Biomedical subjects

Robert J Hacker

Publications and source records attributed to Robert J Hacker.

3 recordsLinked to original sources

PubMed2005

Cervical disc arthroplasty: a controlled randomized prospective study with intermediate follow-up results. Invited submission from the joint section meeting on disorders of the spine and peripheral nerves, March 2005.

OBJECT: The authors of studies of anterior cervical fusion for disc-related disease have documented satisfying clinical results and infrequent complications. Recently, cervical disc arthroplasty has entered clinical trials as an alternative to fusion. Although the results of anecdotal reports and prospective studies support this procedure, these studies have not conferred the validity of a controlled randomized study. In the present study, the author presents data obtained in such a study. METHODS: After symptoms failed to respond to conservative therapy, 46 patients with one-level discogenic cervical radiculopathy and/or myelopathy were randomized to undergo arthroplasty or fusion as part of a US Food and Drug Administration medical device study. In all patients there was a minimum follow-up duration of 1 year. Equivalent results for the relief of arm pain and neck pain were noted in both treatment groups. Treatment parameters other than operative time were similar. No neurological or serious systemic complications occurred. CONCLUSIONS: Although extended follow-up data and larger patient populations are needed, the results of this study indicate that arthroplasty is a viable alternative to cervical fusion.

Arthroplasty↗

PubMed2003

Failed anterior cervical foraminotomy.

OBJECT: Anterior cervical foraminotomy has been advocated as a procedure that preserves the motion segment while treating radiculopathy due to degenerative cervical disc disease. Because the medical literature contains no long-term follow up or randomized studies related to this procedure, the authors reviewed their results, specifically examining cases of failure to determine the efficacy of the approach. METHODS: The authors identified 23 patients in whom unilateral cervical radiculopathy due to degenerative cervical disc disease was refractory to conservative therapy and in whom anterior cervical foraminotomy was performed between 1998 and 2000. The procedure involves ipsilateral exposure, microsurgical removal of the uncovertebral joint to identify the nerve root, and partial removal of the lateral anulus and or disc fragments. Data in those patients who underwent reoperation(s) were reviewed specifically for the procedure type, interval between index procedure and reoperation, and whether multiple procedures were performed. Of the 23 patients, 30% required at least one additional procedure. A good or excellent outcome at last follow-up examination was achieved in only 12 patients. CONCLUSIONS: In the current study the authors found a reoperation rate that is considerably higher than that in most series of anterior cervical surgery for radiculopathy. The presumed benefit of anterior cervical foraminotomy is preservation of the disc interspace; however, in this study, a significant number of patients failed to experience a satisfying outcome. Currently the authors do not recommend anterior cervical foraminotomy as a stand-alone procedure.

Adult↗

PubMed2002

Threaded cages for degenerative cervical disease.

Multiple techniques are used to accomplish anterior interbody fusion in the cervical spine. These various options reflect the lack of any one approach to obtain superior results. Extrapolating from the lumbar spine experience, a cervical cage was proposed as an alternative to the status quo. A device evaluation study was done to determine the safety and efficacy of the cage with a comparison with current allograft or autograft fusion techniques. The study resulted in two publications. One study is a multicenter trial whereas the other is a one-author study with long-term results. A review of the data from both studies follows. Comparable outcomes were seen with the allograft and autograft control group and the experimental group in the multicenter trial. However, that study reported significantly better fusion rates for the patients with cervical cages compared with the control group. Both studies reported a high percentage of donor site morbidity in the patients in the control group who had autograft fusion. A trend toward better outcomes for patients who received a cervical cage was seen in the long-term followup study. The data presented suggest interbody fusion cages are a safe and effective treatment of degenerative cervical disc disorders and avoid iliac crest donor site morbidity.

Biomechanical Phenomena↗