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1.
Purpose
To investigate the association between pain sensitivity in the hand pre-surgery, and patient-reported outcomes (PROs) in function, pain and health pre- and post-surgery in patients with disc herniation or spinal stenosis.Methods
This is a prospective cohort study with 82 patients. Associations between pressure-, cold- and heat pain threshold (PPT, CPT, HPT) in the hand pre-surgery and Oswestry, VAS pain, EQ-5D, HADS, and Self-Efficacy Scale, pre- and three months post-surgery; were investigated with linear regression.Results
Patients with disc herniation more sensitive to pressure pain pre-surgery showed lower function and self-efficacy, and higher anxiety and depression pre-surgery, and lower function, and self-efficacy, and higher pain post-surgery. Results for cold pain were similar. In patients with spinal stenosis few associations with PROs were found and none for HPT and PROs.Conclusions
Altered pain response in pressure- and cold pain in the hand, as a sign of widespread pain pre-surgery had associations with higher pain, lower function and self-efficacy post-surgery in patients with disc herniation.2.
Maryse Fortin Àron Lazáry Peter Paul Varga Iain McCall Michele C. Battié 《European spine journal》2016,25(5):1452-1459
Purpose
To investigate asymmetry in size and composition of the multifidus and erector spinae in patients with posterolateral disc herniation and concordant radicular symptoms, and determine whether symptom duration is associated with degree of asymmetry.Methods
Thirty-three patients diagnosed with posterolateral disc herniation at L4–L5 verified on imaging and concordant leg pain were included. Multifidus and erector spinae cross-sectional area (CSA), functional cross-sectional area (FCSA, fat-free area), signal intensity and ratio of FCSA to total CSA were measured bilaterally from T 2-weighted axial magnetic resonance imaging (MRI) at L3–L4, L4–L5, L5–S1 and S1 levels.Results
No side-to-side differences in multifidus CSA, FCSA, and ratio of FCSA/CSA reached statistical significance at any spinal level. The multifidus signal intensity at L5–S1 was significantly greater (more fatty infiltration) on the side of the disc herniation. The erector spinae FCSA (lean muscle mass) at L5–S1 was found to be significantly smaller on the side of the herniation and the ratio of FCSA/CSA was smaller (more fatty infiltration) on the side of the herniation at L4–L5 and L5–S1. The degree of muscle asymmetry was not associated with symptoms duration.Conclusions
There was no significant asymmetry of the multifidus at spinal level above, same or level below the disc herniation. Instead, variations in muscle composition were observed, with greater fat infiltration on the side and at spinal levels adjacent to the disc herniation. Muscle asymmetry was not correlated with symptom duration.3.
Luiz Armando Vidal Ramos Fábio Jorge Renovato França Bianca Callegari Thomaz Nogueira Burke Maurício Oliveira Magalhães Amélia Pasqual Marques 《European spine journal》2016,25(5):1435-1442
Purpose
The aims of this study were to assess lumbar multifidus fatigue (LM) and transversus abdominis activation (TrA) in individuals with lumbar disc herniation associated with low back pain.Methods
Sixty individuals were divided into the lumbar herniation (LHG, n = 30) and control groups (CG, n = 30). Fatigue of the LM was assessed using surface electromyography during the Sorensen effort test, and activation of the TrA with a pressure biofeedback unit. Pain intensity was determined using a visual analog scale and the McGill pain questionnaire. The Oswestry disability questionnaire and the Borg scale for self-evaluating exertion were used to assess functional disability.Results
Fatigue was significantly more intense and the TrA activation was insufficient (p < 0.01) in individuals with disc herniation relative to the control group. The LHG had mild functional disability and moderate pain. There were differences in the initial exertion self-evaluation between groups, which were not observed in the final exertion evaluation.Conclusion
Individuals with lumbar disc herniation associated with low back pain have increased fatigue of the LM and decreased activation of the TrA, when compared to the control group.4.
