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Zheng S, Wang L, Li J, Li Q, Deng Z, Wang L, Song Y. MRI-based endplate bone quality score independently predicts cage subsidence after anterior cervical corpectomy fusion. 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 2024:10.1007/s00586-024-08511-3. [PMID: 39365434 DOI: 10.1007/s00586-024-08511-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 09/04/2024] [Accepted: 09/29/2024] [Indexed: 10/05/2024]
Abstract
BACKGROUND To reduce the amount of radiation that patients receive during surgery, surgeons can evaluate the quality of the bone prior to surgery using computed tomography (CT) or dual-energy X-ray absorptiometry. Recently, lumbar spine vertebral bone quality has been evaluated using an MRI-based scoring system. However, few studies have investigated the connection between cage subsidence in patients following cervical interbody fusion and site-specific MRI bone evaluation. It is unknown how cage subsidence following anterior cervical corpectomy decompression and fusion is related to MRI-based endplate bone quality assessment. PURPOSE To create a similar MRI-based cervical spine scoring system (C-EBQ) and to investigate the predictive value of the MRI cervical endplate bone quality (C-EBQ) score for cage subsidence after ACCF. METHODS The patients' demographic, surgical, and radiological data were collected. Cage subsidence was defined as fusion segment height loss ≥ 3 mm. Multivariate logistic regression models were developed to determine correlations between potential risk factors and subsidence, and simple linear regression analyses of statistically significant indicators were performed. RESULTS Among the patients who underwent single-level ACCF, 72 met the requirements for inclusion. The C-VBQ scores also improved from 2.28 ± 0.12, indicating no subsidence, to 3.27 ± 0.35, which indicated subsidence, and the C-EBQ scores improved in both the nonsubsidence group (1.95 ± 0.80) and the subsidence group (2.38 ± 0.54). There was a statistically significant difference (p < 0.05) among the groups. Higher C-EBQ scores were strongly correlated with subsidence in the multivariate analysis (odds ratio [OR] = 17.249, 95% CI = 2.269 to 7.537, P < 0.001), and the C-VBQ score was the major independent predictor of subsidence following ACCF ([OR] = 4.752, 95% CI = 3.824 to 8.781, P < 0.05). The C-EBQ score outperformed the C-VBQ score (75.6%) in terms of predictive accuracy, with a ROC curve indicating an 89.4% score. CONCLUSIONS After ACCF, cage subsidence was strongly correlated with higher C-EBQ scores on preoperative MRI. Assessing C-EBQ before ACCF may be a useful way to estimate the likelihood of postoperative subsidence.
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Affiliation(s)
- Shuxin Zheng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, 610041, Chengdu, China
| | - Linnan Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, 610041, Chengdu, China
| | - Junhu Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, 610041, Chengdu, China
| | - Qiujiang Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, 610041, Chengdu, China
| | - Zhipeng Deng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, 610041, Chengdu, China
| | - Lei Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, 610041, Chengdu, China.
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, 610041, Chengdu, China
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Baram A, Capo G, Riva M, Brembilla C, Rosellini E, De Robertis M, Servadei F, Pessina F, Fornari M. Monocentric Retrospective Analysis of Clinical Outcomes, Complications, and Adjacent Segment Disease in 507 Patients Undergoing Anterior Cervical Discectomy and Fusion for Degenerative Cervical Myelopathy. World Neurosurg 2024; 189:e1049-e1056. [PMID: 39019433 DOI: 10.1016/j.wneu.2024.07.079] [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: 02/23/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Degenerative cervical myelopathy (DCM) is a leading cause of nontraumatic spinal cord injury. Surgery aims to arrest neurological decline and improve conditions, but controversies surround risks and benefits in elderly patients, outcomes in mild myelopathy, and the risk of adjacent segment disease (ASD). METHODS Retrospective data of patients who underwent anterior cervical discectomy and fusion for DCM in our hospital were collected. Patients were stratified by preoperative modified Japanese Orthopaedic Association (mJOA) (mild, moderate, severe) and age (under 70, over 70). Clinical outcomes, complications, and ASD rate were analyzed. We evaluated the relationship between mJOA recovery rate and the risk of complications and various preoperative parameters. RESULTS Five hundred seven consecutive patients were included in the study, with a mean follow-up of 43.52 months (12-71). Improvement in all outcome variables was observed in mild, moderate, and severe myelopathy categories, with elderly patients showing a lower improvement. Except for age, no other variable correlated with mJOA recovery rate. We observed 45 complications (11.1% of patients), with 14 in the U70 group and 31 in the O70 group (P value < 0.001). Age, Charlson comorbidity index, and ASA score were found to be predictors of complications. Fourteen patients (2.8% of total), mean age 54.2, developed radiological and clinical ASD. Most had cranial-level ASD with Pfirmann grade ≥ 2 before index surgery. CONCLUSIONS Most myelopathic patients improve after anterior cervical discectomy and fusion. Elderly patients show a lower improvement and higher complication rates than their younger counterparts. ASD rates are low, and younger patients with preexisting cranial level alterations are more susceptible.
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Affiliation(s)
- Ali Baram
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | - Gabriele Capo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marco Riva
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Carlo Brembilla
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Elena Rosellini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Mario De Robertis
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Franco Servadei
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Federico Pessina
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Maurizio Fornari
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Ding Y, Li N, Hu W, Jiang W, Zhu Q, Jiang T, Cheng H. Comparison of anterior and posterior approach in the treatment of acute and chronic cervical spinal cord injury: a meta-analysis. Front Surg 2024; 11:1410220. [PMID: 39247704 PMCID: PMC11377331 DOI: 10.3389/fsurg.2024.1410220] [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: 05/25/2024] [Accepted: 08/12/2024] [Indexed: 09/10/2024] Open
Abstract
Objective A cervical spinal cord injury (CSCI) is a traumatic catastrophe that often leads to neurological dysfunction. The optimal surgical procedure for the treatment of CSCI remains debatable. The aim of this meta-analysis is to compare the neurological outcomes, complications, and clinical factors between anterior and posterior approach in CSCI treatment. Methods We searched PubMed, Embase, Web of Science and Cochrane library from their inceptions to october 2023. Preoperative and postoperative Spinal Injury Association (ASIA) and Japanese Orthopedic Association (JOA) scores, and calculated recovery rates (RRs) were compared between the two strategies, and differences in complication rates, operation time, intraoperative blood loss and length of stay were also analyzed. Results A total of five studies containing 613 patients were included, with 320 patients undergoing the anterior approach and 293 patients undergoing the posterior approach. Four of the studies included were retrospective cohort studies of high quality as assessed by the Newcastle Ottawa Scale. Additionally, there was one randomized controlled trial evaluated with the Cochrane Risk of Bias tool. Although both anterior and posterior approaches effectively facilitate spinal decompression and promote good neurological recovery, there was no significant difference in the incidences of neurological dysfunction and complications or other clinical features between the two approaches. Conclusion There is no evidence thus far supports one approach over the other. Large-scale randomized controlled studies are warranted to further distinguish these two methods. Systematic Review Registration https://www.crd.york.ac.uk/, PROSPERO [CRD42023438831].
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Affiliation(s)
- Yi Ding
- School of Medicine, Southeast University, Nanjing, China
| | - Ning Li
- School of Medicine, Southeast University, Nanjing, China
- Department of Neurosurgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Wenjing Hu
- School of Public Health, Southeast University, Nanjing, China
| | - Wenkang Jiang
- School of Medicine, Southeast University, Nanjing, China
| | - Qianmiao Zhu
- School of Medicine, Southeast University, Nanjing, China
| | - Ting Jiang
- School of Medicine, Southeast University, Nanjing, China
| | - Huilin Cheng
- School of Medicine, Southeast University, Nanjing, China
- Department of Neurosurgery, Zhongda Hospital, Southeast University, Nanjing, China
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Shi L, Ding T, Wang F, Wu C. Comparison of Anterior Cervical Decompression and Fusion and Posterior Laminoplasty for Four-Segment Cervical Spondylotic Myelopathy: Clinical and Radiographic Outcomes. J Neurol Surg A Cent Eur Neurosurg 2024; 85:331-339. [PMID: 36584878 DOI: 10.1055/a-2005-0552] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although anterior or posterior surgery for cervical spondylotic myelopathy (CSM) has been extensively studied, the choice of anterior or posterior approach in four-segment CSM remains poorly studied and controversial. We compared the clinical and radiographic outcomes of four-segment CSM by posterior laminoplasty (LAMP) and anterior cervical decompression fusion (ACDF) to further explore the merits and demerits of ACDF and LAMP for four-segment CSM in this study. METHODS Patients with four-segment CSM who underwent ACDF or LAMP between January 2016 and June 2019 were retrospectively analyzed. We compared the preoperative and postoperative cervical Japanese Orthopaedic Association (JOA) scores, neck disability index (NDI), neck pain visual analog scale (VAS) score, sagittal vertical axis, cervical lordosis (CL), and range of motion. RESULTS There were 47 and 79 patients in the ACDF and LAMP groups, respectively. Patients in the ACDF group had a significantly longer surgical time and lower estimated blood loss and length of stay than those in the LAMP group. There was no significant difference in the JOA, NDI, or neck pain VAS scores between the two groups preoperatively, but the NDI and neck pain VAS scores in the ACDF group were significantly lower than those in the LAMP group at the final follow-up. The preoperative C2-C7 Cobb angle of the ACDF group was significantly lower than that of the LAMP group but there was no significant difference between the two groups postoperatively. The improvement of C2-C7 Cobb angle (∆C2-C7 Cobb angle) in the ACDF group was significantly higher than that in the LAMP group. This indicated that ACDF can improve CL better than LAMP. The linear regression analysis revealed the ∆C2-C7 Cobb angle was negatively correlated with the final follow-up neck pain VAS scores and NDI. This indicated that patients with better improvement of CL may have a better prognosis. CONCLUSIONS Although both ACDF and LAMP surgeries are effective for four-segment CSM, ACDF can better improve CL and neck pain. For patients with poor CL, we suggest ACDF when both approaches are feasible.
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Affiliation(s)
- Liang Shi
- Department of Orthopedics, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Tao Ding
- Department of Spine Surgery, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Fang Wang
- Department of Pathology, Qujing Second People's Hospital of Yunnan Province, Qujing, China
| | - Chengcong Wu
- Department of Spine Surgery, Qujing First People's Hospital: Kunming Medical University Affiliated Qujing Hospital, Qujing, Yunnan, China
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Lee Y, Trenchfield D, Berthiaume E, Tomlak A, Narayanan R, Brush P, Heard J, Maddy K, Issa T, Lambrechts M, Kaye ID, Mangan J, Grasso G, Canseco J, Vaccaro A, Kepler C, Schroeder G, Hilibrand A. A Comparison of Clinical Outcomes Between Anterior Cervical Discectomy and Fusion Versus Posterior Cervical Laminoplasty for Multilevel Cervical Myelopathy. Clin Spine Surg 2024:01933606-990000000-00326. [PMID: 38884360 DOI: 10.1097/bsd.0000000000001634] [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: 08/23/2023] [Accepted: 02/28/2024] [Indexed: 06/18/2024]
Abstract
STUDY DESIGN Retrospective Cohort. OBJECTIVE To compare patient-reported outcomes and surgical outcomes after anterior cervical discectomy and fusion (ACDF) versus cervical laminoplasty for multilevel cervical spondylotic myelopathy. BACKGROUND Treatment options for multilevel cervical spondylotic myelopathy include ACDF and cervical laminoplasty. Given that the literature has been mixed regarding the optimal approach, especially in patients without kyphosis, there is a need for additional studies investigating outcomes between ACDF and cervical laminoplasty. METHODS A retrospective review was conducted of adult patients undergoing 3 or 4-level surgery. Patients with preoperative kyphosis based on C2-C7 Cobb angles were excluded. The electronic medical record and institutional databases were reviewed for baseline characteristics, surgical outcomes, and patient-reported outcomes. RESULTS A total of 101 patients who underwent ACDF and 52 patients who underwent laminoplasty were included in the study. The laminoplasty cohort had a higher overall Charlson Comorbidity Index (3.10 ± 1.43 vs 2.39 ± 1.57, P = 0.011). Both groups had a comparable number of levels decompressed, C2-C7 lordosis, and diagnosis of myelopathy versus myeloradiculopathy. Patients who underwent laminoplasty had a longer length of stay (2.04 ± 1.15 vs 1.48 ± 0.70, P = 0.003) but readmission, complication, and revision rates were similar. Both groups had similar improvement in myelopathy scores (∆modified Japanese Orthopedic Association: 1.11 ± 3.09 vs 1.06 ± 3.37, P = 0.639). ACDF had greater improvement in Neck Disability Index (∆Neck Disability Index: -11.66 ± 19.2 vs -1.13 ± 11.2, P < 0.001), neck pain (∆Visual Analog Scale-neck: -2.69 ± 2.78 vs -0.83 ± 2.55, P = 0.003), and arm pain (∆Visual Analog Scale-arm: -2.47 ± 3.15 vs -0.48 ± 3.19, P = 0.010). These findings persisted in multivariate analysis except for Neck Disability Index. CONCLUSION ACDF and cervical laminoplasty appear equally efficacious at halting myelopathic progression. However, patients who underwent ACDF had greater improvements in arm pain at 1 year postoperatively. Longitudinal studies evaluating the efficacy of laminoplasty to mitigate adjacent segment disease are indicated to establish a robust risk-benefit assessment for these 2 procedures. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yunsoo Lee
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Delano Trenchfield
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Emily Berthiaume
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Alexa Tomlak
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Rajkishen Narayanan
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Parker Brush
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Jeremy Heard
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Krisna Maddy
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Tariq Issa
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Mark Lambrechts
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Ian David Kaye
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - John Mangan
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Giovanni Grasso
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, University of Palermo, Via del Vespro, Palermo, Italy
| | - Jose Canseco
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Alexander Vaccaro
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Christopher Kepler
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Gregory Schroeder
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Alan Hilibrand
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
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Lee DH, Lee HR, Riew KD. An Algorithmic Roadmap for the Surgical Management of Degenerative Cervical Myelopathy: A Narrative Review. Asian Spine J 2024; 18:274-286. [PMID: 38146052 PMCID: PMC11065509 DOI: 10.31616/asj.2023.0413] [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: 12/10/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023] Open
Abstract
Degenerative cervical myelopathy (DCM) is a leading cause of disability, and its surgical management is crucial for improving patient neurological outcomes. Given the varied presentations and severities of DCM, treatment options are diverse. Surgeons often face challenges in selecting the most appropriate surgical approach because there is no universally correct answer. This narrative review aimed to aid the decision-making process in treating DCM by presenting a structured treatment algorithm. The authors categorized surgical scenarios based on an algorithm, outlining suitable treatment methods for each case. Four primary scenarios were identified based on the number of levels requiring surgery and K-line status: (1) K-line (+) and ≤3 levels, (2) K-line (+) and ≥3 levels, (3) K-line (-) and ≤3 levels, and (4) K-line (-) and ≥3 levels. This categorization aids in determining the appropriateness of anterior or posterior approaches and the necessity for fusion, considering the surgical level and K-line status. The complexity of surgical situations and diversity of treatment methods for DCM can be effectively managed using an algorithmic approach. Furthermore, surgical techniques that minimize the stages and address challenging conditions could enhance treatment outcomes in DCM.
