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Liu E, Persad ARL, Baron N, Fourney DR. Long-Term (>24 Months) Duration of Symptoms Negatively Impacts Patient-Reported Outcomes Following Anterior Cervical Discectomy and Fusion for Cervical Radiculopathy. Spine (Phila Pa 1976) 2024; 49:519-529. [PMID: 38084589 DOI: 10.1097/brs.0000000000004896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/22/2023] [Indexed: 03/28/2024]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To investigate the impact of long symptom duration (>24 mo) on patient self-reported outcomes for pain, function, and quality of life following anterior cervical discectomy and fusion (ACDF) for cervical radiculopathy. SUMMARY OF BACKGROUND DATA ACDF is an effective treatment to relieve the symptoms of cervical radiculopathy. However, there is no consensus on whether prolonged preoperative length of symptoms negatively impacts postoperative outcomes. METHODS This study included consecutive patients who underwent ACDF for cervical radiculopathy from May 1, 2012 to Dec 1, 2019 by a single surgeon. Patients were stratified by short (<24 mo) and long (>24 mo) duration of symptoms. Outcomes including visual analog scale (VAS) neck and arm, neck disability index (NDI), EuroQol-5D (EQ-5D), and overall state of health (EQ-VAS) were compared between cohort both for absolute values and percentage of patients achieving minimal clinically important difference. RESULTS A total of 111 consecutive patients were included in our study, including 59 patients in the short symptom duration group and 52 patients in the long symptom duration group. The mean age of the patients was 51.4±9.4 and 41 (36.9%) were female. The baseline VAS neck and arm, NDI, EQ-5D, and EQ-VAS were similar between groups. Patients in both long and short symptom duration groups had clinical improvement following surgery. However, patients with short symptom duration had better VAS Neck and EQ-5D outcomes, and were more likely to meet minimal clinically important difference for NDI, EQ-5D, or any outcome. Multivariate analysis confirmed symptom duration <24 months as an independent predictor for better patient-reported outcomes. CONCLUSION We appreciated better clinical outcomes in patients with shorter symptom duration who received ACDF for cervical radiculopathy. On the basis of this data, we advocate for prompt treatment of cervical radiculopathy to avoid the potential for long-term impairment. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Eva Liu
- Department of Neurosurgery, University of Saskatchewan, Saskatchewan, Canada
| | - Amit R L Persad
- Department of Neurosurgery, Stanford University, Stanford, CA
| | - Nathan Baron
- Department of Radiology, University of Saskatchewan, Saskatchewan, Canada
| | - Daryl R Fourney
- Department of Neurosurgery, University of Saskatchewan, Saskatchewan, Canada
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Choi JHK, Birring PS, Lee J, Hashmi SZ, Bhatia NN, Lee YP. A Comparison of Short-Term Outcomes after Surgical Treatment of Multilevel Degenerative Cervical Myelopathy in the Geriatric Patient Population: An Analysis of the National Surgical Quality Improvement Program Database 2010-2020. Asian Spine J 2024; 18:190-199. [PMID: 38454750 PMCID: PMC11065519 DOI: 10.31616/asj.2023.0276] [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: 08/25/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 03/09/2024] Open
Abstract
STUDY DESIGN Retrospective review of the American College of Surgeons-National Surgical Quality Improvement Program database from 2010 to 2020. PURPOSE To compare the short-term complication rates of anterior cervical decompression and fusion (ACDF), posterior cervical laminoplasty (LP), and posterior cervical laminectomy and fusion (PCF) in a geriatric population. OVERVIEW OF LITERATURE The geriatric population in the United States has increased significantly. Degenerative cervical myelopathy (DCM) is caused by cervical spinal stenosis, and its prevalence increases with age. Therefore, the incidence of multilevel DCM requiring surgical intervention is likely to increase. ACDF, LP, and PCF are the most commonly used surgical techniques for treating multilevel DCM. However, there is uncertainty regarding the optimal surgical technique for the decompression of DCM in geriatric patients. METHODS Patients aged 65 years who had undergone either multilevel ACDF, LP, or PCF for the treatment of DCM were analyzed. Additional analysis was performed by standardizing the data for the American Society of Anesthesiologists classification scores and preoperative functional status. RESULTS A total of 23,129 patients were identified. Patients with ACDF were younger, more often female, and preoperatively healthier than those in the other two groups. The estimated postoperative mortality and morbidity, mean operation time, and length of hospital stay were the lowest for ACDF, second lowest for LP, and highest for PCF. The readmission and reoperation rates were comparable between ACDF and LP; however, both were significantly lower than PCF. CONCLUSIONS PCF is associated with the highest risk of mortality, morbidity, unplanned reoperation, and unplanned readmission in the short-term postoperative period in patients aged 65 years. In contrast, ACDF carries the lowest risk. However, some disease-specific factors may require posterior treatment. For these cases, LP should be included in the preoperative discussion when determining the ideal surgical approach for geriatric patients.
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Affiliation(s)
| | | | - Joshua Lee
- Department of Orthopaedic Surgery, University of California Irvine, Irvine, CA, USA
| | - Sohaib Zafar Hashmi
- Department of Orthopaedic Surgery, University of California Irvine, Irvine, CA, USA
| | - Nitin Narain Bhatia
- Department of Orthopaedic Surgery, University of California Irvine, Irvine, CA, USA
| | - Yu-Po Lee
- Department of Orthopaedic Surgery, University of California Irvine, Irvine, CA, USA
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Elsamadicy AA, Sayeed S, Sherman JJZ, Craft S, Reeves BC, Hengartner AC, Koo AB, Larry Lo SF, Shin JH, Mendel E, Sciubba DM. Racial/Ethnic Disparities Among Patients Undergoing Anterior Cervical Discectomy and Fusion or Posterior Cervical Decompression and Fusion for Cervical Spondylotic Myelopathy: A National Administrative Database Analysis. World Neurosurg 2024; 183:e372-e385. [PMID: 38145651 DOI: 10.1016/j.wneu.2023.12.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION The aim of this study was to investigate the impact of racial disparities on surgical outcomes for cervical spondylotic myelopathy (CSM). METHODS Adult patients undergoing anterior cervical discectomy and fusion (ACDF) or posterior cervical decompression and fusion (PCDF) for CSM were identified from the 2016 to 019 National Inpatient Sample Database using the International Classification of Diseases codes. Patients were categorized based on approach (ACDF or PCDF) and race/ethnicity (White, Black, Hispanic). Patient demographics, comorbidities, operative characteristics, adverse events, and health care resource utilization were assessed. Multivariate logistic regression analyses were used to identify independent predictors of extended length of stay (LOS), nonroutine discharge (NRD), and exorbitant costs. RESULTS A total of 46,500 patients were identified, of which 36,015 (77.5%) were White, 7465 (16.0%) were Black, and 3020 (6.5%) were Hispanic. Black and Hispanic patients had a greater comorbidity burden compared to White patients (P = 0.001) and a greater incidence of any postoperative complication (P = 0.001). Healthcare resource utilization were greater in the PCDF cohort than the ACDF cohort and greater in Black and Hispanic patients compared to White patients (P < 0.001). Black and Hispanic patient race were significantly associated with extended hospital LOS ([Black] odds ratio [OR]: 2.24, P < 0.001; [Hispanic] OR: 1.64, P < 0.001) and NRD ([Black] OR: 2.33, P < 0.001; [Hispanic] OR: 1.49, P = 0.016). Among patients who underwent PCDF, Black race was independently associated with extended hospital LOS ([Black] OR: 1.77, P < 0.001; [Hispanic] OR: 1.47, P = 0.167) and NRD ([Black] OR: 1.82, P < 0.001; [Hispanic] OR: 1.38, P = 0.052). CONCLUSIONS Our study suggests that patient race may influence patient outcomes and healthcare resource utilization following ACDF or PCDF for CSM.
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Affiliation(s)
- Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
| | - Sumaiya Sayeed
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Josiah J Z Sherman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Samuel Craft
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Benjamin C Reeves
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Astrid C Hengartner
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andrew B Koo
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ehud Mendel
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
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Partha Sarathi CI, Sinha A, Rafati Fard A, Bhatti F, Rujeedawa T, Ahmed S, Akhbari M, Bhatti A, Nouri A, Kotter MR, Davies BM, Mowforth OD. The significance of metabolic disease in degenerative cervical myelopathy: a systematic review. Front Neurol 2024; 15:1301003. [PMID: 38375465 PMCID: PMC10876002 DOI: 10.3389/fneur.2024.1301003] [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: 09/23/2023] [Accepted: 01/09/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction Degenerative cervical myelopathy (DCM) is a form of chronic spinal cord injury, with a natural history of potential for progression over time. Whilst driven by mechanical stress on the spinal cord from degenerative and congenital pathology, the neurological phenotype of DCM is likely to be modified by multiple systemic factors. The role of metabolic factors is therefore of interest, particularly given that ischaemia is considered a key pathological mechanism of spinal cord injury. The objective was therefore to synthesise current evidence on the effect of metabolism on DCM susceptibility, severity, and surgical outcomes. Methods A systematic review in MEDLINE and Embase was conducted following PRISMA guidelines. Full-text papers in English, with a focus on DCM and metabolism, including diabetes, cardiovascular disease, anaemia, and lipid profile, were eligible for inclusion. Risk of methodological bias was assessed using the Joanna Briggs Institute (JBI) critical assessment tools. Quality assessments were performed using the GRADE assessment tool. Patient demographics, metabolic factors and the relationships between metabolism and spinal cord disease, spinal column disease and post-operative outcomes were assessed. Results In total, 8,523 papers were identified, of which 57 met criteria for inclusion in the final analysis. A total of 91% (52/57) of included papers assessed the effects of diabetes in relation to DCM, of which 85% (44/52) reported an association with poor surgical outcomes; 42% of papers (24/57) discussed the association between cardiovascular health and DCM, of which 88% (21/24) reported a significant association. Overall, DCM patients with diabetes or cardiovascular disease experienced greater perioperative morbidity and poorer neurological recovery. They were also more likely to have comorbidities such as obesity and hyperlipidaemia. Conclusion Metabolic factors appear to be associated with surgical outcomes in DCM. However, evidence for a more specific role in DCM susceptibility and severity is uncertain. The pathophysiology and natural history of DCM are critical research priorities; the role of metabolism is therefore a key area for future research focus. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42021268814.
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Affiliation(s)
- Celine Iswarya Partha Sarathi
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Amil Sinha
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Amir Rafati Fard
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Faheem Bhatti
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Tanzil Rujeedawa
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Shahzaib Ahmed
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Melika Akhbari
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Aniqah Bhatti
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Aria Nouri
- Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Mark R. Kotter
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Benjamin M. Davies
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Oliver D. Mowforth
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
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Evaniew N, Bailey CS, Rampersaud YR, Jacobs WB, Phan P, Nataraj A, Cadotte DW, Weber MH, Thomas KC, Manson N, Attabib N, Paquet J, Christie SD, Wilson JR, Hall H, Fisher CG, McIntosh G, Dea N. Anterior vs Posterior Surgery for Patients With Degenerative Cervical Myelopathy: An Observational Study From the Canadian Spine Outcomes and Research Network. Neurosurgery 2024:00006123-990000000-01041. [PMID: 38305343 DOI: 10.1227/neu.0000000000002842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/29/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The advantages and disadvantages of anterior vs posterior surgical approaches for patients with progressive degenerative cervical myelopathy (DCM) remain uncertain. Our primary objective was to evaluate patient-reported disability at 1 year after surgery. Our secondary objectives were to evaluate differences in patient profiles selected for each approach in routine clinical practice and to compare neurological function, neck and arm pain, health-related quality of life, adverse events, and rates of reoperations. METHODS We analyzed data from patients with DCM who were enrolled in an ongoing multicenter prospective observational cohort study. We controlled for differences in baseline characteristics and numbers of spinal levels treated using multivariable logistic regression. Adverse events were collected according to the Spinal Adverse Events Severity protocol. RESULTS Among 559 patients, 261 (47%) underwent anterior surgery while 298 (53%) underwent posterior surgery. Patients treated posteriorly had significantly worse DCM severity and a greater number of vertebral levels involved. After adjusting for confounders, there was no significant difference between approaches for odds of achieving the minimum clinically important difference for the Neck Disability Index (odds ratio 1.23, 95% CI 0.82 to 1.86, P = .31). There was also no significant difference for change in modified Japanese Orthopedic Association scores, and differences in neck and arm pain and health-related quality of life did not exceed minimum clinically important differences. Patients treated anteriorly experienced greater rates of dysphagia, whereas patients treated posteriorly experienced greater rates of wound complications, neurological complications, and reoperations. CONCLUSION Patients selected for posterior surgery had worse DCM and a greater number of vertebral levels involved. Despite this, anterior and posterior surgeries were associated with similar improvements in disability, neurological function, pain, and quality of life. Anterior surgery had a more favorable profile of adverse events, which suggests it might be a preferred option when feasible.
