1
|
Mohammadi M, Roohollahi F, Farahbakhsh F, Mohammadi A, Mortazavi Mamaghani E, Kankam SB, Moarrefdezfouli A, Ghamari Khameneh A, Mahmoudi MM, Baghdasaryan D, Martin AR, Harrop J, Rahimi-Movaghar V. Diffusion Tensor Imaging in Diagnosing and Evaluating Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis. Global Spine J 2024:21925682241263792. [PMID: 38877604 DOI: 10.1177/21925682241263792] [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: 06/16/2024] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE Degenerative cervical myelopathy (DCM) is a common spinal cord disorder necessitating surgery. We aim to explore how effectively diffusion tensor imaging (DTI) can distinguish DCM from healthy individuals and assess the relationship between DTI metrics and symptom severity. METHODS We included studies with adult DCM patients who had not undergone decompressive surgery and implemented correlation analyses between DTI parameters and severity, or compared healthy controls and DCM patients. RESULTS 57 studies were included in our meta-analysis. At the maximal compression (MC) level, fractional anisotropy (FA) exhibited lower values in DCM patients, while apparent diffusion coefficient (ADC), mean diffusivity (MD), and radial diffusivity (RD) were notably higher in the DCM group. Moreover, our investigation into the diagnostic utility of DTI parameters disclosed high sensitivity, specificity, and area under the curve values for FA (.84, .80, .83 respectively) and ADC (.74, .84, .88 respectively). Additionally, we explored the correlation between DTI parameters and myelopathy severity, revealing a significant correlation of FA (.53, 95% CI:0.40 to .65) at MC level with JOA/mJOA scores. CONCLUSION Current guidelines for DCM suggest decompressive surgery for both mild and severe cases. However, they lack clear recommendations on which mild DCM patients might benefit from conservative treatment vs immediate surgery. ADC's role here could be pivotal, potentially differentiating between healthy individuals and DCM. While it may not correlate with symptom severity, it might predict surgical outcomes, making it a valuable imaging biomarker for clearer management decisions in mild DCM.
Collapse
Affiliation(s)
| | - Faramarz Roohollahi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Yas Spine Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzin Farahbakhsh
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Aynaz Mohammadi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Samuel Berchi Kankam
- Image guided Neurosurgery Lab, Department of Neurosurgery, Brigham and Women Hospital, Harvard Medical School, Boston, MA, USA
- Brain Trauma Lab, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Azin Moarrefdezfouli
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshar Ghamari Khameneh
- Department of Radiology, Advanced Diagnostic and Interventional Radiology (ADIR) Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamad Mahdi Mahmoudi
- Department of General Surgery, Shahid Mofateh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Allan R Martin
- Department of Neurosurgery, University of California Davis, Davis, CA, USA
| | - James Harrop
- Department of Neurological and Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
| |
Collapse
|
2
|
Ran Y, Qin W, Qin C, Li X, Liu Y, Xu L, Mu X, Yan L, Wang B, Dai Y, Chen J, Han D. A high-quality dataset featuring classified and annotated cervical spine X-ray atlas. Sci Data 2024; 11:625. [PMID: 38871800 PMCID: PMC11176335 DOI: 10.1038/s41597-024-03383-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/15/2024] [Indexed: 06/15/2024] Open
Abstract
Recent research in computational imaging largely focuses on developing machine learning (ML) techniques for image recognition in the medical field, which requires large-scale and high-quality training datasets consisting of raw images and annotated images. However, suitable experimental datasets for cervical spine X-ray are scarce. We fill the gap by providing an open-access Cervical Spine X-ray Atlas (CSXA), which includes 4963 raw PNG images and 4963 annotated images with JSON format (JavaScript Object Notation). Every image in the CSXA is enriched with gender, age, pixel equivalent, asymptomatic and symptomatic classifications, cervical curvature categorization and 118 quantitative parameters. Subsequently, an efficient algorithm has developed to transform 23 keypoints in images into 77 quantitative parameters for cervical spine disease diagnosis and treatment. The algorithm's development is intended to assist future researchers in repurposing annotated images for the advancement of machine learning techniques across various image recognition tasks. The CSXA and algorithm are open-access with the intention of aiding the research communities in experiment replication and advancing the field of medical imaging in cervical spine.
Collapse
Affiliation(s)
- Yu Ran
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Wanli Qin
- Department of Dermatology, Air Force Medical Center, Air Force Medical University, Beijing, 710000, China
| | - Changlong Qin
- Department of Orthopedics and Traumatology, Qiannan Traditional Chinese Medicine Hospital, Guizhou, 558000, China
| | - Xiaobin Li
- Shenzhen Hospital of Beijing University of Chinese Medicine, Shenzhen, 518172, China
| | - Yixing Liu
- School of Management, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Lin Xu
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Xiaohong Mu
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Li Yan
- School of Humanities, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Bei Wang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Yuxiang Dai
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Jiang Chen
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China.
| | - Dongran Han
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, 102488, China.
| |
Collapse
|
3
|
Dai L, Du K, Guo P, Gong H, Wang W, Hou X, Qin C, Zhang C. Comparison of Laminectomy with Fusion and Laminoplasty Treating Multilevel Cervical Spondylotic Myelopathy: A Single-Center Retrospective Study. World Neurosurg 2024; 186:e487-e494. [PMID: 38583558 DOI: 10.1016/j.wneu.2024.03.163] [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: 03/08/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE Comparing laminectomy with fusion (LF) and laminoplasty (LP) for treating multilevel cervical spondylotic myelopathy (MCSM) and comparative analysis of neck pain and sagittal cervical parameters. METHODS This single-center study retrospectively analyzed MCSM patients treated with LF or LP in our department between June 2018 and January 2023, with at least a 12-month follow-up. T-tests were used to identify operation time, hemoglobin, hospital stay, modified Japanese Orthopaedic Association (mJOA) score, C2-C7 Cobb angle, C2-C7 sagittal vertical axis, T1 slope, cervical range of motion (cROM), and C4/5 anterior and posterior spinal canal diameter (A-P diameter) and area. Nonparametric tests were used to identify visual analog scale (VAS) score (assessing neck pain). Pearson correlation analyses were used to identify the neck pain. RESULTS Of all 67 patients (LF: 24, LP: 43), both groups' mJOA scores significantly improved (P < 0.001). The VAS scores had both significantly decreased, with the LF group exhibiting a more marked reduction (LF: P < 0.001, LP: P = 0.037). Both groups' C4/5 A-P diameters and areas increased significantly (P < 0.001). The cROM had both significantly decreased, with the LF group exhibiting a greater reduction. At the last follow-up, the LF group's T1 slope and C2-C7 Cobb angle considerably increased, and pain VAS scores substantially correlated with the C2-C7 Cobb angle (R = -0.451, P < 0.001). CONCLUSIONS LF and LP were efficacious for MCSM. LF relieved neck pain better but caused greater reduction in cervical mobility. Cervical lordosis improvement was significantly correlated with neck pain alleviation.
Collapse
Affiliation(s)
- Liping Dai
- Department of orthopaedics, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Kaili Du
- Department of orthopaedics, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Peiyu Guo
- Department of orthopaedics, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Hongda Gong
- Department of orthopaedics, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Weizhou Wang
- Department of orthopaedics, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xiaodong Hou
- Department of orthopaedics, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Chao Qin
- Department of orthopaedics, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Chunqiang Zhang
- Department of orthopaedics, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
| |
Collapse
|
4
|
Loh RHW, Leong AZ, Lwin S, Goh LG. An approach to neck pain in primary care. Singapore Med J 2024; 65:348-353. [PMID: 38834939 DOI: 10.4103/singaporemedj.smj-2021-288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 03/03/2022] [Indexed: 06/06/2024]
Affiliation(s)
- Raina Hui Wen Loh
- Division of Family Medicine, National University Health System, Singapore
| | - Adriel Zhijie Leong
- Division of Neurosurgery, Department of Surgery, National University Health System, Singapore
| | - Sein Lwin
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore
| | - Lee Gan Goh
- Division of Family Medicine, National University Health System, Singapore
| |
Collapse
|
5
|
Sun K, Jin L, Zhao B, Liu G, Yuan W, Chen H, Tian Y. Radiologic Evaluation of Uncinate Processes of the Cervical Spine and the Relationship Between the Uncinate Process and Vertebral Artery: Implication in Anterior Cervical Spine Surgery. World Neurosurg 2024; 186:e360-e365. [PMID: 38561028 DOI: 10.1016/j.wneu.2024.03.141] [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: 09/13/2023] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To determine the relationship between the uncinate process (UP) and vertebral artery (VA) from a radiologic view and to confirm the surgical safety margin to minimize the risk of VA injury during anterior cervical approaches. METHODS We retrospectively reviewed computed tomography angiography of 205 patients by using a contrast-enhanced computed tomography angiography protocol of the VA. Four kinds of images were simultaneously reconstructed to measure all the parameters associated with VA and UP of cervical spine. RESULTS The shortest distance from the UP's tip to the VA's medial border (P < 0.001) was at the C-6 level (2.9 ± 0.9 mm on the left and 3.2 ± 1.3 mm on the right), and the longest distance (P < 0.001) was at the C-3 level on both sides. The distance between UP's tip and the medial border of the ipsilateral VA was statistically significantly different at each cervical level, and the right distance was larger than the left (P < 0.05). We found the height of UP gradually increased from C-3 to C5-level and then decreased from C-5 to C-7 level for both sides. The mean distance between the medial borders of left UP and left VA was on average 7.5 ± 1.4 mm. The diameter of VA was on average 3.4 ± 0.6 mm on the left side and 3.2 ± 0.7 mm on the right. The diameter of the VA was statistically significantly different on both sides, and the left side was larger than the right (P < 0.05). CONCLUSIONS Detailed radiologic anatomy of VA and UP was reviewed in this study. A deep understanding of the correlation between the UP and VA is essential to perform anterior cervical spine surgery safely and ensure adequate spinal canal decompression.
Collapse
Affiliation(s)
- Ke Sun
- Department of Orthopedics, Spine Center, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Lanbo Jin
- Department of Orthopedics, Spine Center, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Baolian Zhao
- Department of Orthopedics, Spine Center, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Gang Liu
- Department of Orthopedics, Spine Center, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Wen Yuan
- Department of Orthopedics, Spine Center, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Huajiang Chen
- Department of Orthopedics, Spine Center, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Ye Tian
- Department of Orthopedics, Spine Center, Changzheng Hospital, Naval Medical University, Shanghai, China.
| |
Collapse
|
6
|
Caruso JP, Wilson R, Dosselman L, Eakin J, Sundarrajan C, Adenwalla A, Almekkawi AK, Aoun SG, Bagley CA, Van Hal M, Al Tamimi M. Age is Associated with Level of First-Time Anterior Cervical Discectomy and Fusion: An Ordinal Analysis of Factors Influencing Timing of Cervical Degeneration. World Neurosurg 2024; 186:e702-e706. [PMID: 38614370 DOI: 10.1016/j.wneu.2024.04.035] [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: 03/28/2024] [Accepted: 04/07/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Symptomatic cervical spondylosis is often treated with anterior cervical discectomy and fusion (ACDF). However, few factors can predict which cervical level will degenerate and require intervention. This analysis evaluates preprocedural factors associated with level of first-time single-level ACDF. METHODS We performed a retrospective analysis of patients who underwent single-level ACDF without prior history of spine surgery. Mann Whitney U-tests and Spearman rank-order correlation were performed for analyses of associations between variables of interest and ACDF level. Adjusted odds-ratios were calculated by proportional-odds logistic regression, with age, sex, body mass index, current tobacco use, history of neck trauma, preoperative radicular symptoms, and preoperative myelopathic symptoms as covariates. RESULTS One hundred forty-one patients met inclusion criteria, and age demonstrated a negative correlation with ACDF level, such that younger patients tended to have ACDF performed at inferior subaxial levels (P = 0.0006, rho = -0.31, moderately strong relationship). Patients with preoperative radicular symptoms and myelopathic symptoms were more likely to have ACDF performed at inferior (P = 0.0001) and superior (P < 0.0001) levels, respectively. Patient sex, body mass index, current tobacco use, and history of neck trauma were not predictive of ACDF level. When adjusting for the above variables in a proportional-odds ordinal logistic regression model, a one-year increase in age conferred a 4% increase in the odds of requiring an ACDF at a given superior level compared to the adjacent inferior level. CONCLUSIONS Age is correlated with level of first-time single level ACDF. Individual subaxial levels may have unique biomechanical properties that influence degeneration.
Collapse
Affiliation(s)
- James P Caruso
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas, USA.
| | - Remi Wilson
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Luke Dosselman
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas, USA
| | - John Eakin
- University of Texas Southwestern, Department of Orthopedic Surgery, Dallas, Texas, USA
| | | | - Ammar Adenwalla
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Ahmed K Almekkawi
- Saint Luke's Marion Bloch Neuroscience Institute Department of Neurosurgery, Kansas City, Missouri, USA
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Carlos A Bagley
- Saint Luke's Marion Bloch Neuroscience Institute Department of Neurosurgery, Kansas City, Missouri, USA
| | - Michael Van Hal
- University of Texas Southwestern, Department of Orthopedic Surgery, Dallas, Texas, USA
| | - Mazin Al Tamimi
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas, USA
| |
Collapse
|
7
|
Huang J, Tang Y, Wang P, Zhou H, Li H, Cheng Z, Wu Y, Xie Z, Cai Z, Wu D, Shen H. One-Pot Construction of Articular Cartilage-Like Hydrogel Coating for Durable Aqueous Lubrication. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2309141. [PMID: 38339915 DOI: 10.1002/adma.202309141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/22/2024] [Indexed: 02/12/2024]
Abstract
Articular cartilage has an appropriate multilayer structure and superior tribological properties and provides a structural paradigm for design of lubricating materials. However, mimicking articular cartilage traits on prosthetic materials with durable lubrication remains a huge challenge. Herein, an ingenious three-in-one strategy is developed for constructing an articular cartilage-like bilayer hydrogel coating on the surface of ultra-high molecular weight polyethylene (BH-UPE), which makes full use of conceptions of interfacial interlinking, high-entanglement crosslinking, and interface-modulated polymerization. The hydrogel coating is tightly interlinked with UPE substrate through hydrogel-UPE interchain entanglement and bonding. The hydrogel chains are highly entangled with each other to form a dense tough layer with negligible hysteresis for load-bearing by reducing the amounts of crosslinker and hydrophilic initiator to p.p.m. levels. Meanwhile, the polymerization of monomers in the top surface region is suppressed via interface-modulated polymerization, thus introducing a porous surface for effective aqueous lubrication. As a result, BH-UPE exhibits an ultralow friction coefficient of 0.0048 during 10 000 cycles under a load of 0.9 MPa, demonstrating great potential as an advanced bearing material for disc prosthesis. This work may provide a new way to build stable bilayer coatings and have important implications for development of biological lubricating materials.
Collapse
Affiliation(s)
- Jiajun Huang
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, P. R. China
| | - Youchen Tang
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, P. R. China
| | - Peng Wang
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, P. R. China
| | - Hao Zhou
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, P. R. China
| | - He Li
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, P. R. China
| | - Ziying Cheng
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, P. R. China
| | - Yanfeng Wu
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, P. R. China
| | - Zhongyu Xie
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, P. R. China
| | - Zhaopeng Cai
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, P. R. China
| | - Dingcai Wu
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, P. R. China
- PCFM Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, 510006, P. R. China
| | - Huiyong Shen
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, P. R. China
| |
Collapse
|
8
|
Yasaka K, Uehara S, Kato S, Watanabe Y, Tajima T, Akai H, Yoshioka N, Akahane M, Ohtomo K, Abe O, Kiryu S. Super-resolution Deep Learning Reconstruction Cervical Spine 1.5T MRI: Improved Interobserver Agreement in Evaluations of Neuroforaminal Stenosis Compared to Conventional Deep Learning Reconstruction. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01112-y. [PMID: 38671337 DOI: 10.1007/s10278-024-01112-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024]
Abstract
The aim of this study was to investigate whether super-resolution deep learning reconstruction (SR-DLR) is superior to conventional deep learning reconstruction (DLR) with respect to interobserver agreement in the evaluation of neuroforaminal stenosis using 1.5T cervical spine MRI. This retrospective study included 39 patients who underwent 1.5T cervical spine MRI. T2-weighted sagittal images were reconstructed with SR-DLR and DLR. Three blinded radiologists independently evaluated the images in terms of the degree of neuroforaminal stenosis, depictions of the vertebrae, spinal cord and neural foramina, sharpness, noise, artefacts and diagnostic acceptability. In quantitative image analyses, a fourth radiologist evaluated the signal-to-noise ratio (SNR) by placing a circular or ovoid region of interest on the spinal cord, and the edge slope based on a linear region of interest placed across the surface of the spinal cord. Interobserver agreement in the evaluations of neuroforaminal stenosis using SR-DLR and DLR was 0.422-0.571 and 0.410-0.542, respectively. The kappa values between reader 1 vs. reader 2 and reader 2 vs. reader 3 significantly differed. Two of the three readers rated depictions of the spinal cord, sharpness, and diagnostic acceptability as significantly better with SR-DLR than with DLR. Both SNR and edge slope (/mm) were also significantly better with SR-DLR (12.9 and 6031, respectively) than with DLR (11.5 and 3741, respectively) (p < 0.001 for both). In conclusion, compared to DLR, SR-DLR improved interobserver agreement in the evaluations of neuroforaminal stenosis using 1.5T cervical spine MRI.
