Waste not, want not: Report of a completely calcified C1-C2 juxtafacet cyst and literature review

Background

Calcified juxtafacet cysts in the cervical spine are extremely rate. Such symptomatic cysts commonly cause neck pain, radiculopathy, or even myelopathy. MR and CT studies typically document cord/ root compression. On occasion, some of these cysts will spontaneously regress, while many others may warrant surgical removal.

Case Description

A 70-year-old male presented with a 2-year history of a progressive tetraparesis. The preoperative MR/CT studies showed a C1-C2 left extradural mass occupying more than half of the spinal canal. On MR, it was homogeneously hypointense on both T1- and T2-weighted images, while the CT showed a calcified cyst. Intraoperative and histopathological findings documented a calcified cervical juxtafacet cyst (i.e. ganglion subtype) that was fully excised without sequelae.

Conclusion

C1-C2 juxtafacet cervical cyst should be considered when a patient presents with myelopathy due to a calcified MR/CT documented paraspinal lesion contributing to significant cervical cord/root compression.

Cervical spine degenerative disease is an independent risk factor for increased revision rate following total knee arthroplasty

INTRODUCTION

The relationship between cervical degenerative pathology and total knee arthroplasty (TKA) revision rates is not well understood. The aim of the study was to determine whether cervical spine degenerative diseases have a role in complications following TKA within 2 years.

METHODS

Data were collected from the Humana insurance database using the PearlDiver Patient Records Database from 2007-2017. Patients who had a primary TKA were identified using Current Procedural Terminology (CPT) code 27,447, and patients with degenerative cervical disease were identified using CPT and International Classification of Diseases (ICD) codes. Data on patients' demographics, comorbidities and postoperative complications were recorded and analyzed with univariate and multivariate analysis with significance set at p < 0.05. A Kaplan-Meier analysis was conducted to estimate the 1- and 2-year rates of survival free from revision.

RESULTS

A total of 81,873 patients were included in this study. Following multivariate analysis, cervical spine degenerative disease patients were at increased risk of all-cause revision surgery following 1 year (OR: 1.342 95% CI: 1.149-1.569; p < 0.001) and 2 year (OR: 1.338; 95% CI: 1.184-1.512; p < 0.001). At 2 years, patients with cervical spine degenerative disease had a survival rate of 97.7%, while the survival rate was 99.2% among the non-cervical degenerative cohort.

CONCLUSIONS

Based on these results, patients with cervical spine degenerative pathology should be counseled that their spinal pathology may impair outcomes following TKA.

Osteolysis after cervical disc arthroplasty

PURPOSE

Cervical disc arthroplasty (CDA) has become an increasingly popular treatment for cervical degenerative disc disease. One potential complication is osteolysis. However, current literature on this topic appears limited. The purpose of this study is to elucidate the incidence, aetiology, consequence, and subsequent treatment of this complication.

METHODS

A systematic literature review was performed according to the PRISMA guidelines. Studies discussing the causes, incidence and management of osteolysis after a CA were included.

RESULTS

A total of nine studies were included. We divided these studies into two groups: (1) large case series in which an active radiological evaluation for osteolysis was performed (total = six studies), (2) case report studies, which discussed symptomatic cases of osteolysis (total = three). The incidence of asymptomatic osteolysis ranged from 8 to 64%; however, only one study reported an incidence of < 10% and when this case was excluded the incidence ranged from 44 to 64%. Severe asymptomatic bone loss (exposure of the implant) was found in less than 4% of patients. Bone loss from osteolysis appeared to occur early (< 1 year) after surgery and late (> 1 year) as well. Symptomatic patients with osteolysis often required revision surgery. These patients required removal of implant and conversion to fusion in the majority of the cases.

CONCLUSIONS

Osteolysis after CDA is common; however, the majority of cases have only mild or asymptomatic presentations that do not require revision surgery. The timing of osteolysis varies significantly. This may be due to differences in the aetiology of osteolysis.

Does zero-profile anchored cage accompanied by a higher postoperative subsidence compared with cage-plate construct? A meta-analysis

Background

The zero-profile anchored cage (ZP) has been widely used for its lower occurrence of dysphagia. However, it is still controversial whether it has the same stability as the cage-plate construct (CP) and increases the incidence of postoperative subsidence. We compared the rate of subsidence after anterior cervical discectomy and fusion (ACDF) with ZP and CP to determine whether the zero-profile device had a higher subsidence rate.

Methods

We performed a meta-analysis of studies that compared the subsidence rates of ZP and CP. An extensive and systematic search covered the PubMed and Embase databases according to the PRISMA guidelines and identified ten articles that satisfied our inclusion criteria. Relevant clinical and radiological data were extracted and analyzed by the RevMan 5.3 software.

