A review of patients with dysphagia after anterior cervical discectomy and fusion / 中国实用护理杂志

Anterior cervical discectomy and fusion is one of the classic procedures for the treatment of cervical spondylosis, and dysphagia is a common perioperative complication of this procedure, which affects patients′ recovery to different degrees. This paper summarizes and analyzes the perioperative assessment and interventions in the care of patients with dysphagia after anterior cervical discectomy and fusion, aiming to improve clinical nursing staff′s attention to dysphagia in patients after anterior cervical discectomy and fusion, and provide scientific basis for the prevention and treatment of high-risk groups.

Biomechanical Study on Contiguous Three-Level Cervical Hybrid Surgery and Anterior Cervical Discectomy and Fusion / 医用生物力学

Objective To compare the biomechanical effects of contiguous three-level cervical Hybrid surgery[anterior cervical discectomy and fusion (ACDF) + cervical disc arthroplasty ( CDA)] and three-level ACDF. Methods The finite element model of C1-T1 cervical-thoracic spine was developed based on CT data. Three models were simulated by the implantation of Prestige LP and Zero-P prostheses, including two Hybrid models (AFA, Prestige LP implanted at C3-4 and C5-6 segments and Zero-P implanted at C4-5 segment; FAF, Zero-P implanted at C3-4 and C5-6 segments and Prestige LP implanted at C4-5 segment) and three-level ACDF model(FFF). The changes in range of motion (ROM) of adjacent levels during flexion, extension, lateral bending and axial rotation, the overall ROM, as well as the intradiscal pressure ( IDP) and facet contact force ( FCF) of adjacent levels were compared. Results The ROM in adjacent levels and the overall ROM of the AFA modelwere closer to the intact model, and the maximum increases in the ROM of the adjacent levels for the FAF and FFF models were 15. 0% and 23. 4% , respectively. For AFA, FAF and FFF models, the maximum increases in the maximum IDP of adjacent levels were 19. 0% , 66. 7% , 147. 6% , and the maximum increases in FCF were 17. 4% , 55. 7% , 80. 1% , respectively. Conclusions This study provides biomechanical basis for three-level cervical Hybrid surgery in treating patients with the contiguous three-level cervical degenerative disc disease.

Comparative analysis of clinical efficacy between posterior percutaneous endoscopic discectomy and anterior cervical discectomy and fusion in the treatment of cervical spondylotic radiculopathy / 中国骨伤

OBJECTIVE@#To explore the clinical efficacy of posterior percutaneous endoscopic discectomy(PPECD) in the treatment of cervical spondylotic radiculopathy.@*METHODS@#A total of 56 patiens with single segment cervical spondylotic radiculopathy from December 2017 to October 2020, were randomly divided into observation group and control group. In observation group, there were 16 males and 11 females, including 8 cases of C4,5, 13 cases of C5,6 and 6 cases of C6,7 performed posterior percutaneous endoscopic discectomy, aged from 34 to 61 years old with an average of (51.15±6.29) years old. In control group, there were 19 males and 10 females with single segment cervical spondylotic radiculopathy including 10 cases of C4,5, 14 cases of C5,6 and 5 cases of C6,7 performed anterior cervical discectomy and fusion, aged from 40 to 65 years old with an average of (53.24±5.31) years old. The operative time, intraoperative blood loss, postoperative time of lying in bed and length of postoperative hospital stay were recorded. Visual analogue scale(VAS) and neck disability index(NDI) were used to evaluate the clinical efficacy. Cervical plain films or MRIs, CTs were taken for re-visiting patients.@*RESULTS@#All patients were followed up more than 2 years. The observation group patients were followed up, the duration ranged from 24 to 42 months with an average of (30.48±4.91) months. The control group patients were followed up, the duration ranged from 25 to 47 months, with an average of (32.76±4.53) months. Compared with control group, operative time, intraoperative blood loss, postoperative time of lying in bed and length of postoperative hospital stay were decreased(P<0.05). Compared with pre-operation, VAS of neck and upper limb and NDI at the latest follow-up between two groups were significantly improved(P<0.05). Compared with control group, VAS of neck and upper limb at 1 day after operation in observation group were significantly reduced(P<0.05). There was no significant difference in VAS of neck and upper limb and NID at 1, 3 months and the latest follow-up after operation between two groups(P>0.05). In the observation group, one patient's deltoid muscle strength was weakened to grade 4 after operation, and returned to normal after 12 weeks of conservative treatment. In control group, there was 1 case of postoperative adjacent spondylosis with symptoms of spinal compression after 2 years operation, then underwent cervical artificial intervertebral disc replacement. And there was 1 case of dysphagia after operation in control group and improved after 1 year. There was no significant difference in incidence of complications between two groups.@*CONCLUSION@#PPECD has advantages of shortening operative time, decreasing intraoperative blood loss, reducing postoperative time of lying in bed and length of postoperative hospital stay. However, applicable age range of patients and long-term clinical efficacy needs further study.

