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Zhou M, Xu X, Chen H, Qi B. Comparing two surgical approaches for treating multilevel cervical spondylotic myelopathy: A meta-analysis. 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; 32:3485-3496. [PMID: 37393420 DOI: 10.1007/s00586-023-07790-6] [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: 09/21/2022] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE This meta-analysis aims to evaluate the therapeutic efficacy of anterior versus posterior surgical approaches for multisegment cervical spondylotic myelopathy (MCSM). METHODS Eligible studies published between the period of January 2001 and April 2022 and comparing the anterior and posterior surgical approaches for treating cervical spondylotic myelopathy were retrieved from the PubMed, Web of Science, Embase, and Cochrane databases. RESULTS A total of 17 articles were selected based on the inclusion and exclusion criteria. This meta-analysis failed to show any significant difference in the duration of surgery, the hospitalization time, or the improvement in the Japanese Orthopedic Association score between the anterior and posterior approaches. The anterior approach, however, exhibited increased efficacy in the improvement of the neck disability index, reduction in the visual analog scale for cervical pain, and improvement in the cervical curvature compared with the posterior approach. CONCLUSION Bleeding was also less with the anterior surgical approach. The posterior approach provided a significantly higher range of motion of the cervical spine and showed fewer postoperative complications compared with the anterior approach. While both the surgical approaches have good clinical outcomes and show postoperative neurological function improvement, the meta-analysis shows that both anterior and posterior approaches have certain merits and shortcomings. A meta-analysis of a larger number of randomized controlled trials with longer follow-up can conclusively determine which of the surgical approaches is more beneficial in the treatment of MCSM.
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Affiliation(s)
- Min Zhou
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Xin Xu
- Cardiovascular Medicine Department, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Hairen Chen
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Baiwen Qi
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
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Lisitsky IY, Lychagin AV, Zarov AY, Korkunov AL, Cherepanov VG, Vyazankin IA. [Skip corpectomy in surgical treatment of cervical spondylotic myelopathy]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:41-47. [PMID: 37011327 DOI: 10.17116/neiro20238702141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of skip corpectomy in surgical treatment of cervical spondylotic myelopathy. MATERIAL AND METHODS The study included 7 patients with cervical myelopathy following extended cervical spine stenosis. All patients underwent skip corpectomy. Clinical examination included degree of neurological disorders according to the modified scale of the Japanese Orthopedic Association (JOA) with assessment of recovery rate and Nurick score, as well as VAS score of pain syndrome. Verification of diagnosis was based on the data of spondylography, magnetic resonance and computed tomography. The indications for surgical treatment were conduction disorders and their spondylotic genesis confirmed by neuroimaging methods. RESULTS. VAS Score of pain syndrome decreased by 2-4 points (mean 3.1) in long-term postoperative period. The JOA, Nurick scores and recovery rate (mean 42.5%) demonstrated significant improvement of neurological status in all patients. In all cases, the follow-up examination confirmed adequate decompression and spinal fusion. CONCLUSION Skip corpectomy provides adequate spinal cord decompression in case of extended cervical spine stenosis and minimizes the risk of complications typical for multilevel corpectomy. Recovery rate indicates the effectiveness of this method in surgical treatment of cervical myelopathy caused by multilevel stenosis. However, further studies on sufficient clinical material are needed.
