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Rahman T, Kibble MJ, Harbert G, Smith N, Brewer E, Schaer TP, Newell N. Comparison of four in vitro test methods to assess nucleus pulposus replacement device expulsion risk. JOR Spine 2024; 7:e1332. [PMID: 38655007 PMCID: PMC11037461 DOI: 10.1002/jsp2.1332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 04/26/2024] Open
Abstract
Background Nucleus replacement devices (NRDs) are not routinely used in clinic, predominantly due to the risk of device expulsion. Rigorous in vitro testing may enable failure mechanisms to be identified prior to clinical trials; however, current testing standards do not specify a particular expulsion test. Multiple methods have therefore been developed, complicating comparisons between NRD designs. Thus, this study assessed the effectiveness of four previously reported expulsion testing protocols; hula-hoop (Protocol 1), adapted hula-hoop (Protocol 2), eccentric cycling (Protocol 3), and ramp to failure (Protocol 4), applied to two NRDs, one preformed and one in situ curing. Methods Nucleus material was removed from 40 bovine tail intervertebral disks. A NRD was inserted posteriorly into each cavity and the disks were subjected to one of four expulsion protocols. Results NRD response was dependent on both the NRD design and the loading protocol. Protocol 1 resulted in higher migration and earlier failure rates compared to Protocol 2 in both NRDs. The preformed NRD was more likely to migrate when protocols incorporated rotation. The NRDs had equal migration (60%) and expulsion (60%) rates when using unilateral bending and ramp testing. Combining the results of multiple tests revealed complimentary information regarding the NRD response. Conclusions Adapted hula-hoop (Protocol 2) and ramp to failure (Protocol 4), combined with fluoroscopic analysis, revealed complimentary insights regarding migration and failure risk. Therefore, when adopting the surgical approach and animal model used in this study, it is recommended that NRD performance be assessed using both a cyclic and ramp loading protocol.
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Affiliation(s)
- Tamanna Rahman
- Department of BioengineeringImperial College LondonLondonUK
- Biomechanics Group, Department of Mechanical EngineeringImperial College LondonLondonUK
| | | | | | - Nigel Smith
- Division of Surgery and Interventional ScienceUniversity College LondonStanmoreUK
| | - Erik Brewer
- Department of Biomedical EngineeringRowan UniversityGlassboroNew JerseyUSA
| | - Thomas P. Schaer
- Department of Clinical Studies New Bolton CenterUniversity of Pennsylvania School of Veterinary MedicineKennett SquarePennsylvaniaUSA
| | - Nicolas Newell
- Department of BioengineeringImperial College LondonLondonUK
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Nakajima H, Watanabe S, Honjoh K, Kubota A, Matsumine A. Risk factors for early-onset adjacent segment degeneration after one-segment posterior lumbar interbody fusion. Sci Rep 2024; 14:9145. [PMID: 38644389 PMCID: PMC11033273 DOI: 10.1038/s41598-024-59924-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/16/2024] [Indexed: 04/23/2024] Open
Abstract
Adjacent segment degeneration (ASD) is a major postoperative complication associated with posterior lumbar interbody fusion (PLIF). Early-onset ASD may differ pathologically from late-onset ASD. The aim of this study was to identify risk factors for early-onset ASD at the cranial segment occurring within 2 years after surgery. A retrospective study was performed for 170 patients with L4 degenerative spondylolisthesis who underwent one-segment PLIF. Of these patients, 20.6% had early-onset ASD at L3-4. In multivariate logistic regression analysis, preoperative larger % slip, vertebral bone marrow edema at the cranial segment on preoperative MRI (odds ratio 16.8), and surgical disc space distraction (cut-off 4.0 mm) were significant independent risk factors for early-onset ASD. Patients with preoperative imaging findings of bone marrow edema at the cranial segment had a 57.1% rate of early-onset ASD. A vacuum phenomenon and/or concomitant decompression at the cranial segment, the degree of surgical reduction of slippage, and lumbosacral spinal alignment were not risk factors for early-onset ASD. The need for fusion surgery requires careful consideration if vertebral bone marrow edema at the cranial segment adjacent to the fusion segment is detected on preoperative MRI, due to the negative impact of this edema on the incidence of early-onset ASD.
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Affiliation(s)
- 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.
| | - Shuji Watanabe
- 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
| | - Kazuya Honjoh
- 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
| | - Arisa Kubota
- 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
| | - Akihiko Matsumine
- 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
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Wang Y, Maimaiti A, Xiao Y, Tuoheti A, Zhang R, Maitusong M, Chen Q, Rexiti P. Hybrid cortical bone trajectory and modified cortical bone trajectory techniques in transforaminal lumbar interbody fusion at L4-L5 segment: A finite element analysis. Heliyon 2024; 10:e26294. [PMID: 38434416 PMCID: PMC10906328 DOI: 10.1016/j.heliyon.2024.e26294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/03/2024] [Accepted: 02/09/2024] [Indexed: 03/05/2024] Open
Abstract
Background The academia has increasingly acknowledged the superior biomechanical performance of the hybrid fixation technique in recent years. However, there is a lack of research on the hybrid fixation technique using BCS (Bilateral Cortical Screws) and BMCS (Bilateral Modified Cortical Screws). This study aims to investigate the biomechanical performance of the BCS and BMCS hybrid fixation technique in transforaminal lumbar interbody fusion (TLIF) at the L4-L5 segment in a complete lumbar-sacral finite element model. Methods Three cadaver specimens are used to construct three lumbar-sacral finite element models. The biomechanical properties of various fixation technologies (BCS-BCS, BMCS-BMCS, BMCS-BCS, and BCS-BMCS) are evaluated at the L4-5 segment with a TLIF procedure conducted, including the range of motion (ROM) of the L4-5 segment, as well as the stress experienced by the cage, screws, and rods. The testing is conducted under specific loading conditions, including a compressive load of 400 N and a torque of 7.5Nm, subjecting the model to simulate flexion, extension, lateral bending, and rotation. Results No significant variations are seen in the ROM at the L4-5 segment when comparing the four fixation procedures during flexion and extension. However, when it comes to lateral bending and rotation, the ROM is ordered in descending order as BCS-BCS, BCS-BMCS, BMCS-BMCS, and BMCS-BCS. The maximum stress experienced by the cage is observed to be highest within the BMCS-BCS technique during movements including flexion, extension, and lateral bending. Conversely, the BMCS-BMCS technique exhibits the highest cage stress levels during rotational movements. The stress applies to the screws and rods order the sequence of BCS-BCS, BCS-BMCS, BMCS-BCS, and BMCS-BMCS throughout all four working conditions. Conclusion The BMCS-BCS technique shows better biomechanical performance with less ROM and lower stress on the internal fixation system compared to other fixation techniques. BMCS-BMCS technology has similar mechanical performance to BMCS-BCS but has more contact area between screws and cortical bone, making it better for patients with severe osteoporosis.
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Affiliation(s)
- Yixi Wang
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yang Xiao
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abudusalamu Tuoheti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Rui Zhang
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | | | - Qihao Chen
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Key Laboratory of High Incidence Disease Research in Xinjiang (Xinjiang Medical University), Ministry of Education, Urumqi, China
- Xinjiang Clinical Research Center for Orthopedics, Urumqi, China
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Khalaf K, Nikkhoo M, Shams S, Niu CC, Cheng CH. Impact of osteoporosis and Cement-Augmented fusion on adjacent spinal levels Post-Fusion Surgery: Patient-Specific finite element analysis. J Biomech 2024; 166:112070. [PMID: 38569456 DOI: 10.1016/j.jbiomech.2024.112070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/26/2024] [Accepted: 03/30/2024] [Indexed: 04/05/2024]
Abstract
Cement-augmentation is a technique commonly used during posterior lumbar instrumented fusion (PLIF) to reinforce compromised osteoporotic vertebral bone, minimize the risk of loosening screws, enhance stability, and improve overall surgical outcomes. In this study, we introduce a novel segmented vertebral body regional modeling approach to investigate the effects of osteoporosis and cement-augmented lumbar fusion on disc biomechanics at spinal levels adjacent to the fused vertebrae. Using our previously validated personalized-poroelastic-osteoligamentous FE model of the spine, fusion was simulated at L4-L5, and the biomechanics of adjacent levels were studied for 30 patients (non-osteoporotic patients (N = 15), osteoporotic patients (N = 15)). PLIF models, with and without cement-augmentation, were developed and compared after an 8 h-rest period (200 N), following a 16 h-cyclic compressive loading of 500-1000 N (40 and 20 min, respectively). Movement in different directions (flexion/ extension/ lateral bending/ axial rotation) was simulated using 10Nm moment before and after cyclic loading. The material mapping algorithm was validated by comparing the results of voxel-based and parametric models. The FE cement-augmented models, subject to daily activity loading, demonstrated significant differences in disc height loss and fluid loss as compared to non-cemented models. The calculated axial stress and fiber strain values were also significantly higher for these models. This work demonstrates that although osteoporosis does not significantly alter the time-dependent characteristics of adjacent IVDs post-surgery, cement-augmentation increases the risk of adjacent segment disease (ASD) incidence. A holistic understanding of the trade-offs and long-term complex interplay between structural reinforcement modalities, including cement augmentation, and altered biomechanics warrants further investigation.
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Affiliation(s)
- Kinda Khalaf
- College of Medicine and Health Sciences, Khalifa University of Science and Technology, and Health Engineering Innovation Center, Abu Dhabi, United Arab Emirates.
| | - Mohammad Nikkhoo
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Shohreh Shams
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Chi-Chien Niu
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Hsiu Cheng
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
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Liang Y, Qian Y, Xia W, Guo C, Zhu Z, Liu H, Xu S. Adjacent segment degeneration after single- and double-level cervical total disc replacement: a cohort with an over 12-year follow-up. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:232-242. [PMID: 37947890 DOI: 10.1007/s00586-023-08018-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 10/10/2023] [Accepted: 10/21/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To characterize the change of adjacent segment degeneration (ASD) after cervical total disc replacement (CTDR) with more than 12-year follow-up, and identify the risk factors for ASD. METHOD This process included 75 patients underwent CTDR from February 2004 to December 2012, with the follow-up of 151.9 ± 36.0 (m). The artificial disc included ProDisc-C, Prestige-LP and Mobi-C. ASD was followed up at 1 week, 6 months, 1 year, 2 years, 5 years, 10 years after CTDR and at the endpoint of June 2022. The radiographic measurements were cervical mobility, intervertebral disc height (IDH), cervical lordosis and balance status. The complications were implant migration, subsidence and heterotopic ossification (HO). RESULTS Cervical mobility in adjacent segments, IDH and lordosis showed no statistical differences between ASD and NASD group. Balance status, subsidence and migration showed no relationship with ASD. Postoperative ASD increased at 6 m and especially between 6 m to 2y. There was no difference between the incidence of upper ASD and lower ASD all the time and few ASD-related reoperation. The majority of adjacent segments were C4/5 (33.6%) and C6/7 (34.2%), and ASD of C5/6 had the highest incidence (61.5%). Cox regression showed ASD was not related to the types of prosthesis or operated numbers. Generalized estimating equations (GEE) analysis showed severe HO had a higher (2.68 times) probability to suffer from ASD. CONCLUSIONS After over 12-year follow-up of CTDR, the occurrence of ASD and HO had temporal synchronization. ASD was not merely a natural progression but with the pathological process such as HO.
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Affiliation(s)
- Yan Liang
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Yalong Qian
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Weiwei Xia
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Chen Guo
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Zhenqi Zhu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Haiying Liu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Shuai Xu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China.
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Nakao Y, Sakuraba K, Harimaya K, Terada K, Kobara N, Kawaguchi KI, Hayashida M, Iida K, Nakashima Y, Fukushi JI. Clinical features and outcomes of spine surgery in patients with ankylosing spondylitis. Mod Rheumatol 2023; 34:208-213. [PMID: 36469006 DOI: 10.1093/mr/roac142] [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: 05/24/2022] [Revised: 08/10/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2023]
Abstract
OBJECTIVES The study aimed to comprehend the clinical features and outcomes of surgical treatments for spinal disorders in patients with ankylosing spondylitis (AS). METHODS This retrospective study enrolled patients with AS who underwent spine surgery between 2000 and 2019 in our facility. RESULTS Thirteen patients with AS underwent spine surgeries. The mean age was 56.2 years, and the mean disease duration was 25.1 years at the time of surgery. Nine patients had vertebral fracture, two had kyphotic deformity, and two had myelopathy due to the spinal ligament ossification. Fracture cases included five patients with secondary pseudarthrosis/delayed palsy due to conservative treatment failure. Spinal fixation was performed in all patients. Pedicle subtraction osteotomy for kyphosis and laminectomy for myelopathy were also conducted. All patients improved after surgeries. One patient with kyphotic deformity underwent additional surgery of bilateral hip prosthesis, which resulted in better spine alignment. Four cases of perioperative complications were observed. CONCLUSION Myelopathy was newly found as the aetiology requiring surgery in patients with AS. This summarized case series could help physicians to identify patients with surgically treatable spinal disorders among patients with AS.
