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Lee DH, Lee SK, Cho JH, Hwang CJ, Lee CS, Yang JJ, Kim KJ, Park JH, Park S. Efficacy and safety of oblique posterior endplate resection for wider decompression (trumpet-shaped decompression) during anterior cervical discectomy and fusion. J Neurosurg Spine 2023; 38:157-164. [PMID: 36152331 DOI: 10.3171/2022.7.spine22614] [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: 06/01/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Anterior cervical discectomy and fusion (ACDF) provides a limited workspace, and surgeons often need to access the posterior aspect of the vertebral body to achieve sufficient decompression. Oblique resection of the posterior endplate (trumpet-shaped decompression [TSD]) widens the workspace, enabling removal of lesions behind the vertebral body. This study was conducted to evaluate the efficacy and safety of oblique posterior endplate resection for wider decompression. METHODS In this retrospective study, 227 patients who underwent ACDF for the treatment of cervical myelopathy or radiculopathy caused by spondylosis or ossification of the posterior longitudinal ligament and were followed up for ≥ 1 year were included. Patient characteristics, fusion rates, subsidence, and patient-reported outcome measures, including the neck pain visual analog scale (VAS) score, arm pain VAS score, and Neck Disability Index (NDI), were assessed. Patients who underwent TSD during ACDF (TSD group) and those who underwent surgery without TSD (non-TSD group) were compared. RESULTS Fifty-seven patients (25.1%) were included in the TSD group and 170 patients (74.9%) in the non-TSD group. In the TSD group, 28.2% ± 5.5% of the endplate was resected, and 26.0% ± 6.1% of the region behind the vertebral body could be visualized via the TSD technique. The resection angle was 26.9° ± 5.9°. The fusion rate assessed on the basis of interspinous motion, intragraft bone bridging, and extragraft bone bridging did not significantly differ between the two groups. Furthermore, there were no significant intergroup differences in subsidence. The patient-reported outcome measures at the 1-year follow-up were also not significantly different between the groups. CONCLUSIONS TSD widened the workspace during ACDF, and 26% of the region posterior to the vertebral body could be accessed using this technique. The construct stability was not adversely affected by TSD as demonstrated by the similar fusion and subsidence rates among patients who underwent TSD and those who did not. Therefore, TSD can be safely applied during ACDF when compressive lesions extend behind the vertebral body and are not limited to the disc space, enabling adequate decompression without disrupting the construct stability.
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Affiliation(s)
- Dong-Ho Lee
- 1Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Suk-Kyu Lee
- 2Department of Orthopedic Surgery, Asan Bone Hospital, Jeju-si, Republic of Korea
| | - Jae Hwan Cho
- 1Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang Ju Hwang
- 1Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Choon Sung Lee
- 1Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Jun Yang
- 3Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Kook Jong Kim
- 4Department of Orthopedic Surgery, Chungbuk National University Hospital, Chungcheongbuk-do, Cheongju-si, Republic of Korea; and
| | - Jae Hong Park
- 5Department of Orthopedic Surgery, Asan Bone Hospital, Seoul, Republic of Korea
| | - Sehan Park
- 3Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
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Yang Y, Wang Y, Cao J, Lei T, Yang Z, Xia H. Laminoplasty and simultaneous C2 semi-laminectomy with internal fixation in treating ossification of the posterior longitudinal ligament in cervical discs at C2 segment. Am J Transl Res 2022; 14:2419-2427. [PMID: 35559397 PMCID: PMC9091121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/25/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore the effect of open-door laminoplasty and simultaneous C2 semi-laminectomy with lateral mass screw fixation (LSLF) in treating ossification of the posterior longitudinal ligament (OPLL) in cervical discs at C2 segment. METHODS In this retrospective study, 76 patients diagnosed with OPLL in cervical discs at C2 segment from November 2016 to May 2019 were included. These patients were assigned into a LSLF group (n=41, LSLF surgery) and LF group (n=35, laminectomy and lateral mass screw fixation) according to the treatment they received. The surgery time and intraoperative blood loss were recorded. Improvements in neurological function (JOA score), cervical curvature index (CCI), spinal cord drift distance, cross-sectional area (CSA) of the posterior muscles from cervical spine, occurrence of C5 palsy, and severity of axial symptoms were evaluated between LSLF group and LF group. RESULTS Compared with LF group, the operative time was longer and blood loss volume was higher in LSLF group (P<0.05). No statistical difference was found in decompression width between LSLF group and LF group, while the drift distance of spinal cord in LSLF group was larger than that in LF group (P<0.05). No obvious differences were observed in anteroposterior dural sac diameter after the surgery between LSLF group and LF group. CSA in LF group decreased more than that in LSLF group (P<0.05). No remarkable difference was obtained in CCI at the final follow-up between LSLF group and LF group. The NDI score after surgery in the LSLF group was significantly decreased compared to LF group (P<0.05), while no differences were observed in JOA scores or the neurological recovery rate between LSLF group and LF group. The occurrence of C5 palsy in the LSLF group was 4.9%, which was less than that of LF group (20.0%). In contrast to LF group, postoperative axial symptoms in LSLF group were decreased (P<0.05). CONCLUSION Compared to LF, LSLF could better improve neck functions, and reduce the severity of axial symptoms and the occurrence of C5 palsy for patients with OPLL at C2 segment.
