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Medina AV, Murray Ortiz G, Estronza Ojeda S, de Jesus Espinosa A, Pastrana EA. Use of Recombinant Human Bone Morphogenetic Protein-2 After Anterior Cervical Corpectomy and Fusion for the Treatment of Vertebral Osteomyelitis. World Neurosurg 2024; 187:e28-e34. [PMID: 38508383 DOI: 10.1016/j.wneu.2024.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To report the operative outcomes after treating vertebral osteomyelitis patients with an anterior cervical corpectomy and fusion procedure using recombinant human bone morphogenetic protein-2 (rhBMP-2) as graft material. METHODS A retrospective review of electronic medical records of 26 adult patients who underwent an anterior cervical corpectomy and fusion procedure for cervical osteomyelitis using rhBMP-2 at the University of Puerto Rico University District Hospital was performed. Indication, preoperative laboratory results, levels of corpectomy, preoperative American Spinal Injury Association Impairment Scale (ASIA) score, complications, fusion evaluation at 12 months, and ASIA score at 12 months were reviewed. RESULTS For the cohort of patients, mean age was 47 ± 13 years and 65% were male. Spinal instability was present in 54%. The levels of corpectomy were: 1 level in 2 cases, 2 levels in 15 cases, 3 levels in 8 cases, and 5 levels in 1 case. Four patients had complications and, of these, 2 experienced dysphagia. The fusion rate was 100% and no reoperations were performed. An improvement in ASIA score was seen for 54% patients at 12-month follow-up. CONCLUSIONS This study demonstrates a fusion rate of 100% with no reoperations reported. Recombinant human bone morphogenetic protein-2 could be considered and further researched as grafting material for anterior cervical corpectomy and fusion procedures in cervical osteomyelitis patients.
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Affiliation(s)
- Adriana Vazquez Medina
- School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Gisela Murray Ortiz
- Section of Neurological Surgery, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Samuel Estronza Ojeda
- Section of Neurological Surgery, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Aixa de Jesus Espinosa
- Section of Neurological Surgery, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Emil A Pastrana
- Section of Neurological Surgery, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, USA.
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Zhang XB, Yuan WH, An JD, Li SL, Zhang RH, Hu YC, Zhang K, Shi JT, Wang KP, Zhou HY. Comparison between zero-profile and cage plate devices in the treatment of single-level cervical spondylopathy. Br J Neurosurg 2024; 38:562-567. [PMID: 34184600 DOI: 10.1080/02688697.2021.1923654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare the new zero-profile (Zero-P) fusion cage with regular cage and plate (CP) in the treatment of anterior cervical single-level cervical degenerative diseases. METHODS Patients operated from January 2013 to August 2018 were enrolled. They were divided into the Zero-P group (n = 74 cases) and CP groups (n = 116 cases). Follow-up assessment was at 1, 3, 12, and 24 months after surgery, including the incidence of dysphagia, visual analogue scale (VAS) score, Japanese orthopaedic association (JOA)score, C2-C7 Cobb angle, intervertebral disc height (IDH) and adjacent joint degeneration. RESULTS The operation time and blood loss of patients in Zero-P group were less than those in the CP group, and there was no difference in hospitalization time. All 190 patients were followed up for 24 to 72 months, with an average of 35.29 months. In terms of clinical outcomes, vas and JOA scores of the two groups were significantly improved at one month and the last follow-up. The incidence of dysphagia in the Zero-P group was lower than that in the CP group. On radiological effects, Cobb angle and IDH showed significant correction in both groups, but the degeneration rate of adjacent joints in the Zero-P group was lower than the CP group. CONCLUSIONS In ACDF, the clinical and radiological results of Zero-P and CP devices are satisfactory, but Zero-P cage may be superior in operation time, blood loss, the incidence of dysphagia and adjacent joint degeneration.
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Affiliation(s)
- Xiao-Bo Zhang
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, PR China
- Key Laboratory of Bone and Joint Disease Research of Gansu Province, Lanzhou, PR China
| | - Wen-Hua Yuan
- Department of Orthopedics, Xichang People's Hospital, Xichang, PR China
| | - Jiang-Dong An
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, PR China
| | - Shao-Long Li
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, PR China
| | - Rui-Hao Zhang
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, PR China
- Key Laboratory of Bone and Joint Disease Research of Gansu Province, Lanzhou, PR China
| | - Yi-Cun Hu
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, PR China
- Key Laboratory of Bone and Joint Disease Research of Gansu Province, Lanzhou, PR China
| | - Kai Zhang
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, PR China
- Key Laboratory of Bone and Joint Disease Research of Gansu Province, Lanzhou, PR China
| | - Jin-Tao Shi
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, PR China
- Key Laboratory of Bone and Joint Disease Research of Gansu Province, Lanzhou, PR China
| | - Ke-Ping Wang
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, PR China
- Lanzhou Xigu District People's Hospital, Lanzhou, PR China
| | - Hai-Yu Zhou
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, PR China
- Lanzhou Xigu District People's Hospital, Lanzhou, PR China
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Peeters JB, Dessesard Olijnyk L, Janelle F, Shedid D, Bojanowski MW, Labidi M. Surgical management of tumors of the cervical spine and craniovertebral junction involving the vertebral artery: A narrative review. Neurochirurgie 2024; 70:101550. [PMID: 38552591 DOI: 10.1016/j.neuchi.2024.101550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/12/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND The vertebral artery (VA) is in close proximity to bony structures, nerves and nerve sheaths of the cervical spine and craniovertebral junction (CVJ). These structures can be sources of tumors that are responsible for displacement, encasement and sometimes invasion of the VA. Removing these tumors while minimizing the risk of vascular injury requires thorough knowledge of the vascular anatomy, risk factors of vascular injury, the relationships of each tumor type with the VA, and the different surgical approaches and techniques that result in the best outcomes in terms of vascular control, tumoral exposure and resection. OBJECTIVE To present an overview of preoperative and anatomical considerations, differential diagnoses and various approaches to consider in cases of tumors in close relationship with the VA. METHOD A review of recent literature was conducted to examine the anatomy of the VA, the tumors most frequently affecting it, surgical approaches, and the necessary pre-operative preparations for ensuring safe and maximal tumor resection. This review aims to underscore the principles of treatment. CONCLUSION Tumors located at the CVJ and the cervical spine intimately involved with the VA, pose a surgical challenge and increase the risk of incomplete removal of the lesion. Detailed knowledge of the patient-specific anatomy and a targeted pre-operative work-up enable optimal planning of surgical approach and management of the VA, thereby reducing surgical risks and improving extent of resection.
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Affiliation(s)
- Jean-Baptiste Peeters
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Leonardo Dessesard Olijnyk
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Felix Janelle
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Daniel Shedid
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Michel W Bojanowski
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Moujahed Labidi
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada.
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Murphy TP, Tran JD, Colantonio DF, Le AH, Fredericks DR, Roach WB, Chung J, Pisano AJ, Wagner SC, Helgeson MD. Biomechanical Comparison of Anterior Cervical Plate Fixation Versus Integrated Fixation Cage for Anterior Cervical Discectomy and Fusion. Clin Spine Surg 2024:01933606-990000000-00307. [PMID: 38650076 DOI: 10.1097/bsd.0000000000001630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/07/2024] [Indexed: 04/25/2024]
Abstract
STUDY DESIGN Cadaveric, biomechanic study. OBJECTIVE To compare the range of motion profiles of the cervical spine following one-level anterior cervical discectomy and fusion (ACDF) constructs instrumented with either an interbody cage and anterior plate or integrated fixation cage in a cadaveric model. SUMMARY OF BACKGROUND DATA While anterior plates with interbody cages are the most common construct of fixation in ACDF, newer integrated cage-plate devices seek to provide similar stability with a decreased implant profile. However, differences in postoperative cervical range of motion between the 2 constructs remain unclear. METHODS Six cadaveric spines were segmented into 2 functional spine units (FSUs): C2-C5 and C6-T2. Each FSU was nondestructively bent in flexion-extension (FE), right-left lateral bending (LB), and right-left axial rotation (AR) at a rate of 0.5°/s under a constant axial load until a limit of 2-Nm was reached to evaluate baseline range of motion (ROM). Matched pairs were then randomly assigned to undergo instrumentation with either the standard anterior cage and plate (CP) or the integrated fixation cage (IF). Following instrumentation, ROM was then remeasured as previously described. RESULTS For CP fixation, ROM increased by 61.2±31.7% for FE, 36.3±20.4% for LB, and 31.7±19.1% for AR. For IF fixation, ROM increased by 64.2±15.5% for FE, 56.7±39.8% for LB, and 94.5±65.1% for AR. There was no significant difference in motion between each group across FE, LB, and AR. CONCLUSION This biomechanical study demonstrated increased motion in both the CP and IF groups relative to the intact, un-instrumented state. However, our model showed no differences in ROM between CP and IF constructs in any direction of motion. These results suggest that either method of instrumentation is a suitable option for ACDF with respect to constructing stiffness at time zero.
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Affiliation(s)
- Timothy P Murphy
- Department of Orthopaedics, Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Jeremy D Tran
- Department of Orthopaedics, Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Donald F Colantonio
- Department of Orthopaedics, Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Anthony H Le
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
| | - Donald R Fredericks
- Department of Orthopaedics, Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - William B Roach
- Department of Orthopaedics, Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Joon Chung
- Georgetown University School of Medicine, Washington, DC
| | - Alfred J Pisano
- Department of Orthopaedics, Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Scott C Wagner
- Department of Orthopaedics, Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Melvin D Helgeson
- Department of Orthopaedics, Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University of the Health Sciences
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Arnautovic A, Mijares J, Begagić E, Ahmetspahić A, Pojskić M. Four-level ACDF surgical series 2000-2022: a systematic review of clinical and radiological outcomes and complications. Br J Neurosurg 2024:1-12. [PMID: 38606493 DOI: 10.1080/02688697.2024.2337020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/26/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE The primary objective of this investigation is to systematically scrutinize extant surgical studies delineating Four-Level Anterior Cervical Discectomy and Fusion (4L ACDF), with a specific emphasis on elucidating reported surgical indications, clinical and radiological outcomes, fusion rates, lordosis correction, and the spectrum of complication rates. METHODS The literature review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, employing the MEDLINE (PubMed), Embase, and Scopus databases. This analysis encompasses studies implementing the 4L ACDF procedure, with detailed extraction of pertinent data pertaining to surgical methodologies, types of employed interbody cages, clinical and radiological endpoints, rates of fusion, and the incidence of complications. RESULTS Among the 15 studies satisfying inclusion criteria, a marginal increment in the year 2022 (21.4%) was discerned, with a preponderance of study representation emanating from China (35.7%) and the United States (28.6%). 50% of the studies were single-surgeon studies. Concerning follow-up, studies exhibited variability, with 42.9% concentrating on periods of five years or less, and an equivalent proportion extending beyond this timeframe. Across the amalgamated cohort of 2457 patients, males constituted 51.6%, manifesting a mean age range of 52.2-61.3 years. Indications for surgery included radiculopathy (26.9%) and myelopathy (46.9%), with a predilection for involvement at C3-7 (24.9%). Meta-analysis yielded an overall complication rate of 16.258% (CI 95%: 14.823%-17.772%). Dysphagia (4.563%), haematoma (1.525%), hoarseness (0.205%), C5 palsy (0.176%) were the most prevalent complications of 4L ACDF. Fusion rates ranging from 41.3% to 94% were documented. CONCLUSION The 4L ACDF is commonly performed to address mylopathy and radiculopathy. While the surgery carries a complication rate of around 16%, its effectiveness in achieving bone fusion can vary considerably.
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Affiliation(s)
- Alisa Arnautovic
- George Washington University School of Medicine, Washington, DC, USA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph Mijares
- George Washington University School of Medicine, Washington, DC, USA
| | - Emir Begagić
- Department of General Medicine, School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina
| | - Adi Ahmetspahić
- Department of Neurosurgery, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
| | - Mirza Pojskić
- Department of Neurosurgery, University of Marburg, Marburg, Germany
- School of Medicine, Josip Juraj Strossmayr University, Osijek, Croatia
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Singh H, Kukowski NR, Lunati MP, Dawes A, Kim CH, Kim S, Rhee JM. Porous 3D Printed Titanium Cages in Anterior Cervical Discectomy and Fusion are Associated With Less Subsidence, Improved Maintenance of Segmental Lordotic Correction, and Similar Clinical Outcomes as Allograft. Global Spine J 2024; 14:878-888. [PMID: 36062347 PMCID: PMC11192133 DOI: 10.1177/21925682221124527] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY-DESIGN Retrospective chart review. OBJECTIVES Investigate radiographic and clinical outcomes of 3D printed titanium cages (3DTC) vs allograft in patients undergoing Anterior cervical discectomy and fusion (ACDF). METHODS Consecutive series of patients undergoing ACDF with 3DTC were compared to patients using corticocancellous allograft. Cage subsidence, fusion status, sagittal alignment, and patient-reported-outcomes. Radiographic evaluation was performed on the closing intraoperative x-ray and compared to films at 6-weeks, 6-months, and 1-year. Cage subsidence was calculated based on the amount of settling into superior and inferior endplates compared to the intraoperative x-ray. Fusion was assessed based on < 1 mm of flexion/extension motion. Sagittal alignment parameters and patient-reported-outcomes were measured. RESULTS Seventy six-patients/(120 levels) in 3DTC group and 77-patients/(115 levels) in allograft group were evaluated. No significant differences were noted in patient demographics, level fused or the number of levels fused between the groups. The most common level fused was C5-6. 3DTC had a significantly lower subsidence rate at all-time points as compared to allograft (P < .001). 3DTC maintained segmental lordosis better than allograft at all-time points including 1-year postop (P < .001). No significant differences were noted in fusion rate for 3DTC vs allograft at 6-months (P > .05). There were no significant differences in patient-reported-outcomes. CONCLUSION 3D printed titanium cages had similar patient-reported outcomes and fusion rates as allograft, but less subsidence at all-time points. 3D printed titanium cages better maintained the segmental lordosis at the operative level at all-time points. Although longer term evaluation is needed, based on these results, 3DTC appear to be viable graft options for ACDF that better maintain disc space height and improve segmental lordotic interbody correction.
