A 55-year-old woman presented with 6 weeks of right upper extremity pain radiating to her right shoulder and arm. She has cervical radiculopathy likely due to foraminal stenosis. Options for treatment include anterior cervical discectomy and fusion (ACDF) or artificial disc replacement (ADR) to relieve pressure on the nerve root and prevent adjacent segment degeneration. Long-term studies show that both procedures provide relief of symptoms, but ADR is associated with less dysphagia and slightly better preservation of motion compared to ACDF.

1. Cervical radiculopathy
treated with ACDF
Spine conference
July 28, 2020

2. 55y woman RUE pain radiation to R
Th/IF; sx 6 weeks

3. Arcurate foramen

5. We observed
that the
vertebral
artery groove
was on an
average 18.2
mm
away from the
midline and
the vertebral
artery in
relationship
with the
groove was
22.1 mm away
from the
midline.

10. Where is the stenosis, ant v post?

11. goalpost

12. 6 weeks

49. ADR prevents ASP
From preserved
ROM

51. Thursday, March 26, 2020 - American Spine Registry Went Live
The shared vision for the ASR is to:
Utilize data to inform AANS and AAOS care guidelines. The data can test both clinical
performance benchmarks and the validity of various quality measures. Both efforts are critical
to a value-based healthcare system.
Provide feedback that allows surgeons to continuously improve their practice and healthcare
outcomes using methods applicable to all practice settings.
Reduce data-reporting burdens on physicians and allow reuse of data for regulatory
requirements and continuous quality-improvement programs.
Help inform gaps in knowledge and define areas for further education and research.

52. • Swespine: founded 1993, cervical included 2006;
owned by Swedish society of spinal surgeons with
public financial support/ 90% affiliated 75% complete
• 2006-2017
• Primary outcome: NDI neck disability index
• WORK ATTITUDE QUERY: “Do you think you will be able
to return to your previous work after surgery?”
• 3998 patients: 204 ADR v 3794 ACDF
• No difference in outcome measures at 5 y
• Less dysphagia in arthroplasty group
• Adverse events: 15% ADR v 5% ACDF (3% reposition of
device)
• Reoperations: 8% ADR v 3% ACDF
• The long term outcome 5 years postop more
dependent on preop mental distress
(anxiety/depression) than chosen surgical method

56. • No institution or company had a role in data
analysis, preparation of the manuscript, or the
decision to submit the manuscript for publication
• Long term FU with MRI postop

57. DISCOVER

58. • 153 patients 2007-2011 3 centers, 83 ADR v 70 ACDF
ICBG
• All patients had 5 y FU (88%) postop MRI
• NDI, EQ5D, VAS, Dysphagia, HADS,
• Both groups halved their preop NDI scores
• Secondary surgery 17/83 ADR v 7/70 ACDF
• Modest decrease in dysphagia for ADR
• ADR: 54% had motion, 25% fused
• NO RASP: 64% ADR v 44% ACDF
• Severe CASP(clinical adjacent segment pathology)
requiring surgery: 5 each group
• Women with ADR had more secondary surgeries due to
loosening
• HO: none 8%, 1:2%, 2:24%, 3:41%, 4/fused: 25%

59. HO Mehren/Suchomel modification of McAfee
grade 0—segments without any new HO
formation after prosthesis implantation (Fig. 1);
Grade I—segments with new HO formation not
reaching the intervertebral space (Fig. 2);
grade II—HO reaches the intervertebral space but
segmental movement is not limited
grade III—important bridging ossifications with
limited, but possible movement
grade IV—segmental fusion

65. thanks

73. Degenerative Disc Disease
Radiculopathy
Stenosis
Spondylolisthesis
Adjacent Segment Degeneration
Instability
Deformity
Herniated Disc
Non-union
Disease Processes

77. Cervical radiculopathy pathology
masquerade
Brachial plexopathy/ Parson Turner’s syndrome:
mass/viral/inflammatory/systemic illness: DOE
C5: rotator cuff/impingement
C6/C7: CTS
C7: PIN
C8: AIN/cubital tunnel
“Double Crush” Upton & McComas Lancet 2:359 1973
Angina
CRPS (RSD)
Thoracic outlet syndrome

78. DDX Myelopathy Cervical
• amyotrophic lateral sclerosis
• myelitis
• multiple sclerosis
• demyelinating conditions
• intracranial pathology
• syringomyelia
• Chiari malformation
• Ossification of the Posterior Longitudinal Ligament
(OPLL)
• Ankylosing spondylitis

91. Weld cubes together

94. History
• Pain: P,P,Q,R,S,T, function
• Weakness
• Numbness
• Ataxia
• Dexterity

95. DISEASE
•Degenerative
• Infectious
• Metabolic
• Traumatic
• Inflammatory
• Metastatic
• Iatrogenic

102. Physical: Neuro exam
• Gait
• Motor
• Sensory
• Reflexes
• Fine motor
• CN exam

112. Degenerative Disc Disease
Radiculopathy
Stenosis
Spondylolisthesis
Adjacent Segment Degeneration
Instability
Deformity
Herniated Disc
Non-union
CERVICAL INDICATIONS