Anterial cervical discectomy and fusion are the most commonly performed procedures involving the cervical spine, according to an article featuring updates on spine surgery published in The Journal of Bone and Joint Surgery.
In addition to providing research updates on the anterial cervical discectomy and fusion procedure, this article discusses recent research and trends in other types of cervical spine treatment.
Anterial Cervical Discectomy and Fusion
Anterial cervical discectomy and fusion is the most commonly performed surgical procedure involving the cervical spine and is associated with high patient satisfaction. Studies show this procedure as more cost-effective compared with other orthopedic and general medicine treatment. However, the cost varies according to the price of the implants, and the costs are inversely proportional to the volume of surgery performed. The amount spent for anterior cervical spine surgery has increased six-fold from 1992 to 2005, according to a National Inpatient Database study.
Clinical trials, however, have found negative outcomes for the use of rhBMP-2 during cervical spine surgery. The FDA sent a warning letter in July 2008 regarding the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) for anterior cervical spine surgery. This protein has been linked to postoperative reports of dysphagia, dysphonia, hematoma and airway obstruction.
Cervical Disc Arthroplasty
Spine devices using kinematic designs (ball and socket, ball and trough, mobile center core) and different bearing couples (stainless steel metal on metal, cobalt-chromium on polyethylene, titanium on polycarbonate-polyurethane) have been approved for use in the United States. The cobalt-chromium metal-on-metal bearing surface design is being investigated in clinical trials.
Additionally, clinical trials comparing arthrodesis with arthroplasty after decompression for the treatment of single-level cervical disease showed equal or better results following the arthroplasty in terms of clinical success, pain and functional improvement. The research also found reoperation rates were significantly higher following arthrodesis than with arthroplasty.
Cervical Myelopathy
Experts have not reached a consensus as to whether the anterior or posterior approach is more beneficial for cervical myelopathy. The choice depends on factors such as the number of involved levels, cause of compression, spinal alignment, comorbidities and surgeon experience.
A European study examined the natural history of myelopathy in patients who waited more than 20 months for surgery and more than two-thirds experienced deterioration of pain and function while half showed deterioration during the neurological examination.
A Japanese study of 452 patients with acute traumatic spinal cord injury found 25 percent of patients to have ossification of the posterior longitudinal ligament without experiencing bone injury. Half the patients experienced symptoms such as gait disturbance prior to the injury. The researchers concluded that patients who identify symptoms of myelopathy are at risk for spinal cord injury with subsequent trauma.
Read The Journal of Bone and Joint Surgery's full coverage on spine surgery trends.
Read other coverage on spine surgery:
- Dr Arnold Graham Smith Performs New Minimally Invasive SI Joint Surgery
- Neurosurgeon's Transition From Academic Medical Center to Outpatient Treatment Center: Q&A With Dr. Gowriharan Thaiyananthan
- Spine Education Labs Critical in Training for Cutting-Edge Procedures
In addition to providing research updates on the anterial cervical discectomy and fusion procedure, this article discusses recent research and trends in other types of cervical spine treatment.
Anterial Cervical Discectomy and Fusion
Anterial cervical discectomy and fusion is the most commonly performed surgical procedure involving the cervical spine and is associated with high patient satisfaction. Studies show this procedure as more cost-effective compared with other orthopedic and general medicine treatment. However, the cost varies according to the price of the implants, and the costs are inversely proportional to the volume of surgery performed. The amount spent for anterior cervical spine surgery has increased six-fold from 1992 to 2005, according to a National Inpatient Database study.
Clinical trials, however, have found negative outcomes for the use of rhBMP-2 during cervical spine surgery. The FDA sent a warning letter in July 2008 regarding the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) for anterior cervical spine surgery. This protein has been linked to postoperative reports of dysphagia, dysphonia, hematoma and airway obstruction.
Cervical Disc Arthroplasty
Spine devices using kinematic designs (ball and socket, ball and trough, mobile center core) and different bearing couples (stainless steel metal on metal, cobalt-chromium on polyethylene, titanium on polycarbonate-polyurethane) have been approved for use in the United States. The cobalt-chromium metal-on-metal bearing surface design is being investigated in clinical trials.
Additionally, clinical trials comparing arthrodesis with arthroplasty after decompression for the treatment of single-level cervical disease showed equal or better results following the arthroplasty in terms of clinical success, pain and functional improvement. The research also found reoperation rates were significantly higher following arthrodesis than with arthroplasty.
Cervical Myelopathy
Experts have not reached a consensus as to whether the anterior or posterior approach is more beneficial for cervical myelopathy. The choice depends on factors such as the number of involved levels, cause of compression, spinal alignment, comorbidities and surgeon experience.
A European study examined the natural history of myelopathy in patients who waited more than 20 months for surgery and more than two-thirds experienced deterioration of pain and function while half showed deterioration during the neurological examination.
A Japanese study of 452 patients with acute traumatic spinal cord injury found 25 percent of patients to have ossification of the posterior longitudinal ligament without experiencing bone injury. Half the patients experienced symptoms such as gait disturbance prior to the injury. The researchers concluded that patients who identify symptoms of myelopathy are at risk for spinal cord injury with subsequent trauma.
Read The Journal of Bone and Joint Surgery's full coverage on spine surgery trends.
Read other coverage on spine surgery:
- Dr Arnold Graham Smith Performs New Minimally Invasive SI Joint Surgery
- Neurosurgeon's Transition From Academic Medical Center to Outpatient Treatment Center: Q&A With Dr. Gowriharan Thaiyananthan
- Spine Education Labs Critical in Training for Cutting-Edge Procedures