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. 2024 Jan 5;19(1):37.
doi: 10.1186/s13018-023-04515-9.

Comparison of clinical outcomes between sequestered cervical disk herniation and non-sequestered cervical disk herniation after anterior cervical decompression and fusion: a cohort study

Lanbo Jin #  1 , Ke Sun #  1 , Gang Liu #  1 , Wen Yuan  1 , Huajiang Chen  1 , Ye Tian  2
Affiliations

Comparison of clinical outcomes between sequestered cervical disk herniation and non-sequestered cervical disk herniation after anterior cervical decompression and fusion: a cohort study

Lanbo Jin et al. J Orthop Surg Res. .

Abstract

Background: The advantages of anterior cervical decompression and fusion (ACDF) were well published, while research on postoperative results in different subtypes of cervical disk herniation (CDH) still remains blank. This study aimed to explore the surgical outcome between sequestration and other types in CDH.

Methods: This retrospective cohort study enrolled 108 patients treated with ACDF in our hospital. The participants were divided into two groups according to the existence of a sequestered disk. The Visual analog scale score, the Japanese Orthopedics Association (JOA) score and the Neck disability index score were used to evaluate postoperative outcome.

Results: Significant improvements were observed in both groups at every viewpoint (P < 0.001). The mean JOA was 15.04 ± 1.26 in the sequestered disk group and 14.45 ± 1.43 in the non-sequestered disk group two months after the operation (P = 0.026 < 0.05). The improvement in JOA at two months after ACDF showed a significant difference: 46.58% ± 39.17% in the sequestered disk group and 33.39% ± 28.82% in the non-sequestered disk group (P = 0.047 < 0.05). Thirty-two patients in the sequestered disk group (64%) and 19 patients in the non-sequestered disk group (32.76%) presented with high signal intensity of the spinal cord on preoperative cervical T2-weighted MRI (P < 0.001).

Conclusions: Patients with sequestered cervical disks seemed to have a higher degree of symptom improvement two months after ACDF. CDH with a sequestered disk appears to be more likely to cause high signal intensity changes in the compressed cervical spine on T2-weighted MRI. We prefer early positive surgery in patients with sequestered cervical disks from the clinical point of view.

Keywords: Anterior cervical decompression and fusion; Cervical spine; Cord signal change; Outcomes; Sequestered disk.

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Conflict of interest statement

All authors have read and approved the content, certify that this manuscript is a unique submission and is not being considered for publication, in part or in full, with any other source in any medium. There are no ethical/legal conflicts involved in the article.

Figures

Fig. 1
Fig. 1
Flow diagram of the study. CDH cervical disk herniation, ACDF anterior cervical decompression and fusion, MRI magnetic resonance imaging
Fig. 2
Fig. 2
Sequestered disk in surgery. A 58-year-old woman complained of right-hand numbness adopted ACDF in our hospital. A sequestered disk was found in the anterior epidural space during the operation (a). The preoperative MRIs also showed an obvious cervical disk herniation at the C5-C6 level. ACDF anterior cervical decompression and fusion, MRI magnetic resonance imaging
Fig. 3
Fig. 3
A classic case in the non-sequestered disk group. The preoperative MRIs showed cervical disk herniation at the C4-C6 level, the plain radiograph was taken two months after surgery. MRI: magnetic resonance imaging
Fig. 4
Fig. 4
A classic case in the sequestered disk group. The preoperative MRIs showed a sequestered disk at the C5-C6 level, the plain radiograph was taken two months after surgery. MRI: magnetic resonance imaging
Fig. 5
Fig. 5
The changes in clinical outcomes. a JOA, b NDI, c VAS, d Improvement of JOA (%), e Improvement of NDI, f Improvement of VAS. JOA Japanese Orthopedics Association, NDI the Neck disability index, VAS the Visual analog scale. Improvement of JOA(%): (Vn − V1)/(17 − V1) × 100%; Improvement of NDI: V1 − Vn; Improvement of VAS: V1 − Vn
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