1
|
Huang CC, Fitts J, Huie D, Bhowmick DA, Abd-El-Barr MM. Evolution of Cervical Endoscopic Spine Surgery: Current Progress and Future Directions-A Narrative Review. J Clin Med 2024; 13:2122. [PMID: 38610887 PMCID: PMC11012719 DOI: 10.3390/jcm13072122] [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: 02/25/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Cervical endoscopic spine surgery is rapidly evolving and gaining popularity for the treatment of cervical radiculopathy and myelopathy. This approach significantly reduces muscular damage and blood loss by minimizing soft tissue stripping, leading to less postoperative pain and a faster postoperative recovery. As scientific evidence accumulates, the efficacy and safety of cervical endoscopic spine surgery are continually affirmed. Both anterior and posterior endoscopic approaches have surfaced as viable alternative treatments for various cervical spine pathologies. Newer techniques, such as endoscopic-assisted fusion, the anterior transcorporeal approach, and unilateral laminotomy for bilateral decompression, have been developed to enhance clinical outcomes and broaden surgical indications. Despite its advantages, this approach faces challenges, including a steep learning curve, increased radiation exposure for both surgeons and patients, and a relative limitation in addressing multi-level pathologies. However, the future of cervical endoscopic spine surgery is promising, with potential enhancements in clinical outcomes and safety on the horizon. This progress is fueled by integrating advanced imaging and navigation technologies, applying regional anesthesia for improved and facilitated postoperative recovery, and incorporating cutting-edge technologies, such as augmented reality. With these advancements, cervical endoscopic spine surgery is poised to broaden its scope in treating cervical spine pathologies while maintaining the benefits of minimized tissue damage and rapid recovery.
Collapse
Affiliation(s)
- Chuan-Ching Huang
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Jamal Fitts
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | - David Huie
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | - Deb A. Bhowmick
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | - Muhammad M. Abd-El-Barr
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| |
Collapse
|
2
|
Vijaya Saradhi M, Sashanka K, Alugolu R. Does the extent of soft tissue dissection and location of screws in anterior cervical discectomy and fusion impact the development of the adjacent segment degeneration? A prospective short-term radiological analysis. J Neurosurg Sci 2024; 68:195-200. [PMID: 34342205 DOI: 10.23736/s0390-5616.21.05458-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cervical degenerative disc disease is a common condition in neurosurgical practice. Elimination of a motion segment through fusion causes the load shift to the adjacent levels leading to disc degeneration. Our hypothesis is that by avoiding excessive dissection of the prevertebral soft tissue and placing anchoring screws away the adjacent endplate, we can reduce the load bearing and degeneration rate. METHODS This is a prospective randomized control study. The study included 30 consecutive cases requiring single level ACDF, 15 each in conservative and minimal dissection group. MRI evidence of disc degeneration was assessed according to Matsumoto MRI grading system. RESULTS No significant role of age on ASD was noted (P=0.26). ASD was worse in females than males especially at the inferior level (P=0.035). ASD was noted to be higher when the patients were operated at C5-6 level (P=0.026). The reduction in VAS was 5.933 in the minimal dissection group which was significantly better than the conventional surgery group (5.14) (P=0.023). The increase in degeneration score was 0.97 and 0.6 at superior and inferior levels, respectively, in the conventional group and 0.13 and 0.34 in minimal dissection group. CONCLUSIONS The minimal soft tissue dissection for single level ACDF with PEEK cage placement appears to have reducing rate of ASD compared to conventional ACDF. Minimal soft tissue dissection has better postoperative VAS scores.
Collapse
Affiliation(s)
| | - Kode Sashanka
- Service of Neurosurgery, Nizams Institute of Medical Science, Hyderabad, India
| | - Rajesh Alugolu
- Service of Neurosurgery, Nizams Institute of Medical Science, Hyderabad, India -
| |
Collapse
|
3
|
Wang ZJ, Du Q, Wang SF, Su H, He W, Liao WB, Xin ZJ, Kong WJ. Anterior transcorporeal approach combined with posterior translaminar approach in percutaneous endoscopic cervical discectomy for two-segment cervical disc herniation treatment: a technical report and early follow-up. J Orthop Surg Res 2024; 19:3. [PMID: 38167157 PMCID: PMC10763675 DOI: 10.1186/s13018-023-04471-4] [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: 08/26/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Full endoscopic techniques are being gradually introduced from single-segment cervical disc herniation surgery to two-segment cervical disc herniation surgery. However, there is no suitable full endoscopic treatment for mixed-type two-segment cervical disc herniation (MTCDH) in which one segment herniates in front of the spinal cord and the other segment herniates behind the spinal cord. Therefore, we introduce a new full endoscopic technique by combining an anterior transcorporeal approach and a posterior translaminar approach. In addition, we provide a brief description of its safety, efficacy, feasibility, and surgical points. METHODS Thirty patients with MTCDH were given full endoscopic surgical treatment by a combined transcorporeal and transforaminal approach and were followed up for at least 12 months. RESULTS Clinical assessment scales showed that the patient's symptoms and pain were significantly reduced postoperatively. Imaging results showed bony repair of the surgically induced bone defect and the cervical Cobb angle was increased. No serious complications occurred. CONCLUSION This technique enables minimally invasive surgery to relieve the compression of the spinal cord by MTCDH. It avoids the fusion of the vertebral body for internal fixation, preserves the vertebral motion segments, avoids medical destruction of the cervical disc to the greatest extent possible, and expands the scope of adaptation of full endoscopic technology in cervical surgery.
