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Baumann AN, Fiorentino A, Sidloski K, Hitchman K, Conry KT, Hoffmann JC. Clinical Outcomes and Complication Rates for Noncontiguous Anterior Cervical Discectomy and Fusion, Cervical Disc Arthroplasty, and Hybrid Cervical Surgery: A Systematic Review. World Neurosurg 2024; 189:55-69. [PMID: 38823447 DOI: 10.1016/j.wneu.2024.05.157] [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: 05/15/2024] [Accepted: 05/26/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE This study examined clinical outcomes associated with 3 types of noncontiguous cervical surgeries - anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty (CDA), and hybrid cervical surgery (HCS) - to improve surgeon decision-making. METHODS A systematic review was performed using PubMed, CINAHL, MEDLINE, and Web of Science from database inception until June 6th, 2023. Inclusion criteria were studies that reported any type of clinical outcome, examined noncontiguous ACDF, noncontiguous CDA, and/or noncontiguous HCS. RESULTS Ten articles out of 523 articles initially retrieved were included. Patients (n = 388) had a mean age of 52 ± 5.1 years and a mean follow-up time of 33 ± 6.0 months. Overall, 119 patients underwent noncontiguous HCS, 65 underwent noncontiguous CDA, and 204 underwent noncontiguous ACDF. There appears to be no clinically meaningful difference in Neck Disability Index score, Japanese Orthopedic Association score, and improvement in pain based on surgery type. There were a total of 83 complications (21% of cases) with noncontiguous ACDF having a higher absolute rate of dysphagia (20%) as compared to noncontiguous HCS (6.7%) or noncontiguous CDA (6.2%). Noncontiguous ACDF had a higher absolute rate of adjacent segment degeneration anterior cervical discectomy and fusion as a reported complication (6.4%) as compared to noncontiguous HCS (1.7%) and noncontiguous CDA (0.0%). CONCLUSIONS There may be no clinically meaningful difference in many clinical outcomes for different noncontiguous surgical interventions for noncontiguous (cervical degenerative disc disease). However, complication rates, such as dysphagia and anterior cervical discectomy and fusion, appear higher for noncontiguous ACDF as compared to noncontiguous CDA or HCS.
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Affiliation(s)
- Anthony N Baumann
- College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA; Department of Rehabilitation Services, University Hospitals, Cleveland, Ohio, USA
| | - Andrew Fiorentino
- College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Katelyn Sidloski
- College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Kyle Hitchman
- College of Medicine, Campbell University, Lillington, North Carolina, USA.
| | - Keegan T Conry
- Department of Orthopedics, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Jacob C Hoffmann
- Department of Orthopedics, Cleveland Clinic Akron General, Akron, Ohio, USA
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Sun X, Huang J, Zhang Q, Cao L, Liu Y, Song Z, Tang W, Sun S, Wang J. Segment selection for fusion and artificial disc replacement in the hybrid surgical treatment of noncontiguous cervical spondylosis: a finite element analysis. Front Bioeng Biotechnol 2024; 12:1345319. [PMID: 38633668 PMCID: PMC11021715 DOI: 10.3389/fbioe.2024.1345319] [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: 11/27/2023] [Accepted: 03/15/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction: The treatment of skip-level cervical degenerative disease (CDD) with no degenerative changes observed in the intervening segment (IS) is complicated. This research aims to provide a reference basis for selecting treatment approaches for noncontiguous CDD. Methods: To establish accurate finite element models (FEMs), this study included computed tomography (CT) data from 21 patients with CDD (10 males and 11 females) for modeling. The study primarily discusses four cross-segment surgical approaches: upper (C3/4) anterior cervical discectomy and fusion (ACDF) and lower (C5/6) cervical disc arthroplasty (CDA), FA model; upper CDA (C3/4) and lower ACDF (C5/6), AF model; upper ACDF (C3/4) and lower ACDF (C5/6), FF model; upper CDA (C3/4) and lower CDA (C5/6), AA model. An initial axial load of 73.6 N was applied at the motion center using the follower load technique. A moment of 1.0 Nm was applied at the center of the C2 vertebra to simulate the overall motion of the model. The statistical analysis was conducted using STATA version 14.0. Statistical significance was defined as a p value less than 0.05. Results: The AA group had significantly greater ROM in flexion and axial rotation in other segments compared to the FA group (p < 0.05). The FA group consistently exhibited higher average intervertebral disc pressure in C2/3 during all motions compared to the AF group (p < 0.001); however, the FA group displayed lower average intervertebral disc pressure in C6/7 during all motions (p < 0.05). The AA group had lower facet joint contact stresses during extension in all segments compared to the AF group (p < 0.05). The FA group exhibited significantly higher facet joint contact stresses during extension in C2/3 (p < 0.001) and C6/7 (p < 0.001) compared to the AF group. Discussion: The use of skip-level CDA is recommended for the treatment of non-contiguous CDD. The FA construct shows superior biomechanical performance compared to the AF construct.
