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Yokoyama K, Ikeda N, Tanaka H, Ito Y, Sugie A, Yamada M, Wanibuchi M, Kawanishi M. Changes in spinal sagittal balance after a new osteoporotic vertebral compression fracture. Osteoporos Int 2024; 35:645-651. [PMID: 38108858 DOI: 10.1007/s00198-023-06976-4] [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: 06/13/2023] [Accepted: 11/08/2023] [Indexed: 12/19/2023]
Abstract
We conduct a longitudinal study to examine how new VCF alter spinal sagittal balance. New VCF increased SVA by an average of 2.8 cm. Sagittal balance deteriorates as a VCF develops in the lower lumbar spine. A new fracture below L1 increased the relative risk of a deterioration of sagittal balance 2.9-fold compared to one above Th12. PURPOSE Studies on the relationship between osteoporotic vertebral fractures and spinal sagittal balance have all been limited to cross-sectional studies. The aim of this study is to conduct a longitudinal study to examine how new vertebral compression fracture (VCF) alter spinal sagittal balance. METHODS Subjects were patients undergoing periodic examinations after treatment of a vertebral fracture or lumbar spinal canal stenosis. Forty patients who developed a new VCF were included in this study. Full-spine standing radiographs were compared before and after the fracture to examine changes in spinopelvic parameters and factors determining the changes in sagittal balance. RESULTS The mean age of the patients was 79.0 years. The mean interval between pre- and post-fracture radiographs was 22.7 months, and the mean time between development of a fracture and post-fracture radiographs was 4.6 months. After a fracture, sagittal vertical axis (SVA) increased an average of 2.78 cm and spino-sacral angle (SSA) decreased an average of 5.3°. Both ⊿SVA and ⊿SSA were not related to pre-fracture parameters. The wedge angle of the fractured vertebra was not related to changes in sagittal balance. ⊿SVA increased markedly in patients with a fracture of the lower lumbar vertebrae. receiver operating characteristic analysis revealed that the relative risk of a deterioration of sagittal balance was 2.9 times higher for a new fracture below L1 than for a fracture above Th12. CONCLUSION New VCF increased SVA by an average of 2.8 cm. Sagittal balance deteriorates as a new fracture develops in the lower lumbar spine. Early intervention in osteoporosis is vital for the elderly.
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Affiliation(s)
- Kunio Yokoyama
- Department of Neurosurgery, Takeda General Hospital, 28-1, Ishidamoriminami-Machi, Fushimi, Kyoto, 601-1495, Japan.
| | - Naokado Ikeda
- Department of Neurosurgery, Takeda General Hospital, 28-1, Ishidamoriminami-Machi, Fushimi, Kyoto, 601-1495, Japan
| | - Hidekazu Tanaka
- Department of Neurosurgery, Takeda General Hospital, 28-1, Ishidamoriminami-Machi, Fushimi, Kyoto, 601-1495, Japan
| | - Yutaka Ito
- Department of Neurosurgery, Takeda General Hospital, 28-1, Ishidamoriminami-Machi, Fushimi, Kyoto, 601-1495, Japan
| | - Akira Sugie
- Department of Neurosurgery, Takeda General Hospital, 28-1, Ishidamoriminami-Machi, Fushimi, Kyoto, 601-1495, Japan
| | - Makoto Yamada
- Department of Neurosurgery, Takeda General Hospital, 28-1, Ishidamoriminami-Machi, Fushimi, Kyoto, 601-1495, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Masahiro Kawanishi
- Department of Neurosurgery, Takeda General Hospital, 28-1, Ishidamoriminami-Machi, Fushimi, Kyoto, 601-1495, Japan
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Yokoyama K, Ikeda N, Tanaka H, Ito Y, Sugie A, Yamada M, Wanibuchi M, Kawanishi M. Long-Term Changes in Sagittal Balance After Microsurgical Decompression of Lumbar Spinal Canal Stenosis in Elderly Patients: A Follow-Up Study for 5-Years After Surgery. World Neurosurg 2023; 176:e384-e390. [PMID: 37236312 DOI: 10.1016/j.wneu.2023.05.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this study is to investigate long-term changes in spinal sagittal balance after microsurgical decompression in lumbar canal stenosis (LCS). METHODS Fifty-two patients who underwent microsurgical decompression for symptomatic single level L4/5 spinal canal stenosis at our hospital were included in the study. All patients had standing full spine radiographs taken preoperatively, 1 year postoperatively, and 5 years postoperatively. Spinal parameters including sagittal balance were measured from the obtained images. First, preoperative parameters were compared with 50 age-matched asymptomatic volunteers. Next, the parameters before and after surgery were compared to examine long-term changes. RESULTS Sagittal vertical axis (SVA) was significantly increased in the LCS cases compared to the volunteers (P = 0.03). Postoperative lumbar lordosis (LL) was significantly increased (P = 0.03). Postoperative mean SVA decreased but the difference was not significant (P = 0.12). Although there was no correlation between preoperative parameters and the Japanese Orthopedic Association score, postoperative pelvic incidence (PI)-LL and pelvic tilt changes correlated with changes in Japanese Orthopedic Association score (PI-LL; P = 0.0001, pelvic tilt; P = 0.04). However, after 5 years of surgery, LL decreased and PI-LL increased (LL; P = 0.08, PI-LL; P = 0.03). Sagittal balance began to deteriorate but was not significant (P = 0.31). At 5 years postoperatively, 18 of 52 patients (34.6%) were found to have L3/4 adjacent segment disease. Cases with adjacent segment disease showed significantly worse SVA and PI-LL (SVA; P = 0.01, PI-LL; P < 0.01). CONCLUSIONS In LCS, lumbar kyphosis improves and sagittal balance tends to improve after microsurgical decompression. However, after 5 years, adjacent intervertebral degeneration occurs more frequently and sagittal balance begins to deteriorate in about one third of cases.
