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

Abstract

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.

Biomechanical Analysis of an Anterior Cervical Discectomy and Fusion Pseudarthrosis Model Revised With Machined Interfacet Allograft Spacers

“…13,19 Recent studies have described the application of these interfacet allograft spacers to treat disc herniation, and spondylotic radiculopathy and myelopathy. 13,20,21 We have observed that, in addition to foraminal decompression, the interfacet spacers significantly stabilize the spine and may be used for the treatment of pseudarthrosis after ACDF. In this biomechanical study, we hypothesize that the interfacet machined allograft spacers would significantly increase segmental stability after failed anterior interbody fusion.…”

“Only fixation”: Can it be the single remedy for all?

“…He has been promoting this “only fixation” philosophy for about a decade from now for many spinal degenerative disease entities such as cervical spondylosis and spinal canal stenosis and even for cervical disc prolapse. [23456] We greeted the “only fixation” philosophy for cervical spondylotic myelopathy earlier. However, there were some reservations and queries regarding that idea.…”

Prolapsed, herniated, or extruded intervertebral disc-treatment by only stabilization

“…[ 1 2 3 4 ] We identified that even the disc “water” content can be restored and the disc height can return toward normal. It was observed that there is a potential for osteophytes to regress and bone fusions to “unfuse.”[ 6 7 ] Essentially, we described that restoration of spinal height and spinal stabilization are the forms of treatment that are necessary for spinal degeneration, rather than spinal decompression. It was concluded that the surgical procedures such as laminectomy, discectomy, and resection of the osteophytes are not necessary and could even be harmful surgical procedures.…”

“…We recently reported our results of treatment of only spinal fixation for cervical PIVD presenting with symptom of myelopathy. [ 7 ] The symptoms resolved in the immediate postoperative phase and the resolution of herniated disc material was observed on follow-up assessment.…”