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Yoganandan N, Choi H, Purushothaman Y, Vedantam A, Harinathan B, Banerjee A. Comparison of Load-Sharing Responses Between Graded Posterior Cervical Foraminotomy and Conventional Fusion Using Finite Element Modeling. JOURNAL OF ENGINEERING AND SCIENCE IN MEDICAL DIAGNOSTICS AND THERAPY 2024; 7:021006. [PMID: 37860789 PMCID: PMC10583278 DOI: 10.1115/1.4063465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/23/2023] [Indexed: 10/21/2023]
Abstract
Following the diagnosis of unilateral cervical radiculopathy and need for surgical intervention, anterior cervical diskectomy and fusion (conventional fusion) and posterior cervical foraminotomy are common options. Although patient outcomes may be similar between the two procedures, their biomechanical effects have not been fully compared using a head-to-head approach, particularly, in relation to the amount of facet resection and internal load-sharing between spinal segments and components. The objective of this investigation was to compare load-sharing between conventional fusion and graded foraminotomy facet resections under physiological loading. A validated finite element model of the cervical spinal column was used in the study. The intact spine was modified to simulate the two procedures at the C5-C6 spinal segment. Flexion, extension, and lateral bending loads were applied to the intact, graded foraminotomy, and conventional fusion spines. Load-sharing was determined using range of motion data at the C5-C6 and immediate adjacent segments, facet loads at the three segments, and disk pressures at the adjacent segments. Results were normalized with respect to the intact spine to compare surgical options. Conventional fusion leads to increased motion, pressure, and facet loads at adjacent segments. Foraminotomy leads to increased motion and anterior loading at the index level, and motions decrease at adjacent levels. In extension, the left facet load decreases after foraminotomy. Recognizing that foraminotomy is a motion preserving alternative to conventional fusion, this study highlights various intrinsic biomechanical factors and potential instability issues with more than one-half facet resection.
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Affiliation(s)
| | - Hoon Choi
- Cleveland Clinic Florida, Weston, FL 33331
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Maki Y, Kawasaki T, Takayama M. Tailor-Made Surgical Strategy for Coexistent Cervical Myelopathy and Bilateral Radiculopathy. Combined Laminoplasty, Laminectomy, and Foraminotomy: Report of Two Cases. Cureus 2023; 15:e50195. [PMID: 38186492 PMCID: PMC10771864 DOI: 10.7759/cureus.50195] [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: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
Cervical spondylosis is a common and degenerative disease consisting of myelopathy and radiculopathy. Surgical treatment can be considered for patients with cervical spondylosis resulting in severe pain, motor weakness, ambulation difficulty, and urination disorder. As myelopathy and radiculopathy often coexist, two-staged anterior and posterior fixation/decompression surgery can be selected to resolve those two pathologies. However, due to the invasiveness of that management, posterior surgery in a single session seems favorable. In this study, we present two cases of cervical spondylosis. A 67-year-old man was complaining of pain in the neck and right upper extremity. Radiographically, cervical canal stenosis was concurrently diagnosed with the foraminal stenosis of the left C3/4 and right C6/7. Laminoplasty from C3 to C6 (left open; C3 to C5, right open; C6) and foraminotomy of the left C3/4 and right C6/7 were performed in a single session. Another 43-year-old man was bothered by pain in the neck and bilateral upper extremities resulting from cervical canal stenosis and bilateral foraminal stenosis of C6/7. Laminoplasty from C3 to C5, laminectomy of C6, and foraminotomy of bilateral C6/7 were performed in a single session. Preoperative symptoms were remitted in both cases. As described in our cases, a tailor-made combination of laminoplasty, laminectomy, and foraminotomy can effectively resolve cervical spondylosis in a single session.
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Lee DH, Lee HJ, Cho JH, Hwang CJ, Yang JJ, Lee CS, Park S. Foraminal Restenosis After Posterior Cervical Foraminotomy for the Treatment of Cervical Radiculopathy. Global Spine J 2023; 13:2357-2366. [PMID: 35323054 PMCID: PMC10538319 DOI: 10.1177/21925682221083268] [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: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To elucidate incidence, risk factor, and clinical effect of bone regrowth after posterior cervical foraminotomy (PCF). METHODS Ninety-eight patients who underwent PCF for the treatment of cervical radiculopathy and were followed up for >2 years were retrospectively reviewed. Foraminal dimension, sagittal gap at resected area, facet thickness, lamina length, and cervical range of motion (ROM) were measured. Neck pain visual analogue scale (VAS), arm pain VAS, and neck disability index (NDI) were recorded. Radiographic measures were compared between segments with foraminal narrowing of ≥20% at the 2-years follow-up (restenosis segments) and foraminal narrowing of <20% (patent segments). RESULTS Sixty-nine patients with 109 segments were included. 73.4% (80/109) of foramens demonstrated foraminal narrowing and decrease of foraminal dimension of ≥20% occurred in 30.3% (30/109). Foraminal dimension at postoperative 2-days was significantly higher in the restenosis segments (P = .047). Furthermore, increase of foraminal dimension was significantly associated with foraminal restenosis of ≥20% (P = .018). Facet thickness was significantly higher in the restenosis segments compared to patent segments at postoperative 2-years follow-up (P = .038). Neck pain VAS was significantly aggravated only in the restenosis group at postoperative 2-years follow-up (P < .001). CONCLUSIONS Foraminal narrowing commonly occurs after PCF due to bone healing. Bone growth occurs in all directions while medial facet growth contributes more to foraminal restenosis. Greater widening of foramen during PCF is a risk factor for postoperative foramen restenosis. Therefore, amount of bone resection should be kept optimal and excessive resection should be avoided to prevent foramen restenosis.
