Implantation of an empty carbon fiber cage or a tricortical iliac crest autograft after cervical discectomy for single-level disc herniation: a prospective comparative study

2006 ◽  
Vol 4 (4) ◽  
pp. 292-299 ◽  
Author(s):  
Frédéric Schils ◽  
Benedict Rilliet ◽  
Michael Payer
Keyword(s):  
Carbon Fiber ◽  
Neck Pain ◽  
Disc Herniation ◽  
Iliac Crest ◽  
Radicular Pain ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Cervical Discectomy ◽  
Single Level ◽  
Autograft Group

Object The authors conducted a study to evaluate and compare prospectively the implantation of either an empty carbon fiber composite frame cage (CFCFC) or an iliac crest autograft after anterior cervical discectomy (ACD) for cervical disc herniation with monoradiculopathy. Methods Thirty-six consecutive patients with one-level radiculopathy due to single-level cervical disc herniation were treated by ACD, and implantation of either an empty CFCFC (24 patients) or an iliac crest autograft (12 patients). Radiological and clinical assessments were performed preoperatively, immediately postoperatively; and at 3, 6, and 12 months postoperatively. Fusion, at the 12-month follow-up examination was demonstrated in 96% of the patients in the cage group and in 100% of those in the autograft group. The mean anterior intervertebral body height was 3.7 mm preoperatively and 3.9 mm at 12 months in the CFCFC, and 4.1 and 3.8 mm, respectively, in the autograft group. In cage-treated patients, neck pain, as measured using the visual analog scale (VAS) (Score 0 = minimum; 10 = maximum) decreased from 6.4 preoperatively to 2.0 at 12 months, and radicular pain, decreased from 8.4 preoperatively to 1.5 at 12 months. In the autograft group, neck pain changed from a mean preoperative VAS score of 7.2 to 2.5 at 12 months, and radicular pain decreased from a preoperative mean of 7.8 to 1.4 at 12 months. Analysis of the 12-Item Short Form Health Survey domains and the Oswestry Disability Index scores indicated a significant improvement in both the Physical and Mental Component Summary domains in both groups. Conclusions Implantation of an empty CFCFC or a tricortical iliac crest autograft after ACD are safe and reliable options for the treatment of cervical disc herniation causing one-sided radiculopathy. Both procedures produced equally satisfying clinical and radiological results, leading to a high fusion rate and maintaining intervertebral height. Implantation of an empty CFCFC has the advantages of avoiding any donor site morbidity and requiring a significantly shorter operative time.

scholarly journals Surgery in cervical disc herniation: anterior cervical discectomy without fusion or with fusion

2017 ◽  
Vol 31 (1) ◽  
pp. 54-58
Author(s):  
Andrei Stefan Iencean
Keyword(s):  
Range Of Motion ◽  
Disc Herniation ◽  
Clinical Results ◽  
Small Degree ◽  
Anterior Cervical Discectomy ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Cervical Discectomy ◽  
Single Level ◽  
Anteroposterior Translation

Abstract The study included a group of anterior cervical microdiscectomy without fusion performed at one level (either C5-C6 level or at the C6-C7 level) and a second group of patients with same single-level of anterior cervical discectomy with fusion. The kinematic analysis included the range of motion, anteroposterior translation and disc height assessed for the cervical functional spinal units at the operated level and adjacent levels. At the operated level the range of motion and the translation were minimal in the anterior cervical discectomy without fusion group, both for the C5-C6 and C6-C7 levels, and absent in the cervical discectomy with fusion group. The superior adjacent levels translations were greater in the ACDF group compared with the ACD group. The clinical results of both types of cervical discectomy were comparable. In cervical microdiscectomy without fusion the elastic fibrous intradiscal scar at the operated level allows a small degree of mobility and the adjacent cervical levels are not overstressed. No need for anterior cervical discectomy with fusion to trait a single level cervical disc herniation than in selected cases.

scholarly journals Comparative evaluation of posterior percutaneous endoscopy cervical discectomy using a 3.7 mm endoscope and a 6.9 mm endoscope for cervical disc herniation: a retrospective comparative cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Tong Yu ◽  
Jiu-Ping Wu ◽  
Jun Zhang ◽  
Hai-Chi Yu ◽  
Qin-Yi Liu
Keyword(s):  
Clinical Outcomes ◽  
Disc Herniation ◽  
Large Diameter ◽  
Clinical Results ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Cervical Discectomy ◽  
Significant Difference ◽  
Cord Injury ◽  
Percutaneous Endoscopy

