Extreme long-term clinical outcome studies following anterior cervical discectomy and fusion (ACDF) with an autologous iliac crest with and without Caspar plating (ACDF + CP) for the treatment of radiculopathy caused by cervical disc herniation (CDH) are extremely rare. Hospital records of patients who underwent ACDF or ACDF + CP for the treatment of CDH at least 17 years ago were reviewed. Information about diagnosis, surgery, pre- and postoperative clinical process, and repeated procedure was analyzed. At final follow-up, patients were reviewed with a standardized questionnaire including the current neurological status, Neck Disability Index (NDI), Odom's criteria, a modified EQ-5D, and limitations in quality of life. One hundred twenty-two patients with a mean follow-up of 25 years were evaluated. ACDF was performed in 80 and ACDF + CP in 42 patients, respectively. At final follow-up, 81.1% of patients were free of radicular pain and had no repeated procedure. According to Odom's criteria, 86.1% of good to excellent functional recovery was noted. The mean NDI and EQ-5D was 14% and 5 points, respectively. There was no significant difference in the assessed clinical outcome parameters between patients treated with ACDF and ACDF + CP. The rate for repeated procedure due to degenerative cervical disorders was 10.7 and 7.4% due to symptomatic adjacent segment disease with 25 years. ACDF and ACDF + CP achieved a high rate radicular pain relief (89.3%) and clinical success (86.1%) for the treatment of CDH within a 25 years follow-up. No statistical difference concerning clinical outcome and rate of repeated procedure was detected.

PurposeTo report on the outcome and complications of minimal invasive medial unicondylar knee arthroplasty (UKA) after failed prior high tibial osteotomy (HTO) as treatment for medial osteoarthritis in the knee. The hypothesis was that good results can be achieved, if no excessive postoperative valgus alignment and abnormal proximal tibial geometry is present. MethodsAll medial UKAs after failed prior HTO (n = 30), performed between 2010 and 2018 were retrospectively reviewed. The patients were followed for revision surgery and survival of the UKA (defined as revision to TKA). Clinical examination using the Knee Society Score (KSS), Oxford Knee Score (OKS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), as well as radiological examination was performed. Radiographs were studied and the influence of the demographic factors and the radiographic measurements on the survival and the clinical outcome was analysed. ResultsAfter a follow‐up of 4.3 ± 2.6 years (2.1–9.9) 27 UKAs were available. The survival rate was 93.0%. Two UKAs were revised to TKA (excessive valgus alignment and tibial loosening with femoropatellar degeneration). Two further patients had revision surgery (hematoma and lateral meniscus tear). Follow‐up clinical and radiological examination was performed in 21 cases: KSS 82.9 ± 10.1 (54.0–100.0), KSS (function) 93.3 ± 9.7 (70.0–100.0); OKS 42.7 ± 6.0 (25.0–48.0); WOMAC 7.9 ± 15.6 (0.0–67.1). No significant influence of demographic factors or radiological measurements on the clinical outcome was present. ConclusionPrior HTO is not a contraindication for medial UKA, because good‐to‐excellent results can be achieved in selected patients with medial osteoarthritis and previous HTO, treated with medial UKA, in a midterm follow‐up. Excessive mechanical valgus axis should be avoided; therefore, patient selection and accurate evaluation of medial laxity, preoperative mechanical axis, joint line convergence and proximal tibial geometry are important. Level of evidenceIII.

ACDF and ACDF + PS yield significant decrease in neck pain, a significant increase in sensorimotor function and a high rate of clinical success. Patients with preoperative gait disturbance completely recovered in about 60% of cases. Overall prevalence for ASD was 17.4% after 25 years.

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