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de Vries FE, Mesina-Estarrón I, Gerstl JVE, Mekary RA, Vleggeert-Lankamp CLA. Assessing accuracy of measurement methods for bony fusion assessment after anterior cervical discectomy. Spine J 2024:S1529-9430(24)00279-1. [PMID: 38878901 DOI: 10.1016/j.spinee.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/04/2024] [Accepted: 06/08/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND CONTEXT Currently, there is no universally accepted method for assessing radiological fusion shortly after anterior cervical discectomy. Five-year follow-up radiological X-rays demonstrating solid fusion or absence of fusion provided a gold standard for comparison with various assessment methods. PURPOSE Establishing the most accurate diagnostic test for earlier bony fusion assessment by comparing different cut-off values for the difference in interspinous distance and the change in Cobb angle on dynamic radiological images against the established gold standard. DESIGN Post-hoc analysis from the NEtherlands Cervical Kinematics (NECK) trial (NTR1289). PATIENT SAMPLE A total of 40 patients with 1 level herniated disc that underwent anterior discectomy between 2010 and 2014 returned for a 5-year follow-up X-ray. OUTCOME MEASURES Radiological outcome was assessed quantitatively and qualitatively by fusion on radiographic images 5 years after surgery. METHODS Radiological dynamic X-rays were reviewed for fusion at 5-year follow-up by a senior spine surgeon. At this timepoint, bony continuity was indisputable and served as gold standard. Cobb angles and interspinous distances on flexion-extension images were measured independently by 2 investigators. Optimum agreement between the gold standard and the 2 methods was assessed, evaluating varying cut-off values, considering sensitivity, specificity, and area under the curve (AUC). RESULTS Dynamic radiographic assessments revealed fusion in 29 out of 40 patients (mean age: 49 years ± 8; 23 women). For Cobb angle (optimal cut-off: ≤3.0°), the AUC was 0.86 with 100% sensitivity and 72.7% specificity. For interspinous distance (optimal cut-off: ≤1.5 mm), the AUC was 0.89 with 96.6% sensitivity and 81.8% specificity. The highest AUC (0.91) was observed for combined cut-off values (Cobb angle ≤3.0° and interspinous distance ≤2.0 mm), yielding 100% sensitivity and 81.8% specificity. CONCLUSION The combination of cut-off values ≤3.0° difference for Cobb angle and ≤2.0 mm difference for interspinous distance on lateral flexion-extension X-rays was assessed to be an accurate diagnostic criterion for fusion evaluation. This tool provides a practical and easy applicable method for assessing fusion during follow-up after anterior discectomy.
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Affiliation(s)
- Floor E de Vries
- Department of Neurosurgery, Leiden University Medical Center (LUMC), Albinusdreef 2, ZA 2333, Leiden, the Netherlands; Department of Neurosurgery, Computational Neuroscience Outcomes Center at Harvard, Brigham and Women's Hospital, 75 Francis St, Boston MA 02115, USA.
| | - Ignacio Mesina-Estarrón
- Department of Neurosurgery, Computational Neuroscience Outcomes Center at Harvard, Brigham and Women's Hospital, 75 Francis St, Boston MA 02115, USA; Harvard Medical School, 25 Shattuck St, Boston MA 02115, USA
| | - Jakob V E Gerstl
- Department of Neurosurgery, Computational Neuroscience Outcomes Center at Harvard, Brigham and Women's Hospital, 75 Francis St, Boston MA 02115, USA; Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston MA 02115, USA
| | - Rania A Mekary
- Department of Neurosurgery, Computational Neuroscience Outcomes Center at Harvard, Brigham and Women's Hospital, 75 Francis St, Boston MA 02115, USA; Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS University, 179 Longwood Ave, Boston MA 02115, USA
| | - Carmen L A Vleggeert-Lankamp
- Department of Neurosurgery, Leiden University Medical Center (LUMC), Albinusdreef 2, ZA 2333, Leiden, the Netherlands
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Malham GM, Biddau DT, Laggoune JP, Faulks CR, Walsh WR, Wang YY. Porous Cage Macro-Topography Improves Early Fusion Rates in Anterior Cervical Discectomy and Fusion. Surg Res Pract 2024; 2024:8452050. [PMID: 38523843 PMCID: PMC10957252 DOI: 10.1155/2024/8452050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024] Open
Abstract
Objectives Anterior cervical discectomy and fusion (ACDF) aims to improve pain, relieve neural compression, achieve rapid solid bony arthrodesis, and restore cervical alignment. Bony fusion occurs as early as 3 months and up to 24 months after ACDF. The correlations between bony fusion and clinical outcomes after ACDF remain unclear. Macro-topographic and porous features have been introduced to interbody cage technology, aiming to improve the strength of the bone-implant interface to promote early fusion. In this study, we aimed to compare clinical outcomes and CT-evaluated fusion rates in patients undergoing ACDF using one of two different interbody cages: traditional NanoMetalene™ (NM) cages and NM cages with machined porous features (NMRT). Methods This was a prospective, observational, nonrandomised, cohort study of consecutive patients undergoing ACDF. The NM cage cohort was enrolled first, then the NMRT cohort second. The visual analogue scale, neck disability index, and 12-item Short Form Survey scores were evaluated preoperatively and at 6 weeks, 3 months, and 6 months. The minimum clinical follow-up period was 12 months. Plain radiographs were obtained on postoperative day 2 to assess instrumentation positioning, and computed tomography (CT) was performed at 3 and 6 months postoperatively to assess interbody fusion (Bridwell grade). Results Eighty-nine (52% male) patients with a mean age of 62 ± 10.5 years were included in this study. Forty-one patients received NM cages, and 48 received NMRT cages. All clinical outcomes improved significantly from baseline to 6 months. By 3 months, the NMRT group had significantly higher CT fusion rates than the NM group (79% vs 56%, p=0.02). By 6 months, there were no significant differences in fusion rates between the NMRT and NM groups (83% vs 78%, p=0.69). The mean Bridwell grade at 6 months was 1.4 ± 0.7 in the NMRT group and 1.8 ± 1.0 in the NM group (p=0.08). Conclusions With both NM and NMRT cages, serial improvements in postoperative clinical outcomes were associated with fusion progression on CT. NMRT cages demonstrated significantly better fusion at 3 months and a trend toward higher quality of fusion at 6 months compared with NM cages, suggesting earlier cage integration with NMRT. An early 3-month postoperative CT is adequate for fusion assessment in almost 80% of patients undergoing ACDF with an NMRT cage, permitting an earlier return to activity.
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Affiliation(s)
- Gregory M. Malham
- Neuroscience Institute, Epworth Hospital, Richmond, Melbourne, Australia
- Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
- Spine Surgery Research, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Dean T. Biddau
- Neuroscience Institute, Epworth Hospital, Richmond, Melbourne, Australia
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jordan P. Laggoune
- Neuroscience Institute, Epworth Hospital, Richmond, Melbourne, Australia
| | - Charlie R. Faulks
- Neuroscience Institute, Epworth Hospital, Richmond, Melbourne, Australia
| | - William R. Walsh
- Surgical & Orthopaedic Research Laboratories (SORL), UNSW Sydney, Prince of Wales Clinical School, Prince of Wales Hospital, Sydney, Australia
| | - Yi Yuen Wang
- Neuroscience Institute, Epworth Hospital, Richmond, Melbourne, Australia
- Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
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Chung AS, Ravinsky R, Kulkarni R, Hsieh PC, Arts JJ, Rodrigues-Pinto R, Wang JC, Meisel HJ, Buser Z. Comparison of Different Osteobiologics in Terms of Imaging Modalities and Time Frames for Fusion Assessment in Anterior Cervical Discectomy and Fusion: A Systematic Review. Global Spine J 2024; 14:141S-162S. [PMID: 38421332 PMCID: PMC10913913 DOI: 10.1177/21925682231157312] [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] [Indexed: 03/02/2024] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES The study's primary objective was to determine how osteobiologic choice affects fusion rates in patients undergoing anterior cervical discectomy and fusion (ACDF). The study's secondary objectives were to 1) determine the optimal timing of fusion assessment following ACDF and 2) determine if osteobiologic type affects the timing and optimal modality of fusion assessment. METHODS A systematic search of PubMed/MEDLINE was conducted for literature published from 2000 through October 2020 comparing anterior fusion in the cervical spine with various osteobiologics. Both comparative studies and case series of ≥10 patients were included. RESULTS A total of 74 studies met the inclusion criteria. Seventeen studies evaluated the efficacy of autograft on fusion outcomes, and 23 studies assessed the efficacy of allograft on fusion outcomes. 3 studies evaluated the efficacy of demineralized bone matrix, and seven assessed the efficacy of rhBMP-2 on fusion outcomes. Other limited studies evaluated the efficacy of ceramics and bioactive glasses on fusion outcomes, and 4 assessed the efficacy of stem cell products. Most studies utilized dynamic radiographs for the assessment of fusion. Overall, there was a general lack of supportive data to determine the optimal timing of fusion assessment meaningfully or if osteobiologic type influenced fusion timing. CONCLUSIONS Achieving fusion following ACDF appears to remain an intricate interplay between host biology and various surgical factors, including the selection of osteobiologics. While alternative osteobiologics to autograft exist and may produce acceptable fusion rates, limitations in study methodology prevent any definitive conclusions from existing literature.