Collapse
Affiliation(s)
- Koichiro Yasaka
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan
| | - Shunichi Uehara
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shimpei Kato
- Department of Radiology, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Yusuke Watanabe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Taku Tajima
- Department of Radiology, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Hiroyuki Akai
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan
- Department of Radiology, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Naoki Yoshioka
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan
| | - Masaaki Akahane
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan
| | - Kuni Ohtomo
- International University of Health and Welfare, 2600-1 Ktiakanemaru, Ohtawara, Tochigi, 324-8501, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shigeru Kiryu
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan.
| |
Collapse
|
9
|
Ren Z, Cheng X, Xu J, Niu T, Long H. Causal associations of cognition, intelligence, education, health and lifestyle factors with cervical spondylosis: a mendelian randomization study. Front Genet 2024; 15:1297213. [PMID: 38725482 PMCID: PMC11079178 DOI: 10.3389/fgene.2024.1297213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/19/2024] [Indexed: 05/12/2024] Open
Abstract
Background: Education, cognition, and intelligence are phenotypically and genetically related. Education has been shown to have a protective effect on the risk of developing cervical spondylosis. However, it is unclear whether cognition and intelligence have independent causal effects on cervical spondylosis, and whether health and lifestyle factors influence this association. Methods: We first assessed the independent effects of education, cognition, and intelligence on cervical spondylosis by two-sample Mendelian randomization and multivariable Mendelian randomization analysis, and evaluated 26 potential association mediators using two-step Mendelian randomization, and calculated the median proportion. Results: The results showed that only education had an independent causal effect on cervical spondylosis, and had a protective effect on the risk of cervical spondylosis (β: 0.3395; se: 0.166; p < 0.05; OR:0.71; [95%CI: 0.481-0.943]. Of the 26 potential associated mediators, a factor was identified: SHBG (mediated proportion: 2.5%). Univariable Mendelian randomization results showed that the risk factors for cervical spondylosis were time spent watching TV (OR:1.96; [95%CI: 1.39-2.76]), smoking (OR:2.56; [95%CI: 1.061-1.486]), body mass index (OR:1.26; [95%CI: 1.124-1.418]), percentage of body fat (OR:1.32; [95%CI: 1.097-1.593]), major depression (OR:1.27; [95%CI: 1.017-1.587]) and sitting height (OR:1.15; [95%CI: 1.025-1.291]). Protective factors include computer using (OR:0.65; [95%CI: 0.418-0.995]), sex hormone binding globulin (OR:0.87; [95%CI: 0.7955-0.951]) and high-density lipoprotein (OR:0.90; [95%CI: 0.826-0.990]). Conclusion: Our findings demonstrate the causal and independent effects of education on cervical spondylosis and suggest that lifestyle media may be a priority target for the prevention of cervical spondylosis due to low educational attainment.
Collapse
Affiliation(s)
- Zhenxiao Ren
- Department of Spine Surgery, Orthopaedic, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University/The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology/Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xing Cheng
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology/Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
- Department of Spine Surgery, Orthopedics Center of Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jinghui Xu
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology/Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Tianzuo Niu
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology/Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Houqing Long
- Department of Spine Surgery, Orthopaedic, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University/The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong Province, China
| |
Collapse
|
10
|
Zhong YF, Dai YX, Li SP, Zhu KJ, Lin YP, Ran Y, Chen L, Ruan Y, Yu PF, Li L, Li WX, Xu CL, Sun ZT, Weber KA, Kong DW, Yang F, Lin WP, Chen J, Chen BL, Jiang H, Zhou YJ, Sheng B, Wang YJ, Tian YZ, Sun YL. Sagittal balance parameters measurement on cervical spine MR images based on superpixel segmentation. Front Bioeng Biotechnol 2024; 12:1337808. [PMID: 38681963 PMCID: PMC11048045 DOI: 10.3389/fbioe.2024.1337808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/25/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction: Magnetic Resonance Imaging (MRI) is essential in diagnosing cervical spondylosis, providing detailed visualization of osseous and soft tissue structures in the cervical spine. However, manual measurements hinder the assessment of cervical spine sagittal balance, leading to time-consuming and error-prone processes. This study presents the Pyramid DBSCAN Simple Linear Iterative Cluster (PDB-SLIC), an automated segmentation algorithm for vertebral bodies in T2-weighted MR images, aiming to streamline sagittal balance assessment for spinal surgeons. Method: PDB-SLIC combines the SLIC superpixel segmentation algorithm with DBSCAN clustering and underwent rigorous testing using an extensive dataset of T2-weighted mid-sagittal MR images from 4,258 patients across ten hospitals in China. The efficacy of PDB-SLIC was compared against other algorithms and networks in terms of superpixel segmentation quality and vertebral body segmentation accuracy. Validation included a comparative analysis of manual and automated measurements of cervical sagittal parameters and scrutiny of PDB-SLIC's measurement stability across diverse hospital settings and MR scanning machines. Result: PDB-SLIC outperforms other algorithms in vertebral body segmentation quality, with high accuracy, recall, and Jaccard index. Minimal error deviation was observed compared to manual measurements, with correlation coefficients exceeding 95%. PDB-SLIC demonstrated commendable performance in processing cervical spine T2-weighted MR images from various hospital settings, MRI machines, and patient demographics. Discussion: The PDB-SLIC algorithm emerges as an accurate, objective, and efficient tool for evaluating cervical spine sagittal balance, providing valuable assistance to spinal surgeons in preoperative assessment, surgical strategy formulation, and prognostic inference. Additionally, it facilitates comprehensive measurement of sagittal balance parameters across diverse patient cohorts, contributing to the establishment of normative standards for cervical spine MR imaging.
Collapse
Affiliation(s)
- Yi-Fan Zhong
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
- Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, Shanghai, China
| | - Yu-Xiang Dai
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Orthopedics, Suzhou TCM Hospital affiliated to Nanjing University of Traditional Chinese Medicine, Suzhou, China
| | - Shi-Pian Li
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ke-Jia Zhu
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
- Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, Shanghai, China
| | - Yong-Peng Lin
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yu Ran
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- School of Life and Science, Beijing University of Chinese Medicine, Beijing, China
| | - Lin Chen
- Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ye Ruan
- Spine Disease Institute, Shenzhen Pingle Orthopedic Hospital, Affiliated Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Peng-Fei Yu
- Department of Orthopedics, Suzhou TCM Hospital affiliated to Nanjing University of Traditional Chinese Medicine, Suzhou, China
| | - Lin Li
- Second Department of Spinal Surgery, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang, China
| | - Wen-Xiong Li
- Shaanxi University of Chinese Medicine, Xianyang, China
| | - Chuang-Long Xu
- Rehabilitation Center, Ningxia Hui Autonomous Region TCM Hospital and TCM Research Institute, Yinchuan, China
| | - Zhi-Tao Sun
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Kenneth A. Weber
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, Santa Clara, CA, United States
| | - De-Wei Kong
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Feng Yang
- Shaanxi University of Chinese Medicine, Xianyang, China
| | - Wen-Ping Lin
- Spine Disease Institute, Shenzhen Pingle Orthopedic Hospital, Affiliated Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Jiang Chen
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Bo-Lai Chen
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hong Jiang
- Department of Orthopedics, Suzhou TCM Hospital affiliated to Nanjing University of Traditional Chinese Medicine, Suzhou, China
| | - Ying-Jie Zhou
- Second Department of Spinal Surgery, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang, China
| | - Bo Sheng
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
| | - Yong-Jun Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ying-Zhong Tian
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
- Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, Shanghai, China
| | - Yue-Li Sun
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, Santa Clara, CA, United States
| |
Collapse
|
11
|
Huang CC, Fitts J, Huie D, Bhowmick DA, Abd-El-Barr MM. Evolution of Cervical Endoscopic Spine Surgery: Current Progress and Future Directions-A Narrative Review. J Clin Med 2024; 13:2122. [PMID: 38610887 PMCID: PMC11012719 DOI: 10.3390/jcm13072122] [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: 02/25/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Cervical endoscopic spine surgery is rapidly evolving and gaining popularity for the treatment of cervical radiculopathy and myelopathy. This approach significantly reduces muscular damage and blood loss by minimizing soft tissue stripping, leading to less postoperative pain and a faster postoperative recovery. As scientific evidence accumulates, the efficacy and safety of cervical endoscopic spine surgery are continually affirmed. Both anterior and posterior endoscopic approaches have surfaced as viable alternative treatments for various cervical spine pathologies. Newer techniques, such as endoscopic-assisted fusion, the anterior transcorporeal approach, and unilateral laminotomy for bilateral decompression, have been developed to enhance clinical outcomes and broaden surgical indications. Despite its advantages, this approach faces challenges, including a steep learning curve, increased radiation exposure for both surgeons and patients, and a relative limitation in addressing multi-level pathologies. However, the future of cervical endoscopic spine surgery is promising, with potential enhancements in clinical outcomes and safety on the horizon. This progress is fueled by integrating advanced imaging and navigation technologies, applying regional anesthesia for improved and facilitated postoperative recovery, and incorporating cutting-edge technologies, such as augmented reality. With these advancements, cervical endoscopic spine surgery is poised to broaden its scope in treating cervical spine pathologies while maintaining the benefits of minimized tissue damage and rapid recovery.
Collapse
Affiliation(s)
- Chuan-Ching Huang
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Jamal Fitts
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | - David Huie
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | - Deb A. Bhowmick
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | - Muhammad M. Abd-El-Barr
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| |
Collapse
|
12
|
Tsai MC, Liu YF, Lin WH, Lee MC. Restoration of Range of Motion in the Cervical Spine through Single-Segment Artificial Disc Replacement Using the Baguera ®C Prosthesis. J Clin Med 2024; 13:2048. [PMID: 38610813 PMCID: PMC11012751 DOI: 10.3390/jcm13072048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Anterior cervical discectomy and fusion (ACDF) is a standard procedure for degenerative diseases of the cervical spine, providing nerve decompression and spinal stabilization. However, it limits cervical spine motility, restricts fused segment activity, and may lead to adjacent degeneration. Cervical disc arthroplasty (CDA) is an accepted alternative that preserves the structure and flexibility of the cervical spine. This study aimed to explore the dynamic changes in the range of motion (ROM) of the cervical spine after CDA using a viscoelastic artificial disc, as well as the factors affecting mobility restoration. Methods: A retrospective analysis was conducted on 132 patients who underwent single-level anterior cervical discectomy and CDA from January 2015 to June 2022. Result: Analysis of data from 132 patients revealed a significant improvement in clinical outcomes. The mean ROM of C2-C7 and functional spinal unit (FSU) segments significantly increased from 2 to 36 months post-operatively. Cervical spine flexibility was preserved and enhanced after prosthesis implantation. However, it took six months for the cervical spine motility to stabilize. In addition, sex and age were found to impact motility restoration, with female and younger patients exhibiting larger ROMs post-surgery. Additionally, CDA at the C5-C6 level resulted in the greatest increase in ROM, potentially improving overall kinematic ability. Conclusions: Single-segment artificial disc arthroplasty effectively restores the ROM in degenerative cervical spine conditions.
Collapse
Affiliation(s)
- Ming-Cheng Tsai
- School of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Neurosurgical Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan
| | - Ya-Fang Liu
- Research Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan
| | - Wei-Hsing Lin
- Department of Life Science, National Taiwan Normal University, Taipei 116, Taiwan
| | - Ming-Chung Lee
- Department of Life Science, National Taiwan Normal University, Taipei 116, Taiwan
| |
Collapse
|
13
|
Xu ML, Yang YT, Zeng HZ, Cao YT, Zheng LD, Jin C, Zhu SJ, Zhu R. Finite element modeling and analysis of effect of preexisting cervical degenerative disease on the spinal cord during flexion and extension. Med Biol Eng Comput 2024; 62:1089-1104. [PMID: 38148413 DOI: 10.1007/s11517-023-02993-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 12/07/2023] [Indexed: 12/28/2023]
Abstract
Recent studies have emphasized the importance of dynamic activity in the development of myelopathy. However, current knowledge of how degenerative factors affect the spinal cord during motion is still limited. This study aimed to investigate the effect of various types of preexisting herniated cervical disc and the ligamentum flavum ossification on the spinal cord during cervical flexion and extension. A detailed dynamic fluid-structure interaction finite element model of the cervical spine with the spinal cord was developed and validated. The changes of von Mises stress and maximum principal strain within the spinal cord in the period of normal, hyperflexion, and hyperextension were investigated, considering various types and grades of disc herniation and ossification of the ligamentum flavum. The flexion and extension of the cervical spine with spinal canal encroachment induced high stress and strain inside the spinal cord, and this effect was also amplified by increased canal encroachments and cervical hypermobility. The spinal cord might evade lateral encroachment, leading to a reduction in the maximum stress and principal strain within the spinal cord in local-type herniation. Although the impact was limited in the case of diffuse type, the maximum stress tended to appear in the white matter near the encroachment site while compression from both ventral and dorsal was essential to make maximum stress appear in the grey matter. The existence of canal encroachment can reduce the safe range for spinal cord activities, and hypermobility activities may induce spinal cord injury. Besides, the ligamentum flavum plays an important role in the development of central canal syndrome.Significance. This model will enable researchers to have a better understanding of the influence of cervical degenerative diseases on the spinal cord during extension and flexion.
Collapse
Affiliation(s)
- Meng-Lei Xu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Yi-Ting Yang
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China
| | - Hui-Zi Zeng
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China
| | - Yu-Ting Cao
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China
| | - Liang-Dong Zheng
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China
| | - Chen Jin
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Shi-Jie Zhu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China
| | - Rui Zhu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China.
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China.
| |
Collapse
|
14
|
Kondo Y, Higuchi D, Miki T, Watanabe Y, Takebayashi T. Relationship Between Central Sensitization-Related Symptoms and Pain-Related Disability After Cervical Spine Surgery: A Structural Equation Model. Pain Manag Nurs 2024; 25:e126-e131. [PMID: 38272764 DOI: 10.1016/j.pmn.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/13/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND It is unknown if central sensitization (CS)-related symptoms have an intermediate role that might explain how disability develops from pain after cervical spinal surgery. AIMS The study aim was to investigate the role of CS-related symptoms in the relationship between pain and disability reported after cervical spinal surgery. DESIGN Cross-sectional study. SETTINGS Tertiary care spinal surgery center. PARTICIPANTS/SUBJECTS The participants included individuals with a cervical degenerative condition who had undergone surgery. METHODS The following patient-reported outcome measures were evaluated: (1) Numerical Rating Scale; (2) Neck Disability Index; and (3) Short Form of the Central Sensitization Inventory. A hypothesized model containing the CS-related symptoms and the relationships between pain and disability was constructed and tested by structural equation modeling. RESULTS Questionnaires were mailed to 280 individuals, and responses were obtained from 145 participants. Of these respondents, 99 (68.3%) were males and 46 (31.7%) were females, with a mean age of 64.4 ± 12.3 years. The latent variable for pain, represented by the neck (coefficient: 0.856, p < .001) and upper limb pain (0.568, p < .001), influenced CS-related symptoms (coefficient: 0.504, p < .001). Pain directly affected disability (coefficient: 0.497, p < .001) and indirectly through CS-related symptoms. Bootstrap analysis confirmed this indirect effect (point estimate: 2.85, 95% confidence interval: 1.04 to 6.30, p = .04). CONCLUSIONS The results revealed that neck and upper limb pain affected disabilities both directly and through CS-related symptoms. Future research should focus on the efficacy of biopsychosocial approaches for patients after cervical spine surgery with a high risk of disability due to CS-related symptoms.
