scholarly journals Posterior foraminotomy versus anterior decompression and fusion in patients with cervical degenerative disc disease with radiculopathy: up to 5 years of outcome from the national Swedish Spine Register

2020 ◽  
Vol 32 (3) ◽  
pp. 344-352
Author(s):  
Anna MacDowall ◽  
Robert F. Heary ◽  
Marek Holy ◽  
Lars Lindhagen ◽  
Claes Olerud
Keyword(s):  
Degenerative Disc Disease ◽  
Population Based ◽  
Patient Reported Outcome ◽  
Disc Disease ◽  
Degenerative Disc ◽  
Clinically Important Difference ◽  
Cervical Degenerative Disc Disease ◽  
Patient Reported ◽  
Spine Register ◽  
Posterior Foraminotomy

OBJECTIVEThe long-term efficacy of posterior foraminotomy compared with anterior cervical decompression and fusion (ACDF) for the treatment of degenerative disc disease with radiculopathy has not been previously investigated in a population-based cohort.METHODSAll patients in the national Swedish Spine Register (Swespine) from January 1, 2006, until November 15, 2017, with cervical degenerative disc disease and radiculopathy were assessed. Using propensity score matching, patients treated with posterior foraminotomy were compared with those undergoing ACDF. The primary outcome measure was the Neck Disability Index (NDI), a patient-reported outcome score ranging from 0% to 100%, with higher scores indicating greater disability. A minimal clinically important difference was defined as > 15%. Secondary outcomes were assessed with additional patient-reported outcome measures (PROMs).RESULTSA total of 4368 patients (2136/2232 women/men) met the inclusion criteria. Posterior foraminotomy was performed in 647 patients, and 3721 patients underwent ACDF. After meticulous propensity score matching, 570 patients with a mean age of 54 years remained in each group. Both groups had substantial decreases in their NDI scores; however, after 5 years, the difference was not significant (2.3%, 95% CI −4.1% to 8.4%; p = 0.48) between the groups. There were no significant differences between the groups in EQ-5D or visual analog scale (VAS) for neck and arm scores. The secondary surgeries on the index level due to restenosis were more frequent in the foraminotomy group (6/100 patients vs 1/100), but on the adjacent segments there was no difference between groups (2/100).CONCLUSIONSIn patients with cervical degenerative disc disease and radiculopathy, both groups demonstrated clinical improvements at the 5-year follow-up that were comparable and did not achieve a clinically important difference from one another, even though the reoperation rate favored the ACDF group. This study design obtains population-based results, which are generalizable.

Long-term outcome of fusion for degenerative disc disease in the lumbar spine

2019 ◽  
Vol 101-B (12) ◽  
pp. 1526-1533 ◽  
Author(s):  
Peter Endler ◽  
Per Ekman ◽  
Ivan Berglund ◽  
Hans Möller ◽  
Paul Gerdhem
Keyword(s):  
Back Pain ◽  
Lumbar Spine ◽  
Degenerative Disc Disease ◽  
Interbody Fusion ◽  
Patient Reported Outcome ◽  
Posterolateral Fusion ◽  
Disc Disease ◽  
Degenerative Disc ◽  
Additional Surgery ◽  
Patient Reported

AimsChronic low back pain due to degenerative disc disease is sometimes treated with fusion. We compared the outcome of three different fusion techniques in the Swedish Spine Register: noninstrumented posterolateral fusion (PLF), instrumented posterolateral fusion (IPLF), and interbody fusion (IBF).Patients and MethodsA total of 2874 patients who were operated on at one or two lumbar levels were followed for a mean of 9.2 years (3.6 to 19.1) for any additional lumbar spine surgery. Patient-reported outcome data were available preoperatively (n = 2874) and at one year (n = 2274), two years (n = 1958), and a mean of 6.9 years (n = 1518) postoperatively and consisted of global assessment and visual analogue scales of leg and back pain, Oswestry Disability Index, EuroQol five-dimensional index, 36-Item Short-Form Health Survey, and satisfaction with treatment. Statistical analyses were performed with competing-risks proportional hazards regression or analysis of covariance, adjusted for baseline variables.ResultsThe number of patients with additional surgery were 32/183 (17%) in the PLF group, 229/1256 (18%) in the IPLF group, and 439/1435 (31%) in the IBF group. With the PLF group as a reference, the hazard ratio for additional lumbar surgery was 1.16 (95% confidence interval (CI) 0.78 to 1.72) for the IPLF group and 2.13 (95% CI 1.45 to 3.12) for the IBF group. All patient-reported outcomes improved after surgery (p < 0.001) but were without statistically significant differences between the groups at the one-, two- and 6.9-year follow-ups (all p ≥ 0.12).ConclusionThe addition of interbody fusion to posterolateral fusion was associated with a higher risk for additional surgery and showed no advantages in patient-reported outcome Cite this article: Bone Joint J 2019;101-B:1526–1533

scholarly journals Artificial disc replacement versus fusion in patients with cervical degenerative disc disease with radiculopathy: 5-year outcomes from the National Swedish Spine Register

