ACD/ACDF vs Cervical Arthroplasty; Controversies in Spine Surgery; Nancy Epstein. MD

SUMMARY: Dr. Epstein reviews the literature and her own 40 year personal experience in evaluating the surgical approaches to neurological injuries in diseases of the cervical spine. She reviews the anatomy of the cervical spine, and discusses, with examples,  the value in CT, CT Myelography, and MR imaging of the Cervical Spine related to the symptoms of the patient. When an anterior approach to the cervical spine is necessary over a posterior approach for more medially placed lesions. Why?  The risks of Epidural injections related to cervical spine anatomy are discussed. What the best graft for disc replacement is a patient's own iliac crest Autograft. The risks of  Cadaver or synthetic implants, complications and inferior bony fusion rates is compared to autografts. She reviews the reported complications of ACDF, which are significant compared with other approaches. Are anterior stabilization plates necessary and which ones to use. For limited resource areas are all these industry promoted implants really necessary?  What are the complications of the industrial devices in Anterior Cervical Spine surgery?  Do they have higher complication rates and costs than the standard ACDF and autograft results?  Cervical arthoplasty is reviewed with its indications, risks, and complications. 70% short term dysphagia; reoperation in over 5%, and adjacent segment disease and implant failure of nearly 4% each and other complications. Osteolysis in over 40% of cases. She reviews the value and use of the K line in determining whether to use the anterior or posterior approaches for bony anterior  spinal canal lesions. The importance of kyphosis in making that determination. What are the complications of doing ACD/ ACDf in the outpatient setting with specific examples. Managing CSF leaks following surgery and the need to act urgently to diagnose new post op deficits to prevent spinal cord injury. What is really necessary to preform safe operations on the cervical spine anteriorly? Are complications really acceptable with all these alternatives?  For low resource or even high resource environments, what provides the best result for the lowest cost?  It is not what you think it is. What is the place of the Spine industry in influencing your decisions?  What is really the standard of care?  What would you want done for you or your family for spine- neurologiccal diseases?  You decide. These are the facts. (JIA)

Speaker
  • James I. Ausman, MD, MA, PhD

    CEO SNI and SNI Digital; Emeritus Professor Neurosurgery

  • Nancy Epstein, MD

    Chief, Neurosurgical Spine and Education, Winthrop Univesrity Hospital Mineola , New York, USA