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Nishikawa M, Naito K, Yoshimura M, Yamagata T, Iseda K, Hara M, Ikuno H, Ohata K, Goto T. Application and Advantages of the Trans-Unco-Discal (TUD) Approach for Cervical Spondylotic Myelopathy and Radiculopathy: Classification and Modification of Surgical Technique Based on the Location of Spinal Cord and/or Nerve Root Compression. J Clin Med 2024; 13:2666. [PMID: 38731195 PMCID: PMC11084969 DOI: 10.3390/jcm13092666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/15/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Purpose: We assess the application and advantages of modifying the trans-unco-discal (TUD) approach which we underwent for cervical myelo-radiculopathy. We present the surgical techniques of the modified TUD approach. Materials and Methods: The material was 180 cases where anterior cervical decompression (ACD) was performed by the modified TUD approach. We classified the material into four groups based on the location of the nerve root and/or spinal cord compression: I, compression of the root at intervertebral foramen (IVF); II, compression of the posterior margin of the vertebral body; III, compression of the IVF and posterior margin of the vertebral body; IV, compression of the bilateral IVF and posterior margin of the vertebral body. We applied the modified TUD approach to these four types. We present the surgical procedures and techniques for the modified TUD approach. The Japanese orthopedic association (JOA) score and neuroradiological alignment were examined. Results: The improvement rate of the JOA score was 78.4% at 6 months post-surgery and 77.5% in the most recent examinations. By the modified TUD approach, compressive lesions of the spinal cord and/or nerve roots were removed, and good alignment was acquired and sustained. Conclusions: ACD by the modified TUD approach safely achieved appropriate decompression for the spinal cord and/or nerve roots, and the patients had a high improvement rate and good alignment. Complications were less common than with other surgical procedures. If the TUD approach and endoscopic approaches can be combined, their application to new area is anticipated.
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Affiliation(s)
- Misao Nishikawa
- Department of Neurosurgery, Moriguchi-Ikuno Memorial Hospital, 6-17-33 Satanakamachi, Moriguchi City 570-0002, Osaka, Japan; (T.Y.); (K.I.)
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8595, Osaka, Japan; (K.N.); (T.G.)
| | - Kentaro Naito
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8595, Osaka, Japan; (K.N.); (T.G.)
| | - Masaki Yoshimura
- Department of Neuropathology, Yao Tokusyukai General Hospital, 1-17, Wakakusacho, Yao City 581-0011, Osaka, Japan;
| | - Toru Yamagata
- Department of Neurosurgery, Moriguchi-Ikuno Memorial Hospital, 6-17-33 Satanakamachi, Moriguchi City 570-0002, Osaka, Japan; (T.Y.); (K.I.)
| | - Keiichi Iseda
- Department of Neurosurgery, Moriguchi-Ikuno Memorial Hospital, 6-17-33 Satanakamachi, Moriguchi City 570-0002, Osaka, Japan; (T.Y.); (K.I.)
| | - Mitsuhiro Hara
- Department of Neurology, Moriguchi-Ikuno Memorial Hospital, 6-17-33 Satanakamachi, Moriguchi City 570-0002, Osaka, Japan;
| | - Hiromichi Ikuno
- Department of Neuroradiology, Moriguchi-Ikuno Memorial Hospital, 6-17-33 Satanakamachi, Moriguchi City 570-0002, Osaka, Japan;
| | - Kenji Ohata
- Department of Neurosurgery, Naniwa-Ikuno Hospital, 1-10-3 Daikoku Naniwa-ku, Osaka 556-0014, Osaka, Japan;
| | - Takeo Goto
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8595, Osaka, Japan; (K.N.); (T.G.)
