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95. Effect of Postoperative Bracing on Fusion after Instrumented Anterior Cervical Discectomy and Fusion
Proceedings of the NASS 23rd Annual Meeting / The Spine Journal 8 (2008) 1S–191S were satisfactory in both groups. And there was no significant difference in clinical results. But focus on the clinical result of upper extremities, the improvement of JOA score was significantly better in anterior group rather than laminoplasty group. And the clinical result of laminoplasty cases, with over 50% of space occupying lesion was less successful compared with under 50% of the lesion. The complications were respiratory disorder in two cases in anterior group, and tethering effect was observed in two cases in laminoplasty group. CONCLUSIONS: Laminoplasty is gold standard procedure for OPLL of cervical spine because of the less invasiveness and stable clinical results. But the spinal cord shift posterior after surgery and tethering effect may occur with worsening of the upper extremity symptoms. And if the OPLL mass is so huge, it is anxious that the improvement of the symptom is not successful. Anterior floating method is a direct decompression procedure without any anxious of direct injure to the spinal cord. This procedure requires much skill and invasiveness is much rather than posterior procedure. But anterior floating method is one of the ideal and reasonable procedures. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi:10.1016/j.spinee.2008.06.113
95. Effect of Postoperative Bracing on Fusion after Instrumented Anterior Cervical Discectomy and Fusion Christian Fras, MD; Lankenau Spine Center, Broomall, PA, USA BACKGROUND CONTEXT: Post-operative bracing was originally advocated after anterior cervical discectomy and fusion (ACDF); with the advent of anterior instrumentation, some surgeons have chosen to avoid bracing post-operatively. The effect of the use of a rigid brace after instrumented anterior cervical discectomy and fusion with allograft is unknown. PURPOSE: The purpose of this study is to evaluate if use of a rigid brace after instrumented ACDF with allograft has any effect on fusion rate. STUDY DESIGN/ SETTING: Consecutive retrospective review. PATIENT SAMPLE: All patients undergoing ACDF with allograft and instrumentation in the author’s practice from 1/1/2000 to 1/1/2005. OUTCOME MEASURES: Fusion status, as determined by x-ray. METHODS: All patients in the author’s practice undergoing ACDF with allograft and anterior cervical plating between 1/1/2000 and 1/1/2005 were identified. All were followed at regular intervals with x-rays (at least A/P and lateral images). The most recent post-operative x-ray was evaluated for radiographic evidence of fusion; they were classified as fused, not fused, or indeterminate. Note was taken by means of patient chart review if a post-operative brace had been utilized, and for how long. RESULTS: 42 patients were identified who had undergone 1 level ACDF with allograft and rigid plate fixation. Of these, 17 had been prescribed a brace (Miami-J collar) post-operatively; the reason for using the brace was based on either patient preference, or more often, surgeon concern about intra-operative factors (e.g., poor bone stock, poor fixation of screws in plate). The average duration of brace usage was 6 weeks. The remaining 25 patients had no brace prescribed post-operatively. Follow up averaged 3.5 years (range: 2–5 years). Among those patients braced post-operatively, the fusion rate was as follows: 11 fused (64.7%); 4 indeterminate (23.5%); and 2 not fused (11.8%). Among those not braced, the fusion rate was as follows: 17 fused (68%); 5 (20%) indeterminate; and 3 not fused (12%). There was no statistically significant difference among these rates when comparing those patients who were braced with those who were not braced. CONCLUSIONS: Among those patients who underwent 1 level ACDF with allograft and plate fixation, there was no statistically significant
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difference in fusion rate comparing those who were prescribed a brace post-operatively, with those who did not have a brace prescribed postoperatively. These results would suggest that it is not mandatory to prescribe a brace for use post-operatively after 1 level ACDF with allograft and plate fixation. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi:10.1016/j.spinee.2008.06.114
