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Ni H, Mao W, Li H, Dong Y. Physiologic Osseous Remodeling of the Anterior Wall of the Spinal Canal after Anterior Cervical Corpectomy and Fusion: A Retrospective Observational Study. J Neurol Surg A Cent Eur Neurosurg 2024; 85:464-471. [PMID: 35354216 DOI: 10.1055/a-1812-9834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Anterior cervical corpectomy and fusion (ACCF) has been widely used in the treatment of cervical spondylotic myelopathy (CSM), ossification of posterior longitudinal ligament (OPLL), cervical trauma, and other cervical diseases, but few studies have reported the osseous and physiologic remodeling of the anterior wall of the spinal canal following ACCF. In this study, we analyze that remodeling process and its influence on titanium mesh cage (TMC) subsidence. METHODS We performed a clinical and radiologic analysis of consecutive patients treated with ACCF. Growth rates (GRs) reflecting the extent of remodeling of the remnants of the resected vertebral bodies were measured. We compared the computed tomography (CT) scans taken immediately and at least 1 year after surgery, and a literature review was conducted. RESULTS In all, 48 patients underwent ACCF at a mean age of 61.5 ± 12.0 years. The median follow-up was 36 months, and 159 CT images were analyzed. The GR values of the remnants of the vertebral bodies on CT images immediately and 1 year after surgery were 0.505 ± 0.077 and 0.650 ± 0.022 (p < 0.001), respectively, and the GR value at ≥4 years was 1. Axial CT scans showed that remodeling starts from the lateral remnants of the resected vertebral bodies, finally reaching the center. When fusion of the vertebral bodies and the titanium cage was complete during the first year after ACCF, osteogenesis and remodeling were initiated in the osseous anterior wall of the spinal canal. The remodeling of the osseous anterior wall of the spinal canal was completed at the fourth year after surgery, without recompressing the spinal cord, as seen on both axial and lateral CT scans. According to the literature review, there was no TMC subsidence at more than 4 years after surgery. CONCLUSION The anterior wall of the spinal canal undergoes osseous remodeling after ACCF. The process is complete in the fourth year after surgery and prevents TMC subsidence.
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Affiliation(s)
- Haofei Ni
- Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
- Department of Spinal Surgery, Tongji University School of Medicine, Tongji Hospital, Shanghai, China
| | - Wei Mao
- Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hailong Li
- Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Youhai Dong
- Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
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Takase H, Haze T, Yamamoto D, Inagaki N, Nitta M, Murata H, Yamamoto T. Network Meta-Analysis of C5 Palsy After Anterior Cervical Decompression of Three to Six Levels: Comparing Three Different Procedures. Spine (Phila Pa 1976) 2024; 49:188-196. [PMID: 37942814 DOI: 10.1097/brs.0000000000004865] [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: 06/28/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE Using a network meta-analysis (NMA), this study aimed to compare the risks of C5 palsy after three different procedures of anterior cervical decompression. SUMMARY OF BACKGROUND DATA C5 palsy is a well-known complication affecting the quality of life after anterior procedures. Due to the limited evidence on the various procedures available, we evaluate the basis for selection to prevent palsy and achieve maximal decompression in cases spanning 3-6 levels. MATERIALS AND METHODS We conducted a comprehensive search for C5 palsy and complications after 3representative procedures, including anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), and their combination (hybrid), involving 3 to 6 intervertebral levels. The incidence of C5 palsy was compared using a NMA. RESULTS We identified 1655 patients in 11 studies who met inclusion criteria. Sixty-nine patients (4.2%) developed delayed C5 palsies. The incidences among ACDF, ACCF, and hybrid cases were 2.3% (16/684, 95% CI: 1.4% to 3.8%), 6.4% (39/613, 95% CI: 4.7% to 8.6%), and 3.9% (14/358, 95% CI: 2.3% to 6.5%), respectively ( P < 0.01). A NMA was performed for 15 pairwise comparisons across the 3 procedure arms: ACDF versus hybrid, 7/232 (3.0%) versus 11/234 (4.7%); hybrid versus ACCF, 14/301 (4.3%) versus 18/224 (8.0%); ACCF versus ACDF, 38/523 (7.8%) versus 16/619 (2.6%). Compared with ACDF, the risk of C5 palsy was significantly higher in ACCF (odds ratio: 2.72, 95% CI: 1.47 to 5.01), whereas ACDF versus hybrid did not significantly differ in risk (odds ratio: 1.56, 95% CI: 0.68 to 3.60). CONCLUSION We determined that ACCF was associated with a higher risk of postoperative C5 palsy than ACDF in cases spanning 3 to 6 intervertebral levels. If practicable, ACDF surgery may be an appropriate choice for cases requiring anterior decompression of 3 to 6 levels. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Hajime Takase
