Objective To evaluate the safety and effectiveness of anterior cervical discectomy and fusion (ACDF) by using zero-profile anchored cage (ZAC) in treatment of consecutive three-level cervical spondylosis, by comparing with plate-cage construct (PCC). Methods A clinical data of 65 patients with cervical spondylosis admitted between January 2020 and December 2022 and met the selection criteria was retrospectively analyzed. During consecutive three-level ACDF, 35 patients were fixed with ZAC (ZAC group) and 30 patients with PCC (PCC group). There was no significant difference in baseline data between the two groups (P>0.05), including gender, age, body mass index, surgical segment, preoperative Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), visual analogue scale (VAS) score, prevertebral soft tissue thickness (PSTT), cervical lordosis, and surgical segmental angle. The operation time, intraoperative blood loss, hospital stay, clinical indicators (JOA score, NDI, VAS score), and radiological indicators (cervical lordosis, surgical segmental angle, implant subsidence, surgical segment fusion, and adjacent segment degeneration), and the postoperative complications [swelling of the neck (PSTT), dysphagia] were recorded and compared between the two groups. Results Patients in both groups were followed up 24-39 months. There was no significant difference in follow-up duration between the two groups (P>0.05). The operation time and intraoperative blood loss were lower in ZAC group than in PCC group, and the length of hospital stay was longer, but there was no significant difference (P>0.05). At each time point after operation, both groups showed significant improvements in JOA score, VAS score, and NDI compared with preoperative scores (P<0.05), but there was no significant difference between the two groups at each time point after operation (P>0.05). Both groups showed an increase in PSTT at 3 days and 3, 6 months after operation compared to preoperative levels (P<0.05), but returned to preoperative levels at last follow-up (P>0.05). The PSTT at 3 days and 3 months after operation were significantly lower in ZAC group than in PCC group (P<0.05), and there was no significant difference between the two groups at 6 months and at last follow-up (P>0.05). The incidences of dysphagia at 3 days and 3 months were significantly lower in ZAC group than in PCC group (P<0.05), while no significant difference was observed at 6 months and last follow-up between the two groups (P>0.05). There was no postoperative complication in both groups including hoarseness, esophageal injury, cough, or hematoma. Both groups showed improvement in cervical lordosis and surgical segmental angle compared to preoperative levels, with a trend of loss during follow-up. The cervical lordosis loss and surgical segmental angle loss were significantly more in the ZAC group than in PCC group (P<0.05). The incidence of implante subsidence was significantly higher in ZAC group than in PCC group (P<0.05). There was no significant difference between the ZAC group and PCC group in the incidences of surgical segment fusion and adjacent segment degeneration (P>0.05). ConclusionIn consecutive three-level ACDF, both ZAC and PCC can achieve satisfactory effectiveness. The former can reduce the incidence of postoperative dysphagia, while the latter can better maintain cervical curvature and reduce the incidence of implant subsidence.
ObjectiveTo analyze the effectiveness of a new type of decellularized allogeneic bone in the application of anterior cervical discectomy and fusion (ACDF).
MethodsA retrospective analysis was made on the clinical data of 73 patients with single segmental cervical spondylosis treated with ACDF between January 2009 and December 2013. Of 73 cases, autologous iliac bone was used in 22 cases (group A), new decellularized allogeneic bone transplantation (Bio-Gene) in 22 cases (group B), and normal allogeneic bone (Xin Kang Chen) in 24 cases (group C). There was no significant difference in gender, age, type of cervical spondylosis, course of disease, and involved segment among 3 groups (P>0.05). The operation time, intraoperative blood loss, and complications were compared between groups; X-ray films and CT images were taken to observe the bone fusion, and Japanese Orthopaedic Association (JOA) score was used to assess the clinical efficacy.
ResultsThe operation time and intraoperative blood loss of group A were significantly more than those of groups B and C (P<0.05), but no significant difference was found between groups B and C (P>0.05). Pain and numbness at donor site occurred in 12 cases, and poor healing in 1 case of group A; red swelling and exudate were observed in 1 case of group B and in 6 cases of group C; and there was significant difference in complications among 3 groups (χ2=18.82, P=0.00). All patients were followed up 6-54 months (mean, 30 months). The graft fusion rate was 100% in groups A and B, and was 95.8% in group C, showing no significant difference (χ2=2.04, P=0.36). The JOA score at 6 months after operation were significantly improved when compared with preoperative score in 3 groups (P<0.05), but no significant difference was found among the 3 groups at preoperation and 6 months after operation (P>0.05). The excellent and good rates of groups A, B, and C were 90.9%, 88.9%, and 87.5% respectively, showing no significant difference (χ2=0.14, P=0.93).
