Effect of autologous platelet gel on early and late graft fusion in anterior cervical spine surgery

2007 ◽  
Vol 7 (5) ◽  
pp. 496-502 ◽  
Author(s):  
Iman Feiz-Erfan ◽  
Mary Harrigan ◽  
Volker K. H. Sonntag ◽  
Timothy R. Harrington
Keyword(s):  
Short Form ◽  
Randomized Study ◽  
Neck Disability Index ◽  
Cervical Disc ◽  
Disc Disease ◽  
Platelet Gel ◽  
Double Blind ◽  
Cervical Spine Surgery ◽  
Early Fusion

Object In a double-blind randomized study, platelet concentrate was used to treat 50 patients who underwent anterior cervical fusion with allograft bone and internal fixation, predominantly for degenerative disc disease or soft herniated cervical disc. The goal in this study was to compare the outcomes in patients treated with and without the platelet gel. Methods Patients were assessed radiographically at 6, 12, and 52 weeks and at 2 years if needed. Clinically, patients were evaluated with the visual analog scale, Neck Disability Index, Short Form–36, and a modified Prolo Scale. Results Follow-up included 90% of the patients at 1 year and 84% at 2 years. The overall fusion rate was 84%. Conclusions Whereas patients with degenerative discs treated with platelet gel demonstrated early fusion at the 12-week follow-up interval, no consistent early fusion was obtained with the use of the platelet gel preparation in patients with a soft disc herniation.

scholarly journals Early clinical and biomechanical results following cervical arthroplasty

2004 ◽  
Vol 17 (3) ◽  
pp. 62-68 ◽  
Author(s):  
Neil Duggal ◽  
Gwynedd E. Pickett ◽  
Demytra K. Mitsis ◽  
Jana L. Keller
Keyword(s):  
Short Form ◽  
Neck Disability Index ◽  
Cervical Disc ◽  
Disc Disease ◽  
Cervical Arthroplasty ◽  
Spinal Motion ◽  
Sf 36 ◽  
Cervical Disc Prosthesis

Object Spinal arthroplasty may become the next gold standard for the treatment of degenerative cervical spine disease. This new modality must be studied rigorously to ensure in vivo efficacy and safety. The authors review the preliminary clinical experience and radiographic outcomes following insertion of the Bryan Cervical Disc Prosthesis (Medtronic Sofamor Danek, Memphis, TN). Methods This prospective cohort study included 26 patients undergoing single- or two-level implantation of the Bryan artificial cervical disc for treatment of cervical degenerative disc disease resulting in radiculopathy and/or myelopathy. Radiographic and clinical assessments were made preoperatively 1.5, 3 months, and at 6, 12, and up to 24 months postoperatively. The Neck Disability Index (NDI) and Short Form–36 (SF-36) questionnaires were used to assess pain and functional outcomes. Segmental sagittal rotation from C2–3 to C6–7 was measured using quantitative motion analysis software. A total of 30 Bryan discs were placed in 26 patients. A single-level procedure was performed in 22 patients and a two-level procedure in the other four. Follow-up duration ranged from 1.5 to 27 months, with a mean duration of 12.3 months. A statistically significant improvement in the mean NDI scores was seen between pre- and late postoperative follow-up evaluations. A trend toward improvement in the SF-36 physical component was also found. Motion was preserved in the treated spinal segments (mean range of motion 7.8°) for up to 24 months postsurgery. The relative contribution of each segment to overall spinal sagittal rotation differed depending on whether the disc was placed at C5–6 or C6–7. Overall cervical motion (C2–7) was moderately increased on late follow-up evaluations. Conclusions The Bryan artificial cervical disc provided in vivo functional spinal motion at the treated level. Overall cervical spinal motion was not significantly altered. Sagittal rotation did not change significantly at any level after surgery.

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.

