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Halayqeh S, Glueck J, Balmaceno-Criss M, Alsoof D, McDonald CL, Diebo BG, Daniels AH. Delayed cerebrospinal fluid (CSF) leak following anterior cervical discectomy and fusion surgery. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100271. [PMID: 37771759 PMCID: PMC10522904 DOI: 10.1016/j.xnsj.2023.100271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 09/30/2023]
Abstract
Background An uncommon complication of anterior cervical discectomy and fusion (ACDF) is dura tear, which may be further complicated by cerebral spinal fluid (CSF) leak. Dural tears with CSF leak can lead to catastrophic neurologic outcomes and should be recognized early. Case Description This case report describes a 43-year-old female patient with history of Ehlers-Danlos syndrome who presented 1-year post-ACDF with positional headaches and lightheadedness. Imaging revealed ACDF plate subsidence and CSF leak with inferior displacement of the cerebellar tonsils. Outcome The patient underwent a revision procedure with removal of index screws and CSF repair using epidural blood patch, fat graft, and Tisseel. The original bicortical screws were replaced with shorter larger diameter unicortical screws. Post-operative imaging at 2 and 6 weeks confirmed resolution of CSF leak. Conclusions Healthcare professionals and patients undergoing spinal surgery should be aware of late presentation CSF leaks which can represent gradual decline in neurological function. Surgical candidates at risk to develop CSF leaks should be counseled about possible complications in preoperative planning.
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Affiliation(s)
- Sereen Halayqeh
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave East Providence, RI, 02914 United States
| | - Jacob Glueck
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave East Providence, RI, 02914 United States
- Warren Alpert Medical School, Brown University, 222 Richmond St., RI, 02903 United States
| | - Mariah Balmaceno-Criss
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave East Providence, RI, 02914 United States
- Warren Alpert Medical School, Brown University, 222 Richmond St., RI, 02903 United States
| | - Daniel Alsoof
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave East Providence, RI, 02914 United States
- Warren Alpert Medical School, Brown University, 222 Richmond St., RI, 02903 United States
| | - Christopher L. McDonald
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave East Providence, RI, 02914 United States
| | - Bassel G. Diebo
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave East Providence, RI, 02914 United States
| | - Alan H. Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave East Providence, RI, 02914 United States
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Gazzeri R, Galarza M, Callovini G. Use of tissue sealant patch (TachoSil) in the management of cerebrospinal fluid leaks after anterior cervical spine discectomy and fusion. Br J Neurosurg 2023; 37:1406-1409. [PMID: 33538190 DOI: 10.1080/02688697.2021.1881444] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to evaluate a fast, sutureless technique to repair anterior cervical dural tears. Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure for the treatment of cervical degenerative diseases. Although uncommon, incidental durotomy with cerebrospinal fluid (CSF) leak during ACDF is a potentially serious complication. Yet, its technical management for the prevention of CSF leak is controversial. METHODS Between September 2012 and June 2018 we encountered seven cases (2 female/5 male) presenting with intraoperative CSF leaks secondary to incidental dural tears during ACDF surgery. All the cases were surgically treated using a topical fibrin sealant patch (TachoSil) with high adesive strength and fibrin glue (Tisseel). Intraoperative source of leakage, time to leakage control, quantity of Sealant Sponge used and postoperative complications were evaluated. RESULTS Dural tears were tipically the result of dissection of adherent posterior longitudinal ligament and/or calcified disc from the cervical dural sac to allow full decompression of the spinal cord. Effective repair of dural tear defined as cessation of CSF leak after topical sealant agents application was achieved no later than one minute in all cases. Evident clinical and/or radiological postoperative CSF leak was used to determine the patient's postoperative result. Postoperative CSF leak was not evident during a minimum 6 months follow up. CONCLUSIONS In the present study, we have reported our experience with a new sealing technique to manage CSF leaks from iatrogenic cervical dural lacerations. Tachosil tissue sealant patch is a rapid sutureless technique that may help in repairing introperatively incidental dural tears, thus reducing the risk of postoperative CSF leaks. To our knowledge, this is the first series to report the use of Tachosil adhesive sealant patch for the treatment of incidental dural tears during anterior cervical discectomy.
