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Battistelli M, Mazzucchi E, Muselli M, Polli FM, Galieri G, Bazzu P, Pignotti F, Olivi A, Sabatino G, La Rocca G. The Role of Psychosomatic Traits in Tailored Workup for Anterior Cervical Discectomy and Fusion-A Case Series. J Pers Med 2024; 14:454. [PMID: 38793039 PMCID: PMC11122414 DOI: 10.3390/jpm14050454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
STUDY DESIGN Prospective study. OBJECTIVE To evaluate the influence of preoperatively assessed psychosomatic traits on postoperative pain, disability, and quality of life outcomes. SUMMARY OF BACKGROUND DATA Anterior cervical discectomy and fusion (ACDF) is a widely employed surgical procedure for treating cervical spondylosis. Despite its effectiveness, various studies have reported non-success rates in terms of alleviating disability and pain. Psychological factors have become increasingly recognized as critical determinants of surgical outcomes in various medical disciplines. The full extent of their impact within the context of ACDF remains insufficiently explored. This case series aims to assess the influence of preoperative psychological profiling on long-term pain, disability and quality of life outcomes. METHODS We conducted a prospective cohort study of prospectively collected data from 76 consecutive patients who underwent ACDF with PEEK inter-fixed cages from July 2019 to November 2021. The preoperative psychological traits were assessed using the Symptom Checklist 90 (SCL-90) questionnaire. The Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), Neck Disability index (NDI), EuroQol-5D (EQ-5D), and Short Form-36 (SF-36) were collected preoperatively, one month postoperatively, and at least one year after the surgical procedure. RESULTS The correlation analyses revealed associations between psychosomatic traits and multiple preoperative and postoperative outcome measures. The univariate analyses and linear regression analyses demonstrated the influence of the Global Severity Index (GSI) over the final follow-up scores for the ODI, VAS, NDI, EQ-5D, and SF-36. The GSI consistently exhibited a stronger correlation with the final follow-up pain, disability, and quality of life outcomes with respect to the correspondent preoperative values. CONCLUSION This study highlights the importance of psychosomatic traits as predictive factors for ACDF outcomes and emphasizes their relevance in preoperative assessment for informing patients about realistic expectations. The findings underscore the need to consider psychological profiles in the preoperative workup, opening avenues for research into medications and psychological therapies. Recognizing the influence of psychosocial elements informs treatment strategies, fostering tailored surgical approaches and patient care.
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Affiliation(s)
- Marco Battistelli
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Edoardo Mazzucchi
- Department of Neurosurgery, Mater Olbia Hospital, 07026 Olbia, Italy; (E.M.); (F.P.)
| | - Mario Muselli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Filippo Maria Polli
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.P.); (A.O.); (G.S.); (G.L.R.)
| | - Gianluca Galieri
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Paola Bazzu
- Psychology and Psychotherapy Service, Mater Olbia Hospital, 07026 Olbia, Italy;
| | - Fabrizio Pignotti
- Department of Neurosurgery, Mater Olbia Hospital, 07026 Olbia, Italy; (E.M.); (F.P.)
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.P.); (A.O.); (G.S.); (G.L.R.)
| | - Giovanni Sabatino
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.P.); (A.O.); (G.S.); (G.L.R.)
| | - Giuseppe La Rocca
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.P.); (A.O.); (G.S.); (G.L.R.)
