A New Grading of Epidural Hematoma or Scar Formation after Posterior Cervical Spine Surgery: Evaluation of Perioperative Related Factors, Distributions, and Clinical Outcomes after Surgery

Primary Results of Our Protocol for Standardization of Perioperative Antiplatelet Agent Management on the Incidence of Epidural Hematoma and Thrombotic Complications in Posterior Cervical Surgery: A Prospective Cohort Study

Introduction

This study aimed to standardize perioperative interruption of antiplatelet agents in patients undergoing cervical spinal surgery and investigate the incidence of epidural hematoma and thrombotic complications.

Methods

A total of 153 patients, consisting of 85 men and 68 women, were included in this study. Their mean age was 65.5 years. They were divided into two groups: Groups A and B. Group A (139 patients) did not receive preoperative antiplatelet agents, and Group B (14 patients) resumed antiplatelet agents from 7 or 14 days presurgery to 3 days postsurgery. Our analysis encompassed demographic data before surgery, postoperative magnetic resonance image-based assessment of radiological epidural hematoma (EH), and complications such as symptomatic hematoma, blood transfusion, stroke, and venous thromboembolism after surgery.

Results

The frequency of medical conditions, such as hypertension, diabetes, and hyperlipidemia, was significantly higher in Group B than in Group A. The CHADS2 scores, which serve as a clinical prediction rule for estimating stroke risk, were significantly higher in Group B than in Group A. In contrast, the intraoperative blood loss was significantly lower in Group B than in Group A. There was no significant difference in radiologically severe EH, hemorrhage, and thrombotic complications between the two groups. Interestingly, none of the patients in Group B had hemorrhagic and thrombotic complications.

Conclusions

Our standardized perioperative management of antiplatelet agents did not affect the incidence of radiological EH, hemorrhage, and thrombotic complications in patients undergoing cervical spinal surgery.

Modified K-Line in Neck Extension Is a Prognostic Indicator of the Surgical Outcome at 5 Years After Cervical Laminoplasty for Cervical Spondylotic Myelopathy

STUDY DESIGN

A retrospective comparison of the surgical outcome after cervical laminoplasty for cervical spondylotic myelopathy (CSM) using a modified K-line based on lordosis in neck extension as a predictor: in K-line Back CSM (KB group), the K-line crosses the ventral edge of any of the spinous processes, whereas in K-line Front CSM (KF group), the K-line does not.

OBJECTIVE

To investigate the neurological and radiological outcomes 5 years after surgery and the contact between the spinal cord and posterior elements after laminoplasty for CSM using the modified K-line.

SUMMARY OF BACKGROUND DATA

No indicators on a lateral radiograph can predict the neurological outcome after laminoplasty for CSM.

METHODS

Patients with CSM were divided into KB (n = 20) and KF groups (n = 13). We compared the postoperative Japanese Orthopedic Association (JOA) score, recovery rate, grip-and-release and foot-tapping test results, alignment, and contact between the spinal cord and posterior elements between the two groups.

RESULTS

The postoperative JOA score and its recovery rate were significantly lower in the KB group (12.4 points and 34.1%, respectively) than in the KF group (14.1 points and 59.0%, respectively) at final follow-up (P = 0.0415 and 0.0458). The grip-and-release and foot-tapping test results improved significantly in the KF group but not in the KB group. In the KB group, a larger lordotic angle in extension at 1 year postoperatively continued until final follow-up. The rate of recovery of the JOA score in patients with contacts at both C4/5 and C5/6 and any contact in the KB group (-1.5% and 31.9%, respectively) were lower (P = 0.0013 and 0.0534, respectively) than those in the KF group (58.6% and 60.7%, respectively).

CONCLUSION

The K-line Back predicts a poor neurological outcome after laminoplasty for CSM. Decompression with fusion may be recommended for these patients.Level of Evidence: 4.

Management of syringomyelia associated with tuberculous meningitis: A case report and systematic review of the literature

Determinants of tuberculosis (TB) syringomyelia, its management options and outcomes are still under investigation. The aim of this study is to present a case of TB syringomyelia with markedly improved symptoms status-post surgery and to understand the clinical characteristics and outcomes of 33 TB syringomyelia cases reported in the literature. Specifically, we examined the differences between patients who were managed medically and those who underwent surgical intervention. Inclusion criteria for the cases were (1) syringomyelia caused by TB infection rather than co-occurrence of these conditions, (2) management protocol described, and (3) post-treatment outcome described. The median age was 30 years (interquartile range (IQR): 23-40) with 55% males. The median time between TB onset to syringomyelia diagnosis was 2 years. Nineteen patients were surgically treated, 11 were medically treated, and 3 received no treatment. Twenty-one patients showed improvement in at least one prior symptom, but no patient experienced a full recovery. Those that underwent surgical intervention were more likely to have TB meningitis (95% vs. 64%, p < 0.05) upon initial TB presentation and have a greater interval between TB onset and syringomyelia presentation (median of 2.6 vs. 0.33 years, ns). A greater proportion of the surgically managed patients experienced improvement in any symptom (74% vs. 45%, ns). Future case-controlled studies with larger sample sizes are required to validate and further understand the outcomes of surgically-managed TB syringomyelia.