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

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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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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Postoperative structured rehabilitation in patients undergoing surgery for cervical radiculopathy: a 2-year follow-up of a randomized controlled trial

Journal of Neurosurgery Spine ◽

10.3171/2018.12.spine181258 ◽

2019 ◽

Vol 31 (1) ◽

pp. 60-69 ◽

Cited By ~ 1

Author(s):

Anneli Peolsson ◽

Håkan Löfgren ◽

Åsa Dedering ◽

Birgitta Öberg ◽

Peter Zsigmond ◽

...

Keyword(s):

Controlled Trial ◽

Neck Disability Index ◽

Clinical Signs ◽

Cervical Radiculopathy ◽

Postoperative Rehabilitation ◽

Clinical Trial Registration ◽

Randomized Controlled ◽

Negative Side Effects ◽

Neck Disability

OBJECTIVEInformation about postoperative rehabilitation for cervical radiculopathy (CR) is scarce. The aim of this study was to investigate the additional benefits of structured postoperative rehabilitation (SPT), which was performed in all patients, compared with a pragmatic standard postoperative approach (SA), in which rehabilitation was used as needed and patients sought physiotherapy on their own without a referral, in patients with MRI evidence of disc herniation and concomitant clinical signs who underwent surgery for CR.METHODSPatients (n = 202) were randomized to receive SPT or SA. Included key variables in the present study were primary and selected secondary outcomes of a prospective randomized controlled multicenter study. The main outcome was the Neck Disability Index (NDI) score. The NDI score, pain variables, self-efficacy, and health-related quality of life were investigated at baseline and 3, 6, 12, and 24 months postoperatively.RESULTSSPT provided no additional benefits over SA (p = 0.08 to p = 0.99) at the postoperative 2-year follow-up. Both groups improved over time (p < 0.0001), with no reported adverse effects.CONCLUSIONSOne can conclude that SPT offered no additional benefits over SA; however, patients tolerated postoperative neck exercises without any negative side effects. These findings are important for the development of future active and neck-specific postoperative rehabilitation interventions for patients with CR.Clinical trial registration no.: NCT01547611 (clinicaltrials.gov)

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STAND-ALONE CERVICAL CAGE FOR CERVICAL RADICULOPATHY: A RETROSPECTIVE STUDY

(JOINTS) Journal Orthopaedi and Traumatology Surabaya ◽

10.20473/joints.v9i1.2020.17-21 ◽

2020 ◽

Vol 9 (1) ◽

pp. 17

Author(s):

I Ketut Martiana ◽

Reyner Valiant Tumbelaka

Keyword(s):

Neck Disability Index ◽

Cervical Radiculopathy ◽

Surgical Method ◽

Arm Pain ◽

Phone Calls ◽

Specific Muscle ◽

Muscle Groups ◽

Hospital Institution ◽

Neck Disability

Introduction: Cervical radiculopathy is a clinical condition characterized by unilateral arm pain, numbness and tingling in a dermatomal distribution in the hand, and weakness in specific muscle groups that can be treated with nonsurgical or surgical method. This study aims to evaluate the outcome of the stand-alone cervical cage surgical method for cervical radiculopathy in our hospital institution from 2013 to 2017Methods: This is a retrospective observational study on every patient who undergoes a stand-alone cervical cage for cervical radiculopathy in our hospital institution from 2013 to 2017. The study runs from December 2017 until April 2018. We evaluated the clinical outcome with the Neck Disability Index (NDI). The data were collected from medical records, and postoperative follow up is done by house visits, phone calls, and outpatient visits.Results: Five male and one female subjects with a mean age of 58 years old (45–65 years old) underwent the procedure; one patient passed away on three year postoperative due to other events not related to operation procedure; one patient could no longer be reached. Four patient has an increasing score of NDI postoperative. There is no postoperative complicationConclusion: Stand-alone cervical cage is an excellent treatment for cervical radiculopathy in our hospital institution from 2013 to 2017.