Collapse
Affiliation(s)
- Zheng-Ji Wang
- Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Qian Du
- Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Shu-Fa Wang
- Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Heng Su
- Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Wen He
- Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Wen-Bo Liao
- Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
| | - Zhi-Jun Xin
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Wei-Jun Kong
- The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi, Guizhou, China
| |
Collapse
|
4
|
Zaidi SE, Venkatraman V, Sykes DAW, Albanese J, Erickson MM, Crutcher CL, Goodwin CR, Groff MW, Grossi P, Than KD, Haglund MM, Abd-El-Barr MM. Clinical and Radiographic Outcomes for Patients with Cervical Adjacent Segment Disease Treated with Anterior Cervical Discectomy and Fusion with Integrated Interbody Spacers. World Neurosurg 2023; 180:e514-e522. [PMID: 37774788 DOI: 10.1016/j.wneu.2023.09.101] [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: 08/05/2023] [Revised: 09/22/2023] [Accepted: 09/23/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Anterior cervical discectomy and fusion (ACDF) is among the most common spine procedures. Adjacent segment disease (ASD), characterized by degenerative disease at an adjacent spinal level to a prior fusion, is a well-recognized and significant sequela following ACDF. Adjacent segment ACDF may be considered after the failure of non-surgical options for patients with symptomatic ASD. This study aimed to assess the incidence of dysphagia and other complications as well as radiographic outcomes in adult patients who have undergone ACDF with an integrated interbody spacer device for symptomatic ASD. METHODS This was a retrospective review of patients who underwent ACDF for symptomatic ASD with commercially available integrated interbody spacers by three spine surgeons at an academic institution from March 2018 to April 2022. Demographic, radiographic, and postoperative data were collected, including dysphagia, device-related complications, and the need for revision surgery. RESULTS There were 48 patients (26 male, 22 female) who met inclusion criteria (mean age 59.7 years, mean body mass index 19.5 kg/m2) who underwent ACDF for symptomatic ASD (1one-level, n = 44; 2-level, n = 4). Overall, 12 patients (25%) experienced dysphagia postoperatively before the first follow-up appointment. Nine of 44 (20.4%) of 1-level ACDF patients experienced dysphagia, and 3 of 4 (75%) of 2-level ACDF patients experienced dysphagia. Three patients had severe dysphagia which prompted an otolaryngology referral. Two of those patients remained symptomatic at 6 weeks postoperatively. Of 43 patients with prior plate cage systems, none required hardware removal at the time of surgery. Preoperative global and segmental lordosis were 9.07° ± 8.36° (P = 0.22) and 3.58° ± 4.57° (P = 0.14), respectively. At 6 weeks postoperatively, global and segmental lordosis were 11.44° ± 9.06° (P = 0.54) and 5.11° ± 4.44° (P = 0.44), respectively. This constitutes a change of +2.37° and +1.53° in global and segmental lordosis, respectively. The mean anterior disc height change between preoperative and immediate postoperative time points was 6.3 ± 3.1 mm. Between the immediate postoperative and 6-week postoperative time points, the mean anterior disc height change was -1.5 ± 2.7 mm. Between the immediate postoperative and 3-month postoperative time points, the mean anterior disc height change was -3.7 ± 5.0 mm. The posterior disc height changes at the same time points were 2.5 ± 1.7 mm, -0.4 ± 1.8. and -0.5 ± 1.4 mm, respectively. This fusion rate was 50% and 70% at 6 months and 1 year post-surgery, respectively. CONCLUSIONS ACDF with integrated spacer is a viable alternative to traditional plate-cage systems for symptomatic ASD. An advantage over traditional plate-cage systems is that the removal of prior instrumentation is not needed in order to place implants. Based on a review of the literature, these standalone systems allowed for a shorter operative time and had less incidence of dysphagia than plate-cage systems for ASD after ACDF. The different standalone and plate-cage systems used in treating ASD after ACDF surgeries should be compared in prospective studies.
Collapse
Affiliation(s)
- Saif E Zaidi
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA; School of Medicine, Paris Cité University, Paris, France
| | - Vishal Venkatraman
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - David A W Sykes
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jessica Albanese
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA; Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Melissa M Erickson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Clifford L Crutcher
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael W Groff
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Peter Grossi
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Khoi D Than
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael M Haglund
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Muhammad M Abd-El-Barr
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
| |
Collapse
|
5
|
Zhang J, Ruan D, Xuan A, He Q, Zhang C, Xu C, Zhu C, Zhou Q. Comparative study of outcomes between allograft intervertebral disc transplantation and anterior cervical discectomy and fusion: a retrospective cohort study at least 5 years of follow-up. 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; 32:3561-3574. [PMID: 37330937 DOI: 10.1007/s00586-023-07799-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: 02/08/2023] [Revised: 04/24/2023] [Accepted: 05/26/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE Adjacent segment degeneration (ASDeg) after anterior cervical discectomy and fusion (ACDF) seriously affects the long-term efficacy of the operation. Therefore, our team has done a lot of research on allograft intervertebral disc transplantation (AIDT) to prove its feasibility and safety. This study will compare the efficacy between AIDT and ACDF in the treatment of cervical spondylosis. METHODS All patients who received ACDF or AIDT in our hospital from 2000 to 2016 and followed up for at least 5 years were recruited and divided into ACDF and AIDT groups. The clinical outcomes including functional scores and radiological data of both groups were collected and compared preoperatively and postoperatively at 1 week, 3 months, 6 months, 12 months, 24 months, 60 months and last follow-up. Functional scores included Japanese Orthopedic Association score (JOA), Neck Disability Index (NDI), Visual Analog Scale of Neck (N-VAS) and Arms (A-VAS) pain, the Short Form Health Survey-36 (SF-36) and imaging dates including digital radiographs in the lateral, hyperextension and flexion positions to assess the stability, sagittal balance and mobility of the cervical spine and magnetic resonance imaging (MRI) scans to assess the degeneration of adjacent segment. RESULTS There were 68 patients with 25 in AIDT group and 43 in ACDF group. Satisfactory clinical results were obtained in both groups, but the long-term NDI score and N-VAS score in the AIDT group were better. The AIDT obtained the same stability and sagittal balance of the cervical spine as fusion surgery. The range of motion of adjacent segments can be restored to the preoperative level after transplantation, but this increases significantly after ACDF. There were significant differences in the superior adjacent segment range of motion (SROM) between two groups at 12 months (P = 0.039), 24 months (P = 0.035), 60 months (P = 0.039) and the last follow-up (P = 0.011). The inferior adjacent segment range of motion (IROM) and SROM had a similar trend in the two groups. The ratio value of the greyscale (RVG) of adjacent segments showed a downward trend. At the last follow-up, the RVG decreased more significantly in the ACDF group. At the last follow-up, there was a significant difference in the incidence of ASDeg between the two groups (P = 0.000). And the incidence of adjacent segment disease (ASDis) is 22.86% in the ACDF group. CONCLUSION The allograft intervertebral disc transplantation may be as an alternative technique to traditional anterior cervical discectomy and fusion for the management of cervical degenerative diseases. For the more, the results showed it would improve cervical kinematics and reduce the incidence of adjacent segment degeneration.
Collapse
Affiliation(s)
- Junyou Zhang
- The Second School of Clinical Medicine, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, 510515, People's Republic of China
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Dike Ruan
- The Second School of Clinical Medicine, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, 510515, People's Republic of China.
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China.
| | - Anwu Xuan
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, People's Republic of China
| | - Qing He
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Chao Zhang
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Cheng Xu
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Chao Zhu
- The Second School of Clinical Medicine, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, 510515, People's Republic of China
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Qing Zhou
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
- Navy Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, 230032, Anhui Province, China
| |
Collapse
|
6
|
Cheng CH, Chiu PY, Chen HB, Niu CC, Nikkhoo M. The influence of over-distraction on biomechanical response of cervical spine post anterior interbody fusion: a comprehensive finite element study. Front Bioeng Biotechnol 2023; 11:1217274. [PMID: 37650042 PMCID: PMC10464836 DOI: 10.3389/fbioe.2023.1217274] [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: 05/05/2023] [Accepted: 08/04/2023] [Indexed: 09/01/2023] Open
Abstract
Introduction: Anterior cervical discectomy and fusion (ACDF) has been considered as the gold standard surgical treatment for cervical degenerative pathologies. Some surgeons tend to use larger-sized interbody cages during ACDF to restore the index intervertebral disc height, hence, this study evaluated the effect of larger-sized interbody cages on the cervical spine with ACDF under both static and cyclic loading. Method: Twenty pre-operative personalized poro-hyperelastic finite element (FE) models were developed. ACDF post-operative models were then constructed and four clinical scenarios (i.e., 1) No-distraction; 2) 1 mm distraction; 3) 2 mm distraction; and 4) 3 mm distraction) were predicted for each patient. The biomechanical responses at adjacent spinal levels were studied subject to static and cyclic loading. Non-parametric Friedman statistical comparative tests were performed and the p values less than 0.05 were reflected as significant. Results: The calculated intersegmental range of motion (ROM) and intradiscal pressure (IDP) from 20 pre-operative FE models were within the overall ranges compared to the available data from literature. Under static loading, greater ROM, IDP, facet joint force (FJF) values were detected post ACDF, as compared with pre-op. Over-distraction induced significantly higher IDP and FJF in both upper and lower adjacent levels in extension. Higher annulus fibrosus stress and strain values, and increased disc height and fluid loss at the adjacent levels were observed in ACDF group which significantly increased for over-distraction groups. Discussion: it was concluded that using larger-sized interbody cages (the height of ≥2 mm of the index disc height) can result in remarkable variations in biomechanical responses of adjacent levels, which may indicate as risk factor for adjacent segment disease. The results of this comprehensive FE investigation using personalized modeling technique highlight the importance of selecting the appropriate height of interbody cage in ACDF surgery.
