MEDLINE Abstracts: Surgical Treatment of Cervical Disc Disease
MEDLINE Abstracts: Surgical Treatment of Cervical Disc Disease
What's new concerning the surgical treatment of cervical disc disease? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Orthopaedics.
Tokuhashi Y, Matsuzaki H, Shirasaki Y, Tateishi T
Spine. 2000 Feb 1;25(3):337-41
A trial of a new posterior stabilization technique for atlantoaxial instability and a report of preliminary results. OBJECTIVES: To describe a new posterior stabilization technique for atlantoxial instability.
Summary Of Background Data: Magerl's transarticular screw fixation is an accepted technique for rigid atlantoaxial stabilization, which reportedly has yielded many good clinical results. However, the technique is technically demanding and poses a risk of injury to the nerves and veins.
Methods: Eleven patients who had been treated with intra-articular screw fixation in combination with Halifax interlaminar clamp (OSTEONICS, Allendale, NJ) for atlantoaxial instability were observed. Results of their clinical examinations and biomechanical studies using resinous bones of a cervical spine model were reviewed.
Results: In all patients, occipital pain, neck pain, and neural deficit improved, and bony fusion with no correction loss was shown on radiography. To date, no vascular or neural complications have been found, and no instrumentation failures have occurred. In the biomechanical study, the Halifax with transarticular screw fixation had significantly greater flexion stiffness than the Halifax only or the Halifax with intra-articular screw fixation, but the torsion stiffness of the Halifax with intra-articular screw fixation was significantly greater than that of the other Halifax combinations.
Conclusion: The preliminary results showed that this technique was effective in strengthening the rotational stability of the atlantoaxial fixation and was considered useful for atlantoaxial posterior stabilization.
Liu H, Yang Z, Chen T
Chung Kuo Hsiu Fu Chung Chien Wai Ko Tsa Chih. 1998 Sep;12(5):269-71
To cure patients suffering from atlanto-axial instability following old fracture of odontoid process concomitant with stenosis of lower end of cervical spinal canal, a new operative method was designed. It included atlanto-axial fusion by Gallie technique and resection of right half of the laminae of C3-C7 spine at one stage. A female of 63 years old was treated. She was admitted with neck pain and numbness of the upper and lower limbs. A history of neck injury was noted in enquiry. In physical examination showed the sensation of pain of the upper limbs was decreased and the muscle power of the upper and lower limbs ranged from III degree to IV degree. The X-ray film and MRI suggested that there was instability of the atlanto-axial joint with stenosis of 4th-6th cervical spinal canal. The operation was satisfactory. After operation, the patient was followed up for 11 months. The physical examination indicated that sensation of the upper limbs had recovered to normal and the muscle power of the upper limbs reached IV degree and that the lower limbs reached V degree and X-ray showed bony fusion of the atlanto-axial joint. The conclusions were: 1. The stability of atlanto-axial joint was reconstructed with expanding of the spinal canal at the same time. 2. The duration, risk and cost of the therapy were reduced, and maintenance of the stability of the cervical spine throughout whole period of treatment was recommended.
al-Hami S
Minim Invasive Neurosurg. 1999 Mar;42(1):10-7
Over a period of 12 months at the Klinik fur Neurochirurgie (belonging to the Stadtischen Klinikums Fulda) 54 patients were operated upon after presenting with cervical radiculopathy or myelopathy in single vertebral segments with intravertebral disc involvement and/or osteochondrosis. The surgical intervention of all patients was carried out microsurgically by the author using a vental approach in accordance with the operative procedure and technique as described by Smith and Robinson [59]. In no patient was an additional bone plating necessary. Intraoperative data together with postoperative clinical, neurological, and radiological progress controls at 6 weeks and 3 months were, in the frame of a clinical perspective, non-random study, analysed and evaluated. There were no complications during the operative procedure or postoperatively, and of note, in no case was there any implant dislocation or neurological deterioration. Radicular pain was relieved in 98% of patients. Non-radicular pain--neck and shoulder pain--was eradicated in 42 patients (78%), improvement achieved in 8 patients (15%) and 4 patients (7%) still complained of neck pain 3 months postoperatively. Motor radicular deficit was completely relieved in 34 of 38 patients (89%) and in 3 patients (8%) there was a considerable improvement. Similar figures were obtained with relation to radicular sensory deficit. Of 5 patients who presented preoperatively with cervical myelopathy, 3 improved considerably and 2 remained unchanged. For all 50 patients fine layer, computer tomographic examination of the cervical region with 3-dimensional reconstruction was performed immediately postoperatively and at 3 months. All patients showed a correct positioning of the implant and either a complete or convincing bony ingrowth between the operated vertebrae. To summarise, the presented clinical and radiological study shows the cancellous bone tissue filled, titanium implant to be a meaningful and useable alternative to conventional methods of spinal fusion. Essential advantages: (i) Negation of "bone procedure" complications at the iliac crest and neck combined with a simple and safe surgical procedure. (ii) Reduced hospitalisation time and subsequent treatment costs. (iii) The good biocompatibility of titanium combined with a solid stability at the fusion site. Despite the excellent initial operative results the absence of long term results must be born in mind.