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Affiliation(s)
- Hardeep Singh
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut
| | | | - Matthew P. Lunati
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Alexander Dawes
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Chi Heon Kim
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut
| | - Sungkyu Kim
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - John M. Rhee
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
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Aldahamsheh O, Alhammoud A, Halayqeh S, Jacobs WB, Thomas KC, Nicholls F, Evaniew N. Stand-Alone Anchored Spacer vs Anterior Plate Construct in the Management of Adjacent Segment Disease after Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis of Comparative Studies. Global Spine J 2024; 14:1038-1051. [PMID: 37705344 PMCID: PMC11192131 DOI: 10.1177/21925682231201787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
STUDY DESIGN Systematic Review and Meta-Analysis. OBJECTIVES This study aimed to evaluate the clinical and radiological outcomes of surgically treated adjacent segment disease (ASDis) following ACDF with either anterior plate construct (APC) or stand-alone anchored spacers (SAAS). METHOD Multiple databases were searched until December 2022 for pertinent studies. The primary outcome was health-related quality of life outcomes [JOA, NDI, and VAS], whereas, the secondary outcomes included operative characteristics [estimated blood loss (EBL) and operative time (OT)], radiological outcomes [C2-C7 Cobb angle, disc height index (DHI) changes, fusion rate], and complications. RESULTS A total of 5 studies were included, comprising 210 patients who had been surgically treated for cervical ASDis. Among them, 113 received APC, and 97 received SAAS. Postoperative dysphagia was significantly higher in the APC group [47% vs 11%, OR = 7.7, 95% CI = 3.1-18.9, P < .05]. Similarly, operative time and blood loss were higher in the APC group compared to the SAAS group; [MD = 16.96, 95% CI = 7.87-26.06, P < .05] and [MD = 5.22, 95% CI = .35 - 10.09, P < .05], respectively. However, there was no difference in the rate of prolonged dysphagia and clinical outcomes in terms of JOA, NDI, and VAS. Furthermore, there was no difference in the radiological parameters including the C2-7 Cobb angle and DHI as well as the fusion rate. CONCLUSION Our meta-analysis demonstrated that both surgical techniques (APC and SAAS) are effective in treating ASDis. However, with low certainty of the evidence, considering patients are at high risk of dysphagia following revision cervical spine surgery SAAS may be the preferred choice.
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Affiliation(s)
- Osama Aldahamsheh
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, AB, Canada
- Department of Special Surgery, Orthopedic Surgery, Faculty of Medicine, Al- Balqa’ Applied University, Al-Salt, Jordan
| | - Abduljabbar Alhammoud
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | | | - W. Bradley Jacobs
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Kenneth C. Thomas
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Fred Nicholls
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Nathan Evaniew
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, AB, Canada
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Aguirre AO, Soliman MAR, Kuo CC, Ruggiero N, Im J, Chintaluru Y, Khan AMA, Khan A, Hess RM, Rho K, Smolar DE, Mullin JP, Pollina J. Cervical Vertebral Bone Quality Score Independently Predicts Distal Junctional Kyphosis After Posterior Cervical Fusion. Neurosurgery 2024; 94:461-469. [PMID: 37823666 DOI: 10.1227/neu.0000000000002714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/10/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Posterior cervical fusion is the surgery of choice when fusing long segments of the cervical spine. However, because of the limited presence of this pathology, there is a paucity of data in the literature about the postoperative complications of distal junctional kyphosis (DJK). We aimed to identify and report potential associations between the preoperative cervical vertebral bone quality (C-VBQ) score and the occurrence of DJK after posterior cervical fusion. METHODS The authors retrospectively reviewed records of patients who underwent posterior cervical fusion at a single hospital between June 1, 2010, and May 31, 2020. Patient data were screened to include patients who were >18 years old, had baseline MRI, had baseline standing cervical X-ray, had immediate postoperative standing cervical X-ray, and had clinical and radiographic follow-ups of >1 year, including a standing cervical X-ray at least 1 year postoperatively. Univariate analysis was completed between DJK and non-DJK groups, with multivariate regression completed for relevant clinical variables. Simple linear regression was completed to analyze correlation between the C-VBQ score and total degrees of kyphosis angle change. RESULTS Ninety-three patients were identified, of whom 19 (20.4%) had DJK and 74 (79.6%) did not. The DJK group had a significantly higher C-VBQ score than the non-DJK group (2.97 ± 0.40 vs 2.26 ± 0.46; P < .001). A significant, positive correlation was found between the C-VBQ score and the total degrees of kyphosis angle change (r 2 = 0.26; P < .001). On multivariate analysis, the C-VBQ score independently predicted DJK (odds ratio, 1.46; 95% CI, 1.27-1.67; P < .001). CONCLUSION We found that the C-VBQ score was an independent predictive factor of DJK after posterior cervical fusion.
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Affiliation(s)
- Alexander O Aguirre
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
| | - Mohamed A R Soliman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo , New York , USA
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo , Egypt
| | - Cathleen C Kuo
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
| | - Nicco Ruggiero
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
| | - Justin Im
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
| | | | - Ali M A Khan
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo , New York , USA
| | - Ryan M Hess
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo , New York , USA
| | - Kyungduk Rho
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo , New York , USA
| | - David E Smolar
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo , New York , USA
| | - Jeffrey P Mullin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo , New York , USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo , New York , USA
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9
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Fleck S, Lang A, Lehmberg J, Landscheidt JF, Gerlach R, Rathert J, Ulrich C, Schär RT, Hartmann S, Mueller JU, Thome C. Prospective Multicenter Trial of Cervical Arthroplasty with the ROTAIO® Cervical Disc Prosthesis. Global Spine J 2024; 14:429-437. [PMID: 35929409 PMCID: PMC10802525 DOI: 10.1177/21925682221109563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Clinical observational study. OBJECTIVE The ROTAIO® cervical disc prosthesis is a novel unconstrained implant with a variable center of rotation aiming at physiological motion. The objective of this multicenter prospective trial was to evaluate clinical outcome and complications within 2 years. MATERIAL AND METHODS 120 patients (72 females and 48 males with median age of 43.0 years [23-60 yrs] underwent ACDA (ROTAIO®, SIGNUS Medical, Alzenau, Germany) and were prospectively followed for 24 months. Preoperative complaints were mainly associated with radiculopathy (n = 104) or myelopathy (n=16). There were 108 monosegmental and 12 bisegmental procedures including 6 hybrid constructs. Clinical outcome was evaluated at 3, 12 and 24 months in 100%, 96% and 77% of the cohort by VAS, NDI, WL-26, Patient`s Satisfaction Index (PSI), SF-36, Nurick Score, mJOA, Composite Success Rate, complications, patient`s overall satisfaction and analgesics use. RESULTS Highly significant clinical improvements were observed according to NDI and VAS (P < .0001 (arm); P < .001 (neck); P = .002 (head)) at all time points. Analgetic use could be reduced in 87.1 to 95.2%. Doctor`s visits have been reduced in 93.8% after 24 months. Patient`s overall satisfaction was high with 78.4 to 83.5% of patients. The composite success rate was 77.5% after 12 months and 76.9% after 24 months. There were no major complications in this series. Slight subsidence of the prosthesis was observed in 2 patients and 3 patients demonstrated fusion after 24 months. 2 patients developed symptomatic foraminal stenosis, so that implant removal and fusion was performed resulting in a revision rate of 1.7% in 2 years. CONCLUSION The ROTAIO® cervical disc prosthesis is a safe and efficient treatment option for symptomatic degenerative disc disease demonstrating highly significant clinical improvement and high patient`s overall satisfaction with very low revision rates at 2 years.
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Affiliation(s)
- Steffen Fleck
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Anna Lang
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Jens Lehmberg
- Department of Neurosurgery, Klinikum Bogenhausen, Munich, Germany
| | | | - Ruediger Gerlach
- Department of Neurosurgery, University Medicine Erfurt, Erfurt, Germany
| | - Julian Rathert
- Department of Neurosurgery, University Medicine Erfurt, Erfurt, Germany
| | | | - Ralph T. Schär
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Sebastian Hartmann
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Jan-Uwe Mueller
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Claudius Thome
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
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Ye S, Li DL, Kong WJ, Xin ZJ, Ao J, Liao WB, Du Q. Surgical Essentials and 2-Year Follow-Up Results of Channel Repair in Endoscopic Transcorporeal Discectomy for Cervical Disc Herniation. World Neurosurg 2024; 182:e755-e763. [PMID: 38097167 DOI: 10.1016/j.wneu.2023.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE To evaluate long-term outcomes and surgical essentials of channel repair in endoscopic transcorporeal discectomy for cervical disc herniation. METHODS From October 2019 to March 2020, 24 patients with cervical disc herniation underwent channel repair after percutaneous full-endoscopic anterior transcorporeal cervical discectomy. Five interventions were performed at C3-C4, 11 were performed at C4-C5, and 8 were performed at C5-C6. Clinical outcomes were evaluated by Neck Disability Index, Japanese Orthopaedic Association, and visual analog scale scores. Radiologic changes were evaluated with intervertebral disc height and drilled vertebral height. RESULTS All procedures were completed with a mean operating time of 86.40 ± 8.19 minutes. Swollen neck was observed in 5 patients, which resolved within 2 hours. At the final follow-up, Neck Disability Index, Japanese Orthopaedic Association, and visual analog scale scores were improved significantly compared with preoperative assessments (P < 0.05); intervertebral disc height was decreased significantly (P < 0.05); and loss of drilled vertebral height was not significant (P > 0.05). All 24 bony channels disappeared by 3 months postoperatively. No other complications were observed. CONCLUSIONS Percutaneous full-endoscopic anterior transcorporeal cervical discectomy with channel repair offers a minimally invasive and effective treatment option for patients with cervical disc herniation. This technique demonstrates favorable clinical outcomes, including preservation of cervical spine mobility and minimal complications. Although there was a significant loss of intervertebral disc height, no vertebral collapse occurred. Strict adherence to surgical indications and precautions is crucial for successful outcomes. Further research and long-term studies are required to validate the efficacy and safety of this approach in a larger patient population.
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Affiliation(s)
- Sheng Ye
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - De-Li Li
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Wei-Jun Kong
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China; Department of Orthopaedic Surgery, Zunyi Hospital of Traditional Chinese Medicine, Zunyi, Guizhou, China
| | - Zhi-Jun Xin
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Jun Ao
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Wen-Bo Liao
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China; Department of Orthopaedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Qian Du
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
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11
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Burke CJ, Samim M, Babb JS, Walter WR. Utility of a 2D kinematic HASTE sequence in magnetic resonance imaging assessment of adjacent segment degeneration following anterior cervical discectomy and fusion. Eur Radiol 2024; 34:1113-1122. [PMID: 37594524 DOI: 10.1007/s00330-023-10133-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/26/2023] [Accepted: 07/04/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVES To evaluate a dynamic half-Fourier acquired single turbo spin echo (HASTE) sequence following anterior cervical discectomy and fusion (ACDF) at the junctional level for adjacent segment degeneration comparing dynamic listhesis to radiographs and assessing dynamic cord contact and deformity during flexion-extension METHODS: Patients with ACDF referred for cervical spine MRI underwent a kinematic flexion-extension sagittal 2D HASTE sequence in addition to routine sequences. Images were independently reviewed by three radiologists for static/dynamic listhesis, and compared to flexion-extension radiographs. Blinded assessment of the HASTE sequence was performed for cord contact/deformity between neutral, flexion, and extension, to evaluate concordance between readers and inter-modality agreement. Inter-reader agreement for dynamic listhesis and impingement grade and inter-modality agreement for dynamic listhesis on MRI and radiographs was assessed using the kappa coefficient and percentage concordance. RESULTS A total of 28 patients, mean age 60.2 years, were included. Mean HASTE acquisition time was 42 s. 14.3% demonstrated high grade dynamic stenosis (> grade 4) at the adjacent segment. There was substantial agreement for dynamic cord impingement with 70.2% concordance (kappa = 0.62). Concordance across readers for dynamic listhesis using HASTE was 81.0% (68/84) (kappa = 0.16) compared with 71.4% (60/84) (kappa = 0.40) for radiographs. Inter-modality agreement between flexion-extension radiographs and MRI assessment for dynamic listhesis across the readers was moderate (kappa = 0.41; 95% confidence interval: 0.16 to 0.67). CONCLUSIONS A sagittal flexion-extension HASTE cine sequence provides substantial agreement between readers for dynamic cord deformity and moderate agreement between radiographs and MRI for dynamic listhesis. CLINICAL RELEVANCE STATEMENT Degeneration of the adjacent segment with instability and myelopathy is one of the most common causes of pain and neurological deterioration requiring re-operation following cervical fusion surgery. KEY POINTS • A real-time kinematic 2D sagittal HASTE flexion-extension sequence can be used to assess for dynamic listhesis, cervical cord, contact and deformity. • The additional kinematic cine sequence was well tolerated and the mean acquisition time for the 2D HASTE sequence was 42 s (range 31-44 s). • A sagittal flexion-extension HASTE cine sequence provides substantial agreement between readers for dynamic cord deformity and moderate agreement between radiographs and MRI for dynamic listhesis.
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Affiliation(s)
- Christopher J Burke
- Department of Radiology, NYU Langone Orthopedic Hospital, New York, NY, USA.
| | - Mohammad Samim
- Department of Radiology, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - James S Babb
- Department of Radiology, NYU Langone Orthopedic Hospital, New York, NY, USA
- Department of Radiology, NYU Grossman School of Medicine, New York, USA
| | - William R Walter
- Department of Radiology, NYU Langone Orthopedic Hospital, New York, NY, USA
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12
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Jain A, Dhanjani S, Harris A, Cartagena M, Babu J, Riew D, Shin J, Wang JC, Yoon ST, Buser Z, Meisel HJ. Structural Allograft Versus Mechanical Interbody Devices Augmented With Osteobiologics in Anterior Cervical Discectomy and Fusion: A Systematic Review. Global Spine J 2024; 14:34S-42S. [PMID: 38421329 PMCID: PMC10913916 DOI: 10.1177/21925682231171857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
STUDY DESIGN Systematic Literature Review. OBJECTIVE Perform a systematic review evaluating postoperative fusion rates for anterior cervical discectomy and fusion (ACDF) using structural allograft vs various interbody devices augmented with different osteobiologic materials. METHODS Comprehensive literature search using PubMed, Embase, The Cochrane Library, and Web of Science was performed. Included studies were those that reported results of 1-4 levels ACDF using pure structural allograft compared with a mechanical interbody device augmented with an osteobiologic. Excluded studies were those that reported on ACDF with cervical corpectomy; anterior and posterior cervical fusions; circumferential (360° or 540°) fusion or revision ACDF for nonunion or other conditions. Risk of bias was determined using the Cochrane review guidelines. RESULTS 8 articles reporting fusion rates of structural allograft and an interbody device/osteobiologic pair were included. All included studies compared fusion rates following ACDF among structural allograft vs non-allograft interbody device/osteobiologic pairs. Fusion rates were reported between 84% and 100% for structural allograft, while fusion rates for various interbody device/osteobiologic combinations ranged from 26% to 100%. Among non-allograft cage groups fusion rates varied from 73-100%. One study found PEEK cages filled with combinations of autograft, allograft, and demineralized bone matrix (DBM) to have an overall fusion rate of 26%. In one study comparing plate and zero-profile constructs, there was no difference in fusion rates for two-level fusions. CONCLUSION There was limited data comparing fusion outcomes of patients undergoing ACDF using structural allograft vs interbody devices augmented with osteobiologic materials to support superiority of one method.
