Clinical presentation and outcome after anterior cervical discectomy and fusion for degenerative cervical disc disease

Abstract

Background: Anterior cervical discectomy and fusion (ACDF) is a well-described surgical approach for symptomatic degenerative cervical disc disease which does not respond to conservative management. In the present study, we assessed clinical presentation and outcomes of ACDF. Materials and Methods: The present study was conducted from October 1, 2015, to October 31, 2017, in the Department of Neurosurgery, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, among 100 consecutive adult patients who underwent single- or two-level ACDF for degenerative cervical disc disease. Results: The mean age was 47.2 ± 12.8 years (range: 20–74 years). Majority of the patients were male (86/100). Presenting symptoms were neck pain (77%), limb weakness (73%), paresthesias (53%), radicular pain (49%), stiffness in limbs (16%), and bladder involvement (13%). Fusion was done with stand-alone titanium cage/bone graft or titanium cage/bone graft with anterior cervical plate. At the time of discharge, significant improvement in preoperative symptoms (neck pain [47/77-61%], radicular pain [31/49-63%], limb weakness [53/73-72.6%], paresthesias [44/53-83%], stiffness in limbs [13/16-81%], and bladder symptoms [8/13-61%]) was reported by majority of these patients. Majority of these patients also reported improvement in preoperative sensory deficits at the time of discharge. Postoperative complications were hoarseness of voice (22%), dysphagia (16%), deterioration of motor power (8%), and postoperative hematoma (7%). Conclusions: A significant proportion of patients with degenerative cervical disc disease show remarkable recovery after ACDF.

The Recurrence of Symptoms After Anterior Cervical Discectomy and Fusion

“…In the present study, neck pain (28.6%) was the most common recurrent symptom after ACDF. This is consistent with Skrkhande’s 100 participants study, in which the most common recurrent symptoms were neck pain and bladder symptoms (39%) [ 10 ].…”

“…Symptoms were significantly reduced after ACDF in this study. Srikhande et al found similar results, where most symptoms (neck pain, radicular pain, limb weakness, paresthesia, and limb stiffness) improved significantly after surgery [ 10 ]. Furthermore, a similar finding was reported in a study of 235 patients, which measured health-related quality-of-life outcomes, such as the visual analog scale (VAS) for neck pain and the neck disability index, and found that both were significantly reduced after ACDF [ 11 ].…”

A systematic review of risk factors and adverse outcomes associated with anterior cervical discectomy and fusion surgery over the past decade

“…We identified 12 prospective cohort studies[ 7 8 11 12 13 14 16 19 20 21 22 23 ] and 16 retrospective cohort studies. [ 6 9 10 15 24 25 26 27 28 29 30 31 32 33 34 35 ] Across all studies ( n = 4270), the rate of postoperative dysphagia at any point of time was 7.9%. Among prospective studies ( n = 1707), overall rates of postoperative dysphagia ranged from 0.5% to 34.5% with a pooled incidence of 11.1%.…”

Biomechanical Comparison of a New Memory Compression Alloy Plate versus Traditional Titanium Plate for Anterior Cervical Discectomy and Fusion: A Finite Element Analysis

“…The maximum von Mises stresses in these three groups were 30. 23 Figure 6 shows the distributions of stresses in the C5 inferior endplates. Figure 7 shows the distributions of stresses in the traditional plate and new prosthesis groups.…”

“…However, the use of a titanium ACP may be associated with complications including dysphagia and soft tissue injury because of its large volume [6,14]. In addition, the high elastic modulus and rigid fixation of titanium ACP might result in graft stress shielding, leading to screws backing out and looseness of the titanium plate [23]. Thus, it is of great clinical significance to develop a new anterior cervical plate to solve these defects.…”