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Luo M, Yang Y, Liu Z, Tan J, Luo J, Long Z, Chen M, Liang C, Xiao Z. Percutaneous versus traditional open approaches for the treatment of thoracolumbar fractures in patients without neurologic deficits: a meta-analysis of 35 cohort studies. Neurosurg Rev 2024; 47:62. [PMID: 38263482 DOI: 10.1007/s10143-023-02259-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/23/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024]
Abstract
At present, percutaneous surgery is widely used to treat thoracolumbar fractures. However, the actual safety, feasibility, and effectiveness of percutaneous surgery are not clear. Through systematic review and meta-analysis, we compared the efficacies of percutaneous pedicle screw fixation and open pedicle screw fixation in the treatment of thoracolumbar fractures without nerve root symptoms. We systematically searched the PubMed, Embase, and Cochrane libraries for articles published on or before June 2023. All results were evaluated by standard methods recommended for meta-analysis, continuous data were expressed by standard mean differences (SMDs), and binary variables were analyzed by odds ratios (ORs) and 95% confidence intervals (95% CIs). We also explored the main sources of heterogeneity and the stability of the results through sensitivity analysis, Begg's funnel plots, and Egger's test. Thirty-five cohort studies with a total of 3039 patients were included. The study found that patients who undergo percutaneous approaches have less intraoperative blood loss (IBL), shorter length of hospital stay (LOS), shorter operation time, and shorter incision. Moreover, percutaneous approaches had more advantages in terms of visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, and infection rates. However, there was no significant difference in anterior vertebral body height (AVB), Cobb angle (CA), or screw errors between the two groups. In the long run, the clinical and surgical results of the percutaneous approach are better than those of the open approach, but the radiological results of both operations do not seem to show an advantage for any specific approach. Because of publication bias and heterogeneity, our findings must be interpreted with caution. However, this paper will provide some support for clinicians to choose suitable surgical methods for the treatment of thoracolumbar fractures.
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Affiliation(s)
- Mingjiang Luo
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421000, Hunan, China
| | - Yuxin Yang
- Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Zhixuan Liu
- Department of Orthopedic Trauma, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Jiayi Tan
- Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Jiahui Luo
- Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Zifan Long
- Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Miaojue Chen
- Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Can Liang
- Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Zhihong Xiao
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421000, Hunan, China.
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Brook I, Sirdar B, Stemer A. Cervical Radiculopathy Presenting as Ischemic Stroke After Carotid Artery Stent Placement. J Med Cases 2023; 14:387-392. [PMID: 38029053 PMCID: PMC10681767 DOI: 10.14740/jmc4162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
Abrupt loss of focal brain function is the main characteristic of the beginning of ischemic stroke. However, individuals with disorders other than stroke can also present with similar features. These conditions include seizure disorders, migraine, central nervous system abscess or tumor, head trauma, subdural hematoma, cerebral venous thrombosis, viral encephalitis, conversion reaction, hypertensive encephalopathy, multiple sclerosis, and spinal cord disorder. An 82-year-old man presented with a sudden onset of numbness in his left forearm in the distribution of C6 and C7 spinal nerves, 2 days after undergoing endarterectomy and stent placement in his right carotid artery because of stenosis. He was diagnosed with hypo-pharyngeal squamous cell carcinoma (T1, L0, M0) 17 years earlier (2006) which was treated with 70 Gy intensity-modulated radiotherapy (IMRT). The patient underwent stent insertion into his left carotid artery 3.5 years earlier because of 80% carotid artery stenosis. He was initially suspected to have an ischemic stroke. However, computed tomography angiography of the head and neck did not show stenosis or occlusion of the major intracranial arteries and no aneurysms were identified. It showed interval stenting of the cervical portion of the right carotid artery and stable appearance of left carotid artery stent. Both carotid artery stents and the vertebral arteries were patent. The cervical spine showed bilateral moderate to severe foramen stenosis in C3-C4 and C5-C6, and moderate to severe stenosis in the right C2-C3 and left C4-C5. His symptoms subsided after performing neck extension exercises. This is the first report of a patient whose cervical radiculopathy symptoms were suspected to be caused by ischemic stroke. The recent angioplasty and stent placement in the right carotid artery made the association more likely and had to be excluded. Clinicians should be aware that cervical radiculopathy could present as ischemic stroke. It is therefore important that disorders that cause symptoms similar to ischemic stroke are also considered in these individuals.