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Affiliation(s)
- Yipeng Yang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University Shijiazhuang 050035, Hebei Province, China
| | - Yu Wang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University Shijiazhuang 050035, Hebei Province, China
| | - Junming Cao
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University Shijiazhuang 050035, Hebei Province, China
| | - Tao Lei
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University Shijiazhuang 050035, Hebei Province, China
| | - Zongyou Yang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University Shijiazhuang 050035, Hebei Province, China
| | - Hehuan Xia
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University Shijiazhuang 050035, Hebei Province, China
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Huang S, Liang T, Sun X, Chen L, Jiang J, Chen J, Liu C, Zhan X. Can the Risk of Postoperative Cerebrospinal Fluid Leakage Be Predicted for Patients Undergoing Cervical Spine Surgery? Development and Evaluation of a New Predictive Nomogram. World Neurosurg 2021; 159:e70-e78. [PMID: 34896350 DOI: 10.1016/j.wneu.2021.12.009] [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: 11/14/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Previous studies have retrospectively analyzed the likely causes of cerebrospinal fluid leakage (CSFL) during cervical spine surgery and the management of CSFL after its occurrence. In the present study, we aimed to develop and validate a nomogram for the risk of CSFL in Chinese patients who had undergone cervical decompression and internal fixation (CDIF) surgery. METHODS We performed a retrospective analysis of patients who had undergone CDIF surgery. Of the 1286 included patients, 54 were in the CSFL group and 1232 were in the normal group. The patients were randomly divided into training and validation tests. The risk assessment for CSFL included 21 characteristics. The feature selection for the CSFL model was optimized using the least absolute shrinkage and selection operator regression model in the training test. Multivariate logistic regression analysis was performed to construct the model according to the selected characteristics. The clinical usefulness of the predictive model was assessed using the C-index, calibration curve, and decision curve analysis with identification and calibration. RESULTS The risk prediction nomogram included the diagnosis, revision surgery, ossification of the posterior longitudinal ligament, cervical instability, and a history of malignancy in the training test. The model demonstrated high predictive power, with a C-index of 0.914 (95% confidence interval, 0.876-0.951) and an area under the curve of 0.914. The results of the decision curve analysis demonstrated the clinical usefulness of the CSFL risk nomogram when the probability threshold for CSFL was 1%-62%. CONCLUSIONS Our proposed nomogram for CSFL risk includes the diagnosis, revision surgery, ossification of the posterior longitudinal ligament, cervical instability, and a history of malignancy. The nomogram can be used to evaluate the risk of CSFL for patients undergoing CDIF surgery.
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Affiliation(s)
- Shengsheng Huang
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Tuo Liang
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Xuhua Sun
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Liyi Chen
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Jie Jiang
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Jiarui Chen
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Chong Liu
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Xinli Zhan
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China.
