Facetal Fixation Arthrodesis as Treatment of Cervical Radiculopathy

Jadhav

Shah

et al. 2020

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Objective: The authors report their experience with 14 cases having adult idiopathic de novo lumbar scoliosis (AIDLS) and presenting with the predominant symptoms of claudication pain in the low back and legs. The patients were treated by only multisegmental stabilization, and the surgical procedure aimed for arthrodesis without any form of bone or soft-tissue decompression. The clinical outcome of this novel form of surgical treatment is presented. Materials and Methods: During the period of June 2014 to June 2019, 14 patients having AIDLS (degenerative scoliosis) were surgically treated. Apart from clinical and radiological guides, instability was diagnosed on the basis of direct physical observation of the status of articulation and by manual manipulation of bones of the region. The Camille transarticular facet screw fixation technique provided a quick, safe, and strong segmental spinal fixation. An additional inter-screw metal link plate provided intersegmental stability at selected levels. The Oswestry Disability index and visual analog scale were used to assess the patients before and after surgery and at follow-up. In addition, a personalized Patient Satisfaction Score was used to assess the outcome of surgery. Results: Clinical symptomatic recovery was observed in all patients in the immediate postoperative period. During the average follow-up period, 100% patients had varying degrees of symptomatic relief. Conclusions: Spinal instability is the nodal point of pathogenesis of spinal degeneration-related AIDLS. Only fixation of the involved spinal segments is necessary, and decompression by bone or soft-tissue resection is not necessary.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Adult idiopathic de novo lumbar scoliosis: Analysis of surgical treatment in 14 patients by “only fixation”

Jadhav

Shah

et al. 2020

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“…It was observed that more than imaging, it was direct visualization of alignment and status of the facets and identification of instability of the facets by direct handling of the bones during the surgery that is crucial to determine the levels of unstable spine. [1819] We identified that the treatment of single or multilevel spinal degeneration by only fixation resulted in gratifying clinical recovery. It was concluded that transarticular method of screw implantation is a safe, effective, and straightforward surgical procedure for subaxial spinal fixation.…”

Section: Discussionmentioning

confidence: 99%

Cervical spondylosis in patients presenting with “severe” myelopathy: Analysis of treatment by multisegmental spinal fixation – A case series

Vutha

Shah

et al. 2019

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Background:Surgical strategy of multisegmental spinal fixation that includes atlantoaxial joint for patients having cervical spondylosis-related symptoms of severe myelopathy is analyzed.Objective:Surgical outcome of patients presenting with “severe” symptoms of cervical myelopathy having multisegmental degenerative cervical spondylosis and treated by multisegmental spinal fixation is analyzed. Atlantoaxial joint was included in the fixation construct in majority of patients. No bone, soft tissue, osteophyte, or disc resection for decompression was done.Materials and Methods:Sixty-four patients having multisegmental cervical spondylosis who presented with symptoms of severe myelopathy were surgically treated during the period from March 2013 to December 2018. On the basis of the concept that instability is the primary cause of spinal degeneration, multisegmental spinal fixation was done in all patients. Atlantoaxial joint was included in the fixation construct in 48 patients. The levels of spinal fixation were determined on the basis of direct observation of facet joints and by manual manipulation and were guided by the presenting clinical features and radiological information. Clinical monitoring was done using Goel clinical grading, modified Japanese Orthopedic Association Score, and visual analog score parameters. Patient satisfaction index assessed the functional and symptomatic improvement.Results:During the follow-up that ranged from 6 to 75 months, all patients improved in their clinical status. Fifty-five (85.9%) patients could walk independently or with mild support.Conclusions:Multisegmental spinal fixation that includes atlantoaxial joint in most patients forms a rational treatment strategy for patients of cervical spondylosis presenting with severe symptoms of myelopathy.

“…We identified that “only fixation” of the spinal segments was an optimum form of treatment even for prolapsed and herniated disc and for degeneration-related lumbar and cervical radiculopathy. [151617]…”

Section: Discussionmentioning

confidence: 99%

Is cervical instability the cause of lumbar canal stenosis?

Vutha²,

Shah³

et al. 2019

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Aim: On the basis of an experience with 12 cases, the validity and rationale of cervical spinal stabilization for cases having both cervical and lumbar spinal canal stenosis is analyzed. Materials and Methods: From March 2017 to May 2018, 12 patients presented with a major symptom of neurogenic claudication pain generally related to lumbar canal stenosis in addition to other symptoms related to cervical myelopathy. The average age was 57 years. All patients were clinically and radiologically diagnosed to have both cervical and lumbar spinal canal stenosis. Based on the concept that degenerative spinal spondylotic myelopathy is an outcome of spinal instability, all patients underwent cervical spinal stabilization. No decompression by bone resection was done. The lumbar spine was not surgically treated. Visual analog scale, the Japanese Orthopaedic Association, and Oswestry Disability Index were used to monitor patients before and after surgery. Results: There was dramatic relief from symptoms related both to cervical and to lumbar canal stenosis in the postoperative period. During the average period of follow-up of 12 months, none of the patients have experienced recurrence of lumbar pain or needed any surgery. Conclusion: The report highlights the possibility of recovery in lumbar canal stenosis related symptoms following cervical spinal stabilization surgery for associated cervical spinal stenosis. We conclude that in select cases, cervical spinal instability may be the cause of clinical and radiological observations in cases having lumbar canal stenosis.