Analysis of the effect and influencing factors of different surgical methods in the treatment of multi-level cervical spondylotic myelopathy / 中国综合临床

Objective:To explore the use of anterior cervical corpectomy and fusion (ACCF) combined with anterior cervical discectomy and fusion (ACDF) in patients with multilevel cervical spondylopathy myelopathy (CSM).Methods:The clinical data of 83 patients with multi-segment CSM admitted to the Department of Spinal Surgery of Hubei Liuqi2 Orthopaedic Hospital of Integrated Traditional Chinese and Western Medicine from January 2018 to January 2021 were retrospectively analyzed. According to the different surgical methods used in their treatment, they were divided into group A and group B. In group A, 44 patients were treated with anterior cervical ACCF combined with ACDF, and 39 patients in group B were treated with posterior single-door laminoplasty. The general clinical indexes such as operation time, perioperative bleeding volume and hospitalization time were collected.The neurological function and cervical dysfunction improvement effect of the patients before and 6 months after operation were evaluated by using the Japanese Orthopaedic Association (JOA) score and neck disability index (NDI) scale. The cervical curvature of the patients before and 6 months after operation was compared, The complications of the two groups were observed 6 months after operation. The patients were divided into improved group (72 cases) and non improved group (11 cases). Comparison between count data groups χ 2 inspection. Independent sample t-test was used for comparison between measurement data groups conforming to normal distribution. According to the results of univariate analysis, the meaningful factors were included in the binary Logistic regression to analyze the influencing factors related to the surgical efficacy. Result:The perioperative blood loss ((153.36±10.68) mL) and hospital stay ((10.11±2.30) d) in group A were lower than those in group B ((171.47±11.32) mL, (15.58±3.76) d). There were significant differences between the two groups ( t values were 7.50 and 8.10; both P<0.001). Six months after operation, the JOA score (13.70±1.49, 12.94±1.63) and cervical curvature (22.10±3.23, 13.38±3.12) of patients in groups A and B were all higher than those before operation (9.40±1.32, 9.36±1.51; 11.16±2.60, 11.23±2.71), and group A was higher than group B, the difference was statistically significant (JOA scores before and after operation: t values were 14.33 and 10.07, respectively; cervical curvature: t values were 17.50 and 3.25, respectively; t values between groups were 2.22 and 12.47, respectively, and the P values were <0.001, <0.001, <0.001, 0.002, 0.029 and <0.001, respectively). Six months after the operation, the NDI indexes of groups A and B (11.38±4.76, 14.79±4.85) were lower than those before the operation (39.56±9.43, 39.74±9.51), and those in group A were lower than in group B, and the difference was statistically significant ( t values were 17.70, 14.60, and 3.23; all P<0.001). Binary Logistic regression showed that the duration of disease ≥6 months ( OR=59.045, 95% CI: 6.485-537.629), the presence of cervical spinal cord MRI signal changes ( OR=0.031, 95% CI: 0.002-0.587), the surgical approach (posterior approach single-door laminoplasty) ( OR=6.300, 95% CI: 1.269-31.273) was an independent risk factor affecting the surgical outcome ( P values were <0.001, 0.021, and 0.024, respectively). Conclusion:Anterior cervical ACCF combined with ACDF has an ideal surgical effect in the treatment of patients with multi-segment CSM, which can significantly improve the cervical spinal nerve function and cervical curvature, shorten the operation time and reduce the perioperative blood loss. It isstill necessary to pay attention to the patient's disease course, MRI signals changes of cervical spinal cord and the effect of surgical methods on their surgical outcomes.

Effect of zero-profile and self-locking intervertebral cage and plate-cage construct on maintenance of cervical curvature after anterior cervical surgery / 中国修复重建外科杂志

Objective: To compare differences in the maintenance of cervical curvature after anterior cervical surgery between zero-profile and self-locking intervertebral cage and plate-cage construct (PCC). Methods: A clinical data of 100 patients with single-segment cervical disc herniation who were treated with anterior cervical discectomy and fusion were retrospectively analyzed between January 2015 and January 2016. Among them, 50 patients were treated with the zero-profile and self-locking intervertebral cage (group A) and 50 patients with the PCC (group B). There was no significant difference between the two groups in age, gender, bone mineral density, disease duration, operative segment, and preoperative visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, C 2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height ( P>0.05). The operation time and intraoperative blood loss were recorded. The postoperative VAS and JOA scores were used to evaluate the clinical efficacy. The C 2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height were measured on lateral X-ray films, and the interbody fusion was evaluated according to Pitzen's criteria. Results: The operation time in group A was significantly shorter than that in group B ( t=2.442, P=0.021), but there was no significant difference in the intraoperative blood loss between the two groups ( t=0.812, P=0.403). All patients were followed up 24-36 months, with an average of 28.5 months. According to Pitzen's criteria for cervical interbody fusion, bone fusion achieved in both groups. The VAS score, JOA score, C 2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height of the two groups at 1 and 24 months after operation were significantly improved when compared with those before operation ( P0.05). There were significant differences in C 2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height between the two groups at 24 months after operation ( P0.05). Conclusion: Compared with the PCC, the zero-profile and self-locking intervertebral cage can significantly shorten the operation time and obtain the same clinical efficacy, but the intervertebral height loss and secondary cervical curvature change after operation is more serious.

