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Liu FY, Yu JH, Huo LS, Meng DJ, Lu K, Liu Z, Ren L, Sun XZ. Alternate levels versus all levels mini-plate fixation in C3-6 cervical laminoplasty: a retrospective comparative study. BMC Musculoskelet Disord 2024; 25:515. [PMID: 38961403 PMCID: PMC11220940 DOI: 10.1186/s12891-024-07638-0] [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: 08/24/2023] [Accepted: 06/27/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVE The purpose of this study is to compare radiological and clinical outcomes between alternate levels (C4 and C6) and all levels mini-plate fixation in C3-6 unilateral open-door laminoplasty. METHODS Ninety-six patients who underwent C3-6 unilateral open-door laminoplasty with alternate levels mini-plate fixation (54 patients in group A) or all levels mini-plate fixation (42 patients in group B) between September 2014 and September 2019 were reviewed in this study. Radiologic and clinical outcomes were assessed. Clinical results included Visual Analogue Scale (VAS) of axial neck pain and Japanese Orthopedic Association (JOA) score. Radiographic results included cervical range of motion (ROM), cervical curvature index (CCI), and the spinal canal expansive parameters including open angle, anteroposterior diameter (APD), and Pavlov`s ratio. RESULTS There was no significant difference in VAS, JOA score, ROM, and CCI between two groups. There was no significant difference in canal expansion postoperatively between two groups. However, open angle, APD, and Pavlov`s ratio in group A decreased significantly during the follow-up. In group B, APD, Pavlov`s ratio, and open angle were maintained until the final follow-up. There was no hardware failure or lamina reclosure occurred in both groups during the follow-up. The mean cost of group B was higher than that of group A. CONCLUSIONS Despite the differences in the maintenance of canal expansion, alternate levels mini-plate fixation can achieve similar clinical outcomes as all levels mini-plate fixation in C3-6 unilateral open-door laminoplasty. As evidenced in this study, we believe C3-6 laminoplasty with alternate levels (C4 and C6) mini-plate fixation is an economical, effective, and safe treatment method.
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Affiliation(s)
- Feng-Yu Liu
- Department of Spine Surgery, The Third Hospital of Shijiazhuang, No. 15 Tiyu Street, Shijiazhuang, 050000, China
| | - Jin-He Yu
- Department of Spine Surgery, The Third Hospital of Shijiazhuang, No. 15 Tiyu Street, Shijiazhuang, 050000, China
| | - Li-Shuang Huo
- Department of Endocrinology, Shijiazhuang People's Hospital, Shijiazhuang, 050000, China
| | - De-Jing Meng
- Emergency Follow‑up Department, Shijiazhuang Emergency Center, Shijiazhuang, 050000, China
| | - Kuan Lu
- Department of Spine Surgery, The Third Hospital of Shijiazhuang, No. 15 Tiyu Street, Shijiazhuang, 050000, China
| | - Zhao Liu
- Department of Spine Surgery, The Third Hospital of Shijiazhuang, No. 15 Tiyu Street, Shijiazhuang, 050000, China
| | - Liang Ren
- Department of Spine Surgery, The Third Hospital of Shijiazhuang, No. 15 Tiyu Street, Shijiazhuang, 050000, China
| | - Xian-Ze Sun
- Department of Spine Surgery, The Third Hospital of Shijiazhuang, No. 15 Tiyu Street, Shijiazhuang, 050000, China.
