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Scullen T, Milburn J, Mathkour M, Tubbs RS, Kalyvas J. Intrafacet Spacer Placement as a Mobility-Sparing Bailout Option in Atlantoaxial Fusion Construct Salvage. Ochsner J 2024; 24:124-130. [PMID: 38912189 PMCID: PMC11192217 DOI: 10.31486/toj.23.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
Background: Salvage revisions of atlantoaxial (AA) joint complex posterior segmental instrumented fusion constructs require careful individualized planning to prevent occipital extension. In this case report, we describe the use of bilateral intrafacet spacer placement as a mobility-sparing bailout option for the revision surgery. Case Report: A 64-year-old male with a history of diffuse idiopathic skeletal hyperostosis, extremely limited baseline cervical mobility, and prior AA posterior segmental instrumented fusion presented with increasing pain at his 6-month follow-up. Imaging showed fusion and hardware failures and dynamic instability. To prevent occipitocervical fixation, AA intra-articular fusion via a DTRAX spinal system (Providence Medical Technology, Inc) was used as an adjunct to a navigated C1 lateral mass and C2 pars screw posterior segmental instrumented fusion construct. The patient had an uneventful postoperative course and was discharged with resolution of symptoms. Three-month postoperative follow-up confirmed persistent resolution of symptoms and absence of complaints, along with successful arthrodesis on imaging. Conclusion: AA posterior segmental instrumented fusion revision is technically challenging, particularly when partial preservation of craniovertebral junction mobility is required. Bilateral intra-articular cages may be used as an adjunct to hardware revision in construct salvage when sturdy arthrodesis is desired without occipital extension and may represent a major potential strength of intra-articular cages.
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Affiliation(s)
- Tyler Scullen
- Department of Neurological Surgery, Ochsner Clinic Foundation, New Orleans, LA
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, LA
| | - James Milburn
- Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA
| | - Mansour Mathkour
- Department of Neurological Surgery, Ochsner Clinic Foundation, New Orleans, LA
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, LA
| | - R. Shane Tubbs
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, LA
| | - James Kalyvas
- Department of Neurological Surgery, Ochsner Clinic Foundation, New Orleans, LA
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Pinto V, Pereira L, Reinas R, Kitumba D, Alves OL. Minimally Invasive Posterior Cervical Fusion: A Handsome Option. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:351-356. [PMID: 38153492 DOI: 10.1007/978-3-031-36084-8_53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Cervical spondylosis is the leading cause of cervical myelopathy. When surgery is indicated, it is commonly addressed through an anterior or posterior cervical approach, such as cervical discectomy and fusion (ACDF) or laminectomy and fusion (LMF). Besides their own merits, each one has specific approach- or device-related complications, such as dysphagia, significant postoperative pain, wound infection, adjacent segment degeneration (ASD), and pseudoarthrosis. Through a tissue-sparing minimally invasive technique, posterior cervical fusion (PCF) has shown unfolding compelling evidence of biomechanical stability, good clinical outcomes, and high fusion rates, with fewer complications and better econometrics. On the basis of our own experience, we discuss here the indications, advantages, and drawbacks of minimally invasive PCF.
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Affiliation(s)
- V Pinto
- Department of Neurosurgery, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - L Pereira
- Department of Neurosurgery, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - R Reinas
- Department of Neurosurgery, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - D Kitumba
- Department of Neurosurgery, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Department of Neurosurgery, Hospital Américo Boavida, Angola, Portugal
| | - O L Alves
- Department of Neurosurgery, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Department of Neurosurgery, Hospital Lusíadas Porto, Porto, Portugal
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Pereira BDA, Heller JE, Lehrman JN, Sawa AGU, Kelly BP. Biomechanics of Circumferential Cervical Fixation Using Posterior Facet Cages: A Cadaveric Study. Neurospine 2021; 18:188-196. [PMID: 33819945 PMCID: PMC8021845 DOI: 10.14245/ns.2040552.276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/28/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Anterior cervical discectomy and fusion (ACDF) is a common procedure for the treatment of cervical disease. Circumferential procedures are options for multilevel pathology. Potential complications of multilevel anterior procedures are dysphagia and pseudarthrosis, whereas potential complications of posterior surgery include development of cervical kyphosis and postoperative chronic neck pain. The addition of posterior cervical cages (PCCs) to multilevel ACDF is a minimally invasive option to perform circumferential fusion. This study evaluated the biomechanical performance of 3-level circumferential fusion with PCCs as supplemental fixation to anteriorly placed allografts, with and without anterior plate fixation. METHODS Nondestructive flexibility tests (1.5 Nm) performed on 6 cervical C2-7 cadaveric specimens intact and after discectomy (C3-6) in 3 instrumented conditions: allograft with anterior plate (G+P), PCC with allograft and plate (PCC+G+P), and PCC with allograft alone (PCC+G). Range of motion (ROM) data were analyzed using 1-way repeated-measures analysis of variance. RESULTS All instrumented conditions resulted in significantly reduced ROM at the 3 instrumented levels (C3-6) compared to intact spinal segments in flexion, extension, lateral bending, and axial rotation (p < 0.001). No significant difference in ROM was found between G+P and PCC+G+P conditions or between G+P and PCC+G conditions, indicating similar stability between these conditions in all directions of motion. CONCLUSION All instrumented conditions resulted in considerable reduction in ROM. The added reduction in ROM through the addition of PCCs did not reach statistical significance. Circumferential fusion with anterior allograft, without plate and with PCCs, has comparable stability to ACDF with allograft and plate.
