Our Summary

This research paper is about a medical condition called “subsidence” that can occur after a type of spine surgery called anterior cervical discectomy and fusion (ACDF). Subsidence is when the vertebrae (the bones in your spine) move or sink after surgery, which can be very painful and debilitating.

In the study, the researchers looked at seven different types of devices that are used in the surgery to see which ones caused the least amount of subsidence. These devices are things like cages or plates that are put into your spine to help it heal properly.

The researchers found that using a cage with a plate (CP) or an iliac bone graft with a plate (IP) resulted in the least amount of subsidence. These were both better than using a cage alone, an iliac crest autogenous graft (ICAG), or a titanium cage alone (TCA).

They also found that there was a higher rate of subsidence in patients who had surgery on only one level of their spine, compared to those who had surgery on multiple levels. However, all the devices could be used for either single-level or multi-level surgery, with similar rates of subsidence.

In simple terms, the study suggests that using a cage with a plate or a bone graft with a plate seems to be the best way to prevent subsidence after spine surgery. However, more research is needed to confirm these findings.

FAQs

  1. What is subsidence in the context of spine surgery?
  2. Which devices used in anterior cervical discectomy and fusion (ACDF) surgery cause the least amount of subsidence?
  3. Did the study find any differences in subsidence rates between single-level and multi-level spine surgeries?

Doctor’s Tip

A doctor might tell a patient undergoing discectomy surgery to discuss with them the use of a cage with a plate or a bone graft with a plate to help prevent subsidence after surgery. It’s important to follow post-operative instructions carefully and attend all follow-up appointments to monitor healing and address any concerns. Regular physical therapy and strengthening exercises may also be recommended to support the spine and prevent complications.

Suitable For

Patients who are recommended for discectomy typically have a herniated disc in their spine that is causing pain, numbness, or weakness in the back, neck, arms, or legs. These symptoms may be caused by pressure on the spinal cord or nerves due to the herniated disc, which can be confirmed through imaging studies such as MRI or CT scans.

Other factors that may lead to a recommendation for discectomy include:

  • Failure of conservative treatments such as physical therapy, medications, or injections to relieve symptoms
  • Progressive neurological deficits such as weakness, numbness, or difficulty walking
  • Severe pain that is not responding to medication or other treatments
  • Loss of bowel or bladder control, which may indicate a more severe compression of the spinal cord
  • Significant loss of function or quality of life due to the symptoms caused by the herniated disc

It is important for patients to discuss their symptoms and treatment options with their healthcare provider to determine if discectomy is the right course of action for their specific condition. Additionally, patients should be aware of the potential risks and benefits of the surgery, as well as the recovery process and expected outcomes.

Timeline

Before discectomy, a patient may experience symptoms such as back or neck pain, weakness or numbness in the arms or legs, and difficulty walking or performing daily activities. They may undergo diagnostic tests such as MRI or CT scans to determine the extent of the disc herniation or compression on the nerves.

After discectomy, the patient will typically have a period of recovery and rehabilitation. This may involve physical therapy, pain management, and restrictions on certain activities to allow the spine to heal properly. The patient may experience some pain and discomfort in the immediate post-operative period, but this should improve over time.

In the case of subsidence following anterior cervical discectomy and fusion, the patient may experience worsening neck pain, difficulty swallowing or speaking, and weakness or numbness in the arms. They may need additional imaging studies such as X-rays or CT scans to confirm the diagnosis of subsidence.

Treatment for subsidence may involve further surgery to correct the issue, such as removing the device causing the subsidence and stabilizing the spine with a different type of implant. Physical therapy and pain management may also be necessary to help the patient recover and regain function.

Overall, the timeline of a patient’s experience before and after discectomy involves initial symptoms, diagnostic testing, surgery, recovery, and potential complications such as subsidence that may require further treatment. Collaboration with healthcare providers and adherence to post-operative instructions are crucial for a successful outcome.

What to Ask Your Doctor

Here are some questions a patient should ask their doctor about discectomy:

  1. What type of device will be used in my discectomy surgery?
  2. What are the potential risks and complications of subsidence after surgery?
  3. How common is subsidence after discectomy surgery?
  4. Are there any specific factors that may increase my risk of subsidence?
  5. How will subsidence be monitored and treated if it occurs?
  6. What is the expected recovery time after discectomy surgery?
  7. Are there any lifestyle changes or precautions I should take to prevent subsidence?
  8. Will physical therapy be necessary after surgery to help prevent subsidence?
  9. Are there any alternative treatments or devices that could reduce the risk of subsidence?
  10. How can I best prepare for surgery and optimize my chances of a successful outcome?

Reference

Authors: Xu J, He Y, Li Y, Lv GH, Dai YL, Jiang B, Zheng Z, Wang B. Journal: World Neurosurg. 2020 Sep;141:479-489.e4. doi: 10.1016/j.wneu.2020.03.130. Epub 2020 Apr 3. PMID: 32251812