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Sun XF, Wang Y, Sun JC, Xu XM, Kong QJ, Chen Y, Yang HS, Liu Y, Guo YF, Shi GD, Chen XS, Chen DY, Shen Y, Hao DJ, Shen HX, Zhu QS, Yuan W, Jia LS, Shi JG. Consensus statement on diagnosis and treatment of cervical ossification of posterior longitudinal ligament from Asia Pacific Spine Society (APSS) 2020. J Orthop Surg (Hong Kong) 2021; 28:2309499020975213. [PMID: 33355038 DOI: 10.1177/2309499020975213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The study aimed to develop an evidence-based expert consensus statement on diagnosis and treatment of cervical ossification posterior longitudinal ligament (OPLL). METHOD Delphi method was used to perform such survey, and the panel members from Asia Pacific Spine Society (APSS) 2020 were invited to answer the open-ended questions in rounds 1 and 2. Then the results were summarized and developed into a Likert-style questionnaire for voting in round 3, and the level of agreement was defined as 80%. In the whole process, we conducted a systematic literature search on evidence for each statement. RESULTS Cervical OPLL can cause various degrees of neurological symptoms, an it's thought to be more common in Asia population. CT reconstruction is an important imaging examination to assist diagnosis and guide surgical choice. Segmental, continuous, mixed, and focal type is the most widely used classification system. The non-surgical treatment is recommended for patients with no or mild clinical symptoms, or irreversible neurological damage, or failed surgical decompression, or condition cannot tolerant surgery, or refusing surgery. As OPLL may continue to develop gradually, surgical treatment would be considered in their course inevitably. The surgical choice should depend on various conditions, such as involved levels, thickness, and type of OPLL, skill-experiences of surgeons, which are listed and discussed in the article. CONCLUSION In this statement, we describe the clinical features, classifications, and diagnostic criteria of cervical OPLL, and review various surgical methods (such as their indications, complications), and provide a guideline on their choice strategy.
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Affiliation(s)
- Xiao-Fei Sun
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Yuan Wang
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Jing-Chuan Sun
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Xi-Ming Xu
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Qing-Jie Kong
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Yu Chen
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Hai-Song Yang
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Yang Liu
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Yong-Fei Guo
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Guo-Dong Shi
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Xiong-Sheng Chen
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - De-Yu Chen
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Yong Shen
- Department of Spine Surgery, Hebei Medical University, The Third Hospital, Shijiazhuang, China
| | - Ding-Jun Hao
- Department of Spine Surgery, Xi'an Jiaotong University and Xi'an Medical College, Xi'an Honghui Hospital, Xi 'an, China
| | - Hong-Xing Shen
- Department of Spine Surgery, Shanghai Jiaotong University, Renji Hospital, Shanghai, China
| | - Qing-San Zhu
- Department of Spine Surgery, Jilin University, The First Bethune Hospital, Changchun, China
| | - Wen Yuan
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Lian-Shun Jia
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Jian-Gang Shi
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
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Analysis of the Incompletely Hoisted Vertebrae in the Anterior Controllable Antedisplacement and Fusion Surgery: Causes and Prevention. Clin Spine Surg 2021; 34:125-131. [PMID: 32815852 DOI: 10.1097/bsd.0000000000001037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 04/24/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Anterior controllable antedisplacement and fusion (ACAF) has been reported to be a safe and effective technique. However, incompletely hoisted vertebrae (IV) were found in the postoperative images. This study aims to analyze the causes and prevention of IV. METHODS The ACAF-treated case series subjects were retrospectively reviewed. The vertebrae were separated into the IV group and completely hoisted vertebrae (CV) group according to the gap between the vertebrae and plate. The radiographic data, degree of cervical lordosis, bone mineral density, number of hoisted vertebrae, operative time, blood loss, and Japanese Orthopaedic Association score were compared between the patients with IV and the patients without IV. RESULTS A total of 248 vertebrae were hoisted in the enrolled patients. Intervertebral disc height in the IV group was 3.7±0.4 mm, which is significantly lower than that in the CV group. The anterior or posterior overhanging lip, osteoporosis, and oblique osteotomy troughs and hinges existing after osteotomy were found to be impingements preventing the hoisting of the vertebrae. There were no differences in the age, sex, degree of cervical lordosis, number of hoisted vertebrae, and neurological improvement rate between the groups of patients with and without IV. CONCLUSIONS Lower intervertebral space height and impingements preventing hoisting were found to be possible causes of IV in ACAF. Measures to prevent the problem should be carried out.