- YCU Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama
| | - Tatsuya Haze
- YCU Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama
| | | | - Naoko Inagaki
- YCU Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama
| | - Manabu Nitta
- YCU Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama
| | - Hidetoshi Murata
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama
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Incidence of C5 Palsy: Meta-Analysis and Potential Etiology. World Neurosurg 2019; 122:e828-e837. [DOI: 10.1016/j.wneu.2018.10.159] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 10/21/2018] [Accepted: 10/23/2018] [Indexed: 11/15/2022]
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Krätzig T, Mohme M, Mende KC, Eicker SO, Floeth FW. Impact of the surgical strategy on the incidence of C5 nerve root palsy in decompressive cervical surgery. PLoS One 2017; 12:e0188338. [PMID: 29145512 PMCID: PMC5690695 DOI: 10.1371/journal.pone.0188338] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 11/06/2017] [Indexed: 11/18/2022] Open
Abstract
Objective Our aim was to identify the impact of different surgical strategies on the incidence of C5 palsy. Background Degenerative cervical spinal stenosis is a steadily increasing morbidity in the ageing population. Postoperative C5 nerve root palsy is a common complication with severe impact on the patients´ quality of life. Methods We identified 1708 consecutive patients who underwent cervical decompression surgery due to degenerative changes. The incidence of C5 palsy and surgical parameters including type and level of surgery were recorded to identify predictors for C5 nerve palsy. Results The overall C5 palsy rate was 4.8%, with 18.3% of cases being bilateral. For ACDF alone the palsy rate was low (1.13%), compared to 14.0% of C5 palsy rate after corpectomy. The risk increased with extension of the procedures. Hybrid constructs with corpectomy plus ACDF at C3-6 showed significantly lower rates of C5 palsy (10.7%) than corpectomy of two vertebrae (p = 0.005). Multiple regression analysis identified corpectomy of C4 or C5 as a significant predictor. We observed a lower overall incidence for ventral (4.3%) compared to dorsal (10.9%) approaches (p<0.001). When imaging detected a postoperative shift of the spinal cord at index segment C4/5, palsy rate increased significantly (33.3% vs. 12.5%, p = 0.034). Conclusions Extended surgical strategies, such as dorsal laminectomies, multilevel corpectomies and procedures with extensive spinal cord shift were shown to display a high risk of C5 palsy. The use of extended procedures should therefore be employed cautiously. Switching to combined surgical methods like ACDF plus corpectomy can reduce the rate of C5 palsy.
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Affiliation(s)
- Theresa Krätzig
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Malte Mohme
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus C. Mende
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven O. Eicker
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank W. Floeth
- Department of Spine Surgery, Hospital zum Heiligen Geist, Kempen, Germany
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Abstract
PURPOSE We aim to perform a meta-analysis on incidence of C5 nerve root palsy (C5 palsy) for patients after cervical surgery. METHODS An extensive search of the literature was performed in PubMed/MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG databases on incidence of C5 palsy from January 2007 to January 2017. Prevalence of C5 palsy related to different surgery methods was calculated and data analysis was conducted with STATA 12.0. RESULTS A total of 61 studies containing 721 patients with C5 palsy in total 11,481 patients (6.3%) were included in our study. The incidences after anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), anterior corpectomy combined with discectomy (ACCDF), laminoplasty (LP) and laminectomy and fusion (LF) were 5.5%, 7.5%, 6%, 4.4%, and 12.2%, respectively. Compared with anterior approaches (5%), female patients (4%) and patients with cervical spondylotic myelopathy (CSM) (4.8%), posterior approaches (6.2%), male patients (5.7%) and patients with ossification of posterior longitudinal ligament (OPLL) (8.1%) have a higher prevalence. In ACDF and LP, patients with OPLL (5.5%, 8.1%, respectively) have a higher incidence than those in patients with CSM (4.7%, 3.1%, respectively); however, in LF, patients with CSM and OPLL have similar incidence of C5 palsy (13% vs 13.1%). In most cases, C5 palsy was unilateral (74.5%). CONCLUSIONS Based on our meta-analysis, posterior approaches, male patients and patients with OPLL have a higher incidence of C5 palsy. In ACDF and LP, patients with OPLL have a higher incidence of C5 palsy, but in LF, patients with CSM and OPLL have similar result.