Solid radiographic fusion with a nonconstrained device 5 years after cervical arthroplasty

2014 ◽  
Vol 21 (6) ◽  
pp. 951-955 ◽  
Author(s):  
Robert F. Heary ◽  
Ira M. Goldstein ◽  
Katarzyna M. Getto ◽  
Nitin Agarwal
Keyword(s):  
Short Form ◽  
Total Disc Replacement ◽  
Neck Disability Index ◽  
Dynamic Imaging ◽  
Cervical Disc ◽  
First Case ◽  
Sf 36 ◽  
Index Site ◽  
Functional Scores

Cervical disc arthroplasty (CDA) has been gaining popularity as a surgical alternative to anterior cervical discectomy and fusion. Spontaneous fusion following a CDA is uncommon. A few anecdotal reports of heterotrophic ossification around the implant sites have been noted for the BRYAN, ProDisc-C, Mobi-C, PRESTIGE, and PCM devices. All CDA fusions reported to date have been in devices that are semiconstrained. The authors reported the case of a 56-year-old man who presented with left C-7 radiculopathy and neck pain for 10 weeks after an assault injury. There was evidence of disc herniation at the C6–7 level. He was otherwise healthy with functional scores on the visual analog scale (VAS, 4.2); neck disability index (NDI, 16); and the 36-item short form health survey (SF-36; physical component summary [PSC] score 43 and mental component summary [MCS] score 47). The patient underwent total disc replacement in which the DISCOVER Artificial Cervical Disc (DePuy Spine, Inc.) was used. The patient was seen at regular follow-up visits up to 60 months. At his 60-month follow-up visit, he had complete radiographic fusion at the C6–7 level with bridging trabecular bone and no motion at the index site on dynamic imaging. He was pain free, with a VAS score of 0, NDI score of 0, and SF-36 PCS and MCS scores of 61 and 55, respectively. Conclusions This is the first case report that identifies the phenomenon of fusion around a nonconstrained cervical prosthesis. Despite this unwanted radiographic outcome, the patient's clinical outcome was excellent.

Clinical Studies of Anterior Cervical Fusion with PEEK Cages: Comparing Iliac Graft and a Macroporous Biphasic Calcium Phosphate

2012 ◽  
Vol 529-530 ◽  
pp. 261-265
Author(s):  
G. Daculsi ◽  
H. Pascal-Moussellard
Keyword(s):  
Iliac Crest ◽  
Neck Disability Index ◽  
Cervical Disc ◽  
X Rays ◽  
Peek Cage ◽  
Disc Disease ◽  
Autologous Graft ◽  
Patients Satisfaction ◽  
Autograft Group

The objective of the study was to compare clinical efficiency of the fusion after reconstruction with an anatomically shaped PEEK cage associated with a iliac crest autograft or MBCP in the treatment of cervical disc disease in randomized clinical trial. A multicente randomized, comparative and prospective study on 58 patients, with a 12 months follow up are reported. They underwent anterior cervical decompression and fusion being randomized for autologous graft or MBCP. Patients presenting purely degenerative disc disease were implanted with a PEEK cage filled with iliac crest autograft or MBCP. Pain and functionality as well as patients satisfaction were assessed through VAS, Neck Disability Index (NDI) and Patient Satisfaction index were recorded until 24 month follow-up. Radiological evaluation included plain and dynamic short X-rays at each stage of the follow up. The patients satisfaction rates was of 82% in the autograft group versus 96% in the MBCP group. Pain at the donor site was significantly more important in the autograft group at 3 weeks, 3 months and 1 year follow-up. No implant failures were recorded. Previously goat preclinical study was performed. Micro CT, light microscopy and shistomorphometry were related to the high performance of the MBCP insert for filling cage fusion, completing the clinical assessment of our clinical study. The use of MBCP insert is safe and avoids potential graft site morbidity and pain in comparison with an autologous graft procedure.

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.