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Affiliation(s)
- Nathan Evaniew
- University of Calgary Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - Christopher S Bailey
- London Health Science Centre Combined Orthopaedic and Neurosurgery Spine Program, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Y Raja Rampersaud
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - W Bradley Jacobs
- University of Calgary Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - Philippe Phan
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew Nataraj
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - David W Cadotte
- University of Calgary Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - Michael H Weber
- Division of Orthopaedics, McGill University, Montreal, Quebec, Canada
| | - Kenneth C Thomas
- University of Calgary Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - Neil Manson
- Canada East Spine Centre, Saint John, New Brunswick, Canada
| | | | - Jerome Paquet
- Department of Orthopaedics, Centre Hospitalier, Universitaire de Quebec, Quebec, Quebec, Canada
| | - Sean D Christie
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Hamilton Hall
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Charles G Fisher
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Nicolas Dea
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
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Elsamadicy AA, Sayeed S, Sherman JJZ, Craft S, Reeves BC, Lo SFL, Shin JH, Sciubba DM. Impact of Preoperative Frailty on Outcomes in Patients with Cervical Spondylotic Myelopathy Undergoing Anterior vs. Posterior Cervical Surgery. J Clin Med 2023; 13:114. [PMID: 38202121 PMCID: PMC10779741 DOI: 10.3390/jcm13010114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/15/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
Introduction: Frailty has been shown to negatively influence patient outcomes across many disease processes, including in the cervical spondylotic myelopathy (CSM) population. The aim of this study was to assess the impact that frailty has on patients with CSM who undergo anterior cervical discectomy and fusion (ACDF) or posterior cervical decompression and fusion (PCDF). Materials and Methods: A retrospective cohort study was performed using the 2016-2019 national inpatient sample. Adult patients (≥18 years old) undergoing ACDF only or PCDF only for CSM were identified using ICD codes. The patients were categorized based on receipt of ACDF or PCDF and pre-operative frailty status using the 11-item modified frailty index (mFI-11): pre-Frail (mFI = 1), frail (mFI = 2), or severely frail (mFI ≥ 3). Patient demographics, comorbidities, operative characteristics, perioperative adverse events (AEs), and healthcare resource utilization were assessed. Multivariate logistic regression analyses were used to identify independent predictors of extended length of stay (LOS) and non-routine discharge (NRD). Results: A total of 37,990 patients were identified, of which 16,665 (43.9%) were in the pre-frail cohort, 12,985 (34.2%) were in the frail cohort, and 8340 (22.0%) were in the severely frail cohort. The prevalence of many comorbidities varied significantly between frailty cohorts. Across all three frailty cohorts, the incidence of AEs was greater in patients who underwent PCDF, with dysphagia being significantly more common in patients who underwent ACDF. Additionally, the rate of adverse events significantly increased between ACDF and PCDF with respect to increasing frailty (p < 0.001). Regarding healthcare resource utilization, LOS and rate of NRD were significantly greater in patients who underwent PCDF in all three frailty cohorts, with these metrics increasing with frailty in both ACDF and PCDF cohorts (LOS: p < 0.001); NRD: p < 0.001). On a multivariate analysis of patients who underwent ACDF, frailty and severe frailty were found to be independent predictors of extended LOS [(frail) OR: 1.39, p < 0.001; (severely frail) OR: 2.25, p < 0.001] and NRD [(frail) OR: 1.49, p < 0.001; (severely frail) OR: 2.22, p < 0.001]. Similarly, in patients who underwent PCDF, frailty and severe frailty were found to be independent predictors of extended LOS [(frail) OR: 1.58, p < 0.001; (severely frail) OR: 2.45, p < 0.001] and NRD [(frail) OR: 1.55, p < 0.001; (severely frail) OR: 1.63, p < 0.001]. Conclusions: Our study suggests that preoperative frailty may impact outcomes after surgical treatment for CSM, with more frail patients having greater health care utilization and a higher rate of adverse events. The patients undergoing PCDF ensued increased health care utilization, compared to ACDF, whereas severely frail patients undergoing PCDF tended to have the longest length of stay and highest rate of non-routine discharge. Additional prospective studies are necessary to directly compare ACDF and PCDF in frail patients with CSM.
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Affiliation(s)
- Aladine A. Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Sumaiya Sayeed
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Josiah J. Z. Sherman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Samuel Craft
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Benjamin C. Reeves
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center, North Shore University Hospital, Northwell Health, Manhasset, NY 11030, USA
| | - John H. Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Daniel M. Sciubba
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center, North Shore University Hospital, Northwell Health, Manhasset, NY 11030, USA
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Saunders LM, Sandhu HS, McBride L, Maniarasu VS, Taylor S, Dhokia R. A Retrospective Study of Degenerative Cervical Myelopathy and the Surgical Management Within Northern Ireland. Cureus 2023; 15:e49513. [PMID: 38024056 PMCID: PMC10681795 DOI: 10.7759/cureus.49513] [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] [Accepted: 11/27/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Degenerative cervical myelopathy (DCM) is a condition of growing concern due to its increasing incidence among the ageing population. It involves age-associated pathological changes of the cervical spine that can result in spinal cord compression. This can lead to deficits in motor and sensory function of the upper and lower limbs, issues with balance and dexterity, as well as bladder and bowel disturbance. Patients can be categorised as having mild, moderate, or severe degenerative cervical myelopathy depending on their modified Japanese Orthopaedic Association (mJOA) score. This condition is generally managed surgically; however, patients with mild degenerative cervical myelopathy may be offered or opt for non-surgical treatment initially. AIMS The main aim of this study is to evaluate the surgical management of patients with DCM and to ascertain the degree of mJOA improvement from pre-surgery and one-year post-surgery follow-up. The second aim of the study is to explore the demographics within Northern Ireland who are diagnosed with DCM and who undergo surgery. This information could allow for better planning of services in the future for this patient cohort. METHODS This is a retrospective review of the surgical management of degenerative cervical myelopathy within the Regional Spinal Orthopaedic Unit in Northern Ireland over three years with one-year follow-up. The data was retrospectively collected from the Fracture Outcome Research Database. A total of 102 patients (10:7, male:female) with DCM were retrospectively evaluated. Exclusion criteria included all patients diagnosed with spinal tumour, fracture, central cord syndrome, and dislocation. Two patients were removed due to incorrect coding of DCM diagnosis and were not included. Key variables assessed were gender, age, symptoms, type of surgery, complications, and MRC score and mJOA score pre-surgery, 48 hours, six months, and one year post surgery. The choice of surgery was guided by the maximal angle of compression, the number of vertebral levels involved, patient comorbidities, and anesthetic risk. RESULTS The sample consisted of 60 men (58.82%) and 42 women (41.17%) with an average age of 57.17 ± 12.13 years ranging from 27 to 83 years old. Statistical analysis was conducted to explore the effect of time before and after surgery up to one year on the mJOA score. There was a significant difference in mJOA score pre-surgery and at six months and one year post surgery (R = 0.579053, p <0.001). Of the patients, 61.8% with a length of stay greater than three days and 71.4% of patients with a length of stay greater than seven days had a posterior approach surgery. A multiple linear regression analysis revealed that the mJOA score pre-surgery and the presence of complications significantly predicted the length of stay post-surgery (β -1.044, p = .011 and β -5.791, p = .028). CONCLUSION The first key finding of this study is that the mJOA score tends to improve after surgery for the majority of patients, particularly at six months, which is consistent with the literature. The second key finding is that anterior approach surgery is associated with a lower rate of complications and shorter post-surgery length of stay in hospital compared to posterior approach surgery. The third key finding is that the pre-surgery mJOA score and the presence of complications post surgery significantly predict the post-surgery length of stay.
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Affiliation(s)
- Laura M Saunders
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | - Hushil S Sandhu
- Department of Trauma and Orthopaedics, Royal Victoria Hospital, Belfast, GBR
| | - Lorcán McBride
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | | | - Samantha Taylor
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | - Rakesh Dhokia
- Department of Trauma and Orthopaedics, Royal Victoria Hospital, Belfast, GBR
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8
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Sangeorzan I, Antonacci G, Martin A, Grodzinski B, Zipser CM, Murphy RKJ, Andriopoulou P, Cook CE, Anderson DB, Guest J, Furlan JC, Kotter MRN, Boerger TF, Sadler I, Roberts EA, Wood H, Fraser C, Fehlings MG, Kumar V, Jung J, Milligan J, Nouri A, Martin AR, Blizzard T, Vialle LR, Tetreault L, Kalsi-Ryan S, MacDowall A, Martin-Moore E, Burwood M, Wood L, Lalkhen A, Ito M, Wilson N, Treanor C, Dugan S, Davies BM. Toward Shared Decision-Making in Degenerative Cervical Myelopathy: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e46809. [PMID: 37812472 PMCID: PMC10594151 DOI: 10.2196/46809] [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: 03/09/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Health care decisions are a critical determinant in the evolution of chronic illness. In shared decision-making (SDM), patients and clinicians work collaboratively to reach evidence-based health decisions that align with individual circumstances, values, and preferences. This personalized approach to clinical care likely has substantial benefits in the oversight of degenerative cervical myelopathy (DCM), a type of nontraumatic spinal cord injury. Its chronicity, heterogeneous clinical presentation, complex management, and variable disease course engenders an imperative for a patient-centric approach that accounts for each patient's unique needs and priorities. Inadequate patient knowledge about the condition and an incomplete understanding of the critical decision points that arise during the course of care currently hinder the fruitful participation of health care providers and patients in SDM. This study protocol presents the rationale for deploying SDM for DCM and delineates the groundwork required to achieve this. OBJECTIVE The study's primary outcome is the development of a comprehensive checklist to be implemented upon diagnosis that provides patients with essential information necessary to support their informed decision-making. This is known as a core information set (CIS). The secondary outcome is the creation of a detailed process map that provides a diagrammatic representation of the global care workflows and cognitive processes involved in DCM care. Characterizing the critical decision points along a patient's journey will allow for an effective exploration of SDM tools for routine clinical practice to enhance patient-centered care and improve clinical outcomes. METHODS Both CISs and process maps are coproduced iteratively through a collaborative process involving the input and consensus of key stakeholders. This will be facilitated by Myelopathy.org, a global DCM charity, through its Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy community. To develop the CIS, a 3-round, web-based Delphi process will be used, starting with a baseline list of information items derived from a recent scoping review of educational materials in DCM, patient interviews, and a qualitative survey of professionals. A priori criteria for achieving consensus are specified. The process map will be developed iteratively using semistructured interviews with patients and professionals and validated by key stakeholders. RESULTS Recruitment for the Delphi consensus study began in April 2023. The pilot-testing of process map interview participants started simultaneously, with the formulation of an initial baseline map underway. CONCLUSIONS This protocol marks the first attempt to provide a starting point for investigating SDM in DCM. The primary work centers on developing an educational tool for use in diagnosis to enable enhanced onward decision-making. The wider objective is to aid stakeholders in developing SDM tools by identifying critical decision junctures in DCM care. Through these approaches, we aim to provide an exhaustive launchpad for formulating SDM tools in the wider DCM community. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46809.
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Affiliation(s)
| | - Grazia Antonacci
- Department of Primary Care and Public Health, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, Imperial College London, London, United Kingdom
- Centre for Health Economics and Policy Innovation (CHEPI), Business School, Imperial College London, London, United Kingdom
| | - Anne Martin
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, United Kingdom
| | - Ben Grodzinski
- University Hospitals Sussex, NHS Foundation Trust, Brighton, United Kingdom
| | - Carl M Zipser
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Rory K J Murphy
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Panoraia Andriopoulou
- Psychology Department, School of Social Sciences, University of Ioannina, Ioannina, Greece
| | - Chad E Cook
- Division of Physical Therapy, School of Medicine, Duke University, Durham, CA, United States
- Department of Orthopaedics, School of Medicine, Duke University, Durham, CA, United States
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, CA, United States
- Duke Clinical Research Institute, Duke University, Durham, CA, United States
| | - David B Anderson
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - James Guest
- The Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Julio C Furlan
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Mark R N Kotter
- Myelopathy.org, Cambridge, United Kingdom
- Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Timothy F Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | | | | | - Helen Wood
- Myelopathy.org, Cambridge, United Kingdom
| | - Christine Fraser
- Department of Health Sciences, University of Stirling, Scotland, United Kingdom
- Physiotherapy Department, National Health Service Lothian, Edinburgh, United Kingdom
| | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Vishal Kumar
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Orthopaedics, All India Institute of Medical Sciences, Deoghar, India
| | - Josephine Jung
- Institute of Psychiatry, Psychology & Neuroscience, King's College, London, United Kingdom
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - James Milligan
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Aria Nouri
- Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Allan R Martin
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States
| | | | - Luiz Roberto Vialle
- School of Medicine, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Lindsay Tetreault
- Department of Neurology, New York University, New York, NY, United States
| | - Sukhvinder Kalsi-Ryan
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Anna MacDowall
- Department of Surgical Sciences, Uppsala University and Department of Orthopaedics, The Academic Hospital of Uppsala, Uppsala, Sweden
| | | | | | - Lianne Wood
- Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
- NeuroSpinal Assessment Unit, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Abdul Lalkhen
- Northern Care Alliance, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Manabu Ito
- Department of Orthopaedic Surgery, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Nicky Wilson
- Physiotherapy Department, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Caroline Treanor
- Department of Physiotherapy, Beaumont Hospital, Dublin, Ireland
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Benjamin M Davies
- Myelopathy.org, Cambridge, United Kingdom
- Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
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9
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Naghdi N, Elliott JM, Weber MH, Fehlings MG, Fortin M. Cervical muscle morphometry and composition demonstrate prognostic value in degenerative cervical myelopathy outcomes. Front Neurol 2023; 14:1209475. [PMID: 37745653 PMCID: PMC10512835 DOI: 10.3389/fneur.2023.1209475] [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: 04/21/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Objectives This study aimed to examine whether preoperative cervical muscle size, composition, and asymmetry from magnetic resonance imaging (MRI) can predict post-operative outcomes in patients with degenerative cervical myelopathy (DCM). Methods A total of 171 patients with DCM were included. Relative total cross-sectional area (RCSA), functional CSA (fat-free area, FCSA), ratio of FCSA/CSA (fatty infiltration) and asymmetry of the multifidus (MF) and semispinalis cervicis (SCer) together (MF + SCer), and cervical muscle as a group (MF, SCer, semispinalis capitis, and splenius capitis) were obtained from T2-weighted axial MR images at the mid-disk, at the level of maximum cord compression and the level below. Univariate and multivariate linear regression analyses were used to assess the relationship between baseline cervical muscle measurements of interest with the modified Japanese Orthopedic Association (mJOA), Nurick Classification, Neck Disability Index (NDI), and SF-36 health survey at 6-month and 12-month post-surgery. Results Lower RCSA of MF + SCer, less CSA MF + SCer asymmetry and greater FCSA/CSA for the cervical muscle group (e.g., less fatty infiltration), and younger age were significant predictors of higher mJOA scores (e.g., less disability) at 6-month and 12-month post-surgery (all p < 0.05). Greater CSA asymmetry in MF + SCer and lower FCSA/CSA (e.g., more fatty infiltration) for the cervical muscle group were significant predictors of higher Nurick scores (e.g., more disability) at 6-month and 12-month post-surgery (all p < 0.05). Lower FCSA MF + Scer asymmetry, lower FCSA/CSA asymmetry of the muscle group, and greater RCSA MF + SCer were significant predictors of higher NDI scores at 6-month and 12-month post-surgery. Finally, greater FCSA/CSA asymmetry of the MF + SCer, greater FCSA asymmetry of the muscle group, greater RCSA of the muscle group, and greater CSA asymmetry of MF + SCer were significant predictors of lower post-operative SF-36 scores at 6- and 12-month post-surgery. Conclusion Our result suggested that cervical paraspinal muscle morphology, specifically greater asymmetry, and fatty infiltration may be important predictors of functional recovery and post-surgical outcomes in patients with DCM.
