Steven Casha ◽  
Stephan DuPlessis ◽  
W. Bradley Jacobs ◽  
...  
Keyword(s):  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Adjacent Segment ◽  
Low Grade ◽  
High Grade ◽  
Artificial Disc ◽  
Disc Arthroplasty ◽  
The Mean ◽  
Index Level

OBJECTIVECervical disc arthroplasty (CDA) is an accepted motion-sparing technique associated with favorable patient outcomes. However, heterotopic ossification (HO) and adjacent-segment degeneration are poorly understood adverse events that can be observed after CDA. The purpose of this study was to retrospectively examine 1) the effect of the residual exposed endplate (REE) on HO, and 2) identify risk factors predicting radiographic adjacent-segment disease (rASD) in a consecutive cohort of CDA patients.METHODSA retrospective cohort study was performed on consecutive adult patients (≥ 18 years) who underwent 1- or 2-level CDA at the University of Calgary between 2002 and 2015 with > 1-year follow-up. REE was calculated by subtracting the anteroposterior (AP) diameter of the arthroplasty device from the native AP endplate diameter measured on lateral radiographs. HO was graded using the McAfee classification (low grade, 0–2; high grade, 3 and 4). Change in AP endplate diameter over time was measured at the index and adjacent levels to indicate progressive rASD.RESULTSForty-five patients (58 levels) underwent CDA during the study period. The mean age was 46 years (SD 10 years). Twenty-six patients (58%) were male. The median follow-up was 29 months (IQR 42 months). Thirty-three patients (73%) underwent 1-level CDA. High-grade HO developed at 19 levels (33%). The mean REE was 2.4 mm in the high-grade HO group and 1.6 mm in the low-grade HO group (p = 0.02). On multivariable analysis, patients with REE > 2 mm had a 4.5-times-higher odds of developing high-grade HO (p = 0.02) than patients with REE ≤ 2 mm. No significant relationship was observed between the type of artificial disc and the development of high-grade HO (p = 0.1). RASD was more likely to develop in the lower cervical spine (p = 0.001) and increased with time (p < 0.001). The presence of an artificial disc was highly protective against degenerative changes at the index level of operation (p < 0.001) but did not influence degeneration in the adjacent segments.CONCLUSIONSIn patients undergoing CDA, high-grade HO was predicted by REE. Therefore, maximizing the implant-endplate interface may help to reduce high-grade HO and preserve motion. RASD increases in an obligatory manner following CDA and is highly linked to specific levels (e.g., C6–7) rather than the presence or absence of an adjacent arthroplasty device. The presence of an artificial disc is, however, protective against further degenerative change at the index level of operation.

Comparative fixation methods of cervical disc arthroplasty versus conventional methods of anterior cervical arthrodesis: serration, teeth, keels, or screws?

2010 ◽  
Vol 12 (2) ◽  
pp. 214-220 ◽  
Author(s):  
Bryan W. Cunningham ◽  
Nianbin Hu ◽  
Candace M. Zorn ◽  
Paul C. McAfee
Keyword(s):  
Iliac Crest ◽  
Screw Fixation ◽  
Fixation Strength ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Pullout Strength ◽  
Disc Arthroplasty ◽  
Low Profile ◽  
Cervical Plate ◽  
Anterior Cervical Plate

Object Using a synthetic vertebral model, the authors quantified the comparative fixation strengths and failure mechanisms of 6 cervical disc arthroplasty devices versus 2 conventional methods of cervical arthrodesis, highlighting biomechanical advantages of prosthetic endplate fixation properties. Methods Eight cervical implant configurations were evaluated in the current investigation: 1) PCM Low Profile; 2) PCM V-Teeth; 3) PCM Modular Flange; 4) PCM Fixed Flange; 5) Prestige LP; 6) Kineflex/C disc; 7) anterior cervical plate + interbody cage; and 8) tricortical iliac crest. All PCM treatments contained a serrated implant surface (0.4 mm). The PCM V-Teeth and Prestige contained 2 additional rows of teeth, which were 1 mm and 2 mm high, respectively. The PCM Modular and Fixed Flanged devices and anterior cervical plate were augmented with 4 vertebral screws. Eight pullout tests were performed for each of the 8 conditions by using a synthetic fixation model consisting of solid rigid polyurethane foam blocks. Biomechanical testing was conducted using an 858 Bionix test system configured with an unconstrained testing platform. Implants were positioned between testing blocks, using a compressive preload of −267 N. Tensile load-to-failure testing was performed at 2.5 mm/second, with quantification of peak load at failure (in Newtons), implant surface area (in square millimeters), and failure mechanisms. Results The mean loads at failure for the 8 implants were as follows: 257.4 ± 28.54 for the PCM Low Profile; 308.8 ± 15.31 for PCM V-Teeth; 496.36 ± 40.01 for PCM Modular Flange; 528.03± 127.8 for PCM Fixed Flange; 306.4 ± 31.3 for Prestige LP; 286.9 ± 18.4 for Kineflex/C disc; 635.53 ± 112.62 for anterior cervical plate + interbody cage; and 161.61 ± 16.58 for tricortical iliac crest. The anterior plate exhibited the highest load at failure compared with all other treatments (p < 0.05). The PCM Modular and Fixed Flange PCM constructs in which screw fixation was used exhibited higher pullout loads than all other treatments except the anterior plate (p < 0.05). The PCM VTeeth and Prestige and Kineflex/C implants exhibited higher pullout loads than the PCM Low Profile and tricortical iliac crest (p < 0.05). Tricortical iliac crest exhibited the lowest pullout strength, which was different from all other treatments (p < 0.05). The surface area of endplate contact, measuring 300 mm2 (PCM treatments), 275 mm2 (Prestige LP), 250 mm2 (Kineflex/C disc), 180 mm2 (plate + cage), and 235 mm2 (tricortical iliac crest), did not correlate with pullout strength (p > 0.05). The PCM, Prestige, and Kineflex constructs, which did not use screw fixation, all failed by direct pullout. Screw fixation devices, including anterior plates, led to test block fracture, and tricortical iliac crest failed by direct pullout. Conclusions These results demonstrate a continuum of fixation strength based on prosthetic endplate design. Disc arthroplasty constructs implanted using vertebral body screw fixation exhibited the highest pullout strength. Prosthetic endplates containing toothed ridges (≥ 1 mm) or keels placed second in fixation strength, whereas endplates containing serrated edges exhibited the lowest fixation strength. All treatments exhibited greater fixation strength than conventional tricortical iliac crest. The current study offers insights into the benefits of various prosthetic endplate designs, which may potentially improve acute fixation following cervical disc arthroplasty.

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