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13. Minimally invasive posterior cervical foraminotomy as an alternative to anterior cervical discectomy and fusion for unilateral cervical radiculopathy
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S1−S58 13. Minimally invasive posterior cervical foraminotomy as an alternative to anterior cervical discectomy and fusion for unilateral cervical radiculopathy Nikhil K. Sahai, MD, MPH1, Stuart Changoor, MD2, Conor J. Dunn, MD3, Kimona Issa, MD4, Michael J. Faloon, MD5, Kumar G. Sinha, MD5, Ki Soo Hwang, MD5, Arash Emami, MD5; 1 St. Joseph’s Regional Medical Center/Seton Hall University, Paterson, NJ, US; 2 St. Joseph’s University Medical Center, Paterson, NJ, US; 3 St. Joseph’s Regional Medical Center, Paterson, NJ, US; 4 East Orange, NJ, US; 5 University Spine Center, Wayne, NJ, US BACKGROUND CONTEXT: Unilateral cervical radiculopathy refractory to conservative treatment is one of the most common pathologies that spine surgeons treat surgically. Anterior cervical discectomy and fusion (ACDF) has long been considered standard treatment for cervical radiculopathy secondary to lateral disc herniation or foraminal stenosis. Recent studies suggest minimally-invasive posterior cervical foraminotomy (MIPCF) to be an alternative to ACDF, but not without concern for reoperation and magnitude of patient outcome improvement. PURPOSE: To compare patient outcomes, reoperation rate and complication rate of MI-PCF to those of ACDF by analyzing the current literature. STUDY DESIGN/SETTING: Systematic review, meta-analysis. PATIENT SAMPLE: A total of 1,216 patients who underwent MI-PCF for cervical radiculopathy from 14 previously published studies. OUTCOME MEASURES: (1) Patient-reported outcome scores: Visual Analog Scale (VAS) for arm and neck pain, neck disability index (NDI), (2) reoperation rate, (3) complication rate. METHODS: Three electronic databases (PubMed, CINAHL Plus, and SCOPUS) were queried using terms related to MI-PCF. Open approaches were excluded. MINORS scoring was used to assess study quality. A total of 14 studies were included in this analysis. Analyses for heterogeneity and publication bias were performed. Clinical outcome scores (NDI, VASneck and VAS-arm), reoperation proportion, and complications were assessed. Each outcome measure was compared to those of ACDF from two previously published studies. A random-effects model of meta-analysis was used for heterogenous groups, and a fixed-effects model was used for groups that were not. Overlap of 95% confidence intervals suggests no significant difference at the p<0.05 level. RESULTS: Fourteen studies were included in this analysis, with outcome data of 1,216 patients. The mean age of the study population was 51.57 years, who were 61.8% male and had a mean follow-up period of 30 months. The mean improvement in NDI was 20.30 (95% CI, 18.81-21.79) and 16.85 (95% CI, 14.96-19.10) for the MI-PCF and ACDF groups, respectively. The mean improvement in VAS-neck was 4.16 (95% CI, 2.70-5.61) and 2.47 (95% CI, 2.09-2.84) for the MI-PCF and ACDF groups, respectively. The mean improvement in VAS-arm was 5.31 (95% CI, 4.50-6.12) and 2.27 (95% CI, 1.82-2.70) for the MI-PCF and ACDF groups, respectively. 6% (95% CI, 3%-12%) of patients who underwent MI-PCF required a re-operation compared to 3.9% (95% CI, 2.77%5.46%) of those who underwent ACDF. Complications were noted in 4% (95% CI, 3%-7%) of MI-PCF patients and 7.79% (95% CI, 5.54%10.85%) of ACDF patients. The most common complications were transient neuropraxia, wound-related, and durotomy. CONCLUSIONS: MI-PCF resulted in a greater improvement in VAS-arm scores compared to ACDF, supporting its effectiveness as a procedure for lateral pathology. There were no other significant differences in patientreported clinical outcome scores, proportion of patients requiring re-operation, or complications between patients who underwent MI-PCF and those who underwent ACDF for unilateral cervical radiculopathy. Thus, MI-PCF may be utilized as a safe and effective alternative to ACDF in patients with unilateral cervical radiculopathy without myelopathy, without concern for increased reoperations or complications, and with advantages of preservation of cervical motion and quicker recovery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.026
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14. Day surgery anterior cervical discectomy and fusion at one, two and three levels is safe and effective in a public health system: experience from 273 patients at a single Canadian institution Jamie R. Wilson, MbChB, FRCS1, Hetshree Joshi2, Jessica P. Bauer1, Fan Jiang, MD1, Eric M. Massicotte, MD, MBA, MSc2; 1 Toronto Western Hospital, Toronto, ON, Canada; 2 University of Toronto, Toronto, ON, Canada BACKGROUND CONTEXT: Anterior cervical discectomy procedures (ACD) are amongst the most common procedures performed for cervical myeloradiculopathy. Outpatient single- or 2-level ACDs have become popular in recent years due to the high patient satisfaction outcomes and efforts to improve cost-effectiveness in health care. The safety and efficacy of 1, 2, or 3 level procedures in the public health care setting has not been reported in the literature. PURPOSE: To compare the complication profile and outcomes of a cohort of patients undergoing day surgery anterior cervical disectomy and fusion (ACDF) for 1−3 levels, compared to patients undergoing similar procedures with a short stay admission. STUDY DESIGN/SETTING: Retrospective case series at a single Canadian spine specialist centre. PATIENT SAMPLE: Two hundred seventy-three patients undergoing 1, 2 or 3-level ACDF by a singe surgeon over 13 years, as day surgery or overnight stay. OUTCOME MEASURES: Rates of complication, Neck Disability Index (NDI) and SF-36 outcome scores. METHODS: Perioperative and postoperative complication rates, 30-day readmission rates, together with patient-reported outcomes (NDI and SF36 scores) at 2-month, 1-year and 2-year intervals were