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Affiliation(s)
- Dong-Ho Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Hyung Rae Lee
- Department of Orthopaedic Surgery, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu,
Korea
| | - Kiehyun Daniel Riew
- Department of Orthopaedic Surgery, New York-Presbyterian Och Spine Hospital, Columbia University, New York, NY,
USA
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Kong Q, Li F, Yan C, Sun J, Sun P, Ou‐Yang J, Zhong S, Wang Y, Shi J. Biomechanical Comparison of Anterior Cervical Corpectomy Decompression and Fusion, Anterior Cervical Discectomy and Fusion, and Anterior Controllable Antedisplacement and Fusion in the Surgical Treatment of Multilevel Cervical Spondylotic Myelopathy: A Finite Element Analysis. Orthop Surg 2024; 16:687-699. [PMID: 38316415 PMCID: PMC10925493 DOI: 10.1111/os.13994] [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: 07/30/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 02/07/2024] Open
Abstract
PURPOSE Multilevel cervical spondylotic myelopathy poses significant challenges in selecting optimal surgical approaches, warranting a comprehensive understanding of their biomechanical impacts. Given the lack of consensus regarding the most effective technique, this study aims to fill this critical knowledge gap by rigorously assessing and comparing the biomechanical properties of three distinct surgical interventions, including anterior controllable antedisplacement and fusion (ACAF), anterior cervical corpectomy decompression and fusion (ACCF), and anterior cervical discectomy and fusion (ACDF). The study offers pivotal insights to enhance treatment precision and patient outcomes. METHODS The construction of the cervical spine model involved a detailed process using CT data, specialized software (Mimics, Geomagic Studio, and Hypermesh) and material properties obtained from prior studies. Surgical instruments were modeled (titanium mesh, anterior cervical plate, interbody cage, and self-tapping screws) to simulate three surgical approaches: ACAF, ACCF, and ACDF, each with specific procedures replicating clinical protocols. A 75-N follower load with 2 Nm was applied to simulate biomechanical effects. RESULTS The range of motion decreased more after surgery for ACAF and ACDF than for ACCF, especially in flexion and lateral bending. ACCF have higher stress peaks in the fixation system than those of ACAF and ACDF, especially in flexion. The maximum von Mises stresses of the bone-screw interfaces at C3 of ACCF were higher than those of ACAF and ACDF. The maximum von Mises stresses of the bone-screw interfaces at C6 of ACDF were much higher than those of ACAF and ACCF. The maximum von Mises stresses of the grafts of ACCF and ACAF were much higher than those of ACDF. The maximum von Mises stresses of the endplate of ACCF were much higher than those of ACAF and ACDF. CONCLUSION The ACAF and ACDF models demonstrated superior cervical reconstruction stability over the ACCF model. ACAF exhibited lower risks of internal fixation failure and cage subsidence compared to ACCF, making it a promising approach. However, while ACAF revealed improved stability over ACCF, higher rates of subsidence and internal fixation failure persisted compared to ACDF, suggesting the need for further exploration of ACAF's long-term efficacy and potential improvements in clinical outcomes.
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Affiliation(s)
- Qingjie Kong
- Department of Orthopedics, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Fudong Li
- Department of Orthopedic Surgery, Spine Center, Shanghai Changzheng HospitalSecond Military Medical UniversityShanghaiChina
| | - Chen Yan
- Department of Orthopedic Surgery, Spine Center, Shanghai Changzheng HospitalSecond Military Medical UniversityShanghaiChina
| | - Jingchuan Sun
- Department of Orthopedic Surgery, Spine Center, Shanghai Changzheng HospitalSecond Military Medical UniversityShanghaiChina
| | - Peidong Sun
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of AnatomySouthern Medical UniversityGuangzhouChina
| | - Jun Ou‐Yang
- Department of Orthopedic Surgery, Spine Center, Shanghai Changzheng HospitalSecond Military Medical UniversityShanghaiChina
| | - Shizhen Zhong
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of AnatomySouthern Medical UniversityGuangzhouChina
| | - Yuan Wang
- Department of Orthopedic Surgery, Spine Center, Shanghai Changzheng HospitalSecond Military Medical UniversityShanghaiChina
| | - Jiangang Shi
- Department of Orthopedic Surgery, Spine Center, Shanghai Changzheng HospitalSecond Military Medical UniversityShanghaiChina
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Elsamadicy AA, Sayeed S, Sherman JJZ, Craft S, Reeves BC, Hengartner AC, Koo AB, Larry Lo SF, Shin JH, Mendel E, Sciubba DM. Racial/Ethnic Disparities Among Patients Undergoing Anterior Cervical Discectomy and Fusion or Posterior Cervical Decompression and Fusion for Cervical Spondylotic Myelopathy: A National Administrative Database Analysis. World Neurosurg 2024; 183:e372-e385. [PMID: 38145651 DOI: 10.1016/j.wneu.2023.12.103] [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: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION The aim of this study was to investigate the impact of racial disparities on surgical outcomes for cervical spondylotic myelopathy (CSM). METHODS Adult patients undergoing anterior cervical discectomy and fusion (ACDF) or posterior cervical decompression and fusion (PCDF) for CSM were identified from the 2016 to 019 National Inpatient Sample Database using the International Classification of Diseases codes. Patients were categorized based on approach (ACDF or PCDF) and race/ethnicity (White, Black, Hispanic). Patient demographics, comorbidities, operative characteristics, adverse events, and health care resource utilization were assessed. Multivariate logistic regression analyses were used to identify independent predictors of extended length of stay (LOS), nonroutine discharge (NRD), and exorbitant costs. RESULTS A total of 46,500 patients were identified, of which 36,015 (77.5%) were White, 7465 (16.0%) were Black, and 3020 (6.5%) were Hispanic. Black and Hispanic patients had a greater comorbidity burden compared to White patients (P = 0.001) and a greater incidence of any postoperative complication (P = 0.001). Healthcare resource utilization were greater in the PCDF cohort than the ACDF cohort and greater in Black and Hispanic patients compared to White patients (P < 0.001). Black and Hispanic patient race were significantly associated with extended hospital LOS ([Black] odds ratio [OR]: 2.24, P < 0.001; [Hispanic] OR: 1.64, P < 0.001) and NRD ([Black] OR: 2.33, P < 0.001; [Hispanic] OR: 1.49, P = 0.016). Among patients who underwent PCDF, Black race was independently associated with extended hospital LOS ([Black] OR: 1.77, P < 0.001; [Hispanic] OR: 1.47, P = 0.167) and NRD ([Black] OR: 1.82, P < 0.001; [Hispanic] OR: 1.38, P = 0.052). CONCLUSIONS Our study suggests that patient race may influence patient outcomes and healthcare resource utilization following ACDF or PCDF for CSM.
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Affiliation(s)
- Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
| | - Sumaiya Sayeed
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Josiah J Z Sherman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Samuel Craft
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Benjamin C Reeves
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Astrid C Hengartner
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andrew B Koo
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ehud Mendel
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
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Cabrera JP, Agarwal N, Mesregah MK, Rodrigues-Pinto R, Wu Y, Martin C, Buser Z, Wang JC, Meisel HJ. Analysis of Complications in Multilevel Anterior Cervical Discectomy and Fusion Using Osteobiologics Other than Bone Morphogenetic Protein: A Systematic Review. Global Spine J 2024; 14:86S-93S. [PMID: 38421321 PMCID: PMC10913906 DOI: 10.1177/21925682231168083] [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: 03/02/2024] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES The aim of this study is to analyze the complications related to multilevel anterior cervical discectomy and fusion (ACDF) using osteobiologics other than bone morphogenetic protein (BMP). METHODS A systematic review of the literature was conducted using PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov databases. The search to identify studies reporting complications in multilevel ACDF surgery using osteobiologics other than bone morphogenetic protein was performed in August 2020. The study was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). RESULTS A total of 584 articles were found after searching the databases and removing duplicates. Next, screening was performed in a double reviewer process, and 153 eligible articles-with 4 retrospective studies-in full-text were selected; these met all inclusion criteria. A total of 197 patients received 3-level ACDF, while 72 patients received 4-level ACDF. Osteobiologics were used in all selected articles, allograft was used in 4 studies, autologous bone graft was utilized in 3 articles, and hydroxyapatite was used in 1 article. The main complications reported were dysphagia, adjacent segment disease, and pseudarthrosis. CONCLUSIONS Given the limited evidence, no conclusions on complications in multilevel ACDF using osteobiologics other than BMP could be made. However, descriptively, the most common complications found were dysphagia, adjacent segment disease, and pseudoarthrosis. Further prospective studies separately analyzing complications in multilevel ACDF by osteobiologics and a number of treated levels are needed.
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Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
- Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Neha Agarwal
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Halle, Germany
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM). Department of Orthopaedics, Centro Hospitalar Universitário de Santo António; ICBAS - School of Medical and Biomedical Sciences; Hospital CUF Trindade, Porto, Portugal
| | - Yabin Wu
- Research Department, AO Spine, AO Foundation, Davos, Switzerland
| | - Christopher Martin
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hans Jörg Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Halle, Germany
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10
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Jackson-Fowl B, Hockley A, Naessig S, Ahmad W, Pierce K, Smith JS, Ames C, Shaffrey C, Bennett-Caso C, Williamson TK, McFarland K, Passias PG. Adult cervical spine deformity: a state-of-the-art review. Spine Deform 2024; 12:3-23. [PMID: 37776420 DOI: 10.1007/s43390-023-00735-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 07/01/2023] [Indexed: 10/02/2023]
Abstract
Adult cervical deformity is a structural malalignment of the cervical spine that may present with variety of significant symptomatology for patients. There are clear and substantial negative impacts of cervical spine deformity, including the increased burden of pain, limited mobility and functionality, and interference with patients' ability to work and perform everyday tasks. Primary cervical deformities develop as the result of a multitude of different etiologies, changing the normal mechanics and structure of the cervical region. In particular, degeneration of the cervical spine, inflammatory arthritides and neuromuscular changes are significant players in the development of disease. Additionally, cervical deformities, sometimes iatrogenically, may present secondary to malalignment or correction of the thoracic, lumbar or sacropelvic spine. Previously, classification systems were developed to help quantify disease burden and influence management of thoracic and lumbar spine deformities. Following up on these works and based on the relationship between the cervical and distal spine, Ames-ISSG developed a framework for a standardized tool for characterizing and quantifying cervical spine deformities. When surgical intervention is required to correct a cervical deformity, there are advantages and disadvantages to both anterior and posterior approaches. A stepwise approach may minimize the drawbacks of either an anterior or posterior approach alone, and patients should have a surgical plan tailored specifically to their cervical deformity based upon symptomatic and radiographic indications. This state-of-the-art review is based upon a comprehensive overview of literature seeking to highlight the normal cervical spine, etiologies of cervical deformity, current classification systems, and key surgical techniques.
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Affiliation(s)
- Brendan Jackson-Fowl
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Aaron Hockley
- Department of Neurosurgery, University of Alberta, Edmonton, AB, USA
| | - Sara Naessig
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Waleed Ahmad
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Katherine Pierce
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Christopher Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Christopher Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Claudia Bennett-Caso
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Tyler K Williamson
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Kimberly McFarland
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Peter G Passias
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA.
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11
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Elsamadicy AA, Sayeed S, Sherman JJZ, Craft S, Reeves BC, Lo SFL, Shin JH, Sciubba DM. Impact of Preoperative Frailty on Outcomes in Patients with Cervical Spondylotic Myelopathy Undergoing Anterior vs. Posterior Cervical Surgery. J Clin Med 2023; 13:114. [PMID: 38202121 PMCID: PMC10779741 DOI: 10.3390/jcm13010114] [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: 11/21/2023] [Revised: 12/15/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
Introduction: Frailty has been shown to negatively influence patient outcomes across many disease processes, including in the cervical spondylotic myelopathy (CSM) population. The aim of this study was to assess the impact that frailty has on patients with CSM who undergo anterior cervical discectomy and fusion (ACDF) or posterior cervical decompression and fusion (PCDF). Materials and Methods: A retrospective cohort study was performed using the 2016-2019 national inpatient sample. Adult patients (≥18 years old) undergoing ACDF only or PCDF only for CSM were identified using ICD codes. The patients were categorized based on receipt of ACDF or PCDF and pre-operative frailty status using the 11-item modified frailty index (mFI-11): pre-Frail (mFI = 1), frail (mFI = 2), or severely frail (mFI ≥ 3). Patient demographics, comorbidities, operative characteristics, perioperative adverse events (AEs), and healthcare resource utilization were assessed. Multivariate logistic regression analyses were used to identify independent predictors of extended length of stay (LOS) and non-routine discharge (NRD). Results: A total of 37,990 patients were identified, of which 16,665 (43.9%) were in the pre-frail cohort, 12,985 (34.2%) were in the frail cohort, and 8340 (22.0%) were in the severely frail cohort. The prevalence of many comorbidities varied significantly between frailty cohorts. Across all three frailty cohorts, the incidence of AEs was greater in patients who underwent PCDF, with dysphagia being significantly more common in patients who underwent ACDF. Additionally, the rate of adverse events significantly increased between ACDF and PCDF with respect to increasing frailty (p < 0.001). Regarding healthcare resource utilization, LOS and rate of NRD were significantly greater in patients who underwent PCDF in all three frailty cohorts, with these metrics increasing with frailty in both ACDF and PCDF cohorts (LOS: p < 0.001); NRD: p < 0.001). On a multivariate analysis of patients who underwent ACDF, frailty and severe frailty were found to be independent predictors of extended LOS [(frail) OR: 1.39, p < 0.001; (severely frail) OR: 2.25, p < 0.001] and NRD [(frail) OR: 1.49, p < 0.001; (severely frail) OR: 2.22, p < 0.001]. Similarly, in patients who underwent PCDF, frailty and severe frailty were found to be independent predictors of extended LOS [(frail) OR: 1.58, p < 0.001; (severely frail) OR: 2.45, p < 0.001] and NRD [(frail) OR: 1.55, p < 0.001; (severely frail) OR: 1.63, p < 0.001]. Conclusions: Our study suggests that preoperative frailty may impact outcomes after surgical treatment for CSM, with more frail patients having greater health care utilization and a higher rate of adverse events. The patients undergoing PCDF ensued increased health care utilization, compared to ACDF, whereas severely frail patients undergoing PCDF tended to have the longest length of stay and highest rate of non-routine discharge. Additional prospective studies are necessary to directly compare ACDF and PCDF in frail patients with CSM.
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Affiliation(s)
- Aladine A. Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Sumaiya Sayeed
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Josiah J. Z. Sherman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Samuel Craft
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Benjamin C. Reeves
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center, North Shore University Hospital, Northwell Health, Manhasset, NY 11030, USA
| | - John H. Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Daniel M. Sciubba
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center, North Shore University Hospital, Northwell Health, Manhasset, NY 11030, USA
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12
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Ogden M, Karagedik MI, Ozdemir A, Bulut IU, Erdogan AM, Bakar B. Investigation of the Efficacy of Bilateral Osteoligamentous Decompression via Hemilaminectomy in Cervical Spondylotic Myelopathy: A Clinical Study. World Neurosurg 2023; 180:e560-e578. [PMID: 37778625 DOI: 10.1016/j.wneu.2023.09.110] [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: 06/22/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Cervical stability may deteriorate and kyphotic spinal deformities may develop in cervical spondylotic myelopathy (CSM) after laminectomy or laminoplasty. This study aimed to investigate the therapeutic efficacy of the "bilateral osteoligamentous decompression via unilateral hemilaminectomy approach (UHBOLD)" technique in CSM patients. METHODS The study included 34 adult patients who underwent UHBOLD surgery for CSM between 2016 and 2022. A record was made for all patients of age, gender, number of operated levels, preoperative and postoperative long-term follow-up VAS scores, Nurick grade values and mJOA scores, kyphosis angles measured on X-ray, and spinal canal areas measured on T2-weighted MR axial images. RESULTS Preoperative VAS scores of the patients were 6 (4-9), Nurick grade values were 3 (2-5), mJOA scores were 10.50 ± 3.42, kyphosis angles were -13.34 ± 13.69° and spinal canal areas were 87.11 ± 28.30 mm2. In postoperative long-term follow-up of these patients, VAS scores were 2 (1-5), Nurick grade values were 1 (0-5), mJOA scores were 13.94 ± 3.09, kyphosis angles were -15.07 ± 12.78° and spinal canal areas were 149.65 ± 42.57 mm2. A statistically significant difference was determined between the preoperative and the postoperative long-term follow-up VAS scores, Nurick grade values, mJOA scores, and spinal canal areas (P < 0.001). Kyphosis angles were not different (P = 0.198), and no instability was observed in any patient in long-term follow-up. CONCLUSIONS The UHBOLD technique performed in multilevel CSM patients did not cause any change in cervical lordosis angle in long-term follow-up, did not cause cervical kyphotic deformity or cervical instability, and significantly improved Nurick grade values, and VAS and mJOA scores.