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Affiliation(s)
- Bernardo de Andrada Pereira
- Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | | | - Jennifer N Lehrman
- Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Anna G U Sawa
- Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Brian P Kelly
- Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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Effectiveness of cervical zero profile integrated cage with and without supplemental posterior Interfacet stabilization. Clin Biomech (Bristol, Avon) 2020; 78:105078. [PMID: 32585556 PMCID: PMC7430527 DOI: 10.1016/j.clinbiomech.2020.105078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/28/2020] [Accepted: 06/05/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Conditions requiring cervical decompression and stabilization are commonly treated using anterior cervical discectomy and fusion using an anterior cage-plate construct. Anterior zero profile integrated cages are an alternative to a cage-plate construct, but literature suggests they may result in less motion reduction. Interfacet cages may improve integrated cage stability. This study evaluated the motion reduction of integrated cages with and without supplemental interfacet fixation. Motion reduction of integrated cages were also compared to published cage-plate results. METHODS Seven cadaveric (C2-T1) spines were tested in flexion-extension, lateral bending, and rotation. Specimens were tested: 1) intact, 2) C6-C7 integrated cage, 3) C6-C7 integrated cage + interfacet cages, 4) additional integrated cages at C3-C4 and C4-C5, 5) C3-C4, C4-C5 and C6-C7 integrated cages + interfacet cages. Motion, lordosis, disc and neuroforaminal height were assessed. FINDINGS Integrated cage at C6-C7 decreased flexion-extension by 37% (P = .06) and C3-C5 by 54% (P < .01). Integrated + interfacet cages decreased motion by 89% and 86% compared to intact (P < .05). Integrated cages increased lordosis at C4-C5 and C6-C7 (P < .01). Integrated + interfacet cages returned C3-C5 lordosis to intact values, while C6-C7 remained more lordotic (P = .02). Compared to intact, neuroforaminal height increased after integrated cages at C3-C5 (P ≤ .01) and at all levels after interfacet cages (P < .01). INTERPRETATION Anterior integrated cages provides less stability than traditional cage-plate constructs while supplemental interfacet cages improve stabilization. Integrated cages provide more lordosis at caudal levels and increase neuroforaminal height more at cranial levels. After interfacet cages, posterior disc height and neuroforaminal height increased more at the caudal segments.