compared with univariable and propensity analysis, with multivariate regression used to adjust between groups for age and number of operate levels. RESULTS: A total of 144 patients underwent ACDF with the intention to treat (ITT) as a day surgery procedure, with 129 admitted for short stay (24 hours). The day surgery cohort included 74 single-, 51 two- and 19 threelevel patients. The short stay cohort included 54 single-, 45 two-, 29 threelevel and 1 four-level procedures. Six patients (4%) with the ITT as day surgery were admitted for overnight stay or longer (range 2−21 days). Intraoperative dural tear was reported in 8 patients (5.8%) in the day surgery group (4 required admission), compared to 4 patients (3.1%) in the short stay group (odds ratio [OR] = 1.81 [0.53-6.2], p=0.5). One patient (0.7%) in the day surgery group suffered a permanent postoperative neurological deficit compared to 0 patients in the short stay group (p=1). Three patients (2.1%) in the day surgery group and 2 patients (1.5%) in the short stay group required readmission within 30 days (OR = 1.36 [95%CI 0.22 − 8.3], p=1). Regression analysis showed no significant differences in the 2month and 2-year outcomes post-ACDF between groups (p=0.796, 0.315 respectively) after accounting for total number of levels. CONCLUSIONS: Day surgery 1-, 2- or 3-level ACD is safe and effective in the public health care setting, with rates of complications and outcome measures comparable to short-stay patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.027
15. Surgical treatment of lower cervical fracture dislocation with spinal cord injuries using the anterior approach: a 10-year case review with minimum five-year follow-up Biao Wang, MD1, Ding-Jun Hao, MD2; 1 Honghui Hospital, Xi’an, Shaanxi, China; 2 Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China BACKGROUND CONTEXT: Lower cervical fracture-dislocations are often caused by flexion-stretch injuries and frequently combine with spinal cord injuries which can cause serious damage. To date, there is no clear consensus on the best treatment option for lower cervical fracture-
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
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14. Day surgery anterior cervical discectomy and fusion at one, two and three levels is safe and effective in a public health system: experience from 273 patients at a single Canadian institution Jamie R. Wilson, MbChB, FRCS1, Hetshree Joshi2, Jessica P. Bauer1, Fan Jiang, MD1, Eric M. Massicotte, MD, MBA, MSc2; 1 Toronto Western Hospital, Toronto, ON, Canada; 2 University of Toronto, Toronto, ON, Canada BACKGROUND CONTEXT: Anterior cervical discectomy procedures (ACD) are amongst the most common procedures performed for cervical myeloradiculopathy. Outpatient single- or 2-level ACDs have become popular in recent years due to the high patient satisfaction outcomes and efforts to improve cost-effectiveness in health care. The safety and efficacy of 1, 2, or 3 level procedures in the public health care setting has not been reported in the literature. PURPOSE: To compare the complication profile and outcomes of a cohort of patients undergoing day surgery anterior cervical disectomy and fusion (ACDF) for 1−3 levels, compared to patients undergoing similar procedures with a short stay admission. STUDY DESIGN/SETTING: Retrospective case series at a single Canadian spine specialist centre. PATIENT SAMPLE: Two hundred seventy-three patients undergoing 1, 2 or 3-level ACDF by a singe surgeon over 13 years, as day surgery or overnight stay. OUTCOME MEASURES: Rates of complication, Neck Disability Index (NDI) and SF-36 outcome scores. METHODS: Perioperative and postoperative complication rates, 30-day readmission rates, together with patient-reported outcomes (NDI and SF36 scores) at 2-month, 1-year and 2-year intervals were compared with univariable and propensity analysis, with multivariate regression used to adjust between groups for age and number of operate levels. RESULTS: A total of 144 patients underwent ACDF with the intention to treat (ITT) as a day surgery procedure, with 129 admitted for short stay (24 hours). The day surgery cohort included 74 single-, 51 two- and 19 threelevel patients. The short stay cohort included 54 single-, 45 two-, 29 threelevel and 1 four-level procedures. Six patients (4%) with the ITT as day surgery were admitted for overnight stay or longer (range 2−21 days). Intraoperative dural tear was reported in 8 patients (5.8%) in the day surgery group (4 required admission), compared to 4 patients (3.1%) in the short stay group (odds ratio [OR] = 1.81 [0.53-6.2], p=0.5). One patient (0.7%) in the day surgery group suffered a permanent postoperative neurological deficit compared to 0 patients in the short stay group (p=1). Three patients (2.1%) in the day surgery group and 2 patients (1.5%) in the short stay group required readmission within 30 days (OR = 1.36 [95%CI 0.22 − 8.3], p=1). Regression analysis showed no significant differences in the 2month and 2-year outcomes post-ACDF between groups (p=0.796, 0.315 respectively) after accounting for total number of levels. CONCLUSIONS: Day surgery 1-, 2- or 3-level ACD is safe and effective in the public health care setting, with rates of complications and outcome measures comparable to short-stay patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.027
15. Surgical treatment of lower cervical fracture dislocation with spinal cord injuries using the anterior approach: a 10-year case review with minimum five-year follow-up Biao Wang, MD1, Ding-Jun Hao, MD2; 1 Honghui Hospital, Xi’an, Shaanxi, China; 2 Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China BACKGROUND CONTEXT: Lower cervical fracture-dislocations are often caused by flexion-stretch injuries and frequently combine with spinal cord injuries which can cause serious damage. To date, there is no clear consensus on the best treatment option for lower cervical fracture-
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.