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Affiliation(s)
- Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyeong-Joo Lee
- Department of Orthopedic surgery, Busan Bumin Hospital, Republic of Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Jun Yang
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido, Republic of Korea
| | - Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sehan Park
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido, Republic of Korea
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Yao R, Yan M, Liang Q, Wang H, Liu Z, Li F, Zhang H, Li K, Sun F. Clinical efficacy and learning curve of posterior percutaneous endoscopic cervical laminoforaminotomy for patients with cervical spondylotic radiculopathy. Medicine (Baltimore) 2022; 101:e30401. [PMID: 36086740 PMCID: PMC10980377 DOI: 10.1097/md.0000000000030401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022] Open
Abstract
In this study, we aimed to investigate the clinical efficacy and learning curve of posterior percutaneous endoscopic cervical laminoforaminotomy (PPECLF) in patients with cervical spondylotic radiculopathy (CSR). A total of 64 patients with CSR received PPECLF. Clinical outcome scores included the visual analog scale, Japanese Orthopedic Association score, neck disability index, and modified Macnab criteria. Radiological outcomes included the disc height, C2 to C7 Cobb angle, and range of motion. The learning curve was evaluated using cumulative sum analysis. Patients were divided into accumulation phase and mastery phase groups (A and B), and general data and surgical efficacy were compared between the 2 groups. Follow-up ranged from 12 to 24 months. Clinical outcome scores improved significantly at the final follow-up, and there were no differences in radiological outcomes. Surgical efficacy was excellent and good in 82.8% of patients. The operative time showed a decreasing trend with the accumulation of cases. Patients were divided and the 26th case was the cutoff point according to the learning curve. No significant differences were found in the clinical outcomes between the 2 groups. Decompression with PPECLF was safe and effective in the treatment of CSR. With the accumulation of cases, the operative time was gradually shortened, and the clinical efficacy was significant. The PPECLF procedure can be performed efficiently and safely to treat CSR.
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Affiliation(s)
- Ran Yao
- The No.2 Department of Orthopedics, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Ming Yan
- Department of Spinal Surgery, First Hospital of Bethune, Jilin University, Changchun, China
| | - Qingchen Liang
- The No.2 Department of Orthopedics, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Hongqing Wang
- The No.2 Department of Orthopedics, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Zuyao Liu
- The No.2 Department of Orthopedics, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Fu Li
- The No.2 Department of Orthopedics, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Hao Zhang
- The No.2 Department of Orthopedics, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Ke Li
- The No.2 Department of Orthopedics, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Fenglong Sun
- The No.2 Department of Orthopedics, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
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Holy M, MacDowall A, Sigmundsson FG, Olerud C. Operative treatment of cervical radiculopathy: anterior cervical decompression and fusion compared with posterior foraminotomy: study protocol for a randomized controlled trial. Trials 2021; 22:607. [PMID: 34496941 PMCID: PMC8425018 DOI: 10.1186/s13063-021-05492-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cervical radiculopathy is the most common disease in the cervical spine, affecting patients around 50-55 year of age. An operative treatment is common clinical praxis when non-operative treatment fails. The controversy is in the choice of operative treatment, conducting either anterior cervical decompression and fusion or posterior foraminotomy. The study objective is to evaluate short- and long-term outcome of anterior cervical decompression and fusion (ACDF) and posterior foraminotomy (PF) METHODS: A multicenter prospective randomized controlled trial with 1:1 randomization, ACDF vs. PF including 110 patients. The primary aim is to evaluate if PF is non-inferior to ACDF using a non-inferiority design with ACDF as "active control." The neck disability index (NDI) is the primary outcome measure, and duration of follow-up is 2 years. DISCUSSION Due to absence of high level of evidence, the authors believe that a RCT will improve the evidence for using the different surgical treatments for cervical radiculopathy and strengthen current surgical treatment recommendation. TRIAL REGISTRATION ClinicalTrials.gov NCT04177849. Registered on November 26, 2019.
