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Wang S, Song H, Xu X, Ling S, Wang Y, Sun J, Shi J. The CT Classification of Multilevel Cervical Ossification of the Posterior Longitudinal Ligament to Guide Hybrid Anterior Controllable Antedisplacement and Fusion vs. Posterior Laminoplasty. Orthop Surg 2024. [PMID: 38773680 DOI: 10.1111/os.14088] [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: 01/08/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/24/2024] Open
Abstract
OBJECTIVE For precise and minimally invasive treatment of ossification of the posterior longitudinal ligament of the cervical spine, the lifting segment is minimized, anterior controllable antedisplacement and fusion (ACAF) was refined and improved. In addition, the development of appropriate surgical procedures for the ossification of each segment was rarely reported. Therefore, this study aimed to compare the efficacy and safety of hybrid anterior controlled antedisplacement fusion (Hybrid ACAF) with laminoplasty for multilevel ossification of the posterior longitudinal ligament (OPLL). METHODS Between May 2018 and May 2021, 70 patients with multilevel OPLL were divided into a hybrid ACAF group and a laminoplasty group according to surgical methods. All patients were followed up for at least 1 year. Japanese Orthopaedic Association (JOA) score and recovery rate (JOARR), (VAS, NDI) score and C2-C7 Cobb angle, the sagittal vertical axis of the neck (SVA), and complications (cerebrospinal fluid leakage, C5 paralysis, etc.) were compared between the two groups by t test or non-parametric test. RESULTS The operation time of hybrid ACAF was longer. C5 paralysis and axial pain were more common in the laminoplasty group, while dysphagia and hoarseness were more common in the hybrid ACAF group. At the last follow-up, the hybrid ACAF group had better recovery and maintenance of cervical lordosis and sagittal plane balance and a higher JOA score and recovery rate than the laminoplasty group. CONCLUSIONS Hybrid ACAF can reduce the number of vertebral bodies and expand the decompression range, which is safe, effective, and tailored to local conditions. Compared with laminoplasty, hybrid ACAF is a precise alternative for patients with OPLL.
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Affiliation(s)
- Shunmin Wang
- Department of Orthopaedics, Changzheng Hospital Navy Military Medical University, Shanghai, People's Republic of China
- 910 Hospital of China Joint Logistics Support Force, Quanzhou, China
| | - Haibo Song
- Dongying People's Hospital, Dongying City, China
| | - Ximing Xu
- Department of Orthopaedics, Changzheng Hospital Navy Military Medical University, Shanghai, People's Republic of China
| | - Shiyong Ling
- Shanghai Jing'an District Zhabei Center Hospital, Shanghai, China
| | - Yuan Wang
- Department of Orthopaedics, Changzheng Hospital Navy Military Medical University, Shanghai, People's Republic of China
| | - Jingchuan Sun
- Department of Orthopaedics, Changzheng Hospital Navy Military Medical University, Shanghai, People's Republic of China
| | - Jiangang Shi
- Department of Orthopaedics, Changzheng Hospital Navy Military Medical University, Shanghai, People's Republic of China
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Sun X, Li F, Zhao B, Zhang B, Sun K, Sun J, Xu X, Wang Y, Shi J. A Clinical Classification of Cervical Ossification of the Posterior Longitudinal Ligament to Guide Surgical Strategy. Spine (Phila Pa 1976) 2024; 49:239-246. [PMID: 37982704 DOI: 10.1097/brs.0000000000004878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/04/2023] [Indexed: 11/21/2023]
Abstract
STUDY DESIGN A clinical classification of cervical ossification of the posterior longitudinal ligament (COPLL) was developed based on imaging findings. OBJECTIVE This study aimed to establish a clinical classification for COPLL and provide corresponding surgery strategies for each subtype. SUMMARY OF BACKGROUND DATA A practical and reliable classification is needed to guide the treatment of COPLL. MATERIALS AND METHODS This study retrospectively reviewed plain radiographs, computed tomography scans, and magnetic resonance images of patients diagnosed with COPLL between 2018 and 2022 at Shanghai Changzheng Hospital. The types of COPLL were classified according to the location, morphology, and canal-occupying ratio (OR) of the ossification mass. Interobserver and intraobserver reliability were evaluated using Cohen's kappa. RESULTS A total of 1000 cases were included, which were classified into five types: focal type (F type), short-sequential type (S type), long-sequential type (L type), high type (H type), and mixed type (M type). In addition, each type could be classified into subtype 1 or subtype 2 according to the canal-OR. Then each type could be further classified into other subtypes according to location and morphology. The interobserver reliabilities in the first and second rounds were 0.853 and 0.887, respectively. The intraobserver reliability was 0.888. CONCLUSION The authors classified COPLL into a system comprised of five types and several subtypes according to canal-OR, location, and morphology. Surgical strategies for each subtype are also suggested. This provides a theoretical guide for the description and surgical management of COPLL.
