Diagnosis and Treatment of Cervical Radiculopathy and Myelopathy

Lévêque, Jean; Marong-Ceesay, Bintu; Cooper, Teresa; Howe, Chris R.

doi:10.1016/j.pmr.2015.04.008

Cited by 26 publications

(15 citation statements)

References 61 publications

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“…Both anterior and posterior approaches are used in surgeries to treat CSM, including anterior cervical corpectomy and fusion (ACCF), anterior cervical discectomy and fusion (ACDF), laminoplasty, and laminectomy. Surgeons prefer an anterior approach in treating 1- or 2-level CSM, while the posterior approach is more favored in multi-level CSM without kyphosis [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Analysis of Cervical Sagittal Balance in Treating Cervical Spondylotic Myelopathy: 1-Level Anterior Cervical Corpectomy and Fusion Versus 2-Level Anterior Cervical Discectomy and Fusion

Zhou

Zong

et al. 2020

Med Sci Monit

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Background Anterior cervical corpectomy and fusion (ACCF), together with anterior cervical discectomy and fusion (ACDF) are both effective clinical treatments for cervical spondylotic myelopathy (CSM). Cervical sagittal balance is critical to preserving normal alignment, and is also associated with clinical outcomes. Material/Methods We retrospectively reviewed patients who had suffered from CSM and had undergone 1-level ACCF or 2-level ACDF surgery between December 2016 and November 2017. Forty-eight patients were identified: 25 in the ACDF group and 23 in the ACCF group. All patients received follow-up for more than 12 months. The demographic data, radiographic parameters, and clinical efficacy were compared between and within groups, both pre- and postoperatively. Results Both groups acquired good clinical efficacy; both Japanese Orthopedic Association (JOA) scores and Neck Disability Index (NDI) scores improved significantly. At the final follow-up visit, patients in the ACCF and ACDF groups did not differ significantly in C2–C7 Sagittal Vertebral Axis (cSVA), T1 Pelvic Angle (TPA), Neck Tilt (NT), Thoracic Inlet Angle (TIA), JOA, or NDI scores. However, the ACDF group had a significantly larger Cobb angle and T1 Slope (T1S) than the ACCF group. The postoperative Cobb angle increased significantly only in the ACDF group, while postoperative T1S significantly increased in both ACCF and ACDF groups. Conclusions Anterior cervical surgery may change the sagittal balance in terms of T1S or Cobb angle. No significant difference was found between ACCF and ACDF in clinical outcomes or representative global sagittal parameters. ACDF achieved more lordosis improvement than ACCF, with higher T1S. Surgeons need to pay extra attention to cervical sagittal balance, rather than focusing solely on decompression.

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Section: Introductionmentioning

confidence: 99%

Analysis of Cervical Sagittal Balance in Treating Cervical Spondylotic Myelopathy: 1-Level Anterior Cervical Corpectomy and Fusion Versus 2-Level Anterior Cervical Discectomy and Fusion

Zhou

Zong

et al. 2020

Med Sci Monit

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“…For patients experiencing symptoms that are unresponsive to conservative therapy, anterior cervical discectomy and fusion (ACDF) is a reliable surgical management option. [1][2][3] ACDF has demonstrated a high success rate in relieving neck and arm pain, with patient-reported satisfaction rates approaching 96%. [4][5][6] Postopera-tive changes in disability and pain after spinal surgery are measured using patient reported outcomes (PROs).…”

Section: Introductionmentioning

confidence: 99%

Risk Factors Associated With Failure to Reach Minimal Clinically Important Difference in Patient-Reported Outcomes Following Anterior Cervical Discectomy and Fusion