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Affiliation(s)
- Amit Jain
- Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | | | - Andrew Harris
- Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | | | - Jacob Babu
- Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Daniel Riew
- Weill Cornell Brain and Spine Center, New York, NY, USA
| | - John Shin
- Mass General Brigham Inc, Boston, MA, USA
| | | | - S Tim Yoon
- Orthopedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
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13
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Xiao Q, Li Y. Percutaneous Endoscopic Posterior Lateral Approach for the Treatment of Central Cervical Disc Herniation. World Neurosurg 2024; 181:e376-e383. [PMID: 37852470 DOI: 10.1016/j.wneu.2023.10.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND To design percutaneous endoscopic surgery via a posterolateral approach for the treatment of central cervical disc herniation. METHODS From October 2019 to October 2020, 12 consecutive patients with central cervical disc herniation underwent percutaneous endoscopic posterior lateral cervical surgery. The imaging examination (dynamic X-ray, computed tomography, and magnetic resonance imaging of the cervical spine) was conducted after the operation. Visual analog scale score and the modified Japanese Orthopaedic Association score was performed before and after the operation. RESULTS Twelve patients (6 men and 6 women; mean age 52.08 ± 9.3 years) were included, and the average operation time was 105.00 ± 10.55 minutes. Postoperative computed tomography and magnetic resonance imaging results showed that the treatment segment of all patients was prominent, the cervical intervertebral disc was completely removed, the cervical spinal cord was fully decompressed, and there were no cases of infection, cerebrospinal fluid leakage or neurological complications. The average follow-up time after the operation was 22.83 ± 3.13 months. One year after the operation, there was no cervical instability in the X-ray examination of cervical flexion and extension position. Preoperative visual analog scale score and the modified Japanese Orthopaedic Association score were significantly improved at the last follow-up. CONCLUSION Percutaneous endoscopic posterior lateral cervical discectomy provides a new surgical method for the endoscopic treatment of central cervical disc herniation. This treatment has a better surgical field and easier operation, which can remove the protruding cervical disc under the endoscope and make sure that the cervical spinal cord is fully decompressed. The clinical effect is satisfactory. A small amount of pedicle resection will not cause cervical instability.
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Affiliation(s)
- Qingqing Xiao
- Neck-shoulder and Lumbocrural Pain Devision 1, Sichuan Province Orthopedic Hospital, Chengdu, PR China
| | - Yue Li
- Neck-shoulder and Lumbocrural Pain Devision 1, Sichuan Province Orthopedic Hospital, Chengdu, PR China.
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14
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Deng Y, Wang B, Liu H, Meng Y, Rong X, Wu T, Chen H, Hong Y. A Novel Intraoperative Posture-Adjustment Apparatus for Correction of Cervical Lordosis in Anterior Cervical Surgery. Orthop Surg 2023; 15:3162-3173. [PMID: 37866365 PMCID: PMC10694009 DOI: 10.1111/os.13917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/09/2023] [Accepted: 09/13/2023] [Indexed: 10/24/2023] Open
Abstract
OBJECTIVE Cervical alignment is a crucial factor related to the success of anterior cervical surgical procedures. In patients with severe spinal cord compression, a traditional neck pillow (TNP) may not adequately correct cervical position during surgery. Therefore, the aim of this study was to introduce this innovative intraoperative posture-adjustment apparatus (IPAA), and explored its clinical and radiological results in cervical angle correction against TNP in patients who had undergone anterior cervical surgery. METHODS The clinical and radiological data of 86 patients who underwent anterior cervical surgery with a minimum follow-up period of 1 year were retrospectively reviewed. Of these, 58 patients underwent IPAA, whereas 28 underwent TNP. Radiological parameters such as the degree of C2-C7 lordosis (CL), functional spinal unit angle (FSUA), C7 slope (C7S), fusion rate, and adjacent segment disease (ASD) were recorded and compared between the groups. Clinical outcomes including the Japanese Orthopaedic Association (JOA), neck disability index (NDI), visual analogue scale (VAS) for neck and arm were recorded. Complications such as kyphosis, dysphagia, Braden Scale score, revision surgery, hematoma, cerebrospinal fluid leakage, wound infection, and deep venous thrombosis were also recorded. The independent t-test or Mann-Whitney U test was used to compare continuous data, and categorical variables were assessed using the Pearson's chi-square test or Fisher's exact test. RESULTS Compared with the pre-operative data, the post-operative CL, FSUA, and C7S were significantly increased in both groups. CL, FSUA, and C7S in the IPAA group (14.44 ± 4.94°, 7.36 ± 2.91°, 16.54 ± 4.63°) were significantly higher than those in the TNP group (7.17 ± 8.19°, 4.99 ± 5.36°, 14.19 ± 4.48°; P < 0.05). Although there were no significant differences between the groups in terms of VAS arm and JOA scores, the post-operative and final follow-up NDI and VAS neck scores in the IPAA group were significantly lower than those in the TNP group (p < 0.05). At the last follow-up, the TNP group had significantly more kyphotic patients than the IPAA group (2 vs. 0, p = 0,041). There was no significant difference between the groups in terms of fusion rate, ASD, or complications such as dysphagia, Braden's Scale score, revision surgery, hematoma, cerebrospinal fluid leakage, wound infection, or deep venous thrombosis. CONCLUSION IPAA was shown to be more effective than TNP in adjusting cervical alignment (CL, FSUA, and C7S). These findings suggest that IPAA could be used as an alternative way to TNP in neck setting and cervical alignment adjustment and IPAA could potentially improve clinical outcomes after anterior cervical surgery.
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Affiliation(s)
- Yifei Deng
- Department of Orthopedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Beiyu Wang
- Department of Orthopedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Hao Liu
- Department of Orthopedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Yang Meng
- Department of Orthopedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Xin Rong
- Department of Orthopedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Tingkui Wu
- Department of Orthopedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Hao Chen
- Department of Orthopedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Ying Hong
- Department of Anesthesiology, West China HospitalSichuan UniversityChengduChina
- Department of Operation Room, West China HospitalSichuan UniversityChengduChina
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15
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Ratnasamy PP, Rudisill KE, Maloy GC, Grauer JN. Cervical Disc Arthroplasty Usage Has Leveled Out From 2010 to 2021. Spine (Phila Pa 1976) 2023; 48:E342-E348. [PMID: 36728785 PMCID: PMC10300227 DOI: 10.1097/brs.0000000000004560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/18/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Descriptive epidemiologic study. OBJECTIVE To compare trends in utilization and predictive factors for single-level cervical disc arthroplasty (CDA) relative to anterior cervical discectomy and fusion (ACDF) over the years. BACKGROUND CDA is an alternative to ACDF for the treatment of cervical spine pathologies. With both procedures performed for similar indications, controversy on best practices exists. MATERIALS AND METHODS Patients who underwent single-level CDA or ACDF were identified in the 2010 through 2021 PearlDiver M151Ortho data set. The yearly number of CDAs performed and proportionality was assessed. Predictive patient factors for undergoing CDA as opposed to ACDF were determined. Kaplan Meyer survival analysis with an endpoint of cervical spine reoperation compared 5-year outcomes between CDA and ACDF. RESULTS From 2010 to 2021, 19,301 single-level CDAs and 181,476 single-level ACDFs were identified. The proportional utilization of CDA relative to ACDF increased from 4.00% in 2010 to 14.15% in 2018 ( P < 0.0001), after which there was a plateau between 2018 and 2021 where proportional utilization was 14.47% ( P = 0.4654). Multivariate analysis identified several predictors of undergoing CDA rather than ACDF, including: younger age [odds ratio (OR) per decade decrease: 1.72], having surgery performed in the Midwest, Northeast, or West (relative to South, OR: 1.16, 1.13, 2.26, respectively), having Commercial insurance (relative to Medicare, OR: 1.75), and having surgery performed by an orthopedic surgeon (relative to a neurological surgeon, OR: 1.54) ( P < 0.0001 for each). There was no statistically significant difference in 5-year survival to further cervical spine surgery between CDA and ACDF at 5 years (97.6% vs. 97.7%, P = 0.4249). CONCLUSIONS Although the use of CDA relative to ACDF rose from 2010 to 2018, its use has subsequently plateaued between 2018 and 2021 and remained a relatively low percentage of the single-level anterior cervical surgeries performed (14.47% in 2021). The causes for such changes in the trend are unclear.
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Affiliation(s)
- Philip P Ratnasamy
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT
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Su XJ, Chen XY, Dai JF, Zhu C, Song QX, Shen HX. Hybrid fixation versus conventional cage-plate construct in 3-level ACDF: Introduce the "seesaw theory" of stand-alone cage. Clin Neurol Neurosurg 2023; 233:107941. [PMID: 37573679 DOI: 10.1016/j.clineuro.2023.107941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/19/2023] [Accepted: 08/07/2023] [Indexed: 08/15/2023]
Abstract
STUDY DESIGN A retrospective study. BACKGROUND Conventional cage-plate construct (CCP) was widely used in anterior cervical discectomy and fusion (ACDF), but the rigid fixation limits the motion of fused segments. Self-locking stand-alone cage (SSC) was an alternative for ACDF procedures and showed several superiorities. However, the effect of hybrid fixation in 3-level ACDF remains unknown. OBJECTIVE To assess the clinical and radiological outcomes of hybrid fixation with SSC and CCP against conventional CCP in 3-level ACDF. METHOD A retrospective review of patients who underwent 3-level ACDF at Renji Hospital between January 2018 and December 2019 was performed. Eighty-three patients met the inclusion and exclusion criteria and were stratified into 2 groups based on the fixation methods. The clinical outcomes, functional outcomes, and radiological parameters were collected and analyzed. RESULTS No significant difference was observed between the two groups in the mean age, sex, body mass index, hospital stay, and duration of follow-up. The postoperative C2-7 Cobb angle in the CCP group was significantly greater than that in the hybrid group. The rate of cervical proximal junctional kyphosis (CPJK) in the hybrid group was significantly lower than that in the CCP group. The CCP group suffered significantly higher rates of adjacent segment degeneration (ASD) than the hybrid group at 2 years postoperatively. Moreover, the incidence of postoperative dysphagia was lower in the hybrid group. No significant differences were observed in JOA and NDI scores between the two groups. CONCLUSION The hybrid fixation achieved comparable clinical outcomes against CCP fixation, indicating that hybrid fixation is an alternative procedure in 3-level ACDF.
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Affiliation(s)
- Xin-Jin Su
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiu-Yuan Chen
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jia-Feng Dai
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chao Zhu
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qing-Xin Song
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Hong-Xing Shen
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Ahn CH, Kang S, Cho M, Kim SH, Kim CH, Han I, Kim CH, Noh SH, Kim KT, Hwang JM. Comparing zero-profile and conventional cage and plate in anterior cervical discectomy and fusion using finite-element modeling. Sci Rep 2023; 13:15766. [PMID: 37737299 PMCID: PMC10516908 DOI: 10.1038/s41598-023-43086-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/19/2023] [Indexed: 09/23/2023] Open
Abstract
Conventional cage and plate (CCP) implants usually used in ACDF surgery, do have limitations such as the development of postoperative dysphagia, adjacent segment degeneration, and soft tissue injury. To reduce the risk of these complications, zero-profile stand-alone cage were developed. We used finite-element modeling to compare the total von Mises stress applied to the bone, disc, endplate, cage and screw when using CCP and ZPSC implants. A 3-dimensional FE (Finite element) analysis was performed to investigate the effects of the CCP implant and ZPSC on the C3 ~ T1 vertebrae. We confirmed that the maximum von Mises stress applied with ZPSC implants was more than 2 times greater in the endplate than that applied with CCP implants. The 3D analysis of the ZPSC model von Mises stress measurements of screw shows areas of higher stress in red. Although using ZPSC implants in ACDF reduces CCP implant-related sequalae such as dysphagia, we have shown that greater von Mises stress is applied to the endplate, and screw when using ZPSC implants. This may explain the higher subsidence rate associated with ZPSC implant use in ACDF. When selecting an implant in ACDF, surgeons should consider patient characteristics and the advantages and disadvantages of each implant type.
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Affiliation(s)
- Chang-Hwan Ahn
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, 41944, Republic of Korea
| | - Sungwook Kang
- Precision Mechanical Process and Control R&D Group, Korea Institute of Industrial Technology, Jinju-si, Gyeongsangnam-do, 52845, Republic of Korea
| | - Mingoo Cho
- Precision Mechanical Process and Control R&D Group, Korea Institute of Industrial Technology, Jinju-si, Gyeongsangnam-do, 52845, Republic of Korea
| | - Seong-Hun Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, 41944, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Inbo Han
- Department of Neurosurgery, CHA University, School of Medicine, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - Chul-Hyun Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, 41944, Republic of Korea
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, 41944, Republic of Korea
| | - Sung Hyun Noh
- Department of Neurosurgery, Ajou University College of Medicine, Suwon, Republic of Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, 41944, Republic of Korea.
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, 41944, Republic of Korea.
| | - Jong-Moon Hwang
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, 41944, Republic of Korea.
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, 41944, Republic of Korea.
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Shen S, Hu Y, Chu Z, Dong W. Bone resorption of vertebral bodies at the operative segment after prevail cervical interbody fusion: A case report. Medicine (Baltimore) 2023; 102:e35231. [PMID: 37713843 PMCID: PMC10508578 DOI: 10.1097/md.0000000000035231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/24/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND We report an interesting case of bone resorption of vertebral bodies at the operative segment after Peek Prevail cervical interbody fusion. Instability of cervical vertebrae is likely to occur due to increased stress in Peek Prevail implant body for bone resorption. The finite element analysis was used to clarify the biomechanical effects of bone resorption and stress distribution in Peek Prevail implant body. METHODS We reported the case of a 48-year-old male patient who underwent Peek Prevail cervical interbody fusion and exhibited bone resorption 1 month after the surgery in X-ray of cervical vertebra. The degree of bone resorption was aggravated 2 months after surgery. Bone resorption in 3 months was similar to that in 2 months. We established a 3D reconstruction of the surgical segment in this case using Mimics software (vision 20.0) to generate basic boss resorption model. We simulated models of bone resorption using Ansys 17.0. The stress distribution of the contact surface between the screw and bone was analyzed under 6 conditions: flexion, extension, left and right flexion, and left and right rotation. RESULTS The loading conditions affected the stress distribution in the implant body. When bone resorption occurred, the stress distribution of the contact surface between screw and bone focus in the tip of the screw increased sharply. CONCLUSION Bone resorption of vertebral bodies in the operative segment may be a potential complication after Peek Prevail cervical interbody fusion. Great attention must be paid when bone resorption was occurred in order to avoid screw loosening before vertebral fusion.
