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Yang DS, Molla V, Daniels AH, Paxton ES, Green A. The effect of concurrent cervical spine degenerative disease on the outcome of rotator cuff repair: a national database study. J Shoulder Elbow Surg 2024; 33:1017-1027. [PMID: 37838181 DOI: 10.1016/j.jse.2023.09.004] [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: 04/06/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Cervical spine degenerative disease (CSD) can cause shoulder pain, potentially confounding the management of patients with rotator cuff tears. This study aimed to investigate the relationships between CSD and rotator cuff repair (RCR). METHODS A national administrative database (PearlDiver) was used to study 4 patient cohorts: (1) RCR only (RCRo), (2) RCR with concurrent CSD (RCRC), (3) RCR after a cervical spine procedure (RCRA), and (4) RCR before a cervical spine procedure (RCRB). The outcomes of RCR were compared using multivariable logistic regression, controlling for age, sex, and Elixhauser Comorbidity Index, as well as preoperative opioid utilization in the analysis of opioid use. RESULTS Between 2010 and 2021, a total of 889,977 patients underwent RCR. Of these patients, 784,230 (88%) underwent RCRo whereas 105,747 (12%) underwent RCRC, of whom 21,585 (2.4%) underwent cervical spine procedures (RCRA in 9670 [1.1%] and RCRB in 11,915 [1.3%]). At 2 years after RCR, compared with RCRo patients, RCRC patients had an increased risk of surgical-site infection (adjusted odds ratio [aOR] = 1.25, P = .0004), deep vein thrombosis (aOR = 1.17, P = .0002), respiratory complications (aOR = 1.19, P = .0164), and ipsilateral shoulder reoperations (débridement [aOR = 1.66, P < .0001], manipulation under anesthesia or arthroscopic lysis of adhesions [aOR = 1.23, P < .0001], distal clavicle excision [aOR = 1.78, P < .0001], subacromial decompression [aOR = 1.72, P < .0001], biceps tenodesis [aOR = 1.76, P < .0001], incision and drainage [aOR = 1.34, P = .0020], synovectomy [aOR = 1.48, P = .0136], conversion to shoulder arthroplasty [aOR = 1.62, P < .0001], revision RCR [aOR = 1.77, P < .0001], and subsequent contralateral RCR [aOR = 1.71, P < .0001]). At 2 years, compared with RCRC patients who did not undergo cervical spine procedures, RCRC patients who underwent cervical spine procedures had an increased risk of incision and drainage (aOR = 1.50, P = .0255), conversion to arthroplasty (aOR = 1.40, P < .0001), and revision RCR (aOR = 1.11, P = .0374), as well as a lower risk of contralateral RCR (aOR = 0.89, P = .0469). The sequence of cervical spine procedures did not affect the risk of shoulder reoperations. At 1 year, the risk of opioid use after RCR was less for RCRA patients compared with RCRB patients (aOR = 1.71 [95% confidence interval, 1.61-1.80; P < .0001] vs. aOR = 2.01 [95% confidence interval, 1.92-2.12; P < .0001]). CONCLUSION Concurrent CSD has significant detrimental effects on RCR outcomes. Patients with concurrent CSD undergoing cervical spine procedures have a greater risk of ipsilateral shoulder reoperations but a decreased risk of contralateral RCR. The risk of prolonged opioid use was lower if RCR followed a cervical spine procedure. Concurrent CSD must be considered and possibly treated to optimize the outcomes of RCR.
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Affiliation(s)
- Daniel S Yang
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Vadim Molla
- Department of Orthopaedic Surgery, University of Massachusetts, Worcester, MA, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - E Scott Paxton
- Department of Orthopaedic Surgery, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Andrew Green
- Department of Orthopaedic Surgery, The Warren Alpert Medical School, Brown University, Providence, RI, USA.
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Ju B, Lee J, Kim HM, Lee CG, Song H. Impact of neck posture and insulating stick use on neck disability in Korean line workers: a cross-sectional study. Ann Occup Environ Med 2024; 36:e11. [PMID: 38741681 PMCID: PMC11090668 DOI: 10.35371/aoem.2024.36.e11] [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: 01/31/2024] [Revised: 03/29/2024] [Accepted: 04/09/2024] [Indexed: 05/16/2024] Open
Abstract
Background Occupational neck disability is a prevalent issue, especially among line workers, who are often exposed to elevated levels of cervical ergonomic stress. The aim of this study was to investigate the impact of neck posture and insulating stick use on neck disability in a specific occupational group in Korea. Methods This cross-sectional study was conducted among 483 line workers in Gwangju and Jeonnam, Korea. Data were collected using the Neck Disability Index, Cervical Degenerative Index, and a structured questionnaire focusing on demographic and occupational factors. Logistic regression analysis was applied to determine the adjusted odds ratio (OR) and 95% confidence interval (CI) for neck posture and factors related to neck disability. Results Neck disability prevalence was 17.2% among the participants. Multivariate logistic regression analysis showed that factors related to neck disability included age over 60 years (adjusted OR: 3.08; 95% CI: 1.63-5.83), depression (adjusted OR: 8.33; 95% CI: 3.85-18.00), a history of cervical trauma (adjusted OR: 2.13; 95% CI: 1.04-4.40), and radiological degenerative changes in the cervical spine (adjusted OR: 2.33; 95% CI: 1.26-4.33). In particular, the adjusted OR of neck disability among live-line workers was 2.10 (95% CI: 1.12-3.92) when compared with support workers (model 1). Other analysis models showed that use of insulating sticks for more than 10 hours per week (adjusted OR: 2.46; 95% CI: 1.32-4.61) and higher neck extension (adjusted OR: 2.98; 95% CI: 1.14-3.46) were significant work-related risk factors (model 2,3). Conclusions Neck posture, age, depression, cervical trauma history, degenerative changes in the cervical spine, and use of insulating sticks are significant risk factors for neck disability among line workers in Korea. These findings highlight the need to improve the working environment and reduce the burden of cervical ergonomic stress among line workers.