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Affiliation(s)
- Kunio Yokoyama
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan.
| | - Naokado Ikeda
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan
| | - Hidekazu Tanaka
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan
| | - Yutaka Ito
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan
| | - Akira Sugie
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan
| | - Makoto Yamada
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki city, Osaka, Japan
| | - Masahiro Kawanishi
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan
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McDonald CL, Alsoof D, Glueck J, Osorio C, Stone B, McCluskey L, Diebo BG, Daniels AH, Basques BA. Adjacent Segment Disease After Spinal Fusion. JBJS Rev 2023; 11:01874474-202306000-00007. [PMID: 37307327 DOI: 10.2106/jbjs.rvw.23.00028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
» Adjacent segment disease is characterized by a degenerative process adjacent to a previously fused spine segment, with new onset of clinical symptoms such as radiculopathy, myelopathy, or instability.» Etiology is related to the natural history of the disease process, increased biomechanical stress at adjacent segments, clinical factors specific to the individual patient, intraoperative factors, and malalignment.» Treatment is usually nonoperative, but surgical intervention can be indicated. Decompression and fusion remain the mainstay of operative treatment, and isolated decompression should be considered in specific cases.» Further randomized controlled trials are needed to establish how the treatment should progress, particularly with the development of minimally invasive and endoscopic surgery.
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Affiliation(s)
- Christopher L McDonald
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Daniel Alsoof
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Jacob Glueck
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Camilo Osorio
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Benjamin Stone
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Leland McCluskey
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Bassel G Diebo
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Alan H Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Bryce A Basques
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Arnone PA, Kraus SJ, Farmen D, Lightstone DF, Jaeger J, Theodossis C. Examining Clinical Opinion and Experience Regarding Utilization of Plain Radiography of the Spine: Evidence from Surveying the Chiropractic Profession. J Clin Med 2023; 12:jcm12062169. [PMID: 36983168 PMCID: PMC10054546 DOI: 10.3390/jcm12062169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023] Open
Abstract
Plain Radiography of the spine (PROTS) is utilized in many forms of healthcare including the chiropractic profession; however, the literature reflects conflicting opinions regarding utilization and value. Despite being an essential part of Evidence-Based Practice (EBP), few studies assess Doctors of Chiropractic (DCs) clinical opinions and experience regarding the utilization of (PROTS) in practice. In this study, DCs were surveyed regarding utilization of PROTS in practice. The survey was administered to an estimated 50,000 licensed DCs by email. A total of 4301 surveys were completed, of which 3641 were United States (US) DCs. The Clinician Opinion and Experience on Chiropractic Radiography (COECR) scale was designed to analyze survey responses. This valid and reliable scale demonstrated good internal consistency using confirmatory factor analysis and the Rasch model. Survey responses show that 73.3% of respondents utilize PROTS in practice and 26.7% refer patients out for PROTS. Survey responses show that, among US DCs, 91.9% indicate PROTS has value beyond identification of pathology, 86.7% indicate that PROTS is important regarding biomechanical analysis of the spine, 82.9% indicate that PROTS is vital to practice, 67.4% indicate that PROTS aids in measuring outcomes, 98.6% indicate the opinion that PROTS presents very low to no risk to patients, and 93.0% indicate that sharing clinical findings from PROTS studies with patients is beneficial to clinical outcomes. The results of the study indicated that based on clinical experience, the majority of DCs find PROTS to be vital to practice and valuable beyond the identification of red flags.