To investigate the efficacy of cervical external fixation after cervical single-segment anterior fusion / 中国实用护理杂志

Objective This study was to investigate the necessity of wearing a cervical collar after single-segment anterior cervical discectomy and decompression. Methods The experimental methods were used to group the two wards in the same department. There were 54 patients in the experimental group and 48 patients in the control group. The patients in the experimental group did not wear the cervical collar during the postoperative outpatient activities and after discharge. The control group patients wore the cervical collar within 3 months after walking and after discharge. The cervical dysfunction index of the two groups before surgery and 3 months after surgery was compared between the two groups; also vertebral fusion at 6 months postoperatively; and SF-36 (Quality of Life Assessment Scale) scores before surgery and 3 months after surgery. Results The NDI of the experimental group was significantly lower than that of the preoperative NDI (20.62%±1.94% vs 26.06%±2.17%) (t=18.32, P<0.01). The NDI of the control group was 3 months after operation compared with the preoperative NDI (21.30 ±% 1.87% vs26.26%±2.74%) also had a significant decrease (t=16.67, P<0.01). The NDI of the experimental group was significantly lower than that of the preoperative NDI (14.97%±1.85%vs26.06%±2.17%) (t=31.93, P<0.01), the NDI of the control group was significantly lower than that of the preoperative NDI (15.98% ± 1.49%vs26.26%±2.74%) at 6 months after operation (t=24.45, P<0.01). The difference was statistically significant. The SF-36 score in the last 3 months was higher than that in the control group (53.37±9.23 vs 45.77±8.07), and the difference was statistically significant (t=4.40, P<0.01). Conclusions Compared with the external fixation without neck and neck, the treatment of cervical external fixation does not affect the postoperative treatment effect, and can improve the quality of life of patients.

The efficacy of microscope-assisted anterior cervical discectomy and fusion with cervical spondylosis for 37 cases / 中华显微外科杂志

Objective To explore the efficacy and safety of anterior cervical discectomy and fusion assisted with microscope.Methods Thirty-seven patients with cervical spondylosis were included to be retrospectively ana lyzed,including 21 males and 16 females.All these patients had accepted anterior cervical discectomy and fusion (ACDF) assisted with microscope from October,2015 to February,2018,and they were aged from 22 to 77 years old (51.5±6.2 years on the average).In these patients,30 cases were operated on single segment,6 cases were operated on double segments,and 1 case was operated on 3 segments.Among all the patients,15 patients of which (40.54％) had cervical spondylotic myelopathy and 22 patients of which (59.46％) sufferered from cervical spondylotic radicu lopathy.All the operations were performed with a conventional transverse anterior cervical incisions,an intervertebral distractor was placed.The decompression was completed under the microscope,and the fixation was performed under direct vision.Moreover,the operative time,intraoperative blood loss and surgery-related complications were recorded.Follow-up was carried out at different times,including 7 days,1 month,3 months,6 months and every year after operation.Japanese Orthopaedic Association (JOA) score was used to calculate the rate of improvement in neurological function,which can evaluate the clinical efficacy.And cervical dysfunction index (NDI) was used to assess cervical function.Results All patients in this group underwent successful decompression under the microscope.The operation time was 90-160 min,with an average of (110.67±36.42) min;The intraoperative blood loss was 20-110 ml,with an average of (36.00±29.11) ml.All patients were followed-up for 12-31 months,with an average of (15.2±4.7) months.The JOA score improved from 8.37±3.26 preoperatively to 15.96 ± 1.50 at the last follow-up,and its difference had signifi cance in statistics (t=8.592,P=0.000).Neurological function improvement rate could be graded:excellent in 31 cases and good in 6 cases,the excellent and good rate was 100％;NDI was reduced from 19.01 ± 6.47 preoperatively to 5.81 ± 2.58 at the last follow-up,with statistical significant difference (t=5.127,P=0.000).During the follow-up,1 screw was found loosened and slightly withdrawn in 1 female patient at 3 months after operation,of whom had not obvious discomfort.The patient was continuously observed and there was no screw withdrawal again.Moreover,there were no complications such as cerebrospinal fluid leakage,hoarseness and difficulty in swallowing.Conclusion Microscope-assisted ACDF can provide safe and adequate decompression without significantly extending the operation time,which is satisfactory in clinical results.Even in some cases of 1 or 2 segments of intervertebral disc nucleus prolapse,it is possible to avoid a more traumatic ACDF.And it is worthy of clinical promotion.

Stand-Alone Cervical Cages in 2-Level Anterior Interbody Fusion in Cervical Spondylotic Myelopathy: Results from a Minimum 2-Year Follow-up

