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Laskay NMB, Yang LC, Estevez-Ordonez D, Warner JD, Trahan D, Stone C, Grayson JW, Withrow K, Hadley MN. Early Voice and Swallowing Disturbance Incidence and Risk Factors After Revision Anterior Cervical Discectomy and Fusion Using a Multidisciplinary Surgical Approach: A Retrospective Cohort Evaluation of a Prospective Database. Neurosurgery 2024; 94:444-453. [PMID: 37830799 DOI: 10.1227/neu.0000000000002704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/01/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Dysphagia and vocal cord palsy (VCP) are common otolaryngological complications after revision anterior cervical discectomy and fusion (rACDF) procedures. Our objective was to determine the early incidence and risk factors of VCP and dysphagia after rACDF using a 2-team approach. METHODS Single-institution, retrospective analysis of a prospectively collected database of patients undergoing rACDF was enrolled from September 2010 to July 2021. Of 222 patients enrolled, 109 patients were included in the final analysis. All patients had prior ACDF surgery with planned revision using a single otolaryngologist and single neurosurgeon. MD Anderson Dysphagia Inventory and fiberoptic endoscopic evaluation of swallowing (FEES) were used to assess dysphagia. VCP was assessed using videolaryngostroboscopy. RESULTS Seven patients (6.7%) developed new postoperative VCP after rACDF. Most cases of VCP resolved by 3 months postoperatively (mean time-to-resolution 79 ± 17.6 days). One patient maintained a permanent deficit. Forty-one patients (37.6%) reached minimum clinically important difference (MCID) in their MD Anderson Dysphagia Inventory composite scores at the 2-week follow-up (MCID decline of ≥6), indicating new clinically relevant swallowing disturbance. Forty-nine patients (45.0%) had functional FEES Performance Score decline. On univariate analysis, there was an association between new VCPs and the number of cervical levels treated at revision ( P = .020) with long-segment rACDF (≥4 levels) being an independent risk factor ( P = .010). On linear regression, there was an association between the number of levels treated previously and at revision for FEES Performance Score decline ( P = .045 and P = .002, respectively). However, on univariate analysis, sex, age, body mass index, operative time, alcohol use, smoking, and individual levels revised were not risk factors for reaching FEES Performance Score decline nor MCID at 2 weeks postoperatively. CONCLUSION VCP is more likely to occur in long-segment rACDF but is often temporary. Clinically relevant and functional rates of dysphagia approach 37% and 45%, respectively, at 2 weeks postoperatively after rACDF.
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Affiliation(s)
- Nicholas M B Laskay
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Lydia C Yang
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | | | - Jeffrey D Warner
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Duane Trahan
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Caitlin Stone
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Jessica W Grayson
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Kirk Withrow
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Mark N Hadley
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham , Alabama , USA
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Cabrera JP, Agarwal N, Mesregah MK, Rodrigues-Pinto R, Wu Y, Martin C, Buser Z, Wang JC, Meisel HJ. Analysis of Complications in Multilevel Anterior Cervical Discectomy and Fusion Using Osteobiologics Other than Bone Morphogenetic Protein: A Systematic Review. Global Spine J 2024; 14:86S-93S. [PMID: 38421321 PMCID: PMC10913906 DOI: 10.1177/21925682231168083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES The aim of this study is to analyze the complications related to multilevel anterior cervical discectomy and fusion (ACDF) using osteobiologics other than bone morphogenetic protein (BMP). METHODS A systematic review of the literature was conducted using PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov databases. The search to identify studies reporting complications in multilevel ACDF surgery using osteobiologics other than bone morphogenetic protein was performed in August 2020. The study was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). RESULTS A total of 584 articles were found after searching the databases and removing duplicates. Next, screening was performed in a double reviewer process, and 153 eligible articles-with 4 retrospective studies-in full-text were selected; these met all inclusion criteria. A total of 197 patients received 3-level ACDF, while 72 patients received 4-level ACDF. Osteobiologics were used in all selected articles, allograft was used in 4 studies, autologous bone graft was utilized in 3 articles, and hydroxyapatite was used in 1 article. The main complications reported were dysphagia, adjacent segment disease, and pseudarthrosis. CONCLUSIONS Given the limited evidence, no conclusions on complications in multilevel ACDF using osteobiologics other than BMP could be made. However, descriptively, the most common complications found were dysphagia, adjacent segment disease, and pseudoarthrosis. Further prospective studies separately analyzing complications in multilevel ACDF by osteobiologics and a number of treated levels are needed.
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Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
- Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Neha Agarwal
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Halle, Germany
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM). Department of Orthopaedics, Centro Hospitalar Universitário de Santo António; ICBAS - School of Medical and Biomedical Sciences; Hospital CUF Trindade, Porto, Portugal
| | - Yabin Wu
- Research Department, AO Spine, AO Foundation, Davos, Switzerland
| | - Christopher Martin
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hans Jörg Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Halle, Germany
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Meisel HJ, Jain A, Wu Y, Martin CT, Cabrera JP, Muthu S, Hamouda WO, Rodrigues-Pinto R, Arts JJ, Viswanadha AK, Vadalà G, Vergroesen PPA, Ćorluka S, Hsieh PC, Demetriades AK, Watanabe K, Shin JH, Riew KD, Papavero L, Liu G, Luo Z, Ahuja S, Fekete T, Uz Zaman A, El-Sharkawi M, Sakai D, Cho SK, Wang JC, Yoon T, Santesso N, Buser Z. AO Spine Guideline for the Use of Osteobiologics (AOGO) in Anterior Cervical Discectomy and Fusion for Spinal Degenerative Cases. Global Spine J 2024; 14:6S-13S. [PMID: 38421322 PMCID: PMC10913909 DOI: 10.1177/21925682231178204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
STUDY DESIGN Guideline. OBJECTIVES To develop an international guideline (AOGO) about the use of osteobiologics in anterior cervical discectomy and fusion (ACDF) for treating degenerative spine conditions. METHODS The guideline development process was guided by AO Spine Knowledge Forum Degenerative (KF Degen) and followed the Guideline International Network McMaster Guideline Development Checklist. The process involved 73 participants with expertise in degenerative spine diseases and surgery from 22 countries. Fifteen systematic reviews were conducted addressing respective key topics and evidence was collected. The methodologist compiled the evidence into GRADE Evidence-to-Decision frameworks. Guideline panel members judged the outcomes and other criteria and made the final recommendations through consensus. RESULTS Five conditional recommendations were created. A conditional recommendation is about the use of allograft, autograft or a cage with an osteobiologic in primary ACDF surgery. Other conditional recommendations are about the use of osteobiologic for single- or multi-level ACDF, and for hybrid construct surgery. It is suggested that surgeons use other osteobiologics rather than human bone morphogenetic protein-2 (BMP-2) in common clinical situations. Surgeons are recommended to choose 1 graft over another or 1 osteobiologic over another primarily based on clinical situation, and the costs and availability of the materials. CONCLUSION This AOGO guideline is the first to provide recommendations for the use of osteobiologics in ACDF. Despite the comprehensive searches for evidence, there were few studies completed with small sample sizes and primarily as case series with inherent risks of bias. Therefore, high-quality clinical evidence is demanded to improve the guideline.
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Affiliation(s)
- Hans Jörg Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Halle, Germany
| | - Amit Jain
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Yabin Wu
- Research Department, AO Spine, AO Foundation, Davos, Switzerland
| | - Christopher T Martin
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Juan Pablo Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile; Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Sathish Muthu
- Department of Orthopaedics, Government Medical College, Dindigul, India; Orthopaedic Research Group, Coimbatore, TN, India
| | - Waeel O Hamouda
- Department of Neurosurgery, Kasr Alainy Faculty of Medicine, Research, and Teaching Hospitals, Cairo University, Cairo, Egypt; Neurological & Spinal Surgery Service, Security Forces Hospital, Dammam, Saudi Arabia
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal; Hospital CUF Trindade, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Jacobus J Arts
- Laboratory for Experimental Orthopaedics, Department of Orthopaedic Surgery, CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands; Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Gianluca Vadalà
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy; Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | - Stipe Ćorluka
- Spinal Surgery Division, Department of Traumatology, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia; Department of Anatomy and Physiology, University of Applied Health Sciences, Zagreb, Croatia
| | - Patrick C Hsieh
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - K Daniel Riew
- Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, NY, USA; Department of Orthopedic Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Luca Papavero
- Clinic for Spine Surgery, Schoen Clinic Hamburg Eilbek, Hamburg, Germany
| | - Gabriel Liu
- Department of Orthopedic Surgery, National University Hospital, Singapore, Singapore
| | - Zhuojing Luo
- Department of Orthopaedic Surgery, Xijing Hospital, Xi'an, China
| | - Sashin Ahuja
- Welsh Centre for Spinal Surgery & Trauma, Department of Spine Surgery, University Hospital of Wales, Cardiff, UK
| | - Tamás Fekete
- Spine Center Division, Schulthess Klinik, Zurich, Switzerland
| | - Atiq Uz Zaman
- Orthopaedic and Spine Surgery Department, Lahore Medical and Dental College, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Mohammad El-Sharkawi
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Samuel K Cho
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tim Yoon
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | - Nancy Santesso
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA; Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
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Martin CT, Holton K, Broida SE, Hickmann AK, Bakker C, Lender PA, Watanabe K, Meisel HJ, Buser Z, Presciutti SM, Yoon ST. Comparative Complications Associated With BMP Use In Patients Undergoing ACDF for Degenerative Spinal Conditions: Systematic Review and Meta-Analysis. Global Spine J 2024; 14:94S-109S. [PMID: 38421328 PMCID: PMC10913901 DOI: 10.1177/21925682231166325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
STUDY DESIGN Systematic Review and Meta-Analysis. OBJECTIVES To compare complication incidence in patients with or without the use of recombinant human Bone Morphogenic Protein-2 (BMP2) undergoing anterior cervical discectomy and fusion (ACDF) for degenerative conditions. METHODS A systematic search of eight online databases was conducted using PRISMA guidelines. Inclusion criteria included English language studies with a minimum of 10 adult patients undergoing instrumented ACDF surgery for a degenerative spinal condition in which BMP2 was used in all patients or one of the treatment arms. Studies with patients undergoing circumferential fusions, with non-degenerative indications, or which did not report post-operative complication data were excluded. Patients with and without BMP2 were compared in terms of the incidence of dysphagia/dysphonia, anterior soft tissue complications (hematoma, seroma, infection, dysphagia/dysphonia), nonunion, medical complications, and new neurologic deficits. RESULTS Of 1832 preliminary search results, 27 manuscripts were included. Meta-analysis revealed the relative risk of dysphagia or dysphonia (RR = 1.39, CI 95% 1.18 - 1.64, P = <.001), anterior soft tissue complications (RR = 1.43, CI 95% 1.25-1.64, P = <.001), and medical complications (RR = 1.32, CI 95% 1.06-1.66, P = .013) were statistically significant in the BMP2 group while the relative risk of non-union (RR = .5, CI 95% .23 - 1.13, P = .09) trended lower in the BMP2 group. Neurological deficit (RR = 1.06, CI 95% .82-1.37, P = .66), and additional medical complications (RR = 1.53, CI 95% .98-2.38, P = .06) were not found to be statistically different between the groups. CONCLUSIONS This meta-analysis identified a high rate of arthrodesis when BMP2 was used in ACDF, but confirmed increased rates of dysphagia and anterior soft tissue complications. Surgeons may consider reserving BMP2 implementation for cases with a high risk of non-union, and should be aware of the risk of airway compromise.
