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\"Arrian (Flavius Arrianus), of the period ca. AD 95-175, was a Greek historian and philosopher of Nicomedia in Bithynia. Both a Roman and an Athenian citizen, he was governor of the Roman province of Cappadocia 132-137, and repelled an invasion of the Alani in 134. He retired then to Athens (where he was archon in 148-149) and later to Nicomedia. Arrian's Anabasis of Alexander in seven books is the best account we have of Alexander's adult life. Indica, a description of India and of Nearchus's voyage therefrom, was to be a supplement. A student of Epictetus, Arrian took notes at his lectures and published them (in eight books of which we have four, The Discourses) and also the Encheiridion or Manual of Epictetus. Both works are available in the Loeb Epictetus edition.\"--Jacket

Purpose We aimed to analyze the clinical and radiographic efficacy of a new zero-profile anchored spacer called the ROI-C in anterior discectomy and fusion (ACDF) for multilevel cervical spondylotic myelopathy (MCSM). Method We retrospectively reviewed the clinical, radiological outcomes and complications of multilevel ACDF with the ROI-C or with the polyetheretherketone (PEEK) cages with an anterior plate. From April 2011 to April 2014, 60 patients with MCSM were operated on using ACDF, with the ROI-C in 28 patients and PEEK cages with an anterior plate in 32 patients. The operative time, intraoperative blood loss, and clinical and radiological results were compared between the ROI-C group and the cage-plate group. Results The mean follow-up time was 23.8 ± 6.6 months, ranging from 12 to 36 months. At the first month and the last follow-up, the neck disability index (NDI) scores were decreased, and the Japanese Orthopedic Association (JOA) scores were significantly increased, compared with the presurgical measurements in both groups. There were no significant differences in NDI scores or JOA scores between the two groups ( P  > 0.05), but there were significant differences in the operation time, blood loss and the presence of dysphagia ( P  < 0.05). In addition, the cervical Cobb angle and disk height showed significant corrections, compared to those measured before the operation. There was no adjacent disc degeneration observed in the ROI-C group, and one patient with skip levels showed disc degeneration of the normal level between the skip levels in the cage-plate group. The degeneration rate of the cage-plate group was 3.1 %. Conclusions The primary clinical and radiographic efficacies of both ROI-C and cages with plates in ACDF for MCSM were satisfactory; both approaches could improve and maintain cervical lordosis and disk height. However, the ROI-C was associated with a simpler operation, a shorter operation time, less blood loss, and a lower risk of postoperative dysphagia compared to the PEEK cage with an anterior plate.

Background The self-locking cage (ROI-C, LDR, Troyes, France) has been clinically applied in the treatment of cervical degenerative disc disease (CDDD). However, only a few long-term clinical and radiographic studies have been conducted on the treatment of spinal cord injury without fracture or dislocation (SCIWFD) so far. A comparison between ACDF with either ROI-C or CCP was performed to determine the better treatment for SCIWFD. Methods A total of 83 patients who underwent ACDF using either ROI-C or CCP were reviewed for radiological and clinical outcomes. The cohort comprised 60 males and 23 females, aged between 32 and 88 years old, with an average age of 58.23 years. All patients exhibited symptoms of nerve injury, including limb numbness, muscle weakness, hypoesthesia or urinary dysfunction. The preoperative ASIA classification of spinal nerve function: 7 cases of grade A, 23 cases of grade B, 34 cases of grade C and 19 cases of grade D were included in the study. Results A total of 48 patients underwent ACDF with ROI-C, while 35 patients received a conventional cage-plate. They were studied with a follow-up of 28.63 ± 17.41 months and 29.48 ± 15.43 months respectively. No significant difference was found in blood loss, JOA and ASIA between the two groups. No significant difference was found in cervical lordosis (CL) ( P  > 0.05). However, statistical difference was found in disc height of fused segment and T1 slope between the two groups ( P  < 0.05). No statistical difference was in the incidence of cage subsidence ( P  > 0.05). There was significant difference in the incidence of dysphagia. Both of two groups achieved bony fusion at final follow-up. Conclusion Our study demonstrated that ROI-C has the same efficacy as CCP in improving the cervical stability in treatment of SCIWFD. The migration of cage didn’t occur in ROI-C group at final follow-up, showing steadily fixed in cervical column. Moreover, the ROI-C does have the advantages of good therapeutic effect, mis-invasive, shorter operation time and fewer complications.