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Affiliation(s)
- I Yu Lisitsky
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A V Lychagin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A Yu Zarov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A L Korkunov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V G Cherepanov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - I A Vyazankin
- Sechenov First Moscow State Medical University, Moscow, Russia
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Rao H, Chen Y, Xu W, Zhou Z. Clinical Effects of Preoperative K-Line Tilt on Patient Outcomes After Laminoplasty for Cervical Ossification of the Posterior Longitudinal Ligament. World Neurosurg 2021; 150:e639-e644. [PMID: 33757888 DOI: 10.1016/j.wneu.2021.03.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We sought to clarify the effects of the preoperative K-line tilt on cervical sagittal balance and patient outcomes after laminoplasty for cervical ossification of the posterior longitudinal ligament (OPLL). METHODS A retrospective analysis of 45 patients with OPLL treated by laminoplasty from January 2013 to December 2018 was performed. The radiological parameters included the K-line tilt, C2-C7 sagittal vertical axis, C2-C7 lordosis, T1 slope, and T1 slope minus C2-C7 lordosis. The patient quality of life outcomes were assessed using the neck disability index, Japanese Orthopaedic Association disability scale, and visual analog scale. The patients were classified into 2 groups according to the median preoperative K-line tilt angle (14.1°): the high K-line tilt group (n = 23) and the low K-line tilt group (n = 22). The postoperative cervical alignment changes and patient outcomes were compared and analyzed. RESULTS The clinical outcomes demonstrated overall improvement at the final follow-up. The C2-C7 lordosis had significantly decreased from 13.5° ± 9.5° preoperatively to 10.2° ± 9.7°. The C2-C7 lordosis was less in the high K-line tilt group than that in the low K-line tilt group. In addition, the high K-line tilt group revealed significantly greater kyphotic changes and a greater loss of cervical lordosis compared with the low K-line tilt group. Finally, the quality of life outcomes and postoperative visual analog scale scores were higher in the high K-line tilt group. CONCLUSIONS The results of the present study have shown that the parameter K-line tilt is an ideal radiological parameter for predicting the outcomes and determining the need for laminoplasty for cervical ossification of the OPLL. Patients with a higher K-line tilt preoperatively experienced more kyphotic alignment changes and neck pain after laminoplasty.
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Affiliation(s)
- Hongming Rao
- Department of Orthopaedic Surgery, Fuzhou Second Hospital affiliated to Xiamen University, Fuzhou, China
| | - Yufan Chen
- Department of Spine Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Weihong Xu
- Department of Spine Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhangyan Zhou
- Department of Orthopaedic Surgery, Sanming First Hospital Affiliated to Fujian Medical University, Sanming, China.
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Zhai JL, Guo SG, Nie L, Hu JH. Comparison of the anterior and posterior approach in treating four-level cervical spondylotic myelopathy. Chin Med J (Engl) 2020; 133:2816-2821. [PMID: 33273330 PMCID: PMC10631575 DOI: 10.1097/cm9.0000000000001146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The optimal surgical approach for four-level cervical spondylotic myelopathy remains controversial. The purpose of this study was to compare clinical and radiological outcomes and complications between the anterior and posterior approaches for four-level cervical spondylotic myelopathy. METHODS A total of 19 patients underwent anterior decompression and fusion and 25 patients underwent posterior laminoplasty and instrumentation in this study. Perioperative information, intraoperative blood loss, clinical and radiological outcomes, and complications were recorded. Japanese Orthopedic Association (JOA) score, 36-item short form survey (SF-36) score and cervical alignment were assessed. RESULTS There were no significant differences in JOA scores between the anterior and posterior group preoperatively (11.6 ± 1.6 vs. 12.1 ± 1.5), immediately postoperatively (14.4 ± 1.1 vs. 13.8 ± 1.3), or at the last follow-up (14.6 ± 1.0 vs. 14.2 ± 1.1) (P > 0.05). The JOA scores significantly improved immediately postoperatively and at the last follow-up in both groups compared with their preoperative values. The recovery rate was significantly higher in the anterior group both immediately postoperatively and at the last follow-up. The SF-36 score was significantly higher in the anterior group at the last follow-up compared with the preoperative value (69.4 vs. 61.7). Imaging revealed that there was no significant difference in the Cobb angle at C2-C7 between the two groups preoperatively (-2.0° ± 7.3° vs. -1.4° ± 7.5°). The Cobb angle significantly improved immediately postoperatively (12.3° ± 4.2° vs. 9.2° ± 3.6°) and at the last follow-up (12.4° ± 3.5° vs. 9.0° ± 2.6°) in both groups compared with their preoperative values (P = 0.00). Three patients had temporary dysphagia in the anterior group and four patients had persistent axial symptoms in the posterior group. CONCLUSIONS Both the anterior and posterior approaches were effective in treating four-level cervical spondylotic myelopathy in terms of neurological clinical outcomes and radiological features. However, the JOA score recovery rate and SF-36 score in the anterior group were significantly higher. Persistent axial pain could be a major concern when undertaking the posterior approach.
