Anterior cervical discectomy and fusion (ACDF) is a well-established spinal operation for cervical disc degeneration disease with neurological compromise. The procedure involves an anterior approach to the cervical spine with discectomy to relieve the pressure on the impinged spinal cord to slow disease progression. The prosthetic cage replaces the disc and can be inserted stand-alone or with an anterior plate that provides additional stability. The literature demonstrates that the cage-alone (CA) is given preference over the cage-plate (CP) technique due to better clinical outcomes, reduced operation time and resultant morbidity. This retrospective case-controlled study compared CA versus CP fixation used in single and multilevel anterior cervical discectomy and fusion for myelopathy in a tertiary centre in Wales. A retrospective clinico-radiological analysis was undertaken, following ACDF procedures over seven years in a single tertiary centre. Inclusion criteria were patients over 18 years of age with cervical myelopathy who had at least six-month follow-up data. SPSS was used to identify any statistically significant difference between both groups. The data were analysed to evaluate the consistency of our findings in comparison to published literature. Eighty-six patients formed the study cohort; 28 [33%] underwent ACDF with CA and 58 [67%] with CP. The patient demographics were similar in both groups, and fusion was observed in all individuals. There was no statistical difference between the two constructs when assessing subsidence, clinical complication (dysphagia, dysphonia, infection), radiological parameters and reoperations. However, a more significant percentage [43% v 61%] of patients improved their cervical lordosis angle with CP treatment. Furthermore, the study yielded that surgery to upper cervical levels results in a higher incidence of dysphagia [65% v 35%]. Finally, bony growth across the cage was observed on X-ray in 12[43%] patients, a unique finding not mentioned in the literature previously. Our study demonstrates no overall difference between the two groups, and we recommend careful consideration of individual patient factors when deciding what construct to choose

Aims. Whether to perform hybrid surgery (HS) in contrast to anterior cervical discectomy and fusion (ACDF) when treating patients with multilevel cervical disc degeneration remains a controversial subject. To resolve this we have undertaken a meta-analysis comparing the outcomes from HS with ACDF in this condition. Methods. Seven databases were searched for studies of HS and ACDF from inception of the study to 1 September 2019. Both random-effects and fixed-effects models were used to evaluate the overall effect of the C2-C7 range of motion (ROM), ROM of superior/inferior adjacent levels, adjacent segment degeneration (ASD), heterotopic ossification (HO), complications, neck disability index (NDI) score, visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, Odom’s criteria, blood loss, and operating and hospitalization time. To obtain more credible results contour-enhanced funnel plots, Egger’s and Begg’s tests, meta-regression, and sensitivity analyses were performed. Results. In total, 17 studies involving 861 patients were included in the analysis. HS was found to be superior to ACDF in maintaining C2-C7 ROM and ROM of superior/inferior adjacent levels, but HS did not reduce the incidence of associated level ASD. Also, HS did not cause a higher rate of HO than ACDF. The frequency of complications was similar between the two techniques. HS failed to achieve more favourable outcomes than ACDF using the NDI, VAS, JOA, and Odom’s scores. HS did not show any more advantages in operating or hospitalization time but did show reduction in blood loss. Conclusion. Although HS maintained cervical kinetics, it failed to reduce the incidence of ASD. This finding differs from previous reports. Moreover, patients did not show more benefits from HS with respect to symptom improvement, prevention of complications, and clinical outcomes. Cite this article: Bone Joint J 2020;102-B(8):981–996

