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Tatara Y, Niimura T, Sakaguchi A, Katayama H, Miyaoka Y, Mihara H. Screw Motion Used in Semiconstrained Rotational Plate Systems for Anterior Cervical Discectomy and Fusion. Clin Spine Surg 2024:01933606-990000000-00337. [PMID: 39052995 DOI: 10.1097/bsd.0000000000001665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/28/2024] [Indexed: 07/27/2024]
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVE To scrutinize screw motion used in semiconstrained rotational plate systems for anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA Semiconstrained rotational plate systems are supposed to control graft subsidence and facilitate lordosis acquisition and maintenance by toggling the instrumented vertebrae via variable-angle screws. However, their benefits may be unrealized if the screws move within the vertebrae. METHODS We reviewed medical records of 119 patients who underwent 1-level, 2-level, 3-level, or 4-level ACDF, divided them into the short-segment (n=62, 1-level or 2-level ACDF) and long-segment (n=59, 3- level or 4-level ACDF) groups, and investigated their immediate and 1-year postoperative lateral radiographs. We measured the fused segmental angle, screw angles at the upper-instrumented vertebra (UIV) and lower-instrumented vertebra (LIV), distance from the screw base to the endplate of UIV/LIV (SBE), and distance from the screw tip to the endplate of UIV/LIV (STE) to analyze the screw motion used in these plate systems. The differences between the immediate and 1-year postoperative values were statistically analyzed. The nonunion level was also investigated. RESULTS Screw angle and SBE at the LIV significantly decreased in the long-segment group (-14.5±9.8 degrees and -2.8±1.8 mm, respectively) compared with those in the short-segment group (-4.6±6.0 degrees and -1.0±1.5 mm, respectively). Thus, the long-segment group could not maintain the immediate-postoperative segmental angle. Overall, 27 patients developed nonunion, with 19 (70.4%) in the long-segment group and 21 (77.8%) at the lowest fused level. CONCLUSIONS Semiconstrained rotational plate systems provide only vertical forces to the fused segment rather than toggling the instrumented vertebrae. Postoperatively in multilevel ACDF, LIV screws migrate caudally, suggesting that these plate systems are not always effective in maintaining lordosis. Moreover, LIV screws and the anterior wall of the LIV are subject to overloading, resulting in a high rate of nonunion at the lowest fused level. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | | | - Hiroki Katayama
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama
| | - Yoshinari Miyaoka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Schröder J, Kampulz T, Bajaj SK, Hellwig AG, Winking M. PEEK Cages versus Titanium-Coated PEEK Cages in Single-Level Anterior Cervical Fusion: A Randomized Controlled Study. J Neurol Surg A Cent Eur Neurosurg 2024; 85:262-268. [PMID: 37506743 DOI: 10.1055/s-0043-1770694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
BACKGROUND The implantation of a spacer is a common practice after anterior diskectomy in cervical spine. Polyether ether ketone (PEEK) cages have replaced titanium implants due to their better radiologic visibility and appearance in postoperative magnetic resonance imaging (MRI) scans. However, PEEK showed apparently higher nonunion rates than titanium cages. The aim of the study was to evaluate the fusion behavior of plain PEEK cages in comparison to titanium-coated PEEK (TiPEEK) cages. METHOD We randomized 104 patients with single-level cervical radiculopathy or mild myelopathy. They were divided into two groups of 52 patients each, receiving either a PEEK cage or the titanium-coated variant of the same cage type. The 1- and 2-year follow-ups were completed by 43 patients in the PEEK group and by 50 patients in the TiPEEK group. Fusion was determined by plain X-ray and lateral functional X-ray. RESULTS Two years after surgery, a complete fusion was observed in 37 patients of the PEEK group (86%). Six cases were considered as nonunions. In the TiPEEK group, we found 41 fusions (82%) and 9 nonunions at this time. The difference was not considered significant (p = 0.59). The clinical evaluation of the two groups showed no difference in the neurologic examination as well in the pain scores over the time period. CONCLUSIONS Despite some assumptions about an advantage of TiPEEK over PEEK cages for fusion in cervical spine surgery, this prospective randomized controlled study did not find an accelerated or improved fusion using TiPEEK for anterior cervical diskectomy.
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Affiliation(s)
| | - Thomas Kampulz
- ZW-O Zentrum für - Wirbelsäulenchirurgie, Osnabrück, Germany
| | | | | | - Michael Winking
- ZW-O Zentrum für - Wirbelsäulenchirurgie, Osnabrück, Germany
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Singh H, Kukowski NR, Lunati MP, Dawes A, Kim CH, Kim S, Rhee JM. Porous 3D Printed Titanium Cages in Anterior Cervical Discectomy and Fusion are Associated With Less Subsidence, Improved Maintenance of Segmental Lordotic Correction, and Similar Clinical Outcomes as Allograft. Global Spine J 2024; 14:878-888. [PMID: 36062347 PMCID: PMC11192133 DOI: 10.1177/21925682221124527] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY-DESIGN Retrospective chart review. OBJECTIVES Investigate radiographic and clinical outcomes of 3D printed titanium cages (3DTC) vs allograft in patients undergoing Anterior cervical discectomy and fusion (ACDF). METHODS Consecutive series of patients undergoing ACDF with 3DTC were compared to patients using corticocancellous allograft. Cage subsidence, fusion status, sagittal alignment, and patient-reported-outcomes. Radiographic evaluation was performed on the closing intraoperative x-ray and compared to films at 6-weeks, 6-months, and 1-year. Cage subsidence was calculated based on the amount of settling into superior and inferior endplates compared to the intraoperative x-ray. Fusion was assessed based on < 1 mm of flexion/extension motion. Sagittal alignment parameters and patient-reported-outcomes were measured. RESULTS Seventy six-patients/(120 levels) in 3DTC group and 77-patients/(115 levels) in allograft group were evaluated. No significant differences were noted in patient demographics, level fused or the number of levels fused between the groups. The most common level fused was C5-6. 3DTC had a significantly lower subsidence rate at all-time points as compared to allograft (P < .001). 3DTC maintained segmental lordosis better than allograft at all-time points including 1-year postop (P < .001). No significant differences were noted in fusion rate for 3DTC vs allograft at 6-months (P > .05). There were no significant differences in patient-reported-outcomes. CONCLUSION 3D printed titanium cages had similar patient-reported outcomes and fusion rates as allograft, but less subsidence at all-time points. 3D printed titanium cages better maintained the segmental lordosis at the operative level at all-time points. Although longer term evaluation is needed, based on these results, 3DTC appear to be viable graft options for ACDF that better maintain disc space height and improve segmental lordotic interbody correction.
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Affiliation(s)
- Hardeep Singh
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut
| | | | - Matthew P. Lunati
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Alexander Dawes
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Chi Heon Kim
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut
| | - Sungkyu Kim
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - John M. Rhee
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
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Malham GM, Biddau DT, Laggoune JP, Faulks CR, Walsh WR, Wang YY. Porous Cage Macro-Topography Improves Early Fusion Rates in Anterior Cervical Discectomy and Fusion. Surg Res Pract 2024; 2024:8452050. [PMID: 38523843 PMCID: PMC10957252 DOI: 10.1155/2024/8452050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024] Open
Abstract
Objectives Anterior cervical discectomy and fusion (ACDF) aims to improve pain, relieve neural compression, achieve rapid solid bony arthrodesis, and restore cervical alignment. Bony fusion occurs as early as 3 months and up to 24 months after ACDF. The correlations between bony fusion and clinical outcomes after ACDF remain unclear. Macro-topographic and porous features have been introduced to interbody cage technology, aiming to improve the strength of the bone-implant interface to promote early fusion. In this study, we aimed to compare clinical outcomes and CT-evaluated fusion rates in patients undergoing ACDF using one of two different interbody cages: traditional NanoMetalene™ (NM) cages and NM cages with machined porous features (NMRT). Methods This was a prospective, observational, nonrandomised, cohort study of consecutive patients undergoing ACDF. The NM cage cohort was enrolled first, then the NMRT cohort second. The visual analogue scale, neck disability index, and 12-item Short Form Survey scores were evaluated preoperatively and at 6 weeks, 3 months, and 6 months. The minimum clinical follow-up period was 12 months. Plain radiographs were obtained on postoperative day 2 to assess instrumentation positioning, and computed tomography (CT) was performed at 3 and 6 months postoperatively to assess interbody fusion (Bridwell grade). Results Eighty-nine (52% male) patients with a mean age of 62 ± 10.5 years were included in this study. Forty-one patients received NM cages, and 48 received NMRT cages. All clinical outcomes improved significantly from baseline to 6 months. By 3 months, the NMRT group had significantly higher CT fusion rates than the NM group (79% vs 56%, p=0.02). By 6 months, there were no significant differences in fusion rates between the NMRT and NM groups (83% vs 78%, p=0.69). The mean Bridwell grade at 6 months was 1.4 ± 0.7 in the NMRT group and 1.8 ± 1.0 in the NM group (p=0.08). Conclusions With both NM and NMRT cages, serial improvements in postoperative clinical outcomes were associated with fusion progression on CT. NMRT cages demonstrated significantly better fusion at 3 months and a trend toward higher quality of fusion at 6 months compared with NM cages, suggesting earlier cage integration with NMRT. An early 3-month postoperative CT is adequate for fusion assessment in almost 80% of patients undergoing ACDF with an NMRT cage, permitting an earlier return to activity.
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Affiliation(s)
- Gregory M. Malham
- Neuroscience Institute, Epworth Hospital, Richmond, Melbourne, Australia
- Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
- Spine Surgery Research, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Dean T. Biddau
- Neuroscience Institute, Epworth Hospital, Richmond, Melbourne, Australia
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jordan P. Laggoune
- Neuroscience Institute, Epworth Hospital, Richmond, Melbourne, Australia
| | - Charlie R. Faulks
- Neuroscience Institute, Epworth Hospital, Richmond, Melbourne, Australia
| | - William R. Walsh
- Surgical & Orthopaedic Research Laboratories (SORL), UNSW Sydney, Prince of Wales Clinical School, Prince of Wales Hospital, Sydney, Australia
| | - Yi Yuen Wang
- Neuroscience Institute, Epworth Hospital, Richmond, Melbourne, Australia
- Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
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Lambrechts MJ, D’Antonio ND, Heard JC, Toci GR, Karamian BA, Sherman M, Canseco JA, Kepler CK, Vaccaro AR, Hilibrand AS, Schroeder GD. Opioid Use Increases the Rate of Pseudarthrosis and Revision Surgery in Patients Undergoing Anterior Cervical Discectomy and Fusion. Global Spine J 2024; 14:620-630. [PMID: 35959950 PMCID: PMC10802537 DOI: 10.1177/21925682221119132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort. OBJECTIVES To (1) quantify the risk opioids impart on pseudarthrosis development, (2) analyze the effect of pseudarthrosis on clinical outcomes, and (3) identify if the amount of opioids prescribed are predictive of pseudarthrosis revision. METHODS Patients who underwent ACDF at a single institution between 2017-2019 were retrospectively identified. Postoperative dynamic cervical spine radiographs were reviewed to assess fusion status. Logistic regression models measured the effect of morphine milligram equivalents (MME) prescribed on the likelihood of pseudarthrosis development. Receiver operating characteristic (ROC) curves were generated to predict the probability of surgical revision based on MME prescribed. RESULTS Of 298 included patients, an average of 2.01 ± 0.82 levels were included in the construct and 121 (40.9%) patients were diagnosed with a pseudarthrosis. However, only 14 (4.7%) required a pseudarthrosis revision. Patients requiring pseudarthrosis revision had worse one-year postoperative Δ PCS-12 (-1.70 vs. 7.58, P = 0.004), Δ NDI (3.33 vs. -15.26, P = 0.002), and Δ VAS Arm (2.33 vs. -2.48, P = .047). Multivariate logistic regression analyses found the three-month postoperative (OR=1.00, P = .010), one-year postoperative (OR=1.001, P = 0.025), and combined pre- and postoperative MME (OR=1.000, P = .035) increased the risk of pseudarthrosis. ROC analysis identified cutoff values to predict pseudarthrosis revision at 90.00 (area under the curve (AUC): 0.693, confidence interval (CI): 0.554-0.832), 132.86 (0.710, CI: 0.589-0.840), 224.76 (0.687, CI: 0.558-0.817) and 285.00 (0.711, CI: 0.585-0.837) MME in the preoperative, three-month postoperative, one-year postoperative, and combined pre-and postoperative period. CONCLUSION Increased prescription of opioid medications following ACDF procedures may increase the risk of pseudarthrosis development and revision surgery. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Mark J. Lambrechts
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nicholas D. D’Antonio
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jeremy C. Heard
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory R. Toci
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian A. Karamian
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew Sherman
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose A. Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
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Jo J, Lakomkin N, Zuckerman SL, Chanbour H, Riew KD. The incidence of reoperation for pseudarthrosis after cervical spine surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1275-1282. [PMID: 38091104 DOI: 10.1007/s00586-023-08058-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/16/2023] [Accepted: 11/19/2023] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Pseudarthrosis after cervical spine surgery represents an underreported and challenging complication. Using a large multi-center surgical database, we sought to: (1) report the incidence of cervical pseudarthrosis, (2) evaluate changes in rates of cervical pseudarthrosis, and (3) describe risk factors for suboptimal outcomes after cervical pseudarthrosis surgery. METHODS The American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2019 was used. The primary outcome was occurrence of a cervical fusion procedure with a prior diagnosis of pseudarthrosis. Fusion for pseudarthrosis was divided into anterior and posterior approaches. Post-operative complications were classified as major or minor. Prolonged LOS was defined as exceeding the 75th percentile for total hospital stay. RESULTS A total of 780 patients underwent cervical fusion for pseudarthrosis, and a significant increase in rates of surgery for pseudarthrosis was seen (0.25-1.2%, p < 0.001). The majority of cervical pseudarthrosis was treated with a posterior approach (66.5%). Postoperatively, 38 (4.9%) patients suffered a complication and 247 (31.7%) had a prolonged LOS. The three strongest risk factors for complications and extended LOS were > 10% weight loss preoperatively, congestive heart failure, and pre-operative bleeding disorder. CONCLUSION Results from a large multi-center national database revealed that surgery to treat cervical pseudarthrosis has increased from 2012 to 2019. Most pseudarthrosis was treated with a posterior approach. Reoperation to treat cervical pseudarthrosis carried risk, with 5% having complications and 32% having an extended LOS. These results lay the groundwork for a future prospective study to discern the true incidence of cervical pseudarthrosis and how to best avoid its occurrence.
