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Barot K, Ruiz-Cardozo MA, Singh S, Trevino G, Kann MR, Brehm S, Bui T, Joseph K, Patel R, Hardi A, Yahanda AT, Jauregui JJ, Cadieux M, Pennicooke B, Molina CA. A Meta-Analysis of Surgical Outcomes in 25727 Patients Undergoing Anterior Cervical Discectomy and Fusion or Anterior Cervical Corpectomy and Fusion for Cervical Deformity. Global Spine J 2024:21925682241270100. [PMID: 39091072 DOI: 10.1177/21925682241270100] [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: 08/04/2024] Open
Abstract
STUDY DESIGN Systematic Review. OBJECTIVES To evaluate which cervical deformity correction technique between anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) produces better clinical, radiographic, and operative outcomes. METHODS We conducted a meta-analysis comparing studies involving ACDF and ACCF. Adult patients with either original or previously treated cervical spine deformities were included. Two independent reviewers categorized extracted data into clinical, radiographic, and operative outcomes, including complications. Clinical assessments included patient-reported outcomes; radiographic evaluations examined C2-C7 Cobb angle, T1 slope, T1-CL, C2-7 SVA, and graft stability. Surgical measures included surgery duration, blood loss, hospital stay, and complications. RESULTS 26 studies (25727 patients) met inclusion criteria and were extracted. Of these, 14 studies (19077 patients) with low risk of bias were included in meta-analysis. ACDF and ACCF similarly improve clinical outcomes in terms of JOA and NDI, but ACDF is significantly better at achieving lower VAS neck scores. ACDF is also more advantageous for improving cervical lordosis and minimizing the incidence of graft complications. While there is no significant difference between approaches for most surgical complications, ACDF is favorable for reducing operative time, intraoperative blood loss, and length of hospital stay. CONCLUSIONS While both techniques benefit cervical deformity patients, when both techniques are feasible, ACDF may be superior with respect to VAS neck scores, cervical lordosis, graft complications and certain perioperative outcomes. Further studies are recommended to address outcome variability and refine surgical approach selection.
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Affiliation(s)
- Karma Barot
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Miguel A Ruiz-Cardozo
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Som Singh
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Gabriel Trevino
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Michael R Kann
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Samuel Brehm
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Tim Bui
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Karan Joseph
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Rujvee Patel
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Angela Hardi
- Becker Medical Library, Washington University School of Medicine, Saint Louis, MO, USA
| | - Alexander T Yahanda
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Julio J Jauregui
- Becker Medical Library, Washington University School of Medicine, Saint Louis, MO, USA
| | - Magalie Cadieux
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Brenton Pennicooke
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Camilo A Molina
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO, USA
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Biswas S, Aizan LNB, Mathieson K, Neupane P, Snowdon E, MacArthur J, Sarkar V, Tetlow C, Joshi George K. Clinicosocial determinants of hospital stay following cervical decompression: A public healthcare perspective and machine learning model. J Clin Neurosci 2024; 126:1-11. [PMID: 38821028 DOI: 10.1016/j.jocn.2024.05.032] [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: 04/05/2024] [Revised: 05/13/2024] [Accepted: 05/25/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVE Post-operative length of hospital stay (LOS) is a valuable measure for monitoring quality of care provision, patient recovery, and guiding hospital resource management. But the impact of patient ethnicity, socio-economic deprivation as measured by the indices of multiple deprivation (IMD), and pre-existing health conditions on LOS post-anterior cervical decompression and fusion (ACDF) is under-researched in public healthcare settings. METHODS From 2013 to 2023, a retrospective study at a single center reviewed all ACDF procedures. We analyzed 14 non-clinical predictors-including demographics, comorbidities, and socio-economic status-to forecast a categorized LOS: short (≤2 days), medium (2-3 days), or long (>3 days). Three machine learning (ML) models were developed and assessed for their prediction reliability. RESULTS 2033 ACDF patients were analyzed; 79.44 % had a LOS ≤ 2 days. Significant predictors of LOS included patient sex (HR:0.81[0.74-0.88], p < 0.005), IMD decile (HR:1.38[1.24-1.53], p < 0.005), smoking (HR:1.24[1.12-1.38], p < 0.005), DM (HR:0.70[0.59-0.84], p < 0.005), and COPD (HR:0.66, p = 0.01). Asian patients had the highest mean LOS (p = 0.003). Testing on 407 patients, the XGBoost model achieved 80.95 % accuracy, 71.52 % sensitivity, 85.76 % specificity, 71.52 % positive predictive value, and a micro F1 score of 0.715. This model is available at: https://acdflos.streamlit.app. CONCLUSIONS Utilizing non-clinical pre-operative parameters such as patient ethnicity, socio-economic deprivation index, and baseline comorbidities, our ML model effectively predicts postoperative LOS for patient undergoing ACDF surgeries. Yet, as the healthcare landscape evolves, such tools will require further refinement to integrate peri and post-operative variables, ensuring a holistic decision support tool.
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Affiliation(s)
- Sayan Biswas
- Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL Manchester, England, United Kingdom.
| | - Luqman Naim Bin Aizan
- Department of General Surgery, Warrington and Halton Foundation Trust, Warrington, United Kingdom
| | - Katie Mathieson
- Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL Manchester, England, United Kingdom
| | - Prashant Neupane
- Department of Vascular Surgery, Manchester Vascular Centre, Manchester Royal Infirmary, M13 9WL Manchester, United Kingdom
| | - Ella Snowdon
- Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL Manchester, England, United Kingdom
| | - Joshua MacArthur
- Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL Manchester, England, United Kingdom
| | - Ved Sarkar
- College of Letters and Sciences, University of California, Berkeley, CA 94720, United States of America
| | - Callum Tetlow
- Division of Data Science, The Northern Care Alliance NHS Group, M6 8HD Manchester, England, United Kingdom
| | - K Joshi George
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, M6 8HD Manchester, England, United Kingdom
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Wichmann TO, Bech-Azeddine R, Norling AL, Einarsson HB, Rasmussen MM. Comparison of outcomes and complications between one- and two-level anterior cervical discectomy and fusion: a population-based study of 410 patients. Br J Neurosurg 2024; 38:928-933. [PMID: 34821187 DOI: 10.1080/02688697.2021.2005778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/30/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objective of this study was to compare outcomes and patient satisfaction, and secondly to compare complication rates between one- and two-level anterior cervical discectomy and fusion (ACDF) for cervical radiculopathy. METHODS Data from patients receiving one- or two-level ACDF for cervical radiculopathy at two institutions were prospectively collected and retrospectively analysed. Patients were separated into one-level ACDF and two-level ACDF. Comparison analyses of patient-reported outcome measures (PROMs) comprising Visual Analogue Scale for neck pain (VAS-NP) and arm pain (VAS-AP), Neck Disability Index (NDI), and EQ-5D 3-level version (EQ-5D-3L) were performed between baseline and 1-year follow-up and between groups as well as achievement of minimal clinically important differences (MCID) in PROMs and satisfaction. Additionally, complications were compared between groups. RESULTS A total of 410 patients (270 one-level and 140 two-level) were included. PROMs improved significantly from baseline to 1-year follow-up (p < 0.001) in both groups. When comparing PROMs between one- and two-level ACDF, a trend towards greater improvement was observed in patients undergoing one-level ACDF, notably in EQ-5D-3L (p = 0.073). Significantly more patients in the one-level group achieved MCID in VAS-NP compared to patients in the two-level group (56% vs 44%, p = 0.025). Two hundred and ninety-six (67%) patients reported to be satisfied, but the one-level group trended to be more satisfied (70% vs. 62%). One-level ACDF further demonstrated a trend of more favourable complication profiles; however, complication rates were low in both groups. The risk of intraoperative complications was 2.4%, postoperative complications in-hospital were 1.2%, and patient-reported postoperative events post-discharge 42%. CONCLUSIONS One- and two-level ACDF are effective procedures for degenerative cervical nerve root compression. Yet, significantly more patients in the one-level group achieved MCID in neck pain compared to patients in the two-level group.
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Affiliation(s)
| | - Rachid Bech-Azeddine
- Copenhagen Spinal Research Unit - Center of Rheumatology and Spine Diseases Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Anna Louise Norling
- Copenhagen Spinal Research Unit - Center of Rheumatology and Spine Diseases Rigshospitalet Glostrup, Glostrup, Denmark
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Zhuo W, Huang F, Zhu W, Liu F, Liu J, Jin D. Analysis of risk factors for non-fusion of bone graft in anterior cervical discectomy and fusion: A clinical retrospective study. J Orthop Sci 2024; 29:945-951. [PMID: 37500402 DOI: 10.1016/j.jos.2023.07.002] [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: 10/21/2022] [Revised: 06/18/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Bone graft fusion is a major concern among surgeons after Anterior Cervical Discectomy and Fusion (ACDF) surgery as non-fusion may lead to further physical and drug therapies. METHODS The related risk elements of non-fusion of bone graft in ACDF surgery were retrospectively assessed. Patients receiving ACDF operation in our hospital from January 2015 to December 2019 were retrospectively analyzed. According to the criteria, 107 study subjects were recruited with a total of 164 surgical segments. The general information of patients, bone graft materials, imaging parameters, and clinical efficacy was recorded. T-test, chi-square test and binary logistic regression evaluation were employed to explore the risk factors of bone graft nonunion. RESULTS Low housefield unit (HU) value, diabetes, allogeneic bone, and hydroxyapatite (HA) artificial bone could be risk factors for bone graft fusion in ACDF surgery. Further multivariate analysis was performed and confirmed those related factors of bone graft non-fusion including low HU value (non-fusion rate: 32.53% [27/83], OR = 5.024, p = 0.025), diabetes (non-fusion rate: 53.33% [8/15], OR = 4.776, p = 0.031), allogeneic bone (18.57% [13/70], OR = 3.964, p = 0.046), and artificial bone (68.29% [28/41], OR = 50.550, p < 0.01). CONCLUSION By looking at bone graft fusion, selecting autologous iliac bone is an ideal selection to avoid non-fusion of bone graft in ACDF. Diabetes was more important predictor of bone graft nonunion than low HU value. Larger sample size and longer follow-up are required to further confirm these findings in the future.
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Affiliation(s)
- Wentao Zhuo
- Department of Spine Surgery, Section I, Maoming People's Hospital, Maoming City, Guangdong Province, 525000, China
| | - Fuming Huang
- Department of Trauma Orthopedics, Maoming People's Hospital, Maoming City, Guangdong Province, 525000, China
| | - Weijia Zhu
- Department of Surgery of Joint and Extremities Osteopathy, Maoming People's Hospital, Maoming City, Guangdong Province, 525000, China
| | - Fuqiang Liu
- Department of Spine Surgery, Section I, Maoming People's Hospital, Maoming City, Guangdong Province, 525000, China
| | - Jun Liu
- Department of Spine Surgery, Section I, Maoming People's Hospital, Maoming City, Guangdong Province, 525000, China
| | - Dadi Jin
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou City, Guangdong Province, 510000, China.
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Hartman TJ, Nie JW, Khosla I, Oyetayo OO, MacGregor KR, Zheng E, Anwar FN, Roca AM, Loya AC, Medakkar SS, Federico VP, Massel DH, Sayari AJ, Lopez GD, Singh K. Cervical Disk Replacement Versus Anterior Cervical Diskectomy and Fusion: Effect of Procedural Variant on Patients With a Prolonged Preoperative Duration of Symptoms From Disk Herniation. J Am Acad Orthop Surg 2024; 32:558-562. [PMID: 38696821 DOI: 10.5435/jaaos-d-23-00655] [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: 07/25/2023] [Accepted: 02/17/2024] [Indexed: 05/04/2024] Open
Abstract
INTRODUCTION Patients with a prolonged preoperative symptom duration (PSD) in the setting of cervical disk herniation (DH) may suffer inferior outcomes after surgical intervention. Comparison between anterior cervical diskectomy and fusion (ACDF) versus cervical disk arthroplasty (CDA) in this at-risk population has not yet been conducted. METHODS Patients undergoing ACDF or CDA for DH with a PSD > 180 days were selected. Six-week (6W) and final follow-up (FF) patient-reported outcome measures (PROMs) as well as magnitude of postoperative improvements (∆PROM) were compared between cohorts using multivariable linear regression. Intercohort achievement rates of minimal clinically important difference (MCID) in each PROM were compared. RESULTS Seventy-seven of 190 patients were in the CDA cohort. 6W Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF) was superior in the CDA cohort. The ACDF cohort demonstrated notable improvements in the 6W Neck Disability Index (NDI), visual analog scale-neck pain (VAS-N), visual analog scale-arm pain (VAS-A), and 9-item Patient Health Questionnaire (PHQ-9). The CDA cohort demonstrated notable improvements in 6W PROMIS-PF, NDI, VAS-N, and VAS-A. FF VAS-A was better in the CDA cohort. The ACDF cohort demonstrated notable improvements in FF PROMIS-PF, NDI, VAS-N, and VAS-A. The CDA cohort demonstrated notable improvements in all FF PROMs. ∆PROM-6W in PROMIS-PF was greater in the CDA cohort. CONCLUSION Patients with prolonged PSD due to cervical DH demonstrated notable improvements in physical function, disability, pain, and mental health regardless of fusion versus arthroplasty techniques. Accounting for demographic variations, patients undergoing CDA demonstrated a greater magnitude of improvement and superior scores in physical function at the first postoperative follow-up. Rates of clinically tangible improvements in PROMs did not markedly vary by surgical procedure. Patients undergoing CDA may perceive greater early improvements to physical function compared with patients undergoing ACDF for prolonged PSD due to DH.
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Affiliation(s)
- Timothy J Hartman
- From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Duey AH, Gonzalez C, Hoang T, Geng EA, Ferriter PJ, Rosenberg AM, Zaidat B, Zapolsky IJ, Kim JS, Cho SK. The Effect of Intraoperative Overdistraction on Subsidence Following Anterior Cervical Discectomy and Fusion. Clin Spine Surg 2024:01933606-990000000-00322. [PMID: 38828954 DOI: 10.1097/bsd.0000000000001643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 04/29/2024] [Indexed: 06/05/2024]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE The purpose of this study was to evaluate the effect of overdistraction on interbody cage subsidence. BACKGROUND Vertebral overdistraction due to the use of large intervertebral cage sizes may increase the risk of postoperative subsidence. METHODS Patients who underwent anterior cervical discectomy and fusion between 2016 and 2021 were included. All measurements were performed using lateral cervical radiographs at 3 time points - preoperative, immediate postoperative, and final follow-up >6 months postoperatively. Anterior and posterior distraction were calculated by subtracting the preoperative disc height from the immediate postoperative disc height. Cage subsidence was calculated by subtracting the final follow-up postoperative disc height from the immediate postoperative disc height. Associations between anterior and posterior subsidence and distraction were determined using multivariable linear regression models. The analyses controlled for cage type, cervical level, sex, age, smoking status, and osteopenia. RESULTS Sixty-eight patients and 125 fused levels were included in the study. Of the 68 fusions, 22 were single-level fusions, 35 were 2-level, and 11 were 3-level. The median final follow-up interval was 368 days (range: 181-1257 d). Anterior disc space subsidence was positively associated with anterior distraction (beta = 0.23; 95% CI: 0.08, 0.38; P = 0.004), and posterior disc space subsidence was positively associated with posterior distraction (beta = 0.29; 95% CI: 0.13, 0.45; P < 0.001). No significant associations between anterior distraction and posterior subsidence (beta = 0.07; 95% CI: -0.06, 0.20; P = 0.270) or posterior distraction and anterior subsidence (beta = 0.06; 95% CI: -0.14, 0.27; P = 0.541) were observed. CONCLUSIONS We found that overdistraction of the disc space was associated with increased postoperative subsidence after anterior cervical discectomy and fusion. Surgeons should consider choosing a smaller cage size to avoid overdistraction and minimize postoperative subsidence.