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Huang Z, Tong Y, Fan Z, Zhao C, Gong P. Modified Posterior Percutaneous Endoscopic Cervical Discectomy for The treatment of Degenerative Cervical Spondylotic Myelopathy Caused by Vertebral Posterior Osteophytosis. World Neurosurg 2020; 143:462-465. [PMID: 32822958 DOI: 10.1016/j.wneu.2020.08.087] [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: 07/18/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The clinical application of posterior percutaneous endoscopic cervical discectomy (PPECD) achieves stable curative effects and satisfactory results in patients with cervical spondylotic radiculopathy. However, the management of PPECD in the treatment of CSM is rarely discussed. CASE DESCRIPTION A case of CSM in a 37-year-old woman with vertebral posterior marginal osteophytosis was managed by modified PPECD with anterior bony decompression. Here, we describe the first case report of CSM complicated by vertebral posterior marginal osteophytosis that was successfully treated by modified PPECD with anterior bony decompression and showed excellent response to treatment. The clinical symptoms were relieved after surgery, the pain and numbness of the left upper extremity improved significantly, the feeling of banding disappeared, and walking balance was restored. Postoperative scans and images of the cervical spine revealed successful anterior vertebral canal bone excision and decompression. CONCLUSIONS This technique of modified PPECD with anterior bony decompression has the advantages of reduced trauma and shorter operative time, and it is very effective in the treatment of degenerative CSM caused by vertebral posterior osteophytosis. No surgery-related complications were noted.
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Affiliation(s)
- Zhangheng Huang
- Department of Minimally Invasive Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province, China
| | - Yuexin Tong
- Department of Minimally Invasive Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province, China
| | - Zhiyi Fan
- Department of Minimally Invasive Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province, China
| | - Chengliang Zhao
- Department of Minimally Invasive Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province, China.
| | - Ping Gong
- Department of Minimally Invasive Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province, China
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Tong Y, Huang Z, Hu C, Fan Z, Bian F, Yang F, Zhao C. A comparison study of posterior cervical percutaneous endoscopic ventral bony decompression and simple dorsal decompression treatment in cervical spondylotic radiculopathy caused by cervical foraminal and/or lateral spinal stenosis: a clinical retrospective study. BMC Musculoskelet Disord 2020; 21:290. [PMID: 32393314 PMCID: PMC7216365 DOI: 10.1186/s12891-020-03313-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/23/2020] [Indexed: 12/22/2022] Open
Abstract
Background Percutaneous endoscopic cervical decompression (PECD) is an ideal minimally invasive decompression technique for the treatment of cervical spondylotic radiculopathy (CSR). However, the mainstream is the resection of dorsal bone and removal of free nucleus pulposus. The necessity of excision of ventral osteophytes and hyperplastic ligaments in the treatment of CSR caused by cervical foraminal and/or lateral spinal stenosis (CFa/oLSS) to be discussed. Methods We performed a retrospective study of 46 patients with CSR caused by CFa/oLSS from January 2017 to November 2018. These patients received posterior percutaneous endoscopic cervical decompression-ventral bony decompression (PPECD-VBD)(23 cases, classified as VBD group) or posterior percutaneous endoscopic cervical decompression-simple dorsal decompression (PPECD-SDD)(23 cases, classified as SDD group). Following surgery, we recorded Visual Analogue Scale (VAS), Neck Disable Index (NDI), Japanese Orthopaedic Association (JOA) Scores and myodynamia. We further evaluated the changes of cervical curvature and cervical spine motion in the VBD group and recorded the operation time and complications during the follow-up of each patient. Results All patients underwent successful operations, with an average follow-up time of 16.53 ± 9.90 months. The excellent and good rates in the VBD and SDD groups were 91.29 and 60.87%, respectively. In the SDD group, neck-VAS, arm-VAS, and NDI scores were significantly higher than those of the VBD group at 1 day, 6 months, and 12 months after surgery (P < 0.05), while the JOA scores and improvement rate of JOA were significantly lower than those of the VBD group (P < 0.05). There were no significant differences in terms of angular displacement (AD), horizontal displacement (HD), segmental angle (SA) and cervical curvature (CA) before and after the operation in the VBD group (P > 0.05). Conclusion PPECD-VBD was significantly better than PPECD-SDD as well as PPECD-VBD had no significant effects on cervical spine stability or cervical curvature.
