Long-term clinical outcome after anterior cervical discectomy with polymethylmethacrylate (PMMA) as intervertebral spacer:A propensity score matched analysis

Background: For single-level cervical degenerative disorders, an anterior cervical discectomy (ACD) is often performed with interposition of an intervertebral spacer. Most surgeons prefer a cage or arthroplasty, although superiority in comparison with other types of spacers, or leaving out a spacer, still has never been proven. Polymethylmethacrylate (PMMA) is a cost-friendly spacer with reported clinical outcome similar to other spacers. Therefore, the aim of this study was to assess long-term clinical outcome of ACD with PMMA as a spacer compared with ACD with a cage or without a spacer. Methods: A retrospective cohort study among patients with cervical degenerative disorders requiring a single-level ACD was performed in two hospitals in the Netherlands. Subgroups were made for PMMA, cage and no spacer. The primary outcome measure was the Neck Disability Index, secondary outcome measures were complication and reoperation rates, quality of life, workability and the need of additional treatments (e.g. physiotherapy, selective nerve root block, spinal cord stimulation). A 1:1 propensity score matching was performed that adjusted for age, gender, body mass index, comorbidities, duration and type of symptoms, and level of surgery. Results: A total of 241 patients were included in the study, with a median follow-up of 9.4 years. Propensity score matching revealed no statistically significant differences in all clinical outcome parameters between all subgroups. Complications, reoperations and the need for additional treatments were similarly distributed as well. A sensitivity analysis in which multiple PMMA patients were implemented (1: many matching) demonstrated equal results. Conclusions: No differences in long-term clinical outcome were demonstrated between ACD with PMMA compared to ACD with cage, or without any intervertebral spacer. Complication and reoperation rates were equal among the matched cohorts. In conclusion, PMMA is an effective, safe and cost-friendly alternative with equal long-term clinical outcome compared to other surgical techniques for cervical degenerative disorders

Diseases of the spinal cord

The causes of myelopathy are many and various. The damage to the spinal cord may be complete (as in the case of a complete spinal cord injury) but it is more often incomplete (as in the case of an incomplete traumatic spinal cord injury and most types of meylopathy due to non-traumatic causes). There are some classic spinal cord syndromes, but in practice they do not generally display classic sympotmatology. In practice, information from the history-taking combined with examination of the main tract systems enables the height of the damage to be localized and a differential diagnosis to be formulated

Neurological pain syndromes

AbstractPain can be classified into nociceptive (tissue damage) and neuropathic (nerve damage, neurogenic). Radicular syndrome is defined as pain radiating from the neck into the shoulder and/or arm (cervical radicular syndrome, CRS) or from the back into the buttock and/or leg (lumbar radicular syndrome, LRS), accompanied by one or more symptoms or signs that are congruent with damage to a specific cervical or lumbosacral root respectively. Radicular syndrome is usually but not consistently the result of irritation or compression of a nerve root due to a prolapsed or ruptured (herniated) disc or bony compression (= compression caused by bone formation inside or just outside the vertebral canal). Radiating pain can also occur without nerve constriction being present; this is called pseudoradicular syndrome. Cervical and lumbar radicular syndromes share many similarities, but there are also clear differences in both symptomatology and treatment. There is a differential diagnosis in both CRS and LRS. In the case of very severe, especially nocturnal, pain in the shoulder, one should also consider the possibility of neuralgic amyotrophy, and in the case of severe nocturnal pain in the lumbosacral region that of neuroborreliosis. A history of malignancy, of course, points to the possibility of metastatic root compression. If cervical radicular syndrome is suspected, the physical examination is aimed at distinguishing between radicular and pseudoradicular syndrome. The indication for surgery in the case of radicular syndrome caused by a herniated disc is based primarily on clinical and not on MRI findings. Both CRS and LRS are clinical diagnoses, based mainly on the history, with physical examination having only limited value. Watchful waiting pays off, but not for everyone. Cauda equina syndrome (CES) is an indication for emergency surgery