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PubMed2000

Anterior cervical diskectomy and fusion without plate instrumentation in 178 patients.

Between 1989 and 1996, fusion, pseudarthrosis, repeated operation rates, and outcomes were studied in 178 patients undergoing one- to four-level (average, 2.2 levels) anterior cervical diskectomy and fusion (ADF) without plating. Dynamic radiographs taken 3 and 6 months after operation showed fusion or pseudarthrosis without motion in 99% of patients after one-level ADF (78 patients), in 90% after two-level ADF (84 patients), and in 100% after three-level ADF (12 patients) and four-level ADF (4 patients). Pseudarthrosis with motion was noted in 1% after one-level ADF and in 10% after two-level ADF (statistically significant with a lower pseudarthrosis rate in the 1-level; by Fisher's exact test, p = 0.0351). Three patients required secondary posterior wiring and fusion. Good or excellent outcomes (by Odom's criteria) were achieved in 96% of patients within an average of 82 months. Although fusion rates for one-level ADF without plates appear adequate, high pseudarthrosis rates after two-level ADF warrant that plating be considered.

Adult↗

PubMed2000

Vocal fold paralysis after anterior cervical diskectomy and fusion.

OBJECTIVE: The anterior approach to the cervical spine now serves as the surgical access of choice for cervical spine disease. Vocal fold paralysis (VFP) may follow the procedure as a complication. The authors describe their experience with patients having VFP after anterior cervical diskectomy and fusion (ACDF), with an emphasis on outcome and prognosis. STUDY DESIGN: Retrospective. METHODS: Medical records of patients who underwent ACDF between January 1987 and February 1998 were reviewed. Further detailed review of the patients with documented VFP after surgery was then performed. RESULTS: Over the given time period 411 ACDFs were performed and 21 patients with this complication were identified (5%). All 21 patients had right-sided approaches. Eighteen patients had right VFP, 2 had left VFP, and 1 had bilateral VFP. Symptoms included hoarseness (18), persistent cough (7), aspiration (13), and dysphagia (7). The patient with bilateral VFP presented with stridor and respiratory distress requiring tracheotomy. The complete records of 17 patients with 18 VFPs were available for review. Fifteen of 18 VFPs (83.3%) had complete resolution within 12 months. One patient had recovery after 15 months. All patients were treated conservatively with speech and swallowing therapy. One patient required Gelfoam injection and another medialization thyroplasty, both for aspiration symptoms. CONCLUSIONS: The data suggest that at least 80% of VFP after ACDF will recover within 12 months of the procedure. The authors recommend regular follow-up and speech therapy for symptomatic patients. Medialization should be considered in patients with aspiration or persistent problems.

Adolescent↗

PubMed1997

Real-time monitoring of laser diskectomies with a superconducting, open-configuration MR system.

OBJECTIVE: The objective of our study was to assess the ability of a 0.5-T superconducting, open-configuration MR system to guide laser diskectomies. The study was performed ex vivo on six human cadavers as well as in vivo on three patients. CONCLUSION: The macroscopic size of necrosis correlated well with the monitored temperature spread (r2 = .76-.85). After MR-guided introduction of the laser fiber into the targeted disk space, temperature spread was visualized in all subjects.

Adolescent↗

PubMed1999

Video-assisted thoracic diskectomy and anterior release: a biomechanical analysis of an endoscopic technique.

This study evaluates the residual biomechanical stability of the spine following multilevel anterior diskectomies and anterior longitudinal ligament release using video-assisted thoracoscopic surgery (VATS). Eighteen domestic pigs were randomly divided into three groups of six pigs. Group 1 underwent thoracic anterior release from T4-T9 using a left-sided VATS approach, group 2 underwent thoracic anterior release from T4-T9 via a traditional left thoracotomy (open), and group 3 did not undergo surgery and served as a control. After surgery, the animals were euthanized, and the thoracic spinal columns were harvested for biomechanical testing. Nondestructive testing was performed on all specimens in pure compression, flexion, extension, right lateral bending, and torsion. Specimens from group 1 had significantly lower stiffness values (P<.05) than the control group for all five test modes. These data demonstrate that adequate anterior release of the thoracic spine can be obtained with the VATS technique. Further prospective clinical studies on VATS are required before the widespread application of this technique.

Animals↗

PubMed2003

Elective non-instrumented anterior cervical diskectomy and fusion in Ghana: a preliminary report.

