Aims. Surgical approaches to cervical ossification of the posterior longitudinal ligament (OPLL) remain controversial. The purpose of the present study was to analyze and compare the long-term neurological recovery following anterior decompression with fusion (ADF) and posterior laminectomy and fusion with bone graft and internal fixation (PLF) based on > ten-year follow-up outcomes in a single centre. Methods. Included in this retrospective cohort study were 48 patients (12 females; mean age 55.79 years (SD 8.94)) who were diagnosed with cervical OPLL, received treatment in our centre, and were followed up for 10.22 to 15.25 years. Of them, 24 patients (six females; mean age 52.88 years (SD 8.79)) received ADF, and the other 24 patients (five females; mean age 56.25 years (SD 9.44)) received PLF. Clinical data including age, sex, and the OPLL canal-occupying ratio were analyzed and compared. The primary outcome was Japanese Orthopaedic Association (JOA) score, and the secondary outcome was visual analogue scale neck pain. Results. Compared with the baseline, neurological function improved significantly after surgery in all patients of both groups (p < 0.001). The JOA recovery rate in the ADF group was significantly higher than that in the PLF group (p < 0.001). There was no significant difference in postoperative cervical pain between the two groups (p = 0.387). The operating time was longer and intraoperative blood loss was greater in the PLF group than the ADF group. More complications were observed in the ADF group than in the PLF group, although the difference was not statistically significant. Conclusion. Long-term neurological function improved significantly after surgery in both groups, with the improvement more pronounced in the ADF group. There was no significant difference in postoperative neck pain between the two groups. The operating time was shorter and intraoperative blood loss was lower in the ADF group; however, the incidence of perioperative complications was higher. Cite this article: Bone Jt Open 2024;5(9):768–775

The February 2013 Spine Roundup. 360 . looks at: complications with anterior decompression and fusion; lumbar claudication and peripheral vascular disease; increasing cervical instability in rheumatoids; kyphoplasty; cervical stenosis; exercise or fusion for chronic lower back pain; lumbar disc arthroplasty and adjacent level changes; and obese disc prolapses

A retrospective review, comparing outcome following circumferential versus anterior decompression and fusion for patients with cervical spondylotic myelopathy (CSM). To assess the safety and efficacy of the circumferential operation for CSM. Cervical spondylotic myelopathy has traditionally been managed by anterior or posterior decompression with/ without fusion. However, there is a considerable variation in neurological recovery and clinical outcome following these procedures. While circumferential decompression and fusion has been shown to provide superior neurological outcome in selected patients with cervical trauma and tumours, its role in the management of CSM has yet to be clearly defined. Fifteen patients who underwent a 360° operation (Groupl) for CSM were matched (age, number of levels operated and follow-up duration) with patients (Group 2, n=15), that underwent anterior decompression and fusion for the same problem. All patients were operated by a single surgeon and reviewed independently. Charts, radiographs, patient interviews and MODEMS Cervical Spine Outcome questionnaires were the basis for assessment. The operative time, blood loss, in-hospital stay and post-operative complications were higher in group l. The pseudoarthrosis rate was comparable though a trend towards increased graft and hardware problems was noted in group 2. Neurological improvement as measured by the mJOA Myelopathy Scale was significantly better (p = 0. 039) in group 1. 87% of those in group1 and 67% in group 2 showed improved function. Patients in group1 also performed better (p=0. 056) in the neurological domain and treatment expectation scales of the cervical spine questionnaire, though the incidence of post-op, neck pain was higher. Single stage circumferential spinal decompression and fusion permits consistent neurological recovery in selected patients with cervical spondylotic myelopathy and it can be performed with limited morbidity

Patient presenting with clinically significant cervical spinal cord compression have a variety of surgical strategies that may be appropriate. The common denominator for successful intervention is satisfactory decompression of the neural elements, while avoiding early or late complications. In general, one may think of situations with one or two motion segment involvement versus three or more foci of compression. As most applicable cervical pathology causes anterior cord compression, the logic of direct anterior decompression is very compelling. Thus anterior decompression and fusion procedures have been the mainstay of treatment in many quarters. On the other hand, complications with graft healing or displacement, speech and swallowing disturbance, etc. remain an issue. This is especially true for multi-level disease. Under these circumstances, indirect decompression with posterior surgery plays an important role. Laminoplasty, and to a lesser degree laminectomy and fusion, may prove every bit capable of spinal cord decompression and often with fewer complications. Each case must be evaluated on its own merits and the procedure chosen to optimize the likelihood of success