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Affiliation(s)
- Yuki Nakao
- Department of Orthopaedic Surgery, Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Koji Sakuraba
- Department of Orthopaedic Surgery, Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Katsumi Harimaya
- Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, Oita, Japan
| | - Kazuo Terada
- Department of Orthopaedic Surgery, Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Nobuo Kobara
- Department of Orthopaedic Surgery, Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Ken-Ichi Kawaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mitsumasa Hayashida
- Department of Orthopaedic Surgery, Saga-ken Medical Centre Koseikan, Saga, Japan
| | - Keiichiro Iida
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun-Ichi Fukushi
- Department of Orthopaedic Surgery, Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
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Schuermans VN, Smeets AY, Curfs I, van Santbrink H, Boselie TF. A randomized controlled trial with extended long-term follow-up: Quality of cervical spine motion after anterior cervical discectomy (ACD) or anterior cervical discectomy with arthroplasty (ACDA). BRAIN & SPINE 2023; 4:102726. [PMID: 38510600 PMCID: PMC10951699 DOI: 10.1016/j.bas.2023.102726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 11/02/2023] [Accepted: 12/08/2023] [Indexed: 03/22/2024]
Abstract
Introduction In previous research, a consistent sequence of segmental contributions during dynamic extension X-rays of the cervical spine was observed in 80-90% of healthy participants. Research question To investigate whether this previously defined 'normal' sequence of segmental contributions was present in patients who underwent anterior cervical discectomy with arthroplasty (ACDA) or anterior cervical discectomy (ACD). Materials & methods A randomized controlled trial with extended follow-up was conducted. Patients with single level cervical degenerative radiculopathy with a surgical indication were included and randomized. Dynamic X-ray recordings were made before surgery, one-year post-operative, and at long term follow-up. Results A total of 27 patients were included, three in an ACDA pilot group and 24 were randomized to receive ACDA (N = 12) or ACD (N = 12). A total of 20 patients were available for follow-up. Preoperatively, 16.7% of patients in the ACDA group and 58.3% of patients in the ACD group showed a normal sequence. One-year post-operative, 66.7% showed a normal sequence in the ACDA group versus 30.0% in the ACD group (p = 0.036). After an average of 11-years follow-up, a normal sequence was observed in 9.1% of patients in the ACDA group and in none of the patients in the ACD group (p = 0.588). Discussion & conclusion These findings suggest that while ACDA can restore and preserve a normal sequence of segmental contributions in the short term, this effect is not maintained in the long term. Throughout the process of ageing, not only the quantity, but also the quality of motion changes.
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Affiliation(s)
- Valérie N.E. Schuermans
- Dept. of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands
- Dept. of Neurosurgery, Zuyderland Medical Center, Heerlen, the Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Anouk Y.J.M. Smeets
- Dept. of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands
- Dept. of Neurosurgery, Zuyderland Medical Center, Heerlen, the Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Inez Curfs
- Dept. of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Henk van Santbrink
- Dept. of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands
- Dept. of Neurosurgery, Zuyderland Medical Center, Heerlen, the Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Toon F.M. Boselie
- Dept. of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands
- Dept. of Neurosurgery, Zuyderland Medical Center, Heerlen, the Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
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Cannizzaro D, Anania CD, Safa A, Zaed I, Morenghi M, Riva M, Tomei M, Pessina F, Servadei F, Ortolina A, Fornari M. Lumbar adjacent segment degeneration after spinal fusion surgery: a systematic review and meta-analysis. J Neurosurg Sci 2023; 67:740-749. [PMID: 36345970 DOI: 10.23736/s0390-5616.22.05891-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
INTRODUCTION Adjacent segment degeneration is among the most recognized long-term complications of lumbar surgery for degenerative spine pathologies with a relevant impact in spine surgical and clinical practice. It is reported a incidence of clinical adjacent segment disease between 5-30% of patients undergoing spinal fusion. We aimed to evaluate the main clinical and surgical risk factors for developing adjacent segment disease. EVIDENCE ACQUISITION A systematic review and meta-analysis of the pertinent literature was performed, according to PRISMA and PICO guidelines, focusing on clinical and radiological adjacent segment disease. We exclusively included studies reporting demographic and clinical data, and surgical details published from 30 September 2015 to 30 September 2020. The effect of considered risk factors on the presence of adjacent segment disease was explored with a random-effects model. EVIDENCE SYNTHESIS A total of 15 scientific publications, corresponding to 6253 patients, met the inclusion criteria for the qualitative and quantitative analysis. 720 of the patients developed a clinical and/or radiological adjacent syndrome disease, and 473 have been surgically managed. Ten articles qualified for the comparative geographical analysis. Advanced age and obesity are relevant risk factors for developing lumbar adjacent segment degeneration. Our data also reported a higher prevalence of adjacent segment degeneration in Western populations than in Eastern populations. The interbody fusion has a protective role toward lumbar adjacent segment degeneration. CONCLUSIONS This study highlighted multifactorial issues regarding adjacent segment disease: clinical, anatomical, biomechanical, and radiological features. In view of increasing life expectancy and spinal surgery procedures, extensive multicenter studies will be needed to define the correct management of the adjacent segment disease.
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Affiliation(s)
- Delia Cannizzaro
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy -
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy -
| | - Carla D Anania
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Adrian Safa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Ismail Zaed
- Department of Neurosurgery, Neurocenter of South Switzerland, Ente Ospedaliero Cantonale Lugano, Bellinzona, Switzerland
| | - Manuela Morenghi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Marco Riva
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Massimo Tomei
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Federico Pessina
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Franco Servadei
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Kim LJY, Mazur MD, Dailey AT. Mid-term and Long-term Outcomes After Total Cervical Disk Arthroplasty Compared With Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Clin Spine Surg 2023; 36:339-355. [PMID: 37735768 DOI: 10.1097/bsd.0000000000001537] [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: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
STUDY DESIGN A meta-analysis of randomized controlled trials (RCTs). OBJECTIVE The aim of this study was to compare mid-term to long-term outcomes of cervical disk arthroplasty (CDA) with those of anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic cervical degenerative disk disease. SUMMARY OF BACKGROUND DATA After ACDF to treat symptomatic cervical degenerative disk disease, the loss of motion at the index level due to fusion may accelerate adjacent-level disk degeneration. CDA was developed to preserve motion and reduce the risk of adjacent segment degeneration. Early-term to mid-term clinical outcomes from RCTs suggest noninferiority of CDA compared with ACDF, but it remains unclear whether CDA yields better mid-term to long-term outcomes than ACDF. MATERIALS AND METHODS Two independent reviewers searched PubMed, Embase, and the Cochrane Library for RCTs with at least 60 months of follow-up. The risk ratio or standardized mean difference (and 95% CIs) were calculated for dichotomous or continuous variables, respectively. RESULTS Eighteen reports of 14 RCTs published in 2014-2023 were included. The pooled analysis demonstrated that the CDA group had a significantly greater improvement in neurological success and Neck Disability Index than the ACDF group. The ACDF group exhibited a significantly better improvement in the Short Form-36 Health Survey Physical Component Summary than the CDA group. Radiographic adjacent segment degeneration was significantly lower in the CDA group at 60- and 84-month follow-ups; at 120-month follow-up, there was no significant difference between the 2 groups. Although the overall rate of secondary surgical procedures was significantly lower in the CDA group, we did not observe any significant difference at 60-month follow-up between the CDA and ACDF group and appreciated statistically significant lower rates of radiographic adjacent segment degeneration, and symptomatic adjacent-level disease requiring surgery at 84-month and 108- to 120-month follow-up. The rate of adverse events and the neck and arm pain scores in the CDA group were not significantly different from those of the ACDF group. CONCLUSIONS In this meta-analysis of 14 RCTs with 5- to 10-year follow-up data, CDA resulted in significantly better neurological success and Neck Disability Index scores and lower rates of radiographic adjacent segment degeneration, secondary surgical procedures, and symptomatic adjacent-level disease requiring surgery than ACDF. ACDF resulted in improved Short Form-36 Health Survey Physical Component Summary scores. However, the CDA and ACDF groups did not exhibit significant differences in overall changes in neck and arm pain scores or rates of adverse events.
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Affiliation(s)
- Leo J Y Kim
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT
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Torabian KA, Cherian NJ, Dean MC, Eberlin CT, Kucharik MP, Dowley KS, LaPorte ZL, Martin SD. Outcomes of Hip Arthroscopy in the Setting of Concomitant Symptomatic Lumbosacral Spine Pathology: A Matched Control Study With Minimum 24-Month Follow-up. Am J Sports Med 2023; 51:3268-3279. [PMID: 37715499 PMCID: PMC10571439 DOI: 10.1177/03635465231197374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/20/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND The overlapping biomechanical relationship between the lumbosacral spine and pelvis poses unique challenges to patients with concomitant pathologies limiting spinopelvic range of motion. PURPOSE To assess the influence of concomitant, symptomatic lumbosacral spine pathology on patient-reported outcome measures (PROMs) after hip arthroscopy for the treatment of femoroacetabular impingement (FAI) and symptomatic labral tears. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective query of prospectively collected data identified patients aged ≥18 years with a minimum 24-month follow-up who underwent hip arthroscopy by a single surgeon for the treatment of symptomatic labral tears secondary to FAI. Patients were stratified into cohorts based on the presence (hip-spine [HS]) or absence (matched control [MC]) of symptomatic lumbosacral spine pathology. Inclusion within the HS cohort required confirmation of lower back pain/symptoms on preoperative surveys plus a diagnosis of lumbosacral spine pathology verified by radiology reports and correlating clinical documentation. Patients with previous spine surgery were excluded. PROMs were compared between groups, along with rates of achieving minimal clinically important difference (MCID) thresholds, Patient Acceptable Symptom State (PASS) thresholds, revision arthroscopy, and conversion to total hip arthroplasty (THA). RESULTS A total of 70 patients with lumbosacral pathology were coarsened exact matched to 87 control patients without spinal pathology. The HS cohort had preoperative baseline scores that were significantly worse for nearly all PROMs. Follow-ups at 3, 6, 12, and 24 months displayed similar trends, with the HS cohort demonstrating significantly worse scores for most collected outcomes. However, at every time point, HS and MC patients exhibited similar magnitudes of improvement across all PROM and pain metrics. Furthermore, while significantly fewer HS patients achieved PASS for nearly all PROMs at 12- and 24-month follow-ups, MCID thresholds were reached at similar or greater rates across all PROMs relative to the MC cohort. Finally, there were no significant differences in rates of revision or THA between cohorts at maximum available follow-up. CONCLUSION After hip arthroscopy to address labral tears in the setting of FAI, patients with symptomatic lumbosacral pathologies and no history of spine surgery were found to exhibit inferior pre- and postoperative PROMs but achieved statistically similar clinical benefit and rates of PROM improvement through 24-month follow-up compared with the MC cohort with isolated hip disease. These findings aid in providing a realistic recovery timeline and evidence that coexisting hip and spine disorders are not a contraindication for arthroscopic hip preservation surgery.
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Affiliation(s)
- Kaveh A. Torabian
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nathan J. Cherian
- Department of Orthopaedic Surgery, University of Nebraska, Omaha, Nebraska, USA
| | - Michael C. Dean
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Michael P. Kucharik
- Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida, USA
| | - Kieran S. Dowley
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zachary L. LaPorte
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Scott D. Martin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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11
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Ying Y, Cai K, Cai X, Zhang K, Qiu R, Jiang G, Luo K. Recent advances in the repair of degenerative intervertebral disc for preclinical applications. Front Bioeng Biotechnol 2023; 11:1259731. [PMID: 37811372 PMCID: PMC10557490 DOI: 10.3389/fbioe.2023.1259731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/14/2023] [Indexed: 10/10/2023] Open
Abstract
The intervertebral disc (IVD) is a load-bearing, avascular tissue that cushions pressure and increases flexibility in the spine. Under the influence of obesity, injury, and reduced nutrient supply, it develops pathological changes such as fibular annulus (AF) injury, disc herniation, and inflammation, eventually leading to intervertebral disc degeneration (IDD). Lower back pain (LBP) caused by IDD is a severe chronic disorder that severely affects patients' quality of life and has a substantial socioeconomic impact. Patients may consider surgical treatment after conservative treatment has failed. However, the broken AF cannot be repaired after surgery, and the incidence of re-protrusion and reoccurring pain is high, possibly leading to a degeneration of the adjacent vertebrae. Therefore, effective treatment strategies must be explored to repair and prevent IDD. This paper systematically reviews recent advances in repairing IVD, describes its advantages and shortcomings, and explores the future direction of repair technology.
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Affiliation(s)
- Yijian Ying
- Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Kaiwen Cai
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Xiongxiong Cai
- Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Kai Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Rongzhang Qiu
- Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Guoqiang Jiang
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Kefeng Luo
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
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12
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Friedman GN, Grannan BL, Zinzuwadia A, Williams ZM, Coumans JV. Congenitally Fused Cervical Spine Is Associated With Adjacent-Level Degeneration in the Absence of Cervical Spine Surgery. Neurosurgery 2023; 93:409-418. [PMID: 36892290 PMCID: PMC10319372 DOI: 10.1227/neu.0000000000002426] [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: 07/07/2022] [Accepted: 01/03/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Cervical fusion surgery is associated with adjacent-level degeneration, but surgical and technical factors are difficult to dissociate from the mechanical effects of the fusion itself. OBJECTIVE To determine the effect of fusion on adjacent-level degeneration in unoperated patients using a cohort of patients with congenitally fused cervical vertebrae. METHODS We identified 96 patients with incidental single-level cervical congenital fusion on computed tomography imaging. We compared these patients to an age-matched control cohort of 80 patients without congenital fusion. We quantified adjacent-level degeneration through direct measurements of intervertebral disk parameters as well as the validated Kellgren & Lawrence classification scale for cervical disk degeneration. Ordinal logistic regression and 2-way analysis of variance testing were performed to correlate extent of degeneration with the congenitally fused segment. RESULTS Nine hundred fifty-five motion segments were analyzed. The numbers of patients with C2-3, C3-4, C4-5, C5-6, and C6-7 congenitally fused segments were 47, 11, 11, 17, and 9, respectively. We found that patients with congenital fusion at C4-C5 and C5-C6 had a significantly greater extent of degeneration at adjacent levels compared with the degree of degeneration at the same levels in control patients and in patients with congenital fusion at other cervical levels, even while controlling for expected degeneration and age. CONCLUSION Taken together, our data suggest that congenitally fused cervical spinal segments at C4-C5 and C5-C6 are associated with adjacent-level degeneration independent of fixation instrumentation. This study design removes surgical factors that might contribute to adjacent-level degeneration.