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Affiliation(s)
- Mustafa Ogden
- Department of Neurosurgery, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey.
| | | | - Alemiddin Ozdemir
- Department of Neurosurgery, Iskenderun State Hospital, Hatay, Turkey
| | - Ibrahim Umud Bulut
- Department of Neurosurgery, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
| | - Ahmet Melih Erdogan
- Department of Neurosurgery, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
| | - Bulent Bakar
- Department of Neurosurgery, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
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13
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AKGÜN MY, ATEŞ Ö, TEPEBAŞILI MA, GÜNERBÜYÜK C, ÖZER AF. Clinical parameters of laminoplasty and laminectomy with fusion in the treatment of cervical spondylosis and analysis of postoperative sagittal balance. Turk J Med Sci 2023; 53:1458-1464. [PMID: 38813028 PMCID: PMC10763773 DOI: 10.55730/1300-0144.5713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 10/26/2023] [Accepted: 08/11/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim Cervical spondylosis is a progressive disease that causes degenerative changes affecting the spine, intervertebral discs, facets, and ligaments. With anterior and posterior surgical interventions, effective treatments can be applied in cervical spondylotic myelopathy (CSM). The relationship between regional and global spinal alignment and functional and pain outcomes was examined and it was revealed that these parameters play a significant role in obtaining good results. The aim of this study was to compare the perioperative and follow-up results of patients with CSM who underwent laminoplasty or laminectomy with fusion. Materials and method CSM patients who were operated on between 2015 and 2020 and had at least 2 years of clinical and radiological follow-up were analyzed retrospectively. The patients were divided into 2 groups as the laminoplasty group and the laminectomy with fusion group, according to a simple random method. Demographic, clinical, radiological, and perioperative parameters were examined. Measurements were made by an independent observer using Surgimap and 2 years was considered to be sufficient time for the spine to take its final shape. Result A total of 112 patients, including 68 males and 44 females, were included. Of these patients, 69 were in the laminectomy with fusion group, and 43 were in the laminoplasty group. Patient ages ranged from 39 to 85 years. The mean follow-up period was 36.28 months. In both groups, at the 3-month follow-up, a statistically significant improvement in the clinical parameters (neck disability index, visual analogue scale, modified Japanese Orthopaedic Association scores) was observed. When the preoperative cervical radiological parameters were evaluated, no statistically significant difference was found between the groups. The C2-C7 lordotic angles and the cervical SVA values were increased in the postoperative period, for both groups (p < 0.001). Although it is noteworthy that the increases were higher in the laminectomy with fusion group, no statistically significant difference was found between the groups. Conclusion Deformity in a spinal segment may indirectly affect another segment. Being aware of the compensatory mechanisms and radiological parameters will help in determining the effective treatment plan.
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Affiliation(s)
- Mehmet Yiğit AKGÜN
- Department of Neurosurgery, Koç University Hospital, İstanbul,
Turkiye
- Spine Center, Koç University Hospital, İstanbul,
Turkiye
| | - Özkan ATEŞ
- Department of Neurosurgery, Koç University Hospital, İstanbul,
Turkiye
- Spine Center, Koç University Hospital, İstanbul,
Turkiye
| | | | | | - Ali Fahir ÖZER
- Department of Neurosurgery, Koç University Hospital, İstanbul,
Turkiye
- Spine Center, Koç University Hospital, İstanbul,
Turkiye
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14
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Guo L, Li J, Zhang F, Sun Y, Zhang W. Posterior endoscopic decompression combined with anterior cervical discectomy and fusion versus posterior laminectomy and fusion for multilevel cervical spondylotic myelopathy: a retrospective case-control study. BMC Musculoskelet Disord 2023; 24:578. [PMID: 37454072 DOI: 10.1186/s12891-023-06713-2] [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: 03/09/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE To compare the clinical efficacy of surgical treatment for multilevel cervical spondylotic myelopathy (MCSM) between the hybrid procedure, posterior endoscopic decompression (PED) combined with anterior cervical discectomy fusion (ACDF), and posterior cervical laminectomy and fusion (PCLF). METHODS A retrospective analysis was performed on 38 patients who received surgical treatment for MCSM from January 2018 to December 2021, including 19 cases in hybrid procedure group (13 males and 6 females), followed up for 10 to 22 (12.8 ± 10.3) months, and 19 cases in PCLF group (15 males and 4 females), followed up for 10 to 21 (11.7 ± 8.9) months. Perioperative information, including operation time, intraoperative blood loss, length of hospitalization, and complications, were compared between two groups. Visual analogue scale (VAS) of pain, neck disability index (NDI) and Japanese Orthopaedic Association (JOA) score were recorded to evaluate clinical efficacy. Cervical lordosis was calculated by radiographic examination. RESULTS Intraoperative blood loss, length of hospital stay were less in hybrid group than PCLF group, while operation time is longer in hybrid group, with a statistically significant difference (p < 0.05). Increased lordosis was better in hybrid group. There was no significant difference in preoperative VAS, JOA and NDI at pre-operation and final follow-up between two groups. But at post-operation and final follow-up, VAS was less in hybrid group than PCLF group (p < 0.05). There were 2 cases of neurostimulation symptoms in hybrid group, 2 cases of C5 nerve root palsy, 2 cases of subcutaneous fat necrosis and 1 case of dural tear in PCLF group, and all patients relieved with symptomatic treatment. CONCLUSION The hybrid procedure of PED combined with ACDF showed satisfied clinical outcome, with less intraoperative blood loss, shorter length of hospitalization and lower post-operative neck pain than PCLF. It is an effective surgical treatment for MCSM.
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Affiliation(s)
- Lei Guo
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei, China
| | - Jiaqi Li
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei, China
| | - Fei Zhang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei, China
| | - Yapeng Sun
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei, China
| | - Wei Zhang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei, China.
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15
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Yuh WT, Kim M, Choi Y, Han J, Kim J, Kim T, Chung CK, Lee CH, Park SB, Kim KT, Rhee JM, Park MS, Kim CH. Nationwide sample data analysis of additional surgery rate after anterior or posterior cervical spinal surgery. Sci Rep 2023; 13:6317. [PMID: 37072455 PMCID: PMC10113194 DOI: 10.1038/s41598-023-33588-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 04/15/2023] [Indexed: 05/03/2023] Open
Abstract
Surgical outcomes of degenerative cervical spinal disease are dependent on the selection of surgical techniques. Although a standardized decision cannot be made in an actual clinical setting, continued education is provided to standardize the medical practice among surgeons. Therefore, it is necessary to supervise and regularly update overall surgical outcomes. This study aimed to compare the rate of additional surgery between anterior and posterior surgeries for degenerative cervical spinal disease using the National Health Insurance Service-National Sample Cohort (NHIS-NSC) nationwide patient database. The NHIS-NSC is a population-based cohort with about a million participants. This retrospective cohort study included 741 adult patients (> 18 years) who underwent their first cervical spinal surgery for degenerative cervical spinal disease. The median follow-up period was 7.3 years. An event was defined as the registration of any type of cervical spinal surgery during the follow-up period. Event-free survival analysis was used for outcome analysis, and the following factors were used as covariates for adjustment: location of disease, sex, age, type of insurance, disability, type of hospital, Charles comorbidity Index, and osteoporosis. Anterior cervical surgery was selected for 75.0% of the patients, and posterior cervical surgery for the remaining 25.0%. Cervical radiculopathy due to foraminal stenosis, hard disc, or soft disc was the primary diagnosis in 78.0% of the patients, and central spinal stenosis was the primary diagnosis in 22.0% of them. Additional surgery was performed for 5.0% of the patients after anterior cervical surgery and 6.5% of the patients after posterior cervical surgery (adjusted subhazard ratio, 0.83; 95% confidence interval, 0.40-1.74). The rates of additional surgery were not different between anterior and posterior cervical surgeries. The results would be helpful in evaluating current practice as a whole and adjusting the health insurance policy.
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Affiliation(s)
- Woon Tak Yuh
- Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, 7 Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Republic of Korea
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Minjung Kim
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yunhee Choi
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Junghoon Han
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Junhoe Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Taeshin Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Brain and Cognitive Sciences, College of Natural Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Neurosurgery, Seoul National University Boramae Hospital, Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea
- Department of Neurosurgery, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - John M Rhee
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Moon Soo Park
- Department of Orthopedics, Hallym University Dongtan Sacred Heart Hospital, 22 Gwanpyeong-ro 170 Beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Medical Device Development, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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16
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Lambrechts MJ, Brush PL, Lee Y, Issa TZ, Lawall CL, Syal A, Wang J, Mangan JJ, Kaye ID, Canseco JA, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD. Patient-Reported Outcomes Following Anterior and Posterior Surgical Approaches for Multilevel Cervical Myelopathy. Spine (Phila Pa 1976) 2023; 48:526-533. [PMID: 36716386 DOI: 10.1097/brs.0000000000004586] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/11/2023] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To compare health-related quality of life (HRQoL) outcomes between approach techniques for the treatment of multilevel degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA Both anterior and posterior approaches for the surgical treatment of cervical myelopathy are successful techniques in the treatment of myelopathy. However, the optimal treatment has yet to be determined, especially for multilevel disease, as the different approaches have separate complication profiles and potentially different impacts on HRQoL metrics. MATERIALS AND METHODS Retrospective review of a prospectively managed single institution database of patient-reported outcome measures after 3 and 4-level anterior cervical discectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) for DCM. The electronic medical record was reviewed for patient baseline characteristics and surgical outcomes whereas preoperative radiographs were analyzed for baseline cervical lordosis and sagittal balance. Bivariate and multivariate statistical analyses were performed to compare the two groups. RESULTS We identified 153 patients treated by ACDF and 43 patients treated by PCDF. Patients in the ACDF cohort were younger (60.1 ± 9.8 vs . 65.8 ± 6.9 yr; P < 0.001), had a lower overall comorbidity burden (Charlson Comorbidity Index: 2.25 ± 1.61 vs . 3.07 ± 1.64; P = 0.002), and were more likely to have a 3-level fusion (79.7% vs . 30.2%; P < 0.001), myeloradiculopathy (42.5% vs . 23.3%; P = 0.034), and cervical kyphosis (25.7% vs . 7.69%; P = 0.027). Patients undergoing an ACDF had significantly more improvement in their neck disability index after surgery (-14.28 vs . -3.02; P = 0.001), and this relationship was maintained on multivariate analysis with PCDF being independently associated with a worse neck disability index (+8.83; P = 0.025). Patients undergoing an ACDF also experienced more improvement in visual analog score neck pain after surgery (-2.94 vs . -1.47; P = 0.025) by bivariate analysis. CONCLUSIONS Our data suggest that patients undergoing an ACDF or PCDF for multilevel DCM have similar outcomes after surgery.
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Affiliation(s)
- Mark J Lambrechts
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Parker L Brush
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Yunsoo Lee
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Tariq Z Issa
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | | | - Amit Syal
- Thomas Jefferson University Medical School, Philadelphia, PA
| | - Jasmine Wang
- Thomas Jefferson University Medical School, Philadelphia, PA
| | - John J Mangan
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Ian David Kaye
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Jose A Canseco
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Alan S Hilibrand
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Alexander R Vaccaro
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Christopher K Kepler
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Gregory D Schroeder
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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17
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Kimchi G, Michaeli N, Nulman M, Knoller N, Maimon T, Harel R. Post-operative dysphagia following ventral cervical approach: complication or side-effect? Retrospective analysis and review of the literature. Br J Neurosurg 2023; 37:86-89. [PMID: 35943396 DOI: 10.1080/02688697.2022.2107179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To ameliorate the clinical decision-making process when debating between a ventral or dorsal cervical approach by elucidating whether post-operative dysphagia be regarded as a complication or a transient side effect. METHODS A literature review of studies comparing complication rates following ventral and dorsal cervical approaches was performed. A stratified complication rate excluding dysphagia was calculated and discussed. A retrospective cohort of patients operated for degenerative cervical myelopathy in a single institution comprising 665 patients was utilized to analyze complication rates using a uniform definition for dysphagia. RESULTS Both the ventral and the dorsal approach groups exhibited comparable neurological improvement rates. Since transient dysphagia was not considered a complication, the dorsal approach was associated with higher level of overall complications. CONCLUSIONS AND RELEVANCE Inconsistencies in the definition of dysphagia following ventral cervical surgery impedes the interpretation of trials comparing dorsal and ventral complication rates. A uniform definition for complications and side effects may enhance the validity of medical trials.
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Affiliation(s)
- Gil Kimchi
- Spine Surgery Division, Department of Neurosurgery, Sheba Medical Center, Ramat-Gan, Israel
| | - Nofar Michaeli
- Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Maya Nulman
- Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Nachshon Knoller
- Spine Surgery Division, Department of Neurosurgery, Sheba Medical Center, Ramat-Gan, Israel
| | - Tomer Maimon
- Spine Surgery Division, Department of Neurosurgery, Sheba Medical Center, Ramat-Gan, Israel
| | - Ran Harel
- Spine Surgery Division, Department of Neurosurgery, Sheba Medical Center, Ramat-Gan, Israel
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18
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Anterior and Posterior Approaches for 4-Level Degenerative Cervical Myelopathy: Low-Profile Cage Versus Cervical Pedicle Screws Fixation. J Clin Med 2023; 12:jcm12020564. [PMID: 36675493 PMCID: PMC9861750 DOI: 10.3390/jcm12020564] [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: 11/21/2022] [Revised: 12/26/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
(1) Background: The choice of surgical access for 4-level degenerative cervical myelopathy (DCM) remains controversial, and the clinical and radiological outcomes of anterior surgery using a low-profile cage (Low-P) versus posterior surgery using cervical pedicle screw fixation (CPS) have not been compared. (2) Methods: This is a retrospective controlled study conducted between January 2019 and June 2021 of 72 patients with 4-level DCM who underwent ACDF using a low-profile cage (n = 39) or laminectomy and instrument fusion using CPS (n = 33). The minimum follow-up time was 12 months. The outcomes were C2−7Cobb angle, C2−7sagittal vertical axis (SVA) fusion rate, the Japanese Orthopedic Association (JOA) score, pain visual analog scale (VAS), neck disability index (NDI), and complications. (3) Results: Both anterior and posterior procedures significantly improved the patients’ quality-of-life parameters. Anterior cervical convexity and SVA significantly increased in both groups, but the SVA was greater in the posterior group than in the anterior group (p < 0.001). The C2−7 Cobb angle significantly improved in both groups postoperatively, and at the final follow-up, there was a slight but nonsignificant reduction in cervical lordosis in both groups (p = 0.567). There was a longer operative time, less intraoperative blood loss, and reduced mean hospital stay in the anterior group compared to the posterior group, with two cases of postoperative hematoma requiring a second operation, two cases of axial pain (AP), five cases of dysphagia, two cases of c5 palsy in the anterior group, and four cases of axial pain, and three cases of c5 palsy in the posterior group. According to Bridwell fusion grade, anterior fusion reached grade I in 28 cases (71.8%) and grade II in 10 cases (25.6%) in the anterior group, and posterior fusion reached grade I in 25 cases (75.8%) and grade II in 8 cases (24.2%) in the posterior group. (4) Conclusions: There was no difference between the anterior and posterior surgical approaches for MDCM in terms of improvement in neurological function. Posterior surgery using CPS achieved similar recovery of cervical anterior convexity as anterior surgery with a shorter operative time but was more invasive and had a greater increase in SVA. The use of Low-P in anterior surgery reduced the incidence of dysphagia and cage subsidence and was less invasive, but with a longer operative time.