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Affiliation(s)
- Roberto Gazzeri
- Department of Neurosurgery, San Giovanni-Addolorata Hospital, Rome, Italy
- Department of Neurosurgery, Istituto Nazionale Tumori "Regina Elena", Rome, Italy
| | - Marcelo Galarza
- Regional Service of Neurosurgery, "Virgen de la Arrixaca" University Hospital, Murcia, Spain
| | - Giorgio Callovini
- Department of Neurosurgery, San Giovanni-Addolorata Hospital, Rome, Italy
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Prospective Investigation of Surgical Outcomes after Anterior Decompression with Fusion and Laminoplasty for the Cervical Ossification of the Posterior Longitudinal Ligament: A Propensity Score Matching Analysis. J Clin Med 2022; 11:jcm11237012. [PMID: 36498586 PMCID: PMC9736093 DOI: 10.3390/jcm11237012] [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: 10/18/2022] [Revised: 11/08/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
The ideal surgical strategy for cervical ossification of the posterior longitudinal ligament (OPLL) remains controversial due to the lack of high-quality evidence. Herein, we prospectively investigated the surgical outcomes of anterior cervical decompression with fusion (ADF) and laminoplasty (LAMP) with cervical OPLL. Three hundred patients were included in this study (ADF: n = 89; LAMP: n = 211 patients), and propensity score matching yielded 67 pairs of patients with ADF and LAMP, in which clinical outcomes were compared. Crude analysis revealed that the ADF group showed greater neurological recovery in cervical Japanese Orthopedic Association scores at two years, compared with that in the LAMP group (53.1% vs. 44.3%, p = 0.037). The ratio of minimum clinically important difference (MCID) success was significantly greater in the ADF group (59.6% vs. 43.6%, p = 0.016). Multivariate analysis showed that the factors affecting MCID success were age, body mass index, duration of symptoms, and choice of ADF. In the 1:1 matched analysis, neurological improvement was more favorable in the ADF group (57.2%) compared to the LAMP group (46.8%) at two years (p = 0.049). However, perioperative complications, such as dysphagia and graft-related complications, were more common in the ADF group.
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Tang J, Lu Q, Li Y, Wu C, Li X, Gan X, Xie W. Risk factors and management strategies for cerebrospinal fluid leakage following lumbar posterior surgery. BMC Surg 2022; 22:30. [PMID: 35090413 PMCID: PMC8800267 DOI: 10.1186/s12893-021-01442-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To analyze the risk factors of cerebrospinal fluid leakage (CSFL) following lumbar posterior surgery and summarize the related management strategies. METHODS A retrospective analysis was performed on 3179 patients with CSFL strategies lumbar posterior surgery in our hospital from January 2019 to December 2020. There were 807 cases of lumbar disc hemiation (LDH), 1143 cases of lumbar spinal stenosi (LSS), 1122 cases of lumbar spondylolisthesis(LS), 93 cases of lumbar degenerative scoliosis(LDS),14 cases of lumbar spinal benign tumor (LST). Data of gender, age, body mass index(BMI), duration of disease, diabete, smoking history, preoperative epidural steroid injection, number of surgical levels, surgical methods (total laminar decompression, fenestration decompression), revision surgery, drainage tube removal time, suture removal time, and complications were recorded. RESULTS The incidence of 115 cases with cerebrospinal fluid leakage, was 3.6% (115/3179).One-way ANOVA showed that gender, body mass index (BMI), smoking history, combined with type 2 diabetes and surgical method had no significant effect on CSFL (P > 0.05). Age, type of disease, duration of disease, preoperative epidural steroid injection, number of surgical levels and revision surgery had effects on CSFL (P < 0.05). Multivariate Logistic regression analysis showed that type of disease, preoperative epidural steroid injection, number of surgical levels and revision surgery were significantly affected CSFL (P < 0.05).Drainage tube removal time of CSFL patients ranged from 7 to 11 days, with an average of 7.1 ± 0.5 days, drainage tube removal time of patients without CSFL was 1-3 days, with an average of 2.0 ± 0.1 days, and there was a statistical difference between the two groups (P < 0.05).The removal time of CSFL patients was 12-14 days, with an average of 13.1 ± 2.7 days, and the removal time of patients without CSFL was 10-14 days, with an average of 12.9 ± 2.2 days, there was no statistically significant difference between the two groups (P > 0.05). CONCLUSION Type of disease, preoperative epidural steroid injection, number of surgical levels and revision surgery were the risk factors for CSFL. Effective prevention were the key to CSFL in lumbar surgery. Once appear, CSFL can also be effectively dealt without obvious adverse reactions after intraoperative effectively repair dural, head down, adequate drainage after operation, the high position, rehydration treatment, and other treatments.
