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Liu WKT, Yuet Siu KH, Cheung JPY, Shea GKH. Radiographic characterization of OPLL progression in patients receiving laminoplasty with a minimum of two-years follow-up. Neurosurg Rev 2024; 47:505. [PMID: 39207586 PMCID: PMC11362203 DOI: 10.1007/s10143-024-02735-z] [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: 07/29/2024] [Revised: 08/20/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
Ossification of the posterior longitudinal ligament (OPLL) is a common cause of degenerative cervical myelopathy (DCM) in Asian populations. Characterization of OPLL progression following laminoplasty remains limited in the literature. 29 patients with OPLL received cervical laminoplasty and a minimum of 2-years follow-up. Clinical and radiological surveillance occurred at 3-months, 6-months, 12-months post-op and then at yearly intervals. Transverse (anteroposterior) diameter and sagittal length of OPLL in relation to their cervical vertebral level of localisation was assessed upon immediate post-op radiographs compared to those obtained at subsequent follow-up. OPLL progression was defined as an increase in transverse dimensions and/or length by ≥ 2 mm. The average period of clinical follow-up was 6.7 ± 3.3 years. Upon latest follow-up, 79% of patients demonstrated at least 2 mm of transverse or longitudinal progression of OPLL. This corresponded to 2-years and 5-year progression rates of 54% and 71% respectively. OPLL located over C5 demonstrated the greatest transverse progression rate at (0.24 ± 0.34 mm / year). The mean overall longitudinal progression rate was 1.61 ± 2.06 mm / year. No patients experienced neurological decline resulting from OPLL progression requiring revision decompression during the period of post-operative observation. Characterizing transverse and longitudinal progression by cervical level via radiographs has implications in surgical planning for OPLL and should be consolidated upon post-operative CT/MRI scans as well as larger sample sizes.
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Affiliation(s)
- Wai Kiu Thomas Liu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, China
| | - Keira Ho Yuet Siu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, China
| | - Jason Pui-Yin Cheung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, China
| | - Graham Ka-Hon Shea
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, China.
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Fernandes R, Thornley P, Urquhart J, Alahmari A, Alenezi N, Kelly S, Rasoulinejad P, Singh S, Siddiqi F, Gurr K, Bailey C. Cervical orthosis does not improve postoperative pain following posterior cervical fusion: a randomized controlled trial. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08456-7. [PMID: 39167110 DOI: 10.1007/s00586-024-08456-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/28/2024] [Accepted: 08/15/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE To determine whether postoperative neck pain in the first 4 weeks following multi-level posterior cervical fusion (PCF) with orthosis is equivalent to multi-level PCF without orthosis. METHODS Patients were randomly assigned in a 1:1 ratio to postoperative orthosis (CO) for 6 weeks or no orthosis (NO). Randomization was stratified by indication (traumatic vs. degenerative), and preoperative opioid use. A model of longitudinal regression for repeated measures was used. The two-sided 95% confidence interval (CI) was used to test equivalence. If the CI lay between the pre-determined margin of equivalence (-2.0 to + 2.0 pain score) the two groups were considered equivalent. A multiple imputation procedure was used to replace missing data. RESULTS Thirty-one patients were enrolled in each group. At baseline, the CO group had more neck pain (5.3 vs. 3.2, p = 0.013). The Four week post-operative neck pain intensity score was 4.6 ± 0.3 for the CO group vs. 4.9 ± 0.3 for the NO group. The 95% confidence interval (-1.2 to 0.6) was within the pre-determined equivalence margin. Neck Disability Index, quality-of-life scores, and arm pain were similar. Eleven patients in the CO group and 12 patients in the NO group had an adverse event. The CO group had reduced range of motion at 6 weeks. CONCLUSION Pain scores over the first 4 weeks after surgery were equivalent for patients undergoing multi-level PCF treated with or without a cervical orthosis. Our findings do not support the routine use of a postoperative cervical orthosis for postoperative pain control. Clinical Trials Registration Number NCT04308122, April 22, 2020.
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Affiliation(s)
- Renan Fernandes
- Combined Orthopaedic and Neurosurgical Spine Program, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Department of Surgery, Division of Orthopaedics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Patrick Thornley
- Combined Orthopaedic and Neurosurgical Spine Program, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Department of Surgery, Division of Orthopaedics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jennifer Urquhart
- Combined Orthopaedic and Neurosurgical Spine Program, London, ON, Canada.
- Lawson Health Research Institute, London, ON, Canada.
- Department of Surgery, Division of Orthopaedics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
- London Health Sciences Center, Victoria Hospital, E2-619, 800 Commissioners Road, East, London, ON, N6A 5W9, Canada.
| | | | - Nasser Alenezi
- Combined Orthopaedic and Neurosurgical Spine Program, London, ON, Canada
| | - Sean Kelly
- Combined Orthopaedic and Neurosurgical Spine Program, London, ON, Canada
| | - Parham Rasoulinejad
- Combined Orthopaedic and Neurosurgical Spine Program, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Department of Surgery, Division of Orthopaedics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Supriya Singh
- Combined Orthopaedic and Neurosurgical Spine Program, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Department of Surgery, Division of Orthopaedics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Fawaz Siddiqi
- Combined Orthopaedic and Neurosurgical Spine Program, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Department of Surgery, Division of Orthopaedics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Kevin Gurr
- Combined Orthopaedic and Neurosurgical Spine Program, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Department of Surgery, Division of Orthopaedics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Chris Bailey
- Combined Orthopaedic and Neurosurgical Spine Program, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Department of Surgery, Division of Orthopaedics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Donato Z, Gonzalez D, Markowitz M, Gjolaj J. Postoperative Spinal Orthoses: Types and Outcomes. J Am Acad Orthop Surg 2024; 32:211-219. [PMID: 37812569 DOI: 10.5435/jaaos-d-23-00498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/21/2023] [Indexed: 10/11/2023] Open
Abstract
INTRODUCTION Postoperative bracing (POB) after spinal surgery is a common practice that has been used for many decades. In the past few years, the indications, types, and outcomes of POB have been heavily questioned after many studies revealed no consistent evidence to support or refute the use of spinal orthoses after surgery. SUMMARY Currently, there are no indications of the type, duration, or indication for many spinal orthoses and few studies have assessed their efficacy. Although much of the literature lacks adequate comparisons of brace types or specific indications, POB is still widely used for various surgical procedures. This study evaluated the current evidence concerning POB of the cervical, thoracic, and lumbosacral spine.