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Affiliation(s)
- Jacob Jo
- Department of Neurological Surgery, Vanderbilt University Medical Center, Medical Center North T-4224, Nashville, TN, USA
| | - Nikita Lakomkin
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Medical Center North T-4224, Nashville, TN, USA.
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Medical Center North T-4224, Nashville, TN, USA
| | - K Daniel Riew
- Department of Neurological Surgery, Cornell University Medical Center, New York, NY, USA
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
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Redaelli A, Stephan SR, Riew KD. Is neck pain treatable with surgery? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1137-1147. [PMID: 38191741 DOI: 10.1007/s00586-023-08053-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/05/2023] [Accepted: 11/14/2023] [Indexed: 01/10/2024]
Abstract
INTRODUCTION Neck pain is one of the most common complaints in clinical practice and can be caused by a wide variety of conditions. While cervical spine surgery is a well-accepted option for radicular pain and myelopathy, surgery for isolated neck pain is controversial. The identification of the source of pain is challenging and subtle, and misdiagnosis can lead to inappropriate treatment. MATERIALS AND METHODS AND RESULTS: We conducted a thorough literature review to discuss and compare different causes of neck pain. We then supplemented the literature with our senior author's expert analysis of treating cervical spine pathology. CONCLUSIONS This study provides an in-depth discussion of neck pain and its various presentations, as well as providing insight into treatment strategies and diagnostic pearls that may prevent mistreatment of cervical spine pathology.
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Affiliation(s)
- Andrea Redaelli
- GSpine4, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Stephen R Stephan
- Department of Orthopaedic Surgery, San Diego Spine Foundation, San Diego, USA
| | - K Daniel Riew
- Department of Neurological Surgery, Weill-Cornell Medical Center, New York, USA
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, USA
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Cabrera JP, Muthu S, Mesregah MK, Rodrigues-Pinto R, Agarwal N, Arun-Kumar V, Wu Y, Vadalà G, Martin C, Wang JC, Meisel HJ, Buser Z. Complications With Demineralized Bone Matrix, Hydroxyapatite and Beta-Tricalcium Phosphate in Single and Two-Level Anterior Cervical Discectomy and Fusion Surgery. Global Spine J 2024; 14:78S-85S. [PMID: 38421333 PMCID: PMC10913904 DOI: 10.1177/21925682231157320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
STUDY DESIGN Systematic literature review. OBJECTIVES To analyze the evidence available reporting complications in single or two-level anterior cervical discectomy and fusion (ACDF) using a demineralized bone matrix (DBM), hydroxyapatite (HA), or beta-tricalcium phosphate (β-TCP). METHODS A systematic review of the literature using PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov databases was performed in August 2020 to identify studies reporting complications in one or two-level ACDF surgery using DBM, HA, or β-TCP. The study was reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. RESULTS A total of 1857 patients were included, 981 male and 876 female, across 17 articles; 5 prospective, and 12 retrospectives. We noted heterogeneity among the included studies concerning the study design and combination of graft materials utilized in them. However, we noted a higher incidence of adjacent segment disease (17.7%) and pseudoarthrosis (9.3%) in fusion constructs using DBM. Studies using β-TCP reported a higher incidence of pseudoarthrosis (28.2%) and implant failures (17.9%). CONCLUSIONS Degenerative cervical conditions treated with one or two-level ACDF surgery using DBM, HA, or β-TCP with or without cervical plating are associated with complications such as adjacent segment disease, dysphagia, and pseudarthrosis. However, consequent to the study designs and clinical heterogeneity of the studies, it is not possible to correlate these complications accurately with any specific graft material employed. Further well-designed prospective studies are needed to correctly know the related morbidity of each graft used for achieving fusion in ACDF.
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Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
- Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Sathish Muthu
- Department of Orthopaedics, Government Medical College, Dindigul, India
- Orthopaedic Research Group, Coimbatore, India
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Egypt
| | - Ricardo Rodrigues-Pinto
- Spinal Unit/Unidade Vertebro-Medular (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Neha Agarwal
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Germany
| | | | - Yabin Wu
- Research Department, AO Spine, AO Foundation, Davos, Switzerland
| | - Gianluca Vadalà
- Campus Bio-Medico University of Rome and Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Christopher Martin
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Jeffrey C Wang
- USC Spine Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hans Jörg Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Germany
| | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
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Arun-Kumar V, Corluka S, Buser Z, Wu Y, El-Sharkawi M, Carazzo CA, Ponugoti N, Wang JC, Meisel HJ. Do Osteobiologics Augment Fusion in Anterior Cervical Discectomy and Fusion Surgery Performed With Mechanical Interbody Devices (Polyether ether ketone, Carbon Fiber, Metal Cages) and is the Fusion Rate Comparable to that With Autograft? A Systematic Review. Global Spine J 2024; 14:24S-33S. [PMID: 38421330 PMCID: PMC10913910 DOI: 10.1177/21925682231188626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
STUDY DESIGN Systematic Review of the Literature. OBJECTIVE The purpose of this study was to perform a systematic review describing fusion rates for anterior cervical discectomy and fusion (ACDF) using autograft vs various interbody devices augmented with different osteobiologic materials. METHODS A systematic review limited to the English language was performed in Medline, Embase and Cochrane library using Medical Subject Heading (MeSH) terms. Studies that evaluated fusion after ACDF using autografts and osteobiologics combined with PEEK, carbon fibre, or metal cages were searched for. Articles in full text that met the criteria were included in the review. The main outcomes evaluated were the time taken to merge, the definition of the fusion assessment, and the modality of the fusion assessment. The risk of bias of each article was assessed by the MINORS score or ROB 2.0 depending on the randomisation process. RESULTS The total number of references reviewed was six hundred and eighty-two. After applying the inclusion criteria, 54 were selected for the retrieval of the full text. Eight studies were selected and included for final analysis in this study. Fusion rates were reported between 83.3% and 100% for autograft groups compared to 46.5% and 100% for various interbody device/osteobiological combinations. The overall quality of the evidence in all radiographic fusion studies was considered insufficient due to a serious risk of bias. CONCLUSION Mechanical interbody devices augmented with osteobiologics performed similarly to autografts in terms of reliability and efficacy. Their time to fusion and fusion rate were comparable to autografts at the end of the final follow-up.
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Affiliation(s)
| | - Stipe Corluka
- Spinal Surgery Division, Department of Traumatology, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
- Department of Anatomy and Physiology, University of Applied Health Sciences, Zagreb, Croatia
| | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Yabin Wu
- Research Department, AO Spine, AO Foundation, Davos, Switzerland
| | - Mohammad El-Sharkawi
- Professor of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Charles André Carazzo
- Professor of Neurosurgery, Faculty of Medicine, Passo Fundo University, Passo Fundo, Brazil
| | - Nikhil Ponugoti
- Orthopaedic Registrar, Hampshire Hospital NHS Foundation Trust, Hampshire, UK
| | - Jeffrey C Wang
- USC Spine Center, Los Angeles, CA, USA
- Department of Orthopaedic Surgery and Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hans Jörg Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Germany
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Hamouda WO, Veranis S, Krol O, Sagoo NS, Passias PG, Buser Z, Meisel HJ, Yoon T. Dosing Strategy for Osteobiologics Used in ACDF Surgery: Influence on Fusion Rates and Associated Complications. A Systematic Literature Review. Global Spine J 2024; 14:129S-140S. [PMID: 38421331 PMCID: PMC10913908 DOI: 10.1177/21925682231195766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To assess the available evidence related to dose-dependent effectiveness (i.e., bone fusion) and morbidity of osteobiologics used in anterior cervical discectomy and fusion (ACDF). METHODS Studies with more than 9 adult patients with degenerated/herniated cervical discs operated for one-to four-levels ACDF reporting used osteobiologics doses, fusion rates at six months or later, and related comorbidities were included. PubMed, EMBASE, ClinicalTrials, and Cochrane were searched through September 2021. Data extracted in spread sheet and risk of bias assessed using MINORS and Rob-2. RESULTS Sixteen studies were selected and sub-grouped into BMP and non-BMP osteobiologics. For the 10 BMP studies, doses varied from 0.26 to 2.1 mg in 649 patients with fusion rates of 95.3 to 100% at 12 months. For other osteobiologics, each of six studies reported one type of osteobiologic in certain dose/concentration/volume in a total of 580 patients with fusion rates of 6.8 to 96.9% at 12 months. Risk of bias was low in three of the 13 non-randomized (18.75%) and in all the three randomized studies (100%). CONCLUSIONS Taking into account the inconsistent reporting within available literature, for BMP usage in ACDF, doses lower than 0.7 mg per level can achieve equal successful fusion rates as higher doses, and there is no complication-free dose proved yet. It seems that the lower the dose the lower the incidence of serious complications. As for non-BMP osteobiologics the studies are very limited for each osteobiologic and thus conclusions must be drawn individually and with caution.
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Affiliation(s)
- Waeel O Hamouda
- Department of Neurosurgery, Kasr Alainy Faculty of Medicine, Research, and Teaching Hospitals, Cairo University, Cairo, Egypt
- Neurological & Spinal surgery service, Security Forces Hospital, Dammam, Saudi Arabia
| | | | - Oscar Krol
- Spine Research Institute, Department of Orthopaedic and Neurological Surgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
| | | | - Peter G Passias
- Division of Spinal Surgery/ Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
| | - Zorica Buser
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
- Director of Regenerative Medicine (Spine Restoration), Gerling Institute Formerly SpineCare, New York, NY, USA
| | - Hans Jörg Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Halle, Germany
| | - Tim Yoon
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
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11
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Jain A, Dhanjani S, Harris A, Cartagena M, Babu J, Riew D, Shin J, Wang JC, Yoon ST, Buser Z, Meisel HJ. Structural Allograft Versus Mechanical Interbody Devices Augmented With Osteobiologics in Anterior Cervical Discectomy and Fusion: A Systematic Review. Global Spine J 2024; 14:34S-42S. [PMID: 38421329 PMCID: PMC10913916 DOI: 10.1177/21925682231171857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
STUDY DESIGN Systematic Literature Review. OBJECTIVE Perform a systematic review evaluating postoperative fusion rates for anterior cervical discectomy and fusion (ACDF) using structural allograft vs various interbody devices augmented with different osteobiologic materials. METHODS Comprehensive literature search using PubMed, Embase, The Cochrane Library, and Web of Science was performed. Included studies were those that reported results of 1-4 levels ACDF using pure structural allograft compared with a mechanical interbody device augmented with an osteobiologic. Excluded studies were those that reported on ACDF with cervical corpectomy; anterior and posterior cervical fusions; circumferential (360° or 540°) fusion or revision ACDF for nonunion or other conditions. Risk of bias was determined using the Cochrane review guidelines. RESULTS 8 articles reporting fusion rates of structural allograft and an interbody device/osteobiologic pair were included. All included studies compared fusion rates following ACDF among structural allograft vs non-allograft interbody device/osteobiologic pairs. Fusion rates were reported between 84% and 100% for structural allograft, while fusion rates for various interbody device/osteobiologic combinations ranged from 26% to 100%. Among non-allograft cage groups fusion rates varied from 73-100%. One study found PEEK cages filled with combinations of autograft, allograft, and demineralized bone matrix (DBM) to have an overall fusion rate of 26%. In one study comparing plate and zero-profile constructs, there was no difference in fusion rates for two-level fusions. CONCLUSION There was limited data comparing fusion outcomes of patients undergoing ACDF using structural allograft vs interbody devices augmented with osteobiologic materials to support superiority of one method.
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Affiliation(s)
- Amit Jain
- Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | | | - Andrew Harris
- Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | | | - Jacob Babu
- Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Daniel Riew
- Weill Cornell Brain and Spine Center, New York, NY, USA
| | - John Shin
- Mass General Brigham Inc, Boston, MA, USA
| | | | - S Tim Yoon
- Orthopedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Vadalà G, Ambrosio L, De Salvatore S, Riew DK, Yoon ST, Wang JC, Meisel HJ, Buser Z, Denaro V. The Role of Osteobiologics in Augmenting Spine Fusion in Unplated Anterior Cervical Discectomy and Fusion Compared to Plated Constructs: A Systematic Review and Meta-analysis. Global Spine J 2024; 14:43S-58S. [PMID: 38421326 PMCID: PMC10913900 DOI: 10.1177/21925682231156865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE To compare clinical and radiographic outcomes as well as complications of unplated vs plated anterior cervical discectomy and fusion (ACDF) surgery considering the role of osteobiologics in single- and multi-level procedures. METHODS A systematic search of PubMed/MEDLINE, Scopus, CINAHL, EMBASE, CENTRAL, Cochrane and ClinicalTrials.gov databases was performed. Briefly, we sought to identify studies comparing unplated vs. plated ACDF for cervical degenerative disc disease reporting the use of osteobiologics in terms of clinical outcomes, radiographic fusion, and complications. Data on study population, follow-up time, type of cage and plate used, type of osteobiologic employed, number of levels treated, patient-reported outcomes (PROs), radiographic outcomes and complications were collected and compared. Relevant information was pooled for meta-analyses. RESULTS Thirty-eight studies met the inclusion criteria. No significant difference was found in terms of clinical outcomes between groups. Unplated ACDF was characterized by reduced blood loss, operation time and length of hospital stay. Fusion was achieved by the majority of patients in both groups, with no evidence of any specific contribution depending on the osteobiologics used. Dysphagia was more commonly associated with anterior plating, while cage subsidence prevailed in the unplated group. CONCLUSION Unplated and plated ACDF seem to provide similar outcomes irrespective of the osteobiologic used, with minor differences with doubtful clinical significance. However, the heterogeneity and high risk of bias affecting included studies markedly prevent significant conclusions.