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Affiliation(s)
- Ji-Liang Zhai
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Shi-Gong Guo
- Department of Rehabilitation Medicine, University Hospital of Wales Cardiff, UK
| | - Li Nie
- Department of Research and Education, Beijing Centers of Disease Prevention and Control, Beijing 102206, China
| | - Jian-Hua Hu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
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Badhiwala JH, Ellenbogen Y, Khan O, Nouri A, Jiang F, Wilson JR, Jaja B, Witiw CD, Nassiri F, Fehlings MG, Wilson JR. Comparison of the Inpatient Complications and Health Care Costs of Anterior versus Posterior Cervical Decompression and Fusion in Patients with Multilevel Degenerative Cervical Myelopathy: A Retrospective Propensity Score–Matched Analysis. World Neurosurg 2020; 134:e112-e119. [DOI: 10.1016/j.wneu.2019.09.132] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
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Zhang B, Sun J, Xu X, Shi J, Guo Y, Sun K, Yang H, Wang Y, Huan L, Sun X, Wang H, Zheng B, Chen F, Zhang P. Skip corpectomy and fusion (SCF) versus anterior controllable antedisplacement and fusion (ACAF): which is better for patients with multilevel cervical OPLL? Arch Orthop Trauma Surg 2019; 139:1533-1541. [PMID: 30953139 DOI: 10.1007/s00402-019-03182-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND The aim of this study was to compare the clinical efficacy and radiological outcomes of skip corpectomy and fusion (SCF) with anterior controllable antedisplacement and fusion (ACAF) for treating multilevel ossification of the posterior longitudinal ligament (OPLL). METHODS 62 patients with multilevel OPLL who had undergone SCF or ACAF were analyzed retrospectively. Types of OPLL, occupying ratio (OR), Japanese Orthopaedic Association (JOA) score, Recovery Rate (RR), Neck Disability Index (NDI) score, Cobb's angles of C2-C7, operation time, blood loss, hospital stay, ratings for fusion assessment and complications were recorded and assessed. RESULTS Postoperative C2-C7 Cobb's angle (11.1 ± 3.2° vs. 13.7 ± 2.5°; P < 0.05), NDI scores at final follow-up (14.3 ± 1.6 vs. 13.3 ± 1.3; P < 0.05), and rate of cerebral fluid (CSF) leakage (5, 16.7% vs. 0,0%; P < 0.05) were significantly better in the ACAF group. At 6 months, bone graft fusion rate was significantly greater in the ACAF group (24.75% vs. 15.50%; P < 0.05). CONCLUSIONS Surgical treatment of multilevel OPLL by SCF or ACAF showed no significant differences in clinical outcomes, with the exception of better NDI scores at final follow-up in ACAF. In addition, ACAF is better than SCF in terms of early bone graft fusion rate, lordotic curvature improvement, risk of CSF leakage.
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Affiliation(s)
- Bin Zhang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Jingchuan Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Ximing Xu
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Jiangang Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China.
| | - Yongfei Guo
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China.
| | - Kaiqiang Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Haisong Yang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Yuan Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Le Huan
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Xiaofei Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Haibo Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Bing Zheng
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Fangni Chen
- Department of Radiology and Nuclear Medicine, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China
| | - Peng Zhang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China
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Comparison of Clinical and Radiologic Outcomes Between Self-Locking Stand-Alone Cage and Cage with Anterior Plate for Multilevel Anterior Cervical Discectomy and Fusion: A Meta-Analysis. World Neurosurg 2019; 125:e117-e131. [DOI: 10.1016/j.wneu.2018.12.218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/27/2018] [Accepted: 12/28/2018] [Indexed: 02/07/2023]
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Zhang Y, Liu H, Yang H, Pi B. Relationship Between Sagittal Balance and Axial Symptoms in Patients with Cervical Spondylotic Myelopathy Treated with Anterior Cervical Discectomy and Fusion. J INVEST SURG 2019; 33:404-411. [PMID: 30905209 DOI: 10.1080/08941939.2018.1524948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: The purpose of this study was to investigate the sagittal balance of the cervical spine and the clinical outcomes of anterior cervical discectomy and fusion (ACDF) for the treatment of cervical spondylotic myelopathy and to explore whether sagittal balance is related to the incidence of postoperative axial symptoms. Methods: Sixty-seven consecutive patients who underwent ACDF for the treatment of cervical spondylotic myelopathy from January 2014 to December 2016 were enrolled in our study. Sagittal balance parameters (global lordotic angle, segmented lordotic angle, T1 slope, and C2-7 sagittal vertical axis [C2-7 SVA] were recorded in the preoperative period and at 1 month, 3 months, and 1 year postoperatively. Clinical outcomes (JOA and NDI scores) and incidence of axial symptoms were also evaluated before and after surgery. Subgroup analysis included 20 patients with preoperative abnormal sagittal balance group (C2-7 SVA larger than 20 mm), and these patients were divided into two groups, namely axial symptom group and nonaxial symptom group. Result: The sagittal balance parameters (global lordotic angle, segmented lordotic angle, and TI slope) and the clinical outcomes after surgery significantly improved. The subgroup analysis within the preoperative abnormal sagittal balance group showed significant differences in postoperative and change in C2-7 SVA between patients with and without postoperative axial symptoms. Conclusion: ACDF can be applied to restore the sagittal alignment of the cervical spine and effectively improve clinical outcomes for the treatment of cervical spondylotic myelopathy. Sagittal balance improvement may be associated with the low incidence of postoperative axial symptoms for patients with abnormal cervical sagittal balance before surgery.