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Affiliation(s)
- Gabriel N. Friedman
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin L. Grannan
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | | | - Ziv M. Williams
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jean-Valery Coumans
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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13
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Dave B, Chauhan V, Amin P, Mayi S, Krishnan A, Degulmadi D, Rai RR, Dave M, Bali SK, Charde P, Anil A. Long-term functional and radiological outcomes of cervical disc arthroplasty at a tertiary level spine center in India: A retrospective cohort analysis with minimum 2 years of follow-up. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:268-273. [PMID: 37860030 PMCID: PMC10583798 DOI: 10.4103/jcvjs.jcvjs_56_23] [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: 05/24/2023] [Accepted: 07/31/2023] [Indexed: 10/21/2023] Open
Abstract
Context Cervical disc arthroplasty (CDA) was developed for the treatment of cervical disc disease with the potential advantages of preservation of physiological motion at a discal level, thereby potentially reducing adjacent level stresses and degeneration, which were a known complication of anterior cervical arthrodesis. The objective of this study was the assessment of long-term functional and radiological outcomes overtime in all the patients who underwent CDA from 2011 to 2019 at our institute. Materials and Methods Forty-eight patients who underwent CDA (2011-2019) with a minimum 2-year follow-up were retrospectively evaluated. The functional outcome included the Visual Analog Score (VAS) and Neck Disability Index (NDI). Radiographs were assessed for range of motion (ROM) at the index surgical level, presence of heterotopic ossification (HO), and adjacent segment degeneration. Results The mean follow-up was 5.79 ± 2.96 (2.16-11.75) years. Significant improvement (P < 0.05) was observed in the VAS (8.91 ± 2.52 [preoperative] to 0.89 ± 1.27 [follow-up]) and NDI (65.5% ±23.06% [preoperative] to 4.79 ± 3.87 [follow-up]) score. Motion at index level increased significantly from 5.53° preoperatively to 7.47°, and 92% of the implanted segments were still mobile (referring to the threshold of ROM > 3°). HOs are responsible for the fusion of 4/50 (8%) levels at the last follow-up. Distal and proximal adjacent disc degeneration occurred in 36% and 28% of patients, respectively. No migration of the implant was observed on the radiograph. Conclusion Our study showed favorable clinical outcome of CDA with preservation of ROM at the index surgical level. CDA can be a promising alternative to anterior cervical arthrodesis when properly indicated.
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Affiliation(s)
- Bharat Dave
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India
| | - Vikrant Chauhan
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India
| | - Prarthan Amin
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India
| | - Shivanand Mayi
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India
| | - Ajay Krishnan
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India
| | - Devanand Degulmadi
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India
| | - Ravi Ranjan Rai
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India
| | - Mirant Dave
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India
| | - Shiv Kumar Bali
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India
| | - Pranav Charde
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India
| | - Abhijith Anil
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India
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Miscusi M, Trungu S, Ricciardi L, Forcato S, Piazza A, Ramieri A, Raco A. Stand-Alone Oblique Lumbar Interbody Fusion (OLIF) for the Treatment of Adjacent Segment Disease (ASD) after Previous Posterior Lumbar Fusion: Clinical and Radiological Outcomes and Comparison with Posterior Revision Surgery. J Clin Med 2023; 12:jcm12082985. [PMID: 37109321 PMCID: PMC10144531 DOI: 10.3390/jcm12082985] [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: 03/24/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Background: Radiological evidence of adjacent segment disease (ASD) has been reported to have a prevalence of more than 30% and several risk factors have been reported. The aim of this study is to evaluate the clinical and radiological outcomes of patients with symptomatic ASD treated with stand-alone OLIF and compare results with a posterior revision surgery cohort. Methods: This is a retrospective case-control study. Clinical-patient-reported outcomes were obtained at preoperative, postoperative and final follow-up visits using the Short Form (SF-36) scale, the Oswestry Disability Index (ODI) and the visual analog scale (VAS). Radiological measures include lumbar lordosis (LL), segmental lordosis (SL), pelvic incidence-lumbar lordosis (PI-LL) mismatch, segmental coronal Cobb angle and intervertebral disc height (DH). The data are compared with a retrospective series of patients that underwent a posterior revision surgery for ASD. Results: Twenty-eight patients in the OLIF group and 25 patients in the posterior group meet inclusion criteria. The mean ages at the time of the surgery are 65.1 years and 67.5, respectively. The mean follow-up time is 36.1 months (range of 14-56). The clinical outcomes significantly improve from preoperative values from the surgery in both groups. The radiological parameters are significantly improved postoperatively and were maintained at the last follow-up in both groups. A statistically significant difference is observed between the two groups for minor complication rate, length of surgery, blood loss and DH restoration. Conclusions: Stand-alone OLIF is an effective and safe technique with low morbidity and complication rates for the treatment of selected patients with symptomatic ASD following a previous lumbar fusion.
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Affiliation(s)
- Massimo Miscusi
- NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Sokol Trungu
- NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
- Neurosurgery Unit, Cardinale G. Panico Hospital, 73039 Tricase, Italy
| | - Luca Ricciardi
- NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Stefano Forcato
- Neurosurgery Unit, Cardinale G. Panico Hospital, 73039 Tricase, Italy
| | - Amedeo Piazza
- NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Alessandro Ramieri
- Department of Orthopedics, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Antonino Raco
- NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
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15
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Steib JP, Dufour T, Beaurain J, Bernard P, Huppert J. Observational, Multicenter Study of the Efficacy and Safety of Cervical Disk Arthroplasty With Mobi-C in the Treatment of Cervical Degenerative Disk Disease. Results at 10 years Follow-Up. Spine (Phila Pa 1976) 2023; 48:452-459. [PMID: 36730682 DOI: 10.1097/brs.0000000000004536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/04/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cervical disk arthroplasty replacement (CDA) was developed to avoid specific disadvantages of cervical fusion. The purpose of this paper is to provide 10-year follow-up results of an ongoing prospective study after CDA. METHODS Three hundred eighty-four patients treated using the Mobi-C (ZimVie, Troyes, France) were included in a prospective multicenter study. Routine clinical and radiologic examinations were reported preoperatively and postoperatively with up to 10-year follow-up. Complications and revision surgeries were also documented. RESULTS At 10 years showed significant improvement in all clinical outcomes [Neck Disability Index, visual analog scale (VAS) for arm and neck pain, physical component summary of SF36, and mental component summary of SF36). Motion at the index level increased significantly over baseline (mean range of motion=7.6 vs. 8 degrees at five years and 6.0 degrees preoperatively; P <0.001) and 71.3% of the implanted segments remained mobile (range of motion>3 degrees). Adjacent disks were also mobile at 10 years with the same mobility as preoperatively. At 10 years, 20.9% of the implanted segments demonstrated no heterotopic ossification. Thirty-four patients (8.9%) experienced 41 adverse events, with or without reoperation during the first five years. We found only two additional surgeries after five years. We observed an increased percentage of working patients and a decrease in medication consumption. Regarding the overall outcome, 94% of patients were satisfied. CONCLUSIONS Our 10-year results showed significant improvement in all clinical outcomes, with low rates of revision or failure. This experience in patients with long-term follow-up after CDA endorses durable, favorable outcomes in properly selected patients.
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Affiliation(s)
| | - Thierry Dufour
- Parisian Institute, Geoffroy Saint-Hilaire Clinic, Paris, France
| | | | - Pierre Bernard
- Orthopaedic Department, Back Aquitain Center, Mérignac, France
| | - Jean Huppert
- Neuro-Surgery Department, Clinic of Parc, St-Priest-en-Jarez, France
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16
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Merrill RK, Clohisy JC, Albert TJ, Qureshi SA. Concepts and Techniques to Prevent Cervical Spine Deformity After Spine Surgery: A Narrative Review. Neurospine 2023; 20:221-230. [PMID: 37016868 PMCID: PMC10080418 DOI: 10.14245/ns.2244780.390] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/22/2022] [Indexed: 04/03/2023] Open
Abstract
Adult cervical spine deformity is associated with decreased health-related quality of life, disability, and myelopathy. A number of radiographic parameters help to characterize cervical deformity and aid in the diagnosis and treatment. There are several etiologies for cervical spine deformity, the most common being iatrogenic. Additionally, spine surgery can accelerate adjacent segment degeneration which may lead to deformity. It is therefore important for all spine surgeons to be aware of the potential to cause iatrogenic cervical deformity. The aim of this review is to highlight concepts and techniques to prevent cervical deformity after spine surgery.
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Affiliation(s)
- Robert K. Merrill
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - John C. Clohisy
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Todd J. Albert
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sheeraz A. Qureshi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Corresponding Author Sheeraz A. Qureshi Department of Orthopedic Surgery, Minimally Invasive Spine Surgery, Hospital for Special Surgery, 535 East 70th Street, 4th Floor, New York, NY 10021, USA
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17
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Zhang B, Hu Y, Kong Q, Feng P, Liu J, Ma J. Comparison of Oblique Lumbar Interbody Fusion Combined with Posterior Decompression (OLIF-PD) and Posterior Lumbar Interbody Fusion (PLIF) in the Treatment of Adjacent Segmental Disease(ASD). J Pers Med 2023; 13:jpm13020368. [PMID: 36836602 PMCID: PMC9966658 DOI: 10.3390/jpm13020368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/01/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND An unintended consequence following lumbar fusion is the development of adjacent segment disease (ASD). Oblique lumbar interbody fusion combined with posterior decompression (OLIF-PD) is another feasible option for ASD, and there is no literature report on this combined surgical strategy. METHODS A retrospective analysis was performed on 18 ASD patients requiring direct decompression in our hospital between September 2017 and January 2022. Among them, eight patients underwent OLIF-PD revision and ten underwent PLIF revision. There were no significant differences in the baseline data between the two groups. The clinical outcomes and complications were compared between the two groups. RESULTS The operation time, operative blood loss and postoperative hospital stay in the OLIF-PD group were significantly lower than those in the PLIF group. The VAS of low back pain in the OLIF-PD group was significantly better than that in the PLIF group during the postoperative follow-up. The ODI at the last follow-up in the OLIF-PD group and the PLIF group were significantly relieved compared with those before operation. The excellent and good rate of the modified MacNab standard at the last follow-up was 87.5% in the OLIF-PD group and 70% in the PLIF group. There was a statistically significant difference in the incidence of complications between the two groups. CONCLUSION For ASD requiring direct decompression after posterior lumbar fusion, compared with traditional PLIF revision surgery, OLIF-PD has a similar clinical effect, but has a reduced operation time, blood loss, hospital stay and complications. OLIF-PD may be an alternative revision strategy for ASD.
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Affiliation(s)
- Bin Zhang
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu 610041, China
| | - Yuan Hu
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu 610041, China
| | - Qingquan Kong
- Department of Orthopedics Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Correspondence:
| | - Pin Feng
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu 610041, China
| | - Junlin Liu
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu 610041, China
| | - Junsong Ma
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu 610041, China
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18
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Nikkhoo M, Chen WC, Lu ML, Fu CJ, Niu CC, Lien HY, Cheng CH. Anatomical parameters alter the biomechanical responses of adjacent segments following lumbar fusion surgery: Personalized poroelastic finite element modelling investigations. Front Bioeng Biotechnol 2023; 11:1110752. [PMID: 36860879 PMCID: PMC9968854 DOI: 10.3389/fbioe.2023.1110752] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
Introduction: While the short-term post-operative outcome of lumbar fusion is satisfying for most patients, adjacent segment disease (ASD) can be prevalent in long-term clinical observations. It might be valuable to investigate if inherent geometrical differences among patients can significantly alter the biomechanics of adjacent levels post-surgery. This study aimed to utilize a validated geometrically personalized poroelastic finite element (FE) modeling technique to evaluate the alteration of biomechanical response in adjacent segments post-fusion. Methods: Thirty patients were categorized for evaluation in this study into two distinct groups [i.e., 1) non-ASD and 2) ASD patients] based on other long-term clinical follow-up investigations. To evaluate the time-dependent responses of the models subjected to cyclic loading, a daily cyclic loading scenario was applied to the FE models. Different rotational movements in different planes were superimposed using a 10 Nm moment after daily loading to compare the rotational motions with those at the beginning of cyclic loading. The biomechanical responses of the lumbosacral FE spine models in both groups were analyzed and compared before and after daily loading. Results: The achieved comparative errors between the FE results and clinical images were on average below 20% and 25% for pre-op and post-op models, respectively, which confirms the applicability of this predictive algorithm for rough pre-planning estimations. The results showed that the disc height loss and fluid loss were increased for the adjacent discs in post-op models after 16 h of cyclic loading. In addition, significant differences in disc height loss and fluid loss were observed between the patients who were in the non-ASD and ASD groups. Similarly, the increased stress and fiber strain in the annulus fibrosus (AF) was higher in the adjacent level of post-op models. However, the calculated stress and fiber strain values were significantly higher for patients with ASD. Discussion: Evaluating the biomechanical response of pre-op and post-op modeling in the non-ASD and ASD groups showed that the inherent geometric differences among patients cause significant variations in the estimated mechanical response. In conclusion, the results of the current study highlighted the effect of geometrical parameters (which may refer to the anatomical conditions or the induced modifications regarding surgical techniques) on time-dependent responses of lumbar spine biomechanics.