Objective
To present multidimensional long-term results after mono-segmental microdiscectomy for lumbar disc herniation (LDH) in a large adult cohort treated at a tertiary care centre.Methods
Retrospective study design with Oswestry Disability Index (ODI) questionnaire employed at follow-up. All patients undergoing surgical treatment for single-level LDH between 2003 and 2009 were identified. Electronic patient records and imaging data were analysed.Results
A total of 939 patients underwent single-level lumbar MD at our institution. Three hundred and seven complete ODI forms (32.7%) were returned at a median follow-up of 48 months. Mean ODI score was 24.04, and mean age was 58 years. Females reported slightly higher ODI scores (25.52 vs. 22.68). Age and ODI score showed statistically significant correlation. Early surgery yielded lower ODI scores with patients faring significantly worse if symptoms persisted for a year or longer (one-way ANOVA, p < 0.001). ODI scores increased sharply even among those operated later than 1 week after symptom onset. Sequestered herniations were associated with significantly lower ODI scores than contained discs on MRI (21.96 vs. 39.89). Surgical complications occurred in 17 cases (5.6%), 82 patients (26.7%) required additional surgery, 58 (18.9%) of those for recurrent disc herniations.Conclusion
Our findings suggest better outcomes with early surgical treatments. Time limits for conservative treatments should be set to avoid the chronification of pain and the worse overall outcomes that go along with belated surgery. Particularly in those with acute onset of pain, sequestered herniations and only mild degrees of immobilization good outcomes are common and surgical treatment appears best if indicated early.5.
Annemieke J. H. Verwoerd Jan Mens Abdelilah el Barzouhi Wilco C. Peul Bart W. Koes Arianne P. Verhagen 《European spine journal》2016,25(5):1389-1392
Purpose
To test whether the localization of worsening of pain during coughing, sneezing and straining matters in the assessment of lumbosacral nerve root compression or disc herniation on MRI.Methods
Recently the diagnostic accuracy of history items to assess disc herniation or nerve root compression on magnetic resonance imaging (MRI) was investigated. A total of 395 adult patients with severe sciatica of 6–12 weeks duration were included in this study. The question regarding the influence of coughing, sneezing and straining on the intensity of pain could be answered on a 4 point scale: no worsening of pain, worsening of back pain, worsening of leg pain, worsening of back and leg pain. Diagnostic odds ratio’s (DORs) were calculated for the various dichotomization options.Results
The DOR changed into significant values when the answer option was more narrowed to worsening of leg pain. The highest DOR was observed for the answer option ‘worsening of leg pain’ with a DOR of 2.28 (95 % CI 1.28–4.04) for the presence of nerve root compression and a DOR of 2.50 (95 % CI 1.27–4.90) for the presence of a herniated disc on MRI.Conclusions
Worsening of leg pain during coughing, sneezing or straining has a significant diagnostic value for the presence of nerve root compression and disc herniation on MRI in patients with sciatica. This study also highlights the importance of the formulation of answer options in history taking.6.
Steffen Folkvardsen Erland Magnussen Jaro Karppinen Juha Auvinen Rasmus Hertzum Larsen Christian Wong Tom Bendix 《European spine journal》2016,25(9):2849-2855
Purpose
The aim was to elucidate elite swimming’s possible influence on lumbar disc degeneration (DD) and low back pain (LBP).Methods
Lumbar spine MRI was performed on a group of elite swimmers and compared to a matched Finnish population-based no-sport group.Results
One hundred elite swimmers and 96 no-sport adults, mean age 18.7/20.8, respectively, participated. Overall, the two groups had similar prevalence of DD. Swimmers had more DD in the upper lumbar spine but tended to have less DD at the lowest level. Prevalence of bulges and disc herniations were similar, but swimmers had significantly more bulges at L4–5. The swimmers reported less LBP, although not significantly (N.S.). If degenerative findings were present, the association between them and LBP was stronger in the no-sport group.Conclusion
Elite swimmers and controls had similar prevalence of DD and LBP, although the pattern of DD differed between the groups. In case of DD, swimmers reported less LBP, although N.S.7.
Keyvan Mostofi Reza Karimi Khouzani 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2016,26(7):805-808
Background
The incidence of cervical disc herniation is estimated about 5.5/100,000, and they lead to surgical intervention in 26 %. Cervical disc herniation causes radiculopathy, which defines by radicular pain and sensory deficit and maybe weakness following the path of the affected nerves. Classically, cervical radiculopathy is expected to follow its specific dermatome—C4, C5, C6, C7 and C8. We investigate patients who present with discrepancy between classical radiculopathy and imaging findings in the daily practice of our profession.Methods
We reviewed the medical records of 102 patients with cervical radiculopathy, caused by cervical disc herniation. All patients had surgery.Results
We found an apparent discrepancy between clinical and radiological findings, patients complained of radiculopathy on one side, and magnetic resonance imaging (MRI) scan or CT scan finding on the other side in ten patients (10.2 %). We did not found any other abnormalities in preoperative and post-operative period. All patients underwent cervical diskectomy via anterior approach. Six weeks after surgery eight patients (80 %) recovered completely, and 3 months after all ten patients (100 %) had been relieved totally.Comparison with existing method
The aim of this paper is review of this medical concept and management of radiculopathy in patients with this discrepancy. As far as we know, the subject has not yet been touched in this light in medical literature.Conclusion
The discrepancy between clinical radiculopathy and disc herniation level on MRI or on CT scan is not rare. Management of this discrepancy requires further investigation to avoid missing diagnosis and treatment failure.8.
