Anterior surgery for cervical disc disease

1980 ◽  
Vol 53 (1) ◽  
pp. 12-19 ◽  
Author(s):  
L. Dade Lunsford ◽  
David J. Bissonette ◽  
David S. Zorub
Keyword(s):  
Surgical Techniques ◽  
Cervical Disc ◽  
Cervical Canal ◽  
Cervical Disc Disease ◽  
Disc Disease ◽  
Duration Of Symptoms ◽  
Content Type ◽  
Cervical Surgery ◽  
Anterior Cervical Surgery

✓ The results of anterior cervical surgery for treatment of cervical spondylotic myelopathy (CSM) are assessed 1 to 7 years postoperatively in 32 patients. At follow-up review, 50% were improved after surgery and 50% were unimproved or had deteriorated in spite of surgery. The results could not be statistically linked to the patients' age, duration of symptoms, severity of myelopathy, cervical canal size, or the performance of single- or multiple-level operations. Various anterior surgical techniques were used, but none proved to have superior results. The results in this series failed to surpass the results obtained by others for conservative treatment alone. In many cases, symptoms of CSM progressed despite the intervention of anterior cervical surgery.

Failed anterior cervical foraminotomy

2003 ◽  
Vol 98 (2) ◽  
pp. 126-130 ◽  
Author(s):  
Robert J. Hacker ◽  
Christopher G. Miller
Keyword(s):  
Cervical Disc ◽  
Cervical Disc Disease ◽  
Disc Disease ◽  
Content Type ◽  
Degenerative Cervical Disc Disease ◽  
Number Of Patients ◽  
Cervical Surgery ◽  
Cervical Foraminotomy ◽  
Fine Print

Object. Anterior cervical foraminotomy has been advocated as a procedure that preserves the motion segment while treating radiculopathy due to degenerative cervical disc disease. Because the medical literature contains no long-term follow up or randomized studies related to this procedure, the authors reviewed their results, specifically examining cases of failure to determine the efficacy of the approach. Methods. The authors identified 23 patients in whom unilateral cervical radiculopathy due to degenerative cervical disc disease was refractory to conservative therapy and in whom anterior cervical foraminotomy was performed between 1998 and 2000. The procedure involves ipsilateral exposure, microsurgical removal of the uncovertebral joint to identify the nerve root, and partial removal of the lateral anulus and or disc fragments. Data in those patients who underwent reoperation(s) were reviewed specifically for the procedure type, interval between index procedure and reoperation, and whether multiple procedures were performed. Of the 23 patients, 30% required at least one additional procedure. A good or excellent outcome at last follow-up examination was achieved in only 12 patients. Conclusions. In the current study the authors found a reoperation rate that is considerably higher than that in most series of anterior cervical surgery for radiculopathy. The presumed benefit of anterior cervical foraminotomy is preservation of the disc interspace; however, in this study, a significant number of patients failed to experience a satisfying outcome. Currently the authors do not recommend anterior cervical foraminotomy as a stand-alone procedure.

Cervical arthroplasty after previous surgery: results of treating 24 discs in 15 patients

2005 ◽  
Vol 3 (5) ◽  
pp. 335-341 ◽  
Author(s):  
Lali H. S. Sekhon ◽  
William Sears ◽  
Neil Duggal
Keyword(s):  
Interbody Fusion ◽  
Cervical Disc ◽  
Cervical Disc Disease ◽  
Disc Disease ◽  
Cervical Arthroplasty ◽  
Content Type ◽  
Anterior Interbody Fusion ◽  
Posterior Foraminotomy ◽  
Fine Print