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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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Tang J, Gal JS, Geng E, Duey A, Ferriter P, Sicard R, Zaidat B, Girdler S, Rhee H, Zapolsky I, Al-Attar P, Markowitz J, Kim J, Cho S. An 11-Year-Long Analysis of the Risks Associated With Age in Patients Undergoing Anterior Cervical Discectomy and Fusion in a Large, Urban Academic Hospital. Global Spine J 2023:21925682231202579. [PMID: 37703497 DOI: 10.1177/21925682231202579] [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: 09/15/2023] Open
Abstract
STUDY DESIGN A retrospective database study of patients at an urban academic medical center undergoing an Anterior Cervical Discectomy and Fusion (ACDF) surgery between 2008 and 2019. OBJECTIVE ACDF is one of the most common spinal procedures. Old age has been found to be a common risk factor for postoperative complications across a plethora of spine procedures. Little is known about how this risk changes among elderly cohorts such as the difference between elderly (60+) and octogenarian (80+) patients. This study seeks to analyze the disparate rates of complications following elective ACDF between patients aged 60-69 or 70-79 and 80+ at an urban academic medical center. METHODS We identified patients who had undergone ACDF procedures using CPT codes 22,551, 22,552, and 22,554. Emergent procedures were excluded, and patients were subdivided on the basis of age. Then each cohort was propensity matched for univariate and univariate logistic regression analysis. RESULTS The propensity matching resulted in 25 pairs in both the 70-79 and 80+ y.o. cohort comparison and 60-69 and 80+ y.o. cohort comparison. None of the cohorts differed significantly in demographic variables. Differences between elderly cohorts were less pronounced: the 80+ y.o. cohort experienced only significantly higher total direct cost (P = .03) compared to the 70-79 y.o. cohort and significantly longer operative time (P = .04) compared to the 60-69 y.o. cohort. CONCLUSIONS Octogenarian patients do not face much riskier outcomes following elective ACDF procedures than do younger elderly patients. Age alone should not be used to screen patients for ACDF.
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Affiliation(s)
- Justin Tang
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan S Gal
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eric Geng
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Akiro Duey
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pierce Ferriter
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ryan Sicard
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bashar Zaidat
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven Girdler
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hannah Rhee
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ivan Zapolsky
- Department of Orthopedic Surgery, Penn Medicine at the University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Paul Al-Attar
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan Markowitz
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jun Kim
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel Cho
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Mesregah MK, Formanek B, Liu JC, Buser Z, Wang JC. Perioperative Complications of Surgery for Degenerative Cervical Myelopathy: A Comparison Between 3 Procedures. Global Spine J 2023; 13:432-442. [PMID: 33709809 PMCID: PMC9972283 DOI: 10.1177/2192568221998306] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVES To compare the perioperative complications of propensity score-matched cohorts of patients with degenerative cervical myelopathy (DCM), who were treated with anterior cervical discectomy and fusion (ACDF), posterior laminectomy with fusion, or laminoplasty. METHODS The Humana PearlDiver Patient Record Database was queried using the International Classification of Diseases (ICD-9 and ICD-10) and the Current Procedural Terminology (CPT) codes. Propensity score-matched analysis was done using multiple Chi-squared tests with Bonferroni correction of the significance level. RESULTS Cohorts of 11,790 patients who had ACDF, 2,257 patients who had posterior laminectomy with fusion, and 477 patients who had laminoplasty, were identified. After propensity score matching, all the 3 groups included 464 patients. The incidence of dysphagia increased significantly following ACDF compared to laminoplasty, P < 0.001, and in laminectomy with fusion compared to laminoplasty, P < 0.001. The incidence of new-onset cervicalgia was higher in ACDF compared to laminoplasty, P = 0.005, and in laminectomy with fusion compared to laminoplasty, P = 0.004. The incidence of limb paralysis increased significantly in laminectomy with fusion compared to ACDF, P = 0.002. The revision rate at 1 year increased significantly in laminectomy with fusion compared to laminoplasty, P < 0.001, and in ACDF compared to laminoplasty, P < 0.001. CONCLUSIONS The incidence of dysphagia following laminectomy with fusion was not different compared to ACDF. Postoperative new-onset cervicalgia and revisions were least common in laminoplasty. The highest rate of postoperative limb paralysis was noticed in laminectomy with fusion.