Ratko Yurac Juan J. Zamorano Fernando Lira Diego Valiente Vicente Ballesteros Alejandro Urzúa 《European spine journal》2016,25(5):1403-1408
Purpose
A recurrent lumbar disc herniation (RLDH) is the most prevalent cause for new radicular pain after surgery for disc herniation-induced sciatica. Reported risk factors include age, gender and smoking, while its surgical treatment is associated to a higher rate of complications and costs. The purpose of this study is to identify factors that increase the risk of requiring surgical treatment for a first RLDH in workers’ compensation patients.Methods
Nested case–control: 109 patients operated for an RLDH (cases) between June 1st 1994 and May 31st 2011 (minimum follow-up 1 year) and 109 randomly selected patients operated for a first disc herniation with no recurrence during the study period (controls). Age, gender, smoking status, type of work and MRI characteristics of the index herniation were statistically evaluated as potential risk factors.Results
Patient’s age of less than 35 years (p = 0.001) and a subligamentous herniation (p < 0.05) at the time of the index surgery were identified as risk factors for requiring surgical treatment of a first RLDH. No statistical differences were observed between both groups regarding the other evaluated variables.Conclusion
A subligamentous disc herniation and patient’s age inferior to 35 years at the time of the first surgery are risk factors for requiring surgical treatment of a first RLDH among workers’ compensation patients.9.
Purpose
To analyse the clinic-radiological factors associated with neurological deficit following lumbar disc herniation.Methods
A prospective, cross-sectional study was performed in 140 cases of micro-discectomy following lumbar disc herniation. Group 1 included 70 consecutive patients with motor deficit and group 2 (controls) included 70 patients with intact neurology. Motor deficit was defined as the occurrence of motor power ≤3/5 in L2–S1 myotomes. Multiple clinical and radiological parameters were studied between the two groups.Results
Patients with diabetes (p 0.004), acute onset of symptoms (p 0.036), L3–4 discs (p 0.001), sequestrated discs (p 0.004), superiorly migrated discs (p 0.012) and central discs (p 0.004), greater antero-posterior disc dimension (p 0.023), primary canal stenosis (p 0.0001); and greater canal compromise (p 0.002) had a significant correlation with the development of neurological deficit. The presence of four or more of these risk factors showed a higher chance of the presence of motor deficit (sensitivity of 74%, specificity of 77%). Age, sex, previous precipitating events, severity of pain, smoking, and number of herniations levels did not affect the occurrence of deficit (p > 0.05 for all). Patients with or without bladder symptoms were similar with respect to all clinico-radiological parameters. However, the time delay since the occurrence of deficit was significantly shorter in patients with bladder involvement (p 0.001).Conclusion
Patients with diabetes, acute presentation, central, sequestrated and superiorly migrated discs, high lumbar disc prolapse, and greater spinal canal compromise are predisposed to the presence of motor deficit.10.
Background
Cervical and back pains are important clinical problems affecting human populations globally. It is suggested that Propionibacterium acnes (P. acnes) is associated with disc herniation. The aim of this study is to evaluate the distribution of P. acnes infection in the cervical and lumbar disc material obtained from patients with disc herniation.Methods and material
A total of 145 patients with mean age of 45.21 ± 11.24 years who underwent micro-discectomy in cervical and lumbar regions were enrolled into the study. The samples were excited during the operation and then cultured in the anaerobic incubations. The cultured P. acnes were detected by 16S rRNA-based polymerase chain reaction.Results
In this study, 145 patients including 25 cases with cervical and 120 cases with lumbar disc herniation were enrolled to the study. There was no significant difference in the age of male and female patients (p = 0.123). P. acnes infection was detected in nine patients (36%) with cervical disc herniation and 46 patients (38.3%) with lumbar disc herniation and no significant differences were reported in P. acnes presence according to the disc regions (p = 0.508.). Moreover, there was a significant difference in the presence of P. acnes infection according to the level of lumbar disc herniation (p = 0.028).Conclusion
According to the results, the presence of P. acnes is equal in patients with cervical and lumbar disc herniation. There was a significant difference in the distribution of P. acnes infection according to level of lumbar disc herniation.Level of Evidence
II11.
