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Saheb RLC, Soeira TP, Moratelli L, Pontes MDDES, Herrero CFPDAS. EARLY COMPLICATIONS OF SURGICAL TREATMENT OF CERVICAL SPONDYLOTIC MYELOPATHY. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e260397. [PMID: 37547238 PMCID: PMC10399992 DOI: 10.1590/1413-785220233104e260397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/30/2022] [Indexed: 08/08/2023]
Abstract
Objective To evaluate the early postoperative complications associated with the surgical approach of the cervical spine of patients with cervical spondylotic myelopathy (CSM), comparing the anterior surgical, the posterior surgical, and the combined approaches. Methods This is a retrospective study based on a database with 169 patients. Demographic data, such as gender and age, and surgical data, such as surgical approach, number of segments with arthrodesis, surgical time, and complications, were evaluated. Complications were divided into major (deep surgical wound infection, intercurrence with the implant, early new compression, and heart failure) and minor (dysphagia, superficial infection, pain, urinary intercurrence, neuropraxia of the C5 root, acute confusional state, and surgical wound hematoma). Results This included 169 patients, 57 women (33.7%) and 112 men (66.2%). Age ranged from 21 to 87 years, with a mean of 56.48 (± 11) years. Of these, 52 (30.8%) underwent the anterior approach; 111 (65.7%), the posterior approach; and 6 (3.5%), the combined approach. Conclusion As in the literature, we evinced dysphagia, pain, and superficial infection of the surgical wound as the most frequent postoperative complications. However, it was impossible to establish a statistical relationship between the incidence of complications and surgical time, access route, and number of fixed segments. Level of Evidence III, Retrospective Comparative Study.
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Affiliation(s)
- Ricardo Lucca Cabarite Saheb
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto FMRP USP, Departamento de Ortopedia e Anestesiologia, Ribeirão Preto, SP, Brazil
| | - Thabata Pasquini Soeira
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto FMRP USP, Departamento de Ortopedia e Anestesiologia, Ribeirão Preto, SP, Brazil
| | - Lucas Moratelli
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Ortopedia e Traumatologia IOT HCFMUSP, São Paulo, SP, Brazil
| | - Mariana Demétrio DE Sousa Pontes
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto FMRP USP, Departamento de Ortopedia e Anestesiologia, Ribeirão Preto, SP, Brazil
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Kanda Y, Kakutani K, Sakai Y, Miyazaki K, Matsuo T, Yurube T, Takeoka Y, Ohnishi H, Ryu M, Kumagai N, Kuroshima K, Hiranaka Y, Kawamoto T, Hara H, Hoshino Y, Hayashi S, Akisue T, Kuroda R. Clinical Characteristics and Surgical Outcomes of Metastatic Spine Tumors in the Very Elderly: A Prospective Cohort Study in a Super-Aged Society. J Clin Med 2023; 12:4747. [PMID: 37510862 PMCID: PMC10380659 DOI: 10.3390/jcm12144747] [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: 04/21/2023] [Revised: 06/09/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
The number of advanced-age patients with spinal metastases is rising. This study was performed to clarify the characteristics and surgical outcomes of spinal metastases in advanced-age patients. We prospectively analyzed 216 patients with spinal metastases from 2015 to 2020 and divided them into three age groups: <70 years (n = 119), 70-79 years (n = 73), and ≥80 years (n = 24). Although there were no significant intergroup differences in preoperative characteristics and surgery-related factors except for age, patients aged ≥80 years tended to have a worse performance status (PS), Barthel index, and EuroQol-5 dimension (EQ-5D) before and after surgery than the other two groups. Although the median PS, mean Barthel index and mean EQ-5D greatly improved postoperatively in each group, the median PS and mean Barthel index at 6 months and the mean EQ-5D at 1 month postoperatively were significantly poorer in the ≥80-year group than the 70-79-year group. The rates of postoperative complications and re-deterioration of the EQ-5D were significantly higher in the oldest group than in the other two groups. Although surgery for spinal metastases improved the PS, Barthel index, and EQ-5D regardless of age, clinicians should be aware of the poorer outcomes and higher complication rates in advanced-age patients.