Abstract Background Posterior percutaneous endoscopy cervical discectomy (p-PECD) is an effective strategy for the treatment of cervical diseases, with a working cannula ranging from 3.7 mm to 6.9 mm in diameter. However, to date, no studies have been performed to compare the clinical outcomes of the use of endoscopes with different diameters in cervical disc herniation (CDH) patients. The purpose of this study was to compare the clinical outcomes of patients with unilateral CDH treated with p-PECD using a 3.7 mm endoscope and a 6.9 mm endoscope. Methods From January 2016 to June 2018, a total of 28 consecutive patients with single-level CDH who received p-PECD using either the 3.7 mm or the 6.9 mm endoscope were enrolled. The clinical results, including the surgical duration, hospitalization, visual analog scale (VAS) score and modified MacNab criteria, were evaluated. Cervical fluoroscopy, CT, and MRI were also performed during follow-up. Results Tthere was a significant difference in regard to the average identification time of the “V” point (18.608 ± 3.7607 min vs. 11.256 ± 2.7161 min, p < 0.001) and the mean removal time of the overlying tissue (16.650 ± 4.1730 min vs. 12.712 ± 3.3079 min, p < 0.05) for the use of the 3.7 mm endoscope and the 6.9 mm endoscope, respectively. The postoperative VAS and MacNab scores of the two endoscopes were significantly improved compared with those the preoperative scores (p < 0.05). Conclusion The application of both the 3.7 mm endoscope and 6.9 mm endoscope represent an effective method for the treatment of CDH in selected patients, and no significant difference can be observed in the clinical outcomes of the endoscopes. The 6.9 mm endoscope shows superiority to the 3.7 mm endoscope in terms of the efficiency of “V” point identification, the removal of overlying soft tissue and the prevention of spinal cord injury. However, the 6.9 mm endoscope may be inferior to the 3.7 mm endoscope in regards to anterior foraminal decompression due to its large diameter; this result needs to be further evaluated with the support of a large number of randomized controlled trials.

Cervical Interlaminar Epidural Injections In The Treatment Of Cervical Disc Herniation, Post Surgery Syndrome, Or Discogenic Pain: Cost Utility Analysis From Randomized Trials

2019 ◽  
Vol 5 (22;5) ◽  
pp. 421-431
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Neck Pain ◽  
Disc Herniation ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Utility Analysis ◽  
Discogenic Pain ◽  
Epidural Injections ◽  
Post Surgery

Background: Neck pain is one of the major conditions attributing to overall disability in the United States. There have been multiple publications assessing clinical and cost effectiveness of multiple modalities of interventions in managing chronic neck pain. Even then, the literature has been considered sparse in relation to cervical interlaminar epidural injections in managing chronic neck pain. In contrast, cost utility studies of lumbar interlaminar injections, caudal epidural injections, cervical and lumbar facet joint nerve blocks, percutaneous adhesiolysis demonstrated costs of less than $3,500 for quality-adjusted life year (QALY). Objectives: To assess the cost utility of cervical interlaminar epidural injections in managing chronic neck and/or upper extremity pain secondary to cervical disc herniation, post-surgery syndrome in neck, and axial or discogenic neck pain. Study Design: Analysis based on 3 previously published randomized trials of the effectiveness of cervical interlaminar epidural injections assessing their role in disc herniation, cervical post-surgery syndrome, and axial or discogenic pain. Setting: A contemporary, private, specialty referral interventional pain management center in the United States. Methods: Cost utility of cervical interlaminar epidural injections with or without steroids in managing cervical disc herniation, cervical post-surgery syndrome, and cervical discogenic or axial neck back pain was conducted with data derived from 3 randomized controlled trials (RCTs) that included a 2-year follow-up, with inclusion of 356 patients. The primary outcome was significant improvement defined as at least 50% in pain reduction and disability status. Direct payment data from all carriers from 2018 was utilized for the assessment of procedural costs. Overall costs, including drug costs, were determined by multiplication of direct procedural payment data by a factor of 1.67 to accommodate for indirect payments respectively for disc herniation, discogenic pain, and cervical post-surgery syndrome. Results: The results of the 3 RCTs showed direct cost utility for one year of QALY of $2,412.31 for axial or discogenic pain without disc herniation, $2,081.07 for disc herniation, and $2,309.20 for post surgery syndrome, with an average cost per one year QALY of $2,267.57, with total estimated overall costs with addition of indirect costs of $3,475.38, $4,028.55, $3,856.36, and $3,785.89 respectively. Limitations: The limitation of this cost utility analysis includes that it is a single center evaluation. Indirect costs were extrapolated. Conclusion: This cost utility analysis of cervical interlaminar epidural injections in patients nonresponsive to conservative management in the treatment of disc herniation, post surgery syndrome and axial or discogenic neck pain shows $2,267.57 for direct costs with a total cost of $3,785.89 per QALY. Key words: Cervical interlaminar epidural injections, chronic neck pain, cervical disc herniation, cervical discogenic pain, post surgery syndrome, cost utility analysis, cost effectiveness analysis, quality-adjusted life years

