Reliability and scientific use of a surgical planning software for anterior cervical discectomy and fusion (ACDF)

Personalized Medicine in Orthopaedic Surgery: The Case of Spine Surgery

Personalized medicine has made a tremendous impact on patient care. Although initially, it revolutionized pharmaceutical development and targeted therapies in oncology, it has also made an important impact in orthopaedic surgery. The field of spine surgery highlights the effect of personalized medicine because the improved understanding of spinal pathologies and technological innovations has made personalized medicine a key component of patient care. There is evidence for several of these advancements to support their usage in improving patient care. Proper understanding of normative spinal alignment and surgical planning software has enabled surgeons to predict postoperative alignment accurately. Furthermore, 3D printing technologies have demonstrated the ability to improve pedicle screw placement accuracy compared with free-hand techniques. Patient-specific, precontoured rods have shown improved biomechanical properties, which reduces the risk of postoperative rod fractures. Moreover, approaches such as multidisciplinary evaluations tailored to specific patient needs have demonstrated the ability to decrease complications. Personalized medicine has shown the ability to improve care in all phases of surgical management, and several of these approaches are now readily available to orthopaedic surgeons.

Does Early Postoperative T1 Slope Change Affect Clinical Results of Patients With Single-level ACDF?

STUDY DESIGN

This was a retrospective study.

OBJECTIVE

The main question of this study is whether the change of postoperative T1 slope will affect the clinical and imaging recovery of patients with single-level anterior cervical discectomy and fusion (ACDF).

SUMMARY OF BACKGROUND DATA

The T1 slope after ACDF is different from that preoperatively, however, the clinical significance of this change has not been reported.

MATERIALS AND METHODS

A retrospective analysis was conducted on 87 patients with single-level ACDF. Visual Analogue Scale was used to compare neck and upper limb pain before and after surgery. Neurological improvement was assessed by the Japanese Orthopaedic Association Scores and Neck Disability Index. Preoperative and postoperative T1 slope, occipital-C2 angle, C2-C7 overall curvature and functional spinal unit curvature were measured and analyzed by lateral cervical spine x-ray.

RESULTS

All patients were followed up for 23.98±12.17 months. The Japanese Orthopaedic Association, Visual Analogue Scale, and Neck Disability Index scores as well as the overall curvature and change of C2-C7 and functional spinal unit were significantly improved in the last postoperative follow-up. At 12 months after surgery and the last follow-up, patients with increased T1 slope had more severe neck pain symptoms than those with decreased T1 slope (P<0.05). The overall curvature and change of C2-C7 in patients with increased T1 slope were better than those with decreased T1 slope (P<0.05).

CONCLUSION

For patients with increased postoperative T1 slope after single-level ACDF, the degree of postoperative neck pain was more severe, suggesting that some clinical intervention is needed.