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Löfgren H, Osman A, Blomqvist A, Vavruch L. Sagittal Alignment After Laminectomy Without Fusion as Treatment for Cervical Spondylotic Myelopathy: Follow-up of Minimum 4 Years Postoperatively. Global Spine J 2020; 10:425-432. [PMID: 32435562 PMCID: PMC7222687 DOI: 10.1177/2192568219858302] [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] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The aims of this study were to evaluate the incidence of sagittal malalignment including kyphosis following cervical laminectomy without fusion as treatment for cervical spondylotic myelopathy and to assess any correlation between malalignment and clinical outcome. STUDY DESIGN Retrospective cohort study. METHODS In all, 60 patients were followed up with conventional radiography at an average of 8 years postoperatively. The cervical lordosis (C2-C7 Cobb angle), C2-C7 sagittal vertical axis (cSVA) and C7 slope were measured on both preoperative and postoperative images. Patients completed a questionnaire covering Neck Disability Index (NDI), visual analogue scale for neck pain, and general health (EQ-5D). RESULTS Mean C2-C7 Cobb angle was 8.6° (SD 9.0) preoperatively, 3.4° (10.7) postoperatively and 9.6° (14.5) at follow-up. Ultimately, 3 patients showed >20° cervical kyphosis. Mean cSVA was 16.3 mm (SD 10.2) preoperatively, 20.6 mm (11.8) postoperatively, and 31.6 mm (11.8) at follow-up. Mean C7 slope was 20.4° (SD 8.9) preoperatively, 18.4° (9.4) postoperatively, and 32.6° (10.2) at follow-up. The preoperative to follow-up increase in cSVA and C7 slope was statistically significant (both P < .0001), but not for cervical lordosis. The preoperative to follow-up change in cSVA correlated moderately with preoperative cSVA (r = 0.43, P = .002), as did the corresponding findings regarding C7 slope (r = 0.52, P = .0001). A comparison of radiographic measurements with clinical outcome showed no strong correlations. CONCLUSIONS No preoperative to follow-up change in cervical lordosis was found in this group; 5.0% developed >20° kyphosis. No clear correlation between sagittal alignment and clinical outcome was shown.
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Affiliation(s)
- Håkan Löfgren
- Neuroorthopedic Center and Department of Radiology, Jönköping, Region Jönköping County, Sweden,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden,Håkan Löfgren, Neuroorthopedic Center, Ryhov Hospital, SE-551 85 Jönköping, Sweden.
| | - Aras Osman
- Neuroorthopedic Center and Department of Radiology, Jönköping, Region Jönköping County, Sweden,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Anders Blomqvist
- Neuroorthopedic Center and Department of Radiology, Jönköping, Region Jönköping County, Sweden,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ludek Vavruch
- Neuroorthopedic Center and Department of Radiology, Jönköping, Region Jönköping County, Sweden,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Zhao W, Yang S, Diao WB, Yan M, Wu WJ, Luo F. Using Visual Trepan to Treat Single Segment Ossification of the Ligamentum Flavum Under Endoscopy. Orthop Surg 2020; 11:906-913. [PMID: 31663291 PMCID: PMC6819184 DOI: 10.1111/os.12538] [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: 04/25/2019] [Revised: 08/04/2019] [Accepted: 08/20/2019] [Indexed: 11/28/2022] Open
Abstract
This article describes the trepan technique for treating single segment ossification of the ligamentum flavum (OLF) using an endoscope. OLF is the most common cause of thoracic spinal stenosis. The most common surgical procedures involve semi‐lamina or full‐lamina resection and decompression. However, considering the anatomical structure of the thoracic spinal canal and the combination of OLF, traditional surgery has higher risks, more complications, and greater technical requirements. In the past ten years, with the development of endoscopic technology, spinal endoscopy has been increasingly applied for the treatment of intervertebral disc herniation and spinal canal stenosis. The present study demonstrated the effectiveness of visual trepan decompression under spinal endoscopy used for patients with single segment OLF. This surgical procedure had many advantages, including a shorter operation time, minimal trauma, less expenditure, and better functional recovery over the conventional open surgery.