Introduction. Aim was to compare the functional outcome of anterior cervical decompression and fusion (ACDF) with stand-alone tricotical iliac crest auto graft verses stand-alone PEEK cage. Material and methods. Prospectively collected data of 60 patients in each group was compared. Results. There was statistically significant improvement noted in postoperative Modified Japanese Orthopaedic Association scores at one year follow up for both the groups. Perioperative complications were significantly higher in the autograft group when compared with the PEEK cage group. Among the 94 patients who underwent single level non-instrumented ACDF only 4 (4.25%) had psuedoarthrosis. The fusion rate for single level ACDF in our series was 95.74%. Among the 25 patients operated for two level non-instrumented ACDF, 6 patients (24.00%) had pseudoarthrosis. The fusion rate for two levels ACDF in our series is 76.00%. There was no significant difference in fusion rates of the PEEK cage when compared to auto graft group. Conclusion. Fusion rates in ACDF are independent of interbody graft material. Fusion rates for single level ACDF is significantly higher than two levels ACDF. ACDF with PEEK is the fusion technique of choice with fewer complications and better functional recovery

Introduction. Aim was to compare the functional outcome of anterior cervical decompression and fusion (ACDF) with stand-alone tricotical iliac crest auto graft verses stand-alone PEEK cage. Material and methods. Prospectively collected data of 60 patients in each group was compared. Results. There was statistically significant improvement noted in postoperative Modified Japanese Orthopaedic Association scores at one year follow up for both the groups. Perioperative complications were significantly higher in the autograft group when compared with the PEEK cage group. Among the 94 patients who underwent single level non-instrumented ACDF only 4 (4.25%) had psuedoarthrosis. The fusion rate for single level ACDF in our series was 95.74%. Among the 25 patients operated for two level non-instrumented ACDF, 6 patients (24.00%) had pseudoarthrosis. The fusion rate for two levels ACDF in our series is 76.00%. There was no significant difference in fusion rates of the PEEK cage when compared to auto graft group. Conclusion. Fusion rates in ACDF are independent of interbody graft material. Fusion rates for single level ACDF is significantly higher than two levels ACDF. ACDF with PEEK is the fusion technique of choice with fewer complications and better functional recovery

Anterior decompression and fusion has been standard treatment for cervical disc herniation and myelopathy with disc degeneration. Since cervical total disc replacement (TDR) has been introduced with early favorable results and ideal mechanism, it has gained its popularity recently. But varying degrees of heterotopic ossification (HO) around the operated segment have been noted in the literatures. The theoretical advantages of TDR are the maintenance of intervertebral motion and prevention of adjacent segment degeneration. It is questionable that if HO occurs after TDR, mobility of operated segments would be restricted then clinical outcome worse. Purpose of this study is to determine prevalence of HO and to investigate that the presence of HO would limit motion and subsequently negatively affect clinical outcome following cervical TDR. We analyzed 29 patients (30 levels) who were treated with cervical TDR by 2 spine specialists using 4 types of prostheses (Mobi-C: 13 levels, ProDisc: 10, Bryan: 5, Prestige LP: 2) consecutively from July 2004 to June 2007. Postoperative mean follow-up period was 21.4 (12–36) months. We assessed presence of HO and segmental ROM radiographically and clinical outcome by VAS, ODI after 1.5, 3, 6 months, and every year postoperatively in principle. All subjects were divided by 3, which were group A (no HO, McAfee class 0), group B (class I and II), and group C (class III and IV), then compared with each other. HO was detected on 14 levels (46.7%) in the 30 levels after at mean of 8.2 (4–18) months after operation. There were 15 levels(53.3%) of group A (no HO, class 0), 7 levels of group B (class I HO:3, II: 4), and 7 levels of group C (class III: 3, IV: 4). Segmental flexion-extension ROM of group A was 10.1 (5.6–16.2)°, group B is 8.3 (3.5–14.4)°, and group C is 3.1 (0.0–6.6)° (p< 0.001, multiple comparison test with post hoc Bonferroni correction). And no difference in the clinical outcomes, VAS and ODI, was found compared with each other among group A, B, and C (p> 0.05). Nonetheless, longer term follow-up should be performed to investigate whether clinical outcomes would be changed and occur adjacent level degeneration as time goes on. In addition, further study for prevention of HO may be needed as in HO of other joint replacement surgery not to lose superior mechanism to fusion treatment