STUDY DESIGN: A retrospective review of patients who underwent 2-level anterior cervical discectomy and fusion (ACDF) with standalone polyetheretherketone (PEEK) cages for cervical spondylotic myelopathy (CSM). PURPOSE: To evaluate the efficacy of stand-alone PEEK cage in 2-level cervical interbody fusion for CSM. OVERVIEW OF LITERATURE: ACDF is a standard surgical procedure to treat degenerative disc disease. However, the use of additional anterior plating for 2-level ACDF remains controversial. METHODS: We reviewed outcomes of patients who underwent 2-level ACDF with stand-alone PEEK cages for CSM over a 7-year period (2007–2015) in a regional hospital. Japanese Orthopaedic Association (JOA) score, fusion rate, subsidence rate, cage migration, and cervical alignment by the C2–7 angle as well as the local segmental angle (LSA) of the cervical spine were assessed. RESULTS: In total, 31 patients (mean age, 59 years; range, 36–87 years) underwent 2-level ACDF with a cage-only construct procedure between 2007 and 2015. The minimum follow-up was 24 months; mean follow-up was 51 months. C3–5 fusion was performed in 45%, C4–6 fusion in 32%, and C5–7 fusion in 23%. Mean JOA score improved from 10.1±2.2 to 13.9±2.1 (p<0.01) at the 24-month follow-up. Fusion was achieved in all patients. Subsidence occurred in 22.5% of the cages but was not associated with differences in JOA scores, age, sex, or levels fused. Lordosis of the C2–7 angle and LSA increased after surgery, which were maintained for up to 1 year but subsequently disappeared after 2 years, yet the difference was not statistically significant. No cage migration was noted; two patients developed adjacent segment disease requiring posterior laminoplasty 3 years after ACDF. CONCLUSIONS: The use of a stand-alone PEEK cage in a 2-level cervical interbody fusion achieves satisfactory improvements in both clinical outcomes and fusion.

Comparison of Cortical Ring Allograft and Plate Fixation with Autologous Iliac Bone Graft for Anterior Cervical Discectomy and Fusion

STUDY DESIGN: A retrospective cohort study. PURPOSE: To compare the clinical and radiological outcomes of patients who underwent anterior cervical discectomy and fusion (ACDF) supplemented with plate fixation using allograft with those who underwent ACDF using tricortical iliac autograft. OVERVIEW OF LITERATURE: As plate fixation is becoming popular, it is reported that ACDF using allograft may have similar outcomes compared with ACDF using autograft. METHODS: Forty-one patients who underwent ACDF supplemented with plate fixation were included in this study. We evaluated 24 patients who used cortical ring allograft filled with demineralized bone matrix (DBM) (group A) and 17 patients who used tricortical iliac autograft (group B). In radiological evaluations, fusion rate, subsidence of grafted material, cervical lordosis, fused segmental lordosis, and radiological adjacent segment degeneration (ASD) were observed and analyzed with preoperative and postoperative plain radiographs. Clinical outcomes were evaluated using the Neck Disability Index score, Odom criteria, and Visual Analog Scale score of neck and upper extremity pain. Radiological union was determined by dynamic radiographs using cutoff values of 1 mm of interspinous motion as the indication of pseudarthrosis. RESULTS: There was no significant difference in the fusion rate, graft subsidence, cervical lordosis, fused segmental lordosis, and ASD incidence between the groups. Operative time was shorter in group A (136 min) than in group B (141 min), but it was not significant (p>0.05). Blood loss was greater in group B (325 mL) than in group A (210 mL, p=0.013). There was no difference in the clinical outcomes before and after surgery. CONCLUSIONS: In ACDF with plate fixation, cortical ring allograft filled with DBM group showed similar radiological and clinical outcomes compared with those of the autograft group. If the metal plate is reinforced, using cortical ring allograft could be a viable alternative to autograft.

Brown-Séquard Syndrome Caused by Acute Traumatic Cervical Disc Herniation / 대한신경손상학회지

Brown-Séquard syndrome (BSS) is an incomplete spinal cord injury caused by damage to one-half of the spinal cord. Most cases of BSS result from penetrating trauma or tumors, and acute cervical disc herniation is a relatively rare cause of BSS. In this case, a 34-year-old man with a sudden onset posterior neck pain and left side motor weakness was admitted to the local spine hospital. Pain and temperature sensation of pain was decreased below the right C4 dermatome. The left arm and leg motor grade was 0. Magnetic resonance imaging (MRI) showed a huge trans-ligamentous herniated disc rupture from the center to the left at the level of C3–4, and anterior cervical discectomy and fusion were performed. After emergency surgery, left arm and leg motor grade recovered to 2, and normal voiding function returned. MRI verified complete removal of the cervical herniated disc. This case describes the approach to rapid diagnosis in a patient with characteristic clinical symptoms of BSS and radiological findings of a herniated cervical disc. Rapid and accurate diagnosis and immediate decompressive surgery increased the possibility of a good surgical outcome, even if the neurologic deficits are grave at the time of admission.

To investigate the efficacy of cervical external fixation after cervical single-segment anterior fusion / 中国实用护理杂志

Objective@#This study was to investigate the necessity of wearing a cervical collar after single-segment anterior cervical discectomy and decompression.@*Methods@#The experimental methods were used to group the two wards in the same department. There were 54 patients in the experimental group and 48 patients in the control group. The patients in the experimental group did not wear the cervical collar during the postoperative outpatient activities and after discharge. The control group patients wore the cervical collar within 3 months after walking and after discharge. The cervical dysfunction index of the two groups before surgery and 3 months after surgery was compared between the two groups; also vertebral fusion at 6 months postoperatively; and SF-36 (Quality of Life Assessment Scale) scores before surgery and 3 months after surgery.@*Results@#The NDI of the experimental group was significantly lower than that of the preoperative NDI (20.62%±1.94% vs 26.06%±2.17%) (t=18.32, P<0.01). The NDI of the control group was 3 months after operation compared with the preoperative NDI (21.30±%1.87% vs26.26%±2.74%) also had a significant decrease (t=16.67, P<0.01). The NDI of the experimental group was significantly lower than that of the preoperative NDI (14.97%±1.85%vs26.06%±2.17%) (t=31.93, P<0.01), the NDI of the control group was significantly lower than that of the preoperative NDI (15.98%±1.49% vs26.26%±2.74%) at 6 months after operation (t=24.45, P<0.01). The difference was statistically significant. The SF-36 score in the last 3 months was higher than that in the control group (53.37±9.23 vs 45.77±8.07), and the difference was statistically significant (t=4.40, P<0.01).@*Conclusions@#Compared with the external fixation without neck and neck, the treatment of cervical external fixation does not affect the postoperative treatment effect, and can improve the quality of life of patients.