Zoega B, Karrholm J, Lind B
Eur Spine J. 1998;7(4):302-7
This study evaluated whether addition of a cervical spine locking plate (CSLP) in two-level disc fusions improved the postoperative stability and reduced the time to healing. Radiostereometric analysis was used to obtain precise recordings of the three-dimensional motion between the fused vertebrae. Eighteen consecutive patients were operated on with excision of two adjacent cervical discs and anterior horseshoe grafting with autologous bone (Smith Robinson technique). Nine patients were randomized to stabilization with autologous bone grafting and CSLP plate fixation and nine patients to grafting without fixation. Clinical symptoms in terms of pain in the neck and the arm were analysed preoperatively and after 1 year using a visual analogue scale (VAS). The patients operated without a plate displayed increased rotations around the transverse axis, corresponding to the development of a kyphosis [mean value no plate/plate 14.4 degrees/0.8 degrees (repeated measure ANOVA: P < 0.01)]. The mean compression was 3.2 mm larger in patients operated without a plate (repeated measure ANOVA: P < 0.01). Patients operated without a plate had more arm pain at the 1-year follow up (P < 0.05, Mann-Whitney U test). The VAS score for neck pain did not differ significantly between the two groups. Plate fixation could not be demonstrated to increase the healing rate, promote more rapid fusion or influence the frequency of graft complications.
Blauth M, Schmidt U, Bastian L, Knop C, Tscherne H
Zentralbl Chir. 1998;123(8):919-29
Lower cervical spine injuries with instability of the anterior and/or posterior column can be treated by anterior interbody fusion and plate fixation. Plates available for anterior instrumentation of the lower cervical spine can be divided into locking or non-locking systems with uni- or bicortical screw purchase. Our biomechanical comparative testing of different screw fixation systems demonstrates improved stability with the use of bicortical purchase. Clinical studies, however, have proven high fusion rates without loss of correction and a low implant related morbidity with the use of unicortical as well of bicortical plate systems. Correct reduction and intraoperative positioning of the unstable cervical spine is crucial to avoid implant related complications. Also, limitations of anterior instrumentation for the treatment of specific lesions of the lower cervical spine have to be considered, e.g. in complex lesions with axial instability or in fracture dislocations with ankylosing spondylitis. Changes or alterations of adjacent segments can be reduced by the use of plates with correct lengths, contact of uninjured adjacent discs with implants should be avoided. A comparative analysis of two patient collectives--89 patients (1972-1983) and 102 patients (1987-1994), all of them treated with bicortical plate fixation--revealed different results in terms of implant failure, operative reduction and loss of correction. All but one surgical fusions had healed radiologically. Implant related complications during the first 3 months after the initial operation were lower in the latter group, only 3 out of 102 patients (3%) with implant loosening versus 7 our of 89 patients (8%) with implant breakage or loosening required surgical revision. In all cases technical errors could be detected. Clinical follow-ups with personal examination was performed in 144 patients: 57 of 72 survivors of series I (79%) after an average time of 11 years 9 months and 87 out of 94 survivors of series II (85%). The radiologic examination revealed 2 patients with screw breakage in series I, one patient with an asymptomatic implant loosening in series II. Only one case was observed with a loss of correction after loosened and early removed hardware. In all other patients there was no difference of radiologic angles between postoperative X-ray and follow-up. 16 patients, 12 of series I, 4 of series II, were fused in a kyphotic position after insufficient preoperative reduction. Radiologic alterations of adjacent segments, i.e. spondylophyts or "spontaneous" fusions, were observed in more than 50% of all patients of both series. However, complaints or persistent pain did not correlate with radiologic findings. Also in both series there was a high percentage of patients with mild, residual neck pain in spite of a very good radiologic result. Only in a very few cases the complaints had to be treated by drugs.
Eyres KS, Gray DH, Robertson P
Br J Rheumatol. 1998 Jul;37(7):756-9
Twenty-six patients with rheumatoid disease affecting the cervical spine underwent surgical treatment for neck pain, neurological deficit, or both. Atlantoaxial subluxation (n=13), subaxial subluxation (n=7) and vertical migration of the odontoid (n=6) were treated. Arthrodesis with autologous bone was augmented with wire, Ransford loop, Hartshill rectangle or Magerl technique. Pain relief occurred in 92% of patients. Neurological deficit improved in 89% and was unchanged in the remainder. Radiographic stability was achieved in all but one patient. Posterior surgery effectively relieved pain and neurological deficit, and the complications encountered did not jeopardize the outcome.