Results

Ten trials involving 626 patients were included in this meta-analysis. The incidence of postoperative subsidence in the ZP group was significantly higher than that in the CP group [15.1% (89/588) versus 8.8% (51/581), OR = 1.97 (1.34, 2.89), P = 0.0005]. In the subgroup analysis, we found that the definition of subsidence did not affect the higher subsidence rate in the ZP group. Considering the quantity of operative segments, there was no significant difference in the incidence of subsidence between the two groups after single-level fusion (OR 1.43, 95% CI 0.61–3.37, P = 0.41). However, the subsidence rate of the ZP group was significantly higher than that of the CP group (OR 2.61, 95% CI 1.55–4.40, P = 0.0003) after multilevel (≥ 2-level) procedures. There were no significant differences in intraoperative blood loss, JOA score, NDI score, fusion rate, or cervical alignment in the final follow-up between the two groups. In addition, the CP group had a longer operation time and a higher incidence of dysphagia than the ZP group at each follow-up time.

Conclusion

Based on the limited evidence, we suggest that ZP has a higher risk of postoperative subsidence than CP, although with elevated swallowing discomfort. A high-quality, multicenter randomized controlled trial is required to validate our results in the future.

Association between sagittal balance and adjacent segment degeneration in anterior cervical surgery: a systematic review and meta-analysis

Background

ASD is a relatively common degenerative alteration after cervical surgery which occurs above or below the fused segment. In addition, some patients may need reoperation to treat severe ASD after the primary surgery. It was considered that sagittal balance is correlated with postoperative clinical outcomes; however, few studies have reported the influence of sagittal balance on ASD. The present study is designed to investigate whether sagittal balance impacts the pathology of adjacent segment disease (ASD) in patients who undergo anterior cervical surgery for degenerative cervical disease.

Methods

Databases including Pubmed, Embase, Cochrane library, and Web of Science were used to search for literature published before June 2018. Review Manager 5.3 was used to perform the statistical analysis. Sagittal balance parameters before and after surgery were compared between patients with and without ASD. Weighted mean difference (WMD) was summarized for continuous data and P < 0.05 was set for the level of significance.

Results

A total of 221 patients with ASD and 680 patients without ASD from seven articles were studied in this meta-analysis. There were no significant differences in most sagittal balance parameters between the two groups, except for postoperative cervical lordosis (CL) (WMD -3.30, CI -5.91, − 0.69, P = 0.01).

Conclusions

Some sagittal balance parameters may be associated with the development of ASD after anterior cervical surgery. Sufficient restoration of CL may decrease the incidence of ASD. The results in present study needed to be expanded carefully and further high-quality studies are warranted to investigate the impact of sagittal balance on ASD.

Electronic supplementary material

The online version of this article (10.1186/s12891-019-2800-0) contains supplementary material, which is available to authorized users.

Free hand technique of cervical lateral mass screw fixation

Study Design:

We introduce a simple free hand technique with great ease of application, without angles, measures or degrees, and without any fluoroscopic guidance. It is a safe and reproducible technique. We present our preliminary experience with the use this technique, with inimitable simplicity.

Purpose:

The primary aim of the procedure was to achieve adequate screw trajectory in an apparent challenging ease which is reproducible with a good outcome.

Overview of Literature:

Lateral mass screw fixation is used for posterior subaxial cervical fixation. It was described by Louis and Magerl, then by Anderson, An, and Ebraheim et al. Each one described the procedure with a unique screw entrance point and trajectory.

Technical Note:

This study is a prospective case study of 45 patients who underwent subaxial cervical lateral mass screw fixation. The screws were inserted using a free hand method. The described free hand technique was found to minimize the morbidity associated with other techniques without compromising the quality of fixation.

Conclusions:

Surgical experiences with this technique found it equally safe, rapid, easy, and reproducible.

The use of surgery for cervical degenerative disease in Norway in the period 2008-2014 : A population-based study of 6511 procedures

BACKGROUND

The incidence rate of surgical treatment of cervical degenerative diseases (CDD) has increased in the USA and a large geographic variation has been shown. Little is known about such rates in Scandinavia and Europe. The aim of this population-based study was to (1) investigate annual incidence rates of operations performed in Norway, (2) to compare trends and variations in rates for surgical indications with and without myelopathy, and (3) to compare variations in the use of surgery between residential areas.

METHODS

Patients operated for CDD and recorded in the Norwegian Patient Registry from 2008 to 2014 were evaluated according to residential areas (resident county and Regional Health Authority (RHA) area), age, gender, treating hospital, and whether myelopathy was present or not. Surgical rates were adjusted for age and gender. Data from private health care were also included.

RESULTS

The annual surgical rates increased by 74.1 % from 2008 to 2014 (12.5/100,000 inhabitants). The largest increase was for surgical treatment of radiculopathy, 86.5 %. Surgical rates for CDD varied in 2014 with a ratio of 1.5 between the highest and lowest RHA and with a ratio of 2.5 between the different residential counties within one RHA. The treatment rates for myelopathy were relatively stable over time, but showed an increase of 2.1/100,000 (44.6 %) from 2013 to 2014.