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Affiliation(s)
- Shufeng Shen
- Department of Spinal Surgery, Yuyao People’s Hospital, Zhejiang Province, China
| | - Yong Hu
- Department of Spinal Surgery, Ningbo No.6 Hospital, Zhejiang Province, China
| | - Zhentao Chu
- Department of Spinal Surgery, Ningbo No.6 Hospital, Zhejiang Province, China
| | - Weixin Dong
- Department of Spinal Surgery, Ningbo No.6 Hospital, Zhejiang Province, China
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19
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Wang Y, Liu Y, Zhang A, Han Q, Jiao J, Chen H, Gong X, Luo W, Yue J, Zhao X, Wang J, Wu M. Biomechanical evaluation of a novel individualized zero-profile cage for anterior cervical discectomy and fusion: a finite element analysis. Front Bioeng Biotechnol 2023; 11:1229210. [PMID: 37744254 PMCID: PMC10512836 DOI: 10.3389/fbioe.2023.1229210] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction: Anterior cervical discectomy and fusion (ACDF) is a standard procedure for treating symptomatic cervical degenerative disease. The cage and plate constructs (CPCs) are widely employed in ACDF to maintain spinal stability and to provide immediate support. However, several instrument-related complications such as dysphagia, cage subsidence, and adjacent segment degeneration have been reported in the previous literature. This study aimed to design a novel individualized zero-profile (NIZP) cage and evaluate its potential to enhance the biomechanical performance between the instrument and the cervical spine. Methods: The intact finite element models of C3-C7 were constructed and validated. A NIZP cage was designed based on the anatomical parameters of the subject's C5/6. The ACDF procedure was simulated and the CPCs and NIZP cage were implanted separately. The range of motion (ROM), intradiscal pressure (IDP), and peak von Mises stresses of annulus fibrosus were compared between the two surgical models after ACDF under four motion conditions. Additionally, the biomechanical performance of the CPCs and NIZP cage were evaluated. Results: Compared with the intact model, the ROM of the surgical segment was significantly decreased for both surgical models under four motion conditions. Additionally, there was an increase in IDP and peak von Mises stress of annulus fibrosus in the adjacent segment. The NIZP cage had a more subtle impact on postoperative IDP and peak von Mises stress of annulus fibrosus in adjacent segments compared to CPCs. Meanwhile, the peak von Mises stresses of the NIZP cage were reduced by 90.0-120.0 MPa, and the average von Mises stresses were reduced by 12.61-17.56 MPa under different motion conditions. Regarding the fixation screws, the peak von Mises stresses in the screws of the NIZP cage increased by 10.0-40.0 MPa and the average von Mises stresses increased by 2.37-10.10 MPa. Conclusion: The NIZP cage could effectively reconstruct spinal stability in ACDF procedure by finite element study. Compared with the CPCs, the NIZP cage had better biomechanical performance, with a lower stress distribution on the cage and a more moderate effect on the adjacent segmental discs. Therefore, the NIZP cage could prevent postoperative dysphagia as well as decrease the risk of subsidence and adjacent disc degeneration following ACDF. In addition, this study could serve as a valuable reference for the development of personalized instruments.
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Affiliation(s)
- Yang Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Yang Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Aobo Zhang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Qing Han
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Jianhang Jiao
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Hao Chen
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Xuqiang Gong
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Wangwang Luo
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Jing Yue
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, China
| | - Xue Zhao
- Department of Endocrinology and Metabolism, First Hospital of Jilin University, Changchun, China
| | - Jincheng Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Minfei Wu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
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Zavras AG, Dandu N, Espinoza-Orias AA, Singh K, An HS, Inoue N, Colman MW. Computed Tomography Osteoabsorptiometry Evaluation of Cervical Endplate Subchondral Bone Mineral Density. Global Spine J 2023; 13:1803-1811. [PMID: 34736350 PMCID: PMC10556913 DOI: 10.1177/21925682211050325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Basic Science. OBJECTIVE Poor subchondral bone mineral density (sBMD) has been linked with subsidence of cervical interbody devices or grafts, which are traditionally placed centrally on the endplates. Considering that sBMD reflects long-term stress distributions, we hypothesize that the cervical uncovertebral joints are denser than the central endplate region. This study sought to investigate density distributions using computed tomography osteoabsorptiometry (CT-OAM). METHODS Twelve human cervical spines from C3-C7 (60 vertebrae, 120 endplates) were imaged with CT and segmented to create 3D reconstructions. The superior and inferior endplates were isolated, and the sBMD of the whole endplate, endplate center, and uncus was evaluated using CT-OAM. Density distributions were compared across the subaxial cervical spine. RESULTS The uncinate region of the inferior and superior endplates was significantly denser than the central endplate across all vertebral levels (P < .01). When comparing sBMD of the whole inferior and superior endplates, the superior endplate was significantly denser than the inferior endplate (P < .0001). However, the inferior uncus was denser than the superior uncus (P = .035). When assessing sBMD by vertebral level, peak densities were observed at C4 and C5, while C7 was, on average, significantly less dense than all other vertebrae. CONCLUSION The subchondral bone of the cervical uncovertebral joints is significantly denser than the central endplates. While the superior endplate in its entirety is denser than the inferior endplate, the inverse was true for the uncovertebral joints. This study serves as a basis for future investigations of new implant designs and their implications on subsidence.
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Affiliation(s)
| | - Navya Dandu
- Rush University Medical Center, Chicago, IL, USA
| | | | - Kern Singh
- Rush University Medical Center, Chicago, IL, USA
| | - Howard S. An
- Rush University Medical Center, Chicago, IL, USA
| | - Nozomu Inoue
- Rush University Medical Center, Chicago, IL, USA
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Odate S, Shikata J. Interbody Cage Placement Without Plate Supplementation Adjacent to Plated Segments in Multilevel Anterior Cervical Decompression and Fusion. Spine (Phila Pa 1976) 2023; 48:1245-1252. [PMID: 37146055 DOI: 10.1097/brs.0000000000004704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/22/2023] [Indexed: 05/07/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE To evaluate the clinical efficacy and safety of hybrid anterior cervical fixation, focusing on stand-alone segments. SUMMARY OF BACKGROUND DATA In the treatment of multilevel cervical stenosis, the number of segments fixed using a plate is limited by placing an interbody cage without plate supplementation at one end of the surgical segment to reduce long plate-related problems. However, the stand-alone segment may experience cage extrusion, subsidence, cervical alignment deterioration, and nonunion. METHODS Patients who underwent three-segment or four-segment fixation for cervical degenerative disease and completed one-year follow-up were included in this study. Patients were divided into two groups: a cranial group, with stand-alone segments located at the cranial end adjacent to plated segments, and a caudal group, with stand-alone segments located at the caudal end. Differences in radiographic outcomes between the groups were evaluated. Fusion was defined using dynamic radiographs or computed tomography. To identify factors associated with nonunion in stand-alone segments, multivariable logistic regression analyses were performed. To identify factors associated with cage subsidence, multiple regression analyses were performed. RESULTS A total of 116 patients (mean age, 59±11 y; 72% male; mean fixed segments, 3.7±0.5 segments) were included in this study. No case showed cage extrusion or plate dislodgement. In stand-alone segments, the fusion rate was significantly lower in the caudal group than in the cranial group (76% vs. 93%, P =0.019). Change in the cervical sagittal vertical axis was worse in the caudal group than in the cranial group (2.7±12.3 mm vs. -2.7±8.1 mm, P =0.006). One caudal group patient required additional surgery because of nonunion at the stand-alone segment. Multivariable logistic regression indicated factors associated with nonunion included the location of the stand-alone segment (caudal end: OR 4.67, 95% CI, 1.29-16.90), larger pre-disk space range of motion (OR 1.15, 95% CI, 1.04-1.27), and lower preoperative disk space height (OR 0.57, 95% CI, 0.37-0.87). Multiple regression analysis indicated that higher cage height and lower pre-disk space height were associated with cage subsidence. CONCLUSION Hybrid anterior cervical fixation with stand-alone interbody cage placement adjacent to plated segments may avoid long plate-related problems. Our results suggest that the cranial end of the construct may be more suitable for the stand-alone segment than the caudal end.
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Affiliation(s)
- Seiichi Odate
- Department of Orthopedic Surgery, Gakkentoshi Hospital, Kyoto, Japan
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22
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Atıcı Y, Şenel A, Tekin SB, Aktaş MA, Peker B, Polat B. The Effects of the Use of Single-Screw Plates (Univertebral Screw Plates) versus Double-Screw Plates (Bivertebral Screw Plates) on Fusion After One-Level or Two-Level Anterior Cervical Discectomy and Fusion. World Neurosurg 2023; 176:e686-e691. [PMID: 37295469 DOI: 10.1016/j.wneu.2023.05.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE In this study, we aimed to retrospectively analyze the effects of the use of univertebral screw plates (USPs) and bivertebral screw plates (BSPs) on fusion in patients who underwent anterior cervical discectomy and fusion (ACDF). METHODS Forty-two patients who were treated with USPs or BSPs after 1-level or 2-level ACDF and had a minimum follow-up period of 2 years were included in the study. Fusion and the global cervical lordosis angle were evaluated using direct radiographs and computed tomography images of the patients. The clinical outcomes were assessed using the Neck Disability Index and visual analog scale. RESULTS Seventeen patients were treated using USPs and 25 patients using BSPs. Fusion was achieved in all patients who underwent BSP fixation (1-level ACDF, 15 patients; 2-level ACDF, 10 patients) and 16 of the 17 patients who underwent USP fixation (1-level ACDF, 11 patients; 2-level ACDF, 6 patients). The plate of the patient with fixation failure had to be removed because it was symptomatic. A statistically significant improvement was observed in the immediate postoperative period and at the last follow-up in terms of global cervical lordosis angle, visual analog scale score, and Neck Disability Index of all patients who underwent 1-level or 2-level ACDF surgery (P < 0.05) CONCLUSIONS: Although USPs are less costly and easier to implant, the effect of USPs and BSPs on fusion and clinical outcomes is similar. Thus, surgeons may prefer to use USPs after 1-level or 2-level ACDF.
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Affiliation(s)
- Yunus Atıcı
- Department of Orthopedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Ahmet Şenel
- Department of Orthopedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Saltuk Buğra Tekin
- Department of Orthopedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Akif Aktaş
- Department of Orthopedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Barış Peker
- Department of Orthopedics and Traumatology, Dr. Burhan Nalbantoğlu State Hospital, Nicosia, Turkish Republic of Northern Cyprus
| | - Barış Polat
- Department of Orthopedics and Traumatology, Dr. Burhan Nalbantoğlu State Hospital, Nicosia, Turkish Republic of Northern Cyprus
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Lofrese G, Trungu S, Scerrati A, De Bonis P, Cultrera F, Mongardi L, Montemurro N, Piazza A, Miscusi M, Tosatto L, Raco A, Ricciardi L. Two-Level Corpectomy and Fusion vs. Three-Level Anterior Cervical Discectomy and Fusion without Plating: Long-Term Clinical and Radiological Outcomes in a Multicentric Retrospective Analysis. Life (Basel) 2023; 13:1564. [PMID: 37511938 PMCID: PMC10381458 DOI: 10.3390/life13071564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/23/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) represent effective alternatives in the management of multilevel cervical spondylotic myelopathy (CSM). A consensus on which of these techniques should be used is still missing. METHODS The databases of three centers were reviewed (January 2011-December 2018) for patients with three-level CSM, who underwent three-level ACDF without plating or two-level ACCF with expandable cage (VBRC) or mesh (VBRM). Demographic data, surgical strategy, complications, and implant failure were analyzed. The Neck Disability Index (NDI), the Visual Analog Scale (VAS), and the cervical lordosis were compared between the two techniques at 3 and 12 months. Logistic regression analyses investigated independent factors influencing clinical and radiological outcomes. RESULTS Twenty-one and twenty-two patients were included in the ACDF and ACCF groups, respectively. The median follow-up was 18 months. ACDFs were associated with better clinical outcomes at 12 months (NDI: 8.3% vs. 19.3%, p < 0.001; VAS: 1.3 vs. 2.6, p = 0.004), but with an increased risk of loss of lordosis correction ≥ 1° (OR = 4.5; p = 0.05). A higher complication rate in the ACDF group (33.3% vs. 9.1%; p = 0.05) was recorded, but it negatively influenced only short-term clinical outcomes. ACCFs with VBRC were associated with a higher risk of major complications but ensured better 12-month lordosis correction (p = 0.002). No significant differences in intraoperative blood loss were noted. CONCLUSIONS Three-level ACDF without plating was associated with better clinical outcomes than two-level ACCF despite worse losses in lordosis correction, which is ideal for fragile patients without retrovertebral compressions. In multilevel CSM, the relationship between the degree of lordosis correction and clinical outcome advantages still needs to be investigated.
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Affiliation(s)
| | - Sokol Trungu
- NESMOS Department, "Sapienza" University of Rome, Sant'Andrea Hospital, 00185 Rome, Italy
- Neurosurgery Unit, Cardinale G. Panico Hospital, 73039 Tricase, Italy
| | - Alba Scerrati
- Department of Neurosurgery, S. Anna University Hospital, 44124 Ferrara, Italy
| | - Pasquale De Bonis
- Department of Neurosurgery, S. Anna University Hospital, 44124 Ferrara, Italy
| | | | - Lorenzo Mongardi
- Department of Neurosurgery, S. Anna University Hospital, 44124 Ferrara, Italy
| | | | - Amedeo Piazza
- NESMOS Department, "Sapienza" University of Rome, Sant'Andrea Hospital, 00185 Rome, Italy
| | - Massimo Miscusi
- NESMOS Department, "Sapienza" University of Rome, Sant'Andrea Hospital, 00185 Rome, Italy
| | | | - Antonino Raco
- NESMOS Department, "Sapienza" University of Rome, Sant'Andrea Hospital, 00185 Rome, Italy
| | - Luca Ricciardi
- NESMOS Department, "Sapienza" University of Rome, Sant'Andrea Hospital, 00185 Rome, Italy
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Chen Y, Zhang T, Cai B, Xu J, Lian X. Comparison of Single-level Cervical Radiculopathy Outcomes Between Posterior Endoscopic Cervical Decompression and Anterior Cervical Discectomy and Fusion: Mid-term Results. Clin Spine Surg 2023; 36:E252-E257. [PMID: 36823701 DOI: 10.1097/bsd.0000000000001439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 12/13/2022] [Indexed: 02/25/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE To investigate the mid-term results and technical possibilities of posterior endoscopic cervical decompression (PECD) in the treatment of cervical radiculopathy. SUMMARY OF BACKGROUND DATA PECD has been used in the treatment of cervical radiculopathy for the past decades; there is a paucity of studies directly comparing its outcomes with anterior cervical discectomy and fusion (ACDF) for patients with single-level cervical radiculopathy. PATIENTS AND METHODS From January 2016 to December 2018, clinical and radiologic data of 42 patients were collected. Patients were followed for a mean of 40.6 months (range: 30-54 mo) after surgery. Changes in cervical lordosis and degeneration of adjacent segments were analyzed. Dysphagia was assessed using the Bazaz score, and clinical outcomes were analyzed using the Neck Disability Index and visual analog scoring system. RESULTS There were no significant differences in neurological outcomes between the two groups. Significant between-group differences in postoperative dysphagia were observed ( P < 0.05). There were significant differences in postoperative segmental Cobb angles and disc height between the two groups ( P < 0.05). Degenerative changes in the adjacent segments occurred in 5 patients in the ACDF group and 1 patient in the PECD group ( P < 0.05); no revision surgery was needed. CONCLUSIONS Clinical outcomes of PECD for patients with unilateral radiculopathy were satisfactory. On the premise of a strict selection of indications, we consider this technique to be a safe supplement and alternative to ACDF for patients with unilateral cervical radiculopathy. Longer follow-up periods are required to confirm these observations.