What's new concerning the surgical treatment of cervical disc disease? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Orthopaedics.
Tokuhashi Y, Matsuzaki H, Shirasaki Y, Tateishi T
Spine. 2000 Feb 1;25(3):337-41
A trial of a new posterior stabilization technique for atlantoaxial instability and a report of preliminary results. OBJECTIVES: To describe a new posterior stabilization technique for atlantoxial instability.
Summary Of Background Data: Magerl's transarticular screw fixation is an accepted technique for rigid atlantoaxial stabilization, which reportedly has yielded many good clinical results. However, the technique is technically demanding and poses a risk of injury to the nerves and veins.
Methods: Eleven patients who had been treated with intra-articular screw fixation in combination with Halifax interlaminar clamp (OSTEONICS, Allendale, NJ) for atlantoaxial instability were observed. Results of their clinical examinations and biomechanical studies using resinous bones of a cervical spine model were reviewed.
Results: In all patients, occipital pain, neck pain, and neural deficit improved, and bony fusion with no correction loss was shown on radiography. To date, no vascular or neural complications have been found, and no instrumentation failures have occurred. In the biomechanical study, the Halifax with transarticular screw fixation had significantly greater flexion stiffness than the Halifax only or the Halifax with intra-articular screw fixation, but the torsion stiffness of the Halifax with intra-articular screw fixation was significantly greater than that of the other Halifax combinations.
Conclusion: The preliminary results showed that this technique was effective in strengthening the rotational stability of the atlantoaxial fixation and was considered useful for atlantoaxial posterior stabilization.
Liu H, Yang Z, Chen T
Chung Kuo Hsiu Fu Chung Chien Wai Ko Tsa Chih. 1998 Sep;12(5):269-71
To cure patients suffering from atlanto-axial instability following old fracture of odontoid process concomitant with stenosis of lower end of cervical spinal canal, a new operative method was designed. It included atlanto-axial fusion by Gallie technique and resection of right half of the laminae of C3-C7 spine at one stage. A female of 63 years old was treated. She was admitted with neck pain and numbness of the upper and lower limbs. A history of neck injury was noted in enquiry. In physical examination showed the sensation of pain of the upper limbs was decreased and the muscle power of the upper and lower limbs ranged from III degree to IV degree. The X-ray film and MRI suggested that there was instability of the atlanto-axial joint with stenosis of 4th-6th cervical spinal canal. The operation was satisfactory. After operation, the patient was followed up for 11 months. The physical examination indicated that sensation of the upper limbs had recovered to normal and the muscle power of the upper limbs reached IV degree and that the lower limbs reached V degree and X-ray showed bony fusion of the atlanto-axial joint. The conclusions were: 1. The stability of atlanto-axial joint was reconstructed with expanding of the spinal canal at the same time. 2. The duration, risk and cost of the therapy were reduced, and maintenance of the stability of the cervical spine throughout whole period of treatment was recommended.
al-Hami S
Minim Invasive Neurosurg. 1999 Mar;42(1):10-7
Over a period of 12 months at the Klinik fur Neurochirurgie (belonging to the Stadtischen Klinikums Fulda) 54 patients were operated upon after presenting with cervical radiculopathy or myelopathy in single vertebral segments with intravertebral disc involvement and/or osteochondrosis. The surgical intervention of all patients was carried out microsurgically by the author using a vental approach in accordance with the operative procedure and technique as described by Smith and Robinson [59]. In no patient was an additional bone plating necessary. Intraoperative data together with postoperative clinical, neurological, and radiological progress controls at 6 weeks and 3 months were, in the frame of a clinical perspective, non-random study, analysed and evaluated. There were no complications during the operative procedure or postoperatively, and of note, in no case was there any implant dislocation or neurological deterioration. Radicular pain was relieved in 98% of patients. Non-radicular pain--neck and shoulder pain--was eradicated in 42 patients (78%), improvement achieved in 8 patients (15%) and 4 patients (7%) still complained of neck pain 3 months postoperatively. Motor radicular deficit was completely relieved in 34 of 38 patients (89%) and in 3 patients (8%) there was a considerable improvement. Similar figures were obtained with relation to radicular sensory deficit. Of 5 patients who presented preoperatively with cervical myelopathy, 3 improved considerably and 2 remained unchanged. For all 50 patients fine layer, computer tomographic examination of the cervical region with 3-dimensional reconstruction was performed immediately postoperatively and at 3 months. All patients showed a correct positioning of the implant and either a complete or convincing bony ingrowth between the operated vertebrae. To summarise, the presented clinical and radiological study shows the cancellous bone tissue filled, titanium implant to be a meaningful and useable alternative to conventional methods of spinal fusion. Essential advantages: (i) Negation of "bone procedure" complications at the iliac crest and neck combined with a simple and safe surgical procedure. (ii) Reduced hospitalisation time and subsequent treatment costs. (iii) The good biocompatibility of titanium combined with a solid stability at the fusion site. Despite the excellent initial operative results the absence of long term results must be born in mind.