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Affiliation(s)
- Zachary Donato
- From the Department of Education, The University of Miami Leonard M. Miller School of Medicine, (Donato, and Markowitz), and the Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL (Gonzalez, and Gjolaj)
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Xu T, Wang S, Fang H, Zhao H, Fang X, Wu H, Li F. Comparative effectiveness and functional outcome of C3 & C7 dome-hybrid open-door laminoplasty with traditional unilateral open-door laminoplasty for cervical spondylotic myelopathy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:224-231. [PMID: 37819602 DOI: 10.1007/s00586-023-07953-5] [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: 06/13/2023] [Revised: 08/04/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE The C3 & C7 dome-hybrid open-door laminoplasty was proven to be an effective treatment for multi-levels cervical spondylotic myelopathy (CSM). However, its superiority over traditional unilateral open-door laminoplasty (UOLP) remains questionable, and no studies have compared the efficacy of this technique with traditional UOLP. This study aimed to compare the effectiveness of C3 & C7 dome-hybrid open-door laminoplasty with traditional UOLP in treating multi-levels CSM. METHODS A retrospective study of multi-levels CSM with laminoplasty was performed, including 35 cases of traditional UOLP and 27 cases of C3 & C7 dome-hybrid open-door laminoplasty. Radiographic evaluation parameters and clinical outcomes were recorded to evaluate the surgical effectiveness. RESULTS There was no significant difference in demographic baseline parameters. At the final follow-up, the C2-C7 Cobb angle of the modified group was significantly greater than that of the traditional group (p = 0.026). Meanwhile, the C2-C7 SVA of the modified group was significantly smaller than that of the traditional group (p = 0.009). Clinical outcomes such as VAS, NDI, and SF-12 scores, improved significantly in the modified group compared to the traditional group, while the JOA scores had no significant difference in both groups. There was no significant difference in the overall rate of complications between the two groups. CONCLUSION Both techniques have satisfactory outcomes in treating multi-levels CSM. Comparing with traditional UOLP, C3 & C7 dome-hybrid open-door laminoplasty has a greater superiority in reducing postoperative neck pain and maintaining the cervical sagittal alignment. It is proven to be a feasible management for patients with multi-levels CSM.
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Affiliation(s)
- Tao Xu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Shanxi Wang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, 76# Nanguo Road, Xi'an, 710054, People's Republic of China
| | - Huang Fang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China.
| | - Hongqi Zhao
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Xuan Fang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Hua Wu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Feng Li
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
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Liu J, Yang X, Jing W, Guo X, Wang R, Zhou J, Xue Y. Clinical efficacy of duloxetine in the treatment of axial symptoms after posterior cervical spine surgery: a retrospective study. J Orthop Surg Res 2023; 18:496. [PMID: 37438835 DOI: 10.1186/s13018-023-03970-8] [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] [Received: 02/20/2023] [Accepted: 07/01/2023] [Indexed: 07/14/2023] Open
Abstract
PURPOSE To evaluate the efficacy of duloxetine in the treatment of patients with axial symptoms after posterior cervical spine surgery. METHODS Patients with axial symptoms after posterior cervical spine surgery treated by duloxetine or non-drug therapy from 2018 to 2021 were reviewed. Duloxetine was administered gradually, with oral administration of 30 mg in the first week and oral administration of 60 mg from the second week. Visual analogue scale (VAS), 36-Item Short-Form Health Survey questionnaire (SF-36) and EuroQol-5 Dimensions (EQ-5D) questionnaire were used to evaluate the severity of AS at baseline and 1 week, 2 weeks, 1 month, 3 months and 6 months after medication. The occurrence of adverse reactions was recorded. RESULTS A total of 63 eligible patients who received duloxetine therapy (n = 35) or non-drug therapy (n = 28) were included. All patients were followed up for 6 months. Significant improvements were found in VAS score compared with baseline in both groups (1.87 ± 0.81 vs 6.61 ± 1.16, 3.18 ± 0.67 vs 6.31 ± 1.40; P < 0.05 for all). Meanwhile, the VAS score of the duloxetine group was significantly better than that of the non-drug therapy group at 1 week, 2 weeks, 1 month, 3 months and 6 months (P < 0.05). Besides, according to 36-Item Short-Form Health Survey questionnaire (SF-36), the PCS score and MCS score are significantly higher than before the treatment in duloxetine group (PCS 62.82 ± 6.04 vs 44.36 ± 7.25, MCS 65.50 ± 4.53 vs 55.55 ± 6.06; P < 0.05 for all). And when we compared variables between the two groups, the PCS score of the duloxetine group was significantly better than that of the non-drug therapy group (P < 0.05), but there was no significant difference in MCS score between the two groups (P > 0.05). What's more, EQ-5D score had significant improvements in the duloxetine group compared with the non-drug therapy group at 1 week, 2 weeks, 1 month, 3 months and 6 months (P < 0.05). CONCLUSION Oral duloxetine has a better short-term outcome than conventional non-drug therapy in patients with axial symptoms following posterior decompression surgery in the cervical spine.
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Affiliation(s)
- Jinkai Liu
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaotian Yang
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
- Department of Burn and Plastic Surgery, People's Hospital of Chongqing Hechuan, Chongqing, China
| | - Wanli Jing
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
- Department of Orthopaedics, Tianjin First Central Hospital, Tianjin, China
| | - Xing Guo
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Rui Wang
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiaming Zhou
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China.
- Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, China.
| | - Yuan Xue
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China.
- Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, China.
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Hasan S, Babrowicz J, Waheed MA, Piche JD, Patel R, Aleem I. The Utility of Postoperative Bracing on Radiographic and Clinical Outcomes Following Cervical Spine Surgery: A Systematic Review. Global Spine J 2023; 13:512-522. [PMID: 35499300 PMCID: PMC9972282 DOI: 10.1177/21925682221098361] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
STUDY DESIGN Systematic Review. OBJECTIVES To determine the radiographic and clinical utility of postoperative orthoses following cervical spine surgery. METHODS We performed a search of the PubMed, Cochrane Library, Medline Ovid, and SCOPUS databases from inception until November 2021. Eligible studies included outcomes of postoperative bracing vs no bracing following cervical spine surgery. The primary outcome of interest was fusion rates after cervical surgery in braced vs unbraced patients. Secondary outcomes included patient reported outcomes and complication rates. RESULTS A total of 3232 titles were initially screened. After inclusion criteria were applied, 7 studies (550 patients) were included, which compared results of braced vs unbraced patients after cervical spine surgery. These studies showed acceptable reliability for inclusion based on the Methodical Index for Non-Randomized studies and Critical Appraisal Skills Programme assessment tools. There were no significant differences in fusion rates or complications between braced vs unbraced patients identified in any study. Patient reported pain and quality of life measures between braced and unbraced groups varied amongst studies, without any clear overall advantages favoring either method. CONCLUSIONS This systematic review found that external bracing, though widely used following cervical spine surgery, may not offer any advantages in patient-reported outcomes, as compared to not bracing. In regard to the effect of bracing on fusion rates, no strong consensus can be made as the methods of fusion assessment in the included studies were heterogenous and suboptimal. Future high-quality studies using recommended methods of fusion assessment are needed to adequately address this important question.
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Affiliation(s)
- Sazid Hasan
- Oakland University William Beaumont
School of Medicine, Rochester, MI, USA
| | - Joseph Babrowicz
- College of Literature, Science and
the Arts, University of Michigan, Ann Arbor, MI, USA
| | - Muhammad A. Waheed
- Oakland University William Beaumont
School of Medicine, Rochester, MI, USA
| | - Joshua David Piche
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Rakesh Patel
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Ilyas Aleem
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA,Ilyas Aleem, MD, MS, FRCSC, Department of
Orthopedic Surgery, University of Michigan, 1500 East Medical Center Drive, 2912
Taubman Center, SPC 5328, Ann Arbor, MI 48109, USA.
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Nie C, Chen K, Zhu YU, Song H, Lyu F, Jiang J, Xia X, Zheng C. Comparison of time-dependent resistance isometric exercise and active range of motion exercise in alleviating the sensitization of postoperative axial pain after cervical laminoplasty. Musculoskelet Sci Pract 2022; 62:102669. [PMID: 36201875 DOI: 10.1016/j.msksp.2022.102669] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/01/2022] [Accepted: 09/24/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Postoperative axial pain (PAP) is a significant complication after cervical laminoplasty. OBJECTIVE To investigate pain sensitization in PAP patients and effects of time-dependent resistance isometric exercise compared to active range-of-motion exercise on PAP. STUDY DESIGN Retrospective cohort analysis. METHODS 211 patients undergoing postoperative 12-week exercises were evaluated for pressure pain threshold (PPT), temporal summation (TS) and both cross-sectional area and fatty infiltration of paraspinal muscles preoperatively and 3 months postoperatively. There patients underwent Numeric rating pain scale (NRS) and neck disability index (NDI) 3 and 6 months postoperatively. RESULTS At postoperative 3-month assessments, fewer patients undergoing isometric exercise showed PAP compared to range-of-motion exercise group (14/98 vs. 34/113; P = 0.006), and pain-related assessments in the former were lower than the latter (NRS at rest: 0.3 ± 0.8 vs. 0.7 ± 1.4, P = 0.014; NRS with movements: 0.4 ± 1.0 vs. 1.0 ± 1.7, P = 0.015; NDI: 2.4 ± 6.3 vs. 6.7 ± 10.9, P = 0.002). Postoperative cross-sectional area was smaller in isometric exercise group (603.5 ± 190.2) than in range-of-motion exercise group (678.7 ± 215.5) (P = 0.033), and the former showed higher local-area PPT and lower TS than the latter (PPT: 3.9 ± 1.8 vs. 3.1 ± 1.6, P = 0.002; TS: 1.8 ± 0.9 vs. 2.2 ± 1.0, P = 0.003). PAP patients showed lower local-area PPT and greater TS than those without PAP in both isometric (PPT: 2.8 ± 0.7 vs. 4.0 ± 1.9, P = 0.019; TS: 2.4 ± 0.6 vs. 1.7 ± 0.9, P = 0.011) and range-of-motion (PPT: 2.2 ± 0.9 vs. 3.6 ± 1.7, P < 0.001; TS: 2.8 ± 0.8 vs. 1.9 ± 0.9, P < 0.001) exercise groups. CONCLUSIONS Both peripheral and central sensitization are involved in PAP. Time-dependent isometric exercise has more positive effects on PAP than range-of-motion exercise because of its advantages in improving pain sensitization.
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Affiliation(s)
- Cong Nie
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Kaiwen Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Y U Zhu
- Department of Physical Medicine and Rehabilitation, Upstate Medical University, State University of New York at Syracuse, Syracuse, NY, 10212, USA
| | - Huan Song
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Feizhou Lyu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040, China; Department of Orthopedics, The Fifth People's Hospital, Fudan University, Shanghai, 200240, China
| | - Jianyuan Jiang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Xinlei Xia
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Chaojun Zheng
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040, China.
