Our Summary

This study looked at the sinking, or subsidence, of bone grafts after a surgical procedure called an Anterior Cervical Discectomy and Fusion (ACDF), where the damaged disc in the neck is removed and replaced with a bone graft. The researchers reviewed the medical records of patients who underwent this surgery between 2011 and 2019 and used CT scans to measure any subsidence.

They found that half of the grafts sank more than 2 mm, and 10% sank more than 4 mm. The risk of severe subsidence was higher in cases where too much of the original bone was removed during surgery, and when the position of the screw in relation to the vertebra was lower. Severe subsidence was linked to a higher rate of pseudarthrosis, a condition where the bone fails to heal properly. However, it did not lead to more repeat surgeries.

The results suggest that surgeons should take steps to reduce the risk factors for severe subsidence to improve the healing process after surgery.

FAQs

  1. What is Anterior Cervical Discectomy and Fusion (ACDF) surgery?
  2. What factors were found to increase the risk of severe subsidence after ACDF surgery?
  3. Did severe subsidence lead to more repeat surgeries according to the study?

Doctor’s Tip

A doctor might advise their patient undergoing a discectomy to follow post-operative instructions carefully, including avoiding heavy lifting and strenuous activities, to help promote proper healing and reduce the risk of complications such as subsidence. They may also recommend physical therapy to help strengthen the surrounding muscles and support the spine during the recovery process. It is important for patients to communicate any concerns or changes in symptoms to their healthcare provider to ensure the best possible outcome after surgery.

Suitable For

Patients who are typically recommended for discectomy are those who have a herniated or degenerated disc in the spine that is causing symptoms such as severe back or neck pain, weakness, numbness, or tingling in the arms or legs. These symptoms may be due to compression of the spinal nerves or spinal cord.

In the case of Anterior Cervical Discectomy and Fusion (ACDF), patients with cervical disc herniation or degeneration may be recommended for surgery if conservative treatments such as physical therapy, medications, or injections have not provided relief. Patients with symptoms such as neck pain, arm pain, weakness, or numbness due to compression of the nerves in the neck may benefit from ACDF.

It is important for patients to discuss the risks and benefits of surgery with their healthcare provider to determine if discectomy is the best treatment option for their specific condition.

Timeline

Before Discectomy:

  • Patient experiences symptoms of a herniated disc, such as pain, numbness, or weakness in the affected area.
  • Patient undergoes diagnostic tests, such as MRI or CT scan, to confirm the diagnosis.
  • Patient and surgeon discuss the risks and benefits of discectomy surgery.
  • Surgery is scheduled, and pre-operative preparations are made.

After Discectomy:

  • Patient undergoes the discectomy surgery, where the damaged disc is removed.
  • A bone graft is placed in the space where the disc was removed to promote fusion and stability.
  • Patient is monitored in the hospital for a period of time before being discharged.
  • Patient undergoes physical therapy to regain strength and mobility in the affected area.
  • Follow-up appointments with the surgeon are scheduled to monitor healing and address any concerns.
  • Patient may experience some pain and discomfort during the recovery process.
  • CT scans may be used to monitor the bone graft and check for any signs of subsidence.
  • Patient gradually resumes normal activities and should experience improvement in symptoms over time.

What to Ask Your Doctor

  1. What is the probability of subsidence occurring after a discectomy procedure?
  2. What are the factors that may increase the risk of severe subsidence in my case?
  3. How will you ensure that the bone graft is placed correctly to minimize the risk of subsidence?
  4. What steps can I take to promote proper healing and reduce the risk of complications after surgery?
  5. How will you monitor my progress and address any concerns related to subsidence in the post-operative period?
  6. What are the potential long-term effects of subsidence on my overall spinal health?
  7. Are there alternative treatment options that may be less likely to result in subsidence?

Reference

Authors: Pinter ZW, Mikula A, Shirley M, Xiong A, Michalopoulos G, Ghaith AK, Wagner S, Elder BD, Freedman BA, Nassr A, Bydon M, Currier B, Kaye ID, Kepler C, Sebastian AS. Journal: World Neurosurg. 2023 Feb;170:e700-e711. doi: 10.1016/j.wneu.2022.11.109. Epub 2022 Nov 26. PMID: 36574570