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Affiliation(s)
- Yijian Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hao Liu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Huilin Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Bin Pi
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Incidence of C5 Palsy: Meta-Analysis and Potential Etiology. World Neurosurg 2019; 122:e828-e837. [DOI: 10.1016/j.wneu.2018.10.159] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 10/21/2018] [Accepted: 10/23/2018] [Indexed: 11/15/2022]
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Kato S, Ganau M, Fehlings MG. Surgical decision-making in degenerative cervical myelopathy – Anterior versus posterior approach. J Clin Neurosci 2018; 58:7-12. [DOI: 10.1016/j.jocn.2018.08.046] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/13/2018] [Indexed: 11/16/2022]
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Kato S, Nouri A, Wu D, Nori S, Tetreault L, Fehlings MG. Comparison of Anterior and Posterior Surgery for Degenerative Cervical Myelopathy: An MRI-Based Propensity-Score-Matched Analysis Using Data from the Prospective Multicenter AOSpine CSM North America and International Studies. J Bone Joint Surg Am 2017. [PMID: 28632590 DOI: 10.2106/jbjs.16.00882] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgeons often choose between 2 different approaches (anterior and posterior) for surgical treatment of degenerative cervical myelopathy on the basis of imaging features of spinal cord compression, the number of levels affected, and the spinal alignment. However, there is a lack of consensus on which approach is preferable. The objective of the present study was to use magnetic resonance imaging (MRI)-based propensity-score-matched analysis to compare postoperative outcomes between the anterior and posterior surgical approaches for degenerative cervical myelopathy. METHODS A total of 757 patients were enrolled in 2 prospective multicenter AOSpine studies, which involved 26 international sites. Preoperative MRIs were reviewed to characterize the causes of the cord compression, including single-level disc disease, multilevel disc disease, ossification of the posterior longitudinal ligament, enlargement of the ligamentum flavum, vertebral subluxation/spondylolisthesis, congenital fusion, number of compressed levels, or kyphosis. The propensity to choose anterior decompression was calculated using demographic data, preoperative MRI findings, and the modified Japanese Orthopaedic Association (mJOA) scores in a logistic regression model. We then performed 1-to-1 matching of patients who had received anterior decompression with those who had the same propensity score but had received posterior decompression to compare 2-year postoperative outcomes and 30-day perioperative complication rates between the 2 groups after adjustment for background characteristics. RESULTS A total of 435 cases were included in the propensity score calculation, and 1-to-1 matching resulted in 80 pairs of anterior and posterior surgical cases; 99% of these matched patients had multilevel compression. The anterior and posterior groups did not differ significantly in terms of the postoperative mJOA score (15.1 versus 15.3, p = 0.53), Neck Disability Index (20.5 versus 24.1, p = 0.44), or Short Form-36 (SF-36) Physical Component Summary (PCS) score (41.9 versus 40.9, p = 0.30). The overall rates of perioperative complications were similar between the 2 groups (16% versus 11%, p = 0.48); however, dysphagia/dysphonia was reported only in the anterior group whereas surgical site infection and C5 radiculopathy were reported only in the posterior group. CONCLUSIONS Anterior and posterior decompression for degenerative cervical myelopathy resulted in similar postoperative outcomes and rates of complications. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- So Kato
- 1Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