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Affiliation(s)
- Xiaofei Sun
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Fudong Li
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Baolian Zhao
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Bin Zhang
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Kaiqiang Sun
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
- Department of Orthopaedic Surgery, Naval Medical Center, Navy Medical University, Shanghai, People's Republic of China
| | - Jingchuan Sun
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Ximing Xu
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Yuan Wang
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Jiangang Shi
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
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Wang S, Shi J, Sun J. How cervical curvature changes after ACAF and ACDF: a radiological retrospective study. Neurosurg Rev 2023; 46:188. [PMID: 37523095 DOI: 10.1007/s10143-023-02049-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/02/2023] [Accepted: 06/10/2023] [Indexed: 08/01/2023]
Abstract
To assess changes in cervical curvature and demonstrate the feasibility of using ACAF technology to restore lordosis, imaging data from patients undergoing multilevel ACAF and ACDF surgeries were retrospectively analyzed. Forty-seven patients receiving multilevel ACAF and ACDF were included in the study. Total cervical curvature and anterior, middle, and posterior column curvature, spinal canal diameter, cervical range of motion, and surgical complications were measured and analyzed by non-parametric or chi-square tests before and after surgery. The Spearman correlation between imaging data was analyzed. Compared with ACDF, the operation time of the ACAF group was longer, the cervical motion was larger, the median and change value of the middle column curvature was larger, and the change value of the posterior column curvature was smaller (P < 0.05). The postoperative differences in cervical lordosis angle, vertebral canal diameter, and middle and posterior column curvature in the ACAF group were significantly greater than those in the ACDF group (p = 0.015). The expansion of vertebral canal diameter was significantly correlated with the difference in curvature between the middle and posterior columns (r = 0.523, P < 0.01), and the curvature of the anterior column was correlated with that of the middle and posterior columns (P < 0.05). The curvature change of the anterior column is closely related to the curvature change of the middle column and the posterior column. Compared with ACDF, ACAF expands the diameter and volume of the spinal canal by increasing the curvature of the middle column and reducing the anterior movement of the posterior column.
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Affiliation(s)
- Shunmin Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University No.415 Fengyang Road, Shanghai, 200003, People's Republic of China
- 910 Hospital of China Joint Logistics Support Force, 180 Garden Road, Fengze District, Quanzhou City, Fujian Province, People's Republic of China
| | - Jiangang Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University No.415 Fengyang Road, Shanghai, 200003, People's Republic of China.
| | - Jingchuan Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University No.415 Fengyang Road, Shanghai, 200003, People's Republic of China.
