Peri-operative and two year outcomes comparing anterior cervical discectomy and fusion with plating to anterior cervical discectomy and fusion without plating

Peri-operative and two year outcomes comparing anterior cervical discectomy and fusion with plating to anterior cervical discectomy and fusion without plating

BASS 2017 abstracts / The Spine Journal 17 (2017) S3–S22 STUDY DESIGN/SETTING: Observational study in patients with massive Lumbar Disc prolapses trea...

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BASS 2017 abstracts / The Spine Journal 17 (2017) S3–S22 STUDY DESIGN/SETTING: Observational study in patients with massive Lumbar Disc prolapses treated conservatively in our Institute over a period of 2011–2016. PATIENT SAMPLE: Patients with massive lumbar disc prolapses treated conservatively over the period 2011–2016. OUTCOME MEASURES: Patients were reviewed subsequently in outpatient clinics looking at symptoms. METHODS: Clinical outcomes of 16 patients with massive lumbar disc herniation and radiculopathy reated conservatively over a period from 2011– 2016 with average follow up period of 20 months. RESULTS: Out of 16 patients, 11 were discharged following subsequent follow ups a s symptoms were resolved, 3 had trans foraminal epidural injection, 2 of them improved following the injection and discharged and 1 had persistent radiculopathy and is awaiting surgery. One patient underwent emergency discectomy following further recurrence of disc prolapse and had symptoms of impending cauda equine syndrome. CONCLUSIONS: This is the second study from our institution looking at outcome following the conservative management of massive lumbar disc prolapses which reiterates that massive lumbar disc prolapses can be treated conservatively. CONFLICTS OF INTEREST: None. FUNDING SOURCES: None. http://dx.doi.org/10.1016/j.spinee.2016.12.039

Cervical Spine 32. A five-year retrospective analysis of the management of elderly patients with an upper cervical spine fracture Madeline Leadon, Charles Nye, Rodney Laing, Andrew Savill; University of Cambridge School of Clinical Medicine, Box 111 Cambridge Biomedical Campus, Cambridge CB2 0SP, UK BACKGROUND CONTEXT: C2 fractures are common in elderly patients with an incidence approximately 2 per 10,000 yearly. PURPOSE: A five-year retrospective analysis of patients aged over 65 with an upper cervical fracture managed at a major trauma centre/regional neurosurgical unit was undertaken. PATIENT SAMPLE: A total of 310 patients (average age 82.5) were included. 71.0% had C2 fractures following a fall. 137 patients (44.2%) were managed with soft collars, 119 (38.4%) in hard collars, 6 with a HALO device, 2 surgically, 12 received no treatment. OUTCOME MEASURES: The type and mechanism of injury, initial management, time to follow up and mortality were recorded. Outcomes at outpatient appointment were documented where possible, including neck pain, mobility and neurological symptoms. METHODS: Patients were identified from our comprehensive database. RESULTS: Overall 3-month and 12-month mortality rate was 21.0% and 35.1% respectively. There was no significant difference in 12-month mortality between those managed with hard or soft collars. Two patients required surgery after failed conservative management. Mortality in our patient cohort is 21.5% at 3 months and 35.8% at 1 year. This compares with mortality of 16.4% at 3 months and 21.6% at 1 year in our meta-analysis of published case series of upper cervical spine fractures managed surgically. CONCLUSIONS: Whilst these patient series are not strictly comparable we would argue that the mortality rates are independent of the initial management of the fracture; in contradistinction to hip fractures there is no evidence for early surgical intervention. CONFLICTS OF INTEREST: None. FUNDING SOURCES: None. http://dx.doi.org/10.1016/j.spinee.2016.12.040

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33. Peri-operative and two year outcomes comparing anterior cervical discectomy and fusion with plating to anterior cervical discectomy and fusion without plating Shaoen David Sim, Joshi George, Shrijit Panikkar, Irfan Siddique; School Of Medicine, University of Manchester, Stopford Building, Oxford Rd, Manchester M13 9PT BACKGROUND CONTEXT: Anterior cervical discectomy and fusion (ACDF) is commonly used to treat degenerative cervical spine disease. The role of an anterior plate to provide stabilization and fixation of the segment is not clear in single-level disease. PURPOSE: This study aims to elucidate any potential advantage of one approach over the other with regards to peri-operative and two-year outcomes. STUDY DESIGN/SETTING: A retrospective, 2-year follow-up of patients with cervical radiculopathy or myelopathy treated with single-level ACDF with and without plating. PATIENT SAMPLE: In total, 132 patients were studied. 66 patients who underwent ACDF with plating and 66 consecutive patients who underwent ACDF without plating from August 2008 to June 2014 were included. Exclusion criteria included trauma, infection, previous surgery and multilevel surgery. OUTCOME MEASURES: Functional measures: operating time, dysphagia, dysphonia, length of hospital stay, pain referral, re-operative rates. METHODS: Independent t-test, Mann-Whitney’s U test and Fisher’s exact test were used to compare outcome measure between the two groups. RESULTS: ACDF with plating had longer operating times (47 minutes, p<.05) and increased incidence of short-term dysphagia (p<.05). No statistical difference in length of hospital stay, long-term dysphagia rates, long-term dysphonia rates, pain referral rates and re-operative rates. CONCLUSIONS: Stand-alone cages without an anterior plate have similar peri-operative and two-year outcomes to ACDFs with anterior plating. This study suggests that the additional cost of the implant and longer operating time may not justify the routine use of plating for uncomplicated degenerative cervical spine disease. A prospective study is required to confirm our findings. CONFLICTS OF INTEREST: None. FUNDING SOURCES: None. http://dx.doi.org/10.1016/j.spinee.2016.12.041

34. Is dysphagia after ACDF due to recurrent laryngeal nerve (RLN) neuropraxia? A fresh cadaveric study Ali Rajabian, Nasir A. Quraishi; The Centre for Spinal Studies and Surgery, Queen’s Medical Centre, Nottingham NG7 2UH BACKGROUND CONTEXT: Our aim was to explore the possible anatomic correlation of RLN with post ACDF dysphagia. PURPOSE: We believe the hypotheses proposed thus far in the current literature although may have some plausible explanation, however they have not adequately addressed direct etiologic mechanism for this most frequently reported post-op complication of Anterior Cervical Spine procedures (ACDF). STUDY DESIGN/SETTING: Fresh Cadaveric study. PATIENT SAMPLE: Fresh Cadaver. OUTCOME MEASURES: High quality photographs of Cadaveric study. METHODS: 14 Fresh cadavers had extensive layer by layer high magnification dissection performed by 2 surgeons (one of whom has extensive experience as an anatomy demonstrator and dissector). Extra-laryngeal branches of RLN were explored in relation to Oesophagus. Photographs were taken at each stage of the exposure. RESULTS: We observed extensive network of fine extra-laryngeal branches of RLN supplying the upper 1/3 of Oesophagus bilaterally, moreover we noted potential for stretch neuropraxia of these branches during anterior approaches to cervical spine.

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