Anterior cervical discectomy and fusion involving a polyetheretherketone spacer and bone morphogenetic protein

2005 ◽  
Vol 2 (5) ◽  
pp. 521-525 ◽  
Author(s):  
Maxwell Boakye ◽  
Praveen V. Mummaneni ◽  
Mark Garrett ◽  
Gerald Rodts ◽  
Regis Haid
Keyword(s):  
Bone Morphogenetic Protein ◽  
Clinical Outcomes ◽  
Anterior Cervical Discectomy ◽  
Cerebrospinal Fluid Leakage ◽  
Content Type ◽  
Cervical Discectomy ◽  
Morphogenetic Protein ◽  
Flexion Extension ◽  
Fine Print

Object. The authors reviewed clinical and radiographic outcomes in patients who had undergone anterior cervical discectomy and fusion (ACDF) involving the placement of polyetheretherketone (PEEK) spacers filled with recombinant human bone morphogenetic protein (rhBMP)—2. Methods. Data obtained in 24 cases were retrospectively evaluated. The follow-up period ranged from 12 to 16 months (mean 13 months). Fifteen patients presented with radiculopathy, eight with myeloradiculopathy, and one with quadriparesis. Single-level ACDF was performed in 12 patients, two-level ACDF in nine, and three-level ACDF in three. Clinical outcomes were assessed using Odom criteria, and fusion was assessed by examining flexion—extension radiographs and computerized tomography scans in cases in which arthrodesis was questionable. Follow-up data were available for 23 patients. One patient died of medical complications unrelated to surgery 4 weeks after ACDF. Clinical outcomes were rated as good/excellent in 22 patients (95%) and fair in one (5%). Solid radiographically documented fusion, with evidence of solid bridging bone and no instability on flexion—extension x-ray films, was present in all cases. Complications included transient recurrent laryngeal nerve injury in one case, transient C-5 paresis in one, cerebrospinal fluid leakage in one, and transient dysphagia in two. Conclusions. Analysis of the results indicated that ACDF involving an rhBMP-2—filled PEEK spacer leads to good clinical outcomes (by Odum criteria) and solid fusion (even in multilevel cases) while avoiding the complications associated with harvesting iliac crest bone grafts.

Anterior cervical discectomy without interbody bone graft

1972 ◽  
Vol 37 (1) ◽  
pp. 71-74 ◽  
Author(s):  
Michael G. Murphy ◽  
Mokhtar Gado
Keyword(s):  
Bone Graft ◽  
Clinical Result ◽  
Anterior Cervical Discectomy ◽  
Incomplete Fusion ◽  
Cervical Disc ◽  
Content Type ◽  
Cervical Discectomy ◽  
Good Clinical Result ◽  
Fine Print

✓ Twenty-six patients had anterior cervical discectomy without interbody bone graft for lateral cervical disc syndrome. Twenty-four (92%) had a good clinical result. Radiological follow-up was obtained in 20 cases. The incidence of fusion was 72% for discectomy at a single level. Patients undergoing discectomy at two adjacent levels were too few to permit a statement regarding the incidence of fusion. In those cases of incomplete fusion, dynamic films demonstrated stability at the operated site. Half of the cases who had posterior osteophytes preoperatively showed some degree of resorption after 12 months. Neither incomplete fusion nor failure of osteophyte resolution was incompatible with a good clinical result.

Implantation of an empty carbon fiber composite frame cage after single-level anterior cervical discectomy in the treatment of cervical disc herniation: preliminary results

2003 ◽  
Vol 98 (2) ◽  
pp. 143-147 ◽  
Author(s):  
Michael Payer ◽  
Daniel May ◽  
Alain Reverdin ◽  
Enrico Tessitore
Keyword(s):  
Disc Herniation ◽  
Fiber Composite ◽  
Anterior Cervical Discectomy ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Carbon Fiber Composite ◽  
Content Type ◽  
Cervical Discectomy ◽  
Fine Print

