Prognosis of posterior osteophyte after anterior cervical decompression and fusion in patients with cervical spondylotic myelopathy using three-dimensional computed tomography study

Liu, Yin; Luo, Xian-ming; Zhou, Jiahui; Li, Na; Song, Peng; Rong, Pengfei; Wang, Wei

doi:10.1007/s00586-016-4390-y

Cited by 10 publications

(11 citation statements)

References 18 publications

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“…The 59 articles included in this review are listed in Table 1 . 6 – 65 Data collection, analysis, and manuscript preparation followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines ( Figure 1 ). 66 …”

Section: Methodsmentioning

confidence: 99%

Radiological Fusion Criteria of Postoperative Anterior Cervical Discectomy and Fusion: A Systematic Review

Oshina

Oshima

Tanaka

et al. 2018

Global Spine Journal

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Study Design:Systematic review.Objectives:Diagnosis of pseudarthrosis after anterior cervical fusion is difficult, and often depends on the surgeon’s subjective assessment because recommended radiographic criteria are lacking. This review evaluated the available evidence for confirming fusion after anterior cervical surgery.Methods:Articles describing assessment of anterior cervical fusion were retrieved from MEDLINE and SCOPUS. The assessment methods and fusion rates at 1 and 2 years were evaluated to identify reliable radiographical criteria.Results:Ten fusion criteria were described. The 4 most common were presence of bridging trabecular bone between the endplates, absence of a radiolucent gap between the graft and endplate, absence of or minimal motion between adjacent vertebral bodies on flexion-extension radiographs, and absence of or minimal motion between the spinous processes on flexion-extension radiographs. The mean fusion rates were 90.2% at 1 year and 94.7% at 2 years. The fusion rate at 2 years had significant independence (P = .048).Conclusions:The most common fusion criteria, bridging trabecular bone between the endplates and absence of a radiolucent gap between the graft and endplate, are subjective. We recommend using <1 mm of motion between spinous processes on extension and flexion to confirm fusion.

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Section: Methodsmentioning

confidence: 99%

Radiological Fusion Criteria of Postoperative Anterior Cervical Discectomy and Fusion: A Systematic Review

Oshina

Oshima

Tanaka

et al. 2018

Global Spine Journal

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“…After removal of the intervertebral disc with a careful endplate preparation, a high-speed electric drill and Kerrison punch were used to decompress the nerve roots by removing osteophyte overgrowth on the uncovertebral joint and posterior lips of the vertebral body. We performed bilateral UP resection, even in patients with unilateral symptoms, to eliminate remnant osteophyte regrowth 14) . UPR was advanced laterally until the nerve root was sufficiently decompressed.…”

Section: Methodsmentioning

confidence: 99%

The Effect of Uncinate Process Resection on Subsidence Following Anterior Cervical Discectomy and Fusion

Lee

Sung

et al. 2017

J Korean Neurosurg Soc

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ObjectiveSubsidence is a frequent complication of anterior cervical discectomy and fusion. Postoperative segmental micro-motion, thought to be a causative factor of subsidence, has been speculated to increase with uncinate process resection area (UPR). To evaluate the effect of UPR on micro-motion, we designed a method to measure UPR area based on pre- and postoperative computed tomography images and analyzed the relationship between UPR and subsidence as a proxy of micro-motion.MethodsWe retrospectively collected clinical and radiological data from January 2011 to June 2016. A total of 38 patients (53 segments) were included. All procedures included bilateral UPR and anterior plate fixation. UPR area was evaluated with reformatted coronal computer tomography images. To reduce level-related bias, we converted UPR area to the proportion of UPR to the pre-operative UP area (pUPR).ResultsSubsidence occurred in 18 segments (34%) and positively correlated with right-side pUPR, left-side pUPR, and the sum of bilateral pUPR (sum pUPR) (R=0.310, 301, 364; p=0.024, 0.029, 0.007, respectively). Multiple linear regression analysis revealed that subsidence could be estimated with the following formula: subsidence=1.522+2.7×sum pUPR (R2=0.133, p=0.007). Receiver-operating characteristic analysis determined that sum pUPR≥0.38 could serve as a threshold for significantly increased risk of subsidence (p=0.005, area under curve=0.737, sensitivity=94%, specificity=51%). This threshold was confirmed by logistic regression analysis for subsidence (p=0.009, odds ratio=8.471).ConclusionThe UPR measurement method confirmed that UPR was correlated with subsidence. Particularly when the sum of pUPR is ≥38%, the possibility of subsidence increased.

