Anterior cervical corpectomy and fusion with stand-alone cages in patients with multilevel degenerative cervical spine disease is safe

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Abstract

Background

In case of spinal cord compression behind the vertebral body, anterior cervical corpectomy and fusion (ACCF) proves to be a more feasible approach than cervical discectomy. The next step was the placement of an expandable titanium interbody in order to restore the vertebral height. The need for additional anterior plating with ACCF has been debatable and such technique has been evaluated by very few studies. The objective of the study is to evaluate radiographic and clinical outcomes in patients with multilevel degenerative cervical spine disease treated by stand-alone cages for anterior cervical corpectomy and fusion (ACCF).

Methods

Thirty-one patients (66.5 ± 9.75 years, range 53–85 years) were analyzed. Visual Analog Scale (VAS) and the 10-item Neck Disability Index (NDI) were assessed preoperatively and during follow-up on a regular basis after surgery and after one year at least. Assessment of radiographic fusion, subsidence, and lordosis measurement of Global cervical lordosis (GCL); fusion site lordosis (FSL); the anterior interbody space height (ant. DSH); the posterior interbody space height (post. DSH); the distance of the cage to the posterior wall of the vertebral body (CD) were done retrospectively. Mean clinical and radiographic follow-up was 20.0 ± 4.39 months.

Results

VAS-neck ( p = 0.001) and VAS-arm ( p < 0.001) improved from preoperatively to postoperatively. The NDI improved at the final follow-up (p < 0.001). Neither significant subsidence of the cages nor significant loss of lordotic correction were seen. All patients showed a radiographic union of the surgically addressed segments at the last follow up.

Conclusions

Application of a stand-alone expandable cage in the cervical spine after one or two-level ACCF without additional posterior fixation or anterior plating is a safe procedure that results in fusion. Neither significant subsidence of the cages nor significant loss of lordotic correction were seen.

Trial registration

Retrospectively registered. According to the Decision of the ethics committee, Jena on 25th of July 2018, that this study doesn’t need any registration. https://www.laek-thueringen.de/aerzte/ethikkommission/registrierung/.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04883-5.

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Most cited references 34

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How sample size influences research outcomes

Jorge Faber, Lílian Martins Fonseca (2014)

Sample size calculation is part of the early stages of conducting an epidemiological, clinical or lab study. In preparing a scientific paper, there are ethical and methodological indications for its use. Two investigations conducted with the same methodology and achieving equivalent results, but different only in terms of sample size, may point the researcher in different directions when it comes to making clinical decisions. Therefore, ideally, samples should not be small and, contrary to what one might think, should not be excessive. The aim of this paper is to discuss in clinical language the main implications of the sample size when interpreting a study.

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Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults

Domenica A Delgado, Bradley S Lambert, Nickolas Boutris … (2018)

Background: The visual analog scale (VAS) is a validated, subjective measure for acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between “no pain” and “worst pain.” Methods: One hundred consecutive patients aged ≥18 years who presented with a chief complaint of pain were asked to record pain scores via a paper VAS and digitally via both the laptop computer and mobile phone. Ninety-eight subjects, 51 men (age, 44 ± 16 years) and 47 women (age, 46 ± 15 years), were included. A mixed-model analysis of covariance with the Bonferroni post hoc test was used to detect differences between the paper and digital VAS scores. A Bland–Altman analysis was used to test for instrument agreement between the platforms. The minimal clinically important difference was set at 1.4 cm (14% of total scale length) for detecting clinical relevance between the three VAS platforms. A paired one-tailed Student t-test was used to determine whether differences between the digital and paper measurement platforms exceeded 14% (P < 0.05). Results: A significant difference in scores was found between the mobile phone–based (32.9% ± 0.4%) and both the laptop computer– and paper-based platforms (31.0% ± 0.4%, P < 0.01 for both). These differences were not clinically relevant (minimal clinically important difference <1.4 cm). No statistically significant difference was observed between the paper and laptop computer platforms. Measurement agreement was found between the paper- and laptop computer–based platforms (mean difference, 0.0% ± 0.5%; no proportional bias detected) but not between the paper- and mobile phone–based platforms (mean difference, 1.9% ± 0.5%; proportional bias detected). Conclusion: No clinically relevant difference exists between the traditional paper-based VAS assessment and VAS scores obtained from laptop computer– and mobile phone–based platforms.

