Four-year results of a prospective single-arm study on 200 semi-constrained total cervical disc prostheses: clinical and radiographic outcome.

OBJECTIVE Recent studies have described encouraging outcomes after cervical total disc replacement (cTDR), but there are also critical debates regarding the long-term effects of heterotopic ossification (HO) and the prevalence of adjacent-level degeneration. The aim in this paper was to provide 4-year clinical and radiographic outcome results on the activ C disc prosthesis. METHODS A total of 200 subjects underwent single-level activ C (Aesculap AG) implantation between C-3 and C-7 for the treatment of symptomatic degenerative disc disease. Clinical and radiographic assessments were performed preoperatively, intraoperatively, at discharge, and again at 6 weeks, 6 months, 1 year, 2 years, and 4 years. Radiographic evaluations were done by an independent core laboratory using a specific software for quantitative motion analysis. RESULTS Neck Disability Index (NDI) and visual analog scale (VAS) score for neck and arm pain decreased significantly from baseline to the 4-year follow-up. The mean improvement for NDI was 20, for VAS severity and frequency of neck pain 26.4 and 28, and for VAS severity and frequency of arm pain 30.7 and 35.1, respectively. The neurological situation improved for the majority of patients (86.4%); 76.1% of cases were asymptomatic. Subsequent surgical interventions were reported in 7% of the cases, including device removals in 3%. In 2.5% a subsidence greater than 3 mm was recorded; 1 of these cases also had a migration greater than 3 mm. No device displacement, expulsion, disassembly, loose or fractured device, osteolysis, or facet joint degeneration at the index level was observed. Segmental lordotic alignment changed from -2.4° preoperatively to -6.2° at 4 years, and postoperative height was maintained during the follow-up. Advanced HO (Grade III and IV) was present in 27.1% of the cases; 82.4% showed segmental mobility. A progression of radiographic adjacent-segment degeneration occurred in 28.2%, but only 4.5% required surgical treatment. CONCLUSIONS The activ C is a safe and effective device for cervical disc replacement confirming the encouraging results after cTDR. Clinical trial registration no.: NCT02492724 ( clinicaltrials.gov ).

Early and late re-operations after anterior cervical decompression and fusion during an 11-year follow-up.

BACKGROUND: Anterior cervical decompression and fusion (ACDF) may necessitate acute and late re-operations. Published long-term follow studies after ACDF are scarce. OBJECTIVE: Our goal was to give a detailed description of early and late re-operations after ACDF in an 11-year follow-up. METHODS: We retrospectively analyzed all available clinical data, including radiographic imaging for all patients who underwent an ACDF at our institution between 1998 and 1999. ACDF without plating was performed in 327 patients. All re-operations were performed at our institution. RESULTS: Forty-nine patients (15 %, CI 12-19 %) underwent a re-operation; 16 (4.9 %, CI 3-8 %) during the first month and 36 (11 %, CI 8-15 %) later during the follow-up. Five early re-operations were due to postoperative hematomas. No anterior transition of cages was detected. Asymptomatic cage subsidence was seen in 21 re-operated patients, but only one (0.3 %, CI 0-2 %) resulted in a re-operation. Adjacent level re-operation was performed for 26 patients (8 %, CI 5-11 %). This was independent of the number of fused levels or the localization of fusion. Plate reinforcement was used in only two patients in addition to ACDF; both of them were re-operations. The outcome was reported good or excellent for 11 (69 %, CI 44-86 %) and 26 (72 %, CI 56-84 %) patients with an early and late re-operation, respectively. CONCLUSION: Fifteen percent of patients underwent a re-operation during the follow-up. The outcome for re-operated patients is similar to patients without a re-operation. A multilevel fusion does not predispose to adjacent level degeneration. A solid fusion can be achieved without plating.

[Acute spinal cord compression]. / Akillinen selkäydinkompressio.

Paralysis of the lower limbs or both the upper and lower limbs, even partial, is a frightening symptom that will quickly bring the patient to emergency call service. The symptom is a sign of functional disturbance of the spinal cord, possibly resulting from a quickly developed process narrowing the spinal canal. A correct and non-delayed diagnosis and urgent release of the spinal cord from the compressed state are the cornerstones of successful treatment.

[Brain concussion]. / Aivotärähdys.

Brain concussion is a common disturbance caused by external forces or acceleration affecting the head. It may be accompanied by transient loss of consciousness and amnesia. Typical symptoms include headache, nausea and dizziness; these may remain for a week or two. Some patients may experience transient loss of inability to create new memories or other brief impairment of mental functioning. Treatment is symptomatic. Some patients may suffer from prolonged symptoms, the connection of which with brain concession is difficult to show. Almost invariably the prognosis of brain concussion is good.

[Limb amputations in the treatment of neuropathic pain--insanity or evidence-based medicine?]. / Raaja-amputaatiot neuropaattisen kivun hoidossa--hulluutta vai näyttöön perustuvaa lääketiedettä?

Neuropathic pain is a diagnostically and therapeutically challenging problem. Its most typical manifestation is persistent burning pain that may be aggravated by surgical procedures, even by minor ones. Therefore the presumed pros and cons of surgical therapy of a patient suffering from neuropathic pain should be weighed with exceptional care in order to avoid unnecessary operations that could worsen the pain problem. We describe three patient cases, in which treating of difficult limb pain has been attempted by amputation.