Comparative Study between Anterior Cervical Discectomy and Fusion by Standalone Polyetheretherketone Cages and Tricortical Bone Graft with Anterior Plate Fixation for Cervical Spondylotic Myeloradiculopathy

Volume 2 | Issue 2 | October 2021-March 2022 | page: 79-83 | Md. Anowarul Islam, Md. Shohidullah, Rumana Islam, Afia Ibnat Islam, Abu Zaffar Chowdhury

DOI: 10.13107/bbj.2022.v02i02.025

Authors: Md. Anowarul Islam [1], Md. Shohidullah [1], Rumana Islam [1], Afia Ibnat Islam [1], Abu Zaffar Chowdhury [1]

[1] Department of Orthopaedics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.

Address of Correspondence
Dr. Anowarul Islam,
Department of Orthopaedics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.


Background: Cervical spondylotic myeloradiculopathy is a common cause of neck pain and radiating arm pain. It develops when one or more of the intervening discs in the cervical spine starts to break down by wear and tear due to its degeneration. Multiple fixation modalities are used in Anterior Cervical Discectomy and interbody Fusion (ACDF), with their positive and negative sides
Objectives: The objective of the study is to compare the safety and efficacy of ACDF by standalone Polyetheretherketone (PEEK) cages with tricortical bone graft with anterior plate fixation for cervical spondylotic myeloradiculopathy.
Methods: This prospective observational study was conducted in the Department of Orthopaedics, Bangabandhu Sheikh Mujib Medical University, Dhaka from July 2017 to June 2020. Forty patients with cervical spondylotic myeloradiculopathy diagnosed on the basis of presenting complaints, clinical examination, and investigations were enrolled in this study. Modified Odom’s criteria, visual analog scale (VAS), Nurick Grading, and Bridwell criteria for cervical spondylotic myelopathy was used for evaluation of the results.
Result: Male were predominant in this study. Male-female ratio was 2.9: 1. Most of the patients were farmer (30%), C5/6 (55%) was the most commonly involved disc level. Most of the patients had clinical features of neck pain, gait difficulty, and myelopathy sign. Regarding perioperative complications transient dysphagia was seen in 5 (12.5%) patients and transient paraparesis was observed in 2 (5%) patients. Post-operative complications were paresthesia and wound infection seen in significant number of patients of both groups who were recovered within 3–6 months. According to Bridwell’s grade of fusion, Grade I fusion was observed in 16 patients (80%) in cage group and 18 patients (90%) in tricortical Indocyanine Green (ICG) with plate group. According to VAS, postoperatively pain was gradually decline and after 12 months, 12 patients (60%) patients were found in no pain group and 11 patients (55%) were found in no pain group of the tricortical ICG with plate group. There was no significant difference between the two groups (P = 0.04). According to modified Odom’s criteria functional outcome after 12 months was excellent in 18 patients (90%) and good in 2 patients (10%) in cage group and excellent in 17 patients (85%) and good in 3 patients (15%) in tricortical ICG with plate group. There was no statistically significant difference between two groups (P = 0.432).
Conclusion: ACDF is the ideal technique for the treatment of cervical spondylotic myeloradiculopathy with excellent functional outcome and good fusion which could be achieved by either standalone PEEK cage or tricortical ICG with plate and there is no significant difference between two techniques.
Keywords: Cervical spondylotic myeloradiculopathy, Tricortical bone graft, Anterior cervical discectomy and fusion.


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How to Cite this Article: Islam MA, Shohidullah M, Islam R, Islam AI, Chowdhury AZ| Comparative Study between Anterior Cervical Discectomy and Fusion by Standalone Polyetheretherketone Cages and Tricortical Bone Graft with Anterior Plate Fixation for Cer vical Spondylotic Myeloradiculopathy | Back Bone: The Spine Journal | October 2021-March 2022; 2(2): 79-83.


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Surgical Outcomes in Patients Operated for Cervical Myelopathy using Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire

Volume 1 | Issue 1 | October 2020-March 2021 | page: 13-18  | Subir N. Jhaveri, Samir J. Patel, Sharan S. Jhaveri, Nancy Modi, Jignasu Yagnik

Authors: Subir N. Jhaveri [1], Samir J. Patel [1], Sharan S. Jhaveri [1][2], Nancy Modi [1], Jignasu Yagnik [3]

[1] Subir Jhaveri’s Spine Hospital, Satellite, Ahmedabad, Gujrat, India.
[2] Smt. NHL Municipal Medical College, Ellisbridge, Ahmedabad, Gujrat, India.
[3] Indukaka Ipcowala Institute of Management (I2IM), Charotar University of Science & Technology (CHARUSAT), Changa, Anand, Gujrat, India.

Address of Correspondence
Dr. Subir Jhaveri,
Spine Hospital, First floor, Jyoti Plaza, Shyamal cross roads, 132 feet ring road, Satellite, Ahmedabad, Gujrat, India.


Study Design: This was a retrospective case series.
Objective: The objective of the study was to assess the surgical outcomes of patients with cervical myelopathy, using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ).
Summary of Background Data: Degenerative cervical myelopathy (DCM) is a leading cause of morbidity. Patients present with spasticity, gait imbalance, and loss of fine motor function. Most patients present early; however, few manage with disability for years and present late.
Methods: Fifty-two consecutive patients underwent surgery for cervical myelopathy from 2008 to 2013; however, detailed follow-up was available in only 42 patients. Thirty-nine patients were ambulatory, while 3 were non-ambulatory at the outset. Nineteen patients underwent anterior surgery and 23 patients underwent posterior surgery. Frankel, Nurick grades, Neck Disability Index (NDI), and JOACMEQ scores were recorded at time of admission, 6, 12, 24, and 52 weeks, and then annually. Outcomes at final follow-up were included for statistical analysis.
Results: Thirty-four (81%) patients improved, 4 (9.5%) patients remained static, and 4 (9.5%) patients worsened according to Nurick scale. Nurick grades improved from 3.52 to 1.64. Mean NDI scores improved from 42.28 to 20.28. Analyzing the JOACMEQ scores, cervical spine function improved in 15 (35.7%), upper extremity (UE) function improved in 33 (78.6%) patients, while lower extremity (LE) function improved in 32 (76.2%) patients. Bladder function improved in 17 (40.47%). Quality of life improved in 37 (88.1%) patients. LE improved more than UE, in the younger (<45 years) group, and in those with subaxial myelopathy. Pre-operative symptoms greater than 12 months had a negative impact on outcome. Pre-operative neurology, approach, and instrumentation did not impact outcomes. Four (9.5%) patients developed major neurological deficit, 4 (9.5%) patients had C5 deltoid palsy, while 1 patient had recurrent laryngeal palsy.
Conclusion: Surgical results of DCM are highly satisfactory, even in late cases. LE improved more than UE in subaxial cases and in younger individuals. Surgical intervention within 12 months of symptoms affects outcome positively.
Keywords: Degenerative cervical myelopathy, cervical spondylotic myelopathy, surgical outcomes, JOA scores, JOACMEQ scores, ossified posterior longitudinal ligament, cervical discectomy, cervical laminectomy, iliac crest bone graft, anterior cervical discectomy and fusion, artificial cervical disc replacement, lateral mass screws.
Level of Evidence: 4.



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How to Cite this Article: Jhaveri SN, Patel SJ, Jhaveri SS, Modi N, Yagnik J| Surgical Outcomes in Patients Operated for Cervical Myelopathy using Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire| Back Bone: The Spine Journal | October 2020-March 2021; 1(1): 13-18.


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