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Raisch P, Jung MK, Vetter SY, Grützner PA, Kreinest M. Post-operative Use of Cervical Orthoses for Subaxial Cervical Spine Injuries - a Survey-based Analysis at German Spine Care Centres. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:637-645. [PMID: 34496425 DOI: 10.1055/a-1522-9129] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There are no evidence-based recommendations for the post-operative treatment and application of soft or rigid cervical collars after operative treatment of injuries of the subaxial cervical spine. Cervical collars can restrict peak range of motion and serve as a reminder to the patient. However, they can also cause pressure ulcers. The aim of this online-based survey among German spine centres was to gain an overview of post-operative treatment and the application of soft or rigid cervical collars after surgical treatment of injuries of the subaxial cervical spine. MATERIALS AND METHODS An online-based survey was conducted among 59 spine centres certified by the German Spine Society. It comprised seven items and the option of adding remarks in the form of open-ended responses. RESULTS The return rate was 63% (37 out of 59). Of the 37 analysed spine centres, 51% routinely apply a cervical collar post-operatively, 27% apply a soft and 16% a rigid cervical collar, 8% sequentially apply first a rigid and later a soft cervical collar. Less than half of the spine centres (43%) routinely use no cervical collar. Rigid collars are applied for more than 6 weeks and soft collars up to 6 weeks at some spine centres. Standardised post-operative treatment plans are common. The selection of the post-operative treatment plan depends primarily on the type of injury and method of operation and partly on patient age and bone quality. The satisfaction of German spine centres with the current handling of post-operative treatment of subaxial cervical spine injuries is high. DISCUSSION The post-operative treatment of injuries of the subaxial cervical spine at German spine centres is heterogeneous, and the evidence on advantages and disadvantages of the post-operative application of cervical collars is insufficient. Planning and implementation of randomised controlled clinical trials in subaxial cervical spine injuries is challenging.
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Affiliation(s)
- Philipp Raisch
- Clinic for Trauma Surgery and Orthopaedics, BG Trauma Center Ludwigshafen, Germany
| | - Matthias K Jung
- Clinic for Trauma Surgery and Orthopaedics, BG Trauma Center Ludwigshafen, Germany
| | - Sven Y Vetter
- Clinic for Trauma Surgery and Orthopaedics, BG Trauma Center Ludwigshafen, Germany
| | - Paul A Grützner
- Clinic for Trauma Surgery and Orthopaedics, BG Trauma Center Ludwigshafen, Germany
| | - Michael Kreinest
- Clinic for Trauma Surgery and Orthopaedics, BG Trauma Center Ludwigshafen, Germany
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Mao Y, Jindong Z, Zhaohui F. Is brace necessary after cervical surgery: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2022; 101:e29791. [PMID: 35801768 PMCID: PMC9259153 DOI: 10.1097/md.0000000000029791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Currently, there are increasing surgical treatments for neck pain. However, whether to use cervical brace after operation remains poorly defined. We aim to clear the clinical efficacy of the use of cervical brace after cervical surgery. METHODS We searched for relevant studies in 8 electronic databases up to March 2021. The mean difference and 95% confidence intervals were used for continuous data. Cochrane Collaboration's tool was used to assess the risk of bias. The data were collected and input into the Review Manager 5.3 software (The Cochrane Collaboration, Copenhagen, Denmark). RESULTS Four randomized controlled trials were finally included in our study. For pain, the pooled analysis showed that postoperative neck brace compared with no brace can relieve neck pain at all follow-up periods except 6 months. For neck disability index, the result showed that postoperative neck brace compared with no brace can improve neck disability index during the 3 to 12 month follow-up period. However, no significant difference was identified between 2 groups within the follow-up of 6 weeks after surgery. In addition, the result tends to get the opposite at follow-up of 24 months. For 36-Short form health survey Physical Component Summary, there was no significant difference between 2 groups in the early 3 weeks after surgery, but the results were changed after 3 weeks. For 36-short form health survey Mental Component Summary, there appears to be no significant change between 2 groups at all time intervals. CONCLUSION Wearing a cervical brace after cervical surgery is conducive to improving symptoms after cervical surgery at different stages. However, there is no relevant evidence indicating it can improve the mental health of postoperative patients. Higher quality, large prospective randomized studies are needed to verify the current conclusions.
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Affiliation(s)
- Yang Mao
- The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Zhao Jindong
- The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
- Anhui University of Traditional Chinese Medicine, Hefei, China
- Diabetes Institute, Anhui Academy of Chinese Medicine, Hefei, China
- Key Laboratory of Xin'an Medicine, Ministry of Education, Hefei, China
| | - Fang Zhaohui
- The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
- Diabetes Institute, Anhui Academy of Chinese Medicine, Hefei, China
- Key Laboratory of Xin'an Medicine, Ministry of Education, Hefei, China
- *correspondence: Zhaohui Fang, Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China (e-mail: )
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Volumetric Changes in Cervical Disc Herniation: Comparison of Cervical Expansive Open-door Laminoplasty and Cervical Microendoscopic Laminoplasty. Spine (Phila Pa 1976) 2022; 47:E296-E303. [PMID: 34381000 DOI: 10.1097/brs.0000000000004197] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study on 185 patients with 490 cervical disc herniation (CDH). OBJECTIVE The aim of this study was to compare the changes in volumes of CDH in patients with degenerative cervical myelopathy (DCM) surgically treated by expansive open-door laminoplasty (EOLP) or cervical microendoscopic laminoplasty (CMEL). SUMMARY OF BACKGROUND DATA Spontaneous resorption of CDH was shown in patients with DCM after conservation treatment, but very few in surgically treated patients. Our previous study identified the clinical efficiency of CMEL to treat DCM but how CDH sized postoperatively, as well as comparing to EOLP, was unknown. METHODS Consecutive patients with DCM from December 2015 to December 2019, who underwent MRI evaluation, receiving CMEL or EOLP, and repeat MRI in follow-up were included. The volume of CDH were monitored using the picture archiving and communication system, further calculating the incidence of CDH with volume regression and the percentage changes of CDH volume. The correlations of possible determines with CDH volume changes were analyzed by Spearman rank correlation coefficient. RESULTS A total of 89 patients (215 CDHs, EOLP-group) and 96 patients (275 CDHs, CMEL-group) was surveyed, respectively. Resultantly, volume of CDH was decreased postoperatively in both EOLP and CMEL cases. But this CDH volume regression was more profound in CMEL groups (incidence of 81.2% from 223/275, median volume change ratio of -26.7%, occurring from 1 month after CMEL), statistically different from EOLP group (50.2% from 108/215, median volume change ratio of -5.4%, none-appearance within 1 month). Patients information as sex, age, and follow-up time, not CDH significant, was significantly correlated with CDH volume changes. CONCLUSION Patients who underwent CMEL developed a postoperative reduction of CDH volume, with more popularity, greater degree and earlier-staged than EOLP-patients. Young females with longer follow-up time were more likely occur.Level of Evidence: 4.
