Degenerative Cervical Myelopathy: Pathophysiology and Current Treatment Strategies

Choi, Sung Hoon; Kang, Chang Nam

doi:10.31616/asj.2020.0490

Cited by 70 publications

(79 citation statements)

References 69 publications

(81 reference statements)

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“…34,35 In contrast, decreased cervical lordosis related to less T1 slope might affect allospacer failure by increasing the vertical load placed on the allospacer and vertebral body. 35,36 Our study had several limitations. First, different surgical indications for anterior surgery and combined anteriorposterior surgery made it difficult to evenly allocate patients into 3 groups.…”

Section: Discussionmentioning

confidence: 95%

Anterior Plate-Screws and Lower Postoperative T1 Slope Affect Cervical Allospacer Failures in Multi-Level ACDF Surgery: Anterior Versus Posterior Fixation

Suk

Jimenez

et al. 2021

Global Spine Journal

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Study Design: Prospective observational study. Objective: In ACDF, graft failure and subsidence are common complications of surgery. Depending on the cervical fixation, different biomechanical characteristics are applied on the grafts. This aims to describe the incidence of cervical spacer failure in patients with cervical degenerative condition according to the cervical fixation method and sagittal balance. Method: From November 2011 to December 2015, 262 patients who underwent cervical spine surgery were enrolled prospectively. Patients were divided into 3 groups based on fixation method: anterior plate/screw (APS), posterior lateral mass screw (LMS), pedicle screw (PPS) groups. Serial X-rays and CT scans were utilized to evaluate radiologic outcomes. Results: Mean patient ages were 56.1 years in the APS group, 61.5 years in the LMS group, and 57.6 years in the PPS group ( P = 0.002). Allospacer failure was most common in the APS group, compared to the LMS and PPS groups (chi-square, P = 0.038). Longer fusion level was associated with greater allospacer failure (Baseline 2 level surgery; Odds ratio (OR) 3.4 in 3 level, 15.2 in 4 level, P = 0.036,0.013). Higher T1 slope was correlated with less allospacer failure (OR 0.875, P = 0.001). ORs of allospacer failure in the LMS and PPS groups were 0.04 and 0.02, respectively, ( P = 0.01, 0.01), compared with the APS group. Conclusion: This study was able to show that allospacer failure in multi-level ACDF surgery is more common with a longer fusion length, less postoperative T1 slope, and an anterior plate-screws technique. Pedicle screws provided the best biomechanical stability among the 3 constructs.

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Section: Discussionmentioning

confidence: 95%

Anterior Plate-Screws and Lower Postoperative T1 Slope Affect Cervical Allospacer Failures in Multi-Level ACDF Surgery: Anterior Versus Posterior Fixation

Suk

Jimenez

et al. 2021

Global Spine Journal

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show abstract

“…Another advantage in using a short plate when the need arises for revision surgery of an adjacent segment is that the removal of the previously inserted plates and screws is not necessary. This would minimize excessive dissection of the area [ 6 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Short Plate with Screw Angle over 20 Degrees Improves the Radiologic Outcome in ACDF: Clinical Study

Jimenez

Kim

Lee

et al. 2021

JCM

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Background: Anterior cervical discectomy and fusion surgery is a common procedure for degenerative cervical spine. This describes allospacer and implant-related outcomes, comparing medium plate–low screw angle and short plate–high screw angle techniques. Methods: From January 2016 to June 2019, 79 patients who underwent ACDF were prospectively enrolled. Patients were divided, depending on the plate–screw system used: medium plate–low screw angle (12.3 ± 2.5 to 13.2 ± 3.2 degrees), and short plate–high screw angle (22.8 ± 5.3 to 23.3 ± 4.7 degrees). Subsidence, ALOD, and sagittal cervical balance were analyzed using lateral cervical X-rays. NDI and VAS scores were also evaluated. Results: Age for medium plate–low-angled screw group is 58.0 ± 11.3 years, and 55.3 ± 12.0 in the short plate–high-angled screw group (p-value = 0.313). Groups were comparable in mean NDI (p-value = 0.347), VAS (p-value = 0.156), C2–C7 SVA, (p-value = 0.981), and lordosis angle (p-value = 0.836) at 1-year post-surgery. Subsidence was higher in the medium plate–low-angled screw than in the short plate–high-angled screw (25% and 8.5%, respectively, p-value = 0.045). ALOD is also more common in the medium plate group (p-value = 0.045). Conclusion: Use of a short plate and insertion of high-angled screws (more than 20 degrees) has less chance of subsidence and occurrence of ALOD than the traditional technique of using medium plate and low angle.

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“…The spinal cord compression is typically caused by disc pathology, osteophyte formation, and hypertrophy of the ligamentum flavum [2]. The condition is characterized by motor deficits, paresthesia, gait disturbance, spasticity, and incontinence [3]. Decompressive surgery halts disease progression and improves functional outcome [4].…”

Section: Introductionmentioning

confidence: 99%

Laminectomy alone versus laminectomy with fusion for degenerative cervical myelopathy: a long-term study of a national cohort

et al. 2021

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Purpose To compare patient-reported 5-year clinical outcomes between laminectomy alone versus laminectomy with instrumented fusion in patients with degenerative cervical myelopathy in a population-based cohort. Methods All patients in the national Swedish Spine Register (Swespine) from January 2006 until March 2019, with degenerative cervical myelopathy, were assessed. Multiple imputation and propensity score matching based on clinicodemographic and radiographic parameters were used to compare patients treated with laminectomy alone with patients treated with laminectomy plus posterior-lateral instrumented fusion. The primary outcome measure was the European Myelopathy Score, a validated patient-reported outcome measure. The scale ranges from 5 to 18, with lower scores reflecting more severe myelopathy. Results Among 967 eligible patients, 717 (74%) patients were included. Laminectomy alone was performed on 412 patients (mean age 68 years; 149 women [36%]), whereas instrumented fusion was added for 305 patients (mean age 68 years; 119 women [39%]). After imputation, the propensity for smoking, worse myelopathy scores, spondylolisthesis, and kyphosis was slightly higher in the fusion group. After imputation and propensity score matching, there were on average 212 pairs patients with a 5-year follow-up in each group. There were no important differences in patient-reported clinical outcomes between the methods after 5 years. Due to longer hospitalization times and implant-related costs, the mean cost increase per instrumented patient was approximately $4700 US. Conclusions Instrumented fusions generated higher costs and were not associated with superior long-term clinical outcomes. These findings are based on a national cohort and can thus be regarded as generalizable.

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Degenerative Cervical Myelopathy: Pathophysiology and Current Treatment Strategies

Cited by 70 publications

References 69 publications

Anterior Plate-Screws and Lower Postoperative T1 Slope Affect Cervical Allospacer Failures in Multi-Level ACDF Surgery: Anterior Versus Posterior Fixation

Anterior Plate-Screws and Lower Postoperative T1 Slope Affect Cervical Allospacer Failures in Multi-Level ACDF Surgery: Anterior Versus Posterior Fixation

Short Plate with Screw Angle over 20 Degrees Improves the Radiologic Outcome in ACDF: Clinical Study

Laminectomy alone versus laminectomy with fusion for degenerative cervical myelopathy: a long-term study of a national cohort

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