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

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.

scholarly journals Two-Year Clinical and Radiological Outcomes in Patients With Diabetes Undergoing Single-Level Anterior Cervical Discectomy and Fusion

2020 ◽  
pp. 219256822091488
Author(s):  
Paul M. Arnold ◽  
Alexander R. Vaccaro ◽  
Rick C. Sasso ◽  
Benoit Goulet ◽  
Michael G. Fehlings ◽  
...  
Keyword(s):  
Short Form ◽  
Secondary Analysis ◽  
Neck Disability Index ◽  
Cervical Radiculopathy ◽  
Anterior Cervical Discectomy ◽  
Disc Disease ◽  
Cervical Discectomy ◽  
Single Level ◽  
Arm Pain ◽  
Patients With Diabetes

Study Design: Secondary analysis of data from the multicenter, randomized, parallel-controlled Food and Drug Administration (FDA) investigational device exemption study. Objective: Studies on outcomes following anterior cervical discectomy and fusion (ACDF) in individuals with diabetes are scarce. We compared 24-month radiological and clinical outcomes in individuals with and without diabetes undergoing single-level ACDF with either i-FACTOR or local autologous bone. Methods: Between 2006 and 2013, 319 individuals with single-level degenerative disc disease (DDD) and no previous fusion at the index level underwent ACDF. The presence of diabetes determined the 2 cohorts. Data collected included radiological fusion evaluation, neurological outcomes, Neck Disability Index (NDI), Visual Analog Scale (VAS) scores, and the 36-Item Short Form Survey Version 2 (SF-36v2) Physical and Mental component summary scores. Results: There were 35 individuals with diabetes (11.1%; average body mass index [BMI] = 32.99 kg/m2; SD = 5.72) and 284 without (average BMI = 28.32 kg/m2; SD = 5.67). The number of nondiabetic smokers was significantly higher than diabetic smokers: 73 (25.70%) and 3 (8.57%), respectively. Preoperative scores of NDI, VAS arm pain, and SF-36v2 were similar between the diabetic and nondiabetic participants at baseline; however, VAS neck pain differed significantly between the cohorts at baseline ( P = .0089). Maximum improvement for NDI, VAS neck and arm pain, and SF-36v2 PCS and MCS scores was seen at 6 months in both cohorts and remained stable until 24 months. Conclusions: ACDF is effective for cervical radiculopathy in patients with diabetes. Diabetes is not a contraindication for patients requiring single-level surgery for cervical DDD.

The lack of sustained effect of bright light in non-seasonal major depression

2006 ◽  
Vol 36 (9) ◽  
pp. 1247-1252 ◽  
Author(s):  
KLAUS MARTINY ◽  
MARIANNE LUNDE ◽  
MOGENS UNDÉN ◽  
HENRIK DAM ◽  
PER BECH
Keyword(s):  
Major Depression ◽  
Randomized Study ◽  
Bright Light ◽  
Light Therapy ◽  
Treated Group ◽  
Bright Light Therapy ◽  
Double Blind ◽  
Sustained Effect ◽  
The Difference

Background. Recently accumulated evidence has demonstrated that bright-light therapy in combination with antidepressants is effective in patients with non-seasonal major depression. Whether bright light has a sustained effect after discontinuation is, however, poorly investigated.Method. In this double-blind randomized study we report the results from a 4-week follow-up period in patients with major non-seasonal depression who had been treated for 5 weeks with sertraline combined with bright-light therapy or sertraline combined with dim-light therapy. At the beginning of the follow-up period the light therapy was stopped while sertraline treatment continued for 4 weeks.Results. Depression scores decreased substantially in both groups, resulting in high response and remission rates in both groups after 9 weeks of treatment. The difference in depression scores at week 5, favouring the bright-light-treated group, disappeared gradually in the 4-week follow-up period, resulting in similar end-point scores.Conclusions. Bright light did not have a sustained effect after discontinuation. The offset of effect was complete after 4 weeks.

Sign in / Sign up

Export Citation Format

Share Document