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Affiliation(s)
- Wei Zhao
- Department of Orthopaedics, Liu Dong Branch of Liuzhou Maternal and Child Health-Care Hospital, Liuzhou, China
| | - Sen Yang
- Department of Orthopaedics Hospital, Third Military Medical University, Chongqing, China
| | - Wen-Bo Diao
- Zhoukou Xiehe Orthopaedics Hospital, Henan, China
| | - Ming Yan
- Department of Orthopaedics, Affiliated First Hospital, Jilin University, Jilin, China
| | - Wen-Jie Wu
- Department of Orthopaedics Hospital, Third Military Medical University, Chongqing, China
| | - Fei Luo
- Department of Orthopaedics Hospital, Third Military Medical University, Chongqing, China
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Abstract
Laser spine surgery has been a focus of intense interest in the lay press and among patients. On the Internet, a host of purported benefits to laser surgery exists. Lasers have long been used in pain management procedures such as percutaneous diskectomy. However, a few published articles are available on lasers in conventional spine surgery. From our review of the literature, the purported advantages of lasers, such as reduced inflammation and degeneration, are not been supported by preclinical research. The available clinical studies do not show a notable advantage for laser surgery. Moreover, the low enrollment, nonblinded, retrospective studies that are available are heavily subject to bias. The documented advantages of laser spine surgery described in the research studies are not consistent with the public's impression of its purported benefits. Furthermore, laser-specific complications are present about which patients should be informed. On the basis of the current research, we conclude that lasers add distinct potential complications without any corresponding clinical benefit. Because of the public interest, we feel that this is an important topic for the general orthopaedic community.
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Yang S, Yang D, Ma L, Wang H, Ding W. Clinical efficacy of laminectomy with instrumented fixation in treatment of adjacent segmental disease following ACCF surgery: a retrospective observational study of 48 patients. Sci Rep 2019; 9:6551. [PMID: 31024046 PMCID: PMC6483981 DOI: 10.1038/s41598-019-43114-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/16/2019] [Indexed: 11/16/2022] Open
Abstract
This study was designed to investigate the clinical efficacy of laminectomy with instrumented fixation in treatment of adjacent segmental diseases following anterior cervical corpectomy and fusion (ACCF) surgery. Between January 2008 and December 2015, 48 patients who underwent laminectomy with instrumented fixation to treat adjacent segmental diseases following ACCF surgery, were enrolled into this study. The patients were followed up at least 2 years. Pain assessment was determined by visual analogue scale (VAS) score and Neck Disability Index (NDI) score; neurological impairment was evaluated by Japanese Orthopaedic Association (JOA) score; and radiographic parameters were also compared. All comparisons were determined by paired t test with appropriate Bonferronni correction. VAS score preoperatively and at last follow-up was 5.28 ± 2.35 vs 1.90 ± 1.06 (P < 0.001). JOA score preoperatively and at last follow-up was 8.2 ± 3.6 vs 14.5 ± 1.1 (P < 0.001). NDI score preoperatively and at last follow-up was 30.5 ± 12.2 vs 10.6 ± 5.8 (P < 0.001). Moreover, the losses of cervical lordosis and C2-C7 range of motion after laminectomy were significant (both P < 0.005), but not sagittal vertical axis distance. Postoperative complications were few or mild. In conclusion, clinical effectiveness and safety can be guaranteed when the patients undergo laminectomy with instrumented fixation to treat adjacent segmental diseases following ACCF surgery.
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Affiliation(s)
- Sidong Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Dalong Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Lei Ma
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Hui Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Wenyuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China. .,Hebei Provincial Key Laboratory of Orthopedic Biomechanics, Shijiazhuang, 050051, China.