Collapse
Affiliation(s)
- Yu Kondo
- Department of Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan.
| | - Daisuke Higuchi
- Department of Physical Therapy, Takasaki University of Health and Welfare, Takasaki, Japan
| | - Takahiro Miki
- PREVENT Inc., Nagoya, Japan; Graduate school, Hokkaido University, Sapporo, Japan
| | - Yuta Watanabe
- Department of Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan
| | - Tsuneo Takebayashi
- Department of Orthopedic, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan
| |
Collapse
|
15
|
Chien KT, Chen YC, Chang TK, Liu YC, Chen LP, Huang YC, Lian YS, Li JY. Novel Cervical Endoscopic Unilateral Laminoforaminotomy for Bilateral Decompression in Cervical Spondylosis Myeloradiculopathy: A Technical Note and Clinical Results. J Clin Med 2024; 13:1910. [PMID: 38610675 PMCID: PMC11012691 DOI: 10.3390/jcm13071910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/05/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Background: This study investigates the efficacy of the Cervical Endoscopic Unilateral Laminoforaminotomy for Bilateral Decompression (CE-ULFBD) technique in treating cervical myeloradiculopathy, primarily caused by degenerative spondylosis. Traditionally managed through multisegmental anterior cervical discectomy and fusion (ACDF) or laminoplasty combined with foraminotomy, this condition has recently experienced a promising shift towards minimally invasive approaches, particularly endoscopic spinal decompression. While empirical evidence is still emerging, these techniques show potential for effective treatment. Method: The objective was to evaluate the outcomes of CE-ULFBD in achieving single or multilevel bilateral foraminal and central decompression, emphasizing the reduction of injury to posterior cervical muscles and the associated postoperative neck soreness common in conventional procedures. This paper delineates the surgical procedures involved in CE-ULFBD and presents the clinical outcomes of nine patients diagnosed with myeloradiculopathy due to severe cervical stenosis. Result: Assessments were conducted using the Visual Analogue Scale (VAS) for neck and arm pain and the Modified Japanese Orthopaedic Association scale (mJOA) for the activity measurement of daily living. Results indicated a considerable decrease in pain levels according to the VAS, coupled with significant improvements in functional capacities as measured by the mJOA scale. Additionally, no major postoperative complications were noted during the follow-up period. Conclusion: The study concludes that CE-ULFBD is a safe and effective approach for the treatment of cervical myeloradiculopathy resulting from severe cervical stenosis, offering a viable and less invasive alternative to traditional decompressive surgeries.
Collapse
Affiliation(s)
- Kai-Ting Chien
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei 104217, Taiwan; (K.-T.C.)
- Institute of Applied Arts, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Yu-Cheng Chen
- Department of Medical Education, MacKay Memorial Hospital, Taipei 104217, Taiwan
| | - Ting-Kuo Chang
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei 104217, Taiwan; (K.-T.C.)
- Department of Medicine, Mackay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan
| | - Yueh-Ching Liu
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei 104217, Taiwan; (K.-T.C.)
| | - Lei-Po Chen
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei 104217, Taiwan; (K.-T.C.)
- Department of Medicine, Mackay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan
| | - Yu-Ching Huang
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei 104217, Taiwan; (K.-T.C.)
| | - Yan-Shiang Lian
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei 104217, Taiwan; (K.-T.C.)
| | - Jian-You Li
- Institute of Applied Arts, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| |
Collapse
|
16
|
Tang L, Chen Y, Wang F, Liu Y, Song Z, Wang M, Zhou Y, Liu H, Zheng J. Safety and efficacy of day anterior cervical discectomy and fusion procedure for degenerative cervical spondylosis: a retrospective analysis. BMC Musculoskelet Disord 2024; 25:223. [PMID: 38504222 PMCID: PMC10953196 DOI: 10.1186/s12891-024-07356-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVE Our study aimed to develop a day anterior cervical discectomy and fusion (ACDF) procedure to treat degenerative cervical spondylosis (DCS). The goal was to analyze its clinical implications, safety, and early effects to provide a better surgical option for eligible DCS patients. METHODS A retrospective analysis was performed to identify DCS patients who underwent day ACDF from September 2022 to August 2023. The operative time, intraoperative blood loss, postoperative drainage, preoperative and postoperative visual analog scale (VAS) scores, neck disability index (NDI) scores, Japanese Orthopedic Association (JOA) scores, JOA recovery rate (RR), incidence of dysphagia-related symptoms, 30-day hospital readmission rate, and incidence of other complications were recorded to evaluate early clinical outcomes. Radiography was performed to assess the location of the implants, neurological decompression, and cervical physiological curvature. RESULTS All 33 patients (23 women and 10 men) underwent successful surgery and experienced significant symptomatic and neurological improvements. Among them, 26 patients underwent one-segment ACDF, 5 underwent two-segment ACDF, and 2 underwent three-segment ACDF. The average operative time was 71.1 ± 20.2 min, intraoperative blood loss was 19.1 ± 6.2 mL, and postoperative drainage was 9.6 ± 5.8 mL. The preoperative VAS and NDI scores improved postoperatively (7.1 ± 1.2 vs. 3.1 ± 1.3 and 66.7% ± 4.8% vs. 24.1% ± 2.5%, respectively), with a significant difference (P < 0.01). Moreover, the preoperative JOA scores improved significantly postoperatively (7.7 ± 1.3 vs. 14.2 ± 1.4; P < 0.01) with an RR of 93.9% in good or excellent. Postoperative dysphagia-related symptoms occurred in one patient (3.0%). During the follow-up period, no patient was readmitted within 30 days after discharge; however, an incisional hematoma was reported in one patient on the 6th day after discharge, which was cured by pressure dressing. The postoperative radiographs revealed perfect implant positions and sufficient nerve decompression in all patients. Furthermore, the preoperative cervical physiological curvature improved significantly after the operation (14.5° ± 4.0° vs. 26.3° ± 5.4°; P < 0.01). CONCLUSIONS Day ACDF has good safety and early clinical efficacy, and it could be an appropriate choice for eligible DCS patients.
Collapse
Affiliation(s)
- Long Tang
- Department of Spine Surgery, Suining Central Hospital, 127 Desheng West Road, Suining, Sichuan Province, 629000, China
- Department of Neurosurgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, Munich, 81675, Germany
| | - Yu Chen
- Department of Spine Surgery, Suining Central Hospital, 127 Desheng West Road, Suining, Sichuan Province, 629000, China
| | - Fandong Wang
- Department of Spine Surgery, Suining Central Hospital, 127 Desheng West Road, Suining, Sichuan Province, 629000, China
| | - Yuanbin Liu
- Department of Spine Surgery, Suining Central Hospital, 127 Desheng West Road, Suining, Sichuan Province, 629000, China
| | - Zhaojun Song
- Department of Spine Surgery, Suining Central Hospital, 127 Desheng West Road, Suining, Sichuan Province, 629000, China
| | - Miao Wang
- Department of Spine Surgery, Suining Central Hospital, 127 Desheng West Road, Suining, Sichuan Province, 629000, China
| | - Yong Zhou
- Department of Spine Surgery, Suining Central Hospital, 127 Desheng West Road, Suining, Sichuan Province, 629000, China
| | - Huiyi Liu
- Department of Spine Surgery, Suining Central Hospital, 127 Desheng West Road, Suining, Sichuan Province, 629000, China
| | - Jiazhuang Zheng
- Department of Spine Surgery, Suining Central Hospital, 127 Desheng West Road, Suining, Sichuan Province, 629000, China.
| |
Collapse
|
17
|
Santoro GD, Morselli C, Cirullo A, Bassani R. 'Tumour-like' lesion caused by cervical discal instability. BMJ Case Rep 2024; 17:e257373. [PMID: 38479832 PMCID: PMC10941145 DOI: 10.1136/bcr-2023-257373] [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] [Indexed: 03/18/2024] Open
Abstract
We present the case of a man in his 40s who sought medical attention due to central cord syndrome. MRI findings demonstrated contrast uptake, spinal swelling, syrinx formation and narrowing of the spinal canal. We encountered two potential scenarios:when malignancy is suspected, the patient would undergo a biopsy. However, if the lesion is ultimately determined to be benign, the patient would have been subjected to an avoidable risk of neurological damage associated with the procedure. Conversely, addressing the lesion as a result of a degenerative process (discal instability), performing an anterior approach for interbody fusion with an underlying malignant process could lead to substantial delays in the diagnosis, finally producing a poor outcome. A comprehensive imaging workup was conducted to rule out malignancy. We hypothesised that discal instability was responsible for the observed findings. The patient was successfully treated with anterior cervical decompression and fusion, without complications. Follow-up evaluations confirmed remission of the condition.
Collapse
Affiliation(s)
- Giuseppe Diodato Santoro
- Scuola di Specializzazione in Ortopedia e Traumatologia, Università degli Studi di Milano, Milano, Italy
- Second Spinal Surgery Unit, IRCCS Galeazzi-Sant'Ambrogio Hospital, Milano, Italy
| | - Carlotta Morselli
- Second Spinal Surgery Unit, IRCCS Galeazzi-Sant'Ambrogio Hospital, Milano, Italy
| | - Agostino Cirullo
- Second Spinal Surgery Unit, IRCCS Galeazzi-Sant'Ambrogio Hospital, Milano, Italy
| | - Roberto Bassani
- Second Spinal Surgery Unit, IRCCS Galeazzi-Sant'Ambrogio Hospital, Milano, Italy
| |
Collapse
|
18
|
Wang Y, Qu H, Du W, Wang Y. Stroke mimics: A case report of cervical spondylosis with intravenous thrombolysis. CNS Neurosci Ther 2024; 30:e14434. [PMID: 37649425 PMCID: PMC10945389 DOI: 10.1111/cns.14434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/29/2023] [Accepted: 08/15/2023] [Indexed: 09/01/2023] Open
Affiliation(s)
- Yicong Wang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Hui Qu
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Wanliang Du
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Chinese Institute for Brain ResearchBeijingChina
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular DiseaseBeijingChina
| |
Collapse
|
19
|
Elsamadicy AA, Sayeed S, Sherman JJZ, Craft S, Reeves BC, Hengartner AC, Koo AB, Larry Lo SF, Shin JH, Mendel E, Sciubba DM. Racial/Ethnic Disparities Among Patients Undergoing Anterior Cervical Discectomy and Fusion or Posterior Cervical Decompression and Fusion for Cervical Spondylotic Myelopathy: A National Administrative Database Analysis. World Neurosurg 2024; 183:e372-e385. [PMID: 38145651 DOI: 10.1016/j.wneu.2023.12.103] [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: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION The aim of this study was to investigate the impact of racial disparities on surgical outcomes for cervical spondylotic myelopathy (CSM). METHODS Adult patients undergoing anterior cervical discectomy and fusion (ACDF) or posterior cervical decompression and fusion (PCDF) for CSM were identified from the 2016 to 019 National Inpatient Sample Database using the International Classification of Diseases codes. Patients were categorized based on approach (ACDF or PCDF) and race/ethnicity (White, Black, Hispanic). Patient demographics, comorbidities, operative characteristics, adverse events, and health care resource utilization were assessed. Multivariate logistic regression analyses were used to identify independent predictors of extended length of stay (LOS), nonroutine discharge (NRD), and exorbitant costs. RESULTS A total of 46,500 patients were identified, of which 36,015 (77.5%) were White, 7465 (16.0%) were Black, and 3020 (6.5%) were Hispanic. Black and Hispanic patients had a greater comorbidity burden compared to White patients (P = 0.001) and a greater incidence of any postoperative complication (P = 0.001). Healthcare resource utilization were greater in the PCDF cohort than the ACDF cohort and greater in Black and Hispanic patients compared to White patients (P < 0.001). Black and Hispanic patient race were significantly associated with extended hospital LOS ([Black] odds ratio [OR]: 2.24, P < 0.001; [Hispanic] OR: 1.64, P < 0.001) and NRD ([Black] OR: 2.33, P < 0.001; [Hispanic] OR: 1.49, P = 0.016). Among patients who underwent PCDF, Black race was independently associated with extended hospital LOS ([Black] OR: 1.77, P < 0.001; [Hispanic] OR: 1.47, P = 0.167) and NRD ([Black] OR: 1.82, P < 0.001; [Hispanic] OR: 1.38, P = 0.052). CONCLUSIONS Our study suggests that patient race may influence patient outcomes and healthcare resource utilization following ACDF or PCDF for CSM.
Collapse
Affiliation(s)
- Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
| | - Sumaiya Sayeed
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Josiah J Z Sherman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Samuel Craft
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Benjamin C Reeves
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Astrid C Hengartner
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andrew B Koo
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ehud Mendel
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| |
Collapse
|
20
|
Wang X, Jin Z, Feng T, Fang S, Sun C, Qin X, Sun K, Liang L, Liu G, Zhu L, Wei X. The immediate effect of cervical rotation-traction manipulation on cervical paravertebral soft tissue: a study using soft tissue tension cloud chart technology. BMC Musculoskelet Disord 2024; 25:184. [PMID: 38424580 PMCID: PMC10903149 DOI: 10.1186/s12891-024-07277-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 02/12/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND To evaluate the reliability of the Soft Tissue Tension Cloud Chart (STTCC) technology, an original method combining multi-point Cervical Paravertebral Soft Tissue Test (CPSTT) with MATLAB software, we conducted a preliminary analysis on the immediate effects of Orthopaedic Manual Therapy (OMT) on cervical paravertebral soft tissue. METHODS 30 patients with Cervical Spondylotic Radiculopathy (CSR) were included in this study. We analyzed the differences in CPSTT before and after treatment with Cervical Rotation-Traction Manipulation (CRTM), a representative OMT technique in Traditional Chinese Medicine, using the STTCC technology. RESULTS The STTCC results demonstrated that post-treatment CPSTT levels in CSR patients were significantly lower than pre-treatment levels after application of CRTM, with a statistically significant difference (P < 0.001). Additionally, pre-treatment CPSTT levels on the symptomatic side (with radicular pain or numbness) were higher across the C5 to C7 vertebrae compared to the asymptomatic side (without symptoms) (P < 0.001). However, this difference disappeared after CRTM treatment (P = 0.231). CONCLUSIONS The STTCC technology represents a reliable method for analyzing the immediate effects of OMT. CSR patients display uneven distribution of CPSTT characterized by higher tension on the symptomatic side. CRTM not only reduces overall cervical soft tissue tension in CSR patients, but can also balance the asymmetrical tension between the symptomatic and asymptomatic sides. TRIAL REGISTRATION This study was approved by the Chinese Clinical Trials Registry (Website: . https://www.chictr.org.cn .) on 20/04/2021 and the Registration Number is ChiCTR2100045648.