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Affiliation(s)
- Itzhak Brook
- Department of Pediatrics, Georgetown University School of Medicine, and the Neurology Center, Washington DC, USA
| | - Bilaal Sirdar
- Department of Neurology, Georgetown University School of Medicine, and the Neurology Center, Washington DC, USA
| | - Andrew Stemer
- Department of Neurology, Georgetown University School of Medicine, and the Neurology Center, Washington DC, USA
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Simões de Souza NF, Broekema AEH, Soer R, Reneman MF, Groen RJM, van Dijk JMC, Tamási K, Kuijlen JMA. Short-Term Neck Pain After Posterior Foraminotomy Compared with Anterior Discectomy with Fusion for Cervical Foraminal Radiculopathy: A Secondary Analysis of the FACET Randomized Controlled Trial. J Bone Joint Surg Am 2023; 105:667-675. [PMID: 36952440 DOI: 10.2106/jbjs.22.01211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
BACKGROUND Short-term neck pain after posterior cervical foraminotomy (posterior surgery) compared with anterior cervical discectomy with fusion (anterior surgery) treating cervical radiculopathy has only been assessed once, retrospectively, to our knowledge. The aim of this study was to prospectively evaluate the course of neck pain for 6 weeks after both treatments. METHODS This is a secondary analysis of the multicenter Foraminotomy ACDF Cost-Effectiveness Trial (FACET), conducted from January 2016 to May 2020. Of 389 patients who had single-level, 1-sided cervical radiculopathy and were screened for eligibility, 265 were randomly assigned to undergo posterior surgery (n = 132) or anterior surgery (n = 133). The primary outcome of the present analysis was neck pain, assessed weekly for 6 weeks using the visual analog scale (VAS), on a scale of 0 to 100. The secondary outcomes were arm pain, neck disability, work ability, quality of life, treatment satisfaction, motor and sensory changes, and hospital length of stay. Data were analyzed with mixed model analysis in intention-to-treat samples using 2-sided 95% confidence intervals (CIs). RESULTS In the first postoperative week, the mean VAS for neck pain was 56.2 mm (95% CI, 51.7 to 60.8 mm) after posterior surgery and 46.7 mm (95% CI, 42.2 to 51.2 mm) after anterior surgery. The mean between-group difference was 9.5 mm (95% CI, 3.3 to 15.7 mm), which gradually decreased to 2.3 mm (95% CI, -3.6 to 8.1 mm) at postoperative week 6. As of postoperative week 5, there was no significant difference between groups. Responder analyses confirmed this result. Secondary outcomes showed small differences between groups. CONCLUSIONS Insight into the course of neck pain during the first 6 weeks after posterior compared with anterior surgery is provided. Despite initially more neck pain after posterior surgery, patients swiftly improved and, as of postoperative week 5, results similar to those after anterior surgery were observed. Our findings should enable improved patient counseling and enhanced shared decision-making between physicians and patients with cervical radiculopathy, where more neck pain in the first postoperative weeks should be balanced against the benefits of posterior surgery. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Anne E H Broekema
- Department of Neurosurgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Remko Soer
- Department of Anesthesiology, Groningen Pain Center, University Medical Center Groningen, Groningen, the Netherlands
- Research Group Smart Health, Saxion University of Applied Sciences, Enschede, the Netherlands
| | - Michiel F Reneman
- Department of Rehabilitation, University Medical Center Groningen, Groningen, the Netherlands
| | - Rob J M Groen
- Department of Neurosurgery, University Medical Center Groningen, Groningen, the Netherlands
| | - J Marc C van Dijk
- Department of Neurosurgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Katalin Tamási
- Department of Neurosurgery, University Medical Center Groningen, Groningen, the Netherlands
- Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Jos M A Kuijlen
- Department of Neurosurgery, University Medical Center Groningen, Groningen, the Netherlands
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Oshina M, Kawamura N, Hara N, Higashikawa A, Ono T, Takeshita Y, Azuma S, Fukushima M, Iwai H, Kaneko T, Inanami H, Oshima Y. A Propensity Score-matched Analysis of Clinical Outcomes Between Single-level and Multilevel Intervertebral Decompression for Cervical Radiculopathy. Spine (Phila Pa 1976) 2023; 48:247-252. [PMID: 36255352 PMCID: PMC9855740 DOI: 10.1097/brs.0000000000004508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 01/25/2023]
Abstract
