Treatment of cervical radiculopathy: A review of the evolution and economics

Ament, JaredD; Karnati, Tejas; Kulubya, Edwin; Kim, KeeD; Johnson, J. Patrick

doi:10.4103/sni.sni_441_17

Cited by 8 publications

(7 citation statements)

References 11 publications

(13 reference statements)

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“…The ACDF is the most commonly performed cervical spine procedure although previously published clinical trials have demonstrated that this procedure is associated with higher rates of complications than posterior cervical fusion. 6,7,20,21 There has been limited research into identifying, quantifying, and improving outcomes after posterior cervical fusions. DJK is one of the complications of posterior cervical fusion that is not well investigated because there are only a handful of publications focused on this complication.…”

Section: Discussionmentioning

confidence: 99%

Cervical Vertebral Bone Quality Score Independently Predicts Distal Junctional Kyphosis After Posterior Cervical Fusion

Aguirre,

Soliman,

Kuo

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVE: Posterior cervical fusion is the surgery of choice when fusing long segments of the cervical spine. However, because of the limited presence of this pathology, there is a paucity of data in the literature about the postoperative complications of distal junctional kyphosis (DJK). We aimed to identify and report potential associations between the preoperative cervical vertebral bone quality (C-VBQ) score and the occurrence of DJK after posterior cervical fusion. METHODS: The authors retrospectively reviewed records of patients who underwent posterior cervical fusion at a single hospital between June 1, 2010, and May 31, 2020. Patient data were screened to include patients who were >18 years old, had baseline MRI, had baseline standing cervical X-ray, had immediate postoperative standing cervical X-ray, and had clinical and radiographic follow-ups of >1 year, including a standing cervical X-ray at least 1 year postoperatively. Univariate analysis was completed between DJK and non-DJK groups, with multivariate regression completed for relevant clinical variables. Simple linear regression was completed to analyze correlation between the C-VBQ score and total degrees of kyphosis angle change. RESULTS: Ninety-three patients were identified, of whom 19 (20.4%) had DJK and 74 (79.6%) did not. The DJK group had a significantly higher C-VBQ score than the non-DJK group (2.97 ± 0.40 vs 2.26 ± 0.46; P < .001). A significant, positive correlation was found between the C-VBQ score and the total degrees of kyphosis angle change (r2 = 0.26; P < .001). On multivariate analysis, the C-VBQ score independently predicted DJK (odds ratio, 1.46; 95% CI, 1.27-1.67; P < .001). CONCLUSION: We found that the C-VBQ score was an independent predictive factor of DJK after posterior cervical fusion.

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Section: Discussionmentioning

confidence: 99%

Cervical Vertebral Bone Quality Score Independently Predicts Distal Junctional Kyphosis After Posterior Cervical Fusion

Aguirre,

Soliman,

Kuo

et al. 2023

Neurosurgery

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“…Incidence of cervical radiculopathy occurs at an incidence rate of approximately 85 persons per 100,000. (2) The most common presentation of herniated cervical disc is radicular pain noticed upon awakening in the morning. (3) The diagnosis of radiculopathy is based on a detailed history taking and a thorough neurological examination.…”

Section: Discussionmentioning

confidence: 99%

Acute Events that Lead to Cervical Disc Herniation Causing Radiculopathy- A Study in a Tertiary Care Centre in Eastern India