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Affiliation(s)
- Marek Holy
- Department of Orthopedic Surgery, Örebro University School of Medical Sciences, Örebro University Hospital, Örebro, Sweden.
| | - Anna MacDowall
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Freyr Gauti Sigmundsson
- Department of Orthopedic Surgery, Örebro University School of Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - Claes Olerud
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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Maduri R, Cossu G, Aureli V, Wüthrich SP, Bobinski L, Duff JM. Transtubular Anterior Cervical Foraminotomy for the Treatment of Compressive Cervical Radiculopathy: Surgical Results and Complications in a Consecutive Series of Cases. Asian Spine J 2020; 15:673-681. [PMID: 33189103 PMCID: PMC8561162 DOI: 10.31616/asj.2020.0323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/12/2020] [Indexed: 11/23/2022] Open
Abstract
Study Design This was a retrospective review of patients with compressive cervical radiculopathy treated with a minimally invasive anterior cervical foraminotomy (ACF). Purpose This study aimed to evaluate the results and complication rates of ACF in a consecutive series of patients and to report our clinical results of ACF as a minimally invasive technique in a series of 45 consecutive patients treated for compressive cervical radiculopathy. Overview of Literature ACF is a motion-sparing procedure and an alternative to anterior cervical discectomy and fusion (ACDF) and posterior cervical foraminotomy for direct nerve root decompression in patients with compressive cervical radiculopathy. Methods The chart review recorded clinical and radiological features preoperatively and postoperatively and at follow-up (FU). The effect of prognostic factors was analyzed in relation to the clinical outcome. Results Between January 2004 and October 2019, 45 patients (15 females and 30 males) with a mean age of 55.9 years (range, 28-78 years) underwent ACF for unilateral cervical radiculopathy. The global clinical outcome according to the MacNab scale was evaluated as excellent in 64.5% of patients (n=29), good in 28.9% (n=13), fair in 4.4% (n=2), and poor in 2.2% (n=1). The radiological FU was available for 73.3% (n=33). The statistical analysis revealed no influence of age, sex, operated level, and side on the clinical outcome. Only one patient (2.2%) exhibited spontaneous bone fusion at the operated level on FU after a right-sided C6-7 ACF with no clinical consequences. No patient presented with signs of delayed segmental instability. The overall reoperation rate of this series was 4.4%. Conclusions ACF is a feasible and low-cost alternative to ACDF in selected patients with cervical radiculopathy. The use of tubular retractors in ACF may confer an added advantage that creates a safe corridor for direct cervical root decompression yet minimizing surrounding soft tissue retraction and avoiding unnecessary bone removal.
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Affiliation(s)
- Rodolfo Maduri
- Avaton Surgical Group, Clinique de Genolier, Swiss Medical Network, Genolier, Switzerland
| | - Giulia Cossu
- Department of Clinical Neurosciences, Service of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Viviana Aureli
- Department of Clinical Neurosciences, Service of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sonia Plaza Wüthrich
- Centre Leenaards de la Memoire, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Lukas Bobinski
- Spine Unit, Department of Orthopedics, University Hospital of Umeå, Umeå, Sweden
| | - John Michael Duff
- Avaton Surgical Group, Clinique de Genolier, Swiss Medical Network, Genolier, Switzerland
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Kim HJ, Kang MS, Lee SH, Park CH, Chung SW, Shin YH, Lee SY, Park ES. Feasibility of Posterior Cervical Foraminotomy for Adjacent Segmental Disease after Anterior Cervical Fusion. J Korean Neurosurg Soc 2020; 63:767-776. [PMID: 32898966 PMCID: PMC7671782 DOI: 10.3340/jkns.2020.0033] [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: 02/08/2020] [Accepted: 03/19/2020] [Indexed: 12/04/2022] Open
Abstract
Objective The aim of this study is to evaluate the feasibility of posterior cervical foraminotomy (PCF) for adjacent segmental disease (ASD) after anterior cervical fusion (ACF). As ACF is accepted as the standard treatment for cervical spondylosis, many studies have been conducted to evaluate the efficacy of various surgical techniques to overcome symptomatic ASD after the previous surgery. Herein, PCF was performed for the treatment of symptomatic ASD and the feasibility of the surgery was evaluated.
Methods Forty nine patients who underwent PCF due to symptomatic ASD from August 2008 to November 2017 were identified. For demographic and perioperative data, the sex, age, types of previous surgery, ASD levels, operation times, and bleeding amount were recorded. The clinical outcome was assessed using the visual analogue scale for the neck and arm, the modified Odom’s criteria as well as neck disability index. Radiologic evaluations were performed by measuring disc softness, disc height, the cervical 2–7 sagittal vertical axis, cervical cobb angle, and facet violation.