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Affiliation(s)
- Mohammad Nikkhoo
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan,Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Wen-Chien Chen
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Meng-Ling Lu
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chen-Ju Fu
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan,Division of Emergency and Critical Care Radiology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chi-Chien Niu
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hen-Yu Lien
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hsiu Cheng
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan,*Correspondence: Chih-Hsiu Cheng,
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Jiang Y, Shi K, Zhou L, He M, Zhu C, Wang J, Li J, Li Y, Liu L, Sun D, Feng G, Yi Y, Zhang L. 3D-printed auxetic-structured intervertebral disc implant for potential treatment of lumbar herniated disc. Bioact Mater 2023; 20:528-538. [PMID: 35846840 PMCID: PMC9253410 DOI: 10.1016/j.bioactmat.2022.06.002] [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: 10/26/2021] [Revised: 05/26/2022] [Accepted: 06/06/2022] [Indexed: 11/27/2022] Open
Abstract
In this study, a novel artificial intervertebral disc implant with modified “Bucklicrystal” structure was designed and 3D printed using thermoplastic polyurethane. The new implant has a unique auxetic structure with building blocks joined “face-to-face”. The accompanied negative Poisson’s ratio enables its excellent energy absorption and stability under compression. The deformation and load distribution behavior of the implant under various loading conditions (bending, torsion, extension and flexion) has been thoroughly evaluated through finite element method. Results show that, compared to natural intervertebral disc and conventional 3D implant, our new implant exhibits more effective stress transfer and attenuation under practical loading conditions. The implant's ability to contract laterally under compression can be potentially used to alleviate the symptoms of lumbar disc herniation. Finally, the biocompatibility of the implant was assessed in vitro and its ability to restore the physiological function of the disc segment was validated in vivo using an animal model. Auxetic-structured IVD implant features negative Poisson's ratio (NPR) behavior. Modified “Bucklicrystal”structure exhibits better energy absorption and stability. The stress effectively and evenly transfers/attenuates in the auxetic implant. Auxetic implant potentially alleviates the symptoms of lumbar disc herniation.
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Affiliation(s)
- Yulin Jiang
- Analytical and Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, Sichuan University, Chengdu, 610065, China
| | - Kun Shi
- Analytical and Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, Sichuan University, Chengdu, 610065, China
| | - Luonan Zhou
- School of Materials Science and Engineering, Southwest University of Science and Technology, Mianyang, 621010, China
| | - Miaomiao He
- Analytical and Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, Sichuan University, Chengdu, 610065, China
| | - Ce Zhu
- Analytical and Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, Sichuan University, Chengdu, 610065, China
| | - Jingcheng Wang
- Analytical and Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, Sichuan University, Chengdu, 610065, China
| | - Jianhua Li
- Analytical and Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, Sichuan University, Chengdu, 610065, China
| | - Yubao Li
- Analytical and Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, Sichuan University, Chengdu, 610065, China
| | - Limin Liu
- Analytical and Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, Sichuan University, Chengdu, 610065, China
| | - Dan Sun
- Advanced Composite Research Group (ACRG), School of Mechanical and Aerospace Engineering, Queen's University Belfast, BT9 5AH, UK
| | - Ganjun Feng
- Analytical and Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, Sichuan University, Chengdu, 610065, China
- Corresponding author
| | - Yong Yi
- School of Materials Science and Engineering, Southwest University of Science and Technology, Mianyang, 621010, China
| | - Li Zhang
- Analytical and Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, Sichuan University, Chengdu, 610065, China
- Corresponding author.
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20
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Risk Factors for Adjacent Segment Problems after Posterior Instrumentation of the Cervical Spine. SURGERIES 2022. [DOI: 10.3390/surgeries3040037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Adjacent segment problems after cervical spine instrumentation are widely reported. They can range from asymptomatic adjacent segment degeneration (ASD) noted on radiographs to symptomatic adjacent segment disease and even instability. While ASD following anterior instrumentation is well studied, there is a paucity of literature on ASD following posterior instrumentation. We intended to identify the risk factors associated with ASD following posterior instrumentation, focusing on pre-operative and surgical parameters. Eighty-seven patients who underwent posterior instrumentation of the cervical spine were recruited. Clinical and radiological examination was performed preoperatively and up to 24 months postoperatively. The collected data included patient demographics, indication for surgery, sagittal parameters (cervical lordosis, C2–7 sagittal-vertical axis), technique of surgery, number of levels instrumented and fused, number of levels decompressed, and the level at which the instrumentation ended. Based on postoperative evaluation, ASD was found in 29.9% of the patients, of which, one patient was symptomatic and required reoperation. Even though, according to our univariate analysis, reduced pre-operative cervical lordosis and the indication of degenerative spondylosis seemed to significantly influence the occurrence of ASD, multivariate regression analysis did not identify any independent risk factors. We also noted that, even though patients may develop ASD after the instrumented fusion of the cervical spine, this may not necessarily develop into symptomatic adjacent segment disease requiring revision surgery.
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Chiou K, Chiu YC, Lee CY, Huang TJ, Lai YC, Yang CJ, Hsu JC, Wu MH. Comparison of long-term outcomes of spinal fusion surgeries supplemented with "topping-off" implants in lumbar degenerative diseases: A systematic review and network meta-analysis. NORTH AMERICAN SPINE SOCIETY JOURNAL 2022; 12:100177. [PMID: 36394053 PMCID: PMC9650073 DOI: 10.1016/j.xnsj.2022.100177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/06/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022]
Abstract
Background Context Spinal fusion surgery is a common treatment for lumbar degenerative diseases and has been associated with the long-term complication of adjacent segment disease (ASD). In recent years, the "topping-off" technique has emerged as a new surgical method, combining spinal fusion with a hybrid stabilization device (HSD) or interspinous process device (IPD) proximal to the fused vertebrae. Methods A literature search using the PubMed, Cochrane Central Register of Controlled Trials, EMBASE, and Web of Science databases identified eligible studies comparing topping-off implant(s) with spinal fusion surgery for lumbar degenerative diseases. Risk of bias was assessed using the Cochrane RoB 2.0 tool for randomized controlled trials and the Newcastle-Ottawa scale for retrospective studies. Each outcome was analyzed using the statistical Confidence in NMA (CINeMA) 1.9.0 software. Results 17 RCTs and retrospective studies that included 1255 participants and five interventions were identified. The topping-off implants device for intervertebral assisted motion (DIAM; OR = 0.235, p < 0.001), Dynesys (OR = 0.413, p < 0.001), and Coflex (OR = 0.417, p < 0.01) significantly lowered the incidence of radiographic adjacent segment degeneration (RASDeg) compared with spinal fusion surgery alone. Spinal fusion supplemented with DIAM significantly reduced the incidence of clinical adjacent segment disease (CASD) (OR = 0.358, p = 0.032). Conclusions Spinal fusion supplemented with DIAM substantially reduced the incidence of radiographic and clinical adjacent segment disease. No significant difference was observed between the treatment comparators for reoperation due to ASD and back pain relief score.
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Affiliation(s)
- Katie Chiou
- College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Chia Chiu
- College of Business Administration, Shoochow University, Taipei, Taiwan
| | - Ching-Yu Lee
- Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tsung-Jen Huang
- Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Ching Lai
- Graduate Institute of Health and Biotechnology Law, Taipei Medical University, Taipei, Taiwan
| | - Chia-Ju Yang
- Medical and Pharmaceutical Industry of Technology and Development Center, National Taipei University of Technology, Taipei, Taiwan
| | - Jason C. Hsu
- International PhD Program of Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei, Taiwan
- Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
- Research Center of Data Science on Healthcare Industry, College of Management, Taipei Medical University, Taipei, Taiwan
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Meng-Huang Wu
- Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Biodesign Center, Taipei Medical University, Taipei, Taiwan
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22
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Wang T, Si F, Zang L, Fan N, Yuan S, Du P, Wu Q, Wang A, Lu X. Radiographic adjacent segment degeneration and risk factors for osteoporotic vertebral compression fractures treated with percutaneous kyphoplasty. INTERNATIONAL ORTHOPAEDICS 2022; 46:2619-2628. [PMID: 35864260 DOI: 10.1007/s00264-022-05510-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE In this study, we aimed to clarify whether osteoporotic vertebral compression fracture (OVCF) following percutaneous kyphoplasty (PKP) was associated with a high risk for radiographic adjacent segment degeneration (ASD) and to identify the risk factors for radiographic ASD in these individuals. METHODS We retrospectively reviewed consecutive patients with OVCFs who underwent PKP at our institution between November 2015 and January 2021. The incidence of radiographic ASD was calculated and specific subgroups of ASD were identified. Univariate and multivariate analyses of demographic, clinical baseline, and radiologic data were performed to identify risk factors associated with radiographic ASD. RESULTS With a mean follow-up time of 27.3 months, a total of 95 eligible patients were enrolled. The incidence of radiographic ASD distinguished from natural degeneration was 52.6%. Patients with OVCFs who underwent PKP had a high risk of developing radiographic ASD, particularly disc degeneration. Intradiscal cement leakage (odds ratio [OR], 5.706; 95% confidence interval [CI], 2.039-15.970; P = 0.001) and preoperative disc height (OR, 0.681; 95% CI, 0.518-0.895; P = 0.006) were identified as independent risk factors. CONCLUSION Patients with OVCFs who underwent PKP were more likely to develop radiographic ASD, and their progression was distinguished from natural degeneration. Disc degeneration was the most common type of degeneration. Intradiscal cement leakage and preoperative disc height were identified as independent risk factors for developing radiographic ASD in these patients. Further validation through prospective multicenter studies is required.
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Affiliation(s)
- Tianyi Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Fangda Si
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China.
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Peng Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Qichao Wu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Aobo Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Xuanyu Lu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
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23
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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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24
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How I do it: biportal endoscopic spinal surgery for revision of adjacent segment disease after instrumented lumbar fusion. Acta Neurochir (Wien) 2022; 164:2337-2342. [PMID: 35882672 DOI: 10.1007/s00701-022-05318-3] [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: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Lumbar fusion with rigid fixation can be complicated by adjacent segment degeneration, which may cause neurological deficits and back pain, and occasionally necessitates revision surgery. This type of revision surgery is difficult to perform in a minimally invasive manner because it requires the revision of the original internal fixation instruments. METHOD We describe a biportal endoscopic spinal surgery (BESS) procedure for revision surgery due to adjacent segment disease after lumbar fusion with rigid fixation instruments. The radiological images and complete surgical procedure are presented. CONCLUSIONS BESS effectively enabled nerve decompression, intervertebral fusion, and revision of lumbar fusion with fixation instruments in a minimally invasive manner.
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25
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Schuermans VNE, Smeets AYJM, Boselie TFM, Candel MJJM, Curfs I, Evers SMAA, Van Santbrink H. Research protocol: Cervical Arthroplasty Cost Effectiveness Study (CACES): economic evaluation of anterior cervical discectomy with arthroplasty (ACDA) versus anterior cervical discectomy with fusion (ACDF) in the surgical treatment of cervical degenerative disc disease - a randomized controlled trial. Trials 2022; 23:715. [PMID: 36028916 PMCID: PMC9419384 DOI: 10.1186/s13063-022-06574-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION To date, there is no consensus on which anterior surgical technique is more cost-effective in treating cervical degenerative disc disease (CDDD). The most commonly used surgical treatment for patients with single- or multi-level symptomatic CDDD is anterior cervical discectomy with fusion (ACDF). However, new complaints of radiculopathy and/or myelopathy commonly develop at adjacent levels, also known as clinical adjacent segment pathology (CASP). The extent to which kinematics, surgery-induced fusion, natural history, and progression of disease play a role in the development of CASP remains unclear. Anterior cervical discectomy with arthroplasty (ACDA) is another treatment option that is thought to reduce the incidence of CASP by preserving motion in the operated segment. While ACDA is often discouraged, as the implant costs are higher while the clinical outcomes are similar to ACDF, preventing CASP might be a reason for ACDA to be a more cost-effective technique in the long term. METHODS AND ANALYSIS In this randomized controlled trial, patients will be randomized to receive ACDF or ACDA in a 1:1 ratio. Adult patients with single- or multi-level CDDD and symptoms of radiculopathy and/or myelopathy will be included. The primary outcome is cost-effectiveness and cost-utility of both techniques from a healthcare and societal perspective. Secondary objectives are the differences in clinical and radiological outcomes between the two techniques, as well as the qualitative process surrounding anterior decompression surgery. All outcomes will be measured at baseline and every 6 months until 4 years post-surgery. DISCUSSION High-quality evidence regarding the cost-effectiveness of both ACDA and ACDF is lacking; to date, there are no prospective trials from a societal perspective. Considering the aging of the population and the rising healthcare costs, there is an urgent need for a solid clinical cost-effectiveness trial addressing this question. TRIAL REGISTRATION ClinicalTrials.gov NCT04623593. Registered on 29 September 2020.
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Affiliation(s)
- Valérie N E Schuermans
- Department of Neurosurgery, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands.
- Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419 PC, The Netherlands.