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Affiliation(s)
- Jin Tang
- Hubei 672 Orthopaedics Hospital of Integrated Chinese & Western Medicine, No. 279 Luoyu Road, Hongshan District, Wuhan, 430079, Hubei, China
| | - Qilin Lu
- Hubei 672 Orthopaedics Hospital of Integrated Chinese & Western Medicine, No. 279 Luoyu Road, Hongshan District, Wuhan, 430079, Hubei, China
| | - Ying Li
- Hubei 672 Orthopaedics Hospital of Integrated Chinese & Western Medicine, No. 279 Luoyu Road, Hongshan District, Wuhan, 430079, Hubei, China
| | - Congjun Wu
- Hubei 672 Orthopaedics Hospital of Integrated Chinese & Western Medicine, No. 279 Luoyu Road, Hongshan District, Wuhan, 430079, Hubei, China
| | - Xugui Li
- Hubei 672 Orthopaedics Hospital of Integrated Chinese & Western Medicine, No. 279 Luoyu Road, Hongshan District, Wuhan, 430079, Hubei, China
| | - Xuewen Gan
- Hubei 672 Orthopaedics Hospital of Integrated Chinese & Western Medicine, No. 279 Luoyu Road, Hongshan District, Wuhan, 430079, Hubei, China
| | - Wei Xie
- Hubei 672 Orthopaedics Hospital of Integrated Chinese & Western Medicine, No. 279 Luoyu Road, Hongshan District, Wuhan, 430079, Hubei, China.
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Comparison of Perioperative Complications in Anterior Decompression With Fusion and Posterior Decompression With Fusion for Cervical Ossification of the Posterior Longitudinal Ligament: Propensity Score Matching Analysis Using a Nation-Wide Inpatient Database. Spine (Phila Pa 1976) 2020; 45:E1006-E1012. [PMID: 32150133 DOI: 10.1097/brs.0000000000003469] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective comparative study. OBJECTIVE To compare the perioperative complications and costs of anterior decompression with fusion (ADF) and posterior decompression with fusion (PDF) for patients with cervical ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA Surgical treatment of cervical OPLL has a high risk of various complications. ADF and PDF are effective for the treatment of cervical OPLL; however, few studies have compared the two procedures in terms of the perioperative surgical complications. METHODS Patients undergoing ADF and PDF for cervical OPLL from 2010 to 2016 were identified in a nation-wide inpatient database. We investigated systemic and local complications, length of hospital stay, costs for hospitalization, reoperation, and mortality. Propensity score was calculated from patients' characteristics and preoperative comorbidities, and one to one matching was performed. RESULTS Propensity score-matching produced 854 pairs of patients who underwent ADF and PDF. The rate of at least one systemic complication was significantly higher in the ADF group (P = 0.004). The incidence rates of postoperative respiratory failure (P = 0.034) and dysphagia (P = 0.008) were significantly higher in the ADF group. The rates of pneumonia (P = 0.06) and hoarseness (P = 0.08) also tended to be higher in the ADF group. However, no difference was found in the mortality rate (P = 0.22). In the local complications, spinal fluid leakage was significantly higher in the ADF group (P < 0.001). However, blood transfusion rate was significantly higher in the PDF group (P = 0.001). Hospital stay was significantly longer in the PDF group (P < 0.001) and the cost for hospitalization was greater in the PDF group (P < 0.001). CONCLUSION The present study demonstrated that perioperative complications, such as respiratory failure, dysphagia, and spinal fluid leakage, were more common in the ADF group. However, hospital stay was longer in the PDF group, and the cost for hospitalization was greater in the PDF group. LEVEL OF EVIDENCE 3.