STUDY DESIGN Retrospective multicenter study with propensity score matching. OBJECTIVE To compare the clinical outcomes of single-level and multilevel intervertebral decompression for cervical degenerative radiculopathy. SUMMARY OF BACKGROUND DATA In patients with cervical radiculopathy, physical examination findings are sometimes inconsistent with imaging data. Multilevel decompression may be necessary for multiple foraminal stenosis. Additional decompression is more invasive yet expected to comprehensively decompress all suspected nerve root compression areas. However, the surgical outcomes of this approach compared with that of single-level decompression remain unknown. MATERIALS AND METHODS The data of patients with spinal surgery for pure cervical radiculopathy were collected. Patients were categorized into the single-level (SLDG) or multilevel (MLDG) intervertebral decompression group at C3/C4/C5/C6/C7/T1. Demographic data and patient-reported outcome scores, including the Neck Disability Index (NDI) and Numerical Rating Scale (NRS) scores for pain and numbness in the neck, upper back, and arms, were collected. The NDI improvement rates and changes in NRS scores were analyzed one year postoperatively at patient-reported outcome evaluation. Propensity score matching was performed to compare both groups after adjusting for baseline characteristics, including the preoperative NDI and NRS scores. RESULTS Among the 357 patients in this study, SLDG and MLDG comprised 231 and 126 patients, respectively. Two groups (n=112, each) were created by propensity score matching. Compared with the MLDG, the SLDG had a higher postoperative NDI improvement rate ( P =0.029) and lower postoperative arm numbness NRS score ( P =0.037). Other outcomes tended to be more favorable in the SLDG than in the MLDG, yet no statistical significance was detected. CONCLUSIONS In patients with cervical radiculopathy, the surgical outcomes of the SLDG showed better improvement in clinical outcomes than those of the MLDG. Numbness remained on the distal (arms) rather than the central (neck and upper back) areas in patients receiving multilevel decompression.
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Affiliation(s)
- Masahito Oshina
- Department of Orthopedic Surgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Naohiro Kawamura
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Nobuhiro Hara
- Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Akiro Higashikawa
- Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, Kanagawa, Japan
| | - Takashi Ono
- Department of Spinal Surgery, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Yujiro Takeshita
- Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Yokohama Rosai Hospital, Kanagawa, Japan
| | - Seiichi Azuma
- Department of Orthopedic Surgery, Saitama Red Cross Hospital, Saitama, Japan
| | | | - Hiroki Iwai
- Iwai Orthopedic Medical Hospital, Tokyo, Japan
| | | | | | - Yasushi Oshima
- Department of Orthopaedic Surgery, the University of Tokyo, Tokyo, Japan
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Broekema AEH, Simões de Souza NF, Soer R, Koopmans J, van Santbrink H, Arts MP, Burhani B, Bartels RHMA, van der Gaag NA, Verhagen MHP, Tamási K, van Dijk JMC, Reneman MF, Groen RJM, Kuijlen JMA. Noninferiority of Posterior Cervical Foraminotomy vs Anterior Cervical Discectomy With Fusion for Procedural Success and Reduction in Arm Pain Among Patients With Cervical Radiculopathy at 1 Year: The FACET Randomized Clinical Trial. JAMA Neurol 2023; 80:40-48. [PMID: 36409485 PMCID: PMC9679957 DOI: 10.1001/jamaneurol.2022.4208] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/18/2022] [Indexed: 11/23/2022]
Abstract
Importance The choice between posterior cervical foraminotomy (posterior surgery) and anterior cervical discectomy with fusion (anterior surgery) for cervical foraminal radiculopathy remains controversial. Objective To investigate the noninferiority of posterior vs anterior surgery in patients with cervical foraminal radiculopathy with regard to clinical outcomes after 1 year. Design, Setting, and Participants This multicenter investigator-blinded noninferiority randomized clinical trial was conducted from January 2016 to May 2020 with a total follow-up of 2 years. Patients were included from 9 hospitals in the Netherlands. Of 389 adult patients with 1-sided single-level cervical foraminal radiculopathy screened for eligibility, 124 declined to participate or did not meet eligibility criteria. Patients with pure axial neck pain without radicular pain were not eligible. Of 265 patients randomized (132 to posterior and 133 to anterior), 15 were lost to follow-up and 228 were included in the 1-year analysis (110 in posterior and 118 in anterior). Interventions Patients were randomly assigned 1:1 to posterior foraminotomy or anterior cervical discectomy with fusion. Main Outcomes and Measures Primary outcomes were proportion of success using Odom criteria and decrease in arm pain using a visual analogue scale from 0 to 100 with a noninferiority margin of 10% (assuming advantages with posterior surgery over anterior surgery that would justify a tolerable loss of efficacy of 10%). Secondary outcomes were neck pain, disability, quality of life, work status, treatment satisfaction, reoperations, and complications. Analyses were performed with 