Factors predicting adjacent segment disease after anterior cervical discectomy and fusion treating cervical spondylotic myelopathy

You, Jipeng; Tang, Xiaohui; Gao, Wenshan; Shen, Yong; Ding, Wenyuan; Bao, Rong

doi:10.1097/md.0000000000012893

Cited by 14 publications

(10 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Among them, ACDF is a good clinical treatment for more serious and complex conditions such as multi-segment CDH, cervical instability, and free nucleus pulposus. Although ACDF is still the most common surgical procedure for the treatment of cervical disc disease (19,20), the complications related to bone graft fusion associated with long-term followup have had a substantial impact on its status for use as a standard treatment (21,22). With the clinical application of minimally invasive spinal surgery in recent years, low-trauma microsurgeries, especially full-endoscopic anterior cervical discectomy, have been favored by spine surgeons (10,23,24); however, the transdiscal approach inevitably damages the degenerated disc and accelerates the loss of intervertebral height, and can even cause spontaneous bone fusion in the later stage.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Full-Endoscopic Anterior Transcorporeal Cervical Discectomy for the Treatment of Cervical Disc Herniation: Surgical Design and Results

Chen

Jianan

et al. 2021

Pain Physician

View full text Add to dashboard Cite

BACKGROUND: Studies that focus on percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) have rarely been reported. Therefore, the available data on the surgical design of PEATCD and related clinical outcomes are very limited. OBJECTIVES: To design a surgical plan for PEATCD and to evaluate its clinical efficacy in clinical application. STUDY DESIGN: A retrospective cohort study. SETTING: A center for spine surgery, rehabilitation department and pain medicine. METHODS: Based on the size and precise location of the disc protrusions on magnetic resonance imaging (MRI), the diameter and direction of the bone channel were designed to make a surgical plan for PEATCD. A total of 26 patients with central/paracentral cervical disc herniation (CDH) who underwent PEATCD through the designed surgical plan from October 2015 to September 2016 were enrolled in the retrospective study. Clinical outcome evaluations included Visual Analog Scale (VAS) scores, Japanese Orthopedic Association (JOA) scores, and the modified Macnab criteria. Radiologic follow-up included cervical computerized tomography (CT) and MRI evaluations. RESULTS: The diameter of the designed bone channel was about 7.5 mm, and the direction was from the upper edge of the lower endplate obliquely toward the disc protrusion. Through the designed surgical plan, 26 cases of discectomy were successfully completed. The average operation time was 91.50 ± 16.80 min, and the average hospital stay was 4.07 ± 0.84 days. All patients were followed for an average of 19.61 ± 4.04 months. The postoperative VAS and JOA scores were significantly improved compared with the preoperative scores (P < 0.0001). Clinical efficacy at the final follow-up was evaluated by the modified Macnab criteria, and the excellent and good rate was 92.31%. Postoperative MRI showed that the disc protrusion was completely removed, and CT showed no collapse of the vertebral body. LIMITATIONS: This study has several limitations, including the lack of a control group, the small sample size, and the unavoidable nature of the single-center study design. CONCLUSIONS: Based on the size and location of the disc protrusion on MRI, the diameter and direction of the bone channel are designed, which is conducive to have enough space under the full-endoscopic field of view to completely expose and remove the disc protrusion, to avoid residuals, and to ensure that PEATCD achieves good therapeutic results. Trial registration: The study was registered at Chinese Clinical Trial Registry (ChiCTR1900027820). KEY WORDS: Percutaneous full-endoscope, anterior transcorporeal approach, cervical discectomy, cervical disc herniation, minimally invasive surgery

show abstract

Section: Discussionmentioning

confidence: 99%

Percutaneous Full-Endoscopic Anterior Transcorporeal Cervical Discectomy for the Treatment of Cervical Disc Herniation: Surgical Design and Results

Chen

Jianan

et al. 2021

Pain Physician

View full text Add to dashboard Cite

show abstract

“…You et al . [ 16 ] showed that adjacent segment disease (ASD) following ACDF was more frequent in patients with higher C2-SVA as well as higher T1 slope angle. Many authors recognize that a C2-SVA of more than 40–50 mm correlates with adverse clinical outcomes and should thus be addressed if surgery of the cervical spine is planned.…”

Section: Discussionmentioning

confidence: 99%

Junctional kyphosis and junctional failure after multi-segmental posterior cervicothoracic fusion – A retrospective analysis of 64 patients

