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Gong Y, Zhuo H, Zhou Z, Cheng Z, Gan Y, He J, Song Z, Liu H, Liu Y, Liang D, Jiang X, Ren H. Zero-profile implant system versus novel plate systems after ACDF for comparison of sagittal balance parameters and clinical efficacy analysis. J Orthop Surg Res 2024; 19:363. [PMID: 38898467 PMCID: PMC11186272 DOI: 10.1186/s13018-024-04857-y] [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: 04/01/2024] [Accepted: 06/15/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND The zero-profile implant system (Zero-P) and conventional plates have been widely used in anterior cervical discectomy and fusion (ACDF) to treat cervical spondylosis. The purpose of this study was to compare the effects of the application of Zero-P and new conventional plates (ZEVO, Skyline) in ACDF on the sagittal imaging parameters of cervical spondylosis patients and to analyze their clinical efficacy. METHODS We conducted a retrospective study on 119 cervical spondylosis patients from January 2018 to December 2021, comparing outcomes between those receiving the Zero-P device (n = 63) and those receiving a novel conventional plate (n = 56, including 46 ZEVO and 10 Skyline plates) through ACDF. Cervical sagittal alignment was assessed pre- and postoperatively via lateral radiographs. The Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and visual analog scale (VAS) scores were recorded at baseline, after surgery, and at the 2-year follow-up to evaluate patient recovery and intervention success. RESULTS There were significant differences in the postoperative C0-C2 Cobb angle and postoperative sagittal segmental angle (SSA) between patients in the novel conventional plate group and those in the Zero-P group (P < 0.05). Postoperatively, there were significant changes in the C2‒C7 Cobb angle, C0‒C2 Cobb angle, SSA, and average surgical disc height (ASDH) compared to the preoperative values in both patient groups (P < 0.05). Dysphagia in the immediate postoperative period was lower in the Zero-P group than in the new conventional plate group (0% in the Zero-P group, 7.14% in the novel conventional plate group, P = 0.046), and the symptoms disappeared within 2 years in both groups. There was no statistically significant difference between the two groups in terms of complications of adjacent spondylolisthesis (ASD) at 2 years postoperatively (3.17% in the Zero-P group, 8.93% in the novel conventional plate group; P = 0.252). According to the subgroup analysis, there were significant differences in the postoperative C2‒C7 Cobb angle, C0‒C2 Cobb angle, T1 slope, and ASDH between the ZEVO group and the Skyline group (P < 0.05). Compared with the preoperative scores, the JOA, NDI, and VAS scores of all groups significantly improved at the 2-year follow-up (P < 0.01). According to the subgroup analysis, the immediate postoperative NDI and VAS scores of the ZEVO group were significantly better than those of the Skyline group (P < 0.05). CONCLUSION In ACDF, both novel conventional plates and Zero-P can improve sagittal parameters and related scale scores. Compared to the Zero-P plate, the novel conventional plate has a greater advantage in correcting the curvature of the surgical segment, but the Zero-P plate is less likely to produce postoperative dysphagia.
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Affiliation(s)
- Yan Gong
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Hang Zhuo
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Zelin Zhou
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Zhaojun Cheng
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Yanchi Gan
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Jiahui He
- The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Zefeng Song
- Department of Medicine, Dalian University of Technology, Dalian, 116081, China
| | - Hao Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Yu Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - De Liang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Xiaobing Jiang
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China
| | - Hui Ren
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China.
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Shen YW, Yang Y, Hong Y, Ding C, Rong X, Meng Y, Wang BY, Wu TK, Liu H. Association of Craniocervical Sagittal Alignment With the Outcomes of Cervical Disc Replacement. Global Spine J 2024; 14:846-855. [PMID: 36044545 PMCID: PMC11192106 DOI: 10.1177/21925682221124531] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To explore the association between craniocervical sagittal balance and clinical and radiological outcomes of cervical disc replacement (CDR). METHODS Patients who underwent 1-level and 2-level CDR were retrospectively analyzed. Clinical outcomes were evaluated using scores on the Japanese Orthopaedic Association (JOA), Visual Analogue Scale (VAS), and Neck Disability Index (NDI). The craniocervical sagittal alignment parameters, including the C0-C2 Cobb angle, C2-C7 Cobb angle, C2 slope, T1 slope, C2-C7 sagittal vertical axis (SVA), C1-C7 SVA, the center of gravity of the head (CGH)-C7 SVA, and range of motion (ROM) at the surgical segments were measured. RESULTS A total of 169 patients were involved. Significantly lower pre- and postoperative C2 slope and CGH-C7 SVA were found in arthroplasty levels with better ROMs. Patients with a higher preoperative C2 slope and CGH-C7 SVA had lower cervical lordosis and ROM after surgery. There were no significant differences in the clinical outcomes between patients with different sagittal balance statuses. C2-C7 SVA and CGH-C7 SVA were significantly associated with radiographic adjacent segment pathology (rASP). CONCLUSION Craniocervical sagittal balance is associated with cervical lordosis and ROM at the index level after CDR. A higher preoperative SVA is related to the presence and progression of rASP. A relationship between sagittal alignment and clinical outcomes was not observed.
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Affiliation(s)
- Yi-Wei Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Hong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ding
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Rong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Meng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Bei-Yu Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Ting-Kui Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Xu H, Gong Z, Yang Y, Zhang F, Zou F, Xia X, Ma X, Lyu F, Jiang J, Wang H. C4 constant vertebra: a novel benchmark of physiological cervical sagittal alignment. 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; 33:1195-1204. [PMID: 38200269 DOI: 10.1007/s00586-023-08100-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/19/2023] [Accepted: 12/09/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Cervical sagittal alignment is essential, and there is considerable debate as to what constitutes physiological sagittal alignment. The purpose of this study was to identify constant parameters for characterizing cervical sagittal alignment under physiological conditions. METHODS A cross-sectional study was conducted in which asymptomatic subjects were recruited to undergo lateral cervical spine radiographs. Each subject was classified according to three authoritative cervical sagittal morphology classifications, followed by the evaluation of variations in radiological parameters across morphotypes. Moreover, the correlations among cervical sagittal parameters, age, and cervicothoracic junction parameters were also investigated. RESULTS A total of 183 asymptomatic Chinese subjects were enrolled with a mean age of 48.4 years. Subjects with various cervical sagittal morphologies had comparable C4 endplate slope angles under all three different typing systems. Among patients of different ages, C2-C4 endplate slope angles remained constant. Regarding the cervicothoracic junction parameters, T1 slope and thoracic inlet angle affected cervical sagittal parameters, including cervical lordosis and C2-7 sagittal vertical axis, and were correlated with the endplate slope angles of C5 and below and did not affect the endplate slope angles of C4 and above. In general, the slope of the C4 inferior endplate ranges between 13° and 15° under different physiological conditions. CONCLUSIONS In the asymptomatic population, the C4 vertebral body maintains a constant slope angle under physiological conditions. The novel concept of C4 as a constant vertebra would provide a vital benchmark for diagnosing pathological sagittal alignment abnormalities and planning the surgical reconstruction of cervical lordosis.
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Affiliation(s)
- Haocheng Xu
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Zhaoyang Gong
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Yong Yang
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Fan Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Fei Zou
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Xinlei Xia
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Xiaosheng Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Feizhou Lyu
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China.
- Department of Orthopedics, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China.
| | - Jianyuan Jiang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Hongli Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China.