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19
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Li M, Zhang T, Zhang H, Zhang R, Li H, Gou X. Comparison of clinical efficacy between retention and removal of the vertebral bony endplate in anterior cervical discectomy and fusion for the treatment of cervical spondylotic myelopathy. J Orthop Sci 2023; 28:123-130. [PMID: 34895993 DOI: 10.1016/j.jos.2021.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/22/2021] [Accepted: 10/26/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) have a history of more than 60 years to treat cervical spondylotic myelopathy. This study is based on the original classic surgical procedure to remove the bony endplate to expand the range of vertical decompression to analyze and compare the clinical efficacy of two different ACDF in treating cervical spondylotic myelopathy. METHODS The inpatients in hospital were randomly divided into two groups A and B. Patients in Group A received ACDF surgery with bony endplates preserved, and patients in group B received ACDF surgery with bony endplates removed. All patients were followed-up for three years, and then compared the clinical efficacy from the following aspects, blood loss statistics during and after the operation, Japanese Orthopedic Association's scoring (JOA) standard for cervical spondylotic myelopathy, Cervical curvature index, cervical flexion and extension range, intervertebral bone graft fusion time and fusion rate. RESULTS 1. The operative time and intraoperative (postoperative) blood loss in group A were significantly better than that in group B, with statistical significance (P < 0.05)0.2. There was no significant difference in postoperative neurological function recovery, cervical curvature index, cervical flexion and extension activity, and Intervertebral fusion time between two groups (P > 0.05), while group A was superior to group B in terms of bone graft fusion rate (P < 0.05). 3. Four patients (6.7%) in group B suffered from dyspnea due to neck hematoma caused by drainage tube blockage, but all of them were cured immediately and no death occurred. CONCLUSIONS During the 3-year follow-up period after the operation, six patients in group B have subsidence and loosening of the internal fixator due to bone subsidence around the implant. Although immediate surgical treatment is not required, renovation surgery is inevitable in the long term.
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Affiliation(s)
- Mi Li
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.
| | - Tao Zhang
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Hanjun Zhang
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Rui Zhang
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Huazhe Li
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Xusheng Gou
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
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20
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Patient satisfaction three months after elective spine surgery for degenerative spine disease, Addis Ababa, Ethiopia: A one-year prospective study. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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21
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Chang CJ, Liu YF, Hsiao YM, Huang YH, Liu KC, Lin RM, Lin CL. Comparison of anterior cervical discectomy and fusion versus artificial disc replacement for cervical spondylotic myelopathy: a meta-analysis. J Neurosurg Spine 2022; 37:569-578. [PMID: 35453110 DOI: 10.3171/2022.2.spine211500] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 02/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anterior cervical discectomy and fusion (ACDF) has long been regarded as a gold standard in the treatment of cervical myelopathy. Subsequently, cervical artificial disc replacement (c-ADR) was developed and provides the advantage of motion preservation at the level of the intervertebral disc surgical site, which may also reduce stress at adjacent levels. The goal of this study was to compare clinical and functional outcomes in patients undergoing ACDF with those in patients undergoing c-ADR for cervical spondylotic myelopathy (CSM). METHODS A systematic literature review and meta-analysis were performed using the Embase, PubMed, and Cochrane Central Register of Controlled Trials databases from database inception to November 21, 2021. The authors compared Neck Disability Index (NDI), SF-36, and Japanese Orthopaedic Association (JOA) scores; complication rates; and reoperation rates for these two surgical procedures in CSM patients. The Mantel-Haenszel method and variance-weighted means were used to analyze outcomes after identifying articles that met study inclusion criteria. RESULTS More surgical time was consumed in the c-ADR surgery (p = 0.04). Shorter hospital stays were noted in patients who had undergone c-ADR (p = 0.04). Patients who had undergone c-ADR tended to have better NDI scores (p = 0.02) and SF-36 scores (p = 0.001). Comparable outcomes in terms of JOA scores (p = 0.24) and neurological success rate (p = 0.12) were noted after the surgery. There was no significant between-group difference in the overall complication rates (c-ADR: 18% vs ACDF: 25%, p = 0.17). However, patients in the ACDF group had a higher reoperation rate than patients in the c-ADR group (4.6% vs 1.5%, p = 0.02). CONCLUSIONS At the midterm follow-up after treatment of CSM, better functional outcomes as reflected by NDI and SF-36 scores were noted in the c-ADR group than those in the ACDF group. c-ADR had the advantage of retaining range of motion at the level of the intervertebral disc surgical site without causing more complications. A large sample size with long-term follow-up studies may be required to confirm these findings in the future.
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Affiliation(s)
- Chao-Jui Chang
- 1Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- 2Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Yuan-Fu Liu
- 1Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- 3Department of Orthopaedics, Dou-Liou Branch of National Cheng Kung University Hospital, Yunlin
| | - Yu-Meng Hsiao
- 4Department of Orthopedics, Tainan Municipal An-Nan Hospital, China Medical University, Tainan
| | - Yi-Hung Huang
- 1Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- 5Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City
| | - Keng-Chang Liu
- 6Department of Orthopaedic Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi
- 7School of Medicine, Tzu Chi University, Hualien City
| | - Ruey-Mo Lin
- 4Department of Orthopedics, Tainan Municipal An-Nan Hospital, China Medical University, Tainan
| | - Cheng-Li Lin
- 1Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- 2Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- 8Musculoskeletal Research Center, Innovation Headquarters, National Cheng Kung University, Tainan; and
- 9Medical Device Innovation Center (MDIC), National Cheng Kung University, Tainan, Taiwan
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22
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Park D, Cho JM, Yang JW, Yang D, Kim M, Oh G, Kwon HD. Classification of expert-level therapeutic decisions for degenerative cervical myelopathy using ensemble machine learning algorithms. Front Surg 2022; 9:1010420. [PMID: 36147698 PMCID: PMC9485547 DOI: 10.3389/fsurg.2022.1010420] [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] [Received: 08/03/2022] [Accepted: 08/19/2022] [Indexed: 11/28/2022] Open
Abstract
Background Therapeutic decisions for degenerative cervical myelopathy (DCM) are complex and should consider various factors. We aimed to develop machine learning (ML) models for classifying expert-level therapeutic decisions in patients with DCM. Methods This retrospective cross-sectional study included patients diagnosed with DCM, and the diagnosis of DCM was confirmed clinically and radiologically. The target outcomes were defined as conservative treatment, anterior surgical approaches (ASA), and posterior surgical approaches (PSA). We performed the following classifications using ML algorithms: multiclass, one-versus-rest, and one-versus-one. Two ensemble ML algorithms were used: random forest (RF) and extreme gradient boosting (XGB). The area under the receiver operating characteristic curve (AUC-ROC) was the primary metric. We also identified the variable importance for each classification. Results In total, 304 patients were included (109 conservative, 66 ASA, 125 PSA, and 4 combined surgeries). For multiclass classification, the AUC-ROC of RF and XGB models were 0.91 and 0.92, respectively. In addition, ML models showed AUC-ROC values of >0.9 for all types of binary classifications. Variable importance analysis revealed that the modified Japanese Orthopaedic Association score and central motor conduction time were the two most important variables for distinguishing between conservative and surgical treatments. When classifying ASA and PSA, the number of involved levels, age, and body mass index were important contributing factors. Conclusion ML-based classification of DCM therapeutic options is valid and feasible. This study can be a basis for establishing generalizable ML-based surgical decision models for DCM. Further studies are needed with a large multicenter database.
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Affiliation(s)
- Dougho Park
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, Pohang, South Korea
| | - Jae Man Cho
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, South Korea
| | - Joong Won Yang
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, South Korea
| | - Donghoon Yang
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, South Korea
| | - Mansu Kim
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, South Korea
| | - Gayeoul Oh
- Department of Radiology, Pohang Stroke and Spine Hospital, Pohang, South Korea
| | - Heum Dai Kwon
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, South Korea
- Correspondence: Heum Dai Kwon
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23
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Chan AY, Himstead AS, Choi EH, Hsu Z, Kurtz JS, Yang C, Lee YP, Bhatia NN, Lefteris CT, Wilson WC, Hsu FPK, Oh MY. Cost analysis comparison between anterior and posterior cervical spine approaches. Surg Neurol Int 2022; 13:300. [PMID: 35928309 PMCID: PMC9345123 DOI: 10.25259/sni_497_2022] [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: 05/27/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background The costs of cervical spine surgery have steadily increased. We performed a 5-year propensity scoring-matched analysis of 276 patients undergoing anterior versus posterior cervical surgery at one institution. Methods We performed propensity score matching on financial data from 276 patients undergoing 1-3 level anterior versus posterior cervical fusions for degenerative disease (2015-2019). Results We found no significant difference between anterior versus posterior approaches for hospital costs ($42,529.63 vs. $45,110.52), net revenue ($40,877.25 vs. $34,036.01), or contribution margins ($14,230.19 vs. $6,312.54). Multivariate regression analysis showed variables significantly associated with the lower contribution margins included age (β = -392.3) and length of stay (LOS; β = -1151). Removing age/LOS from the analysis, contribution margins were significantly higher for the anterior versus posterior approach ($17,824.16 vs. $6,312.54, P = 0.01). Conclusion Anterior cervical surgery produced higher contribution margins compared to posterior approaches, most likely because posterior surgery was typically performed in older patients requiring longer LOS.
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Affiliation(s)
- Alvin Y. Chan
- Department of Neurological Surgery, University of California, Irvine, UCI Medical Center, Orange, California,,Corresponding author: Alvin Y. Chan, Department of Neurological Surgery, University of California, Irvine, UCI Medical Center, Orange, California, United States.
| | - Alexander S. Himstead
- Department of Neurological Surgery, University of California, Irvine, UCI Medical Center, Orange, California
| | - Elliot H. Choi
- Department of Neurosurgery, Medical Scientist Training Program, Case Western Reserve University, Cleveland, Ohio
| | - Zachary Hsu
- Department of Orthopedic Surgery, University of California, Irvine, UCI Medical Center, Orange, California, United States
| | - Joshua S. Kurtz
- Department of Neurological Surgery, University of California, Irvine, UCI Medical Center, Orange, California
| | - Chenyi Yang
- Department of Neurological Surgery, University of California, Irvine, UCI Medical Center, Orange, California
| | - Yu-Po Lee
- Department of Orthopedic Surgery, University of California, Irvine, UCI Medical Center, Orange, California, United States
| | - Nitin N. Bhatia
- Department of Orthopedic Surgery, University of California, Irvine, UCI Medical Center, Orange, California, United States
| | - Chad T. Lefteris
- Department of UCI Health, University of California, Irvine, UCI Medical Center, Orange, California, United States
| | - William C. Wilson
- Department of UCI Health, University of California, Irvine, UCI Medical Center, Orange, California, United States
| | - Frank P. K. Hsu
- Department of Neurological Surgery, University of California, Irvine, UCI Medical Center, Orange, California
| | - Michael Y. Oh
- Department of Neurological Surgery, University of California, Irvine, UCI Medical Center, Orange, California
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24
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Lee NJ, Kim JS, Park P, Riew KD. A Comparison of Various Surgical Treatments for Degenerative Cervical Myelopathy: A Propensity Score Matched Analysis. Global Spine J 2022; 12:1109-1118. [PMID: 33375849 PMCID: PMC9210244 DOI: 10.1177/2192568220976092] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort. OBJECTIVE To compare the short-term outcomes for Laminoplasty, Laminectomy/fusion, and ACDF. METHODS We utilized a prospectively-collected, multi-center national database with a propensity score matching algorithm to compare the short-term outcomes for laminoplasty, laminectomy/fusion, and multi-level (>3) ACDF (with and without corpectomy). Bivariate analyses involved both chi-square/fisher exact test and t-test/ANOVA on perioperative factors. Multivariate analyses were performed to determined independent risk factors for short term outcomes. RESULTS 546 patients remained after propensity score matching, with 182 patients in each cohort. ACDF required the longest operative time 188 ± 79 versus laminectomy/fusion (169 ± 75, p = 0.017), and laminoplasty (167 ± 66, p = 0.004). ACDF required the shortest hospital stay (LOS ≥ 2: ACDF 56.6%, laminoplasty 89.6%, laminectomy/fusion 93.4%, p < 0.05). ACDF had lower overall complications (ACDF 3.9%, laminoplasty 7.7%, laminectomy/fusion 11.5%, p < 0.05), mortality (ACDF 0%, laminoplasty 0.55%, laminectomy/fusion 2.2%, p < 0.05), and unplanned readmissions (ACDF 4.4%, laminoplasty 4.4%, laminectomy/fusion 9.9%, p < 0.05). No significant differences were seen in the other outcomes including DVT/PT, acute renal failure, UTI, stroke, cardiac complications, or sepsis. In the multivariate analysis, laminectomy/fusion (OR 17, reference: ACDF) and laminoplasty (OR10, reference: ACDF) were strong independent risk factors for LOS ≥ 2 days. Laminectomy/fusion (OR 3.2, reference: ACDF) was an independent predictor for any adverse events 30-days after surgery. CONCLUSIONS Laminectomy/fusion carries the highest risk for morbidity, mortality, and unplanned readmissions in the short-term postoperative period. Laminoplasty and ACDF cases carry similar short-term complications risks. ACDF is significantly associated with the longest operative duration and shortest LOS without an increase in individual or overall complications, readmissions, or reoperations.
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Affiliation(s)
- Nathan J. Lee
- Department of Orthopaedics, Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY, USA,Nathan J. Lee, MD, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA.
| | - Jun S. Kim
- Department of Orthopaedics, Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Paul Park
- Department of Orthopaedics, Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - K. Daniel Riew
- Department of Orthopaedics, Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY, USA
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25
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Liu P, Li X, Liu J, Zhang H, You Z, Zhang J. Cacna2d2 inhibits axonal regeneration following surgical decompression in a rat model of cervical spondylotic myelopathy. BMC Neurosci 2022; 23:42. [PMID: 35778700 PMCID: PMC9248146 DOI: 10.1186/s12868-022-00727-7] [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: 02/08/2022] [Accepted: 06/23/2022] [Indexed: 11/11/2022] Open
Abstract
Background Cervical spondylotic myelopathy (CSM) is a clinically symptomatic condition due to spinal cord compression, leading to spinal cord dysfunction. Surgical decompression is the main treatment of CSM, but the mechanisms of axonal regeneration after surgical decompression are still fragmentary. Methods In a rat model of CSM, the cacna2d2 (α2δ2) expression levels in anterior horn of spinal cord were observed following compression and decompression by western blot and immunofluorescence. The expression levels of 5 hydroxytryptamine (5HT) and GAP43 were also analyzed by immunofluorescence. Furthermore, gabapentin intervention was performed for 4 weeks after decompression to analyze the changes of behaviors and anterior horn of spinal cords. Results Following decompression, the expression levels of α2δ2 in the anterior horn of spinal cord were decreased, but the expression levels of 5HT andGAP43 were increased. Compared with the vehicle treated rats, gabapentin treatment for 4 weeks ameliorated the behaviors of rats and improved the damaged anterior horn of spinal cord. Besides, inhibition of α2δ2 through gabapentin intervention enhanced the axonal regeneration in the anterior horn of damaged spinal cord. Conclusions Inhibition of α2δ2 could enhance axonal recovery in anterior horn of damaged spinal cord induced by CSM after surgical decompression, providing a potential method for promoting axon regeneration following surgery.
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Affiliation(s)
- Peisheng Liu
- Department of Spinal Surgery, Yantaishan Hospital, No. 10087, Keji Avenue, Laishan District, 264000, Yantai, China
| | - Xiaofeng Li
- Department of Spinal Surgery, Yantaishan Hospital, No. 10087, Keji Avenue, Laishan District, 264000, Yantai, China
| | - Jing Liu
- Basic Department, Yantai Vocational College, 264000, Yantai, China
| | - Hengjia Zhang
- Department of Spinal Surgery, Yantaishan Hospital, No. 10087, Keji Avenue, Laishan District, 264000, Yantai, China
| | - Zhitao You
- Department of Spinal Surgery, Yantaishan Hospital, No. 10087, Keji Avenue, Laishan District, 264000, Yantai, China
| | - Jianfeng Zhang
- Department of Spinal Surgery, Yantaishan Hospital, No. 10087, Keji Avenue, Laishan District, 264000, Yantai, China.
