Intervertebral-spreader-assisted anterior cervical discectomy and fusion prevents postoperative axial pain by alleviating facet joint pressure

Journal of Orthopaedic Surgery and Research

Chen Xu¹  Ruizhe Wang¹  Baifeng Sun¹  Huajiang Chen¹  Xiaolong Shen¹  Yang Liu¹  Cheng Cui¹  Ye Tian¹  Huajian Zhong¹  Zifang Zhang¹  Wen Yuan¹  Jingchi Li² 

[1] Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th Fengyang Road, 200003, Shanghai, People’s Republic of China;Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th Fengyang Road, 200003, Shanghai, People’s Republic of China;Department of Orthopedics, Hospital (T.C.M) Affiliated to Southwest Medical University, 182th Chunhui Road, 646000, Luzhou, Sichuan Province, People’s Republic of China;

关键词: Vertebral spreader;    Degenerative cervical spondylosis;    Facet joint;    Axial pain;   

DOI  :  10.1186/s13018-022-02983-z

来源: Springer

【 摘 要 】

ObjectiveTo evaluate the relationship of postoperative cervical axial pain with different vertebral distraction methods used during ACDF procedures in cervical spondylosis patients.MethodsNinety-four single-level cervical spondylotic myelopathy patients with significantly loss of intervertebral disc height who underwent ACDF surgery in our institute between January 2018 and January 2020 were enrolled. Cervical spine lateral radiographs were taken preoperatively, 3 days, 1-month, 2-month and 6-month after the surgery. The intervertebral disc height (IDH), interfacet distance (IFD), JOA (Japanese Orthopaedic Association) score, NDI (Neck Disability Index) score, nVAS (Neck Visual Analogue Scale) score and aVAS (Arm Visual Analogue Scale) score were measured. The correlation of clinical parameters and intervertebral disc height was evaluated. Then the correlation of clinical outcomes and different distraction method was evaluated. The patients were randomly divided into two groups, one uses Casper pin distractor system alone for distraction (Caspar alone group) and the other uses spreader assisted distraction method (Casper + spreader group). In biomechanical study, four cervical spine cadavers were selected for facet pressure measurements under different vertebral distraction methods, and the facet joint pressure was measured using force sensors.ResultsSatisfactory cervical fusion and neurological recovery were achieved in all patients. No significant correlation of IDH, IFD, JOA, NDI or aVAS with nVAS score was found. No significant difference between the change in disc height and clinical outcomes was found. However, by comparing the clinical parameters of patients in different vertebral distraction groups, we found significant changes in the early nVAS and NDI scores (P = 0.11, P = 0.48) of the Casper + spreader group (3 days postoperation), and was associated with a better nVAS score at 2 months postoperation (P < 0.05). The biomechanical study in cervical cadavers also showed significantly and continuously decreased facet joint pressure in the spreader assisted vertebral distraction group (P < 0.01).ConclusionsSpreader-assisted vertebral distraction method effectively alleviates postoperative neck pain in degenerative cervical spondylosis patients treated with ACDF. The mechanism may be related to the transient relief of facet joint pressure during the vertebral distraction procedure in ACDF.

【 授权许可】

CC BY