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

10.21203/rs.2.20402/v1 ◽

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.

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Percutaneous Endoscopic Cervical Discectomy versus Anterior Cervical Discectomy and Fusion: A Comparative Cohort Study with a Five-Year Follow-Up

Journal of Clinical Medicine ◽

10.3390/jcm9020371 ◽

2020 ◽

Vol 9 (2) ◽

pp. 371 ◽

Cited By ~ 2

Author(s):

Yong Ahn ◽

Han Joong Keum ◽

Sang Ha Shin

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Disc Herniation ◽

Invasive Surgery ◽

Neck Disability Index ◽

Anterior Cervical Discectomy ◽

Cervical Disc Herniation ◽

Cervical Disc ◽

Cervical Discectomy ◽

Neck Disability

Percutaneous endoscopic cervical discectomy (PECD) is an effective minimally invasive surgery for soft cervical disc herniation in properly selected cases. The current gold standard is anterior cervical discectomy and fusion (ACDF). However, few studies have evaluated the outcome of PECD compared with ACDF. We compared the surgical results of PECD and ACDF. Data from patients treated with single-level PECD (n = 51) or ACDF (n = 64) were analyzed. Patients were prospectively entered into the clinical database and their records were retrospectively reviewed. Perioperative data and clinical outcomes were evaluated using the visual analogue scale (VAS), Neck Disability Index (NDI), and modified Macnab criteria. VAS and NDI results significantly improved in both groups. The rates of excellent or good results were 88.24% and 90.63% in the PECD and ACDF group, respectively. The revision rates were 3.92% and 1.56% in the PECD and ACDF group, respectively. Operative time, hospital stay, and time to return to work were reduced in the PECD group compared to the ACDF group (p < 0.001). The five-year outcomes of PECD were comparable to those of conventional ACDF. PECD provided the typical benefits of minimally invasive surgery and may be an effective alternative for treating soft cervical disc herniation.

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Posterior endoscopic cervical foramiotomy and discectomy: clinical and radiological computer tomography evaluation on the bony effect of decompression with 2 years follow-up

European Spine Journal ◽

10.1007/s00586-020-06637-8 ◽

2020 ◽

Author(s):

Pang Hung Wu ◽

Hyeun Sung Kim ◽

Yeon Jin Lee ◽

Dae Hwan Kim ◽

Jun Hyung Lee ◽

...

Keyword(s):

