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Anterior Cervical Discectomy with Arthroplasty versus Arthrodesis for Single-Level Cervical Spondylosis: A Systematic Review and Meta-Analysis  [PDF]
Aria Fallah, Elie A. Akl, Shanil Ebrahim, George M. Ibrahim, Alireza Mansouri, Clary J. Foote, Yuqing Zhang, Michael G. Fehlings
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0043407
Abstract: Objective To estimate the effectiveness of anterior cervical discectomy with arthroplasty (ACDA) compared to anterior cervical discectomy with fusion (ACDF) for patient-important outcomes for single-level cervical spondylosis. Data sources Electronic databases (MEDLINE, EMBASE, Cochrane Register for Randomized Controlled Trials, BIOSIS and LILACS), archives of spine meetings and bibliographies of relevant articles. Study selection We included RCTs of ACDF versus ACDA in adult patients with single-level cervical spondylosis reporting at least one of the following outcomes: functionality, neurological success, neck pain, arm pain, quality of life, surgery for adjacent level degeneration (ALD), reoperation and dysphonia/dysphagia. We used no language restrictions. We performed title and abstract screening and full text screening independently and in duplicate. Data synthesis We used random-effects model to pool data using mean difference (MD) for continuous outcomes and relative risk (RR) for dichotomous outcomes. We used GRADE to evaluate the quality of evidence for each outcome. Results Of 2804 citations, 9 articles reporting on 9 trials (1778 participants) were eligible. ACDA is associated with a clinically significant lower incidence of neurologic failure (RR = 0.53, 95% CI = 0.37–0.75, p = 0.0004) and improvement in the Neck pain visual analogue scale (VAS) (MD = 6.56, 95% CI = 3.22–9.90, p = 0.0001; Minimal clinically important difference (MCID) = 2.5. ACDA is associated with a statistically but not clinically significant improvement in Arm pain VAS and SF-36 physical component summary. ACDA is associated with non-statistically significant higher improvement in the Neck Disability Index Score and lower incidence of ALD requiring surgery, reoperation, and dysphagia/dysphonia. Conclusions There is no strong evidence to support the routine use of ACDA over ACDF in single-level cervical spondylosis. Current trials lack long-term data required to assess safety as well as surgery for ALD. We suggest that ACDA in patients with single level cervical spondylosis is an option although its benefits and indication over ACDF remain in question.
Comparison of inpatient vs. outpatient anterior cervical discectomy and fusion: a retrospective case series
Jeffrey T Liu, Rudy P Briner, Jonathan A Friedman
BMC Surgery , 2009, DOI: 10.1186/1471-2482-9-3
Abstract: All patients undergoing single-level anterior cervical discectomy and fusion with plating between August 2005 and May 2007 by two surgeons (RPB or JAF) were retrospectively reviewed. All patients underwent anterior cervical microdiscectomy, arthrodesis using structural allograft, and titanium plating. A planned change from doing ACDF+P on an inpatient basis to doing ACDF+P on an outpatient basis was instituted at the midpoint of the study. There were no other changes in technique, patient selection, instrumentation, facility, or other factors. All procedures were done in full-service hospitals accommodating outpatient and inpatient care.64 patients underwent ACDF+P as inpatients, while 45 underwent ACDF+P as outpatients. When outpatient surgery was planned, 17 patients were treated as inpatients due to medical comorbidities (14), older age (1), and patient preference (2). At a mean follow-up of 62.4 days, 90 patients had an excellent outcome, 19 patients had a good outcome, and no patients had a fair or poor outcome. There was no significant difference in outcome between inpatients and outpatients. There were 4 complications, all occurring in inpatients: a hematoma one week post-operatively requiring drainage, a cerebrospinal fluid leak treated with lumbar drainage, syncope of unknown etiology, and moderate dysphagia.In this series, outpatient ACDF+P was safe and was not associated with a significant difference in outcome compared with inpatient ACDF+P.Spinal surgery is increasingly being done in the outpatient setting. Reasons suggested for this include the refinement of facilities and systems for ambulatory surgery, increasing utilization of minimally-invasive approaches, increasing utilization of allograft instead of autograft for arthrodesis with associated decrease in graft site pain and morbidity, and improvements in tools and techniques for spinal instrumentation [1-4].Because of short operative time and moderate postoperative pain, anterior cervical discecto
Single-level anterior cervical discectomy and interbody fusion using PEEK anatomical cervical cage and allograft bone
C. Faldini,M. Chehrassan,M. T. Miscione,F. Acri,M. d’Amato,C. Pungetti,D. Luciani,S. Giannini
Journal of Orthopaedics and Traumatology , 2011, DOI: 10.1007/s10195-011-0169-4
Abstract: Anterior cervical discectomy and interbody fusion using PEEK anatomical cervical cages can be considered a safe and effective technique to cure cervical disc herniation with intractable pain or neural deficit in cases where conservative treatment failed.