BACKGROUND: This study is a retrospective analysis of forty-one consecutive patients who underwent elective single or multilevel anterior cervical diskectomy and fusion (ACDF) in Ghana. All the patients had been followed up for at least six months. METHODS: The medical records of forty-one consecutive cases were analysed retrospectively. The parameters reviewed included patient demographics and presentations, number of fusion levels, complications and clinical outcome. RESULT: Non-instrumented ACDF constituted 22% of all the neurosurgical procedures performed during the study period. A total of 41 patients underwent the procedure. Seventy-eight percent of the patients were male; the mean age of all the patients was 52 years; follow-up was for an average of 21 months. Preoperative assessment revealed that 98% had myelopathy and 2% had radiculopathy only. No patient was operated on for only pain. There were no repeat operations performed. All levels operated on were fused for a total of 67 levels; 37% at one level only and 63% at two levels; no patient was fused or operated on at three levels. Ninety percent of the fusions were at the C4-5 and C5-6 levels. The mean ages of males and females fused at one level only were 48 and 60 years respectively; the difference was statistically significant (P<0.05). For patients fused at two levels; 81% were males and 19% were females, the difference was statistically significant (P<0.05). However, there was no statistical difference between the ages of males and females operated on at two levels (P>0.05). In addition there was no statistical difference between the ages of males operated on at one level or two levels nor was there a difference between the ages of females operated on at one or two levels (P>0.05). The mean preoperative Nurick grade was 2.3 (SD, 1.9); the mean Nurick grade postoperation was 1.3 (SD, 1.3). The difference is significant (P<0.001). There was also a significant relationship between the preoperative and postoperative Nurick grades for males operated on at either one or two levels (P<0.01); however none could be demonstrated for females (P>0.01). The total operative complication rate was 12%; the most common complication was graft/donor site infection (7%). There was no operative or postoperative mortality. Eighty six percent of the patients had an excellent or good clinical outcome as defined by Odom's criteria. Of the 34% who did not have excellent or good clinical outcome, follow up radiologic studies showed excellent graft fusion in all of them. CONCLUSION: The majority of patients undergoing non-instrumented ACDF in Ghana have cervical myelopathy involving two cervical levels. However, a large majority of them have excellent or good clinical results after surgery. The most common complication is graft/donor site infection.

Cervical Vertebrae↗

PubMedDate not supplied

[The combined rehabilitation of patients in the early and late periods after diskectomy].

Application of low-intensity radiations of optic range early after diskectomy helps to relieve pain more quickly, eliminate morpho-functional disturbances of the tissues in the operated segment, affected roots and relevant nerves. Combined, pathogenetically sound, staged rehabilitation stabilizes the course of the postoperative period, accelerates regression of motor defects, lowers risk of forming postoperative complications.

Combined Modality Therapy↗

PubMedDate not supplied

[Percutaneous laser diskectomy in cervical osteochondrosis].

The paper presents early and late outcomes of treatment in 62 patients undergone paracentetic laser "diskectomy" for discogenic compressed syndromes of the neck. It shows the efficiency of surgery for radicular (92.9%) and myelopathic (92.8%) syndromes. Patients were selected for these interventions on the basis of clinical and neurological examinations, spondylography, MRI, and electric neuromyography. The main stages of an operation were as follows: local anesthesia, right-sided anterolateral access, X-ray guidance of the position of a needle, one-stage removal of herniated disks during multi-levelled injury during an intervention. The operation lasted 18 +/- 2.4 minutes. The mean hospital stay was 12 +/- 1.4 hours. The interventions were performed in 16 of 62 cases in the outpatient setting.

Cervical Vertebrae↗

PubMed2004

[Anterior cervical diskectomy and fusion with allograft and internal fixation].

OBJECTIVE: To evaluate the effect of cylindrical titanium mesh packing cancellous allograft in the anterior cervical fusion for the cervical spondylosis with anterior titanium plate. METHODS: Ninety-eight patients with cervical spondylosis underwent diskectomy and cancellous allograft contained in cylindrical titanium mesh enhanced by anterior titanium plate system. Sixty-four patients were followed up clinically and radiographically. The mean follow-up time was (15.2 +/- 1.7) months. JOA scores and Nurick myelopathy grading system were used for clinical assessment. Roentgenograms were analyzed to identify the stability of fused levels. RESULTS: In all patients of 98 cases, the wounds were normally healed without acute or chronic infection. In statistical analysis of 64 patients followed up, the mean JOA scores was (11.6 +/- 1.8) preoperatively and improved to (16.0 +/- 1.2) at final follow-up (P < 0.05). And the mean Nurick grades were (2.7 +/- 0.7) and (0.7 +/- 0.8) before and after surgery respectively (P < 0.05). The X-ray films demonstrated that no meshes were found displacing or subsiding. New bone formation occurred in the back of meshes at 5 months after surgery. The final follow-up fusion rate was 95%. CONCLUSION: The cancellous allograft impacted into titanium meshes for cervical fusion has gained excellent or good results clinically and radiographically in short term follow-up.

Bone Transplantation↗

PubMed2005

[The clinical comparison of microendoscopic lumbar diskectomy with and without preservation of the ligamentum flavum].