Bhattacharya¹,

Ghosh²,

Ghosh³

et al. 2019

jemds

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BACKGROUNDCervical disc prolapse causing radiculopathy is one of the most common disorders treated by both neurologists and spine surgeons. Herniation of disc most commonly occurs in those below the age of 45 years. Pain appears in the neck and radiates towards the arms or vice versa i.e. arises in the arm and radiates to the neck. With aging and other risk factors, nucleus pulposus of cervical intervertebral disc show degeneration or dehydration. This disc may rupture through the posterior annulus fibrosus into the spinal canal or into the neural foramen compressing the exiting nerve root. Acute events can produce disc prolapse in those susceptible individuals who are already having degenerated disc. METHODSThe study includes patients attending the OPD or those admitted in the Neurology and Neurosurgery Department of Calcutta National Medical College and Hospital with symptoms of cervical radiculopathy. The study period was from 01.03.2018 to 28.02.2019. Inclusion criteria of the study were radicular pain with or without sensory or motor signs with MRI evidence of root compression, electrophysiologic evidence of cervical radiculopathy when MRI was contraindicated or noncontributory and symptoms onset was within the last 3 months. RESULTSIn this retrospective descriptive study, acute events noted within 48 hours that lead to cervical disc herniation are road traffic accidents in 27.9%. of the cases, lifting heavy objects accounted for 16.1% of the cases, violence and assault accounted for 11.7% of the cases, fall accounted for 10.3% of the cases, repetitive strain accounted for 10.3% of cases, Sports & recreation accounted for 7.3% of the cases, falling objects accounted for 4.4% of the cases and no obvious cause (idiopathic) accounted for 11.7% of the cases. 77.9% of the cases of cervical disc prolapse occurred in persons below 49 years of age. In this series, incidence of cervical disc prolapse was higher in males 69.1%. CONCLUSIONSThere is a need for increasing awareness among both the medical and general population about the acute events that can cause cervical disc herniation so that necessary precautions taken and lifestyle modifications be done to maintain cervical spine health.

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“…Three studies demonstrated reduced costs for variants of CLF (i.e..., open CLF, PCF/CPM, MICLF) vs. ACDF when addressing lateral cervical pathology [ Table 1 ]. [ 2 , 6 , 7 ] For 101 patients, Mansfield et al . (2014) compared the 3-year perioperative costs for 1-level ACDF vs. MICLF; average ACDF (largely implants) cost $8192 vs. $4320 for MICLF, but outcomes were comparable for both groups [ Table 1 ].…”

Section: Introductionmentioning

confidence: 99%

“…Cervical laminoforaminotomy (CLF), whether performed open, minimally invasively (MI), or microendoscopically (ME) for lateral/foraminal cervical disc disease, are safer than anterior cervical diskectomy/fusion (ACDF) [Table 1]. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Notably, ACDF risks uniquely include, carotid artery or jugular vein injuries, esophageal tears, dysphagia, tracheal injuries, and recurrent laryngeal nerve injuries not posed by CLF. Further, CLF vs. ACDF offer marked reductions in the frequency of vertebral artery injuries, cord/nerve root deficits, spinal instability, dural tears (DT), tissue damage, operative time, estimated blood loss (EBL), adjacent segment disease, length of stay, and cost.…”

Section: Introductionmentioning

confidence: 99%

Perspective: Cervical laminoforaminotomy (CLF) is safer than anterior cervical diskectomy/fusion (ACDF) for lateral cervical disease

Epstein,

Agulnick

2024

Surgical Neurology International

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Background: The literature documents that laminoforaminotomy (CLF), whether performed open, minimally invasively, or microendoscopically, is safer than anterior cervical diskectomy/fusion (ACDF) for lateral cervical disease. Methods: ACDF for lateral cervical disc disease and/or spondylosis exposes patients to multiple major surgical risk factors not encountered with CLF. These include; carotid artery or jugular vein injuries, esophageal tears, dysphagia, recurrent laryngeal nerve injuries, tracheal injuries, and dysphagia. CLF also exposes patients to lower rates of vertebral artery injury, dural tears (DT)/cerebrospinal fluid fistulas, instability warranting fusion, adjacent segment disease (ASD), plus cord and/or nerve root injuries. Results: Further, CLF vs. ACDF for lateral cervical pathology offer reduced tissue damage, operative time, estimated blood loss (EBL), length of stay (LOS), and cost. Conclusion: CLFs’, whether performed open, minimally invasively, or microendoscopically, offer greater safety, major pros with few cons, and decreased costs vs. ACDF for lateral cervical disease.

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Treatment of cervical radiculopathy: A review of the evolution and economics

Cited by 8 publications

References 11 publications

Cervical Vertebral Bone Quality Score Independently Predicts Distal Junctional Kyphosis After Posterior Cervical Fusion

Cervical Vertebral Bone Quality Score Independently Predicts Distal Junctional Kyphosis After Posterior Cervical Fusion

Acute Events that Lead to Cervical Disc Herniation Causing Radiculopathy- A Study in a Tertiary Care Centre in Eastern India

Perspective: Cervical laminoforaminotomy (CLF) is safer than anterior cervical diskectomy/fusion (ACDF) for lateral cervical disease

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