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A Comparison of the Anterior Approach and the Posterior Approach in Treating Multilevel Cervical Myelopathy: A Meta-Analysis. Clin Spine Surg 2017; 30:65-76. [PMID: 27352375 DOI: 10.1097/bsd.0000000000000398] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A meta-analysis. OBJECTIVE To compare the effectiveness and the safety of the anterior approach with those of the posterior approach for patients diagnosed with multilevel cervical myelopathy (MCM). SUMMARY OF BACKGROUND DATA Although many studies had compared the outcomes of the anterior approach with that of the posterior approach for MCM in recent years, choosing a proper surgical approach is still a controversial issue . METHODS We searched electronic databases for relevant studies that compared the anterior approach with the posterior approach for MCM. Then, data extraction and quality assessment were conducted. We used RevMan 5.3 for data analysis. A random effects model was used for heterogenous data, whereas a fixed-effects model was used for homogenous data. RESULTS A total of 25 nonrandomized controlled studies involving 1843 patients were included. No statistical difference was found with regard to the preoperative Japanese Orthopedic Association (JOA) score between the anterior group and the posterior group (P=0.08, 95% CI, -0.02 to 0.40). The postoperative JOA score and the recovery rate were higher in the anterior group as compared with the posterior group (P=0.02, 95% CI, 0.10-1.33; P=0.006, 95% CI, 2.33-13.90). In the subgroup analysis, better postoperative JOA scores and recovery rates were also obtained in the anterior group for cervical spondylotic myelopathy (P=0.0007, 95% CI, 0.29-1.09; P=0.01, 95% CI, 1.30-9.93). No significant differences were found in the complication rate, the revision rate, the operation time, and blood loss between the 2 groups (P=0.17, 95% CI, 0.89-1.95; P=0.21, 95% CI, 0.72-4.61; P=0.31, 95% CI, -20.20 to 63.30; P=0.88, 95% CI, -166.86 to 143.81). CONCLUSIONS The anterior approach is associated with a better postoperative neurological outcome compared with the posterior approach in cervical spondylotic myelopathy patients. Considering the complication rate, the revision rate, the operation time, and blood loss, the anterior approach appears to be as safe as the posterior approach. Further randomized controlled trials comparing the anterior approach and the posterior approach for MCM should be performed to make a more convincing conclusion.
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Wang T, Tian XM, Liu SK, Wang H, Zhang YZ, Ding WY. Prevalence of complications after surgery in treatment for cervical compressive myelopathy: A meta-analysis for last decade. Medicine (Baltimore) 2017; 96:e6421. [PMID: 28328846 PMCID: PMC5371483 DOI: 10.1097/md.0000000000006421] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE We aim to perform a meta-analysis on prevalence of all kinds of operation-related complications following surgery treating cervical compressive myelopathy (CCM) and to provide reference for surgeons making surgical plan. METHODS An extensive search of literature was performed in PubMed/MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG databases on incidence of operation-related complications from January 2007 to November 2016. Data was calculated and data analysis was conducted with STATA 12.0 and Revman 5.3. RESULTS A total of 107 studies included 1705 of 8612 patients (20.1%, 95% CI 17.3%-22.8%) on overall complications. The incidence of C5 plasy, cerebrospinal fluid (CSF), infection, axial pain, dysphagia, hoarseness, fusion failure, graft subsidence, graft dislodgment, and epidural hematoma is 5.3% (95% CI 4.3%-6.2%), 1.9% (95% CI 1.3%-2.4%), 2.8% (95% CI 1.7%-4.0%), 15.6% (95% CI 11.7%-19.5%), 16.8% (95% CI 13.6%-19.9%), 4.0% (95% CI 2.3%-5.7%), 2.6% (95% CI 0.2%-4.9%), 3.7% (95% CI 2.0%-5.5%), 3.4% (95% CI 2.0%-4.8%), 1.1% (95% CI 0.7%-1.5%), respectively. Patients with ossification of posterior longitudinal ligament (OPLL) (6.3%) had a higher prevalence of C5 plasy than those with cervical spondylotic myelopathy (CSM) (4.1%), and a similar trend in CSF (12.2% vs 0.9%). Individuals after laminectomy and fusion (LF) had highest rate of C5 plasy (15.2%), while those who underwent anterior cervical discectomy and fusion (ACDF) had the lowest prevalence (2.0%). Compared with patients after other surgical options, individuals after anterior cervical corpectomy and fusion (ACCF) have the highest rate of CSF (4.2%), infection (14.2%), and epidural hematoma (3.1%). Patients after ACDF (4.8%) had a higher prevalence of hoarseness than those with ACCF (3.0%), and a similar trend for dysphagia between anterior corpectomy combined with discectomy (ACCDF) and ACCF (16.8% vs 9.9%). CONCLUSIONS Based on our meta-analysis, patients with OPLL have a higher incidence of C5 palsy and CSF. Patients after LF have a higher incidence of C5 palsy, ACCDF have a higher incidence of dysphagia, ACCF have a higher incidence of CSF and infection and ACDF have a higher incidence of hoarseness. These figures may be useful in the estimation of the probability of complications following cervical surgery.