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Affiliation(s)
| | - Robert Ravinsky
- Department of Orthopedic Surgery and Physical Medicine, Medical University of South Carolina, Phoenix, AZ, USA
| | - Ronit Kulkarni
- Department of Orthopedic Surgery and Physical Medicine, Medical University of South Carolina, Phoenix, AZ, USA
| | - Patrick C Hsieh
- USC Spine Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jacobus J Arts
- Laboratory for Experimental Orthopaedics, Department of Orthopaedic Surgery, CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Ricardo Rodrigues-Pinto
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Spinal Unit (UVM), Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Jeffrey C Wang
- USC Spine Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hans Jörg Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Halle, Germany
| | - Zorica Buser
- Gerling Institute, Department of Orthopedic Surgery, NYU Grossman School of Medicine, Brooklyn, NY, USA
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He H, Fan L, Lü G, Li X, Li Y, Zhang O, Chen Z, Yuan H, Pan C, Wang X, Kuang L. Myth or fact: 3D-printed off-the-shelf prosthesis is superior to titanium mesh cage in anterior cervical corpectomy and fusion? BMC Musculoskelet Disord 2024; 25:96. [PMID: 38279132 PMCID: PMC10811816 DOI: 10.1186/s12891-024-07213-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 01/17/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND To find out if three-dimensional printing (3DP) off-the-shelf (OTS) prosthesis is superior to titanium mesh cages in anterior cervical corpectomy and fusion (ACCF) when treating single-segment degenerative cervical spondylotic myelopathy (DCSM). METHODS DCSM patients underwent ACCF from January 2016 to January 2019 in a single center were included. Patients were divided into the 3DP group (28) and the TMC group (23). The hospital stays, operation time, intraoperative blood loss, and the cost of hospitalization were compared. The Japanese Orthopedic Association (JOA) scores and Neck Disability Index (NDI) were recorded pre-operatively, 1 day, 3, 6, 12, and 24 months post-operatively. Radiological data was measured to evaluate fusion, subsidence, and cervical lordosis. Patients were sent with SF-36 to assess their health-related quality of life (HRQoL). RESULTS The differences in operative time, intraoperative blood loss, and hospital stay were not statistically significant between groups (p > 0.05). Postoperative dysphagia occurred in 2 cases in the 3DP group and 3 cases in the TMC group, which all relieved one week later. The difference in improvement of JOA and NDI between the two groups was not statistically significant (p > 0.05). No hardware failure was found and bony fusion was achieved in all cases except one in the 3DP group. The difference in cervical lordosis (CL), fused segmental angle (FSA), mean vertebral height (MVH), and subsidence rates between groups at each follow-up time point was not statistically significant and the results of the SF-36 were similar (p > 0.05). The total cost was higher in the 3DP group with its higher graft cost (p < 0.05). CONCLUSION In treating single-segment DCSM with ACCF, both 3DP OTS prosthesis and TMC achieved satisfactory outcomes. However, the more costly 3DP OTS prosthesis was not able to reduce subsidence as it claimed.
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Affiliation(s)
- Haoyu He
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Lei Fan
- Department of Spinal Surgery, Third Hospital of Changsha, Changsha, Hunan Province, China
| | - Guohua Lü
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Xinyi Li
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Yunchao Li
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Ou Zhang
- Department of Medical Education, California University of Science and Medicine, Colton, CA, USA
| | - Zejun Chen
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Hui Yuan
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Changyu Pan
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Xiaoxiao Wang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Lei Kuang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China.
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Lee S, Jung JW, Lee SW, Kim KT, Kwon HD, Lee S, Ko YS, Kim P, Cho DC. Fusion Assessment of Oblique Lumbar Interbody Fusion Using Demineralized Bone Matrix: A 2-Year Prospective Study. Neurospine 2023; 20:1205-1216. [PMID: 38171289 PMCID: PMC10762405 DOI: 10.14245/ns.2347032.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/24/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Although several studies have reported successful fusion rates after oblique lumbar interbody fusion (OLIF) using allografts or dimerized bone matrix (DBM) instead of autografts, whether OLIF can achieve satisfactory solid fusion without the use of autografts remains unclear. This study investigated the real fusion rates after OLIF using allografts and DBM, which were evaluated using both dynamic radiographs and computed tomography scans. METHODS We enrolled 79 consecutive patients who underwent minimally invasive OLIF followed by percutaneous pedicle screw fixation. All patients were treated with OLIF between L2 and L5 and underwent radiographic and clinical follow-ups at 12, 18, and 24 months after surgery. Radiographic assessment of fusion was performed using the modified BrantigaSteffee-Fraser (mBSF) scale, which was categorized as follows: grades I (radiographic pseudoarthrosis), II (indeterminate fusion), and III (solid radiographic fusion). Other radiologic and clinical outcomes were evaluated using the following parameters: vertebral slippage distance, disc height, subsidence, Oswestry Disability Index (ODI), and visual analogue scale (VAS). RESULTS Clinical outcomes demonstrated significant improvements in the VAS scores for back pain, leg pain, and ODI after surgery. Subsidence was present in 34 cases (35.4%) at 12 months postoperatively, which increased to 47.9% and reached 50.0% at 1.5 years and 2 years after surgery, respectively. The solid fusion rate after OLIF was 32.3% at 1 year, increased to 58.3% at 1.5 years, and reached 72.9% at 2 years. Radiographic pseudoarthrosis was 24.0% at 1 year, which decreased to 6.3% at 1.5 years and 3.1% at 2 years. CONCLUSION OLIF is a safe and effective surgical procedure for the treatment of degenerative lumbar diseases. The mBSF scale, which simultaneously evaluates both dynamic angles and bone bridge formation, offers great reliability for the radiological assessment of fusion. Moreover, OLIF using allografts and DBM, which is performed on one or 2 levels at L2-5, can achieve satisfactory fusion rates within 2 years after surgery.
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Affiliation(s)
- Sangseok Lee
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jin Woo Jung
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang-Woo Lee
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Heum-Dai Kwon
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, Korea
| | - Subum Lee
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young San Ko
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
| | - Pius Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Dae-Chul Cho
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
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Inose H, Takahashi T, Matsukura Y, Hashimoto J, Utagawa K, Egawa S, Yamada K, Hirai T, Yoshii T. Factors Associated With Nonunion After Cervical Fusion Surgery. Cureus 2023; 15:e50866. [PMID: 38249174 PMCID: PMC10799207 DOI: 10.7759/cureus.50866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Background Bony fusion is a critical factor in the outcome of cervical spinal fusion surgery. While several factors have been proposed to affect bony fusion, their relative importance remains unclear. This study aimed to investigate the factors associated with bony fusion after cervical spinal fusion surgery. Methods We retrospectively evaluated the significance of the various factors on bone fusion after cervical fusion surgery. Then, multivariate logistic regression analyses were performed to determine the independent factors associated with bony fusion. A receiver operating characteristic (ROC) analysis was performed to evaluate the cutoff threshold. Results This study included a total of 52 patients with a mean age of 64 years. Among them, 28 (54%) were male, and 39 (75.0%) achieved bony fusion. The multivariate logistic regression analysis showed that preoperative intact parathyroid hormone (PTH) levels (odds ratio, 1.04; 95% confidence interval, 1.01-1.08; p-value = 0.02) and hemoglobin A1c (HbA1c) levels (odds ratio, 2.87; 95% confidence interval, 1.07-8.74; p-value = 0.04) were significant factors associated with bony fusion after cervical fusion surgery. The optimum cutoff values of intact PTH and HbA1c were 63.5 pg/mL and 6.2%, respectively. Conclusions This study identified preoperative intact PTH and HbA1c as significant factors associated with bony fusion after cervical fusion surgery. These biomarkers can be used to identify patients at higher risk of nonunion to optimize patient conditions and guide preoperative and postoperative management strategies.
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Affiliation(s)
- Hiroyuki Inose
- Department of Orthopedics, Dokkyo Medical University Saitama Medical Center, Saitama, JPN
| | - Takuya Takahashi
- Department of Orthopedics, Tokyo Medical and Dental University, Tokyo, JPN
| | - Yu Matsukura
- Department of Orthopedics, Tokyo Medical and Dental University, Tokyo, JPN
| | - Jun Hashimoto
- Department of Orthopedics, Tokyo Medical and Dental University, Tokyo, JPN
| | - Kurando Utagawa
- Department of Orthopedics, Tokyo Medical and Dental University, Tokyo, JPN
| | - Satoru Egawa
- Department of Orthopedics, Tokyo Medical and Dental University, Tokyo, JPN
| | - Kentaro Yamada
- Department of Orthopedics, Tokyo Medical and Dental University, Tokyo, JPN
| | - Takashi Hirai
- Department of Orthopedics, Tokyo Medical and Dental University, Tokyo, JPN
| | - Toshitaka Yoshii
- Department of Orthopedics, Tokyo Medical and Dental University, Tokyo, JPN
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Lee DH, Park S, Seok SY, Cho JH, Hwang CJ, Kim IH, Baek SH. Fate of pseudarthrosis detected 2 years after anterior cervical discectomy and fusion: results of a minimum 5-year follow-up. Spine J 2023; 23:1790-1798. [PMID: 37487933 DOI: 10.1016/j.spinee.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND CONTEXT Prior study has shown that 70% of cervical pseudarthrosis after anterior cervical discectomy and fusion (ACDF) detected at 1 year will go on to fusion by 2 year. Pseudarthrosis detected 2 years after ACDF may have different bone healing potential compared to nonunion detected 1 year after surgery. Therefore, it might have a different clinical significance. PURPOSE To examine the radiographic and clinical prognosis of pseudarthrosis detected 2 years after ACDF with a minimum follow-up of 5 years. STUDY DESIGN/SETTING Retrospective cohort study. PATIENTS SAMPLE A total of 249 patients who completed a 5-year follow-up after ACDF. OUTCOMES MEASURES Clinical outcomes such as neck pain visual analogue scale (VAS), arm pain VAS, and neck disability index (NDI) and radiographic assessment such as X-ray, computed tomography (CT) scan. METHODS A total of 249 patients who completed a 5-year follow-up after ACDF were retrospectively reviewed. Patients who were diagnosed with pseudarthrosis at 2 years postoperatively were included. Fusion, neck pain VAS, arm pain VAS, and NDI were assessed. The results were compared between the union group (patients who achieved union), and the nonunion group (patients with pseudarthrosis) at 5 years postoperatively. RESULTS Among the patients who had pseudarthrosis at 2 years postoperatively, the fusion rate at 5 years was 32.6% (14/43). While the union group showed continued improvements in neck pain VAS, arm pain VAS, and NDI until 5 years, the nonunion group showed significant worsening of arm pain VAS and NDI at 5 years, with the values of neck pain VAS, arm pain VAS, and NDI being significantly worse than those of the union group at 5 years. CONCLUSION The incidence of pseudarthrosis detected at 2 years postoperatively after ACDF was 67.4%, and it remained unfused at 5 years postoperatively. Nonunion identified 2 years after ACDF may be considered a poor prognostic factor because it has less potential to achieve fusion with further follow-up and a higher chance of worsening clinical symptoms. Therefore, the presence of fusion at the 2-year follow-up can be considered an indicator of the success of the surgery.