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Zhang Z, Wang J, Ge R, Guo C, Liang Y, Liu H, Xu S. A novel classification that defines the normal cervical spine: an analysis based on 632 asymptomatic Chinese volunteers. 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; 33:155-165. [PMID: 37880410 DOI: 10.1007/s00586-023-07997-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE The "normal" cervical spine may be non-lordotic shapes and the cervical spine alignment targets are less well established. So, the study was to propose novel classification for cervical spine morphologies with Chinese asymptomatic subjects, and to address cervical balance status based on the classification. METHOD An overall 632 asymptomatic individuals on cervical spine were selected from January 2020 to December 2022, with six age groups from 20-30 year to 70 plus group. Cervical alignment contained C2-7 cervical lordosis (C2-7 CL) and T1 slope (T1S), together with C1-2 CL, C2-4 CL, C5-7 CL, C2S, cervical sagittal vertical axis (CSVA), thoracic inlet angle (TIA) and neck tilt (NT). C2-7 cervical lordosis was regarded as primary outcomes. To identify groups with similar cervical alignment parameters, a 2-step cluster analysis was performed. RESULTS C2-7 CL, T1S, CSVA, TIA and NT increased by age and mean value of them were larger in male than female group. Four unique clusters of female lordotic cluster, female kyphotic cluster, male lordotic cluster and male kyphotic cluster were classified mainly based on gender and C2-C7 CL. T1S was the independent influencing factor for C2-7 CL in all individuals and C2-7 CL = -28.65 + 0.57 × TIA, which varied from clusters. Although interactions among cervical parameters, it showed the alignment was more coordinated in lordotic groups. CONCLUSIONS The cervical sagittal profile varied with age and gender. Four clusters were naturally classified based on C2-7 CL and gender. The cervical balance status was addressed by C2-7 CL = - 28.65 + 0.57 × TIA.
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Affiliation(s)
- Zixiao Zhang
- Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Jinyu Wang
- Qingdao Chengyang People's Hospital, No. 600 Changcheng Road, Chengyang District, Qingdao, Shandong, People's Republic of China
| | - Rile Ge
- Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Chen Guo
- Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Yan Liang
- Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Haiying Liu
- Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Shuai Xu
- Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China.
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Foley D, Hardacker P, McCarthy M. Emerging Technologies within Spine Surgery. Life (Basel) 2023; 13:2028. [PMID: 37895410 PMCID: PMC10608700 DOI: 10.3390/life13102028] [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: 08/30/2023] [Revised: 10/02/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
New innovations within spine surgery continue to propel the field forward. These technologies improve surgeons' understanding of their patients and allow them to optimize treatment planning both in the operating room and clinic. Additionally, changes in the implants and surgeon practice habits continue to evolve secondary to emerging biomaterials and device design. With ongoing advancements, patients can expect enhanced preoperative decision-making, improved patient outcomes, and better intraoperative execution. Additionally, these changes may decrease many of the most common complications following spine surgery in order to reduce morbidity, mortality, and the need for reoperation. This article reviews some of these technological advancements and how they are projected to impact the field. As the field continues to advance, it is vital that practitioners remain knowledgeable of these changes in order to provide the most effective treatment possible.
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Affiliation(s)
- David Foley
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Pierce Hardacker
- Indiana University School of Medicine, Indianapolis, IN 46202, USA;
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Tangsrivimol JA, Schonfeld E, Zhang M, Veeravagu A, Smith TR, Härtl R, Lawton MT, El-Sherbini AH, Prevedello DM, Glicksberg BS, Krittanawong C. Artificial Intelligence in Neurosurgery: A State-of-the-Art Review from Past to Future. Diagnostics (Basel) 2023; 13:2429. [PMID: 37510174 PMCID: PMC10378231 DOI: 10.3390/diagnostics13142429] [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: 05/31/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
In recent years, there has been a significant surge in discussions surrounding artificial intelligence (AI), along with a corresponding increase in its practical applications in various facets of everyday life, including the medical industry. Notably, even in the highly specialized realm of neurosurgery, AI has been utilized for differential diagnosis, pre-operative evaluation, and improving surgical precision. Many of these applications have begun to mitigate risks of intraoperative and postoperative complications and post-operative care. This article aims to present an overview of the principal published papers on the significant themes of tumor, spine, epilepsy, and vascular issues, wherein AI has been applied to assess its potential applications within neurosurgery. The method involved identifying high-cited seminal papers using PubMed and Google Scholar, conducting a comprehensive review of various study types, and summarizing machine learning applications to enhance understanding among clinicians for future utilization. Recent studies demonstrate that machine learning (ML) holds significant potential in neuro-oncological care, spine surgery, epilepsy management, and other neurosurgical applications. ML techniques have proven effective in tumor identification, surgical outcomes prediction, seizure outcome prediction, aneurysm prediction, and more, highlighting its broad impact and potential in improving patient management and outcomes in neurosurgery. This review will encompass the current state of research, as well as predictions for the future of AI within neurosurgery.
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Affiliation(s)
- Jonathan A Tangsrivimol
- Division of Neurosurgery, Department of Surgery, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok 10210, Thailand
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center and Jame Cancer Institute, Columbus, OH 43210, USA
| | - Ethan Schonfeld
- Department Biomedical Informatics, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Michael Zhang
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Anand Veeravagu
- Stanford Neurosurgical Artificial Intelligence and Machine Learning Laboratory, Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Timothy R Smith
- Department of Neurosurgery, Computational Neuroscience Outcomes Center (CNOC), Mass General Brigham, Harvard Medical School, Boston, MA 02115, USA
| | - Roger Härtl
- Weill Cornell Medicine Brain and Spine Center, New York, NY 10022, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute (BNI), Phoenix, AZ 85013, USA
| | - Adham H El-Sherbini
- Faculty of Health Sciences, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Daniel M Prevedello
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center and Jame Cancer Institute, Columbus, OH 43210, USA
| | - Benjamin S Glicksberg
- Hasso Plattner Institute for Digital Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Chayakrit Krittanawong
- Cardiology Division, New York University Langone Health, New York University School of Medicine, New York, NY 10016, USA
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Wei Z, Yang S, Zhang Y, Ye J, Chu TW. Prevalence and Risk Factors for Cervical Adjacent Segment Disease and Analysis of the Clinical Effect of Revision Surgery: A Minimum of 5 Years' Follow-Up. Global Spine J 2023:21925682231185332. [PMID: 37421142 DOI: 10.1177/21925682231185332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2023] Open
Abstract
STUDY DESIGN A retrospective study was performed. OBJECTIVE To investigate the prevalence and risk factors for adjacent segment disease (ASD) after anterior cervical discectomy and fusion (ACDF) and the clinical efficacy of revision surgery. METHOD A total of 219 patients treated with ACDF were analyzed retrospectively. Demographic characteristics, including age, sex, body mass index (BMI) and bone mineral density (BMD), and radiographic measurements, including C2-C7 cervical sagittal vertical axis (cSVA), T1 slope (T1S), thoracic inlet angle (TIA) and C2-C7 Cobb angle, were analyzed. Modified Japanese Orthopaedic Association (mJOA) score and visual analog scale (VAS) score were used to evaluate patient function. Parameters were analyzed with Student's t test, and potential risk factors for ASD were further analyzed with multivariate logistic regression analysis. RESULTS The incidence of ASD after ACDF surgeries was 21%. The severity of osteoporosis, BMI and C2-C7 cSVA were significantly higher in the ASD group than in the NASD group (P < .05). The preoperative and postoperative TIAs were lower in the ASD group (P < .05). Multivariate logistic regression analysis showed that a high BMI, severe osteoporosis and a high C2-C7 cSVA were risk factors for ASD after ACDF (P < .05). The postoperative TIA and postoperative T1S were also correlated with ASD (P < .05). CONCLUSION Patients with a high BMI, severe osteoporosis, and a large C2-C7 cSVA after ACDF have a higher risk of ASD, while a large T1S and TIA may be protective factors. In addition, revision surgery can restore cervical spine balance in patients with ASD and promote better clinical outcomes.