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Cheung JPY, Kuang X, Zhang T, Wang K, Yang C. 5-Year progression prediction of endplate defects: Utilizing the EDPP-Flow convolutional neural network based on unbalanced data. J Orthop 2023; 38:7-13. [PMID: 36910507 PMCID: PMC9999205 DOI: 10.1016/j.jor.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/25/2023] [Accepted: 03/01/2023] [Indexed: 03/14/2023] Open
Abstract
Background Lumbar disc degeneration (LDD) is considered as one of the main causes of low back pain. For clinical diagnosis of LDD, magnetic resonance imaging (MRI) is commonly used. Schmorl's node, high intensity zone (HIZ), Modic changes, and other MRI biomarkers of intervertebral disc (IVD) degeneration are also associated with low back pain. However, the progression and natural history of these features are unclear and there is limited predictive capacity with MRI. Purpose We aim to establish and validate a deep learning pipeline, EDPP-Flow, for the 5-year progression prediction of Schmorl's node, HIZ, and Modic changes, based on clinical MRIs. Materials and methods An MRI dataset developed on 1152 volunteers was used in this study. For each volunteer, two MRI scans, at baseline and 5-year follow-up, were collected and pathology labels were annotated as present or absent (with/without pathology) by two specialists with over 10 years of clinical experience. Our pipeline contained the published MRI-SegFlow and state-of-the-art convolutional neural network for progression prediction of endplate defects. The label distribution of the dataset is unbalanced, where the number of present samples was much smaller than absent samples. The resampling and data augmentation strategies were adopted to increase the number of present samples in the training process and balance the influence of different samples on the model, which can improve the prediction accuracy. Results Our pipeline achieved high weighted accuracy, sensitivity, and specificity for progression prediction of Schmorl's node (89.46 ± 3.71%, 89.19 ± 2.70%, 89.72 ± 2.42%), HIZ (91.75 ± 2.48%, 93.07 ± 3.96%, 90.43 ± 2.51%), and Modic changes (87.51 ± 2.23%, 87.93 ± 1.72%, 87.10 ± 1.99%), on the unbalanced dataset (present sample's percentages of the 3 pathologies above were 4.3%, 11.7%, and 6.7%). Conclusion We developed and validated a deep learning pipeline, for the progression prediction of endplate defects, which showed high prediction accuracy on unbalanced data. The method has significant potential for clinical implementation.
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Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
- Digital Health Laboratory, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Xihe Kuang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
- Digital Health Laboratory, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Teng Zhang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
- Digital Health Laboratory, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kun Wang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Shenzhen Research Institute, Huazhong University of Science and Technology, Shenzhen, China
| | - Cao Yang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Shenzhen Research Institute, Huazhong University of Science and Technology, Shenzhen, China
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Wu J, Lin J, Huang Z, Wu X. The impact of plating level on the postoperative loss of cervical lordosis in alternative skipped-level plating laminoplasty. J Orthop Surg (Hong Kong) 2020; 28:2309499019896882. [PMID: 31916485 DOI: 10.1177/2309499019896882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of this study is to evaluate the impact of plating level on the loss of cervical lordosis (LCL) after laminoplasty with skipped-level plating. METHODS This retrospective study included patients who underwent alternative skipped-level plating laminoplasty from C3 to C6. Patients were divided into two groups according to the plating level. Group 1 had miniplate fixed at C3 and C5 (C3/C5 group), while patients in group 2 were fixed at C4 and C6 (C4/C6 group). The outcome of interest was the difference of LCL between the two groups; meanwhile, kyphosis development after laminoplasty was also compared. RESULTS A total of 70 patients were included in our study with a mean age of 60.44 ± 9.97 years. The median follow-up was 15 (12, 16) months. Median lordosis was 15.43° (9.35°, 22.23°) before surgery and 9.88° (4.15°, 18.94°) after, with a median LCL of 4.48° (-0.66°, 8.11°). There were 17 patients in the C3/C5 group, whereas 53 patients in the C4/C6 group. While preoperative C2-C7 Cobb's angle was comparable between the two groups (15.32° (9.73°, 23.84°) vs. 15.51° (9.03°, 21.70°), p = 0.864), there were statistical differences regarding postoperative C2-C7 Cobb's angle (6.54° (2.49°, 16.42°) vs. 10.62° (5.89°, 18.85°), p = 0.006) and LCL (4.74° (4.17°, 12.03°) vs. 4.07° (-1.89°, 6.69°), p = 0.034) between the C3/C5 group and the C4/C6 group. In all, 94.1% (16 of 17) of patients showed some degree of LCL after laminoplasty in the C3/C5 group, which was significantly higher when compared with 64.2% (34 of 52) of C4/C6 group (p = 0.038). Before surgery, there were no kyphosis patients in either the C3/C5 group or the C4/C6 group. Postoperatively, four patients (23.5%) developed kyphotic alignment in the C3/C5 group, but only one (1.9%) in the C4/C6 group (p = 0.013). CONCLUSIONS Cervical alignment was compromised after laminoplasty. When alternative skipped-level plating is adopted in laminoplasty from C3 to C6, plating at C4/C6 may better preserve cervical lordosis than plating at C3/C5 after surgery.