- CAPHRI School for Public Health and Primary Care, Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands.
| | - Anouk Y J M Smeets
- Department of Neurosurgery, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands
- Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419 PC, The Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands
| | - Toon F M Boselie
- Department of Neurosurgery, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands
- Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419 PC, The Netherlands
| | - Math J J M Candel
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Peter Debyeplein 1, Maastricht, 6229 HA, The Netherlands
| | - Inez Curfs
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419 PC, The Netherlands
| | - Silvia M A A Evers
- Department of Public Health Technology Assessment, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Centre of Economic Evaluation & Machine Learning, Utrecht, The Netherlands
| | - Henk Van Santbrink
- Department of Neurosurgery, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands
- Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419 PC, The Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands
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Peng J, Li S, Lin X, Zhong D, Zheng R, Huang M, Li P, Song H, Asakawa T. Anterior cervical discectomy and fusion without plate (ACDFWP) versus anterior cervical disc arthroplasty (ACDA) for cervical spondylosis: A meta-analysis and literature review. Intractable Rare Dis Res 2022; 11:105-112. [PMID: 36200026 PMCID: PMC9437997 DOI: 10.5582/irdr.2022.01080] [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: 07/26/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/05/2022] Open
Abstract
This meta-analysis compared the clinical outcomes between two alternative surgeries for patients with cervical spondylosis, namely anterior cervical discectomy and fusion (ACDF) without plate (ACDFWP) vs. anterior cervical disc arthroplasty (ACDA). We searched databases, including PubMed, EMBASE, Cochrane Library, Google Scholar, and Web of Science (firstly available-2019). A standard meta-analysis was performed with the included studies. A Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool was used for the evaluation of the study quality of nonrandomized-controlled trials (nRCTs), while a Risk of Bias (RoB) battery was used for randomized controlled trials (RCTs). Eight studies involving 640 patients were included. No significant difference was found in the indices of Neck Disability Index (NDI) score, Visual Analog Score (VAS), Japanese Orthopaedic Association (JOA) score, operative time, blood loss, Swallowing Quality of Life Score (SWAL-QL), and complications. Cervical alignment was significantly better in the ACDFWP than in ACDA (mean difference (MD) = -0.67, 95% confidence interval (CI) [-1.11, -0.23], P = 0.003, I 2 = 20%). Although the alternative ACDFWP was slightly superior in terms of the index of cervical alignment, the limited research on this subject present insufficient evidence. Further well-designed studies are warranted in the future.
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Affiliation(s)
- Jiajie Peng
- Department of Orthopedics, Zhongshan Jishuitan Orthopedic Hospital, Zhongshan, Guangdong, China
| | - Sihan Li
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Gastroenterology, The Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Xiangying Lin
- Department of Gastroenterology, The Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Degui Zhong
- Department of Orthopedics, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
| | - Rong Zheng
- Department of Gastroenterology, The Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Minghan Huang
- Department of Gastroenterology, The Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Pengfei Li
- Department of Nephrology, The People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Hongmei Song
- Department of Gastroenterology, The Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Address correspondence to:Hongmei Song, Division of Science and Education, The Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, No. 282 Wusibei Road, Fuzhou 353003, China. E-mail:
| | - Tetsuya Asakawa
- Institute of Neurology, The Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
- Address correspondence to:Hongmei Song, Division of Science and Education, The Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, No. 282 Wusibei Road, Fuzhou 353003, China. E-mail:
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Song Z, Zhang Z, Yang X, Zhao Z, Li T, Bi N, Wang Y. Mid- and Long-Term Comparison Analysis of Two Approaches for the Treatment of Level III or Higher Lenke-Silva Adult Degenerative Scoliosis: Radical or Limited Surgery? Orthop Surg 2022; 14:2006-2015. [PMID: 35876210 PMCID: PMC9483045 DOI: 10.1111/os.13418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 05/26/2022] [Accepted: 06/26/2022] [Indexed: 11/27/2022] Open
Abstract
Objective As the population in general is living longer, less invasive adult degenerative scoliosis (ADS) surgery that balances risks and benefits requires long‐term clinical outcomes to determine its strengths and weaknesses. We design a retrospective study to compare the postoperative mid‐ and long‐term outcomes in terms of efficacy, surgical complications, and reoperation rate of patients with ADS treated with two different surgical approaches (long‐segment complete reconstruction or short‐segment limited intervention). Methods In this retrospective study, 78 patients with ADS (Lenke–Silva levels III or higher), who accepted surgical treatment at our hospital between June 2012 and June 2019 were included. These patients were assigned to the long‐segment radical group (complete decompression with deformity correction involves ≥3 segments) and the short‐segment limited group (symptomatic segment decompression involves <3 segments). In addition, general information such as age, gender, fixed segment number, efficacy, radiographic parameters, and reoperation rate of patients in the two groups were compared and analyzed. Results There were no significant differences between the two groups with regard to gender, follow‐up time, long‐term surgical complications and reoperation rate (P > 0.05). The mean age of patients in the long‐segment strategy group was 57.1 ± 7.9 years, with a mean number of fixed segments of 7.9 ± 2.4. The mean age of patients in the short‐segment strategy group was 60.8 ± 8.4 years, with a mean number of fixed segments of 1.4 ± 0.5. At the final follow‐up visit, the long‐segment radical group showed better results than the short‐segment limited group with regard to coronal Cobb angle, lumbar lordosis angle and sagittal balance (P < 0.05). The long‐segment strategy group had a higher implant‐related complication rate (P = 0.010); the adjacent segment‐related complication in the two groups showed no significant difference (P = 0.068). Conclusion Considering the risk, rehabilitation pathway and costs of long‐segment radical surgery, short‐segment limited intervention is a better strategy for patients who cannot tolerate the long‐segment surgery, improving symptoms and maintaining efficacy in the mid‐ and long‐term, and not increasing the reoperation rate.
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Affiliation(s)
- Zhibo Song
- Orthopedics Department, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhaoquan Zhang
- Orthopedics Department, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaochen Yang
- Orthopedics Department, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhi Zhao
- Orthopedics Department, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Tao Li
- Orthopedics Department, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ni Bi
- Orthopedics Department, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yingsong Wang
- Orthopedics Department, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
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Biomechanical Comparison between Isobar and Dynamic-Transitional Optima (DTO) Hybrid Lumbar Fixators: A Lumbosacral Finite Element and Intersegmental Motion Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8273853. [PMID: 35845942 PMCID: PMC9286886 DOI: 10.1155/2022/8273853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022]
Abstract
Biomechanical performance of longitudinal component in dynamic hybrid devices was evaluated to display the load-transfer effects of Dynesys cord spacer or Isobar damper-joint dynamic stabilizer on junctional problem based on various disc degenerations. The dynamic component was adapted at the mildly degenerative L3–L4 segment, and the static component was fixed at the moderately degenerative L4–L5 segment under a displacement-controlled mode for the finite element study. Furthermore, an intersegmental motion behavior was analyzed experimentally on the synthetic model under a load-controlled mode. Isobar or DTO hybrid fixator could reduce stress/motion at transition segment, but compensation was affected at the cephalic adjacent segment more than the caudal one. Within the trade-off region (as a motion-preserving balance between the transition and adjacent segments), the stiffness-related problem was reduced mostly in flexion by a flexible Dynesys cord. In contrast, Isobar damper afforded the effect of maximal allowable displacement (more than peak axial stiffness) to reduce stress within the pedicle and at facet joint. Pedicle-screw travel at transition level was related to the extent of disc degeneration in Isobar damper-joint (more than Dynesys cord spacer) attributing to the design effect of axial displacement and angular rotation under motion. In biomechanical characteristics relevant to clinical use, longitudinal cord/damper of dynamic hybrid lumbar fixators should be designed with less interface stress occurring at the screw-vertebral junction and facet joint to decrease pedicle screw loosening/breakage under various disc degenerations.
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Takeda K, Okada E, Shinozaki Y, Ozaki M, Kono H, Yasuda A, Suzuki S, Tsuji O, Nagoshi N, Yagi M, Fujita N, Ogawa J, Nakamura M, Matsumoto M, Watanabe K. Risk factors for early-onset radiographical adjacent segment disease in patients with spondylolytic spondylolisthesis after single-level posterior lumbar interbody fusion. Spine J 2022; 22:1112-1118. [PMID: 35158045 DOI: 10.1016/j.spinee.2022.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/27/2022] [Accepted: 02/04/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The risk factors for radiographical adjacent segment disease (ASD) in patients with degenerative spondylolisthesis have been previously reported. However, there are only few reports on patients with spondylolytic spondylolisthesis who underwent single-level posterior lumbar interbody fusion (PLIF). PURPOSE The study aimed to investigate the risk factors for radiographical ASD in patients with L5-S1 spondylolytic spondylolisthesis who underwent single-level PLIF. STUDY DESIGN/SETTING A retrospective study PATIENT SAMPLE: This study retrospectively reviewed 135 consecutive patients (91 men and 44 women) with symptomatic L5-S1 spondylolytic spondylolisthesis who underwent single-level PLIF. OUTCOME MEASURES The pre- and postoperative (at the final follow-up) spinopelvic parameters, % slip, sacral slope, lumbar lordosis (LL), pelvic tilt, pelvic incidence (PI), PI minus LL (PI - LL), lumbosacral angle, C7 sagittal vertical axis, and thoracic kyphosis were measured using standing radiographs. METHODS Radiographical ASD was defined as disc height loss (>3 mm), increase of posterior angulation (>5°), or progression of spondylolisthesis (>3 mm) between the pre- and postoperative radiographs. Pfirrmann's classification was used to evaluate disc degeneration. The radiographical parameters and changes between the pre- and postoperative values were evaluated and compared for the non-ASD and ASD groups. Binary logistic regression analysis was performed to evaluate the adjusted associations between each potential explanatory variable and ASD development. RESULTS The radiographical ASD incidence was 11%. Additionally, 60% of the patients with ASD had radiographical ASD at 1 year and all cases of radiographical ASD in this follow-up period occurred within 3 years after the initial surgery. The mean period of ASD occurrence after initial surgery was 21.7 ± 12.6 months. No patients required reoperation for radiographical ASD. Multivariate analysis revealed that a preoperative (odds ratio [OR], 5.9; 95% confidence interval [CI], 1.2-28.9; p=.03) and a postoperative (OR, 6.5; 95% CI, 1.2-34.5; p=.03) PI - LL of ≥15° were risk factors for radiographical ASD. CONCLUSIONS Pre- and postoperative PI - LL value mismatch was identified as significant independent risk factors for radiographical ASD in patients with L5-S1 spondylolytic spondylolisthesis. Obtaining larger lordosis at L5-S1 may be the key to preventing radiographical ASD.
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Affiliation(s)
- Kazuki Takeda
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Yoshio Shinozaki
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Masahiro Ozaki
- Department of Orthopaedic Surgery, Medical Corporation Keiyukai Keiyu Orthopedic Hospital, Gunma, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Hitoshi Kono
- Department of Orthopaedic Surgery, Medical Corporation Keiyukai Keiyu Orthopedic Hospital, Gunma, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Akimasa Yasuda
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, Fujita Health University, Toyoake, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Jun Ogawa
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan.
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Abbasi-Ghiri A, Ebrahimkhani M, Arjmand N. Novel force-displacement control passive finite element models of the spine to simulate intact and pathological conditions; comparisons with traditional passive and detailed musculoskeletal models. J Biomech 2022; 141:111173. [PMID: 35705381 DOI: 10.1016/j.jbiomech.2022.111173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/08/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022]
Abstract
Passive finite element (FE) models of the spine are commonly used to simulate intact and various pre- and postoperative pathological conditions. Being devoid of muscles, these traditional models are driven by simplistic loading scenarios, e.g., a constant moment and compressive follower load (FL) that do not properly mimic the complex in vivo loading condition under muscle exertions. We aim to develop novel passive FE models that are driven by more realistic yet simple loading scenarios, i.e., in vivo vertebral rotations and pathological-condition dependent FLs (estimated based on detailed musculoskeletal finite element (MS-FE) models). In these novel force-displacement control FE models, unlike the traditional passive FE models, FLs vary not only at different spine segments (T12-S1) but between intact, pre- and postoperative conditions. Intact, preoperative degenerated, and postoperative fused conditions at the L4-L5 segment for five static in vivo activities in upright and flexed postures were simulated by the traditional passive FE, novel force-displacement control FE, and gold-standard detailed MS-FE spine models. Our findings indicate that, when compared to the MS-FE models, the force-displacement control passive FE models could accurately predict the magnitude of disc compression force, intradiscal pressure, annulus maximal von Mises stress, and vector sum of all ligament forces at adjacent segments (L3-L4 and L5-S1) but failed to predict disc shear and facet joint forces. In this regard, the force-displacement control passive FE models were much more accurate than the traditional passive FE models. Clinical recommendations made based on traditional passive FE models should, therefore, be interpreted with caution.
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Affiliation(s)
- A Abbasi-Ghiri
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - M Ebrahimkhani
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - N Arjmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
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Adjacent segments biomechanics following lumbar fusion surgery: a musculoskeletal finite element model study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1630-1639. [PMID: 35633382 DOI: 10.1007/s00586-022-07262-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 04/18/2022] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This study exploits a novel musculoskeletal finite element (MS-FE) spine model to evaluate the post-fusion (L4-L5) alterations in adjacent segment kinetics. METHODS Unlike the existing MS models with idealized representation of spinal joints, this model predicts stress/strain distributions in all passive tissues while organically coupled to a MS model. This generic (in terms of musculature and material properties) model uses population-based in vivo vertebral sagittal rotations, gravity loads, and an optimization algorithm to calculate muscle forces. Simulations represent individuals with an intact L4-L5, a preoperative severely degenerated L4-L5 (by reducing the disc height by ~ 60% and removing the nucleus incompressibility), and a postoperative fused L4-L5 segment with either a fixed or an altered lumbopelvic rhythm with respect to the intact condition (based on clinical observations). Changes in spine kinematics and back muscle cross-sectional areas (due to intraoperative injuries) are considered based on in vivo data while simulating three activities in upright/flexed postures. RESULTS Postoperative changes in some adjacent segment kinetics were found considerable (i.e., larger than 25%) that depended on the postoperative lumbopelvic kinematics and preoperative L4-L5 disc condition. Postoperative alterations in adjacent disc shear, facet/ligament forces, and annulus stresses/strains were greater (> 25%) than those found in intradiscal pressure and compression (< 25%). Kinetics of the lower (L5-S1) and upper (L3-L4) adjacent segments were altered to different degrees. CONCLUSION Alterations in segmental rotations mainly affected adjacent disc shear forces, facet/ligament forces, and annulus/collagen fibers stresses/strains. An altered lumbopelvic rhythm (increased pelvis rotation) tends to mitigate some of these surgically induced changes.