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Wang S, Sun J, Han D, Fan J, Yu Mm Y, Yang Mm H, Gao C, Zhou X, Guo Y, Shi J. Magnetic Resonance Imaging-CCCFLS Scoring System: Toward Predicting Clinical Symptoms and C5 Paralysis. Global Spine J 2023:21925682231170607. [PMID: 37203443 DOI: 10.1177/21925682231170607] [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: 05/20/2023] Open
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To develop a new MRI scoring system to assess patients' clinical characteristics, outcomes and complications. METHODS A retrospective 1-year follow-up study of 366 patients with cervical spondylosis from 2017 to 2021. The CCCFLS scores (cervical curvature and balance (CC), spinal cord curvature (SC), spinal cord compression ratio (CR), cerebrospinal fluid space (CFS). Spinal cord and lesion location (SL). Increased Signal Intensity (ISI) were divided into Mild group (0-6), Moderate group (6-12), and Severe group (12-18) for comparison, and the Japanese Orthopaedic Association (JOA) scores, visual analog scale (VAS), numerical rating scale (NRS), Neck Disability Index (NDI) and Nurick scores were evaluated. Correlation and regression analyses were performed between each variable and the total model in relation to clinical symptoms and C5 palsy. RESULTS The CCCFLS scoring system was linearly correlated with JOA, NRS, Nurick and NDI scores, with significant differences in JOA scores among patients with different CC, CR, CFS, ISI scores, with a predictive model (R2 = 69.3%), and significant differences in preoperative and final follow-up clinical scores among the 3 groups, with a higher rate of improvement in JOA in the severe group (P < .05), while patients with and without C5 paralysis had significant differences in preoperative SC and SL (P < .05). CONCLUSIONS CCCFLS scoring system can be divided into mild (0-6). moderate (6-12), severe (12-18) groups. It can effectively reflect the severity of clinical symptoms, and the improvement rate of JOA is better in the severe group, while the preoperative SC and SL scores are closely related to C5 palsy. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Shunmin Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
- 910 Hospital, Quanzhou, China
| | - Jingchuan Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Dan Han
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jianping Fan
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yaping Yu Mm
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Haiqin Yang Mm
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chunyan Gao
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - XiaoNan Zhou
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yongfei Guo
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jiangang Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Yang H, Sun Y, Wang L, Guo Q, Jiang J, Lu X. Anterior Canal Reconstruction and Fusion for Myelopathy Caused by Degenerative Cervical Kyphosis and Stenosis With or Without Ossification of the Posterior Longitudinal Ligament. Clin Spine Surg 2022; 35:E53-E61. [PMID: 34039887 DOI: 10.1097/bsd.0000000000001194] [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: 12/28/2020] [Accepted: 04/14/2021] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a retrospective study. OBJECTIVE To introduce an anterior surgical technique for myelopathy caused by degenerative cervical kyphosis and stenosis (DCKS) with or without ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA The optimal approach in the treatment of DCKS remains a controversy because each anterior or posterior route surgery has advantages and disadvantages. MATERIALS AND METHODS In the period from June 2017 through June 2019, a consecutive cohort of adults diagnosed with DCKS underwent anterior canal reconstruction and fusion (ACRF). All patients underwent x-ray, computed tomography, and magnetic resonance imaging of the cervical spine. Radiologic assessment included kyphosis, canal area, canal reconstruction, OPLL, and spinal cord curvature and morphology. The Japanese Orthopaedic Association (JOA) scoring system was used to evaluate the neurological status. Surgery-related and implant-related complications were all recorded. Follow-up was carried out at 3, 6, 12, 24, and 36 months postoperation. RESULTS Fourty-one patients were included in the study, of which 19 presented with OPLL. Postoperatively, the canal area were significantly greater at last follow-up compared with preoperation (208.4 vs. 123.2 mm2; P=0.001). There was significant kyphosis correction (-17.6 vs. 8.5 degrees, P=0.001) at last follow-up. Ninety-six segmental canal reconstruction were performed, 89 (92.7%) reached bone fusion at both grooves with a mean time of 7.9 months. On sagittal magnetic resonance imaging, 33 (80.5%) patients presented with lordosis in the spinal cord curvature, 8 (19.5%) with straight. The mean JOA score at last follow-up was significantly better than preoperation (15.0 vs. 9.3 points; P<0.01). One patient presented with cerebrospinal fluid leakage, 1 with screw displacement and 2 with dysphagia. CONCLUSION ACRF, receiving good correction of kyphosis, amplified canal area, solid instrumented fusion and circumferential decompression, is an effective and safe surgical technique for cervical myelopathy caused by DCKS with or without OPLL. LEVEL OF EVIDENCE Level III-a retrospective analysis.
