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Wang J, Kumar A, Shimer AL, Su BW. Traumatic Cervical Facet Fractures and Dislocations. Clin Spine Surg 2024:01933606-990000000-00373. [PMID: 39392234 DOI: 10.1097/bsd.0000000000001706] [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: 08/29/2024] [Accepted: 09/23/2024] [Indexed: 10/12/2024]
Abstract
Cervical facet injuries, though less common than other spinal injuries, represent a subset of subaxial cervical spine injuries and can present significant challenges in terms of diagnosis, management, and outcomes. A major concern with cervical facet fracture is identifying instability patterns that may necessitate surgical stabilization. Particularly in cases of cervical facet fracture dislocations, there remains controversy regarding requirements for closed reduction, timing, surgical approach, need for preoperative MRI, and method of fixation. This review article aims to provide a thorough understanding of the etiology, clinical presentation, diagnostic techniques, treatment options, and prognostic factors associated with cervical facet fractures.
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Affiliation(s)
- Jesse Wang
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Abhishek Kumar
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Adam L Shimer
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Brian W Su
- Marin Health Spine Institute, A UCSF Clinic, Larkspur, CA
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2
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Zhong W, Tang K, Quan Z. A novel nanohydroxyapatite/polyamide 66 strut for reducing subsidence after one-level anterior cervical corpectomy and fusion: a finite-element study. Eur J Med Res 2024; 29:375. [PMID: 39030641 PMCID: PMC11264631 DOI: 10.1186/s40001-024-01978-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/14/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND The aim of this study is to introduce a novel nanohydroxyapatite/polyamide 66(n-HA/PA66)n strut to improve biomechanical performance and reduce subsidence. METHODS One validated intact and 2 ACCF-simulated C3-C7 cervical spine models were developed (old strut: Group A, new strut: Group B). In the ACCF models, C5 underwent corpectomy and was fixed by an anterior cervical plate. Screw angles were categorized as 1 (0 ) and 2 (45 ) and divided into 4 groups, A1, A2, B1 and B2, for each model. An axial force of 74 N and a moment couple of 1.0 Nm were imposed on the C3 vertebra. The range of motion (ROM) of each segment and the stress distribution on the screw-vertebra interface, strut, and strut-endplate interface were recorded and analysed. RESULTS There was no significant difference in ROM between Group A and Group B during bending, extension and rotation under 74 N axial pressure. The stress concentration on the strut body in Group A was higher than that in Group B. The peak stress values at the screw-vertebral interface in Groups A1 and A2 were higher than those in Groups B1 and B2, except for during extension and lateral bending. Under axial pressure, the peak stress values at the strut body-endplate interface during bending, extension and rotation were lower in the A1 and A2 groups than in the B1 and B2 groups. The Group B model showed much higher graft stress than the Group A model. CONCLUSIONS Based on finite-element analysis, compared with the old strut, the novel strut showed better biomechanical performance at the screw-vertebra interface.
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Affiliation(s)
- Weiyang Zhong
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
- Orthopaedic Laboratory of Chongqing Medical University, Chongqing, China.
| | - Ke Tang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopaedic Laboratory of Chongqing Medical University, Chongqing, China
| | - Zhengxue Quan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopaedic Laboratory of Chongqing Medical University, Chongqing, China
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Cui Y, Zhou Y, Liu J, Duan D, Gong L, Li W. ACDF plus Uncovertebrectomy versus ACDF alone for the Treatment of Cervical Spondylotic Radiculopathy: Minimum 5-Year Follow-Up. J Neurol Surg A Cent Eur Neurosurg 2021; 82:154-160. [PMID: 33386028 DOI: 10.1055/s-0040-1720992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The surgical approach for cervical spondylotic radiculopathy (CSR) is controversial. This study aims to investigate the effectiveness of the combined anterior cervical diskectomy and fusion (ACDF) and uncovertebrectomy for treatment of CSR. METHODS This is a retrospective case control study. One hundred and forty-six patients with CSR who underwent two different procedures (ACDF alone [group A]) and a combination of ACDF and uncovertebrectomy [group B]) from March 2008 to April 2013 were included. The operation time, blood loss, Visual Analog Scale scores of the neck (VAS-neck) and arm (VAS-arm), Neck Disability Index (NDI) score, 36-Item Short Form Health Survey (SF-36) score, fusion segment curvature, global cervical curvature, and the rate of surgical complication were evaluated. RESULTS There were no significant differences in the basic demographic and clinical characteristics between the two groups (p > 0.05). No significant differences were noticed in the fusion segment curvature and global cervical curvature between the two groups (p > 0.05). Whereas the operation time and blood loss in group B were greater than those in group A (p < 0.05), the VAS-neck, VAS-arm, NDI, and SF-36 scores were better in group B (p < 0.05). The surgical complication rate between the two groups was not significantly different (p > 0.05). CONCLUSIONS Clinical efficacy of ACDF plus uncovertebrectomy for the treatment of patients with CSR may be better than that of ACDF alone, but at the expense of more operation time and blood loss.