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Kinon MD, Greeley SL, Harris JA, Gelfand Y, Yassari R, Nakhla J, De la Garza-Ramos R, Patel P, Mirabile B, Bucklen BS. Biomechanical evaluation comparing zero-profile devices versus fixed profile systems in a cervical hybrid decompression model: a biomechanical in vitro study. Spine J 2020; 20:657-664. [PMID: 31634616 DOI: 10.1016/j.spinee.2019.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/08/2019] [Accepted: 10/15/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The use of zero-profile devices and the need for posterior fixation in conjunction with a cervical hybrid decompression model have yet to be investigated. PURPOSE To compare the biomechanics of zero-profile and fixed profile cervical hybrid constructs composed of anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF). Fixed profile devices included anterior plating, whereas zero-profile devices included integrated screws. STUDY DESIGN In vitro cadaveric biomechanical study. METHODS Twelve fresh-frozen cadaveric spines (C2-C7) were divided into two groups of equal bone mineral density, fixed profile versus zero profile (n=6). Groups were instrumented from C3-C6 with either (1) an expandable ACCF device and a static ACDF spacer with an anterior plate (Hybrid-AP) or (2) a zero-profile ACCF spacer with adjacent zero-profile ACDF spacer (Hybrid-Z). Motion was captured for the (1) intact condition, (2) a hybrid model with lateral mass screws (LMS), (3) a hybrid model without LMS, and (4) a hybrid model without LMS following simulated repetitive loading (fatigue). RESULTS Hybrid-AP with LMS reduced motion in flexion-extension (FE), lateral bending (LB), and axial rotation (AR) by 77%, 88%, and 82%, respectively, compared with intact. Likewise, Hybrid-Z with LMS exhibited the greatest reduction in motion relative to intact in FE, LB, and AR by 90%, 95%, and 66%, respectively. Following simulated in vivo fatiguing, an increase in motion was observed for both groups in all planes, particularly during Hybrid-Z postfatigue condition where motion increased relative to intact by 29%. Overall, biomechanical equivalency was observed between Hybrid-AP and Hybrid-Z groups (p>.05). Three (50%) of the Hybrid-Z group specimens exhibited signs of implant migration from the inferior endplate during testing. CONCLUSIONS Fixed profile systems using an anterior plate for supplemental fixation is biomechanically more favorable to maintain stability and prevent dislodgement. Dislodgement of 50% of the Hybrid-Z group without LMS emphasizes the necessity for posterior fixation in a zero-profile cervical hybrid decompression model.
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Affiliation(s)
- Merritt D Kinon
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Samantha L Greeley
- Musculoskeletal Education and Research Center, Globus Medical, Inc., Audubon, PA, USA.
| | - Jonathan A Harris
- Musculoskeletal Education and Research Center, Globus Medical, Inc., Audubon, PA, USA
| | - Yaroslav Gelfand
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Reza Yassari
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Jonathan Nakhla
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | | | - Pavan Patel
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Belin Mirabile
- Department of Mechanical Engineering, College of Engineering, University of Notre Dame, Notre Dame, IN, USA
| | - Brandon S Bucklen
- Musculoskeletal Education and Research Center, Globus Medical, Inc., Audubon, PA, USA
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Kramer S, Albana MF, Ferraro JB, Shah RV. Minimally Invasive Posterior Cervical Fusion With Facet Cages to Augment High-Risk Anterior Cervical Arthrodesis: A Case Series. Global Spine J 2020; 10:56S-60S. [PMID: 32528806 PMCID: PMC7263338 DOI: 10.1177/2192568220911031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVES To evaluate the efficacy and results of minimally invasive posterior cervical fusion with facet cages as an augment to high-risk patients and patients status post multilevel anterior cervical decompression and fusion. METHODS Thirty-five patients with symptomatic cervical stenosis with high risk for pseudoarthrosis underwent circumferential cervical decompression and fusion via staged anterior and posterior approach. Anterior cervical decompression and fusion was performed first by means of the standard anterior approach, with the patient supine on the operating table. The patients were subsequently flipped into a prone position and minimally invasive posterior cervical facet fusion with DTRAX was performed. The patients were then followed in the outpatient clinic for an average of 312.71 days. Postoperative patient satisfaction scores were obtained via the visual analogue scale (VAS). Preoperative VAS scores were compared with postoperative VAS scores in order to evaluate patient outcomes. RESULTS Of the 35 patients evaluated, minimum follow-up was 102 days, with a maximum follow-up of 839 days. Average preoperative and postoperative VAS scores were 7.6 and 2.8, respectively (P < .0001), with an average improvement of 4.86 points. This was an average improvement of 64.70% from preoperative to postoperative. Seventeen patients had excellent outcomes, with a postoperative VAS score ≤2. Seven patients achieved a postoperative VAS score of 0, with 100% improvement of preoperative pain and symptoms. Average blood loss was 70.38 mL. Average length of stay was 1.03 days. CONCLUSIONS The results indicate that minimally invasive posterior cervical decompression and fusion with facet cages, when combined with standard anterior cervical decompression and fusion, is an effective means of obtaining circumferential cervical fusion while simultaneously improving patient outcomes.