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Affiliation(s)
- Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Keck School of Medicine, University of
Southern California, Los Angeles, CA, USA,Department of Orthopaedic Surgery,
Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt
| | - Blake Formanek
- Department of Orthopaedic Surgery, Keck School of Medicine, University of
Southern California, Los Angeles, CA, USA
| | - John C. Liu
- Department of Neurosurgery, Keck School
of Medicine, University of Southern
California, Los Angeles, CA, USA
| | - Zorica Buser
- Department of Orthopaedic Surgery, Keck School of Medicine, University of
Southern California, Los Angeles, CA, USA,Zorica Buser, Department of Orthopaedic
Surgery, Keck School of Medicine, University of Southern California, 1450 San
Pablo St, HC4-#5400A, Los Angeles, CA 90033, USA.
| | - Jeffrey C. Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of
Southern California, Los Angeles, CA, USA
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5
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Lin PI, Chen TH, Chung HH, Su TM, Ma CC, Ou TC. Factors Associated with Postoperative Rehospitalization in Patients with Cervical Disc Herniation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031687. [PMID: 35162713 PMCID: PMC8835259 DOI: 10.3390/ijerph19031687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 02/05/2023]
Abstract
Cervical disc herniation (CDH) is a prevalent disease because of the poor living habits of and great pressure in modern society. Patients experience hand numbness, neck stiffness, soreness, and weakness due to neck nerve root compression, which leads to a gradual increase of neurosurgery outpatients. Although poor posture by the overuse of computers is possibly the origin of CDH, analysis of related factors causing the rehospitalization for CDH patients after surgery in Taiwan is not commonly reported. Thus, the present study focused on the demographics and surgery-related treatment on the relevance of rehospitalization for CDH patients after surgery. The design of the study was retrospective, and we collected data by medical record review, which was derived from the inpatient surgery data of patients at a medical center in southern Taiwan. The study lasted two years from 1 January 2017 to 31 December 2018, and a total of 248 patients underwent surgery for intervertebral disc protrusion in the neck. The retrospective study adopted narrative statistics, the chi-squared test, and binary logistic regression analysis to identify factors affecting postoperative rehospitalization. Among 248 postoperative patients with intervertebral disc protrusion, 178 underwent cervical fusion surgery, and 32 were rehospitalized after surgery for one-year follow up, accounting for an overall prevalence rate of 12.9%. There were no significant differences in sex, age, occupation, hypertension, anterior cervical discectomy and fusion, artificial disc replacement, hybrid surgery, and postoperative cervical coil use (p > 0.05). The results of binary logistic regression analysis showed statistically significant differences in abnormal body mass index (p = 0.0187, 95% CI = 1.238-10.499), diabetes (p = 0.0137, 95% CI = 1.288-9.224) and cervical vertebral surgery hospital days (p = 0.0004, 95% CI = 1.028-1.102), predicting the outcome of rehospitalization for CDH patients after surgery. The above results showed that abnormal body mass index, diabetes, and cervical vertebral surgery hospitalization days impacted rehospitalization in CDH patients after surgery. Thus, to prevent diabetes, weight control must be monitored, and maintaining correct posture can reduce CDH and decrease the rate of rehospitalization after surgery, which provides a critical reference for hospital managers and clinical staff.
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Affiliation(s)
- Pei-I Lin
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan;
| | - Tai-Hsiang Chen
- Administrative Office, Weihope Clinic, Kaohsiung 804, Taiwan;
- College of Management, Yuan Ze University, Taoyuan 320, Taiwan
| | - Hsien-Hui Chung
- Department of Pharmacy and Master Program, College of Pharmacy and Health Care, Tajen University, Pingtung County 907, Taiwan;
| | - Tsung-Ming Su
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan;
- College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan
| | - Chen-Chung Ma
- Department of Healthcare Administration, I-Shou University, Kaohsiung 824, Taiwan
- Correspondence: (C.-C.M.); (T.-C.O.); Tel.: +886-7615-1100 (ext. 7602) (C.-C.M.); +886-2263-0588 (ext. 6091) (T.-C.O.)
| | - Tzu-Chi Ou
- Department of Medical Education, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei 236, Taiwan
- Correspondence: (C.-C.M.); (T.-C.O.); Tel.: +886-7615-1100 (ext. 7602) (C.-C.M.); +886-2263-0588 (ext. 6091) (T.-C.O.)