Collapse
Affiliation(s)
- Chih-Hsiu Cheng
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ping-Yeh Chiu
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hung-Bin Chen
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chien Niu
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Mohammad Nikkhoo
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| |
Collapse
|
7
|
Wei Z, Yang S, Zhang Y, Ye J, Chu TW. Prevalence and Risk Factors for Cervical Adjacent Segment Disease and Analysis of the Clinical Effect of Revision Surgery: A Minimum of 5 Years' Follow-Up. Global Spine J 2023:21925682231185332. [PMID: 37421142 DOI: 10.1177/21925682231185332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2023] Open
Abstract
STUDY DESIGN A retrospective study was performed. OBJECTIVE To investigate the prevalence and risk factors for adjacent segment disease (ASD) after anterior cervical discectomy and fusion (ACDF) and the clinical efficacy of revision surgery. METHOD A total of 219 patients treated with ACDF were analyzed retrospectively. Demographic characteristics, including age, sex, body mass index (BMI) and bone mineral density (BMD), and radiographic measurements, including C2-C7 cervical sagittal vertical axis (cSVA), T1 slope (T1S), thoracic inlet angle (TIA) and C2-C7 Cobb angle, were analyzed. Modified Japanese Orthopaedic Association (mJOA) score and visual analog scale (VAS) score were used to evaluate patient function. Parameters were analyzed with Student's t test, and potential risk factors for ASD were further analyzed with multivariate logistic regression analysis. RESULTS The incidence of ASD after ACDF surgeries was 21%. The severity of osteoporosis, BMI and C2-C7 cSVA were significantly higher in the ASD group than in the NASD group (P < .05). The preoperative and postoperative TIAs were lower in the ASD group (P < .05). Multivariate logistic regression analysis showed that a high BMI, severe osteoporosis and a high C2-C7 cSVA were risk factors for ASD after ACDF (P < .05). The postoperative TIA and postoperative T1S were also correlated with ASD (P < .05). CONCLUSION Patients with a high BMI, severe osteoporosis, and a large C2-C7 cSVA after ACDF have a higher risk of ASD, while a large T1S and TIA may be protective factors. In addition, revision surgery can restore cervical spine balance in patients with ASD and promote better clinical outcomes.
Collapse
Affiliation(s)
- Zihan Wei
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Sizhen Yang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ying Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Jiawen Ye
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Tong-Wei Chu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| |
Collapse
|
8
|
Risk Factors for Adjacent Segment Problems after Posterior Instrumentation of the Cervical Spine. SURGERIES 2022. [DOI: 10.3390/surgeries3040037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Adjacent segment problems after cervical spine instrumentation are widely reported. They can range from asymptomatic adjacent segment degeneration (ASD) noted on radiographs to symptomatic adjacent segment disease and even instability. While ASD following anterior instrumentation is well studied, there is a paucity of literature on ASD following posterior instrumentation. We intended to identify the risk factors associated with ASD following posterior instrumentation, focusing on pre-operative and surgical parameters. Eighty-seven patients who underwent posterior instrumentation of the cervical spine were recruited. Clinical and radiological examination was performed preoperatively and up to 24 months postoperatively. The collected data included patient demographics, indication for surgery, sagittal parameters (cervical lordosis, C2–7 sagittal-vertical axis), technique of surgery, number of levels instrumented and fused, number of levels decompressed, and the level at which the instrumentation ended. Based on postoperative evaluation, ASD was found in 29.9% of the patients, of which, one patient was symptomatic and required reoperation. Even though, according to our univariate analysis, reduced pre-operative cervical lordosis and the indication of degenerative spondylosis seemed to significantly influence the occurrence of ASD, multivariate regression analysis did not identify any independent risk factors. We also noted that, even though patients may develop ASD after the instrumented fusion of the cervical spine, this may not necessarily develop into symptomatic adjacent segment disease requiring revision surgery.
Collapse
|
9
|
Anterior Cervical Discectomy and Fusion Using Zero-P System for Treatment of Cervical Spondylosis: A Meta-Analysis. Pain Res Manag 2021; 2021:3960553. [PMID: 34956433 PMCID: PMC8702348 DOI: 10.1155/2021/3960553] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/17/2021] [Indexed: 12/17/2022]
Abstract
Objective The current study aimed to explore the efficacy of Zero profile intervertebral fusion system (Zero-P) and traditional anterior plate cage system (PC) in the treatment of cervical spondylotic myelopathy (CSM). Further, the present study evaluated effects of the treatments on medical security, height of intervertebral disc, adjacent-level ossification development (ALOD), and adjacent segmentation disease (ASD) through a systematic retrospective analysis. Methods Studies on Zero-P system and traditional anterior plate cage system for ACDF in the treatment of CSM were searched in PubMed, Web of Science, Ovid, Embase, and Cochrane Library databases. Two independent researchers screened articles, extracted data, and evaluated the quality of the articles based on the inclusion and exclusion criteria of the current study. RevMan5.3 software was used for meta-analysis following the guidelines of Cochrane collaboration network. Cervical curvature, interbody fusion rate, preoperative and postoperative disc height index (DHI), fusion cage sinking rate, postoperative dysphagia, ASD, ALOD, and loosening of screw were compared between the two groups. Results A total of 17 literatures were included in the present study, including 6 randomized controlled trials and 11 observational studies. The studies comprised a total of 1204 patients with CSM, including 605 patients in the Zero-P system group (Zero-P group) and 599 patients in the traditional animal plate cage group (PC group). Results of this meta-analysis showed that postoperative dysphagia [OR = 0.40, CI (0.28, 95% 0.58), P < 0.00001], ALOD [OR = 0.09, CI (0.02, 95% 0.39), P = 0.001], ASD [OR = 0.42, CI (0.20, 95% 0.86), P = 0.02], and screw loosening [OR = 0.20, CI (0.08, 95% 0.52), P = 0.0009] of the Zero-P group were significantly lower compared with the PC group. On the other hand, preoperative cervical curvature [WMD = −0.23, CI (−1.38, 95% 0.92), P = 0.69], postoperative cervical curvature [WMD = −0.38, CI (−1.77, 95% 1.01), P = 0.59], cage sinking rate [OR = 1.41, CI [0.52, 95% 3.82], P = 0.50], intervertebral fusion rate [OR = 0.76, CI (0.27, 95% 2.48), P = 0.38], preoperative DHI [WMD = −0.04, CI (−0.14, 95% 0.22), P = 0.65], and postoperative DHI [WMD = 0.06, CI (−0.22, 95% 0.34), P = 0.675] were not significantly different between the two groups. Conclusion It was evident that the Zero-P system used in ACDF is superior compared with the traditional anterior plate cage system in postoperative dysphagia, avoiding ALOD, ASD, and screw loosening.