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Affiliation(s)
- Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sehan Park
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Yun Seok
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, University of Eulji College of Medicine, Daejeon, Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Hee Kim
- Department of Orthopedic Surgery, National police hospital, Seoul, Korea
| | - Seung Hyun Baek
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, University of Eulji College of Medicine, Daejeon, Korea.
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Li Z, Zhou F, Zhai S, Xia T, Pan S, Zhang F, Zhang L, Chen J, Sun Y. Congenital Cervical Scoliosis Treated with Concave Side Distraction with Three-Dimensional Printed Titanium Cage. Orthop Surg 2023; 15:2709-2715. [PMID: 37675762 PMCID: PMC10549856 DOI: 10.1111/os.13843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 09/08/2023] Open
Abstract
STUDY DESIGN Single-center, retrospective study. OBJECTIVE Hemivertebra resection is the only treatment option for congenital cervical scoliosis (CCS). However, this procedure is complex and technically demanding. It often requires a considerably long operation, and there is substantial intraoperative bleeding. Therefore, we have attempted to treat CCS with a concave side distraction comprising a three-dimensional (3D) printed titanium cage. The purpose of this study is to evaluate the safety and efficacy of this technique for the treatment of patients with CCS. METHODS A series of 22 patients with CCS who underwent a concave side distraction technique between 2019 and 2021 were retrospectively reviewed and analyzed. Radiological measurements included the Cobb angle of the distraction segments, the kyphosis angle, the range of movement, and the distraction correction angle. Student's t-test and Spearman correlation analysis were used for statistical analysis. p < 0.05 was considered statistically significant. RESULTS The study included 12 males and 10 females whose ages ranged from 6 to 14 years old (9.8 ± 2.1 years old). Follow-up times ranged from 15 to 30 months (25.8 ± 3.6 months). Among 22 patients, two patients developed a postoperative C5 nerve root palsy and recovered after being treated with conservative treatment for 6 months. The duration of surgery ranged from 229 to 756 min (389 ± 112 min), and the estimated volume of blood loss ranged from 100 to 600mL (235 ± 121 mL). The coronal Cobb angle (p < 0.001), kyphosis angle (p < 0.05), and range of movement (p < 0.001) between the last follow-up and preoperative period were significantly different. A total of 28 segments were distracted, and the Cobb angle of the distraction segment ranged from 2.4 to 14.1° (8.5 ± 3.0°). There were six upper cervical spines (8.9 ± 1.9°) and 22 lower cervical spines (8.4 ± 3.2°) with no significant difference between them (p = 0.130). In addition, there was no correlation between the angle of the concave side distraction and patients' age (r = 0.018, p = 0.315). The fusion was solid between the bone and the customized 3D-printed pore metal cage at the final follow-up. CONCLUSION The concave side distraction comprising a customized 3D-printed titanium cage implantation can provide satisfactory correction results and is a safe and reliable procedure for treating CCS.
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Affiliation(s)
- Zihe Li
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Feifei Zhou
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Shuheng Zhai
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Tian Xia
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Shengfa Pan
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Fengshan Zhang
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Li Zhang
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Jiasheng Chen
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Yu Sun
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
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9
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Odate S, Shikata J. Interbody Cage Placement Without Plate Supplementation Adjacent to Plated Segments in Multilevel Anterior Cervical Decompression and Fusion. Spine (Phila Pa 1976) 2023; 48:1245-1252. [PMID: 37146055 DOI: 10.1097/brs.0000000000004704] [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: 02/04/2023] [Accepted: 04/22/2023] [Indexed: 05/07/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE To evaluate the clinical efficacy and safety of hybrid anterior cervical fixation, focusing on stand-alone segments. SUMMARY OF BACKGROUND DATA In the treatment of multilevel cervical stenosis, the number of segments fixed using a plate is limited by placing an interbody cage without plate supplementation at one end of the surgical segment to reduce long plate-related problems. However, the stand-alone segment may experience cage extrusion, subsidence, cervical alignment deterioration, and nonunion. METHODS Patients who underwent three-segment or four-segment fixation for cervical degenerative disease and completed one-year follow-up were included in this study. Patients were divided into two groups: a cranial group, with stand-alone segments located at the cranial end adjacent to plated segments, and a caudal group, with stand-alone segments located at the caudal end. Differences in radiographic outcomes between the groups were evaluated. Fusion was defined using dynamic radiographs or computed tomography. To identify factors associated with nonunion in stand-alone segments, multivariable logistic regression analyses were performed. To identify factors associated with cage subsidence, multiple regression analyses were performed. RESULTS A total of 116 patients (mean age, 59±11 y; 72% male; mean fixed segments, 3.7±0.5 segments) were included in this study. No case showed cage extrusion or plate dislodgement. In stand-alone segments, the fusion rate was significantly lower in the caudal group than in the cranial group (76% vs. 93%, P =0.019). Change in the cervical sagittal vertical axis was worse in the caudal group than in the cranial group (2.7±12.3 mm vs. -2.7±8.1 mm, P =0.006). One caudal group patient required additional surgery because of nonunion at the stand-alone segment. Multivariable logistic regression indicated factors associated with nonunion included the location of the stand-alone segment (caudal end: OR 4.67, 95% CI, 1.29-16.90), larger pre-disk space range of motion (OR 1.15, 95% CI, 1.04-1.27), and lower preoperative disk space height (OR 0.57, 95% CI, 0.37-0.87). Multiple regression analysis indicated that higher cage height and lower pre-disk space height were associated with cage subsidence. CONCLUSION Hybrid anterior cervical fixation with stand-alone interbody cage placement adjacent to plated segments may avoid long plate-related problems. Our results suggest that the cranial end of the construct may be more suitable for the stand-alone segment than the caudal end.
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Affiliation(s)
- Seiichi Odate
- Department of Orthopedic Surgery, Gakkentoshi Hospital, Kyoto, Japan
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10
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Burke JF, Garcia JH, Safaee MM, Wong C, Gill SA, Chou D, Mummaneni PV, Deviren V, Ames CP, Clark AJ. Patient Frailty Influences Outcome After Open, But Not Minimally Invasive, Transforaminal Interbody Fusion: A Case Series of 115 Patients With Lumbar Degenerative Disease. Oper Neurosurg (Hagerstown) 2023; 24:565-571. [PMID: 36897093 PMCID: PMC10586842 DOI: 10.1227/ons.0000000000000665] [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: 04/17/2022] [Accepted: 12/22/2022] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND For transforaminal lumbar interbody fusion (TLIF), there are equally good open and minimally invasive surgery (MIS) options. OBJECTIVE To determine if frailty has a differential effect on outcome for open vs MIS TLIF. METHODS We performed a retrospective review of 115 TLIF surgeries (1-3 levels) for lumbar degenerative disease performed at a single center; 44 MIS transforaminal interbody fusions and 71 open TLIFs were included. All patients had at least a 2-year follow up, and any revision surgery during that time was recorded. The Adult Spinal Deformity Frailty Index (ASD-FI) was used to separate patients into nonfrail (ASD-FI < 0.3) and frail (ASD-FI > 0.3) cohorts. The primary outcome variables were revision surgery and discharge disposition. Univariate analyses were performed to reveal associations in demographic, radiographic, and surgical data with the outcome variables. Multivariate logistic regression was used to assess independent predictors of outcome. RESULTS Frailty uniquely predicted both reoperation (odds ratio 8.1, 95% CI 2.5-26.1, P = .0005) and discharge to a location other than home (odds ratio 3.9, 95% CI 1.2-12.7, P = .0239). Post hoc analysis indicated that frail patients undergoing open TLIF had a higher revision surgery rate (51.72%) compared with frail patients undergoing MIS-TLIF (16.7%). Nonfrail patients undergoing open and MIS TLIF had a revision surgery rate of 7.5% and 7.7%, respectively. CONCLUSION Frailty was associated with increased revision rate and increased probability to discharge to a location other than home after open transforaminal interbody fusions, but not MIS transforaminal interbody fusions. These data suggest that patients with high frailty scores may benefit from MIS-TLIF procedures.