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Affiliation(s)
- Yaqing Cui
- Department of Orthopaedic, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Yongchun Zhou
- Department of Orthopaedic, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Jun Liu
- Department of Orthopaedic, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Dapeng Duan
- Department of Orthopaedic, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Liqun Gong
- Department of Orthopaedic, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Weiwei Li
- Department of Orthopaedic, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
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Hirai T, Yoshii T, Egawa S, Sakai K, Inose H, Yuasa M, Yamada T, Ushio S, Kato T, Arai Y, Kawabata S, Shindo S, Nakai O, Okawa A. Increased Height of Fused Segments Contributes to Early-Phase Strut Subsidence after Anterior Cervical Corpectomy with Fusion for Multilevel Ossification of the Posterior Longitudinal Ligament. Spine Surg Relat Res 2020; 4:294-299. [PMID: 33195852 PMCID: PMC7661025 DOI: 10.22603/ssrr.2019-0102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/12/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Anterior decompression and fusion have shown favorable neurologic outcomes in patients with cervical myelopathy. However, implant migration sometimes occurs immediately after multilevel anterior cervical corpectomy with fusion (ACCF). Risk factors associated with early bone graft migration have not been precisely documented. The study aimed to investigate how frequently bone graft subsidence occurs after ACCF and to determine the factors affecting implant migration. Methods Forty-seven consecutive patients who underwent ACCF for ossification of the posterior longitudinal ligament at our hospital between 2007 and 2015 and were able to complete 1 year of follow-up were enrolled. Patients treated with hybrid fixation were excluded. Data on demographics and radiographic findings, namely, fused segment angle and fused segment height (FSH), were collected. Implant migration was defined as subsidence of >3 mm. The patients were divided into 2-segment (2F), 3-segment (3F), and ≥4-segment (4F) groups. Results were compared between the groups using one-way analysis of variance, the Mann-Whitney U test, and the chi-square test. Results Mean age was 61.6 years in the 2F group (n = 17), 62.1 years in the 3F group (n = 21), and 69 years in the 4F group (n = 9). There were no significant between-group differences in demographics or clinical characteristics. Implant subsidence occurred in 3 cases (17.6%) in the 2F group, 4 (19%) in the 3F group, and 3 (33.3%) in the 4F group. Revision surgery was required in 2 cases (1 patient each in the 3F and 4F groups). Logistic regression analysis showed a significant association of increased FSH and increased risk of postoperative implant subsidence. Conclusions A postoperative increase in FSH may affect graft stability and lead to early implant migration.
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Affiliation(s)
- Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoru Egawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenichiro Sakai
- Department of Orthopedic Surgery, Kudanzaka Hospital, Tokyo, Japan
| | - Hiroyuki Inose
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masato Yuasa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsuyoshi Yamada
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shuta Ushio
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsuyoshi Kato
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiyasu Arai
- Department of Orthopedic Surgery, Kudanzaka Hospital, Tokyo, Japan
| | - Shigenori Kawabata
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shigeo Shindo
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan
| | - Osamu Nakai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Park BJ, Nourski KV, Noeller J, Seaman SC, Woodroffe RW, Hitchon PW. Indications and Outcomes for Contemporaneous Anteroposterior Surgery in Cervical Stenosis and Myelopathy: Single Center Experience. World Neurosurg 2020; 140:e348-e359. [DOI: 10.1016/j.wneu.2020.05.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022]
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Kinon MD, Greeley SL, Harris JA, Gelfand Y, Yassari R, Nakhla J, De la Garza-Ramos R, Patel P, Mirabile B, Bucklen BS. Biomechanical evaluation comparing zero-profile devices versus fixed profile systems in a cervical hybrid decompression model: a biomechanical in vitro study. Spine J 2020; 20:657-664. [PMID: 31634616 DOI: 10.1016/j.spinee.2019.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/08/2019] [Accepted: 10/15/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The use of zero-profile devices and the need for posterior fixation in conjunction with a cervical hybrid decompression model have yet to be investigated. PURPOSE To compare the biomechanics of zero-profile and fixed profile cervical hybrid constructs composed of anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF). Fixed profile devices included anterior plating, whereas zero-profile devices included integrated screws. STUDY DESIGN In vitro cadaveric biomechanical study. METHODS Twelve fresh-frozen cadaveric spines (C2-C7) were divided into two groups of equal bone mineral density, fixed profile versus zero profile (n=6). Groups were instrumented from C3-C6 with either (1) an expandable ACCF device and a static ACDF spacer with an anterior plate (Hybrid-AP) or (2) a zero-profile ACCF spacer with adjacent zero-profile ACDF spacer (Hybrid-Z). Motion was captured for the (1) intact condition, (2) a hybrid model with lateral mass screws (LMS), (3) a hybrid model without LMS, and (4) a hybrid model without LMS following simulated repetitive loading (fatigue). RESULTS Hybrid-AP with LMS reduced motion in flexion-extension (FE), lateral bending (LB), and axial rotation (AR) by 77%, 88%, and 82%, respectively, compared with intact. Likewise, Hybrid-Z with LMS exhibited the greatest reduction in motion relative to intact in FE, LB, and AR by 90%, 95%, and 66%, respectively. Following simulated in vivo fatiguing, an increase in motion was observed for both groups in all planes, particularly during Hybrid-Z postfatigue condition where motion increased relative to intact by 29%. Overall, biomechanical equivalency was observed between Hybrid-AP and Hybrid-Z groups (p>.05). Three (50%) of the Hybrid-Z group specimens exhibited signs of implant migration from the inferior endplate during testing. CONCLUSIONS Fixed profile systems using an anterior plate for supplemental fixation is biomechanically more favorable to maintain stability and prevent dislodgement. Dislodgement of 50% of the Hybrid-Z group without LMS emphasizes the necessity for posterior fixation in a zero-profile cervical hybrid decompression model.