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Affiliation(s)
- Neda Naghdi
- Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, QC, Canada
| | - James M. Elliott
- The Kolling Institute, The University of Sydney, Sydney, NSW, Australia
- The Northern Sydney Local Health District, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Michael H. Weber
- Montreal General Hospital Site, Department of Orthopedic Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Michael G. Fehlings
- Department of Neurosurgery and Spinal Program, University of Toronto, Toronto, ON, Canada
| | - Maryse Fortin
- Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, QC, Canada
- PERFORM Centre, Concordia University, Montreal, QC, Canada
- Centre de Recherche Interdisciplinaire en Readaptation (CRIR), Montreal, QC, Canada
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10
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Liang Z, Xu G, Liu T, Zhong Y, Mo F, Li Z. Quantitatively biomechanical response analysis of posterior musculature reconstruction in cervical single-door laminoplasty. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 233:107479. [PMID: 36933316 DOI: 10.1016/j.cmpb.2023.107479] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/01/2023] [Accepted: 03/10/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND AND OBJECTIVE The current trend of laminoplasty is developing toward the goal of muscle preservation and minimum tissue damage. Given this, muscle-preserving techniques in cervical single-door laminoplasty have been modified with protecting the spinous processes at the sites of C2 and/or C7 muscle attachment and reconstruct the posterior musculature in recent years. To date, no study has reported the effect of preserving the posterior musculature during the reconstruction. The purpose of this study is to quantitatively evaluate the biomechanical effect of multiple modified single-door laminoplasty procedures for restoring stability and reducing response level on the cervical spine. METHODS Different cervical laminoplasty models were established for evaluating kinematics and response simulations based on a detailed finite element (FE) head-neck active model (HNAM), including ① C3 - C7 laminoplasty (LP_C37), ② C3 - C6 laminoplasty with C7 spinous process preservation (LP_C36), ③ C3 laminectomy hybrid decompression with C4 - C6 laminoplasty (LT_C3 + LP_C46) and ④ C3 - C7 laminoplasty with unilateral musculature preservation (LP_C37 + UMP). The laminoplasty model was validated by the global range of motion (ROM) and percentage changes relative to the intact state. The C2 - T1 ROM, axial muscle tensile force, and stress/strain levels of functional spinal units were compared among the different laminoplasty groups. The obtained effects were further analysed by comparison with a review of clinical data on cervical laminoplasty scenarios. RESULTS Analysis of the locations of concentration of muscle load showed that the C2 muscle attachment sustained more tensile loading than the C7 muscle attachment, primarily in flexion-extension (FE) and in lateral bending (LB) and axial rotation (AR), respectively. Simulated results further quantified that LP_C36 primarily produced 10% decreases in LB and AR modes relative to LP_C37. Compared with LP_C36, LT_C3 + LP_C46 resulted in approximately 30% decreases in FE motion; LP C37 + UMP also showed a similar trend. Additionally, when compared to LP_C37, LT_C3 + LP_C46 and LP C37 + UMP reduced the peak stress level at the intervertebral disc by at most 2-fold as well as the peak strain level of the facet joint capsule by 2-3-fold. All these findings were well correlated with the result of clinical studies comparing modified laminoplasty and classic laminoplasty. CONCLUSIONS Modified muscle-preserving laminoplasty is superior to classic laminoplasty due to the biomechanical effect of the posterior musculature reconstruction, with a retained postoperative ROM and loading response levels of the functional spinal units. More motion-sparing is beneficial for increasing cervical stability, which probably accelerates the recovery of postoperative neck movement and reduces the risk of the complication for eventual kyphosis and axial pain. Surgeons are encouraged to make every effort to preserve the attachment of the C2 whenever feasible in laminoplasty.
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Affiliation(s)
- Z Liang
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China; College of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan 410082, China
| | - G Xu
- Department of Orthopedics, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Guangzhou University of Chinese Medicine, Shenzhen 518000, China
| | - T Liu
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Y Zhong
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi 530023, China
| | - F Mo
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan 410082, China.
| | - Z Li
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi 530023, China.
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11
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Prost S, Farah K, Toquart A, Mansouri N, Blondel B, Fuentes S. Contribution of dynamic cervical MRI to surgical planning for degenerative cervical myelopathy: Revision rate and clinical outcomes at 5 years' postoperative. Orthop Traumatol Surg Res 2023; 109:103440. [PMID: 36228966 DOI: 10.1016/j.otsr.2022.103440] [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: 11/24/2020] [Revised: 11/08/2021] [Accepted: 01/31/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Cervical MRI is the gold standard for surgical planning of degenerative cervical myelopathy; however, the symptomatic postoperative recurrence rate is high in the medium and long terms (9.1% to 10.7%) and may bring into question the quality of the preoperative surgical plan. The objective of this study was to evaluate cervical spinal stenosis and intramedullary hyperintensity with dynamic cervical MRI to determine the recurrence rate and clinical improvement in a cohort of patients who had dynamic cervical MRI incorporated into their surgical plan. METHODS This was a prospective, single-center study. Upon enrolment and at each follow-up visit, patients completed the mJOA score, NDI, cervical pain on visual analog scale (VAS) and radicular pain on VAS. Every enrolled patient underwent dynamic cervical MRI (in neutral, flexion and extension positions). Five levels were measured in the three positions, resulting in 915 levels for analysis. RESULTS Sixty-one patients were included. Eighty-four levels had an intramedullary hyperintensity in neutral position, 93 in extension and 112 in flexion. The mean sagittal diameter varied the most at C4-C5, going from 7.13mm (SD 2.32) on average in neutral to 6.30mm (SD 2.22) in extension and 8.29mm (SD 2.10) in flexion, a variation of -12% and +16%, respectively. A Mühle grade≥2 was found in 134 levels in neutral position versus 189 in extension and 110 in flexion. None of the patients had worse neurological symptoms following the dynamic cervical MRI. The mean postoperative follow-up was 4.4 years (SD 0.88). Two patients (3.1%) required surgical revision because the implants had shifted. One patient developed symptomatic adjacent segment disease. CONCLUSION Preoperative surgical planning that incorporates dynamic cervical MRI before the surgical treatment of degenerative cervical myelopathy appears to be a safe and reliable method and one that helps reduce symptoms in the long term. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Solène Prost
- Aix-Marseille université, AP-HM, CNRS, ISM, CHU Timone, unité de chirurgie rachidienne, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Kaissar Farah
- Aix-Marseille université, AP-HM, CNRS, ISM, CHU Timone, unité de chirurgie rachidienne, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Aurélie Toquart
- Centre chirurgical ADR - Médipôle Gentilly, 6, rue Colette, 54000 Nancy, France
| | - Nacer Mansouri
- CHRU Nancy, service de neurochirurgie, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - Benjamin Blondel
- Aix-Marseille université, AP-HM, CNRS, ISM, CHU Timone, unité de chirurgie rachidienne, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Stéphane Fuentes
- Aix-Marseille université, AP-HM, CNRS, ISM, CHU Timone, unité de chirurgie rachidienne, 264, rue Saint-Pierre, 13005 Marseille, France.
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12
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Mesregah MK, Formanek B, Liu JC, Buser Z, Wang JC. Perioperative Complications of Surgery for Degenerative Cervical Myelopathy: A Comparison Between 3 Procedures. Global Spine J 2023; 13:432-442. [PMID: 33709809 PMCID: PMC9972283 DOI: 10.1177/2192568221998306] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVES To compare the perioperative complications of propensity score-matched cohorts of patients with degenerative cervical myelopathy (DCM), who were treated with anterior cervical discectomy and fusion (ACDF), posterior laminectomy with fusion, or laminoplasty. METHODS The Humana PearlDiver Patient Record Database was queried using the International Classification of Diseases (ICD-9 and ICD-10) and the Current Procedural Terminology (CPT) codes. Propensity score-matched analysis was done using multiple Chi-squared tests with Bonferroni correction of the significance level. RESULTS Cohorts of 11,790 patients who had ACDF, 2,257 patients who had posterior laminectomy with fusion, and 477 patients who had laminoplasty, were identified. After propensity score matching, all the 3 groups included 464 patients. The incidence of dysphagia increased significantly following ACDF compared to laminoplasty, P < 0.001, and in laminectomy with fusion compared to laminoplasty, P < 0.001. The incidence of new-onset cervicalgia was higher in ACDF compared to laminoplasty, P = 0.005, and in laminectomy with fusion compared to laminoplasty, P = 0.004. The incidence of limb paralysis increased significantly in laminectomy with fusion compared to ACDF, P = 0.002. The revision rate at 1 year increased significantly in laminectomy with fusion compared to laminoplasty, P < 0.001, and in ACDF compared to laminoplasty, P < 0.001. CONCLUSIONS The incidence of dysphagia following laminectomy with fusion was not different compared to ACDF. Postoperative new-onset cervicalgia and revisions were least common in laminoplasty. The highest rate of postoperative limb paralysis was noticed in laminectomy with fusion.
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Affiliation(s)
- Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Keck School of Medicine, University of
Southern California, Los Angeles, CA, USA,Department of Orthopaedic Surgery,
Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt
| | - Blake Formanek
- Department of Orthopaedic Surgery, Keck School of Medicine, University of
Southern California, Los Angeles, CA, USA
| | - John C. Liu
- Department of Neurosurgery, Keck School
of Medicine, University of Southern
California, Los Angeles, CA, USA
| | - Zorica Buser
- Department of Orthopaedic Surgery, Keck School of Medicine, University of
Southern California, Los Angeles, CA, USA,Zorica Buser, Department of Orthopaedic
Surgery, Keck School of Medicine, University of Southern California, 1450 San
Pablo St, HC4-#5400A, Los Angeles, CA 90033, USA.
| | - Jeffrey C. Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of
Southern California, Los Angeles, CA, USA
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13
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White cord syndrome secondary to decompressive laminectomy associated with cervical arthrodesis in a patient with diffuse idiopathic skeletal hyperostosis and posterior longitudinal ligament ossification. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2022.101677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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14
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Ali DM, Harrop J, Sharan A, Vaccaro AR, Sivaganesan A. Technical Aspects of Intra-Operative Ultrasound for Spinal Cord Injury and Myelopathy: A Practical Review. World Neurosurg 2023; 170:206-218. [PMID: 36323346 DOI: 10.1016/j.wneu.2022.10.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To compile intra-operative techniques, established imaging parameters, available equipment and software, and clinical applications of intraoperative ultrasound imaging (IOUSI) for spinal cord injury (SCI) and myelopathy. METHODS PubMed and Google Scholar were searched for relevant articles. The articles were reviewed and selected by 2 independent researchers. After article selection, data were extracted and summarized into research domains. PRISMA systematic review process was followed. RESULTS Of the 2477 articles screened, 16 articles met the inclusion criteria. In patients with SCI and myelopathy, common quantitative measurements obtained using IOUSI were noted: 1) ultrasound elastography, 2) midsagittal anteroposterior diameter, 3) transverse, 4) transverse diameter, 5) maximum spinal cord compression, and 6) compression ratioTo ensure adequate decompression and to look for residual compression, the lateral and the craniocaudal margins of the laminectomy site were inspected in both axial and sagittal planes. In instances where quantitative assessment was not possible, cord decompression and degree of residual compression were gauged by inspecting the interface between the ventral border of the spinal cord and any potentially compressive elements, and by searching for symmetric and rhythmic cerebrospinal fluid pulsations. Use of contrast-enhanced ultrasoundand molecular imaging are additional advances in objective assessments for SCI and myelopathy. CONCLUSIONS This review outlines the potential of IOUSI in patients presenting with SCI and myelopathy. Moreover, by identifying potential for inter-operator variability in certain subjective measurements, we illustrate the need for further research to quantify and standardize those assessments.
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Affiliation(s)
- Daniyal Mansoor Ali
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - James Harrop
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ashwini Sharan
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA; Rothman Orthopaedic Institute, Jefferson Health, Philadelphia, Pennsylvania, USA
| | - Ahilan Sivaganesan
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
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15
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Sangeorzan I, Andriopoulou P, Davies BM, McNair A. The information needs of people with degenerative cervical myelopathy: A qualitative study to inform patient education in clinical practice. PLoS One 2023; 18:e0285334. [PMID: 37205664 DOI: 10.1371/journal.pone.0285334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/20/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Individuals with lifelong illnesses need access to adequate information about their condition to make optimal health decisions. Degenerative Cervical Myelopathy (DCM) is the most common form of spinal cord dysfunction in adults worldwide. Its chronic and debilitating nature, varied impact, clinical trajectory, and management options necessitate appropriate informational support to sustain effective clinical and self-directed care strategies. However, before clinicians can meet patients' information needs, they must first have an understanding of their baseline requirements. This study explores the information needs of people with DCM (PwCM). In doing so, it provides a starting point for the development of patient education and knowledge management strategies in clinical practice. METHODS Semi-structured interviews with PwCM were conducted using an interview guide. Interviews were audio-recorded and transcribed verbatim. Thematic analysis according to Braun and Clarke's six-phase approach was used to analyse the data. Findings were reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. RESULTS Twenty PwCM (65% female, 35% male), with ages ranging from 39 to 74 years old participated in the interviews. The findings indicated that the provision of information to PwCM during clinical interactions varies. Accordingly, PwCM's information needs were broad-ranging, as was the nature of the information they found useful. Three main themes were identified (1) Variation in the provision of information to PwCM during clinical interactions, (2) Variations in the information needs of PwCM, and (3) Information that PwCM find useful. CONCLUSION Efforts must turn to adequately educating patients at the time of the clinical encounter. A comprehensive and consistent patient-centered information exchange in DCM is necessary to achieve this.