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Affiliation(s)
- Christopher T Martin
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Kenneth Holton
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Samuel E Broida
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | | | - Caitlin Bakker
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Paul A Lender
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hans Jörg Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Germany
| | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Steven M Presciutti
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Sangwook Tim Yoon
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
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5
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Hoffmann J, Ricciardi GA, Yurac R, Meisel HJ, Buser Z, Qian B, Vergroesen PPA. The Use of Osteobiologics in Single versus Multi-Level Anterior Cervical Discectomy and Fusion: A Systematic Review. Global Spine J 2024; 14:110S-119S. [PMID: 38421334 PMCID: PMC10913903 DOI: 10.1177/21925682221136482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
STUDY DESIGN Systematic literature review. OBJECTIVES In this study we assessed evidence for the use of osteobiologics in single vs multi-level anterior cervical discectomy and fusion (ACDF) in patients with cervical spine degeneration. The primary objective was to compare fusion rates after single and multi-level surgery with different osteobiologics. Secondary objectives were to compare differences in patient reported outcome measures (PROMs) and complications. METHODS After a global team of reviewers was selected, a systematic review using different repositories was performed, confirming to PRISMA and GRADE guidelines. In total 1206 articles were identified and after applying inclusion and exclusion criteria, 11 articles were eligible for analysis. Extracted data included fusion rates, definition of fusion, patient reported outcome measures, types of osteobiologics used, complications, adverse events and revisions. RESULTS Fusion rates ranged from 87.7% to 100% for bone morphogenetic protein 2 (BMP-2) and 88.6% to 94.7% for demineralized bone matrix, while fusion rates reported for other osteobiologics were lower. All included studies showed PROMs improved significantly for each osteobiologic. However, no differences were reported when comparing osteobiologics, or when comparing single vs multi-level surgery specifically. CONCLUSION The highest fusion rates after 2-level ACDF for cervical spine degeneration were reported when BMP-2 was used. However, PROMs did not differ between the different osteobiologics. Further blinded randomized trials should be performed to compare the use of BMP-2 in single vs multi-level ACDF specifically.
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Affiliation(s)
- Jim Hoffmann
- Department of Orthopaedics, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Guillermo A Ricciardi
- Spine Surgery, Orthopaedics and Traumatology, Centro Mdico Integral Fitz Roy, Buenos Aires, Argentina
- Spine Surgery, Orthopaedics and Traumatology, Sanatorio Gemes, Buenos Aires, Argentina
| | - Ratko Yurac
- Professor associate of Orthopedics and Traumatology, University of Development, Santiago, Chile
- Spine Unit, Department of Orthopedics and Traumatology, Clinica Alemana, Santiago, Chile
| | - Hans Jörg Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost, Halle, Germany
| | - Zorica Buser
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, USA
- Gerling Institute, Brooklyn, NY, USA
| | - Bangping Qian
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School University, Nanjing, China
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Muthu S, Diniz SE, Viswanathan VK, Hsieh PC, Abedi A, Yoon T, Meisel HJ, Buser Z, Rodrigues-Pinto R, Knowledge Forum Degenerative AS. What Is the Evidence Supporting Osteobiologic Use in Revision Anterior Cervical Discectomy and Fusion? Global Spine J 2024; 14:173S-178S. [PMID: 38421324 PMCID: PMC10913914 DOI: 10.1177/21925682221133751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
STUDY DESIGN Systematic literature review. OBJECTIVE To analyze the literature and describe the evidence supporting osteobiologic use in revision anterior cervical discectomy and fusion (ACDF) surgery. METHODS A systematic search of PubMed/MEDLINE, EMBASE, Cochrane library, and ClinicalTrials.gov databases was conducted for literature reporting the use of osteobiologics in revision ACDF. We searched for studies reporting outcomes of using any osteobiologic use in revision ACDF surgeries (independently of the number of levels) in the above databases. RESULTS There are currently no studies in the literature describing the outcome and comparative efficacy of diverse osteobiologic agents in the context of revision ACDF surgery. A majority of the current evidence is based only upon studies involving primary ACDF surgery. CONCLUSION The current study highlights the paucity of literature evidence on the role of diverse osteobiologics in revision ACDF, and foregrounds the need for high-quality evidence on this subject.
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Affiliation(s)
- Sathish Muthu
- Department of Orthopaedics, Government Medical College, Dindigul, India
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
| | - Sara Elisa Diniz
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Vibhu Krishnan Viswanathan
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Department of Musculoskeletal Oncology, University of Calgary, Alberta, CA
| | - Patrick C Hsieh
- Department of Neurological Surgery, USC Spine Center, Keck School of Medicine, Los Angeles, CA, USA
| | - Aidin Abedi
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- USC Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tim Yoon
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | - Hans Jörg Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Germany
| | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, USA
| | - Ricardo Rodrigues-Pinto
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal
- Hospital CUF Trindade, Porto, Portugal
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Lovecchio F, Ang B, Louie PK, Chaudary C, Shah SP, Punyala A, Yao YC, Steinhaus M, McCarthy MH, Huang R, Lebl D, Lafage V, Albert TJ, Iyer S, Qureshi S, Kim HJ. Bone Density Distribution in the Cervical Spine. Global Spine J 2024; 14:169-176. [PMID: 35485915 PMCID: PMC10676188 DOI: 10.1177/21925682221098965] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Given changes in bone density induced by degenerative disease, general measures of bone health (ie DEXA) are inadequate to evaluate bone density in surgical areas of interest. Regional differences in HU in the cervical spine may influence surgical strategies. The purposes of our study were to determine whether cervical Hounsfield units (HU) vary by level, examine their relationship with age, comorbidities, and alignment, and propose a technique to measure HU in the lateral masses. METHODS Two hundred twenty-four patients with degenerative spine pathology with a cervical computed tomography were included (2015-2019). Measurements were performed in each vertebral body (C2-T1; mid-axial, anterior-axial, posterior-axial, mid-coronal, and mid-sagittal) and 2 regions of the lateral masses (C3-C6; mid-cor, mid-sag). To evaluate reliability, 6 observers each measured 355 HU values, inter-relater reliability assessed with intraclass correlation coefficients Correlations of HU with age, BMI, comorbidities, and cervical alignment were evaluated. RESULTS Bone density differed by level, with the lowest HU scores in the lower cervical spine (C6-T1) (P < .001). No correlations were found between LM HU and age, BMI, CCI, or alignment (P > .05). Increased kyphosis was weakly correlated with VB HU, while age and CCI showed moderate correlations with VB HU at all levels (P<.001). ICC for HU measurements were good to excellent for the VBs, but poor to moderate for the LMs. CONCLUSION Bone is least dense in the lower cervical spine. HU scoring is not reliable in the lateral masses. We recommend that a level-specific approach to bone density is considered in surgical planning.
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Affiliation(s)
- Francis Lovecchio
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Bryan Ang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Philip K. Louie
- Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Chirag Chaudary
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sachin P. Shah
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Ananth Punyala
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Yu-Cheng Yao
- Department of Orthopedics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mike Steinhaus
- Spine Institute, MountainStar Healthcare, Park City, UT, USA
| | - Michael H. McCarthy
- Department of Orthopaedic Surgery, Indiana Spine Group, University of Indiana, Carmel, ID, USA
| | - Russel Huang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Darren Lebl
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Todd J. Albert
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sravisht Iyer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sheeraz Qureshi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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8
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Divi SN, Plantz MA, Tegethoff J, Su BW. Current and Expanded Indications for Cervical Disc Arthroplasty: Beyond the FDA IDE Studies. Clin Spine Surg 2023; 36:375-385. [PMID: 37691166 DOI: 10.1097/bsd.0000000000001525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
The widespread success of cervical disc arthroplasty (CDA) has led to an interest in expanding indications beyond those outlined in the initial Food and Drug Administration investigational device exemption studies. Some of these off-label indications currently include 3-level and 4-level CDA, hybrid constructs with adjacent segment anterior cervical discectomy and fusion or corpectomy constructs, pre-existing kyphosis, revision of a failed anterior cervical discectomy and fusion to a CDA, CDA in the setting of significant degenerative disc disease and/or facet joint arthropathy, CDA for congenital cervical stenosis, and CDA in the presence of ossification of the posterior longitudinal ligament. This review article will summarize the current literature pertaining to the aforementioned indications.
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Affiliation(s)
- Srikanth N Divi
- Department of Orthopaedic Surgery, Northwestern University, Chicago IL
| | - Mark A Plantz
- Department of Orthopaedic Surgery, Northwestern University, Chicago IL
| | - Jason Tegethoff
- Department of Orthopaedic Surgery, Northwestern University, Chicago IL
| | - Brian W Su
- California Orthopedics & Spine, Novato, CA
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Wu T, He J, Huang K, Rong X, Ding C, Wang B, Liu H. Cervical Disc Arthroplasty for the Treatment of Noncontiguous Cervical Degenerative Disc Disease: Results of Mid- to Long-Term Follow-up. Orthop Surg 2023; 15:2901-2910. [PMID: 37737031 PMCID: PMC10622294 DOI: 10.1111/os.13900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/22/2023] [Accepted: 08/27/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE The long-term results of cervical disc arthroplasty (CDA) for noncontiguous cervical degenerative disc disease (CDDD) are still uncertain. Moreover, it is unclear whether CDA delays or avoids the degeneration of the intermediate segment (IS), leading to controversy in the field. Therefore, this study aimed to investigate the mid- to long-term clinical and radiographic outcomes of CDA in treating noncontiguous CDDD and to explore whether the IS degenerated faster after CDA than other non-surgically treated adjacent segments. METHODS We retrospectively analyzed patients with noncontiguous CDDD who underwent CDA in our department between January 2008 and July 2018. The patients were divided into the CDA and hybrid surgery (HS) groups, and clinical and radiographic outcomes were evaluated at routine postoperative intervals. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA), neck disability index (NDI), and visual analogue scale (VAS), while radiographic outcomes included cervical lordosis (CL), C2-C7 range of motion (ROM), segmental ROM, and disc angle (DA) at the arthroplasty level. Complications were also evaluated.Pre- and postoperative values were compared using paired t-tests or Wilcoxon rank-sum tests. Independent Student t-tests or Mann-Whitney U tests analyzed continuous data between CDA and HS groups, while chi-square or Fisher exact tests assessed categorical data. RESULTS Sixty-four patients with noncontiguous CDDD, with 31 in the CDA group and 33 in the HS group, were evaluated. The mean follow-up time was over 70 months. The most frequently involved levels were C4/5 and C5/6. Both groups showed significant improvements in JOA, NDI, and VAS values after surgery. Although CL was maintained, the CL in the CDA group was consistently lower than that in the HS group (p < 0.05). There was a significant decrease in C2-C7 ROM (p < 0.05), but at the last follow-up, the C2-C7 ROM in the CDA group was greater than that in the HS group (p < 0.05). At the last follow-up, 44.3% of arthroplasty levels had developed heterotopic ossification (HO), and 48.45% had developed anterior bone loss (ABL). In addition, adjacent segment degeneration (ASDeg) was observed in the IS (22.7%), superior adjacent segment (20.6%)and inferior adjacent segment (21.9%). CONCLUSION CDA or CDA combined with fusion are viable treatments for noncontiguous CDDD, with satisfactory outcomes after mid-to-long-term follow-up. ASDeg is similar in non-surgical segments after 70 months of follow-up. ROM of the IS issimilar to preoperative levels, indicating CDA does not increase the risk of IS degeneration.