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Affiliation(s)
- Tao Wang
- Department of Orthopedics, Wuxi NO. 9 People's Hospital Affiliated to Soochow University, Wuxi
| | - Hui Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Sen Liu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wen-Yuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
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Zhou J, Li X, Zhou X, Lin H, Dong J. Anterior decompression and hybrid reconstruction with titanium mesh cage plus plate and self-locking stand-alone cage for the treatment of three-level cervical spondylotic myelopathy. J Clin Neurosci 2017; 43:196-201. [PMID: 28511973 DOI: 10.1016/j.jocn.2017.04.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 04/22/2017] [Indexed: 10/19/2022]
Abstract
It has been reported that anterior cervical decompression has good clinical outcomes for the treatment of adjacent three-level cervical spondylotic myelopathy (CSM). However, the application of a long plate in the anterior cervical spine poses substantial risks of soft tissue damage. In this retrospective study, we aimed to analyze the clinical and radiological results of the hybrid construction with titanium mesh cage (TMC) plus plate and self-locking stand-alone cage for treatment of adjacent three-level CSM. A total of 28 consecutive patients with adjacent three-level CSM were treated by anterior decompression and hybrid reconstruction with TMC plus plate and self-locking stand-alone cage. Clinical outcomes, complications, fusion rate and time, cage subsidence and spinal curvature were assessed. The mean follow-up period was 22.8months. The average operative time was 103±18.5min, and the average blood loss was 115±13.3mL. The JOA score and degree of spinal curvature were significantly increased at the final follow-up compared with preoperatively (P<0.05). Twenty-seven cases finally achieved a solid fusion, and the average time to achieve a solid fusion was 6.2months. Postoperative complications included one case of cerebrospinal fluid leakage (3.57%), one case of temporary sore throat (3.57%) and two cases of TMC subsidence (7.1%). No dysphagia and hoarseness were observed. Anterior decompression and hybrid reconstruction with TMC plus plate and self-locking stand-alone cage could be used safely and effectively for the treatment of adjacent three-level CSM. It could effectively restore cervical lordosis, reduce the complications related to long plate fixation, and lead to satisfactory outcomes.
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Affiliation(s)
- Jian Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xilei Li
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiaogang Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hong Lin
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| | - Jian Dong
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
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Zárate-Kalfopulos B, Araos-Silva W, Reyes-Sánchez A, Rosales-Olivarez LM, Alpizar-Aguirre A, Melendez FL. Hybrid Decompression and Fixation Technique for the Treatment of Multisegmental Cervical Spondylotic Myelopathy. Int J Spine Surg 2016; 10:30. [PMID: 27909651 DOI: 10.14444/3030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Cervical spondilotic myelopathy (CSM) is defined as the compromise of the spinal cord due to degenerative changes of the cervical spine. It is the most common cause of spinal cord dysfunction in patients over 55 years. An early surgical management it is paramount to achieve better neurological outcome. There is still controversy regarding the appropriate surgical treatment for multisegmental CSM involving three or more levels. The hybrid decompression and fixation technique combines one or two level corpectomy and a single level discectomy in order to obtain optimum decompression and fixation in patients with multilevel cervical myelopathy. METHODS A prospective case-control study was made between 2011 and 2013. A total of 15 patients with diagnosis of CSM received surgical treatment with an anterior hybrid decompression and fixation technique procedure. Inclusion criteria were myelopathy confirmed by radiographic studies, magnetic resonance image (MRI) and electromyography. RESULTS During the 2010-2013 period 15 patients were managed by hybrid decompression and fixation technique. Average age 64.8 years SD9.4. The follow up period was 29.6 SD ± 9.8 months. The JOA score improved significantly to 13.8 +/- 1.9 points at follow-up (paired t test, P = 0.001), Nurick Scale preoperative was 3.3 and improved to 2.4 mean, was significantly (Wilcoxon signed rank test p=0.006) The mean C2-C7 lordosis angle was 10.8° +/- 8.9 before surgery, and 14.3° +/- 8.8 at follow-up, there was no significant loss of lordosis angle between the preoperative and follow-up measurements (Wilcoxon signed rank test, P =0.149); At follow-up, graft non fusion was seen in 1 patient (7%, k=1). CONCLUSIONS In this small number, single surgeon, prospective series the use of a single level corpectomy and an adjacent discectomy was shown to provide similar outcomes and complication rates as alternative surgical techniques. The authors thus consider this a viable surgical alternative with some perceived advantages, a low rate of complications and a high rate of spinal fusion. Level of Evidence: IV. This study was approved by the authors' Institutional Review Board and all patients were given informed consent prior to participation in the study.