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Affiliation(s)
- Bounggyun Ju
- Department of Occupational and Environmental Medicine, Chosun University Hospital, Gwangju, Korea
| | - Jaehoo Lee
- Department of Occupational and Environmental Medicine, Chosun University Hospital, Gwangju, Korea
| | - Hye-min Kim
- Department of Occupational and Environmental Medicine, Chosun University Hospital, Gwangju, Korea
| | - Chul Gab Lee
- Department of Occupational and Environmental Medicine, Chosun University Hospital, Gwangju, Korea
| | - Hansoo Song
- Department of Occupational and Environmental Medicine, Chosun University Hospital, Gwangju, Korea
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Tsai MC, Liu YF, Lin WH, Lee MC. Restoration of Range of Motion in the Cervical Spine through Single-Segment Artificial Disc Replacement Using the Baguera ®C Prosthesis. J Clin Med 2024; 13:2048. [PMID: 38610813 PMCID: PMC11012751 DOI: 10.3390/jcm13072048] [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: 01/18/2024] [Revised: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Anterior cervical discectomy and fusion (ACDF) is a standard procedure for degenerative diseases of the cervical spine, providing nerve decompression and spinal stabilization. However, it limits cervical spine motility, restricts fused segment activity, and may lead to adjacent degeneration. Cervical disc arthroplasty (CDA) is an accepted alternative that preserves the structure and flexibility of the cervical spine. This study aimed to explore the dynamic changes in the range of motion (ROM) of the cervical spine after CDA using a viscoelastic artificial disc, as well as the factors affecting mobility restoration. Methods: A retrospective analysis was conducted on 132 patients who underwent single-level anterior cervical discectomy and CDA from January 2015 to June 2022. Result: Analysis of data from 132 patients revealed a significant improvement in clinical outcomes. The mean ROM of C2-C7 and functional spinal unit (FSU) segments significantly increased from 2 to 36 months post-operatively. Cervical spine flexibility was preserved and enhanced after prosthesis implantation. However, it took six months for the cervical spine motility to stabilize. In addition, sex and age were found to impact motility restoration, with female and younger patients exhibiting larger ROMs post-surgery. Additionally, CDA at the C5-C6 level resulted in the greatest increase in ROM, potentially improving overall kinematic ability. Conclusions: Single-segment artificial disc arthroplasty effectively restores the ROM in degenerative cervical spine conditions.
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Affiliation(s)
- Ming-Cheng Tsai
- School of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Neurosurgical Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan
| | - Ya-Fang Liu
- Research Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan
| | - Wei-Hsing Lin
- Department of Life Science, National Taiwan Normal University, Taipei 116, Taiwan
| | - Ming-Chung Lee
- Department of Life Science, National Taiwan Normal University, Taipei 116, Taiwan
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Brusalis CM, Patel KS, An HS, Verma NN. Differentiating Shoulder Pathology from Cervical Spine Pathology: An Algorithmic Approach. J Am Acad Orthop Surg 2024; 32:e251-e261. [PMID: 38029387 DOI: 10.5435/jaaos-d-23-00210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Accurate and timely diagnosis of musculoskeletal conditions is an essential component of high-quality orthopaedic care. The proximity of the shoulder to the cervical spine leads to a multitude of pathologic conditions whose clinical presentations overlap, posing a diagnostic challenge to orthopaedic providers. Missed or delayed diagnosis of the etiology for patient-described 'shoulder pain' causes frustration among patients, incurs increased healthcare costs, and delays treatment. Moreover, patients with concurrent conditions of the cervical spine and shoulder require deliberate consideration for how each condition contributes to patients' symptoms. The purpose of this review was to describe a systematic approach for evaluating and differentiating pathologies of the shoulder and cervical spine.
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Affiliation(s)
- Christopher M Brusalis
- From the Division of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, NY (Dr. Brusalis), the Division of Spine Surgery (Dr. Patel and Dr. An), and the Division of Sports Medicine (Dr. Verma), Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
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Sawalkar RG, Athawale V, Fating T. Comprehensive Physiotherapeutic Management of Cervical and Lumbar Disc Disease: A Case Study. Cureus 2024; 16:e52543. [PMID: 38371115 PMCID: PMC10870066 DOI: 10.7759/cureus.52543] [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: 01/08/2024] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
This case report focuses on a 75-year-old male diagnosed with cervical and lumbar disc disease, common conditions associated with intervertebral disc degeneration. The study aims to highlight the significance of physiotherapy in managing these conditions. The patient presented with neck and lower back pain radiating to the limbs which was managed conservatively with analgesics and physiotherapy. The physiotherapeutic intervention included a tailored regimen involving cryotherapy, transcutaneous electrical nerve stimulation (TENS), strengthening exercises, task-specific training, and the use of a stabilometric platform. The pre- and post-intervention assessments revealed improvements in range of motion, muscle strength, and various outcome measures, emphasizing the effectiveness of the holistic physiotherapy approach. The case underscores the importance of physiotherapy in addressing degenerative disc diseases, offering insights into specific interventions such as cryotherapy, targeted exercises, and advanced technologies like stabilometric platforms. This study contributes to the existing literature on the role of physiotherapy in managing cervical and lumbar disc diseases, emphasizing the need for patient education and a comprehensive approach to improve overall physical functioning.