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Affiliation(s)
| | | | - John B. Ferraro
- Premier Orthopaedics and Sports Medicine of Southern NJ, Vineland, NJ, USA
| | - Rahul V. Shah
- Premier Orthopaedics and Sports Medicine of Southern NJ, Vineland, NJ, USA
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Laratta JL, Gupta K, Smith WD. Tissue-Sparing Posterior Cervical Fusion With Interfacet Cages: A Systematic Review of the Literature. Global Spine J 2020; 10:230-236. [PMID: 32206522 PMCID: PMC7076592 DOI: 10.1177/2192568219837145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
STUDY DESIGN Literature review. OBJECTIVES Posterior cervical interfacet cages are an alternative to lateral mass fixation in patients undergoing cervical spine surgery. Recently, a percutaneous, tissue-sparing system for interfacet cage placement has been developed, however, there is limited clinical evidence supporting its widespread use. The aim was to review studies published on this system for patient reported outcomes, radiographic outcomes, intraoperative outcomes, and complications. METHODS Four electronic databases (PubMed, EMBASE, Scopus, and MEDLINE) were queried for original published studies that evaluated the percutaneous, tissue-sparing technique for posterior cervical fusion with interfacet cage placement. All studies reporting on open techniques and purely biomechanical studies were excluded. RESULTS The extensive literature search returned 7852 studies. After systematic review, a total of 7 studies met inclusion criteria. Studies were independently classified as retrospective or prospective cohort studies and each assessed by the GRADE criteria. Patient reported outcomes, radiographic outcomes, intraoperative outcomes, and complications were extracted from each study and presented. CONCLUSIONS Tissue-sparing, posterior cervical fusion with interfacet cages may be considered a safe and effective surgical intervention in patients failing conservative management for cervical spondylotic disease. However, the quality of evidence in the literature is lacking, and controlled, comparative studies are needed for definitive assessment.
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Affiliation(s)
- Joseph L. Laratta
- Norton Leatherman Spine Center, Louisville, KY, USA,University of Louisville Medical Center, Louisville, KY, USA,Joseph L. Laratta, Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40206, USA.
| | - Karishma Gupta
- Western Regional Center for Brain and Spine Surgery, Las Vegas, NV, USA
| | - William D. Smith
- Western Regional Center for Brain and Spine Surgery, Las Vegas, NV, USA
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Siemionow K, Smith W, Gillespy M, McCormack BM, Gundanna MI, Block JE. Length of stay associated with posterior cervical fusion with intervertebral cages: experience from a device registry. JOURNAL OF SPINE SURGERY 2018; 4:281-286. [PMID: 30069519 DOI: 10.21037/jss.2018.05.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Using a multi-center medical device registry, we prospectively collected a set of perioperative and clinical outcomes among patients treated with tissue-sparing, posteriorly-placed intervertebral cage fusion used in the management of symptomatic, degenerative neural compressive disorders of the cervical spine. Methods Cervical fusion utilizing posteriorly-placed intervertebral cages offers a tissue-sparing alternative to traditional instrumentation for the treatment of symptomatic cervical radiculopathy. A registry was established to prospectively collect perioperative and clinical data in a real-world clinical practice setting for patients treated via this approach. This study evaluated length of stay as well as estimated blood loss and procedural time in 271 registry patients. Results The median length of stay was 1.1, 1.1 and 1.2 days for patients having a stand-alone arthrodesis, revision of a pseudoarthrosis, and circumferential fusion (360°), respectively, and was not related to number of levels treated. Historical comparison to published literature demonstrated that average lengths of stay associated with open, posterior lateral mass fixation were consistently ≥4 days. Average blood loss (range, 32-75 mL) and procedural time (range, 51-88 min) were also diminished in patients having tissue-sparing, cervical intervertebral cage fusion compared to open posterior lateral mass fixation. Conclusions Adoption of this tissue-sparing procedure may offer substantial cost-constraining benefits by reducing the length of post-operative hospitalization by, at least, 3 days compared to traditional lateral mass fixation.