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26
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Karamian BA, Minetos PD, Levy HA, Toci GR, Lambrechts MJ, Canseco JA, Ju DG, Reyes AA, Bowles DR, Kaye ID, Kurd MF, Rihn JA, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. The Effect of Anterior Cervical Discectomy and Fusion Procedure Duration on Patient-Reported Outcome Measures. World Neurosurg 2022; 164:e548-e556. [PMID: 35568127 DOI: 10.1016/j.wneu.2022.05.016] [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: 02/23/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine whether operative duration of anterior cervical discectomy and fusion (ACDF) significantly affects patient-reported outcome measures (PROMs) 90 days after surgery and at 1-year follow-up. METHODS Patients who underwent primary 1-level to 4-level ACDF were retrospectively identified. Demographic data and PROMs were collected through chart review. Patients were split into short, medium, and long tertiles based on procedure duration. PROM surveys were administered preoperatively as baseline measurements, at initial follow-up (between 60 and 120 days postoperatively), and at 1 year postoperatively. Outcomes included Neck Disability Index, Short-Form 12 Physical Component Score (PCS-12), Short-Form 12 Mental Component Score, visual analog scale (VAS) neck score, and VAS arm score. RESULTS Significant short-term improvements were found across all groups for all PROMs. All groups showed long-term improvements in Short-Form 12 Mental Component Score, PCS-12, Neck Disability Index, VAS neck score, and VAS arm score, with the exception of the medium-duration group in PCS-12 (P = 0.093). On multivariate analysis, short-duration procedures predicted better improvement in VAS neck score (β = -1.01; P = 0.012) and VAS arm score (β = -1.38; P = 0.002) compared with long-duration procedures, whereas medium-duration procedures resulted in better improvement in VAS arm score (β = -1.00; P = 0.011). Further, short and medium duration was a predictor of decreased length of hospital stay (β = -0.67, P = 0.001 and β = -0.59, P = 0.001, respectively) compared with long-duration procedures. CONCLUSIONS All groups improved after ACDF regardless of surgical duration. Further, surgical duration was not a predictor of differing improvement in physical function or disability.
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Affiliation(s)
- Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Paul D Minetos
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Hannah A Levy
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory R Toci
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Derek G Ju
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ariana A Reyes
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Daniel R Bowles
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - I David Kaye
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark F Kurd
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jeffrey A Rihn
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Astur N, Martins DE, Kanas M, de Mendonça RGM, Creek AT, Lenza M, Wajchenberg M. Quality assessment of systematic reviews of surgical treatment of cervical spine degenerative diseases: an overview. EINSTEIN-SAO PAULO 2022; 20:eAO6567. [PMID: 35476082 PMCID: PMC9000984 DOI: 10.31744/einstein_journal/2022ao6567] [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] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To gather all systematic reviews of surgical treatment of degenerative cervical diseases and assess their quality, conclusions and outcomes. METHODS A literature search for systematic reviews of surgical treatment of degenerative cervical diseases was conducted. Studies should have at least one surgical procedure as an intervention. Included studies were assessed for quality through Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) and Assessment of Multiple Systematic Reviews (AMSTAR) questionnaires. Quality of studies was rated accordingly to their final score as very poor (<30%), poor (30%-50%), fair (50%-70%), good (70%-90%), and excellent (>90%). If an article reported a conclusion addressing its primary objective with supportive statistical evidence for it, they were deemed to have an evidence-based conclusion. RESULTS A total of 65 systematic reviews were included. According to AMSTAR and PRISMA, 1.5% to 6.2% of studies were rated as excellent, while good studies counted for 21.5% to 47.7%. According to AMSTAR, most studies were of fair quality (46.2%), and 6.2% of very poor quality. Mean PRISMA score was 70.2%, meaning studies of good quality. For both tools, performing a meta-analysis significantly increased studies scores and quality. Cervical spondylosis studies reached highest scores among diseases analyzed. Authors stated conclusions for interventions compared in 70.7% of studies, and only two of them were not supported by statistical evidence. CONCLUSION Systematic reviews of surgical treatment of cervical degenerative diseases present "fair" to "good" quality in their majority, and most of the reported conclusions are supported by statistical evidence. Including a meta-analysis significantly increases the quality of a systematic review.
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Affiliation(s)
- Nelson Astur
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Delio Eulalio Martins
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Michel Kanas
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Rodrigo Góes Medéa de Mendonça
- Irmandade da Santa Casa de Misericórdia de São PauloSão PauloSPBrazilIrmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
| | - Aaron T. Creek
- Norton Leatherman Spine CenterLouisvilleUnited StatesNorton Leatherman Spine Center, Louisville, United States.
| | - Mario Lenza
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Marcelo Wajchenberg
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Efficacy and safety of anterior cervical discectomy and fusion (ACDF) through mini-incision and posterior laminoplasty (LAMP) for treatment of long-level cervical spondylosis: a retrospective cohort study. BMC Surg 2022; 22:115. [PMID: 35337311 PMCID: PMC8957118 DOI: 10.1186/s12893-022-01567-2] [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: 12/23/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The efficacy and safety of anterior cervical discectomy and fusion (ACDF) through mini-incision and posterior laminoplasty for long-level cervical spondylosis were investigated. METHOD From January 2018 to September 2019, clinical patients data with 3-4 segments (C3-7) cervical spondylotic radiculopathy, cervical spondylotic myelopathy, or mixed cervical spondylosis who received ACDF (42 cases) throughwith mini-incision or LAMP (36 cases) treatment were retrospectively collected and analyzed. The operative time, bleeding volume, incisive length, and hospital stay were recorded. Moreover, the intervertebral height, functional segment height, cervical lordosis, cervical hyperextension and hyperflexion range-of-motion (ROM) and ROM in all directions of the cervical spine before and after the operation were measured. Additionally, all relevant postoperative complications were also recorded. Then, the therapeutic effects of both surgical methods were investigated. RESULTS Patients in the ACDF group had less bleeding, shorter incision, and fewer hospitalization days than the LAMP group. There was no significant difference in JOA, VAS score of the upper limb, NDI score after surgery between two groups. Postoperative intervertebral height and functional segment height in the ACDF group were significantly higher than those before the operation, and postoperative functional segment height of the ACDF group was significantly higher than that of the LAMP group. Moreover, the postoperative cervical lordosis angle in the ACDF group was significantly larger than the LAMP group. There was no significant difference between preoperative and postoperative ROM in all directions of the cervical spine for the two groups. CONCLUSIONS Both ACDF through mini-incision and LAMP are effective treatments for long-level cervical spondylosis. However, ACDF through mini-incision shows minor trauma, less bleeding, fast recovery, and it is beneficial for cervical lordosis reconstruction.
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Nunna RS, Khalid S, Chiu RG, Parola R, Fessler RG, Adogwa O, Mehta AI. Anterior vs Posterior Approach in Multilevel Cervical Spondylotic Myelopathy: A Nationwide Propensity-Matched Analysis of Complications, Outcomes, and Narcotic Use. Int J Spine Surg 2022; 16:88-94. [PMID: 35314510 PMCID: PMC9519084 DOI: 10.14444/8198] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND There is unclear evidence regarding the optimal surgical approach for multilevel cervical spondylotic myelopathy (CSM). The objective of this study was to compare complications, outcomes, and narcotic use in anterior discectomy and fusion (ACDF) vs posterior decompression and fusion (PCDF) in CSM patients. STUDY DESIGN Registry-based retrospective cohort analysis. METHODS Patients undergoing 3-level ACDF or PCDF for CSM between 2007 and 2017 were identified from the Humana Claims Database using relevant procedure codes. Propensity score-matched groups were compared in regards to complications, outcomes, and narcotic use. RESULTS Propensity score matching generated equal cohorts of 6124 patients. The posterior fusion group had a higher rate of urinary tract infection (OR 2.47, P < 0.0001), deep vein thrombosis (OR 1.90, P < 0.0001), and pulmonary embolism (OR 1.75, P < 0.0001). In regards to 30-day outcomes, the posterior approach demonstrated higher rates of stroke (OR 1.68, P < 0.0001), wound dehiscence (OR 5.59, P < 0.0001), Surgical site infection (SSI) (OR 4.76, P < 0.0001), wound revision surgery (OR 3.02, P < 0.0001), and all-cause readmission (OR 2.01, P < 0.0001). One-year outcomes revealed higher rates of pseudarthrosis (4.7% vs 2.0%, OR 2.43, P < 0.0001) and revision or extension surgery (OR 2.33, P < 0.0001) in the posterior fusion cohort. These patients also demonstrated significantly higher mean morphine milligram equivalent used at 30 days (OR 1.19, P < 0.0001), as well as 60 (OR 1.20, P < 0.0001), 90 (OR 1.21, P < 0.0001), and 120 (OR 1.21, P < 0.0001) days. CONCLUSIONS This nationwide propensity-matched analysis of multilevel CSM patients found the posterior approach to be associated with increased rates of inpatient complications, wound complications, 30-day readmission, 1-year pseudarthrosis, and 1-year revision or extension surgery. These patients also demonstrated higher levels of narcotic use up to 120 days after surgery. CLINICAL RELEVANCE The posterior approach for treatment of CSM may be associated with increased rates of short- and long-term complications in addition to increased narcotic consumption in comparison to the anterior approach.
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Affiliation(s)
- Ravi S Nunna
- Department of Neurosurgery, Swedish Medical Center, Seattle, WA, USA
| | - Syed Khalid
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Ryan G Chiu
- Department of Neurosurgery, University of Illinois-Chicago Medical Center, Chicago, IL, USA
| | - Rown Parola
- Department of Neurosurgery, University of Illinois-Chicago Medical Center, Chicago, IL, USA
| | - Richard G Fessler
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois-Chicago Medical Center, Chicago, IL, USA
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Zhang MZ, Ou-Yang HQ, Liu JF, Jin D, Wang CJ, Ni M, Liu XG, Lang N, Jiang L, Yuan HS. Predicting postoperative recovery in cervical spondylotic myelopathy: construction and interpretation of T 2*-weighted radiomic-based extra trees models. Eur Radiol 2022; 32:3565-3575. [PMID: 35024949 DOI: 10.1007/s00330-021-08383-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/21/2021] [Accepted: 10/04/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Conventional MRI may not be ideal for predicting cervical spondylotic myelopathy (CSM) prognosis. In this study, we used radiomics in predicting postoperative recovery in CSM. We aimed to develop and validate radiomic feature-based extra trees models. METHODS There were 151 patients with CSM who underwent preoperative T2-/ T2*-weighted imaging (WI) and surgery. They were divided into good/poor outcome groups based on the recovery rate. Datasets from multiple scanners were randomised into training and internal validation sets, while the dataset from an independent scanner was used for external validation. Radiomic features were extracted from the transverse spinal cord at the maximum compressed level. Threshold selection algorithm, collinearity removal, and tree-based feature selection were applied sequentially in the training set to obtain the optimal radiomic features. The classification of intramedullary increased signal on T2/T2*WI and compression ratio of the spinal cord on T2*WI were selected as the conventional MRI features. Clinical features were age, preoperative mJOA, and symptom duration. Four models were constructed: radiological, radiomic, clinical-radiological, and clinical-radiomic. An AUC significantly > 0.5 was considered meaningful predictive performance based on the DeLong test. The mean decrease in impurity was used to measure feature importance. p < 0.05 was considered statistically significant. RESULTS On internal and external validations, AUCs of the radiomic and clinical-radiomic models, and radiological and clinical-radiological models ranged from 0.71 to 0.81 (significantly > 0.5) and 0.40 to 0.55, respectively. Wavelet-LL first-order variance was the most important feature in the radiomic model. CONCLUSION Radiomic features, especially wavelet-LL first-order variance, contribute to meaningful predictive models for CSM prognosis. KEY POINTS • Conventional MRI features may not be ideal in predicting prognosis. • Radiomics provides greater predictive efficiency in the recovery from cervical spondylotic myelopathy.
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Affiliation(s)
- Meng-Ze Zhang
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Han-Qiang Ou-Yang
- Department of Orthopedics, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Jian-Fang Liu
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Dan Jin
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Chun-Jie Wang
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Ming Ni
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Xiao-Guang Liu
- Department of Orthopedics, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Ning Lang
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China.
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
| | - Hui-Shu Yuan
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China.
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Tohamy MH, Osterhoff G, Abdelgawaad AS, Ezzati A, Heyde CE. Anterior cervical corpectomy and fusion with stand-alone cages in patients with multilevel degenerative cervical spine disease is safe. BMC Musculoskelet Disord 2022; 23:20. [PMID: 34980062 PMCID: PMC8725343 DOI: 10.1186/s12891-021-04883-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background In case of spinal cord compression behind the vertebral body, anterior cervical corpectomy and fusion (ACCF) proves to be a more feasible approach than cervical discectomy. The next step was the placement of an expandable titanium interbody in order to restore the vertebral height. The need for additional anterior plating with ACCF has been debatable and such technique has been evaluated by very few studies. The objective of the study is to evaluate radiographic and clinical outcomes in patients with multilevel degenerative cervical spine disease treated by stand-alone cages for anterior cervical corpectomy and fusion (ACCF). Methods Thirty-one patients (66.5 ± 9.75 years, range 53–85 years) were analyzed. Visual Analog Scale (VAS) and the 10-item Neck Disability Index (NDI) were assessed preoperatively and during follow-up on a regular basis after surgery and after one year at least. Assessment of radiographic fusion, subsidence, and lordosis measurement of Global cervical lordosis (GCL); fusion site lordosis (FSL); the anterior interbody space height (ant. DSH); the posterior interbody space height (post. DSH); the distance of the cage to the posterior wall of the vertebral body (CD) were done retrospectively. Mean clinical and radiographic follow-up was 20.0 ± 4.39 months. Results VAS-neck (p = 0.001) and VAS-arm (p < 0.001) improved from preoperatively to postoperatively. The NDI improved at the final follow-up (p < 0.001). Neither significant subsidence of the cages nor significant loss of lordotic correction were seen. All patients showed a radiographic union of the surgically addressed segments at the last follow up. Conclusions Application of a stand-alone expandable cage in the cervical spine after one or two-level ACCF without additional posterior fixation or anterior plating is a safe procedure that results in fusion. Neither significant subsidence of the cages nor significant loss of lordotic correction were seen. Trial registration Retrospectively registered. According to the Decision of the ethics committee, Jena on 25th of July 2018, that this study doesn’t need any registration. https://www.laek-thueringen.de/aerzte/ethikkommission/registrierung/. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04883-5.
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Affiliation(s)
- Mohamed H Tohamy
- Spine Unit, Martin-Ulbrich-Haus Rothenburg, Horkaer Str. 15-21, 02929, Rothenburg, Oberlausitz, Germany.,Spine Departement, Helios Klinikum Erfurt, Nordhäuser Str. 74, 99089, Erfurt, Germany.,Ligamenta Spine Center, Walter-Kolb-Street 9-11, 60594, Frankfurt am Main, Germany
| | - Georg Osterhoff
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04179, Leipzig, Germany
| | - Ahmed Shawky Abdelgawaad
- Spine Departement, Helios Klinikum Erfurt, Nordhäuser Str. 74, 99089, Erfurt, Germany.,Department of Orthopedic and Trauma Surgery, Assiut University Hospitals, Assiut, Egypt
| | - Ali Ezzati
- Spine Departement, Helios Klinikum Erfurt, Nordhäuser Str. 74, 99089, Erfurt, Germany
| | - Christoph-E Heyde
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04179, Leipzig, Germany. .,Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany.