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Affiliation(s)
- John F. Burke
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Joseph H. Garcia
- School of Medicine, University of California, San Francisco, California, USA
| | - Michael M. Safaee
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Christopher Wong
- College of Osteopathic Medicine, Touro University California, Vallejo, California, USA
| | - Sabraj A. Gill
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Dean Chou
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Praveen V. Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Vedat Deviren
- Department of Orthopedic Surgery, University of California, San Francisco, California, USA
| | - Christopher P. Ames
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Aaron J. Clark
- Department of Neurological Surgery, University of California, San Francisco, California, USA
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11
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Hasan S, Babrowicz J, Waheed MA, Piche JD, Patel R, Aleem I. The Utility of Postoperative Bracing on Radiographic and Clinical Outcomes Following Cervical Spine Surgery: A Systematic Review. Global Spine J 2023; 13:512-522. [PMID: 35499300 PMCID: PMC9972282 DOI: 10.1177/21925682221098361] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
STUDY DESIGN Systematic Review. OBJECTIVES To determine the radiographic and clinical utility of postoperative orthoses following cervical spine surgery. METHODS We performed a search of the PubMed, Cochrane Library, Medline Ovid, and SCOPUS databases from inception until November 2021. Eligible studies included outcomes of postoperative bracing vs no bracing following cervical spine surgery. The primary outcome of interest was fusion rates after cervical surgery in braced vs unbraced patients. Secondary outcomes included patient reported outcomes and complication rates. RESULTS A total of 3232 titles were initially screened. After inclusion criteria were applied, 7 studies (550 patients) were included, which compared results of braced vs unbraced patients after cervical spine surgery. These studies showed acceptable reliability for inclusion based on the Methodical Index for Non-Randomized studies and Critical Appraisal Skills Programme assessment tools. There were no significant differences in fusion rates or complications between braced vs unbraced patients identified in any study. Patient reported pain and quality of life measures between braced and unbraced groups varied amongst studies, without any clear overall advantages favoring either method. CONCLUSIONS This systematic review found that external bracing, though widely used following cervical spine surgery, may not offer any advantages in patient-reported outcomes, as compared to not bracing. In regard to the effect of bracing on fusion rates, no strong consensus can be made as the methods of fusion assessment in the included studies were heterogenous and suboptimal. Future high-quality studies using recommended methods of fusion assessment are needed to adequately address this important question.
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Affiliation(s)
- Sazid Hasan
- Oakland University William Beaumont
School of Medicine, Rochester, MI, USA
| | - Joseph Babrowicz
- College of Literature, Science and
the Arts, University of Michigan, Ann Arbor, MI, USA
| | - Muhammad A. Waheed
- Oakland University William Beaumont
School of Medicine, Rochester, MI, USA
| | - Joshua David Piche
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Rakesh Patel
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Ilyas Aleem
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA,Ilyas Aleem, MD, MS, FRCSC, Department of
Orthopedic Surgery, University of Michigan, 1500 East Medical Center Drive, 2912
Taubman Center, SPC 5328, Ann Arbor, MI 48109, USA.
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12
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Gan L, Du J, Sun SG, Ye ZX, Li P, Wang H, Luo ZJ, Li M. Comparison of the Clinical Efficacy of Two Reduction Methods for the Treatment of Irreducible Unilateral Subaxial Cervical Facet Joint Dislocation. World Neurosurg 2023; 169:e51-e58. [PMID: 36252906 DOI: 10.1016/j.wneu.2022.10.032] [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: 08/04/2022] [Revised: 10/07/2022] [Accepted: 10/08/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare the clinical efficacy of the minimally invasive technique and the open method in the treatment of irreducible unilateral subaxial cervical facet joint dislocation (SCFD). METHODS From March 2015 to September 2018, 62 patients with unilateral SCFD were studied. The cases were divided into 2 groups based on different surgery strategies. Thirty-one patients were enrolled in the minimally invasive surgery (MIS) group, and 31 patients were enrolled in the open surgery group. The duration of prone position operation, blood loss, and total hospitalization costs were recorded. The clinical effects were evaluated using visual analogue scale scores, the Oswestry Disability Index, and Japanese Orthopedic Association scores at each follow-up. In addition, the segmental Cobb angle and intervertebral height were recorded and compared. RESULTS The amount of intraoperative blood loss, prone position operation duration, and total hospital costs in the MIS group were significantly lower than in the open surgery group. The visual analogue scale, Oswestry Disability Index, and Japanese Orthopedic Association scores of the 2 groups significantly improved after the operation. A satisfactory fusion rate was obtained in both groups, and the segmental Cobb angle and intervertebral height scores in both groups improved significantly. CONCLUSIONS Minimally invasive reduction had equal clinical efficacy to posterior open surgery. However, MIS was less invasive and had lower costs. Therefore, it is a potential option in the treatment of SCFD.
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Affiliation(s)
- Lu Gan
- Department of Orthopaedic surgery, Air Force Medical Center, Air Force Medical University, Beijing, P. R. China
| | - Junjie Du
- Department of Orthopaedic surgery, Air Force Medical Center, Air Force Medical University, Beijing, P. R. China
| | - Si-Guo Sun
- Department of Orthopaedic surgery, Air Force Medical Center, Air Force Medical University, Beijing, P. R. China
| | - Zheng-Xu Ye
- Department of Orthopaedic surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi Province, P. R. China
| | - Pan Li
- Department of Orthopaedic surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi Province, P. R. China
| | - Han Wang
- Department of Orthopaedic surgery, Air Force Medical Center, Air Force Medical University, Beijing, P. R. China
| | - Zhuo-Jing Luo
- Department of Orthopaedic surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi Province, P. R. China.
| | - Mo Li
- Department of Orthopaedic surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi Province, P. R. China
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Comparing Clinical and Radiographic Outcomes Between the Self-locking Stand-alone Cage and Conventional Cage-plate Construct: A Five-year Retrospective Cohort Study. Spine (Phila Pa 1976) 2023; 48:56-66. [PMID: 36083844 DOI: 10.1097/brs.0000000000004465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN/SETTING A retrospective cohort study. OBJECTIVE To evaluate the clinical efficacy of the self-locking stand-alone (SA) cage and conventional cage-plate construct (CPC) in treating degenerative cervical spondylosis with a five-year follow-up. SUMMARY OF BACKGROUND DATA The SA approach was designed to reduce complications associated with traditional anterior cervical discectomy and fusion. These techniques have been shown to have satisfactory short-term clinical outcomes. Literature describing the mid-term clinical outcomes of SA cage is limited. MATERIALS AND METHODS We retrospectively analyzed patients with cervical spondylosis who had received an SA device or CPC between 2014 and 2016 at the Xijing Hospital. Participants were matched for sex, age, and operative level. Differences in clinical and radiographic outcomes and the occurrence of postoperative complications between the two groups were analyzed. RESULTS In total, 207 patients were included (101 with SA and 106 with CPC), the median follow-up for both groups were 60.2 and 60.9 months. Both groups exhibited significant improvements in all measured values compared with the preoperative values. The SA group had a shorter operation time, less intraoperative blood loss, and a significantly lower incidence of dysphagia after surgery than the CPC group ( P <0.05). At the last visit, cage subsidence was 6.9% and 3.8% in the SA and CPC groups, respectively ( P =0.365). The radiographic adjacent segment degeneration (ASD) was significantly lower in the SA group than in the CPC group (6.9% vs. 27.4%, P <0.01). No symptomatic ASD was observed in the SA group, and six (5.7%) cases occurred in the CPC group ( P =0.029). CONCLUSIONS In this study, the SA cage showed similar efficacy to that of the conventional CPC in treating cervical spondylosis using anterior cervical discectomy and fusion, with a significant reduction in the incidence of immediate postoperative dysphagia and mid-term ASD.
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14
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Park S, Kim JK, Chang MC, Park JJ, Yang JJ, Lee GW. Assessment of Fusion After Anterior Cervical Discectomy and Fusion Using Convolutional Neural Network Algorithm. Spine (Phila Pa 1976) 2022; 47:1645-1650. [PMID: 35905310 DOI: 10.1097/brs.0000000000004439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND A convolutional neural network (CNN) is a deep learning (DL) model specialized for image processing, analysis, and classification. OBJECTIVE In this study, we evaluated whether a CNN model using lateral cervical spine radiographs as input data can help assess fusion after anterior cervical discectomy and fusion (ACDF). STUDY DESIGN Diagnostic imaging study using DL. PATIENT SAMPLE We included 187 patients who underwent ACDF and fusion assessment with postoperative one-year computed tomography and neutral and dynamic lateral cervical spine radiographs. OUTCOME MEASURES The performance of the CNN-based DL algorithm was evaluated in terms of accuracy and area under the curve. MATERIALS AND METHODS Fusion or nonunion was confirmed by cervical spine computed tomography. Among the 187 patients, 69.5% (130 patients) were randomly selected as the training set, and the remaining 30.5% (57 patients) were assigned to the validation set to evaluate model performance. Radiographs of the cervical spine were used as input images to develop a CNN-based DL algorithm. The CNN algorithm used three radiographs (neutral, flexion, and extension) per patient and showed the diagnostic results as fusion (0) or nonunion (1) for each radiograph. By combining the results of the three radiographs, the final decision for a patient was determined to be fusion (fusion ≥2) or nonunion (fusion ≤1). By combining the results of the three radiographs, the final decision for a patient was determined as fusion (fusion ≥2) or nonunion (nonunion ≤1). RESULTS The CNN-based DL model demonstrated an accuracy of 89.5% and an area under the curve of 0.889 (95% confidence interval, 0.793-0.984). CONCLUSION The CNN algorithm for fusion assessment after ACDF trained using lateral cervical radiographs showed a relatively high diagnostic accuracy of 89.5% and is expected to be a useful aid in detecting pseudarthrosis.