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Affiliation(s)
- Tao Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Xiao-Ming Tian
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Si-Kai Liu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Hui Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Ying-Ze Zhang
- Hebei Provincial Key Laboratory of Orthopedic Biomechanics, Shijiazhuang, China
| | - Wen-Yuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
- Hebei Provincial Key Laboratory of Orthopedic Biomechanics, Shijiazhuang, China
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Lin JH, Chien LN, Tsai WL, Chen LY, Hsieh YC, Chiang YH. Reoperation rates of anterior cervical discectomy and fusion versus posterior laminoplasty for multilevel cervical degenerative diseases: a population-based cohort study in Taiwan. Spine J 2016; 16:1428-1436. [PMID: 27520080 DOI: 10.1016/j.spinee.2016.08.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 05/13/2016] [Accepted: 08/02/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The reoperation (reop) rate is a crucial indicator of the efficacy of an operation; however, studies on the reop rates of anterior cervical discectomy and fusion (ACDF) or posterior laminoplasty (LMP) for treating multilevel cervical degenerative diseases (MCDDs) are scant. PURPOSE This study aimed to compare the reop rates and safety of ACDF and LMP for MCDD treatment. STUDY DESIGN This is a retrospective population-based cohort study. PATIENT SAMPLE Our sample consists of patients who underwent ACDF and LMP treatment. OUTCOME MEASURES Reop rate, risk of pneumonia, sepsis, surgery-related complications, and death. METHODS A total of 6,605 patients who underwent ACDF and 1,578 patients who underwent LMP for MCDD treatment from 2001 to 2011 were selected from the Taiwan National Health Insurance Research Database. Cox proportional hazard models were performed to compare the clinical outcomes of the patients who underwent ACDF with those of the patients who underwent LMP. RESULTS Long-term reop rates (per 100 person-month) were slightly Anterior cervical discectomy and fusion; in the patients who underwent ACDF (0.04 [95% confidence interval, CI: 0.03-0.05]) than in those who underwent LMP (0.06 [95% CI: 0.04-0.08]), with adjusted hazard ratio (HR) of 1.43 (95% CI: 0.96-2.11, p=.08), although short-term reop rates were significantly higher in the LMP group (0.41 [95% CI: 0.33-0.51]) than in the ACDF group (0.09 [95% CI: 0.07-0.11]), with adjusted HR of 4.81 (95% CI: 3.46-6.69, p<.001). Patients who underwent LMP had a lower risk of pneumonia, sepsis, surgery-related complications, and death than did those who underwent ACDF within a year of follow-up. The results after adjustment for all covariates showed that osteoarthritis (adjusted HR=2.07, 95% CI: 1.40-3.06, p<.01) was associated with reop risk in the patients who underwent ACDF, and diabetes (adjusted HR=3.27, 95% CI: 1.12-9.54, p=.03) was associated with reop risk in the patients who underwent LMP. CONCLUSIONS There was no significantly higher incidence rate of reop between the patients who underwent LMP and those who underwent ACDF after 1-year follow-up; however, ACDF was associated with a higher rate of 1-year complications and mortality compared with LMP. LMP might be considered as a treatment option for MCDD but could not be appropriate for patients with cervical kyphotic deformity.