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He W, He D, Wang QL, Tian W, Liu B, Liu YJ, Sun YQ, Xing YG, Yuan N, Yuan Q, Xiao B, Han B, Wang YM, Ma TF, Liu MM. Longitudinal Spinous-Splitting Laminoplasty with Coral Bone for the Treatment of Cervical Adjacent Segment Degenerative Disease: A 5-Year Follow-up Study. Orthop Surg 2021; 14:435-442. [PMID: 34939333 PMCID: PMC8867440 DOI: 10.1111/os.13027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/01/2021] [Accepted: 04/01/2021] [Indexed: 11/30/2022] Open
Abstract
This study was designed to analyze the causes of cervical adjacent segment degenerative disease (ASDis), evaluate the surgical outcomes of longitudinal spinous‐splitting laminoplasty with coral bone (SLAC) during cervical reoperation, and accumulate data on reoperation with SLAC in a primary hospital. Based on the inclusion and exclusion criteria, we conducted a retrospective study involving 52 patients who underwent cervical reoperation for ASDis using SLAC at the spinal surgery department of the Beijing Jishuitan Hospital from 1998 to 2014. Among them, 39 were treated with anterior cervical fusion and internal fixation during the first operation (anterior cervical corpectomy with fusion [ACCF], n = 24; anterior cervical discectomy and fusion [ACDF], n = 11; and cervical disc arthroplasty [CDA], n = 4). Outcomes were the Japanese Orthopaedic Association (JOA) score, neck disability index (NDI) score, upper limb/neck and shoulder evaluated using a visual analogue scale (VAS), and rates of ASDis. In patients who underwent an anterior cervical approach in the first instance, the incidence of ASDis was significantly higher in the C3/4 gap than in the other gaps. In the ACCF group, the lateral radiograph of the cervical spine revealed that the distance between the anterior cervical plate and the adjacent segment disc was <5 mm in 15 (62.5%) cases and five (12.8%) cases, respectively, the internal fixation screws broke into the annulus of the adjacent segment. After the first SLAC, ASDis developed at C2/3 and C3/4 in four (30.8%) and eight (61.5%) cases, respectively. After reoperation, all cases were followed up for >5 (average, 6.2) years. The pre‐reoperation and last follow‐up values were as follows: mean Japanese Orthopaedic Association score, 10.2 ± 1.5 vs 15.5 ± 0.7 (P = 0.03); neck disability index, 26.2 vs 13.6 points (P = 0.01); upper‐limb visual analog scale (VAS) score, 6.1 vs 2.6 points (P = 0.04); and neck and shoulder VAS score, 6.6 vs 2.1 points (P = 0.03). SLAC is a simple technique in which the local anatomy is clearly visible and satisfactory clinical outcomes are obtained.
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Affiliation(s)
- Wei He
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Da He
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Qi-Long Wang
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Wei Tian
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Bo Liu
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Ya-Jun Liu
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Yu-Qing Sun
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Yong-Gang Xing
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Ning Yuan
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Qiang Yuan
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Bin Xiao
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Bing Han
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Yu-Mei Wang
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Teng-Fei Ma
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Ming-Ming Liu
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, China
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Nguyen W, Chang KE, Formanek B, Ghayoumi P, Buser Z, Wang J. Comparison of Postoperative Complications and Reoperation Rates Following Surgical Management of Cervical Spondylotic Myelopathy in the Privately Insured Patient Population. Clin Spine Surg 2021; 34:E531-E536. [PMID: 34091490 DOI: 10.1097/bsd.0000000000001216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/14/2021] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a large database study. OBJECTIVE The objective of this study was to compare the incidence of complications and reoperation rates between the most common surgical treatments for cervical spondylotic myelopathy (CSM): anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), and posterior laminectomy and fusion (Lamifusion). SUMMARY OF BACKGROUND DATA CSM is a major contributor to disability and reduced quality of life worldwide. METHODS Humana insurance database was queried for CSM diagnoses between 2007 and 2016. The initial population was divided based on the surgical treatment and matched for age, sex, and Charlson Comorbidity index. Specific postoperative complications or revisions were analyzed at individual time points. Pearson χ2 analysis with Yate continuity correction was used. RESULTS Lamifusion had significantly higher rates of wound infection/disruption than ACDF or ACCF (5.03%, 2.19%, 2.29%; P=0.0008, 0.002, respectively) as well as iatrogenic deformity (4.75%, 2.19%, 2.10%; P=0.0036, 0.0013). Lamifusion also had a significantly higher rate of shock and same-day transfusion than ACDF (4.75%, 2.01%, P=0.0005), circulatory complications (2.01%, <1%, P=0.0183), and C5 palsy (4.84%, 1.74%, P≤0.0001). Compared with ACDF, Lamifusion had higher rates of hardware complication (3.29%, 2.01%, P=0.0468), and revision surgery (8.23% 5.85%, P=0.0395). Lamifusion had significantly lower rates of dysphagia than either ACDF (3.93% vs. 6.58%, P=0.0089) or ACCF (3.93% vs. 8.59%, P<0.0001). When comparing ACCF to ACDF, ACCF had significantly higher rates of circulatory complications (2.38%, <1%, P=0.0053), shock/same-day transfusion (3.2%, 2.0%, P=0.59), C5 palsy (3.47%, 1.74%, P=0.0108), and revision surgery (9.51%, 5.85%, P=0.0086). CONCLUSIONS The data shows that posterior Lamifusion has higher overall rate of complications compared with ACDF or ACCF. Furthermore, when comparing the anterior approaches, ACDF was associated with lower rate of complication and revision. ACCF had the highest overall rate of revision surgery.
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Affiliation(s)
| | - Ki-Eun Chang
- Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Liang Y, Xu S, Yu G, Zhu Z, Liu H. Cervical spine alignment and clinical outcomes after multilevel anterior cervical decompression and fusion with or without plate: A minimal 5-year follow-up of a CONSORT-compliant article. Medicine (Baltimore) 2021; 100:e26126. [PMID: 34397682 PMCID: PMC8322561 DOI: 10.1097/md.0000000000026126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 05/08/2021] [Indexed: 01/04/2023] Open
Abstract
It was reported imperative on cervical sagittal alignment reconstruction after anterior multilevel procedures with self-locked stand-alone cage (SSC) or anterior cage-with-plate (ACP) system multilevel while there was little knowledge about the relationship on cervical alignment and clinical outcomes.To identify the importance of cervical sagittal alignment after 3-level anterior cervical discectomy and fusion on cervical spondylotic myelopathy with SSC and ACP system.Seventy-seven patients with SSC system (SSC group) and 52 cases with ACP system (ACP group) from February 2007 to September 2013 were enrolled with well-matched demographics. Cervical alignment included C2-7 lordosis (CL), operated-segment cervical lordosis (OPCL), upper and lower adjacent-segment cervical lordosis, range of motion of upper and lower adjacent segment at preoperation, immediate postoperation, and the final follow-up. Clinical outcomes contained the neck disability index (NDI), the Japanese Orthopaedic Association (JOA) score, visual analogous scale (VAS) of arm and neck and adjacent segment degeneration (ASD). Patients were then divided into CL improved subgroup (IM subgroup) and non-improved subgroup (NIM subgroup).There were improvements on CL and OPCL in both groups. The change of CL and OPCL larger in ACP group (P < .05) but upper adjacent-segment cervical lordosis/lower adjacent-segment cervical lordosis and range of motion of upper adjacent segment/range of motion of lower adjacent segment were of no significance. NDI, JOA, and VAS got improvement in both groups at immediate postoperation and the final follow-up while ASD was in no difference between SSC and ACP group. A total of 80 patients (39 vs 41) acquired CL improvement with a larger population in ACP group. There were no differences on the rate of ASD, NDI, JOA, VAS, and their change between IM and NIM subgroup. The changes of CL were not correlated to NDI, JOA, VAS, and their change.SSC and ACP group both provide improved OPCL and efficacy on 3-level cervical spondylotic myelopathy with little impact on adjacent segment. The change of CL is not correlated to clinical outcomes.
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Wang S, Zhu J, Sun K, Chen R, Cao J, You R, Liu A, Zhao F, Shi J. Clinical impact and imaging results after a modified procedure of ACDF: a prospective case-controlled study based on ninety cases with two-year follow-up. BMC Musculoskelet Disord 2021; 22:605. [PMID: 34217257 PMCID: PMC8254952 DOI: 10.1186/s12891-021-04229-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/07/2021] [Indexed: 11/18/2022] Open
Abstract
Study design This is a prospective case-controlled study. Background To analyze the postoperative axial pain and cage subsidence of patients presenting with cervical spondylotic myelopathy (CSM) after a modified procedure of ACDF (mACDF). Methods Ninety patients with CSM were prospectively collected from 2014 to 2018. The patients were divided into spread group and non-spread group (48:42 ratio) according to the cage placement with or without releasing the Caspar cervical retractor after decompression. Spread group received conventional ACDF and non-spread group received mACDF. Patients were followed-up for at least 24 months after surgery. Radiologic data, including height of intervertebral space and Cobb Angle, were collected. Nervous system function was obtained using JOA scores, and level of pain was assessed using VAS scores. Results A total of 90 patients were enrolled and the patients were divided into spread group (n = 48) and none-spread group(n = 42). Cage subsidence of (spread group vs none-spread group) was (0.82 ± 0.68 vs 0.58 ± 0.81) mm, (0.64 ± 0.77 vs 0.34 ± 0.46) mm, (0.48 ± 0.43 vs 0.25 ± 0.28) mm, and (0.45 ± 0.47 vs 0.17 ± 0.32) mm at 3 months, 6 months, 12 months and 24 months, respectively. The period exhibiting the most decrease of the height of intervertebral space was 3 months postoperatively. However, there was no statistical difference in the height of intervertebral space, JOA or VAS scores at the final follow-up between the two groups. Conclusions The mACDF can avoid excessive distraction by releasing the Caspar Cervical retractor, restore the “natural height” of cervical vertebra, relieve immediate pain after surgery, and prevent rapid Cage subsidence and the loss of cervical curvature.
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Affiliation(s)
- Shunmin Wang
- 910 Hospital of China Joint Logistics Support Force, 180 Garden Road, Fengze District, Quanzhou City, Fujian Province, China
| | - Jian Zhu
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No.415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Kaiqiang Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No.415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Rongzi Chen
- 910 Hospital of China Joint Logistics Support Force, 180 Garden Road, Fengze District, Quanzhou City, Fujian Province, China
| | - Jie Cao
- 910 Hospital of China Joint Logistics Support Force, 180 Garden Road, Fengze District, Quanzhou City, Fujian Province, China
| | - Ruijin You
- 910 Hospital of China Joint Logistics Support Force, 180 Garden Road, Fengze District, Quanzhou City, Fujian Province, China
| | - Aigang Liu
- 910 Hospital of China Joint Logistics Support Force, 180 Garden Road, Fengze District, Quanzhou City, Fujian Province, China
| | - Feng Zhao
- 910 Hospital of China Joint Logistics Support Force, 180 Garden Road, Fengze District, Quanzhou City, Fujian Province, 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.
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Liu H, Li X, Wang J, Li Z, Li Z, Chen S, Wang H, Zheng Z. Comparison study of clinical outcomes and sagittal alignment improvement between anterior and posterior fusion techniques for multilevel cervical spondylotic myelopathy. J Orthop Surg (Hong Kong) 2021; 29:2309499020988177. [PMID: 33626976 DOI: 10.1177/2309499020988177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To compare the sagittal alignment of different surgical approaches in patients with multiple levels cervical spondylotic myelopathy and explore the relationship between the cervical sagittal alignment and patient's health relative quality of life. METHOD A total of 97 multiple levels cervical spondylotic myelopathy patients who underwent surgery from January 2013 to January 2019 were collected in this study. Patients were divided into three groups: anterior cervical discectomy with fusion, anterior cervical corpectomy with fusion and laminectomy with fusion groups. Clinical outcomes and sagittal alignment parameters were compared preoperative and postoperative. RESULTS There were no significant differences in the average age and sex ratio among the groups. Sagittal parameters correlated to health relative quality of life were C7 slope, occipito-C2 angle, external auditory meatus tilt and cervical sagittal vertical axis. Both anterior cervical discectomy with fusion and anterior cervical corpectomy with fusion groups exhibited better sagittal alignment and clinical outcomes improvement postoperatively. Anterior cervical discectomy with fusion provided better clinical outcomes and the better improvement of cervical lordosis, C7 slope, occipito-C2 angle and cervical sagittal vertical axis compared with patients with Laminectomy with fusion. CONCLUSION C7 slope, occipito-C2 angle, external auditory meatus tilt and cervical sagittal vertical axis are the most important cervical sagittal parameters correlated to clinical outcomes in patients with multilevels cervical spondylotic myelopathy; anterior cervical discectomy with fusion and anterior cervical corpectomy with fusion provides more efficient to restoration of cervical sagittal alignment.
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Affiliation(s)
- Hui Liu
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiang Li
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianru Wang
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zemin Li
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zihao Li
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Siwen Chen
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hua Wang
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhaomin Zheng
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Wadhwa H, Sharma J, Varshneya K, Fatemi P, Nathan J, Medress ZA, Stienen MN, Ratliff JK, Veeravagu A. Anterior Cervical Discectomy and Fusion Versus Laminoplasty for Multilevel Cervical Spondylotic Myelopathy: A National Administrative Database Analysis. World Neurosurg 2021; 152:e738-e744. [PMID: 34153482 DOI: 10.1016/j.wneu.2021.06.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) is effective for the treatment of single-level cervical spondylotic myelopathy (CSM). However, the data surrounding multilevel CSM have remained controversial. One alternative is laminoplasty, although evidence comparing these strategies has remained sparse. In the present report, we retrospectively reviewed the readmission and reoperation rates for patients who had undergone ACDF or laminoplasty for multilevel CSM from a national longitudinal administrative claims database. METHODS We queried the MarketScan Commercial Claims and Encounters database to identify patients who had undergone ACDF or laminoplasty for multilevel CSM from 2007 to 2016. The patients were stratified by operation type. Patients aged <18 years, patients with a history of tumor or trauma, and patients who had undergone anteroposterior approach were excluded from the present study. RESULTS A total of 5445 patients were included, of whom 1521 had undergone laminoplasty. A matched cohort who had undergone ACDF was identified. The overall 90-day postoperative complication rate was greater in the laminoplasty cohort (odds ratio, 1.48; 95% confidence interval, 1.18-1.86; P < 0.0001). The mean length of stay and 90-day readmission rates were greater in the laminoplasty cohort. The hospital and total payments of the index hospitalization were greater in the ACDF cohort, as were the total payments for ≤2 years after the index hospitalization. CONCLUSIONS In the present administrative claims database study, no difference was found in the reoperation rate between ACDF and laminoplasty. ACDF resulted in fewer complications and readmissions compared with laminoplasty but was associated with greater costs. Additional prospective research is required to investigate the factors driving the higher costs of ACDF in this population and the long-term clinical outcomes.
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Affiliation(s)
- Harsh Wadhwa
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Jigyasa Sharma
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Kunal Varshneya
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Parastou Fatemi
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Jay Nathan
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Zachary A Medress
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Martin N Stienen
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - John K Ratliff
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA.
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Gill M, Maheshwari V, Yadav AK, Gadhavi R. A Clinicoradiological Assessment following Surgical Intervention in Patients of Cervical Spondylotic Myelopathy: An Institutional Experience. INDIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1055/s-0041-1726607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Introduction To critically analyze the functional and radiological improvement in patients of cervical spondylotic myelopathy (CSM) who underwent surgical decompression by an anterior or posterior approach.
Materials and Methods A retrospective study was conducted in a tertiary-level Armed Forces Hospital from June 2015 to December 2019. Preoperative assessment included a thorough clinical examination and functional and radiological assessment. The surgical decompression was done by an anterior or a posterior approach with instrumented fusion. Anterior approach was taken for single or two-level involvement and posterior approach for three or more cervical levels. The pre and postoperative neurological outcome was assessed by Nurick and modified Japanese Orthopaedic Association (mJOA) score along with measurement of canal diameter and cross-sectional area.