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Lockey SD, Trent SM, Kalantar SB. Cervical Myelopathy: An Update on Posterior Decompression. Clin Spine Surg 2022; 35:E87-E93. [PMID: 34379613 DOI: 10.1097/bsd.0000000000001126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 11/07/2020] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a narrative review. OBJECTIVE The aim was to discuss current methods and review updated outcome studies regarding posterior decompression in the management of cervical myelopathy. SUMMARY OF BACKGROUND DATA Progressive myelopathy in the cervical segments is an indication for urgent surgical management. Although nonoperative treatment is an option in mild to moderate cases, the majority of patients will experience deterioration in neurological function requiring surgical decompression. METHODS A review of the literature was performed using PubMed to provide updated information regarding posterior cervical decompression in the management of myelopathy. RESULTS There are numerous studies comparing outcome data between cervical laminectomy and fusion with laminoplasty. While each technique has advantages and disadvantages, both provide adequate decompression and good long-term outcomes in patients meeting appropriate criteria. CONCLUSIONS Posterior decompression is an important approach for spine surgeons to have in their toolkits when treating cervical myelopathy.
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Affiliation(s)
- Stephen D Lockey
- Department of Orthopaedic Surgery, Medstar Georgetown University Hospital
| | | | - Seyed Babak Kalantar
- Department of Orthopaedic Surgery, Spine Surgery Division, Medstar Georgetown University Hospital, Washington, DC
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Chen T, Zhang X, Meng F, Yan J, Xu G, Zhao W. Is laminoplasty or laminectomy the best strategy for C 3 segment in French-door laminoplasty? A systematic review and meta-analysis. J Orthop Surg Res 2021; 16:557. [PMID: 34521434 PMCID: PMC8442409 DOI: 10.1186/s13018-021-02596-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background To compare the clinical outcomes of C3 laminectomy and C3 laminoplasty at the C3 segment during French-door laminoplasty. Methods The Cochrane Library, PubMed, Embase, and Web of Science databases were searched from inception to November 10, 2020 for studies comparing the clinical outcomes of two types of French-door laminoplasty in the treatment of multilevel cervical spondylotic myelopathy (MCSM). Review Manager 5.3 was used to analyze the following outcomes: operative time, intraoperative blood loss, preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, recovery rate, cervical curvature, cervical range of motion (ROM), incidence of axial symptoms (AS), and C2-3 bony fusion rate. Results A total of eight studies involving 776 patients were included; there were 424 patients in the C3 laminectomy group and 352 patients in the C3 laminoplasty group. The results of the meta-analysis showed that the C3 laminectomy group was superior to the C3 laminoplasty group in terms of operative time (P < 0.00001), cervical ROM (P = 0.04), and incidence of AS (P < 0.0001). However, no statistically significant differences between the two groups were noted regarding intraoperative bleeding (P = 0.44), preoperative JOA score (P = 0.57), postoperative JOA score (P = 0.09), recovery rate (P = 0.25), cervical curvature (P = 0.22), and C2-3 bony fusion rate (P = 0.06). Conclusion This meta-analysis demonstrated that both C3 laminoplasty and C3 laminectomy could effectively improve neurological function in patients with MCSM in French-door laminoplasty. However, C3 laminectomy can reduce the operative time, preserve cervical ROM, and reduce the incidence of postoperative AS. Trial registration PROSPERO registration number is CRD42021230798. Date of registration: February 11, 2021.
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Affiliation(s)
- Tiantian Chen
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, 148 Baojian Road, Harbin, 150081, China
| | - Xun Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, 148 Baojian Road, Harbin, 150081, China
| | - Fanchao Meng
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, 148 Baojian Road, Harbin, 150081, China
| | - Jinglong Yan
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, 148 Baojian Road, Harbin, 150081, China
| | - Gongping Xu
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, 148 Baojian Road, Harbin, 150081, China.
| | - Wei Zhao
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, 148 Baojian Road, Harbin, 150081, China.