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Affiliation(s)
- Akiro H Duey
- Icahn School of Medicine at Mount Sinai, Department of Orthopaedics, New York, NY, USA
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Aldahamsheh O, Alhammoud A, Halayqeh S, Jacobs WB, Thomas KC, Nicholls F, Evaniew N. Stand-Alone Anchored Spacer vs Anterior Plate Construct in the Management of Adjacent Segment Disease after Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis of Comparative Studies. Global Spine J 2024; 14:1038-1051. [PMID: 37705344 PMCID: PMC11192131 DOI: 10.1177/21925682231201787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
STUDY DESIGN Systematic Review and Meta-Analysis. OBJECTIVES This study aimed to evaluate the clinical and radiological outcomes of surgically treated adjacent segment disease (ASDis) following ACDF with either anterior plate construct (APC) or stand-alone anchored spacers (SAAS). METHOD Multiple databases were searched until December 2022 for pertinent studies. The primary outcome was health-related quality of life outcomes [JOA, NDI, and VAS], whereas, the secondary outcomes included operative characteristics [estimated blood loss (EBL) and operative time (OT)], radiological outcomes [C2-C7 Cobb angle, disc height index (DHI) changes, fusion rate], and complications. RESULTS A total of 5 studies were included, comprising 210 patients who had been surgically treated for cervical ASDis. Among them, 113 received APC, and 97 received SAAS. Postoperative dysphagia was significantly higher in the APC group [47% vs 11%, OR = 7.7, 95% CI = 3.1-18.9, P < .05]. Similarly, operative time and blood loss were higher in the APC group compared to the SAAS group; [MD = 16.96, 95% CI = 7.87-26.06, P < .05] and [MD = 5.22, 95% CI = .35 - 10.09, P < .05], respectively. However, there was no difference in the rate of prolonged dysphagia and clinical outcomes in terms of JOA, NDI, and VAS. Furthermore, there was no difference in the radiological parameters including the C2-7 Cobb angle and DHI as well as the fusion rate. CONCLUSION Our meta-analysis demonstrated that both surgical techniques (APC and SAAS) are effective in treating ASDis. However, with low certainty of the evidence, considering patients are at high risk of dysphagia following revision cervical spine surgery SAAS may be the preferred choice.
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Affiliation(s)
- Osama Aldahamsheh
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, AB, Canada
- Department of Special Surgery, Orthopedic Surgery, Faculty of Medicine, Al- Balqa’ Applied University, Al-Salt, Jordan
| | - Abduljabbar Alhammoud
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | | | - W. Bradley Jacobs
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Kenneth C. Thomas
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Fred Nicholls
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Nathan Evaniew
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, AB, Canada
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Rai V, Sharma V, Kumar M, Thakur L. A systematic review of risk factors and adverse outcomes associated with anterior cervical discectomy and fusion surgery over the past decade. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:141-152. [PMID: 38957769 PMCID: PMC11216642 DOI: 10.4103/jcvjs.jcvjs_168_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/30/2024] [Indexed: 07/04/2024] Open
Abstract
Background Anterior cervical discectomy and fusion (ACDF) is one of the most frequently performed cervical surgeries in the world, yet there have been several reported complications. Objective To determine the actual incidence of complications related to ACDF as well as any risk variables that may have been identified in earlier research. Methods To evaluate the origin, presentation, natural history, and management of the risks and the complications, we conducted a thorough assessment of the pertinent literature. An evaluation of clinical trials and case studies of patients who experienced one or more complications following ACDF surgery was done using a PubMed, Cochrane Library, and Google Scholar search. Studies involving adult human subjects that were written in the English language and published between 2012 and 2022 were included in the search. The search yielded 79 studies meeting our criteria. Results The overall rates of complications were as follows: Dysphagia 7.9%, psudarthrosis 5.8%, adjacent segment disease (ASD) 8.8%, esophageal perforations (EPs) 0.5%, graft or hardware failure 2.2%, infection 0.3%, recurrent laryngeal nerve palsy 1.7%, cerebrospinal fluid leak 0.8%, Horner syndrome 0.5%, hematoma 0.8%, and C5 palsy 1.9%. Conclusion Results showed that dysphagia was a common postoperative sequelae with bone morphogenetic protein use and a higher number of surgical levels being the major risk factors. Pseudarthrosis rates varied depending on the factors such as asymptomatic radiographic graft sinking, neck pain, or radiculopathy necessitating revision surgery. The incidence of ASD indicated no data to support anterior cervical plating as more effective than standalone ACDF. EP was rare but frequently fatal, with no correlation found between patient age, sex, body mass index, operation time, or number of levels.
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Affiliation(s)
- Vikramaditya Rai
- Department of Orthopedics, Dr. Rajendra Prasad Government Medical College and Hospital, Kangra, Himachal Pradesh, India
| | - Vipin Sharma
- Department of Orthopedics, Dr. Rajendra Prasad Government Medical College and Hospital, Kangra, Himachal Pradesh, India
| | - Mukesh Kumar
- Department of Neurosurgery, Dr. Rajendra Prasad Government Medical College and Hospital, Kangra, Himachal Pradesh, India
| | - Lokesh Thakur
- Department of Orthopedics, Dr. Rajendra Prasad Government Medical College and Hospital, Kangra, Himachal Pradesh, India
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Núñez JH, Escudero B, Montenegro JD, Jiménez-Jiménez MJ, Martínez-Peña J, Surroca M, Bosch-García D. [Translated article] Less superior adjacent syndrome and lower reoperation rate. Medium- and long-term results of cervical arthroplasty versus anterior cervical arthrodesis: Systematic review and meta-analysis of randomized clinical trials. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T168-T178. [PMID: 37995814 DOI: 10.1016/j.recot.2023.11.013] [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: 02/17/2023] [Accepted: 06/26/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE To compare medium- and long-term postoperative surgical results, especially the adjacent syndrome rate, adverse event rate, and reoperation rate, of patients operated on with cervical arthroplasty or anterior cervical arthrodesis in published randomized clinical trials (RCTs), at one cervical level. METHODS Systematic review and meta-analysis. Thirteen RCTs were selected. The clinical, radiological and surgical results were analyzed, taking the adjacent syndrome rate and the reoperation rate as the primary objective of the study. RESULTS Two thousand nine hundred and sixty three patients were analyzed. The cervical arthroplasty group showed a lower rate of superior adjacent syndrome (P<0.001), lower reoperation rate (P<0.001), less radicular pain (P=0.002), and a better score of neck disability index (P=0.02) and SF-36 physical component (P=0.01). No significant differences were found in the lower adjacent syndrome rate, adverse event rate, neck pain scale, or SF-36 mental component. A range of motion of 7.91° was also found at final follow-up, and a heterotopic ossification rate of 9.67% in patients with cervical arthroplasty. CONCLUSION In the medium and long-term follow-up, cervical arthroplasty showed a lower rate of superior adjacent syndrome and a lower rate of reoperation. No statistically significant differences were found in the rate of inferior adjacent syndrome or in the rate of adverse events.
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Affiliation(s)
- J H Núñez
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), Spain; Unidad de Columna, Artro-Esport, Centro Médico Teknon, Barcelona, Spain.
| | - B Escudero
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), Spain
| | - J D Montenegro
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), Spain
| | - M J Jiménez-Jiménez
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), Spain
| | - J Martínez-Peña
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), Spain
| | - M Surroca
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), Spain
| | - D Bosch-García
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), Spain; Grup Traumatologic de Catalunya, Barcelona, Spain
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Lambrechts MJ, D’Antonio ND, Heard JC, Toci GR, Karamian BA, Sherman M, Canseco JA, Kepler CK, Vaccaro AR, Hilibrand AS, Schroeder GD. Opioid Use Increases the Rate of Pseudarthrosis and Revision Surgery in Patients Undergoing Anterior Cervical Discectomy and Fusion. Global Spine J 2024; 14:620-630. [PMID: 35959950 PMCID: PMC10802537 DOI: 10.1177/21925682221119132] [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: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort. OBJECTIVES To (1) quantify the risk opioids impart on pseudarthrosis development, (2) analyze the effect of pseudarthrosis on clinical outcomes, and (3) identify if the amount of opioids prescribed are predictive of pseudarthrosis revision. METHODS Patients who underwent ACDF at a single institution between 2017-2019 were retrospectively identified. Postoperative dynamic cervical spine radiographs were reviewed to assess fusion status. Logistic regression models measured the effect of morphine milligram equivalents (MME) prescribed on the likelihood of pseudarthrosis development. Receiver operating characteristic (ROC) curves were generated to predict the probability of surgical revision based on MME prescribed. RESULTS Of 298 included patients, an average of 2.01 ± 0.82 levels were included in the construct and 121 (40.9%) patients were diagnosed with a pseudarthrosis. However, only 14 (4.7%) required a pseudarthrosis revision. Patients requiring pseudarthrosis revision had worse one-year postoperative Δ PCS-12 (-1.70 vs. 7.58, P = 0.004), Δ NDI (3.33 vs. -15.26, P = 0.002), and Δ VAS Arm (2.33 vs. -2.48, P = .047). Multivariate logistic regression analyses found the three-month postoperative (OR=1.00, P = .010), one-year postoperative (OR=1.001, P = 0.025), and combined pre- and postoperative MME (OR=1.000, P = .035) increased the risk of pseudarthrosis. ROC analysis identified cutoff values to predict pseudarthrosis revision at 90.00 (area under the curve (AUC): 0.693, confidence interval (CI): 0.554-0.832), 132.86 (0.710, CI: 0.589-0.840), 224.76 (0.687, CI: 0.558-0.817) and 285.00 (0.711, CI: 0.585-0.837) MME in the preoperative, three-month postoperative, one-year postoperative, and combined pre-and postoperative period. CONCLUSION Increased prescription of opioid medications following ACDF procedures may increase the risk of pseudarthrosis development and revision surgery. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Mark J. Lambrechts
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nicholas D. D’Antonio
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jeremy C. Heard
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory R. Toci
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian A. Karamian
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew Sherman
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose A. Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
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Zhu Q, Li N, Ding Y, Zhang Z, Jiang W, Jiang T, Qiao Q, Qian Y, Cheng H. Incidence of Adjacent Segment Degeneration and Its Associated Risk Factors Following Anterior Cervical Discectomy and Fusion: A Meta-Analysis. World Neurosurg 2024; 183:e153-e172. [PMID: 38103684 DOI: 10.1016/j.wneu.2023.12.050] [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: 11/23/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE This study aimed to investigate the incidence of adjacent segment degeneration (ASD) and its associated risk factors in adults after anterior cervical discectomy and fusion (ACDF) surgery. METHODS An exhaustive search across multiple databases was conducted, including Embase, PubMed, Cochrane Library, and the Web of Science, to identify pertinent studies. We collected such patient data as demographic variables (including age, gender, body mass index), cervical spondylosis type (such as radiculopathy and myelopathy), diabetes status, smoking and drinking history, and radiological risk factors (such as preoperative ASD status, developmental spinal stenosis, T1 slope, and postoperative less cervical lordosis). Incidence estimates were calculated based on relevant data. Risk factors were assessed using odds ratios and weighted mean differences with 95% confidence intervals (CIs). RESULTS Our analysis incorporated a total of 21 studies for incidence analysis. The overall incidence of CASD following ACDF was found to be 11% and radiographical ASD was 30%. Old age (weighted mean difference = 3.21; 95% CI: 0.06, 6.36; P = 0.05), preoperative ASD status (odds ratio = 2.65; 95% CI: 1.53, 4.60; P < 0.01), developmental spinal stenosis (odds ratio = 2.46; 95% CI: 1.61, 3.77; P < 0.01), and postoperative reduction in cervical lordosis were identified as significant risk factors for the occurrence of CASD. CONCLUSIONS The incidence of CASD following ACDF was 11%. Risk factors for CASD included old age, preoperative adjacent segment degeneration, developmental spinal stenosis, and postoperative reduction in cervical lordosis. These findings provide valuable insights for the assessment of adjacent segment disease risk after ACDF, aiding surgeons in diagnosis and treatment decisions.
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Affiliation(s)
- Qianmiao Zhu
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Ning Li
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Yi Ding
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Zifeng Zhang
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Wenkang Jiang
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Ting Jiang
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Qiujiang Qiao
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Yuhang Qian
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Huilin Cheng
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.
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12
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Núñez JH, Escudero B, Montenegro JD, Jiménez-Jiménez MJ, Martínez-Peña J, Surroca M, Bosch-García D. Less superior adjacent syndrome and lower reoperation rate. Medium- and long-term results of cervical arthroplasty versus anterior cervical arthrodesis: Systematic review and meta-analysis of randomized clinical trials. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:168-178. [PMID: 37423383 DOI: 10.1016/j.recot.2023.06.016] [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: 02/17/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVE To compare medium- and long-term postoperative surgical results, especially the adjacent syndrome rate, adverse event rate, and reoperation rate, of patients operated on with cervical arthroplasty or anterior cervical arthrodesis in published randomized clinical trials (RCTs), at one cervical level. METHODS Systematic review and meta-analysis. Thirteen RCTs were selected. The clinical, radiological and surgical results were analyzed, taking the adjacent syndrome rate and the reoperation rate as the primary objective of the study. RESULTS Two thousand nine hundred and sixty three patients were analyzed. The cervical arthroplasty group showed a lower rate of superior adjacent syndrome (P<0.001), lower reoperation rate (P<0.001), less radicular pain (P=0.002), and a better score of neck disability index (P=0.02) and SF-36 physical component (P=0.01). No significant differences were found in the lower adjacent syndrome rate, adverse event rate, neck pain scale, or SF-36 mental component. A range of motion of 7.91 degrees was also found at final follow-up, and a heterotopic ossification rate of 9.67% in patients with cervical arthroplasty. CONCLUSION In the medium and long-term follow-up, cervical arthroplasty showed a lower rate of superior adjacent syndrome and a lower rate of reoperation. No statistically significant differences were found in the rate of inferior adjacent syndrome or in the rate of adverse events.
