Comparison of three techniques of anterior fusion in single-level cervical disc herniation

Muñoz, F. López-Oliva; Heras, Beatriz García de las; López, V. Concejero; Siguero, J. J. Asenjo

doi:10.1007/s005860050117

Cited by 36 publications

(13 citation statements)

References 14 publications

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“…Review of the literature indicates that there are lots of papers about epidemiology, natural history, various treatment options, and outcome of cervical disc herniation, but there are limited studies concerning the role of age and symptom duration in surgical results [ 17 – 19 ]. In this retrospective study we aim to evaluate the impact of these two important factors on outcome of the patients with single-level CSR who had been treated by microscopic ACDF.…”

Section: Introductionmentioning

confidence: 99%

Impact of Age and Duration of Symptoms on Surgical Outcome of Single-Level Microscopic Anterior Cervical Discectomy and Fusion in the Patients with Cervical Spondylotic Radiculopathy

Omidi-Kashani

Hasankhani

Ghandehari

2014

Neuroscience Journal

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We aim to evaluate the impact of age and duration of symptoms on surgical outcome of the patients with cervical spondylotic radiculopathy (CSR) who had been treated by single-level microscopic anterior cervical discectomy and fusion (ACDF). We retrospectively evaluated 68 patients (48 female and 20 male) with a mean age of 41.2 ± 4.3 (ranged from 24 to 72 years old) in our Orthopedic Department, Imam Reza Hospital. They were followed up for 31.25 ± 4.1 months (ranged from 25 to 65 months). Pain and disability were assessed by Visual Analogue Scale (VAS) and Neck Disability Index (NDI) questionnaires in preoperative and last follow-up visits. Functional outcome was eventually evaluated by Odom's criteria. Surgery could significantly improve pain and disability from preoperative 6.2 ± 1.4 and 22.2 ± 6.2 to 3.5 ± 2.0 and 8.7 ± 5.2 (1–21) at the last follow-up visit, respectively. Satisfactory outcomes were observed in 89.7%. Symptom duration of more and less than six months had no effect on surgical outcome, but the results showed a statistically significant difference in NDI improvement in favor of the patients aged more than 45 years (P = 0.032), although pain improvement was similar in the two groups.

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Section: Introductionmentioning

confidence: 99%

Impact of Age and Duration of Symptoms on Surgical Outcome of Single-Level Microscopic Anterior Cervical Discectomy and Fusion in the Patients with Cervical Spondylotic Radiculopathy

Omidi-Kashani

Hasankhani

Ghandehari

2014

Neuroscience Journal

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“…1,15 Although the use of anterior plating has remained controversial, it has become a common practice among spinal surgeons. [16][17][18][19] Anterior cervical plating is not without complications; among them, extrusion of the failed instrumentation is one of the most uncommon but serious ones.…”

Section: Discussionmentioning

confidence: 99%

Extrusion of a Screw Into the Gastrointestinal Tract After Anterior Cervical Spine Plating

Fountas¹,

Kapsalaki²,

Machinis³

et al. 2006

Journal of Spinal Disorders &Amp; Techniques

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In this case report of a screw extrusion into the gastrointestinal tract of a patient 16 months after anterior cervical discectomy and fusion (ACDF), the authors describe a rare but potentially lethal complication and review the literature on this topic. A 70-year-old white man with a surgical history of ACDF at C3-4 underwent an ACDF at C5-6 with autologous bone graft and a dynamic plate using locking, expanding screws. Sixteen months after the operation the patient presented with severe dysphagia. Radiographic findings indicating pulling out of the implanted plate and screws prompted a surgical removal of the instrumentation. One of the screws was not found during the operation and was visualized after surgery by abdominal radiography in the right lower abdominal quadrant. A subsequent Gastrografin swallowing test revealed an esophageal tear. The screw was removed endoscopically and the patient received antibiotics and had no oral intake for 4 days. He was discharged without symptoms on a soft mechanical diet; at 24 weeks, follow-up revealed no changes or symptoms. Screw extrusion into the gastrointestinal tract following ACDF is a rare but potentially lethal complication. The use of locking, expanding screws does not extinguish the risk of this complication, particularly in cases of suboptimal initial placement of the anterior instrumentation. Close follow-up is of paramount importance in detecting any pull-out of the implanted plate. Any signs of postoperative dysphagia or throat soreness should prompt immediate evaluation of the patient and, if indicated, surgical removal of the failed instrumentation.