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Affiliation(s)
- Philip A. Arnone
- The Balanced Body Center, Matthews, NC 28105, USA
- Correspondence:
| | | | - Derek Farmen
- The Balanced Body Center, Matthews, NC 28105, USA
| | | | - Jason Jaeger
- Community Based Internship Program, Associate Faculty, Southern California University of Health Sciences, Whittier, CA 90604, USA
| | - Christine Theodossis
- Chair, Radiology Department, Sherman College of Chiropractic, Boiling Springs, SC 29316, USA
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Risk Factors for Adjacent Segment Problems after Posterior Instrumentation of the Cervical Spine. SURGERIES 2022. [DOI: 10.3390/surgeries3040037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Adjacent segment problems after cervical spine instrumentation are widely reported. They can range from asymptomatic adjacent segment degeneration (ASD) noted on radiographs to symptomatic adjacent segment disease and even instability. While ASD following anterior instrumentation is well studied, there is a paucity of literature on ASD following posterior instrumentation. We intended to identify the risk factors associated with ASD following posterior instrumentation, focusing on pre-operative and surgical parameters. Eighty-seven patients who underwent posterior instrumentation of the cervical spine were recruited. Clinical and radiological examination was performed preoperatively and up to 24 months postoperatively. The collected data included patient demographics, indication for surgery, sagittal parameters (cervical lordosis, C2–7 sagittal-vertical axis), technique of surgery, number of levels instrumented and fused, number of levels decompressed, and the level at which the instrumentation ended. Based on postoperative evaluation, ASD was found in 29.9% of the patients, of which, one patient was symptomatic and required reoperation. Even though, according to our univariate analysis, reduced pre-operative cervical lordosis and the indication of degenerative spondylosis seemed to significantly influence the occurrence of ASD, multivariate regression analysis did not identify any independent risk factors. We also noted that, even though patients may develop ASD after the instrumented fusion of the cervical spine, this may not necessarily develop into symptomatic adjacent segment disease requiring revision surgery.
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Medhat H, Sorour O, Ayoub B, El-Fiki AAS, Salah AM, Marei AAAE. The Early Effect of Anterior Cervical Discectomy and Fusion on Adjacent Segment Degeneration in Cases of Cervical Degenerative Disease: A Clinical and Retrospective Study. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND: The cervical spine is the most mobile part of the spine in the sagittal plane. It is important for surgeons to have reliable, simple, and reproducible parameters to analyze the cervical spine pre-operative and post-operative. Despite anterior cervical discectomy and fusion (ACDF) is a common procedure, adjacent segment failure after surgery is an ongoing clinical concern; adjacent segment disease (ASD) occurs in approximately 3% of patients per year, with an expected incidence of 25% within the first 10 years following fusion. It has been suggested that the increased stress placed on adjacent segments after successful ACDF may increase the rate of symptomatic disc disease at those segments, so our study focuses on how to evaluate ASD using magnetic resonance imaging (MRI) and X-ray.
METHODS: The retrospective study conducted on 72 patients in the department of neurosurgery at Kasr Al-Ainy hospitals to evaluate ASD after ACDF for degenerative cervical spondylosis using pre-operative and post-operative cervical spine X-ray lateral view as well as MRI for cervical spine after 2 years from the date of surgery.
RESULTS: Among the 72 patients in our study, the follow-up MRI after 2 years showed new pathology in 14 patients (19.4%) while 58 patients (80.6%) showed no new pathology; also 20 patients (27.8%) presented with new complaints while 52 patients (72.2%) had no new complaints and only 3 patients (4.16%) were scheduled for surgery.