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Affiliation(s)
- Rutuja G Sawalkar
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vrushali Athawale
- Oncology Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tejaswini Fating
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Lovecchio F, Ang B, Louie PK, Chaudary C, Shah SP, Punyala A, Yao YC, Steinhaus M, McCarthy MH, Huang R, Lebl D, Lafage V, Albert TJ, Iyer S, Qureshi S, Kim HJ. Bone Density Distribution in the Cervical Spine. Global Spine J 2024; 14:169-176. [PMID: 35485915 PMCID: PMC10676188 DOI: 10.1177/21925682221098965] [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: 12/20/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Given changes in bone density induced by degenerative disease, general measures of bone health (ie DEXA) are inadequate to evaluate bone density in surgical areas of interest. Regional differences in HU in the cervical spine may influence surgical strategies. The purposes of our study were to determine whether cervical Hounsfield units (HU) vary by level, examine their relationship with age, comorbidities, and alignment, and propose a technique to measure HU in the lateral masses. METHODS Two hundred twenty-four patients with degenerative spine pathology with a cervical computed tomography were included (2015-2019). Measurements were performed in each vertebral body (C2-T1; mid-axial, anterior-axial, posterior-axial, mid-coronal, and mid-sagittal) and 2 regions of the lateral masses (C3-C6; mid-cor, mid-sag). To evaluate reliability, 6 observers each measured 355 HU values, inter-relater reliability assessed with intraclass correlation coefficients Correlations of HU with age, BMI, comorbidities, and cervical alignment were evaluated. RESULTS Bone density differed by level, with the lowest HU scores in the lower cervical spine (C6-T1) (P < .001). No correlations were found between LM HU and age, BMI, CCI, or alignment (P > .05). Increased kyphosis was weakly correlated with VB HU, while age and CCI showed moderate correlations with VB HU at all levels (P<.001). ICC for HU measurements were good to excellent for the VBs, but poor to moderate for the LMs. CONCLUSION Bone is least dense in the lower cervical spine. HU scoring is not reliable in the lateral masses. We recommend that a level-specific approach to bone density is considered in surgical planning.
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Affiliation(s)
- Francis Lovecchio
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Bryan Ang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Philip K. Louie
- Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Chirag Chaudary
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sachin P. Shah
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Ananth Punyala
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Yu-Cheng Yao
- Department of Orthopedics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mike Steinhaus
- Spine Institute, MountainStar Healthcare, Park City, UT, USA
| | - Michael H. McCarthy
- Department of Orthopaedic Surgery, Indiana Spine Group, University of Indiana, Carmel, ID, USA
| | - Russel Huang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Darren Lebl
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Todd J. Albert
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sravisht Iyer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sheeraz Qureshi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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7
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Niemeyer F, Galbusera F, Tao Y, Phillips FM, An HS, Louie PK, Samartzis D, Wilke HJ. Deep phenotyping the cervical spine: automatic characterization of cervical degenerative phenotypes based on T2-weighted MRI. 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; 32:3846-3856. [PMID: 37644278 DOI: 10.1007/s00586-023-07909-9] [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: 04/17/2023] [Revised: 04/17/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Radiological degenerative phenotypes provide insight into a patient's overall extent of disease and can be predictive for future pathological developments as well as surgical outcomes and complications. The objective of this study was to develop a reliable method for automatically classifying sagittal MRI image stacks of cervical spinal segments with respect to these degenerative phenotypes. METHODS We manually evaluated sagittal image data of the cervical spine of 873 patients (5182 motion segments) with respect to 5 radiological phenotypes. We then used this data set as ground truth for training a range of multi-class multi-label deep learning-based models to classify each motion segment automatically, on which we then performed hyper-parameter optimization. RESULTS The ground truth evaluations turned out to be relatively balanced for the labels disc displacement posterior, osteophyte anterior superior, osteophyte posterior superior, and osteophyte posterior inferior. Although we could not identify a single model that worked equally well across all the labels, the 3D-convolutional approach turned out to be preferable for classifying all labels. CONCLUSIONS Class imbalance in the training data and label noise made it difficult to achieve high predictive power for underrepresented classes. This shortcoming will be mitigated in the future versions by extending the training data set accordingly. Nevertheless, the classification performance rivals and in some cases surpasses that of human raters, while speeding up the evaluation process to only require a few seconds.
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Affiliation(s)
- Frank Niemeyer
- Institute for Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, University Hospital Ulm, Ulm, Germany
| | - Fabio Galbusera
- Department of Teaching, Research and Development, Schulthess Clinic, Spine Center, Lengghalde 2, 8008, Zurich, Switzerland.