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Affiliation(s)
- Ting‐kui Wu
- Department of Orthopaedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Jun‐bo He
- Department of Orthopaedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Kang‐kang Huang
- Department of Orthopaedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Xin Rong
- Department of Orthopaedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Chen Ding
- Department of Orthopaedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Bei‐yu Wang
- Department of Orthopaedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Hao Liu
- Department of Orthopaedic Surgery, West China HospitalSichuan UniversityChengduChina
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Lambrechts MJ, Brush PL, Lee Y, Issa TZ, Lawall CL, Syal A, Wang J, Mangan JJ, Kaye ID, Canseco JA, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD. Patient-Reported Outcomes Following Anterior and Posterior Surgical Approaches for Multilevel Cervical Myelopathy. Spine (Phila Pa 1976) 2023; 48:526-533. [PMID: 36716386 DOI: 10.1097/brs.0000000000004586] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/11/2023] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To compare health-related quality of life (HRQoL) outcomes between approach techniques for the treatment of multilevel degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA Both anterior and posterior approaches for the surgical treatment of cervical myelopathy are successful techniques in the treatment of myelopathy. However, the optimal treatment has yet to be determined, especially for multilevel disease, as the different approaches have separate complication profiles and potentially different impacts on HRQoL metrics. MATERIALS AND METHODS Retrospective review of a prospectively managed single institution database of patient-reported outcome measures after 3 and 4-level anterior cervical discectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) for DCM. The electronic medical record was reviewed for patient baseline characteristics and surgical outcomes whereas preoperative radiographs were analyzed for baseline cervical lordosis and sagittal balance. Bivariate and multivariate statistical analyses were performed to compare the two groups. RESULTS We identified 153 patients treated by ACDF and 43 patients treated by PCDF. Patients in the ACDF cohort were younger (60.1 ± 9.8 vs . 65.8 ± 6.9 yr; P < 0.001), had a lower overall comorbidity burden (Charlson Comorbidity Index: 2.25 ± 1.61 vs . 3.07 ± 1.64; P = 0.002), and were more likely to have a 3-level fusion (79.7% vs . 30.2%; P < 0.001), myeloradiculopathy (42.5% vs . 23.3%; P = 0.034), and cervical kyphosis (25.7% vs . 7.69%; P = 0.027). Patients undergoing an ACDF had significantly more improvement in their neck disability index after surgery (-14.28 vs . -3.02; P = 0.001), and this relationship was maintained on multivariate analysis with PCDF being independently associated with a worse neck disability index (+8.83; P = 0.025). Patients undergoing an ACDF also experienced more improvement in visual analog score neck pain after surgery (-2.94 vs . -1.47; P = 0.025) by bivariate analysis. CONCLUSIONS Our data suggest that patients undergoing an ACDF or PCDF for multilevel DCM have similar outcomes after surgery.
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Affiliation(s)
- Mark J Lambrechts
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Parker L Brush
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Yunsoo Lee
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Tariq Z Issa
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | | | - Amit Syal
- Thomas Jefferson University Medical School, Philadelphia, PA
| | - Jasmine Wang
- Thomas Jefferson University Medical School, Philadelphia, PA
| | - John J Mangan
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Ian David Kaye
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Jose A Canseco
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Alan S Hilibrand
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Alexander R Vaccaro
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Christopher K Kepler
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Gregory D Schroeder
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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Trends in Hospitalization and Economic Impact of Percutaneous Kyphoplasty in Italy. J Clin Med 2022; 11:jcm11247464. [PMID: 36556080 PMCID: PMC9788016 DOI: 10.3390/jcm11247464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/26/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Vertebral Fractures (VFs) caused by osteoporosis are the most typical reason for performing Percutaneous Kyphoplasty (PK). Globally, VF prevalence is not well described in the literature. In Europe, only Sweden has an accurate record of the incidence of this type of fracture. Moreover, the exact incidence of the PK procedure is not reported. Therefore, the annual patterns and financial burden of PK in Europe is not well known, and it could be may better understood by examining national registers. For surgeons, lawmakers, hospital administrators, and the healthcare system, determining the annual national costs of this treatment is helpful. The National Hospital Discharge Reports (SDOs) submitted to the Italian Ministry of Health during the years covered by this study (2009-2015) were used. A total of 13,113 kyphoplasties were performed in Italy, with a prevalence of 3.6 procedures for every 100,000 Italian inhabitants over 15 years. The average age of patients was 68.28 (±12.9). Females represented the majority of patients undergoing PK procedures (68.6%). The median length of hospital stay was 5.33 days. The prevalence of PK procedures increased from 2009 to 2015, while the average days of hospitalization decreased. Older patients were most at risk in undergoing PK procedures. Reporting the national data on PK in Italy could also help compare the findings across nations. The current study aims to determine the trends of PK hospitalisation and patient features in Italy.
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Patel AH, Ofa SA, Collins LK, McCluskey LC, Sherman WF, Cyriac M. Trends of single-level anterior cervical discectomy and fusion documentation after the 2015 Centers for Medicare & Medicaid Services coding audit. J Neurosurg Spine 2022; 37:802-811. [PMID: 35932261 DOI: 10.3171/2022.5.spine22415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE With the use of anterior cervical discectomy and fusion (ACDF) expected to rise by 13.3% from 2020 to 2040, the increased usage of interbody cages with integral anterior fixation prompted a Centers for Medicare & Medicaid Services (CMS) review, which resulted in coding changes affecting anterior instrumentation documentation. CMS determined that Current Procedural Terminology (CPT) code 22845 should not be used to report integrated instrumentation (plate) with an interbody device, and if additional anterior instrumentation (e.g., plates and screws) is placed with an integrated interbody device, then a 59 modifier should be used. There is sparse literature examining the trends of ACDF without and with additional anterior instrumentation after the 2015 CMS audit. Therefore, this study aimed to evaluate the trends of single-level subaxial ACDF utilization from 2011 to 2019 to determine whether the 2015 CMS audit influenced the documented usage of additional anterior instrumentation. METHODS A retrospective cohort study was performed using the commercially available database PearlDiver. Patient records were queried from 2011 to 2019 for single-level subaxial ACDF without (CPT code 22551) and with (CPT codes 22551 + 22845) instrumentation. Cochran-Armitage trend analyses were performed to evaluate the hypothesis that ACDF with additional anterior instrumentation decreased over the given time period. RESULTS Between 2011 and 2019, the total number of single-level ACDFs decreased from 6202 to 4402. From 2011 to 2015, an average of 6240 patients per year underwent single-level subaxial ACDF; of those, 950 patients (15.2%) had ACDF without instrumentation and 5290 patients (84.8%) had ACDF with instrumentation. In 2016, the total number of single-level subaxial ACDFs decreased to 5525, with 1006 patients (18.2%) receiving no instrumentation and 4519 patients (81.8%) receiving instrumentation. From 2017 to 2019, an average of 4283 patients per year underwent a single-level subaxial ACDF; of these, 1280 (29.9%) had no instrumentation and 3003 (70.1%) had instrumentation (all p < 0.0001). CONCLUSIONS From 2015 to 2019, single-level ACDF without instrumentation significantly increased by 91.5% and ACDF with anterior instrumentation significantly decreased by 18.1%. The 2015 CMS audit of interbody cages and anterior instrumentation coding (CPT code 22845) may account for the decreased documentation of anterior instrumentation in the 9-year period. Understanding CMS auditing could help surgeons perceive changes in practice patterns that may lead to a more thorough evaluation of patient outcomes, cost, and overall value.