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Affiliation(s)
- Yuanyuan Chen
- Orthopedic Department, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
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25
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Schupper AJ, Lin D J, Gologorsky Y. Bone Morphogenic Protein in Anterior Cervical Diskectomy and Fusion: Time for a Fresh Look? World Neurosurg 2023; 175:157. [PMID: 37028481 DOI: 10.1016/j.wneu.2023.03.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - James Lin D
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yakov Gologorsky
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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26
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Schmidt GO, Glassman SD, Tomov M, Dimar JR, Crawford CH, Carreon LY. Comparison of revision surgery for pseudarthrosis with or without adjacent segment disease after anterior cervical discectomy and fusion. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 14:100223. [PMID: 37229209 PMCID: PMC10205481 DOI: 10.1016/j.xnsj.2023.100223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023]
Abstract
Background Patients with a pseudarthrosis after anterior cervical discectomy and fusion (ACDF) may have concurrent adjacent segment disease (ASD). Although prior studies have shown posterior cervical decompression and fusion (PCDF) is effective in repairing pseudarthrosis, improvement in patient reported outcomes (PROs) has been marginal. The aim of this study is to evaluate the effectiveness of PCDF in achieving symptom relief in patients with pseudarthrosis after ACDF and whether that is altered by the additional treatment of ASD. Methods Thirty-two patients with pseudarthrosis were compared with 31 patients with pseudarthrosis and concurrent ASD after ACDF who underwent revision PCDF with a minimum 1-year follow-up. Primary outcomes measures included the neck disability index (NDI), and numerical rating scale (NRS) scores for neck and arm pain. Secondary measures included estimated blood loss (EBL), operating room (OR) time, and length of stay. Results Demographics between cohorts were similar, however there was a significantly higher mean body mass index (BMI) in the group with concurrent ASD (32.23 vs. 27.76, p=.007). Patients with concurrent ASD had more levels fused during PCDF (3.7 vs. 1.9, p<.001), greater EBL (165 cc vs. 106 cc, p=.054), and longer OR time (256 minutes vs. 202 minutes, p<.000). Preoperative PROs for NDI (56.7 vs. 56.5, p=.954), NRS arm pain (5.9 vs. 5.7, p=.758), and NRS neck pain (6.6 vs. 6.8, p=.726) were similar in both cohorts. At 12 months patients with concurrent ASD experienced a slightly greater, but not statistically significant, improvement in PROs (Δ NDI 4.40 vs. -1.44, Δ NRS neck pain 1.17 vs. 0.42, Δ NRS arm pain 1.28 vs. 0.10, p=.107). Conclusions PCDF is a standard procedure for treatment of pseudarthrosis following ACDF, however improvements in PROs are marginal. Slightly greater improvements were seen in patients whose indication for surgery also included concurrent ASD, rather than a diagnosis of pseudarthrosis alone.
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Affiliation(s)
| | | | | | | | | | - Leah Y. Carreon
- Corresponding author. Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY 40202, USA. Tel.: (502) 584-7525; fax: (502) 589-0849.
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27
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Oezel L, Okano I, Jones C, Salzmann SN, Shue J, Adl Amini D, Moser M, Chiapparelli E, Sama AA, Carrino JA, Cammisa FP, Girardi FP, Hughes AP. MRI-based vertebral bone quality score compared to quantitative computed tomography bone mineral density in patients undergoing cervical spinal surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1636-1643. [PMID: 36882579 DOI: 10.1007/s00586-023-07570-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE The vertebral bone quality (VBQ) score based on magnetic resonance imaging (MRI) was introduced as a bone quality marker in the lumbar spine. Prior studies showed that it could be utilized as a predictor of osteoporotic fracture or complications after instrumented spine surgery. The objective of this study was to evaluate the correlation between VBQ scores and bone mineral density (BMD) measured by quantitative computer tomography (QCT) in the cervical spine. METHODS Preoperative cervical CT and sagittal T1-weighted MRIs from patients undergoing ACDF were retrospectively reviewed and included. The VBQ score in each cervical level was calculated by dividing the signal intensity of the vertebral body by the signal intensity of the cerebrospinal fluid on midsagittal T1-weighted MRI images and correlated with QCT measurements of the C2-T1 vertebral bodies. A total of 102 patients (37.3% female) were included. RESULTS VBQ values of C2-T1 vertebrae strongly correlated with each other. C2 showed the highest VBQ value [Median (range) 2.33 (1.33, 4.23)] and T1 showed the lowest VBQ value [Median (range) 1.64 (0.81, 3.88)]. There was significant weak to moderate negative correlations between and VBQ Scores for all levels [C2: p < 0.001; C3: p < 0.001; C4: p < 0.001; C5: p < 0.004; C6: p < 0.001; C7: p < 0.025; T1: p < 0.001]. CONCLUSION Our results indicate that cervical VBQ scores may be insufficient in the estimation of BMDs, which might limit their clinical application. Additional studies are recommended to determine the utility of VBQ and QCT BMD to evaluate their potential use as bone status markers.
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Affiliation(s)
- Lisa Oezel
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Ichiro Okano
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Conor Jones
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Stephan N Salzmann
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, Charité University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Spine Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - John A Carrino
- Department of Radiology and Imaging, 535 East 70th Street, New York, NY, 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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El-Hajj VG, Singh A, Blixt S, Edström E, Elmi-Terander A, Gerdhem P. Evolution of Patient-Reported Outcome Measures, 1, 2, and 5 years after Surgery for Subaxial Cervical Spine Fractures, A Nation-Wide Registry Study. Spine J 2023:S1529-9430(23)00175-4. [PMID: 37094774 DOI: 10.1016/j.spinee.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/08/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND CONTEXT A longer duration of patient follow-up arguably provides more reliable data on the long-term effects of a treatment. However, the collection of long-term follow-up data is resource demanding and often complicated by missing data and patients being lost to follow-up. In surgical fixation for cervical spine fractures, data are lacking on the evolution of patient reported outcome measures (PROMs) beyond 1-year of follow-up. We hypothesized that the PROMs would remain stable beyond the 1-year postoperative follow-up mark, regardless of the surgical approach. PURPOSE To assess the trends in the evolution of patient-reported outcome measures (PROMs) at 1, 2-, and 5-years following surgery in patients with traumatic cervical spine injuries. STUDY DESIGN Nation-wide observational study on prospectively collected data. PATIENT SAMPLE Individuals treated for subaxial cervical spine fractures with anterior, posterior, or combined anteroposterior approaches, between 2006 and 2016 were identified in the Swedish Spine Registry (Swespine). OUTCOME MEASURES PROMs consisting of EQ-5D-3Lindex and the Neck Disability Index (NDI) were considered. METHODS PROMs data were available for 292 patients at 1 and 2 years postoperatively. Five-years PROMs data were available for 142 of these patients. A simultaneous within-group (longitudinal) and between group (approach-dependent) analysis was performed using mixed ANOVA. The predictive ability of 1-year PROMs was subsequently assessed using linear regression. RESULTS Mixed ANOVA revealed that PROMs remained stable from 1- to 2-years as well as from 2- to 5-years postoperatively and were not affected by the surgical approach (p<0.05). A strong correlation was found between 1-year and both 2- and 5-years PROMs (R>0.7; p<0.001). Linear regression confirmed the accuracy of 1-year PROMs in predicting both 2- and 5-years PROMs (p<0.001). CONCLUSION PROMs remained stable beyond 1-year of follow-up in patients treated with anterior, posterior, or combined anteroposterior surgeries for subaxial cervical spine fractures. The 1-year PROMs were strong predictors of PROMs measured at 2, and 5 years. The 1-year PROMs were sufficient to assess the outcomes of subaxial cervical fixation irrespective of the surgical approach.
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Affiliation(s)
| | - Aman Singh
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden..
| | - Simon Blixt
- Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.; Department of Reconstructive Orthopedics, Karolinska University Hospital, Sweden..
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Spine Center, Löwenströmska Hospital, Stockholm, Sweden..
| | | | - Paul Gerdhem
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.; Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.; Department of Orthopedics and Hand surgery, Uppsala University Hospital, Uppsala, Sweden..
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Tang L, Liu X, Lu Y, Liu Y, Yu J, Zhao J. Clinical and imaging outcomes of self-locking stand-alone cages and anterior cage-with-plate in three-level anterior cervical discectomy and fusion: a retrospective comparative study. J Orthop Surg Res 2023; 18:276. [PMID: 37020306 PMCID: PMC10074675 DOI: 10.1186/s13018-023-03726-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/17/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Anterior cervical discectomy and fusion has been considered standard management for cervical myelopathy and radiculopathy. However, the option of using self-locking stand-alone cages or cage-with-plate in three-level anterior cervical discectomy and fusion still remains controversial. The aim of this study was to evaluate the clinical and imaging outcomes of the two procedures in multilevel anterior cervical discectomy and fusion. METHODS Sixty-seven patients who underwent three-level anterior cervical discectomy and fusion were enrolled in this study, of which 31 patients underwent surgery using self-locking stand-alone cages (group cage) and 36 patients using cage-with-plate (group plate). For the evaluation of clinical outcomes, modified Japanese Orthopedic Association scores, visual analogue scale for neck pain, neck disability index, Odom's criteria and dysphagia status were measured. Imaging outcomes were evaluated by cervical sagittal angle, fusion segmental Cobb's angle, fusion segmental height, range of motion, cage subsidence rate, fusion rate and adjacent segment degeneration. Statistical analyses were performed using the SPSS software (version 19.0). RESULTS Both groups showed improvement in modified Japanese Orthopedic Association scores, visual analogue scale for neck pain and neck disability index, after surgery, and there was no significant difference between the groups. The occurrence rate of dysphagia is significantly lower in the group cage compared with the group plate (p < 0.05). The postoperative cervical sagittal angle, fusion segmental Cobb's angle, fusion segmental height and cage subsidence rate in the group plate were significantly superior to that in the group cage (p < 0.05). However, the rate of adjacent segment degeneration was significantly lower in the group cage compared with the group plate (p < 0.05). Both groups showed no significant difference in terms of fusion rate (p > 0.05). CONCLUSIONS The self-locking stand-alone cages are effective, reliable and safe in anterior cervical discectomy and fusion for the treatment of cervical myelopathy and radiculopathy. Self-locking stand-alone cages showed a significantly lower rate of dysphagia and adjacent segment degeneration, while anterior cervical cage-with-plate could provide stronger postoperative stability and maintain better cervical spine alignment.
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Affiliation(s)
- Liang Tang
- Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China
| | - Xiaoming Liu
- Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China
| | - Yanghu Lu
- Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China
| | - Yanbin Liu
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Road, Shanghai, 200080, China
| | - Jiangming Yu
- Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China.
| | - Jian Zhao
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China.
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Guo L, Wang J, Zhao Z, Li J, Zhao H, Gao Y, Chen C. Microscopic Anterior Cervical Discectomy and Fusion Versus Posterior Percutaneous Endoscopic Cervical Keyhole Foraminotomy for Single-level Unilateral Cervical Radiculopathy: A Systematic Review and Meta-analysis. Clin Spine Surg 2023; 36:59-69. [PMID: 35344521 PMCID: PMC9949523 DOI: 10.1097/bsd.0000000000001327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVE The objective of this study was to compare the safety of microscopic anterior cervical discectomy and fusion (MI-ACDF) and posterior percutaneous endoscopic keyhole foraminotomy (PPEKF) in patients diagnosed with single-level unilateral cervical radiculopathy. SUMMARY OF BACKGROUND DATA After conservative treatment, the symptoms will be relieved in about 90% of cervical radiculopathy patients. For the other one tenth of patients, surgical treatment is needed. The overall complication rate of MI-ACDF and PPEKF ranges from 0% to 25%, and the reoperation rate ranges from 0% to 20%. MATERIALS AND METHODS Electronic retrieval of studies from PubMed, Embase, and Cochrane Library was performed to identify comparative or single-arm studies on MI-ACDF and PPEKF. A total of 24 studies were included in our meta-analysis by screening according to the inclusion and exclusion criteria. After data extraction and quality assessment of the included studies, a meta-analysis was performed by using the R software. The pooled incidences of efficient rate, total complication rate, and reoperation rate were calculated. RESULTS A total of 24 studies with 1345 patients (MI-ACDF: 644, PPEKF: 701) were identified. There was no significantly statistical difference in pooled patient effective rate (MI-ACDF: 94.3% vs. PPEKF: 93.3%, P =0.625), total complication rate (MI-ACDF: 7.1% vs. PPEKF: 4.7%, P =0.198), and reoperation rate (MI-ACDF: 1.8% vs. PPEKF: 1.1%, P =0.312). However, the common complications of the 2 procedures were different. The most common complications of MI-ACDF were dysphagia and vertebral body sinking, whereas the most common complication of PPEKF was nerve root palsy. CONCLUSIONS Both MI-ACDF and PPEKF can provide a relatively safe and reliable treatment for single-level unilateral cervical radiculopathy. The 2 techniques are not significantly different in terms of effective rate, total complication rate, and reoperation rate.
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Affiliation(s)
| | | | | | - Jing Li
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital
| | | | - Yong Gao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Chao Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
- Department of Orthopaedics, Hefeng Central Hospital, Enshi, Hubei Province, China
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Koller H, Stengel FC, Hostettler IC, Koller J, Fekete T, Ferraris L, Hitzl W, Hempfing A. Clinical and surgical results related to anterior-only multilevel cervical decompression and instrumented fusion for degenerative disease. BRAIN & SPINE 2023; 3:101716. [PMID: 37383455 PMCID: PMC10293232 DOI: 10.1016/j.bas.2023.101716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 11/20/2022] [Accepted: 01/20/2023] [Indexed: 06/30/2023]
Abstract
Introduction Anterior-only multilevel cervical decompression and fusion surgery (AMCS) on 3-5-levels is challenging due to potential complications. Also, outcome predictors after AMCS are poorly understood. Research Question We hypothesize that in patients with at most mild/moderate cervical kyphosis (CK) of the cervical spine, restoration of cervical lordosis (CL) positively influences clinical outcomes. Methods Analysis of consecutive patients presenting with symptomatic degenerative cervical disease or non-union undergoing AMCS. We measured CL from C2 to C7, Cobb angle of fused levels (fusion angle, FA), C7-Slope, and sagittal vertical axis C2-7 (cSVA, stratified into ≤4cm∖>4cm). Patients with excellent outcome were grouped in BEST-outcomes and with moderate/poor outcomes in WORST-outcomes. Results We included 244 patients. Fifty-four percent had 3-, 39% 4-level and 7% had 5-level fusion. At mean follow-up of 26 months, 41% of patients achieved BEST-outcome and 23% WORST-outcome. Complications and reoperation rates did not significantly differ. Non-union significantly influenced outcomes. The number of patients with non-union was significantly higher in patients with a preoperative cSVA>4cm (OR 13.1 (95%CI:1.8-96.8). Our model, based on the multivariable analysis with WORST-outcome as outcome variable showed a high accuracy (NPV=73%, PPV=77%, specificity=79%, sensitivity=71%). Discussion and Conclusion In 3-5-level AMCS, improvement of FA and cSVA were independent predictors of clinical outcome. Improvement of CL positively influenced clinical outcomes and rates of non-union.
