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Qin J, Qian H, Xin Z, Liu G, Ao J, Liao W. Anterior cervical corpectomy and fusion-derived adjacent segment disease managed via channel-repairing anterior endoscopic transcorporeal cervical discectomy: a case report. BMC Musculoskelet Disord 2024; 25:598. [PMID: 39075374 PMCID: PMC11285283 DOI: 10.1186/s12891-024-07721-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 07/19/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Management of anterior cervical corpectomy and fusion (ACCF)-derived adjacent segment disease (ASD) represented a challenge facing the surgeons. METHODS A 41-year man diagnosed as C3-4 level ASD derived from C5-level ACCF surgery 13 years ago was admitted to the hospital for numbness and pain in the right shoulder and upper limb. Percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) was performed, and pre- and postoperative clinical and imaging data were collected. RESULTS The operation was completed within 70 min, and no clinical or radiological complication was reported. The visual analog scale (VAS) score decreased from preoperative 5 points to postoperative 1 point. Numbness was relieved postoperatively and disappeared completely at postoperative 3 months. Imaging data indicated sufficient spinal cord decompression, good channel repairing and cervical alignment. CONCLUSIONS Channel-repairing PEATCD was successfully performed to treat ACCF-derived ASD, nevertheless, the long-term efficacy remained tracing and further clinical trials were needed to validate its efficacy.
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Affiliation(s)
- Jianpu Qin
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi, 563000, China
| | - Hu Qian
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi, 563000, China
| | - Zhijun Xin
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi, 563000, China
| | - Guangyi Liu
- Department of Orthopaedic Surgery, Sandu Shui Autonomous County People's Hospital, Qiannan Prefecture, Guizhou Province, China
| | - Jun Ao
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi, 563000, China
| | - Wenbo Liao
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi, 563000, China.
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Jing X, Zhu Z, Fan H, Wang J, Fu Q, Kong R, Long Y, Wang S, Wang Q. Impact of delay extubation on the reintubation rate in patients after cervical spine surgery: a retrospective cohort study. J Orthop Surg Res 2023; 18:557. [PMID: 37528469 PMCID: PMC10394787 DOI: 10.1186/s13018-023-04008-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/14/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND The incidence of cervical airway obstruction after cervical spine surgery (CSS) ranges from 1.2 to 14%, and some require reintubation. If not addressed promptly, the consequences can be fatal. This study investigated delayed extubation's effect on patients' reintubation rate after cervical spine surgery. METHODS We performed a retrospective case-control analysis of cervical spine surgery from our ICU from January 2021 to October 2022. Demographic and preoperative characteristics, intraoperative data, and postoperative clinical outcomes were collected for all 94 patients. Univariable analysis and multivariable logistic regression were used to analyze postoperative unsuccessful extubation risk factors following cervical spine surgery. RESULTS The patients in the early extubation (n = 73) and delayed extubation (n = 21) groups had similar demographic characteristics. No significant differences were found in the reintubation rate (0 vs. 6.8%, p = 0.584). However, the delayed extubation group had significantly more patients with 4 and more cervical fusion segments (42.9 vs. 15.1%, p = 0.013),more patients with an operative time greater than 4 h (33.3 vs. 6.8%, p = 0.004)and all patients involved C2-4 (78 vs. 100%, p = 0.019).Also, patients in the delayed extubation group had a longer duration of ICU stay (152.9 ± 197.1 h vs. 27.2 ± 45.4 h, p < 0.001) and longer duration of hospital stay (15.2 ± 6.9 days vs. 11.6 ± 4.1 days, p = 0.003). Univariate and multivariate analysis identified the presences of cervical spondylotic myelopathy (CSM) (OR 0.02, 95% CI 0-0.39, p = 0.009) and respiratory diseases (OR: 23.2, 95% CI 2.35-229.51, p = 0.007) as unfavorable prognostic factor for reintubation. CONCLUSIONS Our analysis of patients with cervical spondylosis who received CSS indicated that delayed extubation was associated with the presence of respiratory diseases and CSM, longer operative time, more cervical fusion segments, and longer duration of ICU and hospital stays.