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Affiliation(s)
- Sehan Park
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do Province, Republic of Korea
| | - Jeoung Kun Kim
- Department of Business Administration, School of Business, Yeungnam University, Gyeongsan-si, Gyeonggi-do Province, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Gyeongsang Province, Republic of Korea
| | - Jeong Jin Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Gyeongsang Province, Republic of Korea
| | - Jae Jun Yang
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do Province, Republic of Korea
| | - Gun Woo Lee
- Department of Physical Medicine and Rehabilitation, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Gyeongsang Province, Republic of Korea
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15
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Comparing Fusion Rates Between Fresh-Frozen and Freeze-Dried Allografts in Anterior Cervical Discectomy and Fusion. World Neurosurg X 2022; 16:100126. [PMID: 35783249 PMCID: PMC9243252 DOI: 10.1016/j.wnsx.2022.100126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022] Open
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16
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Balouch E, Burapachaisri A, Woo D, Norris Z, Segar A, Ayres EW, Vasquez-Montes D, Buckland AJ, Razi A, Smith ML, Protopsaltis TS, Kim YH. Assessing Postoperative Pseudarthrosis in Anterior Cervical Discectomy and Fusion (ACDF) on Dynamic Radiographs Using Novel Angular Measurements. Spine (Phila Pa 1976) 2022; 47:1151-1156. [PMID: 35853174 DOI: 10.1097/brs.0000000000004375] [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: 09/30/2021] [Accepted: 03/28/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective review of operative patients at a single institution. OBJECTIVE The aim was to validate a novel method of detecting pseudarthrosis on dynamic radiographs. SUMMARY OF BACKGROUND DATA A common complication after anterior cervical discectomy and fusion is pseudarthrosis. A previously published method for detecting pseudarthrosis identifies a 1 mm difference in interspinous motion (ISM), which requires calibration of images and relies on anatomic landmarks difficult to visualize. An alternative is to use angles between spinous processes, which does not require calibration and relies on more visible landmarks. MATERIALS AND METHODS ISM was measured on dynamic radiographs using the previously published linear method and new angular method. Angles were defined by lines from screw heads to dorsal points of spinous processes. Angular cutoff for fusion was calculated using a regression equation correlating linear and angular measures, based on the 1 mm linear cutoff. Pseudarthrosis was assessed with both cutoffs. Sensitivity, specificity, inter-reliability and intrareliability of angular and linear measures used postoperative computed tomography (CT) as the reference. RESULTS A total of 242 fused levels (81 allograft, 84 polyetheretherketone, 40 titanium, 37 standalone cages) were measured in 143 patients (mean age 52.0±11.5, 42%F). 36 patients (66 levels) had 1-year postoperative CTs; 13 patients (13 levels) had confirmed pseudarthrosis. Linear and angular measurements closely correlated ( R =0.872), with 2.3° corresponding to 1 mm linear ISM. Potential pseudarthroses was found in 28.0% and 18.5% levels using linear and angular cutoffs, respectively. Linear cutoff had 85% sensitivity, 87% specificity; angular cutoff had 85% sensitivity, 96% specificity for detecting CT-validated pseudarthrosis. Interclass correlation coefficients were 0.974 and 0.986 (both P <0.001); intrarater reliability averaged 0.953 and 0.974 ( P <0.001 for all) for linear and angular methods, respectively. CONCLUSIONS The angular measure for assessing potential pseudarthrosis is as sensitive as and more specific than published linear methods, has high interobserver reliability, and can be used without image calibration. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Eaman Balouch
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
| | | | - Dainn Woo
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
| | - Zoe Norris
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
| | - Anand Segar
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
| | - Ethan W Ayres
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
| | | | - Aaron J Buckland
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
- Melbourne Orthopaedic Group, Melbourne Australia
- Spine and Scoliosis Research Associates, Melbourne Australia
| | | | | | | | - Yong H Kim
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
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Morphologic Change of CorticoCancellous Allograft Used for Anterior Cervical Discectomy and Fusion. Spine (Phila Pa 1976) 2022; 47:944-953. [PMID: 35275848 DOI: 10.1097/brs.0000000000004354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/25/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim of this study was to evaluate the incidence and clinical implications of graft morphologic changes in corticocancellous allografts used for anterior cervical discectomy and fusion (ACDF), such as graft resorption or fracture. SUMMARY OF BACKGROUND DATA Although cortico-cancellous allograft is one of the most commonly used interbody spacer for ACDF, clinical implications of allograft resorption or fracture is unclear. METHODS One-hundred and thirty-eight consecutive patients who underwent ACDF for degenerative cervical myelopathy or radiculopathy were retrospectively reviewed. Patients with allograft morphologic changes, including graft resorption and fracture (morphologic change group), were compared with patients without morphologic changes (unchanged group). Furthermore, operated segments with morphologic changes were compared with unchanged segments. Patient characteristics, cervical lordosis, segmental lordosis, fusion, subsidence, neck pain visual analogue scale (VAS), arm pain VAS, and neck disability index (NDi) scores were evaluated. RESULTS Ninety patients (149 segments) were included in the study. Allograft resorption or fracture was detected in 46 (51.1%) patients and 81 (54.3%) segments, respectively. The fusion rate of morphologic change segments was significantly lower than that of the unchanged segments (P < 0.001). Furthermore, segments with morphologic changes had significantly higher rates of subsidence compared to unchanged segments ( P < 0.001). Segmental lordosis at the final follow-up was significantly smaller in the morphologic change segments ( P < 0.001). Neck pain VAS, arm pain VAS, and NDI scores did not demonstrate significant intergroup differences. CONCLUSION Corticocancellous allograft demonstrated a high rate of graft morphologic change (54.3%). Graft resorption or fracture was associated with increased pseudarthrosis, subsidence, and decreased postoperative segmental lordosis; however, the clinical results were not significantly affected. Caution is needed when choosing to use corticocancellous allografts for ACDF due to the high rate of graft resorption or fracture and the negative implications of these risks.
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Luo CA, Lim AS, Lu ML, Chiu PY, Lai PL, Niu CC. The surgical outcome of multilevel anterior cervical discectomy and fusion in myelopathic elderly and younger patients. Sci Rep 2022; 12:4495. [PMID: 35296700 PMCID: PMC8927471 DOI: 10.1038/s41598-022-08243-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 02/28/2022] [Indexed: 11/09/2022] Open
Abstract
The elderly population has an increased risk of degenerative cervical myelopathy due to multilevel disease, causing motor and sensory dysfunctions and a poor quality of life. Multilevel anterior cervical discectomy and fusion (ACDF) is an alternative surgical treatment option, but has a perceived higher risk of complications. The goal of this study is to report the outcome. We retrospectively reviewed patients from 2006 to 2019 undergoing multilevel ACDF for degenerative cervical myelopathy and compared outcomes and complications between elder patients (aged 70 and above) and younger patients (below 70). The patients' comorbidities, and postoperative complications, radiographic parameters such as C2-C7 Cobb angle, C2-C7 sagittal vertical axis, inter-body height of surgical levels and fusion rate were recorded. Japanese Orthopaedic Association (JOA) score and modified Odom's score were collected. Included were 18 elderly (mean age 74, range 70-87) and 45 young patients (mean age 56, range 43-65) with a follow-up of 43.8 and 55.5 months respectively. Three-level ACDF was the most common. The ratios of ASA class III patients were 94.4% and 48.9% (p < 0.001). The Charlson comorbidity indexes were 4.3 ± 1.03 and 2.1 ± 1.11 (p < 0.001). The average lengths of hospital stays were 4.9 and 4.6 days. Eleven patients (61.1%) in the elderly group experienced at least one short-term complication, compared with 16 patients (35.6%) in the younger group (p < 0.05). The middle-term complications were comparable (22.2% and 20.0%). The JOA score, recovery rate and modified Odom score showed comparable result between groups. Despite its extensiveness, multilevel ACDF is feasible for the elder patients with good clinical outcome and fusion rate. When compared to younger cohort, there is a trend of lower preoperative JOA score and recovery rate. The short-term complication rate is higher in the elderly group.
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Affiliation(s)
- Chi-An Luo
- Department of Orthopaedic Surgery, Spine Division, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, ROC.,Department of Orthopaedic Surgery, New Taipei Municipal Tucheng Hospital (Built and Operated By Chang Gung Medical Foundation), No. 6, Sec. 2, Jincheng Rd., Tucheng Dist., New Taipei City, 236, Taiwan, ROC.,Chang Gung University College of Medicine, No.259, Wenhua 1st Rd, Guishan Dist., Taoyuan City, 333, Taiwan, ROC
| | - Austin Samuel Lim
- Department of Surgery, Section of Orthopedics, Orthopedic and Spine Surgery, Metropolitan Medical Center, No.1357, Masangkay St, Santa Cruz, 1012, Manila, Metro Manila, Philippines.,Department of Surgery, Section of Orthopedics, Orthopedic and Spine Surgery, Chinese General Hospital, No.286, Blumentritt Rd, Sampaloc, Manila, Metro Manila, Philippines
| | - Meng-Ling Lu
- Department of Orthopaedic Surgery, Spine Division, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, 833, Taiwan, ROC
| | - Ping-Yeh Chiu
- Department of Orthopaedic Surgery, Spine Division, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, ROC.,Chang Gung University College of Medicine, No.259, Wenhua 1st Rd, Guishan Dist., Taoyuan City, 333, Taiwan, ROC
| | - Po-Liang Lai
- Department of Orthopaedic Surgery, Spine Division, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, ROC.,Chang Gung University College of Medicine, No.259, Wenhua 1st Rd, Guishan Dist., Taoyuan City, 333, Taiwan, ROC
| | - Chi-Chien Niu
- Department of Orthopaedic Surgery, Spine Division, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, ROC. .,Chang Gung University College of Medicine, No.259, Wenhua 1st Rd, Guishan Dist., Taoyuan City, 333, Taiwan, ROC.
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Spurgas MP, Entezami P, Thomas J, DiRisio DJ. Long Segment Anterior Cervical Discectomy and Fusion, Including C2: Surgical Pearls and Review of Our Experience. Clin Spine Surg 2022; 35:E13-E18. [PMID: 34369912 DOI: 10.1097/bsd.0000000000001245] [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: 11/16/2020] [Accepted: 06/23/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A retrospective study of thirteen patients undergoing 5-level anterior spinal surgery for cervical myelopathy. OBJECTIVE While limited literature exists in reviewing the treatment of high cervical pathology extending caudally, we believe long segment surgery beginning at C2-3 can be accomplished with good success and is an option more patients may benefit from. We aim to describe the technique in accessing the C2-C3 disk space and efficacy of treating multilevel disease beginning at the C2 vertebral body. This includes an extensive technical report and surgical pearls. SUMMARY OF BACKGROUND DATA Compression at the level of C2 can be daunting to access because of steep approach required. Few studies have described the technique in reaching the C2 level, with less information describing the efficacy of a 5-level anterior fusion starting at C2. METHODS Patients who underwent surgery between 2000 and 2016 were identified utilizing the department billing database and ICD codes. Patients age, operative indications, levels treated, length of hospital stay, fusion outcome, and operative complications were explored. Independent analysis of fusion was performed. RESULTS The average length of hospital stay was 3.9 days. Eight patients reported significant improvement of hand weakness, numbness, and/or gait at 6 months follow-up. The most frequent complication was dysphagia (23%). One patient experienced recurrent symptoms secondary to nonunion, and another patient suffered a postoperative neurological worsening because of anterior spinal artery syndrome. CONCLUSION This retrospective review discusses the technique to visualize and fully decompress C2-C3 spinal segments. In addition, we explored the efficacy and perioperative risk in long segment anterior cervical discectomy and fusion.
