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Okubo T, Nagoshi N, Iga T, Tsuji T, Horiuchi Y, Kitamura K, Daimon K, Funao H, Takeda K, Ozaki M, Suzuki S, Tsuji O, Matsumoto M, Nakamura M, Watanabe K, Ishii K, Yamane J. Does the presence of preoperative neck pain impact clinical outcomes after posterior decompression in patients with cervical ossification of the posterior longitudinal ligament?: Retrospective multicenter cohort study. Spinal Cord 2024:10.1038/s41393-024-01027-z. [PMID: 39237712 DOI: 10.1038/s41393-024-01027-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 08/25/2024] [Accepted: 08/30/2024] [Indexed: 09/07/2024]
Abstract
STUDY DESIGN Retrospective multicenter study. OBJECTIVES To evaluate how preoperative neck pain influences clinical outcomes following posterior decompression for cervical ossification of the posterior longitudinal ligament (OPLL). SETTING Fourteen medical institutions in Japan. METHODS We enrolled 90 patients with cervical OPLL who underwent posterior decompression and were followed for a minimum of two years. We collected demographic data, medical history, and imaging findings. Patients were divided into two groups based on preoperative neck pain presence (Pre-op. neck pain (-) and (+) groups), and their outcomes were compared. RESULTS There were no significant differences in patient demographics between the Pre-op. neck pain (-) and (+) groups. Both groups showed similar distributions of ossification types and K-line positivity. Perioperative complications were comparable between the two groups. Radiographic analysis revealed no significant differences in C2-7 angles or cervical range of motion, pre- and postoperatively. Both groups demonstrated significant improvement in postoperative Japanese orthopedic association (JOA) scores, but there were no significant differences in scores or recovery rates. In the Pre-op. neck pain (-) group, factors associated with appearance of postoperative neck pain included pre- and postoperative lower JOA scores and larger C2-7 angles in neutral and extension positions. CONCLUSIONS It emerges that lower pre- and postoperative JOA scores or larger C2-7 angles in neutral and extension positions predispose to postoperative neck pain even in those patients without preoperative neck pain. Therefore, this is worth discussing at the time of consenting patients for surgical decompression and fixation.
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Affiliation(s)
- Toshiki Okubo
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
- Keio Spine Research Group (KSRG), Tokyo, Japan.
| | - Takahito Iga
- Keio Spine Research Group (KSRG), Tokyo, Japan
- Department of Orthopaedic Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, Sano Kosei General Hospital, Tochigi, Japan
| | - Takashi Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yosuke Horiuchi
- Keio Spine Research Group (KSRG), Tokyo, Japan
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Saitama Medical Center, Saitama, Japan
- Department of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Kazuya Kitamura
- Keio Spine Research Group (KSRG), Tokyo, Japan
- Department of Orthopaedic Surgery, Hiratsuka City Hospital, Kanagawa, Japan
- Department of Orthopaedic Surgery, National Defense Medical College, Saitama, Japan
| | - Kenshi Daimon
- Keio Spine Research Group (KSRG), Tokyo, Japan
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Saitama Medical Center, Saitama, Japan
- Department of Orthopaedic Surgery, Ogikubo Hospital, Tokyo, Japan
| | - Haruki Funao
- Keio Spine Research Group (KSRG), Tokyo, Japan
- Spine and Spinal cord Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Kazuki Takeda
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Masahiro Ozaki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Ken Ishii
- Keio Spine Research Group (KSRG), Tokyo, Japan
- New Spine Clinic Tokyo, Tokyo, Japan
| | - Junichi Yamane
- Keio Spine Research Group (KSRG), Tokyo, Japan
- Department of Orthopaedic Surgery, National Hospital Organization Murayama Medical Center, Tokyo, Japan
- Department of Orthopaedic Surgery, Kanagawa Prefectural Police Association Keiyu Hospital, Kanagawa, Japan