| | - Youping Tao
- Institute for Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, University Hospital Ulm, Ulm, Germany
| | - Frank M Phillips
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Howard S An
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Philip K Louie
- Spine Clinic, Virginia Mason Medical Center, Seattle, WA, USA
| | - Dino Samartzis
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Hans-Joachim Wilke
- Institute for Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, University Hospital Ulm, Ulm, Germany
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Watts CR, Haapala JL. Cervical Total Disc Replacement and Anterior Cervical Discectomy and Fusion: Comparison of 30-Day Population Comorbidities and Perioperative Complications Using 6 Years of American College of Surgeons National Surgical Quality Improvement Program Participant Use File Data. World Neurosurg 2023; 170:e79-e114. [PMID: 36283651 DOI: 10.1016/j.wneu.2022.10.072] [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: 08/09/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE American College of Surgeons National Surgical Quality Improvement Program Participant Use File data from 2014 through 2019 were used to compare 1- and 2-level anterior cervical discectomy and fusion (ACDF) and cervical total disc replacement (cTDR) with respect to: patient demographics, comorbidities, adverse events, and 30-day morbidity rates. METHODS One- and 2-level ACDF and cTDR patients were identified by current procedural terminology codes. Demographics, comorbidities, and adverse events were summarized. Unmatched cohorts were compared using Wilcoxon Rank Sum test for continuous variables, Pearson χ2 test for categorical variables, and 30-day morbidity using inverse probability of treatment weighted log-binomial regression. RESULTS American College of Surgeons National Surgical Quality Improvement Program 2014 through 2019 Participant Use File datasets represent 4,862,497 unique patients, identifying 13,347 1-level, 6933 2-level ACDF, 3114 1-level, and 862 2-level cTDR patient cohorts. Statistically significant differences between cohorts are extensive: age, sex, race, admission status, patient origin, discharge disposition, emergent surgery, surgical specialty, American Society of Anesthesiologists classification, wound class, operative time, hospital LOS, BMI, functional status, smoking, diabetes, dyspnea, chronic obstructive pulmonary disease, congestive heart failure, hypertension, renal failure, dialysis, cancer, steroid use, anemia, bleeding disorders, systemic sepsis, and number of concurrent comorbid conditions. Inverse probability of treatment weighted log-binomial models, demonstrated increased risk of deep venous thrombosis/thrombophlebitis, pulmonary embolism, deep incisional surgical site infection, pneumonia, and unplanned return to operating room associated with ACDF while increased risk of cerebral vascular accident/stroke with neurological deficit and myocardial infarction associated with cTDR. The composite complications outcome favors cTDR over ACDF for 30-day morbidity. No mortalities occurred within the cTDR cohort. CONCLUSIONS Adjusting for demographics and comorbidities; ACDF has a higher average risk of adverse event. When ACDF and cTDR are equipoise, consideration for cTDR may be indicated in populations with higher rates of comorbid conditions.
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Affiliation(s)
- Charles R Watts
- Department of Neurosurgery, Park Nicollet, Methodist Hospital, St. Louis Park, Minnesota, USA; Health Partners Institute, Bloomington, Minnesota, USA.
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Niu XP, Zhu WH, Wang L, Zhao GN, Liu JT, Huang AB. Assessment of the correlation between clinical and radiological outcomes in patients suffering from mild to moderate cervical spine dysfunction symptoms: a prospective study. J Orthop Surg Res 2022; 17:559. [PMID: 36550557 PMCID: PMC9773613 DOI: 10.1186/s13018-022-03455-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Neck pain and cervical disc degeneration (CDD) are common findings. Valid data on correlation between clinical scores and radiological grade of CDD in patients with mild to moderate clinical disability are not available. The study has been designed to investigate the correlation between clinical and radiological outcomes in these patients. METHODS A cohort of 150 patients who suffered from mild to moderate cervical spine dysfunction symptoms from September 2020 to May 2021 was enrolled. We evaluated functional status using Japanese Orthopaedic Association scores (JOA), the visual analog scale, and the Neck Disability Index. We assessed the CDD with magnetic resonance imaging-based grading systems. We analyzed relationships between radiological grades of CDD and clinical symptoms along with demographic data. RESULTS One hundred thirteen patients [mean age 44.78, 78 (69%) females] were finally included. CDD occurred most at the C5-C6 level, with 56.93% of higher grade III from Miyazaki. The grades of Miyazaki (P < 0.05) and the scores of Nakashima (P < 0.05) were positively correlated with the duration of symptoms, and the severity of the CDD increased with aging (P < 0.01). Moreover, we correlated patients' JOA scores with the current scoring and grading systems, especially the grades of Miyazaki (P < 0.01) and the scores of Nakashima (P < 0.01). CONCLUSION Increasing grades of CDD paralleled decreasing JOA scores in the population studied.
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Affiliation(s)
- Xiao-ping Niu
- grid.411971.b0000 0000 9558 1426Postgraduate School, Dalian Medical University, Dalian, 116000 Liaoning China ,grid.479690.50000 0004 1789 6747Department of Rehabilitation, Affiliated Hospital 5 of Nantong University (Taizhou People’s Hospital), Taizhou, 225300 Jiangsu China
| | - Wei-Hua Zhu
- grid.479690.50000 0004 1789 6747Department of Nursing, Affiliated Hospital 5 of Nantong University (Taizhou People’s Hospital), Taizhou, 225300 Jiangsu China
| | - Lu Wang
- grid.411971.b0000 0000 9558 1426Postgraduate School, Dalian Medical University, Dalian, 116000 Liaoning China ,grid.479690.50000 0004 1789 6747Department of Rehabilitation, Affiliated Hospital 5 of Nantong University (Taizhou People’s Hospital), Taizhou, 225300 Jiangsu China
| | - Gao-nian Zhao
- grid.479690.50000 0004 1789 6747Department of Rehabilitation, Affiliated Hospital 5 of Nantong University (Taizhou People’s Hospital), Taizhou, 225300 Jiangsu China
| | - Ji-tao Liu
- grid.411971.b0000 0000 9558 1426Postgraduate School, Dalian Medical University, Dalian, 116000 Liaoning China ,grid.479690.50000 0004 1789 6747Department of Rehabilitation, Affiliated Hospital 5 of Nantong University (Taizhou People’s Hospital), Taizhou, 225300 Jiangsu China
| | - Ai-bing Huang
- grid.479690.50000 0004 1789 6747Department of Orthopedics, Affiliated Hospital 5 of Nantong University (Taizhou People’s Hospital), Taizhou, 225300 Jiangsu China
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Yan Y, Zhang X, Meng Y, Shen Q, He L, Cheng G, Gong X. Sagittal intervertebral rotational motion: a deep learning-based measurement on flexion–neutral–extension cervical lateral radiographs. BMC Musculoskelet Disord 2022; 23:967. [DOI: 10.1186/s12891-022-05927-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/27/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The analysis of sagittal intervertebral rotational motion (SIRM) can provide important information for the evaluation of cervical diseases. Deep learning has been widely used in spinal parameter measurements, however, there are few investigations on spinal motion analysis. The purpose of this study is to develop a deep learning-based model for fully automated measurement of SIRM based on flexion–neutral–extension cervical lateral radiographs and to evaluate its applicability for the flexion–extension (F/E), flexion–neutral (F/N), and neutral–extension (N/E) motion analysis.