CONCLUSION: ASD is an ongoing process of degeneration that could be accelerated by ACDF procedures, but not every adjacent segment degeneration or symptomatic disease requires additional surgery. Cervical mal-alignment greatly affects the neck pain rather than development of other new neurological manifestations and plays a role in adjacent segment failure which should be considered during cervical fusion surgeries. ASD must be differentiated from adjacent segment degeneration using clinical examination and imaging to help in patients’ follow-up and decision-making of further intervention.
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Deng L, Hua X, Wu Q, Lv N, Shao X, Zhou Q, Liu H, Qian Z. Should adjacent asymptomatic lumbar disc herniation of L5-S1 isthmic spondylolisthesis be simultaneously rectified? Evaluation of postoperative spino-pelvic sagittal balance and functional outcomes. BMC Musculoskelet Disord 2022; 23:843. [PMID: 36064666 PMCID: PMC9442967 DOI: 10.1186/s12891-022-05794-9] [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] [Received: 06/03/2022] [Accepted: 08/31/2022] [Indexed: 11/18/2022] Open
Abstract
Background This study aimed to analyze the efficacy of the simultaneous rectification of adjacent asymptomatic lumbar disc herniation (asLDH) of L5-S1 isthmic spondylolisthesis (IS). Methods One hundred and forty-eight patients with L5-S1 IS, and simultaneous L4-5 asLDH, were recruited between January 2012 and December 2017, for this study. Group A: seventy-two patients received PLIF at L5-S1. Group B: seventy-six patients received PLIF at L4-S1. The radiographic outcomes were assessed via the lumbar lordosis (LL), segmental lordosis (SL), sacral slope (SS), pelvic incidence (PI), pelvic tilt (PT), PI-LL and slip degree (SD). The functional outcomes were evaluated via the visual analog scale (VAS), Oswestry disability index (ODI), and reoperation rate. The potential risk hazards for reoperation were identified using both uni- and multivariate logistic regression analyses. Results The postoperative LL, SL, PT, SS, SD, VAS, and ODI exhibited vast improvements (P < 0.05). Relative to Group A, Group B exhibited markedly better LL, SL, PT, PI-LL,VAS and ODI scores at the final follow-up (P < 0.05). Group B also achieved better SD values post surgery than Group A (P < 0.05). The reoperation rate was remarkably elevated in Group A, compared to Group B (P < 0.05). The multivariate logistic regression analysis showed the L4-5 asLDH grade was a stand-alone risk hazard for reoperation, whereas, pre-SL and pre-LL offered protection against reoperation (P < 0.05). Conclusions L4-S1 PLIF is recommended to correct asLDH in L5-S1 IS patients, with high-grade disc herniation and abnormal sagittal alignment.
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Affiliation(s)
- Lei Deng
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, No.899 Pinhai Road, Suzhou, 215006, Jiangsu, China
| | - Xi Hua
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, No.899 Pinhai Road, Suzhou, 215006, Jiangsu, China
| | - Qian Wu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, No.899 Pinhai Road, Suzhou, 215006, Jiangsu, China
| | - Nanning Lv
- Department of Orthopedic Surgery, The Second People's Hospital of Lianyungang, 41 Hailian East Street, Lianyungang, 222003, Jiangsu, China
| | - Xiaofeng Shao
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, No.899 Pinhai Road, Suzhou, 215006, Jiangsu, China
| | - Quan Zhou
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, No.899 Pinhai Road, Suzhou, 215006, Jiangsu, China
| | - Hao Liu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, No.899 Pinhai Road, Suzhou, 215006, Jiangsu, China.
| | - Zhonglai Qian
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, No.899 Pinhai Road, Suzhou, 215006, Jiangsu, China.