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Affiliation(s)
- Yutaro Kanda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Kunihiko Miyazaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Tomoya Matsuo
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Takashi Yurube
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yoshiki Takeoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Hiroki Ohnishi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Masao Ryu
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Naotoshi Kumagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Kohei Kuroshima
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yoshiaki Hiranaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Teruya Kawamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Hitomi Hara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Toshihiro Akisue
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
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Funao H, Igawa T, Matsuzawa M, Isogai N, Ishii K. Comparative Study of Anticipatory Postural Adjustments between Normal and Cervical Myelopathy Patients. J Clin Med 2023; 12:jcm12103584. [PMID: 37240690 DOI: 10.3390/jcm12103584] [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: 04/26/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Patients with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament have been considered to be prone to falls due to lower extremity dysfunction and gait instability. Anticipatory postural adjustments (APAs) are unconscious muscular activities to counterbalance perturbation. To date, there are no reports on APAs in cervical myelopathy patients, and quantification of postural control remains difficult. Thirty participants were enrolled, of which 15 were cervical myelopathy patients and 15 were normal age- and sex-matched controls. A three-dimensional motion capture system with force plates was used, and the APA phase was defined as the time between start of movement at the center of pressure and heel-off of the step leg. The APA phase (0.47 vs. 0.39 s, p < 0.05) and turning time (2.27 vs. 1.83 s, p < 0.01) were significantly longer, whereas step length tended to be shorter (305.18 vs. 361.04 mm, p = 0.06) in cervical myelopathy patients. There was a significant correlation between Japanese Orthopaedic Association lower extremity motor dysfunction scores and step length (p < 0.01). Cervical myelopathy patients are prone to falls due to longer APA phases with shorter step lengths. Analysis of the APA phase aids the visualization and quantification of postural control during initial gait in cervical myelopathy patients.
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Affiliation(s)
- Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Chiba 286-8686, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, Chiba 286-0124, Japan
| | - Tatsuya Igawa
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, Tochigi 324-8501, Japan
| | - Masaru Matsuzawa
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, Tochigi 324-8501, Japan
| | - Norihiro Isogai
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Chiba 286-8686, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
- Society for Minimally Invasive Spinal Treatment (MIST), Tokyo 101-0063, Japan
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Hirayama Y, Mowforth OD, Davies BM, Kotter MRN. Determinants of quality of life in degenerative cervical myelopathy: a systematic review. Br J Neurosurg 2023; 37:71-81. [PMID: 34791981 DOI: 10.1080/02688697.2021.1999390] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Degenerative cervical myelopathy (DCM) is the most common cause of chronic, progressive spinal cord impairment worldwide. Patients experience substantial pain, functional neurological decline and disability. Health-related quality of life (HRQoL) appears to be particularly poor, even when compared to other chronic diseases. However, the determinants of HRQoL are poorly understood. The objective was to perform a systematic review of the determinants of quality of life of people with DCM. METHODS A systematic search was conducted in MEDLINE and Embase following PRISMA 2020 guidelines (PROSPERO CRD42018115675). Full-text papers in English, exclusively studying DCM, published before 26 March 2020 were eligible for inclusion and were assessed using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias 2 (RoB 2) tool. Study sample characteristics, patient demographics, cohort type, HRQoL instrument utilised, HRQoL score, and relationships of HRQoL with other variables were qualitatively synthesised. RESULTS A total of 1176 papers were identified; 77 papers and 13,572 patients were included in the final analysis. A total of 96% of papers studied surgical cohorts and 86% utilised the 36-Item Short Form Survey (SF-36) as a measure of HRQoL. HRQoL determinants were grouped into nine themes. The most common determinant to be assessed was surgical technique (38/77, 49%) and patient satisfaction and experience of pain (10/77, 13%). HRQoL appeared to improve after surgery. Pain was a negative predictor of HRQoL. CONCLUSION Current data on the determinants of HRQoL in DCM are limited, contradictory and heterogeneous. Limitations of this systematic review include lack of distinction between DCM subtypes and heterogenous findings amongst the papers in which HRQoL is measured postoperatively or post-diagnosis. This highlights the need for greater standardisation in DCM research to allow further synthesis. Studies of greater precision are necessary to account for HRQoL being complex, multi-factorial and both time and context dependent.