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Affiliation(s)
- Xiangyao Sun
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
- Beijing Glitzern Technology Co., Ltd., Beijing, China
| | - Jiang Huang
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Qingming Zhang
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Li Cao
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Yuqi Liu
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zelong Song
- Nankai University School of Medicine, Nankai University, Tianjin, China
- Department of Orthopaedics, The PLA General Hospital, Beijing, China
| | - Wei Tang
- Beijing Glitzern Technology Co., Ltd., Beijing, China
| | - Siyuan Sun
- Department of Interdisciplinary, Life Science, Purdue University, West Lafayette, IN, United States
| | - Juyong Wang
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
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Chen G, Xin Z, Kong W, Wu F, Li X, Qiao Y, Yan X, Liao W. Anterior Full-endoscopic Single-port Double Transcorporeal Spinal Cord Decompression for Noncontinuous Two-segment Cervical Spondylotic Myelopathy: A Technical Note. Orthop Surg 2024; 16:754-765. [PMID: 38287224 PMCID: PMC10925512 DOI: 10.1111/os.13988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVE In clinical practice, noncontinuous two-segment spinal cord cervical spondylosis is a particular form of cervical degenerative disease. Traditional anterior open surgery frequently comes with severe trauma, risks, and debatable treatment options. This study aimed to describe for the first time a novel minimally invasive technique, namely, anterior full-endoscopic single-port double transcorporeal spinal cord decompression for the treatment of patients with noncontinuous two-segment cervical spondylotic myelopathy. METHOD From February 2020 to May 2021, five patients with noncontinuous two-segment cervical spondylotic myelopathy were treated with anterior full-endoscopic single-port double transcorporeal spinal cord decompression. Two bone channels were established by the trephine through the vertebral body oblique upward and downward to the herniated disc osteophyte complex, and the full-endoscopic system could decompress the spinal cord through the channels. All cases were followed up for over 2 years. The modified Japanese Orthopaedic Association (mJOA) score and visual analogue scale (VAS) score before and after operation and during follow-up were used to evaluate the clinical effectiveness. Radiological examinations, including CT and MRI, were utilized to evaluate the efficacy of spinal cord decompression and bone channel repair. RESULTS All operations were successfully completed and the average operation time was 185 min, with no operation-related complications. Compared with the preoperative evaluation, the mJOA score and VAS score were improved at each time point after operation and follow-up. Postoperative CT and MRI scans showed that the intervertebral disc-osteophyte complex was removed through the vertebral bone passage, and the spinal cord was fully decompressed. After 24 months of follow-up, CT and MRI scans showed that the bone channel was almost repaired and healed. CONCLUSION Anterior full-endoscopic single-port double transcorporeal spinal cord decompression is an effective minimally invasive technique for noncontinuous two-segment cervical spondylosis. It provides precise and satisfactory spinal cord decompression under endoscopic visualization with minimum trauma.
