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Zavras AG, Acosta JR, Holmberg KJ, Semenza NC, Jayamohan HR, Cheng BC, Altman DT, Sauber RD. Effect of device constraint: a comparative network meta-analysis of ACDF and cervical disc arthroplasty. Spine J 2024; 24:1858-1871. [PMID: 38843960 DOI: 10.1016/j.spinee.2024.05.016] [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: 04/04/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND CONTEXT Clinical trials have demonstrated that cervical disc arthroplasty (CDA) is an effective and safe alternative treatment to anterior cervical discectomy and fusion (ACDF) for cervical degenerative disc disease in the appropriately indicated patient population. Various devices for CDA exist, differing in the level of device constraint. PURPOSE To investigate outcomes following Anterior Cervical Discectomy and Fusion (ACDF) versus CDA stratified based on the level of device constraint: Constrained, Semiconstrained, and Unconstrained. STUDY DESIGN Systematic review and network meta-analysis. PATIENT SAMPLE A total of 2,932 CDA patients (979 Constrained, 1,214 Semiconstrained, 739 Unconstrained) and 2,601 ACDF patients from 41 studies that compared outcomes of patients undergoing CDA or ACDF at a single level at a minimum of 2 years follow-up. OUTCOME MEASURES Outcomes of interest included the development of adjacent segment degeneration (ASD), index and adjacent segment reoperation rates, range of motion (ROM), high-grade heterotopic ossification (HO, McAfee Grades 3/4), and patient-reported outcomes (NDI/VAS). METHODS CDA devices were grouped based on the degrees of freedom (DoF) allowed by the device, as either Constrained (3 DoF), Semiconstrained (4 or 5 DoF), or Unconstrained (6 DoF). A random effects network meta-analysis was conducted using standardized mean differences (SMD) and log relative risk (RR) were used to analyze continuous and categorical data, respectively. RESULTS Semiconstrained (p=.03) and Unconstrained CDA (p=.01) demonstrated a significantly lower risk for ASD than ACDF. All levels of CDA constraint demonstrated a significantly lower risk for subsequent adjacent segment surgery than ACDF (p<.001). Semiconstrained CDA also demonstrated a significantly lower risk for index level reoperation than both ACDF and Constrained CDA (p<.001). Unconstrained devices retained significantly greater ROM than both Constrained and Semiconstrained CDA (p<.001). As expected, all levels of device constraint retained significantly greater ROM than ACDF (p<.001). Constrained and Unconstrained devices both demonstrated significantly lower levels of disability on NDI than ACDF (p=.02). All levels of device constraint demonstrated significantly less neck pain than ACDF (p<.05), while Unconstrained CDA had significantly less arm pain than ACDF (p=.02) at final follow-up greater than 2 years. CONCLUSION CDA, particularly the unconstrained and semiconstrained designs, appears to be more effective than ACDF in reducing the risk of adjacent segment degeneration and the need for further surgeries, while also allowing for greater range of motion and better patient-reported outcomes. Less constrained CDA conferred a lower risk for index level reoperation, while also retaining more range of motion than more constrained devices.
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Affiliation(s)
- Athan G Zavras
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA.
