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Qiu C, Zhao Y, Wang L, Gao X, Yang W, Li H, Pan X, Li Y, Liu X, Wang S. Anterior cervical tunnectomy and fusion (ACTF): a novel technique for cervical canal decompression. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2110-2119. [PMID: 37067599 DOI: 10.1007/s00586-023-07691-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/22/2023] [Accepted: 03/27/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVE To describe a novel surgical technique note coined as anterior cervical tunnectomy and fusion (ACTF) which applying on removal of posterior vertebral bony protrusions or soft extrusions. METHODS Total twenty-three patients from January 2016 to January 2021 who experienced with spinal cord compression and performed by ACTF were retrospectively reviewed. Herein, relevant information including patient's gender, age, BMI, intraoperative time, intraoperative blood loss, postoperative complications and postoperative hospitalized stay were collected. Furthermore, JOA and VAS score were both collected. Moreover, imaging parameters were measured and calculated on radiographs. Correlated data were analyzed by t test. Significance was considered when P < 0.05. RESULTS All patients in this study were validated with favorable outcomes and none of postoperative complications. The Nurick grade of patients dramatically deceased postoperation (P < 0.001). And postoperative VAS score of patients (P < 0.001), as well as JOA score (P < 0.001), was given dramatical significance comparing to preoperation. Furthermore, occupying rate (OR) (P < 0.001) was obviously reduced while space available cord (SAC) (P < 0.001) and diameter of spinal cord (P < 0.001) was significantly increased postoperation. Meanwhile, disc height of involved segment, C2-7 SVA, and C2-C7 Cobb angle were measured on sagittal plane of lateral radiograph. Postoperative disc height of involved segment (P < 0.001) significantly elevated comparing to preoperation. However, there were no significance on C2-7 SVA (P = 0.460) and C2-C7 Cobb angle (P = 0.097). CONCLUSIONS The novel surgical technique coined by ACTF is a practicable approach during taking charge of bony and soft narrowing behind vertebral space.
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Affiliation(s)
- Cheng Qiu
- Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China
- Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Yunpeng Zhao
- Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Lianlei Wang
- Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Xianlei Gao
- Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Wanliang Yang
- Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Hao Li
- Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Xin Pan
- Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Yuhua Li
- Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China.
| | - Xinyu Liu
- Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China.
| | - Songgang Wang
- Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China.
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Ma Y, Xin Z, Kong W, Zhang L, Du Q, Liao W. Transcorporeal decompression using a fully-endoscopic anterior cervical approach to treat cervical spondylotic myelopathy: surgical design and clinical application. BMC Musculoskelet Disord 2022; 23:1031. [PMID: 36451136 PMCID: PMC9710048 DOI: 10.1186/s12891-022-06001-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/18/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) is a common procedure for treating cervical spondylotic myelopathy (CSM), however, ACDF may cause pseudoarthrosis, accelerated degeneration of adjacent segments, loss of activity of fused segments and other complications. The full-endoscopic technique can treat CSM, without the aforementioned complications above. Therefore, it is of great clinical value to investigate the surgical scheme of anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord (APFETDSC). METHODS A total of 28 cases with single-segment Cervical spondylotic myelopathy (CSM) from April 2017 to July 2019 were involved in this study. The size of the disc-osteophyte complex was measured using imaging data prior to the operation. The diameter and direction of the bony passage was determined according to the size and central position of the complex, respectively. Twenty-eight patients underwent the above scheme for CSM. The clinical outcome evaluations included Visual Analog Scale (VAS) scores, Japanese Orthopedic Association (JOA) scores. The imaging assessment included MRI, CT and X-rays. RESULTS The diameter of the designed bony passage was about 6.9 mm, and directed toward the lower edge of the diseased lower vertebral body oblique to the center of the disc-osteophyte complex. All patients successfully completed the operation. The postoperative neck pain VAS and JOA were significantly improved compared to preoperative values (p < 0.01). Postoperative MRI indicated complete decompression of the spinal cord. CT scanning 1 year after the operation revealed an almost healed bony passage and X-ray imaging showed satisfactory physiological curvature of the cervical spine, without cervical instability. CONCLUSION Based on the diameter and direction of the bony passage, as determined by the size and position of the disc-osteophyte complex, indicated by MRI and CT scanning, anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord offers good decompression of the spinal cord and ensures excellent therapeutic outcome.
