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Kitab SA, AbdulKareem SB, Wakefield AE, Benzel EC. Three-dimensional Spinal Canal Morphometric Analysis and Relevant Spinal Cord Occupational Ratios in Congenital Cervical Spinal Stenosis: A Classification Algorithm of the Stenosis Phenotypes and Data-driven Decompression Approach. World Neurosurg 2024; 187:e982-e996. [PMID: 38750891 DOI: 10.1016/j.wneu.2024.05.024] [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: 02/15/2024] [Revised: 04/21/2024] [Accepted: 05/06/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVES No standardized magnetic resonance imaging (MRI) parameters have defined the 3-dimensional morphoanatomy and relevant spinal cord occupation ratios (occupation of spinal cord dimensions/similar dimensions within the spinal canal) in congenital cervical stenosis (CCS). METHODS A retrospective, comparative analysis was conducted on 200 patients >18 years of age with myelopathy and CCS (mean age, 52.4 years) and 200 age-matched controls with no myelopathy or radiculopathy. The variables assessed from high resolution MRI included sagittal and axial spinal canal dimensions (MRI Torg-Pavlov ratios) from C3 to C7. Morphometric dimensions from the sagittal retrodiscal and retrovertebral regions as well as axial MRI dimensions were compared. Sagittal and axial spinal cord occupation ratios were defined and correlated with spinal canal dimensions. RESULTS Multivariate analyses indicated reduced sagittal and axial anteroposterior (AP) spinal canal dimensions and a large reduction in transverse spinal canal dimensions at all spinal levels. There was a small significant correlation between AP sagittal spinal canal dimensions and axial transverse spinal canal dimensions at C3-C5, but not at C5-C6. Small correlations were noted between AP sagittal spinal canal dimensions and AP axial spinal cord and axial cross-sectional area occupation ratios at C3-C6, but there was no correlation with axial mediolateral spinal cord occupation ratios. CONCLUSIONS The stenosis effect can involve any dimension, including the transverse spinal canal dimension, independent of other dimensions. Owing to the varied observed morphoanatomies, a classification algorithm that defines CCS specific phenotypes was formulated. Objectivizing the stenosis morphoanatomy may allow for data-driven patient-focused decompression approaches in the future.
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Affiliation(s)
- Sameer A Kitab
- Department of Spine Fellowship, University of Al-Qadisiyah, Baghdad, Iraq.
| | - Salam B AbdulKareem
- Department of Spine Fellowship, Scientific Council of Orthopedics, Baghdad, Iraq
| | - Andrew E Wakefield
- Department of Neurosurgery, Hartford Hospital, Hartford, Connecticut, USA; Department of Surgery, Connecticut University School of Medicine, Farmington, Connecticut, USA
| | - Edward C Benzel
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA
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Quiceno E, Seaman S, Hussein A, Dholaria N, Pico A, Abdulla E, Bauer IL, Nosova K, Moniakis A, Khan MA, Deaver C, Barbagli G, Prim M, Baaj A. Clinical Outcomes and Complication Profile of Spine Surgery in Septuagenarians and Octogenarians: Case Series. World Neurosurg 2024; 185:e878-e885. [PMID: 38453010 DOI: 10.1016/j.wneu.2024.02.146] [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: 02/18/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE The aging global population presents an increasing challenge for spine surgeons. Advancements in spine surgery, including minimally invasive techniques, have broadened treatment options, potentially benefiting older patients. This study aims to explore the clinical outcomes of spine surgery in septuagenarians and octogenarians. METHODS This retrospective analysis, conducted at a US tertiary center, included patients aged 70 and older who underwent elective spine surgery for degenerative conditions. Data included the Charlson Comorbidity Index (CCI), ASA classification, surgical procedures, intraoperative and postoperative complications, and reoperation rates. The objective of this study was to describe the outcomes of our cohort of older patients and discern whether differences existed between septuagenarians and octogenarians. RESULTS Among the 120 patients meeting the inclusion criteria, there were no significant differences in preoperative factors between the age groups (P > 0.05). Notably, the septuagenarian group had a higher average number of fused levels (2.36 vs. 0.38, P = 0.001), while the octogenarian group underwent a higher proportion of minimally invasive procedures (P = 0.012), resulting in lower overall bleeding in the oldest group(P < 0.001). Mobility outcomes were more favorable in septuagenarians, whereas octogenarians tended to maintain or experience a decline in mobility(P = 0.012). A total of 6 (5%) intraoperative complications and 12 (10%) postoperative complications were documented, with no statistically significant differences observed between the groups. CONCLUSIONS This case series demonstrates that septuagenarians and octogenarians can achieve favorable clinical outcomes with elective spine surgery. Spine surgeons should be well-versed in the clinical and surgical care of older adults, providing optimal management that considers their increased comorbidity burden and heightened fragility.