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Hsiao YC, Fang JJ, Huang CT, Liu ZQ, Chang CJ. A Three-Dimensional Morphological Assessment for Evaluating Pre- and Postsurgery in Cervical Laminoplasty. World Neurosurg 2024; 188:e357-e366. [PMID: 38796141 DOI: 10.1016/j.wneu.2024.05.115] [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: 05/08/2024] [Accepted: 05/19/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE The efficacy of medical treatments and the changes in radiologic imaging before and after treatment have consistently remained pivotal factors. This is particularly critical for surgical procedures, where precise evaluation of disparities pre and postsurgery or the accuracy of implantation is paramount. Based on three-dimensional morphological interests, we provide an automatic quantification evaluation method that delivers an evident base for assessing the outcomes of a widely employed surgical technique, cervical laminoplasty. METHODS The sample study included patients who underwent cervical laminoplasty for cervical spondylotic myelopathy/ossification of the longitudinal ligament. We present a superimposition method that facilitates a unique and precise assessment between pre and postsurgery. The degree of expansion was evaluated by the canal volume increase and canal expansion rate after surgery. RESULTS There were 31 patients with 112 vertebral segments measured. The target cervical's pre and postoperative canal areas were 122.63 ± 30.34 and 196.50 ± 37.10 mm2, respectively (P < 0.001). The average cervical canal expansion rate was 64.42%. The expansion effect of C5 cervical laminoplasty was the maximum (71.01%), and the canal volume of other segments expanded by approximately 60%. The functional outcomes demonstrated significant improvements in symptoms. CONCLUSIONS The quantification evaluation method can be utilized for any morphology changes before and after laminoplasty, as it does not lead to errors or variations from different inspection machines or human factors. The automatic method delivers an evident base for assessing the outcomes of a widely employed surgical technique.
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Affiliation(s)
- Yu-Ching Hsiao
- Department of Mechanical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Jing-Jing Fang
- Department of Mechanical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Ta Huang
- Division of Neurosurgery, Department of Surgery, Cathay General Hospital, Taipei City, Taiwan
| | - Zhao-Quan Liu
- Division of Neurosurgery, Department of Surgery, Cathay General Hospital, Taipei City, Taiwan
| | - Chih-Ju Chang
- Division of Neurosurgery, Department of Surgery, Cathay General Hospital, Taipei City, Taiwan; Department of Medicine, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
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Suzuki H, Funaba M, Fujimoto K, Ichihara Y, Nishida N, Sakai T. Current Concepts of Cervical Spine Alignment, Sagittal Deformity, and Cervical Spine Surgery. J Clin Med 2024; 13:1196. [PMID: 38592040 PMCID: PMC10932435 DOI: 10.3390/jcm13051196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/29/2024] [Accepted: 02/17/2024] [Indexed: 04/10/2024] Open
Abstract
There are not many reports on cervical spine alignment, and only a few analyze ideal surgical approaches and optimal amounts of correction needed for the various types of deformity. We comprehensively reviewed the present literature on cervical spinal deformities (with or without myelopathy) and their surgical management to provide a framework for surgical planning. A general assessment of the parameters actually in use and correlations between cervical and thoracolumbar spine alignment are provided. We also analyzed posterior, anterior, and combined cervical surgical approaches and indications for the associated techniques of laminoplasty, laminectomy and fusion, and anterior cervical discectomy and fusion. Finally, on the basis of the NDI, SF-36, VAS, and mJOA questionnaires, we fully evaluated the outcomes and measures of postoperative health-related quality of life. We found the need for additional prospective studies to further enhance our understanding of the importance of cervical alignment when assessing and treating cervical deformities with or without myelopathy. Future studies need to focus on correlations between cervical alignment parameters, disability scores, and myelopathy outcomes. Through this comprehensive literature review, we offer guidance on practical and important points of surgical technique, cervical alignment, and goals surgeons can meet to improve symptoms in all patients.
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Affiliation(s)
- Hidenori Suzuki
- Department of Orthopedics Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan; (M.F.); (K.F.); (Y.I.); (N.N.); (T.S.)