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Affiliation(s)
- Akshar H Patel
- 1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana; and
| | - Sione A Ofa
- 1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana; and
| | - Lacee K Collins
- 2Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Leland C McCluskey
- 1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana; and
| | - William F Sherman
- 1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana; and
| | - Mathew Cyriac
- 1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana; and
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Patel MR, Jacob KC, Parsons AW, Vanjani NN, Prabhu MC, Pawlowski H, Singh K. Impact of Gender on Postsurgical Outcomes in Patients Undergoing Anterior Cervical Discectomy and Fusion. Int J Spine Surg 2022; 16:991-1000. [PMID: 36418177 PMCID: PMC9807048 DOI: 10.14444/8366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/05/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Prior studies associate male gender with higher complication rates following anterior cervical discectomy and fusion (ACDF), but none has investigated gender influence on patient-reported outcome measures (PROMs) and minimal clinically important difference (MCID) following single-level ACDF. METHODS Patients undergoing primary, single-level ACDF were divided into female and male groups. Visual analog scale (VAS) neck/arm, Neck Disability Index (NDI), 12-item short form (SF-12) physical composite score (PCS), PROM information system physical function (PROMIS-PF), and veterans RAND 12-item (VR-12) health survey PCS were collected preoperatively and postoperatively. Simple linear regression analysis evaluated the predictive capability of gender on PROMs. Multiple regression analysis was performed to determine the effects of gender on mean PROMs while accounting for insurance type. Established MCID values determined achievement rates across PROMs. χ 2 analysis compared MCID achievement by gender. RESULTS A total of 179 women and 134 men were included. Cohorts differed in insurance type, length of stay, and discharge day (P ≤ 0.017, all). Women improved in PROMs at all timepoints (P ≤ 0.049, all) except SF-12 PCS 6 weeks and PROMIS-PF 6 weeks. Men improved in PROMs at all timepoints (P ≤ 0.042) except VAS arm 2 years, SF-12 PCS 6 weeks and 2 years, PROMIS-PF 6 weeks, and VR-12 PCS 6 weeks. Women demonstrated higher SF-12 PCS (P = 0.043) and VR-12 PCS (P = 0.035) 2 years. Multiple regression determined that VAS neck and arm from 6 weeks to 6 months, NDI from preoperative to 6 months, SF-12 PCS and VR-12 PCS from preoperative to 12 weeks, and PROMIS-PF preoperative, 6 weeks, and 6 months were significantly affected by gender and insurance status (P ≤ 0.031, all). MCID achievement rate did not differ for any PROM between genders. CONCLUSION Women reported significantly higher long-term physical function health (SF-12 PCS and VR-12 PCS) compared with men, while disability and pain did not differ. Nevertheless, no significant differences in MCID achievement were observed for any PROM studied. Gender does not appear to play a significant role in clinically meaningful recovery following single-level ACDF. CLINICAL RELEVANCE Gender has little value in prognostication for determining clinically meaningful recovery after single-level ACDF. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Madhav R. Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kevin C. Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Alexander W. Parsons
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nisheka N. Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael C. Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA, Dr. Kern Singh, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St, Suite 300, Chicago, IL 60612, USA;
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14
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Lambrechts MJ, D'Antonio ND, Toci GR, Karamian BA, Farronato D, Pezzulo J, Breyer G, Canseco JA, Woods B, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GR. Marijuana Use and its Effect on Clinical Outcomes and Revision Rates in Patients Undergoing Anterior Cervical Discectomy and Fusion. Spine (Phila Pa 1976) 2022; 47:1558-1566. [PMID: 35867598 DOI: 10.1097/brs.0000000000004431] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/15/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE To determine if (1) preoperative marijuana use increased complications, readmission, or reoperation rates following anterior cervical discectomy and fusion (ACDF), (2) identify if preoperative marijuana use resulted in worse patient-reported outcome measures (PROMs), and (3) investigate if preoperative marijuana use affects the quantity of opioid prescriptions in the perioperative period. SUMMARY OF BACKGROUND DATA A growing number of states have legalized recreational and/or medical marijuana, thus increasing the number of patients who report preoperative marijuana use. The effects of marijuana on clinical outcomes and PROMs in the postoperative period are unknown. METHODS All patients 18 years of age and older who underwent primary one- to four-level ACDF with preoperative marijuana use at our academic institution were retrospectively identified. A 3:1 propensity match was conducted to compare patients who used marijuana versus those who did not. Patient demographics, surgical characteristics, clinical outcomes, and PROMs were compared between groups. Multivariate regression models measured the effect of marijuana use on the likelihood of requiring a reoperation and whether marijuana use predicted inferior PROM improvements at the one-year postoperative period. RESULTS Of the 240 patients included, 60 (25.0%) used marijuana preoperatively. Multivariate logistic regression analysis identified marijuana use (odds ratio=5.62, P <0.001) as a predictor of a cervical spine reoperation after ACDF. Patients who used marijuana preoperatively had worse one-year postoperative Physical Component Scores of the Short-Form 12 (PCS-12) ( P =0.001), Neck Disability Index ( P =0.003), Visual Analogue Scale (VAS) Arm ( P =0.044) and VAS Neck ( P =0.012). Multivariate linear regression found preoperative marijuana use did not independently predict improvement in PCS-12 (β=-4.62, P =0.096), Neck Disability Index (β=9.51, P =0.062), Mental Component Scores of the Short-Form 12 (MCS-12) (β=-1.16, P =0.694), VAS Arm (β=0.06, P =0.944), or VAS Neck (β=-0.44, P =0.617). CONCLUSION Preoperative marijuana use increased the risk of a cervical spine reoperation after ACDF, but it did not significantly change the amount of postoperative opioids used or the magnitude of improvement in PROMs. LEVEL OF EVIDENCE Levwl III.
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Affiliation(s)
- Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Nicholas D D'Antonio
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Gregory R Toci
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Dominic Farronato
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Joshua Pezzulo
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | | | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Barrett Woods
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Gregory R Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
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Wang W, Huang Y, Wu Z, Hu X, Xiang P, Liu H, Yang H. Comparison of 3-level anterior cervical discectomy and fusion and open-door laminoplasty in cervical sagittal balance: A retrospective study. Front Surg 2022; 9:937479. [PMID: 36171811 PMCID: PMC9510365 DOI: 10.3389/fsurg.2022.937479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Objective To compare the clinical efficacy and radiological outcomes of 3-level anterior cervical discectomy and fusion (ACDF) and open-door laminoplasty (LP). Methods A total of 74 patients from January 2017 to January 2020 were enrolled in this retrospective study. There were two groups. Group A (30 cases) received 3-level ACDF, while Group B (44 cases) received open-door LP. Clinical evaluation included perioperative parameters, Neck Disability Index (NDI), and Japanese Orthopaedic Association (JOA) scores. Radiological evaluation included cervical curve depth (CCD), C2–7 angle, C2–7 sagittal vertical axis (cSVA), C7 slope (C7S), and T1 slope (T1S). Results Perioperative parameters such as blood loss, drainage volume after surgery, and hospital stay of patients in Group A were significantly less than those in Group B (P < .001). NDI scores decreased and JOA scores increased significantly after surgery in both groups (P < .05). There was a significant difference in both scores postoperatively and at 1 month after surgery between the two groups (P < .05). CCD and C2–7 angle of Group A increased significantly postoperatively at 1 month after surgery and at final follow-up (FFU) (P < .05). There was a significant difference in CCD and the C2–7 angle between the two groups postoperatively at 1 month after surgery and at FFU (P < .05). T1S increased significantly in Group A postoperatively and at 1 month after surgery (P < .05). Conclusion 3-level ACDF and open-door LP achieved favorable clinical outcomes and ACDF benefited patients in the early stage of rehabilitation. Compared with open-door LP, 3-level ACDF had advantages of reconstructing cervical lordosis with increased CCD and C2–7 angle.
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Affiliation(s)
- Wenhao Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yixue Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhikai Wu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiayu Hu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, China
| | - Pan Xiang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, China
| | - Hao Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Correspondence: Huilin Yang Hao Liu
| | - Huilin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Correspondence: Huilin Yang Hao Liu
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16
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Cha ED, Lynch CP, Ahn J, Patel MR, Jacob KC, Geoghegan CE, Prabhu MC, Vanjani NN, Pawlowski H, Singh K. Dysphagia May Attenuate Improvements in Postoperative Outcomes Following Anterior Cervical Discectomy and Fusion. Int J Spine Surg 2022; 16:983-990. [PMID: 35840320 PMCID: PMC9807062 DOI: 10.14444/8334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Past studies outline potential risk factors for dysphagia following anterior cervical discectomy and fusion (ACDF). Few studies explored the impact of dysphagia, as measured by the swallowing quality of life (SWAL-QOL), on postoperative patient-reported outcome measure (PROM) improvement. This study aimed to determine the relationship between dysphagia and improvement in pain, disability, physical function, and mental health following ACDF. METHODS A retrospective review of patients undergoing primary 1- or 2-level ACDF was performed. Individuals without a completed preoperative SWAL-QOL were excluded. Outcomes were collected for visual analog scale (VAS) neck and arm pain, Neck Disability Index (NDI), Patient-Reported Outcome Measurement Information System Physical Function (PROMIS-PF), 12-Item Short Form Physical Component Score (SF-12 PCS), 9-Item Patient Health Questionnaire (PHQ-9), and SWAL-QOL. Postoperative improvement from preoperative values was evaluated using a paired t test. The impact of SWAL-QOL on each PROM was assessed using linear regression. RESULTS A total of 91 patients were included. Mean preoperative SWAL-QoL was 90.4, which worsened at 6 weeks and resolved by 6 months (P ≤ 0.007, both). VAS neck and arm scores significantly improved postoperatively (P < 0.001), as did the NDI score (P < 0.001). Physical function significantly improved at 12 weeks and 6 months (P ≤ 0.021, both). Depressive symptoms improved at 6 weeks and 12 weeks (P ≤ 0.007, both). Preoperatively, SWAL-QOL demonstrated significant relationships with all PROMs (P ≤ 0.005, all). At 6 weeks, 12 weeks, and 6 months (P ≤ 0.048, all), SWAL-QoL again demonstrated a similar significant association with all PROMs. Multiple regression did not demonstrate common demographic or operative variables that were significant predictors of PROMs. CONCLUSION Following ACDF, patients experienced a worsening of dysphagia but resolved by 12 weeks. All PROMs demonstrated significant improvements by the 6-month timepoint, except for PHQ-9. SWAL-QoL demonstrated a significant effect on all postoperative outcomes, which may suggest that this questionnaire could effectively evaluate dysphagia and predict positive or negative outcomes following ACDF. LEVEL OF EVIDENCE 3 CLINICAL RELEVANCE: The severity of dysphagia has a significant association with pain, disability, mental health, and physical function patient-reported outcome measures in patients undergoing ACDF.
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Affiliation(s)
- Elliot D.K. Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Conor P. Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Junyoung Ahn
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Madhav R. Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kevin C. Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Cara E. Geoghegan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael C. Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nisheka N. Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA, Kern Singh, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St, Suite #300, Chicago, IL 60612, USA;
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17
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Joo PY, Jayaram RH, McLaughlin WM, Ameri B, Kammien AJ, Arnold PM, Grauer JN. Four-level anterior versus posterior cervical fusions: Perioperative outcomes and five-year reoperation rates: Outcomes after four-level anterior versus posterior cervical procedures. NORTH AMERICAN SPINE SOCIETY JOURNAL 2022; 10:100115. [PMID: 35392022 PMCID: PMC8980614 DOI: 10.1016/j.xnsj.2022.100115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 01/06/2023]
Abstract
Background Multilevel cervical pathology can often be addressed via anterior cervical discectomy and fusion (ACDF) or posterior cervical fusion (PCF). While posterior procedures may be technically easier for four-level pathology, there are advantages and disadvantages to both approaches that make it of interest to compare outcomes. The purpose was to compare perioperative adverse events and long-term cervical reoperation rates of four-level ACDF and PCF. Methods The 2010 to Q1 2020 PearlDiver MSpine database was queried. Patients undergoing isolated elective four-level ACDF or PCF were identified (excluding cases performed for trauma, neoplasm, and/or infections) and 1:1 matched based on age, sex, and comorbidities. Ninety-day adverse events were compared with univariate and multivariate analyses. Five-year incidences of subsequent cervical reoperations were also compared. Results A total of 3,714 patients 1:1 matched for four-level ACDF and PCF performed for degenerative pathologies were identified (1,857 for each of the study groups). On multivariate analysis controlling for age, sex, and comorbidities, PCF was found to have significantly greater odds ratios (OR) for any (OR 2.12), serious (OR 2.31), and minor (OR 1.95) adverse events, as well as for length of stay ≥3 days (OR 1.76), p<0.001 for each. However, PCF had nearly three times lower odds of dysphagia compared to ACDF (OR 0.36, p<0.001). At five years, four-level ACDF cases were found to have significantly higher reoperation rates compared to four-level PCF cases (26.3% vs 18.3%, p<0.001). Conclusion In evaluating four-level cervical cases, compared to anterior approach cases, posterior approach procedures were associated with approximately double the odds of any, serious, and minor adverse events, but around one third the rate of dysphagia and two thirds the rate of five-year reoperations. While the pathology may dictate surgical approach, this data suggests that the choice between four-level anterior versus posterior approach becomes a balance of risks/benefit considerations.