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Kobayashi Y, Kawabata S, Nishiyama Y, Tsuji O, Okada E, Fujita N, Yagi M, Watanabe K, Matsumoto M, Nakamura M, Nagoshi N. Changes in sagittal alignment after surgical excision of thoracic spinal cord tumors in adults. Spinal Cord 2019; 57:380-387. [DOI: 10.1038/s41393-018-0235-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/04/2018] [Accepted: 12/10/2018] [Indexed: 11/09/2022]
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Xiaobing Z, Xingchen L, Honggang Z, Xiaoqiang C, Qidong Y, Haijun M, Hejun Y, Bisheng W. "U" route transforaminal percutaneous endoscopic thoracic discectomy as a new treatment for thoracic spinal stenosis. INTERNATIONAL ORTHOPAEDICS 2018; 43:825-832. [PMID: 30218183 DOI: 10.1007/s00264-018-4145-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 09/05/2018] [Indexed: 11/24/2022]
Abstract
PURPOSES To describe the rationale, surgical technique, and short-term follow-up results of a new minimally invasive treatment for thoracic spinal stenosis (TSS) caused by herniation, ossification of the ligamentum flavum (OLF), and/or ossification of the posterior longitudinal ligament (OPLL) with a "U" route transforaminal percutaneous endoscopic thoracic discectomy (PETD). METHODS Fourteen patients, including seven males and seven females, underwent "U" route PETD. Myelopathy was caused by OLF in 14 patients, OPLL in one, combined OLF-OPLL in ten, and intervertebral disc herniation (IDH) in five. Decompression was performed in one segment in 12 patients, and in two segments in two patients. The Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS) scores, and complications were documented. RESULTS The JOA scores improved from 4.64 ± 2.31 pre-operatively to 7.07 ± 1.59 one day post-operatively and 11.79 ± 1.85 at final follow-up. The difference between pre-operation and post-operation was statistically significant (P < 0.05). Moreover, the VAS score was 6.07 ± 2.06 points pre-operatively, decreasing to 3.00 ± 1.24 points at one day post-operatively, and 1.14 ± 0.86 points at last follow-up (P < 0.05). Dural tear was observed in two cases during the intervention. No patient had transient worsening of pre-operative paralysis. CONCLUSIONS This retrospective analysis shows that "U" route PETD for decompression may be a feasible alternative to treat thoracic spinal stenosis.
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Affiliation(s)
- Zhao Xiaobing
- Department of Mini-invasive Spinal Surgery, Third Hospital of Henan Province, NO198 Funiu Road, Zhengzhou, 450000, China
| | - Li Xingchen
- Department of Mini-invasive Spinal Surgery, Third Hospital of Henan Province, NO198 Funiu Road, Zhengzhou, 450000, China.
| | - Zhou Honggang
- Department of Mini-invasive Spinal Surgery, Third Hospital of Henan Province, NO198 Funiu Road, Zhengzhou, 450000, China
| | - Cao Xiaoqiang
- Department of Mini-invasive Spinal Surgery, Third Hospital of Henan Province, NO198 Funiu Road, Zhengzhou, 450000, China
| | - Yuan Qidong
- Department of Mini-invasive Spinal Surgery, Third Hospital of Henan Province, NO198 Funiu Road, Zhengzhou, 450000, China
| | - Ma Haijun
- Department of Mini-invasive Spinal Surgery, Third Hospital of Henan Province, NO198 Funiu Road, Zhengzhou, 450000, China
| | - Yang Hejun
- Department of Mini-invasive Spinal Surgery, Third Hospital of Henan Province, NO198 Funiu Road, Zhengzhou, 450000, China
| | - Wang Bisheng
- Department of Mini-invasive Spinal Surgery, Third Hospital of Henan Province, NO198 Funiu Road, Zhengzhou, 450000, China
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De la Garza-Ramos R, Goodwin CR, Abu-Bonsrah N, Jain A, Miller EK, Neuman BJ, Protopsaltis TS, Passias PG, Sciubba DM. Prolonged length of stay after posterior surgery for cervical spondylotic myelopathy in patients over 65years of age. J Clin Neurosci 2016; 31:137-41. [DOI: 10.1016/j.jocn.2016.02.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 02/28/2016] [Indexed: 11/15/2022]
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Ghogawala Z, Benzel EC, Riew KD, Bisson EF, Heary RF. Surgery vs Conservative Care for Cervical Spondylotic Myelopathy: Surgery Is Appropriate for Progressive Myelopathy. Neurosurgery 2015; 62 Suppl 1:56-61. [PMID: 26181920 DOI: 10.1227/neu.0000000000000781] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Zoher Ghogawala