Effect of anterior cervical discectomy and decompression with different fusion segments on sagittal spine-pelvis balance / 中国修复重建外科杂志

Objective: To explore the effect on sagittal spine-pelvis balance of different fusion segments in anterior cervical discectomy and fusion (ACDF). Methods: The clinical data of 326 patients with cervical spondylotic myelopathy, treated by ACDF between January 2010 and December 2016, was retrospectively analysed. There were 175 males and 151 females with an average age of 56 years (range, 34-81 years). Fusion segments included single segment in 69 cases, double segments in 85 cases, three segments in 90 cases, and four segments in 82 cases. Full spine anterolateral X-ray films were performed before operationand at 12 months after operation. The spine-pelvis parameters of fusion segments were measured and compared. The parameters included C 0-2 Cobb angle, C 2-7 Cobb angle, C 2-7 sagittal vertical axis (C 2-7 SVA), T 1 slope (T 1S), thoracic inlet angle (TIA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), C 7 sagittal vertical axis (C 7 SVA), T 1 pelvic angle (TPA). The Japanese Orthopaedic Association (JOA) score of cervical spine and visual analogue scale (VAS) scores of pain of cervical spine and upper extremity were compared before operation and at 12 months after operation. Pearson correlation analysis was performed on LL, PI, SS, C 7 SVA, and TPA before and after operation to evaluate the changes of spine-pelvis fitting relationship after ACDF. Results: All 326 patients were followed up 12-32 months (mean, 18.5 months). During the follow-up period, internal fixator was in place, and no spinal cord nerve or peripheral soft tissue injury was found. JOA scores and cervical VAS scores improved significantly at 12 months after operation ( P0.05). The preoperative cervical VAS scores and the postoperative JOA scores at 12 months had significant differences between groups ( P0.05); but the C 0-2 Cobb angle, C 2-7 Cobb angle, C 2-7 SVA, T 1S, TIA, C 7 SVA, and TPA in the double segments, three segments, and four segments groups were significant larger than preoperative ones ( P<0.05). The C 0-2 Cobb angle, C 2-7 Cobb angle, T 1S, C 7 SVA, and TPA among 4 groups had significant differences before operation and at 12 months after operation ( P<0.05). At 12 months after operation, the changes of C 7 SVA and TPA in the double segments, three segments, and four segments groups were significantly larger than those in the single segment group ( P<0.05). PI had positive correlations with LL and SS before and after operation in 4 groups ( P<0.05). Conclusion: Normal fitting relationship between lumbar spine and pelvis in physiological state also exists in patients with cervical spondylotic myelopathy, and ACDF can not change this specific relationship. In patients with cervical spondylotic myelopathy, the sagittal spine-pelvis sequence do not change after ACDF single-level fusion, while the sagittal spine-pelvis balance change after double-level and multi-level fusion.

Dysphagia Incidence after Outpatient Anterior Cervical Surgery Using Instrumentation versus No Instrumentation / Incidencia de la disfagia tras la cirugía cervical anterior ambulatoria con instrumentación y sin instrumentación

ABSTRACT Objective: Dysphagia is a relatively common occurrence in the postoperative period following anterior cervical surgery, with some indicating rates as high as 79%. In most cases, it remains only a transient phenomenon. The cause has been debated, with most speculating injury to nerves in the swallowing mechanism. The objective of this study was to determine if the presence of instrumentation during anterior cervical surgery in the outpatient setting would affect the incidence, duration and severity of dysphagia. Methods: We did a retrospective review of the medical records of 50 consecutive patients who had undergone single-level instrumented anterior cervical discectomy and fusion. Then we compared that group with our control group of 50 patients who had had simple single-level anterior cervical discectomy without instrumentation or fusion. The patients were evaluated for the presence of dysphagia as well as neck disability index outcome scores. Results: There was no significant difference between the groups in postoperative neck disability index outcomes at the two-year follow-up (p = 0.182). Dysphagia occurred only in the instrumented group, with an incidence of 12% (six patients): their symptoms lasted on average three weeks, and all six patients experienced only mild severity on the Bazaz-Yoo scale. There was statistically significant difference between the two groups (p = 0.012). Conclusion: There was a greater trend towards postoperative dysphagia in cases with instrumentation (12% of the patients). Dysphagia was transient with mild severity in patients who received instrumentation compared with those who underwent discectomy alone.