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Affiliation(s)
- Peter Y. Joo
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States
| | - Rahul H. Jayaram
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States
| | - William M. McLaughlin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States
| | - Bijan Ameri
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States
| | - Alexander J. Kammien
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States
| | - Paul M. Arnold
- Department of Neurosurgery, Carle Illinois College of Medicine, Champaign, IL, United States
| | - Jonathan N. Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States
- Corresponding author at: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06510, United States.
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Joo PY, Zhu JR, Kammien AJ, Gouzoulis MJ, Arnold PM, Grauer JN. Clinical outcomes following one-, two-, three-, and four-level anterior cervical discectomy and fusion: a national database study. Spine J 2022; 22:542-548. [PMID: 34774751 DOI: 10.1016/j.spinee.2021.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/15/2021] [Accepted: 11/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND CONTEXT Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure. There is markedly less data on outcomes after three- and four-level cases than one- and two-level cases. PURPOSE To compare perioperative 90-day adverse events and 5-year reoperation rates between isolated one-, two-, three-, and four-level ACDF cases. STUDY DESIGN/SETTING Retrospective review of a large national database. PATIENT SAMPLE Overall, 97,081 patients undergoing ACDF were identified, of which one-level cases were 42,382 (43.7%), two-level cases were 24,055 (24.8%), three-level cases were 28,293 (29.1%), and four-level cases were 2,361 (2.4%). OUTCOME MEASURES Ninety-day adverse events and 5-year reoperation rates. METHODS The 2010 to Q1 2020 PearlDiver database was queried to identify patients who underwent elective ACDF for degenerative pathology without corpectomy or concomitant posterior procedures. Univariate and multivariate analyses were performed to compare outcomes of subcohorts with varying number of levels addressed by ACDF. RESULTS Of the 97,081 cases identified, patient characteristics and complication rates differed between the cohorts defined by levels treated. Univariate analyses revealed statistically different rates of 90-day any, serious, and minor adverse event rates between the groups, but the differences were all less than 2.5%. Readmission rates were statistically different by 2.9%, dysphagia by 3.2%, and prolonged length of stay by 6.3%.By multivariate analyses, three-level ACDF cases were not found to have greater 90-day adverse outcomes than two-level cases. Four-level ACDF cases were found to have significantly greater odds ratios of readmission, dysphagia, and prolonged length of stay (relative to one-level cases, OR 1.28, 1.63, and 1.97, respectively) but not other 90-day adverse events. Reoperation rates at five years for one-, two-, three-, and four-level cases were 13.0%, 13.5%, 15.0%, and 22.1%, respectively (log-rank p<.001). CONCLUSIONS The current study represents one of the largest comparative studies of patients undergoing one-, two-, three-, and four-level ACDF. While odds of 90-day adverse events were not greater for three- versus two-level cases, four-level cases had several that were higher odds than one-level cases. Reoperation and dysphagia rates were higher for four-level cases than lesser levels. While these outcomes were found to be acceptable, they should help guide hospital planning and patient counseling.
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Affiliation(s)
- Peter Y Joo
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, 47 College St, New Haven, CT 06510, USA
| | - Justin R Zhu
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, 47 College St, New Haven, CT 06510, USA
| | - Alexander J Kammien
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, 47 College St, New Haven, CT 06510, USA
| | - Michael J Gouzoulis
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, 47 College St, New Haven, CT 06510, USA
| | | | - Jonathan N Grauer
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, 47 College St, New Haven, CT 06510, USA.
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19
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Clinical outcomes and revision rates following four-level anterior cervical discectomy and fusion. Sci Rep 2022; 12:5339. [PMID: 35351960 PMCID: PMC8964822 DOI: 10.1038/s41598-022-09389-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/09/2022] [Indexed: 12/27/2022] Open
Abstract
Studies on outcomes after four-level anterior cervical discectomy and fusion (ACDF) are limited in the literature. The purpose of this study was to report on clinical outcomes and revision rates following four-level ACDF. Patients operated with four-level ACDF were identified in a prospectively accrued single institution database. Outcome scores included the Neck Disability Index (NDI) and Visual Analogue Scale (VAS) for neck and arm pain. Reoperation rates were determined. Any complications were identified from a review of the medical records. Twenty-eight patients with a minimum of 12 months follow up were included in the analysis. The mean age at surgery was 58.5 years. The median radiographic follow up time was 23 (IQR = 16–31.25) months. Cervical lordosis was significantly improved postoperatively (− 1 to − 13, p < 0.001). At the median 24 (IQR = 17.75–39.50) months clinical follow up time, there was a significant improvement in the NDI (38 to 28, p = 0.046) and VAS for neck pain scores (5.1 to 3, p = 0.012). The most common perioperative complication was transient dysphagia (32%) followed by hoarseness (14%). Four (14%) patients required revision surgery at a median 11.5 (IQR = 2–51) months postoperatively. The results of this study indicate that patients who undergo four-level ACDF have a significant improvement in clinical outcomes at median 24 months follow up. Stand-alone four-level ACDF is a valid option for the management of complex cervical degenerative conditions.
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20
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Luo CA, Lim AS, Lu ML, Chiu PY, Lai PL, Niu CC. The surgical outcome of multilevel anterior cervical discectomy and fusion in myelopathic elderly and younger patients. Sci Rep 2022; 12:4495. [PMID: 35296700 PMCID: PMC8927471 DOI: 10.1038/s41598-022-08243-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 02/28/2022] [Indexed: 11/09/2022] Open
Abstract
The elderly population has an increased risk of degenerative cervical myelopathy due to multilevel disease, causing motor and sensory dysfunctions and a poor quality of life. Multilevel anterior cervical discectomy and fusion (ACDF) is an alternative surgical treatment option, but has a perceived higher risk of complications. The goal of this study is to report the outcome. We retrospectively reviewed patients from 2006 to 2019 undergoing multilevel ACDF for degenerative cervical myelopathy and compared outcomes and complications between elder patients (aged 70 and above) and younger patients (below 70). The patients' comorbidities, and postoperative complications, radiographic parameters such as C2-C7 Cobb angle, C2-C7 sagittal vertical axis, inter-body height of surgical levels and fusion rate were recorded. Japanese Orthopaedic Association (JOA) score and modified Odom's score were collected. Included were 18 elderly (mean age 74, range 70-87) and 45 young patients (mean age 56, range 43-65) with a follow-up of 43.8 and 55.5 months respectively. Three-level ACDF was the most common. The ratios of ASA class III patients were 94.4% and 48.9% (p < 0.001). The Charlson comorbidity indexes were 4.3 ± 1.03 and 2.1 ± 1.11 (p < 0.001). The average lengths of hospital stays were 4.9 and 4.6 days. Eleven patients (61.1%) in the elderly group experienced at least one short-term complication, compared with 16 patients (35.6%) in the younger group (p < 0.05). The middle-term complications were comparable (22.2% and 20.0%). The JOA score, recovery rate and modified Odom score showed comparable result between groups. Despite its extensiveness, multilevel ACDF is feasible for the elder patients with good clinical outcome and fusion rate. When compared to younger cohort, there is a trend of lower preoperative JOA score and recovery rate. The short-term complication rate is higher in the elderly group.
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Affiliation(s)
- Chi-An Luo
- Department of Orthopaedic Surgery, Spine Division, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, ROC.,Department of Orthopaedic Surgery, New Taipei Municipal Tucheng Hospital (Built and Operated By Chang Gung Medical Foundation), No. 6, Sec. 2, Jincheng Rd., Tucheng Dist., New Taipei City, 236, Taiwan, ROC.,Chang Gung University College of Medicine, No.259, Wenhua 1st Rd, Guishan Dist., Taoyuan City, 333, Taiwan, ROC
| | - Austin Samuel Lim
- Department of Surgery, Section of Orthopedics, Orthopedic and Spine Surgery, Metropolitan Medical Center, No.1357, Masangkay St, Santa Cruz, 1012, Manila, Metro Manila, Philippines.,Department of Surgery, Section of Orthopedics, Orthopedic and Spine Surgery, Chinese General Hospital, No.286, Blumentritt Rd, Sampaloc, Manila, Metro Manila, Philippines
| | - Meng-Ling Lu
- Department of Orthopaedic Surgery, Spine Division, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, 833, Taiwan, ROC
| | - Ping-Yeh Chiu
- Department of Orthopaedic Surgery, Spine Division, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, ROC.,Chang Gung University College of Medicine, No.259, Wenhua 1st Rd, Guishan Dist., Taoyuan City, 333, Taiwan, ROC
| | - Po-Liang Lai
- Department of Orthopaedic Surgery, Spine Division, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, ROC.,Chang Gung University College of Medicine, No.259, Wenhua 1st Rd, Guishan Dist., Taoyuan City, 333, Taiwan, ROC
| | - Chi-Chien Niu
- Department of Orthopaedic Surgery, Spine Division, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, ROC. .,Chang Gung University College of Medicine, No.259, Wenhua 1st Rd, Guishan Dist., Taoyuan City, 333, Taiwan, ROC.
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21
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Donnally CJ, Patel PD, Canseco JA, Vaccaro AR, Kepler CK. Current Management of Cervical Spondylotic Myelopathy. Clin Spine Surg 2022; 35:E68-E76. [PMID: 34379614 DOI: 10.1097/bsd.0000000000001113] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022]
Abstract
Cervical spondylotic myelopathy (CSM) develops insidiously as degenerative changes of the cervical spine impact the spinal cord. Unfortunately, CSM is a form of spinal cord injury in older patients that often experiences delayed treatment. This summary evaluates the pathophysiology, natural history, diagnosis, and current management of CSM. Frequently, patients do not appreciate or correlate their symptomatology with cervical spine disease, and those with radiographic findings may be clinically asymptomatic. Providers should remember the classic symptoms of CSM-poor hand dexterity, new unsteady gait patterns, new onset and progressive difficulty with motor skills. An magnetic resonance imaging is required in patients with suspected CSM, but computerized tomography myelography is an alternative in patients with implants as contraindications to magnetic resonance imaging. The management of those with CSM has continued to be a controversial topic. In general, patients with incidental findings of cervical cord compression that are asymptomatic can be managed conservatively. Those with daily moderate-severe disease that significantly affects activities of daily living should be treated operatively.