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Affiliation(s)
- J H Núñez
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), España; Unidad de Columna, Artro-Esport, Centro Médico Teknon, Barcelona, España.
| | - B Escudero
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), España
| | - J D Montenegro
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), España
| | - M J Jiménez-Jiménez
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), España
| | - J Martínez-Peña
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), España
| | - M Surroca
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), España
| | - D Bosch-García
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), España; Grup Traumatologic de Catalunya, Barcelona, España
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13
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Xiao AX, Bellamy JT, Webb AR, Ojemakinde A, Chao M, Niu S, Rhee JM. Plate-only open-door laminoplasty is associated with durable, significantly improved clinical outcomes and a very low reoperation rate for progressive spondylosis or adjacent segment disease: average 8-year follow-up. Spine J 2024; 24:417-423. [PMID: 37844629 DOI: 10.1016/j.spinee.2023.09.033] [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: 03/03/2023] [Revised: 08/28/2023] [Accepted: 09/30/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND CONTEXT Multilevel cervical myelopathy is a common cause of spinal cord dysfunction in adults. Surgical intervention via laminoplasty can provide satisfactory clinical outcomes by expansive decompression of the spinal cord. Traditional suture or bone graft techniques have been associated with insufficient fixation, leading to premature closure and subsequent neurological deterioration. In contrast, plated laminoplasty has been shown to provide stable fixation to maintain canal enlargement, but longer-term outcomes are lacking. PURPOSE To evaluate longer-term clinical outcomes and reoperations associated with plate-only open-door laminoplasty. STUDY DESIGN Retrospective review of prospectively collected data. PATIENT SAMPLE Postoperative patients who underwent plate-only open door laminoplasty with minimum 5-year follow up. OUTCOME MEASURES modified Japanese Orthopaedic Association (mJOA) score, Neck Disability Index (NDI), and 12-item Short Form Health Survey (SF-12). METHODS All patients at a single academic institution who underwent plate-only open-door cervical laminoplasty from 9/1/2006 to 9/1/2016 were identified to ensure minimum 5 year follow up. Clinical outcomes included the modified Japanese Orthopaedic Association (mJOA) score, the Neck Disability Index (NDI), and the 12-item Short Form Health Survey (SF-12). The occurrence of any repeat operations on the cervical spine was evaluated, as well as its cause. The study team attempted to contact all eligible patients to achieve at least 5 years postoperative follow-up. Pairwise t tests were performed to compare clinical outcomes at preoperative, 6 months, 1-year, and final postoperative follow-up with an α level of 0.05. RESULTS A total of 774 met the initial inclusion criteria, of which 157 were included in the study (20.3%). Most common reasons for exclusion included inability to reach after 3 attempts (49.48%), inactive phone numbers (20.28%), and patient declining (3.49%). Included patients had an average age of 60.66±10.63 and an average follow-up time of 8.37±2.57 years (minimum 5 years). mJOA scores (preoperative 11.59±2.16) improved significantly at 6-months (14.57±2.07, p<.001), 1-year (15.19±1.95, p<.001), and final follow-up (14.59±2.63, p<.001). NDI (preoperative 33.89±18.54) improved significantly at 6 months (27.89±19.72, p=.03), 1-year (25.96±19.79, p=.01) and final follow-up (17.88±17.17, p<.001). SF-12 MCS (preoperative 44.73) improved significantly at 6 months (52.01, p=.001), 1-year (51.62, p=.008), and final follow-up (52.32, p<.001). No patient underwent reoperations for plate failure or canal closure with recurrent stenosis. Reoperations for progressive spondylosis during the follow up period were rare and occurred in only three patients for new onset radiculopathy (1.9%) and two patients for myelopathy (1.3%) at an average of 3.2 years postoperative. There were no reoperations performed for adjacent segment disease. CONCLUSIONS At a minimum of 5 years and an average of more than 8 years postoperative, laminoplasty was associated with significant and sustained improvements in mJOA, NDI, and SF-12 MCS. Importantly, no patients underwent revision surgery for plate failure or recurrent canal closure. Reoperations for new onset radiculopathy and myelopathy were also very rare over the 8-year average follow-up period, with no reoperations for adjacent segment disease. Plate-only laminoplasty is a durable means of treating multilevel myelopathy with excellent longer-term outcomes and a very low risk of reoperation, either for premature closure or the inevitable spondylotic changes that occur over time in patients with similar baseline characteristics to the study population.
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Affiliation(s)
- Angel X Xiao
- Department of Orthopaedic Surgery, University of California San Francisco, 500 Parnassus Ave MU-320, San Francisco, CA 94143, USA
| | - J Taylor Bellamy
- Department of Orthopaedic Surgery, Emory Orthopaedics & Spine Center, 21 Ortho Lane, Atlanta, GA, 30329, USA
| | - Alex R Webb
- Department of Orthopaedic Surgery, Emory Orthopaedics & Spine Center, 21 Ortho Lane, Atlanta, GA, 30329, USA
| | - Akin Ojemakinde
- Department of Orthopaedic Surgery, Emory Orthopaedics & Spine Center, 21 Ortho Lane, Atlanta, GA, 30329, USA
| | - Myra Chao
- Department of Orthopaedic Surgery, Emory Orthopaedics & Spine Center, 21 Ortho Lane, Atlanta, GA, 30329, USA
| | - Shuo Niu
- Department of Orthopaedic Surgery, Emory Orthopaedics & Spine Center, 21 Ortho Lane, Atlanta, GA, 30329, USA
| | - John M Rhee
- Department of Orthopaedic Surgery, Emory Orthopaedics & Spine Center, 21 Ortho Lane, Atlanta, GA, 30329, USA.
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14
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Kwon JW, Lee YH, Lee BH, Kim JH, Suk KS. Clinical and radiological outcomes of non-window-type bioactive glass-ceramic cage in single-level ACDF versus PEEK cage filled with autologous bone. Sci Rep 2024; 14:4035. [PMID: 38369553 PMCID: PMC10874951 DOI: 10.1038/s41598-024-54786-3] [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: 09/04/2023] [Accepted: 02/16/2024] [Indexed: 02/20/2024] Open
Abstract
Bioactive glass-ceramic (BGC) cage is a substitute for polyether ether ketone (PEEK) cages in anterior cervical discectomy and fusion (ACDF). Only a few comparative studies exist using PEEK and non-window-type BGC cages (CaO-SiO2-P2O5-B2O3) in single-level ACDF. This study compared PEEK cages filled with autologous iliac bone grafts and BGC cages regarding clinical safety and effectiveness. A retrospective case series was performed on 40 patients who underwent single-level ACDF between October 2020 and July 2021 by a single orthopedic spine surgeon. The spacers used in each ACDF were a PEEK cage with a void filled with an autologous iliac bone graft and a non-window-type BGC cage in 20 cases. The grafts were compared pre-operatively and post-operatively at 6 weeks and 3, 6, and 12 months. Post-operative complications were investigated in each group. Clinical outcome was measured, including Visual Analog Scale (VAS) scores of neck and arm pains, Japanese Orthopedic Association score (JOA), and Neck Disability Index (NDI). Dynamic lateral radiographs were used to assess the inter-spinous motion (ISM) between the fusion segment and subsidence. The fusion status was evaluated using a computed tomography (CT) scan. Overall, 39 patients (19 and 20 patients in the PEEK and BGC groups, respectively) were recruited. Eighteen (94.7%) and 19 (95.0%) patients in the PEEK and BGC groups, respectively, were fused 12 months post-operatively, as assessed by ISM in dynamic lateral radiograph and bone bridging formation proven in CT scan. The PEEK and BGC groups showed substantial improvement in neck and arm VAS, JOA, and NDI scores. No substantial difference was found in clinical and radiological outcomes between the PEEK and BGC groups. However, the operation time was considerably shorter in the BGC group than in the PEEK group. In conclusion, a non-window-type BCG cage is a feasible substitute for a PEEK cage with an autologous iliac bone graft in single-level ACDF.
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Affiliation(s)
- Ji-Won Kwon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea
| | - Yong Ho Lee
- Department of Orthopedic Surgery, Yonsei Baro-Chuk Hospital, Seoul, Republic of Korea
| | - Byung Ho Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea
| | - Jae Hong Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea
| | - Kyung Soo Suk
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea.
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15
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Lainé G, Coudert P, Damade C, Boissiere L, Pointillart V, Vital JM, Bouyer B, Gille O. Effects of indirect foraminal decompression during anterior cervical disc fusion procedure: preliminary results of a prospective study with clinical and radiological outcomes. Neurochirurgie 2024; 70:101523. [PMID: 38096985 DOI: 10.1016/j.neuchi.2023.101523] [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: 08/12/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The respective effects of direct and indirect decompression in the clinical outcome after anterior cervical disc fusion (ACDF) is still debated. The main purpose of this study was to analyze the effects of indirect decompression on foraminal volumes during ACDF performed in patients suffering from cervico-brachial neuralgias due to degenerative foraminal stenosis, i.e. to determine whether implant height was associated with increased postoperative foraminal height and volume. METHODS A prospective follow-up of patients who underwent ACDF for cervicobrachial neuralgias due to degenerative foraminal stenosis was conducted. Patient had performed a CT-scan pre and post-operatively. Disc height, foraminal heights and foraminal volumes were measured pre and post operatively. RESULTS 37 cervical disc fusions were successfully performed in 20 patients, with a total of 148 foramina studied. Foraminal height and volume were measured bilaterally on the pre- and post-operative CT scans (148 foramina studied). After univariate analysis, it was found a significant improvement for every radiological parameter, with a significant increase in disc height, foraminal height and foraminal volume being respectively +3,22 mm (p < 0,001), +2,12 mm (p < 0,001) and +54 mm3 (p < 0,001). Increase in disc height was significantly associated with increase in foraminal height (p < 0,001) and foraminal volume (p < 0,001). At the same time, increase in foraminal height was significantly correlated with foraminal volume (p < 0,001), and seems to be the major component affecting increasing in foraminal volume. CONCLUSION Indirect decompression plays an important part in the postoperative foraminal volume increase after ACDF performed for cervicobrachial neuralgias.
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Affiliation(s)
- G Lainé
- Department of Neurosurgery, University Hospital of Bordeaux, Place Amélie Raba-Léon, Bordeaux, France.
| | - P Coudert
- Department of Spine Surgery, University Hospital of Bordeaux, Place Amélie Raba-Léon, Bordeaux, France
| | - C Damade
- Department of Spine Surgery, University Hospital of Bordeaux, Place Amélie Raba-Léon, Bordeaux, France
| | - L Boissiere
- Department of Spine Surgery, University Hospital of Bordeaux, Place Amélie Raba-Léon, Bordeaux, France
| | - V Pointillart
- Department of Spine Surgery, University Hospital of Bordeaux, Place Amélie Raba-Léon, Bordeaux, France
| | - J M Vital
- Department of Spine Surgery, University Hospital of Bordeaux, Place Amélie Raba-Léon, Bordeaux, France
| | - B Bouyer
- Department of Spine Surgery, University Hospital of Bordeaux, Place Amélie Raba-Léon, Bordeaux, France
| | - O Gille
- Department of Neurosurgery, University Hospital of Bordeaux, Place Amélie Raba-Léon, Bordeaux, France
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16
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Hirvonen T, Hämäläinen M, Konsti J, Antinheimo J, Numminen J, Siironen J, Koski-Palkén A, Niemelä M. Comparable long-term outcomes in patients undergoing total disc replacement or anterior cervical discectomy and noninstrumented fusion. Spine J 2023; 23:1817-1829. [PMID: 37660896 DOI: 10.1016/j.spinee.2023.08.019] [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: 04/24/2023] [Revised: 07/28/2023] [Accepted: 08/29/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND CONTEXT Anterior cervical discectomy and fusion (ACDF) is the leading surgical treatment for cervical radiculopathy. However, ACDF surgery has been suggested for to accelerate the degeneration of the adjacent cervical discs, which causes so-called adjacent segment disease (ASD). Over the past 2 decades, total disc replacement (TDR)/cervical disc arthroplasty (CDA) has become an increasingly common method for treating degenerative cervical diseases. The rationale is that a synthetic disc prosthesis may preserve motion at the operated level, which is expected to lead to reduced stress on the other cervical levels and thus decrease the risk of developing ASD. However, since the method was first introduced in the early 2000s, the long-term outcome after it is still not completely understood. PURPOSE Our goal was to compare the long-term outcomes of TDR and ACDF procedures. STUDY DESIGN Retrospective case-control study. PATIENT SAMPLE All patients who underwent TDR due to degenerative cervical disease at Helsinki University Hospital between 2006 and 2012 (38 patients) and matched control patients who underwent ACDF during this period (76 patients) for degenerative disc disease. OUTCOME MEASURES The primary outcome measure was the rate of reoperations and further cervical surgeries. Secondary outcome measures included neck symptoms (Neck Disability Index, or NDI), health-related quality of life (EQ-5D-3L), satisfaction with the surgery, radiological outcomes, and employment status. METHODS The medical records of all patients who underwent TDR due to degenerative cervical disease at Helsinki University Hospital between 2006 and 2012 and those of the matched control patients were analyzed retrospectively. Questionnaires were sent to all available patients at the end of the follow-up (median 14 years) to evaluate their employment status, levels of satisfaction with the surgery, current neck symptoms, and health-related quality of life. Radiological outcomes were evaluated from the cervical plain radiographs, which were taken either at the end of the follow-up as a part of the present study or earlier on for other clinical reasons, but at least 2 years after index surgery. RESULTS The total rate of reoperations and further cervical surgeries during the follow-up of a median of 14 years was 7/38 (18%) in the TDR group and 6/76 (8%) in the ACDF group (p=.096, ns.). Total disc replacement patients were reoperated earlier, and the 5-year reoperation rate was significantly higher in the TDR group (11% vs 1.3%, p=.026). None of the TDR patients underwent further cervical surgery more than 6 years after index surgery, whereas 5/6 (83%) of the reoperated ACDF patients were reoperated after that time. There were no significant differences in the NDIs between the patient groups. The employment rate and health-related quality of life were slightly higher in the TDR group, but the differences were statistically nonsignificant. TDR was significantly better at maintaining the angular range of motion at the operated level, and the fusion rate was significantly lower among this group. CONCLUSIONS There were no significant differences in the long-term outcomes of ACDF and TDR when measured by reoperation rates, employment status, NDI, EuroQoL, and satisfaction with surgery. Reoperation rate and, on the other hand, employment rate and health-related quality of life, were higher in the TDR group, but the differences were statistically nonsignificant. However, TDR patients were reoperated earlier, and the 5-year reoperation rate was significantly higher in the TDR group. Randomized long-term studies in which these methods are compared are needed to further clarify the differences between them.
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Affiliation(s)
- Tuomas Hirvonen
- University of Helsinki and Department of Neurosurgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland.
| | - Mathias Hämäläinen
- University of Helsinki and Radiology, Helsinki University Hospital Diagnostic Centre, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Juho Konsti
- University of Helsinki and Radiology, Helsinki University Hospital Diagnostic Centre, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Jussi Antinheimo
- University of Helsinki and Department of Neurosurgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Jussi Numminen
- University of Helsinki and Radiology, Helsinki University Hospital Diagnostic Centre, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Jari Siironen
- University of Helsinki and Department of Neurosurgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Anniina Koski-Palkén
- University of Helsinki and Department of Neurosurgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Mika Niemelä
- University of Helsinki and Department of Neurosurgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
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17
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Chen S, Huang K, Liu H, Wu T, He J, Yao M, Wang B. Overloaded vertebral body: a unique radiographic phenomenon following multilevel anterior cervical discectomy and fusion. J Orthop Surg Res 2023; 18:879. [PMID: 37980487 PMCID: PMC10657634 DOI: 10.1186/s13018-023-04365-5] [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: 10/16/2023] [Accepted: 11/11/2023] [Indexed: 11/20/2023] Open
Abstract
PURPOSE Because previous studies have not focused on postoperative cervical collapse, the purpose of the present study was to introduce the overloaded vertebral body (OVB) phenomenon following multilevel zero-profile anterior cervical discectomy and fusion (ACDF) as well as to investigate its effects on radiographic outcomes. METHODS We conducted a retrospective study involving patients who underwent ACDF. A total of 55 patients were included in the analysis, including 110 OVB and 110 non-OVB. The evaluated vertebral parameters included the vertebral cross-sectional area (CSA), wedge angle (WA), vertebral height [anterior (AH) and posterior (PH)] and anterior-posterior vertebral diameter [upper (UD) and lower (LD)]. RESULTS The CSA and WA were significantly lower in the OVB group than in the non-OVB group at 3, 6, and 12 months after surgery as well as at the final follow-up (p < 0.01). The AH of the OVB group was significantly lower at 3, 6, and 12 months after surgery as well as at the final follow-up compared to 1 week after surgery (p < 0.01). CONCLUSIONS OVB, a new phenomenon following multilevel ACDF, is defined as the cervical vertebral body located in the middle of the surgical segments in multilevel anterior cervical spine surgery. Statistical analysis of vertebral parameters, including CSA, WA, AH, PH, UD, and LD, showed that OVB occurs mainly at the anterior edge of the vertebra and that its largest radiographic manifestation is the loss of height at the anterior edge of the vertebra in the early postoperative period.