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Affiliation(s)
- Xin Jing
- Department of Critical Care Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Zhengfang Zhu
- Department of Critical Care Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Hairong Fan
- Department of Critical Care Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Junjie Wang
- Department of Critical Care Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Qing Fu
- Department of Critical Care Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Rongrong Kong
- Department of Critical Care Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Yanling Long
- Department of Critical Care Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Sheng Wang
- Department of Critical Care Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
| | - Qixing Wang
- Department of Critical Care Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
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Xue HH, Tang D, Zhao WH, Chen L, Liao Z, Xue JL. Static mechanical analysis of the vertebral body after modified anterior cervical discectomy and fusion (partial vertebral osteotomy): a finite element model. J Orthop Surg Res 2023; 18:554. [PMID: 37528421 PMCID: PMC10391851 DOI: 10.1186/s13018-023-04033-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/20/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Modified anterior cervical discectomy and fusion (Mod ACDF) can effectively address ossification of the posterior longitudinal ligament (OPLL), which is difficult to remove directly from the posterior edge of the vertebral body, with considerably lesser damage as compared to anterior cervical corpectomy and fusion (ACCF). We compared the static mechanics of different anterior approaches by using an ideal finite element model. METHODS A complete finite element model was established and classified into the following three surgical models according to different model cutting operations: ACDF, ACCF, and Mod ACDF. Three different bone volume situations (normal bone mineral density, osteopenia, and osteoporosis) were simulated. After fixing the lower surface of C5 or C6, a load was applied to the upper surface of C4, and the stress distribution and displacement of the upper surface of C5 or C6 were observed and the related values were recorded. RESULTS The average Von Mises Stress and displacement levels of Mod ACDF were between those of ACDF and ACCF; with the peak Von Mises Stress occurring on the posterior side of the vertebral body (Points 1-4). The change in Von Mises Stress of the vertebral body is not significant during bone loss. However, the degree of displacement of the vertebral body surface and risk of vertebral collapse are increased (100 N: 13.91 vs. 19.47 vs. 21.62 μm; 150 N: 19.60 vs. 29.30 vs. 31.64 μm; 200 N: 28.53 vs. 38.65 vs. 44.83 μm). CONCLUSIONS The static biomechanical effects caused by Mod ACDF are intermediate between ACDF and ACCF, and the risk of vertebral body collapse is lower than that by ACCF. Therefore, Mod ACDF may be an effective solution when targeting OPLL with poorly positioned posterior vertebral body edges.
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Affiliation(s)
- Huo-huo Xue
- Department of Spine Surgery, Fuzhou Second Hospital, 350007 Fuzhou, China
| | - Dian Tang
- Department of Spine Surgery, Fuzhou Second Hospital, 350007 Fuzhou, China
| | - Wen-han Zhao
- Fujian Medical University Union Hospital, Fuzhou, 350100 China
| | - Liang Chen
- Fujian Medical University Union Hospital, Fuzhou, 350100 China
| | - Zhong Liao
- Department of Spine Surgery, Fuzhou Second Hospital, 350007 Fuzhou, China
| | - Jing-lai Xue
- Department of Spine Surgery, Fuzhou Second Hospital, 350007 Fuzhou, China
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Tian X, Zhao H, Han FY, Rudd S, Li Z, Ding W, Yang S. Treatment of three-level cervical spondylotic myelopathy using ACDF or a combination of ACDF and ACCF. Front Surg 2022; 9:1021643. [PMID: 36189403 PMCID: PMC9523112 DOI: 10.3389/fsurg.2022.1021643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/01/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives This study aims to compare the outcomes between two anterior decompression and fusion techniques to treat multilevel cervical spondylotic myelopathy (MCSM). Methods After the screening for eligibility, a total of 66 patients were admitted to this study. These participants underwent anterior surgeries due to MCSM in our hospital between June 2016 and July 2018. All participants underwent either the anterior cervical discectomy and fusion (ACDF) surgery (ACDF group) or the combination of ACDF and anterior cervical corpectomy and fusion (ACCF), which was the anterior cervical hybrid decompression and fusion (ACHDF) surgery group. All the patients were followed up ≥18 months, the average latest followed up time was 23.64 (±2.69) months. The length of hospitalization, operation time, blood loss, visual analog scale (VAS), Japanese Orthopaedic Association (JOA) score, improvement rate, Hounsfield units (HU) of C3–C7, cobb angle, and anterior column height of fusion levels pre and post operation were analyzed. Results There were no statistical differences between the ACDF and ACHDF groups regarding the length of hospitalization, operation time, blood loss, HU of C3–C7, VAS, JOA score, improvement rate, cobb angle, and anterior column height in fusion levels in pre-operation and 3 months after operation (all P > 0.05). However, compared with the ACHDF group, the ACDF group achieved significantly better improvement in the anterior column height of fusion levels in the final 18–29 months post-operatively (P < 0.05). Conclusions Both approaches of ACDF alone and a combination of ACDF and ACCF can achieve satisfactory outcomes in the treatment of MCSM, but ACDF has better outcomes in maintaining anterior column height of fusion levels.