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Affiliation(s)
- Merritt D Kinon
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Samantha L Greeley
- Musculoskeletal Education and Research Center, Globus Medical, Inc., Audubon, PA, USA.
| | - Jonathan A Harris
- Musculoskeletal Education and Research Center, Globus Medical, Inc., Audubon, PA, USA
| | - Yaroslav Gelfand
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Reza Yassari
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Jonathan Nakhla
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | | | - Pavan Patel
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Belin Mirabile
- Department of Mechanical Engineering, College of Engineering, University of Notre Dame, Notre Dame, IN, USA
| | - Brandon S Bucklen
- Musculoskeletal Education and Research Center, Globus Medical, Inc., Audubon, PA, USA
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Kwon JW, Bang SH, Park TH, Lee SJ, Lee HM, Lee SB, Lee BH, Moon SH. Biomechanical comparison of cervical discectomy/fusion model using allograft spacers between anterior and posterior fixation methods (lateral mass and pedicle screw). Clin Biomech (Bristol, Avon) 2020; 73:226-233. [PMID: 32062472 DOI: 10.1016/j.clinbiomech.2020.01.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study is to investigate effects of different fixation methods on the physical stress on allospacers, endplate-vertebral body, and implants using finite element model analyses. METHODS Stress distribution and subsidence risk according to the fixation methods under the condition of hybrid motion control were analyzed. The detailed finite element model of a previously validated, three-dimensional, intact cervical spinal segment model, with C5-C6 segmental fusion using allospacer, was used to evaluate the biomechanical characteristics of different fixation combinations, such as anterior plate/screws, lateral mass screw, and posterior pedicle screw. FINDINGS The load sharing on allospacers increased in extension in order of posterior pedicle screws (21.4%), lateral mass screws (31.5%), and anterior plate/screws (56.6%). lateral mass screw demonstrated the highest load sharing (68.1%) on the allospacer in flexion. The Peak von Mises stress of the allospacer was the lowest in flexion and axial rotation but the highest in extension with anterior plate/screws. Allospacer subsidence risk was the lowest in extension, lateral bending, and axial rotation with posterior pedicle screws but the lowest in flexion with anterior plate/screws. The bone-screw loosening risk was the lowest in all modes with posterior pedicle screws but the highest with anterior plate/screws. INTERPRETATION Posterior pedicle screws demonstrated the best mechanical stability of allospacer failure-subsidence and the lowest risk of screw loosening. Different motion restrictions depending on the fixation method should be considered for implant and allospacer safety.
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Affiliation(s)
- Ji-Won Kwon
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Goyang 10444, Republic of Korea
| | - Sun Hee Bang
- School of Biomedical Engineering, Inje University, 197 Inje-ro, Gimhae-si, Gyeongsangnam-do 50834, Republic of Korea
| | - Tae Hyun Park
- School of Biomedical Engineering, Inje University, 197 Inje-ro, Gimhae-si, Gyeongsangnam-do 50834, Republic of Korea
| | - Sung-Jae Lee
- School of Biomedical Engineering, Inje University, 197 Inje-ro, Gimhae-si, Gyeongsangnam-do 50834, Republic of Korea
| | - Hwan-Mo Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Soo-Bin Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Byung Ho Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | - Seong-Hwan Moon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
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Kang JH, Im SB, Yang SM, Chung M, Jeong JH, Kim BT, Hwang SC, Shin DS, Park JH. Surgical Reconstruction Using a Flanged Mesh Cage without Plating for Cervical Spondylotic Myelopathy and a Symptomatic Ossified Posterior Longitudinal Ligament. J Korean Neurosurg Soc 2019; 62:671-680. [PMID: 31392873 PMCID: PMC6835151 DOI: 10.3340/jkns.2019.0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/09/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We introduce innovative method of cervical column reconstruction and performed the reconstruction with a flanged titanium mesh cage (TMC) instead of a plate after anterior corpectomy for cervical spondylotic myelopathy (CSM) and an ossified posterior longitudinal ligament (OPLL). METHODS Fifty patients with CSM or OPLL who underwent anterior cervical reconstruction with a flanged TMC were investigated retrospectively. Odom's criteria were used to assess the clinical outcomes. The radiographic evaluation included TMC subsidence, fusion status, and interbody height. Thirty-eight patients underwent single-level and 12 patients underwent two-level corpectomy with a mean follow-up period of 16.8 months. RESULTS In all, 19 patients (38%) had excellent outcomes and 25 patients (50%) had good outcomes. Two patients (4%) in whom C5 palsy occurred were categorized as poor. The fusion rate at the last follow-up was 98%, and the severe subsidence rate was 34%. No differences in subsidence were observed among Odom's criteria or between the single-level and two-level corpectomy groups. CONCLUSION The satisfactory outcomes in this study indicate that the flanged TMC is an effective graft for cervical reconstruction.
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Affiliation(s)
- Jung Hoon Kang
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Soo-Bin Im
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sang-Mi Yang
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Moonyoung Chung
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Je Hoon Jeong
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Bum-Tae Kim
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sun-Chul Hwang
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Dong-Seong Shin
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jong-Hyun Park
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Wang W, Pei B, Pei Y, Shi Z, Kong C, Wu X, Wu N, Fan Y, Lu S. Biomechanical effects of posterior pedicle fixation techniques on the adjacent segment for the treatment of thoracolumbar burst fractures: a biomechanical analysis. Comput Methods Biomech Biomed Engin 2019; 22:1083-1092. [PMID: 31225742 DOI: 10.1080/10255842.2019.1631286] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Posterior pedicle fixation technique is a common method for treating thoracolumbar burst fractures, but the effect of different fixation techniques on the postoperative spinal mechanical properties has not been clearly defined, especially on adjacent segments. A finite element model of T10-L2 with moderate T12 vertebra burst fracture was constructed to investigate biomechanical behavior of three posterior pedicle screw fixation techniques. Compared with traditional short-segment 4 pedicle screw fixation (TS-4) and intermediate long-segment 6 pedicle screw fixation (IL-6), mono-segment 4 pedicle screw fixation (MS-4) provides a safer surgical selection to prevent the secondary degeneration of adjacent segments in the long-term.