Methods
A total of 2796 flexion, neutral, and extension cervical lateral radiographs from 932 patients were analyzed. Radiographs from 100 patients were randomly selected as the test set, and those from the remaining 832 patients were used for training and validation. Landmarks were annotated for measuring SIRM at five segments from C2/3 to C6/7 on F/E, F/N, and N/E motion. High-Resolution Net (HRNet) was used as the main structure to train the landmark detection network. Landmark performance was assessed according to the percentage of correct key points (PCK) and mean of the percentage of correct key points (MPCK). Measurement performance was evaluated by intra-class correlation coefficient (ICC), Pearson correlation coefficient, mean absolute error (MAE), root mean square error (RMSE), and Bland-Altman plots.
Results
At a 2-mm distance threshold, the PCK for the model ranged from 94 to 100%. Compared with the reference standards, the model showed high accuracy for SIRM measurements for all segments on F/E and F/N motion. On N/E motion, the model provided reliable measurements from C3/4 to C6/7, but not C2/3. Compared with the radiologists’ measurements, the model showed similar performance to the radiologists.
Conclusions
The developed model can automatically measure SIRM on flexion–neutral–extension cervical lateral radiographs and showed comparable performance with radiologists. It may provide rapid, accurate, and comprehensive information for cervical motion analysis.
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Liebsch C, Wilke HJ. Even mild intervertebral disc degeneration reduces the flexibility of the thoracic spine: an experimental study on 95 human specimens. Spine J 2022; 22:1913-1921. [PMID: 35779838 DOI: 10.1016/j.spinee.2022.06.010] [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: 03/29/2022] [Revised: 05/31/2022] [Accepted: 06/17/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Intervertebral disc degeneration represents one of multiple potential trigger factors for reduced passive spinal mobility and back pain. The effects of age-related degenerative intervertebral disc changes on spinal flexibility were however mainly investigated for the lumbar spine in the past, while intervertebral disc degeneration is also highly prevalent in the thoracic spine. PURPOSE To evaluate the effect of the degeneration grade on the range of motion and neutral zone of the thoracic spine. STUDY DESIGN Experimental study including combined radiological grading of intervertebral disc degeneration and biomechanical testing of 95 human thoracic functional spinal units (min. n=4 per level from T1-T2 to T11-T12) from 33 donors (15 female / 18 male, mean age 56 years, age range 37-80 years). METHODS Degeneration grades of the intervertebral discs were assessed using the validated x-ray grading scheme of Liebsch et al. (0=no, 1=mild, 2=moderate, 3=severe degeneration). Motion segments were loaded with pure moments in flexion/extension, lateral bending, and axial rotation to determine range of motion and neutral zone at 5 Nm. RESULTS All tested specimens exhibited degeneration grades between zero and two. Range of motion significantly decreased for grades one and two compared with grade zero in any motion direction (p<.05), showing the strongest decrease in extension comparing grade two with grade zero (-42%), while no significant differences were detected between grades one and two. Similar trends were found for the neutral zone with the strongest decrease in extension also comparing grade two with grade zero (-47%). Donor age did not significantly affect the range of motion, whereas the range of motion was significantly reduced in specimens from male donors due to the significantly higher degeneration grade in this study. CONCLUSIONS Even mild intervertebral disc degeneration reduces the range of motion and neutral zone of the thoracic spine in any motion plane, whereas progressing degeneration does not further affect its flexibility. This is in contrast to the lumbar spine, where a more gradual decrease of flexibility was found in prior studies, which might be explained by differences between thoracic and lumbar intervertebral disc morphologies. CLINICAL SIGNIFICANCE Thoracic intervertebral disc degeneration should be considered as one of multiple potential causal factors in patients showing reduced passive mobility and middle back pain.
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Affiliation(s)
- Christian Liebsch
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Helmholtzstr. 14, 89081 Ulm, Baden-Wuerttemberg, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Helmholtzstr. 14, 89081 Ulm, Baden-Wuerttemberg, Germany.
