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Guan J, Yuan C, Du Y, Jia S, Zhang C, Liu Z, Wang K, Duan W, Wang Z, Wang X, Wu H, Chen Z, Jian F. Dural ossification associated with ossification of posterior longitudinal ligament in the cervical spine: a retrospective 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 2022; 31:3462-3469. [PMID: 36220957 DOI: 10.1007/s00586-022-07402-9] [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: 07/30/2022] [Revised: 07/30/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Dural ossification (DO) is common in patients with ossification of the posterior longitudinal ligament (OPLL). The existence of DO makes surgery challenging and increases the risk of complications. The aim of this study was to investigate the incidence, distribution and radiological characteristics of DO associated with OPLL. METHODS From January 2017 to January 2019, 55 patients with cervical OPLL were treated in our single center using an anterior cervical approach microsurgery. Preoperative CT images of decompressed segments were evaluated to identify imaging signs of DO. The 'double-layer sign' (DLS), 'parenthese sign' (PS) and 'hook sign' (HS) were considered to be characteristic imaging findings of DO in OPLL. Two kinds of confusing signs (false double-layer) were identified. RESULTS Nineteen segments from 15 patients with OPLL had DO related to OPLL. The incidence of DO in OPLL segments was 30.16% (19/63), and the incidence of DO in patients with OPLL was 27.27% (15/55). DO occurred at the intervertebral space level in 14 cases and at the posterior level of the vertebral body in 5 cases. The sensitivity and specificity of imaging diagnosis were 89.47% (17/19) and 81.82% (36/44), respectively. The positive predictive value was relatively low, 68.00% (17/25), due to the false-positive double-layer sign. The negative predictive value was 94.74% (36/38). CONCLUSION DO was relatively common in cervical OPLL. DLS might be misdiagnosed. PS and HS can vividly and intuitively describe the imaging features of DO and have high diagnostic accuracy.
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Affiliation(s)
- Jian Guan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China-INI, 45 Changchun Street, Beijing, 100053, People's Republic of China
- Spine Center, China International Neuroscience Institute China-INI, Beijing, People's Republic of China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, People's Republic of China
- National Center for Neurological Disorders, Beijing, People's Republic of China
| | - Chenghua Yuan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China-INI, 45 Changchun Street, Beijing, 100053, People's Republic of China
- Spine Center, China International Neuroscience Institute China-INI, Beijing, People's Republic of China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, People's Republic of China
- National Center for Neurological Disorders, Beijing, People's Republic of China
| | - Yueqi Du
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China-INI, 45 Changchun Street, Beijing, 100053, People's Republic of China
- Spine Center, China International Neuroscience Institute China-INI, Beijing, People's Republic of China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, People's Republic of China
- National Center for Neurological Disorders, Beijing, People's Republic of China
| | - Shanhang Jia
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China-INI, 45 Changchun Street, Beijing, 100053, People's Republic of China
- Spine Center, China International Neuroscience Institute China-INI, Beijing, People's Republic of China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, People's Republic of China
- National Center for Neurological Disorders, Beijing, People's Republic of China
| | - Can Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China-INI, 45 Changchun Street, Beijing, 100053, People's Republic of China
- Spine Center, China International Neuroscience Institute China-INI, Beijing, People's Republic of China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, People's Republic of China
- National Center for Neurological Disorders, Beijing, People's Republic of China
| | - Zhenlei Liu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China-INI, 45 Changchun Street, Beijing, 100053, People's Republic of China
- Spine Center, China International Neuroscience Institute China-INI, Beijing, People's Republic of China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, People's Republic of China
- National Center for Neurological Disorders, Beijing, People's Republic of China
| | - Kai Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China-INI, 45 Changchun Street, Beijing, 100053, People's Republic of China
- Spine Center, China International Neuroscience Institute China-INI, Beijing, People's Republic of China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, People's Republic of China
- National Center for Neurological Disorders, Beijing, People's Republic of China
| | - Wanru Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China-INI, 45 Changchun Street, Beijing, 100053, People's Republic of China
- Spine Center, China International Neuroscience Institute China-INI, Beijing, People's Republic of China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, People's Republic of China
- National Center for Neurological Disorders, Beijing, People's Republic of China
| | - Zuowei Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China-INI, 45 Changchun Street, Beijing, 100053, People's Republic of China
- Spine Center, China International Neuroscience Institute China-INI, Beijing, People's Republic of China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, People's Republic of China
- National Center for Neurological Disorders, Beijing, People's Republic of China
| | - Xingwen Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China-INI, 45 Changchun Street, Beijing, 100053, People's Republic of China
- Spine Center, China International Neuroscience Institute China-INI, Beijing, People's Republic of China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, People's Republic of China
- National Center for Neurological Disorders, Beijing, People's Republic of China
| | - Hao Wu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China-INI, 45 Changchun Street, Beijing, 100053, People's Republic of China
- Spine Center, China International Neuroscience Institute China-INI, Beijing, People's Republic of China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, People's Republic of China
- National Center for Neurological Disorders, Beijing, People's Republic of China
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China-INI, 45 Changchun Street, Beijing, 100053, People's Republic of China.
