Object

The authors analyzed headache relief after anterior cervical discectomy. Headache may be relieved after anterior cervical discectomy, but the mechanism is unknown. If headaches were directly referred from upper cervical pathology, more headache relief would be expected from surgery performed at higher cervical levels. If spinal kinesthetics were the mechanism, then headache relief may differ between arthroplasty and fusion. Headache relief after anterior cervical discectomy was quantified by the operated disc level and by the method of operation (arthroplasty vs arthrodesis).

Methods

The authors performed a post hoc analysis of an artificial disc trial. Data on headache pain were extracted from the Neck Disability Index (NDI) questionnaire.

Results

A total of 260 patients underwent single-level arthroplasty or arthodesis. Preoperatively, 52% reported NDI headache scores of 3 or greater, compared with only 13%-17% postoperatively. The model-based mean NDI headache score at baseline was 2.5 (95% CI 2.3-2.7) and was reduced by 1.3 points after surgery (95% CI 1.2-1.4, p < 0.001). Higher cervical levels were associated with a greater degree of preoperative headache, but there was no association with headache relief. There was no significant difference in headache relief between arthroplasty and arthrodesis.

Conclusions

Most patients with symptomatic cervical spondylosis have headache as a preoperative symptom (88%). Anterior cervical discectomy with both arthroplasty and arthrodesis is associated with a durable decrease in headache. Headache relief is not related to the level of operation. The mechanism for headache reduction remains unclear.

Introduction

There is increasing interest in the role of cervical total disc replacement (TDR) as an alternative to anterior cervical discectomy and fusion (ACDF). Multiple prospective randomized studies with minimum 2 year follow-up have shown TDR to be at least as safe and effective as ACDF in treating symptomatic degenerative disc disease at a single level. The purpose of this study was to compare outcomes of cervical TDR using the Mobi-C(®) with ACDF at 5-year follow-up.

Methods

This prospective, randomized, controlled trial was conducted as a Food and Drug Administration regulated Investigational Device Exemption trial across 23 centers with 245 patients randomized (2:1) to receive TDR with Mobi-C(®) Cervical Disc Prosthesis or ACDF with anterior plate and allograft. Outcome assessments included a composite overall success score, Neck Disability Index (NDI), visual analog scales (VAS) assessing neck and arm pain, Short Form-12 (SF-12) health survey, patient satisfaction, major complications, subsequent surgery, segmental range of motion, and adjacent segment degeneration.

Results

The 60-month follow-up rate was 85.5% for the TDR group and 78.9% for the ACDF group. The composite overall success was 61.9% with TDR vs. 52.2% with ACDF, demonstrating statistical non-inferiority. Improvements in NDI, VAS neck and arm pain, and SF-12 scores were similar between groups and were maintained from earlier follow-up through 60 months. There was no significant difference between TDR and ACDF in adverse events or major complications. Range of motion was maintained with TDR through 60 months. Device-related subsequent surgeries (TDR: 3.0%, ACDF: 11.1%, p<0.02) and adjacent segment degeneration at the superior level (TDR: 37.1%, ACDF: 54.7%, p<0.03) were significantly lower for TDR patients.

Conclusions

Five-year results demonstrate the safety and efficacy of TDR with the Mobi-C as a viable alternative to ACDF with the potential advantage of lower rates of reoperation and adjacent segment degeneration, in the treatment of one-level symptomatic cervical degenerative disc disease.

Clinical relevance

This prospective, randomized study with 5-year follow-up adds to the existing literature indicating that cervical TDR is a viable alternative to ACDF in appropriately selected patients.

Level of evidence

This is a Level I study.

