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

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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.
E-mail: maislam.spine@gmail.com

Abstract

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.

References

1. Rao RD, Currier BL, Albert TG. Degenerative cervical Spondylosis clinical syndromes, pathogenesis, and management. J Bone Joint Surg 2007;89:1360-78.
2. Waltz TA. Physical factors in the production of the myelopathy of cervical spondylosis. Brain 1967;90:395-404.
3. Robinson RA, Afeiche N, Dunn EJ, Northrup BE. Cervical spondylotic myelopathy, etiology and treatment concepts. Spine 1977;2:89-99.
4. Bohlman HH, Emery SE, Goodfellow DB, Jones PK. Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg 1993;75:1298-307.
5. Wilkinson M. The morbid anatomy of cervical spondylosis and myelopathy. Brain 1960;83:589-616.
6. Spallone A, Marchione P. Anterior cervical discectomy and fusion with “mini-invasive” harvesting of iliac crest graft versus polyetheretherketone (PEEK) cages: A retrospective outcome analysis. Int J Surg 2014;12:1328-32.
7. Islam MA, Rana MM, Goni MF, Rahman MN. Comparison between anterior cervical discectomy with fusion by polyetheretherketone cages and tricortical iliac crest graft for the treatment of cervical prolapsed intervertebral disc. Bangabandhu Sheikh Mujib Med Univ J 2016;9:169-72.
8. Sharma A, Kishore H. Comparative study of functional outcome of anterior cervical decompression and interbody fusion with tricortical stnad alone iliac crest autograft versus stand-alone polyetheretherketone cage in cervical spondylotic myelopathy. Glob Spine J 2018;8:860-5.
9. Siddiqui AA, Jackowski A. Cage versus tricortical graft for cervical interbody fusion. J Bone Joint Surg Br 2003;85:1019-25.
10. Lee JC, Jang HD, Ahn J, Choi SW, Kang D, Shin BJ. Comparison of cortical ring allograft and plate fixation with autologous iliac bone graft for anterior cervical discectomy and fusion. Asian Spine J 2019;13:258-64.
11. Adam FF, Hasan KM, Meshtaway EM, Refae EH. PEEK cages versus locked plate for multiple levels cervical degenerated disease. J Am Sci 2013;9:100-6.
12. Islam MA, Habib MA, Sakeb N. Anterior cervical discectomy, fusion and stabilization by plate and screw early experience. Bangladesh Med Res Council Bull 2012;38:62-6.
13. Abdallah A, Taha AM. Cages or plates for anterior interbody fusion for cervical radiculopathy: Single and double levels. Egypt Orthop J 2016;51:65-70.
14. Ayman EA, Galhom MD. Comparison between polyetheretherketone cages versus an iliac crest autograft used in treatment of single or double level anterior cervical discectomy. Med J Cairo Univ 2013;81:9-17.
15. Shao MH, Zhang F, Xu HC, Lyu FZ. Titanium cages versus autogenous iliac crest bone grafts in anterior cervical discectomy and fusion treatment of patients with cervical degenerative diseases: A systematic review and meta-analysis. Curr Med Res Opin 2017;33:803-11.
16. Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 1958;40:607-24.

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

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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.
E-mail: subirjhaveri@yahoo.com

Abstract

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.

 