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Affiliation(s)
- Zihan Wei
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Sizhen Yang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ying Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Jiawen Ye
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Tong-Wei Chu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
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Niu Y, Lv Q, Gong C, Duan D, Zhou Z, Wu J. Predictive Effect of Cervical Sagittal Parameters and Corresponding Segmental Paravertebral Muscle Degeneration on the Occurrence of Cervical Kyphosis Following Cervical Laminoplasty. World Neurosurg 2023; 175:e723-e729. [PMID: 37031734 DOI: 10.1016/j.wneu.2023.04.011] [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: 12/04/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Cervical sagittal parameters and paravertebral muscle degeneration are important factors for the occurrence of cervical spondylotic myelopathy. However, the relationship between the 2 risk factors and cervical kyphosis following cervical laminoplasty remains unknown. METHODS A total of 130 patients undergoing cervical laminoplasty were enrolled from July 2018 to July 2020 and were followed up for at least 24 months. Clinical recovery was recorded, including the Japanese Orthopedic Association, neck disability index and visual analog scale scores. Radiographic sagittal parameters were measured on cervical lateral radiographs: T1 slope (T1S), C2-C7 Cobb lordotic angle (CLA), C2-C7 sagittal vertical axis, O-C2 angle, and T1S-CLA. The magnetic resonance imaging (MRI) parameters of the paraspinal muscles were also measured, including cross-sectional area and fat infiltration (FI). The patients were divided into a kyphosis group and a lordosis group based on the last follow-up results of CLA. Multivariate logistic analysis was performed to analyze risk factors for kyphosis following laminoplasty. RESULTS Thirty-two patients were assigned to the kyphosis group and 98 were assigned to the lordosis group. Patient baseline and surgical information in the 2 groups showed no statistically significant difference. In the comparison of clinical recovery, patients with kyphosis showed a lower Japanese Orthopedic Association recovery rate than the lordosis group. For the radiographic parameters and muscle condition comparison, CLA, T1S-CLA, and FI were the most significant parameters. The logistic regression revealed that T1S-CLA and FI were the most important variables that predicted kyphosis. CONCLUSIONS We concluded that FI remarkably differed in the paraspinal muscles in the 2 groups. Multivariate logistic regression demonstrated that T1S-CLA and FI significantly influenced the process of kyphosis after cervical laminoplasty.
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Affiliation(s)
- Yahui Niu
- Department of Orthopaedic Surgery, the Bozhou Hospital Affiliated to Anhui Medical University, Anhui Province, China
| | - Qingqing Lv
- Nursing School of Anhui Medical University, Anhui Province, China
| | - Chen Gong
- Department of Orthopaedic Surgery, the Bozhou Hospital Affiliated to Anhui Medical University, Anhui Province, China
| | - Duanqiang Duan
- Department of Orthopaedic Surgery, the Bozhou Hospital Affiliated to Anhui Medical University, Anhui Province, China
| | - Zhihua Zhou
- Department of Orthopaedic Surgery, the Bozhou Hospital Affiliated to Anhui Medical University, Anhui Province, China
| | - Jianming Wu
- Department of Orthopaedic Surgery, the Bozhou Hospital Affiliated to Anhui Medical University, Anhui Province, China.
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Godlewski B, Bebenek A, Dominiak M, Bochniak M, Cieslik P, Pawelczyk T. Adjacent segment mobility after ACDF considering fusion status at the implant insertion site. 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 2023; 32:1616-1623. [PMID: 36917300 DOI: 10.1007/s00586-023-07634-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/14/2023] [Accepted: 03/03/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE This paper sets out to analyse mobility changes in segments adjacent to the operated segment. Additionally, it investigates the relationship between the degree of fusion in the operated disc space and mobility changes in the adjacent segments. METHODS In total, 170 disc spaces were operated on in 104 consecutive patients qualified for one- or two-level surgery. The degree of mobility of segments directly above and below the implant insertion site was calculated. Measurements were performed the day before the surgery and 12 months post-surgery. Functional (flexion and extension) radiographs of the cervical spine and CT scans obtained 12 months post-surgery were used to evaluate the fusion status. The results were subjected to statistical analysis. RESULTS Statistically significant increase in mobility was recorded for the segments situated immediately below the operative site, with a mean change in mobility of 1.7 mm. Complete fusion was demonstrated in 101 cases (71.1%), and partial fusion in 43 cases (29.9%). In the complete fusion subgroup, the ranges of both flexion and extension in the segments directly below the operative site were significantly greater than those in the partial fusion (pseudoarthrosis) subgroup. CONCLUSION The mobility of the adjacent segment below the implant insertion site was significantly increased at 12 months post-ACDF surgery. The range of this compensatory hypermobility was significantly greater in patients with complete fusion at the ACDF site than in cases of pseudoarthrosis. Implant subsidence was not associated with mobility changes in the segments directly above or directly below the site of ACDF surgery.
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Affiliation(s)
- Bartosz Godlewski
- Department of Orthopaedics and Traumatology, with Spinal Surgery Ward, Scanmed - St. Raphael Hospital in Cracow, ul. Adama Bochenka 12, 30-693, Cracow, Poland.
| | - Adam Bebenek
- Department of Orthopaedics and Traumatology, with Spinal Surgery Ward, Scanmed - St. Raphael Hospital in Cracow, ul. Adama Bochenka 12, 30-693, Cracow, Poland
| | - Maciej Dominiak
- Department of Orthopaedics and Traumatology, with Spinal Surgery Ward, Scanmed - St. Raphael Hospital in Cracow, ul. Adama Bochenka 12, 30-693, Cracow, Poland
| | - Marcin Bochniak
- Department of Orthopaedics and Traumatology, with Spinal Surgery Ward, Scanmed - St. Raphael Hospital in Cracow, ul. Adama Bochenka 12, 30-693, Cracow, Poland
| | - Piotr Cieslik
- Department of Orthopaedics and Traumatology, Military Institute of Medicine, Warsaw, Poland
| | - Tomasz Pawelczyk
- Department of Affective and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
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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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Oyekan AA, LeVasseur CM, Shaw JD, Donaldson WF, Lee JY, Anderst WJ. Changes in intervertebral sagittal alignment of the cervical spine from supine to upright. J Orthop Res 2022. [PMID: 36484123 DOI: 10.1002/jor.25500] [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: 12/14/2022]
Abstract
Cervical sagittal alignment is a critical component of successful surgical outcomes. Unrecognized differences in intervertebral alignment between supine and upright positions may affect clinical outcomes; however, these differences have not been quantified. Sixty-four patients scheduled to undergo one or two-level cervical arthrodesis for symptomatic pathology from C4-C5 to C6-C7, and forty-seven controls were recruited. Upright sagittal alignment was obtained through biplane radiographic imaging and measured using a validated process with accuracy better than 1° in rotation. Supine alignment was obtained from computed tomography scans. Coordinate systems used to measure supine and upright alignment were identical. Distances between adjacent bony endplates were measured to calculate disc height in each position. For both patients and controls, the C1-C2, C2-C3, and C3-C4 motion segments were in more lordosis when upright as compared with supine (all p < 0.001). However, the C4-C5, C5-C6, and C6-C7 motion segments were in less lordosis when upright as compared with supine (all p ≤ 0.004). There was an interaction between group and position at the C1-C2 (p = 0.002) and C2-C3 (p = 0.001) motion segments, with the controls demonstrating a greater increase in lordosis at both motion segments when moving from supine to upright. The results indicate that cervical motion segment alignment changes between supine and upright positioning, those changes differ among motion segments, and cervical pathology affects the magnitude of these changes. Clinical Significance: Surgeons should be mindful of the differences in alignment between supine and upright imaging and the implications they may have on clinical outcomes.
