Surgical treatment of degenerative cervical spine diseases: Analyses of 90 patients clinical study

The effect of degenerative cervical spine surgery depends on good understanding of the pathogenesis and clinical course of disease with a detailed neurological and neuroradiological examination. Surgical approach should be considered separately for each pathological substrate in order to avoid additional morbidity. The aim of our study is to present the results of treatment through analysis of large clinical series focusing on anterior surgical approach with iliac crest graft fusion without cervical plating. The retrospective analysis of 90 patients operated on Neurosurgery of CHC Zemun, from 2008 to 2011, was done. In 81 patients cervical disc herniation was found in one or two levels, and 9 patients had spinal canal stenosis with polydiscopathy. Preoperatively 50 patients had cervical myelopathy, and 40 patients had radiculopathy as dominating clinical sign. Anterior cervical approach was performed in 79 patients, and 11 patients were operated by posterior approach. The treatment outcome was as follows: good outcome 16 (16.8%) patients, improved condition 65 (72.2%), without improvement 6 (6.7%), bad outcome 3 (4.3%). The anterior cervical approach with iliac crest autologous graft fusion, and without additional cervical plating, is reliable treatment option with results comparable to reported clinical series with sintetic graft placement and anterior cervical plate stabilisation.

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The Application of Endoscopic Technique in High Cervical Anterior Approach to the Craniovertebral Junction

10.21203/rs.3.rs-133410/v1 ◽

2020 ◽

Author(s):

Jiangtao Liu ◽

Hongming Ji ◽

Gangli Zhang ◽

Shengli Chen ◽

Shiyuan Zhang ◽

...

Keyword(s):

Cervical Spine ◽

Surgical Approach ◽

Anterior Approach ◽

Craniovertebral Junction ◽

Close Proximity ◽

Cervical Approach ◽

Anterior Cervical Approach ◽

Surgical Corridor ◽

High Cervical ◽

Neurovascular Structures

Abstract Objectives: Surgery on the craniovertebral junction (CVJ) presents particular challenges owing to the close proximity of critical neurovascular structures and the brainstem. It is difficult for classic approaches to obtain the extra exposure of neurovascular structures of the CVJ in practice.The surgical approach to the craniovertebral junction (CVJ) offers specific challenges. We explored the feasibility of an endoscope-assisted high anterior cervical approach to the CVJ. Methods: We quantitatively assessed the surgical corridor to, and extent of exposure of, the CVJ in six cadaveric specimens, using 0° and 30° endoscopes. Results: The endoscope provided sufficient exposure of neurovascular structures and the brainstem in the CVJ. Resection of the anterior arch of C1 was avoided in minimal anterior clivectomy. After removing the odontoid, greater exposure of the CVJ was obtained. Conclusion: An endoscope-assisted high anterior cervical approach to the CVJ preserves cervical spine stability while minimizing the risk of neurovascular injury within the surgical corridor.

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Evaluation of Cervical Spine Surgery by Postoperative Myelography

Neurosurgery ◽

10.1227/00006123-198304000-00008 ◽

1983 ◽

Vol 12 (4) ◽

pp. 416-421 ◽

Cited By ~ 8

Author(s):

Charles A. Fager

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Nerve Root ◽

Spontaneous Remission ◽

Cord Compression ◽

Cervical Disc ◽

Nerve Root Compression ◽

Cervical Fusion ◽

Cervical Spine Surgery ◽

Cervical Spine Fusion

Abstract After spontaneous remission of nerve root compression, a myelographic defect may persist. Similarly, myelopathy may remain nonprogressive for long periods despite appreciable myelographic deformity. Although operation may arrest or improve the symptoms of cervical disc lesions and spondylosis, the ultimate confirmation that entrapped neural elements have been relieved permanently can only be provided by postoperative myelography. Preoperative and postoperative myelography documents the significant improvement that can be achieved by using posterolateral and posterior approaches to the cervical spine in patients with nerve root or spinal cord compression. The results in this group of patients were achieved with none of the disadvantages or complications of cervical spine fusion or of the interbody removal of cervical disc tissue, also leading to cervical fusion.