Object. The authors sought to evaluate retrospectively the radiological and clinical outcome of anterior cervical discectomy followed by implantation of an empty carbon fiber composite frame cage (CFCF) in the treatment of patients with cervical disc herniation and monoradiculopathy. Methods. Twenty-five consecutive patients (12 men, 13 women, mean age 45 years) with monoradiculopathy due to cervical disc herniation were treated by anterior cervical discectomy followed by implantation of an empty CFCF cage. On lateral flexion—extension radiographs segmental stability at a mean follow up of 14 months (range 5–31 months) was demonstrated in all 25 patients, and bone fusion was documented in 24 of 25 patients. The mean anterior intervertebral body height was 3.4 mm preoperatively and 3.8 mm at follow up in 20 patients. In these patients the mean segmental angle (angle between lower endplate of lower and upper vertebra) was 0.9° preoperatively and 3.1° at follow up. In the remaining five patients preoperative images were not retrievable. Self-scored neck pain based on a visual analog scale (1, minimum; 10, maximum) changed from a preoperative average of 5.6 to an average of 2 at follow up; radicular pain was reduced from 7.7 to 2.1 postoperatively. Analysis of the SF12 questionnaires showed a significant improvement in both the physical capacity score (preoperative mean 32.4 points; follow up 46 points) and the mental capacity score (preoperative mean 45.8 points; follow up 57.5 points). Conclusions. Implantation of an empty CFCF cage in the treatment of cervical disc herniation and monoradiculopathy avoids donor site morbidity associated with autologous bone grafting as well as the use of any supplementary material inside the cage. Restoration or maintenance of intervertebral height and thus segmental lordosis and a very high rate of segmental stability and fusion are achieved using this technique.

Radiographic and clinical outcomes following single-level anterior cervical discectomy and allograft fusion without plate placement or cervical collar

2008 ◽  
Vol 8 (5) ◽  
pp. 420-428 ◽  
Author(s):  
Jay Jagannathan ◽  
Christopher I. Shaffrey ◽  
Rod J. Oskouian ◽  
Aaron S. Dumont ◽  
Christian Herrold ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Anterior Cervical Discectomy ◽  
Radiographic Evidence ◽  
Disc Space ◽  
Cervical Discectomy ◽  
Single Level ◽  
Flexion Extension ◽  
The Mean ◽  
Graft Migration

Object Although the clinical outcomes following anterior cervical discectomy and fusion (ACDF) surgery are generally good, 2 major complications are graft migration and nonunion. These complications have led some to advocate rigid internal fixation and/or cervical immobilization postoperatively. This paper examines a single-surgeon experience with single-level ACDF without use of plates or hard collars in patients with degenerative spondylosis in whom allograft was used as the fusion material. Methods The authors conducted a retrospective review of a prospective database of (Cloward-type) ACDF operations performed by the senior author (J.A.J.) between July 1996 and June 2005. Radiographic follow-up included static and flexion/extension radiographs obtained to assess fusion, focal and segmental kyphosis, and change in disc space height. At most recent follow-up, the patients' condition was evaluated by an independent physician examiner. The Odom criteria and Neck Disability Index (NDI) were used to assess outcome. Results One hundred seventy patients underwent single-level ACDF for degenerative pathology during the study period. Their most common presenting symptoms were pain, weakness, and radiculopathy; 88% of patients noted ≥ 2 neurological complaints. The mean hospital stay was 1.76 days (range 0–36 days), and 3 patients (2%) had major immediate postoperative complications requiring reoperation. The mean duration of follow-up was 22 months (range 12–124 months). Radiographic evidence of fusion was present in 160 patients (94%). Seven patients (4%) showed radiographic evidence of pseudarthrosis, and graft migration was seen in 3 patients (2%). All patients had increases in focal kyphosis at the operated level on postoperative radiographs (mean −7.4°), although segmental alignment was preserved in 133 patients (78%). Mean change in disc space height was 36.5% (range 28–53%). At most recent clinical follow-up, 122 patients (72%) had no complaints referable to cervical disease and were able to carry out their activities of daily living without impairment. The mean postoperative NDI score was 3.2 (median 3, range 0–31). Conclusions Single-level ACDF without intraoperative plate placement or the use of a postoperative collar is an effective treatment for cervical spondylosis. Although there is evidence of focal kyphosis and loss of disc space height, radiographic evidence of fusion is comparable to that attained with plate fixation, and the rate of clinical improvement is high.