Object. The potential role of cervical arthroplasty in patients who have undergone previous cervical surgery is unknown. The authors performed a prospective study involving nonrandomized clinical and radiological assessment in patients who had undergone either previous posterior cervical foraminotomy or anterior interbody fusion and who suffered new or persistent arm/neck symptoms related to neural compression. Methods. During a 30-month period, 15 patients who had previously undergone cervical spinal surgery underwent cervical arthroplasty that involved placement of the Bryan disc for neck or arm symptoms related to cervical disc disease. A total of 24 devices were implanted. Six of the 15 patients had undergone a previous posterior foraminotomy, and in nine cases an anterior interbody fusion had been perfomed at some stage prior to surgery. Clinical and radiological evaluations were performed preoperatively and after surgery to assess outcomes. A total of 24 arthroplasties were performed encompassing between one and three levels. There were no major perioperative complications or immediate device-related failures. Two patients were lost to follow up. The follow-up period ranged from 12 to 43 months (mean 24.2 ± 10.5 months). Good results were obtained in all cases as reflected by an increase in the visual analog scale score of 6.4 in terms of neck/arm pain (p < 0.05). There was no difference in Oswestry Disability Index scores for neck pain (p > 0.05) and no patient required surgery at the same level. In one patient hypermobility developed with internal subluxation of the device, which suggested a compromise adjacent to a two-level fusion at 21 months. The segment was hypermobile preoperatively. The patient has experienced recurrent neck pain but otherwise remains clinically well and has not required revision surgery to date. Conclusions. Insertion of the Bryan artificial cervical disc in patients who have previously undergone cervical fusion or posterior foraminotomy, in general, appears to be safe. It provided encouraging early clinical results, although patients with preoperative hypermobility should be treated with caution. Issues such as accelerated device-related wear and the use of arthroplasty after aggressive facetectomy resection will need further study; however, in carefully selected patients who have undergone previous surgery cervical arthroplasty may provide an additional tool in the management of cervical disc disease.

scholarly journals Adjacent-level arthroplasty following cervical fusion

2017 ◽  
Vol 42 (2) ◽  
pp. E5 ◽  
Author(s):  
Deshpande V. Rajakumar ◽  
Akshay Hari ◽  
Murali Krishna ◽  
Subhas Konar ◽  
Ankit Sharma
Keyword(s):  
Cobb Angle ◽  
Anterior Cervical Discectomy ◽  
Cervical Disc ◽  
Cervical Fusion ◽  
Adjacent Level ◽  
Cervical Disc Disease ◽  
Disc Disease ◽  
Cervical Arthroplasty ◽  
Arm Pain

OBJECTIVE Adjacent-level disc degeneration following cervical fusion has been well reported. This condition poses a major treatment dilemma when it becomes symptomatic. The potential application of cervical arthroplasty to preserve motion in the affected segment is not well documented, with few studies in the literature. The authors present their initial experience of analyzing clinical and radiological results in such patients who were treated with arthroplasty for new or persistent arm and/or neck symptoms related to neural compression due to adjacent-segment disease after anterior cervical discectomy and fusion (ACDF). METHODS During a 5-year period, 11 patients who had undergone ACDF anterior cervical discectomy and fusion (ACDF) and subsequently developed recurrent neck or arm pain related to adjacent-level cervical disc disease were treated with cervical arthroplasty at the authors' institution. A total of 15 devices were implanted (range of treated levels per patient: 1–3). Clinical evaluation was performed both before and after surgery, using a visual analog scale (VAS) for pain and the Neck Disability Index (NDI). Radiological outcomes were analyzed using pre- and postoperative flexion/extension lateral radiographs measuring Cobb angle (overall C2–7 sagittal alignment), functional spinal unit (FSU) angle, and range of motion (ROM). RESULTS There were no major perioperative complications or device-related failures. Statistically significant results, obtained in all cases, were reflected by an improvement in VAS scores for neck/arm pain and NDI scores for neck pain. Radiologically, statistically significant increases in the overall lordosis (as measured by Cobb angle) and ROM at the treated disc level were observed. Three patients were lost to follow-up within the first year after arthroplasty. In the remaining 8 cases, the duration of follow-up ranged from 1 to 3 years. None of these 8 patients required surgery for the same vertebral level during the follow-up period. CONCLUSIONS Artificial cervical disc replacement in patients who have previously undergone cervical fusion surgery appears to be safe, with encouraging early clinical results based on this small case series, but more data from larger numbers of patients with long-term follow-up are needed. Arthroplasty may provide an additional tool for the management of post-fusion adjacent-level cervical disc disease in carefully selected patients.