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Fujishiro T, Hayama S, Obo T, Nakaya Y, Nakano A, Usami Y, Nozawa S, Baba I, Neo M. Gap between flexion and extension ranges of motion: a novel indicator to predict the loss of cervical lordosis after laminoplasty in patients with cervical spondylotic myelopathy. J Neurosurg Spine 2021; 35:8-17. [PMID: 33930862 DOI: 10.3171/2020.10.spine201723] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Kyphotic deformity resulting from the loss of cervical lordosis (CL) is a rare but serious complication after cervical laminoplasty (CLP), and it is essential to recognize the risk factors. Previous studies have demonstrated that a greater flexion range of motion (fROM) and smaller extension ROM (eROM) in the cervical spine are associated with the loss of CL after CLP. Considering these facts together, one can hypothesize that an indicator representing the gap between fROM and eROM (gROM) is highly useful in predicting postoperative CL loss. In the present study, the authors aimed to investigate the risk factors of marked CL loss after CLP for cervical spondylotic myelopathy (CSM), including the gROM as a potential predictor. METHODS Patients who had undergone CLP for CSM were divided into those with and those without a loss of more than 10° in the sagittal Cobb angle between C2 and C7 at the final follow-up period compared to preoperative measurements (CL loss [CLL] group and no CLL [NCLL] group, respectively). Demographic characteristics, surgical information, preoperative radiographic measurements, and posterior paraspinal muscle morphology evaluated with MRI were compared between the two groups. fROM and eROM were examined on neutral and flexion-extension views of lateral radiography, and gROM was calculated using the following formula: gROM (°) = fROM - eROM. The performance of variables in discriminating between the CLL and NCLL groups was assessed using the receiver operating characteristic (ROC) curve. RESULTS This study included 111 patients (mean age at surgery 68.3 years, 61.3% male), with 10 and 101 patients in the CLL and NCLL groups, respectively. Univariate analyses showed that fROM and gROM were significantly greater in the CLL group than in the NCLL group (40.2° vs 26.6°, p < 0.001; 31.6° vs 14.3°, p < 0.001, respectively). ROC curve analyses revealed that both fROM and gROM had excellent discriminating capacities; gROM was likely to have a higher area under the ROC curve than fROM (0.906 vs 0.860, p = 0.094), with an optimal cutoff value of 27°. CONCLUSIONS The gROM is a highly useful indicator for predicting a marked loss of CL after CLP. For CSM patients with a preoperative gROM exceeding 30°, CLP should be carefully considered, since kyphotic changes can develop postoperatively.
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Affiliation(s)
- Takashi Fujishiro
- 1Department of Orthopedic Surgery, Osaka Medical College, Takatsuki; and
- 2Department of Orthopedic Surgery, First Towakai Hospital, Takatsuki, Osaka, Japan
| | - Sachio Hayama
- 1Department of Orthopedic Surgery, Osaka Medical College, Takatsuki; and
| | - Takuya Obo
- 1Department of Orthopedic Surgery, Osaka Medical College, Takatsuki; and
- 2Department of Orthopedic Surgery, First Towakai Hospital, Takatsuki, Osaka, Japan
| | - Yoshiharu Nakaya
- 1Department of Orthopedic Surgery, Osaka Medical College, Takatsuki; and
| | - Atsushi Nakano
- 1Department of Orthopedic Surgery, Osaka Medical College, Takatsuki; and
| | - Yoshitada Usami
- 1Department of Orthopedic Surgery, Osaka Medical College, Takatsuki; and
| | - Satoshi Nozawa
- 1Department of Orthopedic Surgery, Osaka Medical College, Takatsuki; and
| | - Ichiro Baba
- 1Department of Orthopedic Surgery, Osaka Medical College, Takatsuki; and
| | - Masashi Neo
- 1Department of Orthopedic Surgery, Osaka Medical College, Takatsuki; and
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Kwok SSS, Cheung JPY. Surgical decision-making for ossification of the posterior longitudinal ligament versus other types of degenerative cervical myelopathy: anterior versus posterior approaches. BMC Musculoskelet Disord 2020; 21:823. [PMID: 33292175 PMCID: PMC7724709 DOI: 10.1186/s12891-020-03830-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/25/2020] [Indexed: 12/02/2022] Open
Abstract
Background The debate between anterior or posterior approach for pathologies such as cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) have drawn heated debate but are still inconclusive. Main body of the abstract A narrative review was performed specifically to study the differences pertaining to OPLL and other causes of degenerative cervical myelopathy (DCM). Current evidence suggests that anterior approach is preferred for K-line (−) OPLL, K-line (+) with canal occupying ratio > 60% and DCM with pre-existing cervical kyphosis. Posterior approach is preferred for K-line (+) OPLL with canal-occupying ratio < 50–60%, and multi-level CSM. No particular advantage for either approach was observed for DCM in a lordotic cervical spine. Anterior approach is generally associated with more complications and thus needs to be weighed carefully during decision-making. The evidence is not convincing for comparing single versus multi-level involvement, and the role of patients' co-morbidity status, pre-existing osteoporosis and co-existent spinal pathologies in influencing patient outcome and surgical options. This should be a platform for future research directives. Conclusion From this review, evidence is still inconclusive but there are some factors to consider, and DCM and OPLL should be considered separately for decision-making. Anterior approach is considered for pre-existing cervical kyphosis in DCM, for K-line (−) regardless of canal-occupying ratio, and K-line (+) and canal-occupying ratio > 60% for OPLL patients. Posterior approach is considered for patients with multi-level pathology for DCM, and K-line (+) and canal-occupying ratio < 50–60% for OPLL.
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Affiliation(s)
- Suzanna Sum Sum Kwok
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China.