2019 ◽  
Vol 30 (2) ◽  
pp. 159-167 ◽  
Author(s):  
Anna MacDowall ◽  
Martin Skeppholm ◽  
Lars Lindhagen ◽  
Yohan Robinson ◽  
Håkan Löfgren ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Degenerative Disc Disease ◽  
Artificial Disc ◽  
Anterior Decompression ◽  
Disc Disease ◽  
Fusion Surgery ◽  
Degenerative Disc ◽  
Clinically Important Difference ◽  
Cervical Degenerative Disc Disease

OBJECTIVEThe long-term efficacy of artificial disc replacement (ADR) surgery compared with fusion after decompression for the treatment of cervical degenerative disc disease and radiculopathy has not previously been investigated in a population-based setting.METHODSAll patients with cervical degenerative disc disease and radiculopathy who were in the national Swedish Spine Registry (Swespine) beginning in January 1, 2006, were eligible for the study. Follow-up information was obtained up to November 15, 2017. The authors compared, using propensity score matching, patients treated with anterior decompression and insertion of an ADR with patients who underwent anterior decompression combined with fusion surgery. The primary outcome was the Neck Disability Index (NDI), a patient-reported function score ranging from 0% to 100%, with higher scores indicating greater disability and a minimum clinically important difference of > 15%.RESULTSA total of 3998 patients (2018:1980 women/men) met the inclusion criteria, of whom 204 had undergone arthroplasty and 3794 had undergone fusion. After propensity score matching, 185 patients with a mean age of 49.7 years remained in each group. Scores on the NDI were approximately halved in both groups after 5 years, but without a significant mean difference in NDI (3.0%; 95% CI −8.4 to 2.4; p = 0.28) between the groups. There were no differences between the groups in EuroQol–5 Dimensions or in pain scores for the neck and arm.CONCLUSIONSIn patients with cervical degenerative disc disease and radiculopathy, decompression plus ADR surgery did not result in a clinically important difference in outcomes after 5 years, compared with decompression and fusion surgery.

scholarly journals Titanium-interlayer mediated hydroxyapatite coating on polyetheretherketone: a prospective study in patients with single-level cervical degenerative disc disease

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Ce Zhu ◽  
Miaomiao He ◽  
Lili Mao ◽  
Tao Li ◽  
Li Zhang ◽  
...  
Keyword(s):  
Degenerative Disc Disease ◽  
Fusion Rate ◽  
Peek Cage ◽  
Disc Disease ◽  
Degenerative Disc ◽  
Single Level ◽  
Cervical Degenerative Disc Disease ◽  
Post Operation

Abstract Background Currently, there are limited reports regarding investigation of the biological properties of polyetheretherketone (PEEK) coated with titanium (Ti) and hydroxyapatite (HA) in human. The objective of this study is to evaluate the in vivo response of the PEEK cages coated with Ti and HA versus uncoated PEEK cages after anterior cervical discectomy and fusion (ACDF) in patients with single-level cervical degenerative disc disease (CDDD). Methods Twenty-four patients with PEEK cages coated with Ti and HA (PEEK/Ti/HA group) were matched one-to-one with patients with uncoated PEEK cages (PEEK group) based on age, gender, and operative segment. All patients had been followed up for more than 2 years. Radiological assessments included intervertebral height (IH), C2-7 angle (C2-7a), segmental alignment (SA), and fusion rate. Clinical parameters included Visual Analogue Scale (VAS) and Japanese Orthopedic Association (JOA) scores. Results There was no statistical difference in SA, IH, and C2-7a between the two groups before and after surgery and all these parameters were restored postoperatively. The fusion rate of PEEK/Ti/HA group was significantly higher than PEEK group at 3-month post-operation (87.5% vs. 62.5%). At the last follow-up, the fusion rate of the both groups achieved 100%. The VAS and JOA scores were comparable between two groups and improved postoperatively. Conclusions In patients with single-level ACDF, PEEK cage coated with Ti and HA provided a higher fusion rate than uncoated PEEK cage at 3-month post-operation, while both two cages could achieve solid osseous fusion at the last follow up. Compared with the uncoated PEEK cage, PEEK/Ti/HA cage yielded similar favorable segmental and overall cervical lordosis, IH, and clinical outcomes after the surgery.

Systematic Review of Anterior Interbody Fusion Techniques for Single- and Double-Level Cervical Degenerative Disc Disease

Spine ◽  
2011 ◽  
Vol 36 (14) ◽  
pp. E950-E960 ◽  
Author(s):  
Wilco Jacobs ◽  
Paul C. Willems ◽  
Moyo Kruyt ◽  
Jacques van Limbeek ◽  
Patricia G. Anderson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Degenerative Disc Disease ◽  
Interbody Fusion ◽  
Disc Disease ◽  
Degenerative Disc ◽  
Anterior Interbody Fusion ◽  
Cervical Degenerative Disc Disease
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