Results A total of 120 patients of CSM who underwent surgical decompression were analyzed. Both the groups were comparable and had male predominance. A total of 59 patients underwent surgical decompression by an anterior approach and the remaining 61 patients by the posterior approach. Out of the 59 patients operated by the anterior approach, 30 (50.85%) underwent anterior cervical discectomy and fusion (ACDF); remaining 29 (49.15%) underwent anterior cervical corpectomy and fusion (ACCF). In the posterior group (n = 61), 26 (42.6%) patients underwent laminoplasty and the remaining 35 (57.4%) underwent laminectomy with or without instrument fusion. Sixteen patients out of these underwent lateral mass fixation and the remaining 19 underwent laminectomy. There was functional improvement (mJOA and Nurick grade) and radiological improvement in both subgroups, which were statistically significant (p < 0.0001).
Conclusion A prompt surgical intervention in moderate-to-severe cases of CSM either by the anterior or the posterior approach is essential for good outcome.
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Affiliation(s)
- Maneet Gill
- Department of Neurosurgery, Army Hospital (R&R), New Delhi, India
| | | | | | - Rushikesh Gadhavi
- Department of Neurosurgery, Armed Forces Medical College, Pune, India
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Efendioğlu M, Akar E. Morphometric analysis of cervical intervertebral disc space to reduce neural complications during anterior approaches to the cervical spine. J Orthop Sci 2021; 26:348-353. [PMID: 32417138 DOI: 10.1016/j.jos.2020.03.019] [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: 02/27/2020] [Revised: 03/23/2020] [Accepted: 03/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although neurovascular complications rarely occur during surgical procedures, they have serious consequences. We reviewed the limits of safe surgery to decrease the possibility of neurovascular injuries. METHODS Four measurements were performed for each patient at the vertebral levels adjacent to the intervertebral discs at C3-C4, C4-C5, C5-C6, and C6-C7. These measurements were: 1)midline anteroposterior diameter of the intervertebral disc, 2)transverse diameter of the intervertebral disc, 3)right and left measurements of the line vertically drawn to the disc anterior from the most lateral point of the dura mater, and 4)measurement of the distance from measurement 3 to the right and left root. RESULTS Average anteroposterior and transverse vertebral diameters were determined to be 18.11 and 27.15 mm, respectively. Average of the results of the 3rd measurement was 5.51 mm on the right and 5.36 on the left. Average of the 4th measurement was 7.8 mm on the right 7.75 mm on the left. The shortest interval was at the C3-4 level and the longest interval was at the C6-7 level. CONCLUSION Determining the safe surgery limits will help surgeons evaluating suitable implant sizes and decreasing the perioperative complications during decompression to cervical vertebrae and instrument procedures.
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Affiliation(s)
- Mustafa Efendioğlu
- Haydarpasa Numune Training and Research Hospital, Department of Neurosurgery, Istanbul, Turkey
| | - Ezgi Akar
- Haydarpasa Numune Training and Research Hospital, Department of Neurosurgery, Istanbul, Turkey.
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Canseco JA, Minetos PD, Karamian BA, Paziuk TM, Basques BA, DiMaria SL, Timmins T, Hallman H, Henry T, Lee JK, Kurd MF, Anderson DG, Rihn JA, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. Comparison Between Three- and Four-Level Anterior Cervical Discectomy and Fusion: Patient-Reported and Radiographic Outcomes. World Neurosurg 2021; 151:e507-e516. [PMID: 33905909 DOI: 10.1016/j.wneu.2021.04.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We compared the long-term clinical and radiographic outcomes after 3- and 4-level anterior cervical discectomy and fusion (ACDF) in a retrospective cohort study. METHODS Patients who had undergone primary 3- or 4-level ACDF were retrospectively identified. The demographic data and patient-reported outcome measures (PROMs) were collected through a review of the medical records. PROM surveys were administered preoperatively for baseline measurements and at 1 year postoperatively. The surveys included the Neck Disability Index, 12-item short-form physical component summary, 12-item short-form mental component summary, and visual analog scale (VAS) scores for neck and arm pain. The cervical sagittal alignment parameters included C2-C7 lordosis, segmental lordosis, the sagittal vertical axis (SVA), and the T1 slope. Multivariate regression models were used to compare the changes in the PROMs and radiographic measurements over time between 3- and 4-level ACDF. Correlation coefficients were calculated to compare the delta scores for the PROMs and radiographic measurements. RESULTS The VAS scores for neck and arm pain had significantly improved from baseline in both cohorts. Only the 3-level group showed significant improvements perioperatively in the Neck Disability Index and 12-item short-form physical component summary. No significant differences were found in the improvement in clinical outcomes between the 2 groups. The pooled results demonstrated a significant negative correlation between the perioperative changes in segmental lordosis and VAS scores for arm pain. A significant negative correlation was also found between the perioperative changes in the SVA and 12-item short-form mental component summary and VAS scores for neck pain. C2-C7 lordosis significantly increased postoperatively only in the 3-level ACDF group. CONCLUSIONS Patients undergoing both 3- and 4-level ACDF experienced significant clinical improvement without significant differences between the 2 groups. The radiographic measures of segmental lordosis and SVA also correlated with the changes in clinical outcomes.
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Affiliation(s)
- Jose A Canseco
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Paul D Minetos
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brian A Karamian
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Taylor M Paziuk
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Bryce A Basques
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Stephen L DiMaria
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tyler Timmins
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Haydn Hallman
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tyler Henry
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joseph K Lee
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark F Kurd
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - D Greg Anderson
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jeffrey A Rihn
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alan S Hilibrand
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher K Kepler
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory D Schroeder
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Alhashash M, Allouch H, Boehm H, Shousha M. Results of Four-Level Anterior Cervical Discectomy and Fusion Using Stand-Alone Interbody Titanium Cages. Asian Spine J 2021; 16:82-91. [PMID: 33687861 PMCID: PMC8873996 DOI: 10.31616/asj.2020.0463] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/19/2020] [Indexed: 11/23/2022] Open
Abstract
Study Design This is a retrospective study with a minimum follow-up of 2 years. Purpose The aim of this study is to assess the long-term outcomes after performing the four-level anterior cervical discectomy and fusion (ACDF) in the treatment of degenerative cervical spine disease using stand-alone titanium cages. Overview of Literature Over the last decades, a rapid increase in the use of stand-alone cages for ACDF has been observed. However, research on their application in the treatment of four-level diseases is insufficient. Methods In this study, 130 patients presenting with symptomatic cervical spondylosis who underwent four-level ACDF using stand-alone cages in our institution between 2008 and 2016 were assessed. Fifty-two patients were women and 78 men with a mean age of 60.5 years. Their clinical and radiological outcomes were assessed. The results of the Neck Disability Index (NDI) and Visual Analog Scale as well as bony fusion were evaluated, and the revisions were analyzed. All of the patients underwent the four-level microscopic ACDF using the same titanium rectangular cage. Results The mean follow-up was 47±11.4 months. A fusion of all four levels was achieved in 80.72% of the patients. In 25 patients (19.23%), an incomplete bony bridging was observed in at least one fusion level at the final follow-up. However, only two patients (1.5%) were symptomatic and underwent revision. The mean NDI improved significantly from 39.4±9.3 at presentation to 8.3±6.6 at the final follow-up. Cervical lordosis improved significantly from a mean of 5.5° preoperatively to a mean of 15° postoperatively. Cage sinking and loss of segment height during healing had a mean of 3 mm. Conclusions Overall, the application of four-level ACDF using titanium cages in a stand-alone technique has been proven to be a safe and effective treatment method for degenerative disease. In a large cohort, a high rate of good long-term clinical and radiological results was achieved.
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Affiliation(s)
- Mohamed Alhashash
- Spine Surgery Department, Zentralklinik Bad Berka, Bad Berka, Germany.,Orthopaedic and Trauma Department, Alexandria University, Alexandria, Egypt
| | - Hassan Allouch
- Spine Surgery Department, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Heinrich Boehm
- Spine Surgery Department, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Mootaz Shousha
- Spine Surgery Department, Zentralklinik Bad Berka, Bad Berka, Germany.,Orthopaedic and Trauma Department, Alexandria University, Alexandria, Egypt
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Xu P, Zhuang JS, Huang YS, Chen JT, Zhong ZM. Is anterior decompression and fusion superior to laminoplasty for cervical myelopathy due to ossification of posterior longitudinal ligament? A systematic review and meta-analysis. J Spinal Cord Med 2021; 44:169-183. [PMID: 30888255 PMCID: PMC7952055 DOI: 10.1080/10790268.2019.1579987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Context: Considerable controversy exists over surgical procedures for ossification of the posterior longitudinal ligament (OPLL).Objective: The purpose of the meta-analysis was to compare the clinical outcome of anterior decompression and fusion (ADF) with laminoplasty (LAMP) in treatment of cervical myelopathy due to OPLL.Methods: PubMed, EMBASE and the Cochrane Register of Controlled Trials database were searched to identify potential clinical studies compared ADF with LAMP for cervical myelopathy owing to OPLL. We also manually searched the reference lists of articles and reviews for possible relevant studies. Thirteen studies with 1120 patients were included in our analysis. Subgroup analyses were performed by the canal occupying ratio of OPLL.Results: Overall, the mean preoperative Japanese Orthopaedic Association (JOA) score was similar between two groups. Compared with LAMP group, ADF group was higher at the mean postoperative JOA scores and mean recovery rate, reoperation rate, and longer at mean operation time. There was not significantly different in mean blood loss and complication rate between two groups. In subgroup analysis, ADF had a higher mean postoperative JOA score and recovery rate than LAMP in cases of OPLL with occupying ratios ≥ 50%, while those difference were not found in cases of OPLL with occupying ratios < 50%.Conclusion: ADF achieves better neurological improvement compared with LAMP in treatment of cervical myelopathy due to OPLL, especially in cases of OPLL with occupying ratios ≥ 50%. Complication rate is similar between two groups, but ADF can increase the risk of reoperation.
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Affiliation(s)
- Ping Xu
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Jing-Shen Zhuang
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Yu-Sheng Huang
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Jian-Ting Chen
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Zhao-Ming Zhong
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China,Correspondence to: Zhao-Ming Zhong, Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou510515, People’s Republic of China.
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Zhong W, Wang L, Huang T, Luo X. Risk factors for rapid progressive neurological deterioration in patients with cervical spondylotic myelopathy. J Orthop Surg Res 2021; 16:75. [PMID: 33478509 PMCID: PMC7818545 DOI: 10.1186/s13018-021-02227-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/11/2021] [Indexed: 01/04/2024] Open
Abstract
Background The rapid progressive cervical spondylotic myelopathy (rp-CSM) which had a course of CSM less than 1 month and suffered rapidly progressive neurological deterioration had few reports. Therefore, it is important for us to recognize the pathophysiology of CSM especially the rp-CSM. The study aimed to investigate the risk factors for rapidly progressive (rp) neurological deterioration in patients with cervical spondylotic myelopathy (CSM). Methods A total of 159 patients were reviewed and divided into an rp-CSM group and a chronic-CSM (c-CSM) group. Various clinical indexes, including age, sex, Japanese Orthopaedic Association (JOA) score, intramedullary MR T2-hyperintensity, congenital/degenerative spinal stenosis, and local type of ossification of the posterior longitudinal ligament (OPLL), were analyzed, and independent risk factors were investigated. Results Thirty-four of 159 patients (21.4%) were diagnosed with rp-CSM. All patients were followed up for a mean of 68.56 ± 14.00 months in the rp-CSM group and 62.66 ± 19.95 months in the c-CSM group. No significant difference was found in sex, mean age, smoking and drinking status, diabetes mellitus (DM), hypertension, surgery time, blood loss, JOA score, degenerative spinal stenosis, or OPLL (local). Univariate analyses demonstrated that rp-CSM patients tended to have MR T2-hyperintensity, longer hospital stay, shorter waiting time for surgery, more congenital spinal stenosis, and worse neurological function and to prefer more posterior surgeries than c-CSM patients. A multiple logistic regression analysis showed that congenital spinal stenosis and MR T2-hyperintensity were independently related to the presence of rp-CSM. Conclusions MR T2-hyperintensity and congenital spinal stenosis were risk factors for rp-CSM. Although neurological function deteriorates rapidly, early surgical decompression is recommended and can achieve good neurological recovery after surgery, indicating that rp-CSM could be a reversible condition.
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Affiliation(s)
- Weiyang Zhong
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P. R. China
| | - Lin Wang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P. R. China
| | - Tianji Huang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P. R. China
| | - Xiaoji Luo
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P. R. China.
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Yoshii T, Egawa S, Chikuda H, Wakao N, Furuya T, Kanchiku T, Nagoshi N, Fujiwara Y, Yoshida M, Taguchi T, Watanabe M. A systematic review and meta-analysis comparing anterior decompression with fusion and posterior laminoplasty for cervical spondylotic myelopathy. J Orthop Sci 2021; 26:116-122. [PMID: 32205020 DOI: 10.1016/j.jos.2020.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/23/2019] [Accepted: 02/09/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND The optimal surgical procedure for the treatment of cervical spondylotic myelopathy (CSM) remains controversial because there are few comprehensive studies that have investigated the surgical methods. Therefore, we conducted a systematic review and meta-analysis to evaluate evidence in the literature and to compare the surgical outcomes between anterior decompression with fusion (ADF) and laminoplasty, which are representative procedures for CSM. METHODS An extensive literature search was performed using PubMed, Embase, and the Cochrane Library to identify comparative studies of ADF and laminoplasty for CSM. The language was restricted to English, and the publication period was from January 2001 to July 2019. We only included studies of CSM and excluded studies that involved patients with ossification of the posterior longitudinal ligament and treatments with posterior instrumented fusion. We extracted outcomes from the studies, such as preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, cervical alignment, surgical complications and reoperation rates. Then, a meta-analysis was performed on these surgical outcomes. RESULTS Nine studies were obtained, and the quality of the studies was acceptable. In the meta-analysis, the preoperative JOA score was similar between the ADF and laminoplasty groups. The postoperative JOA scores and neurological recovery rates were not different between the ADF and laminoplasty groups. ADF exhibited more favorable results than laminoplasty in terms of postoperative cervical alignment. In contrast, overall complications were more frequently observed in the ADF group than in the laminoplasty group, leading to higher rates of reoperation. However, postoperative neck pain was more frequently observed in the laminoplasty group than in the ADF group. CONCLUSIONS This systematic review and meta-analysis showed both the merits and shortcomings of ADF and laminoplasty. ADF and laminoplasty showed similar results in terms of neurological recovery. Postoperative cervical lordosis was better preserved with ADF than with laminoplasty. However, ADF was associated with a higher incidence of surgical complications than laminoplasty.
