National and Regional Rates and Variation of Cervical Discectomy With and Without Anterior Fusion, 1990–1999

Angevine, Peter D.; Arons, Ray R.; McCormick, Paul C.

doi:10.1097/01.brs.0000058880.89444.a9

Cited by 115 publications

(67 citation statements)

References 40 publications

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“…As Angevine and colleagues 2 noted, the rate of hospitalization for operative and nonoperative treatment of cervical disc disease did not increase during the 1990s. However, the proportion of hospitalizations involving cervical fusion did increase, indicating a paradigm shift toward inclusion of arthrodesis.…”

Section: Rationalementioning

confidence: 94%

“…However, the proportion of hospitalizations involving cervical fusion did increase, indicating a paradigm shift toward inclusion of arthrodesis. Although instrumentation was not specifically analyzed in the study by Angevine et al, 2 plating does appear to be popular even for short-segment constructions. More recently, cervical arthroplasty has been developed as an alternative to fusion.…”

Section: Rationalementioning

confidence: 99%

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Techniques for anterior cervical decompression for radiculopathy

Matz

Ryken

Groff

et al. 2009

SPI

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Object The objective of this systematic review was to use evidence-based medicine to identify the best techniques for anterior cervical nerve root decompression. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to techniques for the surgical management of cervical radiculopathy. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer-review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Both anterior cervical discectomy (ACD) and anterior cervical discectomy with fusion (ACDF) are equivalent treatment strategies for 1-level disease with regard to functional outcome (Class II). Anterior cervical discectomy with fusion may achieve a more rapid reduction of neck and arm pain compared to ACD with a reduced risk of kyphosis, although functional outcomes may be similar. Anterior cervical discectomy with fusion is not a lasting means of increasing foraminal or disc height compared to ACD. Anterior cervical plating (ACDF with instrumentation) improves arm pain (but not other clinical parameters) better than ACDF in the treatment of 2-level disease (Class II). With respect to 1-level disease, plating may reduce the risk of pseudarthrosis and graft problems (Class III) but does not necessarily improve clinical outcome alone (Class II). Cervical arthroplasty is recommended as an alternative to ACDF in selected patients for control of neck and arm pain (Class II). Conclusions Anterior cervical discectomy, ACDF, and arthroplasty are effective techniques for addressing surgical cervical radiculopathy.

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Section: Rationalementioning

confidence: 94%

Section: Rationalementioning

confidence: 99%

Techniques for anterior cervical decompression for radiculopathy

Matz

Ryken

Groff

et al. 2009

SPI

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“…Fusion and stabilization are often coupled in the anterior approach to preserve or enhance spinal alignment. 1 The incidence of pseudarthrosis after an anterior cervical approach is used is dependent on the number of levels involved and ranges from 0 to 50%. 2,6,13,15,17,18,20 Despite the widespread application of anterior plates, clinicians have not been able to eliminate the development of pseudarthrosis.…”

Section: Rationalementioning

confidence: 99%

Management of anterior cervical pseudarthrosis

Kaiser

Mummaneni

Matz

et al. 2009

SPI

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Object The objective of this systematic review was to use evidence-based medicine to identify the best methodology for diagnosis and treatment of anterior pseudarthrosis. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to pseudarthrosis and cervical spine surgery. Abstracts were reviewed, after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Evaluation for pseudarthrosis is warranted, as there may be an association between clinical outcome and pseudarthrosis. The strength of this association cannot be accurately determined because of the variable incidence of symptomatic and asymptomatic pseudarthroses (Class III). Revision of a symptomatic pseudarthrosis may be considered because arthrodesis is associated with improved clinical outcome (Class III). Both posterior and anterior approaches have proven successful for surgical correction of an anterior pseudarthrosis. Posterior approaches may be associated with higher fusion rates following repair of an anterior pseudarthrosis (Class III). Conclusions If suspected, pseudarthrosis should be investigated because there may be an association between arthrodesis and outcome. However, the strength of this association cannot be accurately determined. Anterior and posterior approaches have been successful.

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“…39 The pathology underlying cervical radiculopathy is typically presumed to involve narrowing of the intervertebral foramen due to inflammation and/or degenerative changes. 45 Rates of surgical procedures for cervical radiculopathy and degenerative conditions have grown rapidly in the United States, 1,44 with the attendant costs and complication risks, 29 highlighting the need to identify the most effective nonop-T T STUDY DESIGN: Randomized clinical trial.…”

mentioning

confidence: 99%