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Affiliation(s)
| | | | - Benjamin M Davies
- Myelopathy.org, Cambridge, Cambridgeshire, United Kingdom
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, Cambridgeshire, United Kingdom
| | - Angus McNair
- Centre for Surgical Research, Bristol Medical School, University of Bristol, United Kingdom
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16
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Chibbaro S, Cornelius JF, Mallereau CH, Bruneau M, Zaed I, Visocchi M, Maduri R, Todeschi J, Bruno C, George B, Froelich S, Ganau M. Lateral Approach to the Cervical Spine to Manage Degenerative Cervical Myelopathy and Radiculopathy. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:339-343. [PMID: 38153490 DOI: 10.1007/978-3-031-36084-8_51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
BACKGROUND The cervical lateral approach can enlarge the spinal canal and foramen to achieve an effective neural decompression without needing spine stabilization. For this review, the authors' main objective was to illustrate the rationale, advantages, disadvantages, complications, and pitfalls of this technique, highlighting also areas for future development. MATERIALS AND METHODS A Medline via PubMed database search was carried out by using both keywords, namely "cervical oblique corpectomy," "multilevel oblique corpectomy and foraminotomy," and "lateral vertebrectomy," and Medical Subject Headings (MeSH) terms from 1 January 1991, up to 31 December 2021. RESULTS The analyzed articles suggested that the use of such a technique has declined over time; only 29 clinical studies met all the inclusion criteria and were retained for data analysis, including 1200 patients undergoing such an approach for the management of degenerative cervical myelopathies (DCMs) or of radiculopathies. The main etiopathogeneses were cervical stenosis, degenerative disk disease, or a mix of them-78% of which had a favorable outcome; the most frequent complications were transient and permanent Horner syndrome in 13.6% and 9.2% of cases, respectively. Long-term stability was reported in 97% of patients. CONCLUSION Multilevel cervical oblique vertebrectomy and/or lateral foraminotomy allow wide neural structure decompression and optimal stability given that the physiological spinal motion is preserved.
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Affiliation(s)
- S Chibbaro
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - J F Cornelius
- Department of Neurosurgery, Duesseldorf University Hospital, Duesseldorf, Germany
| | - C H Mallereau
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - M Bruneau
- Department of Neurosurgery, UZ Hospital Brussel, Jette, Belgium
| | - I Zaed
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - M Visocchi
- Department of Neurosurgery, Catholic University of Rome, Rome, Italy
| | - R Maduri
- Genolier Spine Care Center, Swiss Medical Network, Genolier, Switzerland
| | - J Todeschi
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - C Bruno
- Department of Neurosurgery, Andria Bonomo Hospital, Andria, Italy
| | - B George
- Department of Neurosurgery, Lariboisiere University Hospital, Paris, France
| | - S Froelich
- Department of Neurosurgery, Lariboisiere University Hospital, Paris, France
| | - M Ganau
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
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17
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Ganau L, Ligarotti GKI, Ganau M. Neurological recovery rate and minimal clinically important difference as metrics for assessing outcomes of decompressive surgery in patients with degenerative cervical myelopathy. Acta Neurochir (Wien) 2022; 164:3181-3183. [PMID: 36136168 DOI: 10.1007/s00701-022-05364-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Laura Ganau
- School of Medicine, University of Cagliari, Cagliari, Italy
| | | | - Mario Ganau
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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Patient satisfaction three months after elective spine surgery for degenerative spine disease, Addis Ababa, Ethiopia: A one-year prospective study. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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19
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Park D, Cho JM, Yang JW, Yang D, Kim M, Oh G, Kwon HD. Classification of expert-level therapeutic decisions for degenerative cervical myelopathy using ensemble machine learning algorithms. Front Surg 2022; 9:1010420. [PMID: 36147698 PMCID: PMC9485547 DOI: 10.3389/fsurg.2022.1010420] [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: 08/03/2022] [Accepted: 08/19/2022] [Indexed: 11/28/2022] Open
Abstract
Background Therapeutic decisions for degenerative cervical myelopathy (DCM) are complex and should consider various factors. We aimed to develop machine learning (ML) models for classifying expert-level therapeutic decisions in patients with DCM. Methods This retrospective cross-sectional study included patients diagnosed with DCM, and the diagnosis of DCM was confirmed clinically and radiologically. The target outcomes were defined as conservative treatment, anterior surgical approaches (ASA), and posterior surgical approaches (PSA). We performed the following classifications using ML algorithms: multiclass, one-versus-rest, and one-versus-one. Two ensemble ML algorithms were used: random forest (RF) and extreme gradient boosting (XGB). The area under the receiver operating characteristic curve (AUC-ROC) was the primary metric. We also identified the variable importance for each classification. Results In total, 304 patients were included (109 conservative, 66 ASA, 125 PSA, and 4 combined surgeries). For multiclass classification, the AUC-ROC of RF and XGB models were 0.91 and 0.92, respectively. In addition, ML models showed AUC-ROC values of >0.9 for all types of binary classifications. Variable importance analysis revealed that the modified Japanese Orthopaedic Association score and central motor conduction time were the two most important variables for distinguishing between conservative and surgical treatments. When classifying ASA and PSA, the number of involved levels, age, and body mass index were important contributing factors. Conclusion ML-based classification of DCM therapeutic options is valid and feasible. This study can be a basis for establishing generalizable ML-based surgical decision models for DCM. Further studies are needed with a large multicenter database.
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Affiliation(s)
- Dougho Park
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, Pohang, South Korea
| | - Jae Man Cho
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, South Korea
| | - Joong Won Yang
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, South Korea
| | - Donghoon Yang
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, South Korea
| | - Mansu Kim
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, South Korea
| | - Gayeoul Oh
- Department of Radiology, Pohang Stroke and Spine Hospital, Pohang, South Korea
| | - Heum Dai Kwon
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, South Korea
- Correspondence: Heum Dai Kwon
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20
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Ding Z, Ren Y, Cao H, Li J. Top 100 most cited articles on anterior cervical discectomy and fusion. Front Surg 2022; 9:1000360. [PMID: 36147696 PMCID: PMC9485582 DOI: 10.3389/fsurg.2022.1000360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022] Open
Abstract
Study Design Bibliometric analysis. Objective Anterior cervical discectomy and fusion (ACDF) is a typical surgical method in spine surgery and has progressed significantly in the last several decades. The purpose of this study is to determine how the 100 most-cited original articles on ACDF have been the most influential in this field by identifying and analyzing them. Methods The articles on ACDF were identified by searching the Thomson ISI Web of Science database on 30 May 2022. The 100 most-cited articles were selected according to specific criteria. The data extracted from the articles included title, publication date, total citations, journal name, first author, institutions, and keywords. Results The total number of citations was 13,181, with a mean number of 131.81 ± 100.18. The publication dates ranged from 1994 to 2018. Most of these articles originated in the United States (68%) and were published in the 2000s (32%) and 2010s (48%). Spine published most of the articles (30%), followed by the Journal of Neurosurgery-Spine (16%), Spine Journal (14%), and European Spine Journal (13%). The most prolific author was Dr. Todd J Albert (n = 7), with 1,312 citations. The Texas Back Institute was the most productive institution (n = 10). The keywords ACDF, cervical spine, cervical spine, and fusion showed the highest degree of centrality. Conclusion One hundred top-cited articles on ACDF were identified and analyzed in this study. We demonstrate that ACDF is a growing and popular area of research, with the focus of research varying through timeline trends. This will provide a comprehensive and detailed basis for spine surgeons to make clinical decisions and assimilate the research focus of cervical spine surgery.
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Affiliation(s)
- Zhiyu Ding
- Department of Orthopaedics, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yijun Ren
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Hongqing Cao
- Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jinsong Li
- Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
- Correspondence: Jinsong Li
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Ma W, Peng Y, Zhang S, Wang Y, Gan K, Zhao X, Xu D. Comparison of Percutaneous Endoscopic Cervical Keyhole Foraminotomy versus Microscopic Anterior Cervical Discectomy and Fusion for Single Level Unilateral Cervical Radiculopathy. Int J Gen Med 2022; 15:6897-6907. [PMID: 36061960 PMCID: PMC9439641 DOI: 10.2147/ijgm.s378837] [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: 06/27/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To compare the clinical and radiological outcomes between microscopic anterior cervical discectomy and fusion (ACDF) and percutaneous endoscopic cervical keyhole foraminotomy (PECF) for single level unilateral cervical radiculopathy. Methods A total of 127 patients (59 in PECF VS 68 in ACDF) were enrolled in this study from April 2016 to May 2018 with a minimum follow-up of 2 years. Clinical data including baseline data, Neck Disability Index (NDI), and Visual Analogue Scale for neck and arm (VAS-n, VAS-a) were collected and compared. Radiological evaluation such as disc height, ROM of cervical, Cobb’s angle of cervical and Cobb’s angle of operated segment was measured by two experienced radiologists in twice. Results There was no significant difference between the two groups in the baseline data, and hospital stay was significantly decreased in PECF group than ACDF group (P < 0.001). PECF group did not yield superior better outcomes in NDI, VAS-a and VAS-n than ACDF group except at 1-month follow-up. As for radiological outcomes, PECF group has significantly better cervical motion, cervical angle and segmental angle than ADCF group at 12- and 24-month follow-up visit (P < 0.05); however, ACDF had shown better disc height restoration and maintenance than PECF (P < 0.05). More complications including surface hematoma and swallowing difficulty were occurred in ADCF group. Conclusion Percutaneous endoscopic cervical keyhole foraminotomy could be the alternative method for anterior cervical discectomy and fusion in selective cases. However, the indication should be fulfilled, more studies need to be conducted to further testify the efficacy of PECF.
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Affiliation(s)
- Weihu Ma
- Orthopedic Department, Ningbo No.6 Hospital, Zhejiang, Ningbo, People’s Republic of China
| | - Yujie Peng
- Clinical Medical Department, Medical School of Ningbo University Zhejiang, Ningbo, People’s Republic of China
| | - Song Zhang
- Clinical Medical Department, Medical School of Ningbo University Zhejiang, Ningbo, People’s Republic of China
| | - Yulong Wang
- Clinical Medical Department, Medical School of Ningbo University Zhejiang, Ningbo, People’s Republic of China
| | - Kaifeng Gan
- Orthopedic Department, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Xuchen Zhao
- Clinical Medical Department, Medical School of Ningbo University Zhejiang, Ningbo, People’s Republic of China
| | - Dingli Xu
- Clinical Medical Department, Medical School of Ningbo University Zhejiang, Ningbo, People’s Republic of China
- Correspondence: Dingli Xu, Email
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22
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Chan AY, Himstead AS, Choi EH, Hsu Z, Kurtz JS, Yang C, Lee YP, Bhatia NN, Lefteris CT, Wilson WC, Hsu FPK, Oh MY. Cost analysis comparison between anterior and posterior cervical spine approaches. Surg Neurol Int 2022; 13:300. [PMID: 35928309 PMCID: PMC9345123 DOI: 10.25259/sni_497_2022] [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: 05/27/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background The costs of cervical spine surgery have steadily increased. We performed a 5-year propensity scoring-matched analysis of 276 patients undergoing anterior versus posterior cervical surgery at one institution. Methods We performed propensity score matching on financial data from 276 patients undergoing 1-3 level anterior versus posterior cervical fusions for degenerative disease (2015-2019). Results We found no significant difference between anterior versus posterior approaches for hospital costs ($42,529.63 vs. $45,110.52), net revenue ($40,877.25 vs. $34,036.01), or contribution margins ($14,230.19 vs. $6,312.54). Multivariate regression analysis showed variables significantly associated with the lower contribution margins included age (β = -392.3) and length of stay (LOS; β = -1151). Removing age/LOS from the analysis, contribution margins were significantly higher for the anterior versus posterior approach ($17,824.16 vs. $6,312.54, P = 0.01). Conclusion Anterior cervical surgery produced higher contribution margins compared to posterior approaches, most likely because posterior surgery was typically performed in older patients requiring longer LOS.
