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 Siemionow1, Piotr Janusz1, 2, Frank M. Phillips3, Jim A. Youssef4, Robert Isaacs5, Marcin Tyrakowski1, 6, Bruce McCormack7
  • 1Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois, United States
  • 2Spine Disorders and Pediatric Orthopedics Department, University of Medical Sciences, Poznan, Poland
  • 3Rush University Medical Center, Minimally Invasive Spine Institute, Chicago, Illinois, United States
  • 4Orthopaedic Surgery, Spine Colorado, Durango, Colorado, United States
  • 5Department of Neurosurgery, Duke University, Durham, North Carolina, United States
  • 6Department of Orthopaedics, Pediatric Orthopaedics and Traumatology, The Centre of Postgraduate Medical Education, Warsaw, Poland
  • 7Department of Neurosurgery, University of California San Francisco Medical Center, San Francisco, California, United States
Further Information

Publication History

09 June 2015

24 March 2016

Publication Date:
08 June 2016 (eFirst)

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.