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Affiliation(s)
- Haisong Yang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Luo X, Wang S, Sun K, Sun J, Wang Y, Jiang J, Zhao F, Guo Y, Shi J. Anterior Controllable Antedisplacement and Fusion (ACAF) Technique for the Treatment of Multilevel Cervical Spondylotic Myelopathy With Spinal Stenosis (MCSMSS): A Retrospective Study of 54 Cases. Clin Spine Surg 2021; 34:322-330. [PMID: 34379608 DOI: 10.1097/bsd.0000000000001144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 11/07/2020] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To investigate the clinical effect of anterior controllable antedisplacement and fusion (ACAF) technique for the treatment of multilevel cervical spondylotic myelopathy with spinal stenosis (MCSMSS), compared with hybrid decompression fixation (HDF). SUMMARY OF BACKGROUND DATA A retrospective analysis of 94 cases with MCSMSS was carried out. Fifty-four patients were treated with ACAF, whereas 40 patients were treated with HDF. METHODS The operation time, intraoperative blood loss, postoperative complications, Japanese Orthopedic Association score, Neck Disability Index score, parameters at axial computed tomography, cervical curvature and the Kang grade were compared between 2 groups. RESULTS The patients were followed up for 12-17 (15.6±1.6) months. Compared with HDF, ACAF group achieved better decompression according to computed tomography measurement and Kang grade (P<0.05), and recovered to a greater cervical Cobb angle (P<0.05). However, Japanese Orthopedic Association score and Neck Disability Index showed no significant difference 1 year after surgery (P>0.05). In addition, ACAF presented longer operation time (P<0.05) and similar intraoperative blood loss (P>0.05), compared with HDF. In terms of complications, ACAF produced less incidences of cerebrospinal fluid leakage, implant complication, epidural hematoma, and C5 palsy compared with HDF. CONCLUSIONS ACAF is an effective method for the treatment of MCSMSS. In comparison to HDF, ACAF has the advantages of more sufficient decompression, more satisfactory cervical curvature, and lower incidence rates of complications.
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Affiliation(s)
- Xi Luo
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai
| | - Shunmin Wang
- Department of Orthopedics, 910 Hospital, Quanzhou, China
| | - Kaiqiang Sun
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai
| | - Jingchuan Sun
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai
| | - Yuan Wang
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai
| | - Jialin Jiang
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai
| | - Feng Zhao
- Department of Orthopedics, 910 Hospital, Quanzhou, China
| | - Yongfei Guo
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai
| | - Jiangang Shi
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai
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Yan C, Jia HC, Tan HY, Yu XW, Li M, Zhou XY, Yang MY, Song DW, Zhao QH, Li GZ, Tang SH, Yu BS, Li LT, Sun JC, Shi JG. How much space of the spinal canal should be restored by hoisting the vertebrae-OPLL complex for sufficient decompression in anterior controllable antedisplacement and fusion? A multicenter clinical radiological study. Spine J 2021; 21:273-283. [PMID: 32966909 DOI: 10.1016/j.spinee.2020.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/31/2020] [Accepted: 09/16/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Anterior controllable antedisplacement and fusion (ACAF) is a novel surgical technique for the treatment of ossification of the posterior longitudinal ligament (OPLL). Its prognostic factors for decompression have not been well studied. Additionally, no detailed radiological standard has been set for hoisting the vertebrae-OPLL complex (VOC) in ACAF. PURPOSE To identify the possible prognostic factors for decompression outcomes after ACAF for cervical OPLL, to determine the critical value of radiological parameters for predicting good outcomes, and to establish a radiological standard for hoisting the VOC in ACAF. STUDY DESIGN This was a retrospective multicenter study. PATIENT SAMPLE A total of 121 consecutive patients with OPLL who underwent ACAF at a point between January 2017 and June 2018 at any one of seven facilities and were monitored for at least 1 year afterward were enrolled in a multicenter study. OUTCOME MEASURES Japanese Orthopedic Association (JOA) scores, recovery rate (RR) of neurologic function, and surgical complications were used to determine the effectiveness of ACAF. METHODS Patients were divided into two groups according to their RR for neurologic function. Patients with an RR of ≥50% and an RR of <50% were designated as having good and poor decompression outcomes, respectively. The relationship between various possible prognostic factors and decompression outcomes was assessed by univariate and multivariate analysis. The receiver operating characteristic curve was used to determine the optimal cutoff value of the radiological parameters for prediction of good decompression outcomes. Next, the patients were redivided into three groups according to the cutoff value of the selected radiological parameter (postoperative anteroposterior canal diameter [APD] ratio). Patients with postoperative APD ratios of ≤80.7%, 80.7%-100%, and ≥100% were defined as members of the incomplete, optimal, and excessive antedisplacement groups, respectively. Differences in decompression outcomes among the three groups were compared to verify the reliability of the postoperative APD ratio and assess the necessity of excessive antedisplacement. RESULTS Multivariate logistic regression analysis showed that patients' age