Study design: Retrospective review of patients with cervical spondylosis treated with three-level anterior cervical discectomy and fusion with plate fixation. Objective: To assess the radiographic and clinical outcome of three-level instrumented anterior cervical discectomy. Summary of Background data: Three-level cervical discectomy without plate fixation has shown high rates of pseudarthrosis and poor outcomes. The addition of internal fixation may improve these parameters. Methods: 46 patients were observed for an average of 17.6 months (range, 6–51). All had three level anterior cervical discectomy and fusion with tricortical iliac crest autograft (4 cases), fibular ring allograft (38 cases), or titanium cage (four cases). Allografts and cages were filled with iliac crest autograft. All patients had semi-rigid plating. Clinical and radiographic follow-up data were obtained. Clinical outcomes were measured as described by Robinson and with the Nurick scale. Results: Forty-four patients achieved solid fusion. Two patients had additional surgery for junctional disease, and in one of them pseudarthrosis repair was also performed. One asymptomatic pseudarthrosis was noted. With a successful result defined as an excellent or good outcome accompanied by significant pain relief, 38 patients had a successful result (83%). Radiographic adjacent level disease was diagnosed in 11 patients postoperatively and was symptomatic in 5. Conclusion: Three-level anterior cervical discectomy with plate fixation has a high rate of fusion, a low complication rate, and acceptable outcome in the treatment of multilevel cervical spondylosis

Introduction: Although anterior cervical discectomy and fusion is a well-established technique for arthrodesis of the cervical spine, there are limited data on the use of allograft with plate in large series. There are even fewer such studies that incorporate three and four level fusions. We report our experience with 252 patients (530 levels). Methods: 252 patients underwent anterior cervical discectomy and fusion (ACDF) with plate and allograft (91-one level, 74-two levels, 57-three levels, 30-four levels; 530 total levels) via a modified Smith-Robinson technique. Radiographic fusion was determined with plain X-rays at predetermined intervals. Fusion was defined as no lucent line and no hardware failure. Average follow-up was 22.5 months. Average age was 50 years (M 26, F 19). Comorbidities included 58 smokers and 16 diabetics. Patients wore an external orthosis for six weeks. Results: There were six reoperations for junctional disease outside the original fusion construct. 16 patient developed junctional disease. 28 levels had residual radiographic lucent lines and/or hardware failure at most recent follow-up for a fusion rate of 94.7% (502/530). Complications occurred in 32 patients (6.0%). There included 16 instances of hardware failure and/or pseudoarthrosis, nine of which occurred in the three and four level group, dysphagia (9), vocal cord dysfunction (2), respiratory distress (2), wound hematoma (2), wound infection (1). Conclusion/discussion: Extremely high fusion rates were recorded in this series, including three and four level constructs, with an acceptable complication rate. We believe that outstanding results are obtainable with allograft and plate, even at three or four levels. The principles of precise fit and fill of the interspace with a contoured graft and fixation with compression and instrumentation must be employed

Background. The controversy concerning the benefits of unisegmental cervical disc arthroplasty (CDA) over anterior cervical discectomy and fusion (ACDF) is still open because some randomised clinical trial (RTC) comparing ACDF with CDA have been highly inconclusive. Most of these studies mixed disc prosthesis with dissimilar kinematic characteristics. To date, a compilation of the clinical and radiologic outcomes and adverse events of anterior cervical discectomy and fusion (ACDF) compared with a single cervical disc arthroplasty (CDA) design, the Bryan disc has partially accomplished. Methods. This is a systematic review of RCTs with level I-II evidence. Only RCTs reporting clinical outcomes were included in this review. After a search on different databases including PubMed, Cochrane Central Register of Controlled Trials, and Ovid MEDLINE, a total of 10 RCTs out of total 51 studies were entered in the study. RTC's were searched from the earliest available records in 2005 to December 2014. Results. Five studies were Level I, and five were Level II. Out of a total of 1101 patients, 562 patients were randomly assigned into the Bryan arthroplasty group and the remaining 539 patients into the ACDF group. The mean follow-up was 30.9 months. Patients undergoing CDA had lower Neck Disability Index, and better SF-36 Physical component scores than ACDF patients. Patients with Bryan CDA had also less radiological degenerative changes at the upper adjacent level. Overall adverse events were twice more frequent in patients with ACDF. The rate of revision surgery including both adjacent and index level were slightly higher in patients with ACDF, showing no statistically significant difference. Conclusions. This review of evidence level I-II RCTs comparing clinical and radiological outcomes of patient undergoing Bryan arthroplasty or ACDF indicated a global superiority of the Bryan disc. The impact of both surgical techniques on the cervical spine (radiological spine deterioration and/or complications) was more severe in patients undergoing ACDF. However, the rate of revision surgeries at any cervical level was equivalent for ACDF and Bryan arthroplasty. These data suggest that even though the loss of motion has a determinant influence in the development of degenerative changes in ACDF cases, these kinematic factors do not imply a higher rate of symptomatic adjacent segment degeneration requiring surgery. Level of Evidence. Level I