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Affiliation(s)
- Gang Chen
- Department of OrthopedicsThe Second Affiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Zhijun Xin
- Department of Orthopedic SurgeryThe Affiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Weijun Kong
- Department of OrthopedicsThe Second Affiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Fujun Wu
- Department of Orthopedic SurgeryThe Affiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Xuyan Li
- Department of Orthopedic SurgeryThe Affiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Yanyu Qiao
- Department of OrthopedicsThe Second Affiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Xiang Yan
- Department of OrthopedicsThe Second Affiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Wenbo Liao
- Department of OrthopedicsThe Second Affiliated Hospital of Zunyi Medical UniversityZunyiChina
- Department of Orthopedic SurgeryThe Affiliated Hospital of Zunyi Medical UniversityZunyiChina
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Sun X, Zhang Q, Cao L, Wang J, Huang J, Liu Y, Zhang Y, Song Z, Tang W, Chen Y, Sun S, Lu S. Biomechanical effects of hybrid constructions in the treatment of noncontinuous cervical spondylopathy: a finite element analysis. J Orthop Surg Res 2023; 18:57. [PMID: 36658557 PMCID: PMC9854215 DOI: 10.1186/s13018-023-03537-7] [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: 07/04/2022] [Accepted: 01/12/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Hybrid construction (HC) may be an ideal surgical strategy than noncontinuous total disc replacement (TDR) and noncontinuous anterior cervical discectomy and fusion (ACDF) in the treatment of noncontinuous cervical spondylopathy. However, there is still no consensus on the segmental selection for ACDF or TDR in HC. The study aims to analyse the effects of different segment selection of TDR and ACDF on cervical biomechanical characteristics after HC surgery. METHODS Twelve FEMs of C2-C7 were constructed based on CT images of 12 mild cervical spondylopathy volunteers. Two kinds of HC were introduced in our study: Fusion-arthroplasty group (Group 1), upper-level (C3/4) ACDF, and lower-level TDR (C5/6); Arthroplasty-fusion group (Group 2), upper-level (C3/4) TDR and lower-level ACDF (C5/6). The follow-load technique was simulated by applying an axial initial load of 73.6 N through the motion centre of FEM. A bending moment of 1.0 Nm was applied to the centre of C2 in all FEMs. Statistical analysis was carried out by SPSS 26.0. The significance threshold was 5% (P < 0.05). RESULTS In the comparison of ROMs between Group 1 and Group 2, the ROM in extension (P = 0.016), and lateral bending (P = 0.038) of C4/5 were significantly higher in Group 1 group. The average intervertebral disc pressures at C2/3 in all directions were significantly higher in Group 1 than those in Group 2 (P < 0.005). The average contact forces in facet joints of C2/3 (P = 0.007) were significantly more than that in Group 2; however, the average contact forces in facet joints of C6/7 (P < 0.001) in Group 1 group were significantly less than that in Group 2. CONCLUSIONS Arthroplasty-fusion is preferred for intervertebral disc degeneration in adjacent upper segments. Fusion-arthroplasty is preferred for patients with lower intervertebral disc degeneration or lower posterior column degeneration. TRIAL REGISTRATION This research was registered in Chinese Clinical Trial Registry (ChiCTR1900020513).
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Affiliation(s)
- Xiangyao Sun
- grid.413259.80000 0004 0632 3337Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 100053 China ,Beijing Glitzern Technology Co., Ltd, Beijing, 100077 China
| | - Qingming Zhang
- grid.413259.80000 0004 0632 3337Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 100053 China
| | - Li Cao
- grid.413259.80000 0004 0632 3337Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 100053 China
| | - Juyong Wang
- grid.413259.80000 0004 0632 3337Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 100053 China
| | - Jiang Huang
- grid.413259.80000 0004 0632 3337Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 100053 China
| | - Yuqi Liu
- grid.413259.80000 0004 0632 3337Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
| | - Yang Zhang
- grid.414252.40000 0004 1761 8894Department of Orthopaedics, The Seventh Medical Center of PLA General Hospital, Beijing, 100191 China
| | - Zelong Song
- grid.216938.70000 0000 9878 7032Nankai University School of Medicine, Nankai University, Tianjin, 300071 China ,grid.414252.40000 0004 1761 8894Department of Orthopaedics, The PLA General Hospital, Beijing, 100000 China
| | - Wei Tang
- Beijing Glitzern Technology Co., Ltd, Beijing, 100077 China
| | - Yunqiang Chen
- Beijing Glitzern Technology Co., Ltd, Beijing, 100077 China
| | - Siyuan Sun
- grid.169077.e0000 0004 1937 2197Department of Interdisciplinary, Life Science, Purdue University, West Lafayette, IN 47907 USA
| | - Shibao Lu
- grid.413259.80000 0004 0632 3337Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053 China ,National Clinical Research Center for Geriatric Diseases, Beijing, 100053 China
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5
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Chmutin G, Antonov G, Chmutin E, Fedyanin A, Livshitz M, Oleynikov B, Zokhidov Z, Shumadalova A. Diagnostic Investigations as a Basis for Optimising Surgical Management of Vertebrobasilar Insufficiency Syndrome. Front Surg 2022; 9:901759. [PMID: 35651687 PMCID: PMC9150087 DOI: 10.3389/fsurg.2022.901759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022] Open
Abstract
Vertebrobasilar insufficiency (VBI) is one of the most common forms of cerebrovascular pathology. The progression of the VBI, especially in the context of inadequate therapy, often leads to the formation of a persistent neurological deficits within the framework of dyscirculatory encephalopathy and the consequences of a stroke in the vertebrobasilar system. This study demonstrate the importance of objective methods of patient investigation to optimize the choice of the most effective methods of surgical treatment for VBI in cases of ineffective medical treatment. We have shown that the optimization of the diagnostic algorithm contributes to the correct individualized determination of types of surgical treatment for patients with VBI. It was found that, in addition to traditional diagnostic methods, the use of radiographic methods (ultrasound Doppler, multispiral computed tomography with contrast enhancement) is invaluable for choosing the tactics of surgical treatment. We propose a significant outcome indicator like the blood flow reactivity index to determine the postoperative improvement of blood flow in the vertebral arteries. In addition, the need to perform cerebral angiography and consultations with related specialists to exclude pathologies with a similar clinical picture is emphasized.