Anterior cervical arthrodesis using DOC dynamic stabilization implant for improvement in sagittal angulation and controlled settling

2003 ◽  
Vol 98 (1) ◽  
pp. 8-13 ◽  
Author(s):  
Bikash Bose
Keyword(s):  
Anterior Cervical Discectomy ◽  
Related Complication ◽  
Common Procedure ◽  
Content Type ◽  
Cervical Discectomy ◽  
Arm Pain ◽  
Advantages And Disadvantages ◽  
Cervical Spondylotic Radiculopathy ◽  
Donor Graft ◽  
Fine Print

Object. Placing instrumentation in the anterior cervical spine is a common procedure. The bi- and unicortical systems currently available, however, have distinct advantages and disadvantages. The author reports a prospective series in which a new dynamized anterior cervical fixation system was evaluated. Methods. Thirty-seven patients underwent anterior cervical discectomy and fusion in which the DOC ventral cervical stabilization system was used for indications including cervical spondylotic radiculopathy, disc herniation, trauma, and myelopathy. Patients underwent anterior cervical discectomy and interbody fusion and/or corpectomy. Preoperative and postoperative clinical data included assessment of spinal cord and nerve root deficit, function, neck pain, and arm pain. Preoperative and postoperative radiographic data included sagittal angle, translation, and settling of the graft. Fusion status was determined by the presence of trabecular bridging bone on plain anteroposterior and lateral cervical radiographs. At a mean follow-up time of 1.3 years, postoperative neck or arm pain was resolved in 52% of the patients, restriction on function was mild or absent in 88%, and fusion was successful in 80% of patients and 88% of the treated levels. There was one implant-related complication, one significant dysphagia complication, and a 10.8% donor graft site complication rate. Conclusions. The use of this system led to a high percentage of pain relief and radiographic fusion. The sagittal angle was controlled while allowing for graft settling. There were no implant failures.

Bilateral vocal cord paralysis following anterior cervical discectomy and fusion

1998 ◽  
Vol 89 (5) ◽  
pp. 839-843 ◽  
Author(s):  
Thomas J. Manski ◽  
Michael D. Wood ◽  
Stewart B. Dunsker
Keyword(s):  
Vocal Cord ◽  
Surgical Procedure ◽  
Vocal Cord Paralysis ◽  
Anterior Cervical Discectomy ◽  
Neurosurgical Procedures ◽  
Bilateral Vocal Cord Paralysis ◽  
Content Type ◽  
Cervical Discectomy ◽  
Unilateral Vocal Cord Paralysis ◽  
Fine Print

✓ The authors report a rare case of bilateral vocal cord paralysis following anterior cervical discectomy and fusion (ACD/F) in a patient who had a preexisting, clinically silent, and unrecognized unilateral vocal cord paralysis from a remote cardiac surgical procedure. The patient, a 41-year-old woman who developed acute respiratory stridor and respiratory insufficiency at the time of extubation after undergoing a C6–7 ACD/F, required emergency reintubation and ventilation. Otolaryngological evaluation revealed bilateral vocal cord paralysis with one vocal cord showing evidence of acute paralysis and the other showing evidence of chronic paralysis. She eventually required a permanent tracheotomy. The patient had undergone previous cardiac surgical procedures to correct Fallot's tetralogy as a neonate and as a child. At those times, there were no recognized symptoms of transient or permanent vocal cord dysfunction. This case emphasizes the importance of identifying patients with preexisting unilateral vocal cord paralysis before performing neurosurgical procedures such as ACD/F, which can place the only functioning vocal cord at risk for paralysis. Guidelines for identifying patients with preexisting unilateral vocal cord paralysis and for modifying the surgical procedure for ACD/F to prevent the catastrophic complication of bilateral vocal cord paralysis are discussed.

Anterior cervical discectomy without bone graft

1977 ◽  
Vol 47 (4) ◽  
pp. 551-555 ◽  
Author(s):  
Donald H. Wilson ◽  
Dwight D. Campbell
Keyword(s):  
Bone Graft ◽  
Bone Grafting ◽  
Anterior Cervical Discectomy ◽  
Cervical Disc ◽  
Content Type ◽  
Cervical Discectomy ◽  
Without Bone Graft ◽  
Fine Print

✓ Anterior cervical discectomy without bone grafting may become the procedure of choice for acute cervical disc protrusions. This operation was performed on 71 patients, all of whom were followed from 1 to 6 years. Complications were minor in nature. The results were excellent and sustained.

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