ConclusionNew type of decellularized allogeneic bone in ACDF has the advantages of shorter operation time, less blood loss, and better early effectiveness. But whether there is a chronic rejection or delayed rejection needs further studies.
ObjectiveTo explore the surgical indication and summarize the experiences of anterior cervical discectomy and fusion (ACDF) for the treatment of cervical spondylosis.
MethodsSeventy-five cases of cervical spondylosis were treated with ACDF from January 2010 to October 2013, including 34 cases of cervical spondylotic radiculopathy and 41 cases of cervical spondylotic myelopathy. The pre/post-operative Japanese Orthopedic Association (JOA) score and imaging data were observed.
ResultsThirty-six patients were followed up for 6 to 25 months, with an average of 16 months. The mean JOA score before surgery was 10.67±2.66, and 3 months later, the score was 13.47±2.06. Six months later the score was 14.11±1.56, and after 12 months the score was 14.97±1.78. No spinal cord injury or esophagus, trachea injury occurred, and there was no superior laryngeal nerve and recurrent laryngeal nerve injury during the operation. Eight cases of postoperative dysphagia obviously decreased within 3-5 days, 6 cases decreased within 5-7 days, and 10 cases decreased within 3 weeks. And all 36 patients recovered within one month. There was no titanium mesh subsidence, displacement or titanium plate failure after operation.
ConclusionACDF is suitable for the decompression of spinal cord or nerve root which is compressed by the degenerated intervertebral disc, especially without rigid kyphosis, ossification of the posterior longitudinal ligament extending across multiple segments, and the compression located at the level of intervertebral disc. The appropriate approach can achieve a stable efficacy, less interference on the stability of the spine, and the incision heals fast. It is a kind of classic anterior cervical operation for it can reduce the complication effectively.
Objective To retrospectively analyze the long-term effectiveness of percutaneous laser disc decompression (PLDD) in treatment of cervical spondylosis. Methods Between March 2003 and June 2005, 156 patients with cervical spondylosis were treated with PLDD. There were 74 males and 82 females with an average age of 55.4 years (range, 31-74 years). The disease duration varied from 2 months to 15 years. Fifty-nine patients were classified as cervical spondyloticradiculopathy, 48 as vertebral-artery-type cervical spondylosis, 19 as cervical spondylotic myelopathy, and 30 as mixed type spondylosis. The lesions were located at the levels of C3,4 in 32 discs, C4,5 in 66 discs, C5,6 in 89 discs, and C6,7 in 69 discs, and including 71 one-leve lesion and 85 multi-level lesions. All cases were followed up to study the long-term effectiveness and correlative factors. Results A total of 117 (75%) patients’ symptoms were l ightened or eased up immediately after operation. Discitis occurred in 1 case at 3 days after operation and was cured after 3 weeks of antibiotic use. All patients were followed up 5 years to 7 years and 3 months (5 years and 6 months on average). According to Macnab criteria, the long-term effectiveness was excellent in 60 cases (38.46%), good in 65 cases (41.67%), fair in 19 cases (12.18%), and poor in 12 cases (7.69%); the excellent and good rate was 80.13%. No significant difference was observed in the wedge angels and displacements of the intervertebral discs between before and after operations (P gt; 0.05). Multiple-factors logistic regression showed that the disease duration and patient’s age had obvious relationship with the effectiveness of treatment (P lt; 0.05), while the type of cervical spondylosis, disc protrusion degree, mild cervical instabil ity, and lesion scope had no correlation with the effectiveness of treatment (P gt; 0.05). Conclusion PLDD is safe and effective in treatment of cervical spondylosis with less compl ication. There is no impact on the stabil ity in cervical spinal constructs. The disease duration and patient’s age have obvious impact on the long-term effectiveness of treatment. The type of cervical spondylosis, disc protrusion degree, cervical instabil ity, and lesion scope are not the correlative factors.
In the context of accelerated rehabilitation, nutritional support for patients with orthopedic cervical spondylosis is an important condition for lessening postoperative stress response, reducing postoperative complications, shortening patient’s length of hospital stay, lowering medical expenses, and promoting early recovery of patients. Based on this, West China Hospital of Sichuan University explored and established the West China Hospital program for nutritional management in cervical spondylosis from the aspects of team building, nutritional assessment and monitoring, and nutritional intervention.
