Presented at the American Association of Neurosurgery 2011 annual meeting by Prof. Dr. Yunus AYDIN: Preservation of segmental motion with anterior contralateral cervical microdiskectomy and interbody fat, a prospective study

1. PRESERVATION OF SEGMENTAL MOTION WITHPRESERVATION OF SEGMENTAL MOTION WITH
ANTERIOR CONTRALATERAL CERVICALANTERIOR CONTRALATERAL CERVICAL
MICRODISKECTOMY AND INTERBODY FAT GRAFT:MICRODISKECTOMY AND INTERBODY FAT GRAFT:
PROSPECTIVE STUDYPROSPECTIVE STUDY
CLINIC OF NEUROSURGERY,CLINIC OF NEUROSURGERY,
ŞİŞLİ ETFAL TEACHING & RESEARCH HOSPITALŞİŞLİ ETFAL TEACHING & RESEARCH HOSPITAL
İSTANBUL, TURKEYİSTANBUL, TURKEY
Yunus AYDIN, MD
Halit ÇAVUŞOĞLU, MD
Cengiz TUNCER, MD
Osman TÜRKMENOĞLU, MD
Ahmet Murat MÜSLÜMAN, MD

2. MATERIAL & METHOD
• with cervical paramedian disc herniation
• who underwent one or two-level anterior contralateral simple
microdiskectomy (without fusion)
• Interbody fat graft raplacement were performed on 91 of 330
patients
• between 1992 and 2009.
The mean follow-up time: 10 years (range 1 to 16 years).

3. at conventional right side
procedures, the left foramina can be
approached easier from the right side!.
• Technique based on opening the
opposite of the brachialgia which
supports the better visualization of the
foraminal area.
SIMPLY THE BEST !
CONTRALATERAL APPROACH

4. SURGICAL TECHNIQUE
• Performed at the contralateral side of the radiculopathy,
• 2 cm. transvers skin incision,
• Only 10 mm. wide mini-size Zenker hand retractor, no spreader,
• The longus colli muscles are not stripped,
• Narrow opening through ALL,
• No bone and cartilage removal,
• The disc material is removed with bayonet microcurettes and
punches down to the PLL,

5. Zenker hand retractors & Bayonet Kambin microcurettes

6. SURGICAL TECHNIQUE
• Lateral parts of annulus fibrosus not
shaved extensively!
• Removal of all posterior & lateral
osteophytes,
• Opening of PLL,
• Transuncal foraminotomy,
• Interbody fat graft replacement is
performed.

8. FOLLOW-UP
• All patients were followed-up regularly at intervals of 1, 3, 6,
12 months, and were followed up annually thereafter.
• Routine radiological investigations, including periodic
dynamic x-ray

9. Clinical outcomes were assessed using the
Neck Disability Index (NDI) and
Short Form-36 (SF-36).
OUTCOME MEASUREMENT

10. In group 1 (without fat graft):
Despite fusion procedures were not performed, spontaneous radiological
fusion signs were obtained in 12% of group 1 patients.
RESULTS

11. In group 2 (with fat graft):
Follow-up radiological studies revealed healing without fusion in group
2 patients.
RESULTS Cont’d.

12. • Despite the kyphosis seen at the treated levels, the overall
alignment between C2 and C7 did not change significantly
in group 1 (without fat graft)
• The kyphosis were not seen at the treated levels in group 2
(with fat graft)
• The ROM increased significantly in group 2 (with fat graft)
(p < 0,05).
RESULTS Cont’d.

13. Neck Disability Index
Scores decreased significantly
in both early and late follow-
up evaluations.
(t = -1.789, p = 0.077)
RESULTS Cont’d.

14. Short Form 36
Physical Function (F = 199, P < .0001),
Physical Role (F= 402,264 P < .0001),
Bodily Pain (F = 242, P < .0001),
General Health (F = 685, P < .0001),
Vitality/Energy (F= 356,266 P < .0001),
Social Function (F= 139, P < .0001),
Emotional Role (F = 135, P < .0001),
Mental Health (F= 125,P < .0001)
Scores demonstrated significant improvement in long-term follow-up
results in the all areas
RESULTS Cont’d.

15. 16 years succesfull history shows that:
Our really minimal invasive technique provides
• better and direct exposure of the pathology,
• preservation of motion segment (NO functional loss),
• going back to work in shorter time with short hospital stay,
• esthetic result,
• lower cost..
CONCLUSION

16. 16 years succesfull history shows that:
Contralateral approach & intervertebral fat graft prevents
• adjacent segment disease,
• serious complications of the instrumentation,
• long term side effects of the foreign materials in body..
CONCLUSION Cont’d.

17. DISCUSSION
The advantages of preserving the mobile segment are widely accepted.
•Advocates of disc replacements base their arguments on this thesis. If
disc replacements could have actually achieved the desired results, it
would have been great.
•Our technique is the less costly approach with less complications that
achieves the results intended with disc replacements.

18. DISCUSSION
The fat graft plays an important role in achieving the desired results
by preventing unintended spontaneous bone fusions.
Already acknowledged multi-potent transformation ability of fat cell
raises great curiosity about its long-term transformations in
intervertebral space.

19. 7 - 10 Years7 - 10 Years
Case SamplesCase Samples
(2(2 levelslevels))

20. Pre-op.Pre-op. Post-op.Post-op.

21. Pre-opPre-op
Post-opPost-op

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23. 7 - 10 Years7 - 10 Years
Case SamplesCase Samples
(1(1 levellevel))

24. Pre-op. Post-op.*with fat graft

25. Pre-op.Pre-op. Post-op.Post-op.

26. Pre-op.Pre-op. Post-op.Post-op.

27. Pre-op.Pre-op. Post-op.Post-op.

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32. THANK YOU
Q & A