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Sayed D, Amirdelfan K, Naidu RK, Raji OR, Falowski S. A Cadaver-Based Biomechanical Evaluation of a Novel Posterior Approach to Sacroiliac Joint Fusion: Analysis of the Fixation and Center of the Instantaneous Axis of Rotation. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2021; 14:435-444. [PMID: 34949942 PMCID: PMC8691588 DOI: 10.2147/mder.s347763] [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: 11/04/2021] [Accepted: 12/09/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose The purpose of this study was to assess the stabilizing effect of a posterior joint fixation technique using a novel cortical allograft implant in unilateral and bilateral fixation constructs. We hypothesize that fixation would reduce the joint's range of motion during flexion-extension, axial rotation, and lateral bending loads. We also hypothesize that fixation would shift the center of the instantaneous axis of rotation during the predominant flexion-extension motions towards the implant's location, and that this shift would be correlated with the reduction in flexion-extension range of motion. Materials and Methods Six cadaveric sacroiliac joint specimens were tested under intact, unilateral fixation, and bilateral fixation conditions. The total range of motion (ROM) of the sacroiliac joint in flexion-extension, lateral bending, and axial rotation were evaluated by an optical tracking system, in a multidirectional flexibility pure moment model, between ± 7.5 Nm applied moment loads. The centers of the instantaneous axis of rotation (cIAR) of the sacroiliac joint were evaluated during flexion-extension loading. A correlation analysis was performed between the ROM reduction in flexion-extension upon implantation and shift of the cIAR to the graft implantation site. Results Unilateral and bilateral fixations generated sacroiliac joint ROM reductions in flexion-extension, lateral bending, and axial rotation motions. Fixation shifted the cIAR to the graft implantation site. Reduction in the total range of motion had a moderate correlation with the shift of the cIAR. Conclusion Our novel posterior approach presents a multifaceted mechanism for stabilizing the joint: first, by the reduction of the total range of motion in all planes of motion; second, by shifting the centers of the instantaneous axis of rotation towards the implant's location in the predominant plane of motion, ensuring little to no motion at the implantation site, thus promoting fusion in this region.
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Affiliation(s)
- Dawood Sayed
- The University of Kansas Medical Center, Kansas City, KS, USA
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Lee DH, Park S, Hong CG, Park KB, Cho JH, Hwang CJ, Yang JJ, Lee CS. Fusion and subsidence rates of vertebral body sliding osteotomy: Comparison of 3 reconstructive techniques for multilevel cervical myelopathy. Spine J 2021; 21:1089-1098. [PMID: 33774212 DOI: 10.1016/j.spinee.2021.03.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/24/2021] [Accepted: 03/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Vertebral body sliding osteotomy (VBSO) was previously reported as a technique to decompress spinal canal by translating the vertebral body anteriorly and is indicated for cervical myelopathy caused by spondylosis or ossification of the posterior longitudinal ligament. However, little is known about its fusion and subsidence rates. PURPOSE To compare the fusion and subsidence rates of VBSO, anterior cervical discectomy and fusion (ACDF), and anterior cervical corpectomy and fusion (ACCF). STUDY DESIGN/SETTING Retrospective cohort study PATIENT SAMPLE: One hundred sixty-eight patients who underwent VBSO, ACDF, or ACCF for the treatment of cervical myelopathy and were followed-up for more than 2 years were retrospectively reviewed. OUTCOME MEASURES Fusion and subsidence rates, visual analog scale (VAS) scores for neck pain, neck disability index (NDI), and Japanese Orthopaedic Association (JOA) scores were assessed. METHODS Results of the VBSO, ACDF, and ACCF groups were compared using Student's t-test and chi-square test. RESULTS The fusion rate at 1-year postoperatively and the final follow-up for VBSO was 92.9% (37/42). VBSO demonstrated a higher 1-year fusion rate than ACDF (77.9% [74/95], p=0.04) and ACCF (74.2% [23/31], p=0.04). However, the fusion rate at the final follow-up did not demonstrate significant difference. The mean amount of subsidence (ACDF group, 1.5±1.2 mm; VBSO group, 1.5±1.5 mm; p=1.00) and rate of significant subsidence of > 3 mm (ACDF group, 13.7% [13/95]; VBSO group, 14.3% [6/42]; p=1.00) were similar for ACDF and VBSO. Furthermore, the mean amount of subsidence in VBSO was significantly less than that in ACCF (1.5±1.5 mm vs 2.4±2.0 mm; p=0.04). Neck pain VAS, NDI, and JOA scores were not significantly different among the groups. CONCLUSIONS VBSO demonstrated faster solid union than ACDF and ACCF, although the fusion rates at the final follow-up were similar. VBSO resulted in less subsidence than ACCF at the 1-year follow-up. VBSO could be applied safely when the shape and/or location of the pathologic foci and sagittal alignment favor its application without much concern for pseudarthrosis or subsidence.
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Affiliation(s)
- Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu Seoul, 05505, Republic of Korea
| | - Sehan Park
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, 14 Siksadong, Ilsandonggu Goyangsi, Gyeonggidoo, 411-773, Republic of Korea.
| | - Chul Gie Hong
- Department of Orthopedic Surgery, Kangwon National University Hospital, 156, Baengnyeong-ro Chuncheon-si, Gangwon-do, 24341, Republic of Korea
| | - Kun-Bo Park
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University, Seoul, Republic of Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu Seoul, 05505, Republic of Korea
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu Seoul, 05505, Republic of Korea
| | - Jae Jun Yang
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, 14 Siksadong, Ilsandonggu Goyangsi, Gyeonggidoo, 411-773, Republic of Korea
| | - Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu Seoul, 05505, Republic of Korea
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22
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Gomez G, Westerlund LE. Clinical and radiographic outcomes using third-generation bioactive glass as a bone graft substitute for multi-level anterior cervical discectomy and fusion-a retrospective case series study. JOURNAL OF SPINE SURGERY 2021; 7:124-131. [PMID: 34296024 DOI: 10.21037/jss-20-645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/28/2021] [Indexed: 11/06/2022]
Abstract
Background Bioactive glasses have unique bone forming properties that have been used as a bone graft substitute for anterior cervical discectomy and fusions (ACDFs). Bone graft substitutes are used for achieving fusion while simultaneously avoiding donor site morbidity of iliac crest autograft. In this study, our principal intention is to assess the clinical and radiographic outcomes in patients with multi-level cervical disc disease undergoing ACDF using a third-generation bioactive glass as a bone graft substitute. Methods A retrospective case series study was performed of patients who underwent primary multi-level instrumented fusions for degenerative cervical disc disease with bioactive glass bone graft substitute between May 2016 and December 2017 by a single fellowship-trained spine surgeon. All patients were treated with a porous PEEK interbody spacer and with a third-generation bioactive glass synthetic bone graft substitute. Patients were assessed pre-operatively, immediately following surgery, and at 3, 6, 12, and 24 months. Accepted standard outcome measures were applied to evaluate preoperative and postoperative metrics, including Visual Analog Scale neck pain and arm pain, and Neck Disability Index. Dynamic lateral radiographs were used to assess sagittal alignment, disc space height, arthrodesis status, osseous integration, and implant migration. Sagittal plane angulation was measured by Cobb's criteria. Results Thirty-nine patients underwent multi-level instrumented fusions: seventeen (43%) were two-level; 12 (31%) were three-level; 9 (23%) were four-level; and 1 (3%) was five-levels. All patients were followed for a minimum of 6 months for mean of 16.0 months (range, 6 to 36 months); none were lost to follow-up. Significant improvements from preoperative scores in Neck Disability Index scores as well as neck and arm visual analog scale pain scores were realized. All patients either maintained or improved their neurological status. Radiographically, all patients were fused by 6 months postoperatively and showed improvement in fusion segment lordosis (Pre-Post and Pre-Final P<0.001), C2-C7 lordosis angle (Pre-Post and Pre-Final P<0.001), T1 slope (Pre-Post P=0.01, Pre-Final P=0.07) and maintenance of disc height (Post-Final P=0.02). There were no adverse events, infections, or reoperations. Conclusions Third-generation bioactive glass synthetic graft is a viable alternative to allograft or autograft in the setting of multi-level instrumented fusions for achieving improved clinical and radiographic outcomes.
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Affiliation(s)
- Gilberto Gomez
- Hughston Spine at the Hughston Clinic, Columbus, Georgia, USA.,Hughston Spine Outcomes Lab, Hughston Spine at The Hughston Clinic, Columbus, Georgia, USA
| | - L Erik Westerlund
- Hughston Spine at the Hughston Clinic, Columbus, Georgia, USA.,Hughston Spine Outcomes Lab, Hughston Spine at The Hughston Clinic, Columbus, Georgia, USA
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Comparison between selective caudal fixed screw construct and all variable screw construct in anterior cervical discectomy and fusion. Sci Rep 2021; 11:10573. [PMID: 34012036 PMCID: PMC8134452 DOI: 10.1038/s41598-021-90121-w] [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: 12/18/2020] [Accepted: 04/19/2021] [Indexed: 11/19/2022] Open
Abstract
This retrospective comparative study aimed to compare the efficacy of selective caudal fixed screw constructs with all variable screw constructs in anterior cervical discectomy and fusion (ACDF). Thirty-five patients who underwent surgery using selective caudal fixed screw construct (SF group) were compared with 44 patients who underwent surgery using all variable constructs (AV group). The fusion rate, subsidence, adjacent level ossification development (ALOD), adjacent segmental disease (ASD), and plate-adjacent disc space distance were assessed. The one-year fusion rates assessed by computed tomography bone bridging and interspinous motion as well as the significant subsidence rate did not differ significantly between the AV and SF groups. The ALOD and ASD rates and plate-adjacent disc space distances did not significantly differ between the two groups at both the cranial and caudal adjacent levels. The number of operated levels was significantly associated with pseudarthrosis in the logistic regression analysis. The stability provided by the locking mechanism of the fixed screw did not lead to an increased fusion rate at the caudal level. Therefore, the screw type should be selected based on individual patient’s anatomy and surgeon’s experience without concern for increased complications caused by screw type.
