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Nursing review section of surgical neurology international: Evaluation of cervical disc disease and when surgery is warranted.

ABSTRACT: Patients with cervical disc disease may present with radiculopathy (root compression), myelopathy (cord compression), or myeloradiculopathy. These complaints must be correlated with x-ray, magnetic resonance (MR) imaging, and computed tomographic (CT) scans. Although most patients can be managed nonsurgically, those with significant neurological deficits and larger disc herniations may require surgery.The symptoms of cervical radiculopathy include pain radiating down one or both arms, while myelopathy may result in more diffuse numbness tingling or weakness in the upper and/or lower extremities. The neurological signs for cervical discs include; focal or diffuse loss of motor strength changes in reflexes (hyporeflexic, normal reflexes, or hyperreflexia), a loss of sensation (e.g., to pin, vibration, touch, and position), and cerebellar dysfunction (e.g., loss of coordination). Patients' symptoms and signs must correlate with focal nerve root and/or spinal cord compression seen on MR and/or CT studies.MR examinations best document soft disc herniations, while CT scans most readily demonstrate calcification/ossification of cervical discs and accompanying arthritic changes. Bulging/protruding can typically be managed nonsurgically. Alternatively, significantly extruded or sequestrated discs, resulting in moderate/marked spinal cord and/or nerve root compression may warrant surgery. Most operations from front of the neck for cervical discs are called anterior cervical discectomy/fusion (ACDF), while those performed from the back of the neck are called laminoforaminotomies.Patients with cervical radiculopathy (root compression) and/or myelopathy (cord compression) with disc herniations on MR/CT studies may or may not require surgery.

SUBMITTER: Epstein NE

PROVIDER: S-EPMC5523477 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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Project description:IntroductionTo date, there is no consensus on which anterior surgical technique is more cost-effective in treating cervical degenerative disc disease (CDDD). The most commonly used surgical treatment for patients with single- or multi-level symptomatic CDDD is anterior cervical discectomy with fusion (ACDF). However, new complaints of radiculopathy and/or myelopathy commonly develop at adjacent levels, also known as clinical adjacent segment pathology (CASP). The extent to which kinematics, surgery-induced fusion, natural history, and progression of disease play a role in the development of CASP remains unclear. Anterior cervical discectomy with arthroplasty (ACDA) is another treatment option that is thought to reduce the incidence of CASP by preserving motion in the operated segment. While ACDA is often discouraged, as the implant costs are higher while the clinical outcomes are similar to ACDF, preventing CASP might be a reason for ACDA to be a more cost-effective technique in the long term.Methods and analysisIn this randomized controlled trial, patients will be randomized to receive ACDF or ACDA in a 1:1 ratio. Adult patients with single- or multi-level CDDD and symptoms of radiculopathy and/or myelopathy will be included. The primary outcome is cost-effectiveness and cost-utility of both techniques from a healthcare and societal perspective. Secondary objectives are the differences in clinical and radiological outcomes between the two techniques, as well as the qualitative process surrounding anterior decompression surgery. All outcomes will be measured at baseline and every 6 months until 4 years post-surgery.DiscussionHigh-quality evidence regarding the cost-effectiveness of both ACDA and ACDF is lacking; to date, there are no prospective trials from a societal perspective. Considering the aging of the population and the rising healthcare costs, there is an urgent need for a solid clinical cost-effectiveness trial addressing this question.Trial registrationClinicalTrials.gov NCT04623593. Registered on 29 September 2020.

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Nursing review section of surgical neurology international: Evaluation of cervical disc disease and when surgery is warranted.

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