An Incidental Finding of a Radiopaque Pill following Cervical Spinal Surgery in a Parkinson's Disease Patient

Comparison between Anterior Cervical Decompression with Fusion and Posterior Cervical Fusion with Wide Facetectomy for Treatment of Severe Bony Foraminal Stenosis

Objective

To compare the anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF) with wide facetectomy in the treatment of parallel-shaped bony foraminal stenosis (FS).

Methods

Thirty-six patients underwent surgery due to one-or-two levels of parallel-shaped cervical FS. ACDF was performed in 16 patients, and PCF using CPS was performed in 20 patients. All patients were followed up at 1, 3, 6, and 12 months postoperatively. Standardized outcome measures such as Numeric rating scale (NRS) score for arm/neck pain and Neck disability index (NDI) were evaluated. Cervical radiographs were used to compare the C2–7 Cobb’s angle, segmental angle, and fusion rates.

Results

There was an improvement in NRS scores after both approaches for radicular arm pain (mean change -6.78 vs. -8.14, p=0.012), neck pain (mean change -1.67 vs. -4.36, p=0.038), and NDI score (-19.69 vs. -18.15, p=0.794). The segmental angle improvement was greater in the ACDF group than in the posterior group (9.4°±2.7° vs. 3.3°±5.1°, p=0.004). However, there was no significant difference in C2–7 Cobb angle between groups (16.2°±7.9° vs. 14.8°±8.5°, p=0.142). As a complication, dysphagia was observed in one case of the ACDF group.

Conclusion

In the treatment of parallel-shaped bony FS up to two surgical levels, segmental angle improvement was more favorable in patients who underwent ACDF. However, PCF with wide facetectomy using CPS should be considered as an alternative treatment option in cases where the anterior approach is burdensome.

Posterior Facetectomy with Fusion Using a Pedicle Screw for Parallel-shaped Cervical Foraminal Stenosis

Objective

To assess the efficacy and safety of posterior facetectomy with fusion using pedicle screw (PF using FPS) for severe cervical foraminal stenosis of parallel shape.

Methods

Patients (n=8) with 1- or 2-level parallel-shaped cervical foraminal stenosis who underwent posterior facetectomy with fusion using cervical pedicle screw between March 2012 and August 2016 were enrolled. Patients were followed up immediately postoperatively and at 1, 3, 6, and 12 months postoperatively. We assessed arm and neck pains and clinical outcomes using a numeric rating scale (NRS) and neck disability index (NDI). We determined cervical Cobb's and segmental angles by radiological evaluations. We identified screw breech as a neurovascular complication.

Results

Neck and arm pains were significantly reduced postoperatively (neck visual analog scale [VAS]: 4.9±3.7 [preoperative] to 0.4±1.1 [final follow-up]; arm VAS: 9.0±0.8 to 0.4±1.1). Cobb's angle for cervical sagittal alignment improved from 11.1±8.4 to 17.0±5.9. Segmental angle of index surgery was maintained (3.4±7.0–4.9±5.6). NDI was also remained from 36.1±26.3 to 13.8±8.4. There are no injuries to the vertebral arteries and neural tissues because of screw insertion.

Conclusion

PF using FPS is a practical treatment option for parallel-shaped cervical foraminal stenosis.

Minimally Invasive Cervical Pedicle Screw Placement With a Freehand Technique Through the Posterolateral Approach Using a Tubular Retractor: A Technical Note

BACKGROUND AND IMPORTANCE

Although many studies have demonstrated the biomechanical superiority of cervical pedicle screw (CPS) placement with sufficient safety and accuracy, it also has an inevitable major drawback in that an extensive posterior neck muscle dissection results in immediate postoperative neck pain. To avoid this disadvantage and highlight the several biomechanical advantages of CPS, we conducted the first minimally invasive surgery using both a tubular retractor through the posterolateral approach and a freehand placement technique.

CLINICAL PRESENTATION

A 77-yr-old man presented with quadriparesis and neck pain. The diagnosis was infectious discitis with ventral epidural abscess extending from C6 to T1. The surgery was performed in 2 steps. First, CPSs were inserted bilaterally in C6 and C7 with a freehand technique through the tubular retractor, and posterolateral fusion was performed with cancellous iliac bone chips after 2 rod connections. Second, C6–7 discectomy with partial upper bony resection of the C7 body was performed through an anterior approach. Anterior interbody fusion was performed with only iliac bone block, without plate fixation. The patient could sit without serious neck pain immediately postoperatively, and ambulation was possible the next day after surgery. Postoperative magnetic resonance images showed complete bilateral preservation of the semispinalis cervicis muscles. Six months after operation, dynamic radiographs showed stability and the visual analogue scale score for neck pain was 1 point.

CONCLUSION

We report on an advantageous minimally invasive approach combined with the freehand technique for the preservation of the posterior ligamentous complex and muscles during CPS placement.

Cervical Spondyloptosis Successfully Treated with Only Posterior Short Segment Fusion Using Cervical Pedicle Screw Fixation

This paper describes two patients with cervical spondyloptosis with severe spinal cord injury treated with cervical pedicle screw (CPS) through a single-stage operation, posterior approach. A 60-year-old male patient with quadriparesis due to trauma 1 day before visited the emergency room. Cervical spine computed tomography (CT) and magnetic resonance imaging showed complete dislocation of the C7 and T1 vertebrae with severe spinal cord compression, disc injury, and disc herniation at the C7–T1 level. Cervical pedicle screw with freehand technique was done on C6 and T1 vertebrae, and bilateral distraction for a reduction was performed with a screw distractor. After reduction of the C7 vertebra on the surgical field, CPS placement on C7 body was done. After surgery, follow-up X-rays showed near complete reduction. The patient completed a rehabilitation program, and his condition improved. From the third month postoperatively, the patient could ambulate without assistance and perform nearly normal daily activities. A postoperative CT scan 1 year later showed accurate screw position and complete fusion bridges on the C6–C7–T1 vertebrae. The other patient, a 39-year-old male, also showed C7–T1 spondyloptosis with quadriparesis (grade IV). C6–T1–T2 fusion surgery was performed only through a posterior approach. The patient showed nearly normal neurology and reduction. Considering early surgery time followed by open reduction and biomechanical superiority of CPS, single posterior approach and short segment fusion appear to be a great surgical method.