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A Correlation Analysis Between Postoperative Dysphagia and Change of C2-C7 Angle after Anterior Cervical Spine Surgery

10.21203/rs.3.rs-200427/v1 ◽

2021 ◽

Author(s):

Jie Yu ◽

Xiaohui Tao

Keyword(s):

Cervical Spine ◽

Spinal Surgery ◽

Cervical Disc ◽

Cervical Lordosis ◽

Postoperative Dysphagia ◽

Cervical Spine Surgery ◽

Cervical Disc Replacement ◽

Anterior Cervical Spine Surgery ◽

Angle Change

Abstract Background. Dysphagia after cervical spinal surgery is one of highly prevalent comorbidities in clinical practice. Studies suggest that excessive O-C2 angle change at occipital-cervical fusion causes the oropharyngeal volume reduction leading to severe dysphagia and even respiratory distress after operation. However, rare study has accessed the impact of C2-C7 angle change on the occurrence of dysphagia after anterior cervical spinal surgery. Methods. From June 2007 to May 2010, A total of 198 patients was treated with anterior cervical decompression and plate fixation and 12 months follow-up was completed in 172 patients. Within the same session, a total of 154 patients underwent anterior cervical disc replacement and at least 1-year follow-up was completed in 98 patients. All 270 patients who participated in this study completed a questionnaire (Bazaz dysphagia questionnaire) after telephone follow-up including the onset and time of appearance of dysphagia, symptom relief, treatment plan and so on. To determine whether excessive cervical lordosis change (change of C2-C7 angle) and other risk factors were associated with the dysphagia symptom, all patients were divided into the dysphagia group and the control group, followed over 12 months.Results. The results showed that 12.8% presented with postoperative dysphagia in anterior cervical discectomy and fusion (ACDF) group and 5.1% in cervical disc replacement (CDR) group. According to the regression equation, the excessive change of C2-C7 angle can significantly increase the incidence rate of postoperative dysphagia. The incidence rate of postoperative dysphagia in patients whose C2-C7 angle change more than 5 degree was significantly greater than patients less than 5 degree. Sex, age, BMI, operation time, blood loss, surgery approach (anterior/posterior), revision ratio, the number of surgical segments, the highest surgical segment, and C3 segment included or not cannot affect the occurrence of dysphagia. Conclusions. Dysphagia after cervical spinal surgery is one of highly prevalent comorbidities. Cervical lordosis change is an important influencing factor on the occurrence of dysphagia after anterior cervical spine surgery.

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Surgical Approach to Radicular Pain of the Degenerative Cervical Spine

Cervical Spondylosis and Similar Disorders ◽

10.1142/9789812812704_0018 ◽

1998 ◽

pp. 441-453

Author(s):

D. GROB

Keyword(s):

Cervical Spine ◽

Surgical Approach ◽

Radicular Pain ◽

Degenerative Cervical Spine

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Orthostatic Hypotension Following Cervical Spine Surgery: Prevalence and Risk Factors

Global Spine Journal ◽

10.1177/2192568219863805 ◽

2019 ◽

Vol 10 (5) ◽

pp. 578-582

Author(s):

Edward Tien-En Ong ◽

Lincoln Kai-Pheng Yeo ◽

Arun-Kumar Kaliya-Perumal ◽

Jacob Yoong-Leong Oh

Keyword(s):

Risk Factors ◽

Cervical Spine ◽

Orthostatic Hypotension ◽

Functional Status ◽

Spine Surgery ◽

Surgical Approach ◽

Mechanism Of Injury ◽

Medical Comorbidities ◽

Cervical Spine Surgery ◽

Cord Injury

Study Design: Retrospective case series. Objectives: This study aims to determine the prevalence and risk factors for orthostatic hypotension (OH) in patients undergoing cervical spine surgery. Methods: Data was collected from records of 190 consecutive patients who underwent cervical spine procedures at our center over 24 months. Statistical comparison was made between patients who developed postoperative OH and those who did not by analyzing characteristics such as age, gender, premorbid medical comorbidities, functional status, mechanism of spinal cord injury, preoperative neurological function, surgical approach, estimated blood loss, and length of stay. Results: Twenty-two of 190 patients (11.6%) developed OH postoperatively. No significant differences in age, gender, medical comorbidities, or premorbid functional status were observed. Based on univariate comparisons, traumatic mechanism of injury ( P = .002), poor ASIA (American Spinal Injury Association) grades (A, B, or C) ( P < .001), and posterior surgical approach ( P = .045) were found to significantly influence occurrence of OH. Among the significant variables, after adjusting for mechanism of injury and surgical approach, only ASIA grade was found to be an independent predictor. Having an ASIA grade of A, B, or C increased the likelihood of developing OH by approximately 5.978 times ( P = .003). Conclusion: Our study highlights that OH is not an uncommon manifestation following cervical spine surgery. Patients with poorer ASIA grades A, B, or C were more likely to have OH when compared with those with ASIA grades D or E (43.5% vs 7.2%). Hence, we suggest that postural blood pressure should be routinely monitored in this group of patients so that early intervention can be initiated.