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Affiliation(s)
- Gennady Chmutin
- Department of Nervous Diseases and Neurosurgery, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Gennady Antonov
- Department of Neurosurgery, 3rd Central Military Clinical Hospital named after A.A. Vishnevsky under the Ministry of Defense of the Russian Federation, Krasnogorsk, Russia
| | - Egor Chmutin
- Department of Nervous Diseases and Neurosurgery, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Aleksei Fedyanin
- Department of Nervous Diseases and Neurosurgery, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Matvey Livshitz
- Department of Nervous Diseases and Neurosurgery, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
- Department of Neurosurgery, Federal State Budgetary Institution of Medical Department of Moscow Morozov Children’s City Clinical Hospital of Medical Department of Moscow, Moscow, Russia
| | - Boris Oleynikov
- Department of Nervous Diseases and Neurosurgery, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
- Department of Neurosurgery, Federal State Budgetary Institution of Medical Department of Moscow Morozov Children’s City Clinical Hospital of Medical Department of Moscow, Moscow, Russia
- Correspondence: Boris Oleynikov
| | - Zokirzhon Zokhidov
- Department of Nervous Diseases and Neurosurgery, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Alina Shumadalova
- Department of General Chemistry, Bashkir State Medical University, Ufa, Russian Federation
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Hui N, Phan K, Lee MY, Kerferd J, Singh T, Mobbs RJ. The Changes in Cervical Biomechanics After CTDR and Its Association With Heterotopic Ossification: A Systematic Review and Meta-analysis. Global Spine J 2021; 11:565-574. [PMID: 32677512 PMCID: PMC8119929 DOI: 10.1177/2192568220922949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVES Cervical total disc replacement (CTDR) can preserve range of motion (ROM) of the operated spinal segment in cadaver studies. Evidence is less clear in clinical trials. The present study aims to investigate the differences in cervical biomechanics before and after CTDR and its association with heterotopic ossification (HO) development. METHOD Articles that reported the rate of HO and ≥1 difference in cervical biomechanics were included in quantitative analyses. We pooled the mean difference (MD) of cervical biomechanics before and after CTDR. Subgroup analyses and metaregression analyses were conducted to identify potential contributors to heterogeneity. RESULTS Of the 599 studies screened, 35 studies were included in the final analysis. In comparison with preoperative values, ROM of the spinal segment inferior (MD: 0.38; 95% CI: 0.02 to 0.74) and superior (MD: 0.43; 95% CI: 0.12 to 0.75) to the surgical spinal segment, functional spinal unit (FSU) angle (MD: 2.23; 95% CI: 1.11 to 3.35), and C2/C7 Cobb angle (MD: 3.49; 95% CI: 1.73 to 5.25) significantly increased after CTDR. In contrast, FSU and cervical ROM at baseline were no different from follow-up. On multivariable meta-regression analyses, HO and ROM-limiting HO were not associated with changes in cervical biomechanics. Single-level CTDR and duration of follow-up were associated with changes in cervical biomechanics. CONCLUSION Our study reported the pooled mean of biomechanics at baseline and final follow-up and their differences. The changes in biomechanics were not associated with the rates of HO and ROM-limiting HO.