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Ke W, Chen C, Wang B, Hua W, Lu S, Song Y, Luo R, Liao Z, Li G, Ma L, Shi Y, Wang K, Li S, Wu X, Zhang Y, Yang C. Biomechanical Evaluation of Different Surgical Approaches for the Treatment of Adjacent Segment Diseases After Primary Anterior Cervical Discectomy and Fusion: A Finite Element Analysis. Front Bioeng Biotechnol 2021; 9:718996. [PMID: 34532313 PMCID: PMC8438200 DOI: 10.3389/fbioe.2021.718996] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/13/2021] [Indexed: 12/31/2022] Open
Abstract
Symptomatic adjacent segment disease (ASD) is a common challenge after anterior cervical discectomy and fusion (ACDF). The objective of this study was to compare the biomechanical effects of a second ACDF and laminoplasty for the treatment of ASD after primary ACDF. We developed a finite element (FE) model of the C2-T1 based on computed tomography images. The FE models of revision surgeries of ACDF and laminoplasty were simulated to treat one-level and two-level ASD after primary ACDF. The range of motion (ROM) and intradiscal pressure (IDP) of the adjacent segments, and stress in the cord were analyzed to investigate the biomechanical effects of the second ACDF and laminoplasty. The results indicated that revision surgery of one-level ACDF increased the ROM and IDP at the C2–C3 segment, whereas two-level ACDF significantly increased the ROM and IDP at the C2–C3 and C7-T1 segments. Furthermore, no significant changes in the ROM and IDP of the laminoplasty models were observed. The stress in the cord of the re-laminoplasty model decreased to some extent, which was higher than that of the re-ACDF model. In conclusion, both ACDF and laminoplasty can relieve the high level of stress in the spinal cord caused by ASD after primary ACDF, whereas ACDF can achieve better decompression effect. Revision surgery of the superior ACDF or the superior and inferior ACDF after the primary ACDF increased the ROM and IDP at the adjacent segments, which may be the reason for the high incidence of recurrent ASD after second ACDF.
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Affiliation(s)
- Wencan Ke
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chao Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bingjin Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenbin Hua
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Saideng Lu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Song
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rongjin Luo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiwei Liao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gaocai Li
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Ma
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yunsong Shi
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuai Li
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinghuo Wu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yukun Zhang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cao Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Gajski D, Dennis AR, Arnautovic KI. Surgical anatomy of microsurgical 3-level anterior cervical discectomy and fusion C4-C7. Bosn J Basic Med Sci 2021; 21:258-260. [PMID: 32563239 PMCID: PMC8112558 DOI: 10.17305/bjbms.2020.4895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/15/2020] [Indexed: 11/16/2022] Open
Abstract
Anterior cervical discectomy and fusion (ACDF) is one of the most common spinal procedures, frequently used for the treatment of cervical spine degenerative diseases. It was first described in 1958. Interestingly, to our knowledge, 3-level ACDF has not been previously published as a peer-reviewed video case with a detailed description of intraoperative microsurgical anatomy. In this video, we present the case of a 33-year-old male who presented with a combination of myelopathy (hyperreflexia and long tract signs in the upper and lower extremities) and bilateral radiculopathy of the upper extremities. He had been previously treated conservatively with physical therapy and pain management for 6 months without success. We performed 3-level microsurgical ACDF from C4 to C7. All 3 levels were decompressed, and bone allografts were placed to achieve intervertebral body fusion. A titanium plate was utilized from C4 to C7 for internal fixation. The patient was discharged home on the first postoperative day. His pain, numbness and tingling resolved, as well as his myelopathy. No perioperative complications were encountered. Herein we present the surgical anatomy of our operative technique including certain technical tips. Written consent was obtained directly from the patient.