| | - Jonathan R Acosta
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Kyle J Holmberg
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Nicholas C Semenza
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Boyle C Cheng
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Daniel T Altman
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Ryan D Sauber
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
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Young MW, Abtahi AM. Impact of Posterior Cervical Foraminotomy Before or After Cervical Disk Replacement: Current Evidence. Clin Spine Surg 2023; 36:391-397. [PMID: 37798824 DOI: 10.1097/bsd.0000000000001524] [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: 06/21/2023] [Accepted: 08/10/2023] [Indexed: 10/07/2023]
Abstract
STUDY DESIGN Narrative review. OBJECTIVES The purpose of this study was to provide a review of the current evidence on the impact of posterior cervical foraminotomy (PCF) performed before or after cervical disk replacement (CDR). SUMMARY OF BACKGROUND DATA The impact of PCF on outcomes in the setting of CDR is an evolving field, given the recent widespread adoption of CDR and the relative rarity of patients who have undergone both procedures. METHODS A literature search was conducted using PubMed to determine current evidence regarding the indications, outcomes, and biomechanical effects of CDR and PCF when performed alone or in combination. RESULTS When radicular symptoms persist following PCF, a CDR can be safely performed to provide further decompression. Conversely, a PCF can be safely performed following CDR for these same indications. The biomechanical effects of these procedures in combination demonstrate maintained stability when the facetectomy is less than 50% of the facet joint. Studies demonstrate that stability is not significantly decreased by the presence, amount, or level of posterior foraminotomies in the setting of CDR. CONCLUSIONS A PCF can be safely performed before or after cervical disk arthroplasty for recurrent radicular symptoms. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Mason W Young
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
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Fainor M, Mahindroo S, Betz KR, Augustin J, Smith HE, Mauck RL, Gullbrand SE. A Tunable Calcium Phosphate Coating to Drive in vivo Osseointegration of Composite Engineered Tissues. Cells Tissues Organs 2023; 212:383-398. [PMID: 36966531 PMCID: PMC10616759 DOI: 10.1159/000528965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/30/2022] [Indexed: 06/18/2023] Open
Abstract
Varying degrees of hydroxyapatite (HA) surface functionalization have been implicated as the primary driver of differential osteogenesis observed in infiltrating cells. The ability to reliably create spatially controlled areas of mineralization in composite engineered tissues is of growing interest in the field, and the use of HA-functionalized biomaterials may provide a robust solution to this challenge. In this study, we successfully fabricated polycaprolactone salt-leached scaffolds with two levels of a biomimetic calcium phosphate coating to examine their effects on MSC osteogenesis. Longer duration coating in simulated body fluid (SBF) led to increased HA crystal nucleation within scaffold interiors as well as more robust HA crystal formation on scaffold surfaces. Ultimately, the increased surface stiffness of scaffolds coated in SBF for 7 days in comparison to scaffolds coated in SBF for 1 day led to more robust osteogenesis of MSCs in vitro without the assistance of osteogenic signaling molecules. This study also demonstrated that the use of SBF-based HA coatings can promote higher levels of osteogenesis in vivo. Finally, when incorporated as the endplate region of a larger tissue-engineered intervertebral disc replacement, HA coating did not induce mineralization in or promote cell migration out of neighboring biomaterials. Overall, these results verified tunable biomimetic HA coatings as a promising biomaterial modification to promote discrete regions of mineralization within composite engineered tissues.
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Affiliation(s)
- Matthew Fainor
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, (PA,) USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, (PA,) USA
| | - Sonal Mahindroo
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, (PA,) USA
- Department of Biology, St. Bonaventure University, St. Bonaventure, (NY,) USA
| | - Kerri R. Betz
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, (PA,) USA
- Department of Biology, Widener University, Chester, (PA,) USA
| | - Janai Augustin
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, (PA,) USA
- Department of Biomedical Engineering, City College of New York, New York City, (NY,) USA
| | - Harvey E. Smith
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, (PA,) USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, (PA,) USA
| | - Robert L. Mauck
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, (PA,) USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, (PA,) USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, (PA,) USA
| | - Sarah E. Gullbrand
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, (PA,) USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, (PA,) USA