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Affiliation(s)
- Kris Siemionow
- Department of Orthopaedic Surgery, University of Illinois, Chicago, IL, USA
| | - William Smith
- Western Regional Center for Brain & Spine Surgery, Las Vegas, NV, USA
| | - Mark Gillespy
- Orthopaedic Clinic of Daytona Beach, Daytona Beach, FL, USA
| | - Bruce M McCormack
- Department of Neurosurgery, University of California, San Francisco, CA, USA
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Bou Monsef JN, Siemionow KB. Multilevel cervical laminectomy and fusion with posterior cervical cages. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2018; 8:316-321. [PMID: 29403242 PMCID: PMC5763587 DOI: 10.4103/jcvjs.jcvjs_69_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Context: Cervical spondylotic myelopathy (CSM) is a progressive disease that can result in significant disability. Single-level stenosis can be effectively decompressed through either anterior or posterior techniques. However, multilevel pathology can be challenging, especially in the presence of significant spinal stenosis. Three-level anterior decompression and fusion are associated with higher nonunion rates and prolonged dysphagia. Posterior multilevel laminectomies with foraminotomies jeopardize the bone stock required for stable fixation with lateral mass screws (LMSs). Aims: This is the first case series of multilevel laminectomy and fusion for CSM instrumented with posterior cervical cages. Settings and Design: Three patients presented with a history of worsening neck pain, numbness in bilateral upper extremities and gait disturbance, and examination findings consistent with myeloradiculopathy. Cervical magnetic resonance imaging demonstrated multilevel spondylosis resulting in moderate to severe bilateral foraminal stenosis at three cervical levels. Materials and Methods: The patients underwent a multilevel posterior cervical laminectomy and instrumented fusion with intervertebral cages placed between bilateral facet joints over three levels. Oswestry disability index and visual analog scores were collected preoperatively and at each follow-up. Pre- and post-operative images were analyzed for changes in cervical alignment and presence of arthrodesis. Results: Postoperatively, all patients showed marked improvement in neurological symptoms and neck pain. They had full resolution of radicular symptoms by 6 weeks postoperatively. At 12-month follow-up, they demonstrated solid arthrodesis on X-rays and computed tomography scan. Conclusions: Posterior cervical cages may be an alternative option to LMSs in multilevel cervical laminectomy and fusion for cervical spondylotic myeloradiculopathy.
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Affiliation(s)
- Jad N Bou Monsef
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Krzysztof B Siemionow
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois, USA
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Siemionow KB, Glowka P, Blok RJ, Gillespy MC, Gundanna MI, Smith WD, Hyder Z, McCormack BM. Perioperative complications in patients treated with posterior cervical fusion and bilateral cages. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2017; 8:342-349. [PMID: 29403247 PMCID: PMC5763592 DOI: 10.4103/jcvjs.jcvjs_61_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Context: Posterior cervical cages have recently become available as an alternative to lateral mass fixation in patients undergoing cervical spine surgery. Aims: The purpose of this study was to quantify the perioperative complications associated with cervical decompression and fusion in patients treated with a posterior cervical fusion (PCF) and bilateral cages. Settings and Design: A retrospective, multicenter review of prospectively collected data was performed at 11 US centers. Subjects and Methods: The charts of 89 consecutive patients with cervical radiculopathy treated surgically at one level with PCF and cages were reviewed. Three cohorts of patients were included standalone primary PCF with cages, circumferential surgery, and patients with postanterior cervical discectomy and fusion pseudarthrosis. Follow-up evaluation included clinical status and pain scale (visual analog scale). Statistical Analysis Used: The Wilcoxon test was used to test the differences for the data. The P level of 0.05 was considered significant. Results: The mean follow-up interval was 7 months (range: 62 weeks - 2 years). The overall postsurgery complication rate was 4.3%. There were two patients with neurological complications (C5 palsy, spinal cord irritation). Two patients had postoperative complications after discharge including one with atrial fibrillation and one with a parietal stroke. After accounting for relatedness to the PCF, the overall complication rate was 3.4%. The average (median) hospital stay for all three groups was 29 h. Conclusions: The results of our study show that PCF with cages can be considered a safe alternative for patients undergoing cervical spine surgery. The procedure has a favorable overall complication profile, short length of stay, and negligible blood loss.
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Affiliation(s)
| | - Pawel Glowka
- Department of Orthopedic, University of Illinois at Chicago, Chicago, IL, USA.,Department of Spine Disorders and Children Orthopaedics, University of Medical Sciences, Poznan, Poland
| | - Robert J Blok
- Department of Orthopedic, Clark Memorial Hospital, Lafayette, USA
| | | | | | - William D Smith
- Western Regional Center For Brain and Spine, Las Vegas, NV, USA
| | | | - Bruce M McCormack
- Department of Neurosurgery, Neuropsine Institute Medical Group, San Francisco, CA, USA
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