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Han B, Ding H, Hai Y, Liu Y, Guan L, Pan A, Zhang X, Yin P. May the midline lumbar interbody fusion (MIDLIF) prevent the early radiographic adjacent segment degeneration? A minimum 3-year follow-up comparative study of MIDLIF in L4/5 with cortical bone trajectory screw versus traditional pedicle screw fixation. BMC Musculoskelet Disord 2022; 23:480. [PMID: 35596180 PMCID: PMC9121621 DOI: 10.1186/s12891-022-05363-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/26/2022] [Indexed: 11/29/2022] Open
Abstract
Study design Retrospective cohort study. Objective To compare the early radiographic adjacent segment degeneration (R-ASD) and regional lumbar sagittal alignment after midline lumbar interbody fusion (MIDLIF) with cortical bone trajectory (CBT) screw fixation (CBT-MIDLIF) and posterior lumbar interbody fusion (PLIF) with the traditional pedicle screw fixation (PS-PLIF) during long-term follow-up. Methods All patients who underwent CBT-MIDLIF or PS-PLIF were identified by a retrospective consecutive case review. Radiographic parameters in cephalad adjacent segment (L3/4), including intervertebral space height (ISH), foraminal height (FH), foraminal width (FW), range of motion were assessed. Lumbar lordosis (LL), sacral slope (SS), L4–L5 Cobb angle, Cobb angle of the intervertebral space at L4–L5, and height of the anterior and posterior edges of the intervertebral space at L4–L5, were measured and compared on preoperative, postoperative, and 3-year follow-up radiographic evaluation. Results Seventy-four patients underwent CBT-MIDLIF (CBT-MIDLIF group) and 114 patients underwent conventional PS-PLIF (PS-PLIF group). ISH, FH and FW were significantly smaller at 6-month follow-up than before operation with PS-PLIF (p < 0.001) but showed no significant changes with CBT-MIDLIF (p > 0.05). At the last follow-up, the changes in cephalad R-ASD parameters were more remarkable after PS-PLIF than after CBT-MIDLIF (p < 0.01). LL and SS were significant larger at the last follow-up than before operation in both groups (p < 0.001). Regarding long-term outcomes, the symptoms caused by degenerative spinal disorders significantly improved in both groups (p < 0.01). Conclusion CBT-MIDLIF had less radiographic degeneration in the adjacent segment than PS-PLIF at 3-year follow-up. The lumbar sagittal alignment could be improved significantly and the surgical outcomes were satisfactory after either CBT-MIDLIF or PS-PLIF.
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Affiliation(s)
- Bo Han
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chao-Yang District, Beijing, 100020, China
| | - Hongtao Ding
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chao-Yang District, Beijing, 100020, China
| | - Yong Hai
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chao-Yang District, Beijing, 100020, China.
| | - Yuzeng Liu
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chao-Yang District, Beijing, 100020, China.
| | - Li Guan
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chao-Yang District, Beijing, 100020, China
| | - Aixing Pan
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chao-Yang District, Beijing, 100020, China
| | - Xinuo Zhang
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chao-Yang District, Beijing, 100020, China
| | - Peng Yin
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chao-Yang District, Beijing, 100020, China
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Schuermans VNE, Smeets AYJM, Boselie AFM, Zarrouk O, Hermans SMM, Droeghaag R, Curfs I, Evers SMAA, van Santbrink H. Cost-effectiveness of anterior surgical decompression surgery for cervical degenerative disk disease: a systematic review of economic evaluations. 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 2022; 31:1206-1218. [PMID: 35224672 DOI: 10.1007/s00586-022-07137-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/06/2021] [Accepted: 01/26/2022] [Indexed: 12/22/2022]
Abstract
PURPOSE No clear consensus exists on which anterior surgical technique is most cost-effective for treating cervical degenerative disk disease (CDDD). One of the most common treatment options is anterior cervical discectomy with fusion (ACDF). Anterior cervical discectomy with arthroplasty (ACDA) was developed in an effort to reduce the incidence of clinical adjacent segment pathology and associated additional surgeries by preserving motion. This systematic review aims to evaluate the evidence regarding the cost-effectiveness of anterior surgical decompression techniques used to treat radiculopathy and/or myelopathy caused by CDDD. METHODS The search was conducted in PubMed, EMBASE, Web of Science, CINAHL, EconLit, NHS-EED and the Cochrane Library. Studies were included if healthcare costs and utility or effectivity measurements were mentioned. RESULTS A total of 23 studies were included out of the 1327 identified studies. In 9 of the 13 studies directly comparing ACDA and ACDF, ACDA was the most cost-effective technique, with an incremental cost effectiveness ratio ranging from $2.900/QALY to $98.475/QALY. There was great heterogeneity between the costs of due to different in- and exclusion criteria of costs and charges, cost perspective, baseline characteristics, and calculation methods. The methodological quality of the included studies was moderate. CONCLUSION The majority of studies report ACDA to be a more cost-effective technique in comparison with ACDF. The lack of uniform literature impedes any solid conclusions to be drawn. There is a need for high-quality cost-effectiveness research and uniformity in the conduct, design and reporting of economic evaluations concerning the treatment of CDDD. TRIAL REGISTRATION PROSPERO Registration: CRD42020207553 (04.10.2020).
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Affiliation(s)
- V N E Schuermans
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands. .,Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands. .,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
| | - A Y J M Smeets
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
| | - A F M Boselie
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
| | - O Zarrouk
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
| | - S M M Hermans
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - R Droeghaag
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - I Curfs
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - S M A A Evers
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Department of Health Services Research, Focusing on Value-Based Care and Ageing and Department of Family Medicine, Maastricht University, Maastricht, The Netherlands.,Center of Economic Evaluation and Machine Learning, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - H van Santbrink
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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Zhou J, Yuan C, Liu C, Liu M, Zhou L, Wang J. Assessment of vertebral bone mineral density and stand-alone oblique lumbar interbody fusion for adjacent segment disease and primary lumbar degenerative diseases. J Orthop Surg (Hong Kong) 2022; 30:10225536221091846. [PMID: 35410526 DOI: 10.1177/10225536221091846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate the vertebral bone mineral density and the value of stand-alone oblique lumbar interbody fusion (SA OLIF) for the management of single-level adjacent segment disease (ASD) and primary lumbar degenerative diseases. PATIENTS AND METHODS Seventy-eight patients undergoing single-level SA OLIF was divided into index surgery group (n = 36) or revision surgery group (n = 42) at single center. The vertebral body Hounsfield units (HU) value was measured to assess bone mineral density of operated level by the preoperative CT. The following data were retrospectively collected and compared between the two groups: demographic, surgical data, clinical results, and complications. RESULTS No differences were found between the two groups in surgical data. The fusion segment HU values in the revision group were significantly higher than that in the index group (147.4 ± 35.3 vs 129.2 ± 38.4 p = .033). There were significant differences while comparing fusion segment HU values to L1-L4 horizontal plane (147.4 ± 35.3 vs 126.1 ± 28.4, p = .000) and L1 (147.4 ± 35.3 vs 126.8 ± 26.2, p = .000) in revision group, meanwhile, no statistically significant difference was observed in index group (p > .05). The cage subsidence was observed in the revision group (n = 2) and index group (n = 9) (p = .045). The patients with cage subsidence had significantly lower vertebral HU values. CONCLUSION SA OLIF is valid alternative to the traditional posterior approach in the management of ASD with good clinical outcomes at short-term follow-up. Increased HU values of fusion segment may play a role in the management of ASD by SA OLIF.
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Affiliation(s)
- Jing Zhou
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, 105785The Third Military Medical University, Chongqing, China
| | - Chao Yuan
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, 105785The Third Military Medical University, Chongqing, China
| | - Chao Liu
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, 105785The Third Military Medical University, Chongqing, China
| | - Minghan Liu
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, 105785The Third Military Medical University, Chongqing, China
| | - Lei Zhou
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, 105785The Third Military Medical University, Chongqing, China
| | - Jian Wang
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, 105785The Third Military Medical University, Chongqing, China
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Risk factors for adjacent segment disease requiring reoperation after posterior lumbar interbody fusion with screw fixation: focus on paraspinal muscle, facet joint, and disc degeneration. Acta Neurochir (Wien) 2022; 164:913-922. [PMID: 34850289 DOI: 10.1007/s00701-021-05073-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/23/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Adjacent segment disease (ASD) requiring revision surgery is the most serious complication that can occur in patients undergoing posterior lumbar interbody fusion (PLIF) surgery. This study aimed to determine the risk factors for surgical ASD requiring revision surgery after PLIF with screw fixation surgery. We especially focused on paraspinal muscle, facet joint, and disc degeneration. METHODS Among the patients who underwent PLIF with screw fixation due to degenerative spinal disease from January 2010 to December 2019, patients who underwent revision surgery for the development of ASD were enrolled. To evaluate the risk factors for surgical ASD, we selected a control group. Each patient in the control group was matched by age, sex, fusion level, number of fused segments, secondary MRI follow-up interval, and follow-up duration with a patient in the surgical ASD group. The radiographic and demographic data were compared between the surgical ASD and control groups. RESULTS There were statistically significant differences between the two groups in radiological parameters of preoperative facet degeneration, facet effusion, facet angle, and fatty degeneration of the multifidus muscle. Multivariable logistic regression analysis revealed that preoperative facet effusion (odds ratio [OR] 6.48), preoperative facet angle (OR 1.24), and progression of fatty degeneration in the multifidus muscle (OR 1.07) were significant risk factors for surgical ASD. CONCLUSIONS Preexisting high-grade adjacent facet effusion, sagittally oriented facet joint angle, and progressive fatty degeneration of the multifidus muscle are associated with the development of surgical ASD after PLIF surgery.
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Schuermans VN, Smeets AY, Wijsen NP, Curfs I, Boselie TF, van Santbrink H. Clinical adjacent segment pathology after anterior cervical discectomy, with and without fusion, for cervical degenerative disc disease: A single center retrospective cohort study with long-term follow-up. BRAIN & SPINE 2022; 2:100869. [PMID: 36248168 PMCID: PMC9560678 DOI: 10.1016/j.bas.2022.100869] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 12/25/2022]
Abstract
Introduction Clinical adjacent segment pathology (CASP) continues to be a cause of concern after anterior surgical treatment for single- or multilevel cervical degenerative disc disease (CDDD). The current literature reports inconsistent incidence rates and contended risk factors in the development of CASP. Research question The aim is to determine the incidence of additional CASP-related surgeries after anterior cervical discectomy with fusion (ACDF) or without fusion (ACD) for CDDD. Secondary outcomes include risk factors for the development of CASP and long-term clinical outcomes. Materials & methods This is a single-center, retrospective cohort study with a long-term follow up. Patients undergoing ACD(F) for CDDD between January 2012 and December 2019 were included. Results A total of 601 patients were included, with an average follow-up period of 5.0 years. Most patients underwent ACDF with stand-alone cages (87.7%). CASP developed in 58 (9.7%) patients, 41 (70.7%) of which required additional adjacent level surgery. ACD significantly accelerated the development of CASP. The C2-C7 Cobb angle appeared less lordotic upon early post-operative imaging in ACDF patients that later-on developed CASP. Baseline degeneration at the index level and adjacent levels was not significantly different between patients with and without CASP. Discussion & conclusion In this retrospective cohort, we observe a relatively low rate of additional surgery for CASP in ACDF with stand-alone cages. We suggest that surgical technique, fusion, segmental kyphosis and natural degeneration play a multifactorial role in the development of CASP. Complication rates were low and clinical outcomes were similar for all techniques used.
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Affiliation(s)
- Valérie N.E. Schuermans
- Department of Neurosurgery, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
- Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, the Netherlands
| | - Anouk Y.J.M. Smeets
- Department of Neurosurgery, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
- Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, the Netherlands
| | - Nienke P.M.H. Wijsen
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands
| | - Inez Curfs
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, the Netherlands
| | - Toon F.M. Boselie
- Department of Neurosurgery, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
- Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, the Netherlands
| | - Henk van Santbrink
- Department of Neurosurgery, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
- Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, the Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands
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Are Congenital Cervical Block Vertebrae a Risk Factor for Adjacent Segment Disease? A Retrospective Cross-Sectional CT and MR Imaging Study. Diagnostics (Basel) 2021; 12:diagnostics12010090. [PMID: 35054258 PMCID: PMC8774787 DOI: 10.3390/diagnostics12010090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/02/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022] Open
Abstract
Adjacent segment disease (ASDI) is a well-described complication of spinal fusion surgery that may ultimately lead to spinal stenosis and repeated surgical intervention. Although congenital block vertebrae also present with degenerative changes in the adjacent segments, this has not yet been systematically investigated. The aim of this study was to assess the presence and degree of ASDI in congenital cervical block vertebrae. Methods: A total of 51 patients with congenital vertebral fusion in one cervical segment were analysed in this IRB-approved retrospective cross-sectional study using available CT/MR imaging. Exclusion criteria were prior spinal surgery and the presence of additional hereditary abnormalities. We assessed the severity of degenerative changes using a sum score. The sum score for adjacent and non-adjacent segments was then divided by the highest possible degeneration score, which resulted in a ratio of severity for adjacent and remaining segments (ranging from 0 to 1). Results: Overall, 35 of 51 patients (68.6%) showed evidence of ASDI, and 34 of 51 patients (66.7%) also showed degenerative changes in the remaining segments. The severity score was significantly higher (p = 0.025) in the segments adjacent to the congenital block vertebrae (mean value 0.307) compared to the non-adjacent segments (mean value 0.188). Conclusions: Our results suggest that ASDI is also caused by congenital block vertebrae of the cervical spine.