Design of the PROCON trial: a prospective, randomized multi – center study comparing cervical anterior discectomy without fusion, with fusion or with arthroplasty
Ronald HMA Bartels, Roland Donk, Gert van der Wilt, J André Grotenhuis, Dick Venderink
BMC Musculoskeletal Disorders , 2006, DOI: 10.1186/1471-2474-7-85
Abstract: Since proof justifying the use of implants or arthroplasty after cervical anterior discectomy is lacking, PROCON was designed. PROCON is a multicenter, randomized controlled trial comparing cervical anterior discectomy without fusion, with fusion with a stand alone cage or with implantation of a disc. The study population will be enrolled from patients with a single level cervical disc disease without myelopathic signs. Each treatment arm will need 90 patients. The patients will be followed for a minimum of five years, with visits scheduled at 6 weeks, 3 months, 12 months, and then yearly. At one year postoperatively, clinical outcome and self reported outcomes will be evaluated. At five years, the development of adjacent disc disease will be investigated.The results of this study will contribute to the discussion whether additional fusion or arthroplasty is needed and cost effective.Current Controlled Trials ISRCTN41681847Since the first description of the cervical anterior discectomy with fusion by Cloward and Smith and Robinson in 1958 respectively in 1955[1,2], and the cervical anterior discectomy without fusion in 1960 by Hirsch[3] a debate is started which of both methods is the best. While this discussion is still not closed[4], the advent of the cervical disc prosthesis has contributed to extra confusion. Instead of two possibilities, nowadays three possible treatments concur with each other: cervical anterior discectomy without implantation of any structure (CAD), cervical anterior discectomy with fusion (CADF), and finally, cervical discectomy with implantation of a disc prosthesis (CADP).Numerous clinical studies have been published. Several prospective, randomized trials have been reported [5-10]. However, methodological flaws as non homogenous patient population, undefined randomization process, small sample sizes, unclear outcome measurements and substantial loss of patients for follow – up, preclude definite conclusions regarding the efficacy of CAD v
前路椎间盘切除椎间融合术治疗伴有交感神经症状的颈椎病
Anterior cervical discectomy and fusion to treat cervical spondylosis with sympathetic symptoms#br#
 [PDF]

刘洪,越雷,陈顺伦,胡博,李淳德,邑晓东,李宏,卢海霖,王宇,于峥嵘,孙浩林,#br# 王诗军,赵耀,漆龙涛,王瑞
- , 2018, DOI: 10.3969/j.issn.1671-167X.2018.02.024
Abstract: 关键词: 前路, 椎间融合, 治疗, 交感神经症状, 颈椎病, 头晕
Key words: Anterior procedure, Cervical discectomy and fusion, Treatment, Cervical spondylosis, Sympathetic symptoms, Vertigo
Four Levels Anterior Cervical Discectomy and Fusion by Stand Alone PEEK Cages  [PDF]
Islam Alaghory, Hany Abdel Gawwad Soliman, Saeed Mostafa Abdelhameed
Open Journal of Modern Neurosurgery (OJMN) , 2018, DOI: 10.4236/ojmn.2018.82014
Abstract:

Background: cervical spondylotic myelopathy is a common health problem that neurosurgeons face in Egypt. The aim of this study is to evaluate the efficacy of PEEK cage only in 4 levels anterior cervical discectomy as one of surgical option other than anterior cervical corpectomy, fixation by plat or posterior approach for cervical laminectomy, and assessment of post spinal surgery pain. Methods: this prospective study on 28 patients with cervical spondylotic myelopathy (CSM) over a period of 3 years (between April 2012 and April 2015) with mean period of follow up 30 months. We have done anterior cervical discectomy with fixation by cage only for all cases with perioperative assessment and scoring clinically and radiologically (Japanese Orthopaedic Association [JOA] scores, Visual Analogue Scale [VAS] scores for assessment of neck and arm pain, perioperative parameters (hospital stay, blood loss, operative time), the European Myelopathy Scoring (EMS) and Odom’s criteria, and the incidence of complication,post spinal surgery pain assessment). Results: clinical outcome was excellent (28.55), good (50%) and fair (21.5) according to Odom criteria. The European Myelopathy Scoring (EMS), improved from 10 to 16. The mean JOA score improved from 10.1 ± 2.1 to 14.2 ± 2.3. Fusion failure had been seen in 4 patients in one level for each secondary to anterior displacement of the cage with no other major complications. Conclusion: 4 levels anterior cervical discectomy with PEEK cage only is an effective, save and less costly with less post operative complication and hospital stay and less post spinal surgery pain.