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Affiliation(s)
- Heiko Koller
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Department for Traumatology and Sports Injuries, Paracelsus Medical University Salzburg, Austria
| | - Felix C. Stengel
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Isabel C. Hostettler
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Juliane Koller
- Department for Orthopedic Surgery, Schoen Clinic Vogtareuth, Vogtareuth, Germany
| | - Tamas Fekete
- Department for Spine Surgery, Schulthess Clinic Zurich, Zurich, Switzerland
| | - Luis Ferraris
- Spine Center, Werner-Wicker-Clinic, Bad Wildungen, Germany
| | - Wolfgang Hitzl
- Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
| | - Axel Hempfing
- Department for Orthopedic Surgery, Schoen Clinic Vogtareuth, Vogtareuth, Germany
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Ryu S, Ryu DS, Kim KS. Long-term results comparison after anterior cervical discectomy with BGS-7 spacer (NOVOMAX®-C) and allograft spacer: A prospective observational study. Front Bioeng Biotechnol 2023; 11:1100462. [PMID: 37152650 PMCID: PMC10154694 DOI: 10.3389/fbioe.2023.1100462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/06/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction: In an anterior cervical discectomy and fusion (ACDF), various types of graft materials including autograft, allograft, and synthetic graft have been used to achieve adequate spinal fusion. Allograft spacer is mainly used in cervical fusion, especially in the anterior approach. The synthetic bone graft material BGS-7(CaO-SiO2-P2O5-B2O3, bioactive Glass-Ceramics) can bind with surrounding bone tissue by forming a hydroxyapatite layer bone bridge, leading to faster graft osseointegration. This study was conducted to compare long-term clinical outcome of BGS-7 spacer and allograft spacer for anterior cervical discectomy and fusion surgery. Materials and Methods: From September 2014 to December 2016, Consecutive anterior cervical discectomy and fusion surgeries using a BGS-7 spacer (N = 18) and Allograft spacer (N = 26) were compared for postoperative clinical outcomes. Radiologic assessments were performed, and Instrumental failure, including breakage, cage migration, subsidence were observed and Fusion status were analyzed. Finite element analysis was performed for simulating mechanical stress between the vertebral body and implant. Clinical outcomes were evaluated using neck VAS, NDI, and JOA on the patient's final follow-up visits. Results: Among the 44 patients who underwent an anterior cervical discectomy and fusion surgery using the BGS-7 spacer and Allograft spacer, there were 30 men and 14 women. The average age at the operation was 47.69 ± 10.49 in allograft spacer and 51.67 ± 11.03 in BGS-7 spacer. The mean follow-up period was 89.18 ± 5.44 months. Twenty three (88.46%) patients in allograft spacer and 20(100%) patients in BGS-7 spacer were demonstrated radiologic evidence of interbody fusion in last OPD, which accounts for fusion grade 4 or 5. Peak stresses were 343.85 MPa in allograft spacer, and 132.55 MPa in BGS-7 spacer. Long-term clinical outcomes including neck VAS, NDI, and JOA didn't show statistical differences between the two groups. There were no adverse events related to the BGS-7 spacer.10.3389/fbioe.2023.110046. Conclusion: The BGS-7 spacer demonstrated reliability as a spacer in anterior cervical discectomy and fusionF surgery without instrumental failure. Early stabilization with a bony bridge formation was observed at the intermediate follow-up period, and the long-term clinical outcome was favorable at more than 60 months after surgery without any adverse events. Thus, the BGS-7 spacer is a safe and effective alternative to the allograft spacer in anterior cervical discectomy and fusion surgery.
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Affiliation(s)
- Seungjun Ryu
- National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
- Department of Neurosurgery, School of Medicine, Eulji University, Daejeon, Republic of Korea
| | - Dal-Sung Ryu
- School of Medicine, Inha University, Inchon, Republic of Korea
- *Correspondence: Dal-Sung Ryu, ; Keun-Su Kim,
| | - Keun-Su Kim
- Gangnam Severance Hospital, Seoul, Seoul, Republic of Korea
- *Correspondence: Dal-Sung Ryu, ; Keun-Su Kim,
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Park S, Kim JK, Chang MC, Park JJ, Yang JJ, Lee GW. Assessment of Fusion After Anterior Cervical Discectomy and Fusion Using Convolutional Neural Network Algorithm. Spine (Phila Pa 1976) 2022; 47:1645-1650. [PMID: 35905310 DOI: 10.1097/brs.0000000000004439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND A convolutional neural network (CNN) is a deep learning (DL) model specialized for image processing, analysis, and classification. OBJECTIVE In this study, we evaluated whether a CNN model using lateral cervical spine radiographs as input data can help assess fusion after anterior cervical discectomy and fusion (ACDF). STUDY DESIGN Diagnostic imaging study using DL. PATIENT SAMPLE We included 187 patients who underwent ACDF and fusion assessment with postoperative one-year computed tomography and neutral and dynamic lateral cervical spine radiographs. OUTCOME MEASURES The performance of the CNN-based DL algorithm was evaluated in terms of accuracy and area under the curve. MATERIALS AND METHODS Fusion or nonunion was confirmed by cervical spine computed tomography. Among the 187 patients, 69.5% (130 patients) were randomly selected as the training set, and the remaining 30.5% (57 patients) were assigned to the validation set to evaluate model performance. Radiographs of the cervical spine were used as input images to develop a CNN-based DL algorithm. The CNN algorithm used three radiographs (neutral, flexion, and extension) per patient and showed the diagnostic results as fusion (0) or nonunion (1) for each radiograph. By combining the results of the three radiographs, the final decision for a patient was determined to be fusion (fusion ≥2) or nonunion (fusion ≤1). By combining the results of the three radiographs, the final decision for a patient was determined as fusion (fusion ≥2) or nonunion (nonunion ≤1). RESULTS The CNN-based DL model demonstrated an accuracy of 89.5% and an area under the curve of 0.889 (95% confidence interval, 0.793-0.984). CONCLUSION The CNN algorithm for fusion assessment after ACDF trained using lateral cervical radiographs showed a relatively high diagnostic accuracy of 89.5% and is expected to be a useful aid in detecting pseudarthrosis.
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Affiliation(s)
- Sehan Park
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do Province, Republic of Korea
| | - Jeoung Kun Kim
- Department of Business Administration, School of Business, Yeungnam University, Gyeongsan-si, Gyeonggi-do Province, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Gyeongsang Province, Republic of Korea
| | - Jeong Jin Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Gyeongsang Province, Republic of Korea
| | - Jae Jun Yang
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do Province, Republic of Korea
| | - Gun Woo Lee
- Department of Physical Medicine and Rehabilitation, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Gyeongsang Province, Republic of Korea
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Performing the 3-level Anterior Cervical Discectomy and Fusion (ACDF): Technical Pearls to Maximize Fusion Rates and Reduce Postoperative Complications. Clin Spine Surg 2022; 35:447-450. [PMID: 36447349 DOI: 10.1097/bsd.0000000000001409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/30/2022] [Indexed: 12/05/2022]
Abstract
The anterior cervical discectomy and fusion is a common and effective treatment for degenerative cervical myelopathy, either with or without concomitant radiculopathy. In many cases, patients with degenerative cervical spondylosis can present with disease at multiple levels. With each additional level included in the procedure, rates of complication rate can increase-both due to the nature of the anterior cervical approach (dysphagia) as well as fusion across all levels. Here, we review several technical considerations with the goal of increasing efficiency and improving outcomes with the 3-level anterior cervical discectomy and fusion.
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Luoma J, Saarenpää I, Rinne J, Frantzén J, Moritz N, Vallittu PK. Quasi-static loading of glass fiber-reinforced composite cervical fusion cage. J Mech Behav Biomed Mater 2022; 136:105481. [PMID: 36206690 DOI: 10.1016/j.jmbbm.2022.105481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Anterior decompression and fusion in cervical spine has become one of the most common procedures in neurosurgery. In the surgery, cervical cage implants made of different biomaterials are used. Our purpose was to create a cervical cage made of glass fiber-reinforced composite (FRC) filled with bioactive glass particles and to characterize its behavior in quasi-static compression/shear stress loading conditions. MATERIALS AND METHODS FRC cages (n = 6) were manufactured with 2, 4, 6, 8 and 10 layers of glass fiber laminates and thermoset dimethacrylate resin matrix resulting in wall thickness from 0.70 to 2.1 mm. Control cage was a commercial PEEK cage (CeSpaceXP) implant with asymmetrical wall thickness of up 4.0 mm. Interior of the cage was filled with glass particles of the size 500-1250 μm simulating the bioactive glass which are used in FRC cranial implants. The FRC cages were quasi-statically loaded (compressive/shear stress) at a constant speed of 1 mm/min in the air. RESULTS The average yield strength force (YF) of the control PEEK cage was 3483.6 N (±134.3 N). The average YFs for tested FRC cage with 2, 4, 6, 8 and 10 layers of FRC fabric varied from 1336.5 N (±403.8 N) to 7675.0 N (±670.0 N), respectively. The average ultimate forces (UF) for tested FRC cages varied from 1535.8 N (±406.2 N) to 9975.0 N (±1492.4 N). With six layers of FRC fabric, YF of the FRC cage was comparable to the PEEK implants. CONCLUSIONS In this study, it was demonstrated that it is possible to manufacture a cervical interbody fusion device made of FRC and filled with bioactive glass with proper load bearing capacities. Because of physical properties of FRC-bioactive glass, the FRC cage might have some advances compared to the state-of-the-art cages, like faster bony union and smaller rate of subsidence, which will be studied in the future.
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Affiliation(s)
- Jaakko Luoma
- Department of Neurosurgery, Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland.
| | - Ilkka Saarenpää
- Department of Neurosurgery, Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Jaakko Rinne
- Department of Neurosurgery, Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Janek Frantzén
- Department of Neurosurgery, Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Niko Moritz
- Department on Biomaterials Science and Turku Clinical Biomaterials Centre, Institute of Dentistry, University of Turku, Turku, Finland; Biomedical Engineering Research Group, Biomaterials and Medical Device Research Program, Finland
| | - Pekka K Vallittu
- Department on Biomaterials Science and Turku Clinical Biomaterials Centre, Institute of Dentistry, University of Turku, Turku, Finland; City of Turku, Welfare Division, Turku, Finland
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Zhang J, Zhou Q, Yan Y, Ren J, Wei S, Zhu H, Song Z. Efficacy and safety of percutaneous endoscopic cervical discectomy for cervical disc herniation: a systematic review and meta-analysis. J Orthop Surg Res 2022; 17:519. [PMID: 36456964 PMCID: PMC9714009 DOI: 10.1186/s13018-022-03365-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/18/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Since there are currently no systematic evidence-based medical data on the efficacy and safety of PECD, this meta-analysis pooled data from studies that reported the efficacy or safety of PECD for cervical disc herniation to examine the efficacy, recurrence and safety of using PECD to treat cervical disc herniation. METHODS We searched the PubMed, EMBASE and Cochrane Library databases for studies published from inception to July 2022. Nine nonrandomized controlled trials (non-RCTs) that reported the efficacy or safety of percutaneous endoscopic cervical discectomy for cervical disc herniation were included. We excluded duplicate publications, studies without full text, studies with incomplete information, studies that did not enable us to conduct data extraction, animal experiments and reviews. STATA 15.1 software was used to analyse the data. RESULTS The proportions of excellent and good treatment results after PECD for CDH were 39% (95% CI: 31-48%) and 47% (95% CI: 34-59%), respectively. The pooled results showed that the VAS scores at 1 week post-operatively (SMD = -2.55, 95% CI: - 3.25 to - 1.85) and at the last follow-up (SMD = - 4.30, 95% CI: - 5.61 to - 3.00) after PECD for cervical disc herniation were significantly lower than the pre-operative scores. The recurrence rate of neck pain and the incidence of adverse events after PECD for cervical disc herniation were 3% (95% CI: 1-6%) and 5% (95% CI: 2-9%), respectively. Additionally, pooled results show that the operative time (SMD = - 3.22, 95% CI: - 5.21 to - 1.43) and hospital stay (SMD = - 1.75, 95% CI: - 2.67to - 0.84) were all significantly lower for PECD than for ACDF. The pooled results also showed that the proportion of excellent treatment results was significantly higher for PECD than for ACDF (OR = 2.29, 95% CI: 1.06-4.96). CONCLUSION PECD has a high success rate in the treatment of CHD and can relieve neck pain, and the recurrence rate and the incidence of adverse events are low. In addition, compared with ACDF, PECD has a higher rate of excellent outcomes and a lower operative time and hospital stay. PECD may be a better option for treating CHD.
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Affiliation(s)
- Jinjie Zhang
- grid.417400.60000 0004 1799 0055The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Post and Telegraph Road Uptown, Hangzhou, 310000 China
| | - Qiujun Zhou
- grid.268505.c0000 0000 8744 8924Department of First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310000 China
| | - Yan Yan
- grid.24695.3c0000 0001 1431 9176The Third Affiliated Hospital of Beijing University of Chinese Medicine, No. 51 Anwai Xiaoguanjie, Chaoyang District, Beijing, 100029 China
| | - Jianlei Ren
- grid.417400.60000 0004 1799 0055The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Post and Telegraph Road Uptown, Hangzhou, 310000 China
| | - Shenyu Wei
- grid.412465.0Department of Hepato-Pancreato-Biliary Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310000 China
| | - Haijia Zhu
- grid.507982.10000 0004 1758 1016Hangzhou Children’s Hospital, Hangzhou, 310000 China
| | - Zhoufeng Song
- grid.417400.60000 0004 1799 0055The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Post and Telegraph Road Uptown, Hangzhou, 310000 China
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Endplate-specific fusion rate 1 year after surgery for two-level anterior cervical discectomy and fusion(ACDF). Acta Neurochir (Wien) 2022; 164:3173-3180. [PMID: 36251069 DOI: 10.1007/s00701-022-05377-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/20/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a retrospective study. OBJECTIVE Implant nonfusion is an important prognostic factor for patients after anterior cervical discectomy and fusion (ACDF). This study aimed to investigate endplate-specific pseudarthrosis after ACDF, to determine if the rate of fusion is inferior in the lower endplate, and to identify any differences in clinical and radiological results. Research comparing each endplate on which the endplate affects nonfusion is limited. METHODS We analyzed 71 patients with 142 total spinal levels who underwent double-level ACDF (C4-5-6 and C5-6-7) with an allograft and plate at our hospital between January 2012 and December 2018. Fusion grades were assessed using computed tomography and the Bridwell fusion grade system at 1 year postoperatively. Radiological parameters were obtained from lateral cervical radiographs collected preoperatively and at 1 month and 1 year after surgery. RESULTS There was no difference in fusion between the C4-5-6 and C5-6-7 ACDF procedures, but the fusion rate and Bridwell fusion grade at the caudal surgery level were lower than those at the cranial surgery level (93 vs. 79%, p < 0.001). The lower endplate of the caudal fusion level showed the most common pseudarthrosis (18 of 71 [25%]). There was no difference in radiological parameters and clinical outcomes between the fusion and pseudarthrosis groups. CONCLUSION In double-level ACDF procedures, the nonfusion rate was higher at the caudal fusion levels, especially at the lower endplates of the caudal fusion levels.