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Clinical practice. Cervical radiculopathy.

Simon Carette, Michael Fehlings (2005)

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Author and article information

Contributors

Mohamed H. Tohamy:

ORCID: https://orcid.org/0000-0001-7577-4105

mohamed.tohamy2000@gmail.com

Georg Osterhoff: Georg.Osterhoff@medizin.uni-leipzig.de

Ahmed Shawky Abdelgawaad: Ahsh313@yahoo.com

Ali Ezzati: Ali.ezzati@helios-kliniken.de

Christoph-E. Heyde: Christoph-Eckhard.Heyde@medizin.uni-leipzig.de , Christoph.heyde2000@gmail.com

Journal

Journal ID (nlm-ta): BMC Musculoskelet Disord

Journal ID (iso-abbrev): BMC Musculoskelet Disord

Title: BMC Musculoskeletal Disorders

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2474

Publication date (Electronic): 3 January 2022

Publication date PMC-release: 3 January 2022

Publication date Collection: 2022

Volume: 23

Electronic Location Identifier: 20

Affiliations

[1 ]Spine Unit, Martin-Ulbrich-Haus Rothenburg, Horkaer Str. 15-21, 02929 Rothenburg, Oberlausitz Germany

[2 ]GRID grid.491867.5, ISNI 0000 0000 9463 8339, Spine Departement, , Helios Klinikum Erfurt, ; Nordhäuser Str. 74, 99089 Erfurt, Germany

[3 ]Ligamenta Spine Center, Walter-Kolb-Street 9-11, 60594 Frankfurt am Main, Germany

[4 ]GRID grid.411339.d, ISNI 0000 0000 8517 9062, Department of Orthopedics, , Trauma and Plastic Surgery, University Hospital Leipzig, ; Liebigstrasse 20, 04179 Leipzig, Germany

[5 ]GRID grid.411437.4, ISNI 0000 0004 0621 6144, Department of Orthopedic and Trauma Surgery, , Assiut University Hospitals, ; Assiut, Egypt

[6 ]GRID grid.411339.d, ISNI 0000 0000 8517 9062, Department of Orthopedics, , Trauma and Plastic Surgery, University Hospital Leipzig, ; 04103 Leipzig, Germany

Author information

Mohamed H. Tohamy https://orcid.org/0000-0001-7577-4105

Article

Publisher ID: 4883

DOI: 10.1186/s12891-021-04883-5

PMC ID: 8725343

PubMed ID: 34980062

SO-VID: e1fb3b47-056c-4fa9-afaf-9f0358a5eca0

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 15 May 2021

Date accepted : 26 October 2021

Funding

Funded by: Universitätsklinikum Leipzig (8929)

Open Access :

Open Access funding enabled and organized by Projekt DEAL.

Custom metadata

ScienceOpen disciplines: Orthopedics

Keywords: cervical spine,stand-alone cage,corpectomy,spinal canal stenosis,anterior plate,anterior cervical decompression,cervical fusion,dysphagia

Data availability:

ScienceOpen disciplines: Orthopedics

Keywords: cervical spine, stand-alone cage, corpectomy, spinal canal stenosis, anterior plate, anterior cervical decompression, cervical fusion, dysphagia

Anterior cervical corpectomy and fusion with stand-alone cages in patients with multilevel degenerative cervical spine disease is safe

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Abstract

Background

Methods

Results

Conclusions

Trial registration

Supplementary Information

Related collections

Orthopedics

Most cited references 34

How sample size influences research outcomes

Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults

Clinical practice. Cervical radiculopathy.

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Contributors

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Affiliations

Author information

Article

History

Funding

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