The NEtherlands Cervical Kinematics (NECK) Trial. Cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation; a double-blind randomised multicenter study
Mark P Arts, Ronald Brand, Elske van den Akker, Bart W Koes, Wilco C Peul
BMC Musculoskeletal Disorders , 2010, DOI: 10.1186/1471-2474-11-122
Abstract: Patients (age 18-65 years) presenting with radicular signs due to single level cervical disc herniation lasting more than 8 weeks are included. Patients will be randomised into 3 groups: anterior discectomy only, anterior discectomy with interbody fusion, and anterior discectomy with disc prosthesis. The primary outcome measure is symptomatic adjacent disc degeneration at 2 and 5 years after surgery. Other outcome parameters will be the Neck Disability Index, perceived recovery, arm and neck pain, complications, re-operations, quality of life, job satisfaction, anxiety and depression assessment, medical consumption, absenteeism, and costs. The study is a randomised prospective multicenter trial, in which 3 surgical techniques are compared in a parallel group design. Patients and research nurses will be kept blinded of the allocated treatment for 2 years. The follow-up period is 5 years.Currently, anterior cervical discectomy with fusion is the golden standard in the surgical treatment of cervical disc herniation. Whether additional interbody fusion or disc prothesis is necessary and cost-effective will be determined by this trial.Netherlands Trial Register NTR1289Anterior cervical discectomy (ACD) is the basic surgical treatment of patients with radicular pain caused by cervical disc herniation. In 1958, Cloward, Smith and Robinson first described anterior cervical decompression with the use of autologous iliac crest interbody graft (ACDF)[1]. Shortly after, Hirsch debated the necessity of interbody fusion[2]. The results of various prospective randomised trials suggest that interbody fusion may not be necessary in all cases, although due to methodological flaws no solid conclusions can be drawn[3-9]. The Cochrane Review even mentioned advantages of anterior discectomy only (e.g. costs, operation time and return to work)[10].At present, ACDF is defined as the golden standard for cervical disc herniation to maintain disc height, cervical alignment, and promote bony f
颈前路零切迹椎间融合内固定系统治疗脊髓型颈椎病的疗效分析
CLINICAL OUTCOME OF ANTERIOR CERVICAL DISCECTOMY AND FUSION USING A ZERO-PROFILE INTERBODY FUSION AND FIXATION DEVICE FOR CERVICAL SPONDYLOTIC MYELOPATHY
 [PDF]

庄超,周栋,汤雪明,徐南伟
- , 2015, DOI: 10.7507/1002-1892.20150161
Abstract: 目的探讨颈前路零切迹椎间融合内固定系统(Zero-profile interbody fusion and fixation device,Zero-P)治疗脊髓型颈椎病的疗效。 方法2011年4月-2013年9月,采用颈前路减压Zero-P椎间植骨融合内固定术治疗26例脊髓型颈椎病患者。其中男12例,女14例;年龄43~82岁,平均58.3岁。病程3个月~10年,平均5.9年。病变节段:C 3、4 5例,C 4、5 3例,C 5、6 6例,C 6、7 12例。比较手术前后疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分(17分法)、颈椎功能障碍指数(NDI)、颈椎Cobb角及椎间隙高度,评价临床疗效。 结果患者均顺利完成手术,手术时间75~140 min,平均105 min;术中出血量20~150 mL,平均45 mL。未发生手术部位感染、神经损伤、食道瘘、椎前血肿及脑脊液漏等并发症。1例患者术后1周内出现轻度吞咽不适,1个月后症状完全消失。26例均获随访,随访时间12~18个月,平均15.3个月。术后患者临床症状均较术前有不同程度缓解。随访期间无内固定物移位或下沉、螺钉拔出或断裂及颈椎不稳征象。术后3、12个月VAS评分、JOA评分、NDI、椎间隙高度及颈椎Cobb角均较术前显著改善,差异有统计学意义( P<0.05);术后3、12个月间比较差异均无统计学意义( P>0.05)。末次随访时JOA评价获优14例,良10例,中2例,优良率92.3%。 结论颈前路减压Zero-P椎间植骨融合内固定术治疗脊髓型颈椎病,稳定性可靠,可重建颈椎曲度并恢复椎间隙高度,术后吞咽不适发生率低,临床疗效满意。
ObjectiveTo analyze the clinical outcome of anterior cervical discectomy and fusion using a Zero-profile interbody fusion and fixation device (Zero-P) for cervical spondylotic myelopathy. MethodsBetween April 2011 and September 2013, 26 cases of cervical spondylotic myelopathy underwent anterior cervical discectomy and fusion with the Zero-P. Of 26 cases, 12 were male and 14 were female, aged 43-82 years (mean, 58.3 years). The disease duration was from 3 months to 10 years (mean, 5.9 years). The involved segments included C 3,4 in 5 cases, C 4,5 in 3 cases, C 5,6 in 6 cases, and C 6,7 in 12 cases. The clinical outcome was evaluated using visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and Neck Disability Index (NDI) score before operation and after operation. ResultsThe operations were successful and the operation time was 75-140 minutes (mean, 105 minutes); and blood loss was 20-150 mL (mean, 45 mL). There was no complications of infection, neural injury, esophageal fistula, prevertebral hematoma, or leakage of cerebrospinal. Dysphagia occurred in 