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Affiliation(s)
- Nicholas Hui
- NeuroSpine Surgery Research Group, Sydney, Australia,7800University of New South
Wales, Sydney, Australia
| | - Kevin Phan
- NeuroSpine Surgery Research Group, Sydney, Australia,7800University of New South
Wales, Sydney, Australia
| | - Mei-Yi Lee
- NeuroSpine Surgery Research Group, Sydney, Australia,85120Hong Kong Polytechnic
University, Hong Kong
| | - Jack Kerferd
- NeuroSpine Surgery Research Group, Sydney, Australia,7800University of New South
Wales, Sydney, Australia
| | - Telvinderjit Singh
- NeuroSpine Surgery Research Group, Sydney, Australia,7800University of New South
Wales, Sydney, Australia
| | - Ralph J. Mobbs
- NeuroSpine Surgery Research Group, Sydney, Australia,7800University of New South
Wales, Sydney, Australia,NeuroSpineClinic, Sydney, Australia,Ralph J. Mobbs, NeuroSpineClinic, Suite 7,
Level 7, Prince of Wales Private Hospital, Randwick, New South Wales 2031,
Australia.
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Wang XF, Meng Y, Liu H, Hong Y, Wang BY. Surgical strategy used in multilevel cervical disc replacement and cervical hybrid surgery: Four case reports. World J Clin Cases 2020; 8:3890-3902. [PMID: 32953869 PMCID: PMC7479569 DOI: 10.12998/wjcc.v8.i17.3890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/18/2020] [Accepted: 07/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Multilevel artificial cervical disc replacement and anterior hybrid surgery have been introduced as reliable treatments for multilevel cervical degenerative disc disease. Surgical techniques are important for resolving patients’ symptoms and maintaining the normal functioning of cervical implants. However, the use of inappropriate surgical strategies could lead to complications such as implant migration and neurological deficit. In this paper, we summarize our surgical strategies used in multilevel cervical disc replacement and hybrid surgery into five major notes.
CASE SUMMARY We share the key notes and our surgical procedures in the form of four typical case presentations. All patients were diagnosed with cervical degenerative disc disease with myelopathy or radiculopathy and needed multilevel cervical spine surgery. The first case demonstrated that index levels indicating the presence of highly serious spinal cord compression required a prioritized decompression. The second case demonstrated that the disc replacement should be performed before fusion in cervical hybrid surgery. The third and forth cases demonstrated that a top-down implantation sequence was needed in continuous two-level cervical disc replacement. The symptoms of all patients were significantly relieved after surgery.
CONCLUSION We hope that our surgical strategies can help improve the performance and outcomes of multilevel cervical spine surgery.
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Affiliation(s)
- Xiao-Fei Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yang Meng
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hao Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ying Hong
- Department of Operation Room, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bei-Yu Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Ryu WHA, Platt A, Deutsch H. Hybrid decompression and reconstruction technique for cervical spondylotic myelopathy: case series and review of the literature. JOURNAL OF SPINE SURGERY 2020; 6:181-195. [PMID: 32309656 DOI: 10.21037/jss.2019.12.08] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The primary treatment of choice for patients with cervical spondylotic myelopathy (CSM) is surgical decompression. The benefit of operative intervention has been well established but, the surgeons' decision of operative approach remains nuanced based on patient-specific variables and surgeon preference. Decompression can involve a cervical corpectomy or a discectomy. A hybrid construct is when both a cervical corpectomy and a discectomy are done in the same patient. The purpose of this study was to review the evidence on the clinical and biomechanical outcomes of hybrid decompression and reconstruction techniques in patients with multilevel CSM. A retrospective study was performed on consecutive patients who received hybrid anterior decompression and reconstruction at Rush University between 2013-2018. Preoperative clinical and radiographic variables were analyzed to characterize specific factors leading to the decision of the surgical approach. In addition, we performed a systematic review and meta-analysis to assess superiority in terms of operative time, blood loss, cervical lordosis, patient-reported outcomes (PRO), fusion rates, and complications. Hybrid surgery (HS) was utilized in cases where multilevel CSM was present in conjunction with stenosis posterior to the vertebral body or acute kyphotic deformity. Our meta-analysis highlighted comparable PRO, complications, and rate of success fusion between 3-level anterior cervical discectomy and fusion (ACDF) and hybrid technique. Furthermore, hybrid fusion led to increased postoperative cervical lordosis, higher fusion rate, lower total complication rate, lower implant failure/mesh subsidence rate, and lower blood loss than 2-level corpectomy. The cervical hybrid technique that combines cervical corpectomy and discectomy represents a balanced option with the benefits of two commonly utilized cervical spine procedures in patients with multilevel CSM. The literature on hybrid technique suggests in cases where multilevel ACDF is not feasible, combining discectomy and corpectomy is superior to two-level corpectomy with lower complication rates, improved clinical outcome, spinal alignment correction, and stronger biomechanical properties.