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Affiliation(s)
- Anthony A Oyekan
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Pittsburgh Ortho Spine Research (POSR) Group, University of Pittsburgh, Pittsburgh, PA, USA.,Biodynamics Laboratory, Orthopaedic Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
| | - Clarissa M LeVasseur
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Pittsburgh Ortho Spine Research (POSR) Group, University of Pittsburgh, Pittsburgh, PA, USA.,Biodynamics Laboratory, Orthopaedic Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeremy D Shaw
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Pittsburgh Ortho Spine Research (POSR) Group, University of Pittsburgh, Pittsburgh, PA, USA.,Biodynamics Laboratory, Orthopaedic Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
| | - William F Donaldson
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Pittsburgh Ortho Spine Research (POSR) Group, University of Pittsburgh, Pittsburgh, PA, USA.,Biodynamics Laboratory, Orthopaedic Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joon Y Lee
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Pittsburgh Ortho Spine Research (POSR) Group, University of Pittsburgh, Pittsburgh, PA, USA.,Biodynamics Laboratory, Orthopaedic Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
| | - William J Anderst
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Pittsburgh Ortho Spine Research (POSR) Group, University of Pittsburgh, Pittsburgh, PA, USA.,Biodynamics Laboratory, Orthopaedic Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
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12
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Takahashi M, Iwamoto K, Tomita K, Igawa T, Miyauchi Y. Incidence of cervical kyphosis and cervical posterior translation in neck pain associated with radiological evidence of degenerative disc disease. Musculoskelet Sci Pract 2022; 62:102637. [PMID: 36049284 DOI: 10.1016/j.msksp.2022.102637] [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: 04/26/2022] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cervical kyphosis mechanically influences the intervertebral discs, which may lead to neck, shoulder, and scapular pain. OBJECTIVES To investigate the incidence of cervical kyphosis and posterior displacement of cervical vertebrae (cervical posterior translation index) in patients with radiologically evident degenerative disc disease. DESIGN Retrospective-cohort study. METHODS Ninety-five patients with radiologically evident degenerative disc disease were recruited at our clinic from 2015 to 2019. Radiography images were used to analyze the straight-line index in each patient in the upright posture. The straight-line index was calculated by drawing a reference line connecting the posterior inferior edges of C2 to C7 and normalizing the addition of the distances from the posterior inferior edges of C3, C4, C5, and C6 to the reference line, respectively. Straight-line index <0 was defined as cervical kyphosis and ≥0 as cervical lordosis, the cervical kyphosis. In cervical kyphosis group, the distance from the posterior inferior edges of C3, C4, C5, and C6 to the reference line was normalized by the reference line distance to determine posterior displacement. Multiple comparison tests aside from simple and multiple linear regression analysis were performed. RESULTS The incidence of cervical kyphosis in patients with radiologically evident degenerative disc disease was 60% (57/95 patients). Multiple comparison tests revealed that the cervical posterior translation indexes of C4 and C5 were significantly higher than those of C3, C4, and C6, in cervical kyphosis group. CONCLUSIONS Cervical kyphosis was present in 60% of patients with radiologically evident degenerative disc disease, with C5 showing the most posterior displacement.
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Affiliation(s)
- Makoto Takahashi
- Department of Physical Therapy, School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte-City, Saitama, 340-0145, Japan; Department of Rehabilitation, Hitachino Orthopedic Clinic: 3-2-1, Hitachino Higashi, Ushiku-City, Ibaraki, 300-1207, Japan.
| | - Koji Iwamoto
- Department of Physical Therapy, School of Rehabilitation, Tokyo Professional University of Health Sciences, 22-10, Shiohama 2-chome, Koto-ku, Tokyo, 135-0043, Japan.
| | - Kazuhide Tomita
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Inashikigun-Ami-machi, Ibaraki, 300-0394, Japan.
| | - Takeshi Igawa
- Department of Rehabilitation, Hitachino Orthopedic Clinic: 3-2-1, Hitachino Higashi, Ushiku-City, Ibaraki, 300-1207, Japan.
| | - Yukio Miyauchi
- Hitachino Orthopedic Clinic, 3-2-1, Hitachino Higashi, Ushiku-City, Ibaraki, 300-1207, Japan.
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13
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Dong J, Liang B, Sun Y, Li X, Han P, Wang C, Song Y, Wu H, Liu R, Huang S, Yu S, Jin L, Yu Z, Fan L, Song H, Zhang C, He X. Biomechanics of a novel artificial cervical vertebra from an in vivo caprine cervical spine non-fusion model. J Orthop Translat 2022; 37:61-68. [PMID: 36225948 PMCID: PMC9523198 DOI: 10.1016/j.jot.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/12/2022] [Accepted: 07/10/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Anterior cervical corpectomy and fusion (ACCF) has been widely used in the treatment of cervical spondylotic myelopathy (CSM) but is accompanied by unavoidable motion loss and destruction of vertebra. We aim to evaluate the range of motion (ROM) of caprine cervical spine constructs implanted with cervical artificial disc and vertebra system (ADVS). The purpose of this study was to investigate the biomechanical properties of the ADVS from an in vivo caprine cervical spine non-fusion model. Methods Twelve goats were randomly divided into ADVS or control group, with 6 animals in each group. The animals in the ADVS group were implanted with ADVS at the C4 level. The cervical spine constructs were harvested 6 months after the operation. The ROM of cervical spine specimens in the ADVS group was recorded. Biomechanical testing of the specimens in the control group were conducted to evaluate the ROM of the cervical spine specimens under intact and fixed condition (C3-C5) by an anterior plate, respectively. Results The biomechanical outcomes showed that the ROM of the levels (C3-C5) implanted with ADVS was maintained. The ROM in the adjacent level (C2-3) did not increase significantly comparing with intact group. Conclusions In general, ADVS could preserve the ROM of operative levels and could reconstruct the height of the vertebra. ADVS did not increase the ROM of upper adjacent level. This device provides a non-fusion method for the treatment of patients suffering from CSM. However, improvements on the design of ADVS are still needed. Translational potential statement This study introduced a novel cervical spinal implant, which was designed to have the ability of motion preservation and vertebra construction. Our study provided a non-fusion procedure in the treatment of CSM after ACCF.
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Affiliation(s)
- Jun Dong
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Baobao Liang
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University, No. 157, West Five Road, Xi'an, 710004, China
| | - Yuan Sun
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Xi Li
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Pei Han
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Chen Wang
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Yabing Song
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Hao Wu
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Ruoxi Liu
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Sihua Huang
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Sen Yu
- Department of Biomaterials, Northwest Institute for Nonferrous Metal Research, No. 96, Wei Yang Road, Xi'an, 710016, China
| | - Lei Jin
- Department of Biomaterials, Northwest Institute for Nonferrous Metal Research, No. 96, Wei Yang Road, Xi'an, 710016, China
| | - Zhentao Yu
- Institute of Advanced Wear & Corrosion Resistant and Functional Materials, Jinan University, Guangzhou, 510632, China
| | - Liying Fan
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Huanjin Song
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Chun Zhang
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Xijing He
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
- Department of Orthopaedics, Xi'an International Medical Center Hospital, No. 777, Xitai Road, Xi'an, 710000, PR China
- Corresponding author. Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Five Road, Xincheng District, Xi'an, Shaanxi Province, 710004, PR China.