RESUMEN Objetivo: La disfagia es una ocurrencia relativamente común en el período postoperatorio después de la cirugía cervical anterior, con algunas tasas indicadoras tan altas como 79%. En la mayoría de los casos, sigue siendo sólo un fenómeno transitorio. Su causa ha sido discutida, atribuyéndose principalmente a una lesión en los nervios del mecanismo de deglución. El objetivo de este estudio fue determinar si la presencia de la instrumentación durante la cirugía cervical anterior en el contexto ambulatorio afectaría la incidencia, duración y severidad de la disfagia. Métodos: Realizamos una revisión retrospectiva de las historias clínicas de 50 pacientes consecutivos que habían tenido discectomía y fusión cervical anterior con instrumentación a un solo nivel. Entonces comparamos ese grupo con nuestro grupo de control de 50 pacientes a quienes se les había practicado una discectomía cervical anterior a un solo nivel simple sin instrumentación o fusión. Los pacientes fueron evaluados con respecto a la presencia de disfagia, así como en relación con las puntuaciones del resultado del índice de la discapacidad cervical. Resultados: No hubo diferencias significativas entre los grupos en cuanto a los resultados del índice de discapacidad cervical postoperatorio en el seguimiento de dos años (p = 0.182). La disfagia se produjo sólo en los grupos con instrumentación, con una incidencia de 12% (seis pacientes): sus síntomas duraron un promedio de tres semanas, y los seis pacientes experimentaron toda una severidad leve en la escala de Bazaz-Yoo. Hubo una diferencia estadísticamente significativa entre los dos grupos (p = 0.012). Conclusión: Hubo una mayor tendencia a la disfagia postoperatoria en los casos con instrumentación (12% de los pacientes). La disfagia fue transitoria con severidad leve en los pacientes que recibieron instrumentación, comparada con la de los que experimentaron discectomía solamente.

Application of distraction before discectomy in anterior cervical surgery / 吉林大学学报(医学版)

Objective:To observe the effect of distraction before discectomy (DBD) in the distraction of the height of anterior cervical space,and to explore its feasibility in restricting the over distraction.Methods:A total of 31 patients with cervical spondylotic myelopathy were treated with anterior cervical discectomy and fusion (ACDF).During surgery,the intervertebral space was distracted before discectomy,the procedure was defined as DBD technique.Before surgery,the distance from the arch top of inferior endplate of upper vertebrae of the index level to the midpoint of superior endplate of lower vertebrae was measured (H0).The same method was used to measure the adjacent proximal and distal intervertebral space heights (Hp and Hd),and the mean value of Hp and Hd,H,was regarded as a referential height that the index intervertebral space should be restored.During operation,the intervertebral space heights before (H1) and after (H2) discectomy with application of DBD were measured withthe aforementioned method.The pre-and post-operation index segment heights AB and A'B'were measured respectively.The change of index segment height was defined as △H (A'B'-AB),the index intervertebral space height after operation was defined as Hs (H0 +△H).The patients were divided into neck pain group and non-neck pain group according to their post-operative neck pain VAS scores.The radiographic data of the patients in two groups was analyzed and compared with statistical methods.Results:The post-operative neck pain incidence rate was 19.35％.During operation,after DBD,the intervertebral space height change △H1 was (1.19±0.51) mm.In non-neck pain group,the difference between H1 (6.95 mm±0.84 mm) and H (6.98 mm±0.70 mm) was not significant (P=0.80),and the difference between H2 (7.31 mm±0.90 mm) and H1 (6.95 mm± 0.84 mm) was significant (P＜0.01).In neck pain group,the difference between H2 (8.33 mm± 1.39 mm) and H1 (7.87 mm±1.35 mm) was significant (P＜0.01).In neck pain group,the △H was (3.04±0.42) mm;in non-neck pain group,the △H was (1.70±0.51) mm;the difference between two groups was significant (P＜0.01).In nonneck pain group,H1,H2 and H3 had good consistency with H.Conclusion:DBD can effectively control the distraction height of the index intervertebral space within 2 mm,also convenient to let the index intervertebral space be similar with the adjacent segment and easy to follow.

Outcomes of Anterior Cervical Fusion Using Polyetheretherketone Cage with Demineralized Bone Matrix and Plate for Management of Subaxial Cervical Spine Injuries / 대한신경손상학회지

OBJECTIVE: We evaluated the usefulness of a polyetheretherketone (PEEK) cage filled with demineralized bone matrix (DBM) and plate fixation in anterior interbody fusions for subaxial cervical spine injuries. METHODS: A retrospective review of 98 patients (58 women, 40 men; mean age, 49.7 years; range, 17–78 years) who underwent single-level anterior cervical discectomy and fusion (ACDF) using a PEEK cage filled with DBM and plate fixation for subaxial cervical spine injuries from March 2005 to June 2018 was conducted. Bone fusion, interbody height (IBH), segmental lordosis, and adjacent segment degeneration (ASD) development were assessed with plain radiographs and computed tomography. Clinical outcomes were assessed using a visual analog scale (VAS) for pain and the Frankel grade for neurologic function. RESULTS: The mean follow-up period was 27.6 months (range, 6–142 months). Twenty-one patients (21.4%) had an improvement of at least one Frankel grade. The mean preoperative and final follow-up neck pain VAS scores were 8.3±0.9 and 2.6±1.5 (p < 0.05). All patients showed solid fusion at the final follow-up. The mean preoperative and final Cobb's angles were −3.7±7.9° and 1.9±5.1° (p < 0.05). The mean preoperative and final IBHs were 36.9±1.7 mm and 38.2±1.8 mm (p < 0.05). Five patients (5%) showed ASD. CONCLUSION: ACDF using a PEEK cage filled with DBM and plate fixation yielded high fusion rates and satisfactory clinical outcomes without donor-site morbidity. This procedure is safe and effective for single-level subaxial cervical spine injuries.