Collapse
Affiliation(s)
- Xu Wang
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zikai Jin
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Tianxiao Feng
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Shengjie Fang
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Liaocheng Hospital of Chinese Medicine, Liaocheng, Shandong, People's Republic of China
| | - Chuanrui Sun
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaokuan Qin
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Kai Sun
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing Key Laboratory of Traditional Chinese Orthopedics and Traumatology, Beijing, People's Republic of China
| | - Long Liang
- Anhui Provincial Hospital of Chinese Medicine, Hefei, Anhui, People's Republic of China
| | - Guangwei Liu
- Beijing Key Laboratory of Traditional Chinese Orthopedics and Traumatology, Beijing, People's Republic of China
| | - Liguo Zhu
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing Key Laboratory of Traditional Chinese Orthopedics and Traumatology, Beijing, People's Republic of China
| | - Xu Wei
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
- Beijing Key Laboratory of Traditional Chinese Orthopedics and Traumatology, Beijing, People's Republic of China.
| |
Collapse
|
21
|
Wang Y, Zhao R, Zhu D, Fu X, Sun F, Cai Y, Ma J, Guo X, Zhang J, Xue Y. Voxel- and tensor-based morphometry with machine learning techniques identifying characteristic brain impairment in patients with cervical spondylotic myelopathy. Front Neurol 2024; 15:1267349. [PMID: 38419699 PMCID: PMC10899699 DOI: 10.3389/fneur.2024.1267349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
Aim The diagnosis of cervical spondylotic myelopathy (CSM) relies on several methods, including x-rays, computed tomography, and magnetic resonance imaging (MRI). Although MRI is the most useful diagnostic tool, strategies to improve the precise and independent diagnosis of CSM using novel MRI imaging techniques are urgently needed. This study aimed to explore potential brain biomarkers to improve the precise diagnosis of CSM through the combination of voxel-based morphometry (VBM) and tensor-based morphometry (TBM) with machine learning techniques. Methods In this retrospective study, 57 patients with CSM and 57 healthy controls (HCs) were enrolled. The structural changes in the gray matter volume and white matter volume were determined by VBM. Gray and white matter deformations were measured by TBM. The support vector machine (SVM) was used for the classification of CSM patients from HCs based on the structural features of VBM and TBM. Results CSM patients exhibited characteristic structural abnormalities in the sensorimotor, visual, cognitive, and subcortical regions, as well as in the anterior corona radiata and the corpus callosum [P < 0.05, false discovery rate (FDR) corrected]. A multivariate pattern classification analysis revealed that VBM and TBM could successfully identify CSM patients and HCs [classification accuracy: 81.58%, area under the curve (AUC): 0.85; P < 0.005, Bonferroni corrected] through characteristic gray matter and white matter impairments. Conclusion CSM may cause widespread and remote impairments in brain structures. This study provided a valuable reference for developing novel diagnostic strategies to identify CSM.
Collapse
Affiliation(s)
- Yang Wang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Rui Zhao
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Dan Zhu
- Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
- Department of Radiology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
| | - Xiuwei Fu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Fengyu Sun
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuezeng Cai
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Juanwei Ma
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Xing Guo
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jing Zhang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuan Xue
- Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, China
| |
Collapse
|
22
|
Danielsen E, Ingebrigtsen T, Gulati S, Salvesen Ø, Johansen TO, Nygaard ØP, Solberg TK. Patient Characteristics Associated With Worsening of Neck Pain-Related Disability After Surgery for Degenerative Cervical Myelopathy: A Nationwide Study of 1508 Patients. Neurosurgery 2024:00006123-990000000-01043. [PMID: 38323820 DOI: 10.1227/neu.0000000000002852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/17/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Functional status, pain, and quality of life usually improve after surgery for degenerative cervical myelopathy (DCM), but a subset of patients report worsening. The objective was to define cutoff values for worsening on the Neck Disability Index (NDI) and identify prognostic factors associated with worsening of pain-related disability 12 months after DCM surgery. METHODS In this prognostic study based on prospectively collected data from the Norwegian Registry for Spine Surgery, the NDI was the primary outcome. Receiver operating characteristics curve analyses were used to obtain cutoff values, using the global perceived effect scale as an external anchor. Univariable and multivariable analyses were performed using mixed logistic regression to evaluate the relationship between potential prognostic factors and the NDI. RESULTS Among the 1508 patients undergoing surgery for myelopathy, 1248 (82.7%) were followed for either 3 or 12 months. Of these, 317 (25.4%) were classified to belong to the worsening group according to the mean NDI percentage change cutoff of 3.3. Multivariable analyses showed that smoking (odds ratio [OR] 3.4: 95% CI 1.2-9.5: P < .001), low educational level (OR 2.5: 95% CI 1.0-6.5: P < .001), and American Society of Anesthesiologists grade >II (OR 2.2: 95% CI 0.7-5.6: P = .004) were associated with worsening. Patients with more severe neck pain (OR 0.8: 95% CI 0.7-1.0: P = .003) and arm pain (OR 0.8: 95% CI 0.7-1.0; P = .007) at baseline were less likely to report worsening. CONCLUSION We defined a cutoff value of 3.3 for worsening after DCM surgery using the mean NDI percentage change. The independent prognostic factors associated with worsening of pain-related disability were smoking, low educational level, and American Society of Anesthesiologists grade >II. Patients with more severe neck and arm pain at baseline were less likely to report worsening at 12 months.
Collapse
Affiliation(s)
- Elisabet Danielsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Sasha Gulati
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- National Advisory Unit on Spinal Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Tonje O Johansen
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Øystein P Nygaard
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- National Advisory Unit on Spinal Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Tore K Solberg
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway
| |
Collapse
|
23
|
Onofrei LV. Structural Myelopathies. Continuum (Minneap Minn) 2024; 30:73-98. [PMID: 38330473 DOI: 10.1212/con.0000000000001384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This article illustrates the clinical importance, diagnosis, and management of degenerative and nondegenerative structural myelopathies. It also aims to create a diagnostic approach for the evaluation of patients with suspected degenerative myelopathies. LATEST DEVELOPMENTS There is considerable interest in developing diagnostic methods that can assist in deciding if surgery is indicated in patients with structural myelopathy and the optimal timing for surgery. Diffusion tensor imaging has emerged as a promising imaging modality although it is not used routinely in clinical practice. Neuroprotective medications and interventions are being studied in patients with degenerative myelopathies. ESSENTIAL POINTS Structural myelopathies and particularly degenerative myelopathies are common disorders that are routinely encountered in clinical practice, with symptoms that frequently overlap with other neurologic disorders. The prompt diagnosis and treatment of patients are essential in achieving good functional outcomes.
Collapse
|
24
|
Feng X, Liu C, Hu DM, Zhang JF, Zheng N, Chi YY, Yu SB, Sui HJ, Xu Q. Magnetic resonance imaging-based classification of the myodural bridge complex and its influencing factors. Surg Radiol Anat 2024; 46:125-135. [PMID: 38194160 PMCID: PMC10861613 DOI: 10.1007/s00276-023-03279-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/05/2023] [Indexed: 01/10/2024]
Abstract
Cerebrospinal fluid (CSF) circulation is considered the third circulation of the human body. Recently, some scholars have proposed the myodural bridge (MDB) as a novel power source for CSF flow. Moreover, the suboccipital muscles can exert a driving force on the CSF via the MDB. This hypothesis is directly supported by head rotation and nodding movements, which can affect CSF circulation. The MDB has been validated as a normal structure in humans and mammals. In addition, the fusion of MDB fibers of different origins that act in concert with each other forms the MDB complex (MDBC). The MDBC may be associated with several CSF disorder-related neurological disorders in clinical practice. Therefore, the morphology of the MDBC and its influencing factors must be determined. In this study, T2-weighted imaging sagittal images of the cervical region were analyzed retrospectively in 1085 patients, and magnetic resonance imaging (MRI) typing of the MDBC was performed according to the imaging features of the MDBC in the posterior atlanto-occipital interspace (PAOiS) and posterior atlanto-axial interspace (PAAiS). The effects of age and age-related degenerative changes in the cervical spine on MRI staging of the MDBC were also determined. The results revealed four MRI types of the MDBC: type A (no MDBC hyposignal shadow connected to the dura mater in either the PAOiS or PAAiS), type B (MDBC hyposignal shadow connected to the dura mater in the PAOiS only), type C (MDBC hyposignal shadow connected to the dura mater in the PAAiS only), and type D (MDBC hyposignal shadow connected to the dura mater in both the PAOiS and PAAiS). The influencing factors for the MDBC typing were age (group), degree of intervertebral space stenosis, dorsal osteophytosis, and degenerative changes in the cervical spine (P < 0.05). With increasing age (10-year interval), the incidence of type B MDBC markedly decreased, whereas that of type A MDBC increased considerably. With the deepening of the degree of intervertebral space stenosis, the incidence of type C MDBC increased significantly, whereas that of type A MDBC decreased. In the presence of dorsal osteophytosis, the incidence of type C and D MDBCs significantly decreased, whereas that of type A increased. In the presence of protrusion of the intervertebral disc, the incidence of type B, C, and D MDBCs increased markedly, whereas that of type A MDBC decreased considerably, with cervical degenerative changes combined with spinal canal stenosis. Moreover, the incidence of both type C and D MDBCs increased, whereas that of type A MDBC decreased. Based on the MRI signal characteristics of the dural side of the MDBC, four types of the MDBC were identified. MDBC typing varies dynamically according to population distribution, depending on age and cervical degeneration (degree of intervertebral space stenosis, vertebral dorsal osteophytosis formation, simple protrusion of intervertebral disc, and cervical degeneration changes combined with spinal canal stenosis, except for the degree of protrusion of the intervertebral disc and the degree of spinal canal stenosis); however, it is not influenced by sex.
Collapse
Affiliation(s)
- Xiao Feng
- Postgraduate Training Base, The 967 Hospital of the Joint Logistics Support Force, Jinzhou Medical University, Dalian, 116021, China
| | - Cong Liu
- Department of Radiology, The 967 Hospital of the Joint Logistics Support Force, Dalian, 116021, China
| | - Dong-Mei Hu
- Department of Health Statistics, School of Public Health, Dalian Medical University, Dalian, 116044, China
| | - Jian-Fei Zhang
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, China
| | - Nan Zheng
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, China
| | - Yan-Yan Chi
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, China
| | - Sheng-Bo Yu
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, China.
| | - Hong-Jin Sui
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, China.
| | - Qiang Xu
- Department of Radiology, The 967 Hospital of the Joint Logistics Support Force, Dalian, 116021, China.
- Postgraduate Training Base, The 967 Hospital of the Joint Logistics Support Force, Jinzhou Medical University, Dalian, 116021, China.
| |
Collapse
|
25
|
Qiu Y, Wei X, Tao Y, Song B, Wang M, Yin Z, Xie M, Duan A, Chen Z, Wang Z. Causal association of leisure sedentary behavior and cervical spondylosis, sciatica, intervertebral disk disorders, and low back pain: a Mendelian randomization study. Front Public Health 2024; 12:1284594. [PMID: 38322127 PMCID: PMC10844448 DOI: 10.3389/fpubh.2024.1284594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024] Open
Abstract
Background Some studies suggest sedentary behavior is a risk factor for musculoskeletal disorders. This study aimed to investigate the potential causal association between leisure sedentary behavior (LSB) (including television (TV) viewing, computer use, and driving) and the incidence of sciatica, intervertebral disk degeneration (IVDD), low back pain (LBP), and cervical spondylosis (CS). Methods We obtained the data of LSB, CS, IVDD, LBP, sciatica and proposed mediators from the gene-wide association studies (GWAS). The causal effects were examined by Inverse Variance Weighted (IVW) test, MR-Egger, weighted median, weighted mode and simple mode. And sensitivity analysis was performed using MR-Pleiotropy Residual Sum and Outlier (MR-PRESSO) and MR-Egger intercept test. Multivariable MR (MVMR) was conducted to investigate the independent factor of other LSB; while two-step MR analysis was used to explore the potential mediators including Body mass index (BMI), smoking initiation, type 2 diabetes mellitus (T2DM), major depressive disorder (MDD), schizophrenia, bipolar disorder between the causal association of LSB and these diseases based on previous studies. Results Genetically associated TV viewing was positively associated with the risk of CS (OR = 1.61, 95%CI = 1.25 to 2.07, p = 0.002), IVDD (OR = 2.10, 95%CI = 1.77 to 2.48, p = 3.79 × 10-18), LBP (OR = 1.84, 95%CI = 1.53 to 2.21, p = 1.04 × 10-10) and sciatica (OR = 1.82, 95% CI = 1.45 to 2.27, p = 1.42 × 10-7). While computer use was associated with a reduced risk of IVDD (OR = 0.66, 95%CI = 0.55 to 0.79, p = 8.06 × 10-6), LBP (OR = 0.49, 95%CI = 0.40 to 0.59, p = 2.68 × 10-13) and sciatica (OR = 0.58, 95%CI = 0.46 to 0.75, p = 1.98 × 10-5). Sensitivity analysis validated the robustness of MR outcomes. MVMR analysis showed that the causal effect of TV viewing on IVDD (OR = 1.59, 95%CI = 1.13 to 2.25, p = 0.008), LBP (OR = 2.15, 95%CI = 1.50 to 3.08, p = 3.38 × 10-5), and sciatica (OR = 1.61, 95%CI = 1.03 to 2.52, p = 0.037) was independent of other LSB. Furthermore, two-step MR analysis indicated that BMI, smoking initiation, T2DM may mediate the causal effect of TV viewing on these diseases. Conclusion This study provides empirical evidence supporting a positive causal association between TV viewing and sciatica, IVDD and LBP, which were potentially mediated by BMI, smoking initiation and T2DM.
Collapse
Affiliation(s)
- Youjia Qiu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xingzhou Wei
- Suzhou Medical School of Soochow University, Suzhou, Jiangsu, China
| | - Yuchen Tao
- Suzhou Medical School of Soochow University, Suzhou, Jiangsu, China
| | - Bingyi Song
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Menghan Wang
- Suzhou Medical School of Soochow University, Suzhou, Jiangsu, China
| | - Ziqian Yin
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Minjia Xie
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Aojie Duan
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhouqing Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| |
Collapse
|
26
|
Xie J, Yang Y, Jiang Z, Zhang K, Zhang X, Lin Y, Shen Y, Jia X, Liu H, Yang S, Jiang Y, Ma L. MRI radiomics-based decision support tool for a personalized classification of cervical disc degeneration: a two-center study. Front Physiol 2024; 14:1281506. [PMID: 38235385 PMCID: PMC10791783 DOI: 10.3389/fphys.2023.1281506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/24/2023] [Indexed: 01/19/2024] Open
Abstract
Objectives: To develop and validate an MRI radiomics-based decision support tool for the automated grading of cervical disc degeneration. Methods: The retrospective study included 2,610 cervical disc samples of 435 patients from two hospitals. The cervical magnetic resonance imaging (MRI) analysis of patients confirmed cervical disc degeneration grades using the Pfirrmann grading system. A training set (1,830 samples of 305 patients) and an independent test set (780 samples of 130 patients) were divided for the construction and validation of the machine learning model, respectively. We provided a fine-tuned MedSAM model for automated cervical disc segmentation. Then, we extracted 924 radiomic features from each segmented disc in T1 and T2 MRI modalities. All features were processed and selected using minimum redundancy maximum relevance (mRMR) and multiple machine learning algorithms. Meanwhile, the radiomics models of various machine learning algorithms and MRI images were constructed and compared. Finally, the combined radiomics model was constructed in the training set and validated in the test set. Radiomic feature mapping was provided for auxiliary diagnosis. Results: Of the 2,610 cervical disc samples, 794 (30.4%) were classified as low grade and 1,816 (69.6%) were classified as high grade. The fine-tuned MedSAM model achieved good segmentation performance, with the mean Dice coefficient of 0.93. Higher-order texture features contributed to the dominant force in the diagnostic task (80%). Among various machine learning models, random forest performed better than the other algorithms (p < 0.01), and the T2 MRI radiomics model showed better results than T1 MRI in the diagnostic performance (p < 0.05). The final combined radiomics model had an area under the receiver operating characteristic curve (AUC) of 0.95, an accuracy of 89.51%, a precision of 87.07%, a recall of 98.83%, and an F1 score of 0.93 in the test set, which were all better than those of other models (p < 0.05). Conclusion: The radiomics-based decision support tool using T1 and T2 MRI modalities can be used for cervical disc degeneration grading, facilitating individualized management.