OBJECTIVE: To discuss the surgical technique, indication and the clinical effects of the Microscope Endoscopic Tubular Retractor System (METRx) for microendoscopic lumbar diskectomy with the preservation of the ligamentum flavum. METHODS: Two hundred and eleven patients underwent single-segment METRx, with ligamentum flavum preservation in 65 patients (Group A), and without preservation in 146 patients (Group B). The two groups were compared clinically. All the patients suffered from low back pain and radicular syndrome to some extent, and the diagnosis was affirmed by CT and/or MRI. After exposed the interlaminar space regularly, the superior, inferior and lateral edge of the ligamentum flavum was released, the 3-sided dissociative ligament pacth was retracted medially during the spinal manipulation and restored anatomically after disc removal and the decompression of the nerve root. RESULTS: According to the results of two groups, ligamentum flavum preservation technique was feasible under endoscope and helpful in reducing the scar formation in the spinal canal. CONCLUSIONS: The ligamentum flavum preservation technique enable the surgeons to preserve the natural barrier. It is feasible to perform METRx, and it is helpful in reducing the epidural fibrosis.

Adult↗

PubMed2006

[The application of METRx microendoscopes diskectomy system in the treatment of far lateral lumbar disc herniation].

OBJECTIVE: To introduce the METRx microendoscopes diskectomy system in the treatment of far lateral lumbar disc herniation. METHODS: Fourteen cases of far lateral lumbar disc herniation were operated with METRx from February 1999 to December 2002. Among them, the average age was 49 years old (range 41 - 55 years old), male in 10 cases, female in 4 cases. All cases were single disc herniation; L(4), 5 herniation in 6 discs, L(5)-S(1) herniation in 8 discs; foraminal disc herniation in 6 cases, extra-foraminal disc herniation in 8 cases. RESULTS: All the cases were followed up from 12 to 46 months (average 26.5 months) with the results of excellence in 10 cases, good in 3 cases, fair in 1 case and no failure case. There were no disc infection, dura laceration, nerve root injury and herniation recurrence. CONCLUSIONS: METRx is suitable for far lateral lumbar disc herniation with the advantages of minimal invasive, complete decompression of nerve root and rapid recovery. The correct approach and precise surgical technique are the key points for this operation.

Adult↗

PubMed2006

Symptomatic epidural gas after open diskectomy: CT and MR imaging findings.

We report a case of symptomatic epidural gas accumulation after open diskectomy, causing lumbar radiculopathy. Surgery had been performed in a 44-year-old man for disk extrusion; however, he was readmitted to the hospital with increased lower back pain 5 months after the operation. CT and MR studies demonstrated accumulation of gas in the lumbar epidural space compressing the dural sac and nerve root. Symptoms disappeared after surgical removal of the gas.

Adult↗

PubMed1994

Laser-assisted laparoscopic lumbar diskectomy.

The authors report the first excision of a herniated lumbar disk using the combination of laparoscopic exposure and contact laser application. A 27-year-old patient experienced immediate complete relief of back and leg pain. Laser-assisted laparoscopic lumbar diskectomy offers unique advantages.

Adult↗

PubMed1994

Minimalist approach to anterior cervical diskectomy.

Since 1975 I have performed a series of 500 anterior cervical diskectomies in my suburban practice. Simple supine positioning and tension in the anterior cervical region created by a folded sheet under the shoulders and posterior neck allowed intraoperative as well as preoperative confirmation of the correct level. The incision was 4.5 cm in length to the left of the midline, and only a small number of standard Cloward instruments were employed. A fiberoptic head light and 4.5x binocular loupes provided adequate illumination and magnification of the entire intervertebral disk space. Removal of degenerative disk material with pituitary rongeurs yielded 4-6 gm of specimen. Microcurettes aided in exploration of the foraminal areas. Use of a power drill facilitated removal of osteophytic ridging. The overall results compared favorably to those of series reporting the results of spinal fusion: minimal blood loss, little tissue swelling, less need for narcotics, fewer days in the hospital, earlier return to normal activity, no wound infection or diskitis, and low rate of reoperation.

Adult↗

PubMed1994

Anterior cervical diskectomy and fusion with methyl methacrylate.

This report documents the experience of one neurosurgeon performing cervical fusion using a technique that avoids iliac bone grafts and provides immediate stabilization of the spine. More than 200 patients underwent anterior cervical diskectomy and methyl methacrylate fusion. No increased neurologic deficit, wound infection, cerebrospinal fluid fistula, direct damage to the esophagus or trachea, or hemorrhage requiring transfusion occurred. None of the patients required reoperation at the same level. The overall results compared favorably to reported series with bone grafts or bank bone.

Bone Cements↗

PubMed1996

Laparoscopic L5-S1 diskectomy: a cost-effective, minimally invasive general surgery--neurosurgery team alternative to laminectomy.