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Affiliation(s)
- Jiann-Her Lin
- Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan; Department of Neurosurgery, Taipei Medical University Hospital, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan; Division of Neurosurgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan
| | - Li-Nien Chien
- School of Health Care Administration, College of Management, Taipei Medical University, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan; Health and Clinical Research Center, College of Public Health and Nutrition, Taipei Medical University, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan
| | - Wan-Ling Tsai
- Department of Neurosurgery, Taipei Medical University Hospital, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan; Graduate Institute of Neural Regenerative Medicine, College of Public Health and Nutrition, Taipei Medical University, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan
| | - Li-Ying Chen
- Health and Clinical Research Center, College of Public Health and Nutrition, Taipei Medical University, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan
| | - Yi-Chen Hsieh
- Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan.
| | - Yung-Hsiao Chiang
- Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan; Department of Neurosurgery, Taipei Medical University Hospital, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan; Division of Neurosurgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan
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An Evidence-Based Stepwise Surgical Approach to Cervical Spondylotic Myelopathy: A Narrative Review of the Current Literature. World Neurosurg 2016; 94:97-110. [DOI: 10.1016/j.wneu.2016.06.109] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 06/25/2016] [Accepted: 06/27/2016] [Indexed: 12/17/2022]
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Abstract
Cervical myelopathy is the most common cause of acquired spinal cord compromise. The concept of degenerative cervical myelopathy (DCM), defined as symptomatic myelopathy associated with degenerative arthropathic changes in the spine axis, is being introduced. Given its progressive nature, treatment options have to be chosen in a timely manner. Surgical options include anterior discectomy and fusion (ACDF), anterior corpectomy and fusion (ACCF), arthroplasty (in highly select cases), posterior laminectomy with/without fusion, and laminoplasty. Indications for each should be carefully considered in individual patients. Riluzole, a sodium-glutamate antagonist, is a promising option to optimize neurologic outcomes post-surgery and is being examined in the CSM-Protect Randomized Controlled Trial. Preoperative risk assessment is mandatory for prognostication. Sagittal alignment is known to play an important role to optimize surgical outcome. Guidelines for optimal management of DCM are in process. In principle, all but the mildest cases of DCM should be offered surgery for optimal outcome.
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Affiliation(s)
- So Kato
- Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Michael Fehlings
- Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
- Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst St. Suite 4WW-449, Toronto, ON, M5T2S8, Canada.
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Sakai K, Yoshii T, Hirai T, Arai Y, Shinomiya K, Okawa A. Impact of the surgical treatment for degenerative cervical myelopathy on the preoperative cervical sagittal balance: a review of prospective comparative cohort between anterior decompression with fusion and laminoplasty. 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 2016; 26:104-112. [DOI: 10.1007/s00586-016-4717-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/25/2016] [Accepted: 07/25/2016] [Indexed: 10/21/2022]
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18
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Comparison of Anterior Decompression and Fusion With Posterior Laminoplasty for Multilevel Cervical Compressive Myelopathy. ACTA ACUST UNITED AC 2015; 28:282-90. [DOI: 10.1097/bsd.0000000000000317] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The Reliability of the Ultrasonic Bone Scalpel in Cervical Spondylotic Myelopathy: A Comparative Study of 46 Patients. World Neurosurg 2015; 84:1962-7. [PMID: 26342784 DOI: 10.1016/j.wneu.2015.08.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND In patients with cervical spondylotic myelopathy (CSM), laminectomy is usually performed with a Kerrison rongeur or a high speed drill (HSD).The HSD, which is most often selected for laminectomy, may cause complications such as duratomy, thermal and mechanical neural injuries. With an ultrasonic bone scalpel (UBS), a less traumatic laminectomy can be performed in a shorter time. The aim of this study was to compare the results of laminectomies using HSD and UBS. METHODS Evaluation was made in 46 patients who were operated on for CSM. Cervical laminectomy was performed on 23 patients using the UBS (group I) and to 23 using the HSD (group II). A comparison was made of the 2 groups in respect of demographic characteristics, laminectomy levels, mean laminectomy duration, bleeding rates, and surgical complications. RESULTS In group I, the mean laminectomy time was 2.2 ± 0.4 min/level, mean blood loss was 180 mL, hospitalization was 3.0 ± 0.0 days, and C5 radiculopathy was seen in 1 patient. In group II, the mean laminectomy time was 7.4 ± 2.6 min/level, mean blood loss was 380 mL, hospitalization was 3.7 ± 1.3 days, C5 radiculopathy was seen in 1 patient and dura injuries in 3 patients. The recovery rate was determined as 47.6% in group I and 48.8% in group II. CONCLUSIONS For patients with CSM, laminectomy using the UBS provides a safe, rapid, and effective decompression with a lesser blood loss. The low rate of complications lessens the postoperative morbidity rates and shortens hospital stay.