Collapse
Affiliation(s)
- Jun Xie
- Information Technology Center, West China Hospital of Sichuan University, Chengdu, China
- Information Technology Center, Sanya People’s Hospital, Sanya, China
| | - Yi Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zekun Jiang
- College of Computer Science, Sichuan University, Chengdu, Sichuan, China
- West China Biomedical Big Data Center, Sichuan University, Chengdu, Sichuan, China
| | - Kerui Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiang Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuheng Lin
- West China Biomedical Big Data Center, Sichuan University, Chengdu, Sichuan, China
| | - Yiwei Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xuehai Jia
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shaofen Yang
- Cadre Health Section, Hezhou People’s Hospital, Hezhou, Guangxi, China
| | - Yang Jiang
- Department of Orthopedic Spine, The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu, Sichuan, China
| | - Litai Ma
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
27
|
Yao Z, Zhang S, Liu W, Wei M, Fang W, Li Q, Cai L, Wang Z, Zhou C, Zhou Y. The efficacy and safety of ultrasonic bone scalpel for removing retrovertebral osteophytes in anterior cervical discectomy and fusion: A retrospective study. Sci Rep 2024; 14:80. [PMID: 38168463 PMCID: PMC10761842 DOI: 10.1038/s41598-023-50545-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
In this study, we present a novel surgical method that utilizes the ultrasonic bone scalpel (UBS) for the removal of large retrovertebral osteophytes in anterior cervical discectomy and fusion (ACDF) and evaluate its safety and efficacy in comparison to the traditional approach of using high-speed drill (HSD). A total of 56 patients who underwent ACDF for retrovertebral osteophytes were selected. We recorded patients' baseline information, operation time, intraoperative blood loss, complications, JOA and VAS scores, and other relevant data. The mean operation time and the mean intraoperative blood loss in the UBS group were less than those in the HSD group (P < 0.05). Although both groups exhibited considerable improvements in JOA and VAS scores following surgery, there was no statistically significant difference between the two groups (P > 0.05). Additionally, no significant disparities were found in bone graft fusion between the two groups at 6- and 12-months postsurgery. Notably, neither group exhibited complications such as dura tear or spinal cord injury. Our study found that the use of UBS reduced operative time, minimized surgical bleeding, and led to clinical outcomes comparable to HSD in ACDF. This technique offers an effective and safe method of removing large retrovertebral osteophytes.
Collapse
Affiliation(s)
- Zhi Yao
- Department of Spine Surgery, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College Affiliated to Huazhong University of Science and Technology, No. 473 Hanzheng Street, Qiaokou District, Wuhan, 430033, China
| | - Shishuang Zhang
- Department of Spine Surgery, Wuhan Fourth Hospital, School of Medicine, Jianghan University, No. 473 Hanzheng Street, Qiaokou District, Wuhan, 430033, China
| | - Weijun Liu
- Department of Spine Surgery, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, 430033, China.
| | - Mengcheng Wei
- Department of Spine Surgery, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College Affiliated to Huazhong University of Science and Technology, No. 473 Hanzheng Street, Qiaokou District, Wuhan, 430033, China
| | - Weizhi Fang
- Department of Spine Surgery, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, 430033, China
| | - Qingbo Li
- Department of Spine Surgery, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, 430033, China
| | - Lei Cai
- Department of Spine Surgery, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, 430033, China
| | - Zhengkun Wang
- Department of Spine Surgery, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, 430033, China
| | - Chuankun Zhou
- Department of Spine Surgery, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, 430033, China
| | - Yichi Zhou
- Department of Spine Surgery, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, 430033, China
| |
Collapse
|
28
|
Shen YW, Yang Y, Liu H, Wang BY, Ding C, Meng Y, Rong X, Hong Y. The Effect of Preoperative Cervical Spondylosis on Heterotopic Ossification After Cervical Disc Replacement. Global Spine J 2024; 14:56-66. [PMID: 35403474 PMCID: PMC10676169 DOI: 10.1177/21925682221094265] [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] [Indexed: 02/05/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES This study aimed to explore the effect of preoperative cervical spondylosis on the heterotopic ossification (HO) formation in different locations after cervical disc replacement (CDR). METHODS The degree of preoperative cervical spondylosis was evaluated radiologically, including the intervertebral disc, uncovertebral joints, facet joints and ligaments. The effects of cervical spondylosis on the HO formation after CDR were analyzed according to the location of HO. Multivariate logistic regression was performed to identify the independent factors. RESULTS 149 patients with a total of 196 arthroplasty segments were involved in this study. HO, anterior HO (AHO), and posterior HO (PHO) developed in 59.69%, 22.96%, and 41.84% levels, respectively. The significant factors in univariate analysis for PHO after CDR included the disc height loss, anterior osteophytes, preoperative uncovertebral joint osteophytes and facet joint degeneration. The incidence of adjacent segment degeneration (ASD) was significantly higher in the PHO group compared to that without PHO at the last follow-up (P = .003). The disc height loss in high-grade HO was significantly more than that in low-grade group (P = .039). Multivariate analysis identified disc height loss was the only independent factor for PHO (P = .009). No significant degenerative factors related to the formation of AHO were found. CONCLUSIONS Preoperative cervical spondylosis predominantly affected the HO formation in the posterior disc space after CDR. The disc height loss was an independent risk factor for PHO formation. Rigorous criteria for the extent of preoperative disc height loss should be used when selecting appropriate candidates for CDR.
Collapse
Affiliation(s)
- Yi-Wei Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Bei-Yu Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ding
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Meng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Rong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Hong
- Department of Operation Room and Anesthesia Center, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
29
|
Elsamadicy AA, Sayeed S, Sherman JJZ, Craft S, Reeves BC, Lo SFL, Shin JH, Sciubba DM. Impact of Preoperative Frailty on Outcomes in Patients with Cervical Spondylotic Myelopathy Undergoing Anterior vs. Posterior Cervical Surgery. J Clin Med 2023; 13:114. [PMID: 38202121 PMCID: PMC10779741 DOI: 10.3390/jcm13010114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/15/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
Introduction: Frailty has been shown to negatively influence patient outcomes across many disease processes, including in the cervical spondylotic myelopathy (CSM) population. The aim of this study was to assess the impact that frailty has on patients with CSM who undergo anterior cervical discectomy and fusion (ACDF) or posterior cervical decompression and fusion (PCDF). Materials and Methods: A retrospective cohort study was performed using the 2016-2019 national inpatient sample. Adult patients (≥18 years old) undergoing ACDF only or PCDF only for CSM were identified using ICD codes. The patients were categorized based on receipt of ACDF or PCDF and pre-operative frailty status using the 11-item modified frailty index (mFI-11): pre-Frail (mFI = 1), frail (mFI = 2), or severely frail (mFI ≥ 3). Patient demographics, comorbidities, operative characteristics, perioperative adverse events (AEs), and healthcare resource utilization were assessed. Multivariate logistic regression analyses were used to identify independent predictors of extended length of stay (LOS) and non-routine discharge (NRD). Results: A total of 37,990 patients were identified, of which 16,665 (43.9%) were in the pre-frail cohort, 12,985 (34.2%) were in the frail cohort, and 8340 (22.0%) were in the severely frail cohort. The prevalence of many comorbidities varied significantly between frailty cohorts. Across all three frailty cohorts, the incidence of AEs was greater in patients who underwent PCDF, with dysphagia being significantly more common in patients who underwent ACDF. Additionally, the rate of adverse events significantly increased between ACDF and PCDF with respect to increasing frailty (p < 0.001). Regarding healthcare resource utilization, LOS and rate of NRD were significantly greater in patients who underwent PCDF in all three frailty cohorts, with these metrics increasing with frailty in both ACDF and PCDF cohorts (LOS: p < 0.001); NRD: p < 0.001). On a multivariate analysis of patients who underwent ACDF, frailty and severe frailty were found to be independent predictors of extended LOS [(frail) OR: 1.39, p < 0.001; (severely frail) OR: 2.25, p < 0.001] and NRD [(frail) OR: 1.49, p < 0.001; (severely frail) OR: 2.22, p < 0.001]. Similarly, in patients who underwent PCDF, frailty and severe frailty were found to be independent predictors of extended LOS [(frail) OR: 1.58, p < 0.001; (severely frail) OR: 2.45, p < 0.001] and NRD [(frail) OR: 1.55, p < 0.001; (severely frail) OR: 1.63, p < 0.001]. Conclusions: Our study suggests that preoperative frailty may impact outcomes after surgical treatment for CSM, with more frail patients having greater health care utilization and a higher rate of adverse events. The patients undergoing PCDF ensued increased health care utilization, compared to ACDF, whereas severely frail patients undergoing PCDF tended to have the longest length of stay and highest rate of non-routine discharge. Additional prospective studies are necessary to directly compare ACDF and PCDF in frail patients with CSM.
Collapse
Affiliation(s)
- Aladine A. Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Sumaiya Sayeed
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Josiah J. Z. Sherman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Samuel Craft
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Benjamin C. Reeves
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center, North Shore University Hospital, Northwell Health, Manhasset, NY 11030, USA
| | - John H. Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Daniel M. Sciubba
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center, North Shore University Hospital, Northwell Health, Manhasset, NY 11030, USA
| |
Collapse
|
30
|
Li S, Yan P, Fan Y, Wang R, Zhang C. Biomechanical analysis of the door-shaped titanium plate in single-level anterior cervical discectomy and fusion. J Orthop Surg Res 2023; 18:982. [PMID: 38129900 PMCID: PMC10734066 DOI: 10.1186/s13018-023-04474-1] [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: 10/26/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Analyse and discuss the immediate stability of the cervical spine after anterior cervical discectomy and fusion using a door-shaped titanium plate and compare it with the traditional titanium plate, to provide biomechanical evidence for the rationality and effectiveness of the door-shaped titanium plate in clinical applications. METHODS Ten adult goat C4/5 vertebral bodies were obtained, and models were prepared using denture base resin. Biomechanical experiments were performed on the specimens before internal fixation. MTS was used to conduct non-destructive biomechanical loading tests in six directions, including flexion, extension, left-right bending, and left-right torsion, recording the range of motion (ROM) and neutral zone (NZ) of each specimen. The specimens were then randomly divided into two groups: the study group was fixed with a door-shaped titanium plate, and the control group was fixed with a traditional titanium plate. ROM and NZ in each direction were measured again. After measurements, both groups were subjected to 0.5 Hz torsion loading with a torque of 2 N m for a total of 3000 cycles, followed by measuring ROM and NZ in six directions once more. RESULTS Compared to before fixation, ROM and NZ in both groups significantly decreased in all six directions after fixation, with statistical significance (P < 0.05); after fixation, the study group showed slightly lower values for various mechanical reference parameters compared to the control group, with no statistical significance (P > 0.05); after 3000 torsional loads, both internal fixation groups showed increased ROM and NZ compared to after fixation but to a lower extent, and no screw or titanium plate loosening was observed. Compared to before fixation, the differences were still statistically significant (P < 0.05), with the study group having slightly lower ROM and NZ values in all directions compared to the control group, with no statistical significance (P > 0.05). CONCLUSION The door-shaped titanium plate exhibits mechanical properties similar to the traditional titanium plate in all directions, and its smaller size and simpler surgical operation can be used for anterior cervical endoscopic surgery, reducing surgical trauma. It is clinically feasible and deserves further research and promotion.
Collapse
Affiliation(s)
- Senli Li
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Peng Yan
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yanwei Fan
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Ruibo Wang
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Changjiang Zhang
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
| |
Collapse
|
31
|
Mai E, Shahi P, Lee R, Shinn DJ, Vaishnav A, Araghi K, Singh N, Maayan O, Tuma OC, Pajak A, Asada T, Korsun MK, Singh S, Kim YE, Louie PK, Huang RC, Albert TJ, Dowdell J, Sheha ED, Iyer S, Qureshi SA. Risk factors for failure to achieve minimal clinically important difference following cervical disc replacement. Spine J 2023; 23:1808-1816. [PMID: 37660897 DOI: 10.1016/j.spinee.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND CONTEXT While cervical disc replacement (CDR) has been emerging as a reliable and efficacious treatment option for degenerative cervical spine pathology, not all patients undergoing CDR will achieve minimal clinically important difference (MCID) in patient-reported outcome measures (PROMs) postoperatively-risk factors for failure to achieve MCID in PROMs following CDR have not been established. PURPOSE To identify risk factors for failure to achieve MCID in Neck Disability Index (NDI, Visual Analog Scale (VAS) neck and arm following primary 1- or 2-level CDRs in the early and late postoperative periods. STUDY DESIGN Retrospective review of prospectively collected data. PATIENT SAMPLE Patients who had undergone primary 1- or 2-level CDR for the treatment of degenerative cervical pathology at a single institution with a minimum follow-up of 6 weeks between 2017 and 2022. OUTCOME MEASURES Patient-reported outcomes: Neck disability index (NDI), Visual analog scale (VAS) neck and arm, MCID. METHODS Minimal clinically important difference achievement rates for NDI, VAS-Neck, and VAS-Arm within early (within 3 months) and late (6 months to 2 years) postoperative periods were assessed based on previously established thresholds. Multivariate logistic regressions were performed for each PROM and evaluation period, with failure to achieve MCID assigned as the outcome variable, to establish models to identify risk factors for failure to achieve MCID and predictors for achievement of MCID. Predictor variables included in the analyses featured demographics, comorbidities, diagnoses/symptoms, and perioperative characteristics. RESULTS A total of 154 patients met the inclusion criteria. The majority of patients achieved MCID for NDI, VAS-Neck, and VAS-Arm for both early and late postoperative periods-79% achieved MCID for at least one of the PROMs in the early postoperative period, while 80% achieved MCID for at least one of the PROMs in the late postoperative period. Predominant neck pain was identified as a risk factor for failure to achieve MCID for NDI in the early (OR: 3.13 [1.10-8.87], p-value: .032) and late (OR: 5.01 [1.31-19.12], p-value: .018) postoperative periods, and VAS-Arm for the late postoperative period (OR: 36.63 [3.78-354.56], p-value: .002). Myelopathy was identified as a risk factor for failure to achieve MCID for VAS-Neck in the early postoperative period (OR: 3.40 [1.08-10.66], p-value: .036). Anxiety was identified as a risk factor for failure to achieve MCID for VAS-Neck in the late postoperative period (OR: 6.51 [1.91-22.18], p-value: .003). CDR at levels C5C7 was identified as a risk factor for failure to achieve MCID in NDI for the late postoperative period (OR: 9.74 [1.43-66.34], p-value: .020). CONCLUSIONS Our study identified several risk factors for failure to achieve MCID in common PROMs following CDR including predominant neck pain, myelopathy, anxiety, and CDR at levels C5-C7. These findings may help inform the approach to counseling patients on outcomes of CDR as the evidence suggests that those with the risk factors above may not improve as reliably after CDR.
Collapse
Affiliation(s)
- Eric Mai
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Pratyush Shahi
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Ryan Lee
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Daniel J Shinn
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Avani Vaishnav
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Kasra Araghi
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Nishtha Singh
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Omri Maayan
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Olivia C Tuma
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Anthony Pajak
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Tomoyuki Asada
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Maximilian K Korsun
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Sumedha Singh
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Yeo Eun Kim
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Philip K Louie
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Russel C Huang
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Todd J Albert
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - James Dowdell
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Evan D Sheha
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Sheeraz A Qureshi
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA.
| |
Collapse
|
32
|
Pu J, Cao W, Chen Y, Fan Y, Cao Y. Ultrasound-guided injection acupotomy as a minimally invasive intervention therapy for cervical spondylotic radiculopathy: a randomized control trial. Ann Med 2023; 55:2233556. [PMID: 37417721 PMCID: PMC10332182 DOI: 10.1080/07853890.2023.2233556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVE To explore the efficacy and safety of ultrasound-guided injection acupotomy as a minimally invasive intervention treatment of cervical spondylotic radiculopathy (CSR). METHODS 160 CSR subjects were recruited who met the inclusion criteria in our hospital from October 2019 to December 2021. The subjects were randomly divided into the experimental and control group, with 80 cases in each. The experimental group received ultrasound-guided injection acupotomy as a minimally invasive intervention therapy. The control group received ultrasound-guided selective nerve root block (SNRB). The Odom's criteria clinical curative effect, visual analogue scale (VAS), neck disability index (NDI), and 36-Item Short Form Health Survey questionnaire (SF-36) were used to evaluate the outcome of subjects at several different points in time. RESULTS At 30 min and 1 month after the end of treatment, there was no significant difference in any scores. However, after six months, the excellent and good rate was better in the experimental group compared to the control (RD = 0.175; 95% CI, 0.044-0.300, p = 0.009). The total effective rate was also better in the experimental group (RD = 0.126; 95% CI, 0.021-0.232, p = 0.018). In contrast, the VAS score (MD = -0.500; 95% CI, -1.000-0.000, p = 0.030) and NDI score (MD = -6.460; 95% CI, -11.067 to -1.852, p = 0.006) were lower in the experimental group compared to the control. The total SF-36 score was higher in the experimental group (MD = 7.568; 95% CI, 2.459-12.677, p = 0.004). CONCLUSION Ultrasound-guided injection acupotomy minimally invasive interventional treatment of CSR has no significant difference in short-term curative effect compared with ultrasound-guided SNRB, but the data indicators are significantly better than the latter at 6 months after the end of the course of treatment, showing better long-term efficacy.