scholarly journals Physiotherapy after anterior cervical spine surgery for cervical disc disease: study protocol of a prospective randomised study to compare internet-based neck-specific exercise with prescribed physical activity

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e027387 ◽  
Author(s):  
Anneli Peolsson ◽  
Gunnel Peterson ◽  
Anna Hermansen ◽  
Maria Landén Ludvigsson ◽  
Åsa Dedering ◽  
...  
Keyword(s):  
Physical Activity ◽  
Disease Patient ◽  
Neck Disability Index ◽  
Cost Effective ◽  
Popular Science ◽  
Cervical Disc ◽  
Ethical Review ◽  
Cervical Disc Disease ◽  
Disc Disease

IntroductionPatients suffering from remaining disability after anterior cervical decompression and fusion (ACDF) surgery for cervical disc disease may be prescribed physical activity (PPA) or neck-specific exercises (NSEs). Currently, we lack data for the success of either approach. There is also a knowledge gap concerning the use of internet-based care for cervical disc disease. The scarcity of these data, and the high proportion of patients with various degrees of incapacity following ACDF, warrant increased efforts to investigate and improve cost-effective rehabilitation. The objective is to compare the effectiveness of a structured, internet-based NSE programme, versus PPA following ACDF surgery.Methods and analysisThis is a prospective, randomised, multicentre study that includes 140 patients with remaining disability (≥30% on the Neck Disability Index, NDI) following ACDF for radiculopathy due to cervical disc disease. Patient recruitment occurs following attendance at routine clinical appointments, scheduled at 3 months postsurgery. Patients are then randomised to one of two groups (70 patients/group) for a 3-month treatment programme/period of either internet-based NSE or PPA. Questionnaires on background data, pain and discomfort, physical and mental capacity, satisfaction with care, and health and workplace factors are completed, along with physical measures of neck-related function conducted by independent test leaders blinded to randomisation. Measures are collected at inclusion, after the 3-month treatments (end of treatment) and at a 2-year follow-up. Radiography will be completed at the 2-year follow-up. Preoperative data will be collected from the Swedish Spine Registry. Data on healthcare consumption, drug use and sick leave will be requested from the relevant national registers.Ethical considerationsThis study was approved by the Regional Ethical Review Board in Linköping Ref. 2016/283–31 and 2017/91– 32. The scientists are independent with no commercial ties. Patients are recruited after providing written informed consent. Patient data are presented at group level such that no connection to any individual can be made. All data are anonymised when reported, and subject to the Swedish Official Secrets Health Acts. The test leaders are independent and blinded for randomisation. Exercises, both general and neck-specific, have been used extensively in clinical practice and we anticipate no harm from their implementation other than a risk of muscle soreness. Both randomisation groups will receive care that is expected to relieve pain, although the group receiving NSE is expected to demonstrate a greater and more cost-effective improvement versu s the PPA group. Any significant harm or unintended effects in each group will be collected by the test leaders. All questionnaires and test materials are coded by the research group, with code lists stored in locked, fireproof file cabinets, housed at the university in a room with controlled (card-based) access. Only individuals in receipt of a unique website address posted by the researchers can access the programme; patients can neither communicate with each other nor with caregivers via the programme.Study participation might lead to improved rehabilitation versus non-participation, and might therefore be of benefit. The results of this study should also contribute to more effective and flexible rehabilitation, shorter waiting times, lower costs and the possibility to implement our findings on a wider level.DisseminationIf effective, the protocols used in this study can be implemented in existing healthcare structures. The results of the study will be presented in scientific journals and popular science magazines of relevance to health. The findings will also be presented at local, regional, national and international conferences and meetings, as well as in the education of university students and at public lectures. Information about the results will be communicated to the general population in cooperation with patient organisations and the media.Trial registrationNCT03036007.