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“…Heavy jobs can have a negative effect on stability of the cervical spine 2391016. With recurrent micro-trauma the chances of spine dysfunction and instability is higher.…”

Section: Discussionmentioning

confidence: 99%

“…Operative time and hospital stay were found to be slightly shorter for anterior cervical discectomy compared with anterior cervical discectomy with fusion 1. The clinical and radiographic findings of some of the common techniques of anterior fusion for cervical disc herniation such as Cloward fusion with autograft, Cloward fusion with freeze-dried bone, BAK-C device fusion and cage have the advantage of affording more stability, with less chances of development, of late kyphotic deformity, but on the other hand, there is concern related to graft donor site morbidity, and / or devices and the need for more manipulative force needed intra operatively for graft or device insertion during operation 2. Although during the last three decades, the anterior approach to the cervical spine with inter-body fusion has been increasingly preferred, but some other retrospective studies on surgical procedure without interbody fusion report that the bone graft and hence fusion is not important for successful operative treatment of single level herniated cervical disc 3…”

Section: Introductionmentioning

confidence: 99%

“…Those neurosurgeons who believe in fusion with instrumentation claim that this technique has significant advantages, including higher patient satisfaction, unnecessary postoperative collar, early rehabilitation and lower rate of complications but others do not believe so 2. In some studies an excellent or good long-term result was achieved in 90.9% of the patients with single level disc herniation with radiculopathy and 58.1% of those with myelopathy operated with anterior discectomy without fusion 2. The age of the patients, the duration of symptoms before diagnosis and pathogenesis of disc herniation did not represent significant parameters influencing the outcome of patients 12…”

Section: Introductionmentioning

confidence: 99%

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Single level cervical disc herniation: A questionnaire based study on current surgical practices

Abrishamkar¹,

Karimi²,

Safavi³

et al. 2009

Indian J Orthop

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Background:Operative procedures like simple discectomy, with or without fusion and with or without instrumentation, for single level cervical disc herniation causing neck pain or neurological compromise have been described and are largely successful. However, there is a debate on definitive criteria to perform fusion (with or without instrumentation) for single level cervical disc herniation. Hence, we conducted a questionnaire based study to elicit the opinions of practicing neurosurgeons.Materials and Methods:About 148 neurosurgeons with atleast 12 years of operative experience on single level cervical disc herniation, utilizing the anterior approach, were enrolled in our study. All participating neurosurgeons were asked to complete a practice based questionnaire. The responses of 120 neurosurgeons were analysed.Results:The mean age of enrolled surgeons was 51 yrs (range 45-73) with mean surgical experience of 16.9 yrs (range 12-40 yrs) on single level cervical disc herniation. Out of 120 surgeons 10(8%) had 15-25 years experience and always preferred fusion with or without instrumentation and six (five per cent with 17-27 yrs experience had never used fusion techniques. However, 104 (87%) surgeons with 12-40 yrs experience had their own criteria based on their experiences for performing fusion with graft and instrumentation (FGI), while. 85 (75%) preferred auto graft with cage.Conclusions:Most of surgeons performed FGI before the age of 40, but for others, patient criteria such as job (heavier job), physical examination (especially myelopathy) and imaging findings (mild degenerative changes on X-ray and signal change in the spinal cord on MRI) were considered significant for performing FGI.

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Comparison of three techniques of anterior fusion in single-level cervical disc herniation

Cited by 36 publications

References 14 publications

Impact of Age and Duration of Symptoms on Surgical Outcome of Single-Level Microscopic Anterior Cervical Discectomy and Fusion in the Patients with Cervical Spondylotic Radiculopathy

Impact of Age and Duration of Symptoms on Surgical Outcome of Single-Level Microscopic Anterior Cervical Discectomy and Fusion in the Patients with Cervical Spondylotic Radiculopathy

Extrusion of a Screw Into the Gastrointestinal Tract After Anterior Cervical Spine Plating

Single level cervical disc herniation: A questionnaire based study on current surgical practices

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