Collapse
Affiliation(s)
- Jianfeng Pu
- Department of Acupuncture, Zhangjiagang Second People’s Hospital, Zhangjiagang City, Jiangsu Province, China
| | - Wenping Cao
- Department of Acupuncture, Zhangjiagang Second People’s Hospital, Zhangjiagang City, Jiangsu Province, China
| | - Yetin Chen
- Department of Acupuncture, Zhangjiagang Second People’s Hospital, Zhangjiagang City, Jiangsu Province, China
| | - Yunwu Fan
- Department of Pain Medicine, Zhangjiagang Second People’s Hospital, Zhangjiagang City, Jiangsu Province, China
| | - Ye Cao
- Department of Pain Medicine, Zhangjiagang Second People’s Hospital, Zhangjiagang City, Jiangsu Province, China
| |
Collapse
|
33
|
Wang C, Ni M, Tian S, Ouyang H, Liu X, Fan L, Dong P, Jiang L, Lang N, Yuan H. Deep learning model for measuring the sagittal Cobb angle on cervical spine computed tomography. BMC Med Imaging 2023; 23:196. [PMID: 38017414 PMCID: PMC10685593 DOI: 10.1186/s12880-023-01156-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/15/2023] [Indexed: 11/30/2023] Open
Abstract
PURPOSES To develop a deep learning (DL) model to measure the sagittal Cobb angle of the cervical spine on computed tomography (CT). MATERIALS AND METHODS Two VB-Net-based DL models for cervical vertebra segmentation and key-point detection were developed. Four-points and line-fitting methods were used to calculate the sagittal Cobb angle automatically. The average value of the sagittal Cobb angle was manually measured by two doctors as the reference standard. The percentage of correct key points (PCK), matched samples t test, intraclass correlation coefficient (ICC), Pearson correlation coefficient, mean absolute error (MAE), and Bland‒Altman plots were used to evaluate the performance of the DL model and the robustness and generalization of the model on the external test set. RESULTS A total of 991 patients were included in the internal data set, and 112 patients were included in the external data set. The PCK of the DL model ranged from 78 to 100% in the test set. The four-points method, line-fitting method, and reference standard measured sagittal Cobb angles were - 1.10 ± 18.29°, 0.30 ± 13.36°, and 0.50 ± 12.83° in the internal test set and 4.55 ± 20.01°, 3.66 ± 18.55°, and 1.83 ± 12.02° in the external test set, respectively. The sagittal Cobb angle calculated by the four-points method and the line-fitting method maintained high consistency with the reference standard (internal test set: ICC = 0.75 and 0.97; r = 0.64 and 0.94; MAE = 5.42° and 3.23°, respectively; external test set: ICC = 0.74 and 0.80, r = 0.66 and 0.974, MAE = 5.25° and 4.68°, respectively). CONCLUSIONS The DL model can accurately measure the sagittal Cobb angle of the cervical spine on CT. The line-fitting method shows a higher consistency with the doctors and a minor average absolute error.
Collapse
Affiliation(s)
- Chunjie Wang
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Ming Ni
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Shuai Tian
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Hanqiang Ouyang
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China
| | - Xiaoming Liu
- Beijing United Imaging Research Institute of Intelligent Imaging, Beijing, 100089, China
| | - Lianxi Fan
- United Imaging Intelligence (Beijing) Co., Ltd., Beijing, 100089, China
| | - Pei Dong
- United Imaging Intelligence (Beijing) Co., Ltd., Beijing, 100089, China
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China
| | - Ning Lang
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China.
| |
Collapse
|
34
|
Ohtake Y, Yasaka K, Hamada A, Fujita N, Abe O. Effect of Deep Learning Reconstruction on Evaluating Cervical Spinal Canal Stenosis With Computed Tomography. J Comput Assist Tomogr 2023; 47:996-1001. [PMID: 37948377 DOI: 10.1097/rct.0000000000001490] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) is commonly used to evaluate cervical spinal canal stenosis; however, some patients are ineligible for MRI. We aimed to assess the effect of deep learning reconstruction (DLR) in evaluating cervical spinal canal stenosis using computed tomography (CT) compared with hybrid iterative reconstruction (hybrid IR). METHODS This retrospective study included 33 patients (16 male patients; mean age, 57.7 ± 18.4 years) who underwent cervical spine CT. Images were reconstructed using DLR and hybrid IR. In the quantitative analyses, noise was recorded by placing the regions of interest on the trapezius muscle. In the qualitative analyses, 2 radiologists evaluated the depiction of structures, image noise, overall image quality, and degree of cervical canal stenosis. We additionally evaluated the agreement between MRI and CT in 15 patients for whom preoperative cervical MRI was available. RESULTS Image noise was less with DLR than hybrid IR in the quantitative ( P ≤ 0.0395) and subjective analyses ( P ≤ 0.0023), and the depiction of most structures was improved ( P ≤ 0.0052), which resulted in better overall quality ( P ≤ 0.0118). Interobserver agreement in the assessment of spinal canal stenosis with DLR (0.7390; 95% confidence interval [CI], 0.7189-0.7592) was superior to that with hybrid IR (0.7038; 96% CI, 0.6846-0.7229). As for the agreement between MRI and CT, significant improvement was observed for 1 reader with DLR (0.7910; 96% CI, 0.7762-0.8057) than hybrid IR (0.7536; 96% CI, 0.7383-0.7688). CONCLUSIONS Deep learning reconstruction provided better quality cervical spine CT images in the evaluation of cervical spinal stenosis than hybrid IR.
Collapse
Affiliation(s)
- Yuta Ohtake
- From the Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | | | | | | | | |
Collapse
|
35
|
Jiang Q, Gao H, Shi X, Wu Y, Ni W, Shang A. Total body bone mineral density and various spinal disorders: a Mendelian randomization study. Front Endocrinol (Lausanne) 2023; 14:1285137. [PMID: 38027141 PMCID: PMC10644298 DOI: 10.3389/fendo.2023.1285137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Observational studies have yielded inconsistent findings regarding the correlation between bone mineral density (BMD) and various spinal disorders. To explore the relationship between total-body BMD and various spinal disorders further, we conducted a Mendelian randomization analysis to assess this association. Methods Two-sample bidirectional Mendelian randomization (MR) analysis was employed to investigate the association between total-body BMD and various spinal disorders. The inverse-variance weighted (IVW) method was used as the primary effect estimate, and additional methods, including weighted median, MR-Egger, simple mode, and weighted mode, were used to assess the reliability of the results. To examine the robustness of the data further, we conducted a sensitivity analysis using alternative bone-density databases, validating the outcome data. Results MR revealed a significant positive association between total-body BMD and the prevalence of spondylosis and spinal stenosis. When total-body BMD was considered as the exposure factor, the analysis demonstrated an increased risk of spinal stenosis (IVW odds ratio [OR] 1.23; 95% confidence interval [CI], 1.14-1.32; P < 0.001) and spondylosis (IVW: OR 1.24; 95%CI, 1.16-1.33; P < 0.001). Similarly, when focusing solely on heel BMD as the exposure factor, we found a positive correlation with the development of both spinal stenosis (IVW OR 1.13, 95%CI, 1.05-1.21; P < 0.001) and spondylosis (IVW OR 1.10, 95%CI, 1.03-1.18; P = 0.0048). However, no significant associations were found between total-body BMD and other spinal disorders, including spinal instability, spondylolisthesis/spondylolysis, and scoliosis (P > 0.05). Conclusion This study verified an association of total-body BMD with spinal stenosis and with spondylosis. Our results imply that when an increasing trend in BMD is detected during patient examinations and if the patient complains of numbness and pain, the potential occurrence of conditions such as spondylosis or spinal stenosis should be investigated and treated appropriately.
Collapse
Affiliation(s)
- Qingyu Jiang
- Chinese PLA Medical School, Beijing, China
- Department of Neurosurgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Haihao Gao
- Chinese PLA Medical School, Beijing, China
- Department of Neurosurgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Xudong Shi
- Chinese PLA Medical School, Beijing, China
| | - Yan Wu
- Medical School, Nankai University, Tianjin, China
| | - Wentao Ni
- Department of Pulmonary and Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Aijia Shang
- Department of Neurosurgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
36
|
Alfaya FF, Reddy RS, Alshahrani MS, Gautam AP, Mukherjee D, Al Salim ZA, Alqhtani RS, Ghulam HSH, Alyami AM, Al Adal S, Jabour AA. Exploring the Interplay of Muscular Endurance, Functional Balance, and Limits of Stability: A Comparative Study in Individuals with Lumbar Spondylosis Using a Computerized Stabilometric Force Platform. Life (Basel) 2023; 13:2104. [PMID: 37895485 PMCID: PMC10608059 DOI: 10.3390/life13102104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 10/29/2023] Open
Abstract
Lumbar spondylosis, characterized by degenerative changes in the lumbar spine, often leads to pain, reduced spinal stability, and musculoskeletal dysfunction. Understanding the impact of lumbar spondylosis on musculoskeletal function, particularly lumbar extensor endurance, functional balance, and limits of stability, is crucial for improving the management and well-being of affected individuals. This study aimed to assess lumbar extensor endurance, functional balance, and limits of stability in individuals with lumbar spondylosis compared to age-matched healthy individuals and explore the correlations among these parameters within the lumbar spondylosis group. The lumbar spondylosis group consisted of 60 individuals initially screened by an orthopedician and referred to physical therapy. Age-matched healthy controls (n = 60) were recruited. Inclusion criteria encompassed adults aged 45-70 years for both groups. Lumbar extensor endurance was assessed using the Sorensen test, functional balance with the Berg Balance Scale, and limits of stability using a computerized stabilometric force platform. Lumbar extensor endurance was significantly lower in individuals with lumbar spondylosis compared to healthy controls (23.06 s vs. 52.45 s, p < 0.001). Functional balance, as assessed by the Berg Balance Scale, demonstrated a significant decrement in the lumbar spondylosis group (48.36 vs. 53.34, p < 0.001). Additionally, limits of stability variables, under both eyes-open and eyes-closed conditions, exhibited marked impairments in the lumbar spondylosis group (p < 0.001 for all variables). Within the lumbar spondylosis group, lumbar extensor endurance exhibited significant positive correlations with functional balance (0.46, p < 0.001) and negative correlations with limits of stability variables (r ranging from -0.38 to -0.49, p < 0.01 for all variables). This study underscores the significance of addressing lumbar extensor endurance, functional balance, and stability impairments in the comprehensive management of lumbar spondylosis.
Collapse
Affiliation(s)
- Fareed F Alfaya
- Department of Orthopedic Surgery, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Mastour Saeed Alshahrani
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Ajay Prashad Gautam
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Debjani Mukherjee
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Zuhair A Al Salim
- Department of Sport Science and Physical Activity, College of Science, University of Hafr Al Batin, Hafr Al Batin 39524, Saudi Arabia
| | - Raee S Alqhtani
- Physical Therapy Department, Medical Applied Sciences College, Najran University, Najran 66462, Saudi Arabia
| | - Hussain Saleh H Ghulam
- Physical Therapy Department, Medical Applied Sciences College, Najran University, Najran 66462, Saudi Arabia
| | - Abdullah Mohammed Alyami
- Physical Therapy Department, Medical Applied Sciences College, Najran University, Najran 66462, Saudi Arabia
| | - Saeed Al Adal
- Physical Therapy Department, Medical Applied Sciences College, Najran University, Najran 66462, Saudi Arabia
| | | |
Collapse
|
37
|
Wang H, Yan C, Wu T, Zhang X, He J, Liu Z, Liu H. YouTube online videos as a source for patient education of cervical spondylosis-a reliability and quality analysis. BMC Public Health 2023; 23:1831. [PMID: 37730621 PMCID: PMC10512502 DOI: 10.1186/s12889-023-16495-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/09/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Given a prolonged course of Cervical spondylosis (CS) could cause irreversible neurological deficits, it is crucial to disseminate CS-related health information to the public to promote early diagnosis and treatment. YouTube has been widely used to search for medical information. However, the reliability and quality of videos on YouTube vary greatly. Thus, this study aimed to assess the reliability and educational quality of YouTube videos concerning CS and further explore strategies for optimization of patient education. METHODS We searched YouTube online library for the keywords "cervical spondylosis", "cervical radiculopathy" and "cervical myelopathy" on January 15, 2023. Ranked by "relevance", the first 50 videos of each string were recorded. After exclusions, a total of 108 videos were included. All videos were extracted for characteristics and classified based on different sources or contents. Two raters independently evaluated the videos using Journal of American Medical Association (JAMA) benchmark criteria, Modified DISCERN (mDISCERN) tool, Global Quality Scale (GQS) and Cervical-Spondylosis-Specific Scale (CSSS), followed by statistical analyses. All continuous data were described as median (interquartile range). RESULTS All videos had median values for JAMA, mDISCERN, GQS and CSSS scores of were 3.00 (1.00), 3.00 (2.00), 2.00 (1.00) and 7.00 (8.88), respectively. There were significant differences in VPI (P = 0.009) and JAMA (P = 0.001), mDISCERN (P < 0.001), GQS (P < 0.001) and CSSS (P < 0.001) scores among different sources. Videos from academic source had advantages in reliability and quality scores than other sources. VPI (P < 0.001), mDISCERN (P = 0.001), GQS (P < 0.001) and CSSS (P = 0.001) scores also significantly differed among videos of various contents. Spearman correlation analysis indicated VPI was not correlated with either reliability or quality. Multiple linear regression analysis showed a longer duration and an academic source were independent predictors of higher reliability and quality, while a clinical source also led to the higher video quality. CONCLUSIONS The reliability and educational quality of current CS-related videos on YouTube are unsatisfactory. Users face a high risk of encountering inaccurate and misleading information when searching for CS on YouTube. Longer duration, source of academic or clinician were closely correlated to higher video reliability and quality. Improving the holistic reliability and quality of online information requires the concerted effort from multiple parties, including uploaders, the platform and viewers.
Collapse
Affiliation(s)
- Hong Wang
- Department of Orthopedics, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, Chengdu, Sichuan, China
| | - Chunyi Yan
- Department of Orthopedics, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, Chengdu, Sichuan, China
| | - Tingkui Wu
- Department of Orthopedics, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, Chengdu, Sichuan, China
| | - Xiang Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, Chengdu, Sichuan, China
| | - Junbo He
- Department of Orthopedics, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, Chengdu, Sichuan, China
| | - Zhihao Liu
- Department of Orthopedics, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, Chengdu, Sichuan, China
| | - Hao Liu
- Department of Orthopedics, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, Chengdu, Sichuan, China.
| |
Collapse
|
38
|
Suo M, Zhang J, Sun T, Wang J, Liu X, Huang H, Li Z. The association between morphological characteristics of paraspinal muscle and spinal disorders. Ann Med 2023; 55:2258922. [PMID: 37722876 PMCID: PMC10512810 DOI: 10.1080/07853890.2023.2258922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Spinal disorders affect millions of people worldwide, and can cause significant disability and pain. The paraspinal muscles, located on either side of the spinal column, play a crucial role in the movement, support, and stabilization of the spine. Many spinal disorders can affect paraspinal muscles, as evidenced by changes in their morphology, including hypertrophy, atrophy, and degeneration. OBJECTIVES The objectives of this review were to examine the current literature on the relationship between the paraspinal muscles and spinal disorders, summarize the methods used in previous studies, and identify areas for future research. METHODS We reviewed studies on the morphological characteristics of the paravertebral muscle and discussed their relationship with spinal disorders, as well as the current limitations and future research directions. RESULTS The paraspinal muscles play a critical role in spinal disorders and are important targets for the treatment and prevention of spinal disorders. Clinicians should consider the role of the paraspinal muscles in the development and progression of spinal disorders and incorporate assessments of the paraspinal muscle function in clinical practice. CONCLUSION The findings of this review highlight the need for further research to better understand the relationship between the paraspinal muscles and spinal disorders, and to develop effective interventions to improve spinal health and reduce the burden of spinal disorders.