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Wang Y, Xie C, Wang P, Wang X, Wang C, Xun X, Lin C, Huang Z, Cheng Y, Li L, Teng H. An elastic gel consisting of natural polyphenol and pluronic for simultaneous dura sealing and treatment of spinal cord injury. J Control Release 2020; 323:613-623. [DOI: 10.1016/j.jconrel.2020.04.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/01/2023]
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Alshameeri ZAF, El-Mubarak A, Kim E, Jasani V. A systematic review and meta-analysis on the management of accidental dural tears in spinal surgery: drowning in information but thirsty for a clear message. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:1671-1685. [DOI: 10.1007/s00586-020-06401-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/21/2020] [Accepted: 03/28/2020] [Indexed: 12/29/2022]
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Gopakumar S, Srinivasan VM, Ropper A, Raber M. Cervical Intradural Disc Herniation: Case Report and Operative Video. Cureus 2020; 12:e7537. [PMID: 32377485 PMCID: PMC7198083 DOI: 10.7759/cureus.7537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cervical intradural disc herniation (CIDH) is a rare presentation of an intradural disc herniation. We present a case of CIDH with associated surgical video depicting an anterior surgical approach to treatment. Patient presentation, relevant radiographic imaging, surgical exposure and technique, and cerebrospinal fluid leak complication and prevention are discussed.
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Affiliation(s)
| | | | | | - Michael Raber
- Neurological Surgery, Baylor College of Medicine, Houston, USA
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Comparison of Perioperative Complications Between Anterior Decompression With Fusion and Laminoplasty For Cervical Spondylotic Myelopathy: Propensity Score-matching Analysis Using Japanese Diagnosis Procedure Combination Database. Clin Spine Surg 2020; 33:E101-E107. [PMID: 31414994 DOI: 10.1097/bsd.0000000000000864] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
STUDY DESIGN A retrospective comparative study with a large national database. OBJECTIVE The objective of this study was to compare the perioperative complications and costs of anterior decompression with fusion (ADF) and laminoplasty (LAMP) for patients who had cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA CSM is the most common spinal cord disorder in the upper middle-aged people in Japan. ADF and LAMP represent 2 major treatments; however, few studies have reported large-scale investigations for perioperative complications with CSM. Thus, it is controversial which surgical approach will lead to the best clinical outcome in CSM. MATERIALS AND METHODS All data in this study were collected from the Japanese Diagnosis Procedure Combination database for patients diagnosed with CSM. We adjusted for known confounding biases with propensity score matching. One-to-one matched pairs between each surgical procedure were analyzed for the purposes of comparing systemic complication rates, local complication rates, medical costs, and mortality. RESULTS After propensity score matching, 1638 pairs of patients undergoing ADF and LAMP were made. More perioperative systemic complications were observed in the ADF group, such as atrial fibrillation (ADF/LAMP=0.7%/0.2%, P=0.032), respiratory failure (1.4%/0.1%, P<0.001), dysphagia (2.2%/0.2%, P<0.001), and sepsis (0.5%/0.1%, P=0.019). In contrast, a high rate of pulmonary embolism was observed with LAMP groups (ADF/LAMP=0%/0.2%, P=0.045). Local complications, such as infection (ADF/LAMP=0.8%/1.7%, P=0.026) and meningitis (0%/0.2%, P<0.045), were more common in the LAMP group. Conversely, spinal fluid leakage (ADF/LAMP=0.6%/0%, P=0.003) was more common in the ADF group. The costs (P<0.001) were higher in the ADF group. CONCLUSIONS More systemic complications, such as respiratory disease, cardiovascular events, and sepsis, were observed in the ADF group, although local infection was more frequently seen in the LAMP group. Medical costs were higher in the ADF group. The findings in this study will contribute to each CSM patient by allowing suitable adaptation of cervical surgeries. LEVEL OF EVIDENCE Level III.