1. A series of 154 patients who underwent anterior cervical discectomy and fusion has been studied. A detailed analysis of the first eighty-four patients who have been observed for periods of from one to eight and a half years is described. In sixty-eight patients the fusion was done with a keystone type of graft, in seventeen by a dowel (Cloward) graft. 2. Despite a preponderance of multiple level fusions in the keystone series, clinically better results (80·8 per cent excellent or good) were found in this group than in the dowel group (64·8 per cent excellent or good). 3. A biomechanical study has indicated the keystone graft to be more stable than a dowel graft under flexion and extension strains as well as lateral bending strain. The graft is more stable the closer it is to the line of "zero velocity.". 4. The three cases of non-union all occurred in the dowel group. The high incidence of fusion with the keystone technique is considered to be related to the type of graft, its method of seating, its depth of penetration, its larger surface area and the fact that raw cancellous bone of the adjacent vertebral bodies is in contact with the graft above and below

We retrospectively reviewed the results of patients having undergone single or two level Anterior Cervical Discectomy and Fusion with the use of the Cervios Cage (SYNTHES). Participants were sent a questionnaire which included generic questions relating to ACDF such as dysphagia, hoarseness of voice and resolution of arm pain in addition to Oswestry Disability scores. Most patients underwent AP/Lateral and flexion/extension radiographs

This study was performed to evaluate the clinical and radiographic outcomes in patients undergoing anterior cervical discectomy and fusion (ACDF) with rhBMP-2 and polyetheretherketone (PEEK) cages with our standard treatment of allograft spacers and demineralised bone matrix. Forty-six patients who underwent primary ACDF were included in the study. Twenty two patients with PEEK spacers and rhBMP-2 were compared to twenty four patients with allograft spacers and demineralised bone matrix all supplemented with an anterior locking plate. All patients were examined preoperatively and at two, six, twelve and twenty-four weeks and one and two years following surgery. Their cervical Oswestry scores,VAS for neck and arm pain and a pain diagram were recorded at every visit. A radiographic examination was also performed and patients were questioned for dysphagia, hoarseness of voice and any other difficulties. Radiographs were evaluated for prevertebral swelling, bone formation, subsidence and likelihood of fusion. CT scans were performed in any individual at twelve months if there was a concern of non union. There was no significant difference in pain scores between rhBMP-2 and allograft spacer patients. There was improvement in both groups from their preoperative scores. Incidence of hoarseness of voice was also similar in both groups. There were statistically significant more patients with dysphagia in the rhBMP-2 group at two and six weeks following surgery. All patients in the rhBMP-2 group achieved a radiological diagnosis of probable fusion at their latest follow up (thirty-eight levels). In the allograft group 23/24 patients achieved a diagnosis of probable fusion (39/40 levels). End plate resorption was observed radiologically in 100% of the levels where rhBMP-2 was used. Prevertebral swelling on lateral radiographs was significantly greater in patients with rhBMP-2 causing dysphagia. The cost of implants was three times higher in patients with PEEK cage and rhBMP-2. The use of rhBMP-2 leads to consistent fusion in the cervical spine. Significantly higher rates of prevertebral swelling, dysphagia and s higher cost are major drawbacks. End plate resorption was an unusual radiographic finding with the use of rhBMP-2