Comparison of clinical effects between anterior cervical discectomy combined with corpectomy and cervical posterior single open-door laminoplasty in treating three-segment cervical spondylotic myelopathy / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical effects between anterior cervical discectomy and fusion(ACDF) combined with anterior cervical corpectomy and fusion(ACCF) and cervical posterior single open-door laminoplasty with mini-titanium plate fixation in treating three-segment cervical spondylotic myelopathy.</p><p><b>METHODS</b>The clinical data of 63 patients (39 males and 24 females) with three-segment cervical spondylotic myelopathy underwent surgical treatment from March 2014 to March 2016 were retrospectively analyzed. Among them, 43 cases were treated by ACDF combined with ACCF(anterior group), and 20 cases were treated by cervical posterior single open-door laminoplasty with mini-titanium plate fixation(posterior group). Operative time, intraoperative blood loss, postoperative complications were compared between two groups. And according to JOA score to evaluate the clinical effect.</p><p><b>RESULTS</b>All the patients were follow-up from 16 to 40 months with an average of 25.8 months. Operative time of anterior group and posterior group were (123.70±6.21) min and(118.70±5.41) min, respectively, there was no significant difference between two groups(>0.05). Intraoperative blood loss of anterior group and posterior group were (85.23±7.51) ml and (107.18±9.41) ml, respectively, there was significant difference between two groups(<0.05). In anterior group, axial symptoms occurred in 6 cases, dysphagia in 1 case, and no C₅ nerve root palsy, hoarseness and choking cough were found, the incidence rate of complication was 16.3%(7/43); and in posterior group, axial symptoms occurred in 5 cases, C5 nerve root palsy in 1 case, and no dysphagia, hoarseness and choking cough were found, the incidence rate of complication was 30.0%(6/20); there was significant defference in incidence rate of complication between two group(<0.05). At 1 week after operation and final follow-up, the JOA scores of anterior group were obviously better than that of posterior group(<0.05).</p><p><b>CONCLUSIONS</b>Above-mintioned two surgical treatment for cervical spondylotic myelopathy can provide instantly stability, the method of ACDF combined with ACCF was obviously better that of the method of cervical posterior single open-door laminoplasty in intraoperative blood loss, the incidence rate of complications, clinical effect.Thus, for the treatment of three-segment cervical spondylotic myelopathy, the method of ACDF combined with ACCF would be firstly chosen.</p>

Application of distraction before discectomy in anterior cervical surgery / 吉林大学学报(医学版)

Objective: To observe the effect of distraction before discectomy (DBD) in the distraction of the height of anterior cervical space, and to explore its feasibility in restricting the over distraction. Methods: A total of 31 patients with cervical spondylotic myelopathy were treated with anterior cervical discectomy and fusion (ACDF). During surgery, the intervertebral space was distracted before discectomy, the procedure was defined as DBD technique. Before surgery, the distance from the arch top of inferior endplate of upper vertebrae of the index level to the midpoint of superior endplate of lower vertebrae was measured (Ho). The same method was used to measure the adjacent proximal and distal intervertebral space heights (Hp and Hj), and the mean value of Hp and H,i, H, was regarded as a referential height that the index intervertebral space should be restored. During operation, the intervertebral space heights before (H1) and after (H2) discectomy with application of DBD were measured with the aforementioned method. The pre- and post-operation index segment heights AB and A' B' were measured respectively. The change of index segment height was defined as δH (A' B'-AB), the index intervertebral space height after operation was defined as H3 (H0+δH). The patients were divided into neck pain group and non-neck pain group according to their post-operative neck pain VAS scores. The radiographic data of the patients in two groups was analyzed and compared with statistical methods. Results: The post-operative neck pain incidence rate was 19. 35%. During operation, after DBD, the intervertebral space height change δH1 was (1. 19 ± 0. 51) mm. In non-neck pain group, the difference between H1 (6. 95 mm ± 0. 84 mm) and H (6. 98 mm ±0. 70 mm) was not significant (P=0. 80), and the difference between H2 (7. 31 mm ±0. 90 mm) and H1 (6. 95 mm ±0. 84 mm) was significant (P<0. 01). In neck pain group, the difference between H2 (8. 33 mm ±l. 39 mm) and H1 (7. 87 mm ± 1.35 mm) was significant (P<0.01). In neck pain group, the δH was (3.04 ± 0.42) mm; in non-neck pain group, the δH was (1. 70 ± 0. 51) mm; the difference between two groups was significant (P<0. 01). In nonneck pain group, H1, H2 and Ha had good consistency with H. Conclusion: DBD can effectively control the distraction height of the index intervertebral space within 2 mm, also convenient to let the index intervertebral space be similar with the adjacent segment and easy to follow.