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Chen C, Li J, Liao Z, Gao Y, Shao Z, Yang C. C3 laminectomy combined with modified unilateral laminoplasty and in situ reconstruction of the midline structures maintained cervical sagittal balance: a retrospective matched-pair case-control study. Spine J 2020; 20:1403-1412. [PMID: 32387294 DOI: 10.1016/j.spinee.2020.04.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Open-door laminoplasty often results in postoperative complications such as loss of cervical lordosis, limitations of cervical motion, and axial symptoms. However, current modified laminoplasty techniques such as muscle-sparing type or spinous process splitting technique are not as effective as expected. PURPOSE To evaluate the radiological and clinical outcomes of C3 laminectomy combined with modified unilateral laminoplasty (preservation of posterior muscle-ligament complex and reconstruction of the midline structures) versus traditional open door laminoplasty in treating cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament. STUDY DESIGN Retrospective case-control study. PATIENT SAMPLE One hundred and eleven patients with multilevel cord compression and myelopathic symptoms. OUTCOME MEASURES The outcome parameters were operation time, blood loss volume, complications, osseous fusion status, C0-C2 and C2-C7 Cobb angles, T1 slope, cervical sagittal vertical axis (cSVA), cervical curvature index (CCI), range of motion (ROM), cross-sectional area (CSA) of the semispinalis cervicis, axial symptoms, visual analog scale (VAS) score, Japanese Orthopedic Association (JOA) score, and neck disability index (NDI). METHODS We matched 37 patients who underwent modified laminoplasty with 74 patients treated by traditional open door laminoplasty (ratio, 1:2) according to age, sex, body mass index, compromised level, and radiographic characteristics. Preoperative and postoperative cervical parameters, namely, the C2-C7 Cobb angle, ROM, and CCI were measured on X-ray films. The CSA of the semispinalis cervicis was assessed on magnetic resonance images, and osseous fusion status of the hinge side and the osteotomy site was evaluated by computed tomography. We used the JOA and VAS scores, and the NDI to evaluate clinical outcomes. RESULTS The average follow-up period in the modified group was 24.1 months (range, 18-37 months) compared with 24.7 months (range, 18-38 months) in the control group. At the final follow-up, C0-C2 Cobb angle, T1 slope, and cSVA increased in the control group and were unchanged in the modified group. The C2-C7 Cobb angle decreased significantly in the control group and did not change in the modified group. ROM and CCI loss rate did not change in the modified group but decreased significantly in the control group. The CSA loss in the semispinalis cervicis was 222.90±79.56 mm2 in the control group and 49.11±75.93 mm2 in the modified group, with a significant difference (p<.001). The final CSA of the semispinalis cervicis at C2 and C4-C7 levels showed no significant difference in the modified group and decreased significantly in the control group compared with preoperation. Changes in the C2-C7 Cobb angle and cSVA were both correlated with the CSA loss of the semispinalis cervicis (r=0.282, p=.003; r=0.267, p=.005, respectively). Moreover, the CSA loss of the semispinalis cervicis also correlated with the CCI loss rate and the changes in ROM (r=0.312, p=.001; r=0.287, p=.002, respectively). Clinical outcomes such as VAS and NDI scores, improved significantly more in the modified group versus the controls (p<.001 and p=.005, respectively), while JOA scores improved similarly in both groups (p=.132). The incidence of axial symptoms was significantly lower in the modified group versus controls (5.4% vs 9.5%, respectively; p=.023). CONCLUSIONS C3 laminectomy combined with modified unilateral laminoplasty is effective for treating patients with multilevel cord compression. This modified technique reconstructs the midline structures and may lead to improved alignment and less axial pain.
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Affiliation(s)
- Chao Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Li
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiwei Liao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Gao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zengwu Shao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cao Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Factors associated with postoperative axial symptom after expansive open-door laminoplasty: retrospective study using multivariable analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2838-2844. [PMID: 32524286 DOI: 10.1007/s00586-020-06494-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 04/30/2020] [Accepted: 05/31/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of the present study was to investigate the factors associated with axial symptom using multivariable analysis. METHODS The authors retrospectively assessed 249 patients treated by open-door laminoplasty. The patients were classified into two groups: axial symptom and no axial symptom group. The possible factors included demographic variables (age, sex, BMI, smoking, heart disease, diabetes, preoperative neck pain, preoperative JOA scores, preoperative NDI, course of disease and pathogenesis) and surgical and radiological variables [operation time, intraoperative blood loss, collar wear time, preoperative cervical curvature, postoperative cervical curvature, T1 slope, preoperative and postoperative C2 sagittal vertical axis (C2 SVA)]. RESULTS The prevalence of axial symptom was 34.9% (89/249). The collar wear time, preoperative and postoperative C2 SVA were risk factors for axial symptom. A cutoff value of 22.6 mm for preoperative C2 SVA and 3.5 weeks for collar wear time predicted the development of axial symptom. CONCLUSIONS The longer collar wear time, larger preoperative and postoperative C2 SVA were positively correlated with the higher incidence of axial symptom.
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Fujishiro T, Nakano A, Yano T, Nakaya Y, Hayama S, Usami Y, Nozawa S, Baba I, Neo M. Significance of flexion range of motion as a risk factor for kyphotic change after cervical laminoplasty. J Clin Neurosci 2020; 76:100-106. [PMID: 32284285 DOI: 10.1016/j.jocn.2020.04.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Abstract
Kyphotic deformity is a rare but serious complication after cervical laminoplasty (CLP), and several studies have investigated its predictors. In these studies, a kyphotic Cobb angle of 0°-5° between C2 and C7 at a certain postoperative time-point was often used to detect kyphotic deformity. However, studies considering the amount of cervical lordosis loss compared to the preoperative measurement are scarce. This study aimed to elucidate risk factors for kyphotic change after CLP by comparing patients with and without marked loss of cervical lordosis postoperatively. The study population was divided into seven patients with and 92 patients without a loss of >10° of the C2-7 angle during the follow-up period compared to the preoperative measurements [cervical lordosis loss (CLL) group and no CLL (NCLL) group, respectively]; demographic characteristics, surgical information, preoperative radiographic sagittal parameters of the cervical spine, and posterior paravertebral muscle morphology evaluated by magnetic resonance imaging were compared between two groups. A univariate analysis revealed that the CLL group had significantly greater flexion range of motion (fROM) than the NCLL group (43.0° vs. 25.8°, P < 0.001); however, no statistical significance was identified for other parameters. The fROM had a high capacity to discriminate between the CLL and NCLL groups (area under the receiver-operating characteristic curve, 0.880; P < 0.001; 95% confidence interval, 0.589-0.974) with an optimal cutoff point of 37°. This study suggests that greater fROM is a risk factor for the development of kyphotic changes after CLP. For patients with preoperative fROM exceeding 40°, CLP should be carefully indicated.