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Affiliation(s)
- Shihao Chen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Kangkang Huang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Tingkui Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Junbo He
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Minghe Yao
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Beiyu Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China.
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18
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Chanbour H, Bendfeldt GA, Johnson GW, Peterson K, Ahluwalia R, Younus I, Longo M, Abtahi AM, Stephens BF, Zuckerman SL. Longer Screws Decrease the Risk of Radiographic Pseudarthrosis Following Elective Anterior Cervical Discectomy and Fusion. Global Spine J 2023:21925682231214361. [PMID: 37950628 DOI: 10.1177/21925682231214361] [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: 11/13/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES In patients undergoing elective anterior cervical discectomy and fusion (ACDF), we sought to determine the impact of screw length on: (1) radiographic pseudarthrosis, (2) pseudarthrosis requiring reoperation, and (3) patient-reported outcome measures (PROMs). METHODS A single-institution, retrospective cohort study was undertaken from 2010-21. The primary independent variables were: screw length (mm), screw length divided by the anterior-posterior vertebral body diameter (VB%), and the presence of any screw with VB% < 75% vs all screws with VB% ≥ 75%. Multivariable logistic regression controlled for age, BMI, gender, smoking, American Society of Anesthesiology grade, number of levels fused, and whether a corpectomy was performed. RESULTS Of 406 patients undergoing ACDF, levels fused were: 1-level (39.4%), 2-level (42.9%), 3-level (16.7%), and 4-level (1.0%). Mean screw length was 14.3 ± 2.3 mm, and mean VB% was 74.4 ± 11.2. A total of 293 (72.1%) had at least one screw with VB% < 75%, 113 (27.8%) had all screws with VB% ≥ 75%, and 141 (34.7%) patients had radiographic pseudarthrosis at 1-year. Patients who had any screw with VB% < 75% had a higher rate of radiographic pseudarthrosis compared to those had all screws with VB% ≥ 75% (39.6% vs 22.1%, P < .001). Multivariable logistic regression revealed that a higher VB% (OR = .97, 95%CI = .95-.99, P = .035) and having all screws with VB% ≥ 75% (OR = .51, 95%CI = .27-.95, P = .037) significantly decreased the odds of pseudarthrosis at 1-year, with no difference in reoperation or PROMs (all P > .05). CONCLUSION Longer screws taking up ≥75% of the vertebral body protected against radiographic pseudarthrosis at 1-year. Maximizing screw length in ACDF is an easily modifiable factor directly under the surgeon's control that may mitigate the risk of pseudarthrosis.
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Affiliation(s)
- Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Graham W Johnson
- Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Keyan Peterson
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ranbir Ahluwalia
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Iyan Younus
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Longo
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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19
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Ratnasamy PP, Rudisill KE, Maloy GC, Grauer JN. Cervical Disc Arthroplasty Usage Has Leveled Out From 2010 to 2021. Spine (Phila Pa 1976) 2023; 48:E342-E348. [PMID: 36728785 PMCID: PMC10300227 DOI: 10.1097/brs.0000000000004560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/18/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Descriptive epidemiologic study. OBJECTIVE To compare trends in utilization and predictive factors for single-level cervical disc arthroplasty (CDA) relative to anterior cervical discectomy and fusion (ACDF) over the years. BACKGROUND CDA is an alternative to ACDF for the treatment of cervical spine pathologies. With both procedures performed for similar indications, controversy on best practices exists. MATERIALS AND METHODS Patients who underwent single-level CDA or ACDF were identified in the 2010 through 2021 PearlDiver M151Ortho data set. The yearly number of CDAs performed and proportionality was assessed. Predictive patient factors for undergoing CDA as opposed to ACDF were determined. Kaplan Meyer survival analysis with an endpoint of cervical spine reoperation compared 5-year outcomes between CDA and ACDF. RESULTS From 2010 to 2021, 19,301 single-level CDAs and 181,476 single-level ACDFs were identified. The proportional utilization of CDA relative to ACDF increased from 4.00% in 2010 to 14.15% in 2018 ( P < 0.0001), after which there was a plateau between 2018 and 2021 where proportional utilization was 14.47% ( P = 0.4654). Multivariate analysis identified several predictors of undergoing CDA rather than ACDF, including: younger age [odds ratio (OR) per decade decrease: 1.72], having surgery performed in the Midwest, Northeast, or West (relative to South, OR: 1.16, 1.13, 2.26, respectively), having Commercial insurance (relative to Medicare, OR: 1.75), and having surgery performed by an orthopedic surgeon (relative to a neurological surgeon, OR: 1.54) ( P < 0.0001 for each). There was no statistically significant difference in 5-year survival to further cervical spine surgery between CDA and ACDF at 5 years (97.6% vs. 97.7%, P = 0.4249). CONCLUSIONS Although the use of CDA relative to ACDF rose from 2010 to 2018, its use has subsequently plateaued between 2018 and 2021 and remained a relatively low percentage of the single-level anterior cervical surgeries performed (14.47% in 2021). The causes for such changes in the trend are unclear.
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Affiliation(s)
- Philip P Ratnasamy
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT
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20
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Nielsen TH, Nanthan KR, Rasmussen MM, Bjarkam CR. Disc prosthesis versus fusion with cage in single level cervical degenerative spine disease - A retrospective case-control patient reported outcome study. Clin Neurol Neurosurg 2023; 233:107933. [PMID: 37591037 DOI: 10.1016/j.clineuro.2023.107933] [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: 07/16/2023] [Accepted: 08/05/2023] [Indexed: 08/19/2023]
Abstract
AIM To compare the clinical outcome of single level cervical degenerative spine disease treated surgically with motion preserving anterior cervical disc arthroplasty versus anterior cervical discectomy and fusion (ACDF). METHODS Patients treated with cervical disc arthroplasty at Aalborg University Hospital and ACDF at Aarhus University Hospital were matched 1:2. Primary outcome measures were Neck Disability Index (NDI), EQ-5D-3 L and Numeric rating scale (NRS) for arm- and neck pain. Data was collected by telephone interviews regarding present and retrospective data. RESULTS 50 patients treated with cervical disc arthroplasty were matched to 100 ACDF patients covering November 2011 to December 2018. Mean improvements for NRS neck pain three-months postoperative, and NDI were significantly better in the cervical disc arthroplasty group, with intergroup differences of 1.56 (p = 0.02) and 5.01 (p = 0.01) respectively. A subgroup analysis of the half of the cohort with the longest follow-up (mean 7.6 years) showed, in favour of cervical disc arthroplasty, mean improvements of NDI: 8.80 (p = 0.00), EQ5D: - 0.19 (p = 0.04), NRS neck three months follow-up: 3.70 (p = 0.00) and long follow-up: 2.54 (p = 0.01) and NRS arm three months follow-up: 2.02 (p = 0.01). Radiologic examination indicated preserved mobility in 80% of the implanted protheses at 24-month post-surgical follow-up. CONCLUSION Surgical treatment of one level degenerative cervical spine disease with cervical disc arthroplasty or anterior cervical discectomy and fusion has a similar good clinical outcome after a mean follow-up of 5.6 years. However, cervical disc arthroplasty displayed long-term superiority in the half of the cohort with the longest follow-up time averaging 7.6 years.
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Affiliation(s)
- Teresa Haugaard Nielsen
- Cense Spine, Department of Neurosurgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark.
| | - Kumanan Rune Nanthan
- Department of Neurosurgery, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Mikkel Mylius Rasmussen
- Cense Spine, Department of Neurosurgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Carsten Reidies Bjarkam
- Department of Neurosurgery, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
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21
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Peng Z, Liu L, Sheng X, Liu H, Ding C, Wang B, Hong Y, Pan X, Meng Y. Risk Factors of Nonfusion after Anterior Cervical Decompression and Fusion in the Early Postoperative Period: A Retrospective Study. Orthop Surg 2023; 15:2574-2581. [PMID: 37538029 PMCID: PMC10549804 DOI: 10.1111/os.13835] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/16/2023] [Accepted: 06/24/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE Although high fusion rates have been reported for anterior cervical decompression and fusion (ACDF) in the medium and long term, the risk of nonfusion in the early period after ACDF remains substantial. This study investigates early risk factors for cage nonfusion in patients undergoing single- or multi-level ACDF. METHODS This was a retrospective study. From August 2020 to December 2021, 107 patients with ACDF, including 197 segments, were enrolled, with a follow-up of 3 months. Among the 197 segments, 155 were diagnosed with nonfusion (Nonfusion group), and 42 were diagnosed with fusion (Fusion group) in the early period after ACDF. We assessed the significance of the patient-specific factors, radiographic indicators, serum factors, and clinical outcomes. The Wilcoxon rank sum test, t-tests, analysis of variance, and stepwise multivariate logistic regression were used for statistical analysis. RESULTS Univariate analysis showed that smoking, insufficient improvement in the C2-7 Cobb angle (p = 0.024) and the functional spinal unit Cobb angle (p = 0.022) between preoperative and postoperative stages and lower serum calcium (fusion: 2.34 ± 0.12 mmol/L; nonfusion: 2.28 ± 0.17 mmol/L, p = 0.003) β-carboxyterminal telopeptide end of type 1 collagen (β-CTX) (fusion: 0.51 [0.38, 0.71]; nonfusion: 0.43 [0.31, 0.57], p = 0.008), and N-terminal fragment of osteocalcin (N-MID-BGP) (fusion: 18.30 [12.15, 22.60]; nonfusion: 14.45 [11.65, 18.60], p = 0.023) are risk factors for nonfusion in the early period after ACDF. Stepwise logistic regression analysis revealed that poor C2-7 Cobb angle improvement (odds ratio [OR], 1.107 [1.019-1.204], p = 0.017) and lower serum calcium (OR, 3.700 [1.138-12.032], p = 0.030) are risk factors. CONCLUSIONS Patients with successful fusion after ACDF had higher preoperative serum calcium and improved C2-7 Cobb angle than nonfusion patients at 3 months. These findings suggest that serum calcium could be used to identify patients at risk of nonfusion following ACDF and that correcting the C2-7 Cobb angle during surgery could potentially increase fusion in the early period after ACDF.
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Affiliation(s)
- Zihan Peng
- Department of Orthopedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Li Liu
- Department of Orthopedics, West China Hospital/West China School of NursingSichuan UniversityChengduChina
| | - Xiaqing Sheng
- Department of Orthopedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Chen Ding
- Department of Orthopedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Beiyu Wang
- Department of Orthopedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Ying Hong
- Department of Operating Room, West China Hospital/West China School of NursingSichuan UniversityChengduChina
| | - Xiaoli Pan
- Department of Orthopedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Yang Meng
- Department of Orthopedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
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22
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Shen S, Hu Y, Chu Z, Dong W. Bone resorption of vertebral bodies at the operative segment after prevail cervical interbody fusion: A case report. Medicine (Baltimore) 2023; 102:e35231. [PMID: 37713843 PMCID: PMC10508578 DOI: 10.1097/md.0000000000035231] [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: 06/03/2023] [Accepted: 08/24/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND We report an interesting case of bone resorption of vertebral bodies at the operative segment after Peek Prevail cervical interbody fusion. Instability of cervical vertebrae is likely to occur due to increased stress in Peek Prevail implant body for bone resorption. The finite element analysis was used to clarify the biomechanical effects of bone resorption and stress distribution in Peek Prevail implant body. METHODS We reported the case of a 48-year-old male patient who underwent Peek Prevail cervical interbody fusion and exhibited bone resorption 1 month after the surgery in X-ray of cervical vertebra. The degree of bone resorption was aggravated 2 months after surgery. Bone resorption in 3 months was similar to that in 2 months. We established a 3D reconstruction of the surgical segment in this case using Mimics software (vision 20.0) to generate basic boss resorption model. We simulated models of bone resorption using Ansys 17.0. The stress distribution of the contact surface between the screw and bone was analyzed under 6 conditions: flexion, extension, left and right flexion, and left and right rotation. RESULTS The loading conditions affected the stress distribution in the implant body. When bone resorption occurred, the stress distribution of the contact surface between screw and bone focus in the tip of the screw increased sharply. CONCLUSION Bone resorption of vertebral bodies in the operative segment may be a potential complication after Peek Prevail cervical interbody fusion. Great attention must be paid when bone resorption was occurred in order to avoid screw loosening before vertebral fusion.
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Affiliation(s)
- Shufeng Shen
- Department of Spinal Surgery, Yuyao People’s Hospital, Zhejiang Province, China
| | - Yong Hu
- Department of Spinal Surgery, Ningbo No.6 Hospital, Zhejiang Province, China
| | - Zhentao Chu
- Department of Spinal Surgery, Ningbo No.6 Hospital, Zhejiang Province, China
| | - Weixin Dong
- Department of Spinal Surgery, Ningbo No.6 Hospital, Zhejiang Province, China
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23
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Al-Jafari M, Abu Tapanjeh S, Al-Azzawi H, Abu Eid S, Baidoun HJ, Abu-Jeyyab M, Sarhan MY, Jbara H, Akel A. Cervical Spine Osteophyte: A Case Report of an Unusual Presentation. Cureus 2023; 15:e44762. [PMID: 37809146 PMCID: PMC10556974 DOI: 10.7759/cureus.44762] [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] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a condition that causes abnormal bone growth at the sites of ligament insertion, mainly in the spine. It is of unknown etiology and usually affects older males. It is often asymptomatic, but it can sometimes cause dysphagia if it affects the anterior cervical spine. We report the case of a 50-year-old male patient with DISH who presented with chronic dysphagia and was diagnosed with a large cervical osteophyte compressing the esophagus. The patient had a history of several comorbidities, including diabetes, hypertension, stroke, and gout. He underwent surgical removal of the osteophyte and recovered well. We discuss the clinical features, diagnosis, and treatment options for this rare complication of DISH.
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Affiliation(s)
| | | | | | - Sura Abu Eid
- College of Medicine, Mutah University, Al-Karak, JOR
| | | | | | - Mohammed Y Sarhan
- Department of Orthopedic Surgery, Hashemite University, Al-Zarqaa, JOR
| | - Hiba Jbara
- Department of Neurosurgery, Al-Basheer Hospital, Amman, JOR
| | - Alaa Akel
- Department of Orthopedic Surgery, Mutah University, Al-Karak, JOR
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24
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Friedman GN, Grannan BL, Zinzuwadia A, Williams ZM, Coumans JV. Congenitally Fused Cervical Spine Is Associated With Adjacent-Level Degeneration in the Absence of Cervical Spine Surgery. Neurosurgery 2023; 93:409-418. [PMID: 36892290 PMCID: PMC10319372 DOI: 10.1227/neu.0000000000002426] [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: 07/07/2022] [Accepted: 01/03/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Cervical fusion surgery is associated with adjacent-level degeneration, but surgical and technical factors are difficult to dissociate from the mechanical effects of the fusion itself. OBJECTIVE To determine the effect of fusion on adjacent-level degeneration in unoperated patients using a cohort of patients with congenitally fused cervical vertebrae. METHODS We identified 96 patients with incidental single-level cervical congenital fusion on computed tomography imaging. We compared these patients to an age-matched control cohort of 80 patients without congenital fusion. We quantified adjacent-level degeneration through direct measurements of intervertebral disk parameters as well as the validated Kellgren & Lawrence classification scale for cervical disk degeneration. Ordinal logistic regression and 2-way analysis of variance testing were performed to correlate extent of degeneration with the congenitally fused segment. RESULTS Nine hundred fifty-five motion segments were analyzed. The numbers of patients with C2-3, C3-4, C4-5, C5-6, and C6-7 congenitally fused segments were 47, 11, 11, 17, and 9, respectively. We found that patients with congenital fusion at C4-C5 and C5-C6 had a significantly greater extent of degeneration at adjacent levels compared with the degree of degeneration at the same levels in control patients and in patients with congenital fusion at other cervical levels, even while controlling for expected degeneration and age. CONCLUSION Taken together, our data suggest that congenitally fused cervical spinal segments at C4-C5 and C5-C6 are associated with adjacent-level degeneration independent of fixation instrumentation. This study design removes surgical factors that might contribute to adjacent-level degeneration.