Aim: To determine the clinical improvement and the radiological time to fusion as well as correction of the lordosis angle in patients undergoing anterior cervical interbody fusion with the use of a silicate substituted calcium phosphate ceramic (Si-CaP) (Actifuse™ Synthetic Bone Graft, ApaTech, Ltd., Elstree, UK) as the bone graft substitute in the cage. Design: We conducted a prospective clinical and radiological study to evaluate the use of Si-CaP as bone graft substitute in anterior cervical fusion for degenerative cervical spondylosis. Materials and methods: Thirty patients were selected prospectively by preoperative and postoperative clinical and radiological assessments. All patients were operated on by a single surgeon (D.A.J.). Neck disability index and visual analogue score were used for the clinical assessment. Radiological assessment included improvement in the lordosis angle and time to fusion. Patients were evaluated at three months, six months and one year post-surgery. Results: At present 14 patients with a total of 19 levels have completed their one year follow-up. The patients had an average of 50.4 years (range 34–69), with ratio of male to female of 6:7. Lordosis angle improved significantly from a mean lordosis angle of 0.31 preoperatively to 4.75 degree postoperatively (p< 0.05). All the levels had fused at the 1 year follow up and there was no radiological evidence of sinkage of the cage. Conclusion: Substitution of silicate ions into calcium phosphate ceramics has been shown to impart a negative surface charge, leading to greater protein absorption, increased osteoblast proliferation, and higher production of extracellular matrix. Our results show that Si-CaP has excellent clinical performance as a synthetic bone graft in anterior cervical discectomy and fusion. Postoperatively, patients demonstrate a good fusion with an excellent correction and maintenance of the lordosis angle

Objectives. Pulsed electromagnetic field (PEMF) stimulation was evaluated after anterior cervical discectomy and fusion (ACDF) procedures in a randomized, controlled clinical study performed for United States Food and Drug Administration (FDA) approval. PEMF significantly increased fusion rates at six months, but 12-month fusion outcomes for subjects at elevated risk for pseudoarthrosis were not thoroughly reported. The objective of the current study was to evaluate the effect of PEMF treatment on subjects at increased risk for pseudoarthrosis after ACDF procedures. Methods. Two evaluations were performed that compared fusion rates between PEMF stimulation and a historical control (160 subjects) from the FDA investigational device exemption (IDE) study: a post hoc (PH) analysis of high-risk subjects from the FDA study (PH PEMF); and a multicentre, open-label (OL) study consisting of 274 subjects treated with PEMF (OL PEMF). Fisher’s exact test and multivariate logistic regression was used to compare fusion rates between PEMF-treated subjects and historical controls. Results. In separate comparisons of PH PEMF and OL PEMF groups to the historical control group, PEMF treatment significantly (p < 0.05, Fisher’s exact test) increased the fusion rate at six and 12 months for certain high-risk subjects who had at least one clinical risk factor of being elderly, a nicotine user, osteoporotic, or diabetic; and for those with at least one clinical risk factor and who received at least a two- or three-level arthrodesis. Conclusion. Adjunctive PEMF treatment can be recommended for patients who are at high risk for pseudoarthrosis. Cite this article: D. Coric, D. E. Bullard, V. V. Patel, J. T. Ryaby, B. L. Atkinson, D. He, R. D. Guyer. Pulsed electromagnetic field stimulation may improve fusion rates in cervical arthrodesis in high-risk populations. Bone Joint Res 2018;7:124–130. DOI: 10.1302/2046-3758.72.BJR-2017-0221.R1