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Affiliation(s)
- Alvin Y. Chan
- Department of Neurological Surgery, University of California, Irvine, UCI Medical Center, Orange, California,,Corresponding author: Alvin Y. Chan, Department of Neurological Surgery, University of California, Irvine, UCI Medical Center, Orange, California, United States.
| | - Alexander S. Himstead
- Department of Neurological Surgery, University of California, Irvine, UCI Medical Center, Orange, California
| | - Elliot H. Choi
- Department of Neurosurgery, Medical Scientist Training Program, Case Western Reserve University, Cleveland, Ohio
| | - Zachary Hsu
- Department of Orthopedic Surgery, University of California, Irvine, UCI Medical Center, Orange, California, United States
| | - Joshua S. Kurtz
- Department of Neurological Surgery, University of California, Irvine, UCI Medical Center, Orange, California
| | - Chenyi Yang
- Department of Neurological Surgery, University of California, Irvine, UCI Medical Center, Orange, California
| | - Yu-Po Lee
- Department of Orthopedic Surgery, University of California, Irvine, UCI Medical Center, Orange, California, United States
| | - Nitin N. Bhatia
- Department of Orthopedic Surgery, University of California, Irvine, UCI Medical Center, Orange, California, United States
| | - Chad T. Lefteris
- Department of UCI Health, University of California, Irvine, UCI Medical Center, Orange, California, United States
| | - William C. Wilson
- Department of UCI Health, University of California, Irvine, UCI Medical Center, Orange, California, United States
| | - Frank P. K. Hsu
- Department of Neurological Surgery, University of California, Irvine, UCI Medical Center, Orange, California
| | - Michael Y. Oh
- Department of Neurological Surgery, University of California, Irvine, UCI Medical Center, Orange, California
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A scoping review of information provided within degenerative cervical myelopathy education resources: Towards enhancing shared decision making. PLoS One 2022; 17:e0268220. [PMID: 35588126 PMCID: PMC9119544 DOI: 10.1371/journal.pone.0268220] [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: 01/23/2022] [Accepted: 04/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background Degenerative cervical myelopathy (DCM) is a chronic neurological condition estimated to affect 1 in 50 adults. Due to its diverse impact, trajectory and management options, patient-centred care and shared decision making are essential. In this scoping review, we aim to explore whether information needs in DCM are currently being met in available DCM educational resources. This forms part of a larger Myelopathy.org project to promote shared decision making in DCM. Methods A search was completed encompassing MEDLINE, Embase and grey literature. Resources relevant to DCM were compiled for analysis. Resources were grouped into 5 information types: scientific literature, videos, organisations, health education websites and patient information leaflets. Resources were then further arranged into a hierarchical framework of domains and subdomains, formed through inductive analysis. Frequency statistics were employed to capture relative popularity as a surrogate marker of potential significance. Results Of 2674 resources, 150 information resources addressing DCM were identified: 115 scientific literature resources, 28 videos, 5 resources from health organisations and 2 resources from health education websites. Surgical management was the domain with the largest number of resources (66.7%, 100/150). The domain with the second largest number of resources was clinical presentation and natural history (28.7%, 43/150). Most resources (83.3%, 125/150) were designed for professionals. A minority (11.3% 17/150) were written for a lay audience or for a combined audience (3.3%, 5/150). Conclusion Educational resources for DCM are largely directed at professionals and focus on surgical management. This is at odds with the needs of stakeholders in a lifelong condition that is often managed without surgery, highlighting an unmet educational need.
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Intraoperative ultrasonography in laminectomy for degenerative cervical spondylotic myelopathy: a clinical and radiological evaluation. Acta Neurochir (Wien) 2022; 164:1873-1881. [PMID: 35536511 PMCID: PMC9233640 DOI: 10.1007/s00701-022-05232-8] [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: 01/27/2022] [Accepted: 04/22/2022] [Indexed: 11/28/2022]
Abstract
Background The incidence of cervical myelopathy due to spinal stenosis is constantly growing in an aging population. Especially in multisegmental disease, dorsal laminectomy is the intervention of choice. Intraoperative imaging with ultrasound might provide additional information about extent and sufficiency of spinal cord decompression. Methods In this prospective study, the width of the subarachnoid space was systematically measured by intraoperative ultrasound at predefined sites at the cranial and caudal edge of decompression in axial and sagittal reconstruction. These data were compared with corresponding sites on postoperative T2-weighted MRI imaging. In addition, the functional outcome was assessed by modified Japanese Orthopaedic Association (mJOA) score. A historical patient cohort treated without ultrasound-guided laminectomy served as control group. Results Altogether, 29 patients were included. According to mJOA score at last follow-up, 7/29 patients reported stable symptoms and 21/29 patients showed a substantial benefit with no or minor residual neurological deficits. One patient suffered from a new C5 palsy. Intraoperative ultrasound-guided posterior decompression provided excellent overview in all cases. Measurement of the width of the subarachnoid space acquired by intraoperative ultrasound and postoperative MRI images showed a very high correlation, especially at the cranial level (p < 0.001, r = 0.880). Bland–Altman analysis showed that most patients were within the 1.96 × SD limits of agreement throughout all measurements. No ultrasound procedure-related complications were observed. Compared to a historical cohort of 27 patients, no significant differences were found regarding functional outcome (p = 0.711). Conclusion Intraoperative sonography visualises the surgically achieved restoration of the subarachnoid space in good correlation with postoperative MRI and might serve as a fast, precise and reliable tool for intraoperative imaging in cervical laminectomy. However, we could not demonstrate a clinical benefit with regard to functional outcome.
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Wilkerson CG, Sherrod BA, Alvi MA, Asher AL, Coric D, Virk MS, Fu KM, Foley KT, Park P, Upadhyaya CD, Knightly JJ, Shaffrey ME, Potts EA, Shaffrey C, Wang MY, Mummaneni PV, Chan AK, Bydon M, Tumialán LM, Bisson EF. Differences in Patient-Reported Outcomes Between Anterior and Posterior Approaches for Treatment of Cervical Spondylotic Myelopathy: A Quality Outcomes Database Analysis. World Neurosurg 2022; 160:e436-e441. [PMID: 35051639 DOI: 10.1016/j.wneu.2022.01.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Surgery for cervical spondylotic myelopathy (CSM) may use anterior or posterior approaches. Our objective was to compare baseline differences and validated postoperative patient-reported outcome measures between anterior and posterior approaches. METHODS The NeuroPoint Quality Outcomes Database was queried retrospectively to identify patients with symptomatic CSM treated at 14 high-volume sites. Demographic, comorbidity, socioeconomic, and outcome measures were compared between treatment groups at baseline and 3 and 12 months postoperatively. RESULTS Of the 1151 patients with CSM in the cervical registry, 791 (68.7%) underwent anterior surgery and 360 (31.3%) underwent posterior surgery. Significant baseline differences were observed in age, comorbidities, myelopathy severity, unemployment, and length of hospital stay. After adjusting for these differences, anterior surgery patients had significantly lower Neck Disability Index score (NDI) and a higher proportion reaching a minimal clinically important difference (MCID) in NDI (P = 0.005 at 3 months; P = 0.003 at 12 months). Although modified Japanese Orthopaedic Association scores were lower in anterior surgery patients at 3 and 12 months (P < 0.001 and P = 0.022, respectively), no differences were seen in MCID or change from baseline. Greater EuroQol-5D improvement at 3 months after anterior versus posterior surgery (P = 0.024) was not sustained at 12 months and was insignificant on multivariate analysis. CONCLUSIONS In the largest analysis to date of CSM surgery data, significant baseline differences existed for patients undergoing anterior versus posterior surgery for CSM. After adjusting for these differences, patients undergoing anterior surgery were more likely to achieve clinically significant improvement in NDI at short- and long-term follow-up.
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Affiliation(s)
- Christopher G Wilkerson
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Brandon A Sherrod
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | | | - Anthony L Asher
- Department of Neurosurgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas HealthCare System, Charlotte, North Carolina, USA
| | - Domagoj Coric
- Department of Neurosurgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas HealthCare System, Charlotte, North Carolina, USA
| | - Michael S Virk
- Department of Neurosurgery, Weill Cornell Medical College, New York, New York, USA
| | - Kai-Ming Fu
- Department of Neurosurgery, Weill Cornell Medical College, New York, New York, USA
| | - Kevin T Foley
- Department of Neurosurgery, University of Tennessee and Semmes Murphy Clinic, Memphis, Tennessee, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | - John J Knightly
- Atlantic Neurosurgical Specialists, Morristown, New Jersey, USA
| | - Mark E Shaffrey
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Eric A Potts
- Department of Neurosurgery, Indiana University; Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA
| | | | - Michael Y Wang
- Department of Neurosurgery, University of Miami, Miami, Florida, USA
| | - Praveen V Mummaneni
- Department of Neurosurgery, University of California, San Francisco, California, USA
| | - Andrew K Chan
- Department of Neurosurgery, University of California, San Francisco, California, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Erica F Bisson
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
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Evaniew N, Charest-Morin R, Jacobs WB, Johnson M, Bailey CS, Christie S, Paquet J, Nataraj A, Cadotte DW, Wilson JR, Craig M, Xu M, Manson N, Hall H, Thomas KC, Rampersaud YR, McIntosh G, Fisher CG, Dea N. Cervical Sagittal Alignment in Patients with Cervical Spondylotic Myelopathy: An Observational Study From the Canadian Spine Outcomes and Research Network. Spine (Phila Pa 1976) 2022; 47:E177-E186. [PMID: 34845179 DOI: 10.1097/brs.0000000000004296] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE Among patients with CSM, we aimed to evaluate the extent to which: (1) Preoperative cervical sagittal alignment is associated with health-related quality of life, function, and symptoms; (2) Surgery leads to changes in cervical sagittal alignment; and (3) Postoperative cervical sagittal alignment is associated with health-related quality of life, function, and symptoms at 12 months of follow-up. SUMMARY OF BACKGROUND DATA The importance of maintaining or improving cervical sagittal alignment in the surgical management of patients with CSM has not been established. METHODS We measured C2-C7 Cobb angle, T1 slope, and C2-C7 cervical sagittal vertical axis (cSVA). We tested for associations with Neck Disability Index, Pain Scales for neck and arm pain, EuroQol 5D, Short Form 12 Physical and Mental Component Summaries, and modified Japanese Orthopaedic Association scores. We adjusted for potential confounders using multiple linear regression, and we performed various prespecified subgroup (cSVA > 40 mm, surgical approach) and sensitivity analyses. RESULTS Among 250 patients, adjusted analyses yielded significant inverse associations prior to surgery between each of cSVA and T1 slope with SF12 Physical Component Summaries (T1 slope: -0.14, 95% CI -0.26 to -0.01, P = 0.03; C2-C7 cSVA: -0.13, 95% CI --0.21 to -0.05 P < 0.01). Surgery was associated with a small but statistically significant increase in cSVA across the cohort (+5.8 mm [SD 11.7], P < 0.01) but no change in Cobb angle or T1 slope. At 12-months after surgery, there were no significant associations between alignment parameters or change in alignment and any measures of health-related quality of life, function, or symptoms. Results were consistent across subgroup and sensitivity analyses. CONCLUSION Increased cSVA and T1 slope were associated with inferior health-related quality of life at presentation among patients with CSM, but no significant associations were observed following surgical treatment.Level of Evidence: 3.
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Affiliation(s)
- Nathan Evaniew
- University of Calgary Spine Program, University of Calgary, Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Raphaële Charest-Morin
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - W Bradley Jacobs
- University of Calgary Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - Michael Johnson
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Sean Christie
- Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jérôme Paquet
- Department of Orthopaedics, Centre Hospitalier Universitaire de Quebec, Quebec, Quebec, Canada
| | - Andrew Nataraj
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - David W Cadotte
- University of Calgary Spine Program, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute and Departments of Clinical Neurosciences and Radiology, Division of Neurosurgery, Cumming School of Medicine, University of Calgary
| | | | - Michael Craig
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Xu
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Neil Manson
- Canada East Spine Centre, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Hamilton Hall
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ken C Thomas
- University of Calgary Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - Y Raja Rampersaud
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Charles G Fisher
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicolas Dea
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
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Huang T, Zhong W, Lu C, Zhang C, Deng Z, Zhou R, Zhao Z, Luo X. Visualized Analysis of Global Studies on Cervical Spondylosis Surgery: A Bibliometric Study Based on Web of Science Database and VOSviewer. Indian J Orthop 2022; 56:996-1010. [PMID: 35662885 PMCID: PMC9123106 DOI: 10.1007/s43465-021-00581-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/21/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE This study used multiple type of bibliometric analysis for identifying and summarizing the publications regarding cervical spondylosis surgery, for clarifying the history of this field, predicting the future hotspots of this field and improving communication among researchers. METHODS Publications from Web of Science database between 1900 and 2019 were downloaded and analyzed by Excel 2016 and VOSviewer. Bibliometric maps of co-citations and maps of co-occurrence of keywords are constructed by VOSviewer software. RESULTS A total of 2110 publications were searched from Web of Science. The total sum of times cited is 40448 with the average citation per publication of 19.17 times. USA published most papers (652, 30.9%). The most productive organizations is University of Toronto (96 publications). Spine (308 publications) published the most publications in this field. In co-citations of references analysis, four clusters of references are constructed by VOSviewer. In co-occurrence of keywords analysis, three clusters of keywords are constructed by VOSviewer. The latest keyword "degenerative cervical myelopathy" appeared in 2017 in 42 papers. Other relatively new keywords include "surgical outcomes", "association", "sagittal alignment", "prognostic-factors" that appeared in 2016 in 33, 31, 34 and 37 papers respectively. CONCLUSION USA dominates the research regarding cervical spondylosis surgery. University of Toronto is the most productive organization in this field. Spine, European Spine Journal and Journal of Neurosurgery Spine are the top three productive journals on publications of cervical spondylosis surgery. "Degenerative cervical myelopathy", "surgical outcomes", "association", "sagittal alignment" and "prognostic-factors" may be the new research hotspots in this field.
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Affiliation(s)
- Tianji Huang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Weiyang Zhong
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Chao Lu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Chunyang Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Zhongqi Deng
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Runtao Zhou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Zenghui Zhao
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Xiaoji Luo
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
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Yang H, Sun Y, Wang L, Guo Q, Jiang J, Lu X. Anterior Canal Reconstruction and Fusion for Myelopathy Caused by Degenerative Cervical Kyphosis and Stenosis With or Without Ossification of the Posterior Longitudinal Ligament. Clin Spine Surg 2022; 35:E53-E61. [PMID: 34039887 DOI: 10.1097/bsd.0000000000001194] [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: 12/28/2020] [Accepted: 04/14/2021] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a retrospective study. OBJECTIVE To introduce an anterior surgical technique for myelopathy caused by degenerative cervical kyphosis and stenosis (DCKS) with or without ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA The optimal approach in the treatment of DCKS remains a controversy because each anterior or posterior route surgery has advantages and disadvantages. MATERIALS AND METHODS In the period from June 2017 through June 2019, a consecutive cohort of adults diagnosed with DCKS underwent anterior canal reconstruction and fusion (ACRF). All patients underwent x-ray, computed tomography, and magnetic resonance imaging of the cervical spine. Radiologic assessment included kyphosis, canal area, canal reconstruction, OPLL, and spinal cord curvature and morphology. The Japanese Orthopaedic Association (JOA) scoring system was used to evaluate the neurological status. Surgery-related and implant-related complications were all recorded. Follow-up was carried out at 3, 6, 12, 24, and 36 months postoperation. RESULTS Fourty-one patients were included in the study, of which 19 presented with OPLL. Postoperatively, the canal area were significantly greater at last follow-up compared with preoperation (208.4 vs. 123.2 mm2; P=0.001). There was significant kyphosis correction (-17.6 vs. 8.5 degrees, P=0.001) at last follow-up. Ninety-six segmental canal reconstruction were performed, 89 (92.7%) reached bone fusion at both grooves with a mean time of 7.9 months. On sagittal magnetic resonance imaging, 33 (80.5%) patients presented with lordosis in the spinal cord curvature, 8 (19.5%) with straight. The mean JOA score at last follow-up was significantly better than preoperation (15.0 vs. 9.3 points; P<0.01). One patient presented with cerebrospinal fluid leakage, 1 with screw displacement and 2 with dysphagia. CONCLUSION ACRF, receiving good correction of kyphosis, amplified canal area, solid instrumented fusion and circumferential decompression, is an effective and safe surgical technique for cervical myelopathy caused by DCKS with or without OPLL. LEVEL OF EVIDENCE Level III-a retrospective analysis.