Collapse
|
10
|
Stifano V, Stati G, Giacobbo Scavo C, Carpineta E, Cacciotti G, Roperto R, Sufianov A, Mastronardi L. Single-Level Cervical Arthroplasty with a Keel-less Prosthesis: Results in a Series of 35 Patients Operated on for Soft Disk Herniation with a Minimum of 3 Years of Follow-Up. J Neurol Surg A Cent Eur Neurosurg 2021; 83:27-30. [PMID: 34044466 DOI: 10.1055/s-0041-1724109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cervical arthroplasty with artificial cervical disks has gained popularity as an alternative to anterior discectomy and fusion. The main advantages of disk arthroplasty include maintenance of the range of movement, restitution of disk height and spinal alignment, and reduction of adjacent segment degeneration (ASD). In this article, we aimed to assess the outcomes of the use of a keel-less prosthesis. MATERIAL AND METHODS We included all the patients who underwent single-level cervical arthroplasties with the Discocerv Cervidisc Evolution for "soft" disk herniation. Clinical assessment included Neck Disability Index (NDI) and visual analog scale (VAS) for neck and arm pain. Radiologic studies investigated the occurrence of ASD and system failure or subsidence. The reoperation rate was also recorded. RESULTS The study included 35 patients (14 men and 21 women; mean age: 42.5 years; mean follow-up: 57.8 months). There was a significant decrease in VAS neck and VAS arm scores, which went from 7.2 and 6.9 preoperatively to 2.2 and 1.7 postoperatively, 2.2 and 1.6 at 6 months, 2.0 and 1.8 at 1 year, and 2.1 and 1.3 at the last follow-up, respectively. The mean NDI score was 58.0 preoperatively, 19.4 postoperatively, 17.0 at 6 months, 16.1 at 1 year, and 16.2 at the last follow-up. Radiologic studies revealed a preserved range of motion in 33 of 35 patients. No ASD occurred and no reoperation was required. CONCLUSIONS Cervical disk arthroplasty with a keel-less prosthesis can be a safe and effective alternative to fusion for degenerative disk disease in selected patients, with a possible reduction of ASD.
Collapse
Affiliation(s)
- Vito Stifano
- Department of Neurosurgery, Catholic University of the Sacred Heart Rome Campus, Roma, Italy
| | - Giovanni Stati
- Department of Neurosurgery, Azienda Complesso Ospedaliero San Filippo Neri, Roma, Lazio, Italy
| | - Carlo Giacobbo Scavo
- Department of Neurosurgery, Azienda Complesso Ospedaliero San Filippo Neri, Roma, Lazio, Italy
| | - Ettore Carpineta
- Department of Neurosurgery, Azienda Complesso Ospedaliero San Filippo Neri, Roma, Lazio, Italy
| | - Guglielmo Cacciotti
- Department of Neurosurgery, Azienda Complesso Ospedaliero San Filippo Neri, Roma, Lazio, Italy
| | - Raffaelino Roperto
- Department of Neurosurgery, Azienda Complesso Ospedaliero San Filippo Neri, Roma, Lazio, Italy
| | - Albert Sufianov
- Department of Neurosurgery, Sechenov University, Moskva, Russian Federation
| | - Luciano Mastronardi
- Department of Neurosurgery, Azienda Complesso Ospedaliero San Filippo Neri, Roma, Lazio, Italy
| |
Collapse
|
11
|
Should Multilevel Posterior Cervical Fusions Involving C7 Cross the Cervicothoracic Junction? A Systematic Review and Meta-Analysis. World Neurosurg 2019; 127:588-595.e5. [DOI: 10.1016/j.wneu.2019.03.283] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 11/23/2022]
|
12
|
Chen WM, Jin J, Park T, Ryu KS, Lee SJ. Strain behavior of malaligned cervical spine implanted with metal-on-polyethylene, metal-on-metal, and elastomeric artificial disc prostheses - A finite element analysis. Clin Biomech (Bristol, Avon) 2018; 59:19-26. [PMID: 30119037 DOI: 10.1016/j.clinbiomech.2018.08.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/25/2018] [Accepted: 08/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Postoperative alterations in cervical spine curvature (i.e. loss of lordotic angle) are frequently observed following total disc replacement surgery. However, it remains unclear whether such changes in lordotic angle are due to preoperative spinal deformities and/or prostheses design limitations. The objective of the study is to investigate strain and segmental biomechanics of the malaligned cervical spine following total disc replacement. METHODS Three disc prostheses were chosen, namely a metal-on-polyethylene, a metal-on-metal, and an elastomeric prosthesis, which feature different geometrical and material design characteristics. All discs were modelled and implanted into multi-segmental cervical spine finite element model (C3-C7) with normal, straight and kyphotic alignments. Comparative analyses were performed by using a hybrid protocol. FINDINGS The results indicated that as the spine loses lordotic alignment, the prosthesis with elastomeric core tends to produce significantly larger flexion range of motion (difference up to 6.1°) than metal-on-polyethylene and metal-on-metal prostheses. In contrast, when the treated spine had normal lordotic alignment, the range of motion behaviors of different prostheses are rather similar (difference within 1.9°). Large localized strains up to 84.8% were found with the elastomeric prosthesis, causing a collapsed anterior disc space under flexion loads. INTERPRETATION Changes in cervical spinal alignments could significantly affect the surgical-level range of motion behaviors following disc arthroplasty; the in situ performance was largely dependent on the designs of the artificial disc devices in particular to the material properties.
Collapse
Affiliation(s)
- Wen-Ming Chen
- Department of Biomedical Engineering, University of Shanghai for Science and Technology, 516 JunGong Road, Shanghai, China.
| | - Jie Jin
- Department of Orthopedic Surgery, YanBian University Hospital, China
| | - Taehyung Park
- Department of Biomedical Engineering, College of Biomedical Science & Engineering, Inje University, 607 O-bang, Gyongnam, Republic of Korea
| | - Kyeong-Sik Ryu
- Department of Neurosurgery, College of medicine, The Catholic University of Korea, 222 Banpo-Daero, Seoul, Republic of Korea
| | - Sung-Jae Lee
- Department of Biomedical Engineering, College of Biomedical Science & Engineering, Inje University, 607 O-bang, Gyongnam, Republic of Korea.
| |
Collapse
|
13
|
Wang Z, Zhou L, Lin B, Song K, Niu Q, Ren D, Tang J. Risk factors for non-fusion segment disease after anterior cervical spondylosis surgery: a retrospective study with long-term follow-up of 171 patients. J Orthop Surg Res 2018; 13:27. [PMID: 29394936 PMCID: PMC5797381 DOI: 10.1186/s13018-018-0717-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/08/2018] [Indexed: 11/24/2022] Open
Abstract
Background The purpose of this study was to investigate the incidence and causes of non-fusion segment disease (NFSD), both adjacent and non-adjacent to a fused segment, after anterior cervical arthrodesis. Methods This is a single-center study. Between January 1998 and January 2011, two surgeons’ 171 patients who had an anterior cervical decompression and fusion were followed clinically for more than 5 years. The correlation between the incidence of symptomatic non-fusion segment disease and the following clinical parameters (age at operation, fusion levels,) and radiological parameters (number of patients who had a plate, anterior cervical decompression and fusion (ACDF) or corpectomies, preoperative and postoperative cervical spine alignment, Pavlov’s ratio at the C5 level, and preoperative existence of a non-fusion segment degeneration on magnetic resonance imaging) was evaluated. Results Of the 171 patients reviewed, 16 patients had non-fusion segment disease (9.36%), of which 12 had adjacent segment disease and 4 had non-adjacent segment disease. Postoperative cervical lordosis in the non-fusion segment disease group was significantly smaller than that of the disease-free group (P < 0.001). Fusion levels in the NFSD group were 1.69 whereas 2.26 in disease-free group (P = 0.005). The incidences of disc degeneration in unfused segments was more severe in the NFSD group than in the disease-free group (P = 0.004). The results of binary logistic regression showed that the major factor affecting NFSD is postoperative cervical lordosis (P = 0.000) followed by disc degeneration (P = 0.024). The other parameters did not show a statistically significant difference. Conclusions The incidence of symptomatic non-fusion segment disease after anterior cervical arthrodesis has multifactorial causes. Postoperative cervical lordosis and disc degeneration in non-fusion segments were major factors in the incidence of NFSD.
