BackgroundThe anterior approach to the cervical spine is the most commonly used surgery with effective decompression and less surgical trauma. Anterior plate construct (APC) is considered a standard technique. However, it appears to cause implant failure and postoperative dysphagia. Due to these reasons, locking stand-alone cages (LSCs) without the addition of an anterior plate have been developed and gained popularity in the past decade. In theory, an LSC could provide immediate load-bearing support to the anterior column of the cervical spine and may enhance the rate of arthrodesis. However, screw skiving and backing off are known complications of LSC. Given the characteristic shape of cervical discs, we wondered whether there may be a role for a shape-conforming cage without screws and plates to achieve desired outcomes, i.e., a true stand-alone cage (TSC). A single surgeon cohort using the cage in a heterogenic set of indications was evaluated.MethodsA total of 45 patients with degenerative cervical conditions who underwent surgery using TSC using CoRoent Small Contoured peek cage (Nuvasive, San Diego, CA) and Orthoblend™ (Medtronics, Memphis, TN) were retrospectively reviewed. Comparisons between preoperative and postoperative Numeric Rating Scale (NRS), the modified AAOS-Modems disability outcome, Neck Disability Index (NDI) scores, and Short Form 36 were evaluated. Operative time, the occurrence rate of fusion, lordosis change of cervical spine, and occurrence rate of complications were evaluated.ResultsThere were one-level (n = 15), two-level (n = 24), and three-level (n = 6) cases making a total of 81 cages implanted and studied. The mean operative time was 132.7 min. The group demonstrated significant improvements in NRS, AAOS-Modems disability outcome, and NDI scores after surgery (mean follow-up 12 months). The cervical lordosis at pre- and last follow-up period was 8.7 ± 2.2° and 8.3 ± 3.2°, respectively. The complication rate was 21.2%.ConclusionsTSC yielded satisfactory long-term clinical and radiological outcomes; this preliminary report can form the basis of a cost–benefit analysis study either prospectively or by way of meta-modeling comparing APC, LSC to TSC.
Introduction: Cranio-cervical instability (CCI) is a condition commonly found in patients with connective tissue disorders such as Ehlers-Danlos Syndrome (EDS), leading to various symptoms. Assessing patients for surgical fusion as a treatment for CCI is challenging due to the complex nature of EDS-related symptoms. This study aimed to evaluate the role of pre-fusion Halo traction in alleviating symptoms and determining suitable candidates for fusion surgeries. Methods: A case series of 15 EDS patients with neurological symptoms underwent halo traction between 2019 and 2022. Patients completed a CCI Questionnaire before and after the traction, reporting symptoms related to headache, vision, hearing, equilibrium, and performance. Symptom groups were assigned scores based on patient responses, with one point for each affirmative answer. The scores were statistically analyzed using a paired t-test. Patients experiencing over 50% improvement in the majority of symptoms were considered for fusion surgery, and 7 out of 12 patients subsequently underwent the procedure. Results: The average age of the patients was 38 years, with a female-to-male ratio of 14:1, consistent with existing literature. Significant improvements were observed in various symptom categories after halo traction, including headache (63% improvement, p < 0.001), brainstem functions (72% improvement, p < 0.001), cerebellar functions (59% improvement,p < 0.001), hearing (65% improvement, p < 0.001), motor functions (62% improvement, p < 0.001), vision (53% improvement, p < 0.001), cardiovascular functions (58% improvement, p< 0.05), sensory and pain (56% improvement, p < 0.001), high cortical functions (54% improvement, p < 0.01), GI functions (41% improvement, p < 0.05), bladder functions (55% improvement, p< 0.001), and Modified Karnofsky score (26% improvement, p < 0.05). Conclusion: halo traction proved to be a simple and effective method for both evaluating patients for surgery and providing symptomatic relief in EDS-related CCI cases. It also allows surgeons to monitor patients with stable cranio-cervical junctions before committing to surgery. However, the study's limitations include the small sample size and the absence of a validated questionnaire with a scoring system.
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