- *Alan and Jacqueline Stuart Spine Research Center, Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts; ‡Department of Neurosurgery, Tufts University School of Medicine, Boston, Massachusetts; §The Center for Spine Health and Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio; ¶Department of Orthopedics, Columbia University, New York, New York; ‖Department of Neurosurgery, University of Utah Health Sciences Center, Salt Lake City, Utah; #Department of Neurosurgery, Rutgers, State University of New Jersey-New Jersey Medical School, Newark, New Jersey
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Gulsen S. The Effect of the PEEK Cage on the Cervical Lordosis in Patients Undergoing Anterior Cervical Discectomy. Open Access Maced J Med Sci 2015; 3:215-23. [PMID: 27275224 PMCID: PMC4877856 DOI: 10.3889/oamjms.2015.034] [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: 02/15/2015] [Revised: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND: Loss of cervical lordosis is a significant factor in the development of degeneration of the spine with aging. This degenerative changings of the cervical spine would cause pressure effect on the cervical root and/or medulla spinalis. AIM: Our goal is to understand the effect of the PEEK cage on cervical lordosis in the early postoperative period. Also, to interpret the effects of one- level, two- level, three-level and four- level disc pathologies on cervical lordosis. MATERIAL AND METHODS: We retrospectively investigated our archive, and we selected thirty-four patients undergoing anterior cervical discectomy and fusion with PEEK cage filled with demineralized bone matrix (ACDFP). RESULTS: We determined that ACDFP provides improvement in the cervical lordosis angle in both groups. Also, we found statistically significant difference between group 1 and 2 regarding causes of radiculomyelopathy statistically. CONCLUSION: We achieved better cervical lordotic angles at the postoperative period by implanting one-level, two-level, three-level or four-level PEEK cage filled with demineralized bone matrix. Also, the causes of cervical root and or medulla spinalis impingement were different in group1 and 2. While extruded cervical disc impingement was the first pathology in group 1, osteophyte formation was the first pathology in group 2.
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Affiliation(s)
- Salih Gulsen
- Baskent University Medical Faculty Hospital - Neurosurgery, Maresal Fevzi Cakmak cad. 10. sok. No: 45, Ankara 06540, Turkey
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Cervical laminectomy and instrumented lateral mass fusion: techniques, pearls and pitfalls. 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 2013; 24 Suppl 2:168-85. [DOI: 10.1007/s00586-013-2838-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 12/01/2012] [Accepted: 05/12/2013] [Indexed: 10/26/2022]
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Son S, Lee SG, Park CW, Kim WK. Combined open door laminoplasty with unilateral screw fixation for unstable multi-level cervical stenosis : a preliminary report. J Korean Neurosurg Soc 2013; 53:83-8. [PMID: 23560171 PMCID: PMC3611064 DOI: 10.3340/jkns.2013.53.2.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 12/15/2012] [Accepted: 02/04/2013] [Indexed: 11/27/2022] Open
Abstract
Objective The authors reviewed their experiences of combined surgery (open door laminoplasty with unilateral screw fixation) for unstable multi-level cervical stenosis, to clarify the situation regarding the surgical approach most appropriate for the treatment of diffuse unstable multi-level cervical stenosis. Methods From January 2011 to January 2012, combined surgery was performed for unstable multi-level cervical stenosis by one surgeon at our institution. The subjects of this study were 6 men of mean age 53.7 years (range, 48-71) with a mean follow-up of 9.3 (range, 3-14) months. All imaging studies showed severe multi-level cervical stenosis with spinal cord signal change, and instability or kyphotic deformity. A retrospective review of clinical, radiological, and surgical data was conducted. Results Average laminoplasty level was 4.8 and the average screw fixation level was 5.0. Japanese Orthopedic Association score improved from an average of 5.2 to 11.2 points. According to Nurick's grades and Odom's criteria, symptom improvement was statistically significant. On the other hand, Cobb's angle changes were not significant. Average operation time was 5.86 hours with an average blood loss of 460 mL. No significant surgical complication was encountered. Conclusion Despite the small cohort and the short follow-up duration, the present study demonstrates that laminoplasty with unilateral screw fixation is a safe and effective treatment for unstable multi-level cervical stenosis.