Collapse
Affiliation(s)
- Ziqiang Wang
- Jinzhou Medical University, Jinzhou, 121001, People's Republic of China.,Department of Orthopedics, The First Affiliated Hospital of the General Hospital of PLA, Beijing, 100048, People's Republic of China
| | - Liangliang Zhou
- Jinzhou Medical University, Jinzhou, 121001, People's Republic of China.,Department of Orthopedics, The First Affiliated Hospital of the General Hospital of PLA, Beijing, 100048, People's Republic of China
| | - Bin Lin
- Department of Orthopedics, The First Affiliated Hospital of the General Hospital of PLA, Beijing, 100048, People's Republic of China
| | - Keran Song
- Department of Orthopedics, The First Affiliated Hospital of the General Hospital of PLA, Beijing, 100048, People's Republic of China
| | - Qinghe Niu
- Department of Orthopedics, The First Affiliated Hospital of the General Hospital of PLA, Beijing, 100048, People's Republic of China
| | - Dongfeng Ren
- Department of Orthopedics, The First Affiliated Hospital of the General Hospital of PLA, Beijing, 100048, People's Republic of China.
| | - Jiaguang Tang
- Department of Orthopedics, The First Affiliated Hospital of the General Hospital of PLA, Beijing, 100048, People's Republic of China.
| |
Collapse
|
14
|
Piper K, DeAndrea-Lazarus I, Algattas H, Kimmell KT, Towner J, Li YM, Walter K, Vates GE. Risk Factors Associated with Readmission and Reoperation in Patients Undergoing Spine Surgery. World Neurosurg 2018; 110:e627-e635. [DOI: 10.1016/j.wneu.2017.11.057] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 11/09/2017] [Accepted: 11/11/2017] [Indexed: 12/21/2022]
|
15
|
Wang KF, Duan S, Zhu ZQ, Liu HY, Liu CJ, Xu S. Clinical and Radiologic Features of 3 Reconstructive Procedures for the Surgical Management of Patients with Bilevel Cervical Degenerative Disc Disease at a Minimum Follow-Up Period of 5 Years: A Comparative Study. World Neurosurg 2018; 113:e70-e76. [PMID: 29408574 DOI: 10.1016/j.wneu.2018.01.157] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/19/2018] [Accepted: 01/20/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess the mid-long-term follow-up of the safety and efficacy of anterior cervical discectomy and fusion (ACDF), cervical artificial disc replacement (CADR) and hybrid surgery (HS) for bilevel cervical degenerative disc disease (cDDD). METHODS 77 patients who underwent ACDF, HS, and CADR were retrospectively reviewed. Clinical effects were evaluated based on Neck Disability Index (NDI), Visual Analog Scale (VAS), and Japanese Orthopedic Association (JOA) scores and the Odom criteria. Radiographic outcomes were evaluated, including cervical range of motion (ROM), ROM in the operative and adjacent segments, incidence of degeneration in the adjacent segments (ASD), and heterotopic ossification (HO). RESULTS NDI, VAS, and JOA scores significantly improved in all patients after surgery without significant differences between groups. The excellent-to-good ratio in the Odom scale was 28/30 for the HS group, 30/33 for the ACDF group, and 13/14 for the CADR group. No significant differences in clinical outcomes or complication were found between groups (P > 0.05). Furthermore, the HS and CADR groups had less decreased ROM in the cervical and operative segments and less compensatory ROM in adjacent segments (P < 0.05). By contrast, the ACDF group had decreased ROM in the cervical and operative segments and significantly increased ROM in adjacent segments (P < 0.05). Moreover, the incidence of ASD was higher in the ACDF group, but the difference was not statistically significant (P > 0.05). HO was found in 10 patients (33.3%) in the HS group and 5 patients (35.7%) in the CADR group. CONCLUSION HS was superior to ACDF with regard to equivalent clinical outcomes in the mid-long-term follow-up. Furthermore, HS was superior in the maintenance of ROM and had less impact on its adjacent segments. The efficacy of HS is similar to that of CADR.
Collapse
Affiliation(s)
- Kai-Feng Wang
- Department of Spine Surgery, Peking University People's Hospital, Beijing, China
| | - Shuo Duan
- Department of Spine Surgery, Peking University People's Hospital, Beijing, China
| | - Zhen-Qi Zhu
- Department of Spine Surgery, Peking University People's Hospital, Beijing, China.
| | - Hai-Ying Liu
- Department of Spine Surgery, Peking University People's Hospital, Beijing, China
| | - Chen-Jun Liu
- Department of Spine Surgery, Peking University People's Hospital, Beijing, China
| | - Shuai Xu
- Department of Spine Surgery, Peking University People's Hospital, Beijing, China
| |
Collapse
|
16
|
Kim SY, Yoon SH, Kim D, Oh CH, Oh S. A Prospective Study with Cage-Only or Cage-with-Plate Fixation in Anterior Cervical Discectomy and Interbody Fusion of One and Two Levels. J Korean Neurosurg Soc 2017; 60:691-700. [PMID: 29142629 PMCID: PMC5678062 DOI: 10.3340/jkns.2017.0211] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/18/2017] [Accepted: 08/30/2017] [Indexed: 11/27/2022] Open
Abstract
Objective The authors prospectively analyzed the effect of one-level or two-level anterior cervical discectomy and fusion (ACDF), comparing stand-alone cages and cage-with-plate fixation constructs with respect to clinical outcomes and radiologic changes. Methods A total of 84 patients who underwent one-level (n=52) or two-level ACDF (n=32) for cervical disc disease and who completed 2 years of follow-up were included in this study. The patients were divided by cervical level and grouped into ACDF-Cage-only and ACDF-Cage-with-plate groups. The following parameters were assessed using radiographs: subsidence, C2–C7 lordosis angle, fusion segment angle, adjacent disc space narrowing, and fusion status. Clinical outcomes were assessed using the neck disability index (NDI) and visual analog scale scores for arm pain. Results In the comparison of one-level ACDF-cage-only and ACDF-cage-with-plate groups, the NDI score was better in the cage-only group at the 3-, 12-, and 24-month follow-ups: however, no significant difference in clinical outcomes was observed. In the comparison of two-level ACDF-cage-only and ACDF-cage-with-plate groups, no difference in any clinical outcome was observed between the two groups. At the 24-month follow-up, subsidence was observed in 45.8% of patients in the one-level cage-only group and 32.1% of patients in the one-level cage-with-plate fixation group. There was no statistically significant difference in the incidence rate between the two groups (p=0.312). Subsidence in the two-level cage-only group (66.6%) was significantly more frequent than in the two-level cage-with-plate fixation group (30%; p=0.049). The fusion rate for patients in the one-level cage-only group was not significantly different from that in the one-level cage-with-plate fixation group (cage-only, 87.5%; cage-with-plate fixation, 92.9%; p=0.425); fusion rate in the two-level patients were also similar between groups (cage-only, 83.3%; cage-with-plate fixation, 95%; p=0.31). Conclusion Our clinical results showed that for single-level cases, plate fixation had no additional benefit versus cage-only; for two-level ACDF cases, the fusion rate and clinical outcomes were similar, although the cage-with-plate fixation group had a lower incidence of cage subsidence than did the cage-only group. We conclude that physicians should be aware of this possible disadvantage associated with using cervical plates in one-level ACDF. However, in two-level ACDF, subsidence is more likely to occur without plate fixation, and thus the addition of plate fixation should be considered.