Collapse
Affiliation(s)
- Moran Suo
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Jing Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Tianze Sun
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Jinzuo Wang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Xin Liu
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Huagui Huang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Zhonghai Li
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| |
Collapse
|
39
|
Wang Y, Liu Y, Zhang A, Han Q, Jiao J, Chen H, Gong X, Luo W, Yue J, Zhao X, Wang J, Wu M. Biomechanical evaluation of a novel individualized zero-profile cage for anterior cervical discectomy and fusion: a finite element analysis. Front Bioeng Biotechnol 2023; 11:1229210. [PMID: 37744254 PMCID: PMC10512836 DOI: 10.3389/fbioe.2023.1229210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction: Anterior cervical discectomy and fusion (ACDF) is a standard procedure for treating symptomatic cervical degenerative disease. The cage and plate constructs (CPCs) are widely employed in ACDF to maintain spinal stability and to provide immediate support. However, several instrument-related complications such as dysphagia, cage subsidence, and adjacent segment degeneration have been reported in the previous literature. This study aimed to design a novel individualized zero-profile (NIZP) cage and evaluate its potential to enhance the biomechanical performance between the instrument and the cervical spine. Methods: The intact finite element models of C3-C7 were constructed and validated. A NIZP cage was designed based on the anatomical parameters of the subject's C5/6. The ACDF procedure was simulated and the CPCs and NIZP cage were implanted separately. The range of motion (ROM), intradiscal pressure (IDP), and peak von Mises stresses of annulus fibrosus were compared between the two surgical models after ACDF under four motion conditions. Additionally, the biomechanical performance of the CPCs and NIZP cage were evaluated. Results: Compared with the intact model, the ROM of the surgical segment was significantly decreased for both surgical models under four motion conditions. Additionally, there was an increase in IDP and peak von Mises stress of annulus fibrosus in the adjacent segment. The NIZP cage had a more subtle impact on postoperative IDP and peak von Mises stress of annulus fibrosus in adjacent segments compared to CPCs. Meanwhile, the peak von Mises stresses of the NIZP cage were reduced by 90.0-120.0 MPa, and the average von Mises stresses were reduced by 12.61-17.56 MPa under different motion conditions. Regarding the fixation screws, the peak von Mises stresses in the screws of the NIZP cage increased by 10.0-40.0 MPa and the average von Mises stresses increased by 2.37-10.10 MPa. Conclusion: The NIZP cage could effectively reconstruct spinal stability in ACDF procedure by finite element study. Compared with the CPCs, the NIZP cage had better biomechanical performance, with a lower stress distribution on the cage and a more moderate effect on the adjacent segmental discs. Therefore, the NIZP cage could prevent postoperative dysphagia as well as decrease the risk of subsidence and adjacent disc degeneration following ACDF. In addition, this study could serve as a valuable reference for the development of personalized instruments.
Collapse
Affiliation(s)
- Yang Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Yang Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Aobo Zhang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Qing Han
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Jianhang Jiao
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Hao Chen
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Xuqiang Gong
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Wangwang Luo
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Jing Yue
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, China
| | - Xue Zhao
- Department of Endocrinology and Metabolism, First Hospital of Jilin University, Changchun, China
| | - Jincheng Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Minfei Wu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| |
Collapse
|
40
|
Shen P, Chi-Chung Tsang R, Liang Y, Chen X. Diagnostic accuracy of the upper limb neurodynamic test with median bias (ULNT1) for cervical radiculopathy: a systematic review and meta-analysis. Physiotherapy 2023; 120:17-25. [PMID: 37356367 DOI: 10.1016/j.physio.2023.06.001] [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: 06/21/2022] [Revised: 05/06/2023] [Accepted: 06/03/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The upper limb neurodynamic test for median nerve (ULNT1) is commonly applied for assessment of cervical radiculopathy (CR). However, the diagnostic accuracy of ULNT1 in diagnosing CR remains unclear. OBJECTIVE This study aimed to examine the diagnostic accuracy of the ULNT1 for the CR. DATA SOURCES Four databases were searched for relevant studies published up to April 30, 2023. STUDY SELECTION Cross-sectional or cohort studies that assessed the diagnostic accuracy of ULNT1 for CR were included. DATA SYNTHESIS The methodological quality of studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) checklist. A bivariate random-effects regression model was used for the data synthesis. The overall quality of evidence was evaluated using the GRADE approach. RESULTS A total of 592 references were identified, and five studies with 465 patients met the inclusion criteria. The overall quality of the body of evidence was very low across studies. Heterogeneity of studies was high. The pooled sensitivity and specificity of the ULNT1 were 0.69 (95% CI 0.50-0.83) and 0.54 (95% CI 0.36-0.71), respectively. The summary receiver operating characteristic curve area was 0.65 (95% CI 0.61-0.69). CONCLUSION There is low certainty of evidence that the ULNT1 has only fair accuracy in diagnosing CR. The ULNT1 was recommended as an add-on test after the existing diagnostic pathway to enhance diagnostic accuracy further. High-quality studies which follow the Standards for Reporting of Diagnostic Accuracy and the QUADAS-2; a revised tool for the quality assessment of diagnostic accuracy, are needed. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO: CRD42021255686 CONTRIBUTION OF THE PAPER.
Collapse
Affiliation(s)
- Peng Shen
- The First Affiliated Hospital of Nanchang University, NO.17, Yong Wai Zheng Jie, 330006 Nanchang, Jiangxi, China
| | | | - Ying Liang
- The First Affiliated Hospital of Nanchang University, NO.17, Yong Wai Zheng Jie, 330006 Nanchang, Jiangxi, China
| | - Xiwen Chen
- The First Affiliated Hospital of Nanchang University, NO.17, Yong Wai Zheng Jie, 330006 Nanchang, Jiangxi, China.
| |
Collapse
|
41
|
Rueangsri C, Puntumetakul R, Leungbootnak A, Sae-Jung S, Chatprem T. Cervical Spine Instability Screening Tool Thai Version: Assessment of Convergent Validity and Rater Reliability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6645. [PMID: 37681785 PMCID: PMC10487595 DOI: 10.3390/ijerph20176645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/06/2023] [Accepted: 08/15/2023] [Indexed: 09/09/2023]
Abstract
Neck pain, dizziness, difficulty supporting the head for an extended period, and impaired movement are all symptoms of cervical spine instability, which may produce cervical spondylolisthesis in patients who have more severe symptoms. To avoid problems and consequences, early detection of cervical spine instability is required. A previous study created a Thai-language version of a cervical spine instability screening tool, named the CSI-TH, and evaluated its content validity. However, other characteristics of the CSI-TH still needed to be evaluated. The objective of the current study was to assess the rater reliability and convergent validity of the CSI-TH. A total of 160 participants with nonspecific chronic neck pain were included in the study. The Neck Disability Index Thai version (NDI-TH), the Visual Analog Scale Thai version (VAS-TH), and the Modified STarT Back Screening Tool Thai version (mSBST-TH) were used to evaluate the convergent validity of the CSI-TH. To determine inter- and intra-rater reliabilities, novice and experienced physical therapists were involved. The results showed that rater reliabilities were excellent: the intra-rater reliability was 0.992 (95% CI = 0.989 ± 0.994), and the inter-rater reliability was 0.987 (95% CI = 0.983 ± 0.991). The convergent validities of the VAS-TH, NDI-TH, and mSBST-TH when compared with the CSI-TH were 0.5446, 0.5545, and 0.5136, respectively (p < 0.01). The CSI-TH was developed for use by physical therapists and is reliable. It can be used by physical therapists, whether they are experienced or novices, and has an acceptable correlation to other neck-related questionnaires. The CSI-TH is concise, suitable for clinical use, and lower-priced when compared to the gold standard in diagnosis for patients with cervical spine instability.
Collapse
Affiliation(s)
- Chanyawat Rueangsri
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand; (C.R.); (R.P.)
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen 40002, Thailand
| | - Rungthip Puntumetakul
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand; (C.R.); (R.P.)
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen 40002, Thailand
| | - Arisa Leungbootnak
- Human Movement Sciences, School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand;
| | - Surachai Sae-Jung
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand;
| | - Thiwaphon Chatprem
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand; (C.R.); (R.P.)
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen 40002, Thailand
| |
Collapse
|
42
|
Li K, Yang Y, Wang P, Song H, Ma C, Zhang Y, Dang X, Shi J, Zhang S, Li Z, Wang X. Exploring the micromorphological characteristics of adult lower cervical vertebrae based on micro-computed tomography. Sci Rep 2023; 13:12400. [PMID: 37524928 PMCID: PMC10390556 DOI: 10.1038/s41598-023-39703-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/29/2023] [Indexed: 08/02/2023] Open
Abstract
We will use micro-computed tomography to scan 31 sets of the adult lower cervical vertebrae (155 vertebrae) to observe the morphological characteristics and direction of trabeculae in the lower cervical vertebrae by outlining and reconstructing the regions of interest and to calculate the variation laws of the microstructure in the regions of interest to reveal their structural characteristics and weak areas. As a result, the images showed that the trabeculae in the lower cervical pedicle near the medial and lateral cortices were relatively dense, and their bone plates were lamellar. There were cavities between the superior and inferior articular processes where the ossification centers had not been absorbed after ossified. The lamellar trabeculae in the vertebral plates near the cortical bones were only 1-2 layers, extended and transformed into rod-shaped trabeculae in a radial shape toward the medullary space. The lamellar trabeculae of the vertebral plate extend over the spinous process near the cortical bone. The statistical results of the trabeculae's morphological parameters showed significant differences in bone volume fraction values among the four parts (P < 0.05). There were substantial differences in BS/BV, except for no differences between the pedicle and the vertebral plate (P < 0.05). There was a significant difference in trabecular pattern factor values between the articular process, the spinous process, and the vertebral plate (P < 0.05) and a significant difference between the pedicle, the spinous process, and the vertebral plate (P < 0.05). There were no significant differences in trabecular bone thickness and trabecular space values among the four parts (P < 0.05). The anatomical microstructural perspective confirms that the optimal choice is internal fixation via the pedicle. If using pedicle screws, the nail tract needs to be placed into the spinous process to increase its holding power and resistance to extraction.
Collapse
Affiliation(s)
- Kun Li
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
- Human Anatomy Teaching and Research Section, School of Basic Medicine, Inner Mongolia Medical University, Hohhot, 010059, Inner Mongolia, China
| | - Yang Yang
- Graduate School, Inner Mongolia Medical University, Hohhot, 010059, Inner Mongolia, China
| | - Peng Wang
- School of Clinical Medicine, Inner Mongolia Medical University, Hohhot, 010059, Inner Mongolia, China
| | - Haoyu Song
- School of Clinical Medicine, Inner Mongolia Medical University, Hohhot, 010059, Inner Mongolia, China
| | - Chunying Ma
- School of Clinical Medicine, Inner Mongolia Medical University, Hohhot, 010059, Inner Mongolia, China
| | - Yansong Zhang
- School of Clinical Medicine, Inner Mongolia Medical University, Hohhot, 010059, Inner Mongolia, China
| | - Xingye Dang
- School of Clinical Medicine, Inner Mongolia Medical University, Hohhot, 010059, Inner Mongolia, China
| | - Jun Shi
- Physiology Teaching and Research Section, School of Basic Medicine, Inner Mongolia Medical University, Hohhot, 010059, Inner Mongolia, China
| | - Shaojie Zhang
- Human Anatomy Teaching and Research Section, School of Basic Medicine, Inner Mongolia Medical University, Hohhot, 010059, Inner Mongolia, China
- Digital Medicine Center, School of Basic Medicine, Inner Mongolia Medical University, Hohhot, 010059, Inner Mongolia, China
| | - Zhijun Li
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
- Human Anatomy Teaching and Research Section, School of Basic Medicine, Inner Mongolia Medical University, Hohhot, 010059, Inner Mongolia, China
| | - Xing Wang
- Human Anatomy Teaching and Research Section, School of Basic Medicine, Inner Mongolia Medical University, Hohhot, 010059, Inner Mongolia, China.
- Digital Medicine Center, School of Basic Medicine, Inner Mongolia Medical University, Hohhot, 010059, Inner Mongolia, China.
| |
Collapse
|
43
|
He J, Chen H, Wu T, Rong X, Ding C, Wang B, Liu H. Is Cervical Disc Arthroplasty an Effective Treatment for Cervical Degenerative Disease With Osteopenia? Global Spine J 2023:21925682231190612. [PMID: 37459175 DOI: 10.1177/21925682231190612] [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: 12/22/2023] Open
Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVES To evaluate postoperative outcomes of single-level cervical disc arthroplasty (CDA) in patients with osteopenia and compare these results with a matched cohort of normal bone mineral density (BMD). METHODS Patients who had undergone single-level CDA were collected and screened. Included patients were divided into the osteopenia group and the normal group. 38 eligible patients with osteopenia were included in the final analysis. Subsequently, a 1:1 match was utilized. Clinical, radiographic data, and complications were recorded. Appropriate statistical methods were applied to conduct analysis using SPSS version 24.0. RESULTS The mean follow-up time was 30.5 ± 27.3 months. The osteopenia group achieved satisfactory clinical outcomes, with no significant intergroup differences. Additionally, there were no significant differences between groups in any of the radiological parameters, either in cervical alignment or segmental height, or range of motion. The radiological incidence rate of adjacent segmental degeneration and heterotopic ossification (HO) was comparable in both groups, respectively, with a similar composition of ROM-limiting HO. However, the osteopenia group had a tendency of more implant subsidence (2.7% vs 15.2%). The logistic regression analysis showed the osteopenia group had a significantly higher incidence rate of anterior bone loss (ABL) (OR = 5.37, 95% CI: 1.50 - 19.22). CONCLUSIONS Single-level CDA for patients with osteopenia achieved similar satisfactory clinical outcomes compared with the normal BMD group. Meanwhile, the osteopenia group maintained adequate sagittal balance and segmental height. Based on this observation, this option may be feasible for selected patients with osteopenia.
Collapse
Affiliation(s)
- Junbo He
- Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Hua Chen
- Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Tingkui Wu
- Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Rong
- Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ding
- Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Beiyu Wang
- Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
44
|
Chang CJ, Liu YF, Hsiao YM, Chang WL, Hsu CC, Liu KC, Huang YH, Yeh ML, Lin CL. Full Endoscopic Spine Surgery for Cervical Spondylotic Myelopathy: A Systematic Review. World Neurosurg 2023; 175:142-150. [PMID: 37169077 DOI: 10.1016/j.wneu.2023.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Cervical spondylotic myelopathy (CSM) may seriously affect quality of life. In the literature, there is scarce evidence of the pros and cons of full endoscopic spine surgery in the treatment of CSM. The main purpose of this study was to conduct a systematic review to elucidate the efficacy of full endoscopic spine surgery in the management of patients with CSM. METHODS This systematic review was conducted in accordance with the PRISMA guidelines. A systematic search of Web of Science, PubMed MEDLINE, Embase, and Cochrane Library was conducted from the database inception to February 1, 2023. RESULTS The study included 183 patients and their age was 56.78 ± 7.87 years. The average surgical time calculated was 96.34 ± 33.58 minutes. Intraoperative blood loss ranged from a minimal amount to 51 mL. The average duration of hospital stay was 3.56 ± 1.6 days. The average span for follow-up was on an interval of 18.7 ± 6.76 months. Significant improvements were noted in all aspects of functional outcomes and image results after full endoscopic cervical spine surgery, with no major complications. CONCLUSIONS The current study found that both anterior transcorporeal and posterior surgical approaches could be used for the treatment of CSM with a full endoscopic technique. Indications of full endoscopic cervical spine surgery for CSM included cervical disc herniation, central canal stenosis, calcified ligamentum flavum, and ossification of the posterior longitudinal ligament. Improved postoperative outcomes with acceptable surgical complications were noted in this systematic review.