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Kumar V, Patel S, Sharma S, Kumar R, Kaur R. Fifty Years of Cervical Myelopathy Research: Results from a Bibliometric Analysis. Asian Spine J 2022; 16:983-994. [PMID: 35065547 PMCID: PMC9827216 DOI: 10.31616/asj.2021.0239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/06/2021] [Indexed: 01/11/2023] Open
Abstract
We performed bibliometric analysis of the research papers published on clinical cervical spondylotic myelopathy (CSM) in the last 50 years. We extracted bibliometric data from Scopus and PubMed from 1970 to 2020 pertaining to clinical studies of CSM. The predominant journals, top cited articles, authors, and countries were identified using performance analysis. Science mapping was also performed to reveal the emerging trends, and conceptual and social structures of the authors and countries. Bibliometrix R-package was deployed for the study. The total numbers of clinical studies available in PubMed and Scopus were 1,302 and 3,470, respectively. The most cited article was published by Hilibrand AS, as observed in Scopus. Regarding the conceptual structure of the research, two main research themes were identified, one involving symptomatology, scientific-scale-based objective evaluation of symptoms, and surgical removal of the offending culprit, while the other was based on patho-etiology, relevant diagnostic modalities, and the surgery commonly performed for CSM. In terms of emerging trends, in recent times there is an increasing trend of scale-based objective evaluations, along with investigations of advanced nonoperative management. The United States is the most productive country, whereas Canada tops the list for inter-country collaboration. The trend of research showed a shift toward noninvasive procedures.
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Affiliation(s)
- Vishal Kumar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Patel
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Siddhartha Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Kumar
- CSIR-Central Scientific Instruments Organisation, Chandigarh, India,Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Rishemjit Kaur
- CSIR-Central Scientific Instruments Organisation, Chandigarh, India,Academy of Scientific and Innovative Research, Ghaziabad, India
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Is the Zero-P Spacer Suitable for 3-Level Anterior Cervical Discectomy and Fusion Surgery in Terms of Sagittal Alignment Reconstruction: A Comparison Study with Traditional Plate and Cage System. Brain Sci 2022; 12:brainsci12111583. [PMID: 36421907 PMCID: PMC9688593 DOI: 10.3390/brainsci12111583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
The Zero-P spacer was primarily developed aiming to reduce the morbidity associated with the traditional anterior cervical plate. During the past decade, many authors have reported the use of Zero-P spacers for anterior cervical discectomy and fusion (ACDF) of one or two segments. Nevertheless, there is still a paucity of knowledge on the safety and feasibility of using Zero-P spacers for 3-level fixation. The objective of this study was to investigate the clinical and radiological outcomes, with a focus on the sagittal alignment reconstruction of 3-level ACDF surgery using Zero-P spacers versus those using a traditional plate and cage system. From Sep 2013 to Aug 2016, a total of 44 patients who received 3-level ACDF surgery due to cervical spondylotic myelopathy were recruited. The Zero-P spacer was used in 23 patients (group ZP) and the traditional plate and cage system in 21 (group PC). Clinical outcomes were analyzed by Neck Disability Index (NDI) and Japanese Orthopedic Association (JOA) scores, and dysphagia was evaluated using the Bazaz score. Radiological outcomes, including fusion rate, adjacent segment degeneration (ASD), and especially changes in cervical sagittal alignment, were analyzed. The NDI and JOA scores did not differ significantly between the two groups postoperatively (p > 0.05); however, there was significantly less dysphagia in patients using Zero-P spacers at the 3- and 6-month follow-up (p < 0.05). At the 24-month follow-up, the fusion rate and ASD were similar between the two groups (p > 0.05). Interestingly, patients using Zero-P spacers had a significantly lower postoperative C2-7 Cobb angle and fused segment Cobb angle, compared to those using a traditional plate and cage system (p < 0.05); meanwhile, the fused segment disc wedge was also found to be significantly smaller in patients using Zero-P spacers after surgery (p < 0.05). Moreover, we further divided patients into subgroups according to their cervical lordosis. In patients with a preoperative C2-7 Cobb angle ≤ 10°, significantly less cervical and local lordosis, as well as disc wedge, were seen in group ZP after surgery (p < 0.05), while in others with a preoperative C2-7 Cobb angle > 10°, no significant difference in postoperative changes of the cervical sagittal alignment was seen between group ZP and group PC (p > 0.05). Zero-P spacers used in 3-level ACDF surgery could provide equivalent clinical outcomes and a lower rate of postoperative dysphagia, compared to the traditional plate and cage system. However, our results showed that it was inferior to the cervical plate in terms of sagittal alignment reconstruction for 3-level fixation. We recommend applying Zero-P spacers for 3-level ACDF in patients with good preoperative cervical lordosis (C2-7 Cobb angle > 10°), in order to restore and maintain physiological curvature of the cervical spine postoperatively.
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40
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Wang X, Lin Y, Wang Q, Gao L, Feng F. A Bibliometric Analysis of the Top 100 Cited Articles in Anterior Cervical Discectomy and Fusion. J Pain Res 2022; 15:3137-3156. [PMID: 36311292 PMCID: PMC9604433 DOI: 10.2147/jpr.s375720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/23/2022] [Indexed: 11/23/2022] Open
Abstract
Study design A bibliometric analysis. Objective To identify and analyze the top 100 cited articles in anterior cervical discectomy and fusion. Summary of Background Data Anterior cervical discectomy and fusion (ACDF) is one of the most routine surgical procedures in spine surgery. Many surgeons and academics have researched ACDF thoroughly and published numerous articles. However, there is no relevant bibliometric analysis. Therefore, our study aims to identify and analyze the top 100 cited articles in ACDF to identify the research trends. Methods We searched the Web of Science (WOS) Core Collection database with restrictions and identified the top 100 cited publications in ACDF for analysis. Results The citation counts of the top 100 cited publications ranged from 37 to 361 (mean 67.42). All studies were published between 2008 and 2019, with 2013 and 2015 the most prolific years. The journals Spine and Journal of Neurosurgery-Spine provided the majority of the articles. Overall, the 100 articles came from 12 countries, with the United States being the top producer, followed by China and South Korea. The most frequent keywords were "spine", "anterior cervical discectomy and fusion", "interbody fusion", 'arthrodesis', "follow-up", "decompression", and "ACDF". Conclusion ACDF has been regarded as a classical gold standard in anterior cervical surgery, and the emergence of new surgical procedures has not affected its status. Cervical disc arthroplasty still needs further research and development. As the first bibliometric analysis of ACDF, this bibliometric study is meant to provide guidance for clinicians and scholars to research the development trend of this field.
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Affiliation(s)
- Xun Wang
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang310053, People’s Republic of China
| | - Yanze Lin
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang310053, People’s Republic of China
| | - Qiongtai Wang
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang310053, People’s Republic of China
| | - Liqing Gao
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang310053, People’s Republic of China
| | - Fabo Feng
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China,Correspondence: Fabo Feng, Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China, Email
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Zhang J, Wang S, Tang X, Xiong W, Wu H, Liu C, Li F. Clinical and radiological comparison of the zero-profile anchored cage and traditional cage-plate fixation in single-level anterior cervical discectomy and fusion. Eur J Med Res 2022; 27:189. [PMID: 36175990 PMCID: PMC9523971 DOI: 10.1186/s40001-022-00813-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the clinical outcomes and radiographic parameters of the zero-profile anchored cage and traditional cage-plate fixation in single-level anterior cervical discectomy and fusion (ACDF). METHODS Between January 2016 and November 2018, a total of 68 patients with degenerative cervical spondylosis who underwent single-level ACDF were evaluated in this retrospective study. Thirty-five patients were treated with the zero-profile anchored cage (Zero-P group), and 33 patients were treated with the traditional cage-plate fixation (Cage group). The two groups were compared in reference to clinical outcomes and radiographic parameters. RESULTS The mean operation time in the Zero-P group was significantly shorter than that in the Cage group. The incidence of postoperative dysphagia in the Cage group was higher than that in the Zero-P group at 3 months and 12 months postoperatively. No bony spurs were found in the Zero-P group, whereas 5 patients in the Cage group developed bony spurs. There were no statistically significant differences between the two groups in the JOA scores, VAS scores, NDI scores, C2-7 Cobb angles, segmental Cobb angles, total interbody height or fusion rates at 3 months or 12 months postoperatively. CONCLUSION In this study, both the zero-profile anchored cage and traditional cage-plate fixation were demonstrated to be effective and safe strategies. Given the lower incidence of dysphagia and degenerative changes, zero-profile anchored cage is a good option.
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Affiliation(s)
- Jun Zhang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China.,Department of Orthopedics, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Xichang Road 295, Kunming, 650000, People's Republic of China
| | - Shanxi Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Xiangyu Tang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Wei Xiong
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Hua Wu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Chaoxu Liu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China.
| | - Feng Li
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China.
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Zhong G, Feng F, Su X, Chen X, Zhao J, Shen H, Chen J, Lao L. Minimally Invasive
Full‐endoscopic
Posterior Cervical Foraminotomy and Discectomy: Introducing a Simple and Useful Localization Technique of the “V” Point. Orthop Surg 2022; 14:2625-2632. [PMID: 36102205 PMCID: PMC9531083 DOI: 10.1111/os.13476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Conventional localization technique of V point for full‐endoscopic posterior cervical foraminotomy and discectomy (FPCD) required repeated fluoroscopies, especially in patients with short and thick necks. To address this issue, the present study aimed to introduce a new localization technique of V point, and further evaluate its efficacy. Methods A K‐wire was inserted and fixed at the pedicle eye under A/P fluoroscopy, then a working channel was established quickly along with it. Thirty‐four patients who underwent minimally invasive FPCD assisted by the new technique were included in this study. The clinical and radiological data were collected and analyzed, including radiation dose, operative time, positioning time, visual analog scale (VAS) for neck and arm pain, neck disability index (NDI) scores, Cobb angle of operative level and range of motion of the cervical spine. Results All operations were performed successfully, and no iatrogenic nerve or vascular injury occurred. None of the patients needed to be transferred to open surgery or revision surgery. The mean radiation dose was found to be1.68 ± 0.36 mSv. The mean positioning time observed was 10.68 ± 5.42 min and the average operation time was 81.18 ± 10.87 min. The operation time significantly declined as the number of patients increased. A significant difference in operation time between the first (96.22 ± 10.36 min) and last quartile (75.00 ± 3.84 min) of cases was observed (t = 4.82, P < 0.001). The VAS scores for neck and arm pain, and NDI scores were significantly improved after surgery (PVAS−Neck<0.0001, PVAS−Arm<0.0001, PNDI<0.0001). Based on MacNab criteria, the excellent plus good rate was 91.17%. The Cobb angle of operative level and range of motion of the cervical spine were significantly improved postoperatively (t = 2.846, POA = 0.015; t = 2.232, PROM−CA = 0.026). Conclusion The new image‐assisted V point localization technique is simple and useful with little radiation exposure and short positioning time. FPCD assisted by the new technique could be a safe and effective alternative on properly selected patients.
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Affiliation(s)
- Guibin Zhong
- Department of Orthopedics Baoshan Branch Ren Ji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
- Department of Spine Surgery, Department of Orthopaedics Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Fan Feng
- Department of Spine Surgery, Department of Orthopaedics Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Xinjin Su
- Department of Spine Surgery, Department of Orthopaedics Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Xiuyuan Chen
- Department of Spine Surgery, Department of Orthopaedics Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Junduo Zhao
- Department of Spine Surgery, Department of Orthopaedics Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Hongxing Shen
- Department of Spine Surgery, Department of Orthopaedics Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Jianwei Chen
- Department of Spine Surgery, Department of Orthopaedics Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Lifeng Lao
- Department of Spine Surgery, Department of Orthopaedics Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
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Huang K, Liu H, Wang B, Wu T, Ding C, He J, Meng Y, Wang H, Hong Y. Cervical disc arthroplasty combined with two-level ACDF for the treatment of contiguous three-level cervical degenerative disc disease: A comparative study. J Orthop Res 2022; 41:1105-1114. [PMID: 36058620 DOI: 10.1002/jor.25436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/05/2022] [Accepted: 08/29/2022] [Indexed: 02/04/2023]
Abstract
To compare the differences among constructs with one-level cervical disc arthroplasty (CDA) and two-level anterior cervical discectomy and fusion (ACDF). A retrospective study was conducted involving patients who underwent one-level CDA and two-level ACDF between June 2012 and July 2020. According to the different locations of CDA and ACDF, we divided the constructs into three types: type Ⅰa: CDA-ACDF-ACDF; type Ⅰb: ACDF-CDA-ACDF; type Ⅰc: ACDF-ACDF-CDA. The differences of clinical and radiological outcomes were evaluated. Fifty-three patients were included with 29 in type Ⅰa group, 11 in type Ⅰb group, and 13 in type Ⅰc group. After surgery, all groups showed significant improvement in apanese Orthopedic Association, Neck Disability Index, and Visual Analog Scale scores (p < 0.001). Range of motion (ROM) of the total cervical spine in type Ⅰc group decreased significantly compared with those in type Ⅰa and type Ⅰb groups (p < 0.05). No significant differences in ROM of the arthroplasty segment and the variations in ROM of the superior adjacent segment were observed among the three groups. The fusion rates of the superior ACDF segments were significantly higher at 6 and 12 months postoperatively than those of the inferior ACDF segments (p < 0.05). The clinical outcomes were similar among constructs concerning different locations of CDA and ACDF in three-level hybrid surgery. ROM of the cervical spine in type Ⅰc group decreased significantly compared with that in type Ⅰa and type Ⅰb groups. The fusion rates of superior ACDF segments were higher at early time points after surgery than those of inferior ACDF segments.
