Posterior cervical fusion utilizing cages placed bilaterally in the facets for the treatment of the upper cervical adjacent segment disease in the elderly. (May 2019)

• Record Type: Journal Article
• Authors: Cheng, Leo; McCormack, Bruce; Eyster, Edward Fletcher
• Is Part Of: Journal of clinical neuroscience. Volume 63(2019)
• Page Start: 149
• Page End: 154
• Publication Date: 2019-05
• Subjects: Cervical spondylosis -- Posterior cervical fusion -- Adjacent segment disease -- Posterior cervical cages -- Fusion -- DTRAX -- CAVUX; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2019.01.018
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Upper cervical adjacent segment disease (ASD) in elderly has increased due to the widespread use of ACDF. Posterior approaches are preferred due to limited anterior access to upper cervical segments in the elderly population. PCF with cages placed bilaterally in the facets using tissue sparing technique reduce hospital stay compared to open PCF. Procedures reported in this paper resulted in high fusion rates and maintained preoperative spinal alignment. NDI and VAS improved compared to the pre-operative values at all time point out to the last follow-up. Abstract: This is a retrospective review of 24 elderly patients with upper cervical adjacent segment disease (ASD) after anterior cervical discectomy and fusion (ACDF), treated with posterior cervical fusion (PCF) and stabilized with cages placed bilaterally in the facets. Eight out of 24 patients had PCF with laminectomy (PCLF). Length of stay for PCF alone cohort was 30 ± 11 h, operative time was 44 ± 11 min and estimated blood loss was 46 ± 26 cc. In the PCLF cohort, hospital length of stay was 73 ± 32 h, operative time was 92 ± 18 min, and blood loss was 155 ± 58 cc. The pooled sample showed significant decreases in mean NDI and VAS for neck and arm pain at each follow-up visit (6 weeks, 3, 6, 12 months) compared to baseline (p < 0.0001). All 19 patients that returned for an additional visit, after 12 months visit, continued to report an improvement over the baseline VAS and NDI scores. For those patients treated with PCLF, Nurick scores improved by more than one point in 62% of patients. The overall fusion rate was 96%, including all 16 patients treated with PCF alone (fusion defined as less than 2 mm interspinous movement on dynamic X-ray), and in 7 out of 8 patients treated with PCLF (fusion defined as less than 3 degrees angulation). There was one asymptomatic non-union. There were no significant changes in the overall cervical lordosis (p = 0.436) or segmental lordosis (p = 0.449), and no device-related complications.