Purpose: When we treat burst fractures, we try to preserve the movable vertebra as much as possible and see to it that the instrument can be extracted finally. We have performed short-segment posterior spinal instrumentation and fusion (PSIF) for cases with no neurological symptoms, and combined short-segment posterior spinal instrumentation and fusion with anterior decompression and fusion (PSIF with AF) for cases with obvious neurological symptoms. In this report, we review the postoperative results of our methods. Methods: We have operated on 18 cases of burst fracture in the past seven years, eleven of them, who had been treated with PSIF (attachment of one level above the fracture to one level below the fracture), were selected for the subjects of the investigation. They consisted of 7 males and 4 females. The average age was 42 years and the mean follow-up of the postoperative image findings was one year and six months (range, eight months to two years and ten months). The number of the cases by traumatic ascensus was T11: 1, T12: 2, L1: 5, L2: 2. Among them, seven cases underwent PSIF. All the cases were operated on with a pedicle screw in combination with a hook. Four cases underwent PSIF with AF. In these cases, only a pedicle screw was used for the posterior, and only the bone transplantation after decompression was done for the anterior. For all cases, the angulation, alignment, and compliance were measured and examined before and after the operation using lateral radiographs, in addition to degree of improvement in the neurological symptoms. Result: Preoperatively, the results of these cases showed that PSIF and PSIF with AF tend to cause larger damage to all of angulation, alignment, and compliance. Postoperatively, the difference in values between PSIF and PSIF with AF was small, and both groups maintained their respective values even with time. Based on the preoperative Frankel classification, the numbers of the cases undergoing PSIF were C: 1, D: 3, and E: 3. The numbers of the cases undergoing PSIF with AF were B: 1, C, 2, and E: 1. Improvement of one stage was seen in three cases undergoing PSIF. Improvement of two stages was seen in two cases undergoing PSIF with AF. No case showed postoperative deterioration of the neurological symptoms. Conclusion: We perform PSIF with no neurological symptoms. In these cases, a pedicle screw and a hook are installed in the same vertebral body and arch to reduce the load on the pedicle screw and prevent the pedicle screw damage. AF is performed together with PSIF, and decompression is done surely for cases with obvious neurological symptoms. In these cases, a pedicle screw is used solely and no hook is used because there is a transplant bone as the prop in the anterior. At the moment, we cannot refer to the occurrence of kyphosis transformation in the future for lack of sufficient cases and length of the observation period. However, it was suggested that cases with no neurological symptoms could be treated with PSIF solely