Short-and medium-term clinical outcomes of Hybrid surgery for treatment of multi-level cervical spondylosis / 军事医学

Objective To evaluate the clinical efficacy of Hybrid surgery for treatment of multi-level cervical spondylosis.Methods A total of 49 patients (26 males, 23 females) with cervical spondylosis treated with Hybrid surgery between June 2012 and April 2014 were retrospectively reviewed.There were 5 cases with cervical spondylitis radiculopathy (n=5), 10 cases with cervical spondylitis myelopathy (n=10) and 34 cases with mixed cervical spondylitis (n=34).Among the 49 patients, 10 underwent two-segment surgery (n=10) and 39 underwent three-segment surgery (n=39).The mean age of patients was 53.4 years (range from 43 to 62 years).Visual analogue scale (VAS), neck disability index (NDI) and Japanese Orthopedics Association Scores (JOA) were used to evaluate the clinical outcomes.Cervical radiography was used to observe the range of motions (ROM) in C2-C7 segments.Results Mean follow-up time was(42.6±2.2)months (ranging from 24 to 46 months).The mean VAS score for neck pain was significantly decreased from (6.9±1.4) preoperatively to (2.5±0.9) at 3 months postoperatively, and (0.7±0.6)during the last follow-up, respectively(P<0.05).The mean NDI score was significantly reduced from (24.6±8.6) preoperatively to (17.8±6.1) at 3 months postoperatively, and(13.8±4.2) during the last follow-up, respectively(P<0.05).The mean JOA scores increased from (11.9±2.8) preoperatively to(12.6±1.5)at 3 months postoperatively, and (14.8±1.4) during the last follow-up (P<0.05).The ROM of C2-C7 segment reduced from (44.2±8.1)°preoperatively to(34.1±6.8)°at 3 months postoperatively, and(30.4±9.5)°during the last follow-up(P<0.05).Conclusion The clinical outcomes of Hybrid surgery are excellent in the treatment of multilevel cervical spondylosis.The motion of the non-fusion segments is reserved and the decompression is complete.It could be an alternative treatment for multilevel spondylosis.

A Prospective Study of Clinical and Radiological Outcomes of Zero-Profile Cage Screw Implants for Single-Level Anterior Cervical Discectomy and Fusion: Is Segmental Lordosis Maintained at 2 Years?

STUDY DESIGN: Prospective cohort study. PURPOSE: To study clinicoradiological parameters of zero-profile cage screw used for anterior cervical discectomy and fusion (ACDF). OVERVIEW OF LITERATURE: Radiological parameters of various implants used for ACDF are available, but those for zero-profile cage are sparse. METHODS: Patients with unilateral intractable brachialgia due to single-level cervical disc prolapse between April 1, 2011 and March 31, 2014 were included. Clinical assessment included arm and neck pain using visual analogue score (VAS) and neck disability index (NDI) scores. Radiological assessment included motion segment height, adjacent disc height (upper and lower), segmental and cervical lordosis, implant subsidence, and pseudoarthrosis. Follow-ups were scheduled at 1, 3, 6, 12, and 24 months. RESULTS: Thirty-four patients (26 males, 8 females) aged 30–50 years (mean, 42.2) showed excellent clinical improvement based on VAS scores (7.4–0 for arm and 2.0–0.6 for neck pains). Postoperative disc height improved by 11.33% (p<0.001), but at 2 years, the score deteriorated by 7.03% (p<0.001). Difference in the adjacent segment disc height at 2 years was 0.08% (p=0.8) in upper and 0.16% (p<0.001) in lower disc spaces. Average segmental lordosis achieved was 5.59° (p<0.001) from a preoperative kyphosis of 0.88°; at 2 years, an average loss of 7.05° (p<0.001) occurred, resulting in an average segmental kyphosis of 1.38°. Cervical lordosis improved from 11.59° to 14.88° (p=0.164), and at 2 years, it progressively improved to 22.59° (p<0.001). Three patients showed bone formation and two mild protrusion of the implant at 2 years without pseudoarthrosis/implant failure. CONCLUSIONS: The zero-profile cage screw device provides good fusion and cervical lordosis but is incapable of maintaining the segmental lordosis achieved up to a 2-year follow-up. We also recommend caution when using it in patients with small vertebrae.

Driving Safety after Spinal Surgery: A Systematic Review

This study aimed to assess driving reaction times (DRTs) after spinal surgery to establish a timeframe for safe resumption of driving by the patient postoperatively. The MEDLINE and Google Scholar databases were analyzed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) Statement for clinical studies that investigated changes in DRTs following cervical and lumbar spinal surgery. Changes in DRTs and patients' clinical presentation, pathology, anatomical level affected, number of spinal levels involved, type of intervention, pain level, and driving skills were assessed. The literature search identified 12 studies that investigated postoperative DRTs. Six studies met the inclusion criteria; five studies assessed changes in DRT after lumbar spine surgery and two studies after cervical spina surgery. The spinal procedures were selective nerve root block, anterior cervical discectomy and fusion, and lumbar fusion and/ordecompression. DRTs exhibited variable responses to spinal surgery and depended on the patients' clinical presentation, spinal level involved, and type of procedure performed. The evidence regarding the patients' ability to resume safe driving after spinal surgery is scarce. Normalization of DRT or a return of DRT to pre-spinal intervention level is a widely accepted indicator for safe driving, with variable levels of statistical significance owing to multiple confounding factors. Considerations of the type of spinal intervention, pain level, opioid consumption, and cognitive function should be factored in the assessment of a patient's ability to safely resume driving.