1 case within 1 week after operation,and disappeared after 1 month. All patients were followed up for an average of 15.3 months (range, 12-18 months). The clinical symptoms were relieved after operation. During follow-up, no implant displacement or subsidence, screw breakage, and cervical instability were observed. At 3 and 12 months after operation, the VAS score and NDI reduced significantly ( P<0.05); the JOA score increased significantly ( P<0.05); and the intervertebral space height and the cervical Cobb angle improved significantly ( P<0.05). But there was no significantly difference between at 3 and 12 months ( P>0.05). According to JOA evaluation, the results were excellent in 14 cases, good in 10 cases, and fair in 2 cases, with an excellent and
Vomiting and Dysphagia due to Fractured of Allograft after Anterior Cervical Discectomy and Fusion  [PDF]
Mehmet Arslan,?zcan H?z,Taner Yaz?c?,?etin Kotan
Journal of Clinical and Analytical Medicine , 2012, DOI: 10.4328
Abstract: Anterior servikal diskektomi ve füzyon servikal disk hastal nda yayg n olarak yap l r. Diskektomiden sonra fibula allograft yerle tirilmesi s kl kla uygulan r. Disfaji, dispne, bilateral vocal cord paralizisi, internal juguler ven z trombozis, servikal ve kemik greftin kmas , vasküler yaralanma ve epidural hematom gibi e itli komplikasyonlar anterior servikal diskektomi ve füzyondan (ACDF) sonra olu abilir. Disfaji ACDF%u2019 den sonra en yayg n komplikasyondur ve etiyolojisi hala karanl kt r. Bu komplikasyon genellikle 6 ay i inde düzelir, ama baz hastalar i in nemli bir problem olarak kal r. Greftin yerinden kmas da iyi tan mlanan bir komplikasyondur. Biz fibula allogreftin kmesine ba l persistan kusma ve disfaji ikayetlerine sahip 44 ya nda bayan bir hastay sunuyoruz. Olgu 7 ay nce klini imizde anterior yakla mla C5-6 diskektomi ve fibula greft ile füzyon ameliyat ge irmi ti. Onun lateral grafisinde, C5-6 seviyesinde greftin ktü ü ve kemik fragmanlar n n zofagusa do ru kt g rüldü. Cerrahiden sonar hastan n komplikasyonlar düzeldi. Disfaji anterior servikal diskektomiden sonra e itli nedenlerden dolay ok s kl kla rapor edilmesine ra men, bulant ve kusma hi bir zaman rapor edilmemi tir. Ayr ca kemik greftin kmesi nadiren rapor edilmi tir.
Three-level anterior cervical discectomy and fusion in elderly patients with wedge shaped tricortical autologous graft: A consecutive prospective series  [cached]
Lee Suk,Oh Kwang,Yoon Kwang,Lee Sung
Indian Journal of Orthopaedics , 2008,
Abstract: Background: Treatment of multilevel cervical spondylotic myelopathy/radiculopathy is a matter of debate, more so in elderly patients due to compromised physiology. We evaluated the clinical and radiological results of cervical fusion, using wedge-shaped tricortical autologous iliac graft and Orion plate for three-level anterior cervical discectomy in elderly patients. Materials and Methods: Twelve elderly patients with mean age of 69.7 years (65-76 years) were treated between April 2000 and March 2005, for three-level anterior cervical discectomy and fusion, using wedge-shaped tricortical autologous iliac graft and Orion plate. Outcome was recorded clinically according to Odom′s criteria and radiologically in terms of correction of lordosis angle and intervertebral disc height span at the time of bony union. The mean follow-up was 29.8 months (12-58 months). Results: All the patients had a complete recovery of clinical symptoms after surgery. Postoperative score according to Odom′s criteria was excellent in six patients and good in remaining six. Bony union was achieved in all the patients with average union time of 12 weeks (8-20 weeks). The mean of sum of three segment graft height collapse was 2.50 mm (SD = 2.47). The average angle of lordosis was corrected from 18.2° (SD = 2.59°) preoperatively to 24.9° (SD = 4.54°) at the final follow-up. This improvement in the radiological findings is statistically significant (P < 0.05). Conclusion: Cervical fusion with wedge-shaped tricortical autologous iliac graft and Orion plate for three-level anterior cervical discectomy is an acceptable technique in elderly patients. It gives satisfactory results in terms of clinical outcome, predictable early solid bony union, and maintenance of disc space height along with restoration of cervical lordosis.
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