Aims. The aim of this study was to determine how the short- and medium- to long-term outcome measures after total disc replacement (TDR) compare with those of anterior cervical discectomy and fusion (ACDF), using a systematic review and meta-analysis. Patients and Methods. Databases including Medline, Embase, and Scopus were searched. Inclusion criteria involved prospective randomized control trials (RCTs) reporting the surgical treatment of patients with symptomatic degenerative cervical disc disease. Two independent investigators extracted the data. The strength of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. The primary outcome measures were overall and neurological success, and these were included in the meta-analysis. Standardized patient-reported outcomes, including the incidence of further surgery and adjacent segment disease, were summarized and discussed. Results. A total of 22 papers published from 14 RCTs were included, representing 3160 patients with follow-up of up to ten years. Meta-analysis indicated that TDR is superior to ACDF at two years and between four and seven years. In the short-term, patients who underwent TDR had better patient-reported outcomes than those who underwent ACDF, but at two years this was typically not significant. Results between four and seven years showed significant differences in Neck Disability Index (NDI), 36-Item Short-Form Health Survey (SF-36) physical component scores, dysphagia, and satisfaction, all favouring TDR. Most trials found significantly less adjacent segment disease after TDR at both two years (short-term) and between four and seven years (medium- to long-term). Conclusion. TDR is as effective as ACDF and superior for some outcomes. Disc replacement reduces the risk of adjacent segment disease. Continued uncertainty remains about degeneration of the prosthesis. Long-term surveillance of patients who undergo TDR may allow its routine use. Cite this article: Bone Joint J 2018;100-B:991–1001

Introduction: Although there are several accepted methods of surgical treatment for single level cervical radiculopathy, the choice depends on the surgeon’s preference. The techniques may vary in perioperative morbidity, short and long term outcome, but no study so far has analysed their cost-effectiveness. To compare the outcome and cost-effectiveness of four techniques commonly used for degenerative cervical disc pathology.

Methods: We conducted a observational cohort study from two spinal units. Between 1999 and 2004, 60 patients underwent surgery for single level anterior cervical disc pathology. Out of this 30 patients underwent their surgery in centre A the other 30 in centre B. Centre A used two ACDF techniques-group 1- plate and tricortical graft, group 2- plate, cage and bone substitute (BCP granules). Centre B used two other techniques- group 3- cage alone with autologous locally harvested graft, group 4- disc arthroplasty. We had 15 patients in each of the above four groups. Operating time, blood loss, duration of stay, donor site morbidity, analgesia requirements, and total cost incurred per patient were recorded. All patients were followed up at 6 weeks, 3 months, 6 months, 1 year and 2 years. The clinical outcome and pain assessment were done using the SF12 and VAS.

Results: The three Fusion groups had a similar radiological outcome. With appropriate statistical analysis, there were no differences in physical and mental domains of the SF12 or pain scores between the groups. The average operative time in the group 1 was 160 minutes, group 2 was 100 minutes, group 3 was 90 minutes and group 4 was 105 minutes. Average blood loss was minimal in all groups. The average hospital stay was of 5, 2.7, 2.5, 2 days for groups 1–4 respectively. The average total cost per patient in the group 1 (surgery+stay+plate) was £2790, group 2 (surgery+stay+plate+cage+BCP) was £2400, group 3 (surgery+stay+cage) was £1900, and group 4(surgery+stay+disc implant) was £2350.

Conclusion: All the techniques gave similarly satisfactory clinical outcomes but using cages alone could be more cost-effective than using iliac crest auto-graft for fusion. The disc arthroplasty was comparable to cage with bone substitute and plate in terms of outcome and may giev the surgeon an alternative choice in patients who are not keen on/ unfit for fusion.

Purpose of the study: ACDF is the cervical surgical technique the most widely used for the treatment of severe discopathy in rugby players. Different techniques have been applied, with no real consensus for the technical procedures or the postoperative rehabilitation. The goal is to normalise the surgical treatment and rehabilitation for elite rugby players who have had a cervical fusion for discopathy with the objective of resuming rugby three months postoperatively.

Material and methods: This was a retrospective study including 85 high-level rugby players (professional and semi-professional players) operated on by three surgeons from 2003 to 2008 for one or two levels presenting discal herniation (levels C3 to T1) with cervicobrachial nevralgia unresponsive to conservative treatment. Postoperative function was assessed with the cervical handicap index, a visual analogue scale for pain, consumption of analgesics, and possibility to resume rugby at three months. Flexion-extension radiographs of the cervical spine were obtained. All patients underwent ACDF using a Peek cage filled with autologous iliac bone fixed with a plate or a compressive staple. The patient completed a self-administered satisfaction questionnaire during follow-up. The radiographs and the clinical exam were done by an independent observer (GG).