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Ryu R, Do A, Chan J, Cuellar J, Schievink W, Baron EM. Postoperative Cerebrospinal Fluid Leak After Lumbar Total Disc Replacement: A Diagnostic and Management Challenge. World Neurosurg 2020; 137:119-125. [PMID: 32035203 DOI: 10.1016/j.wneu.2020.01.226] [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: 01/13/2020] [Revised: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Lumbar total disc replacement is increasingly becoming a more common treatment for discogenic low back pain refractory to conservative measures. Nevertheless, several complications have been reported, including, among others, wound infection, vascular injury, retrograde ejaculation, postsympathectomy syndrome, ileus, and cerebrospinal fluid (CSF) leak. Although CSF leakage is rare, we discuss a case of CSF leakage and the diagnosis and management of CSF leakage after lumbar total disc replacement. CASE DESCRIPTION A 25-year-old man had presented with discogenic low back pain caused by degenerative disc disease of 9 years' duration. His symptoms were exacerbated by activity, worse with sitting, and relieved by ice baths. He developed a cerebrospinal fluid leak after L5-S1 lumbar total disc replacement. CONCLUSIONS Our patient ultimately required device removal, direct repair, and replacement with a different prosthesis to treat his CSF leak.
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Affiliation(s)
- Robert Ryu
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Angelique Do
- Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Julie Chan
- Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Jason Cuellar
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Wouter Schievink
- Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Eli M Baron
- Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, California, USA.
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Rong Y, Wang J, Sui T, Liu W, Luo Y, Cai W. Cervical intradural disc herniation with Brown-Séquard syndrome: case report and literature review. J Pain Res 2019; 12:2403-2410. [PMID: 31534362 PMCID: PMC6682322 DOI: 10.2147/jpr.s200632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 06/25/2019] [Indexed: 01/23/2023] Open
Abstract
Objective To report a rare case of cervical intradural disc herniation (IDH) with Brown-Séquard syndrome and to review the related literature. Methods Pathogenesis, preoperative diagnosis, and the surgical technique are discussed, and previous literature reports are reviewed. Results A 44-year-old woman complained of weakness of the left upper and lower extremities and paresthesias in the right limbs after a bicycle ride 3 days earlier. She had a history of neck pain for 2 years prior. CT showed obvious ossification of the posterior longitudinal ligament (OPLL), and MRI revealed C3-7 disc herniations, with a positive “halo sign” around the herniated C4/5. We performed emergency decompression through anterior cervical corpectomy, and vertebrotomy decompression and fusion. At review 3 months after surgery, the patient’s neck pain was markedly relieved, and motor strength in the limbs had improved. At 1 year after surgery, she had recovered completely. Conclusion Cervical IDH is a rare condition that may be related to the traumatic inflammatory response and OPLL. Relatively rare imaging features such as the hawk-beak sign, halo sign, Y sign, and epidural gas sign could help in preoperative diagnosis. Prompt anterior cervical decompression is the preferred treatment for this condition.