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Affiliation(s)
- Haisong Yang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
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29
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Nakashima H, Imagama S, Yoshii T, Egawa S, Sakai K, Kusano K, Nakagawa Y, Hirai T, Wada K, Katsumi K, Fujii K, Kimura A, Furuya T, Kanchiku T, Nagamoto Y, Oshima Y, Nagoshi N, Ando K, Takahata M, Mori K, Nakajima H, Murata K, Matsunaga S, Kaito T, Yamada K, Kobayashi S, Kato S, Ohba T, Inami S, Fujibayashi S, Katoh H, Kanno H, Li Y, Yatsuya H, Koda M, Kawaguchi Y, Takeshita K, Matsumoto M, Yamazaki M, Okawa A. Comparison of laminoplasty and posterior fusion surgery for cervical ossification of posterior longitudinal ligament. Sci Rep 2022; 12:748. [PMID: 35031694 PMCID: PMC8760337 DOI: 10.1038/s41598-021-04727-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/23/2021] [Indexed: 11/29/2022] Open
Abstract
This prospective multicenter study, established by the Japanese Ministry of Health, Labour and Welfare and involving 27 institutions, aimed to compare postoperative outcomes between laminoplasty (LM) and posterior fusion (PF) for cervical ossification of the posterior longitudinal ligament (OPLL), in order to address the controversy surrounding the role of instrumented fusion in cases of posterior surgical decompression for OPLL. 478 patients were considered for participation in the study; from among them, 189 (137 and 52 patients with LM and PF, respectively) were included and evaluated using the Japanese Orthopaedic Association (JOA) scores, the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and radiographical measurements. Basic demographic and radiographical data were reviewed, and the propensity to choose a surgical procedure was calculated. Preoperatively, there were no significant differences among the participants in terms of patient backgrounds, radiographical measurements (K-line or cervical alignment on X-ray, OPLL occupation ratio on computed tomography, increased signal intensity change on magnetic resonance imaging), or clinical status (JOA score and JOACMEQ) after adjustments. The overall risk of perioperative complications was found to be lower with LM (odds ratio [OR] 0.40, p = 0.006), and the rate of C5 palsy occurrence was significantly lower with LM (OR 0.11, p = 0.0002) than with PF. The range of motion (20.91° ± 1.05° and 9.38° ± 1.24°, p < 0.0001) in patients who had PF was significantly smaller than in those who had LM. However, multivariable logistic regression analysis showed no significant difference among the participants in JOA score, JOA recovery rate, or JOACMEQ improvement at two years. In contrast, OPLL progression was greater in the LM group than in the PF group (OR 2.73, p = 0.0002). Both LM and PF for cervical myelopathy due to OPLL had resulted in comparable postoperative outcomes at 2 years after surgery.
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Affiliation(s)
- Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa Ward, Nagoya, Aichi, 466-8550, Japan.
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa Ward, Nagoya, Aichi, 466-8550, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan
| | - Satoru Egawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan
| | - Kenichiro Sakai
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi, Saitama, 332-8558, Japan
| | - Kazuo Kusano
- Department of Orthopaedic Surgery, Kudanzaka Hospital, 1-6-12 Kudanminami, Chiyodaku, 102-0074, Japan
| | - Yukihiro Nakagawa
- Department of Orthopaedic Surgery, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Itogun, Wakayama, 649-7113, Japan
| | - Takashi Hirai
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan
| | - Kanichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, Aomori, 036-8562, Japan
| | - Keiichi Katsumi
- Department of Orthopaedic Surgery, Niigata University Medicine and Dental General Hospital, 1-754 Asahimachidori, Chuo Ward, Niigata, Niigata, 951-8520, Japan
| | - Kengo Fujii
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Atsushi Kimura
- Department of Orthoaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo Ward, Chiba, Chiba, 260-8670, Japan
| | - Tsukasa Kanchiku
- Department of Orthopaedic Surgery, Yamaguchi University School of Medicine, 111 Minami Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Yukitaka Nagamoto
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Sakaishi, Osaka, 591-8025, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku Ward, Tokyo, 160-8582, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa Ward, Nagoya, Aichi, 466-8550, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Sapporo, 060-8638, Japan
| | - Kanji Mori
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan
| | - Hideaki Nakajima
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Kazuma Murata
- Department of Orthopaedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Shunji Matsunaga
- Department of Orthopaedic Surgery, Imakiire General Hospital, 4-16 Shimotatsuocho, Kagoshimashi, 892-8502, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Kei Yamada
- Department of Orthopaedic Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume-shi, Fukuoka, 830-0011, Japan
| | - Sho Kobayashi
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3125, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Tetsuro Ohba
- Department of Orthopaedic Surgery, University of Yamanashi, 1110 Shimokato, Chuo Ward, Yamanashi, 409-3898, Japan
| | - Satoshi Inami
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, 321-0293, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroyuki Katoh
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Haruo Kanno
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryomachi, Aoba Ward, Sendai, Miyagi, 980-8574, Japan
| | - Yuanying Li
- Department of Public Health, Fujita Health University School of Medicine, Aichi, Japan
| | - Hiroshi Yatsuya
- Department of Public Health, Fujita Health University School of Medicine, Aichi, Japan.,Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yoshiharu Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Katsushi Takeshita
- Department of Orthoaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku Ward, Tokyo, 160-8582, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan
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30
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Owiti W, Peev N, Arif S, Brady Z, AbdelHafiz T. Is surgery beneficial for patients with concurrent multiple sclerosis and degenerative cervical myelopathy? A review of literature. BRAIN AND SPINE 2022; 2:100870. [PMID: 36248132 PMCID: PMC9560582 DOI: 10.1016/j.bas.2022.100870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 12/25/2022]
Abstract
Introduction Due to an overlap in symptoms, there is significant delay in surgical treatment of patients that have concomitant multiple sclerosis (MS) and degenerative cervical Myelopathy (DCM). The purpose of this review is to evaluate if surgical intervention is beneficial to patients that have concurrent presentations. Research question Is surgery beneficial in concurrent MS and DCM? Materials and methods A literature search with no date restrictions was conducted on Pubmed and Medline databases. Keywords searched: Degenerative Cervical Myelopathy, Multiple sclerosis, Treatment, Surgery, Quality of Life. Randomised controlled trials, prospective, retrospective, and case series reporting timing of surgery, post-operative outcomes such as improvement in myelopathic symptoms, quality of life, and any serious complications were included. Results The literature search yielded a total of 8 studies across all databases. Seven articles were selected for full text review, and all of them were sectioned for inclusion in this review. Seven studies evaluated 160 participants with concurrent multiple sclerosis and degenerative cervical myelopathy. Earlier studies had discouraged performing surgery in this subset of patients, the majority of studies found it worthwhile to perform early surgery for patients with concomitant multiple sclerosis and degenerative cord compression, if the patients had radiculopathy. Quality of life for MS patients did not improve as much as it did for patients that did not have MS. Discussion and conclusion Patients with radiculopathy, neck pain and cord compression are most likely to benefit from early surgery. There is no need for delaying to offer surgery unless other medical/anaesthetic contraindications exist.
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Affiliation(s)
- William Owiti
- Department of Neurosurgery, Royal Infirmary of Edinburgh, Edinburgh, UK
- Corresponding author. Department of Neurosurgery, Royal infirmary of Edinburgh, 51 little France crescent, Edinburgh, EH16 4SA, UK.
| | - Nikolay Peev
- Department of Neurosurgery, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Shahswar Arif
- Department of Neurosurgery, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
- Medical University ‘Prof. Dr. Paraskev Stoyanov’ Varna, Varna, Bulgaria
| | - Zarina Brady
- Department of Neurosurgery, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
- Medical University ‘Prof. Dr. Paraskev Stoyanov’ Varna, Varna, Bulgaria
| | - Tarek AbdelHafiz
- Department of Neurosurgery, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
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31
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Comparative Effectiveness and Safety of Open-Door Laminoplasty, French-Door Laminoplasty, Laminectomy and Fusion, and Laminectomy Alone for Multilevel Degenerative Cervical Myelopathy: A Bayesian Network Analysis. Adv Ther 2022; 39:117-139. [PMID: 34812993 DOI: 10.1007/s12325-021-01980-8] [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: 07/28/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate the comparative effectiveness and safety of open-door laminoplasty (OLP), French-door laminoplasty (FLP), laminectomy and fusion (LF), and laminectomy alone (LA) in treating multilevel degenerative cervical myelopathy (MDCM). METHODS Embase, PubMed, and Cochrane library were searched from their inception date to 7 January 2021. Randomized controlled trials and cohort studies comparing OLP, FLP, LF, and LA were identified to perform a network meta-analysis (NMA). RESULTS A total of 30 studies with 2671 patients were included. Our NMA results showed no significant difference between LF and OLP, but both are superior to LA and FLP in the comparison of JOA (Japanese Orthopaedic Association) score improvement. LF showed a most unsatisfactory outcome in postoperative range of motion (ROM) compared with LA or OLP or with FLP. For the complication outcome, no significant differences were found. The surface under the cumulative ranking curves (SUCRA) for JOA improvement was as follows: LF, OPL, LA, and FLP. For ROM reduction it was LA, OPL, FPL, and LF. For complications it was LF, LA, OLP, and FLP. CONCLUSIONS Considering all the evaluated criteria, none of the procedures showed the best outcome with least complications and optimal efficacy. However, OLP can be most recommended because of its second-ranking spectra in both of JOA improvement and ROM reduction, also with an acceptable incidence of complications, with the third least.
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32
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Increased signal intensity on postoperative T2-weighted axial images in cervical spondylotic myelopathy: Patterns of changes and associated impact on outcomes. J Clin Neurosci 2021; 90:244-250. [PMID: 34275557 DOI: 10.1016/j.jocn.2021.06.007] [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: 01/15/2021] [Revised: 04/26/2021] [Accepted: 06/06/2021] [Indexed: 11/23/2022]
Abstract
Although T2-weighted axial magnetic resonance imaging (MRI) has strength in demonstrating morphologic characteristics of the spinal cord in cervical spondylotic myelopathy (CSM), no study has investigated postoperative changes. We aimed to assess postoperative changes on T2-weighted axial MRI using the classification system based on axial imaging in cervical compressive myelopathy (Ax-CCM) and associated impact on outcome in CSM. In total, 250 patients with CSM who underwent decompressive surgery with preoperative and postoperative MRI were included. At first, we investigated the presence of increased signal intensity (SI) in cervical spinal cord on T2-weighted sagittal images. Next, the increased SI was assessed using Ax-CCM on T2weighted axial images. The classifications were type 0, no-signal abnormality; single-level type 1, diffuse; single-level type 2, fuzzy focal; single-level type 3, discrete focal; and two-level. The recovery rates (RRs) of modified Japanese Orthopaedic Association (mJOA) score were evaluated from 5 to 10 months postoperatively. Eighty-seven patients (34.8%) exhibited postoperative changes. Most of postoperative changes were in single-level type 1 and 2. Patterns of changes were resolution, reduced extent, or transition to discrete margin. The most common pattern was resolution in type 1 (23.9%) and transition to discrete margin in type 2 (46.5%). In each group, resolution showed the best RR, but insignificantly (p > 0.05).
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33
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Koda M, Yoshii T, Egawa S, Sakai K, Kusano K, Nakagawa Y, Hirai T, Wada K, Katsumi K, Kimura A, Furuya T, Maki S, Nagoshi N, Watanabe K, Kanchiku T, Nagamoto Y, Oshima Y, Ando K, Nakashima H, Takahata M, Mori K, Nakajima H, Murata K, Matsunaga S, Kaito T, Yamada K, Kobayashi S, Kato S, Ohba T, Inami S, Fujibayashi S, Katoh H, Kanno H, Takahashi H, Fujii K, Miyagi M, Inoue G, Takaso M, Imagama S, Kawaguchi Y, Takeshita K, Nakamura M, Matsumoto M, Okawa A, Yamazaki M. Neurological improvement is associated with neck pain attenuation after surgery for cervical ossification of the posterior longitudinal ligament. Sci Rep 2021; 11:11910. [PMID: 34099784 PMCID: PMC8184776 DOI: 10.1038/s41598-021-91268-2] [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: 01/03/2021] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
Although favourable surgical outcomes for myelopathy caused by cervical ossification of the posterior longitudinal ligament (OPLL) have been reported, factors significantly associated with post-operative neck pain attenuation still remain unclear. The primary aim of the present study was to determine factors significantly associated with post-operative neck pain attenuation in patients with cervical OPLL using a prospective multi-centre registry of surgically treated cervical OPLL. Significant postoperative neck pain reduction (50% reduction of neck pain) was achieved in 31.3% of patients. There was no significant difference in neck pain attenuation between surgical procedures. Statistical analyses with univariate analyses followed by stepwise logistic regression revealed neurological recovery as a factor having a significant positive association with post-operative neck pain attenuation (p = 0.04, odds ratio 5.68 (95% confidence interval: 1.27-22.2)). In conclusion, neurological recovery was an independent factor having a significant positive association with post-operative neck pain attenuation in patients with cervical myelopathy caused by OPLL who underwent cervical spine surgery.
