Multilevel cervical laminectomy and fusion with posterior cervical cages

Minimally Invasive Posterior Cervical Fusion: A Handsome Option

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.

Multilevel, Percutaneous Posterior Cervical Interfacet Distraction and Fusion for Cervical Spondylotic Radiculopathy: Clinical and Radiographic Outcomes

STUDY DESIGN

Retrospective review of patients who underwent multilevel posterior cervical interfacet distraction and fusion (PCIDF) using cages for cervical spondylotic radiculopathy (CSR).

OBJECTIVE

To determine clinical and radiographic outcomes following multilevel PCIDF.

SUMMARY OF BACKGROUND DATA

Anterior cervical discectomy and fusion has long been the standard of treatment for CSR. Advancements in surgery have employed minimally invasive techniques such as endoscopic discectomy, foraminotomy, and PCIDF. Studies on single-level PCIDF have reported good clinical outcomes, short hospital stays, and rare complications, but its application in multilevel disease is still evolving.

METHODS

Patients with CSR and confirmed radiologic evidence of multilevel foraminal stenosis without central canal stenosis were reviewed. Two-year outcomes of multilevel PCIDF included Neck Disability Index, neck and arm Visual Analogue Scale (VAS), radiographic cervical alignment parameters, evidence of fusion, and incidence of adjacent segment degeneration were compared at different time points.

RESULTS

Thirty patients (mean age 54.6 ± 8.3) were included in the study with an average of 3.4 ± 0.8 levels treated. Mean surgical duration and intraoperative blood loss was 143.2 ± 69.7 minutes and 27.7 ± 28.7 mL, respectively, with an average length of stay at 1.8 ± 1.5 days. Neck Disability Index, VAS-neck, and VAS-arm all significantly improved at 2 weeks (P < 0.001) and was maintained until 2 years postoperatively. A significant decrease in segmental and C2-C7 lordosis, with a corresponding increase in sagittal vertical axis, was observed at 3 months postoperatively (P < 0.001) but did not deteriorate further on subsequent visits. Successful fusion was achieved in 90% of patients after 2 years. There was a 13.3% incidence of adjacent segment degeneration in the study cohort and one perioperative complication (3.3%).

CONCLUSION

Our study suggests that multilevel PCIDF is safe and effective for CSR caused by foraminal stenosis. However, its potential to cause kyphosis and clinical impact on global sagittal alignment requires further scrutiny and long-term evaluation.Level of Evidence: 4.

Efficacy of Posterior Cervical Laminectomy and Decompression plus Lateral Mass Screw-Rod Internal Fixation in the Treatment of Multisegment Cervical Spinal Canal Stenosis and Effects on Cervical Curvature and Range of Motion Parameters

OBJECTIVE

To investigate the clinical effects of posterior laminectomy and decompression plus lateral mass screw-rod internal fixation for the treatment of multisegment cervical spinal canal stenosis and the improvement of cervical curvature and range of motion in patients.

METHODS

A total of 68 patients with multisegment cervical spinal stenosis who were treated in our hospital from January 2019 to June 2020 were selected and randomly divided into the control group and the observation group according to the random number table, with 34 patients in each group. The patients in the control group were treated with traditional posterior cervical open-door laminoplasty with silk suture fixation, while those in the observation group were treated with posterior cervical laminectomy and decompression plus lateral mass screw-rod internal fixation. The perioperative index of patients in the two groups was recorded, and the clinical efficacy of patients was evaluated. The patient's JOA score, cervical physiological curvature, and cervical range of motion were evaluated. The occurrence of complications was recorded during follow-up.

RESULTS

The amount of intraoperative bleeding and postoperative rehabilitation training time in the observation group was less than that in the control group (P < 0.05). There was no significant difference in operation time between the two groups (P > 0.05). The total effective rate of the observation group was significantly higher than that of the control group (P < 0.05). The JOA scores at 1 week, 6 months, and 12 months after operation in the observation group were higher than those in the control group (P < 0.05). The physiological curvature of cervical spine in the observation group at 1 week, 6 months, and 12 months after operation was higher than that in the control group (P < 0.05). The cervical range of motion at 12 months after operation in the observation group was significantly higher than that in the control group (P < 0.05). The incidence of postoperative complications in patients of the observation group was significantly lower than that of the control group (P < 0.05).

CONCLUSION

Posterior laminectomy and decompression plus lateral mass screw-rod internal fixation can help patients to improve various clinical symptoms caused by nerve compression and obtain better improvement of cervical curvature and range of motion. It is an ideal surgical method for the treatment of multisegment cervical spinal canal stenosis, and it is conducive to improving the clinical efficacy of patients.

Tissue-Sparing Posterior Cervical Fusion With Interfacet Cages: A Systematic Review of the Literature

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.

Posterior cervical fusion utilizing cages placed bilaterally in the facets for the treatment of the upper cervical adjacent segment disease in the elderly

This is a retrospective review of 24 elderly patients with upper cervical adjacent segment disease (ASD) after anterior cervical discectomy and fusion (ACDF), treated with posterior cervical fusion (PCF) and stabilized with cages placed bilaterally in the facets. Eight out of 24 patients had PCF with laminectomy (PCLF). Length of stay for PCF alone cohort was 30 ± 11 h, operative time was 44 ± 11 min and estimated blood loss was 46 ± 26 cc. In the PCLF cohort, hospital length of stay was 73 ± 32 h, operative time was 92 ± 18 min, and blood loss was 155 ± 58 cc. The pooled sample showed significant decreases in mean NDI and VAS for neck and arm pain at each follow-up visit (6 weeks, 3, 6, 12 months) compared to baseline (p < 0.0001). All 19 patients that returned for an additional visit, after 12 months visit, continued to report an improvement over the baseline VAS and NDI scores. For those patients treated with PCLF, Nurick scores improved by more than one point in 62% of patients. The overall fusion rate was 96%, including all 16 patients treated with PCF alone (fusion defined as less than 2 mm interspinous movement on dynamic X-ray), and in 7 out of 8 patients treated with PCLF (fusion defined as less than 3 degrees angulation). There was one asymptomatic non-union. There were no significant changes in the overall cervical lordosis (p = 0.436) or segmental lordosis (p = 0.449), and no device-related complications.