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Affiliation(s)
- Takashi Fujishiro
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan; Department of Orthopedic Surgery, First Towakai Hospital, Takatsuki, Japan.
| | - Atsushi Nakano
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Toma Yano
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Yoshiharu Nakaya
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Sachio Hayama
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Yoshitada Usami
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Satoshi Nozawa
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Ichiro Baba
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
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How Common Is Back Pain and What Biopsychosocial Factors Are Associated With Back Pain in Patients With Adolescent Idiopathic Scoliosis? Clin Orthop Relat Res 2019; 477:676-686. [PMID: 30516661 PMCID: PMC6437349 DOI: 10.1097/corr.0000000000000569] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) is the most common spine deformity in adolescent patients. Although structural deformity may affect spinal biomechanics of patients with AIS, little is known regarding various period prevalence proportions of back pain and chronic back pain and factors associated with back pain in such patients. QUESTIONS/PURPOSES (1) What are the period prevalence rates of back pain among teenagers with AIS? (2) Is back pain in patients with AIS associated with curve severity? METHODS A total of 987 patients with AIS who were treated without surgery were recruited from a single center's scoliosis clinic. Between December 2016 and July 2017, this center treated 1116 patients with suspected AIS. During that time, patients were offered surgery when their Cobb angle was at least 50° and had evidence of curve progression between two visits, and most of the patients who were offered surgery underwent it; other patients with AIS were managed nonsurgically with regular observation, brace prescription, posture training, and reassurance. To be included in this prospective, cross-sectional study, a patient needed to be aged between 10 and 18 years with a Cobb angle > 10°. No followup data were required. A total of 1097 patients with AIS were managed nonsurgically (98.3% of the group seen during the period in question). After obtaining parental consent, patients provided data related to their demographics; physical activity levels; lifetime, 12-month, 30-day, 7-day, and current thoracic pain and low back pain (LBP); chronic back pain (thoracic pain/LBP); brace use; and treatments for scoliosis/back pain. Pain was rated on a 10-point numeric rating scale for pain. The Insomnia Severity Index, Epworth Sleepiness Scale, and Depression Anxiety Stress Scales were also assessed. These features and radiologic study parameters between patients with and without back pain were also compared. Factors associated with current and 12-month back pain as well as chronic back pain were analyzed by multivariate analyses. RESULTS Depending on the types of period prevalence, the prevalence of thoracic pain ranged from 6% (55 of 987) within 12 months to 14% (139 of 987) within 7 days, whereas that of LBP ranged from 6% (54 of 987) to 29% (289 of 987). Specifically, chronic thoracic pain or LBP had the lowest prevalence. Compared with the no pain group, patients with current back pain had more severe insomnia (odds ratio [OR], 1.80; p = 0.02; 95% confidence interval [CI], 1.10-2.93) and daytime sleepiness (OR, 2.41; p < 0.001, 95% CI, 1.43-4.07). Those with chronic back pain had the same problems along with moderate depression (OR, 2.49; p = 0.03; 95% CI, 1.08-5.71). Older age (OR range, 1.17-1.42; all p values ≤ 0.030) and Cobb angle > 40° (OR range, 2.38-3.74; all p values ≤ 0.015), daytime sleepiness (OR range, 2.39-2.41; all p values ≤ 0.011), and insomnia (OR range, 1.76-2.31; all p values ≤ 0.001) were associated with episodic and/or chronic back pain. Females were more likely to experience back pain in the last 12 months than males. Moderate depression (OR, 3.29; 1.45-7.47; p = 0.004) and wearing a brace (OR, 3.00; 1.47-6.15; p = 0.003) were independently associated with chronic back pain. CONCLUSIONS Biopsychosocial factors are associated with the presence and severity of back pain in the AIS population. Our results highlight the importance of considering back pain screening/management for patients with AIS with their psychosocial profile in addition to curve magnitude monitoring. In particular, sleep quality should be routinely assessed. Longitudinal changes and effects of psychotherapy should be determined in future studies. LEVEL OF EVIDENCE Level II, prognostic study.
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Cheung JPY, Cheung PWH, Chiu CK, Chan CYW, Kwan MK. Variations in Practice among Asia-Pacific Surgeons and Recommendations for Managing Cervical Myelopathy: The First Asia-Pacific Spine Society Collaborative Study. Asian Spine J 2018; 13:45-55. [PMID: 30326696 PMCID: PMC6365774 DOI: 10.31616/asj.2018.0135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/03/2018] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Surgeon survey. PURPOSE To study the various surgical practices of different surgeons in the Asia-Pacific region. OVERVIEW OF LITERATURE Given the diversity among Asia-Pacific surgeons, there is no clear consensus on the preferred management strategies for cervical myelopathy. In particular, the role of prophylactic decompression for silent cervical spinal stenosis is under constant debate and should be addressed. METHODS Surgeons from the Asia-Pacific Spine Society participated in an online questionnaire comprising 50 questions. Data on clinical diagnosis, investigations and outcome measures, approach to asymptomatic and silent cervical spinal stenosis, guidelines for surgical approach, and postoperative immobilization were recorded. All parameters were analyzed by the Mantel-Haenszel test. RESULTS A total of 79 surgeons from 16 countries participated. Most surgeons used gait disturbance (60.5%) and dyskinetic hand movement (46.1%) for diagnosis. Up to 5.2% of surgeons would operate on asymptomatic spinal stenosis, and 18.2% would operate on silent spinal stenosis. Among those who would not operate, most (57.1%) advised patients on avoidance behavior and up to 9.5% prescribed neck collars. For ossification of the posterior longitudinal ligament (OPLL), anterior removal was most commonly performed for one-level disease (p<0.001), whereas laminoplasty was most commonly performed for two- to four-level disease (p=0.036). More surgeons considered laminectomy and fusion for multilevel OPLL. Most surgeons generally preferred to use a rigid neck collar for 6 weeks postoperatively (p<0.001). CONCLUSIONS The pooled recommendations include prophylactic or early decompression surgery for patients with silent cervical spinal stenosis, particularly OPLL. Anterior decompression is primarily suggested for one- or two-level disease, whereas laminoplasty is preferred for multilevel disease.
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Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China
| | | | - Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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