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Affiliation(s)
- Wei Wang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University , Beijing , China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University , Beijing , China
| | - Baoqing Pei
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University , Beijing , China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University , Beijing , China
| | - Yuyang Pei
- School of Public Health, Nanjing Medical University , Nanjing , China
| | - Zhenpeng Shi
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University , Beijing , China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University , Beijing , China
| | - Chao Kong
- Capital Medical University XuanWu Hospital , Beijing , China
| | - Xueqing Wu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University , Beijing , China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University , Beijing , China
| | - Nan Wu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University , Beijing , China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University , Beijing , China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University , Beijing , China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University , Beijing , China
| | - Shibao Lu
- Capital Medical University XuanWu Hospital , Beijing , China
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10
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Zhao L, Chen J, Liu J, Elsamaloty L, Liu X, Li J, Elgafy H, Zhang J, Wang L. Biomechanical analysis on of anterior transpedicular screw-fixation after two-level cervical corpectomy using finite element method. Clin Biomech (Bristol, Avon) 2018; 60:76-82. [PMID: 30326320 DOI: 10.1016/j.clinbiomech.2018.09.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 08/01/2018] [Accepted: 09/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anterior cervical trans-pedicle screw fixation was introduced to overcome some of the disadvantages associated with anterior cervical corpectomy and fusion. In vitro biomechanical studies on the trans-pedicle screw fixation have shown excellent pull-out strength and favorable stability. Comprehensive biomechanical performance studies on the trans-pedicle screw fixation, however, are lacking. METHODS The control computed tomography images (C2-T2) were obtained from a 22-year-old male volunteer. A three dimensional computational model of lower cervical spine (C3-T1) was developed using computed tomography scans from a 22 year old human subject. The models of intact C3-T1 (intact group), anterior cervical trans-pedicle screw fixation (trans-pedicle group), and anterior cervical corpectomy and fusion (traditional group) were analyzed with using a finite element software. A moment of 1 N·m and a compressive load of 73.6 N were loaded on the upper surface and upper facet joint surfaces of C3. Under six conditions, four parameters such as the range of motion, titanium mesh plant stress, end-plate stress, and bone-screw stress were measured and compared on two treatment groups. FINDINGS Compared with the intact model, the range of motions for treatment groups were decreased. Compared with cervical corpectomy and fusion, the titanium plant, C4 upper end-plate and C7 lower end-plate stresses in trans-pedicle group were reduced. No significant difference was discovered on bone-screw stress between the two groups for lateral flexion and rotation, but bone-screw stress is smaller in trans-pedicle group when compared with traditional group. With exception of individual difference, trans-pedicle group had better biomechanical results than traditional group in range of motions, titanium mesh plant stress, end-plate stress and bone-screw stress. INTERPRETATION The trans-pedicle method has better biomechanical properties than the anterior cervical corpectomy and fusion making it a viable alternative for cervical fixations.
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Affiliation(s)
- Liujun Zhao
- Ningbo No.6 Hospital, 1059#, Zhongshan Dong Road, Ningbo City, Zhejiang Province, PR China.
| | - Jianqing Chen
- Jinhua people's Hospital, 228#, Xinhua Road, Jinhua City, Zhejiang Province, PR China
| | - Jiayong Liu
- University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH 43614, USA
| | - Lina Elsamaloty
- University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH 43614, USA
| | - Xiaochen Liu
- University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH 43614, USA
| | - Jie Li
- Ningbo Medical Center Lihuili Eastern Hospital, 1111#, Jiangnan Road, Ningbo City, Zhejiang Province, PR China
| | - Hossein Elgafy
- University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH 43614, USA
| | - Jihui Zhang
- Ningbo No.6 Hospital, 1059#, Zhongshan Dong Road, Ningbo City, Zhejiang Province, PR China
| | - Leining Wang
- Ningbo No.6 Hospital, 1059#, Zhongshan Dong Road, Ningbo City, Zhejiang Province, PR China
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Wang SJ, Ma B, Huang YF, Pan FM, Zhao WD, Wu DS. Four-level anterior cervical discectomy and fusion for cervical spondylotic myelopathy. J Orthop Surg (Hong Kong) 2016; 24:338-343. [PMID: 28031502 DOI: 10.1177/1602400313] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To review the outcome of 32 consecutive patients who underwent 4-level anterior cervical discectomy and fusion (ACDF) with cages and plates and were followed up for at least 5 years. METHODS Records of 19 men and 13 women aged 48 to 69 years who underwent 4-level ACDF with cages and plates for myelopathy (n=11) or myeloradiculopathy (n=21) at C3 to C7 by a single surgeon and were followed up for a minimum of 5 years were reviewed. Clinical outcome was assessed using the visual analogue scale (VAS), Neck Disability Index (NDI), and modified Japanese Orthopaedic Association (JOA) score for pain or myelopathic symptoms. Radiographic evaluation included fusion rate, range of motion, cervical lordosis (C2-to-C7 Cobb angle), and disc height. RESULTS The mean follow-up was 66 months. All patients had good recovery of muscle strength and resolution of limb sensory disturbance, except for 4 who still had some numbness. The mean VAS for neck and arm pain improved from 14.2 to 6.84 (p=0.012); the mean NDI improved from 31.62 to 12.17 (p<0.01); and the mean JOA score improved from 10.1 to 13.9 (p=0.027). The mean percentage of recovery was 62.9. The mean Cobb angle improved from 10.24º to 1.28º (p=0.019); the mean disc height improved from 4.12 to 6.58 mm (p<0.01). 30 (94%) patients achieved solid fusion. CONCLUSION Multilevel ACDF using PEEK cages and plates is safe and effective for multilevel cervical spondylotic myelopathy and achieves satisfactory mid-term outcome.