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ANTERIOR CERVICAL APPROACH FOR THE TREATMENT OF CERVICAL MYELOPATHY

Neurosurgery ◽

10.1227/01.neu.0000215399.67006.05 ◽

2007 ◽

Vol 60 (suppl_1) ◽

pp. S1-64-S1-70 ◽

Cited By ~ 19

Author(s):

Paul G. Matz ◽

Patrick R. Pritchard ◽

Mark N. Hadley

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Surgical Technique ◽

Cervical Myelopathy ◽

Cervical Spondylotic Myelopathy ◽

Clinical Symptoms ◽

Recovery Of Function ◽

Surgical Decompression ◽

Cervical Approach ◽

Anterior Cervical Approach

Abstract COMPRESSION OF THE spinal cord by the degenerating cervical spine tends to lead to progressive clinical symptoms over a variable period of time. Surgical decompression can stop this process and lead to recovery of function. The choice of surgical technique depends on what is causing the compression of the spinal cord. This article reviews the symptoms and assessment for cervical spondylotic myelopathy (clinically evident compression of the spinal cord) and discusses the indications for decompression of the spinal cord anteriorly.

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Complications of the anterior retropharyngeal surgical approach to the degenerative cervical spine

BMC Proceedings ◽

10.1186/1753-6561-6-s4-o3 ◽

2012 ◽

Vol 6 (S4) ◽

Author(s):

S Mihaylova ◽

D Ferdinandov ◽

K Ninov ◽

A Bussarsky ◽

V Karakostov ◽

...

Keyword(s):

Cervical Spine ◽

Surgical Approach ◽

Degenerative Cervical Spine

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Postoperative Urinary Retention Following Anterior Cervical Spine Surgery for Degenerative Cervical Disc Diseases

Clinics in Orthopedic Surgery ◽

10.4055/cios.2013.5.2.134 ◽

2013 ◽

Vol 5 (2) ◽

pp. 134 ◽

Cited By ~ 15

Author(s):

Hyun Ju Jung ◽

Jong-Beom Park ◽

Chae-Gwan Kong ◽

Young-Yul Kim ◽

Jangsu Park ◽

...

Keyword(s):

Cervical Spine ◽

Urinary Retention ◽

Spine Surgery ◽

Cervical Disc ◽

Postoperative Urinary Retention ◽

Cervical Spine Surgery ◽

Anterior Cervical Spine Surgery

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CERVICAL SPINE REOPERATION RATES AND HOSPITAL RESOURCE UTILIZATION AFTER INITIAL SURGERY FOR DEGENERATIVE CERVICAL SPINE DISEASE IN 12 338 PATIENTS IN WASHINGTON STATE

Neurosurgery ◽

10.1227/01.neu.0000360347.10596.bd ◽

2009 ◽

Vol 65 (6) ◽

pp. 1011-1023 ◽

Cited By ~ 35

Author(s):

Joseph T. King ◽

Khalid M. Abbed ◽

Grahame C. Gould ◽

Edward C. Benzel ◽

Zoher Ghogawala

Keyword(s):

Cervical Spine ◽

Length Of Stay ◽

Primary Diagnosis ◽

Hospital Charges ◽

Fusion Surgery ◽

Cervical Spine Surgery ◽

Degenerative Cervical Spine ◽

Reoperation Rates ◽

Spine Disease ◽

Degenerative Cervical Spine Disease

Abstract OBJECTIVE Patients undergoing surgery for degenerative cervical spine disease may require future surgery for disease progression. We investigated factors related to the rate of additional cervical spine surgery, the associated length of stay, and hospital charges. METHODS The was a longitudinal retrospective cohort study using Washington state's 1998 to 2002 state inpatient databases and International Classification of Diseases–Ninth Revision–Clinical Modification (ICD-9) codes to analyze patients undergoing degenerative cervical spine surgery. Multivariate Poisson regression to identify patient and surgical factors associated with reoperation for degenerative cervical spine disease was used. Multivariate linear regressions to identify factors associated with length of stay and hospital charges adjusted for age, sex, year of surgery, primary diagnosis, payment type, discharge status, and comorbidities were also used. RESULTS A total of 12 338 patients underwent initial cervical spine surgeries from 1998 to 2002; the mean follow-up duration was 2.3 years, and 688 patients (5.6%) underwent a reoperation (2.5% per year). Higher reoperation rates were independently associated with younger patients (P < 0.001) and a primary diagnosis of disc herniation with myelopathy (P = 0.011). Ventral surgery (P < 0.001) and fusion (P < 0.001) were both associated with lower rates of reoperation; however, a high correlation (Spearman's rho = 0.82; P < 0.001) made it impossible to determine which factor was dominant. Longer length of stay was independently associated with nonventral approaches (+1.0 day; P < 0.001) and fusion surgery (+0.8 day; P < 0.001). Greater hospital charges were independently associated with nonventral approaches (+$2900; P < 0.001) and fusion surgery (+$9600; P < 0.001). CONCLUSION Patients undergoing surgery for degenerative cervical spine disease undergo reoperations at the rate of 2.5% per year. An initial ventral approach and/or fusion seem to be associated with lower reoperation rates. An initial nonventral approach and fusion were more expensive.

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