2-proportion z tests at 1-sided .05 significance levels with Bonferroni corrections. Results Among 265 included patients, the mean (SD) age was 51.2 (8.3) years; 133 patients (50%) were female and 132 (50%) were male. Patients were randomly assigned to posterior (132) or anterior (133) surgery. The proportion of success was 0.88 (86 of 98) in the posterior surgery group and 0.76 (81 of 106) in the anterior surgery group (difference, -0.11 percentage points; 1-sided 95% CI, -0.01) and the between-group difference in arm pain was -2.8 (1-sided 95% CI, -9.4) at 1-year follow-up, indicating noninferiority of posterior surgery. Decrease in arm pain had a between-group difference of 3.4 (1-sided 95% CI, 11.8), crossing the noninferiority margin with 1.8 points. All secondary outcomes had 2-sided 95% CIs clustered around 0 with small between-group differences. Conclusions and Relevance In this randomized clinical trial, posterior surgery was noninferior to anterior surgery for patients with cervical radiculopathy regarding success rate and arm pain at 1 year. Decrease in arm pain and secondary outcomes had small between-group differences. These results may be used to enhance shared decision-making. Trial Registration Netherlands Trial Register Identifier: NTR5536.
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Affiliation(s)
- Anne E. H. Broekema
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Nádia F. Simões de Souza
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Remko Soer
- Department of Anesthesiology, Groningen Pain Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Research Group Smart Health, Saxion University of Applied Sciences, Enschede, the Netherlands
| | - Jan Koopmans
- Department of Neurosurgery, Martini Hospital Groningen, Groningen, the Netherlands
| | - Henk van Santbrink
- Care and Public Health Research Institute School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
- Department of Neurosurgery, Zuyderland Medical Center, Heerlen, the Netherlands
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Mark P. Arts
- Department of Neurosurgery, Medical Center Haaglanden, the Hague, the Netherlands
| | - Bachtiar Burhani
- Department of Neurosurgery, Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
| | - Ronald H. M. A. Bartels
- Department of Neurosurgery, Radboud University Medical Center Nijmegen and Canisius Wilhelmina Hospital Nijmegen, Nijmegen, the Netherlands
| | - Niels A. van der Gaag
- Department of Neurosurgery, Haaglanden Medical Center, the Hague, the Netherlands
- Department of Neurosurgery Haga Teaching Hospital, the Hague, the Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Katalin Tamási
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J. Marc C. van Dijk
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Michiel F. Reneman
- Department of Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rob J. M. Groen
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jos M. A. Kuijlen
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Sun B, Xu C, Qi M, Shen X, Zhang K, Yuan W, Liu Y. Predictive Effect of Intervertebral Foramen Width on Pain Relief After ACDF for the Treatment of Cervical Radiculopathy. Global Spine J 2023; 13:133-139. [PMID: 33557606 PMCID: PMC9837496 DOI: 10.1177/2192568221993444] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To investigate the relationship between the preoperative width of the intervertebral foramen (WIVF) and the pain relief in patients who underwent anterior cervical discectomy and fusion (ACDF) for the treatment of cervical radiculopathy. METHODS Patients were divided into 2 groups based on pain relief status at the 6-month follow-up (pain relief group: 430 patients; persistent pain group: 108 patients). Possible factors such as age, sex, body mass index (BMI), the symptom duration, the preoperative Japanese Orthopedic Association (JOA) scores, the canal stenosis status, and the graft material were obtained. The C2-C7 Cobb angle, disc space, and width and height of the intervertebral foramen were measured on X-ray and CT 3-dimension reconstruction. Multivariate logistic regression was performed to identify the factors that affected pain relief. A receiver operating characteristic (ROC) curve was drawn for the predictive factors to determine the optimal threshold for foreseeing persistent pain. RESULTS There were significant differences in the preoperative WIVF, symptom duration and ratio of disc space distraction between the 2 groups (each P < 0.05). The regression model showed that pain relief was negatively affected by the symptom duration and ratio of disc space distraction. Besides, an increase in the preoperative width of the intervertebral foramen (WIVF) could significantly decrease the possibility of persistent pain. Based on the ROC curve, the optimal threshold of preoperative WIVF was 4.35 mm. CONCLUSION When the preoperative WIVF is equal to or less than 4.35 mm, the possibility of the occurrence of postoperative persistent pain significantly increased.