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Lin M, Shapiro SZ, Doulgeris J, Engeberg ED, Tsai CT, Vrionis FD. Cage-screw and anterior plating combination reduces the risk of micromotion and subsidence in multilevel anterior cervical discectomy and fusion-a finite element study. Spine J 2021; 21:874-882. [PMID: 33460810 DOI: 10.1016/j.spinee.2021.01.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 12/23/2020] [Accepted: 01/12/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Anterior cervical discectomy and fusion (ACDF) is widely used to treat patients with spinal disorders, where the cage is a critical component to achieve satisfactory fusion results. However, it is still not clear whether a cage with screws or without screws will be the best choice for long-term fusion as the micromotion (sliding distance) and subsidence (penetration) of the cage still take place repeatedly. PURPOSE This study aims to examine the effect of cage-screws on the biomechanical characteristics of the human spine, implanted cage, and associate hardware by comparing the micromotion and subsidence. STUDY DESIGN A finite element (FE) analysis study. METHODS A FE model of a C3-C5 cervical spine with ACDF was developed. The spinal segment was modeled with the removal of the anterior longitudinal ligament (ALL), posterior longitudinal ligament (PLL), and discectomy was then implanted with a cage-screw system. Three models were analyzed: the first was the original spine (S1 model), the second, S2, was implanted with cages and anterior plating, and the third, S3, was implanted with a cage-screw system in addition to the anterior plate. All investigations were under 1 N•m in flexion, extension, lateral bending, and axial rotation situations. RESULTS Finite element analysis (FEA) demonstrated that range of motion (ROM) at C3-C4 in the S2 model was significantly reduced more than that in the S3 model, while the ROM at both C4-C5 in the S3 model was reduced more than that in the S2 model in all simulations. The ROM at C3-C5 in the S1 model was reduced by over 5° in the S2 and S3 models in all loading conditions. The micromotion and subsidence at all contacts of C3-C5 in the S3 model were lower than that in the S2 model in all flexion, extension, bending, and axial simulations. The subsidence and micromotion could be seen in the barrier area of the S2 model, while they occurred near the edge of the screw in the S3 model. CONCLUSIONS These results showed that the cage-screw and anterior plating combination has promising potential to reduce the risk of micromotion and subsidence of implanted cages in two or more level ACDFs. CLINICAL SIGNIFICANCE The use of double segmental fixation with cage-screw anterior plating combination constructs may increase the stiffness of the construct and reduce the incidence of clinical and radiographic pseudarthrosis following multilevel ACDF, which in turn, could decrease the need for revision surgeries or supplemental posterior fixation.
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Affiliation(s)
- Maohua Lin
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, FL, USA
| | - Stephen Z Shapiro
- Department of Neurosurgery, Marcus Neuroscience Institute, Boca Raton Regional Hospital, Boca Raton, FL, USA.
| | - James Doulgeris
- Department of Neurosurgery, Marcus Neuroscience Institute, Boca Raton Regional Hospital, Boca Raton, FL, USA
| | - Erik D Engeberg
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, FL, USA
| | - Chi-Tay Tsai
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, FL, USA
| | - Frank D Vrionis
- Department of Neurosurgery, Marcus Neuroscience Institute, Boca Raton Regional Hospital, Boca Raton, FL, USA
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25
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Makhni MC, Yeung CM, Riew KD. The Art of Diagnosis in the Cervical Spine. Neurospine 2020; 17:695-703. [PMID: 33401849 PMCID: PMC7788414 DOI: 10.14245/ns.2040556.278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Melvin C Makhni
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Caleb M Yeung
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - K Daniel Riew
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital, New York, NY, USA.,Columbia University Irving Medical Center, New York, NY, USA
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Is There a Relationship Between Bony Fusion After Anterior Cervical Discectomy and Fusion and Heterotopic Ossification After Cervical Disc Arthroplasty in Hybrid Surgery? Spine (Phila Pa 1976) 2020; 45:E1653-E1660. [PMID: 32925690 DOI: 10.1097/brs.0000000000003687] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE The aim of this study was to investigate the relationship between bony fusion after anterior cervical discectomy and fusion (ACDF) and heterotopic ossification (HO) after cervical disc arthroplasty (CDA) in hybrid surgery (HS). SUMMARY OF BACKGROUND DATA The mechanism of postoperative bone formation still remains unknown. It is considered a risk factor in CDA but is essential for a solid union in ACDF. With HS, we could directly study the mechanism and relationship of different forms of postoperative bone formation. METHODS Clinical data of 91 patients who had undergone consecutive two-level HS between January 2011 and January 2018 and with a minimum of 2-year follow-up was analyzed. HO was assessed based on McAfee's classifications, whereas fusion success was evaluated according the Food and Drug Administration approved criteria. Clinical outcomes and radiographic parameters were collected and used for the relevant comparisons. RESULTS HO was identified in 48.4% of patients (44/91). The fusion rates of patients in the HO group and the non-HO group at 3, 6, and 12 months postoperatively, and the final follow-up were 81.8% and 19.1%, 95.4% and 74.5%, 95.4% and 85.1%, and 97.7% and 93.6%, respectively. The fusion rates were significantly higher at 3 and 6 months after operation in the HO group than in the non-HO group (P < 0.05). Patients in both groups had significant improvements across all clinical outcomes at final follow-up. CONCLUSION There was a significant relationship between bony fusion and occurrence of HO after HS, suggesting that both bony fusion and HO are reflections of individual osteogenic capacity. However, a reliable predictor of postoperative bone formation is needed in the future to guarantee a solid bony fusion after ACDF and to further take full advantage of the motion-preserving from CDA. LEVEL OF EVIDENCE 3.
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Lee NJ, Vulapalli M, Park P, Kim JS, Boddapati V, Mathew J, Amorosa LF, Sardar ZM, Lehman RA, Riew KD. Does screw length for primary two-level ACDF influence pseudarthrosis risk? Spine J 2020; 20:1752-1760. [PMID: 32673728 DOI: 10.1016/j.spinee.2020.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/28/2020] [Accepted: 07/08/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Pseudarthrosis remains a major complication for patients undergoing anterior cervical discectomy and fusion (ACDF; 0%-15% at 1-year follow-up). Potentially modifiable risk factors are known in literature, such as smoking and osteoporosis. Biomechanical studies suggest that plates with locking screws can enhance the fixation rigidity and pull-out strength. Although longer screws are known to be correlated with increased pull-out strength, deeper screw depths can increase the risk for intraoperative complications. An important factor that has yet to be studied is the minimum screw length relative to the diameter of the vertebral body (VB) necessary to achieve successful fusion. In this study, we hypothesize that screws with shorter depths relative to the VB will increase the risk for radiographic pseudarthrosis and result in poor patient reported outcomes (PROs). PURPOSE To examine the impact of ACDF screw length on pseudarthrosis risk. STUDY DESIGN A review of prospectively collected data. PATIENT SAMPLE A total of 85 patients were included in this study. The mean age ±standard deviation was 58.9±10.3 and 42.4% of patients were female. The mean follow-up was 21.6±8.3 months. OUTCOME MEASURES The neck disability index (NDI) was used to assess PROs up to 2-years after surgery. For each ACDF level, the screw length and VB% (screw length divided by the anterior-posterior VB diameter) were measured. Radiographic pseudarthrosis (interspinous motion [ISM] ≥1 mm) was recorded at 6-weeks, 6-months, and 1-year for each patient. The positive and negative predictive values (PPV, NPV) for ISM ≥ 1mm were measured for different VB% thresholds. A VB% of <75% was found to have the highest PPV (93%) and NPV (70%) for radiographic pseudarthrosis. This threshold of <75% was then assessed in our bivariate and multivariate analyses. METHODS We reviewed a database (2015-2018) of adult (≥18 years old) patients who underwent a primary two-level ACDF with or without corpectomy. All ACDF constructs involved fixed angle screws. The minimum follow-up period was 1 year. Multivariate analyses were performed to determine if screw VB% was an independent risk factor for radiographic pseudarthrosis. RESULTS By 1-year, overall fusion success was achieved in 92.9% of patients. The 1-year revision rate was 4.7%. Patients with any screw VB% <75% had substantially worse fusion success (64.3%) than those who did not (98.6%) at 1-year. The VB% <75% increased the risk for radiographic pseudarthrosis at every follow up period. In comparison to other time-points, patients with radiographic pseudarthrosis at 6 weeks had significantly worse NDI scores by 2-years (p=.047). The independent risk factors for radiographic pseudarthrosis at 6-weeks included any screw VB% <75% (OR 77, p<.001), prior/current smoker (OR 6.8, p=.024), and corpectomy (OR 0.1, p=.010). Patients with ISM≥1 mm had a higher rate of revision surgery at 1-year (5.9% vs. 3.9%), but this was not statistically significant (p=.656). CONCLUSIONS In primary two-level ACDF, VB% <75% is significantly associated with increased ISM (≥1 mm) at all time points for this study. As an intraoperative guide, spine surgeons can use the screw VB% threshold of <75% to avoid unnecessarily short screws. This threshold can be easily measured pre- and intraoperatively, and has been found to be strongly correlated to radiographic pseudarthrosis in the early postoperative period.