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Affiliation(s)
- Seong Son
- Department of Neurosurgery, Gachon University, Gil Hospital, Incheon, Korea
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Son S, Lee SG, Yoo CJ, Park CW, Kim WK. Single stage circumferential cervical surgery (selective anterior cervical corpectomy with fusion and laminoplasty) for multilevel ossification of the posterior longitudinal ligament with spinal cord ischemia on MRI. J Korean Neurosurg Soc 2010; 48:335-41. [PMID: 21113361 DOI: 10.3340/jkns.2010.48.4.335] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 10/07/2010] [Accepted: 10/11/2010] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Anterior cervical corpectomy with fusion (ACF) or laminoplasty may be associated with substantial number of complications for treating multilevel cervical ossification of the posterior longitudinal ligament (OPLL) with significant cord compression. For more safe decompression and stabilization in multilevel cervical OPLL with prominent cord compression, we propose circumferential cervical surgery (selective ACF and laminoplasty) based on our favorable experience. METHODS Twelve patients with cervical myelopathy underwent circumferential cervical surgery and all patients showed multilevel OPLL with signal change of the spinal cord on magnetic resonance imaging (MRI). A retrospective review of clinical, radiological, and surgical data was conducted. RESULTS There were 9 men and 3 women with mean age of 56.7 years and a mean follow up period of 15.6 months. The average corpectomy level was 1.16 and laminoplasty level was 4.58. The average Japanese Orthopedic Association score for recovery was 5.1 points and good clinical results were obtained in 11 patients (92%) (p < 0.05). The average space available for the cord improved from 58.2% to 87.9% and the average Cobb's angle changed from 7.63 to 12.27 at 6 months after operation without failure of fusion (p < 0.05). Average operation time was 8.36 hours, with an estimated blood loss of 760 mL and duration of bed rest of 2.0 days. There were no incidences of significant surgical complications, including wound infection. CONCLUSION Although the current study examined a small sample with relatively short-term follow-up periods, our study results demonstrate that circumferential cervical surgery is considered favorable for safety and effectiveness in multilevel OPLL with prominent cord compression.
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Affiliation(s)
- Seong Son
- Department of Neurosurgery, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea
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Barbagallo GMV, Assietti R, Corbino L, Olindo G, Foti PV, Russo V, Albanese V. Early results and review of the literature of a novel hybrid surgical technique combining cervical arthrodesis and disc arthroplasty for treating multilevel degenerative disc disease: opposite or complementary techniques? 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 2009; 18 Suppl 1:29-39. [PMID: 19415346 DOI: 10.1007/s00586-009-0978-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/14/2009] [Indexed: 10/20/2022]
Abstract
We report the clinical and radiological results on the safety and efficacy of an unusual surgical strategy coupling anterior cervical discectomy and fusion and total disc replacement in a single-stage procedure, in patients with symptomatic, multilevel cervical degenerative disc disease (DDD). The proposed hybrid, single-stage, fusion-nonfusion technique aims either at restoring or maintaining motion where appropriate or favouring bony fusion when indicated by degenerative changes. Twenty-four patients (mean age 46.7 years) with symptomatic, multilevel DDD, either soft disc hernia or different stage spondylosis per single level, with predominant anterior myeloradicular compression and absence of severe alterations of cervical spine sagittal alignment, have been operated using such hybrid technique. Fifteen patients underwent a two-level surgery, seven patients received a three-level surgery and two a four-level procedure, for a total of 59 implanted devices (27 disc prostheses and 32 cages). Follow-up ranged between 12 and 40 months (mean 23.8 months). In all but one patient clinical follow-up (neurological examination, Nurick scale, NDI, SF-36) demonstrated significant improvement; radiological evaluation showed functioning disc prostheses (total range of motion 3-15 degrees ) and fusion through cages. None of the patients needed revision surgery for persisting or recurring symptoms, procedure-related complications or devices dislocations. To the authors' best knowledge, this is the first study with the longest available follow-up describing a different concept in the management of cervical multilevel DDD. Although larger series with longer follow-up are needed, in selected cases of symptomatic multilevel DDD, the proposed surgical strategy appears to be a safe and reliable application of combined arthroplasty and arthrodesis during a single surgical procedure.
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Affiliation(s)
- Giuseppe M V Barbagallo
- Department of Neurosurgery, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico, Catania, Italy.