Background: Cervical myelopathy and radiculopathy has been treated commonly with anterior cervical decompression and fusion with autologous bone graft and anterior cervical plating. Long term results have shown excellent pain relief and 73%–90% fusion rates. However, the development of late adjacent-level disease has been reported following anterior cervical arthrodesis which recently have been correlated to clinical findings. The Bryan disc arthroplasty device was developed to preserve the kinematics of the functional spine unit thus preventing adjacent level disease. There have been few studies comparing the incidence of adjacent level changes in patients undergoing ACDF compared to implantation of a Bryan disc arthroplasty device. Objectives: The object of this study is to compare the clinical results and radiographic outcomes of anterior cervical decompression and fusion versus cervical disc replacement using the Bryan Cervical Disc Prosthesis (Medtronic Sofamor Danek, Memphis, TN) in terms of overall range of motion (ROM) of the cervical spine; ROM, anterior intervertebral height (AIH), posterior intervertebral height (PIH) and radiographic changes at the implanted and adjacent levels. Methods: The study consisted of 105 patients with symptomatic single or two-level cervical disc disease. Fifty-one received the Bryan Cervical Artificial Disc Prosthesis (Medtronic Sofamor Danek, Memphis, TN). A total of 63 Bryan disc were placed in these 51 patients. A single-level procedure was performed in 39 patients and a two-level procedure in the other twelve. The patient group who underwent ACDF totaled 54 patients which consisted of 26 single level cases and 28 double level cases. The Bryan group had a mean follow-up 19 months (12–38). The mean follow-up for the ACDF group was 20 months (12–40 months). All patients were evaluated using static and dynamic cervical spine radiographs as well as MR imaging. All patients underwent anterior cervical discectomy followed by anterior cervical plating or implantation of the Bryan artificial disc prosthesis, done by one surgeon. Clinical evaluation included the visual analogue scale (VAS), and neck disability index (NDI). Radiographic evaluation included static and dynamic flexion-extension radiographs in an upright position using the computer software (Infinitt PiviewSTAR 5051) program. Range of motion/disc space angle and inter vertebral height were measured at the operative site and adjacent levels. Functional spinal unit (FSU) and overall sagittal alignment (C2–C7) were also measured pre-operatively, postoperatively and at final follow-up. ROM was calculated for all 3 areas and data collected were compared from pre operative to last follow-up as well as between the two groups. Radiographic assessment for adjacent level changes was also done. Radiologic change was analyzed using chi square test (95% confidence interval). Other data were analyzed using the mixed model. (SAS enterprise guide 4.1 version). Results: There was clinical improvement within each group in terms of VAS and NDI scores from pre-op to final follow-up for both single (VAS: p=0.8371, NDI: p=0.2872) and double (VAS: p=0.2938, NDI: p=0.6753) level surgeries but not significantly between the two groups. Overall, ROM and intervertebral height was relatively well maintained during the follow-up in the Bryan group compared to ACDF. Comparing the pattern of ROM measurements from pre-op to final follow-up between the two arms regardless of the number of levels operated on; significant differences were noted for overall ROM of the cervical spine (p< .0001) and all other levels except at the upper level for single level surgeries (p=0.2872). In terms of inter vertebral height measurements from pre-op to final follow-up, statistically significant (p< 0.0001 and p=0.0172) differences in the pattern between the two groups were noted at all levels except for the AIH of single level surgeries at the upper (p=0.1264) and lower (p=0.7598) levels as well as PIH for double level surgeries at the upper (p=0.8363) level. Radiologic change was 3.5 times more observed for the ACDF group compared to the Bryan group. Conclusion: Clinical status of both groups, regardless of the number of levels, showed improvement. Although clinical outcomes between the two groups were not significantly different at final follow-up, radiographic parameters, namely ROM and intervertebral heights at the operated site, some adjacent levels as well as FSU and overall sagittal alignment of the cervical spine were relatively well maintained in our Bryan group compared to our ACDF group. We surmise that to a certain degree, the maintenance of these parameters could contribute to reduce development of adjacent level change. Noteworthy is that radiographic change was 3.5 times more observed for ACDF surgeries. A longer period of evaluation is needed, to see if all these radiographic changes will translate to symptomatic adjacent level disease