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Affiliation(s)
- Won Hyung A Ryu
- Department of Neurological Surgery, Rush University, Chicago, IL, USA
| | - Andrew Platt
- Section of Neurosurgery, University of Chicago, Chicago, IL, USA
| | - Harel Deutsch
- Department of Neurological Surgery, Rush University, Chicago, IL, USA
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Hui N, Phan K, Kerferd J, Lee M, Mobbs RJ. Cervical Total Disc Replacement and Heterotopic Ossification: A Review of Literature Outcomes and Biomechanics. Asian Spine J 2020; 15:127-137. [PMID: 32050310 PMCID: PMC7904491 DOI: 10.31616/asj.2019.0234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/11/2019] [Indexed: 12/30/2022] Open
Abstract
Anterior cervical discectomy and fusion (ACDF) immobilizes surgical segments and can lead to the development of adjacent segment degeneration and adjacent segment disease. Thus, cervical total disc replacement (CTDR) has been developed with the aim to preserve the biomechanics of spine. However, heterotopic ossification (HO), a complication following CTDR, can reduce the segmental range of motion (ROM) and defects the motion-preservation benefit of CTDR. The pathological process of HO in CTDR remains unknown. HO has been suggested to be a self-defense mechanism in response to the non-physiological biomechanics of the cervical spine following CTDR. The current literature review is concerned with the association between the biomechanical factors and HO formation and the clinical significance of HO in CTDR. Endplate coverage, disc height, segmental angle, and center of rotation may be associated with the development of HO. The longer the follow-up, the higher the rate of ROM-limiting HO. Regardless of the loss of motion-preservation benefit of CTDR in patients with HO, CTDR confers patients with a motion-preservation period before the development of ROM-limiting HO. This may delay the development of adjacent segment degeneration compared with ACDF. Future clinical studies should explore the association between HO and changes in biomechanical factors of the cervical spine.
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Affiliation(s)
- Nicholas Hui
- NeuroSpine Surgery Research Group, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kevin Phan
- NeuroSpine Surgery Research Group, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Jack Kerferd
- NeuroSpine Surgery Research Group, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Meiyi Lee
- NeuroSpine Surgery Research Group, Sydney, Australia.,Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Ralph Jasper Mobbs
- NeuroSpine Surgery Research Group, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,NeuroSpineClinic, Sydney, Australia
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10
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Sun X, Sun S, Zhang T, Kong C, Wang W, Lu S. Biomechanical comparison of noncontiguous cervical disc arthroplasty and noncontiguous cervical discectomy and fusion in the treatment of noncontinuous cervical degenerative disc disease: a finite element analysis. J Orthop Surg Res 2020; 15:36. [PMID: 32005193 PMCID: PMC6995191 DOI: 10.1186/s13018-020-1549-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 01/07/2020] [Indexed: 12/29/2022] Open
Abstract
Background Biomechanical characteristics of noncontinuous ACDF and noncontinuous CDA in the treatment of noncontinuous cervical degenerative disc disease were still unclear. The aim of this research is to compare the differences between these two kinds of treatment methods and to verify the effectiveness of Prodisc-C in noncontinuous CDA. Methods Eight FEMs of the cervical spine (C2–C7) were built based on CT images of 8 mild CDDD volunteers. In the arthroplasty group, we inserted Prodisc-C at C3/4 and C5/6. In the fusion group, CoRoent® Contour and NuVasive® Helix ACP were implanted at C3/4 and C5/6. Initial loads of 75 N were used to simulate the head weight and muscle forces. The application of 1.0 N m moment on the top on the C2 vertebra was used to create motion in all directions. Statistical analyses were performed using STATA version 14.0 (Stata Corp LP, College Station, Texas, USA). Statistical significance was set at P < 0.05. Results The IDPs in C2/3 (P < 0.001, P = 0.005, P < 0.001, P < 0.001), C4/5 (P < 0.001), and C6/7 (P < 0.001) of the intact group were significantly less than that in the fusion group in flexion, extension, lateral bending, and axial rotation, respectively. In addition, the IDPs in C2/3 (P < 0.001, P = 0.001, P < 0.001, P < 0.001), C4/5 (P < 0.001), and C6/7 (P < 0.001) of the arthroplasty group were significantly less than that in the fusion group in flexion, extension, lateral bending, and axial rotation, respectively. Contact forces of facet joints in C2/3 (P = 0.010) in the arthroplasty group was significantly less than that in the intact group. Contact forces of facet joints in C2/3 (P < 0.001), C4/5 (P < 0.001), and C6/7 (P < 0.001) in the arthroplasty group was significantly less than that in the fusion group. Contact forces of facet joints in C2/3 (P < 0.001), C4/5 (P < 0.001), and C6/7 (P < 0.001) in the intact group were significantly less than that in the fusion group. Conclusions Noncontinuous CDA could preserve IDP and facet joint forces at the adjacent and intermediate levels to maintain the kinematics of cervical spine near preoperative values. However, noncontinuous ACDF would increase degenerative risks at adjacent and intermediate levels. In addition, the application of Prodisc-C in noncontinuous CAD may have more advantages than that of Prestige LP.