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Affiliation(s)
- Gianluca Vadalà
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Luca Ambrosio
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Sergio De Salvatore
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Daniel K Riew
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
| | - S Tim Yoon
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hans Jörg Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Halle, Germany
| | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Vincenzo Denaro
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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13
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Zhao HH, Xu HW, Wang SJ, Hu T, Wu DS. Anterior cervical discectomy and fusion with a zero-profile VA spacer device: a clinical and radiological study with two-year follow-up. J Orthop Surg Res 2024; 19:51. [PMID: 38212759 PMCID: PMC10782712 DOI: 10.1186/s13018-024-04539-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024] Open
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE The aim of this study was to compare clinical and radiological outcomes of the anterior cervical discectomy and fusion (ACDF) with a novel zero-profile variable-angle (Zero-P VA) spacer and a traditional poly-ether-ether-ketone (PEEK) cage and plate system in cases pertaining to cervical radiculopathy/myelopathy. There are two conventional types of ACDF procedures aimed at treating symptomatic cervical spondylosis. The first one involves an uninstrumented "stand-alone" approach utilizing bone graft/cage, while the second incorporates bone graft/cage in conjunction with a front plate positioned before the vertebral bodies. Both procedures have their own inherent advantages and disadvantages. The Zero-P VA spacer, however, represents a unique synthesis by amalgamating the advantages of both traditionally typical procedures. Notably, this spacer can potentially circumvent the issue related to prevertebral soft-tissue disturbance and reduce the occurrence of dysphagia. METHODS Using our surgical database, the authors systematically conducted a retrospective analysis encompassing all patients who underwent single-level ACDF between January 2018 and January 2019, with a minimum two-year follow-up. Patients either received a Zero-P VA implant or PEEK cage coupled with plating. The Japanese Orthopedic Association (JOA) score and Visual Analogue Scale (VAS) for arm and neck pain were documented. Dysphagia was evaluated using the Eating Assessment Tool-10 (ETA-10). Additional parameters such as cervical alignment, fusion rate and the incidence of postoperative complications were assessed. RESULTS According to the outcomes of the statistical analysis, there was no substantial disparity that emerged in the advancements observed in the JOA and VAS metrics between the two study cohorts. Noteworthy, however, the ETA-10 scores were statistically significantly reduced in the Zero-P VA group compared to the cage and plating group (p < 0.05). At the final follow-up, there were no statistically significant differences in the height of the operated segment, Cobb angle of the fused segment, C2-C7 Cobb angle and fusion rate between the two groups (p > 0.05). However, postoperative complications were slightly lower in patients with the Zero-P VA group (7.69%) as compared to the cage and plating group (16.67%). CONCLUSION The clinical outcomes observed with the Zero-P VA spacer used for single-level ACDF were found to be satisfactory. The performance of this device is comparable or even superior to the traditional cage and plating method in preventing postoperative dysphagia and mitigating potential complications associated with the use of a plate.
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Affiliation(s)
- Hai-Hong Zhao
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China
| | - Hao-Wei Xu
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China
| | - Shan-Jin Wang
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China
| | - Tao Hu
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China.
| | - De-Sheng Wu
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China
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14
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Park J, Park SM, Ham DW, Hong JY, Kim HJ, Yeom JS. Anterior Cervical Discectomy and Fusion Performed Using a CaO-SiO 2-P 2O 5-B 2O 3 Bioactive Glass Ceramic or Polyetheretherketone Cage Filled with Hydroxyapatite/β-Tricalcium Phosphate: A Prospective Randomized Controlled Trial. J Clin Med 2023; 12:4069. [PMID: 37373762 DOI: 10.3390/jcm12124069] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
A CaO-SiO2-P2O5-B2O3 bioactive glass-ceramic (BGS-7) spacer provides high mechanical stability, produces a chemical bond to the adjacent endplate, and facilitates fusion after spine surgery. This prospective, randomized, single-blind, non-inferiority trial aimed to evaluate the radiographic outcomes and clinical efficacy of anterior cervical discectomy and fusion (ACDF) using a BGS-7 spacer for treating cervical degenerative disorders. Thirty-six patients underwent ACDF using a BGS-7 spacer (Group N), and 40 patients underwent ACDF using polyetheretherketone (PEEK) cages filled with a mixture of hydroxyapatite (HA) and β-tricalcium phosphate (β-TCP) for the treatment of cervical degenerative disorders. The spinal fusion rate was assessed 12 months postoperatively using three-dimensional computed tomography (CT) and dynamic radiographs. Clinical outcomes included patient-reported outcome measures, visual analog scale scores for neck and arm pain, and scores from the neck disability index (NDI), European Quality of Life-5 Dimensions (EQ-5D), and 12-item Short Form Survey (SF-12v2). All participants were randomly assigned to undergo ACDF using either a BGS-7 spacer or PEEK cage filled with HA and β-TCP. The primary outcome was the fusion rate on CT scan image at 12 months after ACDF surgery based on a per-protocol strategy. Clinical outcomes and adverse events were also assessed. The 12-month fusion rates for the BGS-7 and PEEK groups based on CT scans were 81.8% and 74.4%, respectively, while those based on dynamic radiographs were 78.1% and 73.7%, respectively, with no significant difference between the groups. There were no significant differences in the clinical outcomes between the two groups. Neck pain, arm pain, NDI, EQ-5D, and SF-12v2 scores significantly improved postoperatively, with no significant differences between the groups. No adverse events were observed in either group. In ACDF surgery, the BGS-7 spacer showed similar fusion rates and clinical outcomes as PEEK cages filled with HA and β-TCP.
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Affiliation(s)
- Jiwon Park
- Department of Orthopedic Surgery, Korea University Ansan Hospital, Ansan-si 15355, Republic of Korea
| | - Sang-Min Park
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
| | - Dae-Woong Ham
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea
| | - Jae-Young Hong
- Department of Orthopedic Surgery, Korea University Ansan Hospital, Ansan-si 15355, Republic of Korea
| | - Ho-Joong Kim
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
| | - Jin S Yeom
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
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15
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Byvaltsev VA, Kalinin AA, Belykh EG, Aliyev MA, Sanzhin BB, Kukharev AV, Dyussembekov YK, Shepelev VV, Riew KD. Clinical and radiological outcomes of one-level cervical corpectomy with an expandable cage for three-column uncomplicated subaxial type «B» injures: a multicenter retrospective study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1644-1654. [PMID: 36976341 DOI: 10.1007/s00586-023-07648-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE To evaluate the clinical and radiological results of the operative management of three-column uncomplicated type «B» subaxial injures treated with a one-level cervical corpectomy with an expandable cage. METHODS This study included 72 patients with a three-column uncomplicated type «B» subaxial injures who met the inclusion criteria, underwent a one-level cervical corpectomy with an expandable cage at one of three neurosurgical departments between 2005 and 2020, and were followed up for clinical and radiological outcomes at a minimum 3-yr follow-up. RESULTS There was a decrease in the VAS pain score from an average of 80 mm to 7 mm (p = 0.03); a decrease in the average NDI score from 62 to 14% (p = 0.01); excellent and good outcomes according to Macnab's scale were 93% (n = 67/72). There was an average change in the cervical lordosis (Cobb method) from -9.10 to -15.40 (p = 0.007), without significant loss of lordosis (p = 0.27). There was no significant degeneration of the adjacent levels by 3 years post-op. The fusion rate, using the Cervical Spine Research Society criteria, was poor: it was 62.5% (n = 45/72), and using the CT criteria, it was 65.3% (n = 47/72). 15.4% patients (n = 11/72) suffered complications. Statistical difference between the fusion and pseudoarthrosis (according to X-ray criteria) subgroups showed that there were no statistically significant differences in the smoking status, diabetes, chronic steroid use, cervical injury level, subtypes of AO type B subaxial injuries and types of expandable cage systems. CONCLUSIONS One-level cervical corpectomy with an expandable cage, despite a poor fusion rate, can be considered a feasible and relatively safe method for treating three-column uncomplicated subaxial type «B» injures, with the benefit of immediate stability, anatomical reduction, and direct decompression of the spinal cord. While no one in our series had any catastrophic complications, we did note a high complication rate.
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Affiliation(s)
- Vadim A Byvaltsev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia.
- Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia.
- Department of Traumatology, Orthopedic and Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia.
| | - Andrei A Kalinin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
| | - Evgenii G Belykh
- Department of Neurosurgery, New Jersey Medical School, Rutgers University, New York, USA
| | - Marat A Aliyev
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
- Department of Neurosurgery, City Clinical Hospital No. 7, Almaty, Kazakhstan
| | - Bair B Sanzhin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | | | | | - Valerii V Shepelev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- Department of Neurosurgery, 1477 Clinical Hospital, Vladivostok, Russia
| | - K Daniel Riew
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
- Department of Neurological Surgery, Weill Cornell Medical School, New York, USA
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16
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Park S, Kim JK, Chang MC, Park JJ, Yang JJ, Lee GW. Assessment of Fusion After Anterior Cervical Discectomy and Fusion Using Convolutional Neural Network Algorithm. Spine (Phila Pa 1976) 2022; 47:1645-1650. [PMID: 35905310 DOI: 10.1097/brs.0000000000004439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND A convolutional neural network (CNN) is a deep learning (DL) model specialized for image processing, analysis, and classification. OBJECTIVE In this study, we evaluated whether a CNN model using lateral cervical spine radiographs as input data can help assess fusion after anterior cervical discectomy and fusion (ACDF). STUDY DESIGN Diagnostic imaging study using DL. PATIENT SAMPLE We included 187 patients who underwent ACDF and fusion assessment with postoperative one-year computed tomography and neutral and dynamic lateral cervical spine radiographs. OUTCOME MEASURES The performance of the CNN-based DL algorithm was evaluated in terms of accuracy and area under the curve. MATERIALS AND METHODS Fusion or nonunion was confirmed by cervical spine computed tomography. Among the 187 patients, 69.5% (130 patients) were randomly selected as the training set, and the remaining 30.5% (57 patients) were assigned to the validation set to evaluate model performance. Radiographs of the cervical spine were used as input images to develop a CNN-based DL algorithm. The CNN algorithm used three radiographs (neutral, flexion, and extension) per patient and showed the diagnostic results as fusion (0) or nonunion (1) for each radiograph. By combining the results of the three radiographs, the final decision for a patient was determined to be fusion (fusion ≥2) or nonunion (fusion ≤1). By combining the results of the three radiographs, the final decision for a patient was determined as fusion (fusion ≥2) or nonunion (nonunion ≤1). RESULTS The CNN-based DL model demonstrated an accuracy of 89.5% and an area under the curve of 0.889 (95% confidence interval, 0.793-0.984). CONCLUSION The CNN algorithm for fusion assessment after ACDF trained using lateral cervical radiographs showed a relatively high diagnostic accuracy of 89.5% and is expected to be a useful aid in detecting pseudarthrosis.
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Affiliation(s)
- Sehan Park
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do Province, Republic of Korea
| | - Jeoung Kun Kim
- Department of Business Administration, School of Business, Yeungnam University, Gyeongsan-si, Gyeonggi-do Province, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Gyeongsang Province, Republic of Korea
| | - Jeong Jin Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Gyeongsang Province, Republic of Korea
| | - Jae Jun Yang
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do Province, Republic of Korea
| | - Gun Woo Lee
- Department of Physical Medicine and Rehabilitation, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Gyeongsang Province, Republic of Korea
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Grasso G, Torregrossa F, Karamian BA, Canseco JA, Vaccaro AR. Anterior cervical discectomy and fusion is more effective than cervical arthroplasty in relieving atypical symptoms in patients with cervical spondylosis. Br J Neurosurg 2022; 36:777-785. [PMID: 35587738 DOI: 10.1080/02688697.2022.2077309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE Patients with cervical spondylosis often present with concurrent 'atypical symptoms' of unknown etiology that have been associated with cervical spondylotic disease, including dizziness, headache, nausea, tinnitus, blurred vision, palpitations, and memory and gastrointestinal disturbances. Few studies have addressed whether surgical intervention to treat classic symptoms of cervical spondylosis can also effectively alleviate atypical symptoms. Accordingly, the purpose of this study is to compare the ability of cervical arthroplasty (CA) and anterior cervical discectomy and fusion (ACDF) to alleviate atypical symptoms associated with cervical spondylosis. MATERIALS AND METHODS A retrospective analysis of 140 patients with cervical spondylosis and associated atypical symptoms was performed. Atypical symptoms were defined vertigo, headache, nausea and vomiting, tinnitus, blur vision, palpitation, hypomnesia, and gastroenteric disturbances not otherwise explained by medical comorbidities. Seventy-eight patients (55.7%) underwent ACDF and 62 (44.3%) patients underwent CA. Demographics, surgical characteristics, patient reported outcome measures (PROMs), radiographs, complication rates, and resolution in atypical symptoms were recorded and compared between groups. Atypical symptoms were assessed using a 20-point system. All the patients had a minimum of five years follow-up. RESULTS VAS, SF-36, JOA, and NDI scores improved significantly in all the patients (p < 0.001). At the last follow-up, the fusion rate was 97% in the ACDF group. Atypical symptoms improved in both groups (p < 0.001), although the ACDF group demonstrated greater improvement in headache and vertigo resolution compared to the CA group (p < 0.0001). CONCLUSIONS While both ACDF and CA are effective in alleviating atypical symptoms associated with cervical spondylosis, ACDF demonstrated greater improvements in atypical symptoms.