Injuries of the cervical spine can be classified into six categories according to a mechanistic system describing the biomechanical deficiencies incurred in a cervical spine injury. However high velocity flexion compression loads cause multiple contiguous and noncontiguous fractures due to multiple force vectors. A universal classification system cannot be applied. Instability exists if there is greater than 3.5 mm of translation or greater than 11 degrees of angulation as compared to other segments. The degree of ligamentous injury on MRI correlates with instability in patients with lateral mass facet fractures, with rupture of multiple ligaments including the anterior longitudinal, posterior longitudinal, interspinous, or facet capsule. Patients with less than 13 mm of narrowing of the sagittal canal are predisposed to neurologic injury. Vertical compression injuries cause canal occlusion and vertebral column shortening. The timing of surgery in cases of spinal cord injury is controversial. There is no difference in outcome between early (< 72 hours) and late (> 5 days) surgery. However, there remains at least a theoretical benefit to early surgery. Compression-flexion injuries result in loss of the anterior column by compression followed by the posterior column in distraction. The injury is considered unstable if there is a vertical cleavage fracture of the vertebral body or displacement. Treatment includes a cervical orthosis or halo for minor injuries, depending on the degree of kyphosis. Major injuries with displacement should be treated surgically by anterior corpectomy and plate or an anterior/posterior fusion, depending on the degree of posterior instability. The most common level of vertical-compression injuries is at the C6 or C7 level. Minimally displaced injuries can be treated with a collar or halo. Fragmentation and peripheral displacement of the bony fragments needs a halo followed by surgery and this may include an anterior corpectomy and plating. Distraction-flexion injuries may result in facet sub-luxation with less than 25% displacement, or dislocation of one (UFD) or both (BFD) facet joints. When there is 3 mm of translation (25%), the canal is occluded 20–25%. With 6mm of translation (50%), there is 40–50% canal occlusion. MRI can help analyse the soft tissue and ligamentous injuries. In UFD, all posterior ligamentous structures including joint capsule, and half the disc annulus are disrupted. Disruption of ALL and PLL is not necessary to create a UFD. In addition to the posterior structures, the ALL, the PLL and disc are disrupted in BFD. Rupture of the intervertebral disc may include posterior herniation or circumferential disruption. All distraction flexion injuries should be reduced closed. The necessity of a preoperative MRI is undetermined. Preoperative MRI is recommended if there is an unreliable exam due to the patient being uncooperative, if there is neurological worsening with, or failure of closed reduction. If the patient is neurologically intact and closed reduction successful, a posterior cervical fusion is advocated if there is no evidence of an extruded disc on the post reduction MRI. If the closed reduction failed, or MRI indicated, and there is no evidence of a herniated disc, an open posterior reduction followed by fusion is performed. Anterior discectomy with reduction, a graft and a plate is performed for a herniated disc. Compression-extension injuries fail by compression of the posterior elements followed by distraction of the anterior elements. There are unilateral or bilateral fractures of the laminae/neural arch with degrees of displacement. Undisplaced neural arch fractures can be treated with a cervical orthosis or halo. Displaced neural arch fractures are treated with a posterior cervical fusion. There are two stages in the distraction-extension injury group. The anterior longitudinal ligament is disrupted with possibly a transverse fracture of the body. With more major injuries, there is a significant displacement injuring the posterior column. Stage 1 injuries can be treated with a halo and Stage 2 with an anterior decompression and fusion with a plating device. There are two stages to lateral flexion injuries. Minor injuries include asymmetric centrum fracture and a unilateral arch fracture. In addition, there is displacement of the body with contralateral ligamentous failure in major injuries. The treatment for Stage 1 is usually a collar while treatment for Stage 2 is usually a posterior cervical fusion. Posterior stabilization procedures may be performed with wires and cables with or without rods. Posterior clamps usually are not recommended; while plates and screws are preferred. The plates and screws are biomechanically superior to wiring and avoid canal penetration. They are ideal when there is loss of the posterior elements. Pedicle fixation should be considered when operating on the C2 or C7 level. One in five patients may have complete disruption of vertebral artery blood flow. This occurs most commonly with flexion-distraction or flexion-compression injuries. Vertebral artery evaluation is recommended in patients with flexion injuries and symptoms consistent with vertebral artery insufficiency. It is important to understand the mechanism of injury; to understand which elements are compromised. We have to get the appropriate imaging studies, we have to be cognizant of the fact that the vertebral artery may be injured, or there may be an associated herniated disc. We have to understand the degree of instability, which dictates the appropriate treatment and we have to understand the risk benefit of the specific internal fixation systems that we use

Objective:. To observe the incidence of intra-operative vascular injuries during anterior cervical decompression and fusion (ACDF). Secondly, management and monitoring of the outcome post vascular injury during ACDF. Methods:. This a prospective study. A review of all spinal patients' records was performed from June 2006 to April 2011. A comprehensive literature review was also utilized. Inclusion criteria – all patients had ACDF post trauma. All non-traumatic cases were excluded. Results:. The study consisted of 55 patients; 15 were females and 40 were males. The age distribution was 23–65 years. Two patients were excluded due to non-traumatic causes. Of the remaining 53 patients, four sustained intra-operative vascular injuries during ACDF surgery. All 4 patients had corpectomies, and one case was an iatrogenic injury. The commonly injured vessel during the ACDF surgery was the left vertebral artery. Haemostatic control was achieved via tamponade and haemostatic agents. The left common carotid was iatrogenically injured in one case and was treated by microvascular repair. Three patients were treated with antiplatelet therapy for three months duration. The patient with an iatrogenic injury was treated with anticoagulation therapy for three months duration. All computerized tomographic angiograms at three months follow up illustrated patent vessels. Conclusion:. There is an increased incidence of intra operative vascular injuries during ACDF associated with corpectomies. It is essential to be aware of the low incidence of intra operative arterial injury during ACDF and to have a management approach, such as tamponade or microvascular repair. Anticoagulation and antiplatelet therapy is effective in decreasing the complications of vascular injuries post ACDF