at surgery (odds ratio [OR]=1.18; 95% confidence interval [CI]=1.08-1.29; p<.01) and postoperative APD ratio (OR=0.83; 95% CI=0.77-0.90; p<.01) were independently associated with decompression outcomes. The optimal cutoff point of the postoperative APD ratio was calculated at 80.7%, with 86.2% sensitivity and 73.5% specificity. There were no significant differences in the postoperative JOA scores and RRs between the excessive antedisplacement group and optimal antedisplacement group (p>.05). However, a lower incidence of cerebrospinal fluid leakage and screw slippage was observed in the optimal antedisplacement group (p<.05). CONCLUSIONS Patients' age at surgery and their postoperative APD ratio are the two prognostic factors of decompression outcomes after ACAF. The postoperative APD ratio is also the most accurate radiological parameter for predicting good outcomes. Our findings suggest that it is essential for neurologic recovery to restore the spinal canal to more than 80.7% of its original size (postoperative APD ratio >80.7%), and restoration to less than its original size (postoperative APD ratio <100%) will help reduce the incidence of surgical complications. This may serve as a valuable reference for establishment of a radiological standard for hoisting the VOC in ACAF.
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Affiliation(s)
- Chen Yan
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, China, 200001
| | - Huai-Cheng Jia
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, China, 200001
| | - Hao-Yuan Tan
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, China, 200001
| | - Xue-Wei Yu
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, China, 200001
| | - Ming Li
- Department of Spine Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, China, 200433
| | - Xiao-Yi Zhou
- Department of Spine Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, China, 200433
| | - Ming-Yuan Yang
- Department of Spine Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, China, 200433
| | - Dian-Wen Song
- Department of Spine Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University, 85 Wujin Rd, Shanghai, China, 200080
| | - Qing-Hua Zhao
- Department of Spine Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University, 85 Wujin Rd, Shanghai, China, 200080
| | - Guo-Zheng Li
- Department of Orthopedics, Linzhou Hospital of Traditional Chinese Medicine, 244 Taihang Rd, Linzhou, China, 456550
| | - Sheng-Hui Tang
- Department of Orthopedics, Fifth Hospital of Southern Medical University, Southern Medical University, 566 Congcheng Ave, Guangzhou, China, 510900
| | - Bin-Sheng Yu
- Department of Spine Surgery, Shenzhen Hospital of Beijing University, 1120 Lianhua Rd, Shenzhen, China, 518036
| | - Lin-Tao Li
- Department of Spine Surgery, General Hospital of Nanjing Military Command, 305 East Zhongshan Rd, Nanjing, China, 210000
| | - Jing-Chuan Sun
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, China, 200001.
| | - Jian-Gang Shi
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, China, 200001
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Cervical Canal Morphology: Effects of Neck Flexion in Normal Condition: New Elements for Biomechanical Simulations and Surgical Management. Spine (Phila Pa 1976) 2020; 45:1102-1109. [PMID: 32205694 DOI: 10.1097/brs.0000000000003496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Continuous measurements and computation of absolute metrics of cervical subarachnoid space (CSS) and spinal cord (SC) geometries proposed are based on in vivo magnetic resonance imaging and 3D reconstruction. OBJECTIVE The aim of the study is to offer a new methodology to continuously characterize and to quantify the detailed morphology of the CSS and the cervical SC in 3D for healthy subjects in both neutral supine and flexion. SUMMARY OF BACKGROUND DATA To the best of our knowledge, no study provides a morphological quantification by absolute indices based on the 3D reconstruction of SC and CSS thanks to in vivo magnetic resonance imaging. Moreover, no study provides a continuous description of the geometries. METHODS Absolute indices of SC (cross-sectional area, compression ratio, position in the canal, length) and of CSS (cross-sectional area, occupational ratio, lengths) were computed by measures from 3D semi-automatic reconstructions of high resolution in vivo magnetic resonance images (3D T2-SPACE sequence) on healthy subjects (N = 11) for two postures: supine neutral and flexion neck positions. The variability induced by the semi-automatic reconstruction and by the landmarks positioning were investigated by preliminary sensitivity analyses. Inter and intra-variability were also quantified on a randomly chosen part of our population (N = 5). RESULTS The length and cross-sectional area of SC are significantly different (P < 0.05) in flexion compared with neutral neck position. Spinal cord stays centered in the canal for both postures. However, the cross-sectional area of CSS is submitted to low variation after C3 vertebra for both postures. Occupational ratio (OR) and compression ratio (CR) after C3 are significantly lower in flexion. CONCLUSION This study presented interpretations of morphological measures: (1) left-right stability (described by the Left-Right eccentricity index) ensured by the denticulate ligaments and the nerve roots attached to the dural sheaths, (2) a Poisson effect of the SC was partially notified through its axial (antero-posterior [AP] diameter, OR, CR) and its longitudinal geometrical descriptions (length of spinal cord [LSC]). Such morphological data can be useful for geometrical finite element modeling and could now be used to compare with injured or symptomatic subjects. LEVEL OF EVIDENCE 3.