- Spine Center, China International Neuroscience Institute China-INI, Beijing, People's Republic of China.
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, People's Republic of China.
- National Center for Neurological Disorders, Beijing, People's Republic of China.
| | - Fengzeng Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China-INI, 45 Changchun Street, Beijing, 100053, People's Republic of China.
- Spine Center, China International Neuroscience Institute China-INI, Beijing, People's Republic of China.
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, People's Republic of China.
- National Center for Neurological Disorders, Beijing, People's Republic of China.
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Leng X, Zhang Y, Wang G, Liu L, Fu J, Yang M, Chen Y, Yuan J, Li C, Zhou Y, Feng C, Huang B. An enhanced recovery after surgery pathway: LOS reduction, rapid discharge and minimal complications after anterior cervical spine surgery. BMC Musculoskelet Disord 2022; 23:252. [PMID: 35292011 PMCID: PMC8925186 DOI: 10.1186/s12891-022-05185-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Enhance recovery after surgery (ERAS) is a new and promising paradigm for spine surgery. The purpose of this study is to investigate the effectiveness and safety of a multimodal and evidence-based ERAS pathway to the patients undergoing anterior cervical discectomy and fusion (ACDF). METHODS The patients treated with the ACDF-ERAS pathway were compared with a historical cohort of patients who underwent ACDF before ERAS pathway implementation. Primary outcome was length of stay (LOS). Secondary outcomes included cost, MacNab grading, complication rates and 90-day readmission and reoperation. And perioperative factors and postoperative complications were reviewed. RESULTS The ERAS protocol was composed of 21 components. More patients undergoing multi-level surgery (n ≥ 3) were included in the ERAS group. The ERAS group showed a shorter LOS and a lower cost than the conventional group. The postoperative satisfaction of patients in ERAS group was better than that in conventional group. In addition, the rate of overall complications was significantly higher in the conventional group than that in the ERAS group. There were no significant differences in operative time, postoperative drainage, or 90-day readmission and reoperation. CONCLUSIONS The ACDF-tailored ERAS pathway can reduce LOS, cost and postoperative complications, and improve patient satisfaction without increasing 90-day readmission and reoperation.
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Affiliation(s)
- Xue Leng
- Department of Orthopedics Xinqiao Hospital, Army Medical University, 183 Xinqiao Main Street Shapingba, Chongqing, 400037, People's Republic of China
| | - Yaqing Zhang
- Department of Orthopedics Xinqiao Hospital, Army Medical University, 183 Xinqiao Main Street Shapingba, Chongqing, 400037, People's Republic of China
| | - Guanzhong Wang
- Department of Orthopedics Xinqiao Hospital, Army Medical University, 183 Xinqiao Main Street Shapingba, Chongqing, 400037, People's Republic of China
| | - Libangxi Liu
- Department of Orthopedics Xinqiao Hospital, Army Medical University, 183 Xinqiao Main Street Shapingba, Chongqing, 400037, People's Republic of China
| | - Jiawei Fu
- Department of Orthopedics Xinqiao Hospital, Army Medical University, 183 Xinqiao Main Street Shapingba, Chongqing, 400037, People's Republic of China
| | - Minghui Yang
- Department of Orthopedics Xinqiao Hospital, Army Medical University, 183 Xinqiao Main Street Shapingba, Chongqing, 400037, People's Republic of China
| | - Yu Chen
- Department of Orthopedics Xinqiao Hospital, Army Medical University, 183 Xinqiao Main Street Shapingba, Chongqing, 400037, People's Republic of China
| | - Jiawei Yuan
- Department of Orthopedics Xinqiao Hospital, Army Medical University, 183 Xinqiao Main Street Shapingba, Chongqing, 400037, People's Republic of China
| | - Changqing Li
- Department of Orthopedics Xinqiao Hospital, Army Medical University, 183 Xinqiao Main Street Shapingba, Chongqing, 400037, People's Republic of China
| | - Yue Zhou
- Department of Orthopedics Xinqiao Hospital, Army Medical University, 183 Xinqiao Main Street Shapingba, Chongqing, 400037, People's Republic of China
| | - Chencheng Feng
- Department of Orthopedics Xinqiao Hospital, Army Medical University, 183 Xinqiao Main Street Shapingba, Chongqing, 400037, People's Republic of China.
| | - Bo Huang
- Department of Orthopedics Xinqiao Hospital, Army Medical University, 183 Xinqiao Main Street Shapingba, Chongqing, 400037, People's Republic of China.