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Affiliation(s)
- Giovanni Grasso
- Neurosurgical Clinic, Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, School of Medicine, Palermo, Italy
| | - Fabio Torregrossa
- Neurosurgical Clinic, Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, School of Medicine, Palermo, Italy
| | - Brian A Karamian
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose A Canseco
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Is the Zero-P Spacer Suitable for 3-Level Anterior Cervical Discectomy and Fusion Surgery in Terms of Sagittal Alignment Reconstruction: A Comparison Study with Traditional Plate and Cage System. Brain Sci 2022; 12:brainsci12111583. [PMID: 36421907 PMCID: PMC9688593 DOI: 10.3390/brainsci12111583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
The Zero-P spacer was primarily developed aiming to reduce the morbidity associated with the traditional anterior cervical plate. During the past decade, many authors have reported the use of Zero-P spacers for anterior cervical discectomy and fusion (ACDF) of one or two segments. Nevertheless, there is still a paucity of knowledge on the safety and feasibility of using Zero-P spacers for 3-level fixation. The objective of this study was to investigate the clinical and radiological outcomes, with a focus on the sagittal alignment reconstruction of 3-level ACDF surgery using Zero-P spacers versus those using a traditional plate and cage system. From Sep 2013 to Aug 2016, a total of 44 patients who received 3-level ACDF surgery due to cervical spondylotic myelopathy were recruited. The Zero-P spacer was used in 23 patients (group ZP) and the traditional plate and cage system in 21 (group PC). Clinical outcomes were analyzed by Neck Disability Index (NDI) and Japanese Orthopedic Association (JOA) scores, and dysphagia was evaluated using the Bazaz score. Radiological outcomes, including fusion rate, adjacent segment degeneration (ASD), and especially changes in cervical sagittal alignment, were analyzed. The NDI and JOA scores did not differ significantly between the two groups postoperatively (p > 0.05); however, there was significantly less dysphagia in patients using Zero-P spacers at the 3- and 6-month follow-up (p < 0.05). At the 24-month follow-up, the fusion rate and ASD were similar between the two groups (p > 0.05). Interestingly, patients using Zero-P spacers had a significantly lower postoperative C2-7 Cobb angle and fused segment Cobb angle, compared to those using a traditional plate and cage system (p < 0.05); meanwhile, the fused segment disc wedge was also found to be significantly smaller in patients using Zero-P spacers after surgery (p < 0.05). Moreover, we further divided patients into subgroups according to their cervical lordosis. In patients with a preoperative C2-7 Cobb angle ≤ 10°, significantly less cervical and local lordosis, as well as disc wedge, were seen in group ZP after surgery (p < 0.05), while in others with a preoperative C2-7 Cobb angle > 10°, no significant difference in postoperative changes of the cervical sagittal alignment was seen between group ZP and group PC (p > 0.05). Zero-P spacers used in 3-level ACDF surgery could provide equivalent clinical outcomes and a lower rate of postoperative dysphagia, compared to the traditional plate and cage system. However, our results showed that it was inferior to the cervical plate in terms of sagittal alignment reconstruction for 3-level fixation. We recommend applying Zero-P spacers for 3-level ACDF in patients with good preoperative cervical lordosis (C2-7 Cobb angle > 10°), in order to restore and maintain physiological curvature of the cervical spine postoperatively.
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19
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Lambrechts MJ, Issa TZ, Toci GR, D'Antonio ND, Karamian BA, Tecce E, Fras S, Kaye ID, Woods BI, Kepler CK, Vaccaro AR, Schroeder GD, Hilibrand AS, Canseco JA. Soft Cervical Orthosis Use Does Not Improve Fusion Rates After One-Level and Two-Level Anterior Cervical Discectomy and Fusion. World Neurosurg 2022; 167:e1461-e1467. [PMID: 36174948 DOI: 10.1016/j.wneu.2022.09.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine if postoperative soft cervical orthosis use affects arthrodesis rates on a per-level or construct basis after 1-level and 2-level anterior cervical discectomy and fusion (ACDF). METHODS Electronic medical records were queried for 1-level and 2-level primary ACDF between 2016 and 2019 at a single academic center. Surgeons prescribed either a soft cervical orthosis or no orthosis. Pseudarthrosis rates were evaluated by dynamic cervical spine radiographs with arthrodesis defined by <1 mm of interspinous motion. Continuous and categorical data were compared using analysis of variance or χ2 tests. Multivariate logistic regression analysis was used to examine independent predictors of pseudarthrosis. RESULTS A total of 316 unique patients (504 instrumented levels) met the inclusion criteria. Eighty-four percent of patients were prescribed a soft cervical orthosis. Overall, arthrodesis occurred at 344 (80.9%) and 62 (78%) levels in patients with and without cervical orthosis, respectively. When evaluating patients placed in a cervical orthosis versus those who were not, there were no differences in pseudarthrosis or revision rates. Further, there were no differences in pseudarthrosis on a per-level basis. Further, cervical orthosis use was not an independent predictor of pseudarthrosis (odds ratio, 0.86; 95% confidence interval, 0.47-1.57; P =0.623) on multivariate analysis. CONCLUSIONS Postoperative placement of soft cervical orthoses after 1-level or 2-level ACDF was not associated with improved arthrodesis or reduced rate of revision surgery.
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Affiliation(s)
- Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Tariq Z Issa
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory R Toci
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nicholas D D'Antonio
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Eric Tecce
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sebastian Fras
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ian David Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Barrett I Woods
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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20
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Godlewski B, Bebenek A, Dominiak M, Bochniak M, Cieslik P, Pawelczyk T. Reliability and Utility of Various Methods for Evaluation of Bone Union after Anterior Cervical Discectomy and Fusion. J Clin Med 2022; 11:jcm11206066. [PMID: 36294384 PMCID: PMC9605251 DOI: 10.3390/jcm11206066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/09/2022] [Accepted: 10/13/2022] [Indexed: 11/25/2022] Open
Abstract
Most surgical procedures performed on account of degenerative disease of the cervical spine involve a discectomy and interbody fixation. Bone fusion at the implant placement site is evaluated post-operatively. It is agreed that computed tomography is the best modality for assessing bone union. We evaluated the results obtained with various methods based solely on conventional radiographs in the same group of patients and compared them with results obtained using a method that is a combination of CT and conventional radiography, which we considered the most precise and a reference method. We operated on a total of 170 disc spaces in a group of 104 patients. Fusion was evaluated at 12 months after surgery with five different and popular classifications based on conventional radiographs and then compared with the reference method. Statistical analyses of test accuracy produced the following classification of fusion assessment methods with regard to the degree of consistency with the reference method, in descending order: (1) bone bridging is visible on the anterior and/or posterior edge of the operated disc space on a lateral radiograph; (2) change in the value of Cobb's angle for a motion segment on flexion vs. extension radiographs (threshold for fusion vs. pseudoarthrosis is 2°); (3) change in the interspinous distance between process tips on flexion vs. extension radiographs (threshold of 2 mm); (4) change in the value of Cobb's angle of a motion segment (threshold of 4°); (5) change in the interspinous distance between process bases on flexion vs. extension radiographs (threshold of 2 mm). When bone union is evaluated on the basis on radiographs, without CT evidence, we suggest using the "bone bridging" criterion as the most reliable commonly used approach to assessing bone union.
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Affiliation(s)
- Bartosz Godlewski
- Department of Orthopaedics and Traumatology, with spinal Surgery Ward, Scanmed—St. Raphael Hospital, ul. Adama Bochenka 12, 04-141 Cracow, Poland
- Correspondence: ; Tel./Fax: +48-12-3855634
| | - Adam Bebenek
- Department of Orthopaedics and Traumatology, with spinal Surgery Ward, Scanmed—St. Raphael Hospital, ul. Adama Bochenka 12, 04-141 Cracow, Poland
| | - Maciej Dominiak
- Department of Orthopaedics and Traumatology, with spinal Surgery Ward, Scanmed—St. Raphael Hospital, ul. Adama Bochenka 12, 04-141 Cracow, Poland
| | - Marcin Bochniak
- Department of Orthopaedics and Traumatology, with spinal Surgery Ward, Scanmed—St. Raphael Hospital, ul. Adama Bochenka 12, 04-141 Cracow, Poland
| | - Piotr Cieslik
- Department of Orthopaedics and Traumatology, Military Institute of Medicine, 04-141 Warsaw, Poland
| | - Tomasz Pawelczyk
- Department of Affective and Psychotic Disorders, Medical University of Lodz, 92-213 Lodz, Poland
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21
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Weinberg DS, Eoh JH, Manz WJ, Fakunle OP, Dawes AM, Park ET, Rhee JM. Off-label usage of RhBMP-2 in posterior cervical fusion is not associated with early increased complication rate and has similar clinical outcomes. Spine J 2022; 22:1079-1088. [PMID: 35181539 DOI: 10.1016/j.spinee.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Arthrodesis is important for the success of posterior cervical fusion (PCF), however, there exists limited data regarding the safety and efficacy of bone morphogenic protein (BMP) in PCF. PURPOSE The primary objective was to evaluate early postoperative complications associated with BMP in PCF and determine whether BMP leads to adverse early clinical outcomes. A secondary objective was to determine the optimal location for BMP sponge placement, within the facet joint (IF) or elsewhere, and the optimal dosage/level. DESIGN Retrospective, consecutive case-control study. PATIENT SAMPLE Seven hundred sixty-five patients who underwent PCF OUTCOME MEASURES: Patient-reported outcomes (PROs), complications, arthrodesis, optimum dose/level of BMP METHODS: Surgical data, including preoperative diagnosis, levels fused, type of bone graft, BMP dose (when used), and fusion technique were recorded. Complications were assessed by reviewing the medical record encompassing the first 6-weeks postoperative. These included medical, neurological, and wound-related complications and reoperation. Neurological complications were defined as any new weakness, radicular pain, or numbness. PROs were collected, including SF36, VAS, EQ-5D, and NDI scores. To determine the optimal dosage and location for BMP placement, a sub-analysis was performed. RESULTS There were no significant differences between the BMP and no BMP group with regards to wound complications, neurological complications, or reoperation. There were no differences in PROs between BMP and no BMP. Placement of BMP for IF and at a dose of 0.87 mg/level minimized wound-related complications. The BMP group had a higher fusion rate compared to the no BMP group (96% vs. 91%, p=.02) when assessed 1 year post-operatively. CONCLUSION BMP was not associated with a higher rate of early complications after PCF when the dose was minimized. Complications thought to be associated with BMP, such as compressive seroma, radiculitis, and wound-related complications were not seen at a higher rate. PROs at early follow-up were similar. Placement of BMP for IF and at lower doses than previously reported may minimize complications.
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Affiliation(s)
- Douglas S Weinberg
- Department of Orthopedic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jae Hyung Eoh
- Department of Orthopedics, Pohang Semyeong Christianity Hospital, Pohang, Korea
| | - Wesley J Manz
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Eric T Park
- Emory University School of Medicine, Atlanta, GA, USA
| | - John M Rhee
- Department of Orthopedic Surgery and Neurosurgery, The Emory Spine Center, Emory University School of Medicine, 59 Executive Park South, Atlanta, GA, USA.
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22
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Toci GR, Karamian BA, Lambrechts MJ, Mao J, Reiter D, Alfonsi S, Fikru T, Canseco JA, Kurd MF, Woods BI, Kaye ID, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. What Is the Impact of Smoking on Patient-Reported Outcomes Following Posterior Cervical Decompression and Fusion? World Neurosurg 2022; 162:e319-e327. [PMID: 35259508 DOI: 10.1016/j.wneu.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this retrospective cohort study was to investigate the impact of smoking on patient-reported outcome measures (PROMs) following elective posterior cervical decompression and fusion (PCF). METHODS Electronic medical records at a single institution were reviewed for patients undergoing elective PCF. Patients were grouped based on smoking history: current smokers, former smokers, and never smokers. A delta score (Δ) was calculated for all PROMs (postoperative minus preoperative scores). Continuous and categorical data were compared using analysis of variance or χ2 tests. Regression analysis controlled for demographics. Patients were then regrouped into current smokers and nonsmokers for reanalysis. RESULTS A total of 195 patients were included, of whom 35 (22.1%) were current smokers, 51 (26.2%) were former smokers, and 101 (51.8%) were never smokers. Preoperative and postoperative Short-Form 12 Mental Component Score (MCS-12) were significantly lower in the current smoker group (preoperative: current 42.7, former 49.9, and never 46.6; P = 0.024; postoperative: current 44.6, former 53.7, and never 52.2; P = 0.003). Only never smokers improved in MCS-12 and Neck Disability Index following surgery. On regrouping, current smokers had significantly lower preoperative MCS-12 (42.7 vs. 47.7, P = 0.031), lower preoperative modified Japanese Orthopaedic Association (12.2 vs. 14.0, P = 0.039), greater preoperative visual analog scale Arm (6.39 vs. 4.94, P = 0.025), and lower postoperative MCS-12 (44.6 vs. 52.7, P = 0.001). Only the nonsmokers improved in MCS-12 and Neck Disability Index following surgery. On regression analysis, smoking was not an independent predictor of ΔPROMs. CONCLUSIONS Univariate analysis found that smokers have worse symptoms at baseline. However, smoking status was not an independent predictor of improvement in ΔPROMs following elective PCF.
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Affiliation(s)
- Gregory R Toci
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Jennifer Mao
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David Reiter
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Samuel Alfonsi
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Teleale Fikru
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark F Kurd
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Barrett I Woods
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - I David Kaye
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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23
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Clinical outcomes and revision rates following four-level anterior cervical discectomy and fusion. Sci Rep 2022; 12:5339. [PMID: 35351960 PMCID: PMC8964822 DOI: 10.1038/s41598-022-09389-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/09/2022] [Indexed: 12/27/2022] Open
Abstract
Studies on outcomes after four-level anterior cervical discectomy and fusion (ACDF) are limited in the literature. The purpose of this study was to report on clinical outcomes and revision rates following four-level ACDF. Patients operated with four-level ACDF were identified in a prospectively accrued single institution database. Outcome scores included the Neck Disability Index (NDI) and Visual Analogue Scale (VAS) for neck and arm pain. Reoperation rates were determined. Any complications were identified from a review of the medical records. Twenty-eight patients with a minimum of 12 months follow up were included in the analysis. The mean age at surgery was 58.5 years. The median radiographic follow up time was 23 (IQR = 16–31.25) months. Cervical lordosis was significantly improved postoperatively (− 1 to − 13, p < 0.001). At the median 24 (IQR = 17.75–39.50) months clinical follow up time, there was a significant improvement in the NDI (38 to 28, p = 0.046) and VAS for neck pain scores (5.1 to 3, p = 0.012). The most common perioperative complication was transient dysphagia (32%) followed by hoarseness (14%). Four (14%) patients required revision surgery at a median 11.5 (IQR = 2–51) months postoperatively. The results of this study indicate that patients who undergo four-level ACDF have a significant improvement in clinical outcomes at median 24 months follow up. Stand-alone four-level ACDF is a valid option for the management of complex cervical degenerative conditions.