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Han K, You ST, Lee HJ, Kim IS, Hong JT, Sung JH. Hounsfield unit measurement method and related factors that most appropriately reflect bone mineral density on cervical spine computed tomography. Skeletal Radiol 2022; 51:1987-1993. [PMID: 35419706 DOI: 10.1007/s00256-022-04050-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Our study's purpose was to determine the most reliable Hounsfield unit (HU) measurement method to reflect bone mineral density (BMD) on cervical spine computed tomography (CT) and to identify any factors that influence these results. MATERIALS AND METHODS We retrospectively analyzed 439 consecutive patients with mild head and neck injuries. Mean HU values of the C2-C7 vertebra were determined on each sagittal, coronal, and axial CT image. Correlation patterns were analyzed between the HU value and corresponding dual-energy X-ray absorptiometry (DXA) in the lumbar vertebra (T-score) and femoral neck (T-score). A sub-group analysis was performed according to patient age, sex, and degree of spinal degeneration. RESULTS The correlation coefficients for HU and DXA ranged from 0.52 to 0.65 in all cervical segments. A simple linear regression analysis revealed the following formula: T-score = 0.01 × (HU) - 4.55. The mean HU values for osteopenia and osteoporosis were 284.0 ± 63.3 and 231.5 ± 52.8, respectively. The ROC curve indicated that the HU method has a sensitivity of 89.2% and specificity of 88.7% to diagnose osteoporosis. The HU measurement showed a high correlation value (range: r = 0.64-0.70) with spine DXA score regardless of the degree of degeneration or patient age or sex. CONCLUSION HU values using the upper two cervical vertebrae (C2 and C3) reflected a more reliable BMD level than other segments. Additionally, the HU of cervical CT provided reliable information regardless of measurement plane, age or sex, and degree of degeneration.
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Affiliation(s)
- Kyungmin Han
- Department of Neurosurgery, College of Medicine, St. Vincent Hospital, The Catholic University of Korea, 93-6 Ji-Dong, Paldal-gu, Suwon, 442-723, Korea
| | - Soon Tae You
- Department of Neurosurgery, College of Medicine, St. Vincent Hospital, The Catholic University of Korea, 93-6 Ji-Dong, Paldal-gu, Suwon, 442-723, Korea
| | - Ho Jin Lee
- Department of Neurosurgery, College of Medicine, St. Vincent Hospital, The Catholic University of Korea, 93-6 Ji-Dong, Paldal-gu, Suwon, 442-723, Korea.
| | - Il Sup Kim
- Department of Neurosurgery, College of Medicine, St. Vincent Hospital, The Catholic University of Korea, 93-6 Ji-Dong, Paldal-gu, Suwon, 442-723, Korea
| | - Jae Taek Hong
- Department of Neurosurgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, College of Medicine, St. Vincent Hospital, The Catholic University of Korea, 93-6 Ji-Dong, Paldal-gu, Suwon, 442-723, Korea
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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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Zeng HZ, Zheng LD, Xu ML, Zhu SJ, Zhou L, Candito A, Wu T, Zhu R, Chen Y. Biomechanical effect of age-related structural changes on cervical intervertebral disc: A finite element study. Proc Inst Mech Eng H 2022; 236:1541-1551. [DOI: 10.1177/09544119221122007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Previous literature has investigated the biomechanical response of healthy and degenerative discs, but the biomechanical response of suboptimal healthy intervertebral discs received less attention. The purpose was to compare the biomechanical responses and risk of herniation of young healthy, suboptimal healthy, and degenerative intervertebral discs. A cervical spine model was established and validated using the finite element method. Suboptimal healthy, mildly, moderately, and severely degenerative disc models were developed. Disc height deformation, range of motion, intradiscal pressure, and von Mises stress in annulus fibrosus were analyzed by applying a moment of 4 Nm in flexion, extension, lateral bending, and axial rotation with 100 N compressive loads. Disc height deformation in young healthy, suboptimal healthy, mildly, moderately, and severely degenerative discs was 40%, 37%, 21%, 12%, and 8%, respectively. The decreasing order of the range of motion was young healthy spine > suboptimal healthy spine > mildly degenerative spine > moderately degenerative spine > severely degenerative spine. The mean stress of annulus ground substance in the suboptimal healthy disc was higher than in the young healthy disc. The mean stress of inter-lamellar matrix and annulus ground substance in moderately and severely degenerative discs was higher than in other discs. Age-related structural changes and degenerative changes increased the stiffness and reduced the elastic deformation of intervertebral discs. Decreased range of motion due to the effects of aging or degeneration on the intervertebral disc, may cause compensation of adjacent segments and lead to progressive degeneration of multiple segments. The effect of aging on the intervertebral disc increased the risk of annulus fibrosus damage from the biomechanical point of view. Moderately and severely degenerative discs may have a higher risk of herniation due to the higher risk of damage and layers separation of annulus fibrosus caused by increased stress in the annulus ground substance and inter-lamellar matrix.
