Clinical impact and imaging results after a modified procedure of ACDF: a prospective case-controlled study based on ninety cases with two-year follow-up

Abstract

Study design This is a prospective case-controlled study. Background To analyze the postoperative axial pain and cage subsidence of patients presenting with cervical spondylotic myelopathy (CSM) after a modified procedure of ACDF (mACDF). Methods Ninety patients with CSM were prospectively collected from 2014 to 2018. The patients were divided into spread group and non-spread group (48:42 ratio) according to the cage placement with or without releasing the Caspar cervical retractor after decompression. Spread group received conventional ACDF and non-spread group received mACDF. Patients were followed-up for at least 24 months after surgery. Radiologic data, including height of intervertebral space and Cobb Angle, were collected. Nervous system function was obtained using JOA scores, and level of pain was assessed using VAS scores. Results A total of 90 patients were enrolled and the patients were divided into spread group (n = 48) and none-spread group(n = 42). Cage subsidence of (spread group vs none-spread group) was (0.82 ± 0.68 vs 0.58 ± 0.81) mm, (0.64 ± 0.77 vs 0.34 ± 0.46) mm, (0.48 ± 0.43 vs 0.25 ± 0.28) mm, and (0.45 ± 0.47 vs 0.17 ± 0.32) mm at 3 months, 6 months, 12 months and 24 months, respectively. The period exhibiting the most decrease of the height of intervertebral space was 3 months postoperatively. However, there was no statistical difference in the height of intervertebral space, JOA or VAS scores at the final follow-up between the two groups. Conclusions The mACDF can avoid excessive distraction by releasing the Caspar Cervical retractor, restore the “natural height” of cervical vertebra, relieve immediate pain after surgery, and prevent rapid Cage subsidence and the loss of cervical curvature.

Modified ACDF Technique for the Treatment of Centrum Focal Ossification of the Posterior Longitudinal Ligament: A Case Report

“…4). All quantitative scores were better than those before the operation and were similar to those of previous patients with ACDF 12,13 . There were no related complications in this case.…”

Comparative Study between Caspar Cervical Retractor System and Traditional S Retractor in Application on Anterior Cervical Decompression and Fixation

“…It is difficult for the assistant to maintain the traction force and position continuously by using the traditional S retractor during a long operation, so that the airway and esophagus and other soft tissues are repeatedly stimulated, which is easy to cause postoperative edema and increase the risk of surgery. 25 As to how to improve the operation and surgical instruments to reduce the risk of surgery has become a key point in anterior cervical surgery. 26 , 27 The CCRS retractor is placed by the operator according to the size and depth of the incision after fully exposing the anatomical position.…”

A Novel Cervical Vertebral Bone Quality Score Independently Predicts Cage Subsidence After Anterior Cervical Diskectomy and Fusion

“…16 In the current study, cage subsidence was calculated using a well-validated method of total loss of segmental height as the difference from the postoperative X-ray taken within 1 week after surgery to the most recent follow-up X-ray. 10,[17][18][19][20] The segmental height was calculated on lateral X-ray as the distance from the inferior endplate of the inferior fused vertebral body to the superior endplate of the superior fused vertebral body. Cage subsidence was defined as ≥3 mm loss of segmental height of the fusion, which has been demonstrated as a well validated threshold in previous literature.…”