Results: Mean follow-up was 26 months (4–55). Mean operative time was 50 minutes (30–70). Mean hospital stay 2.3 days (1–3). There was no difference between plate and staple fixation. There were no major postoperative complications. Fusion was radiographically achieved in all cases. All patients played competition rugby three months after surgery. At last follow-up, seven players had interrupted rugby playing for personal reasons or for other intercurrent medical conditions. Seventy-eight percent stated their clinical situation had improved and that they were satisfied.

Conclusion: The results of this series confirm the pertinence of this method to achieve effective fusion authorising resumption of rugby playing three months postoperatively. Use of a Peek cage filled with autologous bone and stabilised with fixation appears to be necessary to allow rapid functional rehabilitation exercises using a programme of three phases of one month. The normalisation of the treatment for sever cervical discopathies in the high-level rugby player appears to be possible and safe, compared with data in the literature.

Aims

The purpose of this retrospective study was to investigate the clinical relevance of increased facet joint distraction as a result of anterior cervical decompression and fusion (ACDF) for trauma.

The December 2022 Spine Roundup. 360. looks at: Deep venous thrombosis prophylaxis protocol on a Level 1 trauma centre patient database; Non-specific spondylodiscitis: a new perspective for surgical treatment; Disc degeneration could be recovered after chemonucleolysis; Three-level anterior cervical discectomy and fusion versus corpectomy- anterior cervical discectomy and fusion “hybrid” procedures: how does the alignment look?; Rivaroxaban or enoxaparin for venous thromboembolism prophylaxis; Surgical site infection: when do we have to remove the implants?; Determination of a neurologic safe zone for bicortical S1 pedicle placement; Do you need to operate on unstable spine fractures in the elderly: outcomes and mortality; Degeneration to deformity: when does the patient need both?

The October 2024 Spine Roundup. 360. looks at: Analysis of risk factors for non-fusion of bone graft in anterior cervical discectomy and fusion: a clinical retrospective study; Does paraspinal muscle mass predict lumbar lordosis before and after decompression for degenerative spinal stenosis?; Return to work after surgery for lumbar disk herniation: a nationwide registry-based study; Can the six-minute walking test assess ambulatory function impairment in patients with cervical spondylotic myelopathy?; Complications after adult deformity surgery: losing more than sleep; Frailty limits how good we can get in adult spine deformity surgery

Aims. In order to evaluate the effectiveness of the Mobi-C implant in cervical disc degeneration, a randomised study was conducted, comparing the Mobi-C prosthesis arthroplasty with anterior cervical disc fusion (ACDF) in patients with single level cervical spondylosis. Patients and Methods. From January 2008 to July 2009, 99 patients were enrolled and randomly divided into two groups, those having a Mobi-C implant (n = 51; 30 men, 21 women) and those undergoing ACDF (n = 48; 28 men, 20 women).The patients were followed up for five years, with the primary outcomes being the Japanese Orthopaedic Association score, visual analogue scale for pain and the incidence of further surgery. The secondary outcomes were the Neck Disability Index and range of movement (ROM) of the treated segment. Results. The incidence of further surgery was found to be statistically significant between the two groups (p = 0.49), with seven ACDF patients requiring further surgery and only one Mobi-C patient requiring re-operation. There were significant differences (p < 0.001) between the two groups in the ROM of the treated segment. However, both Mobi-C surgery and ACDF surgery were effective in improving the patient’s clinical symptoms. Take home message: Mobi-C implant surgery is a safe alternative to ACDF surgery in cervical disc degeneration. Cite this article: Bone Joint J 2016;98-B:829–3