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Affiliation(s)
- Yuri Hirayama
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Oliver D Mowforth
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Benjamin M Davies
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Mark R N Kotter
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
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Luo CA, Lim AS, Lu ML, Chiu PY, Lai PL, Niu CC. The surgical outcome of multilevel anterior cervical discectomy and fusion in myelopathic elderly and younger patients. Sci Rep 2022; 12:4495. [PMID: 35296700 PMCID: PMC8927471 DOI: 10.1038/s41598-022-08243-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 02/28/2022] [Indexed: 11/09/2022] Open
Abstract
The elderly population has an increased risk of degenerative cervical myelopathy due to multilevel disease, causing motor and sensory dysfunctions and a poor quality of life. Multilevel anterior cervical discectomy and fusion (ACDF) is an alternative surgical treatment option, but has a perceived higher risk of complications. The goal of this study is to report the outcome. We retrospectively reviewed patients from 2006 to 2019 undergoing multilevel ACDF for degenerative cervical myelopathy and compared outcomes and complications between elder patients (aged 70 and above) and younger patients (below 70). The patients' comorbidities, and postoperative complications, radiographic parameters such as C2-C7 Cobb angle, C2-C7 sagittal vertical axis, inter-body height of surgical levels and fusion rate were recorded. Japanese Orthopaedic Association (JOA) score and modified Odom's score were collected. Included were 18 elderly (mean age 74, range 70-87) and 45 young patients (mean age 56, range 43-65) with a follow-up of 43.8 and 55.5 months respectively. Three-level ACDF was the most common. The ratios of ASA class III patients were 94.4% and 48.9% (p < 0.001). The Charlson comorbidity indexes were 4.3 ± 1.03 and 2.1 ± 1.11 (p < 0.001). The average lengths of hospital stays were 4.9 and 4.6 days. Eleven patients (61.1%) in the elderly group experienced at least one short-term complication, compared with 16 patients (35.6%) in the younger group (p < 0.05). The middle-term complications were comparable (22.2% and 20.0%). The JOA score, recovery rate and modified Odom score showed comparable result between groups. Despite its extensiveness, multilevel ACDF is feasible for the elder patients with good clinical outcome and fusion rate. When compared to younger cohort, there is a trend of lower preoperative JOA score and recovery rate. The short-term complication rate is higher in the elderly group.
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Affiliation(s)
- Chi-An Luo
- Department of Orthopaedic Surgery, Spine Division, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, ROC.,Department of Orthopaedic Surgery, New Taipei Municipal Tucheng Hospital (Built and Operated By Chang Gung Medical Foundation), No. 6, Sec. 2, Jincheng Rd., Tucheng Dist., New Taipei City, 236, Taiwan, ROC.,Chang Gung University College of Medicine, No.259, Wenhua 1st Rd, Guishan Dist., Taoyuan City, 333, Taiwan, ROC
| | - Austin Samuel Lim
- Department of Surgery, Section of Orthopedics, Orthopedic and Spine Surgery, Metropolitan Medical Center, No.1357, Masangkay St, Santa Cruz, 1012, Manila, Metro Manila, Philippines.,Department of Surgery, Section of Orthopedics, Orthopedic and Spine Surgery, Chinese General Hospital, No.286, Blumentritt Rd, Sampaloc, Manila, Metro Manila, Philippines
| | - Meng-Ling Lu
- Department of Orthopaedic Surgery, Spine Division, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, 833, Taiwan, ROC
| | - Ping-Yeh Chiu
- Department of Orthopaedic Surgery, Spine Division, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, ROC.,Chang Gung University College of Medicine, No.259, Wenhua 1st Rd, Guishan Dist., Taoyuan City, 333, Taiwan, ROC
| | - Po-Liang Lai
- Department of Orthopaedic Surgery, Spine Division, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, ROC.,Chang Gung University College of Medicine, No.259, Wenhua 1st Rd, Guishan Dist., Taoyuan City, 333, Taiwan, ROC
| | - Chi-Chien Niu
- Department of Orthopaedic Surgery, Spine Division, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, ROC. .,Chang Gung University College of Medicine, No.259, Wenhua 1st Rd, Guishan Dist., Taoyuan City, 333, Taiwan, ROC.