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Affiliation(s)
- Baifeng Sun
- Spine Center, Department of Orthopedics,
Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Chen Xu
- Spine Center, Department of Orthopedics,
Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Min Qi
- Spine Center, Department of Orthopedics,
Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Xiaolong Shen
- Spine Center, Department of Orthopedics,
Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Ke Zhang
- Spine Center, Department of Orthopedics,
Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Wen Yuan
- Spine Center, Department of Orthopedics,
Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Yang Liu
- Spine Center, Department of Orthopedics,
Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China,Yang Liu, Spine Center, Department of
Orthopedics, Changzheng Hospital, Naval Medical University, 415th Feng Yang
Road, Shanghai 200003, People’s Republic of China.
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8
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Gao QY, Wei FL, Zhu KL, Zhou CP, Zhang H, Cui WX, Li T, Qian JX, Hao DJ. Clinical Efficacy and Safety of Surgical Treatments in Patients With Pure Cervical Radiculopathy. Front Public Health 2022; 10:892042. [PMID: 35910906 PMCID: PMC9330161 DOI: 10.3389/fpubh.2022.892042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Traditionally paired meta-analysis revealed inconsistencies in the safety and effectiveness of surgical interventions. We conducted a network meta-analysis to assess various treatments' clinical efficacy and safety for pure cervical radiculopathy. Methods The Embase, PubMed, and Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing different treatment options for patients with pure cervical radiculopathy from inception until October 23, 2021. The primary outcomes were postoperative success rates, postoperative complication rates, and postoperative reoperation rates. The pooled data were subjected to a random-effects consistency model. The protocol was published in PROSPERO (CRD42021284819). Results This study included 23 RCTs (n = 1,844) that evaluated various treatments for patients with pure cervical radiculopathy. There were no statistical differences between treatments in the consistency model in terms of major clinical effectiveness and safety outcomes. Postoperative success rates were higher for anterior cervical foraminotomy (ACF: probability 38%), posterior cervical foraminotomy (PCF: 24%), and anterior cervical discectomy with fusion and additional plating (ACDFP: 21%). Postoperative complication rates ranked from high to low as follows: cervical disc replacement (CDR: probability 32%), physiotherapy (25%), ACF (25%). Autologous bone graft (ABG) had better relief from arm pain (probability 71%) and neck disability (71%). Among the seven surgical interventions with a statistical difference, anterior cervical discectomy with allograft bone graft plus plating (ABGP) had the shortest surgery time. Conclusions According to current results, all surgical interventions can achieve satisfactory results, and there are no statistically significant differences. As a result, based on their strengths and patient-related factors, surgeons can exercise discretion in determining the appropriate surgical intervention for pure cervical radiculopathy. Systematic Review Registration: CRD42021284819.