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Affiliation(s)
- Shan-Jin Wang
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Liu W, Hu L, Chou PH, Liu M, Kan W, Wang J. Comparison of anterior decompression and fusion versus laminoplasty in the treatment of multilevel cervical ossification of the posterior longitudinal ligament: a systematic review and meta-analysis. Ther Clin Risk Manag 2016; 12:675-85. [PMID: 27217760 PMCID: PMC4853147 DOI: 10.2147/tcrm.s100046] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose A meta-analysis was conducted to evaluate the clinical outcomes, complications, reoperation rates, and late neurological deterioration between anterior decompression and fusion (ADF) and laminoplasty (LAMP) in the treatment of multilevel cervical ossification of the posterior longitudinal ligament (OPLL). Methods All related studies published up to August 2015 were acquired by searching PubMed and EMBASE. Exclusion criteria were case reports, revision surgeries, combined anterior and posterior surgeries, the other posterior approaches including laminectomy or laminectomy and instrumented fusion, non-English studies, and studies with quality assessment scores of <7. The main end points including Japanese Orthopedic Association (JOA) score, recovery rate of JOA, cervical lordosis, complication rate, reoperation rate, and late neurological deterioration were analyzed. All available data was analyzed using RevMan 5.2.0 and Stata 12.0. Results A total of seven studies were included in the meta-analysis. The mean surgical level of ADF was 3.1, and the mean preoperative occupation ratios of ADF and LAMP group were 55.9% and 51.9%, respectively. No statistical difference was observed with regard to preoperative occupation ratio and preoperative JOA score. Although LAMP group had a higher preoperative cervical lordosis than ADF group (P<0.05, weighted mean difference [WMD] =−5.73, 95% confidence interval [CI] =−9.67–−1.80), significantly decreased cervical lordosis was observed in LAMP group after operation. ADF group had higher postoperative JOA score (P<0.05, WMD =2.18, 95% CI =0.98–3.38) and neurological recovery rate (P<0.05, WMD =27.22, 95% CI =15.20–39.23). Furthermore, ADF group had a lower late neurological deterioration rate than the LAMP group (P<0.05, risk difference =0.16, 95% CI =0.04–0.73). The complication rates of both groups had no statistical difference. However, LAMP group had a significantly lower reoperation rate than ADF group. The reoperation rate of ADF group (20.5%) was almost six times that of LAMP group (3.5%). Conclusion Our meta-analysis suggested that ADF was associated with better postoperative neurological function, neurological recovery rate, and less late neurological deterioration than LAMP in the treatment of multilevel cervical OPLL with a high mean occupation ratio. LAMP was associated with a decreased postoperative cervical lordosis, which might be a cause of late neurological deterioration. The complication rates of both groups showed no statistical difference. However, the reoperation rate was significantly higher in ADF group compared with LAMP group. Benefits and risks should be balanced when ADF or LAMP is selected.
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Affiliation(s)
- Weijun Liu
- Department of Orthopedics, Pu Ai Hospital, Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Ling Hu
- Department of Anesthesiology, Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, People's Republic of China
| | - Po-Hsin Chou
- Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ming Liu
- Department of Orthopedics, Pu Ai Hospital, Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Wusheng Kan
- Department of Orthopedics, Pu Ai Hospital, Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Junwen Wang
- Department of Orthopedics, Pu Ai Hospital, Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China; Department of Orthopedics, Pu Ai Hospital, Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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Mackiewicz A, Banach M, Denisiewicz A, Bedzinski R. Comparative studies of cervical spine anterior stabilization systems--Finite element analysis. Clin Biomech (Bristol, Avon) 2016; 32:72-9. [PMID: 26851563 DOI: 10.1016/j.clinbiomech.2015.11.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The object of the study was to assess the impact of one-level stabilization of the cervical spine for both anterior static and dynamic plates. Segments C2-C6 of the cervical spine, were investigated, from which was determined the stress and strain fields in the region of implantation and adjacent motion segments. The purpose was the comparison of changes that affect the individual stabilizers. METHODS For testing we used finite element analysis. The cervical spine model takes into account local spondylodesis. The study includes both an intact anatomical model and a model with implant stabilization. FINDINGS The analysis covered the model loaded with a moment of force for 1 Nm in the sagittal plane during movement. We compared both the modeled response of the whole fragment C2-C6 and the response of individual motion segments. The largest limitation of range of motion occurred after implantation with static plates. The study also showed that the introduction of the one-level stabilization resulted in an increase in stress in intervertebral disc endplates of adjacent segments. INTERPRETATION The results indicate that the increase in stress caused by stiffening may result in disorders in remodeling of bone structures. The use of dynamic plates showed improved continuity strains in the tested spine, thereby causing remodeling most similar to the physiological state and reducing the stresses in adjacent segments.
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Affiliation(s)
- A Mackiewicz
- University of Zielona Góra, Zielona Góra, Poland.
| | - M Banach
- St. Raphael Hospital in Krakow, Krakow, Poland.
| | | | - R Bedzinski
- University of Zielona Góra, Zielona Góra, Poland.