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Yee TJ, Swong K, Park P. Complications of anterior cervical spine surgery: a systematic review of the literature. JOURNAL OF SPINE SURGERY 2020; 6:302-322. [PMID: 32309668 DOI: 10.21037/jss.2020.01.14] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The anterior approach to the cervical spine is commonly utilized for a variety of degenerative, traumatic, neoplastic, and infectious indications. While many potential complications overlap with those of the posterior approach, the distinct anatomy of the anterior neck also presents a unique set of hazards. We performed a systematic review of the literature to assess the etiology, presentation, natural history, and management of these complications. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a PubMed search was conducted to evaluate clinical studies and case reports of patients who suffered a complication of anterior cervical spine surgery. The search specifically included articles concerning adult human subjects, written in the English language, and published from 1989 to 2019. The PubMed search yielded 240 articles meeting our criteria. The overall rates of complications were as follows: dysphagia 5.3%, esophageal perforation 0.2%, recurrent laryngeal nerve palsy 1.3%, infection 1.2%, adjacent segment disease 8.1%, pseudarthrosis 2.0%, graft or hardware failure 2.1%, cerebrospinal fluid leak 0.5%, hematoma 1.0%, Horner syndrome 0.4%, C5 palsy 3.0%, vertebral artery injury 0.4%, and new or worsening neurological deficit 0.5%. Morbidity rates in anterior cervical spine surgery are low. Nevertheless, the unique anatomy of the anterior neck presents a wide variety of potential complications involving vascular, aerodigestive, neural, and osseous structures.
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Affiliation(s)
- Timothy J Yee
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Kevin Swong
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
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Wang W, Ding T, Harrop JS, Yang H, Gu X, Feng D, Zhang Y, Liu H, Tang F, Xue Y, Lu M, Wu C. Cervical posterior longitudinal ligament ossification : Microscopy-assisted anterior corpectomy and fusion. DER ORTHOPADE 2018; 48:426-432. [PMID: 30238145 DOI: 10.1007/s00132-018-3640-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore the clinical efficacy and safety of microscopy-assisted anterior corpectomy and fusion for cervical ossification of the posterior longitudinal ligament (OPLL). METHODS A retrospective review of 32 cervical OPLL patients who underwent microscopy-assisted anterior corpectomy and fusion from June 2012 to March 2017 was carried out. Patients were evaluated with outcome metrics: Japanese Orthopaedic Association (JOA) scores (17 points method), visual analog scale (VAS), and radiographic parameters of the lordotic angle. The complications during treatment and follow-up were recorded. RESULTS This study included 32 patients (15 males and 17 females) with a mean age of 58.3 ± 2.9 years (range 42-68 years). The average duration of follow-up was 19.0 ± 3.5 months (range 11-46 months). The scores of postoperative VAS significantly decreased (P < 0.05). The average JOA score at 12 months postoperation significantly improved (p < 0.05). The lordotic angle increased after surgery (P < 0.05). There was no titanium mesh subsidence, no pseudarthrosis or hardware failure at 1‑year follow-up. COMPLICATIONS One cerebrospinal fluid leakage in the surgery was managed using a gelatine sponge and the patient recovered after 1 week: One patient developed laryngeal nerve injury symptom of hoarseness and recovered spontaneously in 2 weeks without intervention and 1 patient suffered slight postoperative infection. There was no worsening of neurological function. CONCLUSION Microscopy-assisted anterior cervical anterior surgery appears to be a safe and effective treatment option for selected cases of cervical posterior longitudinal ligament ossification.
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Affiliation(s)
- Wanyi Wang
- Department of Orthopaedics, Wuxi People's Hospital Afflicted to Nanjing Medical University, 299 Qing yang Road, 214023, Wuxi, Jiangsu Province, China
| | - Tao Ding
- Department of Orthopaedics, Wuxi People's Hospital Afflicted to Nanjing Medical University, 299 Qing yang Road, 214023, Wuxi, Jiangsu Province, China.
| | - James S Harrop
- Departments of Neurological and Orthopedic Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 19107, Philadelphia, PA, USA
| | - Huilin Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiaofeng Gu
- Department of Orthopaedics, Wuxi People's Hospital Afflicted to Nanjing Medical University, 299 Qing yang Road, 214023, Wuxi, Jiangsu Province, China
| | - Dehong Feng
- Department of Orthopaedics, Wuxi People's Hospital Afflicted to Nanjing Medical University, 299 Qing yang Road, 214023, Wuxi, Jiangsu Province, China
| | - Yafeng Zhang
- Department of Orthopaedics, Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine, Wuxi, Jiangsu, China
| | - Hao Liu
- Department of Orthopaedics, Wuxi 9th People Hospital, Wuxi, Jiangsu, China
| | - Fenglin Tang
- Department of Orthopaedics, Wuxi People's Hospital Afflicted to Nanjing Medical University, 299 Qing yang Road, 214023, Wuxi, Jiangsu Province, China
| | - Yuntao Xue
- Department of Orthopaedics, Wuxi People's Hospital Afflicted to Nanjing Medical University, 299 Qing yang Road, 214023, Wuxi, Jiangsu Province, China
| | - Miao Lu
- Department of Orthopaedics, Wuxi People's Hospital Afflicted to Nanjing Medical University, 299 Qing yang Road, 214023, Wuxi, Jiangsu Province, China
| | - Chao Wu
- Wuxi 3th People Hospital, Wuxi, Jiangsu, China
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