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Affiliation(s)
- Gabriel N. Friedman
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin L. Grannan
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | | | - Ziv M. Williams
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jean-Valery Coumans
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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25
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Swiatek PR, Roumeliotis AG, Weiner JA, Ramesh A, Johnson DJ, Gerlach EB, Divi SN, Hsu WK, Patel AA. Social Media Posts Pertaining to Anterior Cervical Discectomy and Fusion (ACDF) Surgery: A Cross-sectional Analysis of Patient and Surgeon Perceptions. Clin Spine Surg 2023; 36:E167-E173. [PMID: 36174204 DOI: 10.1097/bsd.0000000000001398] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To analyze publicly available content on a major social media outlet related to anterior cervical discectomy and fusion (ACDF) surgery based on perspective, location, timing, content, tone, and patient satisfaction. SUMMARY OF BACKGROUND DATA Social media offers a powerful platform for sharing the patient experience with the public through an unfiltered perspective. Social media content may influence future perceptions around surgical care and postings around ACDF have not been previously reported. METHODS A query of content from a major social media outlet was performed for the study period January 1, 2018, to January 1, 2020, and returned 6500 publicly available posts. Content was identified by the hashtags "#acdf" or "#acdfsurgery." Content was ranked by number of "likes." Of the 1500 most popular posts, 1136 related to ACDF surgery and were included. Post content was characterized and classified. RESULTS Patients created 85% of ACDF-related content and spine surgeons created 11.8%. Most posts portrayed the patient experience in the postoperative period and depicted patients performing activities of daily living, participating in sports, or completing work activities (54.4%). The connotation of posts was deemed to be positive in 79.2% of cases. In regard to their care or state of health as it related to ACDF surgery, 59.8% of patients expressed satisfaction, whereas 14.1% expressed dissatisfaction. Female patients were >4 times as likely to express dissatisfaction (odds ratio=4.16, P =<0.0001), with their clinical course compared with their male counterparts. CONCLUSIONS Patients were the source of most posts on a major social media outlet that pertained to ACDF surgery with a majority reporting positive tone and satisfaction. These mechanisms of communication offer surgeons unique insights into patient experience and may provide an opportunity for surgeons to assess patient feedback, influence patient perceptions, and enhance delivery of cervical spine care.
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Affiliation(s)
- Peter R Swiatek
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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26
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Bajouri Z, Reyes Orozco F, Fresquez Z, Safaee MM, Hsieh P, Liu J, Buser Z. Comparison of Surgical Outcomes Between Anterior and Posterior Cervical Fusions Stratified by Levels Decompressed. Clin Spine Surg 2023; 36:E206-E211. [PMID: 36728282 DOI: 10.1097/bsd.0000000000001423] [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: 04/27/2022] [Accepted: 12/13/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Retrospective database study. OBJECTIVE To compare outcomes between 1-, 2-, 3-, and 4- level anterior cervical discectomy and fusions (ACDF) and posterior cervical fusions (PCF) procedures using a national database. SUMMARY OF BACKGROUND DATA Surgical outcomes involving 3- or 4-level ACDF and PCF cases are not well-described. As there are situations where both ACDF and PCF can be employed, it is important to compare the risks and benefits of both procedures. MATERIALS AND METHODS Patients who underwent ACDF or PCF between 2010 and 2020 were identified in PearlDiver using current procedural terminology codes. Surgeries done for infectious, traumatic, or neoplastic etiologies were excluded. 2-year reoperations and 90-day readmissions were queried. Surgical complications and transfusions were compiled using ICD-9/10 billing codes. ACDF and PCF procedures were then matched by age, sex, Charlson Comorbidity Index, and a number of levels fused, and the above outcomes were compared. RESULTS In all, 31,301 PCFs and 110,526 ACDFs were identified. After matching for age, sex, and Charlson Comorbidity Index, a total of 30,353 ACDF and PCF procedures were compared. Three-level and 4-level PCFs had higher rates of 90-day postoperative surgical complications compared with ACDF (OR=2.4 and 2.87, respectively; P <0.001). In addition, higher rates of 90-day readmissions were noted in 3-level PCF compared with 3-level ACDF (OR=1.24, P <0.001). Ninety-day postoperative transfusions were higher in both 3- and 4-level PCFs (OR=2.44 and 18.27, respectively; P <0.001). Two-year reoperations rates were higher for 3-level PCF procedures than 3-level ACDF (OR=1.22; P =0.01). CONCLUSIONS Patients who underwent 3-4-level ACDF had lower rates of readmission, blood transfusions, and postoperative complications compared with 3-4-level PCF. This data suggests that in cases of 3-4-level pathology with clinical equipoise regarding approach, ACDF may be associated with less short-term morbidity, however, data on fusion rates and adjacent level disease are needed.
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Affiliation(s)
| | | | - Zoe Fresquez
- Department of Orthopedic Surgery, Keck School of Medicine USC, Los Angeles, CA
| | | | | | - John Liu
- Department of Neurological Surgery
| | - Zorica Buser
- Department of Neurological Surgery
- Department of Orthopedic Surgery, Keck School of Medicine USC, Los Angeles, CA
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27
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Lorentz NA, Galetta MS, Zabat MA, Raman T, Protopsaltis TS, Fischer C. Post-Operative Physical Therapy Following Cervical Spine Surgery: Analysis of Patient-Reported Outcomes. Cureus 2023; 15:e40559. [PMID: 37465791 PMCID: PMC10351333 DOI: 10.7759/cureus.40559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2023] [Indexed: 07/20/2023] Open
Abstract
Introduction Post-operative physical therapy (PT) following anterior cervical discectomy and fusion (ACDF) surgery is often performed to improve a patient's functional ability and reduce neck pain. However, current literature evaluating the benefits of post-operative PT using patient-reported outcomes (PROs) is limited and remains inconclusive. Here we compare post-operative improvement between patients who did and did not undergo formal PT after ACDF using Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Methods A retrospective observational study examining patients who underwent one- or two-level primary ACDF or cervical disc replacement (CDR) at an academic orthopedic hospital and who had PROMIS scores recorded pre-operatively and through two-year follow-up. Patients were stratified according to whether or not they attended formal postoperative PT. PROMIS scores and patient demographics were compared using the Mann-Whitney U test, Fisher's exact test, chi-square test of independence, and Student's t-test within and between cohorts. Results Two hundred and twenty patients were identified. Demographic differences between PT and no PT groups include age (PT 54.1 vs. no PT 49.5, p=0.005) and BMI (PT 28.1 vs. no PT 29.8, p=0.028). The only significant difference in post-operative PROMIS scores was in physical health scores at three months post-operatively (no PT 43.9 vs. PT 39.1, p=0.008). Physical health scores improved from baseline to one-year follow-up in both cohorts (PT +3.5, p=0.025; no PT +6.6, p=0.008). There were no significant differences when comparing improvements in physical health scores between groups at six months and one year. Conclusion In conclusion, there was no significance to support the benefits of post-operative PT as measured by PROMIS scores. No significant differences in PROMIS were observed between groups from pre-operative baseline scores to six-month and one-year follow-ups.
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Affiliation(s)
- Nathan A Lorentz
- Orthopaedic Surgery, New York University (NYU) Grossman School of Medicine, New York, USA
| | - Matthew S Galetta
- Orthopaedic Surgery, New York University (NYU) Grossman School of Medicine, New York, USA
| | - Michelle A Zabat
- Orthopaedic Surgery, New York University (NYU) Grossman School of Medicine, New York, USA
| | - Tina Raman
- Orthopaedic Surgery, New York University (NYU) Grossman School of Medicine, New York, USA
| | | | - Charla Fischer
- Orthopaedic Surgery, New York University (NYU) Grossman School of Medicine, New York, USA
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Hermansen A, Hedlund R, Zsigmond P, Peolsson A. A more than 20-year follow-up of pain and disability after anterior cervical decompression and fusion surgery for degenerative disc disease and comparisons between two surgical techniques. BMC Musculoskelet Disord 2023; 24:406. [PMID: 37217867 DOI: 10.1186/s12891-023-06503-w] [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: 01/31/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Follow-ups more than 20 years after neck surgery are extremely rare. No previous randomized studies have investigated differences in pain and disability more than 20 years after ACDF surgery using different techniques. The purpose of this study was to describe pain and functioning more than 20 years after anterior cervical decompression and fusion surgery, and to compare outcomes between the Cloward Procedure and the carbon fiber fusion cage (CIFC). METHODS This study is a 20 to 24-year follow-up of a randomized controlled trial. Questionnaires were sent to 64 individuals, at least 20 years after ACDF due to cervical radiculopathy. Fifty individuals (mean age 69, 60% women, 55% CIFC) completed questionnaires. Mean time since surgery was 22.4 years (range 20,5-24). Primary outcomes were neck pain and neck disability index (NDI). Secondary outcomes were frequency and intensity of neck and arm pain, headache, dizziness, self-efficacy, health related quality of life or global outcome. Clinically relevant improvements were defined as 30 mm decrease in pain and a decrease in disability of 20 percentage units. Between-group differences over time were analyzed with mixed design ANOVA and relationships between main outcomes and psychosocial factors were analyzed by Spearman´s rho. RESULTS Neck pain and NDI score significantly improved over time (p < .001), with no group differences in primary or secondary outcomes. Eighty-eight per cent of participants experienced improvements or full recovery, 71% (pain) and 41% (NDI) had clinically relevant improvements. Pain and NDI were correlated with lower self-efficacy and quality of life. CONCLUSION The results from this study do not support the idea that fusion technique affects long-term outcome of ACDF. Pain and disability improved substantially over time, irrespective of surgical technique. However, the majority of participants reported residual disability not to a negligible extent. Pain and disability were correlated to lower self-efficacy and quality of life.
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Affiliation(s)
- Anna Hermansen
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Building 511, Entrance 76, Level 15, Linköping, SE-581 83, Sweden.
| | - Rune Hedlund
- Aleris Ortopedi, Nacka Specialistsjukhus, Stockholm, Sweden
| | - Peter Zsigmond
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden and Department of Neurosurgery, Region Östergötland, Linköping, Sweden
| | - Anneli Peolsson
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping, Sweden; Occupational and Environmental Medicine Centre and Department of Health, Medicine and Caring Sciences, Unit of Clinical Medicine, Linköping University, Linköping, Sweden
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El-Hajj VG, Singh A, Blixt S, Edström E, Elmi-Terander A, Gerdhem P. Evolution of Patient-Reported Outcome Measures, 1, 2, and 5 years after Surgery for Subaxial Cervical Spine Fractures, A Nation-Wide Registry Study. Spine J 2023:S1529-9430(23)00175-4. [PMID: 37094774 DOI: 10.1016/j.spinee.2023.04.014] [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: 02/15/2023] [Revised: 04/08/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND CONTEXT A longer duration of patient follow-up arguably provides more reliable data on the long-term effects of a treatment. However, the collection of long-term follow-up data is resource demanding and often complicated by missing data and patients being lost to follow-up. In surgical fixation for cervical spine fractures, data are lacking on the evolution of patient reported outcome measures (PROMs) beyond 1-year of follow-up. We hypothesized that the PROMs would remain stable beyond the 1-year postoperative follow-up mark, regardless of the surgical approach. PURPOSE To assess the trends in the evolution of patient-reported outcome measures (PROMs) at 1, 2-, and 5-years following surgery in patients with traumatic cervical spine injuries. STUDY DESIGN Nation-wide observational study on prospectively collected data. PATIENT SAMPLE Individuals treated for subaxial cervical spine fractures with anterior, posterior, or combined anteroposterior approaches, between 2006 and 2016 were identified in the Swedish Spine Registry (Swespine). OUTCOME MEASURES PROMs consisting of EQ-5D-3Lindex and the Neck Disability Index (NDI) were considered. METHODS PROMs data were available for 292 patients at 1 and 2 years postoperatively. Five-years PROMs data were available for 142 of these patients. A simultaneous within-group (longitudinal) and between group (approach-dependent) analysis was performed using mixed ANOVA. The predictive ability of 1-year PROMs was subsequently assessed using linear regression. RESULTS Mixed ANOVA revealed that PROMs remained stable from 1- to 2-years as well as from 2- to 5-years postoperatively and were not affected by the surgical approach (p<0.05). A strong correlation was found between 1-year and both 2- and 5-years PROMs (R>0.7; p<0.001). Linear regression confirmed the accuracy of 1-year PROMs in predicting both 2- and 5-years PROMs (p<0.001). CONCLUSION PROMs remained stable beyond 1-year of follow-up in patients treated with anterior, posterior, or combined anteroposterior surgeries for subaxial cervical spine fractures. The 1-year PROMs were strong predictors of PROMs measured at 2, and 5 years. The 1-year PROMs were sufficient to assess the outcomes of subaxial cervical fixation irrespective of the surgical approach.
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Affiliation(s)
| | - Aman Singh
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden..
| | - Simon Blixt
- Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.; Department of Reconstructive Orthopedics, Karolinska University Hospital, Sweden..
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Spine Center, Löwenströmska Hospital, Stockholm, Sweden..
| | | | - Paul Gerdhem
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.; Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.; Department of Orthopedics and Hand surgery, Uppsala University Hospital, Uppsala, Sweden..