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Li B, Liu S, Wang Y, Zhao J, Song Y, Xu W, Zhang C, Gao C, Zhao Q, Wu D. The influence of carotid atherosclerosis on surgical outcomes of patients with cervical spondylotic myelopathy: A retrospective study. Medicine (Baltimore) 2022; 101:e28743. [PMID: 35119027 PMCID: PMC8812591 DOI: 10.1097/md.0000000000028743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/12/2022] [Indexed: 01/04/2023] Open
Abstract
The appearance of atherosclerosis in the carotid artery may be suggest the possibility of atherosclerosis in the spinal cord artery, which can cause spinal cord ischemia and further lead to neural element damage.According to the inclusion and exclude standard, there are 137 patients with cervical spondylotic myelopathy (CSM) incorporating retrospective analysis. These patients were consecutively admitted into The Second Hospital- Cheeloo College of Medicine-Shandong University from January 2016 to December 2018 and have accepted surgical treatment. All patients were examined by color Doppler ultrasound to detect carotid atherosclerosis before surgery. All patients were divided into 2 groups according to the presence or absence of carotid atherosclerosis: carotid atherosclerosis group (n = 88) and noncarotid atherosclerosis group (n = 49). All patients were followed up for at least 12 months after surgery. Demographic and surgery-related data were collected and analyzed to identify potential factors that affect the surgical outcomes in CSM.The average age of carotid atherosclerosis group (51 males and 37 females), and noncarotid atherosclerosis group (24 males and 25 females) were 62.02 ± 10.34 years (range, 38-85 years) and 49.61 ± 10.28 years (range, 26-67 years), respectively.In carotid atherosclerosis group: pre and postoperative modify Japanese Orthopedic Association Scores (mJOA score) were 11.58 ± 1.82 and 14.36 ± 1.64; the recovery rate of mJOA score was 45.57% ± 13.28%. In noncarotid atherosclerosis group: pre and postoperative mJOA score were 12.00 ± 2.11 and 15.04 ± 1.70; the recovery rate of mJOA score was 53.90% ± 13.22%. Univariate logistic regression analysis demonstrated that gender (P = .004), age ≥65 years (P = .001), duration of symptoms ≥12 months (P = .040), smoking history (P < .001), preoperative mJOA score ≤11 (P = .007) and carotid atherosclerosis (P = .004) were related to poor surgical outcomes. Multivariate logistic regression analysis showed significant correlations between poor surgical outcomes and age ≥65 years (P = .047), smoking history (P = .010), preoperative mJOA score ≤11 (P = .008) or carotid atherosclerosis (P = .047).Carotid atherosclerosis may be a risk factor for poor surgical outcomes in CSM.