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Affiliation(s)
- Yuluo Rong
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, People's Republic of China
| | - Jiaxing Wang
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, People's Republic of China
| | - Tao Sui
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, People's Republic of China
| | - Wei Liu
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, People's Republic of China
| | - Yongjun Luo
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, People's Republic of China
| | - Weihua Cai
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, People's Republic of China
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Morishita S, Yoshii T, Okawa A, Fushimi K, Fujiwara T. Perioperative complications of anterior decompression with fusion versus laminoplasty for the treatment of cervical ossification of the posterior longitudinal ligament: propensity score matching analysis using a nation-wide inpatient database. Spine J 2019; 19:610-616. [PMID: 30914129 DOI: 10.1016/j.spinee.2018.10.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Surgical treatment of cervical ossification of the posterior longitudinal ligament (OPLL) has a high risk of various complications. Anterior decompression with fusion (ADF) and laminoplasty (LAMP) are the most representative surgical procedures. However, few studies have compared the two procedures in terms of perioperative surgical complications. PURPOSE To compare the perioperative complications post-ADF and LAMP for cervical OPLL using a large national inpatient database. STUDY DESIGN A retrospective cohort study with propensity score matching analysis. PATIENT SAMPLE Overall, 8,718 (ADF/LAMP:1,333/7,485) patients who underwent surgery for cervical OPLL from April 1, 2010 to March 31, 2016 in hospitals using the diagnosis procedure combination were analyzed. OUTCOME MEASURES The occurrence of postoperative complications during hospitalization. METHODS We compared the perioperative systemic and local complications, reoperation rates, and costs between ADF and LAMP using propensity score matching analysis. RESULTS One-to-one matching resulted in 1,192 pairs of patients who underwent ADF and LAMP. The postoperative cardiovascular event rate was significantly higher (ADF/LAMP=1.9/0.8%, p=.013) in the ADF group. The incidence rates of dysphagia (similarly, 2.4/0.2%, p<.001), pneumonia (1.0/0.3%, p=.045), and spinal fluid leakage (2.4/0.4%, p<.001) were also higher in the ADF group, even after matching. The costs were also higher in the ADF group. However, surgical site infection (2.0/3.4%, p=.033) was significantly lower in the ADF group. No significant difference in the reoperation rates was found between the groups. CONCLUSION The present study, using a large nationwide database, demonstrated that perioperative complications were more common in the ADF group, but that surgical site infection (SSI) was more frequently observed in the LAMP group.
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Affiliation(s)
- Shingo Morishita
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
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Management of iatrogenic spinal cerebrospinal fluid leaks: A cohort of 124 patients. Clin Neurol Neurosurg 2018; 170:61-66. [DOI: 10.1016/j.clineuro.2018.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 04/10/2018] [Accepted: 04/21/2018] [Indexed: 11/21/2022]
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Guan Q, Xing F, Long Y, Xiang Z. Cervical intradural disc herniation: A systematic review. J Clin Neurosci 2018; 48:1-6. [DOI: 10.1016/j.jocn.2017.10.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/02/2017] [Indexed: 11/29/2022]
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Risk Factors and Management of Dural Defects in Anterior Surgery for Cervical Ossification of the Posterior Longitudinal Ligament. World Neurosurg 2017; 111:e527-e538. [PMID: 29288856 DOI: 10.1016/j.wneu.2017.12.113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate risk factors and outcomes and to develop a cogent perioperative management algorithm for dural defects (DDs) in anterior surgery for cervical ossification of the posterior longitudinal ligament (OPLL). METHODS Ninety OPLL patients who had undergone anterior cervical decompression between January 2014 and December 2016 were reviewed. DDs occurred in 12 patients. Demographic, clinical, and radiologic data; intraoperative and postoperative management; and complications were analyzed. Risk factors for DDs were assessed with multivariate analysis. A treatment algorithm was identified based on these findings and our experience. RESULTS The prevalence of DDs was 13.3% (12/90). Univariate and multivariate analyses showed that the ratio of OPLL base to spinal canal (odds ratio [OR] 1.09, P = 0.012), kyphotic cervical alignment with thick OPLL masses (OR 9.44, P = 0.026), and lateral, curved, and irregular OPLL masses (OR 8.28, P = 0.037) could be risk factors for DDs. DDs were repaired intraoperatively with onlay grafts, and lumbar drains were placed in all DD patients. The treatment was successful in all DD patients, and outcome measures did not differ between the DD and no DD groups. No patient had experienced complications associated with DDs and CSF leaks at the final follow-up visit. CONCLUSIONS Patients with broad-based OPLL, kyphotic cervical alignment with thick OPLL masses, and lateral, curved, and irregular OPLL masses have a higher risk of DD in anterior surgery for OPLL. Intraoperative primary repair with onlay grafts combined with early lumbar drains is a simple, safe, and effective strategy for DDs. The outlook for the long-term sequelae of DDs is optimistic if they are managed adequately.
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