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Affiliation(s)
- Xiaoming Tian
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hongwei Zhao
- The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Felicity Y. Han
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Australia
| | - Samuel Rudd
- School of Chemical Engineering, The University of Queensland, Brisbane, Australia
| | - Zhaohui Li
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wenyuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Correspondence: Wenyuan Ding Sidong Yang
| | - Sidong Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Correspondence: Wenyuan Ding Sidong Yang
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Ji H, Xie X, Zhuang S, Zhang C, Xie L, Wu X. Comparative analysis of three types of titanium mesh cages for anterior cervical single-level corpectomy and fusion in term of postoperative subsidence. Am J Transl Res 2020; 12:6569-6577. [PMID: 33194053 PMCID: PMC7653575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/20/2020] [Indexed: 06/11/2023]
Abstract
A titanium mesh cage (TMC) is a common device used for interbody fusion in anterior cervical corpectomy and fusion (ACCF) surgery, with postoperative subsidence being a common complication. Among the many influencing factors, there is a paucity of research on the end-covers of the TMC. A total of 62 patients with cervical spondylotic myelopathy were treated with single-level ACCF. TMC without end-covers (group A), traditional TMC with end-covers (group B) and new TMC with end-covers (group C) were used as the fusion device. We evaluated the surgery time, intraoperative blood loss, postoperative drainage volume, postoperative fusion, falling height of the fused segment, cervical curvature and severe subsidence rate (the number of falling height of the fused segment > 3 mm/total surgical cases in the group). In addition, the Japanese Orthopaedic Association score was used for neurological status assessment and a 10-point Visual Analog Scale for postoperative neck pain. The results showed that the falling height of the fused segment in group A (1.9 ± 0.6 mm) was significantly greater than in group B (0.9 ± 0.2 mm) and group C (0.8 ± 0.3 mm). The area of the end-covers increased gradually in group A, group B and group C, while the severe subsidence rate of group A (8/20, 40%), group B (5/22, 23%) and group C (2/20, 10%) gradually decreased. The surgery time and blood loss in group B (116.4 ± 12.2 min, 183.5 ± 36.4 mL) were higher than those in group A (90.22 ± 5.60 min, 110.4 ± 20.8 mL) and group C (92.8 ± 8.47 min, 114 ± 24.0 mL). These results showed that there was a correlation between the postoperative subsidence and the end-covers of TMC. The larger the end-cover area was, the lower the severe postoperative subsidence rate was. In addition, the design of the end-covers extending inward was more conducive to the operation.
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Affiliation(s)
- Hangyu Ji
- School of Medicine, Southeast UniversityNanjing, China
| | - Xinhui Xie
- The Department of Orthopedics, Zhongda Hospital of Southeast UniversityNanjing, China
| | - Suyang Zhuang
- The Department of Orthopedics, Zhongda Hospital of Southeast UniversityNanjing, China
| | - Cong Zhang
- The Department of Orthopedics, Zhongda Hospital of Southeast UniversityNanjing, China
| | - Linghan Xie
- School of Medicine, Southeast UniversityNanjing, China
| | - Xiaotao Wu
- School of Medicine, Southeast UniversityNanjing, China
- The Department of Orthopedics, Zhongda Hospital of Southeast UniversityNanjing, China
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