Immediate Postoperative Reversal of Disc Herniation Following Facetal Distraction-Fixation Surgery: Report of 4 Cases

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Aim:An alternative form of surgical treatment of prolapsed cervical intervertebral disc in patients presenting with symptoms related to myelopathy is discussed. The treatment involved fixation of the affected spinal segments and aimed at arthrodesis. No direct manipulation or handling of the disc was done.Materials and Methods:During the period August 2010 to June 2017, 16 patients presenting with symptoms attributed to myelopathy and diagnosed to have prolapsed cervical intervertebral disc were surgically treated by spinal stabilization. There were 11 males and 5 females and their ages ranged from 20 to 66 years (average: 40.6 years). Apart from clinical and radiological indicators, the number of spinal segments that were stabilized depended on direct observation of facetal morphology, alignment, and stability. Surgery involved distraction-fixation of facets using Goel facet spacer (8 patients), transarticular facetal fixation (5 patients) using screws or a combination of both facetal spacer, and transarticular screws (3 patients).Results:All patients had “remarkable” clinical improvement in the immediate postoperative period as assessed by visual analog scale, Goel's clinical grading, and Japanese Orthopedic Association scores. Follow-up ranged from 3 to 84 months (average: 50 months). The herniated disc regressed or disappeared at follow-up radiological assessment that ranged from 24 h to 3 months after surgery.Conclusions:Spinal segmental fixation aiming at arthrodesis with or without distraction of facets and without any direct surgical manipulation in the disc space or removal of the prolapsed portion of the disc can be considered in the armamentarium of the surgeon.

Section: Discussionmentioning

confidence: 99%

Only spinal fixation as treatment of prolapsed cervical intervertebral disc in patients presenting with myelopathy

Goel

Dharurkar²,

Shah³

et al. 2017

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“…Facet distraction as a treatment for cervical spondylotic radiculopathy and myelopathy was described by Goel. [ 1 2 3 4 ] (US Patent No. 9668783 B2 - Goel - Devices and method for spondylotic disease) Posterior cervical cages (Goel facetal spacers) have recently become available as an alternative to lateral mass fixation (LMF) to achieve cervical fusion by a posterior surgical approach.…”

Section: Introductionmentioning

confidence: 99%

Perioperative complications in patients treated with posterior cervical fusion and bilateral cages

Siemionow

Główka

Blok

et al. 2017

Context:Posterior cervical cages have recently become available as an alternative to lateral mass fixation in patients undergoing cervical spine surgery.Aims:The purpose of this study was to quantify the perioperative complications associated with cervical decompression and fusion in patients treated with a posterior cervical fusion (PCF) and bilateral cages.Settings and Design:A retrospective, multicenter review of prospectively collected data was performed at 11 US centers.Subjects and Methods:The charts of 89 consecutive patients with cervical radiculopathy treated surgically at one level with PCF and cages were reviewed. Three cohorts of patients were included standalone primary PCF with cages, circumferential surgery, and patients with postanterior cervical discectomy and fusion pseudarthrosis. Follow-up evaluation included clinical status and pain scale (visual analog scale).Statistical Analysis Used:The Wilcoxon test was used to test the differences for the data. The P level of 0.05 was considered significant.Results:The mean follow-up interval was 7 months (range: 62 weeks - 2 years). The overall postsurgery complication rate was 4.3%. There were two patients with neurological complications (C5 palsy, spinal cord irritation). Two patients had postoperative complications after discharge including one with atrial fibrillation and one with a parietal stroke. After accounting for relatedness to the PCF, the overall complication rate was 3.4%. The average (median) hospital stay for all three groups was 29 h.Conclusions:The results of our study show that PCF with cages can be considered a safe alternative for patients undergoing cervical spine surgery. The procedure has a favorable overall complication profile, short length of stay, and negligible blood loss.

“…Facetal distraction as a treatment of cervical spondylosis with radiculopathy and myelopathy was described by Goel. [ 10 11 ] Recently, intervertebral cervical cages implanted by a posterior approach bilaterally between the facet joints have demonstrated[ 12 13 14 15 ] good clinical and radiological outcome at 24 months. [ 16 ] Stabilization achieved after bilateral posterior cervical cage implantation is reported to be similar to anterior cervical discectomy and fusion (ACDF) and lateral mass screws (LMSs) in biomechanical studies.…”

Section: Introductionmentioning

confidence: 99%

Multilevel cervical laminectomy and fusion with posterior cervical cages

Monsef

Siemionow

2017

Context:Cervical spondylotic myelopathy (CSM) is a progressive disease that can result in significant disability. Single-level stenosis can be effectively decompressed through either anterior or posterior techniques. However, multilevel pathology can be challenging, especially in the presence of significant spinal stenosis. Three-level anterior decompression and fusion are associated with higher nonunion rates and prolonged dysphagia. Posterior multilevel laminectomies with foraminotomies jeopardize the bone stock required for stable fixation with lateral mass screws (LMSs).Aims:This is the first case series of multilevel laminectomy and fusion for CSM instrumented with posterior cervical cages.Settings and Design:Three patients presented with a history of worsening neck pain, numbness in bilateral upper extremities and gait disturbance, and examination findings consistent with myeloradiculopathy. Cervical magnetic resonance imaging demonstrated multilevel spondylosis resulting in moderate to severe bilateral foraminal stenosis at three cervical levels.Materials and Methods:The patients underwent a multilevel posterior cervical laminectomy and instrumented fusion with intervertebral cages placed between bilateral facet joints over three levels. Oswestry disability index and visual analog scores were collected preoperatively and at each follow-up. Pre- and post-operative images were analyzed for changes in cervical alignment and presence of arthrodesis.Results:Postoperatively, all patients showed marked improvement in neurological symptoms and neck pain. They had full resolution of radicular symptoms by 6 weeks postoperatively. At 12-month follow-up, they demonstrated solid arthrodesis on X-rays and computed tomography scan.Conclusions:Posterior cervical cages may be an alternative option to LMSs in multilevel cervical laminectomy and fusion for cervical spondylotic myeloradiculopathy.