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Affiliation(s)
- Bohan Li
- Health Management Center, The Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, PR China
| | - Shuling Liu
- Department of Radiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Shandong, PR China
| | - Yongmei Wang
- Department of Cardiology, The Second Hospital, Cheeloo College of Medicine, Shandong University,Shandong, PR China
| | - Jie Zhao
- Department of Spine Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, PR China
| | - Yang Song
- Department of Spine Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, PR China
| | - Wen Xu
- Department of Spine Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, PR China
| | - Cheng Zhang
- Department of Spine Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, PR China
| | - Chunzheng Gao
- Department of Spine Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, PR China
| | - Qian Zhao
- Department of cardiovascular, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Shandong, PR China
| | - Dongjin Wu
- Department of Spine Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, PR China
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Hirai T, Yoshii T, Egawa S, Sakai K, Kusano K, Nakagawa Y, Wada K, Katsumi K, Fujii K, Kimura A, Furuya T, Nagoshi N, Kanchiku T, Nagamoto Y, Oshima Y, Ando K, Takahata M, Mori K, Nakajima H, Murata K, Matsunaga S, Kaito T, Yamada K, Kobayashi S, Kato S, Ohba T, Inami S, Fujibayashi S, Katoh H, Kanno H, Imagama S, Koda M, Kawaguchi Y, Takeshita K, Matsumoto M, Yamazaki M, Okawa A. Severity of Myelopathy is Closely Associated With Advanced Age and Signal Intensity Change in Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Nationwide Investigation. Clin Spine Surg 2022; 35:E155-E161. [PMID: 33769979 DOI: 10.1097/bsd.0000000000001164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Prospective, nationwide case series. OBJECTIVE To identify preoperative factors associated with myelopathy and neurological impairment in patients with cervical ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA Various studies have reported clinical outcomes following the surgical treatment of OPLL. However, there has been no large-scale study of preoperative clinical features in patients with cervical OPLL. MATERIALS AND METHODS Data were prospectively collected from 28 institutions nationwide in Japan. In total, 512 patients with neurological impairment caused by cervical OPLL requiring surgery were enrolled. Basic demographic and clinical data, including age, sex, diabetes status, body mass index, smoking history, and disease duration were collected. C2-7 lordotic angle, canal narrowing ratio, range of motion in flexion-extension at C2-7, and type of OPLL were evaluated on lateral radiographs to identify factors influencing the clinical features of patients with OPLL in whom surgery was planned. RESULTS Complete documentation was available for 490 patients (362 male, 128 female). In total, 34 patients had the localized type, 181 had the segmental type, 64 had the continuous type, and 211 had the mixed type. Although there were no significant differences in age, body mass index, disease duration, Japanese Orthopedic Association (JOA) score, and lordotic angle at C2-7 according to the type of OPLL, significant differences were observed in a range of motion at C2-7 and the canal narrowing ratio among the 4 types. Multiple regression analysis revealed that the JOA score was significantly associated with age and signal intensity change on magnetic resonance imaging. CONCLUSIONS This is the first large-scale, prospective, multicenter case series study to investigate factors influencing preoperative neurological status in patients with OPLL. Age and signal intensity change on magnetic resonance images were significantly associated with JOA score in patients requiring surgery. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
| | - Satoru Egawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
| | - Kenichiro Sakai
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Saitama
| | - Kazuo Kusano
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Kudanzaka Hospital, Chiyadaku
| | - Yukihiro Nakagawa
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedic Surgery, Wakayama Medical University Kihoku Hospital, Wakayama
| | - Kanichiro Wada
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Aomori
| | - Keiichi Katsumi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Niigata University Medicine and Dental General Hospital, Niigata
| | - Kengo Fujii
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Atsushi Kimura
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedics, Jichi Medical University, Tochigi
| | - Takeo Furuya
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba
| | - Narihito Nagoshi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo
| | - Tsukasa Kanchiku
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Yamaguchi
| | - Yukitaka Nagamoto
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Osaka
| | - Yasushi Oshima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo
| | - Kei Ando
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Aichi
| | - Masahiko Takahata
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo
| | - Kanji Mori
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Shiga
| | - Hideaki Nakajima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, Fukui
| | - Kazuma Murata
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo