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Takenaka S, Nagamoto Y, Aono H, Kaito T, Hosono N. Differences in the time of onset of postoperative upper limb palsy among surgical procedures: a meta-analysis. Spine J 2016; 16:1486-1499. [PMID: 27725308 DOI: 10.1016/j.spinee.2016.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/24/2016] [Accepted: 09/12/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The time of onset of postoperative upper limb palsy (ULP), also referred to as C5 palsy, varies among patients. Although some studies addressed the relationship between the time of onset of ULP and the potential etiologies, no meta-analysis has been conducted regarding the association between the time of onset of ULP and other factors such as surgical procedure type and treated diseases. PURPOSE This study aimed to elucidate differences in the time of onset of ULP among spinal surgical procedures and treated diseases to understand its etiology. STUDY DESIGN This is a meta-analysis. OUTCOME MEASURES The time of onset of ULP after cervical decompression surgery. METHODS We conducted a meta-analysis via searches of the PubMed, EMBASE, and Cochrane Library databases. Upper limb palsy within 2 days postoperatively or at 3 days or more postoperatively was defined as early- and late-onset, respectively. We calculated the pooled prevalence of early- and late-onset ULP with regard to surgical procedures and diseases using a random effects model. The proportion of early-onset ULP relative to all ULP was also determined. Surgical procedures were categorized into four procedures: (1) anterior cervical discectomy and fusion (ACDF); (2) anterior cervical corpectomy and fusion (ACCF); (3) laminoplasty or laminectomy (LPN); and (4) posterior spinal fusion with decompression (PSF). Treated diseases were classified as ossification of the posterior longitudinal ligament (OPLL) and non-OPLL. RESULTS The pooled prevalence of early-onset ULP was significantly stratified across three groups of surgical procedures (PSF [9.0%]>ACCF [3.7%] and LPN [2.5%]>ACDF [0.6%]). In the pooled analysis of late-onset ULP prevalence, three procedures (PSF [4.3%], ACCF [2.8%], and LPN [2.9%]) were similar, but ACDF (1.0%) was associated with a significantly lower prevalence than LPN. The prevalence of both early- and late-onset ULP was significantly higher with OPLL than without OPLL. However, the proportion of early-onset ULP relative to all ULP was similar between non-OPLL and OPLL (50.8% vs. 49.5%). CONCLUSIONS The high prevalence of early-onset ULP in PSF is attributable to a lag correction effect, which is triggered by posterior correction and fusion through comparison with LPN. The combination of our meta-analysis results and previous knowledge facilitates our understanding of the etiology of ULP.
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Affiliation(s)
- Shota Takenaka
- Orthopaedic Surgery, National Hospital Organization, Osaka Medical Center, 2-1-14, Hoenzaka, Chuo-ku, Osaka 540-0006, Japan.
| | - Yukitaka Nagamoto
- Orthopaedic Surgery, National Hospital Organization, Osaka Medical Center, 2-1-14, Hoenzaka, Chuo-ku, Osaka 540-0006, Japan
| | - Hiroyuki Aono
- Orthopaedic Surgery, National Hospital Organization, Osaka Medical Center, 2-1-14, Hoenzaka, Chuo-ku, Osaka 540-0006, Japan
| | - Takashi Kaito
- Orthopaedic Surgery, Japan Community Healthcare Organization Osaka Hospital, 4-2-78 Fukushima, Osaka 553-0003, Japan
| | - Noboru Hosono
- Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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Guo Q, Wang L, Zhang B, Jiang J, Guo X, Lu X, Ni B. Standalone Anterior Cervical Discectomy and Fusion Versus Combination with Foraminotomy for the Treatment of Cervical Spondylotic Radiculopathy Secondary to Bony Foraminal Stenosis. World Neurosurg 2016; 95:134-142. [PMID: 27506401 DOI: 10.1016/j.wneu.2016.07.099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/25/2016] [Accepted: 07/27/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare the results of anterior cervical discectomy and fusion (ACDF) combined with anterior cervical foraminotomy (ACF) and standalone ACDF for the treatment of cervical spondylotic radiculopathy (CSR). METHODS The data of 24 consecutive patients who underwent ACDF combined with ACF for significant bony foraminal stenosis were reviewed. The clinical outcomes, including visual analog scale (VAS) scores for neck pain and arm pain and Neck Disability Index, were evaluated by questionnaires. Radiologic outcomes as manifested by C2-7 angle and surgical segmental angle were recorded. The outcomes were compared with outcomes of standalone ACDF for CSR secondary to posterolateral spurs. RESULTS At the final follow-up evaluation, all patients obtained bone fusion. No patient developed adjacent segment disease. Operative time was longer and blood loss was more in the ACDF combined with ACF group than in the ACDF group (all P < 0.05). However, in both groups, the neck VAS score, arm VAS score, and Neck Disability Index were significantly reduced postoperatively (all P < 0.05). The segmental curve and C2-7 lordosis were significantly improved postoperatively (all P < 0.05). There was no significant difference between the 2 groups in clinical and radiologic outcomes (P > 0.05). CONCLUSIONS For CSR with foraminal stenosis secondary to significant bony pathology that cannot be managed with standalone ACDF, ACDF combined with ACF is an effective and safe treatment strategy.
