Cervical arthroplasty after previous surgery: results of treating 24 discs in 15 patients
Bibliographic record
Abstract
OBJECT: The potential role of cervical arthroplasty in patients who have undergone previous cervical surgery is unknown. The authors performed a prospective study involving nonrandomized clinical and radiological assessment in patients who had undergone either previous posterior cervical foraminotomy or anterior interbody fusion and who suffered new or persistent arm/neck symptoms related to neural compression. METHODS: During a 30-month period, 15 patients who had previously undergone cervical spinal surgery underwent cervical arthroplasty that involved placement of the Bryan disc for neck or arm symptoms related to cervical disc disease. A total of 24 devices were implanted. Six of the 15 patients had undergone a previous posterior foraminotomy, and in nine cases an anterior interbody fusion had been perfomed at some stage prior to surgery. Clinical and radiological evaluations were performed preoperatively and after surgery to assess outcomes. A total of 24 arthroplasties were performed encompassing between one and three levels. There were no major perioperative complications or immediate device-related failures. Two patients were lost to follow up. The follow-up period ranged from 12 to 43 months (mean 24.2 +/- 10.5 months). Good results were obtained in all cases as reflected by an increase in the visual analog scale score of 6.4 in terms of neck/arm pain (p < 0.05). There was no difference in Oswestry Disability Index scores for neck pain (p > 0.05) and no patient required surgery at the same level. In one patient hypermobility developed with internal subluxation of the device, which suggested a compromise adjacent to a two-level fusion at 21 months. The segment was hypermobile preoperatively. The patient has experienced recurrent neck pain but otherwise remains clinically well and has not required revision surgery to date. CONCLUSIONS: Insertion of the Bryan artificial cervical disc in patients who have previously undergone cervical fusion or posterior foraminotomy, in general, appears to be safe. It provided encouraging early clinical results, although patients with preoperative hypermobility should be treated with caution. Issues such as accelerated device-related wear and the use of arthroplasty after aggressive facetectomy resection will need further study; however, in carefully selected patients who have undergone previous surgery cervical arthroplasty may provide an additional tool in the management of cervical disc disease.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".