| | - Shunji Matsunaga
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Imakiire General Hospital, Kagoshimashi
| | - Takashi Kaito
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, Osaka
| | - Kei Yamada
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Fukuoka
| | - Sho Kobayashi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Shizuoka
| | - Satoshi Kato
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa
| | - Tetsuro Ohba
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, University of Yamanashi, Yamanashi
| | - Satoshi Inami
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, Tochigi
| | - Shunsuke Fujibayashi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Hiroyuki Katoh
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa
| | - Haruo Kanno
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Miyagi
| | - Shiro Imagama
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Aichi
| | - Masao Koda
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Yoshiharu Kawaguchi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Katsushi Takeshita
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedics, Jichi Medical University, Tochigi
| | - Morio Matsumoto
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo
| | - Masashi Yamazaki
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Tokyo
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Surgical management of cervical spinal cord injury in extremely elderly patients, aged 80 or older. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Impact of Tobacco Smoking on Outcomes After Posterior Decompression Surgery in Patients With Cervical Spondylotic Myelopathy: A Retrospective Multicenter Study. Clin Spine Surg 2020; 33:E493-E498. [PMID: 33000929 DOI: 10.1097/bsd.0000000000000984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a case-control study. OBJECTIVE The objective of this study was to clarify the surgical outcomes after cervical posterior decompression in patients who smoked. SUMMARY OF BACKGROUND DATA Smoking is associated with poor outcomes in the field of spinal surgery. However, the impact of tobacco smoking on the outcomes after posterior decompression surgery has not been fully evaluated in patients with cervical spondylotic myelopathy. MATERIALS AND METHODS In this retrospective multicenter study, 587 patients with cervical spondylotic myelopathy were enrolled at 17 institutions in Japan. Patients underwent cervical laminoplasty or laminectomy and were followed up for at least 1 year after surgery. Outcome measures were: preoperative smoking status, perioperative complications, the Japanese Orthopedic Association scale, and the Visual Analog Scale for neck pain. After adjusting for age and sex by exact matching, smoking and nonsmoking groups were compared using an unpaired t test for continuous variables or a χ test for categorical variables. RESULTS There were 182 (31%) current smokers and 405 (69%) nonsmokers including previous smokers. After matching, 158 patients were extracted from each group. Demographic data and surgical information were almost the same between the groups. Regarding postoperative complications, there was no significant difference in the rate of surgical site infection, cerebrospinal fluid leakage, hematoma, segmental motor paralysis, or neurological deficit. However, smokers showed a significantly higher risk for delirium (3.8% vs. 0.0%, P=0.039). Smokers and nonsmokers showed comparable changes in functional recovery according to Japanese Orthopedic Association scores (3.2±2.1 vs. 3.0±2.1, P=0.425) and in neck pain reduction using the Visual Analog Scale (-1.7±3.1 vs. -1.4±2.8, P=0.417) at the final follow-up. CONCLUSIONS Smokers exhibited functional restoration and neck pain reduction after cervical posterior decompression. Attention is required, however, for the postoperative complication of delirium, which could be caused by the acute cessation of tobacco smoking after admission. LEVEL OF EVIDENCE Level III.
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Complications and Accuracy of Computed Tomography-guided Transthoracic Needle Biopsy in Patients Over 80 Years of Age. J Thorac Imaging 2019; 34:187-191. [PMID: 30817502 DOI: 10.1097/rti.0000000000000403] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the complications and diagnostic accuracy of computed tomography-guided percutaneous transthoracic needle biopsy (PTNB) in patients aged 80 years and older. MATERIALS AND METHODS Consecutive PTNB procedures performed in an academic institution between July 2009 and June 2013 were reviewed. Procedures were performed according to a standard protocol using conscious sedation and rapid on-site pathology evaluation. Patient demographics, lesion characteristics, complications, and final tissue diagnosis were reviewed. Patients below 80 years of age and over 80 years were compared using binary logistic regression. RESULTS Of 894 biopsies, 141 (16%) were performed on patients over 80 years of age. Comparison of patients over and below 80 years of age did not differ significantly with regard to lesion size and morphology (P=0.663 and 0.453, respectively), and diagnostic accuracy (P=0.268). Pneumothorax rates were 23% versus 24% (P=0.682), and chest tube insertion was required in 2% of both groups (P=0.924). Hemoptysis rates were 3% versus 2% (P=0.376). CONCLUSIONS PTNB is a safe and accurate procedure in patients aged 80 years and older. Complications and diagnostic accuracy are similar to those observed in younger patients.