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Wu J, Guo R, Yang C, Yan H, Wang Z, Chen Z, Peng X, Zhang D, Jiang X, Zhao Q, Li B, Hu X, Gao L. The Difference of Sagittal Correction of Adult Subaxial Cervical Spine Surgery According to Age: A Retrospective Study. Orthop Surg 2022; 14:1790-1798. [PMID: 35819084 PMCID: PMC9363747 DOI: 10.1111/os.13385] [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] [Received: 10/14/2021] [Revised: 06/05/2022] [Accepted: 06/07/2022] [Indexed: 11/06/2022] Open
Abstract
Objective At present, the true sagittal alignment of the cervical spine is uncertain, resulting in no standard reference for subaxial cervical surgery. So, we aimed to explore the age difference of normal cervical sagittal alignment and to further investigate the mid‐and long‐term changes of sagittal alignment after subaxial cervical spine surgery. Materials and Methods This was a retrospective study and 1223 asymptomatic volunteers and 79 patients undergoing subaxial cervical spine surgery were retrospectively reviewed in total. Asymptomatic volunteers and patients were divided into six subgroups: 20–29, 30–39, 40–49, 50–59, 60–69 and ≥70 groups. The age difference and trend with age of cervical sagittal parameters of asymptomatic volunteers were assessed by cervical lateral radiography and analyzed by ANOVA test, and the regression equation of C2‐7 Cobb was established via multiple linear regression. Based on the C2‐7 Cobb regression equations of different ages, the theoretical value, deviation value, loss value of the C2‐7 Cobb, and JOA recovery rate of patients were calculated, and the correlation among the loss value, deviation value of the C2‐7 Cobb, and JOA recovery rate of the 79 patients was evaluated by Pearson correlation analysis. Results For the asymptomatic volunteers, the C0‐2 Cobb decreased gradually with increasing age. The C2‐7 Cobb, C2‐7 SVA, T1S, NT, and TIA increased gradually with increasing age. The CBVA fluctuated with increasing age. T1S demonstrated a moderate correlation with C2‐7 Cobb (r = 0.60, p < 0.01); C0‐2 Cobb, C2‐7 SVA, CBVA, and TIA demonstrated a fair correlation with C2‐7 Cobb (r = −0.30, −0.33, 0.41, 0.40, p < 0.01); age demonstrated a poor correlation with C2‐7 Cobb (r = 0.19, p < 0.01). The regression equations of C2‐7 Cobb were established using C0‐2 Cobb, C2‐7 SVA, CBVA, and T1S. For the patients with subaxial cervical spine surgery, the loss of C2‐7 Cobb was moderately correlated with the deviation of C2‐7 Cobb (r = 0.33, p < 0.01). Conclusion The age difference of cervical sagittal alignment was obvious, and the C2‐7 Cobb increased with age especially. The closer the postoperative C2‐7 Cobb was to the theoretical value of corresponding age, the smaller the loss of correction angle was, and the better the mid‐ and long‐term outcomes. The personalized sagittal reconstruction should be performed according to age difference for subaxial cervical spine surgery.
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Affiliation(s)
- Jionglin Wu
- Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Rui Guo
- Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Canchun Yang
- Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Haolin Yan
- Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zheyu Wang
- Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhipeng Chen
- Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoshuai Peng
- Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Di Zhang
- Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xu Jiang
- Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qiancheng Zhao
- Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Bo Li
- Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xumin Hu
- Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Liangbin Gao
- Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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Morphologic Change of CorticoCancellous Allograft Used for Anterior Cervical Discectomy and Fusion. Spine (Phila Pa 1976) 2022; 47:944-953. [PMID: 35275848 DOI: 10.1097/brs.0000000000004354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/25/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim of this study was to evaluate the incidence and clinical implications of graft morphologic changes in corticocancellous allografts used for anterior cervical discectomy and fusion (ACDF), such as graft resorption or fracture. SUMMARY OF BACKGROUND DATA Although cortico-cancellous allograft is one of the most commonly used interbody spacer for ACDF, clinical implications of allograft resorption or fracture is unclear. METHODS One-hundred and thirty-eight consecutive patients who underwent ACDF for degenerative cervical myelopathy or radiculopathy were retrospectively reviewed. Patients with allograft morphologic changes, including graft resorption and fracture (morphologic change group), were compared with patients without morphologic changes (unchanged group). Furthermore, operated segments with morphologic changes were compared with unchanged segments. Patient characteristics, cervical lordosis, segmental lordosis, fusion, subsidence, neck pain visual analogue scale (VAS), arm pain VAS, and neck disability index (NDi) scores were evaluated. RESULTS Ninety patients (149 segments) were included in the study. Allograft resorption or fracture was detected in 46 (51.1%) patients and 81 (54.3%) segments, respectively. The fusion rate of morphologic change segments was significantly lower than that of the unchanged segments (P < 0.001). Furthermore, segments with morphologic changes had significantly higher rates of subsidence compared to unchanged segments ( P < 0.001). Segmental lordosis at the final follow-up was significantly smaller in the morphologic change segments ( P < 0.001). Neck pain VAS, arm pain VAS, and NDI scores did not demonstrate significant intergroup differences. CONCLUSION Corticocancellous allograft demonstrated a high rate of graft morphologic change (54.3%). Graft resorption or fracture was associated with increased pseudarthrosis, subsidence, and decreased postoperative segmental lordosis; however, the clinical results were not significantly affected. Caution is needed when choosing to use corticocancellous allografts for ACDF due to the high rate of graft resorption or fracture and the negative implications of these risks.