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Qi M, Xu C, Liu Y, Cao P, Wang X, Chen H, Yuan W. Comparison of clinical outcomes between cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of single-level cervical spondylosis: a 10-year follow-up study. Spine J 2023; 23:361-368. [PMID: 36481680 DOI: 10.1016/j.spinee.2022.11.013] [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: 08/09/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND CONTEXT The theoretical advantage of cervical disc arthroplasty includes preserved motion at the cervical level, which may reduce degeneration of the adjacent segments. The long-term follow-up results are still controversial. PURPOSE The present study aimed to retrospectively study the long-term efficacy and complications of cervical disc arthroplasty using a single commercially-available device in a single center. STUDY DESIGN This was a propensity-score matched cohort study. PATIENT SAMPLE This study enrolled 148 single-level cervical degenerative disease patients from January 2009 to March 2012. After 1:1 propensity score matching, 39 patients remained in the ACDF or ACDR groups. OUTCOME MEASURES The outcome measures were neurological functions (Neck Disability Index (NDI) and Japan Orthopedic Association (JOA) scores), radiographic evaluations (cervical curvature, operative segment range of motion, degenerative condition of adjacent segments, heterotopic ossification (HO) of the surgical segment), and complications. METHODS NDI and JOA scores were used to evaluate patient neurological functions. Cervical curvature (C2-C7 Cobb angle) and operative segment range of motion (ROM) were compared between the two groups. Grading criteria for osteophyte formation were used to evaluate the degenerative condition of adjacent segments. HO after ACDR was graded according to the McAfee grading method. RESULTS The average follow-up time was 119.3 ±17.2 months. Satisfactory improvements in neurological function were obtained for both the ACDR and ACDF groups. There were no significant differences in VAS or NDI scores between the two groups. In the ACDR group, the ROM of the operative segment increased from 6.7 ±4.3° before the operation to 8.9 ±3.5° on the second day after the operation (p<.001). The ROM of the operative segment was 8.1 ±4.0° at the 1-year follow-up, 7.2 ±3.6° at the 2-year follow-up, 5.7 ±4.5° at the 5-year follow-up and 4.3 ±3.9° at the last follow-up. ASD was more likely to develop in the caudal adjacent segments and progressed with the follow-up time. At the last follow-up, HO was present in 27 patients (69.23%), while high-grade HO (McAfee scores III and IV) was detected in 6 patients (15.38%). CONCLUSIONS Through nearly 10 years of follow-up, ACDR was as effective as ACDF for treating single-level degenerative cervical disc disease. However, HO and the role of ACDR in the protection of ASD remains to be further observed and followed up.
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Affiliation(s)
- Min Qi
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th Fengyang Road, Shanghai, People's Republic of China, 200003
| | - Chen Xu
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th Fengyang Road, Shanghai, People's Republic of China, 200003
| | - Yang Liu
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th Fengyang Road, Shanghai, People's Republic of China, 200003
| | - Peng Cao
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th Fengyang Road, Shanghai, People's Republic of China, 200003
| | - Xinwei Wang
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th Fengyang Road, Shanghai, People's Republic of China, 200003
| | - Huajiang Chen
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th Fengyang Road, Shanghai, People's Republic of China, 200003.
| | - Wen Yuan
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th Fengyang Road, Shanghai, People's Republic of China, 200003.
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Lee NJ, Joaquim AF, Boddapati V, Mathew J, Park P, Kim JS, Sardar ZM, Lehman RA, Riew KD. Revision Anterior Cervical Disc Arthroplasty: A National Analysis of the Associated Indications, Procedures, and Postoperative Outcomes. Global Spine J 2022; 12:1338-1344. [PMID: 33464126 PMCID: PMC9393989 DOI: 10.1177/2192568220979140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To examine the associated indications, procedures, and postoperative outcomes after revision ACDA. METHODS We utilized a national database to identify adult(≥18 years) patients who underwent either a primary ACDA or removal of ACDA over a 10-year period(2008-2017). An in-depth assessment of the reasons for revision surgery and the subsequent procedures performed after the removal of ACDA was done by using both Current Procedural Terminology(CPT) and International Statistical Classification of Diseases (ICD-9,10) coding. RESULTS From 2008 to 2017, a total of 3,350 elective, primary ACDA cases were performed. During this time, 69 patients had a revision surgery requiring the removal of ACDA. The most common reasons for revision surgery included cervical spondylosis(59.4%) and mechanical complications(27.5%). After removal of ACDA, common procedures performed included anterior cervical fusion with or without decompression(69.6%), combined anterior/posterior fusion/decompression (11.6%), and replacement of ACDA (7.2%). The indications for surgery did not vary significantly among the different procedures performed (p = 0.318). Patients requiring revision surgery for mechanical complications or those who underwent a combined surgical approach were at significantly higher risk for subsequent short-term complications (p<0.05). CONCLUSION Over a 10-year period, the rate of revision surgery for ACDA was low (2.1%). Nearly 90% of revision cases were due to either cervical spondylosis or mechanical complications. These indications for surgery did not vary significantly among the different procedures performed. These findings will be important during the shared-decision making process for patients undergoing primary or revision ACDA.