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Yang X, Arts MP, Bartels RHMA, Vleggeert-Lankamp CLA. The type of cervical disc herniation on MRI does not correlate to clinical outcomes. Bone Joint J 2022; 104-B:1242-1248. [PMID: 36317351 DOI: 10.1302/0301-620x.104b11.bjj-2022-0657.r2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
AIMS The aim of this study was to investigate whether the type of cervical disc herniation influences the severity of symptoms at the time of presentation, and the outcome after surgical treatment. METHODS The type and extent of disc herniation at the time of presentation in 108 patients who underwent anterior discectomy for cervical radiculopathy were analyzed on MRI, using a four-point scale. These were dichotomized into disc bulge and disc herniation groups. Clinical outcomes were evaluated using the Neck Disability Index (NDI), 36-Item Short Form Survey (SF-36), and a visual analogue scale (VAS) for pain in the neck and arm at baseline and two years postoperatively. The perceived recovery was also assessed at this time. RESULTS At baseline, 46 patients had a disc bulge and 62 had a herniation. There was no significant difference in the mean NDI and SF-36 between the two groups at baseline. Those in the disc bulge group had a mean NDI of 44.6 (SD 15.2) compared with 43.8 (SD 16.0) in the herniation group (p = 0.799), and a mean SF-36 of 59.2 (SD 6.9) compared with 59.4 (SD 7.7) (p = 0.895). Likewise, there was no significant difference in the incidence of disabling arm pain in the disc bulge and herniation groups (84% vs 73%; p = 0.163), and no significant difference in the incidence of disabling neck pain in the two groups (70.5% (n = 31) vs 63% (n = 39); p = 0.491). At two years after surgery, no significant difference was found in any of the clinical parameters between the two groups. CONCLUSION In patients with cervical radiculopathy, the type and extent of disc herniation measured on MRI prior to surgery correlated neither to the severity of the symptoms at presentation, nor to clinical outcomes at two years postoperatively.Cite this article: Bone Joint J 2022;104-B(11):1242-1248.
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Affiliation(s)
- Xiaoyu Yang
- Department of Neurosurgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Mark P Arts
- Department of Neurosurgery, Haaglanden Medical Centre, The Hague, the Netherlands
| | - Ronald H M A Bartels
- Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, the Netherlands
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15
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Lambrechts MJ, Toci GR, Karamian BA, Kozick Z, Prodoehl J, Reiter D, Muchintala R, Tecce E, Vaccaro A, O'Connor P, Syal A, Lambo D, Canseco JA, Kaye ID, Woods BI, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. Sagittal alignment differences on the operating room table compared to preoperative and postoperative imaging in anterior cervical discectomy and fusion. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:415-420. [PMID: 36777914 PMCID: PMC9910136 DOI: 10.4103/jcvjs.jcvjs_100_22] [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: 08/14/2022] [Accepted: 10/14/2022] [Indexed: 12/12/2022] Open
Abstract
Study Design The study design used was a retrospective cohort. Objective The objective of this study is to determine if intraoperative improvements in sagittal alignment on the operating table persisted on postoperative standing radiographs. Summary of Background Data Cervical sagittal alignment may be correlated to postoperative outcomes. Since anterior cervical discectomy and fusions (ACDFs) can restore some cervical lordosis through intervertebral grafts/cages, it is important to understand if intraoperative radiographic measurements correlate with persistent postoperative radiographic changes. Materials and Methods Patients undergoing elective primary ACDF were screened for the presence of lateral cervical radiographs preoperatively, intraoperatively, and postoperatively. Patients were excluded if their first postoperative radiograph was more than 3 months following the procedure or if cervical lordosis was not able to be measured at each time point. Paired t-tests were utilized to compare differences in measurements between time points. Statistical significance was set at P < 0.05. Results Of 46 included patients, 26 (56.5%) were female, and the mean age was 55.2 ± 11.6 years. C0-C2 lordosis significantly increased from the preoperative to intraoperative time point (delta [Δ] = 4.49, P = 0.029) and significantly decreased from the intraoperative to postoperative time period (Δ = -6.57, P < 0.001), but this resulted in no significant preoperative to postoperative change (Δ = -2.08, P = 0.096). C2 slope decreased from the preoperative to the intraoperative time point (Δ = -3.84, P = 0.043) and significantly increased from the intraoperative to the postoperative time point (Δ = 3.68, P = 0.047), which also resulted in no net change in alignment between the preoperative and postoperative periods (Δ = -0.16, P = 0.848). There was no significant difference in the C2-C7 SVA from the preoperative to intraoperative (Δ = 0.85, P = 0.724) or intraoperative to postoperative periods (Δ = 2.04, P = 0.401); however, the C2-C7 SVA significantly increased from the preoperative to postoperative period (Δ = 2.88, P = 0.006). Conclusions Intraoperative positioning predominantly affects the mobile upper cervical spine, particularly C0-C2 lordosis and C2 slope, but these changes do not persist postoperatively.
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Affiliation(s)
- Mark J. Lambrechts
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory R. Toci
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian A. Karamian
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Zachary Kozick
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - John Prodoehl
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - David Reiter
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rahul Muchintala
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Eric Tecce
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Patrick O'Connor
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Amit Syal
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dominic Lambo
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose A. Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - I. David Kaye
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Barrett I. Woods
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
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16
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Bakare AA, Kolcun JPG, Piracha AZ, Moss JR, Khanna R, O'Toole JE, Deutsch H, Traynelis VC, Fessler RG. Cervical Alignment Analysis Comparing Two-Level Cervical Disc Arthroplasty with Anterior Cervical Discectomy and Fusion with Anterior Plate Fixation. World Neurosurg 2022; 165:e597-e610. [PMID: 35768058 DOI: 10.1016/j.wneu.2022.06.109] [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: 05/09/2022] [Accepted: 06/21/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study assesses cervical alignments after 2-level cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) with anterior plate fixation. METHODS Eighty-two patients who underwent 2-level CDA or ACDF in 2014-2019 were identified. Cervical alignment parameters were compared between the 2 cohorts. Subgroup analyses were performed to determine factors that differentiate alignment outcomes between the 2 procedures. RESULTS Although both cohorts achieved significant focal lordosis (FL) and overall cervical lordotic (CL) gains, CDA cohorts achieved significantly greater 12-month FL gain (P = 0.022). However, in a multivariate analysis controlling for preoperative variables, FL gain was no longer significant. Although the CDA cervical sagittal vertical axis (cSVA) significantly improved at 3 (P = 0.030) and 12 (P = 0.007) months, these improvements were not superior to the ACDF cSVA. Male patients undergoing CDA achieved greater 12-month CL gain. Patients undergoing CDA with body mass index >25 kg/m2 achieved greater 12-month FL gain. Patients undergoing CDA with symptom duration >12 months achieved greater FL gain at 3 and 12 months. Patients undergoing CDA with high baseline T1 slope or cSVA achieved greater 12-month cSVA reduction. Clinical outcomes were comparable between the 2 cohorts. Unlike the ACDF group, CL gain in the CDA group was significantly correlated with the cSVA reduction, which was associated with significant improvement in the Neck Disability Index, arm pain, and 12-Item Short-Form Mental Component Scores. Heterotopic ossification was not found to significantly affect patient outcome and cervical alignment in both cohorts. CONCLUSIONS ACDF and CDA are viable options for 2-level degenerative disc disease in carefully selected patients. Both approaches produced equivalent postoperative alignment changes in a 2-level operation.