References

1. Furlan JC, Kalsi-Ryan S, Kailaya-Vasan A, Massicotte EM, Fehlings MG. Functional and clinical outcomes following surgical treatment in patients with cervical spondylotic myelopathy: A prospective study of 81 cases. J Neurosurg Spine 2011;14:348-55.
2. Kaminsky SB, Clark CR, Traynelis VC. Operative treatment of cervical spondylotic myelopathy and radiculopathy. A comparison of laminectomy and laminoplasty at five year average follow-up. Iowa Ortho J 2004;24:95-105.
3. Fukui M, Chiba K, Kawakami M, Kikuchi SI. An outcome measure for patients with cervical myelopathy: Japanese orthopaedic association cervical myelopathy evaluation questionnaire (JOACMEQ): Part 1. J Orthop Sci 2007;12:227-40.
4. Chang V, Lu DC, Hoffmann H, Buchanan C, Holly LT. Clinical results of cervical laminectomy and fusion for the treatment of cervical spondylotic myelopathy in 58 consecutive patients. Surg Neurol Int 2014;16:S133-7.
5. Al-Tamimi YZ, Guilfoyle M, Seeley H, Laing J. Measurement of long-term outcome in patients with cervical spondylotic myelopathy treated surgically. Eur Spine J 2013;22:2552-7.
6. Morio Y, Teshima R, Nagashima H, Nawata K, Yamasaki D, Nanjo Y. Correlation between operative outcomes of cervical compression myelopathy and MRI of the spinal cord. Spine (Phila Pa 1976) 2001;26:1238-45.
7. Karpova A, Arun R, Davis AM, Kulkarni AV, Massicotte EM, Mikulis DJ, et al. Predictors of surgical outcome in cervical spondylotic myelopathy. Spine (Phila Pa 1976) 2013;38:392-400.
8. Boakye M, Patil CG, Santarelli J, Ho C, Tian W, Lad SP. Cervical spondylotic myelopathy: Complications and outcomes after spinal fusion. Neurosurgery 2008;62:455-62.
9. Sakaura H, Hosono N, Mukai Y, Iwasaki M, Yoshikawa H. C3-6 laminoplasty for cervical spondylotic myelopathy maintains satisfactory long-term surgical outcomes. Global Spine J 2014;4:169-74.
10. Son DK, Son DW, Song GS, Lee SW. Effectiveness of the laminoplasty in the elderly patients with cervical spondylotic myelopathy. Korean J Spine 2014;11:39-44.
11. Fehlings MG, Barry S, Kopjar B, Yoon ST, Arnold P, Massicotte EM, et al. Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy: Outcomes of the prospective multicenter AOSpine North America CSM study in 264 patients. Spine (Phila Pa 1976) 2013;38:2247-52.
12. Lawrence BD, Jacobs WB, Norvell DC, Hermsmeyer JT, Chapman JR, Brodke DS. Anterior versus posterior approach for treatment of cervical spondylotic myelopathy: A systematic review. Spine 2013;38:S173-82.
13. Gao R, Yang L, Chen H, Liu Y, Liang L, Yuan W. Long term results of anterior corpectomy and fusion for cervical spondylotic myelopathy. PLoS One 2012;7:e34811.
14. Hirabayashi K, Miyakawa J, Satomi K, Maruyama T, Wakano K. Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine (Phila Pa 1976) 1981;6:354-64.
15. Fehlings MG, Wilson JR, Kopjar B, Yoon ST, Arnold PM, Massicotte EM, et al. Efficacy and safety of surgical decompression in patients with cervical spondylotic myelopathy: Results of the AOSpine North America prospective multi-center study. J Bone Joint Surg Am 2013;95:1651-8.
16. Chiba K, Toyama Y, Matsumoto M, Maruiwa H, Watanabe M, Hirabayashi K. Segmental motor paralysis after expansive open-door laminoplasty. Spine (Phila Pa 1976) 2002;27:2108-15.
17. Dai L, Ni B, Yuan W, Jia L. Radiculopathy after laminectomy for cervical compression myelopathy. J Bone Joint Surg Br 1998;80:846-9.
18. Satomi K, Ogawa J, Ishii Y, Hirabayashi K. Short-term complications and long-term results of expansive open-door laminoplasty for cervical stenotic myelopathy. Spine J 2001;1:26-30.
19. Chiba K, Ogawa Y, Ishii K, Takaishi H, Nakamura M, Maruiwa H, et al. Long-term results of expansive open-door laminoplasty for cervical myelopathy–average 14-year follow-up study. Spine (Phila Pa 1976) 2006;31:2998-3005.
20. Tanaka N, Nakanishi K, Fujiwara Y, Kamei N, Ochi M. Postoperative segmental C5 palsy after cervical laminoplasty may occur without intraoperative nerve injury: A prospective study with transcranial electric motor-evoked potentials. Spine (Phila Pa 1976) 2006;31:3013-7.

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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