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Wang Q. Treatment of subaxial cervical facet dislocations. J Neurosurg Spine 2015; 24:672-3. [PMID: 26682600 DOI: 10.3171/2015.6.spine15673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Qi Wang
- General Hospital of Shenyang Military Area Command, Liaoning Province, China
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Quinn JC, Kiely PD, Lebl DR, Hughes AP. Anterior surgical treatment of cervical spondylotic myelopathy: review article. HSS J 2015; 11:15-25. [PMID: 25737664 PMCID: PMC4342400 DOI: 10.1007/s11420-014-9408-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 07/03/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cervical spondylotic myelopathy (CSM) is a common indication for cervical spine surgery. Surgical options include anterior, posterior, or combined procedures each with specific advantages and disadvantages. QUESTIONS/PURPOSES This article will provide a description of the various anterior alternatives and discuss the available evidence used in guiding the surgical decision making process with the aim of answering the following questions: (1) What anatomical/disease related factors favor anterior over posterior surgeries? (2) What are the common anterior procedures and how safe and effective are they? (3) What are the most effective options for multilevel CSM? (4) Is there a role for motion preservation? An additional objective is to discuss technical advances that have improved success rates for anterior procedures. METHODS The PubMed database was searched. Keywords were CSM and anterior surgery. Three hundred eighty two articles were found one hundred three were reviewed. Articles describing anterior cervical techniques were selected along with studies describing the various anterior techniques or comparisons of anterior to posterior techniques. RESULTS Anterior decompression and fusion procedures are more effective than posterior procedures for patients with primarily ventrally located compression especially in the presence of cervical kyphosis. ACDF, ACCF, and hybrid combinations are safe and effective treatment options for multilevel CSM. Anterior procedures may be more cost effective and result in significantly improved postoperative quality of life and health-related quality of life measures compared to posterior procedures. CONCLUSION Anterior cervical decompression techniques are safe and effective in the treatment of CSM. Anterior surgeries may be preferable to posterior approaches, when considering health-related quality of life measures and cost effectiveness.
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Affiliation(s)
- John C. Quinn
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Paul D. Kiely
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Darren R. Lebl
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Koller H, Schmoelz W, Zenner J, Auffarth A, Resch H, Hitzl W, Malekzadeh D, Ernstbrunner L, Blocher M, Mayer M. Construct stability of an instrumented 2-level cervical corpectomy model following fatigue testing: biomechanical comparison of circumferential antero-posterior instrumentation versus a novel anterior-only transpedicular screw–plate fixation technique. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24:2848-56. [DOI: 10.1007/s00586-015-3770-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 01/12/2015] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
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Anterior cervical discectomy versus corpectomy for multilevel cervical spondylotic myelopathy: a meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:31-9. [PMID: 25326181 DOI: 10.1007/s00586-014-3607-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 09/27/2014] [Accepted: 09/28/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE This is a meta-analysis to compare the results between anterior cervical discectomy fusion (ACDF) and anterior cervical corpectomy fusion (ACCF) for the patients with multilevel cervical spondylotic myelopathy (MCSM). METHODS Systematic review and meta-analysis of cohort studies between ACDF with plate fixation and ACCF with plate fixation for the treatment of MCSM. An extensive search of literature was performed in PubMed, Mediline, Embase and the Cochrane library. The following outcome measures were extracted: JOA scores, fusion rate, cervical lordosis (C2-7), complications, blood loss and operation time. Data analysis was conducted with RevMan 5.0. RESULTS Four cohorts (six studies) involving 258 patients were included in this study. The pooled analysis showed that there was no significant difference in the postoperative JOA score [WMD = -0.14 (-1.37, 1.10), P = 0.83], fusion rate [OR = 0.84 (0.15, 4.86), P = 0.85] between two group. However, there was significant difference in the cervical lordosis [WMD = 3.38 (2.52, 4.23), P < 0.00001], surgical complication rate and instrument related complication rate (P = 0.01, 0.005 respectively), blood loss [WMD = -52.53 (-73.53, -31.52), P < 0.00001], and operation time [WMD = -14.10 (-20.27, -7.93), P < 0.00001]. CONCLUSIONS As compared with ACCF with plate fixation, ACDF with plate fixation showed no significant differences in terms of postoperative JOA score, fusion rate, but better improved cervical lordosis, lower complication and smaller surgical trauma. As the limitations of small sample and short follow-up in this study, it still could not be identified whether ACDF with plate fixation is more effective and safer than ACCF with plate fixation.
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Abstract
STUDY DESIGN A retrospective case series. SUMMARY OF BACKGROUND DATA The authors present their experience with the ATHLET vertebral body replacement (VBR) system in combination with the TOSCA plating system for the treatment of cervical spondylotic myelopathy. METHODS Data obtained from 20 cases were reviewed. Corpectomy and VBR with the ATHLET system was performed in all cases. Patients underwent preoperative and postoperative assessment involving the Japanese Orthopedic Association score, Odom criteria, and radiographic studies to determine the position of the implant as well as cervical lordosis. The mean follow-up period was 20 months (16-28 mo). RESULTS Implantation of the ATHLET VBR itself was uncomplicated in all cases. The adjustment of the implants' height could be done in 2 mm steps. With increasing height of the implant, the angle of lordosis increases comparable with physiological conditions. The authors performed 13 one-level and 7 two-level corpectomies; from the latter group there were 2 revision cases (10%) with implant dislocation. Four cases (20%) of secondary subsidence of the implant were observed radiographs 12 months postoperatively; in all cases treatment remained conservative. Ten patients (50%) had excellent, 4 (30%) good, 2 (10%) satisfactory, and 2 (10%) poor outcome according to Odom criteria. The average improvement of the Japanese Orthopedic Association score was 1.6. All cases achieved osseous fusion without complications, 55% of them had an improvement, and 15% of them had no change of the sagittal contour. CONCLUSIONS The ATHLET VBR is easy to implant and avoids bone graft site morbidity. Due to a relatively high rate of secondary subsidence of the implant (20%) and secondary dislocation (10%) in combination to a poor to satisfactory outcome according to Odom criteria in 20%, the authors do not recommend the use of this PEEK implant for cervical VBR.