The future in the care of the cervical spine: interbody fusion and arthroplasty

2004 ◽  
Vol 1 (2) ◽  
pp. 155-159 ◽  
Author(s):  
Praveen V. Mummaneni ◽  
Regis W. Haid
Keyword(s):  
Adjacent Segment Degeneration ◽  
Cervical Disc ◽  
Adjacent Segment ◽  
Cervical Fusion ◽  
Cervical Disc Disease ◽  
Disc Disease ◽  
Cervical Arthroplasty ◽  
Content Type ◽  
Fine Print

✓ In the past 50 years tremendous advances have been made in the treatment of cervical disc disease with cervical fusion. Fusion rates have surpassed 95% after application of anterior cervical implants. Adjacent-segment degeneration, however, has plagued the long-term clinical success of cervical fusion. Cervical arthroplasty has been introduced to maintain cervical motion and potentially avoid or minimize adjacent-segment degeneration. If cervical arthroplasty is successful, the long-term results of surgery for cervical disc disease may improve; however, there are associated drawbacks that must be overcome. Implant wear, fatigue, and failure have been reported in cases of large-joint arthroplasty, and research is underway to limit these problems in cervical arthroplasty. In this article the authors trace the evolution of cervical fusion and the new technique of cervical arthroplasty. The nomenclature of cervical arthroplasty will also be introduced.

Use of a polymethylmethacrylate cervical cage in the treatment of single-level cervical disc disease

2005 ◽  
Vol 3 (1) ◽  
pp. 24-28 ◽  
Author(s):  
Jyi-Feng Chen ◽  
Chieh-Tsai Wu ◽  
Sai-Cheung Lee ◽  
Shih-Tseng Lee
Keyword(s):  
Cancellous Bone ◽  
Disc Herniation ◽  
Interbody Fusion ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Cervical Disc Disease ◽  
Disc Disease ◽  
Content Type ◽  
Single Level ◽  
Fine Print

Object. Polymethylmethacrylate (PMMA) bone cement has been used as a spacer in the treatment of patients with cervical disc disease with good long-term outcomes, but solid bone fusion has not been demonstrated in all cases. To achieve cervical interbody fusion, the authors designed a modified PMMA cervical cage that they filled with spongy bone for the treatment of single-level cervical disc herniation. Methods. Sixty-three patients underwent anterior cervical microdiscectomy and implantation of a PMMA cervical cage filled with autograft cancellous bone and were followed for a minimum of 2 years. The fusion rates were 90.5 and 100% at the 6- and 12-month follow-up examinations, respectively. The mean intervertebral disc height gain was 3.4 ± 1.9 mm when preoperative and 24-month postoperative values were compared. Neck pain, measured using the Huskissan visual analog scale (0 mm, no pain; 100 mm, worst possible pain), decreased from 71 ± 13 mm at preoperative baseline to 28 ± 17 at 6, 23 ± 19 at 12, and 31 ± 19 mm at 24 months. Based on the same scale, radicular pain decreased from 83 ± 15 mm at preoperative baseline to 24 ± 11 at 6, 27 ± 13 at 12, and 22 ± 11 mm at 24 months. The self-rated clinical outcome was excellent in 45 (71.4%) and good in 18 (28.6%) of the 63 patients. Conclusions. The autograft cancellous bone—filled PMMA cage is safe and effective for cervical interbody fusion in the treatment of single-level cervical disc herniation and monoradiculopathy.