Repeat epidural steroid injections for radicular pain due to lumbar or cervical disc herniation

2018 ◽  
Vol 100-B (10) ◽  
pp. 1364-1371 ◽  
Author(s):  
H. Joswig ◽  
A. Neff ◽  
C. Ruppert ◽  
G. Hildebrandt ◽  
M. N. Stienen
Keyword(s):  
Functional Outcome ◽  
Disc Herniation ◽  
Radicular Pain ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Arm Pain ◽  
One Year ◽  
Epidural Steroid

AimsThe aim of this study was to determine the efficacy of repeat epidural steroid injections as a form of treatment for patients with insufficiently controlled or recurrent radicular pain due to a lumbar or cervical disc herniation.Patients and MethodsA cohort of 102 patients was prospectively followed, after an epidural steroid injection for radicular symptoms due to lumbar disc herniation, in 57 patients, and cervical disc herniation, in 45 patients. Those patients with persistent pain who requested a second injection were prospectively followed for one year. Radicular and local pain were assessed on a visual analogue scale (VAS), functional outcome with the Oswestry Disability Index (ODI) or the Neck Pain and Disability Index (NPAD), as well as health-related quality of life (HRQoL) using the 12-Item Short-Form Health Survey questionnaire (SF-12).ResultsA second injection was performed in 17 patients (29.8%) with lumbar herniation and seven (15.6%) with cervical herniation at a mean of 65.3 days (sd 46.5) and 47 days (sd 37.2), respectively, after the initial injection. All but one patient, who underwent lumbar microdiscectomy, responded satisfactorily with a mean VAS for leg pain of 8.8 mm (sd 10.3) and a mean VAS for arm pain of 6.3 mm (sd 9) one year after the second injection, respectively. Similarly, functional outcome and HRQoL were improved significantly from the baseline scores: mean ODI, 12.3 (sd 12.4; p < 0.001); mean NPAD, 19.3 (sd 24.3; p = 0.041); mean SF-12 physical component summary (PCS) in lumbar herniation, 46.8 (sd 7.7; p < 0.001); mean SF-12 PCS in cervical herniation, 43 (sd 6.8; p = 0.103).ConclusionRepeat steroid injections are a justifiable form of treatment in symptomatic patients with lumbar or cervical disc herniation whose symptoms are not satisfactorily relieved after the first injection. Cite this article: Bone Joint J 2018;100-B:1364–71.

Use of a polymethylmethacrylate cervical cage in the treatment of single-level cervical disc disease

2005 ◽  
Vol 3 (1) ◽  
pp. 24-28 ◽  
Author(s):  
Jyi-Feng Chen ◽  
Chieh-Tsai Wu ◽  
Sai-Cheung Lee ◽  
Shih-Tseng Lee
Keyword(s):  
Cancellous Bone ◽  
Disc Herniation ◽  
Interbody Fusion ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Cervical Disc Disease ◽  
Disc Disease ◽  
Content Type ◽  
Single Level ◽  
Fine Print

Object. Polymethylmethacrylate (PMMA) bone cement has been used as a spacer in the treatment of patients with cervical disc disease with good long-term outcomes, but solid bone fusion has not been demonstrated in all cases. To achieve cervical interbody fusion, the authors designed a modified PMMA cervical cage that they filled with spongy bone for the treatment of single-level cervical disc herniation. Methods. Sixty-three patients underwent anterior cervical microdiscectomy and implantation of a PMMA cervical cage filled with autograft cancellous bone and were followed for a minimum of 2 years. The fusion rates were 90.5 and 100% at the 6- and 12-month follow-up examinations, respectively. The mean intervertebral disc height gain was 3.4 ± 1.9 mm when preoperative and 24-month postoperative values were compared. Neck pain, measured using the Huskissan visual analog scale (0 mm, no pain; 100 mm, worst possible pain), decreased from 71 ± 13 mm at preoperative baseline to 28 ± 17 at 6, 23 ± 19 at 12, and 31 ± 19 mm at 24 months. Based on the same scale, radicular pain decreased from 83 ± 15 mm at preoperative baseline to 24 ± 11 at 6, 27 ± 13 at 12, and 22 ± 11 mm at 24 months. The self-rated clinical outcome was excellent in 45 (71.4%) and good in 18 (28.6%) of the 63 patients. Conclusions. The autograft cancellous bone—filled PMMA cage is safe and effective for cervical interbody fusion in the treatment of single-level cervical disc herniation and monoradiculopathy.

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