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Affiliation(s)
- Yuexin Tong
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province, China
| | - Zhangheng Huang
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province, China
| | - Chuan Hu
- Department of Orthopedic Surgery, The Affiliated Hospital of Qingdao University, Shinan District, Qingdao, Shandong province, China
| | - Zhiyi Fan
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province, China
| | - Fucheng Bian
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province, China
| | - Fengkai Yang
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province, China
| | - Chengliang Zhao
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Shuangqiao District, Chengde, Hebei Province, China.
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Clinical significance of microsurgical excision of the posterior longitudinal ligament using a high-frequency electrosurgical excision procedure in anterior cervical discectomy and fusion. Wideochir Inne Tech Maloinwazyjne 2020; 14:575-580. [PMID: 31908705 PMCID: PMC6939216 DOI: 10.5114/wiitm.2019.84827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/01/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Anterior cervical decompression and fusion surgery using traditional methods to remove the posterior longitudinal ligament often causes massive bleeding, increasing the risk of surgery. However, the use of a high-frequency electrotome under the microscope can significantly reduce bleeding and reduce the risk of surgery. Aim To explore the clinical significance of electrosurgical excision of the posterior longitudinal ligament in the cervical anterior approach under the microscope. Material and methods From December 2015 to December 2017, patients who underwent anterior cervical discectomy and fusion at our hospital were followed up. We enrolled 73 men and 50 women who were 30 to 74 years old (mean, 49.96 years). Among 67 patients in group A treated with a high-frequency electrosurgical knife under the microscope, 58 were followed up; among 73 patients in group B treated with a traditional cervical hook knife under the microscope, 65 were followed up. Clinical data, operative time, intraoperative bleeding volume, VAS score, and Japanese Orthopaedic Association (JOA) improvement rate were retrospectively analyzed. Results There were significant differences in the mean operative time and intraoperative bleeding volume between the two groups (p < 0.05); however, no significant differences were found in the incidence of cerebrospinal fluid leakage, JOA improvement rate at 3 months postoperatively, and VAS score at 3 months postoperatively between the two groups (p > 0.05). Conclusions Electrosurgical resection of the posterior longitudinal ligament of the cervical vertebrae under the microscope can significantly reduce intraoperative bleeding and shorten the operative time and has obvious advantages compared with traditional methods.
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Shao F, Bai H, Tang M, Xue Y, Dai Y, Zhang J. Tissue discrimination by bioelectrical impedance during PLL resection in anterior decompression surgery for treatment of cervical spondylotic myelopathy. J Orthop Surg Res 2019; 14:341. [PMID: 31694719 PMCID: PMC6836645 DOI: 10.1186/s13018-019-1380-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background The electrical properties of biological tissues differ depending on their physical properties. This study aimed to explore if bioelectrical impedance (modulus and phase) would discriminate tissues relevant to resection of the posterior longitudinal ligament (PLL) in anterior cervical decompression surgery. Methods PLL resection via an anterior approach was performed on the C4/5 segments in six mini-pigs. The bioelectrical impedance measurements were performed for two tissue groups (annulus fibrosus, endplate cartilage, sub-endplate cortical bone, and PLL; PLL, dura mater, spinal cord, and nerve root) using a novel probe and a precision inductance-capacitance-resistance meter. For each group, impedance was analyzed in terms of modulus and phase along a broad spectrum of frequencies (200–3000 kHz) using a nonparametric statistical analysis (Kruskal-Wallis). Results The analysis showed a clear difference among the tissues. The modulus and phase show the same changing trend with frequency and present lower values at higher frequencies. Among annulus fibrosus, endplate cartilage, sub-endplate cortical bone, and PLL, it was possible to discriminate each tissue at every frequency point, considering the phase (p < 0.05), while this was not always the case (i.e., annulus fibrosus vs PLL at frequency of 200 kHz, 400 kHz, and 3000 kHz, p > 0.05) for modulus. Among PLL, dura mater, spinal cord, and nerve root, for every comparison, a statistically significant difference was reported in the modulus, phase, or both (p < 0.05). Conclusions The results indicated the potential of bioelectrical impedance to provide real-time tissue differentiation and enhance safe PLL resection in anterior cervical decompression surgery, particularly in robot-assisted minimally invasive surgery (RMIS).