Collapse
Affiliation(s)
- Sam Yeol Kim
- Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea
| | - Seung Hwan Yoon
- Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea
| | - Dokeun Kim
- Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea
| | | | - Seyang Oh
- Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea
| |
Collapse
|
17
|
Li Z, Wang H, Li L, Tang J, Ren D, Hou S. A new zero-profile, stand-alone Fidji cervical cage for the treatment of the single and multilevel cervical degenerative disc disease. J Clin Neurosci 2017; 41:115-122. [PMID: 28262396 DOI: 10.1016/j.jocn.2017.02.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/12/2017] [Indexed: 01/05/2023]
Abstract
To investigate the clinical and radiological results of the new zero-profile, stand-alone Fidji cervical cage to treat single- and multiple-level cervical DDD, and evaluate the safety and efficiency. Between October 2011 and July 2014, 72 consecutive patients (41 males and 31 females; mean age 50.9years [range, 33-68years]) with cervical DDD who underwent surgery and were followed for more than 2years were enrolled in this study (mean 31.1months, range 24-47months). The study compared clinical outcomes, radiologic parameters and complication rates. The SF-36, VAS, NDI, and JOA scores of all patients were improved significantly after surgery at any time point. (all p<0.05). The C2-C7 Cobb angle and the disc height index (DHI) of all patients were improved significantly after surgery at any time point (all p<0.05). From 3months after surgery to final follow-up the DHI showed a significant reduction comparing 1week after surgery (all p<0.05). The fusion rates were 91.7% (66/72) and the radiologic mean fusion time was 9.9months. Radiological evidence of adjacent segment degeneration (ASD) was observed in 4/41 patients (9.8%). Postoperative complications included epidural hematoma, hoarseness, dysphagia, axial neck pain, and subsidence. The zero-profile, stand-alone Fidji cervical cage for ACDF can be considered an effective, reliable and safe alternative procedure in the treatment of cervical DDD.
Collapse
Affiliation(s)
- Zhonghai Li
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China; Department of Orthopaedics, First Affiliated Hospital of PLA General Hospital, Beijing, People's Republic of China.
| | - Huadong Wang
- Department of Orthopaedics, First Affiliated Hospital of PLA General Hospital, Beijing, People's Republic of China
| | - Li Li
- Department of Orthopaedics, First Affiliated Hospital of PLA General Hospital, Beijing, People's Republic of China
| | - Jiaguang Tang
- Department of Orthopaedics, First Affiliated Hospital of PLA General Hospital, Beijing, People's Republic of China
| | - Dongfeng Ren
- Department of Orthopaedics, First Affiliated Hospital of PLA General Hospital, Beijing, People's Republic of China
| | - Shuxun Hou
- Department of Orthopaedics, First Affiliated Hospital of PLA General Hospital, Beijing, People's Republic of China
| |
Collapse
|
18
|
Wu TK, Wang BY, Cheng D, Rong X, Lou JG, Hong Y, Liu H. Clinical and radiographic features of hybrid surgery for the treatment of skip-level cervical degenerative disc disease: A minimum 24-month follow-up. J Clin Neurosci 2017; 40:102-108. [PMID: 28246009 DOI: 10.1016/j.jocn.2017.02.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/10/2017] [Indexed: 02/06/2023]
Abstract
We describe the radiographic changes of IS and investigate the safety and feasibility of hybrid surgery (HS) coupling cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) for the treatment of skip-level cervical degenerative disc disease (CDDD). Twenty-seven patients who received HS were retrospectively reviewed. Clinical evaluation based on the Japanese Orthopedic Association (JOA) and Neck Disability Index (NDI) and Visual Analog Scale (VAS) scores. Radiographic parameters included cervical alignment (CA), functional spine unite (FSU) angle of intermediated segment (IS), range of motion (ROM) and intervertebral disc height (IDH). Data regarding radiographic changes at IS were collected. The mean follow-up duration of 30.10months. Compared with preoperative value, JOA, NDI and VAS scores significantly improved after surgery (p<0.05). The CA was recovered significantly after surgery (p<0.05). There was no significant difference in the FSU angle and the IDH of IS between before and at 24months postoperatively (p>0.05). The ROM of IS significantly decreased at the first week after surgery (p<0.05), was similar to preoperative value at 3months postoperatively and significantly increased after 6months (p<0.05). Radiographic changes at IS were observed in 2 patients and Class II Heterotopic ossification (HO) was detected in 2 patients. HS is a safe and feasible alternative procedure for the treatment of skip-level CDDD. It preserved the IS intact and achieved satisfactory clinical and radiographic outcomes over a 24-month follow-up.
Collapse
Affiliation(s)
- Ting-Kui Wu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Sichuan 610041, China
| | - Bei-Yu Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Sichuan 610041, China
| | - Ding Cheng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Sichuan 610041, China
| | - Xin Rong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Sichuan 610041, China
| | - Ji-Gang Lou
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Sichuan 610041, China
| | - Ying Hong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Sichuan 610041, China
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Sichuan 610041, China.
