Adjacent level discitis after anterior cervical discectomy and fusion (ACDF): a case report

Kulkarni, Arvind G; Hee, Hwan Tak

doi:10.1007/s00586-005-0003-x

Cited by 44 publications

(27 citation statements)

References 9 publications

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“…Various organ culture systems have been in development and use: (1) culture of discs without endplates (Chiba et al, 1998), (2) with vertebral bone (Lee et al, 2006;IllienJunger et al, 2010;Chan and Gantenbein-Ritter, 2012b) and (3) with cartilaginous endplates Jim et al, 2011). Organ culture systems except for those retaining only the cartilaginous endplate model were unable to maintain high cell viability even for short durations of culture; whereas the cartilaginous endplate model for human disc culture developed by us has overcome this problem.…”

Section: Discussionmentioning

confidence: 99%

“…Beyond Thompson grade 3, surgical treatment would be the mainstay treatment due to severely depleted cell population and the disrupted integrity of the disc. Link-N therapy thus may not be able to repair higher grades of degeneration where annular fissures and tears are present, although it could be used post-surgery to delay adjacent level disc disease (Kulkarni and Hee, 2006;Lund and Oxland, 2011).…”

Section: Discussionmentioning

confidence: 99%

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Best Paper NASS 2013: Link-N can stimulate proteoglycan synthesis in the degenerated human intervertebral discs

Gawri¹,

Antoniou²,

Ouellet³

et al. 2013

eCM

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Intervertebral disc (IVD) degeneration is the most common cause of back pain. Presently there is no medical treatment, leaving surgery as the only offered option. Here we evaluate the potential of Link-N to promote extracellular matrix regeneration in human IVDs. Human disc cells cultured in alginate and intact human discs were exposed to a combination of Link-N and 35 SO 4 in the presence or absence of interleukin (IL)-1, and the effect on proteoglycan synthesis was evaluated. In addition, message levels of aggrecan, matrix metalloproteinase (MMP)-3, MMP-13, a Disintegrin And Metalloproteinase with Thrombospondin Motifs (ADAMTS)-4 and ADAMTS-5 were evaluated in alginate cultures. Human disc cells responded in a dose dependent manner with maximal proteoglycan synthesis at 1 µg/mL Link-N. Link-N treatment also induced proteoglycan synthesis in intact human discs, and a prolonged effect was found up to one week after Link-N treatment. Message levels of proteinases were decreased by Link-N in the presence of IL-1. Thus, Link-N can promote proteoglycan synthesis and deplete proteinase expression in adult human discs. Link-N could therefore be a promising candidate for biologically-induced disc repair, and could provide an alternative to surgical intervention for early stage disc degeneration.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Best Paper NASS 2013: Link-N can stimulate proteoglycan synthesis in the degenerated human intervertebral discs

Gawri¹,

Antoniou²,

Ouellet³

et al. 2013

eCM

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“…27,30 Application of a cervical plate has gained acceptance as a means of increasing fusion rates and preventing graft dislodgement, but it can be expensive and has been associated with complications such as dysphagia, infection, and instrumentation failure. 4,13,23,24 Instrumented fusion is also associated with a significantly higher amount of intraoperative blood loss when compared with procedures in which plate fixation is not used. 31 The effectiveness of plate fixation in single-level ACDF is controversial, and there are significant differences in fusion rates among published studies.…”

Section: Discussionmentioning

confidence: 99%

Radiographic and clinical outcomes following single-level anterior cervical discectomy and allograft fusion without plate placement or cervical collar