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Wang X, Meng Y, Liu H, Chen H, Wang B, Hong Y. Association of cervical sagittal alignment with adjacent segment degeneration and heterotopic ossification following cervical disc replacement with Prestige-LP disc. J Orthop Surg (Hong Kong) 2021; 28:2309499020968295. [PMID: 33169634 DOI: 10.1177/2309499020968295] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Cervical sagittal balance plays important roles in transmitting the load of the head and maintaining global spinal balance. This study aimed to identify the association of cervical sagittal alignment with adjacent segment degeneration (ASD) and heterotopic ossification (HO) after Prestige-LP cervical disc replacement (CDR). METHODS We enrolled 132 patients who underwent one-level Prestige-LP CDR with 2-10 years of follow-up. Cervical sagittal alignment parameters, including the degree of C2-C7 lordosis (CL), functional spinal unit angle (FSUA), sagittal vertical axis (SVA),, and T1 slope (T1s), were measured. ASD and HO were evaluated at the last follow-up. Unpaired t tests and logistic regression analysis were used to identify the associations of cervical sagittal alignment with ASD and HO. RESULTS We found that patients who developed ASD showed significantly lower FSUA (2.1° vs. -1.4°, p < 0.001) and T1s values (28.4° vs. 25.5°, p = 0.029) after surgery. Similarly, the postoperative CL was significantly better in patients without ASD or HO (18.0° vs. 14.4°, p = 0.043). The decrease in the T1s at the last follow-up was significantly larger in the patients with ASD (-11.0° vs. -3.2°, p = 0.003), HO (-6.7° vs. -2.7°, p = 0.050), and ASD or HO (-7.0° vs. -0.8°, p < 0.001) than in those without ASD or HO. Multivariate logistic regression analysis showed that both the FSUA and T1s are associated with ASD and that the degree of CL is associated with postoperative complications. CONCLUSION The results imply that maintaining cervical sagittal alignment after Prestige-LP CDR is important.
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Affiliation(s)
- Xiaofei Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Yang Meng
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Hao Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Hua Chen
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Beiyu Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Ying Hong
- Department of Operation Room, West China Hospital, Sichuan University, Sichuan, China.,West China School of Nursing, Sichuan University, Sichuan, China
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Correlations and Age-Related Changes of Cervical Sagittal Parameters in Adults Without Symptoms of Cervical Spinal Disease. Spine (Phila Pa 1976) 2020; 45:E1542-E1548. [PMID: 32890305 DOI: 10.1097/brs.0000000000003680] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To determine the correlations and age-related changes of cervical sagittal parameters in adults without obvious cervical spinal disease. SUMMARY OF BACKGROUND DATA Cervical sagittal parameters play essential roles in the pathogenesis and therapy of cervical spinal diseases. However, few studies have investigated the correlations and age-related changes of cervical sagittal parameters. METHODS The enrolled participants were divided into three age groups and their cervical sagittal parameters were collected. Correlations and age-related changes of these parameters were analyzed. RESULTS Significant differences in the C2-C7 angle, center of gravity of the head-C7 sagittal vertical axis (CGH-C7 SVA), C2-C7 SVA, neck tilt (NT), and thoracic inlet angle (TIA) were found among the three age groups. Pearson correlation analysis showed positive correlations between the C0-C2 angle and CGH-C7 SVA, C0-C2 angle and C2-C7 SVA, C2-C7 angle and T1 slope, C2-C7 angle and TIA, CGH-C7 SVA and C2-C7 SVA, C2-C7 SVA and T1 slope, T1 slope and TIA, and NT and TIA as well as negative correlations between the C0-C2 angle and C2-C7 angle, C2-C7 angle and CGH-C7 SVA, and C2-C7 angle and C2-C7 SVA. Paired t tests showed significant changes in the C2-C7 angle in groups I and II, and in the CGH-C7 SVA and C2-C7 SVA in all age groups with increasing age. CONCLUSION The results indicate that cross correlations exist between different cervical sagittal parameters in adults without symptoms of cervical spinal disease, and the lower cervical curvature and SVA change obviously with increasing age. LEVEL OF EVIDENCE 3.
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