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Epstein NE, Hollingsworth R. C5 Nerve root palsies following cervical spine surgery: A review. Surg Neurol Int 2015; 6:S154-63. [PMID: 26005577 PMCID: PMC4431054 DOI: 10.4103/2152-7806.156556] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 12/31/2014] [Indexed: 11/05/2022] Open
Abstract
Background: Cervical C5 nerve root palsies may occur in between 0% and 30% of routine anterior or posterior cervical spine operations. They are largely attributed to traction injuries/increased cord migration following anterior/posterior decompressions. Of interest, almost all studies cite spontaneous resolution of these deficits without surgery with 3–24 postoperative months. Methods: Different studies cite various frequencies for C5 root palsies following anterior or posterior cervical spine surgery. In their combined anterior/posterior series involving C4-C5 level decompressions, Libelski et al. cited up to a 12% incidence of C5 palsies. In Gu et al. series, C5 root palsies occurred in 3.1% of double-door laminoplasty, 4.5% of open-door laminoplasty, and 11.3% of laminectomy. Miller et al. observed an intermediate 6.9% frequency of C5 palsies followed by posterior cervical decompressions and fusions (PCDF). Results: Gu et al. also identified multiple risk factors for developing C5 palsies following posterior surgery; male gender, ossification of the posterior longitudinal ligament (OPLL), narrower foramina, laminectomy, and marked dorsal spinal cord drift. Miller et al. also identified an average $1918 increased cost for physical/occupational therapy for patients with C5 palsies. Conclusions: The incidence of C5 root deficits for anterior/posterior cervical surgery at C4-C5 was 12% in one series, and ranged up to 11.3% for laminectomies, while others cited 0–30%. Although identification of preoperative risk factors for C5 root deficits may help educate patients regarding these risks, there is no clear method for their avoidance at this time.
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Affiliation(s)
- Nancy E Epstein
- Department of NeuroScience, Winthrop University Hospital, Mineola, NY 11501, USA
| | - Renee Hollingsworth
- Department of NeuroScience, Winthrop University Hospital, Mineola, NY 11501, USA
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Kizilay Z, Yilmaz A, Ozkul A, Ismailoglu O. Cervicothoracic Arachnoid Cyst Causing Cervical Myelopathy: A Case Report. Open Access Maced J Med Sci 2015; 3:135-8. [PMID: 27275210 PMCID: PMC4877772 DOI: 10.3889/oamjms.2015.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/08/2015] [Accepted: 02/09/2015] [Indexed: 11/05/2022] Open
Abstract
Several types of intraspinal cyst develop within the spinal canal from the craniovertebral junction to the sacrum. These lesions occur in both children and adults. Arachnoid cysts are one of them and are more frequent in the paediatric population, being a relatively uncommon lesion in adults. The arachnoid cyst may be located intradurally or extradurally. The intradural type may be congenital or from spinal trauma, infection or spondylosis. Although intradural arachnoid cysts are often asymptomatic, they may give early symptoms when they exist with synchronous pathologies constricting the spinal canal gradually as in cervical spondylosis. In this report, a 60-year-old man with an arachnoid cyst of the cervicothoracic spine is presented. His cyst remained undiagnosed because of the nonspecific nature of the symptoms. It was only when he developed right hemiparesis that a posterior fluid collection compressing the spinal cord was found in Magnetic resonance imaginig. An intradural extramedullary cyst was removed with successful surgery and cord compression and symptoms were reversed. We discuss radiological diagnosis and surgical treatment of an arachnoid cyst in this report.
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Affiliation(s)
- Zahir Kizilay
- Adnan Menderes University, Medical Faculty, Neurosurgery, Aytepe Campus, Aydin 09100, Turkey
| | - Ali Yilmaz
- Adnan Menderes University, Medical Faculty, Neurosurgery, Aytepe Campus, Aydin 09100, Turkey
| | - Ayca Ozkul
- Adnan Menderes University, Medical Faculty, Department of Neurology, Aydin 09100, Turkey
| | - Ozgur Ismailoglu
- Süleyman Demirel University, Neurosurgery, 32260 Isparta, Turkey
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