Zoega B, Karrholm J, Lind B
Eur Spine J. 1998;7(4):302-7
This study evaluated whether addition of a cervical spine locking plate (CSLP) in two-level disc fusions improved the postoperative stability and reduced the time to healing. Radiostereometric analysis was used to obtain precise recordings of the three-dimensional motion between the fused vertebrae. Eighteen consecutive patients were operated on with excision of two adjacent cervical discs and anterior horseshoe grafting with autologous bone (Smith Robinson technique). Nine patients were randomized to stabilization with autologous bone grafting and CSLP plate fixation and nine patients to grafting without fixation. Clinical symptoms in terms of pain in the neck and the arm were analysed preoperatively and after 1 year using a visual analogue scale (VAS). The patients operated without a plate displayed increased rotations around the transverse axis, corresponding to the development of a kyphosis [mean value no plate/plate 14.4 degrees/0.8 degrees (repeated measure ANOVA: P < 0.01)]. The mean compression was 3.2 mm larger in patients operated without a plate (repeated measure ANOVA: P < 0.01). Patients operated without a plate had more arm pain at the 1-year follow up (P < 0.05, Mann-Whitney U test). The VAS score for neck pain did not differ significantly between the two groups. Plate fixation could not be demonstrated to increase the healing rate, promote more rapid fusion or influence the frequency of graft complications.
Blauth M, Schmidt U, Bastian L, Knop C, Tscherne H
Zentralbl Chir. 1998;123(8):919-29
Lower cervical spine injuries with instability of the anterior and/or posterior column can be treated by anterior interbody fusion and plate fixation. Plates available for anterior instrumentation of the lower cervical spine can be divided into locking or non-locking systems with uni- or bicortical screw purchase. Our biomechanical comparative testing of different screw fixation systems demonstrates improved stability with the use of bicortical purchase. Clinical studies, however, have proven high fusion rates without loss of correction and a low implant related morbidity with the use of unicortical as well of bicortical plate systems. Correct reduction and intraoperative positioning of the unstable cervical spine is crucial to avoid implant related complications. Also, limitations of anterior instrumentation for the treatment of specific lesions of the lower cervical spine have to be considered, e.g. in complex lesions with axial instability or in fracture dislocations with ankylosing spondylitis. Changes or alterations of adjacent segments can be reduced by the use of plates with correct lengths, contact of uninjured adjacent discs with implants should be avoided. A comparative analysis of two patient collectives--89 patients (1972-1983) and 102 patients (1987-1994), all of them treated with bicortical plate fixation--revealed different results in terms of implant failure, operative reduction and loss of correction. All but one surgical fusions had healed radiologically. Implant related complications during the first 3 months after the initial operation were lower in the latter group, only 3 out of 102 patients (3%) with implant loosening versus 7 our of 89 patients (8%) with implant breakage or loosening required surgical revision. In all cases technical errors could be detected. Clinical follow-ups with personal examination was performed in 144 patients: 57 of 72 survivors of series I (79%) after an average time of 11 years 9 months and 87 out of 94 survivors of series II (85%). The radiologic examination revealed 2 patients with screw breakage in series I, one patient with an asymptomatic implant loosening in series II. Only one case was observed with a loss of correction after loosened and early removed hardware. In all other patients there was no difference of radiologic angles between postoperative X-ray and follow-up. 16 patients, 12 of series I, 4 of series II, were fused in a kyphotic position after insufficient preoperative reduction. Radiologic alterations of adjacent segments, i.e. spondylophyts or "spontaneous" fusions, were observed in more than 50% of all patients of both series. However, complaints or persistent pain did not correlate with radiologic findings. Also in both series there was a high percentage of patients with mild, residual neck pain in spite of a very good radiologic result. Only in a very few cases the complaints had to be treated by drugs.
Eyres KS, Gray DH, Robertson P
Br J Rheumatol. 1998 Jul;37(7):756-9
Twenty-six patients with rheumatoid disease affecting the cervical spine underwent surgical treatment for neck pain, neurological deficit, or both. Atlantoaxial subluxation (n=13), subaxial subluxation (n=7) and vertical migration of the odontoid (n=6) were treated. Arthrodesis with autologous bone was augmented with wire, Ransford loop, Hartshill rectangle or Magerl technique. Pain relief occurred in 92% of patients. Neurological deficit improved in 89% and was unchanged in the remainder. Radiographic stability was achieved in all but one patient. Posterior surgery effectively relieved pain and neurological deficit, and the complications encountered did not jeopardize the outcome.