Objective
The goal of this paper was to describe how endoscope-assisted oblique lumbar interbody fusion (OLIF) could remove huge lumbar disc herniation (HLDH) manifested with cauda equina syndrome (CES).Methods
In this study, the authors made an attempt to treat CES with a direct endoscopic decompression through the OLIF corridor and performed OLIF in two patients with HLDH.Results
Two patients with HLDH were successfully treated using OLIF with spinal endoscopic discectomy. We achieved direct ventral decompression by removal of herniated disc fragments located beyond the posterior longitudinal ligament (PLL). All preoperative symptoms in two patients improved postoperatively.Conclusions
Endoscope-assisted oblique lumbar interbody fusion (OLIF) could successfully achieve neural decompression without additional posterior decompression in CES and could be used as an alternative treatment in well selected cases.12.
Background
It is known that sagittal compensating mechanisms are created for counteracting sagittal imbalance problems; however, they can sometimes be associated with incidents which affect the plan of management.Purpose
The purpose of this study was to report a case of the occurrence of common iliac vessel displacement into the intervertebral disc space following one of the spinal compensatory mechanisms.Material and methods
The authors demonstrated this case by showing the patient history, physical examination, imaging studies, and treatment strategy as well as by reviewing some related literature.Results
An 81-year-old woman presented with a long history of low back pain with claudication. An upright plain radiograph and flexion–extension study demonstrated a progressive local thoracolumbar kyphosis and losing of lumbar lordosis with significant widening of the intervertebral disc space of L4–L5. An MRI scan and 3D volume rendering spiral computed tomography (3D-CT) revealed an abnormal content which was depicted as common iliac vessels inside the disc space of L4–L5. Consequently, a rare case of the occurrence of common iliac vessel displacement into the intervertebral disc space following one of the spinal compensatory mechanisms was reported.Conclusion
The occurrence of vascular displacement into the intervertebral disc space related to lumbar hyperextension, as a compensating mechanism, is a rare incident but can occur. Consequently, when this mechanism presents with abnormal widening of the intervertebral disc space, especially at the low lumbar level, it should raise surgeon’s concern about the probability of vascular injury when performing a disc procedure. Thorough investigation with imaging studies and selecting the optimum surgical treatment are warranted.13.
Purpose
The use of transforaminal percutaneous endoscopic discectomy for the treatment of far-lateral lumbar disc herniations has been applied mostly in adults. However, transforaminal percutaneous endoscopic discectomy in children has probably been rarely documented. The aim of this study was to assess the efficacy of transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral lumbar disc herniations in children.Methods
Overall, 12 cases of far-lateral lumbar disc herniations were treated with the procedure of transforaminal percutaneous endoscopic discectomy between January 2010 and December 2014. There were seven male and five female children included, with an average age of 12.6 years (11–16 years). Pre-operative and post-operative (6 weeks, 6 months and 12 months) clinical outcome data (back and leg visual analog scale [VAS] and Macnab criteria) were collected along with clinical assessments of motor strength (graded 0–5).Results
All patients were discharged to home on the same day of surgery. The average leg VAS score improved from 8.6?±?1.6 to 2.1?±?0.4 (p?<?0.005). Six patients had excellent outcomes, five had good outcomes, one had fair outcomes, and none had poor outcomes, according to the Macnab criteria. Eleven of 12 patients had excellent or good outcomes, for an overall success rate of 91.6 %. No patients required re-operation. There were no incidental durotomies, infections, vascular or visceral injuries. There was one complication, a case of leg numbness caused by ganglion injury. The numbness improved after two weeks. After three months, it was obvious that the total area of numbness in the legs had become smaller. At last follow-up, the patient had no pain, and only a few areas with numbness remained and did not affect the patient’s activities of daily living.Conclusions
Transforaminal percutaneous endoscopic discectomy achieved satisfactory results for children with far-lateral lumbar disc herniations.14.