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Affiliation(s)
| | - Parthik D Patel
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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22
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Ramos MRD, Mendoza CJP, Yumol JV, Joson RS, Ver MLP, Ver MR. Multilevel, Percutaneous Posterior Cervical Interfacet Distraction and Fusion for Cervical Spondylotic Radiculopathy: Clinical and Radiographic Outcomes. Spine (Phila Pa 1976) 2021; 46:E1146-E1154. [PMID: 34033597 DOI: 10.1097/brs.0000000000004129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of patients who underwent multilevel posterior cervical interfacet distraction and fusion (PCIDF) using cages for cervical spondylotic radiculopathy (CSR). OBJECTIVE To determine clinical and radiographic outcomes following multilevel PCIDF. SUMMARY OF BACKGROUND DATA Anterior cervical discectomy and fusion has long been the standard of treatment for CSR. Advancements in surgery have employed minimally invasive techniques such as endoscopic discectomy, foraminotomy, and PCIDF. Studies on single-level PCIDF have reported good clinical outcomes, short hospital stays, and rare complications, but its application in multilevel disease is still evolving. METHODS Patients with CSR and confirmed radiologic evidence of multilevel foraminal stenosis without central canal stenosis were reviewed. Two-year outcomes of multilevel PCIDF included Neck Disability Index, neck and arm Visual Analogue Scale (VAS), radiographic cervical alignment parameters, evidence of fusion, and incidence of adjacent segment degeneration were compared at different time points. RESULTS Thirty patients (mean age 54.6 ± 8.3) were included in the study with an average of 3.4 ± 0.8 levels treated. Mean surgical duration and intraoperative blood loss was 143.2 ± 69.7 minutes and 27.7 ± 28.7 mL, respectively, with an average length of stay at 1.8 ± 1.5 days. Neck Disability Index, VAS-neck, and VAS-arm all significantly improved at 2 weeks (P < 0.001) and was maintained until 2 years postoperatively. A significant decrease in segmental and C2-C7 lordosis, with a corresponding increase in sagittal vertical axis, was observed at 3 months postoperatively (P < 0.001) but did not deteriorate further on subsequent visits. Successful fusion was achieved in 90% of patients after 2 years. There was a 13.3% incidence of adjacent segment degeneration in the study cohort and one perioperative complication (3.3%). CONCLUSION Our study suggests that multilevel PCIDF is safe and effective for CSR caused by foraminal stenosis. However, its potential to cause kyphosis and clinical impact on global sagittal alignment requires further scrutiny and long-term evaluation.Level of Evidence: 4.
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Affiliation(s)
| | | | | | | | - Mikhail Lew Perez Ver
- Institute of Orthopaedics and Sports Medicine, St. Luke's Medical Center, Quezon City, Philippines
| | - Mario Ratio Ver
- Institute of Orthopaedics and Sports Medicine, St. Luke's Medical Center, Quezon City, Philippines
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23
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Menon N, Turcotte J, Patton C. Structural Allograft Versus Synthetic Interbody Cage for Anterior Cervical Discectomy and Fusion: A Comparison of 1-Year Outcomes From a National Database. Global Spine J 2021; 11:1215-1222. [PMID: 32748651 PMCID: PMC8453680 DOI: 10.1177/2192568220942217] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Observational cohort study. OBJECTIVE To compare 1-year perioperative complications between structural allograft (SA) and synthetic cage (SC) for anterior cervical discectomy and fusion (ACDF) using a national database. METHODS The TriNetX Research Network was retrospectively queried. Patients undergoing initial single or multilevel ACDF surgery between October 1, 2015 and April 30, 2019 were propensity score matched based on age and comorbidities. The rates of 1-year revision ACDF surgery and reported diagnoses of pseudoarthrosis, surgical site infection (SSI), and dysphagia were compared between structural allograft and synthetic cage techniques. RESULTS A comparison of 1-year outcomes between propensity score matched cohorts was conducted on 3056 patients undergoing single-level ACDF and 3510 patients undergoing multilevel ACDF. In single-level ACDF patients, there was no difference in 1-year revision ACDF surgery (P = .573), reported diagnoses of pseudoarthrosis (P = .413), SSI (P = .620), or dysphagia (P = .529) between SA and SC groups. In multilevel ACDF patients, there was a higher rate of revision surgery (SA 3.8% vs SC 7.3%, odds ratio = 1.982, P < .001) in the SC group, and a higher rate of dysphagia in the SA group (SA 15.9% vs SC 12.9%). CONCLUSION While the overall revision and complication rate for single-level ACDF remains low despite interbody graft selection, SC implant selection may result in higher rates of revision surgery in multilevel procedures despite yielding lower rates of dysphagia. Further prospective study is warranted.
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Affiliation(s)
- Nandakumar Menon
- Anne Arundel Medical Center, Annapolis, MD, USA,Nandakumar Menon, AAMC Orthopedics, Anne Arundel Medical Center, 2000 Medical Parkway, Suite 101, Annapolis, MD 21401, USA.
| | | | - Chad Patton
- Anne Arundel Medical Center, Annapolis, MD, USA
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24
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Gomez G, Westerlund LE. Clinical and radiographic outcomes using third-generation bioactive glass as a bone graft substitute for multi-level anterior cervical discectomy and fusion-a retrospective case series study. JOURNAL OF SPINE SURGERY 2021; 7:124-131. [PMID: 34296024 DOI: 10.21037/jss-20-645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/28/2021] [Indexed: 11/06/2022]
Abstract
Background Bioactive glasses have unique bone forming properties that have been used as a bone graft substitute for anterior cervical discectomy and fusions (ACDFs). Bone graft substitutes are used for achieving fusion while simultaneously avoiding donor site morbidity of iliac crest autograft. In this study, our principal intention is to assess the clinical and radiographic outcomes in patients with multi-level cervical disc disease undergoing ACDF using a third-generation bioactive glass as a bone graft substitute. Methods A retrospective case series study was performed of patients who underwent primary multi-level instrumented fusions for degenerative cervical disc disease with bioactive glass bone graft substitute between May 2016 and December 2017 by a single fellowship-trained spine surgeon. All patients were treated with a porous PEEK interbody spacer and with a third-generation bioactive glass synthetic bone graft substitute. Patients were assessed pre-operatively, immediately following surgery, and at 3, 6, 12, and 24 months. Accepted standard outcome measures were applied to evaluate preoperative and postoperative metrics, including Visual Analog Scale neck pain and arm pain, and Neck Disability Index. Dynamic lateral radiographs were used to assess sagittal alignment, disc space height, arthrodesis status, osseous integration, and implant migration. Sagittal plane angulation was measured by Cobb's criteria. Results Thirty-nine patients underwent multi-level instrumented fusions: seventeen (43%) were two-level; 12 (31%) were three-level; 9 (23%) were four-level; and 1 (3%) was five-levels. All patients were followed for a minimum of 6 months for mean of 16.0 months (range, 6 to 36 months); none were lost to follow-up. Significant improvements from preoperative scores in Neck Disability Index scores as well as neck and arm visual analog scale pain scores were realized. All patients either maintained or improved their neurological status. Radiographically, all patients were fused by 6 months postoperatively and showed improvement in fusion segment lordosis (Pre-Post and Pre-Final P<0.001), C2-C7 lordosis angle (Pre-Post and Pre-Final P<0.001), T1 slope (Pre-Post P=0.01, Pre-Final P=0.07) and maintenance of disc height (Post-Final P=0.02). There were no adverse events, infections, or reoperations. Conclusions Third-generation bioactive glass synthetic graft is a viable alternative to allograft or autograft in the setting of multi-level instrumented fusions for achieving improved clinical and radiographic outcomes.
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Affiliation(s)
- Gilberto Gomez
- Hughston Spine at the Hughston Clinic, Columbus, Georgia, USA.,Hughston Spine Outcomes Lab, Hughston Spine at The Hughston Clinic, Columbus, Georgia, USA
| | - L Erik Westerlund
- Hughston Spine at the Hughston Clinic, Columbus, Georgia, USA.,Hughston Spine Outcomes Lab, Hughston Spine at The Hughston Clinic, Columbus, Georgia, USA
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25
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Farber SH, Mauler DJ, Sagar S, Pacult MA, Walker CT, Bohl MA, Snyder LA, Chapple KM, Sonntag VKH, Uribe JS, Turner JD, Chang SW, Kakarla UK. Perioperative and swallowing outcomes in patients undergoing 4- and 5-level anterior cervical discectomy and fusion. J Neurosurg Spine 2021:1-8. [PMID: 33799303 DOI: 10.3171/2020.10.spine201307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/01/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anterior cervical discectomy and fusion (ACDF) is a common and robust procedure performed on the cervical spine. Literature on ACDF for 4 or more segments is sparse. Increasing the number of operative levels increases surgical complexity, tissue retraction, and risks of complications, particularly dysphagia. The overall risks of these complications and rates of dysphagia are not well studied for surgery on 4 or more segments. In this study, the authors evaluated their institution's perioperative experience with 4- and 5-level ACDFs. METHODS The authors retrospectively reviewed patients who underwent 4- or 5-level ACDF at their institution over a 6-year period (May 2013-May 2019). Patient demographics, perioperative complications, readmission rates, and swallowing outcomes were recorded. Outcomes were analyzed with a multivariate linear regression. RESULTS A total of 174 patients were included (167 had 4-level and 7 had 5-level ACDFs). The average age was 60.6 years, and 54.0% of patients (n = 94) were men. A corpectomy was performed in 12.6% of patients (n = 22). After surgery, 56.9% of patients (n = 99) experienced dysphagia. The percentage of patients with dysphagia decreased to 22.8% (37/162) at 30 days, 12.9% (17/132) at 90 days, and 6.3% (5/79) and 2.8% (1/36) at 1 and 2 years, respectively. Dysphagia was more likely at 90 days postoperatively in patients with gastroesophageal reflux (OR 4.4 [95% CI 1.5-12.8], p = 0.008), and the mean (± SD) lordosis change was greater in patients with dysphagia than those without at 90 days (19.8° ± 13.3° vs 9.1° ± 10.2°, p = 0.003). Dysphagia occurrence did not differ with operative implants, including graft and interbody type. The mean length of time to solid food intake was 2.4 ± 2.1 days. Patients treated with dexamethasone were more likely to achieve solid food intake prior to discharge (OR 4.0 [95% CI 1.5-10.6], p = 0.004). Postsurgery, 5.2% of patients (n = 9) required a feeding tube due to severe approach-related dysphagia. Other perioperative complication rates were uniformly low. Overall, 8.6% of patients (n = 15) returned to the emergency department within 30 days and 2.9% (n = 5) required readmission, whereas 1.1% (n = 2) required unplanned return to surgery within 30 days. CONCLUSIONS This is the largest series of patients undergoing 4- and 5-level ACDFs reported to date. This procedure was performed safely with minimal intraoperative complications. More than half of the patients experienced in-hospital dysphagia, which increased their overall length of stay, but dysphagia decreased over time.