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Anterior cervical intercorporal fusion in patients with osteoporotic or tumorous fractures using a cement augmented cervical plate system: first results of a prospective single-center study. ACTA ACUST UNITED AC 2013; 26:E112-7. [PMID: 23073150 DOI: 10.1097/bsd.0b013e3182764b37] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Prospective observational clinical study. OBJECTIVE The aim of this study is to evaluate the technical feasibility and the safety of additional cement augmentation of anterior cervical implants in patients with poor bone quality because of osteoporosis or tumor infiltration. SUMMARY OF BACKGROUND DATA With an increasing number of elderly patients in spinal surgery the problem of implant dislocation after cervical instrumentation will become a more and more important problem. Whereas in the thoracolumbar area cement augmented screws have become widely accepted to ensure a rigid fixation in patients with reduced bone quality there are no data concerning an additional intravertebral cement augmentation after cervical plating. METHODS Nine patients (4 males, 5 females, mean age 62.8 y) with newly diagnosed fractures of 1 or 2 cervical vertebrae because of tumor infiltration (6 cases) or osteoporosis (3 cases) were included in our study. A standard 1-level or 2-level cervical corpectomy with vertebral body replacement by an in situ expandable titanium cage and additional anterior plating was carried out. After this, additional cement augmentation was performed as a vertebroplasty of the anterior two thirds of the cranial and caudal adjacent vertebra by a new anterior hole. The cement should enclose the screws and stabilize the endplates of the adjacent vertebrae. Follow-up comprised clinical examinations, SF-36 questionnaire and visual analog scale 3, 6, and 12 months after surgery. Cervical spine radiographs were obtained 3 and 6 months after surgery and computed tomography scans 6 and 12 months after surgery. RESULTS The median follow-up was 10 months with a range of 4-18 months. There was no intraoperative cement leakage into the spinal canal. The visual analog scale decreased from 8.2 to 4.2 at 6 months, physical and mental component summaries of SF-36 increased significantly from 27.7 to 36.1 and 31.5 to 48.6 at 6 months, respectively. Loosening of screws or plates was not detected throughout the whole observation period. There was 1 subsidence of a titanium cage into an adjacent vertebra without any clinical consequences. There was no adjacent fracture during the follow-up period and other surgical interventions or revisions were not necessary in any patient. CONCLUSIONS In patients with severe osteoporosis or in patients with advanced tumor disease, excellent surgical, clinical, and radiologic results are possible following our method. In our opinion, a second-step posterior approach can be avoided by this technique.
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Hussain M, Nassr A, Natarajan RN, An HS, Andersson GBJ. Relationship between biomechanical changes at adjacent segments and number of fused bone grafts in multilevel cervical fusions: a finite element investigation. J Neurosurg Spine 2013; 20:22-9. [PMID: 24180310 DOI: 10.3171/2013.9.spine121081] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Biomechanical studies have shown that anterior cervical fusion construct stiffness and arthrodesis rates vary with different reconstruction techniques; however, the behavior of the adjacent segments in the setting of different procedures is poorly understood. This study was designed to investigate the adjacent-segment biomechanics after 3 different anterior cervical decompression and fusion techniques, including 3-level discectomy and fusion, 2-level corpectomy and fusion, and a corpectomy-discectomy hybrid technique. The authors hypothesized that biomechanical changes at the segments immediately superior and inferior to the multilevel fusion would be inversely proportional to the number of fused bone grafts and that these changes would be related to the type of fusion technique. METHODS A previously validated 3D finite element model of an intact C3-T1 segment was used. Three C4-7 fusion models were built from this intact model by varying the number of bone grafts used to span the decompression: a 1-graft model (2-level corpectomy), a 2-graft model (C-5 corpectomy and C6-7 discectomy), and a 3-graft model (3-level discectomy). The corpectomy and discectomy models were also previously validated and compared well with the literature findings. Range of motion, disc stresses, and posterior facet loads at the segments superior (C3-4) and inferior (C7-T1) to the fusion construct were assessed. RESULTS Motion, disc stresses, and posterior facet loads generally increased at both of the adjacent segments in relation to the intact model. Greater biomechanical changes were noted in the superior C3-4 segment than in the inferior C7-T1 segment. Increasing the number of bone grafts from 1 to 2 and from 2 to 3 was associated with a lower magnitude of biomechanical changes at the adjacent segments. CONCLUSIONS At segments adjacent to the fusion level, biomechanical changes are not limited solely to the discs, but also propagate to the posterior facets. These changes in discs and posterior facets were found to be lower for discectomy than for corpectomy, thereby supporting the current study hypothesis of inverse relationship between the adjacent-segment variations and the number of fused bone grafts. Such changes may go on to influence the likelihood of adjacent-segment degeneration accordingly. Further studies are warranted to identify the causes and true impact of these observed changes.