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Affiliation(s)
- Nathan J. Lee
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA,Nathan J. Lee, MD, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA.
| | - Andrei F. Joaquim
- Department of Neurosurgery, University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Venkat Boddapati
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Justin Mathew
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Paul Park
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Jun S. Kim
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Zeeshan M. Sardar
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Ronald A. Lehman
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - K. Daniel Riew
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
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Guo Y, Liu H, Meng Y, Ding C, Hong Y, Wang B. Over-correction of curvature causes the non-surgical curvature loss in one- and two-level anterior cervical discectomy and fusion. Chin Med J (Engl) 2022; 135:00029330-990000000-00051. [PMID: 35838520 PMCID: PMC9532029 DOI: 10.1097/cm9.0000000000002039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Indexed: 02/05/2023] Open
Affiliation(s)
- Yingjun Guo
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Meng
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ding
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Hong
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Beiyu Wang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
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Jarrah R, Reardon T, Warner T, Stefano FD, Fiani B. Spinal intervertebral disc regeneration versus repair: cost, outcomes and future considerations. Regen Med 2022; 17:337-340. [PMID: 35545959 DOI: 10.2217/rme-2022-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ryan Jarrah
- Department of Neurosurgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Taylor Reardon
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, KY 41501, USA
| | - Tyler Warner
- School of Medicine, St. George's University, West Indies, Grenada
| | - Frank De Stefano
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO 64106, USA
| | - Brian Fiani
- Department of Neurosurgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY 10065, USA
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He S, Zhou Z, Shao X, Zhou L, Zhang C, Zhou X, Wu S, Chen K, Wang Y, Qian Z. Comparing the Bridge-Type Zero-Profile Anchored Spacer (ROI-C) Interbody Fusion Cage System and Anterior Cervical Discectomy and Fusion (ACDF) with Plating and Cage System in Cervical Spondylotic Myelopathy. Orthop Surg 2022; 14:1100-1108. [PMID: 35478487 PMCID: PMC9163982 DOI: 10.1111/os.13268] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To compare the clinical efficacy and radioactivity of the bridge-type zero-profile anchored spacer (ROI-C) interbody fusion cage and anterior cervical discectomy and fusion with plating and cage system (ACDF) for cervical spondylotic myelopathy (CSM). METHODS This is a retrospective contrastive study. We recruited 35 patients who received ROI-C (ROI-C group) and 34 patients who received ACDF (ACDF group), between January 2014 to January 2019, at our treatment center. The ROI-C group comprised of 11 males and 24 females with a mean age of 61.59 ± 8.21 years (range, 51-71 years). The ACDF group comprised of 12 males and 22 females with a mean age of 60.15 ± 7.52 years (range, 52-74 years). Neck Disability Index (NDI), Japanese Orthopaedic Association score (JOA), Odom's score, cervical Cobb angle, fusion rate, adjoining ossification, and dysphagia. RESULTS A total of 69 patients met the inclusion criteria, and these patients received more than two years of follow-up. There were significant differences in surgical duration (101 ± 22 min vs. 118 ± 29 min) and blood loss (102 ± 46 ml vs. 145 ± 58 ml) between two groups (P < 0.05). The JOA and NDI of these two groups of patients significantly improved, when compared with those before the operation (P < 0.05). Twenty-nine of 35 patients in the ROI-C group and 27 of 34 patients in ACDF group achieved good or excellent outcomes according to Odom's criteria. The cervical lordosis of both two groups significantly increased, when compared with those before the operation (P < 0.05). In the ROI-C group, the postoperative fusion rate was 85.7% at the 3-month follow-up and 100% at the final follow-up. In the ACDF group, the postoperative fusion rate was 82.4% at the 3-month follow-up and 100% at the final follow-up. The dysphagia incidence of the ACDF group was higher than that of the ROI-C group postoperatively and at the one month after surgery (P < 0.05), but no significant difference was found in the incidence of dysphagia at final follow-up (P > 0.05). CONCLUSION Both ROI-C and ACDF achieved good therapeutic effects. However, ROI-C can reduce the operation time and postoperative complications.