et al. 2019

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Background: The minimum clinically importance difference (MCID) represents a threshold for improvements in patient-reported outcomes (PROs) that patients deem important. No previous study has comprehensively examined risk factors for failure to achieve MCID after anterior cervical discectomy and fusion (ACDF) procedures for radiculopathic symptomatology. The purpose of this study is to determine risk factors for failure to reach MCID for Neck Disability Index (NDI), Visual Analog Scale (VAS) neck pain, and VAS arm pain in patients undergoing 1-or 2-level ACDF procedures. Methods: A surgical registry of patients who underwent primary, 1-or 2-level ACDF from 2014 to 2016 was reviewed. Rates of MCID achievement for NDI, VAS neck pain, and VAS arm pain at final follow-up were calculated based on published MCID values. Patients were then categorized into demographic and procedural categories. Bivariate regression was used to test for association of demographic and procedural characteristics with failure to reach MCID for each PRO. The final multivariate model including all demographic and procedural categories as controls was created using backward stepwise regression. Results: Eighty-three, 84, and 77 patients were included in the analysis for VAS neck, VAS arm, and NDI, respectively. Rates of MCID achievement for VAS neck, VAS arm, and NDI were 55.4%, 36.9%, and 76.6%, respectively. On bivariate analysis, patients with Charlson Comorbidity Index (CCI) ! 2 were less likely to achieve MCID for NDI than patients with CCI , 2 (P ¼ .025). On multivariate analysis, CCI ! 2 (P ¼ .025) was further associated with failure to reach MCID for NDI. Conclusions: The results of this study suggest that the majority of patients do not reach MCID for arm pain. Additionally, higher comorbidity burden as evidenced by higher CCI scores is a negative predictive factor for the achievement of MCID in neck disability following ACDF.

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“…It is now considered the gold standard for the treatment of degenerative cervical diseases. Previous studies have reported that patients can achieve significant neurologic recovery and alleviation of pain after ACDF [ 12 – 14 ]. However, fusion of two vertebral bodies inevitably leads to increased stress on the intervertebral disks of adjacent levels.…”

Section: Discussionmentioning

confidence: 99%

ACDF vs TDR for patients with cervical spondylosis – an 8 year follow up study

et al. 2017

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BackgroundACDF has been considered as the gold standard in the treatment of single level cervical disk protrusion. However, it may cause adjacent level degeneration due to regional biomechanical changes. TDR has been applied with satisfactory results for over a decade, but there is no consensus if TDR is safer and more efficient than ACDF. The current study was carried out to compare the efficiency and safety of TDR and ACDF in the treatment of patients with single level cervical disk protrusion.MethodsOne hundred forty-five consecutive patients who underwent either TDR or ACDF in our center were included in the current study. Time of surgery, intraoperative blood loss, VAS arm and neck pain scores, ROM, ODI, SF36 and Patient satisfaction were compared before the surgery, after the surgery, and during follow up 1, 3, 5, 8 years after the surgery.ResultsThe time of surgery was 64.6 ± 20.7 min in the ACDF group and 69.4 ± 19.3 min in the TDR group; intraoperative hemorrhage was 67.2 ± 14.3 ml in ACDF group and 70.7 ± 18.6 ml in TDR group. There were no significant differences between two groups concerning time of surgery and intraoperative blood loss. No differences were found concerning patient satisfaction between the two groups during the follow up (P > 0.05). Significant differences were found between the groups concerning VAS arm and neck pain scores, ROM, ODI and SF36 after the surgery and during the 8 year follow up.ConclusionTDR may be a more effective approach than ACDF for treating patients with single level cervical disk protrusion.KeywordsCervical disk herniation, ACDF, TDR, Retrospective study

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Diagnosis and Treatment of Cervical Radiculopathy and Myelopathy

Cited by 26 publications

References 61 publications

Analysis of Cervical Sagittal Balance in Treating Cervical Spondylotic Myelopathy: 1-Level Anterior Cervical Corpectomy and Fusion Versus 2-Level Anterior Cervical Discectomy and Fusion

Analysis of Cervical Sagittal Balance in Treating Cervical Spondylotic Myelopathy: 1-Level Anterior Cervical Corpectomy and Fusion Versus 2-Level Anterior Cervical Discectomy and Fusion

Risk Factors Associated With Failure to Reach Minimal Clinically Important Difference in Patient-Reported Outcomes Following Anterior Cervical Discectomy and Fusion

ACDF vs TDR for patients with cervical spondylosis – an 8 year follow up study

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