Reoperation Rates After Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Radiculopathy and Myelopathy

Park, Moon Soo; Ju, Young Su; Moon, Seong Hwan; Kim, Tae Hwan; Oh, Jae Keun; Makhni, Melvin C.; Riew, K. Daniel

doi:10.1097/brs.0000000000001590

Cited by 24 publications

(22 citation statements)

References 21 publications

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“…12 According to our findings, smoking and diabetes have been previously identified as important risk factors for cervical radiculopathy, perioperative complication rates, and worse postoperative outcome. 1,10,14,21,22 In this cohort of painless paresis, we found C-5 and C-6 to be the most frequently affected nerve roots. Anatomically, the focal compression at the entrance of the neural foramen was most often attributable to uncovertebral joint arthrosis with or without soft-tissue pathologies and led to a predominant isolated lesion of the motor ventral nerve root.…”

Section: Discussionmentioning

confidence: 51%

Painless motor radiculopathy of the cervical spine: clinical and radiological characteristics and long-term outcomes after operative decompression

Siller¹,

Kasem²,

Witt³

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEVarious neurological diseases are known to cause progressive painless paresis of the upper limbs. In this study the authors describe the previously unspecified syndrome of compression-induced painless cervical radiculopathy with predominant motor deficit and muscular atrophy, and highlight the clinical and radiological characteristics and outcomes after surgery for this rare syndrome, along with its neurological differential diagnoses.METHODSMedical records of 788 patients undergoing surgical decompression due to degenerative cervical spine diseases between 2005 and 2014 were assessed. Among those patients, 31 (3.9%, male to female ratio 4.8 to 1, mean age 60 years) presented with painless compressive cervical motor radiculopathy due to neuroforaminal stenosis without signs of myelopathy; long-term evaluation was available in 23 patients with 49 symptomatic foraminal stenoses. Clinical, imaging, and operative findings as well as the long-term course of paresis and quality of life were analyzed.RESULTSPresenting symptoms (mean duration 13.3 months) included a defining progressive flaccid radicular paresis (median grade 3/5) without any history of radiating pain (100%) and a concomitant muscular atrophy (78%); 83% of the patients were smokers and 17% patients had diabetes. Imaging revealed a predominantly anterior nerve root compression at the neuroforaminal entrance in 98% of stenoses. Thirty stenoses (11 patients) were initially decompressed via an anterior surgical approach and 19 stenoses (12 patients) via a posterior surgical approach. Overall reoperation rate due to new or recurrent stenoses was 22%, with time to reoperation shorter in smokers (p = 0.033). Independently of the surgical procedure chosen, long-term follow-up (mean 3.9 years) revealed a stable or improved paresis in 87% of the patients (median grade 4/5) and an excellent general performance and quality of life.CONCLUSIONSPainless cervical motor radiculopathy predominantly occurs due to focal compression of the anterior nerve root at the neuroforaminal entrance. Surgical decompression is effective in stabilizing or improving motor function with a resulting favorable long-term outcome.

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Section: Discussionmentioning

confidence: 51%

Painless motor radiculopathy of the cervical spine: clinical and radiological characteristics and long-term outcomes after operative decompression

Siller¹,

Kasem²,

Witt³

et al. 2018

Journal of Neurosurgery: Spine

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“…ACDF is widely used to treat multilevel CDDD [22]. However, several studies reported that ACDF could result in certain complications [9,[23][24][25][26][27][28]. It has been reported that the incidences of complications in different levels of fusion are variable: the rates of internal fixation failures in one to four-level fusion are 20%, 36%, 71%, and 80%, respectively [23]; the incidences of reoperation in one to four-level fusion are 5.8%, 6.5%, 8%, and 16.8%, respectively [27]; in addition, the incidences of ASD in single-level fusion and multilevel fusion are 13.2% and 32.1%, respectively [29].…”

Section: Discussionmentioning

confidence: 99%

Biomechanical comparison of noncontiguous cervical disc arthroplasty and noncontiguous cervical discectomy and fusion in the treatment of noncontinuous cervical degenerative disc disease: a finite element analysis