Anterior cervical discectomy and fusion (ACDF) is the gold standard for treating symptomatic cervical disc degeneration. Cervical total disc replacements (TDRs) have emerged as an alternative for some patients. The purpose of this study was to evaluate the safety and effectiveness of a new TDR device compared with ACDF for treating single-level cervical disc degeneration. This was a prospective, randomized, controlled, multicenter Food and Drug Administration (FDA) regulated Investigational Device Exemption (IDE) study. A total of 245 patients were treated (164 TDR: 81 ACDF). The primary outcome measure was overall success based on improvement in Neck Disability Index (NDI), no subsequent surgical interventions, and no adverse events (AEs) classified as major complications. Secondary outcome measures included SF-12, visual analog scale (VAS) assessing neck and arm pain, patient satisfaction, radiographic range of motion, and adjacent level degeneration. Patients were evaluated preoperatively and postoperatively at 6 weeks, 3, 6, 12, 18, and 24 months. The hypothesis was that the TDR success rate was non-inferior to ACDF at 24 months. Overall success rates were 73.6% for TDR and 65.3% for ACDF, confirming non-inferiority (p < 0.0025). TDR demonstrated earlier improvements with significant differences in NDI scores at 6 weeks and 3 months, and VAS neck pain and SF-12 PCS scores at 6 weeks (p<0.05). Operative level range of motion in the TDR group was maintained throughout follow-up. Radiographic evidence of inferior adjacent segment degeneration was significantly greater with ACDF at 12 and 24 months (p < 0.05). AE rates were similar. Mobi-C TDR is a safe and effective treatment for single-level disc degeneration, producing outcomes similar to ACDF with less adjacent segment degeneration. Level I. This study adds to the literature supporting cervical TDR as a viable option to ACDF in appropriately selected patients with disc degeneration.

Purpose: Low pH is associated with intervertebral disc (IVD)-generated low back pain (LBP). The purpose of this work was to develop an in vivo pH level-dependent magnetic resonance imaging (MRI) method for detecting discogenic LBP, without using exogenous contrast agents. Methods: The ratio of R1ρ dispersion and chemical exchange saturation transfer (CEST) (RROC) was used for pH-level dependent imaging of the IVD while eliminating the effect of labile proton concentration. The technique was validated by numerical simulations and studies on phantoms and ex vivo porcine spines. Four male (ages 42.8 ± 18.3) and two female patients (ages 55.5 ± 2.1) with LBP and scheduled for discography were examined with the method on a 3.0 Tesla MR scanner. RROC measurements were compared with discography outcomes using paired t-test. Results: Simulation and phantom results indicated RROC is a concentration independent and pH level-dependent technique. Porcine spine study results found higher RROC value was related to lower pH level. Painful discs based on discography had significant higher RROC values than those with negative diagnosis (P < 0.05). Conclusion: RROC imaging is a promising pH level dependent MRI technique that has the potential to be a noninvasive imaging tool to detect painful IVDs in vivo. © 2014 Wiley Periodicals, Inc.

Active galactic nuclei (AGNs) show a correlation between the size of the broad line region and the monochromatic continuum luminosity at 5100 Å, allowing black hole mass estimation based on single-epoch spectra. However, the validity of the correlation is yet to be clearly tested for high-luminosity AGNs. We present the first reverberation mapping results of the Seoul National University AGN Monitoring Project (SAMP), which is designed to focus on luminous AGNs for probing the high end of the size-luminosity relation. We report time lag measurements of two AGNs, namely, 2MASS J10261389+5237510 and SDSS J161911.24+501109.2, using the light curves obtained over an ∼1000 days period with an average cadence of 10 and 20 days, respectively, for photometry and spectroscopy monitoring. Based on a cross-correlation analysis and Hβ line width measurements, we determine the Hβ lag as and days in the observed frame, and black hole mass as and respectively, for 2MASS J1026 and SDSS J1619.

In the Spring of 2011 we carried out a 2.5 month reverberation mapping campaign using the 3 m Shane telescope at Lick Observatory, monitoring 15 low-redshift Seyfert 1 galaxies. This paper describes the observations, reductions and measurements, and data products from the spectroscopic campaign. The reduced spectra were fitted with a multicomponent model in order to isolate the contributions of various continuum and emission-line components. We present light curves of broad emission lines and the active galactic nucleus (AGN) continuum, and measurements of the broad Hβ line widths in mean and rms spectra. For the most highly variable AGNs we also measured broad Hβ line widths and velocity centroids from the nightly spectra. In four AGNs exhibiting the highest variability amplitudes, we detect anticorrelations between broad Hβ width and luminosity, demonstrating that the broad-line region "breathes" on short timescales of days to weeks in response to continuum variations. We also find that broad Hβ velocity centroids can undergo substantial changes in response to continuum variations; in NGC 4593, the broad Hβ velocity shifted by ∼250 km s-1 over a 1 month period. This reverberation-induced velocity shift effect is likely to contribute a significant source of confusion noise to binary black hole searches that use multi-epoch quasar spectroscopy to detect binary orbital motion. We also present results from simulations that examine biases that can occur in measurement of broad-line widths from rms spectra due to the contributions of continuum variations and photon-counting noise.