Objective To investigate the effect difference between the Solis fixation fusion and the titanium plate fixation by the cervical anterior approach after decompression and bone graft implantation. Methods Of the 104 patients with cervical disease from September 2001 to March 2004, 36 were treated with the Solis implantation after decompression by the cervical anterior approach, and 68 were treated with the titanium plate fixation after decompression and bone graft implantation. The recovery of the neurological function in all the patients were assessed with the JOA Scoring at 6 weeks,3,6,12,24 and 36 months. The fragment fusion and its stability as well as the changes in the intervertebral height were assessed with X-ray examination. Results According to the JOA Scoring, the excellent and good outcomes accounted for 94.4% in the Solis group and 94.1% in the titanium plate group. In allthe patients, the fragment fusion was achieved in 3 months. The change in the Cobb angle of the fused fragment was less than 5° at the flexionextension posture, 3.6±0.8° in the Solis group, 2.4±0.7° in the titanium plate group. There was significant differences between the two groups(P＜0.05). The intervertebral height of the operation fragment in the Solis group increased 1.6±0.7mm, which was higher than that in the titanium plate group(P＜0.05). Conclusion Clinical effects of the two internalfixation operations are good; however, the Solis fixation has more advantages because of its simpler performance,less trauma, and fewer complications.
ObjectiveTo evaluate the efficacy and safety of Fugui ostealgia particles for cervical spondylosis (Yang-asthenia and cold-damp type).
MethodsFrom December 2010 to July 2011, we carried out a multi-centered, randomized, double-blind and double-simulation clinical observation study based on the Guiding Principles for the Clinical Research on New Chinese Traditional Medicine (TCM). A total of 240 patients were divided into experimental group and control group with the number of patients at a ratio of 3:1. The treatment group (n=180) was treated by Fugui ostealgia particles, while patients in the control group (n=60) received Kangguzengsheng capsules. The treatment course lasted for 90 days.
ResultsThe total effective rate in the experimental group was 92.44%, and was 75.47% in the control group, with a significant difference between the two groups (P<0.05). The total effective rate for TCM syndromes was significantly different between the two groups (P<0.05). The effect on main symptoms such as nuchal pain, aversion to cold, and cold hands and feet, was significantly different between the two groups (P<0.05). Laboratory test results showed no abnormality before and after treatment, and no drug-related adverse reactions occurred.
ConclusionFugui ostealgia particles are safe and effective for the treatment of Yang-asthenia and cold-damp type cervical spondylosis, especially for the treatment of nuchal pain, aversion to cold, and cold hands and feet.
The incidence of perioperative sleep disorders in patients with cervical spondylosis is high, which affects the physiological and psychological rehabilitation effect of patients after surgery. The expert consensus (preliminary draft) was prepared by summarizing expert experience and recommendations. After expert review and revision, the consensus was formed. The consensus was developed based on existing evidence-based medical evidence and expert clinical experience, which is scientific and practical and can provide a basis for clinical medical personnel to prevent and treat perioperative sleep disorders in patients with cervical spondylosis.
Objective To evaluate the long-term effect of excessive length of bone graft via anterior cervical approach and over distraction of intervertebral space on cervical curvature and postoperative neck axial symptom (AS). Methods FromJune 2001 to June 2004, 30 patients with nerve root cervical spondylosis at the C5,6 level underwent anterior cervicaldecompression, autogenous il iac bone graft and internal fixation with titanium plate. There were 14 males and 16 females aged 32-73 years old (average 54.7 years old), and the course of disease was 1-31 months (average 7 months). No instabil ity of cervical vertebrae was noted on the cervical dynamic position x-ray films. Intervertebral height was measured immediately after operation, and accordingly the patients were divided into two groups: the over distraction group (n=11), in which the length of bone graft was excessive, the intervertebral space was over distracted, and the intervertebral height was increased by more than 3 mm compared with the preoperative value; the proper distraction group (n=19), in which the length of bone graft was proper, no over distraction of the intervertebral space occured, and the intervertebral height was increased by less than 3 mm compared with the preoperative value. Regular X-ray exams were performed 1 week and 3, 24, and 48 months after operation to analyze bone fusion condition of the grafted bone, changes of the intervertebral