Developing an Individual Neurosurgical Strategy in Patients With a Two-Level Cervical Degenerative Disc Disease

Разработка персонифицированной нейрохирургической тактики при лечении пациентов с двухуровневым дегенеративным заболеванием шейных межпозвонковых дисков
Byvaltsev V.A. Kalinin A.A. Aliev M.A. Aglakov B.M. Shepelev V.V. Kukharev A.V. Azhibekov N.O. Satardinova E.E. Komogortsev I.E.
2023 Scientific Research Institute — Ochapovsky Clinical Regional Hospital no. 1

Innovative Medicine of Kuban
2023 Issue 1 29 - 37 pp.

Background: Little is written about substantiated clinical and biometric indications for dynamic stabilization, rigid fixation, and their combinations in patients with two-level degenerative disease of the cervical intervertebral discs (IVD). Objective: To study the risk factors for poor outcomes of two-segment interventions (total disk arthroplasty, TDA; anterior cervical discectomy and fusion, ACDF; and their combination) in patients with two-level degenerative diseases of the cervical IVD; to develop a custom clinical and instrumental assessment strategy for future interventions. Materials and methods: We retrospectively analyzed the outcomes in 118 patients with a two-level degenerative disease of the cervical IVD, who underwent TDA (n = 37), ACDF (n = 41), and their combination (n = 40) from 2005 to 2015. After this analysis, we built a mixed effects logistic regression model to identify and assess the impact of various risk factors on poor clinical outcomes in each intervention. Results: TDA correlated with favorable outcomes in patients with cervical lordosis over 12 °; I–III grade IVD changes according to Pfirrmann scale; I–II grade facet joints (FJ) changes according to Pathria criteria; no FJ tropism; segmental movements amplitude > 8 °; interbody space height ≤ 6 mm, and with no central spinal stenosis/spine interventions. Favorable ACDF outcomes may be achieved in patients with cervical lordosis ≥ 7 °; more than III grade IVD changes according to Pfirrmann scale; more than II grade changes in FJ according to Pathria criteria; segmental movements amplitude ≤ 8 °; interbody space height < 6 mm. FJ tropism, central spinal stenosis, and history of spine interventions do not affect ACDF outcomes. Conclusions: An individual approach to TDA, ACDF, and their combination as well as comprehensive preoperative clinical and instrumental assessment in patients with a two-level degenerative IVD disease contribute to the effective resolution of existing neurological symptoms, which reduced the pain severity in the cervical region and upper limbs, improve the patients’ functional status and quality of life in the late postoperative period, and reduce the number of postoperative complications and reinterventions.

anterior cervical discectomy and fusion , cervical spine , individual strategy , risk factors , total disk arthroplasty , two-level cervical degenerative disc disease

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Irkutsk State Medical University, Irkutsk, Russian Federation
Clinical Hospital “Russian Railways – Medicine”, Irkutsk, Russian Federation
Irkutsk State Medical Academy of Continuing Education, Irkutsk, Russian Federation
Marat Ospanov west Kazakhstan Medical University, Aktobe, Kazakhstan

Irkutsk State Medical University
Clinical Hospital “Russian Railways – Medicine”
Irkutsk State Medical Academy of Continuing Education
Marat Ospanov west Kazakhstan Medical University

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