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Kanhere AP, Paziuk T, Lambrechts MJ, Issa TZ, Karamian BA, Mazmudar A, Tran KS, Purtill C, Mangan JJ, Vaccaro AR, Kepler CK, Schroder GD, Hilibrand AS, Rihn JA. Facet Distraction and Dysphagia: A Prospective Evaluation of This Common Postoperative Issue Following Anterior Cervical Spine Surgery. Spine (Phila Pa 1976) 2023; 48:407-413. [PMID: 36730732 DOI: 10.1097/brs.0000000000004535] [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: 07/20/2022] [Accepted: 09/20/2022] [Indexed: 02/04/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE Our primary study was to investigate whether the degree of postoperative facet and disk space distraction following anterior cervical discectomy and fusion (ACDF) affects the rate of postoperative dysphagia. SUMMARY OF BACKGROUND DATA Although ACDF is safe and well tolerated, postoperative dysphagia remains a common complication. Intervertebral disk space distraction is necessary in ACDF to visualize the operative field, prepare the endplates for fusion, and facilitate graft insertion. However, the degree of distraction tolerated, before onset of dysphagia, is not well characterized ACDF. MATERIALS AND METHODS A prospective cohort study was conducted of 70 patients who underwent ACDF between June 2018 and January 2019. Two independent reviewers measured all preoperative and postoperative radiographs measured for interfacet distraction distance and intervertebral distraction distance, with intrareviewer reproducibility measurements after one month. For multilevel surgery, the level with the greatest distraction was measured. Primary outcomes were numerical dysphagia (0-10), Eating Assessment Tool 10, and Dysphagia Symptom Questionnaire score collected at initial visit and two, six, 12, and 24 weeks postoperatively. RESULTS A total of 70 patients were prospectively enrolled, 59 of whom had adequate radiographs. An average of 1.71 (SD: 0.70) levels were included in the ACDF construct. Preoperatively, 13.4% of patients reported symptoms of dysphagia, which subsequently increased in the postoperative period at through 12 weeks postoperatively, before returning to baseline at 24 weeks. Intrareviewer and interreviewer reliability analysis demonstrated strong agreement. There was no relationship between interfacet distraction distance/intervertebral distraction distance and dysphagia prevalence, numerical rating, Eating Assessment Tool 10, or Dysphagia Symptom Questionnaire. CONCLUSIONS Patients who had an ACDF have an increased risk of dysphagia in the short term, however, this resolved without intervention by six months. Our data suggests increased facet and intervertebral disk distraction does not influence postoperative dysphagia rates. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Arun P Kanhere
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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Zabat MA, Elboghdady I, Mottole NA, Mojica E, Maglaras C, Jazrawi LM, Virk MS, Campbell KA, Buckland AJ, Protopsaltis TS, Fischer CR. Evaluation of Health-related Quality of Life Improvement in Patients Undergoing Cervical Versus Shoulder Surgery. Clin Spine Surg 2023; 36:E80-E85. [PMID: 35969677 DOI: 10.1097/bsd.0000000000001379] [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: 03/27/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective analysis of outcomes in cervical spine and shoulder arthroscopy patients. OBJECTIVE The objective of this study is to assess differential improvements in health-related quality of life for cervical spine surgery compared with shoulder surgery. SUMMARY OF BACKGROUND DATA An understanding of outcome differences between different types of orthopedic surgeries is helpful in counseling patients about expected postoperative recovery. This study compares outcomes in patients undergoing cervical spine surgery with arthroscopic shoulder surgery using computer-adaptive Patient-reported Outcome Information System scores. MATERIALS AND METHODS Patients undergoing cervical spine surgery (1-level or 2-level anterior cervical discectomy and fusion, cervical disc replacement) or arthroscopic shoulder surgery (rotator cuff repair±biceps tenodesis) were grouped. Patient-reported Outcome Information System scores of physical function, pain interference, and pain intensity at baseline and at 3, 6, and 12 months were compared using paired t tests. RESULTS Cervical spine (n=127) and shoulder (n=91) groups were similar in sex (25.8% vs. 41.8% female, P =0.731) but differed in age (51.6±11.6 vs. 58.60±11.2, P <0.05), operative time (148.3±68.6 vs. 75.9±26.9 min, P <0.05), American Society of Anesthesiologists (ASAs) (2.3±0.6 vs. 2.0±0.5, P =0.001), smoking status (15.7% vs. 4.4%, P =0.008), and length of stay (1.1±1.0 vs. 0.3±0.1, P =0.000). Spine patients had worse physical function (36.9 ±12.6 vs. 49.4±8.6, P <0.05) and greater pain interference (67.0±13.6 vs. 61.7±4.8, P =0.001) at baseline. Significant improvements were seen in all domains by 3 months for both groups, except for physical function after shoulder surgery. Spine patients had greater physical function improvements at all timepoints (3.33 vs. -0.43, P =0.003; 4.81 vs. 0.08, P =0.001; 6.5 vs. -5.24, P =<0.05). Conversely, shoulder surgery patients showed better 6-month improvement in pain intensity over spine patients (-8.86 vs. -4.46, P =0.001), but this difference resolved by 12 months. CONCLUSIONS Cervical spine patients had greater relative early improvement in physical function compared with shoulder patients, whereas pain interference and intensity did not significantly differ between the 2 groups after surgery. This will help in counseling patients about relative difference in recovery and improvement between the 2 surgery types. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Michelle A Zabat
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York City, NY
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Hamilton GM, Ladha K, Wheeler K, Nguyen F, McCartney CJL, McIsaac DI. Incidence of persistent postoperative opioid use in patients undergoing ambulatory surgery: a retrospective cohort study. Anaesthesia 2023; 78:170-179. [PMID: 36314355 DOI: 10.1111/anae.15900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 01/11/2023]
Abstract
The opioid crisis remains a major public health concern. In ambulatory surgery, persistent postoperative opioid use is poorly described and temporal trends are unknown. A population-based retrospective cohort study was undertaken in Ontario, Canada using routinely collected administrative data for adults undergoing ambulatory surgery between 1 January 2013 and 31 December 2017. The primary outcome was persistent postoperative opioid use, defined using best-practice methods. Multivariable generalised linear models were used to estimate the association of persistent postoperative opioid use with prognostic factors. Temporal trends in opioid use were examined using monthly time series, adjusting for patient-, surgical- and hospital-level variables. Of 340,013 patients, 44,224 (13.0%, 95%CI 12.9-13.1%) developed persistent postoperative opioid use after surgery. Following multivariable adjustment, the strongest predictors of persistent postoperative opioid use were pre-operative: utilisation of opioids (OR 9.51, 95%CI 8.69-10.39); opioid tolerance (OR 88.22, 95%CI 77.21-100.79); and utilisation of benzodiazepines (OR 13.75, 95%CI 12.89-14.86). The time series model demonstrated a small but significant trend towards decreasing persistent postoperative opioid use over time (adjusted percentage change per year -0.51%, 95%CI -0.83 to -0.19%, p = 0.003). More than 10% of patients who underwent ambulatory surgery experienced persistent postoperative opioid use; however, there was a temporal trend towards a reduction in persistent opioid use after surgery. Future studies are needed that focus on interventions which reduce persistent postoperative opioid use.
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Affiliation(s)
- G M Hamilton
- Department of Anesthesiology and Pain Medicine, University of Ottawa, ON, Canada.,The Ottawa Hospital Research Institute, ON, Canada
| | - K Ladha
- Department of Anesthesia, St. Michael's Hospital, Unity Health Toronto and Institute of Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
| | - K Wheeler
- Department of Anesthesiology and Pain Medicine, University of Ottawa, ON, Canada
| | - F Nguyen
- Department of Anesthesiology and Pain Medicine, University of Ottawa, ON, Canada
| | - C J L McCartney
- Department of Anesthesiology and Pain Medicine, University of Ottawa, ON, Canada.,The Ottawa Hospital Research Institute, ON, Canada
| | - D I McIsaac
- Department of Anesthesiology and Pain Medicine, University of Ottawa, ON, Canada.,The Ottawa Hospital Research Institute, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, ON, Canada
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Tadokoro N, Kiyasu K, Aoyama N, Mizobuchi S, Ikeuchi M, Kida K, Tani T, Kasai Y. A comparison of reoperation rates after single-level anterior cervical discectomy and fusion (ACDF) between the procedures with and without anterior plate fixation. THE JOURNAL OF MEDICAL INVESTIGATION 2023; 70:334-342. [PMID: 37940516 DOI: 10.2152/jmi.70.334] [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: 11/10/2023]
Abstract
INTRODUCTION The plate fixation for anterior cervical discectomy and fusion (ACDF) has become increasingly widespread for facilitating early mobilization and improving fusion rate. However, apart from multilevel operations, there is still some controversy over its use for single-level ACDF. This retrospective study has compared the reoperation rates after single-level ACDFs performed at our institution between the procedures with and without plate fixation. METHODS This retrospective study included a total of 131 patients with???1-year of follow-up after a single-level ACDF, consisting of 100 patients without plating (conventional ACDF) and 31 patients with plate fixation (plated ACDF). RESULTS Eleven patients (8.4% of all patients):four conventional ACDFs (4% of the conventional ACDFs) and seven plated ACDFs (22.6% of the plated ACDFs), had reoperation surgeries. The incidence of reoperation was significantly higher in the plated ACDFs than in the conventional ACDFs (P=0.0037). The log-rank test revealed a significant difference (P=0.00003) in 5-year reoperation-free survival rates between the conventional (96.9%) and the plated groups (68.3%). CONCLUSION Anterior cervical plating may have a negative impact on the adjacent segment integrity, resulting in an increased reoperation rate after a single-level ACDF at relatively shorter postoperative time points. J. Med. Invest. 70 : 334-342, August, 2023.
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Affiliation(s)
- Nobuaki Tadokoro
- Department of Orthopaedic Surgery, Kochi University, Kochi, Japan
| | - Katsuhito Kiyasu
- Department of Orthopaedic Surgery, Kochi University, Kochi, Japan
| | - Naoki Aoyama
- Department of Orthopaedic Surgery, Kochi University, Kochi, Japan
| | - Shuhei Mizobuchi
- Department of Orthopaedic Surgery, Kochi University, Kochi, Japan
| | - Masahiko Ikeuchi
- Department of Orthopaedic Surgery, Kochi University, Kochi, Japan
| | - Kazunobu Kida
- Department of Orthopaedic Surgery, Kubokawa Hospital, Kochi, Japan
| | - Toshikazu Tani
- Department of Orthopaedic Surgery, Kubokawa Hospital, Kochi, Japan
| | - Yusuke Kasai
- Department of Orthopaedic Surgery, Kochi Prefectural Hata Kenmin Hospital, Kochi, Japan
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Mjåset C, Solberg TK, Zwart JA, Småstuen MC, Kolstad F, Grotle M. Anterior surgical treatment for cervical degenerative radiculopathy: a prediction model for non-success. Acta Neurochir (Wien) 2023; 165:145-157. [PMID: 36481873 PMCID: PMC9840586 DOI: 10.1007/s00701-022-05440-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE By using data from the Norwegian Registry for Spine Surgery, we wanted to develop and validate prediction models for non-success in patients operated with anterior surgical techniques for cervical degenerative radiculopathy (CDR). METHODS This is a multicentre longitudinal study of 2022 patients undergoing CDR surgery and followed for 12 months to find prognostic models for non-success in neck disability and arm pain using multivariable logistic regression analysis. Model performance was evaluated by area under the receiver operating characteristic curve (AUC) and a calibration test. Internal validation by bootstrapping re-sampling with 1000 repetitions was applied to correct for over-optimism. The clinical usefulness of the neck disability model was explored by developing a risk matrix for individual case examples. RESULTS Thirty-eight percent of patients experienced non-success in neck disability and 35% in arm pain. Loss to follow-up was 35% for both groups. Predictors for non-success in neck disability were high physical demands in work, low level of education, pending litigation, previous neck surgery, long duration of arm pain, medium-to-high baseline disability score and presence of anxiety/depression. AUC was 0.78 (95% CI, 0.75, 0.82). For the arm pain model, all predictors for non-success in neck disability, except for anxiety/depression, were found to be significant in addition to foreign mother tongue, smoking and medium-to-high baseline arm pain. AUC was 0.68 (95% CI, 0.64, 0.72). CONCLUSION The neck disability model showed high discriminative performance, whereas the arm pain model was shown to be acceptable. Based upon the models, individualized risk estimates can be made and applied in shared decision-making with patients referred for surgical assessment.
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Affiliation(s)
- Christer Mjåset
- Faculty of Medicine, University of Oslo, Oslo, Norway.
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, P.O. Box 4956, 0424, Oslo, Nydalen, Norway.
| | - Tore K Solberg
- Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
- Department of Neurosurgery and The Norwegian Registry for Spine Surgery (NORspine), The University Hospital of North Norway, Tromsø, Norway
| | - John-Anker Zwart
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, P.O. Box 4956, 0424, Oslo, Nydalen, Norway
| | - Milada C Småstuen
- Department of Rehabilitation and Technology, Faculty of Health Science, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, 0130, Oslo, Norway
| | - Frode Kolstad
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Margreth Grotle
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, P.O. Box 4956, 0424, Oslo, Nydalen, Norway
- Department of Rehabilitation and Technology, Faculty of Health Science, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, 0130, Oslo, Norway
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Chambers JS, Kropp RG, Gardocki RJ. Reoperation rates and patient-reported outcomes of single and two-level anterior cervical discectomy and fusion. Arch Orthop Trauma Surg 2023; 143:265-268. [PMID: 34244874 DOI: 10.1007/s00402-021-04056-y] [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: 10/28/2020] [Accepted: 07/02/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purposes of this study were to identify the 2 year rate of reoperation and determine patient-reported outcomes after elective one- and two-level anterior cervical discectomy and fusion (ACDF) with structural allograft and anterior plating using indications similar to cervical disc arthroplasty. MATERIALS AND METHODS A retrospective chart review was performed on 116 consecutive one- and two-level primary ACDF for adult degenerative disease with structural allograft and anterior plating in one surgeon's practice. Patient-reported visual analog score (VAS), Oswestry disability index (ODI) and radiographs, collected prospectively on all operative patients preoperatively and postoperatively at 6 weeks, 3 months, 6 months, 1 year, and 2 years were reviewed. Patient demographics and reoperation rates were obtained from the chart. RESULTS One hundred and four patients were identified with a final reoperation rate of 2.9% at a mean final follow-up 2 years (95% CI 17.2-29.0). No reoperations occurred within 90 days. After 1 year, three patients required reoperation. The mean patient-reported outcomes improved (VAS, 6.6 preoperatively to 3.0 at final follow-up and ODI, 24.3 preoperatively to 12.3 at final follow-up). These improvements were statistically significant (p < 0.01). No significant patient risk factors for reoperation were found. CONCLUSIONS The rate of reoperation for one- and two-level anterior cervical discectomy and fusion at follow-up was found to be lower than those previously published in the literature quoted for CDA. Arthrodesis continues to demonstrate improvements in patient-reported outcomes.
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Affiliation(s)
- James S Chambers
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee/Campbell Clinic, Memphis, TN, USA
| | - Robert G Kropp
- University of Tennessee Health Science Center, 1211 Union Avenue, Suite 500, Memphis, TN, 38104, USA
| | - Raymond J Gardocki
- University of Tennessee Health Science Center, 1211 Union Avenue, Suite 500, Memphis, TN, 38104, USA.
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Ryu S, Ryu DS, Kim KS. Long-term results comparison after anterior cervical discectomy with BGS-7 spacer (NOVOMAX®-C) and allograft spacer: A prospective observational study. Front Bioeng Biotechnol 2023; 11:1100462. [PMID: 37152650 PMCID: PMC10154694 DOI: 10.3389/fbioe.2023.1100462] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/06/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction: In an anterior cervical discectomy and fusion (ACDF), various types of graft materials including autograft, allograft, and synthetic graft have been used to achieve adequate spinal fusion. Allograft spacer is mainly used in cervical fusion, especially in the anterior approach. The synthetic bone graft material BGS-7(CaO-SiO2-P2O5-B2O3, bioactive Glass-Ceramics) can bind with surrounding bone tissue by forming a hydroxyapatite layer bone bridge, leading to faster graft osseointegration. This study was conducted to compare long-term clinical outcome of BGS-7 spacer and allograft spacer for anterior cervical discectomy and fusion surgery. Materials and Methods: From September 2014 to December 2016, Consecutive anterior cervical discectomy and fusion surgeries using a BGS-7 spacer (N = 18) and Allograft spacer (N = 26) were compared for postoperative clinical outcomes. Radiologic assessments were performed, and Instrumental failure, including breakage, cage migration, subsidence were observed and Fusion status were analyzed. Finite element analysis was performed for simulating mechanical stress between the vertebral body and implant. Clinical outcomes were evaluated using neck VAS, NDI, and JOA on the patient's final follow-up visits. Results: Among the 44 patients who underwent an anterior cervical discectomy and fusion surgery using the BGS-7 spacer and Allograft spacer, there were 30 men and 14 women. The average age at the operation was 47.69 ± 10.49 in allograft spacer and 51.67 ± 11.03 in BGS-7 spacer. The mean follow-up period was 89.18 ± 5.44 months. Twenty three (88.46%) patients in allograft spacer and 20(100%) patients in BGS-7 spacer were demonstrated radiologic evidence of interbody fusion in last OPD, which accounts for fusion grade 4 or 5. Peak stresses were 343.85 MPa in allograft spacer, and 132.55 MPa in BGS-7 spacer. Long-term clinical outcomes including neck VAS, NDI, and JOA didn't show statistical differences between the two groups. There were no adverse events related to the BGS-7 spacer.10.3389/fbioe.2023.110046. Conclusion: The BGS-7 spacer demonstrated reliability as a spacer in anterior cervical discectomy and fusionF surgery without instrumental failure. Early stabilization with a bony bridge formation was observed at the intermediate follow-up period, and the long-term clinical outcome was favorable at more than 60 months after surgery without any adverse events. Thus, the BGS-7 spacer is a safe and effective alternative to the allograft spacer in anterior cervical discectomy and fusion surgery.