Introduction: In comparison to anterior cervical decompression and fusion (ACDF), cervical disc arthroplasty has the potential of maintaining normal segmental lordosis, anatomical disc space height, and physiological motion patterns that may reduce or delay the onset of degenerative disc disease at adjacent cervical spinal motion segments. Aim: The objective of this study was to determine patient satisfaction post cervical disc arthroplasty. by evaluating each patient both clinically and radiologically. Materials and Methods: A retrospective study was performed on all patients with symptomatic cervical radiculopathy and/or myelopathy who had undergone cervical disc arthroplasty by a single surgeon after a standard anterior cervical discectomy. Outcome measures included the Short Form-36 (SF-36) and Neck Disability Index (NDI) questionnaires, neurological status, and radiographic status. Results: Over a 32 month period, 15 patients underwent cervical disc arthroplasty, with 12 patients undergoing single level arthroplasty. 2 patients undergoing 2 level arthroplasty and one patient undergoing a 3 level arthroplasty. The C5/C6 level was involved in 9 cases (60%). The male female ratio was 7:8. The mean age at presentation was 45 years (range, 28–59). The mean follow up was 24 months (range, 5–31). The mean improvement in NDI scores was 34.8. The mean PCS and MCS scores of the SF-36 test improved by 12.8 and 7.7 respectively. There was no neurological deficit. There were no cases of implant failures, migrations or subsidence. Conclusion: High patient satisfaction levels highlight the efficacy and safety of cervical disc arthroplasty, but longer term follow up is required to assess the long term functionality of the prosthesis and its protective influence on adjacent levels

The cervical spine is the most vulnerable segment in high velocity injuries. Bifacet dislocations are associated with significant soft tissue damage and neurological deficit. Management of delayed presentation of cervical facet dislocations, which are not uncommon, is varied. The aims of this study are to create awareness and to develop a management strategy. We retrospectively reviewed 14 patients (10 men and four women) with chronic dislocations treated over 4 years. The mean age was 42.5 years (23 to 62). The delay in presentation ranged from 15 to 135 days. Seven patients had neurological deficit. All patients underwent CT scan and MRI. Common areas of involvement were C6/7 (five patients) and C5/6 (four patients). Associated fracture of posterior elements was identified in 40% of patients. In two patients sequestrated disc ruptured into the canal. All patients underwent surgical reduction and stabilisation, with eight having one-stage and six two-stage surgery. The sequence of one-stage surgery was posterior release, reduction (facet reduction/facetectomy), anterior discectomy and anterior fusion. In three patients with sequestrated discs, anterior decompression preceded posterior release and finally anterior fusion. The six patients who had staged surgery had a prolonged delay (over 3 months) in presentation. Posterior release was followed by an anterior decompression, then a 7 to 10-day period of traction reduction and finally anterior fusion. None of our patients developed neurological deficit. Three patients improved from Frankel-C to Frankel-D. We recommend that the sequence of surgery should be posterior release/reduction and then anterior decompression and anterior fusion. However, in chronic cases, staged reduction and fusion is a viable option

The purpose of the study was to determine the effectiveness of rhBMP-2 when applied to an absorbable collagen sponge for interbody fusion with allograft spacers. Seventy-seven consecutive patients requiring inter-body fusion with one hundred and eighteen levels were included in the study. In thirty-six patients cervical or lumbar interbody fusions were performed using allograft and rhBMP-2. In the remaing allograft was used with demineralised bone matrix. In patients undergoing anterior cervical decompression and fusion (ALIF) machined allograft spacers were supplemented with anterior locking plates. In those scheduled for anterior lumbar inter-body fusion (ALIF) or transforaminal lumbar interbody fusion (TLIF), machined allograft spacers were supplemented with posterior pedicle screw constructs. There were no stand alone ALIF procedures. All patients undergoing surgery were assessed preoperatively and at two weeks, six weeks, three, six, twelve, twenty-four months following surgery.Their Oswestry disability index (ODI) questionaires, Visual analogue scale (VAS) scores and a pain diagram were recorded. Radiographic measurements were made on the electronic public access computer system (EPACS). All patients with allograft plus rhBMP-2 showed radiographic evidence of fusion by six months following surgery. The allograft with demineralised bone matrix group took considerably longer to achieve the same radiographic end plate appearance. Subsidence was obvious on radiographs in greater than 50% of cases with allograft and rhBMP-2 at three months. It was noted to occur between six weeks and three months and there was no significant subsidence after six months. This was statistically significant with a p< 0.0001 (fisher exact test). The average subsidence for the entire rhBMP-2 group at twelve months was 16.5%(SE 2.5% and range 0–58%) and for the allograft and bone matrix group was 4.6%(SE.74% range 0–15%)with a p< 0.0001 (independant t test). Although high rates of fusion can be accomplished with allograft and rhBMP-2 (100%), significant subsidence occurs in greater than 50% of lumbar spine cases and 30% of cervical spine cases. This is possibly a result of early bone turnover with loss of structural support of the allograft spacer and end plate resorption

Aims

The aim of this paper is to describe the impact of COVID-19 on spine surgery services in a district general hospital in England in order to understand the spinal service provisions that may be required during a pandemic.