| |
Collapse
|
19
|
Basques BA, Ondeck NT, Geiger EJ, Samuel AM, Lukasiewicz AM, Webb ML, Bohl DD, Massel DH, Mayo BC, Singh K, Grauer JN. Differences in Short-Term Outcomes Between Primary and Revision Anterior Cervical Discectomy and Fusion. Spine (Phila Pa 1976) 2017; 42:253-260. [PMID: 28207667 DOI: 10.1097/brs.0000000000001718] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To compare short-term morbidity for primary and revision anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA Revision ACDF procedures are relatively common, yet their risks are poorly characterized in the literature. There is a need to assess the relative risk of revision ACDF procedures compared with primary surgery. METHODS The prospectively collected American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients who underwent primary and revision ACDF from 2005 to 2014. The occurrence of 30-day postoperative complications, readmission, operative time, and postoperative length of stay were compared between primary and revision procedures using multivariate regression to control for patient and operative characteristics. RESULTS A total of 20,383 ACDF procedures were identified, 1219 (6.0%) of which were revision cases. On multivariate analysis, revision procedures were associated with significantly increased risk of any adverse event (relative risk [RR] 2.3, P < 0.001), any severe adverse event (RR 2.2, P < 0.001), thromboembolic events (RR 3.3, P = 0.001), surgical site infections (RR 3.2, P < 0.001), return to the operating room (RR 1.9, P = 0.001), any minor adverse event (RR 2.5, P < 0.001), and blood transfusion (RR 8.3, P < 0.001). Revision procedures had significantly increased risk of readmission within 30 days (RR = 1.6, P = 0.001). Minor, but statistically significant increases in average operative time and postoperative length of stay were identified for revisions procedures (7 min and half a day, respectively [P < 0.001 for both]). CONCLUSION Revision procedures were associated with significantly increased risk of multiple adverse outcomes, including thromboembolic events, surgical site infections, return to the operating room, blood transfusion, and readmission within 30 days. These results are important for patient counseling and risk stratification. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Bryce A Basques
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Nathaniel T Ondeck
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Erik J Geiger
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA
| | - Andre M Samuel
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Adam M Lukasiewicz
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Matthew L Webb
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Daniel D Bohl
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Dustin H Massel
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Benjamin C Mayo
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Kern Singh
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Jonathan N Grauer
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| |
Collapse
|
20
|
Dejaegher J, Walraevens J, van Loon J, Van Calenbergh F, Demaerel P, Goffin J. 10-year follow-up after implantation of the Bryan Cervical Disc Prosthesis. 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 2016; 26:1191-1198. [PMID: 27904963 DOI: 10.1007/s00586-016-4897-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 11/02/2016] [Accepted: 11/23/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE Cervical arthroplasty is being used as an alternative for cervical fusion, but long-term follow-up results have rarely been reported. In this paper, we present 10-year follow-up results after implantation of the Bryan Cervical Disc Prosthesis in a single center. METHODS 89 patients underwent implantation of a single-level Bryan Cervical Disc Prosthesis to treat radiculopathy and/or myelopathy. Clinical (Neurological Success, Neck Disability Index (NDI), Neck- and Arm-Pain, and SF-36) and radiological follow-up was prospectively organized up to 10 years after surgery. Adverse events and second surgeries were recorded and evaluated. RESULTS Ten-year follow-up data were available for 72 (81%) patients. Maintenance or improvement of the neurological state was seen in 89% of patients after 10-year follow-up. SF-36 PCS scores improved significantly at all follow-up points. SF-36 MCS improvement was significant at 4 and 6 year, but not at 8- and 10-year follow-up. Significant improvement for NDI, and Neck- and Arm-Pain scores was found for the subgroup of patients in whom these data were available. Mean angular motion of the prosthesis at 10-year follow-up was 8.6°. Mobility of the device, defined as >2° of angular motion, was reached in 81% of patients. During the study period, 21 patients (24%) developed new or recurrent radiculopathy or myelopathy, the majority of these being treated conservatively. Seven patients (8%) required 8 additional spine surgeries to treat persistent or recurrent symptoms. Of these, 2 patients (2%) were reoperated at the index level and at 5 (6%) an adjacent level. CONCLUSION In this study, favorable long-term clinical outcome after implantation of the Bryan Cervical Disc Prosthesis was seen, with the majority of prostheses remaining mobile after 10-year follow-up. However, still 6% of patients required adjacent level surgery.
Collapse
Affiliation(s)
- Joost Dejaegher
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium.
| | | | - Johannes van Loon
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Philippe Demaerel
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Jan Goffin
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
21
|
Li Z, Zhao Y, Tang J, Ren D, Guo J, Wang H, Li L, Hou S. A comparison of a new zero-profile, stand-alone Fidji cervical cage and anterior cervical plate for single and multilevel ACDF: a minimum 2-year follow-up 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 2016; 26:1129-1139. [PMID: 27554353 DOI: 10.1007/s00586-016-4739-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 07/16/2016] [Accepted: 08/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Zhonghai Li
- Department of Orthopedics, First Affiliated Hospital of PLA General Hospital, Beijing, The People's Republic of China.
- Beijing Engineering Research Center of Orthopedic Implants, Beijing, The People's Republic of China.
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian, The People's Republic of China.
| | - Yantao Zhao
- Department of Orthopedics, First Affiliated Hospital of PLA General Hospital, Beijing, The People's Republic of China
- Beijing Engineering Research Center of Orthopedic Implants, Beijing, The People's Republic of China
| | - Jiaguang Tang
- Department of Orthopedics, First Affiliated Hospital of PLA General Hospital, Beijing, The People's Republic of China
- Beijing Engineering Research Center of Orthopedic Implants, Beijing, The People's Republic of China
| | - Dongfeng Ren
- Department of Orthopedics, First Affiliated Hospital of PLA General Hospital, Beijing, The People's Republic of China
- Beijing Engineering Research Center of Orthopedic Implants, Beijing, The People's Republic of China
| | - Jidong Guo
- Department of Orthopedics, First Affiliated Hospital of PLA General Hospital, Beijing, The People's Republic of China
- Beijing Engineering Research Center of Orthopedic Implants, Beijing, The People's Republic of China
| | - Huadong Wang
- Department of Orthopedics, First Affiliated Hospital of PLA General Hospital, Beijing, The People's Republic of China
- Beijing Engineering Research Center of Orthopedic Implants, Beijing, The People's Republic of China
| | - Li Li
- Department of Orthopedics, First Affiliated Hospital of PLA General Hospital, Beijing, The People's Republic of China.
- Beijing Engineering Research Center of Orthopedic Implants, Beijing, The People's Republic of China.
| | - Shuxun Hou
- Department of Orthopedics, First Affiliated Hospital of PLA General Hospital, Beijing, The People's Republic of China.
- Beijing Engineering Research Center of Orthopedic Implants, Beijing, The People's Republic of China.
| |
Collapse
|
22
|
Kong L, Cao J, Wang L, Shen Y. Prevalence of adjacent segment disease following cervical spine surgery: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2016; 95:e4171. [PMID: 27399140 PMCID: PMC5058869 DOI: 10.1097/md.0000000000004171] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
UNLABELLED Prevalence estimates of adjacent segment degeneration (ASD) following cervical spine surgery varied greatly in current studies. We conducted a systematic review and meta-analysis to summarize the point prevalence of ASD after cervical spine surgery. METHODS Comprehensive electronic searches of PubMed, Embase, Web of Knowledge, and Cochrane Library databases were conducted to identify any study published from initial state to January 2016. Those reporting the prevalence of ASD after cervical surgery were included. A random-effects model was used to estimate the prevalence of radiographic ASD, symptomatic ASD, and reoperation ASD. Univariate meta-regression analyses were conducted to explore the potential associations between prevalence and length of follow-up. All analyses were performed using R version 3.2.3 (R Foundation for Statistical Computing). RESULTS A total of 83 studies were included in the meta-analysis. The prevalence of radiographic ASD, symptomatic ASD, and reoperation ASD after cervical surgery was 28.28% (95% confidence interval [CI], 20.96-36.96), 13.34% (95% CI, 11.06-16.00), and 5.78% (95% CI, 4.99-6.69), respectively, in a general analysis. It was found 2.79%, 1.43%, and 0.24% additions per year of follow-up in the incidence of radiographic ASD, symptomatic ASD, and reoperation ASD, respectively. CONCLUSION This meta-analysis provides some details about the prevalence of radiographic ASD, symptomatic ASD, and reoperation ASD after cervical spine surgery. However, the results of this meta-analysis should be interpreted with caution because of the heterogeneity among the studies.