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Affiliation(s)
- Seungjun Ryu
- National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
- Department of Neurosurgery, School of Medicine, Eulji University, Daejeon, Republic of Korea
| | - Dal-Sung Ryu
- School of Medicine, Inha University, Inchon, Republic of Korea
- *Correspondence: Dal-Sung Ryu, ; Keun-Su Kim,
| | - Keun-Su Kim
- Gangnam Severance Hospital, Seoul, Seoul, Republic of Korea
- *Correspondence: Dal-Sung Ryu, ; Keun-Su Kim,
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Patel AH, Ofa SA, Collins LK, McCluskey LC, Sherman WF, Cyriac M. Trends of single-level anterior cervical discectomy and fusion documentation after the 2015 Centers for Medicare & Medicaid Services coding audit. J Neurosurg Spine 2022; 37:802-811. [PMID: 35932261 DOI: 10.3171/2022.5.spine22415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE With the use of anterior cervical discectomy and fusion (ACDF) expected to rise by 13.3% from 2020 to 2040, the increased usage of interbody cages with integral anterior fixation prompted a Centers for Medicare & Medicaid Services (CMS) review, which resulted in coding changes affecting anterior instrumentation documentation. CMS determined that Current Procedural Terminology (CPT) code 22845 should not be used to report integrated instrumentation (plate) with an interbody device, and if additional anterior instrumentation (e.g., plates and screws) is placed with an integrated interbody device, then a 59 modifier should be used. There is sparse literature examining the trends of ACDF without and with additional anterior instrumentation after the 2015 CMS audit. Therefore, this study aimed to evaluate the trends of single-level subaxial ACDF utilization from 2011 to 2019 to determine whether the 2015 CMS audit influenced the documented usage of additional anterior instrumentation. METHODS A retrospective cohort study was performed using the commercially available database PearlDiver. Patient records were queried from 2011 to 2019 for single-level subaxial ACDF without (CPT code 22551) and with (CPT codes 22551 + 22845) instrumentation. Cochran-Armitage trend analyses were performed to evaluate the hypothesis that ACDF with additional anterior instrumentation decreased over the given time period. RESULTS Between 2011 and 2019, the total number of single-level ACDFs decreased from 6202 to 4402. From 2011 to 2015, an average of 6240 patients per year underwent single-level subaxial ACDF; of those, 950 patients (15.2%) had ACDF without instrumentation and 5290 patients (84.8%) had ACDF with instrumentation. In 2016, the total number of single-level subaxial ACDFs decreased to 5525, with 1006 patients (18.2%) receiving no instrumentation and 4519 patients (81.8%) receiving instrumentation. From 2017 to 2019, an average of 4283 patients per year underwent a single-level subaxial ACDF; of these, 1280 (29.9%) had no instrumentation and 3003 (70.1%) had instrumentation (all p < 0.0001). CONCLUSIONS From 2015 to 2019, single-level ACDF without instrumentation significantly increased by 91.5% and ACDF with anterior instrumentation significantly decreased by 18.1%. The 2015 CMS audit of interbody cages and anterior instrumentation coding (CPT code 22845) may account for the decreased documentation of anterior instrumentation in the 9-year period. Understanding CMS auditing could help surgeons perceive changes in practice patterns that may lead to a more thorough evaluation of patient outcomes, cost, and overall value.
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Affiliation(s)
- Akshar H Patel
- 1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana; and
| | - Sione A Ofa
- 1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana; and
| | - Lacee K Collins
- 2Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Leland C McCluskey
- 1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana; and
| | - William F Sherman
- 1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana; and
| | - Mathew Cyriac
- 1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana; and
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Lambrechts MJ, D'Antonio ND, Toci GR, Karamian BA, Farronato D, Pezzulo J, Breyer G, Canseco JA, Woods B, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GR. Marijuana Use and its Effect on Clinical Outcomes and Revision Rates in Patients Undergoing Anterior Cervical Discectomy and Fusion. Spine (Phila Pa 1976) 2022; 47:1558-1566. [PMID: 35867598 DOI: 10.1097/brs.0000000000004431] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/15/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE To determine if (1) preoperative marijuana use increased complications, readmission, or reoperation rates following anterior cervical discectomy and fusion (ACDF), (2) identify if preoperative marijuana use resulted in worse patient-reported outcome measures (PROMs), and (3) investigate if preoperative marijuana use affects the quantity of opioid prescriptions in the perioperative period. SUMMARY OF BACKGROUND DATA A growing number of states have legalized recreational and/or medical marijuana, thus increasing the number of patients who report preoperative marijuana use. The effects of marijuana on clinical outcomes and PROMs in the postoperative period are unknown. METHODS All patients 18 years of age and older who underwent primary one- to four-level ACDF with preoperative marijuana use at our academic institution were retrospectively identified. A 3:1 propensity match was conducted to compare patients who used marijuana versus those who did not. Patient demographics, surgical characteristics, clinical outcomes, and PROMs were compared between groups. Multivariate regression models measured the effect of marijuana use on the likelihood of requiring a reoperation and whether marijuana use predicted inferior PROM improvements at the one-year postoperative period. RESULTS Of the 240 patients included, 60 (25.0%) used marijuana preoperatively. Multivariate logistic regression analysis identified marijuana use (odds ratio=5.62, P <0.001) as a predictor of a cervical spine reoperation after ACDF. Patients who used marijuana preoperatively had worse one-year postoperative Physical Component Scores of the Short-Form 12 (PCS-12) ( P =0.001), Neck Disability Index ( P =0.003), Visual Analogue Scale (VAS) Arm ( P =0.044) and VAS Neck ( P =0.012). Multivariate linear regression found preoperative marijuana use did not independently predict improvement in PCS-12 (β=-4.62, P =0.096), Neck Disability Index (β=9.51, P =0.062), Mental Component Scores of the Short-Form 12 (MCS-12) (β=-1.16, P =0.694), VAS Arm (β=0.06, P =0.944), or VAS Neck (β=-0.44, P =0.617). CONCLUSION Preoperative marijuana use increased the risk of a cervical spine reoperation after ACDF, but it did not significantly change the amount of postoperative opioids used or the magnitude of improvement in PROMs. LEVEL OF EVIDENCE Levwl III.
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Affiliation(s)
- Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Nicholas D D'Antonio
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Gregory R Toci
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Dominic Farronato
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Joshua Pezzulo
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | | | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Barrett Woods
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Gregory R Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
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Kwok WCH, Wong CYY, Law JHW, Tsang VWT, Tong LWL, Samartzis D, An HS, Wong AYL. Risk Factors for Adjacent Segment Disease Following Anterior Cervical Discectomy and Fusion with Plate Fixation: A Systematic Review and Meta-Analysis. J Bone Joint Surg Am 2022; 104:1915-1945. [PMID: 36321969 DOI: 10.2106/jbjs.21.01494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Adjacent segment disease (ASD) following anterior cervical discectomy and fusion with plating (ACDF-P) may yield a poor prognosis or reoperation. This review aimed to summarize risk factors for radiographic ASD (RASD) and clinical ASD (CASD) after ACDF-P. METHODS Six electronic databases were searched from inception to October 30, 2021. Four reviewers independently screened titles, abstracts, and full-text articles to identify relevant studies. Methodological quality of the included studies was evaluated. Meta-analyses for risk factors were conducted, if possible. RESULTS Sixteen cohort and 3 case-control studies (3,563 participants) were included. These studies showed low (n = 2), moderate (n = 9), and high (n = 8) risk of bias. One risk factor for RASD was pooled for 2 meta-analyses based on the follow-up period. Four different risk factors for CASD at ≥4 years were pooled for meta-analyses. Limited evidence showed that multi-level fusion, greater asymmetry in total or functional cross-sectional area of the cervical paraspinal muscle, and preoperative degeneration in a greater number of segments were associated with a higher RASD incidence <4 years after ACDF-P. In contrast, no significant risk factors were identified for CASD <4 years after ACDF-P. At ≥4 years after ACDF-P, limited evidence supported that both cephalad and caudal plate-to-disc distances of <5 mm were associated with a higher RASD incidence, and very limited evidence supported that developmental canal stenosis, preoperative RASD, unfused C5-C6 or C6-C7 adjacent segments, use of autogenous bone graft, and spondylosis-related ACDF-P were associated with a higher CASD incidence. CONCLUSIONS Although several risk factors for RASD and CASD development after ACDF-P were identified, the supporting evidence was very limited to limited. Future prospective studies should extend the existing knowledge by more robustly identifying risk factors for RASD and CASD after ACDF-P to inform clinical practice. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Wallace C H Kwok
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Christina Y Y Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Jason H W Law
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Vy W T Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Leo W L Tong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Dino Samartzis
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Howard S An
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
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Lindsey RW. Adjacent Segment Disease Risk Following Anterior Cervical Discectomy and Fusion: Unknowns, or Known Unknowns, in Our Pursuit of an Evidence-Based Risk Determination: Commentary on an article by Wallace C.H. Kwok, PT, et al.: "Risk Factors for Adjacent Segment Disease Following Anterior Cervical Discectomy and Fusion with Plate Fixation. A Systematic Review and Meta-Analysis". J Bone Joint Surg Am 2022; 104:1959. [PMID: 36321972 DOI: 10.2106/jbjs.22.00878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ronald W Lindsey
- University of Texas Medical Branch, University of Texas, Galveston, Texas
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41
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Lambrechts MJ, Issa TZ, Toci GR, D'Antonio ND, Karamian BA, Tecce E, Fras S, Kaye ID, Woods BI, Kepler CK, Vaccaro AR, Schroeder GD, Hilibrand AS, Canseco JA. Soft Cervical Orthosis Use Does Not Improve Fusion Rates After One-Level and Two-Level Anterior Cervical Discectomy and Fusion. World Neurosurg 2022; 167:e1461-e1467. [PMID: 36174948 DOI: 10.1016/j.wneu.2022.09.095] [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: 07/19/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine if postoperative soft cervical orthosis use affects arthrodesis rates on a per-level or construct basis after 1-level and 2-level anterior cervical discectomy and fusion (ACDF). METHODS Electronic medical records were queried for 1-level and 2-level primary ACDF between 2016 and 2019 at a single academic center. Surgeons prescribed either a soft cervical orthosis or no orthosis. Pseudarthrosis rates were evaluated by dynamic cervical spine radiographs with arthrodesis defined by <1 mm of interspinous motion. Continuous and categorical data were compared using analysis of variance or χ2 tests. Multivariate logistic regression analysis was used to examine independent predictors of pseudarthrosis. RESULTS A total of 316 unique patients (504 instrumented levels) met the inclusion criteria. Eighty-four percent of patients were prescribed a soft cervical orthosis. Overall, arthrodesis occurred at 344 (80.9%) and 62 (78%) levels in patients with and without cervical orthosis, respectively. When evaluating patients placed in a cervical orthosis versus those who were not, there were no differences in pseudarthrosis or revision rates. Further, there were no differences in pseudarthrosis on a per-level basis. Further, cervical orthosis use was not an independent predictor of pseudarthrosis (odds ratio, 0.86; 95% confidence interval, 0.47-1.57; P =0.623) on multivariate analysis. CONCLUSIONS Postoperative placement of soft cervical orthoses after 1-level or 2-level ACDF was not associated with improved arthrodesis or reduced rate of revision surgery.
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Affiliation(s)
- Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Tariq Z Issa
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory R Toci
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nicholas D D'Antonio
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Eric Tecce
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sebastian Fras
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ian David Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Barrett I Woods
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Salamanna F, Contartese D, Tschon M, Borsari V, Griffoni C, Gasbarrini A, Fini M. Sex and gender determinants following spinal fusion surgery: A systematic review of clinical data. Front Surg 2022; 9:983931. [PMID: 36325040 PMCID: PMC9618873 DOI: 10.3389/fsurg.2022.983931] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022] Open
Abstract
In the last decade, numerous studies analyzed and described the surgical outcomes in male and female patients submitted to orthopedic surgery. Although this, the impact of sex/gender on spinal fusion surgery clinical outcomes is still poorly defined. This review systematically maps and synthesizes the scientific literature on sex/gender differences in postoperative outcomes for patients undergoing spinal fusion surgery. The search was performed in PubMed, Scopus, and Web of Science in the last 22 years. Clinical studies evaluating potential sex/gender differences in postoperative outcomes and/or complications, as primary or secondary aim, were included and analyzed. Out of the 1,885 records screened, 47 studies were included. These studies comprised a total of 1,158,555 patients (51.31% female; 48.69% male). About 77% of the analyzed studies reported sex/gender-related differences in postoperative outcomes. Most studies treated patients for lumbar degenerative diseases and more than 55% of them reported a worse postoperative outcome in female patients in terms of pain, disability, health-related quality of life questionnaires, and complications. Differently, a significant heterogeneity across studies on patients treated for cervical and sacral degenerative diseases as well as for spinal deformity and traumatic spinal fracture prevented the understanding of specific sex/gender differences after spinal fusion surgery. Despite this, the present review highlighted those female patients treated for lumbar degenerative spine diseases could require more clinical awareness during postoperative care. The understanding of how sex/gender differences can really affect clinical outcomes after spinal fusion surgeries is mandatory for all spinal pathological conditions to drive clinical research toward oriented and personalized protocols.
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Affiliation(s)
- Francesca Salamanna
- Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Deyanira Contartese
- Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy,Correspondence: Deyanira Contartese
| | - Matilde Tschon
- Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Veronica Borsari
- Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | | | - Milena Fini
- Scientific Direction, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Delayed Esophageal Perforation Diagnosed 12 Years After Anterior Cervical Diskectomy and Fusion: A Case Report and Review of Current Literature. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202210000-00003. [PMID: 36227832 PMCID: PMC9575766 DOI: 10.5435/jaaosglobal-d-22-00080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/25/2022] [Indexed: 11/05/2022]
Abstract
Esophageal perforation associated with anterior cervical diskectomy and fusion (ACDF) is a rare but serious complication. ACDF-related esophageal perforations can be acute or delayed. Delayed perforations more than 10 years after ACDF are exceedingly rare. Here, a delayed esophageal perforation discovered 12 years after a three-level ACDF is presented. This case highlights two main points. First, all diverticula after an ACDF warrant close clinical monitoring. Second, routine follow-up should be performed for patients with screw pullout to assist in early diagnosis of delayed esophageal perforation.
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Wang X, Lin Y, Wang Q, Gao L, Feng F. A Bibliometric Analysis of the Top 100 Cited Articles in Anterior Cervical Discectomy and Fusion. J Pain Res 2022; 15:3137-3156. [PMID: 36311292 PMCID: PMC9604433 DOI: 10.2147/jpr.s375720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/23/2022] [Indexed: 11/23/2022] Open
Abstract
Study design A bibliometric analysis. Objective To identify and analyze the top 100 cited articles in anterior cervical discectomy and fusion. Summary of Background Data Anterior cervical discectomy and fusion (ACDF) is one of the most routine surgical procedures in spine surgery. Many surgeons and academics have researched ACDF thoroughly and published numerous articles. However, there is no relevant bibliometric analysis. Therefore, our study aims to identify and analyze the top 100 cited articles in ACDF to identify the research trends. Methods We searched the Web of Science (WOS) Core Collection database with restrictions and identified the top 100 cited publications in ACDF for analysis. Results The citation counts of the top 100 cited publications ranged from 37 to 361 (mean 67.42). All studies were published between 2008 and 2019, with 2013 and 2015 the most prolific years. The journals Spine and Journal of Neurosurgery-Spine provided the majority of the articles. Overall, the 100 articles came from 12 countries, with the United States being the top producer, followed by China and South Korea. The most frequent keywords were "spine", "anterior cervical discectomy and fusion", "interbody fusion", 'arthrodesis', "follow-up", "decompression", and "ACDF". Conclusion ACDF has been regarded as a classical gold standard in anterior cervical surgery, and the emergence of new surgical procedures has not affected its status. Cervical disc arthroplasty still needs further research and development. As the first bibliometric analysis of ACDF, this bibliometric study is meant to provide guidance for clinicians and scholars to research the development trend of this field.
