Outcome Study of Anterior Cervical Discectomy and Fusion with Lordotic Cage Insertion

Intervertebral Disk ◽

P Value ◽

Sagittal Vertical Axis ◽

Cervical Discectomy ◽

Radiographic Outcomes ◽

Disk Height

Objective: This study retrospectively evaluated the clinical and radiographic outcomes following the use of a lordotic cage in anterior cervical discectomy and fusion (ACDF).Material and Methods: All patients who underwent ACDF, at Vajira Hospital; between May 2017 and May 2020, were included in this study. Radiographic images were used to evaluate the device-level Cobb angle (DLCA), segmental Cobb angle (SCA), global Cobb angle (GCA), sagittal vertical axis (SVA), sagittal alignment (SA), and intervertebral disk height. The visual analog scale (VAS) for neck pain, and the Japanese Orthopaedic Association (JOA) score were reviewed as part of the patient’s medical records. Preoperative DLCA, SCA, GCA, SVA, SA, and intervertebral disk height measurements were compared with postoperative measurements at 1 year.Results: A total of 51 patients (88 disks), having undergone ACDF with lordotic cage insertion were included in this study. The initial curvature of the cervical spine was diagnosed as kyphosis in 30 (58.8%) patients, and as lordosis in 21 (41.2%) patients. There was significant improvement in the VAS, JOA, DLCA, SCA, GCA, SVA, SA, and intervertebral disk height after ACDF (p-value<0.050). In patients with preoperative kyphosis, the greatest changes were observed in the GCA (p-value=0.004).Conclusion: The use of a lordotic cage in ACDF improved both the clinical and radiographic outcomes of all postoperative parameters, regardless of the patient’s preoperative cervical spine curvature; although, patients with preoperative kyphosis had greater improvement in GCA.

Four-Level Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy

Journal of Orthopaedic Surgery ◽

10.1177/1602400313 ◽

2016 ◽

Vol 24 (3) ◽

pp. 338-343 ◽

Cited By ~ 4

Author(s):

Shan-Jin Wang ◽

Bin Ma ◽

Yu-Feng Huang ◽

Fu-Min Pan ◽

Wei-Dong Zhao ◽

...

Keyword(s):

Cobb Angle ◽

Cervical Spondylotic Myelopathy ◽

Neck Disability Index ◽

Disc Height ◽

Radiographic Evaluation ◽

Cervical Discectomy ◽

Arm Pain ◽

The Mean

Purpose To review the outcome of 32 consecutive patients who underwent 4-level anterior cervical discectomy and fusion (ACDF) with cages and plates and were followed up for at least 5 years. Methods Records of 19 men and 13 women aged 48 to 69 years who underwent 4-level ACDF with cages and plates for myelopathy (n=11) or myeloradiculopathy (n=21) at C3 to C7 by a single surgeon and were followed up for a minimum of 5 years were reviewed. Clinical outcome was assessed using the visual analogue scale (VAS), Neck Disability Index (NDI), and modified Japanese Orthopaedic Association (JOA) score for pain or myelopathic symptoms. Radiographic evaluation included fusion rate, range of motion, cervical lordosis (C2-to-C7 Cobb angle), and disc height. Results The mean follow-up was 66 months. All patients had good recovery of muscle strength and resolution of limb sensory disturbance, except for 4 who still had some numbness. The mean VAS for neck and arm pain improved from 14.2 to 6.84 (p=0.012); the mean NDI improved from 31.62 to 12.17 (p<0.01); and the mean JOA score improved from 10.1 to 13.9 (p=0.027). The mean percentage of recovery was 62.9. The mean Cobb angle improved from 10.24° to 1.28° (p=0.019); the mean disc height improved from 4.12 to 6.58 mm (p<0.01). 30 (94%) patients achieved solid fusion. Conclusion Multilevel ACDF using PEEK cages and plates is safe and effective for multilevel cervical spondylotic myelopathy and achieves satisfactory mid-term outcome.

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

10.21203/rs.2.12368/v1 ◽

2019 ◽

Author(s):

Penghuan Wu ◽

Aidong Yuan ◽

Shaoxiong Min ◽

Benchao Shi ◽

Anmin Jin

Keyword(s):

Cobb Angle ◽

Standard Procedure ◽

Neck Disability Index ◽

Operation Time ◽

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.

P92. Adjacent disc pressure and facet force comparison for cervical spine arthroplasty with Spinal Kinetics, Prodisc-C, Prestige artificial discs, and anterior cervical discectomy and fusion

The Spine Journal ◽

10.1016/j.spinee.2005.05.307 ◽

2005 ◽

Vol 5 (4) ◽

pp. S154-S156 ◽

Cited By ~ 1

Author(s):

Daniel Kim ◽

Jesse Limm ◽

Max Lee ◽

Jon Park

Keyword(s):

Cervical Spine ◽

Cervical Discectomy ◽

Adjacent Disc

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

Journal of International Medical Research ◽

10.1177/0300060519884828 ◽

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 ◽

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.