96. Surgical Treatment of Patients with Cervical Myeloradiculopathy and Coexistent Multiple Sclerosis Report of Nine Patients with Two Year Follow-up Paul M. Arnold, MD, FACS1, Robert Kyle Warren, MS2; 1University of Kansas Medical Center, Kansas City, KS, USA; 2Kansas City University of Medicine and Biosciences, Kansas City, MO, USA BACKGROUND CONTEXT: Background Context: Multiple sclerosis and cervical myeloradiculopathy share clinical signs, including gait dysfunction, motor weakness, and hyperreflexia. Distinguishing between these two entities may be difficult, and in rare cases they may co-exist. Controversy exists regarding the use of surgery in patients with multiple sclerosis as treatment for degenerative cervical spondylotic disease. PURPOSE: Purpose: To report a series of nine patients with co-existing multiple sclerosis and progressive myeloradiculopathy who were successfully treated with surgical decompression, fusion, and fixation. STUDY DESIGN/ SETTING: Study Design/Setting: A case series at an academic medical center with an average 30-month follow-up. PATIENT SAMPLE: Patient Sample: Nine patients: six females; three males; average age 48. OUTCOME MEASURES: Outcome Measures: Neurological assessment; subjective reports of pain and paraesthesias; radiographic fusion assessment. METHODS: Methods: This case series was composed of nine patients (six female, three male, average age 48) with a confirmed diagnosis of multiple sclerosis who presented with worsening cervical myeloradiculopathy. All patients had MRI evidence of cervical spinal cord compression from an abnormal disk/osteophyte complex, hypertrophied ligament, or both. Six patients had neck pain, four had upper extremity pain and/or paresthesias, six had worsening upper extremity weakness, five had progressive lower extremity weakness, and one had new bladder incontinence. The average duration of symptoms prior to presentation was six months. Eight patients underwent anterior cervical diskectomy and fusion, and one underwent C6 vertebrectomy and fusion. RESULTS: Results: Eight patients showed subjective improvement in neurologic function, including increased lower and upper extremity strength. One patient’s symptoms stabilized. Eight of nine patients also had improvement in neck and/or upper extremity pain or paresthesias; one patient had continuing upper and lower extremity paresthesias. The patient with bladder incontinence did not improve. All patients went on to radiographic fusion, and there were no surgical complications. CONCLUSIONS: Conclusions: Patients with co-existent multiple sclerosis and cervical myeloradiculopathy may present a diagnostic challenge, and it may be difficult to ascertain the exact disease pathophysiology. However, patients with multiple sclerosis and degenerative cervical spondylotic disease can benefit from surgical decompression. Surgery is an efficacious, low-risk procedure and should be offered to appropriately selected patients who harbor both diseases. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi:10.1016/j.spinee.2008.06.115
95. Effect of Postoperative Bracing on Fusion after Instrumented Anterior Cervical Discectomy and Fusion Christian Fras, MD; Lankenau Spine Center, Broomall, PA, USA BACKGROUND CONTEXT: Post-operative bracing was originally advocated after anterior cervical discectomy and fusion (ACDF); with the advent of anterior instrumentation, some surgeons have chosen to avoid bracing post-operatively. The effect of the use of a rigid brace after instrumented anterior cervical discectomy and fusion with allograft is unknown. PURPOSE: The purpose of this study is to evaluate if use of a rigid brace after instrumented ACDF with allograft has any effect on fusion rate. STUDY DESIGN/ SETTING: Consecutive retrospective review. PATIENT SAMPLE: All patients undergoing ACDF with allograft and instrumentation in the author’s practice from 1/1/2000 to 1/1/2005. OUTCOME MEASURES: Fusion status, as determined by x-ray. METHODS: All patients in the author’s practice undergoing ACDF with allograft and anterior cervical plating between 1/1/2000 and 1/1/2005 were identified. All were followed at regular intervals with x-rays (at least A/P and lateral images). The most recent post-operative x-ray was evaluated for radiographic evidence of fusion; they were classified as fused, not fused, or indeterminate. Note was taken by means of patient chart review if a post-operative brace had been utilized, and for how long. RESULTS: 42 patients were identified who had undergone 1 level ACDF with allograft and rigid