Analysis of the three United States Food and Drug Administration investigational device exemption cervical arthroplasty trials

2012 ◽  
Vol 16 (3) ◽  
pp. 216-228 ◽  
Author(s):  
Cheerag D. Upadhyaya ◽  
Jau-Ching Wu ◽  
Gregory Trost ◽  
Regis W. Haid ◽  
Vincent C. Traynelis ◽  
...  
Keyword(s):  
Random Effects ◽  
Anterior Cervical Discectomy ◽  
Cervical Disc ◽  
Adjacent Level ◽  
Cervical Disc Disease ◽  
Disc Disease ◽  
Single Level ◽  
Investigational Device Exemption ◽  
Time Point

Object There are now 3 randomized, multicenter, US FDA investigational device exemption, industry-sponsored studies comparing arthroplasty with anterior cervical discectomy and fusion (ACDF) for single-level cervical disease with 2 years of follow-up. These 3 studies evaluated the Prestige ST, Bryan, and ProDisc-C artificial discs. The authors analyzed the combined results of these trials. Methods A total of 1213 patients with symptomatic, single-level cervical disc disease were randomized into 2 treatment arms in the 3 randomized trials. Six hundred twenty-one patients received an artificial cervical disc, and 592 patients were treated with ACDF. In the three trials, 94% of the arthroplasty group and 87% of the ACDF group have completed 2 years of follow-up. The authors analyzed the 2-year data from these 3 trials including previously unpublished source data. Statistical analysis was performed with fixed and random effects models. Results The authors' analysis revealed that segmental sagittal motion was preserved with arthroplasty (preoperatively 7.26° and postoperatively 8.14°) at the 2-year time point. The fusion rate for ACDF at 2 years was 95%. The Neck Disability Index, 36-Item Short Form Health Survey Mental, and Physical Component Summaries, neck pain, and arm pain scores were not statistically different between the groups at the 24-month follow-up. The arthroplasty group demonstrated superior results at 24 months in neurological success (RR 0.595, I2 = 0%, p = 0.006). The arthroplasty group had a lower rate of secondary surgeries at the 2-year time point (RR 0.44, I2 = 0%, p = 0.004). At the 2-year time point, the reoperation rate for adjacent-level disease was lower for the arthroplasty group when the authors analyzed the combined data set using a fixed effects model (RR 0.460, I2 = 2.9%, p = 0.030), but this finding was not significant using a random effects model. Adverse event reporting was too heterogeneous between the 3 trials to combine for analysis. Conclusions Both anterior cervical discectomy and fusion as well as arthroplasty demonstrate excellent 2-year surgical results for the treatment of 1-level cervical disc disease with radiculopathy. Arthroplasty is associated with a lower rate of secondary surgery and a higher rate of neurological success at 2 years. Arthroplasty may be associated with a lower rate of adjacent-level disease at 2 years, but further follow-up and analysis are needed to confirm this finding.

Anterior surgery for cervical disc disease

1980 ◽  
Vol 53 (1) ◽  
pp. 1-11 ◽  
Author(s):  
L. Dade Lunsford ◽  
David J. Bissonette ◽  
Peter J. Jannetta ◽  
Peter E. Sheptak ◽  
David S. Zorub
Keyword(s):  
Disc Herniation ◽  
University Hospital ◽  
Cervical Disc ◽  
Complete Relief ◽  
Anterior Fusion ◽  
Disc Disease ◽  
Anterior Surgery ◽  
Cervical Surgery ◽  
Anterior Cervical Surgery ◽  
Results Of Surgery

✓ Between 1971 and 1977, 334 patients at the Presbyterian-University Hospital underwent anterior surgery for treatment of hard or soft cervical disc herniation. Of these patients, 295 had radicular symptoms only. This retrospective study details the results of anterior cervical surgery for treatment of lateral disc herniation in 253 patients who survived 1 to 7 years postoperatively. Sixty-seven percent had excellent or good results. Although 77% initially noted complete relief of symptoms after surgery, 38% subsequently developed one or more recurrent symptoms at some time during the follow-up period. The overall results of surgery for soft disc cases were no different from the results for hard discs, although significantly more hard disc cases required postoperative conservative treatment. The results of surgery after anterior fusion were no different than the results after anterior discectomy alone. However, overall postoperative complications were more frequent and hospitalizations were longer in the patients who underwent fusion. Patients with multiple-level surgery had statistically similar results to those with single-level surgery. None of the nine preoperative clinical features reported by others to influence the results of anterior cervical surgery were found to consistently affect outcome in the present series.

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