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Affiliation(s)
- Xiangyao Sun
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053, China. .,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China. .,Charité - Universitätsmedizin Berlin, Berlin, 113353, Germany.
| | - Siyuan Sun
- Department of Interdisciplinary Life Science, Purdue University, West Lafayette, IN, 47907, USA
| | - Tongtong Zhang
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China.,Department of Orthopaedics, ChuiYang Liu Hospital affiliated to Tsinghua University, Beijing, 100020, China
| | - Chao Kong
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Wei Wang
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Shibao Lu
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053, China. .,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China.
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Kerezoudis P, Alvi MA, Goyal A, Ubl DS, Meyer J, Habermann EB, Currier BL, Bydon M. Commentary: Utilization Trends of Cervical Disk Replacement in the United States. Oper Neurosurg (Hagerstown) 2019; 15:40-43. [PMID: 30060145 DOI: 10.1093/ons/opy181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/14/2018] [Indexed: 01/16/2023] Open
Affiliation(s)
- Panagiotis Kerezoudis
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohammed Ali Alvi
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anshit Goyal
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel S Ubl
- Surgical Outcomes Program, Robert and Patricia Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Jenna Meyer
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Elizabeth B Habermann
- Surgical Outcomes Program, Robert and Patricia Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | | | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Wu TK, Meng Y, Liu H, Wang BY, Hong Y, Rong X, Ding C, Chen H. Biomechanical effects on the intermediate segment of noncontiguous hybrid surgery with cervical disc arthroplasty and anterior cervical discectomy and fusion: a finite element analysis. Spine J 2019; 19:1254-1263. [PMID: 30742975 DOI: 10.1016/j.spinee.2019.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/02/2019] [Accepted: 02/05/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND CONTEXT Surgery for cervical degenerative disc disorder (CDDD) at two noncontiguous segments is infrequent. Few studies have explored the biomechanical effects on the intermediate adjacent segment of anterior cervical discectomy and fusion (ACDF) or cervical disc arthroplasty (CDA) in this situation. No study has examined biomechanical differences between ACDF and hybrid surgery (HS) constructs for noncontiguous CDDD. Differences in the biomechanical changes between the intermediate and adjacent segments are unknown. PURPOSE This study was conducted to compare the biomechanical changes resulting from noncontiguous ACDFs and HS. STUDY DESIGN A finite element analysis study. METHODS A finite element model of a healthy cervical spine (C2-C7) was constructed. Three surgical models were developed: (1) ACDF at C3/4 and C5/6 (FF), (2) ACDF at C3/4 and CDA at C5/6 (FA) and (3) CDA at C3/4 and ACDF at C5/6 (AF). A 75-N follower load with 1.0 N·m moments was applied to the top of the C2 vertebra in the intact model to simulate flexion, extension, lateral bending, and axial rotation. Surgical models achieved identical motion angles of the intact model in each direction following the displacement-control protocols. RESULTS The FF model required much higher moments than did the AF and FA models to achieve the same amount of motion. In the FF model, the motion contributions of the unfused segments were unevenly increased. The magnitude of the increased motion in the intermediate segment was larger than those in the supra- or infra-adjacent segments. The facet contact force (FCF) and intradiscal pressure (IDP) at the intermediate segment were also more susceptible to impact. In the FA and AF models, the motion contributions of the untreated levels were evenly changed, and the intermediate segment did not experience additive motion, FCF, or IDP. The segment adjacent to the level of ACDF had greater FCF and IDP than did the segment adjacent to the level of CDA in the two HS constructs. CONCLUSIONS HS constructs resulted in less altered biomechanics and kinematics of the untreated levels and showed no additive biomechanical effects on the intermediate segments compared with ACDF at noncontiguous levels. However, the effects were associated with the relative location of the ACDF and CDA levels. CLINICAL SIGNIFICANCE This study provides a biomechanical rationale for the use of HS to treat patients with noncontiguous CDDD.