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26
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Davies BM, Francis JJ, Butler MB, Mowforth O, Goacher E, Starkey M, Kolias A, Wynne-Jones G, Hutton M, Selvanathan S, Thomson S, Laing RJC, Hutchinson PJ, Kotter MRN. Current surgical practice for multi-level degenerative cervical myelopathy: Findings from an international survey of spinal surgeons. J Clin Neurosci 2021; 87:84-88. [PMID: 33863541 DOI: 10.1016/j.jocn.2021.01.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 12/23/2020] [Accepted: 01/29/2021] [Indexed: 12/15/2022]
Abstract
Degenerative cervical myelopathy (DCM) results from compression of the cervical spine cord as a result of age related changes in the cervical spine, and affects up to 2% of adults, leading to progressive disability. Surgical decompression is the mainstay of treatment, but there remains significant variation in surgical approaches used. This survey was conducted in order to define current practice amongst spine surgeons worldwide, as a possible prelude to further studies comparing surgical approaches. METHODS An electronic survey was developed and piloted by the investigators using SurveyMonkey. Collected data was categorical and is presented using summary statistics. Where applicable, statistical comparisons were made using a Chi-Squared test. The level of significance for all statistical analyses was defined as p < 0.05. All analysis, including graphs was performed using R (R Studio). RESULTS 127 surgeons, from 30 countries completed the survey; principally UK (66, 52%) and North America (15, 12%). Respondents were predominantly Neurosurgeons by training (108, 85%) of whom 84 (75%) reported Spinal Surgery as the principal part of their practice. The majority indicated they selected their surgical procedure for multi-level DCM on a case by case basis (62, 49%). Overall, a posterior approach was more popular for multi-level DCM (74, 58%). Region, speciality or annual multi-level case load did not influence this significantly. However, there was a trend for North American surgeons to be more likely to favour a posterior approach. CONCLUSIONS A posterior approach was favoured and more commonly used to treat multi-level DCM, in an international cohort of surgeons. Posterior techniques including laminectomy, laminectomy and fusion or laminoplasty appeared to be equally popular.
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Affiliation(s)
- Benjamin M Davies
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom.
| | - Jibin J Francis
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Max B Butler
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Oliver Mowforth
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Edward Goacher
- Department of Musculoskeletal, Spinal Unit, Royal Victoria Infirmary, Newcastle, United Kingdom
| | - Michelle Starkey
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Angelos Kolias
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Guy Wynne-Jones
- Department of Musculoskeletal, Spinal Unit, Royal Victoria Infirmary, Newcastle, United Kingdom
| | - Mike Hutton
- Royal Devon and Exeter Hospital, United Kingdom
| | | | | | - Rodney J C Laing
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Peter J Hutchinson
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Mark R N Kotter
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom; Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom
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Revision surgery of an older patient with adjacent segment disease (ASD) following anterior cervical discectomy and fusion by PCB: A case report. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Marrache M, Bronheim R, Harris AB, Puvanesarajah V, Raad M, Lee S, Skolasky R, Jain A. Synthetic Cages Associated With Increased Rates of Revision Surgery and Higher Costs Compared to Allograft in ACDF in the Nonelderly Patient. Neurospine 2020; 17:896-901. [PMID: 33401868 PMCID: PMC7788413 DOI: 10.14245/ns.2040216.108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/20/2020] [Indexed: 11/19/2022] Open
Abstract
Objective The aim of this study was to compare all-cause reoperation rates and costs in nonelderly patients treated with anterior cervical discectomy and fusion (ACDF) with structural allograft versus synthetic cages for degenerative pathology.
Methods We queried a private claims database to identify adult patients (≤ 65 years) who underwent single-level ACDF in a hospital setting using either structural allograft or a synthetic cage (polyetheretherketone, metal, or hybrid device), from 2010 to 2016. The rate of all-cause reoperations at 2 years were compared between the 2 groups. Index hospitalization costs and 90-day complication rates were also compared. Significance was set at p < 0.05.
Results A total of 26,754 patients were included in the study. 11,514 patients (43%) underwent ACDF with structural allograft and 15,240 (57%) underwent ACDF with a synthetic cage. The patients in the allograft group were younger and more likely to be male. There was no significant difference between the 2 groups with respect to 90-day complications including: wound dehiscence, dysphagia, dysphonia, and hematoma/seroma. In the 2-year postoperative period, the synthetic cage group had a significantly higher rate of allcause reoperation compared to the allograft group (9.1% vs. 8.0%, p = 0.002). Index hospitalization costs were significantly higher in the synthetic cage group compared to those in the allograft group ($23,475 vs. $20,836, p < 0.001).
Conclusion Structural allograft is associated with lower all-cause reoperation rates and lower index costs in nonelderly patients undergoing ACDF surgery for degenerative pathology. It is important to understand this data as we transition toward value-based care.
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Affiliation(s)
- Majd Marrache
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachel Bronheim
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew B Harris
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Micheal Raad
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sang Lee
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard Skolasky
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amit Jain
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Lee NJ, Vulapalli M, Park P, Kim JS, Boddapati V, Mathew J, Amorosa LF, Sardar ZM, Lehman RA, Riew KD. Does screw length for primary two-level ACDF influence pseudarthrosis risk? Spine J 2020; 20:1752-1760. [PMID: 32673728 DOI: 10.1016/j.spinee.2020.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/28/2020] [Accepted: 07/08/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Pseudarthrosis remains a major complication for patients undergoing anterior cervical discectomy and fusion (ACDF; 0%-15% at 1-year follow-up). Potentially modifiable risk factors are known in literature, such as smoking and osteoporosis. Biomechanical studies suggest that plates with locking screws can enhance the fixation rigidity and pull-out strength. Although longer screws are known to be correlated with increased pull-out strength, deeper screw depths can increase the risk for intraoperative complications. An important factor that has yet to be studied is the minimum screw length relative to the diameter of the vertebral body (VB) necessary to achieve successful fusion. In this study, we hypothesize that screws with shorter depths relative to the VB will increase the risk for radiographic pseudarthrosis and result in poor patient reported outcomes (PROs). PURPOSE To examine the impact of ACDF screw length on pseudarthrosis risk. STUDY DESIGN A review of prospectively collected data. PATIENT SAMPLE A total of 85 patients were included in this study. The mean age ±standard deviation was 58.9±10.3 and 42.4% of patients were female. The mean follow-up was 21.6±8.3 months. OUTCOME MEASURES The neck disability index (NDI) was used to assess PROs up to 2-years after surgery. For each ACDF level, the screw length and VB% (screw length divided by the anterior-posterior VB diameter) were measured. Radiographic pseudarthrosis (interspinous motion [ISM] ≥1 mm) was recorded at 6-weeks, 6-months, and 1-year for each patient. The positive and negative predictive values (PPV, NPV) for ISM ≥ 1mm were measured for different VB% thresholds. A VB% of <75% was found to have the highest PPV (93%) and NPV (70%) for radiographic pseudarthrosis. This threshold of <75% was then assessed in our bivariate and multivariate analyses. METHODS We reviewed a database (2015-2018) of adult (≥18 years old) patients who underwent a primary two-level ACDF with or without corpectomy. All ACDF constructs involved fixed angle screws. The minimum follow-up period was 1 year. Multivariate analyses were performed to determine if screw VB% was an independent risk factor for radiographic pseudarthrosis. RESULTS By 1-year, overall fusion success was achieved in 92.9% of patients. The 1-year revision rate was 4.7%. Patients with any screw VB% <75% had substantially worse fusion success (64.3%) than those who did not (98.6%) at 1-year. The VB% <75% increased the risk for radiographic pseudarthrosis at every follow up period. In comparison to other time-points, patients with radiographic pseudarthrosis at 6 weeks had significantly worse NDI scores by 2-years (p=.047). The independent risk factors for radiographic pseudarthrosis at 6-weeks included any screw VB% <75% (OR 77, p<.001), prior/current smoker (OR 6.8, p=.024), and corpectomy (OR 0.1, p=.010). Patients with ISM≥1 mm had a higher rate of revision surgery at 1-year (5.9% vs. 3.9%), but this was not statistically significant (p=.656). CONCLUSIONS In primary two-level ACDF, VB% <75% is significantly associated with increased ISM (≥1 mm) at all time points for this study. As an intraoperative guide, spine surgeons can use the screw VB% threshold of <75% to avoid unnecessarily short screws. This threshold can be easily measured pre- and intraoperatively, and has been found to be strongly correlated to radiographic pseudarthrosis in the early postoperative period.
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Affiliation(s)
- Nathan J Lee
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA.
| | - Meghana Vulapalli
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Paul Park
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Jun S Kim
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Venkat Boddapati
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Justin Mathew
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Louis F Amorosa
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Zeeshan M Sardar
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Ronald A Lehman
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - K Daniel Riew
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
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Wang H, Zhou C, Yu Y, Wang C, Tsai TY, Han C, Li G, Cha T. Quantifying the ranges of relative motions of the intervertebral discs and facet joints in the normal cervical spine. J Biomech 2020; 112:110023. [DOI: 10.1016/j.jbiomech.2020.110023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/01/2020] [Accepted: 08/26/2020] [Indexed: 12/23/2022]
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Gornet MF, Schranck FW, Sorensen KM, Copay AG. Multilevel Cervical Disc Arthroplasty: Long-Term Outcomes at 3 and 4 Levels. Int J Spine Surg 2020; 14:S41-S49. [PMID: 32994305 DOI: 10.14444/7090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Multilevel cervical degenerative disc disease in 2 or more segments poses treatment challenges. Anterior cervical discectomy and fusion is a viable treatment option, but one with high rates of adjacent segment disease and pseudoarthrosis. Cervical disc arthroplasty (CDA) is approved by the US Food and Drug Administration for the treatment of 1- and 2-level cervical pathology, with established long-term safety and effectiveness. Limited evidence exists for CDA at more than 2 levels. This study investigates the long-term outcomes of 3- and 4-level CDA out to 7 years. METHODS In a retrospective review of prospectively collected data, patient demographics and surgical characteristics were collected. Patient-reported outcomes (PROs) were collected preoperatively and at 6 weeks, 3 months, 6 months, and 12 months postoperatively, and annually thereafter, including: Neck Disability Index (NDI), numeric rating scales for neck pain and arm pain, the Veterans Rand 12-item Health Survey physical component summary (PCS) score and mental component summary (MCS) score, and patient satisfaction scores. Secondary surgery data were also collected. Predictive methods using mixed-effects regression models were used to analyze the data. RESULTS Data for 139 CDAs were available for evaluation (n = 116 three-level and n = 23 four-level). Statistical improvement was shown for all PRO scores at all postoperative intervals (P < .001). From preoperatively to 7 years postoperatively, mean NDI decreased from 57.9 to 31.3 (45.9% improvement), mean neck pain decreased from 15.6 to 7.9 (49.4% improvement), mean arm pain decreased from 12.2 to 5.6 (54.1% improvement), mean PCS increased from 29.2 to 41.4 (41.8% improvement), and mean MCS increased from 37.1 to 44.5 (19.9% improvement). Five (3.6%) 3-level patients underwent secondary surgery. Patient satisfaction exceeded 88% 7 years after surgery. CONCLUSION Statistical improvement in PROs, with a low rate of secondary surgeries out to 7 years, demonstrates that 3- and 4-level CDA may be performed safely and effectively in appropriately selected patients. LEVEL OF EVIDENCE 4.