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Affiliation(s)
- Domagoj Gajski
- Department of Neurosurgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia; Department of Anatomy and Physiology, University of Applied Health Sciences, Zagreb, Croatia; School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Alicia R Dennis
- Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee, United States
| | - Kenan I Arnautovic
- Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee, United States; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
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Abstract
BACKGROUND Back pain is a common chief complaint within the United States and is caused by a multitude of etiologies. There are many different treatment modalities for back pain, with a frequent option being spinal fusion procedures. The success of spinal fusion greatly depends on instrumentation, construct design, and bone grafts used in surgery. Bone allografts are important for both structural integrity and providing a scaffold for bone fusion to occur. METHOD Searches were performed using terms "allografts" and "bone" as well as product names in peer reviewed literature Pubmed, Google Scholar, FDA-510k approvals, and clinicaltrials.gov. RESULTS This study is a review of allografts and focuses on currently available products and their success in both animal and clinical studies. CONCLUSION Bone grafts used in surgery are generally categorized into 3 main types: autogenous (from patient's own body), allograft (from cadaveric or living donor), and synthetic. This paper focuses on allografts and provides an overview on the different subtypes with an emphasis on recent product development and uses in spinal fusion surgery.
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Affiliation(s)
- Justin D. Cohen
- Department of
Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Linda E. Kanim
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Andrew J. Tronits
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Hyun W. Bae
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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9
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Revision surgery of an older patient with adjacent segment disease (ASD) following anterior cervical discectomy and fusion by PCB: A case report. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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10
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Mangan JJ, Goyal DKC, Divi SN, Bowles DR, Nicholson KJ, Mujica VE, Lee TJ, DePaola RV, Saline A, Fang T, Galetta MS, Kaye ID, Kurd MF, Woods BI, Radcliff KE, Rihn JA, Anderson DG, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. Does Smoking Status Influence Health-Related Quality of Life Outcome Measures in Patients Undergoing ACDF? Global Spine J 2021; 11:50-56. [PMID: 32875848 PMCID: PMC7734264 DOI: 10.1177/2192568219890292] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVE Whereas smoking has been shown to affect the fusion rates for patients undergoing an anterior cervical discectomy and fusion (ACDF), the relationship between smoking and health-related quality of life outcome measurements after an ACDF is less clear. The purpose of this study was to evaluate whether smoking negatively affects patient outcomes after an ACDF for cervical degenerative pathology. METHODS Patients with tumor, trauma, infection, and previous cervical spine surgery and those with less than a year of follow-up were excluded. Smoking status was assessed by self-reported smoking history. Patient outcomes, including Neck Disability Index, Short Form 12 Mental Component Score, Short Form 12 Physical Component Score (PCS-12), Visual Analogue Scale (VAS) arm pain, VAS neck pain, and pseudarthrosis rates were evaluated. Outcomes were compared between smoking groups using multiple linear and logistic regression, controlling for age, sex, and body mass index (BMI), among other factors. A P value <.05 was considered significant. RESULTS A total of 264 patients were included, with a mean follow-up of 19.8 months, age of 53.1 years, and BMI of 29.6 kg/m2. There were 43 current, 69 former, and 152 nonsmokers in the cohort. At baseline, nonsmokers had higher PCS-12 scores than current smokers (P = .010), lower VAS neck pain than current (P = .035) and former (P = .014) smokers, as well as lower VAS arm pain than former smokers (P = .006). Postoperatively, nonsmokers had higher PCS-12 scores than both current (P = .030) and former smokers (P = .035). Smoking status was not a significant predictor of change in patient outcome in multivariate analysis. CONCLUSIONS Whereas nonsmokers had higher function and lower pain than former or current smokers preoperatively, smoking status overall was not found to be an independent predictor of outcome scores after ACDF. This supports the notion that smoking status alone should not deter patients from undergoing ACDF for cervical degenerative pathology.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Taolin Fang
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | - Mark F. Kurd
- Thomas Jefferson University, Philadelphia, PA, USA
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11