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Wang S, Shi J, Sun J. How cervical curvature changes after ACAF and ACDF: a radiological retrospective study. Neurosurg Rev 2023; 46:188. [PMID: 37523095 DOI: 10.1007/s10143-023-02049-6] [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: 05/01/2023] [Revised: 06/02/2023] [Accepted: 06/10/2023] [Indexed: 08/01/2023]
Abstract
To assess changes in cervical curvature and demonstrate the feasibility of using ACAF technology to restore lordosis, imaging data from patients undergoing multilevel ACAF and ACDF surgeries were retrospectively analyzed. Forty-seven patients receiving multilevel ACAF and ACDF were included in the study. Total cervical curvature and anterior, middle, and posterior column curvature, spinal canal diameter, cervical range of motion, and surgical complications were measured and analyzed by non-parametric or chi-square tests before and after surgery. The Spearman correlation between imaging data was analyzed. Compared with ACDF, the operation time of the ACAF group was longer, the cervical motion was larger, the median and change value of the middle column curvature was larger, and the change value of the posterior column curvature was smaller (P < 0.05). The postoperative differences in cervical lordosis angle, vertebral canal diameter, and middle and posterior column curvature in the ACAF group were significantly greater than those in the ACDF group (p = 0.015). The expansion of vertebral canal diameter was significantly correlated with the difference in curvature between the middle and posterior columns (r = 0.523, P < 0.01), and the curvature of the anterior column was correlated with that of the middle and posterior columns (P < 0.05). The curvature change of the anterior column is closely related to the curvature change of the middle column and the posterior column. Compared with ACDF, ACAF expands the diameter and volume of the spinal canal by increasing the curvature of the middle column and reducing the anterior movement of the posterior column.
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Affiliation(s)
- Shunmin Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University No.415 Fengyang Road, Shanghai, 200003, People's Republic of China
- 910 Hospital of China Joint Logistics Support Force, 180 Garden Road, Fengze District, Quanzhou City, Fujian Province, People's Republic of China
| | - Jiangang Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University No.415 Fengyang Road, Shanghai, 200003, People's Republic of China.
| | - Jingchuan Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University No.415 Fengyang Road, Shanghai, 200003, People's Republic of China.
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Du W, Wang S, Wang H, Zhang J, Wang F, Zhang X, Shen Y. Cervical alignment and clinical outcome of open-door laminoplasty vs. laminectomy and instrumentation in kyphotic multilevel cervical degenerative myelopathy. Arch Orthop Trauma Surg 2023; 143:1429-1440. [PMID: 35066642 DOI: 10.1007/s00402-021-04316-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 12/13/2021] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The aim of this study was to determine whether the sagittal lordotic alignment, clinical outcomes and axial symptoms (AS) could be improved by kyphotic correction through the posterior approach for the treatment of multilevel cervical degenerative myelopathy (CDM) and to further analyze the changes of cervical spinal alignment parameters after correction of kyphosis. The hypothesis was that correction of kyphosis can improve the severity of AS and neurological recovery. MATERIALS AND METHODS We retrospectively reviewed 109 patients who suffered from multilevel CDM combined with kyphosis. The patients had undergone open-door laminoplasty (Group LP, 53 patients) and laminectomy with instrumentation (Group LI, 56 patients) between January 2014 and December 2018. Cervical spinal alignment parameters, including curvature index (CI), T1 slope, C2-7 Cobb angle, C2-7 SVA, were measured on the pre- and postoperative lateral radiographs. The recovery rate was calculated based on the Japanese Orthopedic Association (JOA) score. AS severity was quantified using Neck Disability Index (NDI). A P value less than 0.05 was considered to be significant. RESULTS Analyses of postoperative follow-up data showed significant differences (P < 0.001) in CI, correction of CI, C2-7 Cobb angle, T1 slope, C2-7 SVA and NDI between Group LP and LI, but no significant differences in JOA score (P = 0.23) and recovery rate (P = 0.13). There were significant differences (P < 0.001) in CI, T1 slope, C2-7 Cobb angle, C2-7 SVA, JOA score, and NDI between pre- and postoperative follow-up in both groups. Correction of CI showed negative correlation with AS severity (r = -0.51, P < 0.001), and no association with recovery rate (r = 0.14, P = 0.15). CONCLUSIONS Satisfied neurological improvement was achieved by LP and LI for multilevel CDM combined with kyphosis. Cervical kyphotic correction produced significant improvement of AS and increase of T1 slope and C2-7 SVA. However, the kyphotic correction may not be associated with better neurological recovery in the short-term postoperative period.