Jagannathan¹,

Shaffrey²,

Oskouian³

et al. 2008

SPI

130

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Object Although the clinical outcomes following anterior cervical discectomy and fusion (ACDF) surgery are generally good, 2 major complications are graft migration and nonunion. These complications have led some to advocate rigid internal fixation and/or cervical immobilization postoperatively. This paper examines a single-surgeon experience with single-level ACDF without use of plates or hard collars in patients with degenerative spondylosis in whom allograft was used as the fusion material. Methods The authors conducted a retrospective review of a prospective database of (Cloward-type) ACDF operations performed by the senior author (J.A.J.) between July 1996 and June 2005. Radiographic follow-up included static and flexion/extension radiographs obtained to assess fusion, focal and segmental kyphosis, and change in disc space height. At most recent follow-up, the patients' condition was evaluated by an independent physician examiner. The Odom criteria and Neck Disability Index (NDI) were used to assess outcome. Results One hundred seventy patients underwent single-level ACDF for degenerative pathology during the study period. Their most common presenting symptoms were pain, weakness, and radiculopathy; 88% of patients noted ≥ 2 neurological complaints. The mean hospital stay was 1.76 days (range 0–36 days), and 3 patients (2%) had major immediate postoperative complications requiring reoperation. The mean duration of follow-up was 22 months (range 12–124 months). Radiographic evidence of fusion was present in 160 patients (94%). Seven patients (4%) showed radiographic evidence of pseudarthrosis, and graft migration was seen in 3 patients (2%). All patients had increases in focal kyphosis at the operated level on postoperative radiographs (mean −7.4°), although segmental alignment was preserved in 133 patients (78%). Mean change in disc space height was 36.5% (range 28–53%). At most recent clinical follow-up, 122 patients (72%) had no complaints referable to cervical disease and were able to carry out their activities of daily living without impairment. The mean postoperative NDI score was 3.2 (median 3, range 0–31). Conclusions Single-level ACDF without intraoperative plate placement or the use of a postoperative collar is an effective treatment for cervical spondylosis. Although there is evidence of focal kyphosis and loss of disc space height, radiographic evidence of fusion is comparable to that attained with plate fixation, and the rate of clinical improvement is high.

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“…Kulkarni et al [24] reported a case of adjacent level discitis after anterior cervical discectomy and fusion, and the radiographs showed segmental C4-C5 kyphosis, decreased disc height at this level with erosion of end-plates, halo around the screws and enlarged prevertebral soft tissue shadow. MRI showed discitis at the C4-C5 level with prevertebral and epidural abscesses from C4-C6.…”

Section: Imaging Studiesmentioning

confidence: 99%

“…Kulkarni et al [24] reported a case of adjacent level discitis after anterior cervical discectomy and fusion and the perioperative biopsy was positive for Serratia marcescens.…”

Section: Postoperative Pyogenic Spondylodiscitismentioning

confidence: 99%

Postoperative spondilodiscitis

Gerometta

Bittan

Olaverri

2012

International Orthopaedics (SICOT)

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Introduction Postoperative spondylodiscitis is a primary infection of the nucleus pulposus with secondary involvement of the cartilaginous endplate and vertebral bone. Although uncommon, postoperative spondylodiscitis causes major morbidity and may be associated with serious long-term sequelae. Several risk factors had been identified, including immunosuppression, obesity, alcohol, smoking, diabetes and malnutrition. Materials and methods A review of the literature was done to analyse the diagnosis, treatment and prevention of postoperative spondylodiscitis. Results We found that the principles of conservative treatment are to establish an accurate microbiological diagnosis, treat with appropriate antibiotics, immobilise the spine, and closely monitor for spinal instability and neurological deterioration. The purpose of surgical treatment is to obtain multiple cultures of bone and soft tissue, perform a thorough debridement of infected tissue, decompress neural structures, and reconstruct the unstable spinal column with bone graft with or without concomitant instrumentation. Conclusions Appropriate management requires aggressive medical treatment and, at times, surgical intervention. If recognised early and treated appropriately, a full recovery can often be expected. Therefore, clinicians should be aware of the clinical presentation of such infections to improve patient outcome. A review of the literature was done to advance our understanding of the diagnosis, treatment, prevention and outcome of these infections.

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Adjacent level discitis after anterior cervical discectomy and fusion (ACDF): a case report

Cited by 44 publications

References 9 publications

Best Paper NASS 2013: Link-N can stimulate proteoglycan synthesis in the degenerated human intervertebral discs

Best Paper NASS 2013: Link-N can stimulate proteoglycan synthesis in the degenerated human intervertebral discs

Radiographic and clinical outcomes following single-level anterior cervical discectomy and allograft fusion without plate placement or cervical collar

Postoperative spondilodiscitis

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