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Affiliation(s)
- Adewale A Bakare
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - John Paul G Kolcun
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ali Z Piracha
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jonah R Moss
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ryan Khanna
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - John E O'Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Harel Deutsch
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Vincent C Traynelis
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Richard G Fessler
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
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17
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Coban D, Faloon M, Changoor S, Saela S, Sahai N, Record N, Sinha K, Hwang K, Emami A. Should we bridge the cervicothoracic junction in long cervical fusions? A meta-analysis and systematic review of the literature. J Neurosurg Spine 2022; 37:166-174. [PMID: 35120314 DOI: 10.3171/2021.12.spine211090] [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: 08/16/2021] [Accepted: 12/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Long posterior cervical decompression and fusion (PCF) is commonly performed to surgically treat patients with multilevel cervical pathology. In cases in which constructs may necessitate crossing the cervicothoracic junction (CTJ), recommendations for appropriate caudal fusion level vary in the literature. The aim of this study was to report the clinical and radiological outcomes of multilevel PCFs ending at C7 versus those crossing the CTJ. METHODS A systematic search of PubMed, CINAHL Plus, and Scopus was conducted to identify articles that evaluated clinical and radiological outcomes of long PCFs that ended at C7 (cervical group) or crossed the CTJ (thoracic group). Based on heterogeneity, random-effects models of a meta-analysis were used to estimate the pooled estimates and the 95% confidence intervals. RESULTS PCF outcome data of 1120 patients from 10 published studies were included. Compared with the cervical group, the thoracic group experienced greater mean blood loss (453.0 ml [95% CI 333.6-572.5 ml] vs 303.5 ml [95% CI 203.4-403.6 ml]), longer operative times (235.5 minutes [95% CI 187.7-283.3 minutes] vs 198.5 minutes [95% CI 157.9-239.0 minutes]), and a longer length of stay (6.7 days [95% CI 3.3-10.2 days] vs 6.2 days [95% CI 3.8-8.7 days]); however, these differences were not statistically significant. None of the included studies specifically investigated factors that led to the decision of whether to cross the CTJ. The cervical group had a mean fusion rate of 86% (95% CI 71%-94%) compared with the thoracic group with a rate of 90% (95% CI 81%-95%). Of patients in the cervical group, 17% (95% CI 10%-28%) required revision surgery compared with 7% (95% CI 4%-13%) of those in the thoracic group, but this difference was not statistically significant. The proportion of patients who experienced complications in the cervical group was found to be 28% (95% CI 12%-52%) versus 14% (95% CI 7%-26%) in the thoracic group; however, this difference was not statistically significant. There was no significant difference (no overlap of 95% CIs) in the incidence of adjacent-segment disease, pseudarthrosis, or wound-related complications between groups. CONCLUSIONS This meta-analysis suggests similar clinical and radiographic outcomes in multilevel PCF, regardless of inclusion of the CTJ. The lowest instrumented level did not significantly affect revision rates or complications. The ideal stopping point must be tailored to each patient on an individualized basis.
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Affiliation(s)
- Daniel Coban
- 1Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey; and
| | - Michael Faloon
- 1Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey; and
| | - Stuart Changoor
- 1Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey; and
| | - Stephen Saela
- 1Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey; and
| | - Nikhil Sahai
- 1Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey; and
| | - Nicole Record
- 2LA Bone and Joint Institute, Department of Orthopaedics, Encino, California
| | - Kumar Sinha
- 1Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey; and
| | - Ki Hwang
- 1Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey; and
| | - Arash Emami
- 1Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey; and
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Wang XJ, Huang KK, He JB, Wu TK, Rong X, Liu H. Fatty infiltration in cervical extensor muscle: is there a relationship with cervical sagittal alignment after anterior cervical discectomy and fusion? BMC Musculoskelet Disord 2022; 23:641. [PMID: 35791024 PMCID: PMC9254416 DOI: 10.1186/s12891-022-05606-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/30/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose To investigate the relationship between the preoperative paraspinal Goutalier grade of fatty infiltration and postoperative cervical sagittal alignment in patients undergoing anterior cervical discectomy and fusion (ACDF). Methods A total of 101 patients who underwent single-level ACDF with the Zero-profile implant system between March 2011 and April 2020 were included in this study. Cervical sagittal alignment parameters, including the C2-C7 Cobb angle, functional spinal unit (FSU) angle, cervical sagittal vertical axis (SVA), and T1 slope (T1S), were assessed. Preoperative magnetic resonance images were used to classify patients according to Goutalier grade. Clinical outcomes including Neck Disability Index (NDI) scores, Japanese Orthepaedic Association (JOA) scores and Visual Analogue Scale (VAS) scores were collected and analyzed. Results According to the Goutalier grade, 33 patients were classified as Goutalier 0–1 (Group A), 44 were classified as Goutalier 1.5–2 (Group B), and 24 were classified as Goutalier 2.5–4.0 (Group C). The mean age among the three groups showed significant differences (P = 0.007). At the last follow-up, the C2-C7 Cobb angle, FSU angle, and T1S improved after the surgery among the groups. Although there were varying degrees of loss of curvature among the different groups during the follow-up period, the postoperative cervical sagittal alignment parameters demonstrated no statistical differences among the three groups (P > 0.05). In addition, patients in all groups experienced significant relief of their symptoms, and the clinical scores were comparable among the groups (P > 0.05). Conclusion The complex nature of anterior cervical surgery requires surgical attention both in decompression and sagittal alignment. Our study demonstrates satisfactory postoperative cervical sagittal alignment of patients despite different grades of fatty infiltration of the multifidus muscle following single-level ACDF. Based on our results, the improvement and maintenance of cervical sagittal alignment after ACDF remains a complex problem that spine surgeons should consider before surgery.
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Lin J, Bao M, Lin S, Liu J, Liu Q, Li R, Huang Z, Zhu Q, Zhang Z, Ji W. Cervical Alignment of Patients with Basilar Invagination: A Radiological Study. Orthop Surg 2022; 14:566-576. [PMID: 35156312 PMCID: PMC8926990 DOI: 10.1111/os.13212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 12/08/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jun‐yu Lin
- Division of Spinal Surgery, Department of Orthopaedics Nanfang Hospital, Southern Medical University Guangzhou China
- Department of Orthopaedics and Traumatology, LKS Faculty of Medicine The University of Hong Kong Hong Kong City Hong Kong
| | - Ming‐gui Bao
- Division of Spinal Surgery, Department of Orthopaedics Nanfang Hospital, Southern Medical University Guangzhou China
| | - Shao‐yi Lin
- Division of Spinal Surgery, Department of Orthopaedics Nanfang Hospital, Southern Medical University Guangzhou China
| | - Jun‐hao Liu
- Division of Spinal Surgery, Department of Orthopaedics Nanfang Hospital, Southern Medical University Guangzhou China
| | - Qi Liu
- Division of Spinal Surgery, Department of Orthopaedics Nanfang Hospital, Southern Medical University Guangzhou China
| | - Ruo‐yao Li
- Division of Spinal Surgery, Department of Orthopaedics Nanfang Hospital, Southern Medical University Guangzhou China
| | - Zu‐cheng Huang
- Division of Spinal Surgery, Department of Orthopaedics Nanfang Hospital, Southern Medical University Guangzhou China
| | - Qing‐an Zhu
- Division of Spinal Surgery, Department of Orthopaedics Nanfang Hospital, Southern Medical University Guangzhou China
| | - Zhong‐min Zhang
- Division of Spinal Surgery, Department of Orthopaedics Nanfang Hospital, Southern Medical University Guangzhou China
| | - Wei Ji
- Division of Spinal Surgery, Department of Orthopaedics Nanfang Hospital, Southern Medical University Guangzhou China
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A meta-analysis comparing the short- and mid- to long-term outcomes of artificial cervical disc replacement(ACDR) with anterior cervical discectomy and fusion (ACDF) for the treatment of cervical degenerative disc disease. INTERNATIONAL ORTHOPAEDICS 2022; 46:1609-1625. [PMID: 35113188 DOI: 10.1007/s00264-022-05318-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/23/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE Anterior cervical discectomy and fusion (ACDF) surgery is commonly performed to treat cervical degenerative disc disease (CDDD). The lost of range of motion (ROM) is also found after ACDF, which contributes to degenerate in adjacent segment disease (ASD). Artificial cervical disc replacement (ACDR), an alternative to ACDF, is developed to preserve the ROM and reduce ASD. This article aims to compare the outcomes between ACDR and ACDF in the short-, mid-, and long-term. METHODS Databases including Cochrane, Embase, PubMed, and Web of Science were searched. Only RCTs were included in this meta-analysis, and the search strategy followed the requirements of the Cochrane Handbook. The strength of evidence was assessed using GRADE. Two reviewers independently assessed the methodological quality of each included study and extracted the relevant data. RESULTS Thirty prospective RCTs were included. Prolonged operative duration, better overall success, neurological success, and NDI success rates were found in ACDR group in all follow-up periods, with lower dysphagia/dysphonia during short-term follow-up. Moreover, a lower ASD was found in ACDR group during long-term follow-up and overall analysis, with lower reoperation rates in all follow-up periods. Comparable length of hospital stay and blood loss were found in both groups. Moreover, ASD was similar in short- and mid-term follow-ups, while dysphagia/dysphonia incidence was similar in mid- and long-term follow-ups. The incidence of implant events was comparable in all follow-up periods (p > 0.05). CONCLUSIONS ACDR is as effective as ACDF and superior for some success rates. Disc replacement can reduce the risk of dysphagia/dysphonia, ASD, and re-operation.