Spiessberger

Dietz

Grüter

et al. 2020

J Craniovert Jun Spine

View full text Add to dashboard Cite

Introduction: Junctional kyphosis (JK) and junctional failure (JF) are known complications after thoracolumbar spinal deformity surgery. This study aims to define the incidence and possible risk factors for JK/JF following multi-segmental cervicothoracic fusion. Methods: This is a retrospective analysis of 64 consecutive patients undergoing cervicothoracic fusion surgery, including at least five segments. Clinical and radiographic outcome measures were analyzed. A univariate analysis was performed to determine the effect of the level of upper instrumented vertebra (UIV) and lower instrumented vertebra (LIV), fusion status, C2 sagittal vertical axis (SVA), C2–C7 lordotic angle and T1 slope angle on the occurrence of JK/JF. Results: A total of 46 patients were followed up for a median of 1.1 years (range 0.3–4) with a median age of 65.5 years (range 42.2–84.5). Indication for surgery was spinal stenosis in 87%, trauma in 7%, and tumor in 6% of cases. The median number of levels fused was 7; the most frequent UIV was C2, and the most frequent LIV was T2. Solid fusion was achieved in 78% at the last follow-up. Postoperatively, the median C2 SVA was 32 mm (range − 7–75), median T1 slope angle was 33° (range 2°–57°), C2–C7 sagittal cobb angle was 4° (−29°–12°). JK developed in 4% of cases, no case of JF was observed. No statistically significant impact of bone density, level of UIV, level of LIV or postoperative sagittal parameters on the occurrence of JK/JF was observed, even though fusion status and pathologic T1 slope angle showed a trend toward significance. Conclusion: In this cohort of patients with mildly pathologic sagittal balance, JK was a rare event after multi-segmental fusion, observed in only 4% of cases. Neither level of UIV nor LIV had an influence on its occurrence; however, nonunion and pathologic sagittal alignment showed a nonsignificant trend.

show abstract

“…Both obesity and pathological weight loss are important nutrition-related factors to consider. Whilst majority of papers (21/28, 75%), found significant correlations between weight/ BMI and specific DCM outcomes, a total of 7 studies (7/28, 25%) reported no significant correlation between increased weight/BMI and DCM outcome, [19][20][21][22][23][24][25] For example, an international multi-centre study of 479 DCM patients reported that, although those with post-operative complications were older and had a higher BMI, these differences were statistically insignificant. 19 The effect of weight on the spinal column.…”

Section: Weight/bmimentioning

confidence: 99%

The Role of Nutrition in Degenerative Cervical Myelopathy: A Systematic Review

Partha-Sarathi

Mowforth

Sinha

et al. 2021

Nutr Metab Insights

View full text Add to dashboard Cite

Introduction: Degenerative cervical myelopathy (DCM) is the commonest cause of adult spinal cord impairment worldwide, encompassing chronic compression of the spinal cord, neurological disability and diminished quality of life. Evidence on the contribution of environmental factors is sparse; in particular, the role of nutrition in DCM is unknown. The objective of this review was to assess the effect of nutrition on DCM susceptibility, severity and surgical outcome. Methods: A systematic review in MEDLINE and Embase was conducted following PRISMA guidelines. Full-text papers in English papers, focussing on cervical myelopathy and nutrition, published before January 2020 were considered eligible. Quality assessments were performed using the GRADE assessment tool. Patient demographics, nutritional factor and DCM outcomes measures were recorded. Relationships between nutritional factors, interventions and disease prognosis were assessed. Results: In total, 5835 papers were identified of which 44 were included in the final analysis. DCM patients with pathological weight pre-operatively were more likely to see poorer improvements post-surgically. These patients experienced poorer physical and mental health improvements from surgery compared to normal weight patients and were more likely to suffer from post-operative complications such as infection, DVT, PE and hospital readmissions. Two trials reporting benefits of nutritional supplements were identified, with 1 suggesting Cerebrolysin to be significant in functional improvement. An unbalanced diet, history of alcohol abuse and malnourishment were associated with poorer post-operative outcome. Conclusion: Although the overall strength of recommendation is low, current evidence suggests nutrition may have a significant role in optimising surgical outcome in DCM patients. Although it may have a role in onset and severity of DCM, this is a preliminary suggestion. Further work needs to be done on how nutrition is defined and measured, however, the beneficial results from studies with nutritional interventions suggest nutrition could be a treatment target in DCM.

show abstract

Factors predicting adjacent segment disease after anterior cervical discectomy and fusion treating cervical spondylotic myelopathy

Cited by 14 publications

References 20 publications

Percutaneous Full-Endoscopic Anterior Transcorporeal Cervical Discectomy for the Treatment of Cervical Disc Herniation: Surgical Design and Results

Percutaneous Full-Endoscopic Anterior Transcorporeal Cervical Discectomy for the Treatment of Cervical Disc Herniation: Surgical Design and Results

Junctional kyphosis and junctional failure after multi-segmental posterior cervicothoracic fusion – A retrospective analysis of 64 patients

The Role of Nutrition in Degenerative Cervical Myelopathy: A Systematic Review

Contact Info

Product

Resources

About