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24
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Chin KR, Gohel NN, Aloise DM, Seale JA, Pandey DK, Pencle FJ. Effectiveness of a Fully Impregnated Hydroxyapatite Polyetheretherketone Cage on Fusion in Anterior Cervical Spine Surgery. Cureus 2021; 13:e17457. [PMID: 34603859 PMCID: PMC8475745 DOI: 10.7759/cureus.17457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Anterior cervical discectomy and fusion (ACDF) is the gold standard for the treatment of cervical spondylosis. However, new techniques, technologies, and improved implants have aided surgeons in reducing operative time with enhanced patient outcomes. Impregnated hydroxyapatite polyetheretherketone (HA PEEK) cages (Arena-C HA®, LESspine Inc. Malden, MA) are one such option that has aimed to increase the fusion rate. The authors herein aimed to assess the use of HA PEEK interbody cages by looking at outcomes, complications, and radiographic fusion. Methods The medical records of 41 consecutive patients undergoing single-level ACDF with impregnated HA PEEK cages (group 1) were compared to the control group of 47 patients who had single-level ACDF without impregnated HA PEEK cages (group 2). Outcomes assessed included Visual Analog Scale (VAS) neck, Neck Disability Index (NDI) scores, radiographic fusion, and complication rates. Results Of the 41 patients in group 1 (HA PEEK), 48% were female population with a mean age of 58.5+/- 1.7 years and BMI 29.7+/-1.2 kg/m2. Of the 47 patients in group 2 (non-HA PEEK), 53% were female with a mean age of 54.3+/- 1.2 years and BMI 27.8+/-0.8 kg/m2. Using t-test, there was a statistically significant intergroup difference in two-year VAS neck and NDI scores, p=0.007, and p=0.001, respectively. Radiographic fusion occurred as early as three months in the HA PEEK group. Conclusions This study has demonstrated the equivalence of impregnated HA PEEK cages in single-level ACDF. Significant improvements were seen in VAS and NDI scores in the HA PEEK group. There was no incidence of heterotopic bone formation or reaction to HA PEEK cages. Additionally, a trend toward fusion was seen in HA PEEK patients as early as three to five months compared to seven to eight months for the ACDF group. We conclude that HA PEEK cages can be safely placed with excellent outcomes. However, further studies are required to look at added benefits.
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Affiliation(s)
- Kingsley R Chin
- Orthopedics, Florida International University, Miami, USA.,Orthopedics, Less Exposure Surgery (LES) Clinic, Hollywood, USA.,Faculty of Science and Sports, University of Technology, Kingston, JAM
| | - Nishant N Gohel
- Orthopedic Surgery, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Daniel M Aloise
- Orthopedics, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Jason A Seale
- Orthopedics, Less Exposure Surgery (LES) Clinic, Hollywood, USA
| | - Deepak K Pandey
- Orthopedics, Less Exposure Surgery (LES) Society, Hollywood, USA
| | - Fabio J Pencle
- Faculty of Science and Sports, University of Technology, Kingston, JAM.,Orthopedics, Less Exposure Surgery (LES) Society, Hollywood, USA
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25
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Byvaltsev VA, Kalinin AA, Aliyev MA, Azhibekov NO, Shepelev VV, Riew KD. Poor Fusion Rates Following Cervical Corpectomy Reconstructed With an Expandable Cage: Minimum 2-Year Radiographic and Clinical Outcomes. Neurosurgery 2021; 89:617-625. [PMID: 34270755 PMCID: PMC8440060 DOI: 10.1093/neuros/nyab240] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/04/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Expandable cages are often used to reconstruct cervical corpectomies but there are few long-term follow-up studies with large numbers. OBJECTIVE To analyze the clinical and radiographic results of cervical corpectomy reconstructed with expandable cages for degenerative stenosis. METHODS We performed a retrospective analysis of 78 patients with degenerative cervical stenosis treated with a corpectomy reconstructed with an expandable cage. We evaluated the clinical and radiographic outcomes, as well as complications of the procedure at a minimum 2-yr follow-up. RESULTS There was a decrease in the visual analog scale pain average from 75 mm to 8.5 mm (P = .02); a decrease in the Neck Disability Index average from 55% to 12% (P = .009); and improvement in the Japanese Orthopaedic Association average from 12 to 14 points (P = .01). There was a change in cervical lordosis (Cobb method) average from −9.3° to −15.1° (P = .002), without significant loss of lordosis (P = .63). The fusion rate, by criteria of the Cervical Spine Research Society (CSRS), was low: using dynamic X-rays – 50% (n = 39/78) and using computed tomography (CT) – 47.4% (n = 37/78). A total of 11 patients (14.1%) suffered complications. CONCLUSION To our knowledge, this is the largest series (78) with a minimum 2-yr follow-up in the literature and the first using the dynamic radiographic and CT criteria endorsed by the CSRS. Using these criteria, our fusion rates were much lower than all previous reports in the literature. Despite this, patient-reported outcomes were reasonable. There was a relatively low incidence of perioperative complications, most of which were likely not implant-specific and there was only 1 case of implant failure.
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Affiliation(s)
- Vadim A Byvaltsev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia.,Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia.,Department of Traumatology, Orthopedics and Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education - A Branch of the Federal State Budgetary Educational Institution of Continuing Professional Education "Russian Medical Academy of Continuing Professional Education" of the Ministry of Health of the Russian Federation, Irkutsk, Russia
| | - Andrei A Kalinin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia.,Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
| | - Marat A Aliyev
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | | | - Valerii V Shepelev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | - K Daniel Riew
- Department of Orthopedic Surgery, Columbia University, New York, New York, USA.,Department of Neurological Surgery, Weill Cornell Medical School, New York, New York, USA
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26
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Okamoto N, Kato S, Doi T, Matsubayashi Y, Taniguchi Y, Yoshida Y, Kawamura N, Nakarai H, Higashikawa A, Tozawa K, Takeshita Y, Yu J, Hara N, Sasaki K, Azuma S, Tanaka S, Oshima Y. Relative Risks and Benefits of Crossing the Cervicothoracic Junction During Multilevel Posterior Cervical Fusion: A Multicenter Cohort. World Neurosurg 2021; 153:e265-e274. [PMID: 34175484 DOI: 10.1016/j.wneu.2021.06.091] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare the clinical and radiographic outcomes and complications in patients undergoing multilevel posterior cervical fusion surgery, ending at C7 or crossing the cervicothoracic junction (CTJ). METHODS A total of 96 patients undergoing multilevel posterior cervical fusion surgery ending at C7, T1, or T2 were screened. The patients who fulfilled the inclusion criteria were divided into 2 groups based on the lower instrumented vertebra (LIV) level: group C7 (ending at C7) and group T1-T2 (crossing the CTJ). The radiographic and clinical outcomes were compared between the 2 groups, and the risk factors for instrument failure at LIV were investigated. RESULTS In total, 73 patients (76%) completed at least 1 year follow-up and divided into group C7 (n = 43) and group T1-T2 (n = 30). Preoperative and postoperative radiographic parameters, the Japanese Orthopaedic Association score, and patient-reported outcomes were not significantly different between the 2 groups. Significantly longer surgical time, increased blood loss, and higher incidence rates of perioperative or postoperative complications were noted in group T1-T2. On the other hand, the incidence of instrument failures at LIV was significantly higher in group C7. Multivariate analysis showed that ending at C7, skipping screw insertion at the proximal vertebra adjacent to LIV, and a large postoperative cervical sagittal vertical axis (>40 mm) were risk factors for instrument failure at LIV. CONCLUSIONS Crossing the CTJ during multilevel posterior cervical fusion surgery reduced instrument failures at LIV, but increased the surgical invasiveness and perioperative and postoperative complications.
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Affiliation(s)
- Naoki Okamoto
- Department of Orthopaedic Surgery, University of Tokyo, Bunkyo-ku, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo-ku, Tokyo, Japan
| | - So Kato
- Department of Orthopaedic Surgery, University of Tokyo, Bunkyo-ku, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo-ku, Tokyo, Japan
| | - Toru Doi
- Department of Orthopaedic Surgery, University of Tokyo, Bunkyo-ku, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo-ku, Tokyo, Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, University of Tokyo, Bunkyo-ku, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo-ku, Tokyo, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, University of Tokyo, Bunkyo-ku, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo-ku, Tokyo, Japan
| | - Yuichi Yoshida
- University of Tokyo Spine Group (UTSG), Bunkyo-ku, Tokyo, Japan; Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Naohiro Kawamura
- University of Tokyo Spine Group (UTSG), Bunkyo-ku, Tokyo, Japan; Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Hiroyuki Nakarai
- Department of Orthopaedic Surgery, University of Tokyo, Bunkyo-ku, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo-ku, Tokyo, Japan; Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, Nakahara-ku, Kawasaki, Kanagawa, Japan
| | - Akiro Higashikawa
- University of Tokyo Spine Group (UTSG), Bunkyo-ku, Tokyo, Japan; Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, Nakahara-ku, Kawasaki, Kanagawa, Japan
| | - Keiichiro Tozawa
- Department of Orthopaedic Surgery, University of Tokyo, Bunkyo-ku, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo-ku, Tokyo, Japan; Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Yokohama Rosai Hospital, Japan, Kouhoku-ku, Yokohama, Kanagawa, Japan
| | - Yujiro Takeshita
- University of Tokyo Spine Group (UTSG), Bunkyo-ku, Tokyo, Japan; Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Yokohama Rosai Hospital, Japan, Kouhoku-ku, Yokohama, Kanagawa, Japan
| | - Jim Yu
- University of Tokyo Spine Group (UTSG), Bunkyo-ku, Tokyo, Japan; Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, Musashino, Tokyo, Japan
| | - Nobuhiro Hara
- University of Tokyo Spine Group (UTSG), Bunkyo-ku, Tokyo, Japan; Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, Musashino, Tokyo, Japan
| | - Katsuyuki Sasaki
- University of Tokyo Spine Group (UTSG), Bunkyo-ku, Tokyo, Japan; Department of Orthopedic Surgery, Japanese Red Cross Saitama Hospital, Chuou-ku, Saitama, Japan
| | - Seiichi Azuma
- University of Tokyo Spine Group (UTSG), Bunkyo-ku, Tokyo, Japan; Department of Orthopedic Surgery, Japanese Red Cross Saitama Hospital, Chuou-ku, Saitama, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, University of Tokyo, Bunkyo-ku, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo-ku, Tokyo, Japan.
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27
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Makhni MC, Yeung CM, Riew KD. The Art of Diagnosis in the Cervical Spine. Neurospine 2020; 17:695-703. [PMID: 33401849 PMCID: PMC7788414 DOI: 10.14245/ns.2040556.278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Melvin C Makhni
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Caleb M Yeung
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - K Daniel Riew
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital, New York, NY, USA.,Columbia University Irving Medical Center, New York, NY, USA
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Luna LP, Dua SG, Kocak M, Lovblad KO, Fontes R, Guryildirim M. Imaging Evaluation of the Spinal Hardware: What Residents and Fellows Need to Know. Curr Probl Diagn Radiol 2020; 50:675-686. [PMID: 33143951 DOI: 10.1067/j.cpradiol.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/25/2020] [Accepted: 09/15/2020] [Indexed: 11/22/2022]
Abstract
We provide a comprehensive review of the purpose and expected imaging findings of different types of spinal instrumentation. We also demonstrate the imaging evaluation for optimal positioning and assessment of hardware failure.
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Affiliation(s)
- Licia P Luna
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD
| | - Sumeet G Dua
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL
| | - Mehmet Kocak
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL
| | - Karl-Olof Lovblad
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL
| | - Ricardo Fontes
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL
| | - Melike Guryildirim
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD.
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Lee NJ, Vulapalli M, Park P, Kim JS, Boddapati V, Mathew J, Amorosa LF, Sardar ZM, Lehman RA, Riew KD. Does screw length for primary two-level ACDF influence pseudarthrosis risk? Spine J 2020; 20:1752-1760. [PMID: 32673728 DOI: 10.1016/j.spinee.2020.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/28/2020] [Accepted: 07/08/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Pseudarthrosis remains a major complication for patients undergoing anterior cervical discectomy and fusion (ACDF; 0%-15% at 1-year follow-up). Potentially modifiable risk factors are known in literature, such as smoking and osteoporosis. Biomechanical studies suggest that plates with locking screws can enhance the fixation rigidity and pull-out strength. Although longer screws are known to be correlated with increased pull-out strength, deeper screw depths can increase the risk for intraoperative complications. An important factor that has yet to be studied is the minimum screw length relative to the diameter of the vertebral body (VB) necessary to achieve successful fusion. In this study, we hypothesize that screws with shorter depths relative to the VB will increase the risk for radiographic pseudarthrosis and result in poor patient reported outcomes (PROs). PURPOSE To examine the impact of ACDF screw length on pseudarthrosis risk. STUDY DESIGN A review of prospectively collected data. PATIENT SAMPLE A total of 85 patients were included in this study. The mean age ±standard deviation was 58.9±10.3 and 42.4% of patients were female. The mean follow-up was 21.6±8.3 months. OUTCOME MEASURES The neck disability index (NDI) was used to assess PROs up to 2-years after surgery. For each ACDF level, the screw length and VB% (screw length divided by the anterior-posterior VB diameter) were measured. Radiographic pseudarthrosis (interspinous motion [ISM] ≥1 mm) was recorded at 6-weeks, 6-months, and 1-year for each patient. The positive and negative predictive values (PPV, NPV) for ISM ≥ 1mm were measured for different VB% thresholds. A VB% of <75% was found to have the highest PPV (93%) and NPV (70%) for radiographic pseudarthrosis. This threshold of <75% was then assessed in our bivariate and multivariate analyses. METHODS We reviewed a database (2015-2018) of adult (≥18 years old) patients who underwent a primary two-level ACDF with or without corpectomy. All ACDF constructs involved fixed angle screws. The minimum follow-up period was 1 year. Multivariate analyses were performed to determine if screw VB% was an independent risk factor for radiographic pseudarthrosis. RESULTS By 1-year, overall fusion success was achieved in 92.9% of patients. The 1-year revision rate was 4.7%. Patients with any screw VB% <75% had substantially worse fusion success (64.3%) than those who did not (98.6%) at 1-year. The VB% <75% increased the risk for radiographic pseudarthrosis at every follow up period. In comparison to other time-points, patients with radiographic pseudarthrosis at 6 weeks had significantly worse NDI scores by 2-years (p=.047). The independent risk factors for radiographic pseudarthrosis at 6-weeks included any screw VB% <75% (OR 77, p<.001), prior/current smoker (OR 6.8, p=.024), and corpectomy (OR 0.1, p=.010). Patients with ISM≥1 mm had a higher rate of revision surgery at 1-year (5.9% vs. 3.9%), but this was not statistically significant (p=.656). CONCLUSIONS In primary two-level ACDF, VB% <75% is significantly associated with increased ISM (≥1 mm) at all time points for this study. As an intraoperative guide, spine surgeons can use the screw VB% threshold of <75% to avoid unnecessarily short screws. This threshold can be easily measured pre- and intraoperatively, and has been found to be strongly correlated to radiographic pseudarthrosis in the early postoperative period.