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Affiliation(s)
- Hui-zi Zeng
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Liang-dong Zheng
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Meng-lei Xu
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shi-jie Zhu
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Liang Zhou
- Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Antonio Candito
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
| | - Tao Wu
- Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Rui Zhu
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Clinical Research Center for Ageing and Medicine, Shanghai, China
| | - Yuhang Chen
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
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Rodrigues AJ, Jokhai R, Varshneya K, Stienen MN, Veeravagu A. Factors Which Predict Adverse Outcomes in Anterior Cervical Discectomy and Fusion Procedures in the Nonelderly Adult Population. Clin Spine Surg 2022; 35:E584-E589. [PMID: 35385403 DOI: 10.1097/bsd.0000000000001326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE The largest published cohort of anterior cervical discectomy and fusion (ACDF) patients was queried to better characterize demographic and operative factors that predict 90-day complication and 2-year reoperation risk. SUMMARY OF BACKGROUND DATA The MarketScan Database was queried from 2007 to 2016 to identify adult patients until 65 years, who underwent an ACDF procedure using International Classification of Diseases 9th Version (ICD-9) and Current Procedural Terminology (CPT) codes. MarketScan is a national insurance claims database that contains millions of patient records across all 50 states. METHODS Multivariate logistic regression was used to identify factors associated with complications until 90 days and reoperations until 2 years. RESULTS Of 138,839 ACDF procedures, 8500 patients (6.1%) experienced a complication within 90 days of the ACDF, and 7433 (5.4%) underwent surgical revision by 2 years. While the use of anterior cervical plating did not predict 2-year reoperation, it was associated with dramatically reduced 90-day complication risk (adjusted odds ratio [aOR]: 0.32; 95% confidence interval [CI]: 0.30-0.34; P <0.001). Upon multivariate analysis, female sex (aOR: 0.83; 95% CI: 0.79-0.87; P <0.001) was associated with decreased risk of 2-year reoperation, while depression predicted a 50% increase in reoperation risk (aOR: 1.51; 95% CI: 1.43-1.59; P <0.001). The single largest factor associated with reoperation risk, however, was the presence of a 90-day postoperative complication (aOR: 1.79; 95% CI: 1.66-1.94; P <0.001). CONCLUSION Increased patient comorbidities and the use of bone morphogenic protein were found to increase the risk for postoperative complications, while cervical plating was associated with a strong decline in this risk. In addition, poor patient mental health outweighed the adverse of impact of other comorbidities on 2-year revision risk. The presence of a postoperative complication was the key modifiable risk factor associated with reoperation risk. Conclusions from this study may help surgeons better identify high-risk ACDF patients for more careful patient selection, counseling, informed consent, and management.
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Affiliation(s)
- Adrian J Rodrigues
- Neurosurgery AI Lab and Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Rayyan Jokhai
- Neurosurgery AI Lab and Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Kunal Varshneya
- Neurosurgery AI Lab and Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Martin N Stienen
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Anand Veeravagu
- Neurosurgery AI Lab and Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
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Banerjee A, Mowforth OD, Nouri A, Budu A, Newcombe V, Kotter MRN, Davies BM. The Prevalence of Degenerative Cervical Myelopathy-Related Pathologies on Magnetic Resonance Imaging in Healthy/Asymptomatic Individuals: A Meta-Analysis of Published Studies and Comparison to a Symptomatic Cohort. J Clin Neurosci 2022; 99:53-61. [PMID: 35255357 DOI: 10.1016/j.jocn.2022.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/03/2022] [Accepted: 03/01/2022] [Indexed: 11/29/2022]
Abstract
Degenerative cervical myelopathy (DCM) is a progressive cervical spinal cord injury brought about by mechanical stress from degenerative changes in the cervical spine. It is typically diagnosed on clinical symptoms and examination findings together with MRI findings. In this study, we explore the significance of these degenerative pathology to onset of DCM by performing the first meta-analysis on the prevalence of degenerative features reported on MRI amongst healthy and asymptomatic populations and compare this to the prevalence of degenerative features reported on MRI amongst a symptomatic population calculated in a previous review. We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines, cognizant of their adaptation for epidemiological studies. A search strategy was used to identify original research carrying out MRI screening of cervical spines of asymptomatic patients in MEDLINE and Embase from 1985 to present day. The search yielded a total of 1098 studies of which 17 were included in this meta-analysis covering a total of 5059 patients. Ossification of posterior longitudinal ligament (pooled asymptomatic prevalence of 0.4%, 95% Confidence Interval [0.1%, 0.8%]), enlargement of ligamentum flavum (pooled asymptomatic prevalence of 11.8%, 95% Confidence Interval [5.3%, 18.4%]) and degenerative multilevel disc pathology (pooled asymptomatic prevalence of 64.5%, 95% Confidence Interval [48.3%, 80.8%], I2 100%) were found to be significantly lower in asymptomatic populations. Symptomatic populations have a prevalence of 10.5% (95% Confidence Interval [7.7%, 13.3%]) for ossification of posterior longitudinal ligament, 56.8% (95% Confidence Interval [52.3%, 61.3%]) for enlargement of ligamentum flavum and 89.7% (95% Confidence Interval [86.9%, 92.5%]) for degenerative multilevel disc pathology [18]. Understanding the natural history of DCM is a recognised research priority, and whilst these perspectives require further evaluation, they may be of significant relevance to the evolving biomechanical understanding of the disease.
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Affiliation(s)
| | | | - Aria Nouri
- Department of Neurosurgery, University of Geneva, 1205 Geneva, Switzerland
| | - Alexandru Budu
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Virginia Newcombe
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Mark R N Kotter
- Department of Neurosurgery, University of Cambridge, Cambridge, UK; Myelopathy.org, University of Cambridge, UK
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Manickam PS, Roy S. The biomechanical effects of S-type dynamic cage using Ti and PEEK for ACDF surgery on cervical spine varying loads. Int J Artif Organs 2021; 44:748-755. [PMID: 34387526 DOI: 10.1177/03913988211039525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Anterior cervical discectomy with fusion (ACDF) is the common method to treat the cervical disc degeneration. The most serious problems in the fusion cages are adjacent disc degeneration, loss of lordosis, pain, subsidence, and migration of the cage. The objective of our work is to develop the three-dimensional finite element (FE) model from C3-C6 and virtually implant a designed S-type dynamic cage at C4-C5 segment of the model. The dynamic cage design will provide mobility in the early stage after ACDF surgery. Titanium (Ti) and PEEK (polyether ether ketone) were used as the material property for the cages. We applied the physiological motions at different loads from 0.5, 1, 1.5, 2.0 Nm to evaluate the dynamic cage design and the biomechanical performances of the designed S-type dynamic cage. It was observed that in all the loading condition the range of motion in the adjacent level was maintained and the maximum stress at the adjacent disc was reduced. The clinical significance of the S-type dynamic cage is better stress profile at the fusion level and adjacent segments which translates into higher rate of fusion, lower risk of cage subsidence, lower risk of adjacent segment degeneration, and good mechanical stability.