Study Design Retrospective study. Objective This retrospective study primary focus is to investigate the relationship between the C-VBQ score and the occurrence of postoperative zero-profile anchored spacer (ROI-C) interbody fusion cage subsidence. Additionally, we aim to evaluate the predictive efficacy of the C-VBQ scoring system for subsidence in the context of ACDF with the ROI-C. Methods Patients who underwent ACDF with the ROI-C cage at our hospital between January 2016 and December 2022 were included in this study. Univariate analysis and multivariate logistic regression were employed to identify independent risk factors associated with ROI-C cage subsidence after ACDF. Pearson correlation analysis was utilized to assess the correlation between the C-VBQ score and the height of ROI-C cage subsidence. Results A total of 102 patients underwent ACDF with ROI-C in our hospital were included in this study. Univariate analysis showed that age (P = 0.021) and C-VBQ score (P < 0.001) were the influencing factors of cage subsidence. Pearson correlation analysis showed that there was a significant positive correlation between the subsidence height of ROI-C cage and C-VBQ (r = 0.55, P < 0.01). Multivariate binary logistic regression analysis showed that C-VBQ score was the only variable that could significantly predict the subsidence of ROI-C cage after ACDF. Higher C-VBQ score was significantly associated with cage subsidence (P < 0.001).The AUC was 0.89, and the cutoff value for C-VBQ was 2.70. Conclusion The findings indicate a significant correlation between a higher C-VBQ score before surgery and ROI-C cage subsidence after ACDF. The preoperative assessment of C-VBQ proves valuable for clinicians, enabling them to identify patients with low bone mineral density and predict the risk of zero-profile anchored spacer interbody fusion cage subsidence following ACDF.

•No significant differences in the radiographic and clinical outcomes.•The cage group showed a lower risk of postoperative dysphagia and ASD.•The stand-alone cage was an effective and safe alternative for the CDDD. The self-locking stand-alone cage has been clinically applied in treating cervical degenerative disc disease (CDDD). However, no long-term clinical and radiographic studies have been performed so far. This retrospective study was designed to analyze and compare the efficacy and outcomes of anterior cervical discectomy and fusion (ACDF) using self-locking stand-alone cages and cages with the anterior cervical plating system. A total of 98 consecutive patients were recruited in this study. Patients in the cage group were given stand-alone self-locking cages, and patients in the plate group were treated with cages and anterior plate fixation. The operative time, intraoperative blood loss and complications were recorded. Clinical outcomes were evaluated using the JOA scoring system, Neck Disability Index and Odom’s criteria. The cervical lordosis, subsidence and cervical fusion status were assessed by X-ray and computed tomography. The mean follow-up period was 39.7 months in the cage group and 42.2 months in the plate group. The operative time, intraoperative blood loss, postoperative dysphagia, sore throat and adjacent segment degeneration in the cage group were significantly less than those in the plate group (p < 0.05). All the patients in both groups achieved complete interbody fusion. Postoperative JOA and NDI scores in both groups were obviously improved compared with the preoperative ones. The postoperative cervical lordosis was effectively restored in both groups. The self-locking stand-alone cage for ACDF could effectively restore the cervical physiological curvature, cause few complications, and lead to satisfactory outcomes. Therefore, it could be used as an effective and reliable treatment for the CDDD.

