Minimally Invasive Anterior Cervical Discectomy Without Fusion to Treat Cervical Disc Herniations in Patients with Previous Cervical Fusions

Abstract

Adjacent level cervical disc disease and secondarily progressive disc space degeneration that develops years after previously successful anterior cervical fusion at one or more levels is a common, but potentially complex problem to manage. The patient is faced with the option of further open surgery which involves adding another level of disc removal with fusion, posterior decompression, and stabilization, or possibly replacing the degenerated disc with an artificial disc construct. These three cases demonstrate that some patients, especially after minor trauma, may have small herniated discs as the cause for their new symptoms rather than progressive segmental degeneration. Each patient became symptomatic after minor trauma three to six years after the original fusion and had no or minimal radiologic changes of narrowing of the disc or spur formation commonly seen in adjacent level disease, but rather had magnetic resonance imaging (MRI) findings typical of small herniated discs. After failing multiple months of conservative treatment they were offered surgery as an option. Subsequently, all three were successfully treated with minimal anterior discectomy without fusion. There are no reports in the literature of using minimal anterior cervical discectomy without fusion in previous fused patients. This report reviews the background of adjacent level cervical disease, the various biomechanical explanations for developing a new disc herniation rather than progressive segmental degeneration, and how anterior cervical discectomy without fusion can be an option in these patients.

Efficacy of the Clinical-Instrumental Algorithm in the Treatment of Spinal Tandem Stenosis

“…The surgical techniques used in the study group patients are standard and have been widely used by various groups of authors in the surgical treatment of patients with isolated stenoses of the spinal canal at the cervical and lumbar levels. 14,15 However, approaches to the step-by-step implementation of surgical interventions and the timing of their implementation, the personified use of ventral and dorsal surgical techniques, as well as the priority of applying decompressive techniques before decompressive-stabilizing techniques in patients with tandem stenosis, were absent.…”

“…11,12 The introduction of minimally invasive microsurgical techniques undoubtedly brought a more positive perspective for the treatment of these patients. 13,14 A comprehensive clinical evaluation of neurological symptoms directly arising from the degree of narrowing of the vertebral canal and intervertebral foramen combined with tandem stenoses is used to determine the dominant role in the surgical tactics, and the effectiveness of the intervention. 4,10,15 Neuroimaging techniques have significantly expanded the diagnostic capabilities for early verification of degenerative spinal diseases, which in turn, has led to an increase in the number of surgical interventions for spinal stenosis.…”

Multicenter Analysis of Surgical Treatment Effectiveness for Patients With Symptomatic Tandem Stenosis of the Cervical and Lumbar Spine Based on Differentiated Clinical-Instrumental Algorithm

“…Хирургические технологии, используемые при лечении пациентов исследуемой группы, являются стандартными и широко применяются различными авторами при хирургическом лечении пациентов с изолированными стенозами позвоночного канала [14,15]. но подходы к этапному выполнению оперативных вмешательств и срокам их проведения, персонифицированному использованию вентральных и дорзальных хирургических технологий, а также приоритетность применения декомпрессивных методик перед и декомпрессивно-стабилизирующими у пациентов с тандемстенозом отсутствовали.…”

“…консервативное лечение стеноза способствует некоторому улучшению только на ранних стадиях заболевания [11,12]. Внедрение минимально инвазивных технологий микрохирургической техники, безусловно, определило позитивную перспективу в лечении пациентов с дегенеративным стенозом позвоночника [13,14].…”

A New Method to Evaluate Pressure Distribution Using a 3D-Printed C2-C3 Cervical Spine Model with an Embedded Sensor Array

“…However, various complications, such as adjacent disc degeneration, disc space narrowing, and other mechanical issues, continue to pose significant concerns [2,3]. The reported rates of these issues following artificial cervical disc replacement are quite high, with approximately 15% reported in single-level procedures and about 50% in multisegment procedures [4,5]. These issues are thought to be caused by increased stress in the adjacent level, which leads to hypermobility and quicker degeneration.…”