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Comparison of Radiographic Reconstruction and Clinical Improvement between Artificial Cervical Disc Replacement and Anterior Cervical Discectomy and Fusion. Pain Res Manag 2022; 2022:3353810. [PMID: 35140830 PMCID: PMC8820923 DOI: 10.1155/2022/3353810] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/22/2021] [Indexed: 12/14/2022]
Abstract
Background The surgical management of cervical degenerative disc degeneration (CDDD) has not reached a consensus. Artificial cervical disc replacement (ACDR) has been shown to be efficient in reducing symptoms after CDDD, although the topic remains highly controversial in this field. This study aimed to evaluate the effectiveness of ACDR on the treatment of CDDD on the aspect of radiographic reconstruction and clinical improvement compared with anterior cervical discectomy and fusion (ACDF). Methods This was a retrospective comparative study with 47 patients who underwent single-level ACDR and 46 patients who underwent single-level ACDF. The radiographic reconstruction was assessed by the cervical sagittal alignment parameters, consisting of two aspects, distance and angle, such as cervical sagittal vertical axis (cSVA), cervical lordosis (CL), T1 slope (T1s), and intervertebral space height (ISH). The clinical improvement was assessed by patient-related outcomes (PROs), consisting of two aspects, relief of axial neck pain and recovery of cervical dysfunction, measured through the Visual Analogue Scale (VAS), Neck Disability Index (NDI), and Japanese Orthopedic Association (JOA). Results Significant variations were achieved on aspects of radiographic reconstruction and clinical improvement after ACDR (P < 0.05), which were similar to that of the ACDF group (P < 0.05). A significantly larger postoperative range of motion (ROM) was found in patients less than 45 years of age in the ACDR group (P < 0.05). In addition, a significantly better postoperative JOA was found in patients with a preoperative ISH less than 4 mm in the ACDF group than that in the ACDR group (P < 0.05). Other than that mentioned above, no significant variations in radiographic and clinical outcomes were found between the two groups (P > 0.05). Conclusions Overall, this study showed that a similar capability in terms of radiographic reconstruction and clinical improvement was found between the two methods. Specific concerns should be analyzed while choosing between an ACDR and an ACDF. It should be pointed out that, based on our experience, if the patient is younger, ACDR is recommended; for patients with preoperative ISH less than 4 mm, ACDF is more recommended.
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Goel V, Mumtaz M, Mendoza J, Tripathi S, Kelkar A, Nishida N, Sahai A. Total disc replacement alters the biomechanics of cervical spine based on sagittal cervical alignment: A finite element study. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:278-287. [PMID: 36263350 PMCID: PMC9574107 DOI: 10.4103/jcvjs.jcvjs_21_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/08/2022] [Indexed: 11/04/2022] Open
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Goedmakers CMW, Lak AM, Duey AH, Senko AW, Arnaout O, Groff MW, Smith TR, Vleggeert-Lankamp CLA, Zaidi HA, Rana A, Boaro A. Deep Learning for Adjacent Segment Disease at Preoperative MRI for Cervical Radiculopathy. Radiology 2021; 301:664-671. [PMID: 34546126 DOI: 10.1148/radiol.2021204731] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Patients who undergo surgery for cervical radiculopathy are at risk for developing adjacent segment disease (ASD). Identifying patients who will develop ASD remains challenging for clinicians. Purpose To develop and validate a deep learning algorithm capable of predicting ASD by using only preoperative cervical MRI in patients undergoing single-level anterior cervical diskectomy and fusion (ACDF). Materials and Methods In this Health Insurance Portability and Accountability Act-compliant study, retrospective chart review was performed for 1244 patients undergoing single-level ACDF in two tertiary care centers. After application of inclusion and exclusion criteria, 344 patients were included, of whom 60% (n = 208) were used for training and 40% for validation (n = 43) and testing (n = 93). A deep learning-based prediction model with 48 convolutional layers was designed and trained by using preoperative T2-sagittal cervical MRI. To validate model performance, a neuroradiologist and neurosurgeon independently provided ASD predictions for the test set. Validation metrics included accuracy, areas under the curve, and F1 scores. The difference in proportion of wrongful predictions between the model and clinician was statistically tested by using the McNemar test. Results A total of 344 patients (median age, 48 years; interquartile range, 41-58 years; 182 women) were evaluated. The model predicted ASD on the 93 test images with an accuracy of 88 of 93 (95%; 95% CI: 90, 99), sensitivity of 12 of 15 (80%; 95% CI: 60, 100), and specificity of 76 of 78 (97%; 95% CI: 94, 100). The neuroradiologist and neurosurgeon provided predictions with lower accuracy (54 of 93; 58%; 95% CI: 48, 68), sensitivity (nine of 15; 60%; 95% CI: 35, 85), and specificity (45 of 78; 58%; 95% CI: 56, 77) compared with the algorithm. The McNemar test on the contingency table demonstrated that the proportion of wrongful predictions was significantly lower by the model (test statistic, 2.000; P < .001). Conclusion A deep learning algorithm that used only preoperative cervical T2-weighted MRI outperformed clinical experts at predicting adjacent segment disease in patients undergoing surgery for cervical radiculopathy. © RSNA, 2021 An earlier incorrect version appeared online. This article was corrected on September 22, 2021.
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Affiliation(s)
- Caroline M W Goedmakers
- From the Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115 (C.M.W.G., A.M.L., A.H.D., A.W.S., O.A., M.W.G., T.R.S., H.A.Z., A.R., A.B.); and Spine Research Department, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands (C.M.W.G., C.L.A.V.L.)
| | - Asad M Lak
- From the Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115 (C.M.W.G., A.M.L., A.H.D., A.W.S., O.A., M.W.G., T.R.S., H.A.Z., A.R., A.B.); and Spine Research Department, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands (C.M.W.G., C.L.A.V.L.)
| | - Akiro H Duey
- From the Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115 (C.M.W.G., A.M.L., A.H.D., A.W.S., O.A., M.W.G., T.R.S., H.A.Z., A.R., A.B.); and Spine Research Department, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands (C.M.W.G., C.L.A.V.L.)
| | - Alexander W Senko
- From the Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115 (C.M.W.G., A.M.L., A.H.D., A.W.S., O.A., M.W.G., T.R.S., H.A.Z., A.R., A.B.); and Spine Research Department, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands (C.M.W.G., C.L.A.V.L.)
| | - Omar Arnaout
- From the Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115 (C.M.W.G., A.M.L., A.H.D., A.W.S., O.A., M.W.G., T.R.S., H.A.Z., A.R., A.B.); and Spine Research Department, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands (C.M.W.G., C.L.A.V.L.)
| | - Michael W Groff
- From the Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115 (C.M.W.G., A.M.L., A.H.D., A.W.S., O.A., M.W.G., T.R.S., H.A.Z., A.R., A.B.); and Spine Research Department, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands (C.M.W.G., C.L.A.V.L.)
| | - Timothy R Smith
- From the Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115 (C.M.W.G., A.M.L., A.H.D., A.W.S., O.A., M.W.G., T.R.S., H.A.Z., A.R., A.B.); and Spine Research Department, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands (C.M.W.G., C.L.A.V.L.)
| | - Carmen L A Vleggeert-Lankamp
- From the Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115 (C.M.W.G., A.M.L., A.H.D., A.W.S., O.A., M.W.G., T.R.S., H.A.Z., A.R., A.B.); and Spine Research Department, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands (C.M.W.G., C.L.A.V.L.)
| | - Hasan A Zaidi
- From the Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115 (C.M.W.G., A.M.L., A.H.D., A.W.S., O.A., M.W.G., T.R.S., H.A.Z., A.R., A.B.); and Spine Research Department, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands (C.M.W.G., C.L.A.V.L.)
| | - Aakanksha Rana
- From the Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115 (C.M.W.G., A.M.L., A.H.D., A.W.S., O.A., M.W.G., T.R.S., H.A.Z., A.R., A.B.); and Spine Research Department, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands (C.M.W.G., C.L.A.V.L.)
| | - Alessandro Boaro
- From the Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Boston, MA 02115 (C.M.W.G., A.M.L., A.H.D., A.W.S., O.A., M.W.G., T.R.S., H.A.Z., A.R., A.B.); and Spine Research Department, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands (C.M.W.G., C.L.A.V.L.)