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McGrath KA, Schmidt ES, Loss JG, Gillespie CM, Colbrunn RW, Butler RS, Steinmetz MP. Assessment of L5-S1 anterior lumbar interbody fusion stability in the setting of lengthening posterior instrumentation constructs: a cadaveric biomechanical study. J Neurosurg Spine 2021:1-9. [PMID: 34920420 DOI: 10.3171/2021.9.spine21821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Excessive stress and motion at the L5-S1 level can lead to degenerative changes, especially in patients with posterior instrumentation suprajacent to L5. Attention has turned to utilization of L5-S1 anterior lumbar interbody fusion (ALIF) to stabilize the lumbosacral junction. However, questions remain regarding the effectiveness of stand-alone ALIF in the setting of prior posterior instrumented fusions terminating at L5. The purpose of this study was to assess the biomechanical stability of an L5-S1 ALIF with increasing lengths of posterior thoracolumbar constructs. METHODS Seven human cadaveric spines (T9-sacrum) were instrumented with pedicle screws from T10 to L5 and mounted to a 6 degrees-of-freedom robot. Posterior fusion construct lengths (T10-L5, T12-L5, L2-5, and L4-5) were instrumented to each specimen, and torque-fusion level relationships were determined for each construct in flexion-extension, axial rotation, and lateral bending. A stand-alone L5-S1 ALIF was then instrumented, and L5-S1 motion was measured as increasing pure moments (2 to 12 Nm) were applied. Motion reduction was calculated by comparing L5-S1 motion across the ALIF and non-ALIF states. RESULTS The average motion at L5-S1 in axial rotation, flexion-extension, and lateral bending was assessed for each fusion construct with and without ALIF. After adding ALIF to a posterior fusion, L5-S1 motion was significantly reduced relative to the non-ALIF state in all but one fused surgical condition (p < 0.05). Longer fusions with ALIF produced larger L5-S1 motions, and in some cases resulted in motions higher than native state motion. CONCLUSIONS Posterior fusion constructs up to L4-5 could be appropriately stabilized by a stand-alone L5-S1 ALIF when using a nominal threshold of 80% reduction in native motion as a potential positive indicator of fusion. The results of this study allow conclusions to be drawn from a biomechanical standpoint; however, the clinical implications of these data are not well defined. These findings, when taken in appropriate clinical context, can be used to better guide clinicians seeking to treat L5-S1 pathology in patients with prior posterior thoracolumbar constructs.
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Affiliation(s)
- Kyle A McGrath
- 1Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland
| | - Eric S Schmidt
- 1Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland.,2Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine, Cleveland
| | - Jeremy G Loss
- 3Lerner Research Institute, Cleveland Clinic, Cleveland; and
| | | | - Robb W Colbrunn
- 3Lerner Research Institute, Cleveland Clinic, Cleveland; and
| | - Robert S Butler
- 4Department of Quantitative Health Services, Cleveland Clinic, Cleveland, Ohio
| | - Michael P Steinmetz
- 1Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland.,2Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine, Cleveland
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Tan MWP, Sayampanathan AA, Jiang L, Guo CM. Comparison of Outcomes Between Single-level Lateral Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion: A Meta-analysis and Systematic Review. Clin Spine Surg 2021; 34:395-405. [PMID: 33298799 DOI: 10.1097/bsd.0000000000001107] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This is a meta-analysis and systematic review of the available literature. OBJECTIVE This study aims to compare the clinical and radiologic outcomes of single-level lateral lumbar interbody fusion (LLIF) with single-level transforaminal lumbar interbody fusion (TLIF). SUMMARY OF BACKGROUND DATA In the treatment of adult spinal deformity, LLIF allows interbody fusion while avoiding complications associated with an anterior or transforaminal approach, although the clinical outcomes of LLIF compared with other approaches have not been well established. METHODS We searched PubMed, Embase, and Scopus for 385 unique studies. On the basis of our exclusion criteria, 8 studies remained for our systematic review. Data were analyzed using Review Manager 5.3 using Mantel-Haenszel statistics and random effect models. This study identified self-reported Visual Analog Scale (VAS), Oswestry Disability Index, length of stay, blood loss, complication rate, and radiologic parameters (disk height, lumbar lordosis, segmental lordosis). RESULTS Our meta-analysis showed that LLIF contributed to decreased blood loss [mean difference (MD)=-67.62 mL, 95% confidence interval (CI): -104 to -30.90, P<0.001], superior restoration of segmental lordosis (MD=1.91 degrees, 95% CI: 0.71-3.10, P=0.002), lumbar lordosis (MD=1.95 degrees, 95% CI: 0.15-3.74, P=0.03), and disk height (MD=2.18 mm, 95% CI: 1.18-3.17, P<0.001) when compared with TLIF. However, current data suggests no significant difference in clinical outcomes between LLIF and TLIF based on overall complication rates (P=0.22), length of hospital stay (P=0.65), postoperative Oswestry Disability Index (P=0.13), postoperative VAS Back Pain (P=0.47) and VAS Leg Pain (P=0.16). CONCLUSIONS LLIF is an increasingly popular option for single-level anterior column reconstruction. When compared with single-level TLIF, single-level LLIF is associated with greater changes in lumbar lordosis and disk height. The single-level LLIF is a viable alternative to TLIF, demonstrating comparable clinical outcomes and better restoration of spinopelvic parameters. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Marcus Wei Ping Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Placement of Unilateral Cortical Bone Trajectory Screws in Previously Instrumented Pedicle without Removal of Existing Hardware for Adjacent Segment Disease. Case Rep Orthop 2021; 2021:9994539. [PMID: 34796033 PMCID: PMC8595017 DOI: 10.1155/2021/9994539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 09/17/2021] [Indexed: 11/17/2022] Open
Abstract
Adjacent segment disease (ASD) in the lumbar spine is a possible consequence in segments adjacent to a fusion. As the number of lumbar fusions in the United States increases, the rates of ASD will continue to climb. There are several treatment options for ASD with open decompression and extension of the fusion being common. However, need for exposure and removal of existing instrumentation can lead to increased operative times resulting in increasing blood loss and infection risk. The purpose of this paper is to describe a case report for unilateral cortical trajectory screw instrumentation, allowing for posterior instrumentation without having to remove the existing pedicle screws in the setting of ASD. Our technique can be done with standard c-arm fluoroscopy without the need for navigation.
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Biomechanical effects of lumbar fusion surgery on adjacent segments using musculoskeletal models of the intact, degenerated and fused spine. Sci Rep 2021; 11:17892. [PMID: 34504207 PMCID: PMC8429534 DOI: 10.1038/s41598-021-97288-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/23/2021] [Indexed: 12/25/2022] Open
Abstract
Adjacent segment disorders are prevalent in patients following a spinal fusion surgery. Postoperative alterations in the adjacent segment biomechanics play a role in the etiology of these conditions. While experimental approaches fail to directly quantify spinal loads, previous modeling studies have numerous shortcomings when simulating the complex structures of the spine and the pre/postoperative mechanobiology of the patient. The biomechanical effects of the L4–L5 fusion surgery on muscle forces and adjacent segment kinetics (compression, shear, and moment) were investigated using a validated musculoskeletal model. The model was driven by in vivo kinematics for both preoperative (intact or severely degenerated L4–L5) and postoperative conditions while accounting for muscle atrophies. Results indicated marked changes in the kinetics of adjacent L3–L4 and L5–S1 segments (e.g., by up to 115% and 73% in shear loads and passive moments, respectively) that depended on the preoperative L4–L5 disc condition, postoperative lumbopelvic kinematics and, to a lesser extent, postoperative changes in the L4–L5 segmental lordosis and muscle injuries. Upper adjacent segment was more affected post-fusion than the lower one. While these findings identify risk factors for adjacent segment disorders, they indicate that surgical and postoperative rehabilitation interventions should focus on the preservation/restoration of patient’s normal segmental kinematics.
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Wang H, Wang X, Liu H, Meng Y, Guo Y, Hong Y. Risk Factors for High-Grade Heterotopic Ossification After Total Disc Replacement: A Single-Center Experience of 394 Cases. Neurosurgery 2021; 89:852-861. [PMID: 34382657 DOI: 10.1093/neuros/nyab298] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/09/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Heterotopic ossification (HO) is a common complication following total disc replacement (TDR). High-grade HO is a clinically relevant complication, however, only a few studies have evaluated risk factors for high-grade HO. OBJECTIVE To evaluate potential risk factors for HO and high-grade HO and their impact on clinical outcomes. METHODS We retrospectively reviewed patients who underwent TDR or hybrid surgery (HS) with Prestige-LP (Medtronic), Discover (Depuy), and Prodisc-C (Synthes). Clinical outcomes were assessed using Japanese Orthopaedic Association, Visual Analogue Scale, and Neck Disability Index scores. Radiological variables, including preoperative ossification, global and segmental range of motion (ROM), HO, and adjacent segment degeneration (ASD) were reviewed. RESULTS A total of 394 patients were evaluated. HO and high-grade HO occurred in 67.77% and 11.17% patients, respectively. Preoperative ossification was significantly associated with the occurrence of HO (P < .001, OR: 3.507, 95%CI: 2.211-5.562) and high-grade HO (P = .019, OR: 2.176, 95%CI: 1.137-4.166). The ROM of replacement levels and C2-7 were significantly lower in the high-grade HO group compared to those without high-grade HO: (3.80° vs 10.18°, P < .001) and (42.81° vs 54.00°, P < .001), respectively. The incidence of ASD was significantly higher in patients with high-grade HO than those without high-grade HO (22.73% vs 11.14%, P = .048). CONCLUSION Preoperative ossification was identified as a potential risk factor for HO and high-grade HO. Patients with high-grade HO had limited ROM of replacement levels and the cervical spine and had a high incidence of ASD compared to those without high-grade HO.
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Affiliation(s)
- Han Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaofei Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Meng
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yingjun Guo
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Hong
- Department of Anesthesia and Operation Center, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
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Fuster S, Martínez-Anda JJ, Castillo-Rivera SA, Vargas-Reverón C, Tornero E. Dynamic Fixation Techniques for the Prevention of Adjacent Segment Disease: A Retrospective Controlled Study. Asian Spine J 2021; 16:401-410. [PMID: 34130381 PMCID: PMC9260399 DOI: 10.31616/asj.2020.0585] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/31/2021] [Indexed: 12/27/2022] Open
Abstract
Study Design Retrospective, controlled study. Purpose Dynamic fixation (topping-off technique) adjacent to a transforaminal lumbar interbody fusion (TLIF) level was developed to reduce the risk of adjacent segment disease (ASDi). This study was designed to compare the clinical and radiological outcomes between patients who underwent circumferential lumbar fusion (CLF) without the topping-off technique, CLF with dynamic rod constructs (DRC), and CLF with interspinous device (ISD). Overview of Literature Lumbar fusion can result in the re-distribution of stress, increased mobility, and increased intradiscal pressure at adjacent levels, ultimately leading to adjacent segment degeneration (ASDe) and ASDi. Dynamic fixation techniques (topping-off techniques) adjacent to vertebral fusion have been developed to reduce the risk of ASDe and ASDi because they provide a transitional zone between a caudal rigid fused segment and cephalad-mobile unfused levels. Methods A single-center, retrospective, controlled study was designed, including all patients who underwent CLF due to degenerative lumbar spinal disease in Hospital Clinic of Barcelona between 2012 and 2018. Three groups of patients were evaluated as per the type of topping-off technique used: CLF alone group, DRC group, and ISD group. Clinical and radiological outcomes were evaluated. Results A total of 117 patients were enrolled in the study. Sixty patients (51.3%) underwent CLF without dynamic stabilization, 24 (20.5%) were treated with DRC as topping-off technique, and 33 (28.5%) were treated with an ISD. A total of 12 patients (20.0%) in the CLF alone group showed ASDi at the final follow-up, compared to 1 (4.2%) in the DRC group (p=0.097) and 2 (6.1%) in the ISD group (p=0.127). The Cox regression model identified a significantly decreased risk of ASDi when a topping-off technique (DRC or ISD) was used (hazard ratio, 0.154; 95% confidence interval, 0.31–0.77). Conclusions Dynamic fixation adjacent to CLF was a safe and efficient procedure associated with improved clinical outcomes in patients with lumbar spine degenerative disease.