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Affiliation(s)
- Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo, 113-8511, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan.
| | - Satoru Egawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo, 113-8511, Japan
| | - Hirotaka Chikuda
- Department of Orthopedic Surgery, Gunma University School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8513, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Norimitsu Wakao
- Department of Orthopedic Surgery, National Center for Geriatrics and Gerontology, Moriokacho7-430, Obu City, Aichi, 474-8511, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8670, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Tsukasa Kanchiku
- Department of Orthopedic Surgery, Yamaguchi Rosai Hospital, 1315-4, Oaza-Onoda, Onoda City, Yamaguchi, 756-0095, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Yasushi Fujiwara
- Department of Orthopedic Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami2-1-1, Asakitaku, Hiroshima City, 731-0293, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Masahiro Yoshida
- Department of Surgery, International University of Health and Welfare Ichikawa Hospital, Konodai 6-1-14, Ichikawashi, Chiba, 272-0827, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Toshihiko Taguchi
- Department of Orthopedic Surgery, Yamaguchi Rosai Hospital, 1315-4, Oaza-Onoda, Onoda City, Yamaguchi, 756-0095, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Tokai University, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
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Kwok SSS, Cheung JPY. Surgical decision-making for ossification of the posterior longitudinal ligament versus other types of degenerative cervical myelopathy: anterior versus posterior approaches. BMC Musculoskelet Disord 2020; 21:823. [PMID: 33292175 PMCID: PMC7724709 DOI: 10.1186/s12891-020-03830-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/25/2020] [Indexed: 12/02/2022] Open
Abstract
Background The debate between anterior or posterior approach for pathologies such as cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) have drawn heated debate but are still inconclusive. Main body of the abstract A narrative review was performed specifically to study the differences pertaining to OPLL and other causes of degenerative cervical myelopathy (DCM). Current evidence suggests that anterior approach is preferred for K-line (−) OPLL, K-line (+) with canal occupying ratio > 60% and DCM with pre-existing cervical kyphosis. Posterior approach is preferred for K-line (+) OPLL with canal-occupying ratio < 50–60%, and multi-level CSM. No particular advantage for either approach was observed for DCM in a lordotic cervical spine. Anterior approach is generally associated with more complications and thus needs to be weighed carefully during decision-making. The evidence is not convincing for comparing single versus multi-level involvement, and the role of patients' co-morbidity status, pre-existing osteoporosis and co-existent spinal pathologies in influencing patient outcome and surgical options. This should be a platform for future research directives. Conclusion From this review, evidence is still inconclusive but there are some factors to consider, and DCM and OPLL should be considered separately for decision-making. Anterior approach is considered for pre-existing cervical kyphosis in DCM, for K-line (−) regardless of canal-occupying ratio, and K-line (+) and canal-occupying ratio > 60% for OPLL patients. Posterior approach is considered for patients with multi-level pathology for DCM, and K-line (+) and canal-occupying ratio < 50–60% for OPLL.
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Affiliation(s)
- Suzanna Sum Sum Kwok
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China.
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Zhai JL, Guo SG, Nie L, Hu JH. Comparison of the anterior and posterior approach in treating four-level cervical spondylotic myelopathy. Chin Med J (Engl) 2020; 133:2816-2821. [PMID: 33273330 PMCID: PMC10631575 DOI: 10.1097/cm9.0000000000001146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The optimal surgical approach for four-level cervical spondylotic myelopathy remains controversial. The purpose of this study was to compare clinical and radiological outcomes and complications between the anterior and posterior approaches for four-level cervical spondylotic myelopathy. METHODS A total of 19 patients underwent anterior decompression and fusion and 25 patients underwent posterior laminoplasty and instrumentation in this study. Perioperative information, intraoperative blood loss, clinical and radiological outcomes, and complications were recorded. Japanese Orthopedic Association (JOA) score, 36-item short form survey (SF-36) score and cervical alignment were assessed. RESULTS There were no significant differences in JOA scores between the anterior and posterior group preoperatively (11.6 ± 1.6 vs. 12.1 ± 1.5), immediately postoperatively (14.4 ± 1.1 vs. 13.8 ± 1.3), or at the last follow-up (14.6 ± 1.0 vs. 14.2 ± 1.1) (P > 0.05). The JOA scores significantly improved immediately postoperatively and at the last follow-up in both groups compared with their preoperative values. The recovery rate was significantly higher in the anterior group both immediately postoperatively and at the last follow-up. The SF-36 score was significantly higher in the anterior group at the last follow-up compared with the preoperative value (69.4 vs. 61.7). Imaging revealed that there was no significant difference in the Cobb angle at C2-C7 between the two groups preoperatively (-2.0° ± 7.3° vs. -1.4° ± 7.5°). The Cobb angle significantly improved immediately postoperatively (12.3° ± 4.2° vs. 9.2° ± 3.6°) and at the last follow-up (12.4° ± 3.5° vs. 9.0° ± 2.6°) in both groups compared with their preoperative values (P = 0.00). Three patients had temporary dysphagia in the anterior group and four patients had persistent axial symptoms in the posterior group. CONCLUSIONS Both the anterior and posterior approaches were effective in treating four-level cervical spondylotic myelopathy in terms of neurological clinical outcomes and radiological features. However, the JOA score recovery rate and SF-36 score in the anterior group were significantly higher. Persistent axial pain could be a major concern when undertaking the posterior approach.
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Affiliation(s)
- Ji-Liang Zhai
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Shi-Gong Guo
- Department of Rehabilitation Medicine, University Hospital of Wales Cardiff, UK
| | - Li Nie
- Department of Research and Education, Beijing Centers of Disease Prevention and Control, Beijing 102206, China
| | - Jian-Hua Hu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
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47
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Gelfand Y, Benton JA, Longo M, de la Garza Ramos R, Berezin N, Nakhla JP, Yanamadala V, Yassari R. Comparison of 30-Day Outcomes in Patients with Cervical Spine Metastasis Undergoing Corpectomy Versus Posterior Cervical Laminectomy and Fusion: A 2006-2016 ACS-NSQIP Database Study. World Neurosurg 2020; 147:e78-e84. [PMID: 33253949 DOI: 10.1016/j.wneu.2020.11.126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with metastatic disease to the cervical spine have historically had poor outcomes, with an average survival of 15 months. Every effort should be made to avoid complications of surgical intervention for stabilization and decompression. METHODS We identified patients who had undergone anterior cervical corpectomy and fusion (ACCF) or posterior cervical laminectomy and fusion (PCLF) for metastatic disease of the cervical spine using the American College of Surgeons National Surgical Quality Improvement Program database from 2006 to 2016. Patients meeting the inclusion criteria were subsequently propensity matched 1:1. We compared the overall complications, intensive care unit level complications, mortality, and return to the operating room between the 2 groups. RESULTS After identifying the patients who met the inclusion criteria and propensity matching, a cohort of 240 patients was included, with 120 (50%) in the ACCF group and 120 (50%) in the PCLF group. The patients in the ACCF group were more likely to have experienced any complication (odds ratio, 2.1; 95% confidence interval, 1.1-4.1; P = 0.026) but not severe complications or a return to the operating room (P = 0.406 and P = 0.450, respectively). CONCLUSION In the present study, we found that anterior surgical approaches (ACCF) for metastatic cervical spine disease resulted in a significantly greater rate of overall complications (2.1 times more) compared with PCLF in the first 30 days. Although more studies are required to further elucidate this relationship, the general belief that the anterior approach is better tolerated by patients might not apply to patients with metastatic tumors.
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Affiliation(s)
- Yaroslav Gelfand
- Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
| | - Joshua A Benton
- Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael Longo
- Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rafael de la Garza Ramos
- Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Naomi Berezin
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jonathan P Nakhla
- Department of Neurosurgery, Rhode Island Hospital of Brown University, Providence, Rhode Island, USA
| | - Vijay Yanamadala
- Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Reza Yassari
- Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Khan I, Archer KR, Wanner JP, Bydon M, Pennings JS, Sivaganesan A, Knightly JJ, Foley KT, Bisson EF, Shaffrey C, McGirt MJ, Asher AL, Devin CJ. Trajectory of Improvement in Myelopathic Symptoms From 3 to 12 Months Following Surgery for Degenerative Cervical Myelopathy. Neurosurgery 2020; 86:763-768. [PMID: 31435676 DOI: 10.1093/neuros/nyz325] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/18/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Degenerative cervical myelopathy (DCM) is a progressive disease resulting from cervical cord compression. The modified Japanese Orthopaedic Association (mJOA) is commonly used to grade myelopathic symptoms, but its persistent postoperative improvement has not been previously explored. OBJECTIVE To utilize the Quality Outcomes Database (QOD) to evaluate the trajectory of outcomes in those operatively treated for DCM. METHODS This study is a retrospective analysis of prospectively collected data. The QOD was queried for patients undergoing elective surgery for DCM. Patients were divided into mild (≥14), moderate (9-13), or severe (<9) categories for their baseline severity of myelopathic symptoms (mJOA scores). A parsimonious multivariable logistic regression model was fitted with 2 points improvement on mJOA from 3- to 12-mo follow-up as the outcome of interest. RESULTS A total of 2156 patients who underwent elective surgery for DCM and had complete 3- and 12-mo follow-up were included in our analysis. Patients improved significantly from baseline to 3-mo on their mJOA scores, regardless of their baseline mJOA severity. After adjusting for the relevant preoperative characteristics, the baseline mJOA categories had significant impact on outcome of whether a patient keeps improving in mJOA score from 3 to 12 mo postsurgery. Patient with severe mJOA score at baseline had a higher likelihood of improvement in their myelopathic symptoms, compared to patients with mild mJOA score in. CONCLUSION Most patients achieve improvement on a shorter follow-up; however, patients with severe symptoms keep on improving until after a longer follow-up. Preoperative identification of such patients helps the clinician settling realistic expectations for each follow-up timepoint.
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Affiliation(s)
- Inamullah Khan
- Department of Orthopedic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Neurological surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.,Vanderbilt Center for Musculoskeletal Research, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Kristin R Archer
- Department of Orthopedic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.,Vanderbilt Center for Musculoskeletal Research, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - John Paul Wanner
- Department of Orthopedic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Mohamad Bydon
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jacquelyn S Pennings
- Department of Orthopedic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.,Vanderbilt Center for Musculoskeletal Research, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Ahilan Sivaganesan
- Department of Neurological surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Kevin T Foley
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Erica F Bisson
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Christopher Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Matthew J McGirt
- Carolina Neurosurgery and Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Anthony L Asher
- Carolina Neurosurgery and Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Clinton J Devin
- Department of Orthopedic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Neurological surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.,Steamboat Orthopaedic and Spine Institute, Steamboat Springs, Colorado
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49
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Lee JJ, Lee N, Oh SH, Shin DA, Yi S, Kim KN, Yoon DH, Shin HC, Ha Y. Clinical and radiological outcomes of multilevel cervical laminoplasty versus three-level anterior cervical discectomy and fusion in patients with cervical spondylotic myelopathy. Quant Imaging Med Surg 2020; 10:2112-2124. [PMID: 33139991 DOI: 10.21037/qims-20-220] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Cervical spondylotic myelopathy (CSM) is one of the most common causes of spinal cord impairment in elderly patients. However, a consensus has yet to be reached on the ideal method of surgical intervention. In this study, we investigated serial changes of radiological findings after three-level anterior cervical discectomy and fusion (ACDF) and multilevel laminoplasty and attempted to identify the radiological parameters affecting long-term clinical outcomes in CSM. Methods Of the 152 patients with multilevel CSM treated with three-level ACDF and multilevel laminoplasty, 42 had complete radiological parameters both before and 2 years after surgery (three-level ACDF, 22 patients; multilevel laminoplasty, 20 patients). Radiological parameters included spinal cord signal intensity (SI) changes on magnetic resonance imaging (MRI). Clinical outcomes including the Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), Oswestry disability index (ODI), and 36-Item Short Form Health Survey score were measured. Results The ACDF group showed significant restoration of segmental lordosis postoperatively (preoperatively: 2.21°, 6 months: 8.37°, P=0.026), and segmental and cervical range of motion (ROM) was markedly reduced and well maintained until the final follow-up (preoperatively: 25.48°, 24 months: 4.35°, P<0.001; preoperatively: 41.71°, 24 months: 20.18°, P<0.001). The recovery rates of the JOA score were 42.85% and 57.40% in the ACDF and laminoplasty groups, respectively, although this difference was not statistically significant. Multivariate regression analysis demonstrated that signal change on MRI significantly affected the recovery rate (P=0.003). The visual analog scale (VAS) score and NDI decreased considerably only in the laminoplasty group, and device complications were confirmed only in the ACDF group (incidence rate =36.5%). Conclusions Multilevel laminoplasty showed better radiological and similar clinical outcomes. ACDF had more surgical complications. Spinal cord SI change on preoperative MRI was the independent risk factor for poor clinical outcomes. We recommend laminoplasty instead of three-level ACDF to treat multilevel CSM.
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Affiliation(s)
- Jong Joo Lee
- Department of Neurosurgery, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Nam Lee
- Department of Neurosurgery, Yonsei Cheok Hospital, Busan, Korea
| | - Sung Han Oh
- Department of Neurosurgery, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine, and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yi
- Department of Neurosurgery, Spine, and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Keung Nyun Kim
- Department of Neurosurgery, Spine, and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Do Heum Yoon
- Department of Neurosurgery, Spine, and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Chul Shin
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine, and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
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50
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Yoshii T, Egawa S, Chikuda H, Wakao N, Furuya T, Kanchiku T, Nagoshi N, Fujiwara Y, Yoshida M, Taguchi T, Watanabe M. Comparison of anterior decompression with fusion and posterior decompression with fusion for cervical spondylotic myelopathy-A systematic review and meta-analysis. J Orthop Sci 2020; 25:938-945. [PMID: 32008876 DOI: 10.1016/j.jos.2019.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/21/2019] [Accepted: 12/03/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND The optimal surgical procedure for the treatment of cervical spondylotic myelopathy (CSM) remains controversial. Recently, laminectomy/laminoplasty with instrumented fusion (LAMF) has been increasingly applied to treat CSM. However, few comprehensive studies have compared anterior decompression with fusion (ADF) and LAMF. Therefore, we conducted a meta-analysis to evaluate the evidence in the literature and to compare the surgical outcomes between the 2 procedures. Since the surgical outcomes and risks differ between patients with CSM and ossification of the posterior longitudinal ligament (OPLL) and between only posterior decompression and decompression with fusion treatments, we excluded patients with OPLL and patients with only posterior decompression in this review. METHODS An extensive literature search was performed using PubMed, Embase, and the Cochrane Library to identify comparative studies of ADF and LAMF for the treatment of CSM. The language was restricted to English, and the publication period was from January 2001 to July 2019. We only included studies about CSM and excluded studies that involved patients with ossification of the posterior longitudinal ligament and with the treatment of posterior decompression without fusion. We extracted outcomes from the studies, such as preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, neck disability index (NDI) scores, cervical alignment data, and surgical complications. Then, a meta-analysis was performed on these surgical outcomes. RESULTS Eleven studies were obtained, and the quality of the studies was acceptable. In the meta-analysis, the pre- and postoperative JOA scores were similar between the ADF and LAMF groups. The ADF group exhibited more favorable results than the LAMF group in terms of postoperative cervical alignment and the NDI. Overall complications were similar between the ADF and LAMF groups; however, C5 palsy was more frequently observed in the LAMF group than in the ADF group. CONCLUSIONS While the ADF and LAMF groups demonstrated similar results in terms of neurological recovery, postoperative cervical lordosis and NDI scores were more favorable with ADF than with LAMF. The overall complication rate was similar between the ADF and LAMF groups. Surgeons should understand the merits and shortcomings of both procedures when deciding on a surgical procedure.
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Affiliation(s)
- Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo, 113-8511, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan.
| | - Satroru Egawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo, 113-8511, Japan
| | - Hirotaka Chikuda
- Department of Orthopedic Surgery, Gunma University School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8513, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Norimitsu Wakao
- Department of Orthopedic Surgery, National Center for Geriatrics and Gerontology, Moriokacho 7-430, Obu, Aichi, 474-8511, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Tsukasa Kanchiku
- Department of Orthopedic Surgery, Yamaguchi Rosai Hospital, 1315-4, Oaza-Onoda, Onoda, Yamaguchi, 756-0095, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Yasushi Fujiwara
- Department of Orthopedic Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakitaku, Hiroshima, 731-0293, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Masahiro Yoshida
- Department of Surgery, International University of Health and Welfare Ichikawa Hospital, Konodai 6-1-14, Ichikawashi, Chiba, 272-0827, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Toshihiko Taguchi
- Department of Orthopedic Surgery, Yamaguchi Rosai Hospital, 1315-4, Oaza-Onoda, Onoda, Yamaguchi, 756-0095, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan; Guideline Committee of Ossification of the Spinal Ligament, Japanese Orthopaedic Association, Japan
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