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Affiliation(s)
- Kangkang Huang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hao Liu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Beiyu Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tingkui Wu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chen Ding
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Junbo He
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yang Meng
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Han Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying Hong
- Department of Operation Room, Sichuan University, West China Hospital, Chengdu, Sichuan, China.,West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
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Maki Y, Kawasaki T, Nakajima K, Takayama M. Pathological Examination of Radiologically Fused Interbody Tissue Five Years After Anterior Cervical Discectomy and Fusion Using the Titanium Cage System: A Report of Two Cases. Cureus 2022; 14:e28059. [PMID: 36134104 PMCID: PMC9481214 DOI: 10.7759/cureus.28059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
This case report aimed to identify potential relationships between pathological and radiological assessments of bony fusion after anterior cervical discectomy and fusion (ACDF). ACDF can resolve neurological symptoms related to cervical spondylosis, such as myelopathy and radiculopathy. Intervertebral bony fusion is a key outcome for successful ACDF, often assessed on radiography and computed tomography (CT) images. However, the pathological findings of tissues demonstrating bony fusion after ACDF have not been well studied. This report presents the cases of two female patients, aged 62 and 40 years, who underwent additional ACDFs for recurrent cervical radiculopathy. Findings from CT imaging identified intervertebral calcification in the titanium spacers placed in the first ACDF. In both cases, recurrent compression of nerve roots was observed radiologically. Cervical nerve root block identified habitual symptoms related to recurrent radiculopathy. To resolve the clinical symptoms, additional ACDFs were performed in two cases. In the second ACDF, the titanium cases from the prior ACDF were removed. Histopathological examination of the tissues from the removed cages revealed growth of cartilage tissue. This is the first report concerning the histopathological evaluation of the tissue in titanium spacers placed in ACDF. Completion of intervertebral calcification in titanium spacers placed in ACDF may not signify completion of intervertebral bony fusion after ACDF.
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45
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Bakare AA, Smitherman AD, Fontes RBV, O'Toole JE, Deutsch H, Traynelis VC. Comparison of Fusion vs Nonunion After 4-Level and 5-Level Anterior Cervical Diskectomy and Fusion With Anterior Plate Fixation. Neurosurgery 2022; 91:764-774. [PMID: 35951736 DOI: 10.1227/neu.0000000000002108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/12/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Nonunion remains a concern in multilevel anterior cervical discectomy and fusion (ACDF), yet there are limited data on nonunion after 4 to 5-level ACDF. In fact, the largest series on 4-level or 5-level ACDF focused specifically on the swallowing outcomes. OBJECTIVE To assess nonunion after 4 to 5-level ACDF. METHODS Forty-one patients treated with 4 to 5-level ACDF with minimum of 12-month radiographic follow-up were retrospectively reviewed. Nonunion was found in 25 patients (61%) and 42 levels (25%) and complete fusion in 16 (39%) patients and 126 levels (75%). The 2 groups were further compared. RESULTS One-level nonunion was by far the most common pattern compared with multilevel nonunion. Nonunion occurred more frequently at the caudal than the cranial or middle segments (P < .0001). There were significantly more subsidence (P < .0001) and screw fractures/pullouts (P < .0001) in the nonunion compared with the fusion group. The symptomatic patients were significantly younger than the asymptomatic patients (P = .044). The symptomatic levels were significantly more than asymptomatic levels (P = .048). Equal proportion of patients implanted with allograft and polyetheretherketone had nonunion. However, there were markedly more nonunion than fused levels with allograft and more fused than nonunion levels with polyetheretherketone (P = .023). The reoperation rate was 24.4% and mostly due to nonunion. There were no reoperations within 90 days of the primary surgery. CONCLUSION The nonunion rate for 4-level and 5-level ACDF may be higher than previously reported. Symptomatic nonunion remains a major reason for reoperation after multilevel ACDF. Baseline characteristics that negatively affect fusion may be obviated by careful patient selection.
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Affiliation(s)
- Adewale A Bakare
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Adam D Smitherman
- Baxter Regional Neurosurgery & Spine Clinic, Mountain Home, Arkansas, USA
| | - Ricardo B V Fontes
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - John E O'Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Harel Deutsch
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Vincent C Traynelis
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
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Balouch E, Burapachaisri A, Woo D, Norris Z, Segar A, Ayres EW, Vasquez-Montes D, Buckland AJ, Razi A, Smith ML, Protopsaltis TS, Kim YH. Assessing Postoperative Pseudarthrosis in Anterior Cervical Discectomy and Fusion (ACDF) on Dynamic Radiographs Using Novel Angular Measurements. Spine (Phila Pa 1976) 2022; 47:1151-1156. [PMID: 35853174 DOI: 10.1097/brs.0000000000004375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/28/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective review of operative patients at a single institution. OBJECTIVE The aim was to validate a novel method of detecting pseudarthrosis on dynamic radiographs. SUMMARY OF BACKGROUND DATA A common complication after anterior cervical discectomy and fusion is pseudarthrosis. A previously published method for detecting pseudarthrosis identifies a 1 mm difference in interspinous motion (ISM), which requires calibration of images and relies on anatomic landmarks difficult to visualize. An alternative is to use angles between spinous processes, which does not require calibration and relies on more visible landmarks. MATERIALS AND METHODS ISM was measured on dynamic radiographs using the previously published linear method and new angular method. Angles were defined by lines from screw heads to dorsal points of spinous processes. Angular cutoff for fusion was calculated using a regression equation correlating linear and angular measures, based on the 1 mm linear cutoff. Pseudarthrosis was assessed with both cutoffs. Sensitivity, specificity, inter-reliability and intrareliability of angular and linear measures used postoperative computed tomography (CT) as the reference. RESULTS A total of 242 fused levels (81 allograft, 84 polyetheretherketone, 40 titanium, 37 standalone cages) were measured in 143 patients (mean age 52.0±11.5, 42%F). 36 patients (66 levels) had 1-year postoperative CTs; 13 patients (13 levels) had confirmed pseudarthrosis. Linear and angular measurements closely correlated ( R =0.872), with 2.3° corresponding to 1 mm linear ISM. Potential pseudarthroses was found in 28.0% and 18.5% levels using linear and angular cutoffs, respectively. Linear cutoff had 85% sensitivity, 87% specificity; angular cutoff had 85% sensitivity, 96% specificity for detecting CT-validated pseudarthrosis. Interclass correlation coefficients were 0.974 and 0.986 (both P <0.001); intrarater reliability averaged 0.953 and 0.974 ( P <0.001 for all) for linear and angular methods, respectively. CONCLUSIONS The angular measure for assessing potential pseudarthrosis is as sensitive as and more specific than published linear methods, has high interobserver reliability, and can be used without image calibration. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Eaman Balouch
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
| | | | - Dainn Woo
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
| | - Zoe Norris
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
| | - Anand Segar
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
| | - Ethan W Ayres
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
| | | | - Aaron J Buckland
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
- Melbourne Orthopaedic Group, Melbourne Australia
- Spine and Scoliosis Research Associates, Melbourne Australia
| | | | | | | | - Yong H Kim
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
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Jung SB, Kim N. Biportal endoscopic spine surgery for cervical disk herniation: A technical notes and preliminary report. Medicine (Baltimore) 2022; 101:e29751. [PMID: 35801784 PMCID: PMC9259155 DOI: 10.1097/md.0000000000029751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Biportal endoscopic spine surgery (BESS) for cervical disk herniation (CDH) has been rarely reported. The aim of the article is to describe a novel BESS as a posterior approach for CDH and report the preliminary outcomes and complications. This single-centered retrospective chart review included 109 consecutive patients who underwent BESS for symptomatic single-level CDH. Working and viewing portals were created in each unilateral paravertebral area at the target disk level. Endoscopic exploration allowed for effective and minimally invasive decompression via safe access to the medial foramen with minimal laminectomy and facetectomy. Clinical outcomes, including the visual analog scale, neck disability index, Macnab criteria, and the motor function of the involved arm, were evaluated at 4, 8, 12, and 24 postoperative weeks. Visual analog scale and neck disability index improved significantly at 24 weeks postoperatively (P < .01). According to the Macnab criteria, "excellent," "good," and "fair" results were obtained for 55.9%, 30.3%, and 13.8% of patients, respectively. The post 24-week distribution of the involved upper extremity strength grade was significantly improved compared to the initial value (P = .02). One patient had a motor weakness with a decreased grade over 4 weeks from excessive irrigation. The posterior approach of BESS was efficient and feasible for the treatment of CDH.
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Affiliation(s)
- Seok Bong Jung
- Spine Center, Jinju Bon Hospital, Jinju-si, Gyeongsangnam-do, Republic of Korea
| | - Nackhwan Kim
- Department of Physical Medicine and Rehabilitation, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, Republic of Korea
- *Correspondence: Nackhwan Kim, Department of Physical Medicine and Rehabilitation, Korea University Ansan Hospital, 15355, Jeokgeum-Ro 123, Danwon-gu, Ansan-si, Gyeonggi-do, Republic of Korea (e-mail: )
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Padhye K, Shultz P, Alcala C, Mehbod A, Garvey T, Schwender J, Dawson JM, Transfeldt E. Surgical Treatment of Single Level Cervical Radiculopathy: A Comparison of Anterior Cervical Decompression and Fusion (ACDF) Versus Cervical Disk Arthroplasty (CDA) Versus Posterior Cervical Foraminotomy (PCF). Clin Spine Surg 2022; 35:149-154. [PMID: 35351839 DOI: 10.1097/bsd.0000000000001316] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/01/2022] [Indexed: 01/06/2023]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The objective of this study is to retrospectively compare the clinical outcomes, complication rates, and reoperation rates among the 4 treatments in patients with cervical radiculopathy. SUMMARY OF BACKGROUND DATA Surgical options for cervical radiculopathy include anterior cervical discectomy and fusion (ACDF), open posterior cervical foraminotomy (O-PCF), minimally invasive posterior cervical foraminotomy (MI-PCF), and cervical disk arthroplasty (CDA). MATERIALS AND METHODS Retrospective chart review after Review Board approval. Of the 384 patients in the study-257 ACDF, 18 O-PCF, 52 MI-PCF, and 56 CDA. Information was obtained from the charts and compared between the groups. PATIENT SAMPLE Patients above 18 years of age with single-level, unilateral cervical radiculopathy correlating with magnetic resonance imaging, failure of nonoperative management, and 1-level ACDF, O-PCF, MI-PCF, or CDA with >24 months of follow-up. OUTCOME MEASURES Neck Disability Index (NDI), Visual Analog Score neck and arm pain, minimum clinically significant difference (MCID), complication rates, and reoperation rates. RESULTS Operative time was significantly shorter for MI-PCF. Median estimated blood loss was small, but greater with O-PCF compared with other interventions. The length of hospital stay was longest for the ACDF group. At 2 years' follow-up, 36 subjects (9%) had subsequent neck surgery. The most common indication for additional surgery was recurrent symptoms (3.4%) followed by adjacent segment disease (2.6%), pseudoarthrosis (2.1%), adjacent segment disease + pseudoarthrosis (0.5%), and implant-related complications (0.3%). There was no statistically significant difference in complication rates between groups. MCID in NDI was achieved in 40% of MI-PCF subjects, 42% of O-PCF subjects, 66% of CDA subjects and 46% of ACDF subjects. CONCLUSIONS All 4 treatment options confer good clinical results on patients for cervical radiculopathy. Intraoperative and postoperative complications were low and comparable in all 4 groups. MI-PCF had the shortest surgical time and length of hospital stay. More CDA patients achieved MCID in NDI compared with the others, and the rate for additional surgery at 2 years was lowest in the CDA group.
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Critical analysis of the evaluation of postoperative dysphagia following an anterior cervical discectomy and fusion. Am J Otolaryngol 2022; 43:103466. [PMID: 35427936 DOI: 10.1016/j.amjoto.2022.103466] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE Postoperative dysphagia is a known complication of anterior cervical discectomy and fusion (ACDF) with reported incidences ranging from 1 to 79%. No standardized guidelines exist for spine surgeons to evaluate postoperative dysphagia after ACDF. A systematic method may be beneficial in distinguishing transient postoperative dysphagia secondary to intubation from those with postoperative complications. This study evaluates the causes, recognition, and clinical evaluation of postoperative dysphagia following ACDF. METHODS International classification of disease (ICD) and current procedural terminology (CPT) codes were used to identify ACDF patients and compared to anterior lumbar discectomy and fusion (ALDF), serving as a control group, between the years 2015-2019 and those diagnosed with dysphagia within 1 year. Demographics, operative details, and clinical evaluation were reviewed. Exclusion criteria included history of head and neck procedures, cancer, stroke, radiation, and trauma. RESULTS One hundred thirty-one ACDF and 93 ALDF patients met inclusion criteria. Twenty-seven (20.6%) ACDF patients were diagnosed with dysphagia within 1 year. Less than half of the dysphagia patients had the word "dysphagia" documented in their 1-month spine surgeon follow up visit. Only 66% of dysphagia patients had specialist evaluation and one third of those patients were referred by their surgeon. Only six patients received diagnostic barium swallow evaluations. CONCLUSION Postoperative dysphagia risk increases in ACDF compared to ALDF, likely due to underlying anatomy. Postoperative dysphagia symptoms are not effectively documented by spine surgeons and as a result underevaluated by dysphagia specialists. Patients may benefit from more extensive pre- and post-operative screening, evaluation, and referral regarding dysphagia symptoms following ACDF.
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Clinical outcomes and revision rates following four-level anterior cervical discectomy and fusion. Sci Rep 2022; 12:5339. [PMID: 35351960 PMCID: PMC8964822 DOI: 10.1038/s41598-022-09389-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/09/2022] [Indexed: 12/27/2022] Open
Abstract
Studies on outcomes after four-level anterior cervical discectomy and fusion (ACDF) are limited in the literature. The purpose of this study was to report on clinical outcomes and revision rates following four-level ACDF. Patients operated with four-level ACDF were identified in a prospectively accrued single institution database. Outcome scores included the Neck Disability Index (NDI) and Visual Analogue Scale (VAS) for neck and arm pain. Reoperation rates were determined. Any complications were identified from a review of the medical records. Twenty-eight patients with a minimum of 12 months follow up were included in the analysis. The mean age at surgery was 58.5 years. The median radiographic follow up time was 23 (IQR = 16–31.25) months. Cervical lordosis was significantly improved postoperatively (− 1 to − 13, p < 0.001). At the median 24 (IQR = 17.75–39.50) months clinical follow up time, there was a significant improvement in the NDI (38 to 28, p = 0.046) and VAS for neck pain scores (5.1 to 3, p = 0.012). The most common perioperative complication was transient dysphagia (32%) followed by hoarseness (14%). Four (14%) patients required revision surgery at a median 11.5 (IQR = 2–51) months postoperatively. The results of this study indicate that patients who undergo four-level ACDF have a significant improvement in clinical outcomes at median 24 months follow up. Stand-alone four-level ACDF is a valid option for the management of complex cervical degenerative conditions.
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