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Affiliation(s)
- Masao Koda
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan. .,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan.
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Satoru Egawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Kenichiro Sakai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi, Saitama, 332-8558, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Kazuo Kusano
- Department of Orthopedic Surgery, Kudanzaka Hospital, 1-6-12 Kudanminami, Chiyadaku, 102-0074, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Yukihiro Nakagawa
- Department of Orthopaedic Surgery, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Itogun, Wakayama, 649-7113, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Kanichiro Wada
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, Aomori, 036-8562, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Keiichi Katsumi
- Department of Orthopedic Surgery, Niigata University Medicine and Dental General Hospital, 1-754 Asahimachidori, Chuo Ward, Niigata, Niigata, 951-8520, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Atsushi Kimura
- Department of Orthopedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Takeo Furuya
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo Ward, Chiba, Chiba, 260-0856, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Satoshi Maki
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo Ward, Chiba, Chiba, 260-0856, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku Ward, Tokyo, 160-8582, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku Ward, Tokyo, 160-8582, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Tsukasa Kanchiku
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, 1144 Kogushi, Ube, Yamaguchi, 755-8505, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Yukitaka Nagamoto
- Department of Orthopedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Sakaishi, Osaka, 591-8025, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa Ward, Nagoya, Aichi, 466-8550, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa Ward, Nagoya, Aichi, 466-8550, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Sapporo, 060-8638, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Kanji Mori
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Hideaki Nakajima
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Kazuma Murata
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Shunji Matsunaga
- Department of Orthopedic Surgery, Imakiire General Hospital, 4-16 Shimotatsuocho, Kagoshimashi, 892-8502, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Takashi Kaito
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Kei Yamada
- Department of Orthopaedic Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume-shi, Fukuoka, 830-0011, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Sho Kobayashi
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3125, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Tetsuro Ohba
- Department of Orthopedic Surgery, University of Yamanashi, 1110 Shimokato, Chuo Ward, Yamanashi, 409-3898, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Satoshi Inami
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, 321-0293, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Hiroyuki Katoh
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Haruo Kanno
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryomachi, Aoba Ward, Sendai, Miyagi, 980-8574, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Hiroshi Takahashi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Kengo Fujii
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Minami Ward, 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0375, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Minami Ward, 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0375, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Minami Ward, 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0375, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa Ward, Nagoya, Aichi, 466-8550, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Yoshiharu Kawaguchi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Katsushi Takeshita
- Department of Orthopedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku Ward, Tokyo, 160-8582, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku Ward, Tokyo, 160-8582, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.,Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo, Japan
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Marie-Hardy L, Pascal-Moussellard H. Degenerative cervical myelopathy. Rev Neurol (Paris) 2021; 177:490-497. [PMID: 33781560 DOI: 10.1016/j.neurol.2020.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 10/21/2022]
Abstract
Degenerative cervical myelopathy (DCM) frequently leads to severe neurologic disability but is still frequently underdiagnosed. One explanation may be the variability of the symptoms presented by the patients, from paresthesia to quadriplegia, making it another great masquerader. What do we know? How can we manage better these patients? We will review the keys points concerning its challenging diagnosis (clinical and radiologic), some of the recent discoveries about DCM, notably the underlying genetic mutations identified, linked to its pathophysiology, before addressing the consensual points concerning its management and the major evolutive risk: acute decompensation.
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Affiliation(s)
- L Marie-Hardy
- Orthopaedic surgery department, Pitié-Salpétrière hospital, 47, boulevard de l'Hôpital, 75013 Paris, France.
| | - H Pascal-Moussellard
- Orthopaedic surgery department, Pitié-Salpétrière hospital, 47, boulevard de l'Hôpital, 75013 Paris, France
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Alhashash M, Allouch H, Boehm H, Shousha M. Results of Four-Level Anterior Cervical Discectomy and Fusion Using Stand-Alone Interbody Titanium Cages. Asian Spine J 2021; 16:82-91. [PMID: 33687861 PMCID: PMC8873996 DOI: 10.31616/asj.2020.0463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/19/2020] [Indexed: 11/23/2022] Open
Abstract
Study Design This is a retrospective study with a minimum follow-up of 2 years. Purpose The aim of this study is to assess the long-term outcomes after performing the four-level anterior cervical discectomy and fusion (ACDF) in the treatment of degenerative cervical spine disease using stand-alone titanium cages. Overview of Literature Over the last decades, a rapid increase in the use of stand-alone cages for ACDF has been observed. However, research on their application in the treatment of four-level diseases is insufficient. Methods In this study, 130 patients presenting with symptomatic cervical spondylosis who underwent four-level ACDF using stand-alone cages in our institution between 2008 and 2016 were assessed. Fifty-two patients were women and 78 men with a mean age of 60.5 years. Their clinical and radiological outcomes were assessed. The results of the Neck Disability Index (NDI) and Visual Analog Scale as well as bony fusion were evaluated, and the revisions were analyzed. All of the patients underwent the four-level microscopic ACDF using the same titanium rectangular cage. Results The mean follow-up was 47±11.4 months. A fusion of all four levels was achieved in 80.72% of the patients. In 25 patients (19.23%), an incomplete bony bridging was observed in at least one fusion level at the final follow-up. However, only two patients (1.5%) were symptomatic and underwent revision. The mean NDI improved significantly from 39.4±9.3 at presentation to 8.3±6.6 at the final follow-up. Cervical lordosis improved significantly from a mean of 5.5° preoperatively to a mean of 15° postoperatively. Cage sinking and loss of segment height during healing had a mean of 3 mm. Conclusions Overall, the application of four-level ACDF using titanium cages in a stand-alone technique has been proven to be a safe and effective treatment method for degenerative disease. In a large cohort, a high rate of good long-term clinical and radiological results was achieved.
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Affiliation(s)
- Mohamed Alhashash
- Spine Surgery Department, Zentralklinik Bad Berka, Bad Berka, Germany.,Orthopaedic and Trauma Department, Alexandria University, Alexandria, Egypt
| | - Hassan Allouch
- Spine Surgery Department, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Heinrich Boehm
- Spine Surgery Department, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Mootaz Shousha
- Spine Surgery Department, Zentralklinik Bad Berka, Bad Berka, Germany.,Orthopaedic and Trauma Department, Alexandria University, Alexandria, Egypt
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Chen G, Wei F, Li J, Shi L, Zhang W, Wang X, Xu Z, Liu X, Zou X, Liu S. Intensity of Intraoperative Spinal Cord Hyperechogenicity as a Novel Potential Predictive Indicator of Neurological Recovery for Degenerative Cervical Myelopathy. Korean J Radiol 2021; 22:1163-1171. [PMID: 33739631 PMCID: PMC8236360 DOI: 10.3348/kjr.2020.0755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/29/2020] [Accepted: 11/03/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To analyze the correlations between intraoperative ultrasound and MRI metrics of the spinal cord in degenerative cervical myelopathy and identify novel potential predictive ultrasonic indicators of neurological recovery for degenerative cervical myelopathy. MATERIALS AND METHODS Twenty-two patients who underwent French-door laminoplasty for multilevel degenerative cervical myelopathy were followed up for 12 months. The Japanese Orthopedic Association (JOA) scores were assessed preoperatively and 12 months postoperatively. Maximum spinal cord compression and compression rates were measured and calculated using both intraoperative ultrasound imaging and preoperative T2-weight (T2W) MRI. Signal change rates of the spinal cord on preoperative T2W MRI and gray value ratios of dorsal and ventral spinal cord hyperechogenicity on intraoperative ultrasound imaging were measured and calculated. Correlations between intraoperative ultrasound metrics, MRI metrics, and the recovery rate JOA scores were analyzed using Spearman correlation analysis. RESULTS The postoperative JOA scores improved significantly, with a mean recovery rate of 65.0 ± 20.3% (p < 0.001). No significant correlations were found between the operative ultrasound metrics and MRI metrics. The gray value ratios of the spinal cord hyperechogenicity was negatively correlated with the recovery rate of JOA scores (ρ = -0.638, p = 0.001), while the ventral and dorsal gray value ratios of spinal cord hyperechogenicity were negatively correlated with the recovery rate of JOA-motor scores (ρ = -0.582, p = 0.004) and JOA-sensory scores (ρ = -0.452, p = 0.035), respectively. The dorsal gray value ratio was significantly higher than the ventral gray value ratio (p < 0.001), while the recovery rate of JOA-motor scores was better than that of JOA-sensory scores at 12 months post-surgery (p = 0.028). CONCLUSION For degenerative cervical myelopathy, the correlations between intraoperative ultrasound and preoperative T2W MRI metrics were not significant. Gray value ratios of the spinal cord hyperechogenicity and dorsal and ventral spinal cord hyperechogenicity were significantly correlated with neurological recovery at 12 months postoperatively.
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Affiliation(s)
- Guoliang Chen
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology/Orthopaedic Research Institute, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Fuxin Wei
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Jiachun Li
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Liangyu Shi
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Wei Zhang
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Xianxiang Wang
- Department of Ultrasound, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Zuofeng Xu
- Department of Ultrasound, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Xizhe Liu
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology/Orthopaedic Research Institute, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Xuenong Zou
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology/Orthopaedic Research Institute, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shaoyu Liu
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology/Orthopaedic Research Institute, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
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37
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Ottesen TD, Bagi PS, Malpani R, Galivanche AR, Varthi AG, Grauer JN. Underweight patients are an often under looked “At risk” population after undergoing posterior cervical spine surgery. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2021; 5:100041. [PMID: 35141608 PMCID: PMC8820029 DOI: 10.1016/j.xnsj.2020.100041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/07/2020] [Accepted: 12/02/2020] [Indexed: 11/17/2022]
Abstract
Background Body Mass Index (BMI) is a weight-for-height metric that is used to quantify tissue mass and weight levels. Past studies have mainly focused on the association of high BMI on spine surgery outcomes and shown variable conclusions. Prior results may have varied due to insufficient power or inconsistent categorical separation of BMI groups (e.g. underweight, overweight, or obese). Additionally, few studies have considered outcomes of patients with low BMI. The aim of the current study was to analyze patients along the entirety of the BMI spectrum and to establish specific granular BMI categories for which patients become at risk for complication and mortality following posterior cervical spine surgery. Methods Patients undergoing elective posterior cervical spine surgery were abstracted from the 2005–2016 National Surgical Quality Improvement Program (NSQIP) databases. Patients were aggregated into pre-established WHO BMI categories and adverse outcomes were normalized to average risk of normal-weight subjects (BMI 18.5–24.9 kg/m2). Risk-adjusted multivariate regressions were performed controlling for patient demographics and overall health. Results A total of 16,806 patients met inclusion criteria. Odds for adverse events for underweight patients (BMI < 18.5 kg/m2) were the highest among any category of patients along the BMI spectrum. These patients experienced increased odds of any adverse event (Odds Ratio (OR) = 1.67, p = 0.008, major adverse events (OR=2.08, p = 0.001), post-operative infection (OR = 1.95, p = 0.002), and reoperation (OR = 1.84, p = 0.020). Interestingly, none of the overweight or obese categories were found to be correlated with increased risk of adverse event categories other than super-morbidly obese patients (BMI>50.0 kg/m2) for post-operative infection (OR = 1.54, p = 0.041). Conclusions The current study found underweight patients to have the highest risk of adverse events after posterior cervical spine surgery. Increased pre-surgical planning and resource allocation for this population should be considered by physicians and healthcare systems, as is often already done for patients on the other end of the BMI spectrum.
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Ganau M, Iqbal M, Ligarotti GKI, Kato S. Letter to the Editor. Randomized controlled trials on anterior versus posterior surgical decompression for degenerative cervical myelopathy. J Neurosurg Spine 2021:1-3. [PMID: 33545676 DOI: 10.3171/2020.10.spine201895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Mario Ganau
- 1Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Mohammad Iqbal
- 1Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Kwok SSS, Cheung JPY. Surgical decision-making for ossification of the posterior longitudinal ligament versus other types of degenerative cervical myelopathy: anterior versus posterior approaches. BMC Musculoskelet Disord 2020; 21:823. [PMID: 33292175 PMCID: PMC7724709 DOI: 10.1186/s12891-020-03830-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/25/2020] [Indexed: 12/02/2022] Open
Abstract
Background The debate between anterior or posterior approach for pathologies such as cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) have drawn heated debate but are still inconclusive. Main body of the abstract A narrative review was performed specifically to study the differences pertaining to OPLL and other causes of degenerative cervical myelopathy (DCM). Current evidence suggests that anterior approach is preferred for K-line (−) OPLL, K-line (+) with canal occupying ratio > 60% and DCM with pre-existing cervical kyphosis. Posterior approach is preferred for K-line (+) OPLL with canal-occupying ratio < 50–60%, and multi-level CSM. No particular advantage for either approach was observed for DCM in a lordotic cervical spine. Anterior approach is generally associated with more complications and thus needs to be weighed carefully during decision-making. The evidence is not convincing for comparing single versus multi-level involvement, and the role of patients' co-morbidity status, pre-existing osteoporosis and co-existent spinal pathologies in influencing patient outcome and surgical options. This should be a platform for future research directives. Conclusion From this review, evidence is still inconclusive but there are some factors to consider, and DCM and OPLL should be considered separately for decision-making. Anterior approach is considered for pre-existing cervical kyphosis in DCM, for K-line (−) regardless of canal-occupying ratio, and K-line (+) and canal-occupying ratio > 60% for OPLL patients. Posterior approach is considered for patients with multi-level pathology for DCM, and K-line (+) and canal-occupying ratio < 50–60% for OPLL.
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Affiliation(s)
- Suzanna Sum Sum Kwok
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China.