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Affiliation(s)
- Ting-Kui Wu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Yang Meng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
| | - Bei-Yu Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Ying Hong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Xin Rong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Chen Ding
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Hua Chen
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
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Wu TK, Liu H, Meng Y, Wang BY. Reply to the letter to the Editor: Is the behavior of disc replacement adjacent to fusion affected by the location of the fused level in hybrid surgery? Spine J 2018; 18:2166. [PMID: 30545646 DOI: 10.1016/j.spinee.2018.06.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Ting-Kui Wu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Yang Meng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
| | - Bei-Yu Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China
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Wang KF, Duan S, Zhu ZQ, Liu HY, Liu CJ, Xu S. Clinical and Radiologic Features of 3 Reconstructive Procedures for the Surgical Management of Patients with Bilevel Cervical Degenerative Disc Disease at a Minimum Follow-Up Period of 5 Years: A Comparative Study. World Neurosurg 2018; 113:e70-e76. [PMID: 29408574 DOI: 10.1016/j.wneu.2018.01.157] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/19/2018] [Accepted: 01/20/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess the mid-long-term follow-up of the safety and efficacy of anterior cervical discectomy and fusion (ACDF), cervical artificial disc replacement (CADR) and hybrid surgery (HS) for bilevel cervical degenerative disc disease (cDDD). METHODS 77 patients who underwent ACDF, HS, and CADR were retrospectively reviewed. Clinical effects were evaluated based on Neck Disability Index (NDI), Visual Analog Scale (VAS), and Japanese Orthopedic Association (JOA) scores and the Odom criteria. Radiographic outcomes were evaluated, including cervical range of motion (ROM), ROM in the operative and adjacent segments, incidence of degeneration in the adjacent segments (ASD), and heterotopic ossification (HO). RESULTS NDI, VAS, and JOA scores significantly improved in all patients after surgery without significant differences between groups. The excellent-to-good ratio in the Odom scale was 28/30 for the HS group, 30/33 for the ACDF group, and 13/14 for the CADR group. No significant differences in clinical outcomes or complication were found between groups (P > 0.05). Furthermore, the HS and CADR groups had less decreased ROM in the cervical and operative segments and less compensatory ROM in adjacent segments (P < 0.05). By contrast, the ACDF group had decreased ROM in the cervical and operative segments and significantly increased ROM in adjacent segments (P < 0.05). Moreover, the incidence of ASD was higher in the ACDF group, but the difference was not statistically significant (P > 0.05). HO was found in 10 patients (33.3%) in the HS group and 5 patients (35.7%) in the CADR group. CONCLUSION HS was superior to ACDF with regard to equivalent clinical outcomes in the mid-long-term follow-up. Furthermore, HS was superior in the maintenance of ROM and had less impact on its adjacent segments. The efficacy of HS is similar to that of CADR.
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Affiliation(s)
- Kai-Feng Wang
- Department of Spine Surgery, Peking University People's Hospital, Beijing, China
| | - Shuo Duan
- Department of Spine Surgery, Peking University People's Hospital, Beijing, China
| | - Zhen-Qi Zhu
- Department of Spine Surgery, Peking University People's Hospital, Beijing, China.
| | - Hai-Ying Liu
- Department of Spine Surgery, Peking University People's Hospital, Beijing, China
| | - Chen-Jun Liu
- Department of Spine Surgery, Peking University People's Hospital, Beijing, China
| | - Shuai Xu
- Department of Spine Surgery, Peking University People's Hospital, Beijing, China
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