Overpowering the Previously Posterior Instrumented Cervical Spine With Cage-Assisted Anterior Cervical Discectomy and Fusion: A Cadaveric Study

Spine Deformity ◽

10.1016/j.jspd.2018.02.005 ◽

2018 ◽

Vol 6 (5) ◽

pp. 492-497

Author(s):

Philip Saville ◽

Rikesh A. Gandhi ◽

Harvey E. Smith ◽

Vincent Arlet

Keyword(s):

Cervical Spine ◽

Cadaveric Study ◽

Cervical Discectomy

Late deep cervical infection after anterior cervical discectomy and fusion: a case report and literature review

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2783-x ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Ying-Chun Chen ◽

Lin Zhang ◽

Er-Nan Li ◽

Li-Xiang Ding ◽

Gen-Ai Zhang ◽

...

Keyword(s):

Cervical Spine ◽

Esophageal Perforation ◽

Radical Neck Dissection ◽

Titanium Implant ◽

Antibiotic Administration ◽

Cervical Discectomy ◽

Cervical Infection ◽

Unstable Cervical Spine ◽

Degenerative Cervical Spine

Abstract Background Anterior cervical discectomy and fusion (ACDF) is often performed for the treatment of degenerative cervical spine. While this procedure is highly successful, 0.1–1.6% of early and late postoperative infection have been reported although the rate of late infection is very low. Case presentation Here, we report a case of 59-year-old male patient who developed deep cervical abscess 30 days after anterior cervical discectomy and titanium cage bone graft fusion (autologous bone) at C3/4 and C4/5. The patient did not have esophageal perforation. The abscess was managed through radical neck dissection approach with repated washing and removal of the titanium implant. Staphylococcus aureus was positively cultured from the abscess drainage, for which appropriate antibiotics including cefoxitin, vancomycin, levofloxacin, and cefoperazone were administered postoperatively. In addition, an external Hallo frame was used to support unstable cervical spine. The patient’s deep cervical infection was healed 3 months after debridement and antibiotic administration. His cervial spine was stablized 11 months after the surgery with support of external Hallo Frame. Conclusions This case suggested that deep cervical infection should be considered if a patient had history of ACDF even in the absence of esophageal perforation.

Utility of modified transarticular screw in the middle and lower cervical spine as intermediate fixation in posterior long fusion surgery

Journal of Neurosurgery Spine ◽

10.3171/2009.5.spine08348 ◽

2009 ◽

Vol 11 (5) ◽

pp. 555-561 ◽

Cited By ~ 11

Author(s):

Hiroshi Miyamoto ◽

Masatoshi Sumi ◽

Koki Uno

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Cobb Angle ◽

Nerve Root ◽

Transarticular Screw ◽

Fusion Surgery ◽

Nerve Root Injury ◽

A New Technique

Object The use of a pedicle screw (PS) in the cervical spine ensures strong fixation. However, 6.7–29% of such screws appear to be malpositioned using manual insertion techniques, especially at C-3 to C-6 where the pedicle diameter is smaller, potentially causing catastrophic complications such as vertebral artery (VA) and spinal cord or nerve root injuries. To optimize safety, the authors use a new technique: cephalad and/or caudad ends at C-2 and C-7/T-1, respectively, are fixed with PSs, and intermediate points around C3–6 are fixed using a modified transarticular screw technique that captures 3 dorsal cortices and preserves the ventral cortex of the facet in posterior long fusion surgery involving occipitospinal fixation. The purpose of the present study was to demonstrate this technique and evaluate the clinical and radiological outcomes. Methods Thirty-nine patients, 8 men and 31 women, with a mean age of 61.7 ± 11.0 years at surgery, were included in the study. Twenty-eight occipitospinal fusions and 11 posterior long fusions were performed. Patients were divided into 2 groups: a rheumatoid arthritis (RA) group consisting of 26 patients and a non-RA group of 13 patients including 7 with athetoid cerebral palsy. Clinical outcomes were evaluated according to the Japanese Orthopaedic Association (JOA) score. For radiological evaluation, the Cobb angle on lateral radiographs was measured preoperatively, postoperatively, and at the final follow-up, and the degree of realignment from pre- to postoperation and the loss of correction from postoperation to the follow-up were compared between the 2 patient groups. Results The recovery rate of the JOA score was 50.6 ± 20.7% in the RA group and 37.3 ± 24.3% in the non-RA group. Neither VA injury nor spinal cord or nerve root injury occurred among this series. The degree of realignment was greater in the non-RA group (9.2 ± 13.9°) than the RA group (1.4 ± 12.7°) as the Cobb angle was more kyphotic preoperatively in the non-RA group (2.9 ± 18.6°) than in the RA group (17.4 ± 15.7°). However, 38.5% of patients in the non-RA group had a correction loss > 10% compared with 7.7% in the RA group; this difference was statistically significant. Conclusions The featured transarticular screw technique, which preserves the ventral cortex of the facet, as intermediate fixation in long fusion is a safe and easy procedure with few complications. It ensures acceptable clinical and radiological outcomes, especially in patients with RA.