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Affiliation(s)
- Yanyan Ma
- grid.413390.c0000 0004 1757 6938Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099 Guizhou China ,Rehabilitation Department, Guizhou Provincial Orthopedics Hospital, Sixian street, Guiyang, 550007 China
| | - Zhijun Xin
- grid.413390.c0000 0004 1757 6938Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099 Guizhou China
| | - Weijun Kong
- grid.413390.c0000 0004 1757 6938Orthopaedics, The Second Affiliated Hospital of Zunyi Medical University, Intersection between Xinpu Avenue and Xinlong Avenue, Zunyi, 563006 China
| | - Longsheng Zhang
- grid.413390.c0000 0004 1757 6938Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099 Guizhou China
| | - Qian Du
- grid.413390.c0000 0004 1757 6938Orthopaedics, The Second Affiliated Hospital of Zunyi Medical University, Intersection between Xinpu Avenue and Xinlong Avenue, Zunyi, 563006 China
| | - Wenbo Liao
- grid.413390.c0000 0004 1757 6938Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099 Guizhou China
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Clinical significance of microsurgical excision of the posterior longitudinal ligament using a high-frequency electrosurgical excision procedure in anterior cervical discectomy and fusion. Wideochir Inne Tech Maloinwazyjne 2020; 14:575-580. [PMID: 31908705 PMCID: PMC6939216 DOI: 10.5114/wiitm.2019.84827] [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: 01/18/2019] [Accepted: 04/01/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Anterior cervical decompression and fusion surgery using traditional methods to remove the posterior longitudinal ligament often causes massive bleeding, increasing the risk of surgery. However, the use of a high-frequency electrotome under the microscope can significantly reduce bleeding and reduce the risk of surgery. Aim To explore the clinical significance of electrosurgical excision of the posterior longitudinal ligament in the cervical anterior approach under the microscope. Material and methods From December 2015 to December 2017, patients who underwent anterior cervical discectomy and fusion at our hospital were followed up. We enrolled 73 men and 50 women who were 30 to 74 years old (mean, 49.96 years). Among 67 patients in group A treated with a high-frequency electrosurgical knife under the microscope, 58 were followed up; among 73 patients in group B treated with a traditional cervical hook knife under the microscope, 65 were followed up. Clinical data, operative time, intraoperative bleeding volume, VAS score, and Japanese Orthopaedic Association (JOA) improvement rate were retrospectively analyzed. Results There were significant differences in the mean operative time and intraoperative bleeding volume between the two groups (p < 0.05); however, no significant differences were found in the incidence of cerebrospinal fluid leakage, JOA improvement rate at 3 months postoperatively, and VAS score at 3 months postoperatively between the two groups (p > 0.05). Conclusions Electrosurgical resection of the posterior longitudinal ligament of the cervical vertebrae under the microscope can significantly reduce intraoperative bleeding and shorten the operative time and has obvious advantages compared with traditional methods.
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Shao F, Tang M, Bai H, Xue Y, Dai Y, Zhang J. Drilling Condition Identification Based on Sound Pressure Signal in Anterior Cervical Discectomy Surgery. Med Sci Monit 2019; 25:6574-6580. [PMID: 31474746 PMCID: PMC6738008 DOI: 10.12659/msm.917676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In anterior cervical discectomy and fusion (ACDF) surgery, drilling operation causes a high risk of tissue injury. This study aimed to present a novel feedback system based on sound pressure signals to identify drilling condition during ACDF. Material/Methods ACDF surgery was performed on the C4/5 segments of 6 porcine cervical specimens. The annulus fibrosus, endplate cartilage, sub-endplate cortical bone, and posterior longitudinal ligament (PLL) were drilled until penetration using a 2-mm high-speed burr. Sound pressure signals were collected using a microphone and dynamic signal analyzer. The recorded signals of different tissues were proceeded with lifting wavelet transform for extracting harmonic components. The frequencies of harmonic components are 1, 2, 3, 4, and 5 times higher than the motor frequency. The magnitude of harmonic components was calculated to identify different drilling conditions, along a broad spectrum of frequencies (1–5 kHz). For statistical analysis, one-way ANOVA (analysis of variance) and post hoc test (Dunnett’s T3) were performed. Results Very good demarcation was found among the signal magnitudes of different drilling conditions. Different drilling conditions do not present the same rate of variation of frequency. Differences in magnitude among all drilling conditions were statistically significant at certain frequency points (p<0.05). In 3 cases, one tissue could not be identified with respect to another (annulus fibrosus and endplate cartilage at 2 kHz, PLL and penetration at 3 kHz, annulus fibrosus and sub-endplate cortical bone at 5 kHz, p>0.05). Conclusions Sound pressure signals may provide an auxiliary feedback system for enhancing drilling operation in ACDF surgery, especially in minimally invasive surgery.
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Affiliation(s)
- Fuqiang Shao
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China (mainland).,Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, China (mainland)
| | - Muyao Tang
- Experimental Trauma Surgery, Justus-Liebig University Giessen, Giessen, Germany
| | - He Bai
- Department of Orthopedics Surgery, Inner Mongolia Cancer Hospital and Affiliated People's Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Yuan Xue
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China (mainland).,Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, China (mainland)
| | - Yu Dai
- Institute of Robotics and Automatic Information System, Tianjin Key Laboratory of Intelligent Robotics, College of Computer and Control Engineering, Nankai University, Tianjin, China (mainland)
| | - Jianxun Zhang
- Institute of Robotics and Automatic Information System, Tianjin Key Laboratory of Intelligent Robotics, College of Computer and Control Engineering, Nankai University, Tianjin, China (mainland)
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