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Affiliation(s)
- Jinyan Wu
- Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Junyu Lin
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zucheng Huang
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaoliang Wu
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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Zhang Z, Wang LN, Song YM, Wang L, Liu H, Liu LM, Xiu P, Zhou ZJ. Comparison of long-term clinical and radiographic outcomes between alternative-level and all-level fixation unilateral open-door laminoplasty. Spine J 2020; 20:1761-1769. [PMID: 32615327 DOI: 10.1016/j.spinee.2020.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND CONTEXT Titanium mini-plate has been used in unilateral open-door laminoplasty to maintain the open angle of laminae. Previously, both all-level fixation (C3-C7) and alternative-level (C3, C5, C7) unilateral open-door laminoplasty have been proven to have satisfactory clinical outcomes. However, whether they could achieve similar long-term clinical and radiographic efficacy is still questionable. PURPOSE To compare the long-term clinical and radiological outcomes between alternative-level and all-level fixation unilateral open-door laminoplasty with a mini-plate fixation system. STUDY DESIGN/SETTING Retrospective comparative study. PATIENT SAMPLE Ninety-one patients who underwent unilateral open-door laminoplasty. OUTCOME MEASURES Clinical results including Japanese Orthopedic Association score, Visual Analogue Score, Neck Dysfunction Index score. Radiographic results including cervical curvature index, cervical range of motion, and the spinal canal expansive parameters, including anteroposterior diameter, Pavlov's ratio, and open angle. METHODS Between April 2007 and June 2011, 91 patients with minimum 7-year postoperative follow-up were included. Thirty-eight underwent alternative-level fixation (group A) and 53 underwent all-level fixation (group B). Demographic data, including age, gender, operative time, blood loss, and cost, were collected and compared between the two groups. Clinical and radiographic data were obtained preoperatively, at 3 and 6 months and 1 and 3 years postoperatively, as well as at final follow-up. The difference between the two groups and between different time points within one group was compared. RESULTS Both groups obtained satisfactory clinical outcomes till the final follow-up. No statistic difference was found in Japanese Orthopedic Association, Visual Analogue Score, and Neck Dysfunction Index between the two groups throughout the whole follow-up. Both groups maintained APD and Pavlov's ratio well till follow-up. However, statistic difference was found in the open angle between two groups at final follow-up (34.17±2.75° vs. 36.19±1.80°, p<.05). When we subdivided the cervical segments in group A, we found the mini-plate segments showed maintenance in open angle but a 4.52° decrease in suture segments. The mean cost in group B (17,669.82±1,157.65 $) was significantly higher than in group A (11,452.19±871.07 $; p<.05). CONCLUSIONS Despite a difference in the maintenance of open angle, both fixation methods achieved satisfactory clinical outcomes. We believe alternative-level fixation is also a safe, effective, and economical fixation method.
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Affiliation(s)
- Zhuang Zhang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Rd., Wuhou District, Chengdu, 610041, Sichuan, PR China
| | - Lin-Nan Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Rd., Wuhou District, Chengdu, 610041, Sichuan, PR China
| | - Yue-Ming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Rd., Wuhou District, Chengdu, 610041, Sichuan, PR China.