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Affiliation(s)
- Nathan J Lee
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA.
| | - Meghana Vulapalli
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Paul Park
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Jun S Kim
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Venkat Boddapati
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Justin Mathew
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Louis F Amorosa
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Zeeshan M Sardar
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Ronald A Lehman
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - K Daniel Riew
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
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Nichols NM, Jamieson A, Wang M, Chou D, Mummaneni PV, Tan LA. Characterizing the fusion order and level-specific rates of arthrodesis in 3-level anterior cervical discectomy and fusion: A radiographic study. J Clin Neurosci 2020; 81:328-333. [PMID: 33222940 DOI: 10.1016/j.jocn.2020.10.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/13/2020] [Accepted: 10/03/2020] [Indexed: 11/17/2022]
Abstract
Pseudarthrosis is a well-recognized complication following multi-level ACDF. We aim to characterize the fusion order and level-specific rates of arthrodesis across four time points following 3-level ACDF. Patients who underwent 3-level ACDF by three UCSF spine surgeons from August 2012 to December 2019 were identified. Fusion status at each level was determined by measuring the interspinous motion on flexion and extension radiographs and assessing for evidence of bridging bone. Measurements were performed post-operatively at 6 weeks, 6 months, 12 months, and 18-24 months. A total of 77 patients with 3-level ACDF were identified and included in this study. Specific ACDF levels include C3-C6 (17 patients), C4-C7 (57 patients), and C5-T1 (3 patients). At 6 months, the cranial, middle, and caudal level fusion rates were 17.0%, 34.0%, and 3.8%, respectively. By 24 months, fusion rates were 61.1%, 88.9%, and 27.8% at the cranial, middle, and caudal level, respectively. PEEK cages were associated with lower odds of multi-level arthrodesis. Arthrodesis occurred the quickest at the middle level with an 88.9% fusion rate by 24 months after surgery. The caudal level had the slowest rate of arthrodesis with only a 27.8% fusion rate at 24 months, likely due to increased biomechanical stress at the most caudal level. Allograft was associated with higher odds of multi-level arthrodesis compared to PEEK cages.
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Affiliation(s)
- Noah M Nichols
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Room 779 M, San Francisco, CA 94143-0112, USA
| | - Alysha Jamieson
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Room 779 M, San Francisco, CA 94143-0112, USA
| | - Minghao Wang
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Room 779 M, San Francisco, CA 94143-0112, USA
| | - Dean Chou
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Room 779 M, San Francisco, CA 94143-0112, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Room 779 M, San Francisco, CA 94143-0112, USA
| | - Lee A Tan
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Room 779 M, San Francisco, CA 94143-0112, USA.
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Lee CJ, Boody BS, Demeter J, Smucker JD, Sasso RC. Long-Term Radiographic and Functional Outcomes of Patients With Absence of Radiographic Union at 2 Years After Single-Level Anterior Cervical Discectomy and Fusion. Global Spine J 2020; 10:741-747. [PMID: 32707013 PMCID: PMC7383798 DOI: 10.1177/2192568219874768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN Retrospective radiographic investigation. OBJECTIVE To evaluate the long-term radiographic and functional outcomes of patients in whom there is absence of radiographic union at 2 years after single-level anterior cervical discectomy and fusion (ACDF). METHODS Thirty-one patients were evaluated at standard postoperative time intervals per index trial protocol. Plain film radiographic fusion criteria at the arthrodesis level was defined as interspinous motion (ISM) <1 mm with corresponding motion at a non-arthrodesed superjacent level ISM ≥4 mm. Radiographs and functional outcome measures were acquired at each follow-up visit. Delayed union was defined as lack of radiographic union by 24 months. RESULTS Nine patients demonstrated radiographic evidence of delayed radiographic union at 24 months. Of those 9 patients, 5 patients demonstrated evidence of union during the follow-up period to 72 months. Despite the absence of radiographic union based on our criteria, 3 of the 4 remaining patients reported remarkable improvements in pain scores and functional outcomes. CONCLUSIONS The natural history of delayed union at 24 months after ACDF was still favorable despite the prolonged delay in union. The majority of patients (5 of 9) without radiographic union at 24 months did proceed to radiographic union by final follow-up. In addition, patients that did not meet our criteria for fusion maintained postoperative improvements in patient-reported outcome scores. In summary, our study patients undergoing a single-level ACDF with asymptomatic radiographic delayed union at 24 months can expect maintained improvements in postoperative patient-reported outcomes scores and can still progress to successful radiographic fusion.
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Affiliation(s)
| | | | - Jaclyn Demeter
- Indiana Spine Group, Carmel, IN, USA,Jaclyn Demeter, Indiana Spine Group, 13225 North Meridian Street, Carmel, IN 46032, USA.
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van Bilsen MWT, Ullrich C, Ferraris L, Hempfing A, Hitzl W, Mayer M, Koller H. Diagnostic accuracy of CT scan-based criteria compared with surgical exploration for the analysis of cervical fusion and nonunion. J Neurosurg Spine 2020; 33:51-57. [PMID: 32114527 DOI: 10.3171/2019.12.spine191011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/05/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Computed tomography (CT) scans are accepted as the imaging standard of reference to define union after anterior cervical discectomy and fusion (ACDF). However, ideal CT criteria to diagnose union have not been identified or validated. The objective of this study was to analyze the diagnostic value of 9 CT-based criteria and identify the ideal criteria among them to assess cervical fusion after ACDF using surgical exploration as the standard of reference. METHODS The authors performed a retrospective radiographic study of a single surgeon's prospective assessment of osseous fusion during cervical revision surgery by analyzing complete radiographic data in 44 patients who underwent anterior cervical revision surgery due to symptomatic suspected nonunion or adjacent level disease. All patients received standard preoperative CT scans, which were assessed by an independent radiologist to evaluate 9 diagnostic criteria for osseous union. During revision surgery, scar tissue was removed and manual segmental translation tests were performed. Nonunion was defined by visualized motion at the treated ACDF level. RESULTS In total, 44 patients were included in the study (30 men; patient age 54 ± 6 years, BMI 28 ± 5 kg/m2). For analysis of fusion, 75 cervical levels were explored, of which 61 levels (81%) showed intraoperative movement indicating nonunion. Statistical analysis showed that of the 9 parameters used to diagnose bone union, "bridging bone on ≥ 3 CT slices" yielded the highest sensitivity (100%) and specificity (58%). Multivariate analysis revealed that prediction accuracy was not increased if several criteria were combined to determine fusion. CONCLUSIONS The authors found that the best indicator of bone union was the item bridging bone on ≥ 3 CT slices. Combining the scoring of more than one criterion did not increase the diagnostic accuracy.
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Affiliation(s)
- Martine W T van Bilsen
- 1Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Christopher Ullrich
- 3Charlotte Radiology PA and Department of Radiology, Carolinas Medical Center, Charlotte, North Carolina
| | | | | | - Wolfgang Hitzl
- 6Research Office, Paracelsus Medical University, Salzburg, Austria; and
| | - Michael Mayer
- 7Wirbelsäulenzentrum am Stiglmaierplatz, Munich, Germany
| | - Heiko Koller
- 2Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Germany
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Moo IH, Kam CJW, Lai MWS, Yeo W, Soh RCC. A comparison of contiguous two-level anterior cervical discectomy and fusion using a structural allograft versus a Polyetheretherketone (PEEK) cage: the results of a three-year follow-up. BMC Musculoskelet Disord 2020; 21:331. [PMID: 32466749 PMCID: PMC7257195 DOI: 10.1186/s12891-020-03325-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 04/30/2020] [Indexed: 11/18/2022] Open
Abstract
Background Allografts and polyetheretherketone (PEEK) cages are the two most commonly used materials in anterior cervical discectomy and fusion (ACDF). However, their effectiveness in two-level ACDF remains controversial. The primary aim of this retrospective study was to compare the clinical and radiological outcomes of two-level ACDF with plate fixation using either a structural allograft or a PEEK cage. Methods From 2010 to 2015, 88 consecutive patients underwent two-level ACDF, of whom 53 received an allograft and 35 patients received a PEEK cage. All PEEK cages were filled with local autografts. All clinical outcomes were prospectively collected before and six months and two years after surgery. Clinical efficacy was evaluated using a visual analogue scale for neck pain and limb pain, the Neck Pain and Disability Score, the Neck Disability Index, the Neurogenic Symptom Score, and the Japanese Orthopedic Association score. Radiological outcomes were assessed preoperatively, immediately after surgery, and at the final follow-up. Results A preoperative comparison revealed no difference between the two patient groups in terms of age, sex, body mass index, smoking status, preoperative symptoms, operation level, or follow-up (mean = 42.8 months). No differences in the improvements in clinical outcomes were observed between the two groups. Both groups showed significant improvement in mean disc height, segmental height, and segmental lordosis postoperatively. The fusion rate for the PEEK cage was 100% at both levels, while the fusion rate for the allograft group was 98.1% at the cephalad level and 94.2% at the caudad level (p > 0.05). Subsidence at the cephalad level occurred in 22.9% (8/35) of segments in the PEEK group and 7.7% (4/52) of segments in the allograft group (p = 0.057). At the caudal level, a higher incidence of cage subsidence was noted in the PEEK group than in the allograft group [37.1% (13/35) versus 15.4% (8/52)] (p = 0.02). Overall, subsidence was noted in 30% (21/70) of the PEEK group and in 11% (12/104) of the allograft group (p < 0.05). Conclusion The use of PEEK cages resulted in a higher rate of subsidence in two-level ACDF than the use of allografts. Two-level ACDF using either allografts or PEEK cages resulted in similar clinical outcomes, radiological improvements in alignment and fusion rates.
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Affiliation(s)
- Ing How Moo
- Department of Orthopedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
| | - Carmen Jia Wen Kam
- Changi General Hospital, 2 Simei Street 3, Bukit Merah, 529889, Singapore
| | - Maksim Wen Sheng Lai
- Department of Orthopedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - William Yeo
- Department of Orthopedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Reuben Chee Cheong Soh
- Department of Orthopedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
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Cui S, Daffner SD, France JC, Emery SE. The Effects of Perioperative Corticosteroids on Dysphagia Following Surgical Procedures Involving the Anterior Cervical Spine: A Prospective, Randomized, Controlled, Double-Blinded Clinical Trial. J Bone Joint Surg Am 2019; 101:2007-2014. [PMID: 31764363 PMCID: PMC7508280 DOI: 10.2106/jbjs.19.00198] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Dysphagia is one of the most common complications of surgical procedures in the anterior cervical spine, and can persist up to 2 years postoperatively. Corticosteroids are relatively safe and inexpensive for treating various inflammatory conditions. Perioperative corticosteroid administration for anterior cervical spine procedures may effectively minimize postoperative dysphagia, potentially leading to better outcomes, decreased readmission rates, and improved patient satisfaction. The purpose of this study was to determine the efficacy of perioperative corticosteroids in decreasing the severity and duration of dysphagia following single-level and multilevel anterior cervical spine procedures. METHODS Seventy-four patients undergoing elective anterior cervical surgical procedures for degenerative conditions were recruited. Patients with prior cervical procedures; with a diagnosis of fracture, malignancy, or infection; or requiring combined anterior-posterior procedures were excluded. Patients were randomized to perioperative intravenous dexamethasone or saline solution. Doses were administered before incision and at 8 and 16 hours postoperatively. Investigators and patients were blinded to the treatment throughout the study. Dysphagia outcomes were assessed with use of the Bazaz dysphagia scale and the Dysphagia Short Questionnaire (DSQ) at 1 day, 2 days, 1 week, 2 weeks, 1 month, 3 months, 6 months, and 12 months postoperatively. Statistical analysis was performed comparing means and standard deviations; significance was set at p < 0.05. Clinical outcomes were measured with use of the Quality of Life-12 and Neck Disability Index. RESULTS Sixty-four patients were included in the analysis. There were 49 anterior cervical discectomies and fusions, 8 corpectomies, 1 hybrid procedure (corpectomy and adjacent discectomy), and 6 single-level arthroplasties. Patients who received corticosteroids had significantly better dysphagia scores on both the Bazaz scale and DSQ at most time points up to 6 months postoperatively (p < 0.05). On subgroup analysis, patients with multilevel (≥2-level) fusion benefited significantly from corticosteroids on both scales, whereas those with single-level procedures did not. There were no short-term wound complications or infections, and length of stay and fusion rates were comparable. CONCLUSIONS Perioperative administration of corticosteroids can reduce dysphagia symptoms following multilevel anterior cervical procedures. Benefit was noted immediately and up to 6 months postoperatively. There was no significant effect on short-term wound-healing, infection rates, length of stay, or fusion rates. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Shari Cui
- Department of Orthopaedic Surgery, West Virginia University, Morgantown, West Virginia
| | - Scott D Daffner
- Department of Orthopaedic Surgery, West Virginia University, Morgantown, West Virginia
| | - John C France
- Department of Orthopaedic Surgery, West Virginia University, Morgantown, West Virginia
| | - Sanford E Emery
- Department of Orthopaedic Surgery, West Virginia University, Morgantown, West Virginia
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Riew KD, Yang JJ, Chang DG, Park SM, Yeom JS, Lee JS, Jang EC, Song KS. What is the most accurate radiographic criterion to determine anterior cervical fusion? Spine J 2019; 19:469-475. [PMID: 29990594 DOI: 10.1016/j.spinee.2018.07.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/30/2018] [Accepted: 07/02/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The accuracy of radiographic criteria for determining anterior cervical fusion remains controversial, and inconsistency in the literature makes a comparison of published clinical results problematic. The descriptions of bridging bone are still lacking and subjective, and the interpretation of images can be influenced by the type of graft or cage used. PURPOSE To assess and validate the diagnostic accuracies of four radiographic fusion criteria using the results of surgical exploration. STUDY DESIGN Retrospective, radiographic, and comparative study. PATIENT SAMPLE This study included patients who required anterior or posterior exploration of a previous anterior cervical arthrodesis level(s) ranging from C3-C4 to C7-T1 for suspected pseudarthrosis or adjacent-segment pathologies. They underwent radiologic examinations to determine the four fusion criteria. We included patients whose images were taken at least 1 year after the index surgery, and 82 patients with 151 cervical segments were enrolled. OUTCOME MEASURES The inter- and intra-rater reliabilities and validity that correlated with the results of surgical exploration for the four fusion criteria were assessed using data (fusion or not) that were collected by two raters. METHODS The four published radiographic fusion criteria were interspinous motion (ISM) < 1 mm and superjacent ISM ≥ 4 mm, seen on dynamic radiographs; conventional bridging bone, as seen on computed tomography (CT) scans; and extra-graft bridging bone (ExGBB) and intragraft bridging bone (InGBB), observed on multi-axial reconstructed CT scans. The criteria were evaluated by two raters (spine surgeons with 5 and 7 years of experience). The raters evaluated each criterion twice at two different time points, 3 to 4 weeks apart. First, ISM and conventional bridging bone on CT scans were evaluated, followed by ExGBB and InGBB, with a time interval of 4 months. This Research was supported by the Chung-Ang University Research Grants (less than 5,000 US dollars) in 2016. RESULTS The inter- and intra-rater reliability values of the ExGBB (0.887-0.933) criteria were the highest, followed by those for the ISM (0.860-0.906), bridging bone (0.755-0.907), and InGBB (0.656-0.695) criteria. The validity values that correlated with the exploration results were the highest for the ExGBB criteria (k=0.889), followed by the ISM (k=0.776), bridging bone (k=0.757), and InGBB (k=0.656) criteria and ExGBB showed the highest sensitivity (91.7%) and specificity (98.4%). Regarding the graft materials that were used, all criteria had the highest values in the auto-cortical group and lowest values in the cage group. Of note, sensitivity and specificity of ExGBB were 100% in autocortical group. In the cage group, the validity values for the ExGBB (k=0.663) and ISM (k=0.666) criteria were higher than those for the bridging bone (k=0.504) and InGBB (k=0.308) criteria CONCLUSION: The presence of ExGBB (anterior, posterior, or lateral to the graft or cage) correlated the best with surgical exploration. The ISM criteria demonstrated a similar accuracy to that of conventional bridging bone criteria on CT scans. In arthrodesed segments with auto-cortical bone, criteria showed the highest validity values. In cage group, ISM and ExGBB had acceptable accuracy, but the conventional bridging bone and InGBB were worse than guessing. We recommend that ISM and ExGBB criteria should be used to increase accuracy in patients who undergo arthrodesis with cages.