Objective The intersomatic cage ROI-C one is a new promising system in anterior cervical discectomy with subsequent fusion. Methods Patients were studied prospectively. ROI-C cages were used in consecutive 32 patients. Intraoperative parameters, clinical features and dysphagia scores were recorded. Radiographs evaluated the height of intervertebral space, the cervical Cobb angle and implant positioning. Data were collected on the last day of hospital stay, at 6 weeks, at 3, 6, 12 and 24 months. Results A total of 32 cages were implanted. One patient had transient dysphagia. The intervertebral height and the cervical Cobb angle were significantly improved at 24 months follow-up ( P  < 0.05). Compared to pre-operatively, visual analog scale pain score and neck pain and disability scale were reduced at 1-month follow-up without change during subsequent follow-up. Conclusions This is the first prospective study on ROI-C cages. Although this is a preliminary assessment, the ROI-C cage may represent an excellent alternative to other devices or simple bone graft.

Anterior cervical discectomy and fusion (ACDF) has been the gold standard for treating cervical degenerative disc disease (cDDD). The use of anterior plates in ACDF poses an increased risk of complications such as screw or plate dislodgement, soft tissue injury, esophagus perforation, and dysphagia. The ROI-C™ implant system consists of a zero-profile interbody fusion cage with self-locking plates designed for stand-alone fusion without external plates or screws. The purpose of this report is to describe the ROI-C™ implant system with VerteBRIDGE™ anchor plates, including indications for use, surgical technique, preclinical testing, and clinical study results. The objectives of the clinical study were to assess fusion status, incidence of dysphagia and other device-related complications, and patient reported outcomes. This was a retrospective, multicenter cohort study of 110 patients who underwent ACDF with ROI-C at seven study centers. Patient charts and radiographs were reviewed for any complications or device malfunction. The final follow-up was conducted prospectively and included collection of neck disability index, and visual analog scale (VAS) neck and arm pain scores. The mean operation time was 73 minutes, and mean blood loss was 25 mL (range 0-75 mL). Mean follow-up was 20.7 months (range 9.5-42.2). Dysphagia was reported in two patients (1.8%), and 99.1% of patients achieved fusion. One patient had radiographically confirmed pseudarthrosis at 12 months that was asymptomatic and did not require surgery. One patient had subsequent surgery owing to adjacent level degeneration. The mean neck disability index, VAS neck pain, and VAS right and left arm pain scores at final follow-up were 19, 26.5, 12.5, and 15.3, respectively. The ROI-C interbody cage with VerteBRIDGE anchor plates achieved a high rate of fusion, with a low incidence of dysphagia. These patients had similar or better outcomes compared to ACDF with anterior plating reported in peer-reviewed literature.

To investigate the early and mid-term efficacy and safety of the bridge-type ROI-C interbody fusion cage system in the treatment of cervical spondylosis with osteoporosis during anterior cervical discectomy and fusion (ACDF). The clinical data from 24 cervical spondylosis patients with osteoporosis treated with ACDF were retrospectively analyzed. All patients were treated with ROI-C cage. Double-energy X-ray absorptiometry (DEXA) was used to measure the bone mineral density (BMD). The cervical sagittal radiographic parameters were measured and compared using X-ray including C2-C7 Cobb angle, segmental angle (SA), cervical vertebral bow depth, and height of operation segment (HOS). Postoperative dysphagia was recorded according to the Bazaz score. The Japanese Orthopedic Association (JOA) scores and Neck Disability Index (NDI) scores were used to evaluate the clinical outcomes at different time points. Odom and Vaccaro criteria were used to assess the surgical effects and to evaluate the fusion of the bone graft. The mean duration of the postoperative follow-up was 27.4±5.7 months (ranging from 21 to 36 months). The JOA scores and NDI scores at 3 months post operation and at the time of final follow-up were significantly different from those before surgery ( <0.05). Two patients had mild dysphagia after surgery, but it disappeared after symptomatic treatment for 3-5 days. Sagittal radiographic outcomes were significantly improved at 3 months post operation ( <0.05). At the time of final follow-up, the radiographic parameters were well maintained and were not significantly different compared with 3 months post operation ( >0.05). The ROI-C cage system is safe and effective for use in patients undergoing anterior cervical spondylosis surgery for osteoporosis treatment. It results in a positive effect on bone graft fusion, is able to effectively improve cervical curvature, restores intervertebral height, and reduces the incidence of postoperative dysphagia. The clinical effects were positive at the early and middle postoperative stages.

He leaves to cherish his memories his parents, Roy C.