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Affiliation(s)
- Shuangjun He
- Department of Orthopedic Surgery, The People's Hospital of Danyang, Affiliated Danyang Hospital of Nantong University, Danyang, China
| | - Zhangzhe Zhou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaofeng Shao
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lijian Zhou
- Department of Orthopedic Surgery, The People's Hospital of Danyang, Affiliated Danyang Hospital of Nantong University, Danyang, China
| | - Changhao Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xinfeng Zhou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shuhua Wu
- Department of Orthopedic Surgery, The People's Hospital of Danyang, Affiliated Danyang Hospital of Nantong University, Danyang, China
| | - Kangwu Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yaowei Wang
- Department of Orthopedic Surgery, The People's Hospital of Danyang, Affiliated Danyang Hospital of Nantong University, Danyang, China
| | - Zhonglai Qian
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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Meng GD, Xu BS. Circular RNA hsa_circ_0001658 Inhibits Intervertebral Disc Degeneration Development by Regulating hsa-miR-181c-5p/FAS. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:7853335. [PMID: 34925543 PMCID: PMC8683186 DOI: 10.1155/2021/7853335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/15/2021] [Indexed: 12/29/2022]
Abstract
METHODS We obtained microarray data (GSE116726, GSE67566) from Gene Expression Omnibus database, and differential expression level of ncRNA in nucleus pulposus (NP) tissues of IDD patients was analyzed. The potential circRNA-miRNA-mRNA regulatory network was analyzed by starBase. The effect of the interaction between hsa_circ_0001658, hsa-miR-181c-5p, and FAS on the proliferation and apoptosis of human neural progenitor cells (hNPCs) was studied. RESULTS hsa_circ_0001658 was significantly upregulated (logFC > 2.0 and adj.P.Val < 0.01) in the NP tissues of IDD patients, and hsa-miR-181c-5p expression was downregulated (logFC < -2.0 and adj.P.Val < 0.01). Silencing of hsa-miR-181c-5p or overexpression of hsa_circ_0001658 inhibited the proliferation of hNPCs and promoted their apoptosis. hsa_circ_0001658 acted as a sponge of hsa-miR-181c-5p. hsa-miR-181c-5p downregulated the expression of Fas cell surface death receptor (FAS), promoted the proliferation, and inhibited the apoptosis of hNPCs. hsa_circ_0001658 functioned in hNPCs through targeting hsa-miR-181c-5p/FAS. CONCLUSION Circular RNA hsa_circ_0001658 inhibits IDD development by regulating hsa-miR-181c-5p/FAS. It is expected to be a potential target for the therapy of IDD.
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Affiliation(s)
- Ge-dong Meng
- Tianjin Medical University, Tianjin 300070, China
- Department of Spine Surgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010010 Inner Mongolia Autonomous Region, China
| | - Bao-shan Xu
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin 300211, China
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Xue R, Ji ZY, Cheng XD, Zhang ZQ, Zhang F. Risk Factors for Dysphagia after Anterior Cervical Discectomy and Fusion with the Zero-P implant system: A Study with Minimum of 2 Years Follow-up. Orthop Surg 2021; 14:149-156. [PMID: 34841666 PMCID: PMC8755882 DOI: 10.1111/os.13170] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/24/2021] [Accepted: 10/19/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To evaluate the risk factors for dysphagia after anterior cervical discectomy and fusion (ACDF) with the Zero-P Implant System by multidimensional analysis and investigated the predictive values of these risk factors for dysphagia. METHODS A retrospective analysis of 260 patients who underwent ACDF with the Zero-P Implant System and had at least 2 year of follow-up were performed. All patients were divided into a non-dysphagia group and a dysphagia group. Sex, age, body mass index (BMI), intraoperative time, estimated blood loss, diabetes mellitus, hypertension, smoking, alcohol consumption, prevertebral soft-tissue thickness, the levels of surgery, O-C2 angle, C2-7 angle, T1 slope and segmental angle were analyzed. The Modified Japanese Orthopaedic Association (JOA) scoring system was used to determine functional status. NDI was used to evaluate neck pain and disability. The Bazaz grading system was chosen to evaluate dysphagia after surgery. Postoperative cerebrospinal fluid (CSF) leakage, infection, and dysphagia were recorded in both groups. An independent t-test was used to compare quantitative variables, a chi-square test was used to compare qualitative data between the two groups. To