Laparoscopic L5-S1 diskectomy (LLD) is a promising new technique for managing disabling pain from herniated lumbar disks. It is unknown, however, whether the clinical results of LLD are superior to those of traditional laminectomy (LAM). This study was undertaken, therefore, in order to compare LLD and LAM in the management of L5-S1 disk herniation unresponsive to conservative treatment measures. Clinical records of 22 patients who underwent 23 LLD procedures and of 23 LAM patients were reviewed with respect to demographics and median age, operative blood loss, operative time, hospital stay, and time of rehabilitation to work/normal activity, as well as postoperative morbidity, recurrent symptoms, long-term functional status, and inhospital patient charges. Two LLD patients had undergone LAM previously, and one had a percutaneous microdiskectomy. All LLD patients had relief of disk pain immediately after surgery. Morbidity after LLD included transient brachial plexus neuropraxia (1), urinary retention (1), and rectus hematoma (1). No LAM complications were reported. Among LLD patients, compared with LAM, median age (34.5 years versus 40 years), estimated blood loss (12 mL versus 68 mL), hospital length of stay (1 day versus 3 days), time to normal activity (17 days versus 79 days) and mean inhospital patient charges ($5,737 +/- 283 versus $7,762 +/- 662) were reduced significantly (P < 0.05). LLD operating time was significantly longer than LAM (210 versus 160 minutes median, P < 0.01). With a median follow-up time of 11.0 months (range, 2 to 23 months) all LLD patients had returned to normal activity, whereas 7 of the LAM group (30%) remained disabled (P < 0.01). Sixty-eight per cent of LLD patients were pain-free during follow-up, compared with 39 per cent of the LAM group (P < 0.05). Sixty-four per cent of LLD patients and 57 per cent of the LAM group needed postoperatively physical therapy. One LLD and 4 LAM patients required reoperation, by LLD and LAM, respectively, for recurrent disk herniation. LLD is a safe, cost-effective, minimally invasive operation for managing disabling L5-S1 disk herniation. Compared with LAM, LLD reduces blood loss, length of stay, rehabilitation time, and patient charges, and improves long-term functional and pain-free status. LLD should be considered as an alternative to LAM for patients with herniated L5-S1 intervertebral disks unresponsive to conservative management.

Adult↗

PubMed1995

Results of intervertebral diskectomy without fusion at L4-5 versus L5-S1.

The results of diskectomy without fusion at L4-5 were compared with those at L5-S1. Strict indications for surgery had been applied to each group. Evaluation was carried out using the Oswestry Disability scale, as well as a modified Smiley-Webster scale, and a subjective improvement rating scale, as well as documenting work status, whether any future surgery was required, and other factors. Results were placed into categories based on these evaluation methods and were analyzed statistically. Average follow-up was 51 months with a minimum of 24 months. Overall excellent and good results occurred in 81% of patients in both groups. No difference in reoperation rate was detected between the two groups. Women were more likely to undergo a subsequent procedure, usually fusion. Equally satisfactory results can be obtained at L4-5 and L5-S1 if strict selection criteria are used.

Adult↗

PubMed1994

Percutaneous diskectomy for disk space infections.

To diagnose and treat intervertebral disk space infection, we used percutaneous diskectomy in four patients to harvest a large amount of disk material and to decompress and lavage the infected disk space with a broad spectrum antibiotic solution. This treatment regimen rapidly diminished pain and shortened the acute clinical course of the process. The long-term course in this small number of patients, however, appears not to have been altered.

Acute Disease↗

PubMed1997

An in vivo analysis of the dimensional changes of the neuroforamen after anterior cervical diskectomy and fusion: a radiologic investigation.

Eighteen patients (11 men, 7 women; average age, 45.5 years) who underwent anterior cervical diskectomy and fusion (ACDF) for the treatment of radiculopathy had preoperative and immediate postoperative computed tomography (CT) scans to measure pre- and postoperative foraminal heights and foraminal areas, preoperative disk space height, and postoperative graft height. The mean foraminal height preoperatively was 0.851 cm; postoperatively, it was 1.01 cm, with a mean percentage increase of 20% (-8.8 to 56.8%). Mean preoperative foraminal area was 37.53 mm2, increasing to a mean of 49.04 mm2 postoperatively with a mean percentage increase of 33% (range, -1.5 to 76.9%). No significant correlations between graft height and change in maximal foraminal height or foraminal area or between changes in foraminal height or area and postoperative symptom relief were found. Although significant increases in foraminal dimensions were seen radiographically after ACDF, these increases were variable and not strongly related to graft height. In addition, the increases in foraminal dimensions were not related to the short-term clinical results of ACDF. This study fails to support the hypothesis that the reliable results of ACDF can be ascribed primarily to indirect decompression of the uncovertebral foramen by disk-space distraction.

Adult↗