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Yan C, Jia HC, Xu JX, Xu T, Chen K, Sun JC, Shi JG. Computer-Based 3D Simulations to Formulate Preoperative Planning of Bridge Crane Technique for Thoracic Ossification of the Ligamentum Flavum. Med Sci Monit 2019; 25:9666-9678. [PMID: 31847005 PMCID: PMC6929566 DOI: 10.12659/msm.918387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The bridge crane technique is a novel surgical technique for the treatment of thoracic ossification of the ligamentum flavum (TOLF), but its preoperative planning has not been studied well, which limits the safety and efficacy of surgery to some extent. The purpose of this study was to investigate the method of application and effect of computer-aided preoperative planning (CAPP) on the bridge crane technique for TOLF. Material/Methods This retrospective multi-center included 40 patients with TOLF who underwent the bridge crane technique from 2016 to 2018. According to the utilization of CAPP, patients were divided into Group A (with CAPP, n=21) and Group B (without CAPP, n=19). Comparisons of clinical and radiological outcomes were carried out between the 2 groups. Results The patients in Group A had higher post-mJOA scores and IR of neurological function than those in Group B (p<0.05). Group A had shorter surgery time, fewer fluoroscopic images, and lower incidence of complications than Group B. In Group A, there was a high consistency of all the anatomical parameters between preoperative simulation and postoperative CT (p>0.05). In Group B, there were significant differences in 3 anatomical parameters between postoperative simulation and postoperative CT (p<0.05). In Group B, the patients with no complications had higher post-SVOR and lower SVRR and height of posterior suspension of LOC in postoperative CT than those in postoperative simulation (p<0.05). Conclusions CAPP can enable surgeons to control the decompression effect accurately and reduce the risk of related complications, which improves the safety and efficacy of surgery.
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Affiliation(s)
- Chen Yan
- Second Department of Spine Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China (mainland).,Undergraduate Incubation Center, Navy Medical University, Shanghai, China (mainland)
| | - Huai-Cheng Jia
- Second Department of Spine Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China (mainland).,Undergraduate Incubation Center, Navy Medical University, Shanghai, China (mainland)
| | - Jia-Xi Xu
- Second Department of Spine Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China (mainland).,Undergraduate Incubation Center, Navy Medical University, Shanghai, China (mainland)
| | - Tao Xu
- Department of Orthopedic Surgery, No. 906 Hospital of the People's Liberation Army (PLA), Ningbo, Zhejiang, China (mainland)
| | - Kun Chen
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China (mainland)
| | - Jing-Chuan Sun
- Second Department of Spine Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China (mainland)
| | - Jian-Gang Shi
- Second Department of Spine Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China (mainland)
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Analysis of the spinal cord angle for severe cervical ossification of the posterior longitudinal ligament: comparison between anterior controllable antedisplacement and fusion (ACAF) and posterior laminectomy. 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 2019; 29:1001-1012. [DOI: 10.1007/s00586-019-06216-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 10/02/2019] [Accepted: 11/08/2019] [Indexed: 10/25/2022]
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