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Ebot J, Foskey S, Domingo R, Nottmeier E. Kyphosis Correction in Patients Undergoing a Four-Level Anterior Cervical Discectomy and Fusion. Cureus 2020; 12:e8826. [PMID: 32742839 PMCID: PMC7384706 DOI: 10.7759/cureus.8826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction Cervical kyphotic deformity can be quite debilitating. Most patients present with neck pain, but they can also present with radiculopathy, myelopathy, altered vertical gaze, swallowing problems, and even cosmetic issues from the severe kyphotic deformity. After failing conservative management, surgery remains the only option for halting symptom progression. Surgical options for cervical kyphosis have included anterior-only approaches, posterior-only approaches, or 360- and 540-degree reconstructions. This paper addresses the correction of cervical kyphotic deformity via an anterior-only approach consisting of a four-level anterior cervical discectomy and fusion (ACDF). Methods We interrogated our procedure log system and the keyword “anterior cervical discectomy and fusion (ACDF)” was typed into the search bar. All patients with an ACDF for the past five years were reviewed and patients with a four-level ACDF were selected. Chart review was performed and patients presenting with multi-level cervical stenosis with kyphosis were included in the study. Pre- and post-surgery images were reviewed, and the degrees of pre-operative kyphosis and post-operative lordosis were measured. Results Our search produced 20 patients. All the patients had a diagnosis of multi-level cervical stenosis with or without myelopathy and were all symptomatic. Pre-operative kyphosis ranged from 2.3 to 35 (mean 11.5) degrees, and post-operative lordosis ranged from 2 to 38 (mean 16) degrees. All the patients had varying degrees of kyphosis correction post-surgery which ranged from 6 to 44 (mean 27) degrees. Significant improvement or complete resolution of symptoms post-operatively occurred in all patients. Conclusion Four-level ACDF in carefully selected patients can be used to correct cervical alignment in patients presenting with symptomatic multi-level cervical stenosis with kyphosis.
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Affiliation(s)
- James Ebot
- Neurological Surgery, Mayo Clinic, Jacksonville, USA
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Improvements in Grip and Pinch Strength and Patient-reported Outcomes After Anterior Cervical Discectomy and Fusion. Clin Spine Surg 2019; 32:403-408. [PMID: 31567533 DOI: 10.1097/bsd.0000000000000892] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Prospective. OBJECTIVE To evaluate improvements in grip and pinch strength in patients with or without myelopathy and determine patient factors that are predictive of continued postoperative grip strength weakness. SUMMARY OF BACKGROUND DATA The degree to which cervical myelopathy can diminish upper extremity muscle strength has not been objectively characterized. Few studies have investigated the association between the expected improvements in patient-reported outcomes (PROs) and strength in grip and pinch after anterior cervical discectomy and fusion (ACDF). METHODS Patients were asked to perform grip and pinch strength tests both preoperatively and at 6-month follow-up. Patients were also administered PRO surveys, which included Neck Disability Index, Short-Form-12 physical composite score and mental composite score, and Visual Analog Scale neck and arm pain scores. Receiver operating characteristic (ROC) curve analysis was used to determine optimum cutoff values of preoperative patient factors to predict postoperative dominant handgrip weakness after ACDF. RESULTS Patients with radiculopathy demonstrated a significantly greater improvement in Visual Analog Scale arm pain compared with patients with myelopathy. The ROC curve analysis determined the optimum cutoff for preoperative dominant handgrip strength to be 22 kgf. This value demonstrated a sensitivity of 0.89 and a specificity of 0.62. The area under the ROC curve value was 0.71 (95% confidence interval, 0.55-0.88), indicating fair prognostic accuracy of the cutoff for postoperative dominant handgrip weakness. CONCLUSIONS In this prospective, observational study, postoperative increase in grip and pinch strength demonstrated an association with improvement of pain and disability of the neck and overall quality of health regardless of the presence of cervical myelopathy. Preoperative grip strength weakness was found to be predictive of postoperative grip strength deficiency after ACDF. Our investigation suggests the recovery of hand function may be correlated with improvement of PROs after ACDF.
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Huang KT, Silva MA, See AP, Wu KC, Gallerani T, Zaidi HA, Lu Y, Chi JH, Groff MW, Arnaout OM. A computer vision approach to identifying the manufacturer and model of anterior cervical spinal hardware. J Neurosurg Spine 2019; 31:844-850. [PMID: 31491759 DOI: 10.3171/2019.6.spine19463] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/19/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Recent advances in computer vision have revolutionized many aspects of society but have yet to find significant penetrance in neurosurgery. One proposed use for this technology is to aid in the identification of implanted spinal hardware. In revision operations, knowing the manufacturer and model of previously implanted fusion systems upfront can facilitate a faster and safer procedure, but this information is frequently unavailable or incomplete. The authors present one approach for the automated, high-accuracy classification of anterior cervical hardware fusion systems using computer vision. METHODS Patient records were searched for those who underwent anterior-posterior (AP) cervical radiography following anterior cervical discectomy and fusion (ACDF) at the authors' institution over a 10-year period (2008-2018). These images were then cropped and windowed to include just the cervical plating system. Images were then labeled with the appropriate manufacturer and system according to the operative record. A computer vision classifier was then constructed using the bag-of-visual-words technique and KAZE feature detection. Accuracy and validity were tested using an 80%/20% training/testing pseudorandom split over 100 iterations. RESULTS A total of 321 total images were isolated containing 9 different ACDF systems from 5 different companies. The correct system was identified as the top choice in 91.5% ± 3.8% of the cases and one of the top 2 or 3 choices in 97.1% ± 2.0% and 98.4 ± 13% of the cases, respectively. Performance persisted despite the inclusion of variable sizes of hardware (i.e., 1-level, 2-level, and 3-level plates). Stratification by the size of hardware did not improve performance. CONCLUSIONS A computer vision algorithm was trained to classify at least 9 different types of anterior cervical fusion systems using relatively sparse data sets and was demonstrated to perform with high accuracy. This represents one of many potential clinical applications of machine learning and computer vision in neurosurgical practice.
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Milavec H, Kellner C, Ravikumar N, Albers CE, Lerch T, Hoppe S, Deml MC, Bigdon SF, Kumar N, Benneker LM. First Clinical Experience with a Carbon Fibre Reinforced PEEK Composite Plating System for Anterior Cervical Discectomy and Fusion. J Funct Biomater 2019; 10:E29. [PMID: 31269693 PMCID: PMC6787668 DOI: 10.3390/jfb10030029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/13/2019] [Accepted: 06/24/2019] [Indexed: 12/11/2022] Open
Abstract
Carbon fibre reinforced polyether ether ketone (CFR-PEEK) is a suitable material to replace metal implants in orthopaedic surgery. The radiolucency of CFR-PEEK allows an optimal visualisation of the bone and soft tissue structures. We aimed to assess the performance and radiological and clinical outcomes of anterior cervical discectomy and fusion (ACDF) with CFR-PEEK anterior cervical plating (ACP) under first use clinical conditions. We retrospectively studied the prospectively-collected data of 42 patients who underwent ACDF with CFR-PEEK ACP between 2011 and 2016. We assessed clinical outcome (Odom's criteria, complications) and radiological parameters (global and segmental cervical lordosis, Bridwell score for fusion, adjacent segment degeneration) preoperatively, immediately post-operatively, and after a 12-month follow-up period. Patients' satisfaction was excellent, good, fair, and poor in 12, 19, 3, and 1 patients, respectively. Two patients developed dysphagia. No hardware failure occurred. Compared with preoperative radiographs, we observed a gain of global cervical lordosis and segmental lordosis (7.4 ± 10.1 and 5.6 ± 7.1 degrees, respectively) at the 12-month follow-up. Bridwell IF grades I, II, and III were observed in 22, 6, and 7 patients, respectively. The 12-month adjacent segment degeneration-free and adjacent segment disease-free survival rates were 93.1% and 96.3%, respectively. We observed a dysphagia rate of 5.7% and a reoperation rate of 4.8%. In conclusion, CFR-PEEK ACP shows positive outcomes in terms of implant safety, restoration of cervical lordosis, and functional recovery, and is suitable for ACDF.
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Affiliation(s)
- Helena Milavec
- Department of Orthopaedic Surgery, Spine Unit, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
- Department of Orthopaedic Surgery, National University Health System (NUHS)-Tower Block, Level 11, 1E Kent Ridge Road, Singapore 119228, Singapore.
| | - Christoph Kellner
- Department of Orthopaedic Surgery, Spine Unit, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Nivetha Ravikumar
- Department of Orthopaedic Surgery, National University Health System (NUHS)-Tower Block, Level 11, 1E Kent Ridge Road, Singapore 119228, Singapore
| | - Christoph E Albers
- Department of Orthopaedic Surgery, Spine Unit, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Till Lerch
- Department of Orthopaedic Surgery, Spine Unit, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Sven Hoppe
- Department of Orthopaedic Surgery, Spine Unit, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Moritz C Deml
- Department of Orthopaedic Surgery, Spine Unit, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Sebastian F Bigdon
- Department of Orthopaedic Surgery, Spine Unit, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Naresh Kumar
- Department of Orthopaedic Surgery, National University Health System (NUHS)-Tower Block, Level 11, 1E Kent Ridge Road, Singapore 119228, Singapore
| | - Lorin M Benneker
- Department of Orthopaedic Surgery, Spine Unit, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
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