Isaac C. Stein Khoi D. Than Kevin S. Chen Anthony C. Wang Paul Park 《European spine journal》2015,24(4):555-559
Purpose
Expandable cages are a more recent option for maintaining or restoring disc height and segmental lordosis with transforaminal lumbar interbody fusion (TLIF). Complications associated with expandable cages have not yet been widely reported. We report a case of postoperative failure of a polyether-ether-ketone (PEEK) expandable interbody device used during TLIF.Methods
A 50-year-old man presented with severe back and right leg pain after undergoing L4-5 and L5-S1 TLIFs with expandable cages and L3-S1 posterior instrumented fusion. Imaging showed retropulsion of a portion of the interbody cage into the spinal canal causing nerve compression. Displacement occurred in a delayed manner. In addition, pseudoarthrosis was present.Results
The patient underwent re-exploration with removal of the retropulsed wafer and redo fusion.Conclusions
Expandable cages are a recent innovation; as such, efficacy and complication data are limited. As with any new device, there exists potential for mechanical failure, as occurred in the case presented.15.
Background
Surgical site infection is a catastrophic complication after spinal surgery, which seriously affects the progress of rehabilitation and clinical outcome. Currently the clinical reports on spinal surgical site infections are mostly confined to the surgical segment itself and there are few reports on adjacent segment infections after spinal surgery.Study design
Case report.Objective
To report a clinical case with adjacent level infection after spinal fusion.Methods
We report the case of a 68-year-old woman who underwent posterior lumbar 4?5 laminectomy, posterolateral fusion and internal fixation. The patient showed signs of surgical site infection, such as surgical site pain, high fever and increase of the inflammatory index 1 week after the operation. Magnetic resonance imaging (MRI) confirmed the diagnosis of adjacent intervertebral disc infection. The patient received early combined, high-dose anti-infection treatment instead of debridement.Results
After the conservative treatment, the infection was controlled and the patient subsequently enjoyed a normal daily life.Conclusion
Adjacent level infections can occur after spinal surgery. Early diagnosis and anti-infection treatment played an important role in the treatment of this kind of complication.16.
Hans-Joachim Wilke Annette Kienle Sebastian Maile Volker Rasche Nikolaus Berger-Roscher 《European spine journal》2016,25(5):1363-1372
Purpose
The cause of disc herniation is not well understood yet. It is assumed that heavy lifting and extreme postures can cause small injuries starting either in the inner anulus or from the outside close to the endplate. Such injuries are accumulated over years until its structure is weakened and finally a single loading event leads to a sudden failure of the last few intact lamellae. This paper describes a novel, custom-developed dynamic 6-DOF disc-loading simulator that allows complex loading to provoke such disc damage and herniations.Methods
The machine’s axes are driven by six independent servomotors providing high loads (10 kN axial compression, 2 kN shear, 100 Nm torque) up to 5 Hz. A positional accuracy test was conducted to validate the machine. Subsequently, initial experiments with lumbar ovine motion segments under complex loading were performed. After testing, the discs were examined in an ultra-high field MRI (11.7 T). A three-dimensional reconstruction was performed to visualise the internal disc lesions.Results
Validation tests demonstrated positioning with an accuracy of ≤0.08°/≤0.026 mm at 0.5 Hz and ≤0.27°/≤0.048 mm at 3.0 Hz with amplitudes of ±17°/±2 mm. Typical failure patterns and herniations could be provoked with complex asymmetrical loading protocols. Loading with axial compression, flexion, lateral bending and torsion lead in 8 specimens to 4 herniated discs, two protrusions and two delaminations. All disc failures occurred in the posterior region of the disc.Conclusion
This new dynamic disc-loading simulator has proven to be able to apply complex motion combinations and allows to create artificial lesions in the disc with complex loading protocols. The aim of further tests is to better understand the mechanisms by which disc failure occurs at the microstructural level under different loading conditions. Visualisation with ultra-high field MRI at different time points is a promising method to investigate the gradual development of such lesions, which may finally lead to disc failure. These kinds of experiments will help to better investigate the mechanical failure of discs to provide new insights into the initiation of intervertebral disc herniation. This device will also serve for many other applications in spine biomechanics research.17.