height of the fused segments, and variation of physiological curvature of the cervical vertebra. The postoperative neck AS was evaluated according to the the neck AS evaluation criteria set by ZENG Yan and co-workers. Results All patients were followed up for 48-66 months (average 54.5 months). Cl inical symptoms were el iminated in all cases. No compl ications occurred in the proper distraction group; 1 patient of the over distraction group had ostoperative nerve root paralysis at C5 level, and recovered 3 months after proactive treatment. Bone fusion was achieved in all patients 3-6 months after operation, except for 1 case in the proper distraction group suffering from non-fusion 12 months after operation. There was no occurrence of loosening or breakage of steel plate and screw, and no displacement of the grafted bone. At 48 months after operation, the intervertebral height of the proper distraction group and the over distraction group was increased by (1.9 ± 1.8) mm and (3.5 ± 2.7) mm, respectively, when compared with the preoperativevalue (P gt; 0.05). The physiological curvature of the operated cervical segment was well maintained. The curvature of the proper distraction group and the over distraction group at the final follow-up visit was increased by (2.17 ± 1.83)° and (3.32 ± 2.71)°, respectively, when compared with the preoperative value (P gt; 0.05). The physiological curvature of the whole cervical vertebra at the final follow-up visit was increased by (4.57 ± 3.71)° in the proper distraction group and decreased by (2.43 ± 2.13)° in the over distraction group, when compared with the preoperative value (P lt; 0.05). The incidence rate of postoperative neck S at 48 months after operation was 15.79% in the proper distraction group (11 cases excellent, 5 cases good, 3 cases fair) and 54.55% in the over distraction group (3 cases excellent, 2 cases good, 5 cases fair, 1 case poor), showing a significant difference between two groups (P lt; 0.05). Conclusion Excessive length of bone graft via anterior cervical approach and over distraction of intervertebral space are bad for maintaining the physiological curvature of the whole cervical vertebra, and increase the incidence of postoperative neck AS. Selection of bone graft at the proper height is essential in anterior cervical operation.
Objective
To evaluate the early outcome of anterior cervical discectomy and fusion (ACDF) using a Zero-profile implant system (Zero-P) for interbody fusion in the treatment of cervical spondylosis.
Methods
Between March 2010 and June 2011, 25 patients with cervical spondylosis underwent ACDF with Zero-P. There were 13 males and 12 females with an average age of 44.2 years (range, 26-67 years), including 14 cases of nerve root cervical spondylosis, 6 cases of spinal cervical spondylosis, and 5 cases of mixed cervical spondylosis. The disease duration was 3-120 months (median, 25 months). Single segment was involved in 20 cases, 2 segments in 4 cases, and 3 segments in 1 case. A total of 31 Zero-P were implanted (3 at C3, 4, 8 at C4, 5, 12 at C5, 6, and 8 at C6, 7). Primary cervical operation was performed in 23 cases and re-operation in 2 cases. Before and after operation, the height of intervertebral space and the cervical Cobb angle were measured; clinical outcome was evaluated using visual analogue scale (VAS) score for pain in the neck and upper limb, and Japanese Orthopaedic Association (JOA) score for myelopathy; and intervertebral fusion and the incidence of dysphagia were also observed.
Results
All incisions healed by first intention. All the patients were followed up 12-16 months (mean, 13.9 months). Interbody bone fusion was obtained, and the fusion time was 2.7-6.0 months (mean, 3.8 months). Three patients had dysphagia after operation; symptom disappeared at 1 week and 3 months after operation in 2 cases and 1 case, respectively. No fixation loosening, subsidence, or breakage occurred. The height of intervertebral space was significantly improved (P lt; 0.05) from (4.5 ± 0.5) mm at preoperation to (6.0 ± 0.7) mm at 1 week and (5.7 ± 0.6) mm at 12 months after operation; the cervical Cobb angle was significantly improved (P lt; 0.05) from (11.9 ± 6.1)° at preoperation to (21.2 ± 4.1)° at 1 week and (20.2 ± 3.7)° at 12 months after operation; and there was no significant difference between at 1 week and 12 months after operation (P gt; 0.05). The VAS score was significantly reduced (P lt; 0.05) from 7.1 ± 0.8 at preoperation to 1.9 ± 0.8 at 3 months and 1.0 ± 0.5 at 12 months after operation; the JOA score was significantly increased (P lt; 0.05) from 9.6 ± 1.3 at preoperation to 13.5 ± 1.0 at 3 months and 14.9 ± 1.0 at 12 months after operation; and there was significant difference between at 3 months and at 12 months after operation (P lt; 0.05).
Conclusion
The early outcome of ACDF using a Zero-P in the treatment of cervical spondylosis is satisfactory and reliable, and it can restore and maintain the cervical alignment and disc height, and disc has low incidence of postoperative dysphagia.