The prominent broad Fe II emission blends in the spectra of active galactic nuclei have been shown to vary in response to continuum variations, but past attempts to measure the reverberation lag time of the optical Fe II lines have met with only limited success. Here we report the detection of Fe II reverberation in two Seyfert 1 galaxies, NGC 4593 and Mrk 1511, based on data from a program carried out at Lick Observatory in Spring 2011. Light curves for emission lines including Hβ and Fe II were measured by applying a fitting routine to decompose the spectra into several continuum and emission-line components, and we use cross-correlation techniques to determine the reverberation lags of the emission lines relative to V-band light curves. In both cases, the measured lag (τcen) of Fe II is longer than that of Hβ, although the inferred lags are somewhat sensitive to the choice of Fe II template used in the fit. For spectral decompositions done using the Fe II template of Véron-Cetty et al., we find τcen (Fe II)/τcen (Hβ) = 1.9 ± 0.6 in NGC 4593 and 1.5 ± 0.3 in Mrk 1511. The detection of highly correlated variations between Fe II and continuum emission demonstrates that the Fe II emission in these galaxies originates in photoionized gas, located predominantly in the outer portion of the broad-line region. © 2013. The American Astronomical Society. All rights reserved.

We present dynamical modeling of the broad-line region (BLR) in the Seyfert 1 galaxy Mrk 50 using reverberation mapping data taken as part of the Lick AGN Monitoring Project (LAMP) 2011. We model the reverberation mapping data directly, constraining the geometry and kinematics of the BLR, as well as deriving a black hole mass estimate that does not depend on a normalizing factor or virial coefficient. We find that the geometry of the BLR in Mrk 50 is a nearly face-on thick disk, with a mean radius of 9.6+1.2-0.9 light days, a width of the BLR of 6.9+1.2-1.1 light days, and a disk opening angle of 25 ± 10 deg above the plane. We also constrain the inclination angle to be 9+7-5 deg, close to face-on. Finally, the black hole mass of Mrk 50 is inferred to be log10(M BH/M = 7.57+0.44-0.27. By comparison to the virial black hole mass estimate from traditional reverberation mapping analysis, we find the normalizing constant (virial coefficient) to be log10 f = 0.78+0.44-0.27, consistent with the commonly adopted mean value of 0.74 based on aligning the M BH-σ* relation for active galactic nuclei and quiescent galaxies. While our dynamical model includes the possibility of a net inflow or outflow in the BLR, we cannot distinguish between these two scenarios. © 2012. The American Astronomical Society. All rights reserved..

The Lick AGN Monitoring Project 2011 observing campaign was carried out over the course of 11 weeks in spring 2011. Here we present the first results from this program, a measurement of the broad-line reverberation lag in the Seyfert 1 galaxy Mrk50. Combining our data with supplemental observations obtained prior to the start of the main observing campaign, our data set covers a total duration of 4.5 months. During this time, Mrk50 was highly variable, exhibiting a maximum variability amplitude of a factor of 4 in the U-band continuum and a factor of ∼2 in the Hβ line. Using standard cross-correlation techniques, we find that Hβ and Hγ lag the V-band continuum by τcen = 10.64+0.82- 0.93 and 8.43+1.30- 1.28days, respectively, while the lag of He II λ4686 is unresolved. The Hβ line exhibits a symmetric velocity-resolved reverberation signature with shorter lags in the high-velocity wings than in the line core, consistent with an origin in a broad-line region (BLR) dominated by orbital motion rather than infall or outflow. Assuming a virial normalization factor of f = 5.25, the virial estimate of the black hole mass is (3.2 ± 0.5) × 107 M ⊙. These observations demonstrate that Mrk50 is among the most promising nearby active galaxies for detailed investigations of BLR structure and dynamics. © 2011. The American Astronomical Society. All rights reserved.