Download PDF
J Neurol Surg A Cent Eur Neurosurg 2016; 77(06): 482-488
DOI: 10.1055/s-0036-1584210
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Clinical and Radiographic Results of Indirect Decompression and Posterior Cervical Fusion for Single-Level Cervical Radiculopathy Using an Expandable Implant with 2-Year Follow-Up

Kris Siemionow
1   Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois, United States
,
Piotr Janusz
1   Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois, United States
2   Spine Disorders and Pediatric Orthopedics Department, University of Medical Sciences, Poznan, Poland
,
Frank M. Phillips
3   Rush University Medical Center, Minimally Invasive Spine Institute, Chicago, Illinois, United States
,
Jim A. Youssef
4   Orthopaedic Surgery, Spine Colorado, Durango, Colorado, United States
,
Robert Isaacs
5   Department of Neurosurgery, Duke University, Durham, North Carolina, United States
,
Marcin Tyrakowski
1   Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois, United States
6   Department of Orthopaedics, Pediatric Orthopaedics and Traumatology, The Centre of Postgraduate Medical Education, Warsaw, Poland
,
Bruce McCormack
7   Department of Neurosurgery, University of California San Francisco Medical Center, San Francisco, California, United States
› Author Affiliations
Further Information

Publication History

09 June 2015

24 March 2016

Publication Date:
08 June 2016 (online)

    Permissions and Reprints

Abstract

Background Indirect posterior cervical nerve root decompression and fusion performed by placing bilateral posterior cervical cages in the facet joints from a posterior approach has been proposed as an option to treat select patients with cervical radiculopathy. The purpose of this study was to report 2-year clinical and radiologic results of this treatment method.

Methods Patients who failed nonsurgical management for single-level cervical radiculopathy were recruited. Surgical treatment involved a posterior approach with decortication of the lateral mass and facet joint at the treated level followed by placement of the DTRAX Expandable Cage (Providence Medical Technology, Lafayette, California, United States) into both facet joints. Iliac crest bone autograft was mixed with demineralized bone matrix and used in all cases. The Neck Disability Index (NDI), visual analog scale (VAS) for neck and arm pain, and SF-12 v.2 questionnaire were evaluated preoperatively and 2 years postoperatively. Segmental (treated level) and overall C2–C7 cervical lordosis, disk height, adjacent segment degeneration, and fusion were assessed on computed tomography scans and radiographs acquired preoperatively and 2 years postoperatively.

Results Overall, 53 of 60 enrolled patients were available at 2-year follow-up. There were 35 females and 18 males with a mean age of 53 years (range: 40–75 years). The operated level was C3–C4 (N = 3), C4–C5 (N = 6), C5–C6 (N = 36), and C6–C7 (N = 8). The mean preoperative and 2-year scores were NDI: 32.3 versus 9.1 (p < 0.0001); VAS Neck Pain: 7.4 versus 2.6 (p < 0.0001); VAS Arm Pain: 7.4 versus 2.6 (p < 0.0001); SF-12 Physical Component Summary: 34.6 versus 43.6 (p < 0.0001), and SF-12 Mental Component Summary: 40.8 versus 51.4 (p < 0.0001). No significant changes in overall or segmental lordosis were noted after surgery. Radiographic fusion rate was 98.1%. There was no device failure, implant lucency, or surgical reinterventions.

Conclusions Indirect decompression and posterior cervical fusion using an expandable intervertebral cage may be an effective tissue-sparing option in select patients with single-level cervical radiculopathy.

Keywords

DTRAX Facet System - posterior cervical fusion - cervical radiculopathy - cervical spondylosis - minimally invasive surgery
 