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Li J, Zheng Q, Guo X, Zeng X, Zou Z, Liu Y, Hao S. Anterior surgical options for the treatment of cervical spondylotic myelopathy in a long-term follow-up study. Arch Orthop Trauma Surg 2013; 133:745-51. [PMID: 23503888 DOI: 10.1007/s00402-013-1719-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To provide a basis for the choice of anterior surgery procedures in the treatment of cervical spondylotic myelopathy (CSM) through long-term follow-up. METHODS A consecutive series of 89 patients with CSM having complete follow-up data were analyzed retrospectively. All patients were treated with anterior cervical discectomy and fusion (ACDF), and anterior cervical corpectomy and fusion (ACCF) from July 2000 to June 2007. The lesions were located in one segment (n = 25), two segments (n = 56), and three segments (n = 8). Preoperative and postoperative, the C2-C7 angle, cervical intervertebral height, radiographic fusion status, result of the adjacent segment degeneration, the Japanese Orthopaedic Association (JOA), and the Short Form 36-item (SF36) questionnaire scores were used to evaluate the efficacy of the surgery. RESULTS According to the different compression conditions of the 89 cases, different anterior operation procedures were chosen and satisfactory results were achieved, indicating that direct anterior decompressions were thorough and effective. The follow-up period was 60-108 months, and the average was 79.6 months. The 5-year average symptom improvement rate, effectiveness rate, and fineness rate were 78.36 %, 100 % (89/89), and 86.52 % (77/89), respectively. CONCLUSIONS For CSM with compression coming from the front side, proper anterior decompression based on the specific conditions could directly eliminate the compression. Through long-term follow-up, the effect of decompression became observable.
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Affiliation(s)
- Jingfeng Li
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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Vrints I, Depreitere B, Vranckx J. Multilevel cervical reconstruction with no remaining hardware: The potential of a vascularised fibular strut graft. J Plast Reconstr Aesthet Surg 2012; 65:e344-7. [DOI: 10.1016/j.bjps.2012.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 07/06/2012] [Accepted: 09/10/2012] [Indexed: 11/26/2022]
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Utility of postoperative radiographs for cervical spine fusion: a comprehensive evaluation of operative technique, surgical indication, and duration since surgery. Spine (Phila Pa 1976) 2012; 37:1994-2000. [PMID: 22565389 DOI: 10.1097/brs.0b013e31825c0130] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To assess the utility of postoperative radiographs in patients across a spectrum of cervical fusion procedures, surgical indication, and time since surgery. SUMMARY OF BACKGROUND DATA Postoperative radiographs are routinely obtained after cervical spine fusion despite lack of evidence supporting such practice. Studies assessing postoperative radiographical utility in the cervical spine have been limited. To date, no study has comprehensively evaluated the utility of obtaining such radiographs across multiple cervical fusion procedures. METHODS A total of 972 clinic notes from 301 patients during a 10-year period at a single institution were retrospectively reviewed. Patients in this study underwent an anterior cervical discectomy and fusion, anterior corpectomy and fusion, a combined anterior cervical discectomy and fusion and anterior corpectomy and fusion (hybrid), posterior spine fusion, or 360° fusion. All postoperative clinic notes and radiographs were reviewed for abnormalities and changes in treatment course. It was determined whether an abnormal radiograph alone led to a change in treatment course among the various operative techniques, surgical indication, or time since surgery. RESULTS No statistical significant difference in radiograph utility between anterior cervical discectomy and fusion (0 changes in treatment course due to radiograph alone out of 332 clinic notes), anterior corpectomy and fusion (0 of 140), hybrid procedure (1 of 72), posterior spine fusion (5 of 357), and 360° fusion (0 of 71) was found. Surgical indication (trauma vs. degeneration) and duration from surgery yielded no statistical significant difference in radiograph utility. The overall sensitivity, specificity, and positive and negative predictive values of radiographs were 33.8%, 87.6%, 19.0%, and 93.9%, respectively. CONCLUSION Regardless of operative techniques performed, surgical indication, and time since surgery, routine postoperative radiographs provide low utility in guiding treatment course in asymptomatic patients. Although radiographs may provide important diagnostic utility in certain individual cases, the results of this study provide further evidence that radiographs should not be considered routine during postoperative visits, thus minimizing unnecessary radiation exposure and medical costs.
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Goel VK, Elgafy H. Commentary: Biomechanics of various surgical procedures for the treatment of multilevel cervical spine. Spine J 2012; 12:409-10. [PMID: 22698151 DOI: 10.1016/j.spinee.2012.05.016] [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: 04/30/2012] [Revised: 05/14/2012] [Accepted: 05/17/2012] [Indexed: 02/07/2023]
Abstract
Hussain M, Nassr A, Natarajan RN, et al. Corpectomy versus discectomy for the treatment of multilevel cervical spine pathology: a finite element model analysis. Spine J 2012;12:401-8 (in this issue).
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Affiliation(s)
- Vijay K Goel
- Departments of Bioengineering and Orthopaedic Surgery, Engineering Center for Orthopaedic Research Excellence, The University of Toledo, 2801 West Bancroft St, Toledo, OH 43606, USA.
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Siemionow KB, Neckrysh S. Anterior approach for complex cervical spondylotic myelopathy. Orthop Clin North Am 2012; 43:41-52, viii. [PMID: 22082628 DOI: 10.1016/j.ocl.2011.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Cervical spondylotic myelopathy (CSM) is a slowly progressive disease resulting from age-related degenerative changes in the spine that can lead to spinal cord dysfunction and significant functional disability. The degenerative changes and abnormal motion lead to vertebral body subluxation, osteophyte formation, ligamentum flavum hypertrophy, and spinal canal narrowing. Repetitive movement during normal cervical motion may result in microtrauma to the spinal cord. Disease extent and location dictate the choice of surgical approach. Anterior spinal decompression and instrumented fusion is successful in preventing CSM progression and has been shown to result in functional improvement in most patients.
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Affiliation(s)
- Krzysztof B Siemionow
- Department of Orthopaedic Surgery, University of Illinois, 835 South Wolcott Avenue, Room E-270, Chicago, IL 60612, USA.
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