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Affiliation(s)
- Qunfeng Guo
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Liang Wang
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Bangke Zhang
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Jiayao Jiang
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Xiang Guo
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Xuhua Lu
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, China.
| | - Bin Ni
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, China.
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Basaran R, Kaner T. C5 nerve root palsy following decompression of cervical spine with anterior versus posterior types of procedures in patients with cervical myelopathy. 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 2016; 25:2050-9. [DOI: 10.1007/s00586-016-4567-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/09/2016] [Accepted: 04/10/2016] [Indexed: 11/29/2022]
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Prevalence of C5 nerve root palsy after cervical decompressive surgery: a meta-analysis. 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 2015; 24:2724-34. [PMID: 26281981 DOI: 10.1007/s00586-015-4186-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 08/05/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
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Kersten RFMR, van Gaalen SM, de Gast A, Öner FC. Polyetheretherketone (PEEK) cages in cervical applications: a systematic review. Spine J 2015; 15:1446-60. [PMID: 24374100 DOI: 10.1016/j.spinee.2013.08.030] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 07/22/2013] [Accepted: 08/23/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Polyetheretherketone (PEEK) cages have been widely used during the past decade in patients with degenerative disorders of the cervical spine. Their radiolucency and low elastic modulus make them attractive attributes for spinal fusion compared with titanium and bone graft. Still, limitations are seen such as pseudoarthrosis, subsidence, and migration of the cages. Limited evidence on the clinical outcome of PEEK cages is found in the literature other than noncomparative cohort studies with only a few randomized controlled trials. PURPOSE To assess the clinical and radiographic outcome of PEEK cages in the treatment of degenerative disc disorders and/or spondylolisthesis in the cervical spine. STUDY DESIGN Systematic review of all randomized controlled trials and prospective and retrospective nonrandomized comparative studies with a minimum follow-up of 6 months and all noncomparative cohort studies with a long-term follow-up of more than 5 years. OUTCOME MEASURES The primary outcome variable was clinical performance. Secondary outcome variables consisted of radiographic scores. METHODS The MEDLINE, EMBASE, and Cochrane Library databases were searched according to the Preferred Reporting Items of Systematic reviews and Meta-Analyses statement and Meta-analysis Of Observational Studies in Epidemiology guidelines. No conflict of interest reported. No funding received. RESULTS A total of 223 studies were identified, of which 10 studies were included. These comprised two randomized controlled trials, five prospective comparative trials, and three retrospective comparative trials. CONCLUSIONS Minimal evidence for better clinical and radiographic outcome is found for PEEK cages compared with bone grafts in the cervical spine. No differences were found between PEEK, titanium, and carbon fiber cages. Future studies are needed to improve methodology to minimize bias. Publication of lumbar interbody fusion studies needs to be promoted because differences in clinical and/or radiographic scores are more likely to be demonstrated in this part of the spine.
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Affiliation(s)
- Roel Frederik Mark Raymond Kersten
- Department of Orthopaedics, Clinical Orthopaedic Research Center midden-Nederland (CORC-mN), Diakonessenhuis Hospital Utrecht/Zeist, PO Box 80250, 3508 TG Utrecht, The Netherlands.