  • References

  • 1 Fessler RG, Khoo LT. Minimally invasive cervical microendoscopic foraminotomy: an initial clinical experience. Neurosurgery 2002; 51 (5, Suppl): S37-S45
    CrossrefPubMedGoogle Scholar
  • 2 Vieweg U. Anterior cervical discectomy and fusion. In: Vieweg U, ed. Manual of Spine Surgery. Berlin, Germany: Springer; 2012: 127-133
    CrossrefGoogle Scholar
  • 3 Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion?. Spine J 2004; 4 (6, Suppl): 190S-194S
    CrossrefPubMedGoogle Scholar
  • 4 Fountas KN, Kapsalaki EZ, Nikolakakos LG , et al. Anterior cervical discectomy and fusion associated complications. Spine 2007; 32 (21) 2310-2317
    Google Scholar
  • 5 Riley III LH, Vaccaro AR, Dettori JR, Hashimoto R. Postoperative dysphagia in anterior cervical spine surgery. Spine 2010; 35 (9, Suppl): S76-S85
    CrossrefPubMedGoogle Scholar
  • 6 Herkowitz HN, Kurz LT, Overholt DP. Surgical management of cervical soft disc herniation. A comparison between the anterior and posterior approach. Spine 1990; 15 (10) 1026-1030
    CrossrefPubMedGoogle Scholar
  • 7 Russell SM, Benjamin V. Posterior surgical approach to the cervical neural foramen for intervertebral disc disease. Neurosurgery 2004; 54 (3) 662-665 ; discussion 665–666
    CrossrefPubMedGoogle Scholar
  • 8 McCormack BM, Bundoc RC, Ver MR, Ignacio JM, Berven SH, Eyster EF. Percutaneous posterior cervical fusion with the DTRAX Facet System for single-level radiculopathy: results in 60 patients. J Neurosurg Spine 2013; 18 (3) 245-254
    CrossrefPubMedGoogle Scholar
  • 9 Siemionow K, McCormack BM, Menchetti PPM. Tissue sparing posterior cervical indirect decompression and fusion in foraminal stenosis. In: Menchetti P, ed. Cervical Spine: Minimally Invasive and Open Surgery. New York, NY: Springer Berlin Heidelberg; 2015: 135-148
    Google Scholar
  • 10 Cobb J. Outline for the study of scoliosis. Am Acad Orthop Surg Instr Course Lect 1948; 5: 261-275
    PubMedGoogle Scholar
  • 11 Goel A, Shah A. Facetal distraction as treatment for single- and multilevel cervical spondylotic radiculopathy and myelopathy: a preliminary report. J Neurosurg Spine 2011; 14 (6) 689-696
    CrossrefPubMedGoogle Scholar
  • 12 Fraser JF, Härtl R. Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates. J Neurosurg Spine 2007; 6 (4) 298-303
    CrossrefPubMedGoogle Scholar
  • 13 Tan LA, Gerard CS, Anderson PA, Traynelis VC. Effect of machined interfacet allograft spacers on cervical foraminal height and area. J Neurosurg Spine 2014; 20 (2) 178-182
    CrossrefPubMedGoogle Scholar
  • 14 Leasure JM, Buckley J. Biomechanical evaluation of an interfacet joint decompression and stabilization system. J Biomech Eng 2014; 136 (7)
    PubMedGoogle Scholar
  • 15 Patwardhan AG, Tzermiadianos MN, Tsitsopoulos PP , et al. Primary and coupled motions after cervical total disc replacement using a compressible six-degree-of-freedom prosthesis. Eur Spine J 2012; 21 (Suppl. 05) S618-S629
    CrossrefPubMedGoogle Scholar
  • 16 Yue JJ. Primary indications and disc space preparation for cervical disc arthroplasty. In: Yue JJ, ed. Motion Preservation Surgery of the Spine: Advanced Techniques and Controversies. Philadelphia, PA: Saunders/Elsevier; 2008: 185-192
    Google Scholar
  • 17 Bhadra AK, Raman AS, Casey ATH, Crawford RJ. Single-level cervical radiculopathy: clinical outcome and cost-effectiveness of four techniques of anterior cervical discectomy and fusion and disc arthroplasty. Eur Spine J 2009; 18 (2) 232-237
    PubMedGoogle Scholar
  • 18 Sasso RC, Anderson PA, Riew KD, Heller JG. Results of cervical arthroplasty compared with anterior discectomy and fusion: four-year clinical outcomes in a prospective, randomized controlled trial. J Bone Joint Surg Am 2011; 93 (18) 1684-1692
    CrossrefPubMedGoogle Scholar
  • 19 Scoville WB, Whitcomb BB. Lateral rupture of cervical intervertebral disks. Postgrad Med 1966; 39 (2) 174-180
    CrossrefPubMedGoogle Scholar
  • 20 Frykholm R. Cervical root compression resulting from disc degeneration and root sleeve fibrosis. Acta Chir Scand 1951; 160: 1-149
    PubMedGoogle Scholar
  • 21 Skovrlj B, Gologorsky Y, Haque R, Fessler RG, Qureshi SA. Complications, outcomes, and need for fusion after minimally invasive posterior cervical foraminotomy and microdiscectomy. Spine J 2014; 14 (10) 2405-2411
    CrossrefPubMedGoogle Scholar