Cervical Spine ◽

Clinical Outcomes ◽

Analogue Scale ◽

Neck Disability Index ◽

Cervical Radiculopathy ◽

3D Ct ◽

Retrospective Evaluation ◽

Neck Disability ◽

Cervical Foraminotomy

Abstract Purpose Cervical radiculopathy is a common disabling cervical spine condition. Open anterior and posterior approaches are the conventional surgical treatment approaches with good clinical outcomes. However, the soft tissue damage in these procedures can lead to increase perioperative morbidity. Endoscopic spine surgery provides more soft tissue preservation than conventional approaches. We investigate the radiological and clinical outcomes of posterior endoscopic cervical foraminotomy and discectomy. Methods A prospective clinical and radiological study with retrospective evaluation were done for 25 patients with 29 levels of cervical radiculopathy who underwent posterior endoscopic cervical discectomy from November 2016 to December 2018. Clinical outcomes of Visual Analogue Scale, Neck Disability Index and MacNab’s score were evaluated at pre-operative, post-operative 1 week, 3 months and final follow-up. Preoperative and post-operative final follow-up flexion and extension roentgenogram were evaluated for cervical stability assessment. Pre-operative and post-operative computer tomography cervical spine evaluation of foraminal length in ventro-dorsal, cephalad-caudal dimensions, sagittal foraminal area and using 3D CT reconstruction coronal decompression area were done. Results Twenty-nine levels of cervical radiculopathy underwent posterior endoscopic cervical decompression. The mean follow-up was 29.6 months, and the most common levels affected were C5/6 and C6/7. There was a complication rate of 12% with 2 cases of neurapraxia and one case of recurrent of prolapsed disc. There was no revision surgery in our series. There was significant clinical improvement in Visual Analogue Scale and Neck Disability Index. Prospective comparative study between preoperative and final follow-up mean improvement in VAS score was 5.08 ± 1.75, and NDI was 45.1 ± 13.3. Ninety-two percent of the patients achieved good and excellent results as per MacNab’s criteria. Retrospective evaluation of the radiological data showed significant increments of foraminal dimensions: (1) sagittal area increased 21.4 ± 11.2 mm2, (2) CT Cranio Caudal length increased 1.21 ± 1.30 mm and (3) CT ventro-dorsal length increased 2.09 ± 1.35 mm and (4) 3D CT scan reconstruction coronal decompression area increased 536 ± 176 mm2, p < 0.05. Conclusion Uniportal posterior endoscopic cervical foraminotomy and discectomy are safe, efficient and precise choreographed set of technique in the treatment of cervical radiculopathy. It significantly improved clinical outcomes and achieved the objective of increasing in the cervical foramen size in our cohort of patients.

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Evaluation of Anterior Decompression Surgical Outcomes of Proximal-type Cervical Spondylotic Amyotrophy, a Retrospective Study

10.21203/rs.2.11411/v1 ◽

2019 ◽

Author(s):

Chang-bo Lu ◽

Zhen-sheng Ma ◽

Jin-bo Hu ◽

Zi-xiang Wu ◽

Xiao-jiang Yang ◽

...

Keyword(s):

Muscle Strength ◽

Neck Disability Index ◽

Cervical Radiculopathy ◽

Decompression Surgery ◽

Anterior Decompression ◽

Improvement Rate ◽

Japanese Orthopedic Association ◽

Cervical Spondylotic Amyotrophy ◽

Neck Disability

Abstract Background To investigate the effect of anterior decompression on cervical spondylotic amyotrophy patients with cervical radiculopathy. Methods From January 2012 to December 2016, 21 patients with proximal-type cervical spondylotic amyotrophy(CSA) underwent anterior decompression were included. There were 15 males and 6 females, aged 35-73 years with an average of 51.62 years. All underwent surgery of anterior decompression (ACDF or ACCF). Among them, 12 patients underwent C4/5 single level ACDF, 8 patients underwent C4/5 and C5/6 double level ACDF, and one patient underwent C5 anterior cervical corpectomy decompression and fusion surgery. Preoperative and postoperative clinical and radiologic results were assessed. The evaluation items include muscle strength, visual analog scale (VAS) score, neck disability index (NDI) score, Japanese Orthopedic Association (JOA) score, and improvement rate at the last follow-up. Neurological and radiological follow-up averaged 13.2 months. Results Severe preoperative muscle atrophy was observed in the deltoid or biceps muscles of 21 patients before surgeries. At the final follow-up, all patients showed statistically improvements in muscle strength, VAS scores, and NDI scores (P<0.05, P<0.05, P<0.05), especially for the deltoid muscles force and JOA scores (P<0.01, P<0.01), of which the average improvement rates were 66.49±10.04% and 62.23±9.23%, respectively. Conclusions For CSA patients, especially resulted from cervical radiculopathy, anterior decompression surgery can improve patient's muscle strength and nerve root compression symptoms and generally achieve satisfactory curative effects

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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 ◽

10.1093/neuros/nyx432 ◽

2017 ◽

Vol 83 (3) ◽

pp. 377-384 ◽

Cited By ~ 7

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 >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.

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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-154388/v1 ◽

2021 ◽

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 ◽

Cervical Spondylotic Radiculopathy ◽

Anterior Cervical Decompression ◽

Intermediate Outcomes ◽

Significant Difference

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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