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Affiliation(s)
- K Daniel Riew
- Department of Orthopedic Surgery, The Spine Hospital, Columbia University Medical Center, NY, USA
| | - Jae Jun Yang
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Republic of Korea
| | - Dong-Gune Chang
- Department of Orthopedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
| | - Sang-Min Park
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jin S Yeom
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae Sung Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Eui-Chan Jang
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Kwang-Sup Song
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
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Kreitz TM, Hollern DA, Padegimas EM, Schroeder GD, Kepler CK, Vaccaro AR, Hilibrand AS. Clinical Outcomes After Four-Level Anterior Cervical Discectomy and Fusion. Global Spine J 2018; 8:776-783. [PMID: 30560028 PMCID: PMC6293423 DOI: 10.1177/2192568218770763] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Anterior cervical discectomy and fusion (ACDF) demonstrates reliable improvement in neurologic symptoms associated with anterior compression of the cervical spine. There is a paucity of data on outcomes following 4-level ACDFs. The purpose of this study was to evaluate clinical outcomes for patients undergoing 4-level ACDF. METHODS All 4-level ACDFs with at least 1-year clinical follow-up were identified. Clinical outcomes, including fusion rates, neurologic outcomes, and reoperation rates were determined. RESULTS Retrospective review of our institutional database revealed 25 patients who underwent 4-level ACDF with at least 1-year clinical follow-up. Average age was 57.5 years (range 38.2-75.0 years); 14 (56%) were male, and average body mass index was 30.2 kg/m2 (range 19.9-43.4 kg/m2). Two (8%) required secondary cervical surgery at an average of 94.5 days postoperatively while the remaining 23 did not with an average follow-up of 19 months. Of 23 patients not requiring revision surgery, 16 (69%) patients fused by definition of less than 1 mm of spinous process motion per fused level in flexion and extension. Fifteen (65%) had at least one muscle group with one grade of weakness preoperatively. Nineteen of these patients (83%) had improved to full strength while no patients lost muscle strength. CONCLUSIONS Review of our institution's experience demonstrated a low rate of revision cervical surgery for any reason of 8% at mean 19 months follow-up, and neurological examinations consistently improved, despite a high rate of radiographic nonunion (31%).
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Affiliation(s)
- Tyler M. Kreitz
- Thomas Jefferson University, Philadelphia, PA, USA,Tyler M. Kreitz, Department of Orthopaedic Surgery,
Thomas Jefferson University, 1025 Walnut Street, Room 516 College, Philadelphia, PA 19107,
USA.
| | | | | | | | | | | | - Alan S. Hilibrand
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA,
USA
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Sharma A, Kishore H, Singh V, Shawky Abdelgawaad A, Sinha S, Kamble PC, Jorule K, Agrawal R, Mathapati S, Deepak P. Comparative Study of Functional Outcome of Anterior Cervical Decompression and Interbody Fusion With Tricortical Stand-Alone Iliac Crest Autograft Versus Stand-Alone Polyetheretherketone Cage in Cervical Spondylotic Myelopathy. Global Spine J 2018; 8:860-865. [PMID: 30560039 PMCID: PMC6293426 DOI: 10.1177/2192568218780345] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective analysis of prospectively collected data. OBJECTIVE The aim of the study was to compare the outcome of anterior cervical decompression and fusion (ACDF) with stand-alone tricortical iliac crest autograft versus stand-alone polyetheretherketone (PEEK) cage in cases of cervical spondylotic myelopathy. METHODS Prospectively collected data of 60 patients in each group were compared. RESULTS There was statistically significant improvement noted in postoperative Modified Japanese Orthopaedic Association (MJOA) follow-up scores with comparison pairs of preoperative versus 6 months, preoperative versus 1 year, and 3 months versus 6 months, 3 months versus 1 year in both groups. But improvements in MJOA scores were statistically insignificant between 6 months and 1 year (P = .0639) for the autograft group when compared with PEEK cage group (P = 0001). The mean loss of segmental lordosis on follow-up X-ray for the autograft group was (5.89 ± 2.90°), which was significantly higher (1.88 ± 2.77°) than the mean loss seen in the PEEK cage group (P = .01). This was most evident between 6 months and 1 year, resulting in plateauing of the improvement in MJOA score between 6 months to 1 year in the autograft group. While there was no statistical difference between fusion rates between the groups for 1 and 2 levels of ACDF, overall fusion rates were significantly better for 1-level ACDF (95.74%) when compared with 2-level ACDF (76.00%). CONCLUSION ACDF with PEEK cage is the fusion technique of choice for cervical fusion with fewer complications and better functional recovery in the treatment of cervical spondylotic myelopathy.
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Affiliation(s)
- Ayush Sharma
- Dr. Babasaheb Ambedkar Central Railway Hospital, Mumbai, India,Ayush Sharma, Dr. Babasaheb Ambedkar Central
Railway Hospital, Byculla, Mumbai 400027, Maharashtra, India.
| | - Hari Kishore
- Dr. Babasaheb Ambedkar Central Railway Hospital, Mumbai, India
| | | | | | - Shorabh Sinha
- Dr. Babasaheb Ambedkar Central Railway Hospital, Mumbai, India
| | | | - Kailash Jorule
- Dr. Babasaheb Ambedkar Central Railway Hospital, Mumbai, India
| | - Romit Agrawal
- Dr. Babasaheb Ambedkar Central Railway Hospital, Mumbai, India
| | - Sumit Mathapati
- Dr. Babasaheb Ambedkar Central Railway Hospital, Mumbai, India
| | - Priyank Deepak
- Dr. Babasaheb Ambedkar Central Railway Hospital, Mumbai, India
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Oshina M, Oshima Y, Tanaka S, Riew KD. Radiological Fusion Criteria of Postoperative Anterior Cervical Discectomy and Fusion: A Systematic Review. Global Spine J 2018; 8:739-750. [PMID: 30443486 PMCID: PMC6232720 DOI: 10.1177/2192568218755141] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Diagnosis of pseudarthrosis after anterior cervical fusion is difficult, and often depends on the surgeon's subjective assessment because recommended radiographic criteria are lacking. This review evaluated the available evidence for confirming fusion after anterior cervical surgery. METHODS Articles describing assessment of anterior cervical fusion were retrieved from MEDLINE and SCOPUS. The assessment methods and fusion rates at 1 and 2 years were evaluated to identify reliable radiographical criteria. RESULTS Ten fusion criteria were described. The 4 most common were presence of bridging trabecular bone between the endplates, absence of a radiolucent gap between the graft and endplate, absence of or minimal motion between adjacent vertebral bodies on flexion-extension radiographs, and absence of or minimal motion between the spinous processes on flexion-extension radiographs. The mean fusion rates were 90.2% at 1 year and 94.7% at 2 years. The fusion rate at 2 years had significant independence (P = .048). CONCLUSIONS The most common fusion criteria, bridging trabecular bone between the endplates and absence of a radiolucent gap between the graft and endplate, are subjective. We recommend using <1 mm of motion between spinous processes on extension and flexion to confirm fusion.
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Affiliation(s)
- Masahito Oshina
- The University of Tokyo Hospital, Tokyo, Japan,Columbia University, New York, NY, USA,Masahito Oshina, Department of Orthopaedic Surgery,
The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
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Chin KR, Pencle FJR, Mustafa LM, Mustafa MM, Benny A, Seale JA. Sentinel sign in standalone anterior cervical fusion: Outcomes and fusion rate. J Orthop 2018; 15:935-939. [PMID: 30190635 DOI: 10.1016/j.jor.2018.08.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 08/15/2018] [Indexed: 02/06/2023] Open
Abstract
Background The authors aim to demonstrate the feasibility, outcomes and fusion rate of a standalone PEEK cage in the outpatient setting. Methods 48 consecutive patients undergoing standalone ACDF (S-ACDF) (Group 1) were compared to control group of 49 patients who had ACDF with ACP (Group 2). Results Analysis of follow-up at the one year period postoperative outcomes between groups 1 and 2 demonstrated no intergroup statistical significant difference in VAS neck, arm and NDI scores p = 0.414, 0.06 and p = 0.328 respectively. Conclusion We conclude that S-ACDF can be safely done in an ambulatory surgery center with satisfactory clinical and patient-reported outcomes.
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Affiliation(s)
- Kingsley R Chin
- Less Exposure Surgery Specialists Institute (LESS Institute), USA.,Herbert Wertheim College of Medicine at Florida International University, USA.,Charles E. Schmidt College of Medicine at Florida Atlantic University, USA.,University of Technology, Jamaica
| | | | - Luai M Mustafa
- Herbert Wertheim College of Medicine at Florida International University, USA
| | - Moawiah M Mustafa
- Herbert Wertheim College of Medicine at Florida International University, USA
| | - Amala Benny
- Less Exposure Surgery Specialists Institute (LESS Institute), USA.,Less Exposure Surgery (LES) Society, USA
| | - Jason A Seale
- Less Exposure Surgery Specialists Institute (LESS Institute), USA.,Less Exposure Surgery (LES) Society, USA
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Chin KR, Pencle FJ, Valdivia JM, Seale JA, Gabriel JP. Limiting fusion levels by combining anterior cervical decompression and fusion with posterior laminectomy: Technical note. J Orthop 2018; 15:412-415. [PMID: 29881166 PMCID: PMC5990210 DOI: 10.1016/j.jor.2018.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/19/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Authors aim to report on the outcomes of combining selective anterior cervical decompression and fusion (ACDF) with laminectomy in patients with cervical spondylotic radiculomyelopathy (CSR). METHODS 10 patients with ACDF and posterior laminectomy reviewed. RESULTS 60% female population, mean age 61 ± 3 years, mean BMI 24.7 ± 3.4 kg/m2. VAS and NDI showed significant improvement, p < 0.001, p = 0.02 respectively. Mean PCS 31.9 ± 2.7, MCS 38.9 ± 3.4 improved to mean PCS 42.2 ± 5.1, MCS 51.0 ± 4.7, p = 0.09 and 0.06 respectively. At final follow up fusion rate was 90% and all patients had Nurick Grade 0. CONCLUSION In this pilot study, procedure shown to be safe with improved symptoms.
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Affiliation(s)
- Kingsley R. Chin
- Herbert Wertheim College of Medicine at Florida International University
- Charles E. Schmidt College of Medicine at Florida Atlantic University
- Less Exposure Surgical Specialists Institute (LESS Institute), 3816 Hollywood Blvd. Ste #102, Hollywood, FL 33021
- Univerity of Technology, Jamaica, WI
| | - Fabio J.R. Pencle
- Less Exposure Surgery (LES) Society, 350 Main St., Malden, MA 02148
- Less Exposure Surgical Specialists Institute (LESS Institute), 3816 Hollywood Blvd. Ste #102, Hollywood, FL 33021
| | - Juan M. Valdivia
- Less Exposure Surgery (LES) Society, 350 Main St., Malden, MA 02148
- BayCare Medical Group, 2727 West Dr. Martin Luther King Jr. Blvd. Suite 460, Tampa, FL 33607
| | - Jason A. Seale
- Less Exposure Surgery (LES) Society, 350 Main St., Malden, MA 02148
- Less Exposure Surgical Specialists Institute (LESS Institute), 3816 Hollywood Blvd. Ste #102, Hollywood, FL 33021
| | - Josue P. Gabriel
- Less Exposure Surgery (LES) Society, 350 Main St., Malden, MA 02148
- Spine Institute of Ohio, 3535 Fishinger Blvd, Suite 280, Hilliard, OH 43026
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Zeng J, Duan Y, Yang Y, Wang B, Hong Y, Lou J, Ning N, Liu H. Anterior corpectomy and reconstruction using dynamic cervical plate and titanium mesh cage for cervical spondylotic myelopathy: A minimum 5-year follow-up study. Medicine (Baltimore) 2018; 97:e9724. [PMID: 29384855 PMCID: PMC5805427 DOI: 10.1097/md.0000000000009724] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Anterior cervical corpectomy and fusion (ACCF) is an effective surgical technique for cervical spondylotic myelopathy (CSM). However, no data exist regarding long-term outcomes after ACCF with the dynamic cervical plate for CSM. This study aimed to provide minimum 5-year clinical and radiographic outcomes of anterior corpectomy and reconstruction using dynamic cervical plate and titanium mesh cage (TMC) for CSM.Thirty-five patients who underwent single- or 2-level ACCF with dynamic cervical plate and TMC for the treatment of CSM were retrospectively investigated. The Japanese Orthopedic Association (JOA) score was used to assess the clinical outcome. Radiographic evaluations included TMC subsidence, fusion status, cervical lordosis, segmental angle, and segmental height.Twenty-eight patients underwent single-level and 7 patients underwent 2-level corpectomy with a mean follow-up period of 69.5 months. The average preoperative JOA score was 11.3 ± 3.0 and improved significantly to 14.2 ± 2.0 at the last follow-up (P < .001). Both cervical lordosis (P = .013) and segmental angle (P = .001) were significantly increased toward lordosis at the last follow-up. The TMC subsidence rate was 31.4% (n = 11) at the last follow-up. There was no significant difference in JOA recovery rate between subsidence and no subsidence group (P = .43). All patients obtained solid fusion at 1-year follow-up.Anterior corpectomy and reconstruction with dynamic cervical plate and TMC might be an effective method for the treatment of CSM at a minimum 5-year follow-up. It can maintain or restore cervical sagittal alignment. Subsidence of the TMC did not influence the clinical outcome.