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Mostofi K, Peyravi M, Moghadam BG. Cervicothoracic junction disc herniation: Our experience, technical remarks, and outcome. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:22-25. [PMID: 32549708 PMCID: PMC7274365 DOI: 10.4103/jcvjs.jcvjs_102_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 02/25/2020] [Indexed: 12/29/2022] Open
Abstract
Background: C7-D1 disc herniation is rare in comparison with other cervical levels. The incidence rates are between 3.5% and 8%. The cervicothoracic junction disc herniation can be operated posteriorly or anteriorly. The anterior approach can be challenging because of the difficulty of access resulted from the manubrium. In this article, we present our experience about cervicothoracic junction disc herniation (C7-T1) surgery. Materials and Methods: Between January 2008 and December 2017, 21 patients have been operated for solitary C7-T1 disc herniation. We operated 12 male patients and 9 female patients. Eight patients have been operated by the anterior approach, and 13 patients underwent surgery by the posterior approach. The mean symptoms duration was 11.4 months. Results: All patients had C8 cervicobrachial neuralgia. Other clinical presentations were numbness, tingling sensation, and weakness. All patients improved after surgery. We had no significant complication. Conclusion: We did not find a great difference between the clinical features of cervicothoracic herniated disc and other cervical levels. The anterior approach seems more difficult to carry out in particularly in large patients with the short neck. The posterior approach can be used for all types of patients except in the case of medial disc herniation.
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Affiliation(s)
- Keyvan Mostofi
- Department of Neurosurgery, Centre Clinical, Chirurgie De Rachis, Soyaux, France
| | - Morad Peyravi
- Department of Neurosurgery, Carl-Thiem-Klinikum, Academic Teaching Hospital of Charity Medical University of Berlin, Berlin, Germany
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12
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Zhang Y, Shao Y, Liu H, Zhang J, He F, Chen A, Yang H, Pi B. Association between sagittal balance and adjacent segment degeneration in anterior cervical surgery: a systematic review and meta-analysis. BMC Musculoskelet Disord 2019; 20:430. [PMID: 31521137 PMCID: PMC6745077 DOI: 10.1186/s12891-019-2800-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 08/29/2019] [Indexed: 12/30/2022] Open
Abstract
Background ASD is a relatively common degenerative alteration after cervical surgery which occurs above or below the fused segment. In addition, some patients may need reoperation to treat severe ASD after the primary surgery. It was considered that sagittal balance is correlated with postoperative clinical outcomes; however, few studies have reported the influence of sagittal balance on ASD. The present study is designed to investigate whether sagittal balance impacts the pathology of adjacent segment disease (ASD) in patients who undergo anterior cervical surgery for degenerative cervical disease. Methods Databases including Pubmed, Embase, Cochrane library, and Web of Science were used to search for literature published before June 2018. Review Manager 5.3 was used to perform the statistical analysis. Sagittal balance parameters before and after surgery were compared between patients with and without ASD. Weighted mean difference (WMD) was summarized for continuous data and P < 0.05 was set for the level of significance. Results A total of 221 patients with ASD and 680 patients without ASD from seven articles were studied in this meta-analysis. There were no significant differences in most sagittal balance parameters between the two groups, except for postoperative cervical lordosis (CL) (WMD -3.30, CI -5.91, − 0.69, P = 0.01). Conclusions Some sagittal balance parameters may be associated with the development of ASD after anterior cervical surgery. Sufficient restoration of CL may decrease the incidence of ASD. The results in present study needed to be expanded carefully and further high-quality studies are warranted to investigate the impact of sagittal balance on ASD. Electronic supplementary material The online version of this article (10.1186/s12891-019-2800-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yijian Zhang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, China.,Orthopedic Institute, Soochow University, Suzhou, 215006, China
| | - Yijie Shao
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, China.,Orthopedic Institute, Soochow University, Suzhou, 215006, China
| | - Hao Liu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, China.,Orthopedic Institute, Soochow University, Suzhou, 215006, China
| | - Junxin Zhang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, China.,Orthopedic Institute, Soochow University, Suzhou, 215006, China
| | - Fan He
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, China.,Orthopedic Institute, Soochow University, Suzhou, 215006, China
| | - Angela Chen
- Department of School of Public Health and Health Systems, Faculty of Applied Health Sciences Biochemistry Department, University of Waterloo, Waterloo, Canada
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, China. .,Orthopedic Institute, Soochow University, Suzhou, 215006, China.
| | - Bin Pi
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, China. .,Orthopedic Institute, Soochow University, Suzhou, 215006, China.