Abstract. Objectives. There is still controversy in the literature over whether Cervical Foraminotomy or Anterior Cervical discectomy and fusion (ACDF) is best for treating cervical Radiculopathy. Numerous studies have focused on the respective complication rates of these procedures and outcome measures with a lack of due consideration to preoperative MRI findings. Proximal foraminal stenosis can theoretically be accessed via either approach. We aimed to investigate whether patient reported outcome measures (PROMs) favoured one approach over the other in patients with proximal foraminal stenosis. Methods. A single centre retrospective review of patients undergoing either ACDF or Cervical foraminotomy over the period 2012 to 2022. VAS, Neck disability index (NDI), EQ5DL and Patient Satisfaction on a Five Point Likert scale were obtained. Patients who had both an ACDF and a Foraminotomy were excluded. Axial MRI images were analysed and the location of the worst clinically relevant disc herniation stratified as follows: Central (1), Paracentral (2) and Foraminal (3). Correlations and average PROMs were analysed in SPSS. Results. PROMs scores were available for 33 ACDF patients and 37 Foraminotomy patients. Average surgery time in ACDF group was 167 minutes while Foraminotomy 142 minutes. Average Length of hospital stay was 6.24 days in the Foraminotomy group and 3.54 days in the ACDF group. 18 patients were excluded due to having both surgeries (2 of which developed CSF leaks postoperatively). Of the included patients there were no postoperative complications. 13 patients in the ACDF had Central or Paracentral stenosis in addition to proximal Foraminal stenosis, 3 patients in the Foraminotomy group had some significant Paracentral herniation just before the Proximal foramen. The majority of patients in both groups had pure proximal Foraminal stenosis (N= 17 (ACDF), 20 (Foraminotomy). The results showed no significant difference in PROMs between patients who received an ACDF or a Foraminotomy for Proximal foraminal stenosis (EQ5DL, NDI, and satisfaction, P= 0.268, 0.253 and 0.327). There was no correlation between location of the stenosis and PROM scores in either group. Conclusions. Our data suggest that Proximal foraminal stenosis can be effectively addressed by either an anterior ACDF or a Foraminotomy with no difference in complication rates. Foraminotomy has the benefit of no implant cost but longer hospital stay. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

AO Spine Guideline for Using Osteobiologics in Spine Degeneration project is an international collaborative initiative to identify and evaluate evidence on existing use of osteobiologics in spine degenerative diseases. It aims to formulate clinically relevant and internationally applicable guidelines ensuring evidence-based, safe and effective use of osteobiologics. The current focus is the use of osteobiologics in anterior cervical discectomy and fusion surgeries. The guideline development is planned in three phases. Phase 1- Evidence synthesis and Recommendation; Phase 2- Guideline with osteobiologics grading and Validation; Phase 3- Guideline dissemination and Development of a clinical decision support tool. The key questions formulating the guidelines for the use of osteobiologics will be addressed in a series of systematic reviews in Phase 1. The evidence synthesized by the systematic reviews will be assessed by Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology, including expert panel discussions to formulate a recommendation. In Phase 2, osteobiologics will be graded based on evidence and the grading will be integrated with the recommendation from Phase 1, and thus formulate a guideline. The guideline will be further validated by prospective clinical studies. In the third phase, dissemination of the proposed guideline and development of a decision support tool is planned. AO-GO aims to bridge an important gap between quality of evidence and use of osteobiologics in spine fusion surgeries. With a holistic approach the guideline aims to facilitate evidence-based, patient-oriented decision-making process in clinical practice, thus stimulating further evidence-based studies regarding osteobiologics usage in spine surgeries

The August 2015 Spine Roundup360 looks at: Steroids may be useful in avoiding dysphagia in anterior cervical discectomy and fusion (ACDF); Perhaps X-Stop ought to stop?; Is cervical plexus block in ACDF the gateway to day case spinal surgery?; Epidural past its heyday?; Steroids in lumbar back pain; Lumbar disc replacement improving; Post-discectomy arthritis