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Affiliation(s)
- Wei Du
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Shuai Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Haixu Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Jingtao Zhang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Feng Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Xu Zhang
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Yong Shen
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China.
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Bąkowski P, Kaszyński J, Baka C, Kaczmarek T, Ciemniewska-Gorzela K, Bąkowska-Żywicka K, Piontek T. Patients with stage II of the knee osteoarthritis most likely benefit from the intra-articular injections of autologous adipose tissue-from 2 years of follow-up studies. Arch Orthop Trauma Surg 2023; 143:55-62. [PMID: 34117558 PMCID: PMC9886583 DOI: 10.1007/s00402-021-03979-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/26/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Knee osteoarthritis (OA) is a common, chronic, progressive and degenerative disease which affects patients' quality of life and may cause disability and social isolation. OA is a huge economic burden for the patient and a large strain for the whole healthcare system. Articular cartilage has a small potential to repair, with progressively more clinicians emphasizing cellular therapy. Subcutaneous fat tissue in human body is a large reservoir of mesenchymal stem cells (MSCs) and is been harvested in minimally invasive, simple procedure. The purpose of this study was to define a specific group of patients with knee osteoarthritis, who are the most likely to benefit from the treatment with intra-articular injection of an autologous adipose tissue (AAT). METHODS From 2016 to 2018, 59 symptomatic bilateral and unilateral knee OA patients were treated with a single intra-articular (IA) injection of an autologous adipose tissue (AAT). Before the treatment and at the follow-up, the participant was asked to fulfill the Knee Injury and Osteoarthritis Outcome Score (KOOS), the International Knee Documentation Committee 2000 (IKDC 2000), The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Health Questionnaire EQ-5D-5L and to quantify the pain in the affected joint with a Numeric Rating Scale (NRS). Moreover, the patients were asked to: (i) assess their satisfaction with the effects of the conducted treatment: from 0 (unsatisfied) to 10 (very satisfied), (ii) describe the rehabilitation, if it was performed (supervised or individual and duration in weeks) and (iii) indicate any additional treatment applied, like IA injections of hyaluronic acid (HA) or platelet-rich plasma (PRP), knee arthroscopy, partial or total knee arthroplasty (TKA) at the follow-up. RESULTS The mean age of 37 participants (16 males and 21 females) included into statistical analysis was 57.78 ± 7.39 years, the mean BMI was 31.30 ± 7.51. The questionnaires were fulfilled after the average follow-up time of 27 ± 6.5 months. A significant difference (p < 0.05) compared with the baseline, was observed in pain [NRS], WOMAC, KOOS index, pain, symptoms, ADL, Sport and Rec, QoL, EQ-5D-5L index. The satisfaction in the whole group was 6.16 ± 3.07. There was no significant difference between satisfied and unsatisfied patients in BMI and pain [NRS] at the baseline. 6 out of 7 patients with stage IV in K-L were unsatisfied with the effects of the treatment with AAT. DISCUSSION The main conclusion of this study is that the patients with stage II of the knee OA with normal BMI are were most likely to benefit from IA injection of AAT, in contrast to the patients with stage IV, who will not beware not satisfied with the effectiveness of this kind of treatment. There were no adverse events reported at the donor site as well as in the treated knee joints.
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Affiliation(s)
- Paweł Bąkowski
- Department of Orthopedic Surgery, Rehasport Clinic, Poznan, Poland
| | - Jakub Kaszyński
- Department of Orthopedic Surgery, Rehasport Clinic, Poznan, Poland
| | - Cezary Baka
- Department of Orthopedic Surgery, Rehasport Clinic, Poznan, Poland
| | - Tomasz Kaczmarek
- Department of Orthopedic Surgery, Rehasport Clinic, Poznan, Poland
| | | | | | - Tomasz Piontek
- Department of Orthopedic Surgery, Rehasport Clinic, Poznan, Poland
- Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences Poznan, Poznan, Poland
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