CONCLUSIONS

Our study shows that the rate of surgical treatment for radiculopathy due to CDD has increased substantially from 2008 to 2014 for all RHAs in Norway. The incidence rate for surgical treatment of myelopathy was more stable. An unexplained and moderate geographic variation was found.

A meta-analysis comparing total disc arthroplasty with anterior cervical discectomy and fusion for the treatment of cervical degenerative diseases

PURPOSE

To evaluate the efficacy and safety of total disc arthroplasty (TDA) and anterior cervical discectomy and fusion (ACDF) for treating cervical degenerative diseases.

METHODS

We conducted a comprehensive search in the electronic databases including Pubmed, Medline, EBSCO, Springer, Ovid, CNKI and Cochrane Database of Systematic Reviews. Two independent reviewers performed the data extraction from archives. All data were performed with Review Manager 5.2 software. The relative risk (RR) and its 95% confidence interval (CI) were calculated for count data. Standardized mean difference (SMD) and corresponding 95% CI for continuous outcomes were pooled.

RESULTS

After applying inclusion and exclusion criteria, nine papers were included in meta-analyses. The results of the meta-analysis indicated better neurological success, better overall success, lower incidence of secondary surgical procedures and lower incidence of secondary surgical procedures in TDA group than in ACDF group. After removing a study with considerable weight, TDA group displayed lower incidence of dysphagia and dysphonia than ACDF group.

CONCLUSION

This meta-analysis revealed that the clinical outcomes of TDA are equivalent or superior to ACDF.

Cervical kinematics and radiological changes after Discover artificial disc replacement versus fusion

BACKGROUND CONTEXT

The cervical disc arthroplasty has emerged as a promising alternative to the anterior cervical discectomy and fusion (ACDF) in patients with radiculopathy or myelopathy with disc degeneration disease. The advantages of this technique have been reported to preserve the cervical mobility and possibly reduce the adjacent segment degeneration. However, no studies have compared the clinical outcomes and radiological results in patients treated with Discover artificial disc replacement to those observed in matched group of patients that have undergone ACDF.

PURPOSE

We conducted this clinical study to compare the cervical kinematics and radiographic adjacent-level changes after Discover artificial disc replacement with ACDF.

STUDY DESIGN

Analysis and evaluation of data acquired in a comparative clinical study.

PATIENT SAMPLE

The number of patients in the Discover and ACDF group were 149 and 196, respectively.

OUTCOME MEASURES

The Neck Disability Index (NDI) and visual analog scale (VAS) pain score were evaluated. The range of movement (ROM) by the shell angle, the functional segment unit and global angles were measured, and the postoperative radiological changes at adjacents levels were observed.

METHODS

A total of 149 patients with symptomatic single or two-level cervical degenerative diseases received the Discover cervical artificial disc replacement from November 2008 to February 2010. During the same period, there were a total of 196 patients undergoing one or two-level ACDF. The average follow-up periods of the Discover disc group and ACDF group were 22.1 months and 22.5 months, respectively. Before surgery, patients were evaluated using static and dynamic cervical spine radiographs in addition to computerized tomography and magnetic resonance imaging. Static and dynamic cervical spine radiographs were obtained after surgery and then at 3- and 6-month follow-up. Then, the subsequent follow-up examinations were performed at every 6-month interval. The clinical results in terms of NDI and VAS scores, the parameters of cervical kinematics, postoperative radiological changes at adjacent levels, and complications in the two groups were statistically analyzed and compared. No funding was received for this study, and the authors report no potential conflict of interest-associated biases in the text.

RESULTS

Although the clinical improvements in terms of NDI and VAS scores were achieved in both the Discover and ACDF group, no significant difference was found between the two groups for both single- (VAS p=.13, NDI p=.49) and double-level surgeries (VAS p=.28, NDI p=.21). Significant differences of cervcial kinematics occurred between the Discover and the ACDF group for both the single- and double-level surgeries at the operative segments (p<.001). Except the upper adjacent levels for the single-level Discover and ACDF groups (p=.33), significant increases in adjacent segment motion were observed in the ACDF group compared with the minimal ROM changes in adjacent segment motion noted in the Discover group, and the differences between the two groups for both single and double-level procedures were statistically significant (p<.05). There were significant differences in the postoperative radiological changes at adjacent levels between the Discover and ACDF groups for the single-level surgery (p<.001, χ(2)=18.18) and the double-level surgery (p=.007, χ2=7.2). No significant difference of complications was found between the Discover and ACDF groups in both single (p=.25, χ2=1.32) and double-level cases (p=.4, χ2=0.69).

CONCLUSIONS

The adjacent segment ROM and the incidence of radiographic adjacent-level changes in patients undergoing ACDF were higher than those undergoing Discover artificial disc replacement. The cervical mobility was relatively well maintained in the Discover group compared with the ACDF group, and the Discover cervical disc arthroplasty can be an effective alternative to the fusion technique.