| | - Steven M van Gaalen
- Department of Orthopaedics, Clinical Orthopaedic Research Center midden-Nederland (CORC-mN), Diakonessenhuis Hospital Utrecht/Zeist, PO Box 80250, 3508 TG Utrecht, The Netherlands
| | - Arthur de Gast
- Department of Orthopaedics, Clinical Orthopaedic Research Center midden-Nederland (CORC-mN), Diakonessenhuis Hospital Utrecht/Zeist, PO Box 80250, 3508 TG Utrecht, The Netherlands
| | - F Cumhur Öner
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
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Guzman JZ, Baird EO, Fields AC, McAnany SJ, Qureshi SA, Hecht AC, Cho SK. C5 nerve root palsy following decompression of the cervical spine. Bone Joint J 2014; 96-B:950-5. [DOI: 10.1302/0301-620x.96b7.33665] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
C5 nerve root palsy is a rare and potentially debilitating complication of cervical spine surgery. Currently, however, there are no guidelines to help surgeons to prevent or treat this complication. We carried out a systematic review of the literature to identify the causes of this complication and options for its prevention and treatment. Searches of PubMed, Embase and Medline yielded 60 articles for inclusion, most of which addressed C5 palsy as a complication of surgery. Although many possible causes were given, most authors supported posterior migration of the spinal cord with tethering of the nerve root as being the most likely. Early detection and prevention of a C5 nerve root palsy using neurophysiological monitoring and variations in surgical technique show promise by allowing surgeons to minimise or prevent the incidence of C5 palsy. Conservative treatment is the current treatment of choice; most patients make a full recovery within two years. Cite this article: Bone Joint J 2014;96-B:950–5.
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Affiliation(s)
- J Z Guzman
- Icahn School of Medicine at Mount Sinai, Leni & Peter W. May Department of Orthopaedic Surgery, 5 E. 98th Street, Box 1188, New York, New York 10029, USA
| | - E O Baird
- Icahn School of Medicine at Mount Sinai, Leni & Peter W. May Department of Orthopaedic Surgery, 5 E. 98th Street, Box 1188, New York, New York 10029, USA
| | - A C Fields
- Icahn School of Medicine at Mount Sinai, Leni & Peter W. May Department of Orthopaedic Surgery, 5 E. 98th Street, Box 1188, New York, New York 10029, USA
| | - S J McAnany
- Icahn School of Medicine at Mount Sinai, Leni & Peter W. May Department of Orthopaedic Surgery, 5 E. 98th Street, Box 1188, New York, New York 10029, USA
| | - S A Qureshi
- Icahn School of Medicine at Mount Sinai, Leni & Peter W. May Department of Orthopaedic Surgery, 5 E. 98th Street, Box 1188, New York, New York 10029, USA
| | - A C Hecht
- Icahn School of Medicine at Mount Sinai, Leni & Peter W. May Department of Orthopaedic Surgery, 5 E. 98th Street, Box 1188, New York, New York 10029, USA
| | - S K Cho
- Icahn School of Medicine at Mount Sinai, Leni & Peter W. May Department of Orthopaedic Surgery, 5 E. 98th Street, Box 1188, New York, New York 10029, USA
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Li J, Zheng Q, Guo X, Zeng X, Zou Z, Liu Y, Hao S. Anterior surgical options for the treatment of cervical spondylotic myelopathy in a long-term follow-up study. Arch Orthop Trauma Surg 2013; 133:745-51. [PMID: 23503888 DOI: 10.1007/s00402-013-1719-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To provide a basis for the choice of anterior surgery procedures in the treatment of cervical spondylotic myelopathy (CSM) through long-term follow-up. METHODS A consecutive series of 89 patients with CSM having complete follow-up data were analyzed retrospectively. All patients were treated with anterior cervical discectomy and fusion (ACDF), and anterior cervical corpectomy and fusion (ACCF) from July 2000 to June 2007. The lesions were located in one segment (n = 25), two segments (n = 56), and three segments (n = 8). Preoperative and postoperative, the C2-C7 angle, cervical intervertebral height, radiographic fusion status, result of the adjacent segment degeneration, the Japanese Orthopaedic Association (JOA), and the Short Form 36-item (SF36) questionnaire scores were used to evaluate the efficacy of the surgery. RESULTS According to the different compression conditions of the 89 cases, different anterior operation procedures were chosen and satisfactory results were achieved, indicating that direct anterior decompressions were thorough and effective. The follow-up period was 60-108 months, and the average was 79.6 months. The 5-year average symptom improvement rate, effectiveness rate, and fineness rate were 78.36 %, 100 % (89/89), and 86.52 % (77/89), respectively. CONCLUSIONS For CSM with compression coming from the front side, proper anterior decompression based on the specific conditions could directly eliminate the compression. Through long-term follow-up, the effect of decompression became observable.
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Affiliation(s)
- Jingfeng Li
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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