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Vaishnav AS, Qureshi SA. Reply to Commentary on "Impact of Nonlordotic Sagittal Alignment on Short-term Outcomes of Cervical Disc Replacement". Neurospine 2021; 18:415-416. [PMID: 34218624 PMCID: PMC8255759 DOI: 10.14245/ns.2142446.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/16/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Sheeraz A Qureshi
- Hospital for Special Surgery, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
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Zhang K, Liu H, Wu T. Commentary on "Impact of Nonlordotic Sagittal Alignment on Short-term Outcomes of Cervical Disc Replacement". Neurospine 2021; 18:413-414. [PMID: 34218625 PMCID: PMC8255763 DOI: 10.14245/ns.2142442.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/02/2021] [Indexed: 02/05/2023] Open
Affiliation(s)
- Kerui Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Hao Liu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Tingkui Wu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Teo SJ, Goh GS, Yeo W, Chen JLT, Soh RCC. The Relationship Between Cervical Sagittal Balance and Adjacent Segment Disease After Three-level Anterior Cervical Discectomy and Fusion. Clin Spine Surg 2021; 34:E264-E270. [PMID: 33560012 DOI: 10.1097/bsd.0000000000001135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 12/22/2020] [Indexed: 12/29/2022]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE To determine the relationship between cervical sagittal balance and adjacent segment degeneration (ASD) development after 3-level anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA ASD is a common complication after ACDF. Previous studies have shown that sagittal imbalance may be associated with ASD development after 1-level or 2-level ACDF. However, these findings may not be generalizable to 3-level procedures. MATERIALS AND METHODS We reviewed prospectively collected data of 46 patients who underwent 3-level ACDF at a tertiary institution. Lateral cervical radiographs taken preoperatively, postoperatively, and at last follow-up were reviewed for ASD. The mean follow-up duration was 5 years. Radiographic parameters measured were cervical sagittal alignment (CSA), segmental sagittal alignment, T1 slope (T1S), sagittal vertical axis, and T1S-cervical lordosis. RESULTS ASD was present in 27 (58.7%) patients, but only 1 patient (2.2%) underwent reoperation at 4.8 years. The CSA, sagittal vertical axis, and T1S were similar preoperatively, but the T1S-cervical lordosis was higher in the ASD group (18.28 vs. 9.82, P =0.016). All 4 parameters were similar postoperatively and at last follow-up. The ASD group had a greater change in CSA over the follow-up period (-6.26 vs. -1.47, P =0.05), but they achieved similar sagittal alignment at last follow-up. There was no difference in clinical outcomes between the 2 groups. CONCLUSIONS Unlike studies on 1-level and 2-level ACDF, this study found that cervical spinal alignment was not associated with ASD development after 3-level ACDF. ASD development also had no impact on clinical outcomes at 2 years. LEVEL OF EVIDENCE Level III-nonrandomized cohort study.
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Affiliation(s)
- Shao Jin Teo
- Singapore General Hospital, Singapore, Singapore
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Wang X, Meng Y, Liu H, Chen H, Wang B, Hong Y. Cervical sagittal alignment after Prestige LP cervical disc replacement: radiological results and clinical impacts from a single-center experience. BMC Musculoskelet Disord 2021; 22:82. [PMID: 33451340 PMCID: PMC7809768 DOI: 10.1186/s12891-021-03962-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 01/05/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cervical disc replacement (CDR) has been widely used to treat one- and two-level cervical degenerative disc disease. Studies have shown the effectiveness of CDR in preserving range of motion (ROM) and delaying adjacent segment degeneration (ASD). Cervical sagittal alignment is an important factor affecting favorable clinical outcomes in cervical spine surgery. This study aimed to explore whether cervical sagittal alignment can be maintained after CDR and to identify the impact of cervical sagittal alignment on outcomes after CDR. METHODS This was a single-center, retrospective study. 132 patients who underwent one-level CDR were included. Cervical sagittal alignments, including cervical lordosis (CL), segmental alignment (SA), sagittal vertical axis (SVA), T1 slope (T1s), and T1s minus CL (T1s-CL), were measured. The effects of cervical sagittal alignment on the CDR outcomes were analyzed. Patients were divided into the heterotopic ossification (HO) group and ASD group to determine the potential impacts of cervical sagittal parameters. RESULTS The cervical sagittal alignment parameters, except for the SVA, were significantly improved after CDR and showed decreasing trends at the last follow-up. Significantly higher CL and T1s were found in patients with better ROM after CDR. SVA ≥ 20 mm increased the risk of anterior HO (odds ratio = 2.945, P = 0.007). Significantly kyphotic SA and lower T1s values were found in the ASD patients than in the non-ASD patients (P < 0.05). Patients with ASD at the inferior level showed significantly worse CL (P < 0.05). CONCLUSION CDR had limited function of improving cervical sagittal alignment. Poor cervical sagittal alignment after CDR was associated with HO, ASD, and less ROM.
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Affiliation(s)
- Xiaofei Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yang Meng
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Hao Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
| | - Hua Chen
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Beiyu Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Ying Hong
- Department of Anesthesia and Operation Center/West China School of Nursing, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
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Wang H, Meng Y, Liu H, Wang X, Ding C. A Comparison of 2 Anterior Hybrid Techniques for 3-Level Cervical Degenerative Disc Disease. Med Sci Monit 2020; 26:e927972. [PMID: 33154343 PMCID: PMC7653971 DOI: 10.12659/msm.927972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Novel hybrid surgical techniques that incorporate anterior cervical discectomy and fusion with total disc replacement are widely used. Based on the number of implanted discs, 3-level hybrid surgery can be classified as single fusion combined with double replacement and single replacement combined with double fusion. Few studies to date have directly compared these hybrid techniques. The present study compared the clinical and radiological outcomes of these methods and assessed their characteristics and benefits. Material/Methods Clinical and radiological outcomes were retrospectively evaluated in 64 consecutive patients who underwent 3-level hybrid surgery by single fusion combined with double replacement or single replacement combined with double fusion. Results Significant differences between the 2 groups were observed in postoperative range of motion of C2–C7. C2–C7 cervical lordosis assessed preoperatively and at final follow-up differed significantly in patients who underwent single replacement combined with double fusion. This group showed a higher incidence of heterotopic ossification than patients who underwent double replacement combined with single fusion. Conclusions Both types of hybrid surgery are safe and effective in treating 3-level cervical degenerative disc diseases. Single replacement combined with double fusion showed greater accuracy in correcting cervical lordosis, but was associated with a higher incidence of heterotopic ossification. In contrast, single fusion combined with double replacement was superior in maintaining cervical range of motion.
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Affiliation(s)
- Han Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Yang Meng
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Hao Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Xiaofei Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Chen Ding
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
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