Background: Smaller versions of threaded lumbar cages were developed for cervical spine to obviate the need for allograft, iliac autograft use and to provide initial stability before fusion. Clinical trials of threaded cervical fusion cages have shown higher fusion rates and lower rates of graft-donor site complications. Study design/Aims: Prospective. Radiological and clinical outcomes of an age, sex and diagnosis matched patient population who underwent cervical fusion with (A) BAK/C cages filled with autograft reamings (Center-pulse Spine-tech Inc., Minneapolis, MN) (N=50) were compared with (B) Anterior cervical decompression and fusion (ACDF, N=50). Methods: Patients with symptomatic cervical discogenic radiculopathy were treated with either anterior cervical discectomy with uninstrumented bone-only fusion (ACDF) or BAK/C fusion cage(s). Independent radiographic assessment of fusion was made and patient-based outcome was assessed by a Short Form (SF)-36 Health Status Questionnaire. All patients had minimum follow up of at least 2 years. Results: Similar outcomes were noted for duration of surgery, hospital stay, improvements in neck pain and radicular pain in the affected limb, improvements in the SF-36 Physical Component subscale and Mental Component subscale, and the patients’ perception of overall surgical outcome. Symptom improvements were maintained at 2 years. Iliac crest harvesting was carried out as a standard procedure in all cases of ACDF whereas only 2 cases in BAK/C group required the same. Average operative time of 115 minutes and 145 minutes, blood loss of 110ml and 175ml and hospital stay of 1.5 and 3.5 days were noted for BAK/C and ACDF groups respectively. Successful fusion was achieved in 49 cases in BAK/C and 46 patients in ACDF group. None of the patients in the BAK/C group had reappearance of symptoms while 3 patients in ACDF group had developed symptomatic adjacent level disc disease. The complication rate for the ACDF group was 9% compared with an overall complication rate of 3% with BAK/C. Complications that necessitated a second operative procedure included. Graft dislodgement (N=3) and. Cage subsidence, both requiring re-operation in the form of ACDF with plate supplementation. Conclusions: These results demonstrate that outcomes after a cervical fusion procedure with a threaded cage are the same as those of a conventional uninstrumented bone-only anterior discectomy and fusion with a low risk of complications, less operative time and rare need for autogenous bone graft harvest