| | - Lei Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Rd., Wuhou District, Chengdu, 610041, Sichuan, PR China
| | - Hao Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Rd., Wuhou District, Chengdu, 610041, Sichuan, PR China
| | - Li-Min Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Rd., Wuhou District, Chengdu, 610041, Sichuan, PR China
| | - Peng Xiu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Rd., Wuhou District, Chengdu, 610041, Sichuan, PR China
| | - Zhong-Jie Zhou
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Rd., Wuhou District, Chengdu, 610041, Sichuan, PR China
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Cheung JPY, Cheung PWH, Law K, Borse V, Lau YM, Mak LF, Cheng A, Samartzis D, Cheung KMC. Postoperative Rigid Cervical Collar Leads to Less Axial Neck Pain in the Early Stage After Open-Door Laminoplasty-A Single-Blinded Randomized Controlled Trial. Neurosurgery 2020; 85:325-334. [PMID: 30113664 DOI: 10.1093/neuros/nyy359] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/11/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cervical collars are used after laminoplasty to protect the hinge opening, reduce risks of hinge fractures, and avoid spring-back phenomena. However, their use may lead to reduced range of motion and worse neck pain. OBJECTIVE To investigate the clinical, radiological, and functional outcomes of patients undergoing single-door laminoplasty with or without collar immobilization. METHODS This was a prospective, parallel, single-blinded randomized controlled trial. Patients underwent standardized single-door laminoplasty with mini-plates for cervical myelopathy and were randomly allocated into 2 groups based on the use of collar postoperatively. Clinical assessments included cervical range of motion, axial neck pain (VAS [visual analogue scale]), and objective scores (short-form 36-item, neck disability index, and modified Japanese Orthopaedic Association). All assessments were performed preoperatively and at postoperative 1, 2, 3, and 6 wk, and 3, 6, and 12 mo. Comparative analysis was performed via analysis of variance adjusted by baseline scores, sex, and age as covariates. RESULTS A total of 35 patients were recruited and randomized to collar use (n = 16) and without (n = 19). There were no dropouts or complications. There were no differences between groups at baseline. Subjects had comparable objective scores and range of motion at postoperative time-points. Patients without collar use had higher VAS at postoperative 1 wk (5.4 vs 3.5; P = .038) and 2 wk (3.5 vs 1.5; P = .028) but subsequently follow-up revealed no differences between the 2 groups. CONCLUSION The use of a rigid collar after laminoplasty leads to less axial neck pain in the first 2 wk after surgery. However, there is no additional benefit with regards to range of motion, quality of life, and complication risk.
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Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Prudence Wing Hang Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Karlen Law
- Department of Occupational Therapy, Duchess of Kent Children's Hospital, Sandy Bay, Hong Kong SAR, China
| | - Vishal Borse
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Yuk Ming Lau
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Ling Fung Mak
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Aldous Cheng
- Department of Physiotherapy, Duchess of Kent Children's Hospital, Sandy Bay, Hong Kong SAR, China
| | - Dino Samartzis
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Kenneth Man Chee Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Cheung JPY, Cheung PWH, Chiu CK, Chan CYW, Kwan MK. Variations in Practice among Asia-Pacific Surgeons and Recommendations for Managing Cervical Myelopathy: The First Asia-Pacific Spine Society Collaborative Study. Asian Spine J 2018; 13:45-55. [PMID: 30326696 PMCID: PMC6365774 DOI: 10.31616/asj.2018.0135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/03/2018] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Surgeon survey. PURPOSE To study the various surgical practices of different surgeons in the Asia-Pacific region. OVERVIEW OF LITERATURE Given the diversity among Asia-Pacific surgeons, there is no clear consensus on the preferred management strategies for cervical myelopathy. In particular, the role of prophylactic decompression for silent cervical spinal stenosis is under constant debate and should be addressed. METHODS Surgeons from the Asia-Pacific Spine Society participated in an online questionnaire comprising 50 questions. Data on clinical diagnosis, investigations and outcome measures, approach to asymptomatic and silent cervical spinal stenosis, guidelines for surgical approach, and postoperative immobilization were recorded. All parameters were analyzed by the Mantel-Haenszel test. RESULTS A total of 79 surgeons from 16 countries participated. Most surgeons used gait disturbance (60.5%) and dyskinetic hand movement (46.1%) for diagnosis. Up to 5.2% of surgeons would operate on asymptomatic spinal stenosis, and 18.2% would operate on silent spinal stenosis. Among those who would not operate, most (57.1%) advised patients on avoidance behavior and up to 9.5% prescribed neck collars. For ossification of the posterior longitudinal ligament (OPLL), anterior removal was most commonly performed for one-level disease (p<0.001), whereas laminoplasty was most commonly performed for two- to four-level disease (p=0.036). More surgeons considered laminectomy and fusion for multilevel OPLL. Most surgeons generally preferred to use a rigid neck collar for 6 weeks postoperatively (p<0.001). CONCLUSIONS The pooled recommendations include prophylactic or early decompression surgery for patients with silent cervical spinal stenosis, particularly OPLL. Anterior decompression is primarily suggested for one- or two-level disease, whereas laminoplasty is preferred for multilevel disease.
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Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China
| | | | - Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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