Seung-Kook Kim Su-Chan Lee Seung-Woo Park Eun-Sang Kim 《Journal of orthopaedic surgery and research》2017,12(1):187
Background
Trans-sacral epiduroscopic lumbar decompression (SELD) is an emerging procedure for the treatment of lumbar disc herniation (LDH), with favorable outcomes having been reported. However, the complications associated with SELD have not been comprehensively evaluated to date. Therefore, the aim of our study was to describe the incidence rate, types, and characteristics of complications following SELD and management outcomes.Methods
Retrospective analysis of the surgical and clinical outcomes for 127 patients (average age, 42.2?±?15.2 years) who underwent SELD for LDH at L2-3, L3-4, L4-5, and/or L5-S1, performed by a single experienced spine surgeon at a single center, between January 2015 and April 2017, was conducted.Results
All procedures were successful, with a mean follow-up of 12.3?±?2.3 months. Complications were identified in 8 patients (6.3%), including 3 cases of incomplete decompression (2.4%), 2 cases of recurrent disc herniation (1.6%), and one case each of hematoma, dural tearing, and subchondral osteonecrosis (0.8%). Among these cases with complications, only 2 cases with incomplete decompression and one case with recurrent LDH did not improve with conservative treatment and required re-operation using an open approach. The rate of complications decreased from 12.6% when considering only the first 50 cases to 2.6% for cases 51–127.Conclusions
Incomplete decompression, recurrent herniation, epidural hematoma, dural tear, and subchondral osteonecrosis were identified as complications of SELD, although the overall rate of complications was low. Practice with the procedure and careful patient selection can lower the risk of complications.18.
Matthew Fernandez Manuela L. Ferreira Kathryn M. Refshauge Jan Hartvigsen Isabela R. C. Silva Chris G. Maher Bart W. Koes Paulo H. Ferreira 《European spine journal》2016,25(11):3495-3512
Purpose
Previous reviews have compared surgical to non-surgical management of sciatica, but have overlooked the specific comparison between surgery and physical activity-based interventions.Methods
Systematic review using MEDLINE, CINAHL, Embase and PEDro databases was conducted. Randomised controlled trials comparing surgery to physical activity, where patients were experiencing the three most common causes of sciatica—disc herniation, spondylolisthesis and spinal stenosis. Two independent reviewers extracted pain and disability data (converted to a common 0–100 scale) and assessed methodological quality using the PEDro scale. The size of the effects was estimated for each outcome at three different time points, with a random effects model adopted and the GRADE approach used in summary conclusions.Results
Twelve trials were included. In the short term, surgery provided better outcomes than physical activity for disc herniation: disability [WMD ?9.00 (95 % CI ?13.73, ?4.27)], leg pain [WMD ?16.01 (95 % CI ?23.00, ?9.02)] and back pain [WMD ?12.44 (95 % CI ?17.76, ?7.09)]; for spondylolisthesis: disability [WMD ?14.60 (95 % CI ?17.12, ?12.08)], leg pain [WMD ?35.00 (95 % CI ?39.66, ?30.34)] and back pain [WMD ?20.00 (95 % CI ?24.66, ?15.34)] and spinal stenosis: disability [WMD ?11.39 (95 % CI ?17.31, ?5.46)], leg pain [WMD, ?27.17 (95 % CI ?35.87, ?18.46)] and back pain [WMD ?20.80 (95 % CI ?25.15, ?16.44)]. Long-term and greater than 2-year post-randomisation results favoured surgery for spondylolisthesis and stenosis, although the size of the effects reduced with time. For disc herniation, no significant effect was shown for leg and back pain comparing surgery to physical activity.Conclusion
There are indications that surgery is superior to physical activity-based interventions in reducing pain and disability for disc herniation at short-term follow-up only; but high-quality evidence in this field is lacking (GRADE). For spondylolisthesis and spinal stenosis, surgery is superior to physical activity up to greater than 2 years follow-up. Results should guide clinicians and patients when facing the difficult decision of having surgery or engaging in active care interventions. PROSPERO registration number : CRD42013005746.19.
Introduction
Cervical artificial discs (CADs) represent an established surgical option in selected patients with cervical spinal disc degeneration. Though CADs have been available for many years, there is a lack of information concerning long-term safety, durability and implant-related failure rates.Materials and methods
The authors describe the failure of a M6-C CAD (Spinal Kinetics, Sunnyvale, CA, USA).Results
Eight years after implantation of a CAD of the M6 type, a 39-year-old female presented with new clinical signs of cervical myelopathy. Radiologically, medullar compression due to posterior core herniation was the suspected cause. The damaged CAD was removed and the segment fused. During revision surgery, rupture of the posterior structures could be detected. Possible mechanisms leading to implant failure are discussed.Conclusion
As there is no standard regarding clinical and radiological follow-up for patients with CADs, radiological long-term follow-up investigations seem to be justified for exclusion of implant failure.20.
Javad?Aghazadeh Firooz?Salehpour Ehsan?Ziaeii Naghme?Javanshir Afshin?Samadi Javid?sadeghi Farhad?Mirzaei