eliminate the influence of confounding factors, logistic regression was performed for multifactor regression of factors. The results were regarded as significant when the P-values were less than 0.05 in this study. RESULTS In total, the non-dysphagia group comprised 70 patients and the dysphagia group comprised 190 patients, with an average age of 58.33 ± 4.68 years (ranging, 42-82 years). These patients were followed up for 28.5 ± 3.5 months (range, 24-32 months). For clinical outcomes, both groups demonstrated significant improvement in the NDI and JOA scores (P < 0.001). According to the Bazaz dysphagia grading system, mild, moderate, and severe dysphagia were found in 50, 17, and 3 patients, respectively. In total, 37.1% (n = 26) had resolved by 3 month, 38.6% (n = 27) by 6 months, and 17.1% (n = 12) by 12 months. Chi-square test results indicated that number of operated levels, operation time dT1 slope, dO-C2 angle, dC2-7 angle, segmental angle and dPSTT were associated with a high incidence of dysphagia. Multivariate logistic regression analysis showed that number of operated levels, operation time, dC2-7 angle and dPSTT were significantly associated with postoperative dysphagia. CONCLUSIONS More operated levels, more operation time, more dC2-7 angle and dPSTT were the risk factors for postoperative dysphagia. In additional, sufficient preoperative preparation, evaluation combined with proficient and precise surgical treatment were suggested to reduce the incidence of postoperative dysphagia when ACDF was performed.
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Affiliation(s)
- Rong Xue
- Department of Orthopaedics, Xinghua People's Hospital, Taizhou, China.,Department of Orthopaedics, Affiliated Hospital of Nantong University, Nantong, China
| | - Zhu-Yong Ji
- Department of Orthopaedics, Xinghua People's Hospital, Taizhou, China
| | - Xing-Dong Cheng
- Department of Orthopaedics, Xinghua People's Hospital, Taizhou, China
| | - Zhu-Qiu Zhang
- Department of Orthopaedics, Xinghua People's Hospital, Taizhou, China
| | - Feng Zhang
- Department of Orthopaedics, Affiliated Hospital of Nantong University, Nantong, China
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Effects of endplate coverage and intervertebral height change on heterotopic ossification following cervical disc replacement. J Orthop Surg Res 2021; 16:693. [PMID: 34823557 PMCID: PMC8614029 DOI: 10.1186/s13018-021-02840-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/12/2021] [Indexed: 02/08/2023] Open
Abstract
Background Heterotopic ossification (HO) is a common complication after cervical disc replacement (CDR). Biomechanical factors including endplate coverage and intervertebral disc height change may be related to HO formation. However, there is a dearth of quantitative analysis for endplate coverage, intervertebral height change and their combined effects on HO. Methods Patients who underwent single-level or two-level CDR with Prestige-LP were retrospectively reviewed. Clinical outcomes were evaluated through Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) score, and visual analogue scale (VAS) score. Radiological data, including the prosthesis-endplate depth ratio, intervertebral height change, posterior heterotopic ossification (PHO) and angular parameters, were collected. Logistic regression analysis was used to identify the potential risk factors. Receiver operating characteristic curves were plotted and the cut-off values of each potential factors were calculated. Results A total of 138 patients with 174 surgical segments were evaluated. Both the prosthesis-endplate depth ratio (P < 0.001) and post-operative disc height change (P < 0.001) were predictive factors for PHO formation. The area under the curve (AUC) of the prosthesis-endplate depth ratio, disc height change and their combined effects represented by the combined parameter (CP) were 0.728, 0.712 and 0.793, respectively. The risk of PHO significantly increased when the prosthesis-endplate depth ratio < 93.77% (P < 0.001, OR = 6.909, 95% CI 3.521–13.557), the intervertebral height change ≥ 1.8 mm (P < 0.001, OR = 5.303, 95% CI 2.592–10.849), or the CP representing the combined effect < 84.88 (P < 0.001, OR = 10.879, 95% CI 5.142–23.019). Conclusions Inadequate endplate coverage and excessive change of intervertebral height are both potential risk factors for the PHO after CDR. Endplate coverage less than 93.8% or intervertebral height change more than 1.8 mm would increase the risk of PHO. The combination of these two factors may exacerbate the non-uniform distribution of stress in the bone-implant interface and promote HO development.
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