Surgical tactics of two-segmental cervical degenerative diseases: risk factors retrospective assessment and preoperative planning

Background

Currently, in the specialized literature there are no substantiated clinical and radiological indications for differentiated use of anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) in the treatment of patients with two-segmental cervical degenerative diseases. The objectives of this study were to (I) identify risk factors that were associated with unsatisfactory results of two-level ACDF and one-level ACCF in the treatment of patients with cervical degenerative diseases despite current perioperative management, and (II) develop a clinical and radiological algorithm for personalized surgical tactics.

Methods

We retrospectively identified risk factors for the development of unsatisfactory clinical postoperative results after two-level ACDF (n=81) and one-level ACCF (n=78), operated in the period of 2009-2019 for two-segmental cervical degenerative disease.

Results

Satisfactory clinical results after two-level ACDF were noted in cases with total kyphotic deformity of less than 15°; local kyphotic deformity less than 10˚; the absence of circumferential spondylotic cervical stenosis; the absence of a myelopathic lesion at the level of the vertebral body; absence of migrating intervertebral disk (IVD) hernia more than 1/3 of the vertebral body; T1 slope vertebra less than 15°; IVD degeneration according to Suzuki A. 0-II; facet joint (FJ) degeneration according to Okamoto A. I-III; interbody height (IH) more than 2 mm. Satisfactory clinical results after single-level ACCF were registered in cases with IVD degeneration according to Suzuki A. III; FJ degeneration according to Okamoto A. IV-V; IH 3 mm or less; regardless of the cervical lordosis, the angle of local kyphotic deformity and T1 slope, the presence of circumferential spondylotic cervical stenosis, the localization of the myelopathic lesion and the distance of migration IVD herniation.

Conclusions

Individual planning and differentiated implementation of ACDF and ACCF in patients with two-segmental cervical degenerative disease, taking into account a comprehensive preoperative clinical and radiological assessment, contributes to the effective elimination of existing neurological symptoms, reducing the intensity of neck pain and upper limbs pain, restoring the functional state and quality of patients' lives in the minimum 24 months postoperative period, as well as reducing the number of postoperative complications and reoperations.

Simultaneous Versus Staged Surgery For Double Crush Syndrome Of Cervical Radiculopathy And Peripheral Nerve Compression At The Wrist: A Retrospective Single-Center Study

STUDY DESIGN

Retrospective single-center study.

OBJECTIVES

to evaluate the results of surgical treatment in patients with double crush syndrome associated with cervical radiculopathy and upper limb peripheral nerve compression after staged and simultaneous operations.

SUMMARY OF BACKGROUND DATA

Currently, choosing the optimal diagnostic and therapeutic modalities in treating patients with double crush syndrome remains unresolved.

METHODS

The study included 79 patients with double crush syndrome (cervical radiculopathy and syndrome of Guyon's canal or Carpal tunnel syndrome). Two independent groups were studied: In the Staged Group (n=35), we performed a cervical decompression with stabilization and peripheral nerve decompression at separate days due to ongoing clinical symptoms (average interval between interventions being 22 (18;26) days). In the Simultaneous Group (n=33), we performed both the cervical spine surgery, as well as the peripheral nerve procedures in one surgical session. Total operative time, estimate blood loss, length of hospitalization, complications and clinical data (NDI score, SF-36, VAS neck pain score, VAS arm pain score, Disabilities of Arm, Shoulder and Hand (DASH) score, Macnab scale) were compared. We used the Mann-Whitney (MW) test for intergroup comparisons, Wilcoxon criterion for dependent samples, and Fisher's exact test for binomial parameters.

RESULTS

There was a significantly lower operative time, duration of inpatient treatment and temporary disability in the Simultaneous Group (P=0.01, P=0.04 and P=0.006 respectively). Comparative analysis did not reveal significant intergroup differences using NDI, VAS and DASH (P>0.05), whereas, at discharge, significantly better clinical parameters were appreciated for the Simultaneous Group using SF-36 and Macnab scores (P=0.04 and P=0.03, respectively). At Last Follow-up, an intra-group analysis revealed comparable clinical effectiveness between the two approaches (P>0.05).

CONCLUSION

Comparison of the effectiveness of simultaneous and staged surgery revealed comparable long-term clinical outcomes. However, simultaneous surgery conveys clinically important advantages in terms of surgical time, anesthesia duration, length of hospitalization and patient disability.

LEVEL OF EVIDENCE

3.

Treatment of the two-level degenerative cervical disk diseases based on algorithmic anterior approach: a multicenter prospective study

To analyze the effectiveness of an algorithmic anterior approach to the surgical treatment of patients with two-level cervical degenerative disk disease based on the preoperative clinical and imaging parameters. The study included 244 patients with two-level cervical degenerative disk disease. Three groups of patients were evaluated at 3 neurosurgical centers between 2016-2019. The prospective group (Group I, n = 126) consisted of patients who were treated using an algorithm to decide whether they should be treated with a two-level Total Disk replacement (TDR), Anterior Cervical Discectomy and Fusion (ACDF) and hybrid technique. The control group (Group II, n = 118) consisted of patients who underwent two-level anterior decompression with TDR, ACDF and hybrid stabilization between 2005-2015. Visual Analogue Scale (VAS) neck pain, VAS upper limbs pain, Neck Disability Index (NDI), SF-36, Macnab and Nurick scales were collected. Perioperative complications were identified. At 2 years of follow up Group I had significantly better clinical outcomes based on VAS neck pain score (p = 0.02), VAS upper limbs pain (p = 0.04), NDI score (p = 0.02), SF-36 score (p = 0.01), satisfaction with surgery on the Macnab scale (p < 0.001) and outcome of surgery based on Nurick scale (p < 0.001). Complication rate was lower in Group I, 6.3% compared to 24.6% in Group II, p = 0.0001. The algorithmic anterior approach to the surgical treatment of patients with two-level cervical degenerative disk disease resulted in significant improvement of functional outcomes and a decrease in complications at a minimum 2 years of follow-up.