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Affiliation(s)
- Xun Wang
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang310053, People’s Republic of China
| | - Yanze Lin
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang310053, People’s Republic of China
| | - Qiongtai Wang
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang310053, People’s Republic of China
| | - Liqing Gao
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang310053, People’s Republic of China
| | - Fabo Feng
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China,Correspondence: Fabo Feng, Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China, Email
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Yeni YN, Azad S, Oravec D, Schildcrout A, Basheer A, Bey MJ, Bartol SW, Chang V. Intervertebral kinematics during neck motion 6.5 years after fusion and artificial disc replacement. Clin Biomech (Bristol, Avon) 2022; 99:105756. [PMID: 36063742 DOI: 10.1016/j.clinbiomech.2022.105756] [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: 01/21/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Arthroplasty with artificial disc replacement for surgical treatment of cervical spine degeneration was introduced with the notion that motion-preserving approaches would prevent development of adjacent segment disease. Though clinical outcomes favor arthroplasty over the commonly used anterior cervical discectomy with fusion approach, clinical studies confirming the biomechanical basis of these results are lacking. The aim of this study was to compare intervertebral kinematics between arthroplasty and fusion patients 6.5 years post-surgery during physiological motion of the neck. METHODS Using a biplane dynamic X-ray system, computed tomography imaging and model based tracking algorithms, three dimensional intervertebral kinematics were measured during neck axial rotation and extension in 14 patients treated for cervical radiculopathy with fusion (n = 8) or arthroplasty (n = 6). The measurements were performed at 2-year (baseline) and 6.5 year post-surgical time points, with the main interest being in the interaction between surgery types and time points. 3 translations and 3 rotations were investigated for the index (C5C6), and upper- (C4C5) and lower adjacent levels (C6C7). FINDINGS Surgery-time interaction was significant for axial rotation (P < 0.04) and flexion-extension rotation (P < 0.005) in C4C5 during neck axial rotation, left-right translation (P < 0.04) in C5C6 and anterior-posterior translation in C6C7 (P < 0.04) during neck extension. In contrast with the expectations, axial rotation and flexion-extension decreased in C4C5 during neck rotation and anterior-posterior translation decreased in C6C7 during neck extension for fusion. INTERPRETATION The findings do not support the notion that adjacent segment motion increases after fusion.
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Affiliation(s)
- Yener N Yeni
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA.
| | - Sherwin Azad
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA; School of Medicine, Wayne State University, Detroit, MI, USA
| | - Daniel Oravec
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA
| | - Andrew Schildcrout
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA
| | - Azam Basheer
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
| | - Michael J Bey
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA
| | - Stephen W Bartol
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
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Lambrechts MJ, D'Antonio ND, Karamian BA, Toci GR, Sherman M, Canseco JA, Kepler CK, Vaccaro AR, Hilibrand AS, Schroeder GD. What is the role of dynamic cervical spine radiographs in predicting pseudarthrosis revision following anterior cervical discectomy and fusion? Spine J 2022; 22:1610-1621. [PMID: 35568109 DOI: 10.1016/j.spinee.2022.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/23/2022] [Accepted: 04/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Postoperative dynamic radiographs are used to assess fusion status after anterior cervical discectomy and fusion (ACDF) with comparable accuracy to computed tomography (CT) scans. PURPOSE To (1) determine if dynamic radiographs accurately predict pseudarthrosis revision in a cohort of largely asymptomatic patients who underwent ACDF, (2) determine how adjacent segment motion is affected by fusion status, and (3) analyze how clinical outcomes differ between patients with symptomatic and asymptomatic pseudarthrosis. STUDY DESIGN Retrospective cohort study. PATIENT SAMPLE Patients ≥ 18 years who underwent primary one- to four-level ACDF at a single institution over a 10-year period. OUTCOME MEASURES Interspinous motion on preoperative and postoperative flexion-extension radiographs and preoperative and postoperative Visual Analogue Scale for Neck Pain (VAS Neck) and Arm Pain (VAS Arm), Neck Disability Index (NDI), Modified Japanese Orthopaedic Association scale (mJOA), Mental and Physical Component Scores of the Short-Form 12 (SF-12) Health Survey (MCS-12 and PCS-12) METHODS: The difference in spinous process motion between flexion and extension radiographs was used to determine motion at each level of the ACDF construct. Pseudarthrosis was defined as ≥ 1 mm spinous process motion on dynamic radiographs. A receiver operating characteristic (ROC) curve was generated to predict the probability of surgical revision for pseudarthrosis based on millimeters of interspinous motion at each instrumented level. Patient reported outcome measures (PROMs) were used to assess the effect of pseudarthrosis on clinical outcomes. Alpha was set at p<.05. RESULTS A total of 597 patients met inclusion criteria including 1,203 ACDF levels. Of those, 215 patients (36.0%) were diagnosed with a pseudarthrosis on dynamic radiographs with 29 patients (4.9%) requiring pseudarthrosis revision. ROC analysis identified a "cutoff" value of 1.00 mm of interspinous process motion for generating an optimal area under the curve (AUC). The negative predictive value (NPV) was 99.6%, whereas the positive predictive value (PPV) was 13.7%. When analyzing adjacent segment motion, the Δ supra-adjacent interspinous process motion (ISM) was significantly lower for patients with a superior construct pseudarthrosis (-1.06 mm vs. 1.80 mm, p<.001), whereas the Δ infra-adjacent level ISM was significantly lower for patients with an inferior construct pseudarthrosis (-1.21 mm vs. 2.15 mm, p<.001). Patients with a pseudarthrosis not requiring revision had worse postoperative NDI (29.3 vs. 23.4, p=.027), VAS Neck (3.40 vs. 2.63, p=.012), and VAS Arm (3.09 vs. 1.85, p=.001) scores at 3 months, but not 1-year, compared with patients who were fused. Patients requiring pseudarthrosis revision had higher 1-year postoperative NDI (38.0 vs. 23.7, p=.047) and lower 1-year postoperative Δ VAS Arm (-0.22 vs. -2.97, p=.016) scores. CONCLUSIONS One-year postoperative dynamic radiographs have a greater than 99% negative predictive value for identifying patients requiring pseudarthrosis revision, but they have a low positive predictive value. Most patients with a pseudarthrosis remain asymptomatic with similar 1-year postoperative patient-reported outcomes compared with patients without a pseudarthrosis.
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Affiliation(s)
- Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | - Nicholas D D'Antonio
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Gregory R Toci
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Matthew Sherman
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Núñez JH, Escudero B, Omiste I, Martínez-Peñas J, Surroca M, Alonzo-González F, Bosch-García D. Outcomes of cervical arthroplasty versus anterior cervical arthrodesis: a systematic review and meta-analysis of randomized clinical trials with a minimum follow-up of 7-year. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03365-1. [PMID: 35986813 DOI: 10.1007/s00590-022-03365-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Compare the outcomes of randomized clinical trials of cervical disc arthroplasty (CDA) versus anterior cervical discectomy with fusion (ACDF), with a minimum follow-up of 7 years. METHODS Nine randomized clinical trials were selected. The clinical, radiological, and surgical outcomes were analyzed, including functional and pain scores, range of motion, adjacent segment degeneration, adverse events, and need for reoperation. RESULTS 2664 patients were included in the study. Pooled results indicated that the CDA group had a significantly higher overall success rate (p < 0.001), a higher improvement in the neck disability index (NDI) (p = 0.002), less VAS arm pain (p = 0.01), and better health questionnaire SF-36 physical component (p = 0.01) than ACDF group. Likewise, the pooled results indicated a significantly higher motion rate (p < 0.001), less adjacent syndrome (p < 0.05), and a lower percentage of reoperation (p < 0.001) in the CDA group. There were no significant differences between the CDA and ACDF groups in the neck pain scale (p = 0.11), the health questionnaire SF-36 mental component (p = 0.10), and in adverse events (p = 0.42). CONCLUSION In long-term follow-up, CDA showed a better overall success rate, better improvement in NDI, less VAS arm pain, better health questionnaire SF-36 physical component, a higher motion rate, less adjacent syndrome, and less reoperation rate than ACDF. No significant differences were found in the neck pain scale, SF-36 mental component, and in adverse events.
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Affiliation(s)
- Jorge H Núñez
- Spine Unit, Department of Traumatology and Orthopedic Surgery, University Hospital of Mutua Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain.
- Spine Unit, Artro-Esport, Centro Médico Teknon, Carrer de Vilana, 12, 08022, Barcelona, Spain.
| | - Berta Escudero
- Spine Unit, Department of Traumatology and Orthopedic Surgery, University Hospital of Mutua Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
| | - Irene Omiste
- Spine Unit, Department of Traumatology and Orthopedic Surgery, University Hospital of Mutua Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
| | - Judith Martínez-Peñas
- Spine Unit, Department of Traumatology and Orthopedic Surgery, University Hospital of Mutua Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
| | - Maria Surroca
- Spine Unit, Department of Traumatology and Orthopedic Surgery, University Hospital of Mutua Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
| | - Francisco Alonzo-González
- Hospital Ceibal de Accidentes Del Instituto Guatemalteco de Seguridad Social, Cuidad de Guatemala, Guatemala
| | - David Bosch-García
- Spine Unit, Department of Traumatology and Orthopedic Surgery, University Hospital of Mutua Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
- Grup Traumatologic de Catalunya, Barcelona, Spain
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Maki Y, Kawasaki T, Nakajima K, Takayama M. Pathological Examination of Radiologically Fused Interbody Tissue Five Years After Anterior Cervical Discectomy and Fusion Using the Titanium Cage System: A Report of Two Cases. Cureus 2022; 14:e28059. [PMID: 36134104 PMCID: PMC9481214 DOI: 10.7759/cureus.28059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
This case report aimed to identify potential relationships between pathological and radiological assessments of bony fusion after anterior cervical discectomy and fusion (ACDF). ACDF can resolve neurological symptoms related to cervical spondylosis, such as myelopathy and radiculopathy. Intervertebral bony fusion is a key outcome for successful ACDF, often assessed on radiography and computed tomography (CT) images. However, the pathological findings of tissues demonstrating bony fusion after ACDF have not been well studied. This report presents the cases of two female patients, aged 62 and 40 years, who underwent additional ACDFs for recurrent cervical radiculopathy. Findings from CT imaging identified intervertebral calcification in the titanium spacers placed in the first ACDF. In both cases, recurrent compression of nerve roots was observed radiologically. Cervical nerve root block identified habitual symptoms related to recurrent radiculopathy. To resolve the clinical symptoms, additional ACDFs were performed in two cases. In the second ACDF, the titanium cases from the prior ACDF were removed. Histopathological examination of the tissues from the removed cages revealed growth of cartilage tissue. This is the first report concerning the histopathological evaluation of the tissue in titanium spacers placed in ACDF. Completion of intervertebral calcification in titanium spacers placed in ACDF may not signify completion of intervertebral bony fusion after ACDF.
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The Variability and Contributions to Cost of Anterior Cervical Discectomy and Fusion Constructs. Clin Spine Surg 2022:01933606-990000000-00054. [PMID: 35943872 DOI: 10.1097/bsd.0000000000001371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 06/29/2022] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE To characterize the variability in cost for anterior cervical discectomy and fusion (ACDF) constructs and to identify key predictors of procedural cost. SUMMARY OF BACKGROUND DATA ACDF is commonly performed for surgical treatment of cervical radiculopathy and myelopathy. Numerous biomechanical constructs and graft/biological options are available, with most demonstrating relatively equivalent clinical results. Despite the substantial focus on value in spine care, the differences and contributions to procedural cost in ACDF have not been well defined. MATERIALS AND METHODS We evaluated the records of patients who underwent a single level ACDF from 2016 to 2020 at 4 hospitals in a major metropolitan area. We abstracted demographics, insurance status, operative time, diagnosis, surgeon, institution, and components of procedural costs. Costs based on construct were compared using multivariable adjusted analyses using negative binomial regression. The primary outcome measures were cost differences between ACDF techniques. RESULTS Two hundred sixty-four patients were included, with procedures by 13 surgeons across 4 institutions. The total procedural cost for ACDF had a mean of US$2317 with wide variation (range, US$967-US$7370). Multivariable analysis revealed body mass index and use of polyether ether ketone to be correlated with increased cost while carbon fiber and autograft correlated with decreased cost. When comparing standalone device constructs to cases with anterior instrumentation (plate/screws), the total cost was significantly higher in the plate/screw group (US$2686±US$921 vs. US$1466±US$878, P<0.001). CONCLUSIONS We encountered wide variation in procedural costs associated with ACDF, including as much as an 8-fold difference in the cost of constructs. The most important drivers included instrumentation type and implant materials. Here, we identify potential targets of opportunity for health care organizations that are looking to reduce variance in procedural expenditures to improve health care savings associated with the performance of ACDF.
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Wang XJ, Huang KK, He JB, Wu TK, Rong X, Liu H. Fatty infiltration in cervical extensor muscle: is there a relationship with cervical sagittal alignment after anterior cervical discectomy and fusion? BMC Musculoskelet Disord 2022; 23:641. [PMID: 35791024 PMCID: PMC9254416 DOI: 10.1186/s12891-022-05606-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/30/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose To investigate the relationship between the preoperative paraspinal Goutalier grade of fatty infiltration and postoperative cervical sagittal alignment in patients undergoing anterior cervical discectomy and fusion (ACDF). Methods A total of 101 patients who underwent single-level ACDF with the Zero-profile implant system between March 2011 and April 2020 were included in this study. Cervical sagittal alignment parameters, including the C2-C7 Cobb angle, functional spinal unit (FSU) angle, cervical sagittal vertical axis (SVA), and T1 slope (T1S), were assessed. Preoperative magnetic resonance images were used to classify patients according to Goutalier grade. Clinical outcomes including Neck Disability Index (NDI) scores, Japanese Orthepaedic Association (JOA) scores and Visual Analogue Scale (VAS) scores were collected and analyzed. Results According to the Goutalier grade, 33 patients were classified as Goutalier 0–1 (Group A), 44 were classified as Goutalier 1.5–2 (Group B), and 24 were classified as Goutalier 2.5–4.0 (Group C). The mean age among the three groups showed significant differences (P = 0.007). At the last follow-up, the C2-C7 Cobb angle, FSU angle, and T1S improved after the surgery among the groups. Although there were varying degrees of loss of curvature among the different groups during the follow-up period, the postoperative cervical sagittal alignment parameters demonstrated no statistical differences among the three groups (P > 0.05). In addition, patients in all groups experienced significant relief of their symptoms, and the clinical scores were comparable among the groups (P > 0.05). Conclusion The complex nature of anterior cervical surgery requires surgical attention both in decompression and sagittal alignment. Our study demonstrates satisfactory postoperative cervical sagittal alignment of patients despite different grades of fatty infiltration of the multifidus muscle following single-level ACDF. Based on our results, the improvement and maintenance of cervical sagittal alignment after ACDF remains a complex problem that spine surgeons should consider before surgery.
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