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13
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A Novel Competing Risk Analysis Model to Determine the Role of Cervical Lordosis in Bony and Ligamentous Injuries. World Neurosurg 2018; 119:e962-e967. [PMID: 30114533 DOI: 10.1016/j.wneu.2018.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine role of lordosis in cervical spine injuries using a novel competing risk analysis model. METHODS The first subgroup of published experiments (n = 20) subjected upright human cadaver head-neck specimens to impact loading. The natural lordosis was removed. The second (n = 21) and third (n = 10) subgroups of published tests subjected inverted specimens to head impact loading. Lordosis was preserved in these 2 subgroups. Using axial force and age as variables, competing risks analysis techniques were used to determine the role of lordosis in the risk of bone-only, ligament-only, and bone and ligament injuries. RESULTS Bony injuries were focused more at 1 level to a straightened spine, and ligament injuries were spread around multiple levels. Age was not a significant (P < 0.05) covariate. A straightened spine had 3.23 times higher risk of bony injuries than a lordotic spine. The spine with maintained lordosis had 1.14 times higher risk of ligament injuries, and 2.67 times higher risk of bone and ligament injuries than a spine without lordosis (i.e., preflexed column). CONCLUSIONS Increased risk of bony injuries in a preflexed spine and ligament injuries in a lordotic spine may have implications for military personnel, as continuous use of helmets in the line of duty affects the natural curvature; astronauts, as curvatures are less lordotic after missions; and civilian patients with spondylotic myelopathy who use head protective devices, as curvatures may change over time in addition to the natural aging process.
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Doria C, Mosele GR, Balsano M, Maestretti G, Caggiari G. Anterior decompression and plate fixation in treatment of cervical myelopathy: A multicentric retrospective review. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:185-190. [PMID: 29544917 PMCID: PMC6136330 DOI: 10.1016/j.aott.2017.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/22/2017] [Accepted: 12/07/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the results on anterior decompression and fusion with titanium mesh or expanding cage and plate fixation in patients with cervical myelopathy. METHODS We conducted a retrospective multicentric review of 114 patients, 75 males and 39 females, with cervical myelopathy who underwent surgical treatment between July 2009 to December 2011. All surgeries were performed via a ventral approach. Based on the type of surgery the patients received, they were divided into 3 groups: group 1 consisted of 49 patients who received multilevel corpectomies and fusion with strut iliac bone graft and plates; group 2 consisted of 26 patients who received multilevel corpectomies and fusion with titanium expanding cage and plating; group 3 consisted of 39 patients who received multilevel corpectomies and fusion using titanium mesh with autologous bone graft and anterior plating. RESULTS Decompression of the cervical spinal cord and grafting with plate fixation via a ventral approach demonstrated a high rate of improvement in neurological function with minimal complications. Fusion was documented radiologically in all cases. Eighty-three patients experienced a partial improvement and 41 had a complete recovery according to Nurick's myelopathy grading. Sixty-two patients were ranked as excellent, 48 as good, 4 as fair; unsatisfactory outcome was related to donor site complications. CONCLUSION Spinal decompression and fusion with titanium cages and plates appears to be a safe and effective alternative in patients with cervical spinal myelopathy. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Carlo Doria
- Orthopaedic Department, University of Sassari, Sassari, Italy
| | | | - Massimo Balsano
- Orthopaedic Department, Santorso Hospital AUSSL 4 Schio, Italy
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