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Affiliation(s)
- Salvador Fuster
- Spine Surgery Department, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Caribay Vargas-Reverón
- Spine Surgery Department, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Eduard Tornero
- Spine Surgery Department, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
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Kotkansalo A, Leinonen V, Korajoki M, Korhonen K, Rinne J, Malmivaara A. Occurrence, Risk Factors, and Time Trends for Late Reoperations due to Degenerative Cervical Spine Disease: A Finnish National Register Study of 19 377 Patients Operated on Between 1999 and 2015. Neurosurgery 2021; 88:558-573. [PMID: 33372210 PMCID: PMC8133327 DOI: 10.1093/neuros/nyaa464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 08/12/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Surgery for degenerative cervical spine disease has escalated since the 1990s. Fusion has become the mainstay of surgery despite concerns regarding adjacent segment degeneration. The patient-specific trends in reoperations have not been studied previously. OBJECTIVE To analyze the occurrence, risk factors, and trends in reoperations in a long-term follow-up of all the patients operated for degenerative cervical spine disease in Finland between 1999 and 2015. METHODS The patients were retrospectively identified from the Hospital Discharge Registry. Reoperations were traced individually; only reoperations occurring >365 d after the primary operation were included. Time trends in reoperations and the risk factors were analyzed by regression analysis. RESULTS Of the 19 377 identified patients, 9.2% underwent a late reoperation at a median of 3.6 yr after the primary operation. The annual risk of reoperation was 2.4% at 2 yr, 6.6% at 5 yr, 11.1% at 10 yr, and 14.2% at 15 yr. Seventy-five percent of the late reoperations occurred within 6.5 yr of the primary operation. Foraminal stenosis, the anterior cervical decompression and fusion (ACDF) technique, male gender, weak opiate use, and young age were the most important risk factors for reoperation. There was no increase in the risk of reoperations over the follow-up period. CONCLUSION The risk of reoperation was stable between 1999 and 2015. The reoperation risk was highest during the first 6 postoperative years and then declined. Patients with foraminal stenosis had the highest risk of reoperation, especially when ACDF was performed.
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Affiliation(s)
- Anna Kotkansalo
- Turku University Hospital, Division of Clinical Neurosciences, Department of Neurosurgery, Turku, Finland.,University of Turku, Faculty of Medicine, Department of Clinical Medicine, Turku, Finland.,National Institute for Health and Welfare, Centre for Health and Social economics, Helsinki, Finland
| | - Ville Leinonen
- Unit of Clinical Neuroscience, Neurosurgery, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland.,Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland, Kuopio, Finland.,Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Merja Korajoki
- National Institute for Health and Welfare, Centre for Health and Social economics, Helsinki, Finland
| | | | - Jaakko Rinne
- Turku University Hospital, Division of Clinical Neurosciences, Department of Neurosurgery, Turku, Finland.,University of Turku, Faculty of Medicine, Department of Clinical Medicine, Turku, Finland
| | - Antti Malmivaara
- National Institute for Health and Welfare, Centre for Health and Social economics, Helsinki, Finland.,Orton Orthopedic Hospital, Helsinki, Finland
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Azadi A, Arjmand N. A comprehensive approach for the validation of lumbar spine finite element models investigating post-fusion adjacent segment effects. J Biomech 2021; 121:110430. [PMID: 33873115 DOI: 10.1016/j.jbiomech.2021.110430] [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: 08/11/2020] [Revised: 02/17/2021] [Accepted: 03/29/2021] [Indexed: 11/15/2022]
Abstract
Spinal fusion surgery is usually followed by accelerated degenerative changes in the unfused segments above and below the treated segment(s), i.e., adjacent segment disease (ASD). While a number of risk factors for ASD have been suggested, its exact pathogenesis remains to be identified. Finite element (FE) models are indispensable tools to investigate mechanical effects of fusion surgeries on post-fusion changes in the adjacent segment kinematics and kinetics. Existing modeling studies validate only their intact FE model against in vitro data and subsequently simulate post-fusion in vivo conditions. The present study provides a novel approach for the comprehensive validation of a lumbar (T12-S1) FE model in post-fusion conditions. Sixteen simulated fusion surgeries, performed on cadaveric specimens using various testing and loading conditions, were modeled by this FE model. Predictions for adjacent segment range of motion (RoM) and intradiscal pressure (IDP) were compared with those obtained from the corresponding in vitro tests. Overall, 70% of the predicted adjacent segment RoMs were within the range of in vitro data for both intact and post-fusion conditions. Correlation (r) values between model and in vitro findings for the adjacent segment RoMs were positive and greater than 0.84. Most of the predicted IDPs were, however, out of the narrow range of in vitro IDPs at the adjacent segments but with great positive correlations (r ≥ 0.89). FE modeling studies investigating the effect of fusion surgery on in vivo adjacent segment biomechanics are encouraged to use post-surgery in vitro data to validate their FE model.
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Affiliation(s)
- A Azadi
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - N Arjmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
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Sharma JK, Rustagi T, Marathe N, Mallepally AR, Mahajan R, Chhabra HS, Das K. Clinico-Radiological Outcome of Single-Level and Hybrid Total Disc Replacement with Spineart Baguera®-C for Cervical Myeloradiculopathy: Minimum 2-Year Follow-Up Study in Indian Population. Asian J Neurosurg 2021; 15:856-862. [PMID: 33708654 PMCID: PMC7869274 DOI: 10.4103/ajns.ajns_288_20] [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: 07/08/2020] [Accepted: 09/17/2020] [Indexed: 11/04/2022] Open
Abstract
Context Cervical radiculopathy and myelopathy is one of the most frequent ailments encountered by spine surgeon. Motion-preserving surgeries in cervical spine is a standard of care due to its certain advantages such as biomechanical anatomical conformity, reduced chances of adjacent segment degeneration, and revision surgeries. While there is abundant data from some centers, data from developing countries are still limited. Aims The aim was to study the clinico-radiological outcome of single-level and hybrid total disc replacement (TDR) with Spineart Baguera®-C cervical prosthesis for cervical myeloradiculopathy. Settings and Design Retrospective study. Materials and Methods Retrospective analysis of the 29 consecutive patient undergoing single level TDR and hybrid fixation (i.e., TDR with anterior cervical discectomy and fusion) with Spineart Baguera®-C cervical prosthesis for myeloradiculopathy from January 1, 2014 to December 31, 2017, was done. Radiological features and outcome were studied from data collected on Insta-picture archiving and communication system. Statistical Analysis Used SAS 9.4 was used for all computations. Results on continuous measurements were presented as mean and standard deviation (min-max) and results on categorical measurements were presented as numbers (n) and percentages. Results Twenty-nine patients were included in the study. The mean age was 43.31 ± 9.04 years with 14 males and 15 females. The most common level of TDR was C5-C6 (72.41%). The mean follow-up duration was 3.14 years ± 1.13 years (2-5 years). The mean hospital stay was 4.93 ± 2.12 days. The mean neck disability index (NDI) at admission was 27.24 ± 7.66 which decreased to 6.41 ± 4.29 at final follow-up. Conclusions Two-year data on treatment with Spineart Baguera®-C cervical prosthesis shows significantly improved NDI, visual analog scale (arm) with maintenance of movement of the prosthesis.
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Screven R, Pressman E, Rao G, Freeman TB, Alikhani P. The Safety and Efficacy of Stand-Alone Lateral Lumbar Interbody Fusion for Adjacent Segment Disease in a Cohort of 44 Patients. World Neurosurg 2021; 149:e225-e230. [PMID: 33610868 DOI: 10.1016/j.wneu.2021.02.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND A mainstay of treatment for symptomatic adjacent segment disease (ASD) has consisted of revision with posterior decompression and fusion. This carries significant morbidity and can be technically difficult. An alternative is stand-alone lateral lumbar interbody fusion (LLIF), which may avoid complications associated with revision surgery. We describe the largest cohort of patients treated with LLIF for ASD to our knowledge. METHODS We conducted a retrospective cohort study on all patients who underwent transpsoas LLIF for ASD at a single academic center between 2012 and 2019. Postoperative improvement was measured using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). RESULTS Forty-four patients who underwent LLIF for ASD were identified. Median age was 65 years. Median time from index surgery to ASD development was 78 months. Median levels fused via LLIF was 1. Our median follow-up was 358 days. At follow-up, the median VAS back pain score was 0 (mean, 0.884), median VAS leg pain score was 1 (mean, 0.953), and median ODI was 8. The median improvement for VAS back pain was 8, for VAS leg pain was 6, and for ODI was 40. No patients suffered new neurologic symptoms postoperatively. Of the 17 patients who initially presented with non-pain neurologic symptoms, 8 (47.1%) experienced complete resolution of symptoms, and 5 (29.4%) experienced only some improvement. CONCLUSIONS To our knowledge, this is the largest cohort study of patients to date evaluating stand-alone LLIF for ASD. Our patient outcomes show it is safe and effective with low risk of morbidity.
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Affiliation(s)
- Ryan Screven
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA
| | - Elliot Pressman
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA
| | - Gautam Rao
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA
| | - Thomas B Freeman
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA
| | - Puya Alikhani
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA.
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Khalooeifard R, Shariatpanahi ZAHRAVAHDAT, Ahani A, Keykhaee M, Oraee-Yazdani M, Zali A, Oraee-Yazdani S. Effect of Protein Supplement on Paraspinal Muscles in Spine Fusion Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial. Int J Spine Surg 2021; 15:47-54. [PMID: 33900956 PMCID: PMC7931746 DOI: 10.14444/8005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Dysfunction and weakness due to atrophy of the paraspinal muscles is a major issue after posterior spinal fusion (PSF) surgery, resulting in pain and disability. Considering the role of protein in muscle regeneration, it seems that protein supplements after surgery may prevent muscle atrophy. To date, to our knowledge, no intervention study has investigated the effect of protein supplementation on the volume of paraspinal muscles, pain, or disability after PSF. METHODS In this randomized, double-blind, placebo-controlled clinical trial, patients were randomly assigned to a control (placebo + diet with 1.2 g/kg body weight of protein, n = 40) or a protein supplementation (36 g/day + a diet with 1.2 g/kg body weight of protein, n = 40) group, which received intervention from 48 hours before to 1 month after surgery. The cross-sectional area (CSA) of the paraspinal muscles was measured by thin-slice computed tomography, and pain and disability were assessed using the visual analog scale and Oswestry Disability Index. RESULTS After 4 weeks of protein supplementation, the CSAs of multifidus and psoas muscles on both sides were significantly higher in the supplementation group than the placebo group (P <.001). Less atrophy was seen in the right erector spinae and quadratus lumborum muscles in the group receiving protein supplements than the placebo group (P < .001). In addition, protein supplementation was significantly negatively correlated with both pain (P < .001) and disability (P < .001). CONCLUSIONS In conclusion, we demonstrated that 36 g/day protein supplementation significantly increased the CSA of muscles and reduced the atrophy, pain, and disability after PSF surgery. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Razieh Khalooeifard
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - ZAHRA VAHDAT Shariatpanahi
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirahmad Ahani
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Keykhaee
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Oraee-Yazdani
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Zali
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Oraee-Yazdani
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Yoganandan N, Khandelwal P, Porwal V, Humm J, Banerjee A. Human Thoracolumbar Spine Tolerance to Injury and Mechanisms From Caudo-Cephalad Loading: A Parametric Modeling Study. JOURNAL OF ENGINEERING AND SCIENCE IN MEDICAL DIAGNOSTICS AND THERAPY 2021; 4:011007. [PMID: 35832262 PMCID: PMC8597559 DOI: 10.1115/1.4049523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/27/2020] [Indexed: 06/15/2023]
Abstract
The aims of this investigation were to delineate the internal biomechanics of the spine under vertical impact vector and assess the probability of injury. Male and female whole-body human finite element models were used. The restrained occupants were positioned on the seat, and caudo-cephalad impacts were applied to the base. Different acceleration-time profiles (50-200 ms pulse durations, 11-46 g peak accelerations) were used as inputs in both models. The resulting stress-strain profiles in the cortical and cancellous bones were evaluated at different vertebral levels. Using the peak transmitted forces at the thoracolumbar disc level as the response variable, the probability of injury for the male spine was obtained from experimental risk curves for the various pulses. Results showed that the shorter pulse durations and rise times impart greater loading on the thoracolumbar spine. The analysis of von Mises stress and strain distributions showed that the compression-related fractures are multifaceted with contributions from both the cortical and cancellous bony components of the body. Profiles are provided in the paper. The intervertebral disc may be involved in the fracture mechanism, because it acts as a medium of load transfer between adjacent vertebrae. Injury risks for the shortest pulse was 63%, and for the widest pulse it was close to zero, and injury probabilities for other pulses are given. The present modeling study provides insights into the mechanisms of internal load transfer and describes injury risk levels from caudal to cephalad impacts.
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Affiliation(s)
- Narayan Yoganandan
- Biomedical Engineering, Center for NeuroTrauma Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226
| | - Prashant Khandelwal
- Center for NeuroTrauma Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226
| | - Vaibhav Porwal
- Center for NeuroTrauma Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226
| | - John Humm
- Center for NeuroTrauma Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226
| | - Anjishnu Banerjee
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI 53226
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Kim HJ, Yang JH, Chang DG, Suk SI, Suh SW, Song KS, Park JB, Cho W. Adult Spinal Deformity: Current Concepts and Decision-Making Strategies for Management. Asian Spine J 2020; 14:886-897. [PMID: 33254357 PMCID: PMC7788366 DOI: 10.31616/asj.2020.0568] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 01/05/2023] Open
Abstract
Adult spinal deformity (ASD) is characterized by three-dimensional abnormalities of the thoracic or thoracolumbar spine that exerts significant impacts on the health-related quality of life (HRQoL). With the important effects that deformity of the sagittal plane exerts on the HRQoL, there have been paradigm shifts in ASD evaluation and management. Loss of lumbar lordosis is recognized as a key driver of ASD followed by reducing kyphosis, pelvic retroversion, and knee flexion. The Scoliosis Research Society (SRS)– Schwab classification reflects the sagittal spinopelvic parameters that correlate pain and disability in ASD patients. Although the SRS–Schwab classification provides a realignment target framework for surgeons, a structured patient-specific systemic approach is crucial for the process of decision-making. ASD management should be focused on restoring age-specific harmonious alignment and should consider the comorbidities and risk factors of each patient to prevent catastrophic complications and enhance the HRQoL.
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Affiliation(s)
- Hong Jin Kim
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jae Hyuk Yang
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dong-Gune Chang
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Se-Il Suk
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Seung Woo Suh
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kwang-Sup Song
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jong-Beom Park
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woojin Cho
- Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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