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“…Anterior cervical discectomy and fusion (ACDF), a common surgical procedure, has been used for decades in patients suffering from neck pain and/or neurological deficits without response to conservative managements [ [1] , [2] , [3] ]. The procedure of ACDF includes the removal of the herniated or degenerative disc, followed by insertion of an interbody graft to fuse together the bones above and below the disc [ [4] , [5] , [6] ].…”

Section: Introductionmentioning

confidence: 99%

Exploratory meta-analysis on dose-related efficacy and complications of rhBMP-2 in anterior cervical discectomy and fusion: 1,539,021 cases from 2003 to 2017 studies

Wen

Jiang

Yang

et al. 2020

Journal of Orthopaedic Translation

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s Background/Objective Anterior cervical discectomy and fusion (ACDF), commonly using autogenous iliac bone graft may be limited by donor site availability, donor-site morbidity, lower fusion rate among specific patients and longer surgical time. Surgeons used rhBMP-2 as an alternative in order to fill these clinical needs. However, studies comparing with and without rhBMP-2 in ACDF have reported conflicting results on efficacy and complications. Therefore, the purpose of this article was to evaluate efficacy and complications through dose-related rhBMP-2 and surgical level-dependence in ACDF. Methods We comprehensively searched PubMed and the Cochrane Library and performed a systematic review and cumulative meta-analysis of all randomized controlled trials (RCTs), prospective and retrospective comparative studies assessing with and without rhBMP-2 treatments. Results 1 RCTs, 4 prospective studies and 24 retrospective studies including a total of 1,539,021 cases were identified. Patients in ACDF with rhBMP-2 might benefit from significantly higher fusion rates than that in non-rhBMP-2, not only total value but also in 3 tiers of rhBMP-2 doses. It is worth noting that the low dose of rhBMP-2 (<0.7 mg/level) showed highest fusion rate among all rhBMP-2 doses. Patients in rhBMP-2 also experienced higher complication rate, dysphagia and wound infections than that in non-rhBMP-2. In 2-level ACDF, the fusion rate was significantly better in rhBMP-2 than non-rhBMP-2 but not for complication rate. Surgery operative time, lengths of hospital stay and neurologic symptoms did not differ significantly between two treatments. Conclusions rhBMP-2 chosen in ACDF offered higher fusion, but also higher complication rate with more dysphagia and wound infections than non-rhBMP-2. To gain the efficacy and safety, rhBMP-2 dosing recommendations for ACDF would be better < 0.7 mg/level. Moreover, rhBMP-2 may be an option to improve nonunion in high risk of multi-level ACDF. The translational potential of this article This article indicated that the product development of facilities used in ACDF, the dose of rhBMP-2 may be lower than 0.7 mg/level was enough to gain the good fusion rates. However, the complications were higher in patients used rhBMP-2, therefore the manufacturers should pay attention to mitigate such side effects.

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Prognosis of posterior osteophyte after anterior cervical decompression and fusion in patients with cervical spondylotic myelopathy using three-dimensional computed tomography study

Cited by 10 publications

References 18 publications

Radiological Fusion Criteria of Postoperative Anterior Cervical Discectomy and Fusion: A Systematic Review

Radiological Fusion Criteria of Postoperative Anterior Cervical Discectomy and Fusion: A Systematic Review

The Effect of Uncinate Process Resection on Subsidence Following Anterior Cervical Discectomy and Fusion

Exploratory meta-analysis on dose-related efficacy and complications of rhBMP-2 in anterior cervical discectomy and fusion: 1,539,021 cases from 2003 to 2017 studies

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