Double level stand alone cage assisted fusion in cervical radiculopathy [preliminary report]

Interbody fusion following ACD [Anterior cervical discectomy] for treatment of cervical radiculopathy or cervical myelopathy is thought to have several advantages compared with discectomy alone. There is no consensus, however, regarding the optimum indications for cervical fusion. Double level interbody cervical fusion adds more concern regarding fusion rates, maintenance of lordosis and sagittal balance, and clinical outcome. The aim of this study was to assess clinically and radiologically the use of standalone double cervical cage in treatment of double level cervical radiculopathy. A prospective study enrolled 10 patients [6 males and 4 females] who were surgically treated for radiculopathy secondary to double level degenerative cervical disc disease. Radiographic and clinical outcome measures were analyzed prospectively. All patients underwent a standardized clinical, neurological and radiographic examination and completed outcome questionnaires [visual analogue scale for neck and arm pain, and modified Oswestery neck disability index] preoperatively and at each postoperative intervals [6 weeks, 3, 6, 12, and 24 months], with a mean follow up 18 months. X-ray films were reviewed and assessed at the treated levels, preoperatively, 6 weeks, 3, 6, 12, and 24 months postoperatively. After standard anterior discectomy and neural decompression, PEEK stand alone cages were inserted after packing with bone graft taken from iliac crest by special device. Decompression levels were C4/5 and C5/6 in 7 patients and C5/6 and C6/7 in 3 patients. Standard statistical methods were used to compare all outcome measures. Clinical results regarding neck and arm pain was markedly improved [VAS neck 3.4 to 0.8, VAS arm 8.1 to 0.4, both are statistically significant; p < 0.05. functional outcome was improved [NDI 20.4 to 2.8, statistically significant; p < 0.05]. Lordosis was maintained in 2 cases only, and fusion was achieved in all cases without symptomatic pseudarthrosis. The standalone double interbody cages assisted fusion achieves fusion rates similar to single level fusion, but it cannot maintain or correct cervical lordosis without plate supplementation

Thoracic outlet syndrome; anterior approach

Thoracic outlet syndrome comprises a wide spectrum of disorders with different compressive pathologies attributed to the neurovascular bundle passing from the root of the neck to supply the upper extremity. New concepts and advances in diagnosis and treatment are emerging. This study evaluates effectiveness and safety of the anterior supraclavicular approach in management of neurovascular compression at the thoracic outlet. Ten patients [7 females and 3 males] with age average 29 years [range from 21 to 37 years] underwent anterior neurovascular decompression procedures because of symptoms of lower plexus compression [C8-T1]. Preoperative plain radiography, MRI and nerve conduction velocity studies confirmed the clinical diagnosis. Nine patients had neck pain, all had sensory deficit and eight had motor deficit. After 12 months of follow-up, 7 patients showed excellent results, 2 cases had good results and one case had fair results according to the visual analogue scale, and nerve conduction velocities. The past 50 years have seen improved recognition and management of TOS, which is still a challenging problem. We recommend nerve conduction velocity studies beside clinical assessment for diagnosis and follow up, and anterior supraclavicular approach in neurogenic decompression which is relatively safe and effective