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Machino M, Ando K, Kobayashi K, Nakashima H, Kanbara S, Ito S, Inoue T, Koshimizu H, Ito K, Kato F, Imagama S. Prediction of outcome following laminoplasty of cervical spondylotic myelopathy: Focus on the minimum clinically important difference. J Clin Neurosci 2020; 81:321-327. [PMID: 33222939 DOI: 10.1016/j.jocn.2020.09.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/13/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
Abstract
The minimum clinically important difference (MCID) of the Japanese Orthopaedic Association (JOA) score has been reported to be around 2.5 points in cervical myelopathy. This study sought to define significant predictive factors on achieving the MCID following laminoplasty in a large series of patients with cervical spondylotic myelopathy (CSM). A total of 485 consecutive patients with CSM (295 males and 190 females; mean age: 67.0 years; age range: 42-91 years) who underwent laminoplasty were prospectively enrolled. The average postoperative follow-up period was 26.6 months (range: 12-66 months). We calculated the achieved JOA score. The relationships between outcomes and various clinical and imaging predictors including comorbidity and quantitative performance tests were examined. Logistic regression analysis was conducted to identify the predictors correlated with a JOA score of 2.5 points or more. Clinically meaningful gains were exhibited in 299 patients (61.6%) with a JOA score of ≥2.5 points, whereas 186 patients (38.4%) achieved a JOA score of <2.5 points. Univariate logistic regression analysis showed the predictive factors with a shorter duration of CSM symptoms, lower preoperative JOA scores, absence of hypertension, no use of anticoagulant/antiplatelet agents, and nonsmoking status. Multivariate logistic regression analysis determined that the duration of CSM symptoms (odds ratio: 0.771, 95% confidence interval: 0.705-0.844; p < 0.01) was the only significant predictive factor for achieving JOA scores of ≥2.5 points. An important predictor of MCID achievement following laminoplasty was shorter duration of CSM symptoms.
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Affiliation(s)
- Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Kanbara
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taro Inoue
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Koshimizu
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keigo Ito
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan.
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Zipser CM, Pfender N, Spirig JM, Betz M, Aguirre J, Hupp M, Farshad M, Curt A, Schubert M. Study protocol for an observational study of cerebrospinal fluid pressure in patients with degenerative cervical myelopathy undergoing surgical deCOMPression of the spinal CORD: the COMP-CORD study. BMJ Open 2020; 10:e037332. [PMID: 32958488 PMCID: PMC7507854 DOI: 10.1136/bmjopen-2020-037332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Degenerative cervical myelopathy (DCM) is a disabling spinal disorder characterised by sensorimotor deficits of upper and lower limbs, neurogenic bladder dysfunction and neuropathic pain. When suspected, cervical MRI helps to reveal spinal cord compression and rules out alternative diagnoses. However, the correlation between radiological findings and symptoms is weak. Cerebrospinal fluid pressure (CSFP) analysis may complement the appreciation of cord compression and be used for intraoperative and postoperative monitorings in patients undergoing surgical decompression. METHODS AND ANALYSIS Twenty patients diagnosed with DCM undergoing surgical decompression will receive standardised lumbar CSFP monitoring immediately before, during and 24 hours after operation. Rest (ie, opening pressure, CSF pulsation) and stimulated (ie, Valsalva, Queckenstedt's) CSFP-findings in DCM will be compared with 20 controls and results from CSFP monitoring will be related to clinical and neurophysiological findings. Arterial blood pressure will be recorded perioperatively and postoperatively to calculate spinal cord perfusion pressure and spinal vascular reactivity index. Furthermore, measures of CSFP will be compared with markers of spinal cord compression by means of MR imaging. ETHICS AND DISSEMINATION The study protocol conformed to the latest revision of the Declaration of Helsinki and was approved by the local Ethics Committee of the University Hospital of Zurich (KEK-ZH number PB-2016-00623). The main publications from this study will cover the CSFP fluid dynamics and pressure analysis preoperative, perioperative and postoperative correlated with imaging, clinical scores and neurophysiology. Other publications will deal with preoperative and postoperative spinal perfusion. Furthermore, we will disseminate an analysis on waveform morphology and the correlation with blood pressure and ECG. Parts of the data will be used for computational modelling of cervical stenosis. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT02170155).
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Affiliation(s)
- Carl Moritz Zipser
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Nikolai Pfender
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Jose Miguel Spirig
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Michael Betz
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Jose Aguirre
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
- Department of Anesthesiology, Balgrist University Hospital, Zurich, Switzerland
| | - Markus Hupp
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Mazda Farshad
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Armin Curt
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Martin Schubert
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
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Chen G, Li J, Wei F, Ji Q, Sui W, Chen B, Zou X, Xu Z, Liu X, Liu S. Short-term predictive potential of quantitative assessment of spinal cord impairment in patients undergoing French-door Laminoplasty for degenerative cervical myelopathy: preliminary results of an exploratory study exploiting intraoperative ultrasound data. BMC Musculoskelet Disord 2020; 21:336. [PMID: 32473626 PMCID: PMC7261379 DOI: 10.1186/s12891-020-03319-w] [Citation(s) in RCA: 5] [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] [Received: 02/05/2020] [Accepted: 04/28/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND To study the correlation of neurological function in degenerative cervical myelopathy (DCM) patients with quantitative assessment of spinal cord compression and impairment by intraoperative ultrasound imaging (IOUSI). METHODS Twenty-three patients who underwent French-Door laminoplasty for multilevel DCM were followed for 6 months. Modified Japanese Orthopaedic Association (mJOA) score and cervical MRI were assessed before surgery and at postoperative 6 months. IOUS, used to guide decompression, were recorded. The anteroposterior diameter (APD) and the gray values of the IOUSI hyperechogenicity of the midsagittal IOUSI at the narrowest level and at the lesion-free level, and the APD and traverse diameter at the traverse maximum compression level of IOUSI were measured. Maximum spinal cord compression (MSCC), compression rate (CR), and IOUSI gray value ratio (Rgray) were calculated. The appearance of preoperative T2W MRI increased signal intensity (ISI), and the signal change rate (SCR) on postoperative T2W MRI of 9 patients were also measured and calculated, and compared with that of IOUSI hyperechogenicity. RESULTS Average mJOA score increased significantly from 11.57 ± 2.67 before surgery to 15.39 ± 1.50 at 6 months after surgery, with an average recovery rate (RR) of 71.11 ± 22.81%. The difference between the appearance of preoperative T2W MRI ISI and IOUSI hyperechogenicity was not significant. Spearman correlation analysis found that the IOUSI Rgray were negatively correlated with the RR of mJOA score with a coefficient of - 0.77, and the IOUSI Rgray was not correlated with the postoperative MRI SCR. CONCLUSIONS In DCM patients, the gray values of IOUSI can be measured accurately. The IOUSI Rgray correlated with postoperative neurological recovery significantly.
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Affiliation(s)
- Guoliang Chen
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, P.R. China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology /Orthopaedic Research Institute, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, No.58 Zhongshan 2nd Road, Guangzhou, 510080, P.R. China
| | - Jiachun Li
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, P.R. China
| | - Fuxin Wei
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, P.R. China
| | - Qiao Ji
- Department of Ultrasound, The Seventh Affiliated Hospital, Sun Yat-sen University, No.628 Zhenyuan Road, Shenzhen, 518107, P.R. China
| | - Wenyuan Sui
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, P.R. China
| | - Bailing Chen
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology /Orthopaedic Research Institute, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, No.58 Zhongshan 2nd Road, Guangzhou, 510080, P.R. China
| | - Xuenong Zou
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology /Orthopaedic Research Institute, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, No.58 Zhongshan 2nd Road, Guangzhou, 510080, P.R. China
| | - Zuofeng Xu
- Department of Ultrasound, The Seventh Affiliated Hospital, Sun Yat-sen University, No.628 Zhenyuan Road, Shenzhen, 518107, P.R. China.
| | - Xizhe Liu
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology /Orthopaedic Research Institute, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, No.58 Zhongshan 2nd Road, Guangzhou, 510080, P.R. China.
| | - Shaoyu Liu
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, P.R. China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology /Orthopaedic Research Institute, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, No.58 Zhongshan 2nd Road, Guangzhou, 510080, P.R. China
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Du L, Gao Y, Gao K, Yang G, Gao S. Lateral Position versus Prone Position for Cervical Laminoplasty: A Retrospective Comparative Study. Ther Clin Risk Manag 2020; 16:133-140. [PMID: 32110031 PMCID: PMC7041431 DOI: 10.2147/tcrm.s227799] [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: 10/12/2019] [Accepted: 02/06/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To examine the safety of lateral decubitus positions for cervical laminoplasty. Patients and Methods A retrospective comparative study was conducted on the safety between the lateral and prone positions in cervical laminoplasty. After screening, 466 patients who underwent cervical laminoplasty at a single medical center were enrolled and categorized into the lateral (n=229) and prone (n=237) groups. Data on positioning time, surgical time, blood loss, complication rates, and surgical outcomes were collected and compared between the two groups. The patients were further divided into underweight, normal weight, overweight, and obesity subgroups according to their body mass index, and the collected data were compared between the lateral and prone groups. Results The lateral group had a lower incidence of facial pressure ulcers (2.18%) than the prone group (11.39%). However, positioning time, surgical time, blood loss, and surgical outcomes were not significantly different between the two groups. In the subgroup analysis, no significant difference in positioning time, operative time, and blood loss was observed in the underweight, normal weight, and overweight patients between the two groups, but in the obesity subgroup, the lateral group had a significantly shorter positioning time (15.23±6.44 vs 21.63±9.43 min, P=0.045) and operative time (140.16±40.48 vs 178.62±51.82 min, P=0.037) and lesser blood loss (285.31±171.75 vs 430.46±189.84 mL, P=0.044) than the prone group. Conclusion The lateral position is as safe as the prone position for cervical laminoplasty, but it has advantages over the prone position for patients with obesity.
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Affiliation(s)
- Lin Du
- Department of Spine Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China.,Microbiome Laboratory, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Yanzheng Gao
- Department of Spine Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Kun Gao
- Department of Spine Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Guang Yang
- Department of Spine Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Shanjun Gao
- Microbiome Laboratory, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
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Ozaki M, Nishioka K, Kitayama M, Kawaguchi T, Nakao N. Quantitative evaluation for cervical foraminal bony stenosis based on angled sagittal slices along a nerve root on computed tomography. J Clin Neurosci 2020; 71:89-92. [DOI: 10.1016/j.jocn.2019.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/12/2019] [Accepted: 10/04/2019] [Indexed: 12/20/2022]
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Krishnan SS, Nigam P. Comment on “Surgical decision-making in degenerative cervical myelopathy – Anterior versus posterior approach”. J Clin Neurosci 2019; 69:286. [DOI: 10.1016/j.jocn.2019.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
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46
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Moghaddamjou A, Fehlings MG. An Age-old Debate: Anterior Versus Posterior Surgery for Ossification of the Posterior Longitudinal Ligament. Neurospine 2019; 16:544-547. [PMID: 31607086 PMCID: PMC6790737 DOI: 10.14245/ns.19edi.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Ali Moghaddamjou
- Division of Neurosurgery and Spine Program, Department of Surgery, Toronto Western Hospital, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Michael G. Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, Toronto Western Hospital, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Pan Z, Huang K, Huang W, Kim KH, Wu H, Yu Y, Kim KN, Yi S, Shin DA, Vora D, Gragnaniello C, Phan K, Tasiou A, Winder MJ, Koga H, Azimi P, Kang SY, Ha Y. The risk factors associated with delirium after lumbar spine surgery in elderly patients. Quant Imaging Med Surg 2019; 9:700-710. [PMID: 31143661 DOI: 10.21037/qims.2019.04.09] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background To prospectively explore the incidence and risk factors for postoperative delirium in elderly patients following lumbar spine surgery. Methods This prospective study enrolled 148 consecutive patients over the age of 65 who were scheduled to undergo spine surgery. Patients were screened for delirium using the short Confusion Assessment Method (CAM) postoperatively. Patient demographics and relevant medical information were collected. Logistic regression analysis was used to identify the risk factors associated with postoperative delirium. Results Eighty-three patients (56.1%) who underwent lumbar spine surgery (not coexisting with cervical or thoracic spine surgery) were enrolled in our study. Post-operative delirium was noted in 14.5% of patients over 65 years old. The presence of preoperative Parkinsonism was significantly higher in the delirium group (41.7% vs. 8.5%, P=0.002), as was a higher preoperative C-reactive protein (CRP) (7.0±15.2 vs. 1.3±2.3 mg/L, P=0.017) when compared with the non-delirium group. Of the risk factors, male sex [odds ratio (OR) =0.10, 95% confidence interval (CI): 0.01-0.66, P=0.017], Parkinsonism (OR =5.83, 95% CI: 1.03-32.89, P=0.046), and lower baseline MMSE score (OR =0.71, 95% CI: 0.52-0.97, P=0.032) were independently associated with postoperative delirium in elderly patients undergoing lumbar spine surgery. Conclusions Post-operative delirium occurred in 14.5% of elderly patients who underwent lumbar spine surgery. Male sex, Parkinsonism, and lower baseline MMSE score were identified as independent risk factors for postoperative delirium in elderly patients following lumbar surgery.
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Affiliation(s)
- Zhimin Pan
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Kai Huang
- Department of Orthopedics, Zhabei Central Hospital of Jing'an District, Shanghai 200070, China
| | - Wei Huang
- Department of Clinical Laboratory, Jiangxi Province Children's Hospital, Nanchang 330006, China
| | - Ki Hoon Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Hao Wu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yanghong Yu
- Department of Radiology, Jiangxi Province Children's Hospital, Nanchang 330006, China
| | - Keung Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Darshan Vora
- Department of Neurosurgery, George Washington University, Washington, DC 20037, USA
| | | | - Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Randwick, NSW 2031, Australia
| | - Anastasia Tasiou
- Department of Neurosurgery, University Hospital of Larissa, Larissa 41110, Greece
| | - Mark J Winder
- Department of Neurosurgery, St Vincent's Public and Private Hospitals, Darlinghurst 2010, NSW, Australia
| | - Hisashi Koga
- PELD Center, Iwai Orthopaedic Medical Hospital, Tokyo 133-0056, Japan
| | - Parisa Azimi
- Functional Neurosurgery Research Center of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Suk Yun Kang
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, Republic of Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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