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Affiliation(s)
| | | | | | | | - Ying Hong
- Department of Operation room, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Preoperative Radiographic Parameters to Predict a Higher Pseudarthrosis Rate After Anterior Cervical Discectomy and Fusion. Spine (Phila Pa 1976) 2017; 42:1772-1778. [PMID: 28459780 DOI: 10.1097/brs.0000000000002219] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To determine whether postoperative pseudarthrosis can be predicted from specific preoperative radiograph measurements. SUMMARY OF BACKGROUND DATA Various factors reportedly influence the occurrence of pseudarthrosis after anterior cervical discectomy and fusion (ACDF). However, to our knowledge, there are no reports on the relationships between preoperative radiographic parameters and pseudarthrosis. METHODS We analyzed 84 consecutive patients (45 males, 39 females, mean age, 58.9 ± 11.2 yrs) who underwent ACDF. In all patients, allografts filled with local chip bone were inserted after discectomy and anterior plating was performed. On preoperative plain radiographs, we analyzed C2-C7 sagittal vertical axis, T1 sagittal slope, segmental motion, global cervical motion, and location of fusion segments. Pseudarthrosis was diagnosed as interspinous motion >1 mm with superjacent interspinous motion ≥4 mm on magnified dynamic lateral radiographs. Multivariate logistic regression was used to analyze the risk factors for pseudarthrosis and the receiver operating characteristic (ROC) curve was used to define a cutoff value. RESULTS One hundred and twenty-five segments from 84 patients were included. The pseudarthrosis rate was 29% based on number of patients (24/84) and 20% based on number of segments (25/125). Multilevel surgery and segments at the lowest levels showed higher pseudarthrosis rates (P = 0.01). Per multivariate logistic regression analysis, greater preoperative segmental motion, greater preoperative T1 sagittal slope, and C6-7 segments were associated with a higher risk of pseudarthrosis (all P < 0.05). A segmental motion cutoff value of 12° demonstrated pseudarthrosis with sensitivity of 87%, specificity of 84%, and area under the curve of 0.899, indicating moderate accuracy. CONCLUSION Greater preoperative segmental motion, greater preoperative T1 sagittal slope, and lower fusion levels could be risk factors for pseudarthrosis following ACDF. Preoperative segmental motion >12° is likely to be an important indicator of the development of pseudarthrosis. LEVEL OF EVIDENCE 3.
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Kwon SW, Kim CH, Chung CK, Park TH, Woo SH, Lee SJ, Yang SH. The Formation of Extragraft Bone Bridging after Anterior Cervical Discectomy and Fusion: A Finite Element Analysis. J Korean Neurosurg Soc 2017; 60:611-619. [PMID: 29142619 PMCID: PMC5678065 DOI: 10.3340/jkns.2017.0178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/05/2017] [Accepted: 07/20/2017] [Indexed: 11/27/2022] Open
Abstract
Objective In addition to bone bridging inside a cage or graft (intragraft bone bridging, InGBB), extragraft bone bridging (ExGBB) is commonly observed after anterior cervical discectomy and fusion (ACDF) with a stand-alone cage. However, solid bony fusion without the formation of ExGBB might be a desirable condition. We hypothesized that an insufficient contact area for InGBB might be a causative factor for ExGBB. The objective was to determine the minimal area of InGBB by finite element analysis. Methods A validated 3-dimensional, nonlinear ligamentous cervical segment (C3-7) finite element model was used. This study simulated a single-level ACDF at C5-6 with a cylindroid interbody graft. The variables were the properties of the incorporated interbody graft (cancellous bone [Young's modulus of 100 or 300 MPa] to cortical bone [10000 MPa]) and the contact area between the vertebra and interbody graft (Graft-area, from 10 to 200 mm2). Interspinous motion between the flexion and extension models of less than 2 mm was considered solid fusion. Results The minimal Graft-areas for solid fusion were 190 mm2, 140 mm2, and 100 mm2 with graft properties of 100, 300, and 10000 MPa, respectively. The minimal Graft-areas were generally unobtainable with only the formation of InGBB after the use of a commercial stand-alone cage. Conclusion ExGBB may be formed to compensate for insufficient InGBB. Although various factors may be involved, solid fusion with less formation of ExGBB may be achieved with refinements in biomaterials, such as the use of osteoinductive cage materials; changes in cage design, such as increasing the area of polyetheretherketone or the inside cage area for bone grafts; or surgical techniques, such as the use of plate/screw systems.
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Affiliation(s)
- Shin Won Kwon
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.,Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.,Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea
| | - Tae Hyun Park
- Department of Biomedical Engineering, Inje University, Gimhae, Korea.,R&D Center, Medyssey Co., Ltd, Jecheon, Korea
| | - Su Heon Woo
- Department of Biomedical Engineering, Inje University, Gimhae, Korea.,R&D Center, Medyssey Co., Ltd, Jecheon, Korea
| | - Sung-Jae Lee
- Department of Biomedical Engineering, Inje University, Gimhae, Korea
| | - Seung Heon Yang
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.,Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
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Chin KR, Pencle FJR, Seale JA, Valdivia JM. Soft tissue swelling incidence using demineralized bone matrix in the outpatient setting. World J Orthop 2017; 8:770-776. [PMID: 29094007 PMCID: PMC5656492 DOI: 10.5312/wjo.v8.i10.770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/11/2017] [Accepted: 08/16/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To assess use of demineralized bone matrix (DBM) use in anterior cervical discectomy and fusion (ACDF) in outpatient setting.
METHODS One hundred and forty-five patients with prospectively collected data undergoing single and two level ACDF with DBM packed within and anterior to polyetheretherketone (PEEK) cages. Two groups created, Group 1 (75) outpatients and control Group 2 (70) hospital patients. Prevertebral soft tissue swelling (PVSTS) was measured anterior to C2 and C6 on plain lateral cervical radiographs preoperatively and one week postoperatively and fusion assessed at two years.
RESULTS There was no intergroup significance between preoperative and postoperative visual analogue scales (VAS) and neck disability index (NDI) scores between Group 1 and 2. Mean preoperative PVSTS in Group 1 was 4.7 ± 0.2 mm at C2 level and 11.1 ± 0.5 at C6 level compared to Group 2 mean PVSTS of 4.5 ± 0.5 mm and 12.8 ± 0.5, P = 0.172 and 0.127 respectively. There was no radiographic or clinical evidence of adverse reaction noted. In Group 1 mean postoperative PVSTS was 5.5 ± 0.4 mm at C2 and 14.9 ± 0.6 mm at C6 compared Group 2 mean PVSTS was 4.9 ± 0.3 mm at C2 and 14.8 ± 0.5 mm at C6, P = 0.212 and 0.946 respectively. No significant increase in prevertebral soft tissue space at C2 and C6 level demonstrated.
CONCLUSION ACDF with adjunct DBM packed PEEK cages showed a statistical significant intragroup improvement in VAS neck pain scores and NDI scores (P = 0.001). There were no reported serious patient complications; post-operative radiographs demonstrated no significant difference in prevertebral space. We conclude that ACDF with DBM-packed PEEK cages can be safely done in an ASC with satisfactory outcomes.
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Affiliation(s)
- Kingsley R Chin
- Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, FL 33431, United States
- Less Exposure Surgery Specialists Institute, Fort Lauderdale, FL 33311, United States
- Herbert Wertheim College of Medicine at Florida International University, Miami, FL 33199, United States
| | | | - Jason A Seale
- Less Exposure Surgery Specialists Institute, Fort Lauderdale, FL 33311, United States
- Less Exposure Surgery Society, Malden, MA 02148, United States
| | - Juan M Valdivia
- Less Exposure Surgery Specialists Institute, Fort Lauderdale, FL 33311, United States
- Less Exposure Surgery Society, Malden, MA 02148, United States
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TO THE EDITOR. Spine (Phila Pa 1976) 2017; 42:E1155. [PMID: 28945682 DOI: 10.1097/brs.0000000000002338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Comparison of Curvature Between the Zero-P Spacer and Traditional Cage and Plate After 3-Level Anterior Cervical Discectomy and Fusion: Mid-term Results. Clin Spine Surg 2017; 30:E1111-E1116. [PMID: 27642818 DOI: 10.1097/bsd.0000000000000440] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To compare clinical and radiologic outcomes of 3-level anterior cervical discectomy and fusion between a zero-profile (Zero-P) spacer and a traditional plate in cases of symptomatic cervical spine spondylosis. SUMMARY OF BACKGROUND DATA Anterior cervical decompression and fusion is indicated for patients with anterior compression or stenosis of the spinal cord. The Zero-P spacers have been used for anterior cervical interbody fusion of 1 or 2 segments. However, there is a paucity of published clinical data regarding the exact impact of the device on cervical curvature of 3-level fixation. METHODS Clinical and radiologic data of 71 patients undergoing 3-level anterior cervical discectomy and fusion from January 2010 to January 2012 were collected. Zero-P spacer was implanted in 33 patients, and in 38 cases stabilization was accomplished using an anterior cervical plate and intervertebral cage. Patients were followed for a mean of 30.8 months (range, 24-36 mo) after surgery. Fusion rates, changes in cervical lordosis, and degeneration of adjacent segments were analyzed. Dysphagia was assessed using the Bazaz score, and clinical outcomes were analyzed using the Neck Disability Index and Japanese Orthopedic Association scoring system. RESULTS Neurological outcomes did not differ significantly between groups. Significantly less dysphagia was seen at 2- and 6-month follow-up in patients with the Zero-P implant (P<0.05); however, there was significant less cervical lordosis and the lordosis across the fusion in patients with the Zero-P implant (both P<0.05). Degenerative changes in the adjacent segments occurred in 4 patients in the Zero-P group and 6 patients in the standard-plate group (P=0.742); however, no revision surgery was done. CONCLUSIONS Clinical results for the Zero-P spacer were satisfactory. The device is superior to the traditional plate in preventing postoperative dysphagia; however, it is inferior at restoring cervical lordosis. It may not provide better sagittal cervical alignment reconstruction in 3-level fixation. Prospective randomized trials with more patients and longer follow-up periods are required to confirm these observations.
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Misaligned Versus Straight Placement of Anterior Cervical Plates: A Clinical and Radiologic Outcomes Study. J Am Acad Orthop Surg 2017; 25:389-395. [PMID: 28379913 DOI: 10.5435/jaaos-d-16-00332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In anterior cervical diskectomy and fusion (ACDF), misaligned plates are concerning because of the risk of screw-and-plate failure; however, these plates also hypothetically have the potential for asymmetric micromotion on the facet and uncovertebral joint. The aim of this study was to determine whether misaligned plate placement during ACDF had clinical benefits compared with straight plate placement. METHODS Postoperative AP radiographs of 128 consecutive patients who underwent ACDF with anterior cervical plate (ACP) fixation were reviewed, and plate alignment was assessed. Patients were separated into control group 1 (straight plates) or group 2 (misaligned plates). RESULTS The mean age of patients was 51.5 ± 0.9 years, and women represented 51% of the total population. There was no significant difference between groups with regard to the preoperative visual analog scale (VAS) and Neck Disability Index (NDI) scores (P = 0.744 and P = 0.943, respectively). At 6 weeks postoperatively, the VAS scores for group 1 decreased from 7.6 ± 0.2 to 4.0 ± 0.2 compared with the scores in group 2, which decreased from 7.7 ± 0.2 to 2.1 ± 0.1, which demonstrated statistical significance (P = 0.019). At 2-year follow-up, no significant difference was demonstrated between the groups' VAS and NDI scores (P = 0.670 and P = 0.266). CONCLUSION Misaligned plates have increased torsional strength and are associated with better clinical outcomes compared with those of straight plates in the early postoperative period. After fusion, no significant difference in clinical outcomes between the groups was noted, which may reduce the concerns regarding misaligned plates. LEVEL OF EVIDENCE Retrospective comparative study.
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Abstract
Anterior cervical discectomy and fusion can be performed for a variety of pathologies but is most commonly used for the treatment of cervical radiculopathy or myelopathy. The procedure involves an anterior decompression of the disc space followed by interbody grafting and fusion. Supplemental anterior plating is commonly performed, and in certain circumstances, posterior instrumentation may provide additional fixation. The procedure includes the following steps: (1) The use of an anterior approach to the cervical spine, most commonly the Smith-Robinson approach medial to the sternocleidomastoid muscle and the carotid sheath. (2) Confirmation of the proper spinal level. (3) Elevation of the longus colli muscle, which acts as a cuff for the placement of retractors. (4) Removal of the involved disc and decompression of the spinal cord and nerve roots. This is facilitated by disc space distraction, most commonly via distraction pins. Osteophytes along the floor of the spinal canal impinging on the spinal cord are removed with a burr. Soft disc and anular material are also removed, usually with curets and rongeurs. Uncovertebral osteophyte resection and foraminotomies are completed to decompress the exiting nerve roots. (5) Carpentry and decortication of the end plates in preparation for fusion. (6) Sizing of the disc space followed by insertion of an interbody graft. (7) Anterior fixation, most commonly via application of a plate-and-screw construct. (8) Hemostasis and closure.
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Affiliation(s)
- John M Rhee
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Kevin L Ju
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
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