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Affiliation(s)
- Pechimuthu Susai Manickam
- Department of Mechanical Engineering, College of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
| | - Sandipan Roy
- Department of Mechanical Engineering, College of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
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Tao Y, Niemeyer F, Galbusera F, Jonas R, Samartzis D, Vogele D, Kienle A, Wilke HJ. Sagittal wedging of intervertebral discs and vertebral bodies in the cervical spine and their associations with age, sex and cervical lordosis: A large-scale morphological study. Clin Anat 2021; 34:1111-1120. [PMID: 34309067 DOI: 10.1002/ca.23769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/05/2021] [Accepted: 07/16/2021] [Indexed: 11/11/2022]
Abstract
Many recent studies have focused on the functional and clinical importance of cervical lordosis. However, there is little accurate knowledge of the anatomical parameters that constitute cervical lordosis (i.e., the sagittal wedging angles of intervertebral discs and vertebral bodies) and their associations with age and sex. Standing lateral cervical radiographs of 1020 subjects (424 males, 596 females) with a mean age of 36.6 ± 17.0 years (range 7-95 years) were evaluated retrospectively. Cervical lordosis, the sum of intervertebral disc wedging angles from C2/C3 to C6/C7 and the sum of vertebral body wedging angles from C3 to C7 were measured. The sum of intervertebral disc wedging and the sum of vertebral body wedging were 20.6° ± 14.7° and -12.8° ± 10.3°, respectively. The sum of intervertebral disc wedging increased significantly with age and was significantly greater in males than females, whereas there was no sex-related difference in the sum of vertebral body wedging. The sum of intervertebral disc wedging was negatively correlated with sum of vertebral body wedging. Wedging of discs contributed to C2-C7 cervical lordosis more significantly than wedging of vertebral bodies. There were moderate positive correlations between cervical lordosis and intervertebral disc wedging angles at C3/C4, C4/C5 and C5/C6; weak correlations were observed at C2/C3 and C6/C7. This study constitutes the largest currently available analysis comprehensively documenting the anatomical characteristics of sagittal wedging of intervertebral discs and vertebral bodies in the cervical spine. The findings could improve understanding of the internal architecture of cervical lordosis among clinicians.
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Affiliation(s)
- Youping Tao
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Frank Niemeyer
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University Medical Centre, Ulm, Germany
| | | | - René Jonas
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center and Rush Graduate College, Chicago, Illinois, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, Illinois, USA
| | - Daniel Vogele
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | | | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University Medical Centre, Ulm, Germany
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Tao Y, Galbusera F, Niemeyer F, Jonas R, Samartzis D, Vogele D, Wilke HJ. The impact of age, sex, disc height loss and T1 slope on the upper and lower cervical lordosis: a large-scale radiologic study. 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 2021; 30:2434-2442. [PMID: 34331122 DOI: 10.1007/s00586-021-06933-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To clarify the relative influence of age, sex, disc height loss and T1 slope on upper (Occiput-C2) and lower cervical lordosis (C2-C7). METHODS Standing lateral cervical radiographs of 865 adult subjects were evaluated. The presence and severity of disc height loss from C2/C3 to C6/C7 (a total of 4325 discs) were assessed using a validated grading system. The total disc height loss score for each subject was calculated as the sum of the score of each disc space. Sagittal radiographic parameters included: occipital slope, occiput-C2 (Oc-C2) lordosis, C2-C7 lordosis and T1 slope. Multivariable regression analyses were performed to examine the relative influence of the multiple factors on upper and lower cervical lordosis. RESULTS This study included 360 males and 505 females, with a mean age of 40.2 ± 16.0 years (range, 20-95 years). Linear multivariate regression analyses showed that greater age, male sex, greater T1 slope were each found to be significantly and independently associated with greater C2-C7 lordosis, whereas total disc height loss score was negatively associated with C2-C7 lordosis. T1 slope had the most independent influence on C2-C7 lordosis among these factors. Age, sex and disc height loss were not independently associated with Oc-C2 lordosis. CONCLUSIONS Results from our large-scale radiologic analysis may enhance the understanding of the factors that affect cervical lordosis, indicating that age, sex, disc height loss and T1 slope were each independently associated with C2-C7 lordosis. However, age, sex and disc height loss were not independently associated with upper cervical lordosis.
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Affiliation(s)
- Youping Tao
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University, Helmholtzstrasse 14, 89081, Ulm, Germany
| | | | - Frank Niemeyer
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University, Helmholtzstrasse 14, 89081, Ulm, Germany
| | - René Jonas
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University, Helmholtzstrasse 14, 89081, Ulm, Germany
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center and Rush Graduate College, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Daniel Vogele
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University, Helmholtzstrasse 14, 89081, Ulm, Germany.
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