Introduction. Anterior cervical decompression and fusion (ACDF) is considered a standard surgical treatment to degenerative discogenic diseases. Lately, the question arises whether or not ACDF significantly influences the progression of adjacent disc degeneration (ADD). The etiology of ADD is obscure and it has not been fully understood whether ADD is a consequence of fusion or it represents the aging pathway of the degenerative cervical process, thus making it a controversial topic [1-3]. There have been several discussions about the possibility of ACDF altering biomechanical conditions at adjacent segments, therefore resulting in increased load and excessive motion [3,4]. The purpose of this study was to compare the cervical segmental motion pre- and post-ACDF using novel 3D analytical techniques. Methods. Nine patients (2F/7M, mean age: 54.1 years, range 36–76 y.o.) underwent ACDF due to symptomatic cervical degenerative discogenic disease. One-level ACDF was performed in 4 patients, whereas 2-level ACDF was done in five, using cylindrical titanium porous cage implants. Pre- and post (postoperative periods ranged from 11-months, 25 days to 12-months, 22 days, mean postoperative period: 12.09 months) surgery, dynamic-CT examinations were conducted in neutral, flexion and extension positions. Subject-based 3D CT models were created for segmental motion analysis (Fig. 1). Six-degrees-of-freedom 3D segmental movements were analyzed using a validated Volume-Merge methods (accuracy: 0.1 mm in translation, 0.2°in rotation) [5]. The segmental translation was evaluated by the segmental translations of gravity centers of endplates (Fig. 2). Disc-height distribution was measured using a custom-written Visual C++ routine implementing a lease-distance calculation algorithm. The mean translation distance was calculated for the each adjacent level (Fig. 2). Differences of segmental motions and mean disc height between pre- and post-surgery at each level were compared by the Wilcoxon signed rank test. Results were presented mean±SEM. Results. Regarding the fusion level, the data shows decreases in both the flexion/extension (F/E) angular range of motion (ROM) (7.46±1.17°preoperatively vs. 3.14±0.56°post-operatively, p<0.003) and the segmental translation in the anterior/posterior direction (AP translation) after surgery (1.22±0.20 mm pre-operatively and 0.32±0.11 mm post-operatively, p<0.01). For the adjacent levels category (inferior and superior combined), the E/F angular ROM was larger after surgery (6.74±1.22°pre-operatively vs. 8.48±0.56°post-operatively, p<0.03). The lateral and axial rotational angular ranges of motion pre- and post-surgery did not show any statistically differences at the adjacent levels. The AP translation at the adjacent levels did not change after surgery (1.22±0.26 mm pre-operatively and 1.45±0.29 mm post-operatively). Translations in lateral and cranio-caudal directions also did not show change following surgery. The mean disc height in the adjacent level (2.39±0.14 mm) showed no differences with respect to the post-surgical measurements (2.40±0.19 mm). Conclusions. The use of a high-accuracy in vivo 3D kinematic analysis method enabled the detection of subtle changes in segmental movement between pre- and post-ACDF conditions. The result of the current study showed increased segmental movements in F/E angles at the adjacent level. These results are consistent with the some previous studies in the literature [4,6-11]. The magnitude of the increased movement, however, was only 1.74°from full-full-flexion to full-extension and no increase was found in AP translation. No disc height loss associated with disc degeneration was observed during a 1-year period after ACDF. Longer follow-up studies with larger patient cohorts will be required to investigate whether the increased F/E angle at the adjacent level effectively causes symptomatic ADD

Introduction: While anterior cervical decompression and fusion has been shown to be clinically effective in cases of myelopathy or radiculopathy, several studies have suggested an increased risk of development of adjacent segment degeneration. The Bryan Cervical Disc Pros-thesis was developed to address this complication and was fi rst used clinically in Europe in January 2000. The author began to use the device in June of 2001 and since that time has implanted 30 prostheses in 22 patients. The present prospective study was commenced at the time (concurrently with an ASERNIPS study) with a view to examine the clinical efficacy and safety of this device. The results in the author’s first 14 patients are reported, all with a minimum follow-up of 12 months (mean 20 months). Methods: An observational audit of 14 consecutive patients with cervical radiculopathy (6 patients), myelopathy (6 patients) or discogenic neck pain (2 patients) operated upon between July 2001 and November 2002. Average age was 48 years (range 27 – 61 years). 5 patients underwent two level procedures. Operative / post-op complications and clinical / radiological outcomes were recorded at 6 weeks, 3, 6, 12 months and January 2004. Results: Follow-up data is available at > 12 months on 13 of the 14 patients at an average 23 months post op (Range: 14–30 months). The patient for whom data is not available is known to have had a poor clinical outcome. She developed an unusual symptom complex with complex regional pain syndrome and is very unhappy with the surgery. Of the other 13 patients, 12 consider their outcome to have been excellent and 1 fair. In the two patients who underwent surgery purely for discogenic neck pain, substantial relief was reported. In the 8 patients with pre-operative arm pain, 6 reported complete relief, 1 substantial relief and one partial relief. There were no intra-operative complications. Two patients developed dysphagia which resolved after several months, one has described a clicking sensation in his neck for which no cause has been identified and one experiences persistent ‘neural surges’. One patient required surgery for a disc herniation at an adjacent level, 9 months post-op while in another patient, on routine 12 month follow-up MRI scan, an asymptomatic disc herniation adjacent to the operated segment had resolved spontaneously. One patient underwent foraminotomy for recurrent arm pain, 19 months post-op. All prostheses appear mobile on dynamic x-rays but it is apparent that the Bryan device does not correct any pre-operative degenerative deformity using the current technique. Discussion: The current study appears to indicate satisfactory clinical outcomes at an average of 23 months post surgery in this group of patients. Longer follow-up and larger patient numbers are required as well as comparative studies

The February 2015 Spine Roundup³⁶⁰ looks at: Paracetamol use for lower back pain; En-bloc resection of vertebra reported for the first time; Spinopelvic disassociation under the spotlight; Hope for back pain; Disc replacement and ACDF equivalent in randomised study; Interspinous process devices ineffective