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Gok B, McLoughlin GS, Sciubba DM, McGirt MJ, Chaichana KL, Wolinsky JP, Bydon A, Gokaslan ZL, Witham TF. Surgical management of cervical spondylotic myelopathy with laminectomy and instrumented fusion. Neurol Res 2009; 31:1097-101. [PMID: 19215639 DOI: 10.1179/174313209x383277] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The indications for treating cervical spondylotic myelopathy (CSM) with laminectomy and instrumented fusion remain ill-defined. Cervical laminectomy without instrumented fusion has been associated with suboptimal outcomes, particularly in the setting of cervical kyphosis. This work's purpose is to retrospectively review our experience in patients who underwent laminectomy with instrumented fusion for CSM and to assess the neurological and radiological outcomes of patients treated with this technique. METHODS Fifty-four consecutive patients underwent multilevel laminectomy and instrumented fusion for CSM. The indications were patients with (1) cervical stenosis > or = 3 spinal segments and (2) absence of a cervical kyphosis or (3) patients older than 65 years with significant medical comorbidities. Nurick myelopathy grades and cervical radiographs were obtained preoperatively and at 3, 6, 12 and 24 months post-operatively. Perioperative complications, radiographic and clinical outcomes were assessed and reported in this paper. RESULTS Forty-four (81%) of patients showed improvement in Nurick grade after surgery by a mean of 17 months. Ten patients (19%) demonstrated stable but unimproved myelopathy. Increasing pre-operative Nurick grade was associated with an improved post-operative outcome (p<0.02). Increasing duration of pre-operative myelopathy was associated with a decreased likelihood of myelopathy improvement (p<0.001). DISCUSSION Multilevel cervical laminectomy with instrumented fusion for patients with CSM resulted in an improvement in myelopathy in the majority of cases. Efficacy was similar for patients who may not have tolerated an anterior decompression, such as elderly patients with significant medical comorbidities. Hardware-related complication rates were relatively low.
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Affiliation(s)
- Beril Gok
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21287, USA
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Abstract
STUDY DESIGN Database study using the Nationwide Inpatient Sample administrative data from 1988 through 2004. OBJECTIVE To examine perioperative morbidity and mortality for patients diagnosed with myelopathy, with and without diabetes mellitus (DM) (and subclassifications) following cervical spinal fusion. SUMMARY OF BACKGROUND DATA DM has been associated with worse outcomes in a variety of orthopedic procedures including spinal surgery. Evidence that patients with DM have more complications following cervical fusion, specifically those treated for myelopathy, has been suggested within the literature but has been poorly explored. METHODS Data from 37,732 patients within Nationwide Inpatient Sample database (1988-2004) with diagnostic codes specifying the presence of myelopathy and who underwent cervical fusion were included in the analysis. Patients were compared on the basis of the presence of DM, type of DM, and whether DM was controlled or uncontrolled. Bivariate statistical analyses compared postoperative complication rates while multivariate statistics were used to determine likelihood of complications with DM. RESULTS Multivariate regression modeling outlined higher likelihoods of complications and hospital discharge variables with DM, particularly if it was diagnosed as uncontrolled disease. Fewer significant discrepancies in complications were noted in comparison of Type I versus Type II DM. CONCLUSION This nationally representative study of inpatients in the United States provides evidence that patients with DM who received cervical fusion secondary to myelopathy are associated with greater perioperative complications, nonroutine discharge, and increased total charges. Subanalyses suggest that uncontrolled DM is a significant associative factor in outcome.
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Bartels RH, Verbeek ALM, Grotenhuis JA. Design of Lamifuse: a randomised, multi-centre controlled trial comparing laminectomy without or with dorsal fusion for cervical myeloradiculopathy. BMC Musculoskelet Disord 2007; 8:111. [PMID: 17996094 PMCID: PMC2194678 DOI: 10.1186/1471-2474-8-111] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Accepted: 11/09/2007] [Indexed: 11/29/2022] Open
Abstract
Background laminectomy is a valuable surgical treatment for some patients with a cervical radiculomyelopathy due to cervical spinal stenosis. More recently attention has been given to motion of the spinal cord over spondylotic spurs as a cause of myelopathic changes. Immobilisation by fusion could have a positive effect on the recovery of myelopathic signs or changes. This has never been investigated in a prospective, randomised trial. Lamifuse is an acronyme for laminectomy and fusion. Methods/Design Lamifuse is a multicentre, randomised controlled trial comparing laminectomy with and without fusion in patients with a symptomatic cervical canal stenosis. The study population will be enrolled from patients that are 60 years or older with myelopathic signs and/or symptoms due to a cervical canal stenosis. A kyphotis shape of the cervical spine is an exclusion criterium. Each treatment arm needs 30 patients. Discussion This study will contribute to the discussion whether additional fusion after a cervical laminectomy results in a better clinical outcome. ISRCT number ISRCTN72800446
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Affiliation(s)
- Ronald Hma Bartels
- Department of Neurosurgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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