Collapse
Affiliation(s)
- Chao-Jui Chang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedics, Dou-Liou Branch of National Cheng Kung University Hospital, Yunlin, Taiwan
| | - Yuan-Fu Liu
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedics, Dou-Liou Branch of National Cheng Kung University Hospital, Yunlin, Taiwan
| | - Yu-Meng Hsiao
- Department of Orthopedics, Tainan Municipal An-Nan Hospital, China Medical University, Tainan, Taiwan
| | - Wei-Lun Chang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedics, Dou-Liou Branch of National Cheng Kung University Hospital, Yunlin, Taiwan
| | - Che-Chia Hsu
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Keng-Chang Liu
- School of Medicine, Tzu Chi University, Hualien City, Taiwan; Department of Orthopaedic Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
| | - Yi-Hung Huang
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center (MDIC), National Cheng Kung University Hospital, Tainan, Taiwan
| | - Cheng-Li Lin
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center (MDIC), National Cheng Kung University Hospital, Tainan, Taiwan; Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
45
|
Wang R, Bai H, Xia G, Zhou J, Dai Y, Xue Y. Identification of milling status based on vibration signals using artificial intelligence in robot-assisted cervical laminectomy. Eur J Med Res 2023; 28:203. [PMID: 37381061 DOI: 10.1186/s40001-023-01154-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 06/03/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND With advances in science and technology, the application of artificial intelligence in medicine has significantly progressed. The purpose of this study is to explore whether the k-nearest neighbors (KNN) machine learning method can identify three milling states based on vibration signals: cancellous bone (CCB), ventral cortical bone (VCB), and penetration (PT) in robot-assisted cervical laminectomy. METHODS Cervical laminectomies were performed on the cervical segments of eight pigs using a robot. First, the bilateral dorsal cortical bone and part of the CCB were milled with a 5 mm blade and then the bilateral laminae were milled to penetration with a 2 mm blade. During the milling process using the 2 mm blade, the vibration signals were collected by the acceleration sensor, and the harmonic components were extracted using fast Fourier transform. The feature vectors were constructed with vibration signal amplitudes of 0.5, 1.0, and 1.5 kHz and the KNN was then trained by the features vector to predict the milling states. RESULTS The amplitudes of the vibration signals between VCB and PT were statistically different at 0.5, 1.0, and 1.5 kHz (P < 0.05), and the amplitudes of the vibration signals between CCB and VCB were significantly different at 0.5 and 1.5 kHz (P < 0.05). The KNN recognition success rates for the CCB, VCB, and PT were 92%, 98%, and 100%, respectively. A total of 6% and 2% of the CCB cases were identified as VCB and PT, respectively; 2% of VCB cases were identified as PT. CONCLUSIONS The KNN can distinguish different milling states of a high-speed bur in robot-assisted cervical laminectomy based on vibration signals. This method is feasible for improving the safety of posterior cervical decompression surgery.
Collapse
Affiliation(s)
- Rui Wang
- Key Laboratory of Spine and Spinal Cord, Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - He Bai
- Key Laboratory of Spine and Spinal Cord, Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Guangming Xia
- Tianjin Key Laboratory of Intelligent Robotics, Institute of Robotics and Automatic Information System, College of Artificial Intelligence, Nankai University, 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Jiaming Zhou
- Key Laboratory of Spine and Spinal Cord, Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Yu Dai
- Tianjin Key Laboratory of Intelligent Robotics, Institute of Robotics and Automatic Information System, College of Artificial Intelligence, Nankai University, 94 Weijin Road, Nankai District, Tianjin, 300071, China.
| | - Yuan Xue
- Key Laboratory of Spine and Spinal Cord, Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China.
| |
Collapse
|
46
|
Yadav SRM, Goyal B, Mamgain G, Kothari A, Kumar S, Saha S, Naithani M, Mirza AA, Kumar R, Arora R. Genetic Variations in IL-1β, TNF-α, and TGF-β Associated with the Severity of Chronic Cervical Spondylitis in Patients. Cells 2023; 12:1594. [PMID: 37371064 PMCID: PMC10297355 DOI: 10.3390/cells12121594] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/28/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic cervical spondylitis (CCS), a degenerative disorder of the spine, is known for causing disability among old and young people. Single-nucleotide polymorphisms (SNPs) in various cytokine genes have demonstrated an impactful association with several inflammatory disorders. In the present study, we have investigated the SNPs and allelic distribution of the three most prevalent cytokines genes, IL-1β (-511C/T), TNF-α (-308G/A), and TGF-β (-509C/T), along with serum levels of these cytokines in 252 subjects. SNPs were analyzed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), and digested fragments were separated and visualized using agarose gel electrophoresis and Native Polyacrylamide gel electrophoresis (PAGE). The serum cytokine levels were analyzed with a flow cytometer using a customized multiplex bead-based assay. It was observed that these SNPs did not reflect the susceptibility to CCS but were associated with susceptibility to CCS. We found a significant association between the C/C and G/G genotypes and the C and G alleles of IL-1β and TNF-α, respectively, suggesting a lower risk of CCS. The frequency distribution of risk alleles (-511T) and (-308A) were simultaneously higher in CCS compared to the control, reflecting the susceptibility to CCS. TGF-β showed a significant association with disease susceptibility, along with a significant correlation between age and the chronicity of CCS. The serum cytokine levels were significantly different in CCS and controls.
Collapse
Affiliation(s)
| | - Bela Goyal
- Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh 249203, India
| | - Garima Mamgain
- Department of Medical Oncology/Hematology, All India Institute of Medical Sciences, Rishikesh 249203, India
| | - Ashish Kothari
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh 249203, India
| | - Sandeep Kumar
- Department of Medicine, OUHSC, Oklahoma City, OK 73104, USA
| | - Sarama Saha
- Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh 249203, India
| | - Manisha Naithani
- Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh 249203, India
| | - Anissa Atif Mirza
- Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh 249203, India
| | - Raj Kumar
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh 249203, India
| | - Rajnish Arora
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh 249203, India
| |
Collapse
|
47
|
Pu PM, Li ZY, Dai YX, Sun YL, Wang YJ, Cui XJ, Yao M. Analysis of gene expression profiles and experimental validations of a rat chronic cervical cord compression model. Neurochem Int 2023:105564. [PMID: 37286109 DOI: 10.1016/j.neuint.2023.105564] [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: 03/08/2023] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 06/09/2023]
Abstract
Cervical spondylotic myelopathy (CSM) is a severe non-traumatic spinal cord injury (SCI) wherein the spinal canal and cervical cord are compressed due to the degeneration of cervical tissues. To explore the mechanism of CSM, the ideal model of chronic cervical cord compression in rats was constructed by embedding a polyvinyl alcohol polyacrylamide hydrogel in lamina space. Then, the RNA sequencing technology was used to screen the differentially expressed genes (DEGs) and enriched pathways among intact and compressed spinal cords. A total of 444 DEGs were filtered out based on the value of log2(Compression/Sham); these were associated with IL-17, PI3K-AKT, TGF-β, and Hippo signaling pathways according to the GSEA, KEGG, and GO analyses. Transmission electron microscopy indicated the changes in mitochondrial morphology. Western blot and immunofluorescent staining revealed neuronal apoptosis, astrogliosis and microglial neuroinflammation in the lesion area. Specifically, the expression of apoptotic indicators, such as Bax and cleaved caspase-3, and inflammatory cytokines, such as IL-1β, IL-6, and TNF-α, were upregulated. The activation of IL-17 signaling pathways was observed in microglia instead of neurons or astrocytes, the activation of TGF-β and inhibition of Hippo signaling pathways were detected in astrocytes instead of neurons or microglia, and the inhibition of PI3K-AKT signaling pathway was discovered in neurons rather than microglia of astrocytes in the lesion area. In conclusion, this study indicated that neuronal apoptosis was accompanied by inhibiting of the PI3K-AKT pathway. Then, the activation of microglia IL-17 pathway and NLRP3 inflammasome effectuated the neuroinflammation, and astrogliosis was ascribed to the activation of TGF-β and the inhibition of the Hippo pathway in the chronic cervical cord of compression. Therefore, therapeutic methods targeting these pathways in nerve cells could be promising CSM treatments.
Collapse
Affiliation(s)
- Pei-Min Pu
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China; Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
| | - Zhuo-Yao Li
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China; Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
| | - Yu-Xiang Dai
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China; Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
| | - Yue-Li Sun
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China; Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
| | - Yong-Jun Wang
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China; Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
| | - Xue-Jun Cui
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China; Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
| | - Min Yao
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China; Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
| |
Collapse
|
48
|
Das A, Vazquez S, Stein A, Greisman JD, Ng C, Ming T, Vaserman G, Spirollari E, Naftchi AF, Dominguez JF, Hanft SJ, Houten J, Kinon MD. Disparities in anterior cervical discectomy and fusion provision and outcomes for cervical stenosis. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 14:100217. [PMID: 37214264 PMCID: PMC10192645 DOI: 10.1016/j.xnsj.2023.100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/28/2023] [Accepted: 04/03/2023] [Indexed: 05/24/2023]
Abstract
Background Disparities in neurosurgical care have emerged as an area of interest when considering the impact of social determinants on access to health care. Decompression via anterior cervical discectomy and fusion (ACDF) for cervical stenosis (CS) may prevent progression towards debilitating complications that may severely compromise one's quality of life. This retrospective database analysis aims to elucidate demographic and socioeconomic trends in ACDF provision and outcomes of CS-related pathologies. Methods The Healthcare Cost and Utilization Project National Inpatient Sample database was queried between 2016 and 2019 using International Classification of Diseases 10th edition codes for patients undergoing ACDF as a treatment for spinal cord and nerve root compression. Baseline demographics and inpatient stay measures were analyzed. Results Patients of White race were significantly less likely to present with manifestations of CS such as myelopathy, plegia, and bowel-bladder dysfunction. Meanwhile, Black patients and Hispanic patients were significantly more likely to experience these impairments representative of the more severe stages of the degenerative spine disease process. White race conferred a lesser risk of complications such as tracheostomy, pneumonia, and acute kidney injury in comparison to non-white race. Insurance by Medicaid and Medicare conferred significant risks in terms of more advanced disease prior to intervention and negative inpatient. Patients in the highest quartile of median income consistently fared better than patients in the lowest quartile across almost every aspect ranging from degree of progression at initial presentation to incidence of complications to healthcare resource utilization. All outcomes for patients age > 65 were worse than patients who were younger at the time of the intervention. Conclusions Significant disparities exist in the trajectory of CS and the risks associated with ACDF amongst various demographic cohorts. The differences between patient populations may be reflective of a larger additive burden for certain populations, especially when considering patients' intersectionality.
Collapse
Affiliation(s)
- Ankita Das
- School of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, United States
| | - Sima Vazquez
- School of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, United States
| | - Alan Stein
- Department of Neurosurgery, Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595, United States
| | - Jacob D. Greisman
- School of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, United States
| | - Christina Ng
- School of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, United States
| | - Tiffany Ming
- School of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, United States
| | - Grigori Vaserman
- School of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, United States
| | - Eris Spirollari
- School of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, United States
| | - Alexandria F. Naftchi
- School of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, United States
| | - Jose F. Dominguez
- Department of Neurosurgery, Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595, United States
| | - Simon J. Hanft
- Department of Neurosurgery, Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595, United States
| | - John Houten
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY 10029, United States
| | - Merritt D. Kinon
- Department of Neurosurgery, Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595, United States
| |
Collapse
|
49
|
Zhang Y, Zhang J, Sun Z, Wang H, Ning R, Xu L, Zhao Y, Yang K, Xi X, Tian J. MAPK8 and CAPN1 as potential biomarkers of intervertebral disc degeneration overlapping immune infiltration, autophagy, and ceRNA. Front Immunol 2023; 14:1188774. [PMID: 37325630 PMCID: PMC10266224 DOI: 10.3389/fimmu.2023.1188774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Abstract
Background Intervertebral disc degeneration (IDD) is one of the most common health problems in the elderly and a major causative factor in low back pain (LBP). An increasing number of studies have shown that IDD is closely associated with autophagy and immune dysregulation. Therefore, the aim of this study was to identify autophagy-related biomarkers and gene regulatory networks in IDD and potential therapeutic targets. Methods We obtained the gene expression profiles of IDD by downloading the datasets GSE176205 and GSE167931 from the Gene Expression Omnibus (GEO) public database. Subsequently, differentially expressed genes (DEGs) analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis, gene ontology (GO), and gene set enrichment analysis (GSEA) were performed to explore the biological functions of DEGs. Differentially expressed autophagy-related genes (DE-ARGs) were then crossed with the autophagy gene database. The hub genes were screened using the DE-ARGs protein-protein interaction (PPI) network. The correlation between the hub genes and immune infiltration and the construction of the gene regulatory network of the hub genes were confirmed. Finally, quantitative PCR (qPCR) was used to validate the correlation of hub genes in a rat IDD model. Results We obtained 636 DEGs enriched in the autophagy pathway. Our analysis revealed 30 DE-ARGs, of which six hub genes (MAPK8, CTSB, PRKCD, SNCA, CAPN1, and EGFR) were identified using the MCODE plugin. Immune cell infiltration analysis revealed that there was an increased proportion of CD8+ T cells and M0 macrophages in IDD, whereas CD4+ memory T cells, neutrophils, resting dendritic cells, follicular helper T cells, and monocytes were much less abundant. Subsequently, the competitive endogenous RNA (ceRNA) network was constructed using 15 long non-coding RNAs (lncRNAs) and 21 microRNAs (miRNAs). In quantitative PCR (qPCR) validation, two hub genes, MAPK8 and CAPN1, were shown to be consistent with the bioinformatic analysis results. Conclusion Our study identified MAPK8 and CAPN1 as key biomarkers of IDD. These key hub genes may be potential therapeutic targets for IDD.
Collapse
Affiliation(s)
- Yuxin Zhang
- School of Medicine, Shanghai University, Shanghai, China
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiahui Zhang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhongyi Sun
- Department of Orthopedics, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Wang
- Department of Orthopaedics, Shanghai Changzheng Hospital, Shanghai, China
| | - Ruonan Ning
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Longyu Xu
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yichen Zhao
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kai Yang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaobing Xi
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiwei Tian
- School of Medicine, Shanghai University, Shanghai, China
- Department of Orthopedics, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
50
|
Gong S, Cui L, Liu H, Ye Y. Clinical efficacy of posterior endoscopic cervical modified trench technique in the treatment of cervical spondylotic myelopathy: A retrospective study. Medicine (Baltimore) 2023; 102:e33772. [PMID: 37233430 PMCID: PMC10219704 DOI: 10.1097/md.0000000000033772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
To investigate the clinical efficacy of the posterior endoscopic cervical modified trench technique in the treatment of cervical spondylotic myelopathy (CSM). This retrospective study included 9 patients with single-segment CSM, who were treated with posterior endoscopic cervical modified trench technique. Related clinical data, the visual analog scale, Japanese Orthopedic Association (JOA) ratings, JOA improvement rate, the minimum sagittal diameter of the spinal canal, and surgical complications were recorded. There were 5 men and 4 females, with an average age of 60.44 ± 16.49 years. Without any significant side effects like paralysis, vascular damage, or cerebrospinal fluid leaking, all surgeries were successfully completed. One year's worth of follow-up with patients lasted for 8.56 ± 3.68 months. When compared to before surgery, the postoperative visual analog scale ratings, JOA scores, and minimum sagittal diameter of the spinal canal value all showed a substantial improvement (P < .01). At the most recent follow-up, 2 patients had a JOA improvement rate of >75%, 6 patients had a JOA improvement rate of 74 to 50%, 1 patient had a JOA improvement rate of 49 to 25%, and none had a JOA improvement rate of <25%. The JOA improvement rate was above 90% for overall excellent and good ratings. In our study, the ventral epidural space may be maneuvered more easily and instrument-induced nerve discomfort is decreased when using the posterior endoscopic cervical modified trench approach with posterior endoscopy. The short-term clinical effect of the posterior endoscopic cervical modified trench technique for CSM is satisfactory.
Collapse
Affiliation(s)
- Shuangquan Gong
- The Minimally Invasive Spinal Department of Mianyang Orthopedic Hospital, Mianyang City, Sichuan Province, China
| | - Liqiang Cui
- The Minimally Invasive Spinal Department of Mianyang Orthopedic Hospital, Mianyang City, Sichuan Province, China
| | - Hongjun Liu
- The Minimally Invasive Spinal Department of Mianyang Orthopedic Hospital, Mianyang City, Sichuan Province, China
| | - Yu Ye
- The Minimally Invasive Spinal Department of Mianyang Orthopedic Hospital, Mianyang City, Sichuan Province, China
| |
Collapse
|