Sun

Zhang

et al. 2020

J Orthop Surg Res

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Background: Biomechanical characteristics of noncontinuous ACDF and noncontinuous CDA in the treatment of noncontinuous cervical degenerative disc disease were still unclear. The aim of this research is to compare the differences between these two kinds of treatment methods and to verify the effectiveness of Prodisc-C in noncontinuous CDA. Methods: Eight FEMs of the cervical spine (C2-C7) were built based on CT images of 8 mild CDDD volunteers. In the arthroplasty group, we inserted Prodisc-C at C3/4 and C5/6. In the fusion group, CoRoent® Contour and NuVasive® Helix ACP were implanted at C3/4 and C5/6. Initial loads of 75 N were used to simulate the head weight and muscle forces. The application of 1.0 N m moment on the top on the C2 vertebra was used to create motion in all directions. Statistical analyses were performed using STATA version 14.0 (Stata Corp LP, College Station, Texas, USA). Statistical significance was set at P < 0.05. Results: The IDPs in C2/3 (P < 0.001, P = 0.005, P < 0.001, P < 0.001), C4/5 (P < 0.001), and C6/7 (P < 0.001) of the intact group were significantly less than that in the fusion group in flexion, extension, lateral bending, and axial rotation, respectively. In addition, the IDPs in C2/3 (P < 0.001, P = 0.001, P < 0.001, P < 0.001), C4/5 (P < 0.001), and C6/7 (P < 0.001) of the arthroplasty group were significantly less than that in the fusion group in flexion, extension, lateral bending, and axial rotation, respectively. Contact forces of facet joints in C2/3 (P = 0.010) in the arthroplasty group was significantly less than that in the intact group. Contact forces of facet joints in C2/3 (P < 0.001), C4/5 (P < 0.001), and C6/7 (P < 0.001) in the arthroplasty group was significantly less than that in the fusion group. Contact forces of facet joints in C2/3 (P < 0.001), C4/5 (P < 0.001), and C6/7 (P < 0.001) in the intact group were significantly less than that in the fusion group.

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“…Previous studies have discovered higher rates of reoperation for myelopathy compared with radiculopathy, 9 , 23 which may reflect differences in the number of vertebral levels operated. The risk of reoperation has been found to be smaller in longer fusions.…”

Section: Discussionmentioning

confidence: 95%

Occurrence, Risk Factors, and Time Trends for Late Reoperations due to Degenerative Cervical Spine Disease: A Finnish National Register Study of 19 377 Patients Operated on Between 1999 and 2015

et al. 2020

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BACKGROUND Surgery for degenerative cervical spine disease has escalated since the 1990s. Fusion has become the mainstay of surgery despite concerns regarding adjacent segment degeneration. The patient-specific trends in reoperations have not been studied previously. OBJECTIVE To analyze the occurrence, risk factors, and trends in reoperations in a long-term follow-up of all the patients operated for degenerative cervical spine disease in Finland between 1999 and 2015. METHODS The patients were retrospectively identified from the Hospital Discharge Registry. Reoperations were traced individually; only reoperations occurring >365 d after the primary operation were included. Time trends in reoperations and the risk factors were analyzed by regression analysis. RESULTS Of the 19 377 identified patients, 9.2% underwent a late reoperation at a median of 3.6 yr after the primary operation. The annual risk of reoperation was 2.4% at 2 yr, 6.6% at 5 yr, 11.1% at 10 yr, and 14.2% at 15 yr. Seventy-five percent of the late reoperations occurred within 6.5 yr of the primary operation. Foraminal stenosis, the anterior cervical decompression and fusion (ACDF) technique, male gender, weak opiate use, and young age were the most important risk factors for reoperation. There was no increase in the risk of reoperations over the follow-up period. CONCLUSION The risk of reoperation was stable between 1999 and 2015. The reoperation risk was highest during the first 6 postoperative years and then declined. Patients with foraminal stenosis had the highest risk of reoperation, especially when ACDF was performed.

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Reoperation Rates After Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Radiculopathy and Myelopathy

Abstract: 3.

Cited by 24 publications

References 21 publications

Painless motor radiculopathy of the cervical spine: clinical and radiological characteristics and long-term outcomes after operative decompression

Painless motor radiculopathy of the cervical spine: clinical and radiological characteristics and long-term outcomes after operative decompression

Biomechanical comparison of noncontiguous cervical disc arthroplasty and noncontiguous cervical discectomy and fusion in the treatment of noncontinuous cervical degenerative disc disease: a finite element analysis

Occurrence, Risk Factors, and Time Trends for Late Reoperations due to Degenerative Cervical Spine Disease: A Finnish National Register Study of 19 377 Patients Operated on Between 1999 and 2015

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