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Affiliation(s)
- Nathan J Lee
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA.
| | - Meghana Vulapalli
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Paul Park
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Jun S Kim
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Venkat Boddapati
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Justin Mathew
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Louis F Amorosa
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Zeeshan M Sardar
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Ronald A Lehman
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - K Daniel Riew
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
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Nichols NM, Jamieson A, Wang M, Chou D, Mummaneni PV, Tan LA. Characterizing the fusion order and level-specific rates of arthrodesis in 3-level anterior cervical discectomy and fusion: A radiographic study. J Clin Neurosci 2020; 81:328-333. [PMID: 33222940 DOI: 10.1016/j.jocn.2020.10.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/13/2020] [Accepted: 10/03/2020] [Indexed: 11/17/2022]
Abstract
Pseudarthrosis is a well-recognized complication following multi-level ACDF. We aim to characterize the fusion order and level-specific rates of arthrodesis across four time points following 3-level ACDF. Patients who underwent 3-level ACDF by three UCSF spine surgeons from August 2012 to December 2019 were identified. Fusion status at each level was determined by measuring the interspinous motion on flexion and extension radiographs and assessing for evidence of bridging bone. Measurements were performed post-operatively at 6 weeks, 6 months, 12 months, and 18-24 months. A total of 77 patients with 3-level ACDF were identified and included in this study. Specific ACDF levels include C3-C6 (17 patients), C4-C7 (57 patients), and C5-T1 (3 patients). At 6 months, the cranial, middle, and caudal level fusion rates were 17.0%, 34.0%, and 3.8%, respectively. By 24 months, fusion rates were 61.1%, 88.9%, and 27.8% at the cranial, middle, and caudal level, respectively. PEEK cages were associated with lower odds of multi-level arthrodesis. Arthrodesis occurred the quickest at the middle level with an 88.9% fusion rate by 24 months after surgery. The caudal level had the slowest rate of arthrodesis with only a 27.8% fusion rate at 24 months, likely due to increased biomechanical stress at the most caudal level. Allograft was associated with higher odds of multi-level arthrodesis compared to PEEK cages.
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Affiliation(s)
- Noah M Nichols
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Room 779 M, San Francisco, CA 94143-0112, USA
| | - Alysha Jamieson
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Room 779 M, San Francisco, CA 94143-0112, USA
| | - Minghao Wang
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Room 779 M, San Francisco, CA 94143-0112, USA
| | - Dean Chou
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Room 779 M, San Francisco, CA 94143-0112, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Room 779 M, San Francisco, CA 94143-0112, USA
| | - Lee A Tan
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Room 779 M, San Francisco, CA 94143-0112, USA.
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Lee CJ, Boody BS, Demeter J, Smucker JD, Sasso RC. Long-Term Radiographic and Functional Outcomes of Patients With Absence of Radiographic Union at 2 Years After Single-Level Anterior Cervical Discectomy and Fusion. Global Spine J 2020; 10:741-747. [PMID: 32707013 PMCID: PMC7383798 DOI: 10.1177/2192568219874768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN Retrospective radiographic investigation. OBJECTIVE To evaluate the long-term radiographic and functional outcomes of patients in whom there is absence of radiographic union at 2 years after single-level anterior cervical discectomy and fusion (ACDF). METHODS Thirty-one patients were evaluated at standard postoperative time intervals per index trial protocol. Plain film radiographic fusion criteria at the arthrodesis level was defined as interspinous motion (ISM) <1 mm with corresponding motion at a non-arthrodesed superjacent level ISM ≥4 mm. Radiographs and functional outcome measures were acquired at each follow-up visit. Delayed union was defined as lack of radiographic union by 24 months. RESULTS Nine patients demonstrated radiographic evidence of delayed radiographic union at 24 months. Of those 9 patients, 5 patients demonstrated evidence of union during the follow-up period to 72 months. Despite the absence of radiographic union based on our criteria, 3 of the 4 remaining patients reported remarkable improvements in pain scores and functional outcomes. CONCLUSIONS The natural history of delayed union at 24 months after ACDF was still favorable despite the prolonged delay in union. The majority of patients (5 of 9) without radiographic union at 24 months did proceed to radiographic union by final follow-up. In addition, patients that did not meet our criteria for fusion maintained postoperative improvements in patient-reported outcome scores. In summary, our study patients undergoing a single-level ACDF with asymptomatic radiographic delayed union at 24 months can expect maintained improvements in postoperative patient-reported outcomes scores and can still progress to successful radiographic fusion.
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Affiliation(s)
| | | | - Jaclyn Demeter
- Indiana Spine Group, Carmel, IN, USA,Jaclyn Demeter, Indiana Spine Group, 13225 North Meridian Street, Carmel, IN 46032, USA.
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Response to Dr. Hao Liu's Letter RE: Asymptomatic ACDF Nonunions Underestimate the True Prevalence of Radiographic Pseudoarthrosis. Spine (Phila Pa 1976) 2020; 45:E975-E976. [PMID: 32675625 DOI: 10.1097/brs.0000000000003554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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He J, Wu T, Liu H, Wang B. Letter to the Editor Concerning "Asymptomatic ACDF Non-unions Underestimate the True Prevalence of Radiographic Pseudarthrosis" by Crawford et al. Spine (Phila Pa 1976) 2020; 45:E975. [PMID: 32675624 DOI: 10.1097/brs.0000000000003553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Junbo He
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Yeung KKL, Cheung PWH, Cheung JPY. Anterior cervical discectomy and fusion for cervical myelopathy using stand-alone tricortical iliac crest autograft: Predictive factors for neurological and fusion outcomes. J Orthop Surg (Hong Kong) 2020; 27:2309499019869166. [PMID: 31451033 DOI: 10.1177/2309499019869166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this article is to investigate the outcomes after anterior cervical discectomy and fusion (ACDF) surgery with stand-alone tricortical iliac crest autograft and to determine predictive factors for poor neurological recovery, non-union, graft collapse and loss of C2-C7 sagittal alignment. METHODS This was a retrospective study involving patients with cervical myelopathy who underwent ACDF surgery with stand-alone tricortical iliac autograft between 2006 and 2016, with a minimum 2-year postoperative follow-up. Outcomes included the change in Japanese Orthopaedic Association (JOA) scores clinically and timing of fusion, graft height and C2-7 angle measured on lateral radiographs. Any complication such as neurological deterioration, non-union, graft collapse or loss of angle was recorded. Delayed union was considered as radiological union identified only beyond postoperative 6 months. Risk factors including age, smoking, drinking, comorbidities and operative levels were analysed through a multivariate regression for their respective influences on the various outcomes. RESULTS Of the 69 patients studied, none of the patients had non-union, while 33 (47.1%) achieved fusion in 6 months. The most common complications were anterior protrusion of graft (5.8%) and hoarseness (2.9%). The 1-year mean change in JOA score was 3.9 ± 2.7. The C2-7 angle gradually became more kyphotic, despite an initial lordosis correction intraoperatively. The graft height also gradually collapsed during subsequent follow-ups. Multivariate regression model suggested that diabetics (cumulative odds ratio 7.4) and drinkers (cumulative odds ratio 8.6) were associated with delayed union. CONCLUSION ACDF using tricortical iliac crest autograft has satisfactory outcomes with low occurrence of complications. Diabetics and drinkers were predictors of delayed union.
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Affiliation(s)
- Kenneth Kam Leung Yeung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong
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Lin W, Ha A, Boddapati V, Yuan W, Riew KD. Diagnosing Pseudoarthrosis After Anterior Cervical Discectomy and Fusion. Neurospine 2018; 15:194-205. [PMID: 31352693 PMCID: PMC6226130 DOI: 10.14245/ns.1836192.096] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/19/2018] [Indexed: 12/18/2022] Open
Abstract
Radiographic confirmation of fusion after anterior cervical discectomy and fusion (ACDF) surgery is a critical aspect of determining surgical success. However, there is a lack of established diagnostic radiographic parameters for pseudoarthrosis. The purpose of this study is to summarize the findings of previous studies, review the advantages and disadvantages of frequently employed diagnostic criteria, and present our recommended protocol of fusion assessment. This study identified randomized controlled trials, case-control studies, and prospective and retrospective cohort studies reporting on spinal fusion and how successful fusion after ACDF. Among the 39 articles reviewed, bridging bone across the operated levels on static radiographs was the most commonly used criteria to confirm fusion (31 of 39, 79%). Dynamic flexion-extension radiographs were used to assess for interspinous movement (ISM) (22 of 39, 56.4%) and change in Cobb angle (12 of 39, 30.8%). Computed tomography (CT) based findings (21 of 39, 53.8%) were employed in ambiguous cases with improved sensitivity and specificity. Reconstructed CT scans were used to assess for intragraft bridging bone and extragraft bridging bone (ExGBB). ExGBB were proved to have the highest diagnostic sensitivity and specificity for pseudoarthrosis detection when compared to all other radiographic criteria. The ISM <1 mm on dynamic flexion-extension radiographs had high diagnostic sensitivity and specificity as well. After our reviewing, we recommend using dynamic lateral flexion-extension cervical spine radiographs at 150% magnificationin which the interspinous motion <1 mm and superjacent interspinous motion ≥4 mm confirms fusion. In ambiguous cases, we recommend using reconstructed CT scans to evaluate for ExGBB.
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Affiliation(s)
- Wenbo Lin
- Department of Orthopedic, Changzheng Hospital, Second Military Medical University, Shang Hai, China
| | - Alex Ha
- Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital, New York-Presbyterian Healthcare System, New York, NY, USA
| | - Venkat Boddapati
- Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital, New York-Presbyterian Healthcare System, New York, NY, USA
| | - Wen Yuan
- Department of Orthopedic, Changzheng Hospital, Second Military Medical University, Shang Hai, China
| | - K Daniel Riew
- Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital, New York-Presbyterian Healthcare System, New York, NY, USA
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