Collapse
Affiliation(s)
| | | | | | - Yong Shen
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
- Correspondence: Yong Shen, Department of Orthopedics, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, Hebei 050051, P.R. China (e-mail: )
| |
Collapse
|
23
|
Yue JJ, Garcia R, Miller LE. The activL(®) Artificial Disc: a next-generation motion-preserving implant for chronic lumbar discogenic pain. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2016; 9:75-84. [PMID: 27274317 PMCID: PMC4869850 DOI: 10.2147/mder.s102949] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Degeneration of the lumbar intervertebral discs is a leading cause of chronic low back pain in adults. Treatment options for patients with chronic lumbar discogenic pain unresponsive to conservative management include total disc replacement (TDR) or lumbar fusion. Until recently, only two lumbar TDRs had been approved by the US Food and Drug Administration - the Charité Artificial Disc in 2004 and the ProDisc-L Total Disc Replacement in 2006. In June 2015, a next-generation lumbar TDR received Food and Drug Administration approval - the activL(®) Artificial Disc (Aesculap Implant Systems). Compared to previous-generation lumbar TDRs, the activL(®) Artificial Disc incorporates specific design enhancements that result in a more precise anatomical match and allow a range of motion that better mimics the healthy spine. The results of mechanical and clinical studies demonstrate that the activL(®) Artificial Disc results in improved mechanical and clinical outcomes versus earlier-generation artificial discs and compares favorably to lumbar fusion. The purpose of this report is to describe the activL(®) Artificial Disc including implant characteristics, intended use, surgical technique, postoperative care, mechanical testing, and clinical experience to date.
Collapse
Affiliation(s)
- James J Yue
- Department of Orthopaedic Surgery, Yale School of Medicine, New Haven, CT, USA
| | | | | |
Collapse
|
24
|
Abstract
STUDY DESIGN Retrospective cohort analysis of risk factors in revision spine surgery using a prospectively collected database. OBJECTIVE To examine the risk of developing early (30-day) complications across obesity level after adjusting for comorbidities in patients undergoing revision spine surgery. SUMMARY OF BACKGROUND DATA Prior studies suggest obesity influences early complications after primary surgery. The association between obesity and early complications after revision surgery remains to be characterized. METHODS Data were abstracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2012. Adult Caucasian patients undergoing removal/revision of instrumentation or exploration of fusion were included. Patients were categorized by WHO body mass index (BMI, kg/m): Non-Obese (18.5-29.9), Obese Class I (30-34.9), and Obese Class II/III (≥35). Univariate regression was performed to assess the predictive value of obesity level and baseline risk factors in the presence of at least one early complication, and significant predictors were entered into the multivariable model. RESULTS Of 2538 patients, 57.6% were nonobese, 23% Obese Class I, and 19.4% Obese Class II/III. Obesity was associated with diabetes, hypertension, respiratory disease, and American Society of Anesthesiologists (ASA) score of 3-4 (all P < 0.001). BMI group (P = 0.01), older age (P = 0.008), functional dependence (P < 0.001), ASA 3-4 (P = 0.008), bleeding disorder (P = 0.04), and diabetes (P = 0.016) were identified as univariate predictors for early complications. In the multivariable model, higher BMI (P = 0.04), older age (P = 0.014), and functional dependence (P < 0.001) remained significant predictors for early complications. Notably, patients who were Obese Class II/III (OR 1.66, 95% CI [1.12-2.45]), age ≥75 (OR 1.83, [1.20-2.81]), and functionally dependent (OR 3.02 [1.85-4.94]) had significantly higher risk compared with their reference groups. CONCLUSION Obesity is an independent risk factor for early complications after revision spine surgery. Although obesity may not contraindicate revision surgery, its status as a modifiable risk factor warrants disclosure and preoperative counseling to optimize outcomes. LEVEL OF EVIDENCE 3.
Collapse
|
25
|
Heterotopic ossification and clinical outcome in nonconstrained cervical arthroplasty 2 years after surgery: the Norwegian Cervical Arthroplasty Trial (NORCAT). 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 2016; 25:2271-8. [DOI: 10.1007/s00586-016-4549-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 12/27/2022]
|
26
|
Yokoyama K, Kawanishi M, Yamada M, Tanaka H, Ito Y, Kuroiwa T. Cervical facet dislocation adjacent to the fused motion segment. J Neurosci Rural Pract 2016; 7:133-6. [PMID: 26933361 PMCID: PMC4750312 DOI: 10.4103/0976-3147.172150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This study reports on a case that forces re-examination of merits and demerits of anterior cervical fusion. A 79-year-old male was brought to the emergency room (ER) of our hospital after he fell and struck the occipital region of his head following excessive alcohol consumption. Four years prior, he had undergone anterior cervical discectomy and fusion of C5/6 and a magnetic resonance imaging (MRI) performed 3 years after this surgery indicated that he was suffering from degeneration of C6/7 intervertebral discs. After arriving at the ER, he presented motor impairment at level C7 and lower of manual muscle testing grade 1 as well as moderate loss of physical sensation from the trunk and peripheries of both upper limbs to the peripheries of both lower limbs (Frankel B). Cervical computed tomography (CT) indicated anterior dislocation of C6/7, and MRI indicated severe spinal cord edema. We performed manipulative reduction of C6/7 with the patient under general anesthesia. Next, we performed laminectomy on C5-T1 and posterior fusion on C6/7. Postoperative CT indicated that cervical alignment had improved, and MRI indicated that the spinal cord edema observed prior to surgery had been mitigated. Three months after surgery, motor function and sensory impairment of the lower limbs had improved, and the patient was ambulatory upon discharge from the hospital (Frankel D). In the present case, although C5 and 6 were rigidly fused, degeneration of the C6/7 intervertebral disc occurred and stability was compromised. As a result, even slight trauma placed a severe dynamic burden on the facet joint of C6/7, which led to dislocation.
Collapse
Affiliation(s)
- Kunio Yokoyama
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan
| | - Masahiro Kawanishi
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan
| | - Makoto Yamada
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan
| | - Hidekazu Tanaka
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan
| | - Yutaka Ito
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan
| | - Toshihiko Kuroiwa
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan; Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan
| |
Collapse
|
27
|
Lagier M, Briere M, Giorgi H, Fuentes S, Blondel B, Tropiano P. Delayed hypersensitivity reaction after cervical disc replacement: a case report. Orthop Traumatol Surg Res 2015. [PMID: 26205565 DOI: 10.1016/j.otsr.2015.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report a case of allergic reaction after total cervical disc arthroplasty. A 52-year old woman was operated on for right C6 cervicobrachial neuralgia secondary to C5-C6 disc disease with foraminal stenosis. A cobalt-chromium-molybdenum total disc prosthesis had been implanted two years earlier. The patient was referred to our institution for recurrence of axial neck pain associated with abdominal patches of erythematous itching rash and swallowing disorder. Allergy tests confirmed type-4 allergic reaction to chromium. Symptoms decreased after removal of the prosthesis with secondary fusion. Delayed allergic reaction is uncommon in spine surgery, but should be considered in case of recurrence of initial symptomatology associated with non-spinal signs.
Collapse
Affiliation(s)
- M Lagier
- Unité de chirurgie du Rachis, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - M Briere
- Unité de chirurgie du Rachis, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - H Giorgi
- Unité de chirurgie du Rachis, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - S Fuentes
- Unité de chirurgie du Rachis, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - B Blondel
- Unité de chirurgie du Rachis, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
| | - P Tropiano
- Unité de chirurgie du Rachis, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| |
Collapse
|