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Clinical comparison between simple laminectomy and laminectomy plus posterior instrumentation in surgical treatment of cervical myelopathy. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:975-982. [PMID: 30737557 DOI: 10.1007/s00590-019-02395-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 02/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Posterior stabilization in patients treated with laminectomy for spondylotic cervical myelopathy is still a debate. Despite both being reported in literature by several authors, some controversies still exist. The aim of this study is to compare clinical and radiological outcomes in patients treated with laminectomy or laminectomy with posterior stabilization. MATERIAL AND METHODS We retrospectively evaluated 42 patients affected by cervical myelopathy (mean age 70.43 ± 5.03 years), 19 treated with laminectomy (group A) and 23 with laminectomy and posterior instrumentation (group B). Neurological status was assessed with Nurick scale, pain with VAS and radiological parameters with C2-C7 SVA, T1 slope and C2-C7 lordosis, clinical function with modified Japanese Orthopaedic Association score (JOA). Also, surgery time and blood loss were recorded. Student's t test was used for continuous variables, while Kruskal-Wallis test was used for categorical values. RESULTS No differences were found in postoperative Nurick scale (p = 0.587), VAS (p = 0.62), mJOA (p = 0.197) and T1 slope (p = 0.559), while laminectomy with fusion showed better postoperative cervical lordosis (p = 0.007) and C2-C7 SVA (p < 0.00001), but higher blood loss (p < 0.00001) and surgical time (p < 0.00001). Both groups showed better Nurick scale (p = 0.00017 for group A and p = 0.00081 for group B), VAS (p = 0.02 for group A and p = 0.046 for group B) and mJOA (p < 0.00001 for both groups) than preoperative values. CONCLUSIONS Both treatments are a valuable choice, offering some benefits and disadvantages against each other. Each procedure must be carefully evaluated on the basis of patients' general status, preoperative pain, signs of instability and potential benefits from cervical alignment correction.
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Kire N, Jain S, Merchant ZA, Kundnani V. The Efficacy of Posterior Cervical Laminectomy for Multilevel Degenerative Cervical Spondylotic Myelopathy in Long Term Period. Asian J Neurosurg 2019; 14:848-852. [PMID: 31497113 PMCID: PMC6703065 DOI: 10.4103/ajns.ajns_49_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Study Design: This was a retrospective analysis. Background: Surgical decompression is the gold standard for preventing the progression of neurological deficit in degenerative multilevel cervical spondylotic myelopathy (CSM). The efficacy of posterior laminectomy in the surgical management of CSM has been described in the past, but long-term follow-up data are scanty. Objective: The aim of this study is to assess the long-term clinical-radiological outcomes following posterior cervical decompressive laminectomy in multilevel degenerative CSM. Materials and Methods: A retrospective analysis of 110 patients with degenerative multilevel CSM who underwent posterior cervical laminectomy alone in a single hospital by a single surgeon from 2009 to 2013 with minimum 5-year follow-up. Pre- and post-operative clinical parameters (visual analog scale [VAS], Nurick and modified Japanese orthopedic association [mJOA]), radiological parameter (Sagittal cervical Cobb's Angle), perioperative complications (time, blood loss, and hospital stay), postoperative complications (infection, C5 palsy, and neurological worsening) were evaluated. Results: Totally 110 patients (males – 68 and females – 42) with age varying from 46 to 80 (mean-57) years, and the mean duration of illness was 3 months were evaluated. Mean clinical parameters are VAS (preoperative = 5 ± 1.31, postoperative = 1.49 ± 0.687), Nurick grading (preoperative = 3.23 ± 71, postoperative = 1.924 ± 0.75), and mJOA (preoperative = 6.32 ± 0.87, postoperative = 9.89 ± 1.37). The mean blood loss was 93.95 ± 19.18 ml, and the mean time taken for surgery was 83.65 ± 10.18 min. About 13% (n = 15) patients developed cervical kyphosis and 29% (n = 32) developed changes in cervical spine alignment and 10% (n = 11) developed worsening of neurology at final follow-up. Two patients developed a superficial infection which was managed with antibiotics. Three patients developed C5 palsy which recovered with due time. Conclusions: With the proper selection of patients, posterior cervical laminectomy is effective in offering a clinical improvement to patients with degenerative multilevel CSM with a low incidence of clinically significant radiological deterioration.
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Affiliation(s)
- Neilakuo Kire
- Spine Unit, Department of Orthopeadics, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Sanyam Jain
- Spine Unit, Department of Orthopeadics, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Zahir Abbas Merchant
- Spine Unit, Department of Orthopeadics, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Vishal Kundnani
- Spine Unit, Department of Orthopeadics, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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