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Different surgical approaches for the treatment of adjacent segment diseases after anterior cervical fusion: A retrospective study of 49 patients.

Abstract Studies in the literature have not delineated the surgical approaches of symptomatic adjacent segment diseases (ASDs) in patients undergoing reoperation after an initial anterior cervical fusion (ACF). The purpose of this study was to determine the optimal surgical approaches of ASD and the incidence of the dysphagia after reoperation.This was a retrospective study of 49 patients with ASD after an initial ACF surgery, which had undergone a reoperation at our medical center between January 2010 and December 2014. The surgical approaches were used by anterior cervical discectomy and fusion (ACDF), ACDF with the Zero-profile device, laminoplasty, and laminectomy with internal fixation. Patients were classified according to the different surgical approaches of anterior (n = 38) versus posterior (n = 11) groups and ACDF (n = 25) versus Zero-P (n = 13) groups. Clinical evaluations were performed preoperatively and repeated in 24 months after operation.This retrospective study included 26 men and 23 women with a mean age at revision surgery of 54.3 years and ASD onset time of 7.3 years. The patients were followed up with an average of 4.1 years. The reoperation rate was 5.4% in this study. The Japanese Orthopaedic Association (JOA), Neck Disability Index (NDI), and visual analogue scale (VAS) scores demonstrated significant improvements compared with preoperative in both anterior and posterior groups (P < .05). However, there were no differences between the 2 groups (P > .05). The operation time of ACDF group was more than Zero-P group, with significant differences (P < .05). However, there were no differences in JOA, NDI, and VAS scores between the ACDF and Zero-P groups pre- and postoperative (P > .05). A total of 12 (24.5%) patients had dysphagia after reoperation. The incidence of dysphagia in Zero-P group (1/13) was less than ACDF group (11/25), with significant differences (P < .05). There were no cases of major neurological or vascular complications, and wound complications.The clinical situation, initial operation, and secondary preoperative imaging findings were analyzed comprehensively, anterior or posterior approach were chosen, which can effectively relieve spinal cord compression and improve spinal cord function. In ACDF with the Zero-profile device surgery, there was no need to remove the previous internal fixation, shorten the operation time, and reduce the incidence of postoperative dysphagia.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28591037
OWN - NLM
STAT- MEDLINE
DA  - 20170607
DCOM- 20170706
LR  - 20170706
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 23
DP  - 2017 Jun
TI  - Different surgical approaches for the treatment of adjacent segment diseases
      after anterior cervical fusion: A retrospective study of 49 patients.
PG  - e7042
LID - 10.1097/MD.0000000000007042 [doi]
AB  - Studies in the literature have not delineated the surgical approaches of
      symptomatic adjacent segment diseases (ASDs) in patients undergoing reoperation
      after an initial anterior cervical fusion (ACF). The purpose of this study was to
      determine the optimal surgical approaches of ASD and the incidence of the
      dysphagia after reoperation.This was a retrospective study of 49 patients with
      ASD after an initial ACF surgery, which had undergone a reoperation at our
      medical center between January 2010 and December 2014. The surgical approaches
      were used by anterior cervical discectomy and fusion (ACDF), ACDF with the
      Zero-profile device, laminoplasty, and laminectomy with internal fixation.
      Patients were classified according to the different surgical approaches of
      anterior (n = 38) versus posterior (n = 11) groups and ACDF (n = 25) versus
      Zero-P (n = 13) groups. Clinical evaluations were performed preoperatively and
      repeated in 24 months after operation.This retrospective study included 26 men
      and 23 women with a mean age at revision surgery of 54.3 years and ASD onset time
      of 7.3 years. The patients were followed up with an average of 4.1 years. The
      reoperation rate was 5.4% in this study. The Japanese Orthopaedic Association
      (JOA), Neck Disability Index (NDI), and visual analogue scale (VAS) scores
      demonstrated significant improvements compared with preoperative in both anterior
      and posterior groups (P &lt; .05). However, there were no differences between the 2 
      groups (P &gt; .05). The operation time of ACDF group was more than Zero-P group,
      with significant differences (P &lt; .05). However, there were no differences in
      JOA, NDI, and VAS scores between the ACDF and Zero-P groups pre- and
      postoperative (P &gt; .05). A total of 12 (24.5%) patients had dysphagia after
      reoperation. The incidence of dysphagia in Zero-P group (1/13) was less than ACDF
      group (11/25), with significant differences (P &lt; .05). There were no cases of
      major neurological or vascular complications, and wound complications.The
      clinical situation, initial operation, and secondary preoperative imaging
      findings were analyzed comprehensively, anterior or posterior approach were
      chosen, which can effectively relieve spinal cord compression and improve spinal 
      cord function. In ACDF with the Zero-profile device surgery, there was no need to
      remove the previous internal fixation, shorten the operation time, and reduce the
      incidence of postoperative dysphagia.
FAU - Wang, Feng
AU  - Wang F
AD  - Department of Spine Surgery, Hebei Provincial Key Laboratory of Orthopedic
      Biomechanics, The Third Hospital of Hebei Medical University, Shijiazhuang,
      China.
FAU - Wang, Peng
AU  - Wang P
FAU - Miao, De-Chao
AU  - Miao DC
FAU - Du, Wei
AU  - Du W
FAU - Shen, Yong
AU  - Shen Y
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Adult
MH  - Aged
MH  - Cervical Vertebrae/diagnostic imaging/*surgery
MH  - Deglutition Disorders/epidemiology/etiology
MH  - Disability Evaluation
MH  - Diskectomy/adverse effects
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Incidence
MH  - Internal Fixators
MH  - Intervertebral Disc Degeneration/complications/diagnostic imaging/*surgery
MH  - Laminectomy/adverse effects
MH  - Male
MH  - Middle Aged
MH  - Operative Time
MH  - Pain Measurement
MH  - Postoperative Complications/epidemiology
MH  - Radiculopathy/surgery
MH  - Reoperation
MH  - Retrospective Studies
MH  - Spinal Cord Diseases/surgery
MH  - Spinal Fusion/*methods
MH  - Treatment Outcome
PMC - PMC5466215
EDAT- 2017/06/08 06:00
MHDA- 2017/07/07 06:00
CRDT- 2017/06/08 06:00
AID - 10.1097/MD.0000000000007042 [doi]
AID - 00005792-201706090-00013 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Jun;96(23):e7042. doi: 10.1097/MD.0000000000007042.