Results Thirty-seven patients were enrolled in this study. The patients were divided into two groups based on the location of the pathology; paracentral (group P) or foramina (group F). Both groups showed significant clinical improvement (p<0.05). The proportion of calcified disc and facet violations was significantly larger in group F (p<0.05). The minimal disc height decrease with mild improvement on sagittal alignment and cervical lordosis was radiologically measured without statistical significance in both groups (p>0.05).
Conclusion PCF showed satisfactory clinical and radiologic outcomes for both paracentral and foraminal pathologies of ASD after ACF. Complications related to anterior revision were also avoided. PCF can be considered a feasible and safe surgical option for ASD after ACF.
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Affiliation(s)
- Hyun Jun Kim
- Department of Neurosurgery, Daegu Wooridul Spine Hospital, Daegu, Korea
| | - Min Soo Kang
- Department of Neurosurgery, Daegu Wooridul Spine Hospital, Daegu, Korea
| | - Sang Ho Lee
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea
| | - Chan Hong Park
- Department of Anesthesiology and Pain Medicine, Daegu Wooridul Spine Hospital, Daegu, Korea
| | - Seok Won Chung
- Department of Neurosurgery, Daegu Wooridul Spine Hospital, Daegu, Korea
| | - Yong Hwan Shin
- Department of Neurosurgery, Daegu Wooridul Spine Hospital, Daegu, Korea
| | - Shin Young Lee
- Department of Neurosurgery, Daegu Wooridul Spine Hospital, Daegu, Korea
| | - Eun Soo Park
- Department of Neurosurgery, Daegu Wooridul Spine Hospital, Daegu, Korea
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Tong Y, Huang Z, Hu C, Fan Z, Bian F, Yang F, Zhao C. A comparison study of posterior cervical percutaneous endoscopic ventral bony decompression and simple dorsal decompression treatment in cervical spondylotic radiculopathy caused by cervical foraminal and/or lateral spinal stenosis: a clinical retrospective study. BMC Musculoskelet Disord 2020; 21:290. [PMID: 32393314 PMCID: PMC7216365 DOI: 10.1186/s12891-020-03313-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/23/2020] [Indexed: 12/22/2022] Open
Abstract
Background Percutaneous endoscopic cervical decompression (PECD) is an ideal minimally invasive decompression technique for the treatment of cervical spondylotic radiculopathy (CSR). However, the mainstream is the resection of dorsal bone and removal of free nucleus pulposus. The necessity of excision of ventral osteophytes and hyperplastic ligaments in the treatment of CSR caused by cervical foraminal and/or lateral spinal stenosis (CFa/oLSS) to be discussed. Methods We performed a retrospective study of 46 patients with CSR caused by CFa/oLSS from January 2017 to November 2018. These patients received posterior percutaneous endoscopic cervical decompression-ventral bony decompression (PPECD-VBD)(23 cases, classified as VBD group) or posterior percutaneous endoscopic cervical decompression-simple dorsal decompression (PPECD-SDD)(23 cases, classified as SDD group). Following surgery, we recorded Visual Analogue Scale (VAS), Neck Disable Index (NDI), Japanese Orthopaedic Association (JOA) Scores and myodynamia. We further evaluated the changes of cervical curvature and cervical spine motion in the VBD group and recorded the operation time and complications during the follow-up of each patient. Results All patients underwent successful operations, with an average follow-up time of 16.53 ± 9.90 months. The excellent and good rates in the VBD and SDD groups were 91.29 and 60.87%, respectively. In the SDD group, neck-VAS, arm-VAS, and NDI scores were significantly higher than those of the VBD group at 1 day, 6 months, and 12 months after surgery (P < 0.05), while the JOA scores and improvement rate of JOA were significantly lower than those of the VBD group (P < 0.05). There were no significant differences in terms of angular displacement (AD), horizontal displacement (HD), segmental angle (SA) and cervical curvature (CA) before and after the operation in the VBD group (P > 0.05). Conclusion PPECD-VBD was significantly better than PPECD-SDD as well as PPECD-VBD had no significant effects on cervical spine stability or cervical curvature.
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Affiliation(s)
- Yuexin Tong
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province, China
| | - Zhangheng Huang
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province, China
| | - Chuan Hu
- Department of Orthopedic Surgery, The Affiliated Hospital of Qingdao University, Shinan District, Qingdao, Shandong province, China
| | - Zhiyi Fan
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province, China
| | - Fucheng Bian
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province, China
| | - Fengkai Yang
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province, China
| | - Chengliang Zhao
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province, China.
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