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Affiliation(s)
- Quan-You Gao
- Health Science Center of Xi'an Jiaotong University, Xi'an, China
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiao Tong University, Xi'an, China
| | - Fei-Long Wei
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Kai-Long Zhu
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Cheng-Pei Zhou
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Hu Zhang
- School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Wen-Xing Cui
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, Xi'an, China
- *Correspondence: Ding-Jun Hao
| | - Ji-Xian Qian
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
- Ji-Xian Qian
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiao Tong University, Xi'an, China
- Tian Li
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Broekema AEH, Cosijn MCFJ, Koopmans J, Soer R, Reneman MF, Groen RJM, Kuijlen JMA. Long-term clinical outcome after anterior cervical discectomy with polymethylmethacrylate (PMMA) as intervertebral spacer: A propensity score matched analysis. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Borton ZM, Oakley BJ, Clamp JA, Birch NC, Bateman AH. Cervical transforaminal epidural steroid injections for radicular pain : a systematic review. Bone Joint J 2022; 104-B:567-574. [PMID: 35491579 DOI: 10.1302/0301-620x.104b5.bjj-2021-1816.r1] [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] [Indexed: 11/05/2022]
Abstract
AIMS Cervical radiculopathy is a significant cause of pain and morbidity. For patients with severe and poorly controlled symptoms who may not be candidates for surgical management, treatment with transforaminal epidural steroid injections (CTFESI) has gained widespread acceptance. However, a paucity of high-quality evidence supporting their use balanced against perceived high risks of the procedure potentially undermines the confidence of clinicians who use the technique. We undertook a systematic review of the available literature regarding CTFESI to assess the clinical efficacy and complication rates of the procedure. METHODS OVID, MEDLINE, and Embase database searches were performed independently by two authors who subsequently completed title, abstract, and full-text screening for inclusion against set criteria. Clinical outcomes and complication data were extracted, and a narrative synthesis presented. RESULTS Six studies (three randomized controlled trials and three non-randomized observational studies; 443 patients) were included in the final review. The aggregate data support the efficacy of CTFESI in excess of the likely minimal clinically important difference. No major complications were described. CONCLUSION There is increasing evidence supporting the efficacy of CTFESI. Concerns regarding the occurrence of catastrophic complications, widely shared in the case report and anecdotal literature, were not found when reviewing the best available evidence. However, the strength of these findings remains limited by the lack of highly powered high-level studies and the heterogeneity of the studies available. Further high-quality studies are recommended to address the issues of efficacy and safety with CTFESI. Cite this article: Bone Joint J 2022;104-B(5):567-574.
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Chang PJ, Asher A, Smith SR. A Targeted Approach to Post-Mastectomy Pain and Persistent Pain following Breast Cancer Treatment. Cancers (Basel) 2021; 13:5191. [PMID: 34680339 PMCID: PMC8534110 DOI: 10.3390/cancers13205191] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/09/2021] [Accepted: 10/14/2021] [Indexed: 01/10/2023] Open
Abstract
Persistent pain following treatment for breast cancer is common and often imprecisely labeled as post-mastectomy pain syndrome (PMPS). PMPS is a disorder with multiple potential underlying causes including intercostobrachial nerve injury, intercostal neuromas, phantom breast pain, and pectoralis minor syndrome. Adding further complexity to the issue are various musculoskeletal pain syndromes including cervical radiculopathy, shoulder impingement syndrome, frozen shoulder, and myofascial pain that may occur concurrently and at times overlap with PMPS. These overlapping pain syndromes may be difficult to separate from one another, but precise diagnosis is essential, as treatment for each pain generator may be distinct. The purpose of this review is to clearly outline different pain sources based on anatomic location that commonly occur following treatment for breast cancer, and to provide tailored and evidence-based recommendations for the evaluation and treatment of each disorder.
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Affiliation(s)
- Philip J. Chang
- Department of Physical Medicine and Rehabilitation, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Arash Asher
- Department of Physical Medicine and Rehabilitation, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Sean R. Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48108, USA;
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Broekema AE, Groen RJ, Tegzess E, Reneman MF, Soer R, Kuijlen JM. Anterior or posterior approach in the surgical treatment of cervical radiculopathy; neurosurgeons’ preference in the Netherlands. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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