Abstract
Despite the occasional complications, anterior cervical discectomy with fusion (ACDF) is regarded as a standard surgical solution for cervical spondylosis with myelopathy, radiculopathy, or disc herniation refractory to conservative management. Despite the high volume of the performed ACDFs, several issues regarding the optimal peri-operative and post-operative management of these patients remain controversial. Published studies to date describe the experience of particular individuals and groups, but do not convey an overall rationale for clinical practice policies, and the actual reasoning on which those practice decisions were based. At present, ACDF with a PEEK cage is a prominent method for cervical disc herniation that has been established successful to reduce neck and arm pain, to restore both vertebral disc height and foraminal height, to maintain cervical alignment, and also to promote controlled bony fusion. In addition, the implantation of a PEEK cage, do not risk the transm ...
Despite the occasional complications, anterior cervical discectomy with fusion (ACDF) is regarded as a standard surgical solution for cervical spondylosis with myelopathy, radiculopathy, or disc herniation refractory to conservative management. Despite the high volume of the performed ACDFs, several issues regarding the optimal peri-operative and post-operative management of these patients remain controversial. Published studies to date describe the experience of particular individuals and groups, but do not convey an overall rationale for clinical practice policies, and the actual reasoning on which those practice decisions were based. At present, ACDF with a PEEK cage is a prominent method for cervical disc herniation that has been established successful to reduce neck and arm pain, to restore both vertebral disc height and foraminal height, to maintain cervical alignment, and also to promote controlled bony fusion. In addition, the implantation of a PEEK cage, do not risk the transmission of infection from the donor. Although there are a significant number of clinical and radiological studies in the literature regarding the progress of fusion and also the clinical improvement of patients underwent ACDF with PEEK, there are no studies to investigate the relation of clinical improvement to cervical sagittal alignment and also to cervical range of motion of such patients.The current study is constituted from two parts. The purpose of the first part was to form a clinical consensus regarding the practice of anterior cervical spine surgery among Greek spinal surgeons. Therefore, a web-based survey among Greek spinal surgeons was conducted. Eighty responses were received and analyzed. Neurosurgeons represented 70%, and orthopedic surgeons 30%. The majority of the participants (91.3%) considered fusion necessary. Allograft was the preferred type of graft. Neurosurgeons used a plate in 42.9% of cases, whereas orthopedic surgeons in 100%. An ESO was recommended for 87.5% of patients without plates, and in 83.3% of patients with plates. The average duration of ESO usage was four weeks. Physical therapy was routinely prescribed postoperatively by 75% of the neurosurgeons, and by the 83.3% of the orthopedic surgeons. The majority of the participants recommended four weeks leave of absence. In conclusion, it was accented that there was a wide variation of clinical practice between Greek spinal surgeons regarding the anterior cervical interventions due to degenerative disease.The purpose of the second part was to investigate the effect of pain relief, cervical lordosis restoration and also cervical range of motion, on neck disability of patients underwent ACDF with PEEK cage filled with allograft. Therefore, a prospective repeated-measures study of patients underwent ACDF with PEEK cage was conducted. 75 patients who underwent single-, two-, or three-level ACDF involving PEEK interbody cage filled with allograft between C3-C7 was included in the study. Radiological and clinical evaluation of the patients was performed preoperatively, at the day of hospital discharge and also at 6- and 12-month follow-up periods. There was significant reduction of NRS regarding neck/arm pain symptoms immediate postoperatively that is continued until the last follow-up. Regarding the effect of pain in activities of daily-living there was gradually reduction through 12-month follow-up. Additionally, there was a significant postoperative improvement of NDI score that was continued through the last follow-up. Physical and mental component of SF-12 questionnaire were presented gradually improved at 6-month and also 12-month follow-up. The mean Cob angle from C2 to C7 (SACS) slightly increased immediate postoperatively, following to significant decrease at 6-month and 12-month follow-up. However, it remained into the acceptable levels, related to the age and the level of cervical degeneration of the patients. Regarding the sagittal C2-C7 ROM, there was a significant reduction at 6-month follow-up that was maintained at 12-month follow-up. However, it remained into the acceptable levels, related to the age and the level of cervical degeneration of the patients. In conclusion, the improvement of disability patients’ undergo ACDF with PEEK cage filled with allograft, as it is assessed by NDI, significantly correlated to pain reduction. Contrary, there was no correlation between SACS and NDI and also between cervical ROM and NDI. Additionally, when NRS is used to investigate the effect of pain in activities of daily-living, it seems to be responsible to successfully replace NDI on the investigation of patients’ disability.
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