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Affiliation(s)
- Fuqiang Shao
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, 300052, Tianjin, People's Republic of China.,Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - He Bai
- Department of Orthopedics Surgery, Inner Mongolia Cancer Hospital & Affiliated People's Hospital of Inner Mongolia Medical University, 42 Zhao wuda Road, Hohhot, 010020, Inner Mongolia, People's Republic of China
| | - Muyao Tang
- Experimental Trauma Surgery, Justus-Liebig University Giessen, Aulweg 128, 35392, Giessen, Germany
| | - Yuan Xue
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, 300052, Tianjin, People's Republic of China. .,Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, People's Republic of China.
| | - Yu Dai
- Institute of Robotics and Automatic Information System, Tianjin Key Laboratory of Intelligent Robotics, College of Computer and Control Engineering, Nankai University, 94 Weijin Road, Nankai District, 300071, Tianjin, People's Republic of China.
| | - Jianxun Zhang
- Institute of Robotics and Automatic Information System, Tianjin Key Laboratory of Intelligent Robotics, College of Computer and Control Engineering, Nankai University, 94 Weijin Road, Nankai District, 300071, Tianjin, People's Republic of China
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Surgical Approaches for the Treatment of Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: Results of a Decision Analysis. World Neurosurg 2018; 112:e375-e384. [DOI: 10.1016/j.wneu.2018.01.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 01/05/2018] [Accepted: 01/11/2018] [Indexed: 01/24/2023]
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Shang Z, Zhang Y, Zhang D, Ding W, Shen Y. Clinical and Radiological Analysis of Bryan Cervical Artificial Disc Replacement for "Skip" Multi-Segment Cervical Spondylosis: Long-Term Follow-Up Results. Med Sci Monit 2017; 23:5254-5263. [PMID: 29101314 PMCID: PMC5683675 DOI: 10.12659/msm.904863] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to retrospectively analyze the clinical and radiological efficacy of Bryan cervical artificial disc replacement (ADR) for "skip" multi-segment cervical spondylosis (SCS). MATERIAL AND METHODS We enrolled 49 patients with SCS treated with either Bryan cervical ADR (18 cases) or ACDF (31 cases). Each case was evaluated preoperatively and at more than 48 months postoperatively in follow-up using the JOA, NDI, and VAS. Cervical sagittal curvature, total cervical ROM, and degree of middle segments of motion were also evaluated. MRI was used to assess adjacent segment degeneration(ASD), spinal cord compression, and signal changes. RESULTS The JOA, NDI, and VAS scores in the 2 groups improved significantly postoperatively. At the last follow-up, the results of Group Bryan were better than those of Group ACDF with respect to the incidence of axial symptoms (11.1% and 45.2%, respectively), VAS, ROM, and the degree of middle segments of motion. The ROM in Group Bryan was 38.2±4.6° and in Group ACDF was 25.3±4.6°. The middle segments of motion were 8.4±2.0° in Group Bryan and 12.2±2.2° in Group ACDF. There were no patients with ASD in Group Bryan. In Group ACDF, 1 case with an internal fixation device developed dislocation, and 2 cases developed degeneration, but there was no need for reoperation. CONCLUSIONS ADR for SCS can effectively improve neurological function and retain the overall activity of the cervical, thereby reducing ASD and the incidence of postoperative axial symptoms.
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Affiliation(s)
- Zikun Shang
- Department of Orthopedics Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland).,The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Yingze Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland).,The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Di Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland).,The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Wenyuan Ding
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland).,The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Yong Shen
- Department of Orthopedics Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland).,The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
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