plate fixation. Of these, 17 had been prescribed a brace (Miami-J collar) post-operatively; the reason for using the brace was based on either patient preference, or more often, surgeon concern about intra-operative factors (e.g., poor bone stock, poor fixation of screws in plate). The average duration of brace usage was 6 weeks. The remaining 25 patients had no brace prescribed post-operatively. Follow up averaged 3.5 years (range: 2–5 years). Among those patients braced post-operatively, the fusion rate was as follows: 11 fused (64.7%); 4 indeterminate (23.5%); and 2 not fused (11.8%). Among those not braced, the fusion rate was as follows: 17 fused (68%); 5 (20%) indeterminate; and 3 not fused (12%). There was no statistically significant difference among these rates when comparing those patients who were braced with those who were not braced. CONCLUSIONS: Among those patients who underwent 1 level ACDF with allograft and plate fixation, there was no statistically significant
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difference in fusion rate comparing those who were prescribed a brace post-operatively, with those who did not have a brace prescribed postoperatively. These results would suggest that it is not mandatory to prescribe a brace for use post-operatively after 1 level ACDF with allograft and plate fixation. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi:10.1016/j.spinee.2008.06.114
96. Surgical Treatment of Patients with Cervical Myeloradiculopathy and Coexistent Multiple Sclerosis Report of Nine Patients with Two Year Follow-up Paul M. Arnold, MD, FACS1, Robert Kyle Warren, MS2; 1University of Kansas Medical Center, Kansas City, KS, USA; 2Kansas City University of Medicine and Biosciences, Kansas City, MO, USA BACKGROUND CONTEXT: Background Context: Multiple sclerosis and cervical myeloradiculopathy share clinical signs, including gait dysfunction, motor weakness, and hyperreflexia. Distinguishing between these two entities may be difficult, and in rare cases they may co-exist. Controversy exists regarding the use of surgery in patients with multiple sclerosis as treatment for degenerative cervical spondylotic disease. PURPOSE: Purpose: To report a series of nine patients with co-existing multiple sclerosis and progressive myeloradiculopathy who were successfully treated with surgical decompression, fusion, and fixation. STUDY DESIGN/ SETTING: Study Design/Setting: A case series at an academic medical center with an average 30-month follow-up. PATIENT SAMPLE: Patient Sample: Nine patients: six females; three males; average age 48. OUTCOME MEASURES: Outcome Measures: Neurological assessment; subjective reports of pain and paraesthesias; radiographic fusion assessment. METHODS: Methods: This case series was composed of nine patients (six female, three male, average age 48) with a confirmed diagnosis of multiple sclerosis who presented with worsening cervical myeloradiculopathy. All patients had MRI evidence of cervical spinal cord compression from an abnormal disk/osteophyte complex, hypertrophied ligament, or both. Six patients had neck pain, four had upper extremity pain and/or paresthesias, six had worsening upper extremity weakness, five had progressive lower extremity weakness, and one had new bladder incontinence. The average duration of symptoms prior to presentation was six months. Eight patients underwent anterior cervical diskectomy and fusion, and one underwent C6 vertebrectomy and fusion. RESULTS: Results: Eight patients showed subjective improvement in neurologic function, including increased lower and upper extremity strength. One patient’s symptoms stabilized. Eight of nine patients also had improvement in neck and/or upper extremity pain or paresthesias; one patient had continuing upper and lower extremity paresthesias. The patient with bladder incontinence did not improve. All patients went on to radiographic fusion, and there were no surgical complications. CONCLUSIONS: Conclusions: Patients with co-existent multiple sclerosis and cervical myeloradiculopathy may present a diagnostic challenge, and it may be difficult to ascertain the exact disease pathophysiology. However, patients with multiple sclerosis and degenerative cervical spondylotic disease can benefit from surgical decompression. Surgery is an efficacious, low-risk procedure and should be offered to appropriately selected patients who harbor both diseases. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi:10.1016/j.spinee.2008.06.115