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Affiliation(s)
- Esteban Quiceno
- Banner University Medical Center Phoenix USA, University of Arizona Department of Neurosurgery, Phoenix, Arizona, USA.
| | - Scott Seaman
- Department of Neurosurgery, University of Iowa, Iowa City, Iowa, USA
| | - Amna Hussein
- Banner University Medical Center Phoenix USA, University of Arizona Department of Neurosurgery, Phoenix, Arizona, USA
| | - Nikhil Dholaria
- The University of Arizona College of Medicine - Phoenix USA, Phoenix, Arizona, USA
| | - Annie Pico
- The University of Arizona College of Medicine - Phoenix USA, Phoenix, Arizona, USA
| | - Ebtesam Abdulla
- University of Arizona Department of Neurosurgery, Phoenix, Arizona, USA
| | - Isabel L Bauer
- The University of Arizona College of Medicine - Phoenix USA, Phoenix, Arizona, USA
| | - Kristin Nosova
- University of Arizona Department of Neurosurgery, Phoenix, Arizona, USA
| | | | - Monis Ahmed Khan
- University of Arizona Department of Neurosurgery, Phoenix, Arizona, USA
| | - Courtney Deaver
- University of Arizona Department of Neurosurgery, Phoenix, Arizona, USA
| | - Giovanni Barbagli
- University of Arizona Department of Neurosurgery, Phoenix, Arizona, USA
| | - Michael Prim
- Banner University Medical Center Phoenix USA, University of Arizona Department of Neurosurgery, Phoenix, Arizona, USA
| | - Ali Baaj
- Banner University Medical Center Phoenix USA, University of Arizona Department of Neurosurgery, Phoenix, Arizona, USA
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Arnautovic A, Mijares J, Begagić E, Ahmetspahić A, Pojskić M. Four-level ACDF surgical series 2000-2022: a systematic review of clinical and radiological outcomes and complications. Br J Neurosurg 2024:1-12. [PMID: 38606493 DOI: 10.1080/02688697.2024.2337020] [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: 01/11/2023] [Accepted: 03/26/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE The primary objective of this investigation is to systematically scrutinize extant surgical studies delineating Four-Level Anterior Cervical Discectomy and Fusion (4L ACDF), with a specific emphasis on elucidating reported surgical indications, clinical and radiological outcomes, fusion rates, lordosis correction, and the spectrum of complication rates. METHODS The literature review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, employing the MEDLINE (PubMed), Embase, and Scopus databases. This analysis encompasses studies implementing the 4L ACDF procedure, with detailed extraction of pertinent data pertaining to surgical methodologies, types of employed interbody cages, clinical and radiological endpoints, rates of fusion, and the incidence of complications. RESULTS Among the 15 studies satisfying inclusion criteria, a marginal increment in the year 2022 (21.4%) was discerned, with a preponderance of study representation emanating from China (35.7%) and the United States (28.6%). 50% of the studies were single-surgeon studies. Concerning follow-up, studies exhibited variability, with 42.9% concentrating on periods of five years or less, and an equivalent proportion extending beyond this timeframe. Across the amalgamated cohort of 2457 patients, males constituted 51.6%, manifesting a mean age range of 52.2-61.3 years. Indications for surgery included radiculopathy (26.9%) and myelopathy (46.9%), with a predilection for involvement at C3-7 (24.9%). Meta-analysis yielded an overall complication rate of 16.258% (CI 95%: 14.823%-17.772%). Dysphagia (4.563%), haematoma (1.525%), hoarseness (0.205%), C5 palsy (0.176%) were the most prevalent complications of 4L ACDF. Fusion rates ranging from 41.3% to 94% were documented. CONCLUSION The 4L ACDF is commonly performed to address mylopathy and radiculopathy. While the surgery carries a complication rate of around 16%, its effectiveness in achieving bone fusion can vary considerably.
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Affiliation(s)
- Alisa Arnautovic
- George Washington University School of Medicine, Washington, DC, USA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph Mijares
- George Washington University School of Medicine, Washington, DC, USA
| | - Emir Begagić
- Department of General Medicine, School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina
| | - Adi Ahmetspahić
- Department of Neurosurgery, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
| | - Mirza Pojskić
- Department of Neurosurgery, University of Marburg, Marburg, Germany
- School of Medicine, Josip Juraj Strossmayr University, Osijek, Croatia
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Ling J, Thirumavalavan J, Shin C, Lee TM, Marco RAW, Hirase T. Postoperative Rehabilitation to Improve Outcomes After Cervical Spine Fusion for Degenerative Cervical Spondylosis: A Systematic Review. Cureus 2023; 15:e39081. [PMID: 37332472 PMCID: PMC10269395 DOI: 10.7759/cureus.39081] [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] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Postoperative rehabilitation has recently been identified as a high-priority research topic for improving surgical outcomes for degenerative cervical spondylosis (DCS). However, there remains no consensus on specific rehabilitation strategies. Thus, the objective of this study was to evaluate the effectiveness of postoperative rehabilitation strategies for short-term and long-term outcomes after cervical spine fusion for DCS. A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines using the PubMed, Scopus, and Ovid Medline databases. All level I-IV therapeutic studies in the English language investigating the outcomes of postoperative rehabilitation strategies after cervical spine fusion for DCS were included. Nine studies with 895 patients with DCS (747 anterior-only fusion, 55 patients with posterior-only fusion, 93 patients with physiotherapy alone) were included in this analysis, with 446 (49.8%) patients receiving physiotherapy alone or standard postoperative therapy and 449 (50.2%) patients receiving standard postoperative therapy with additional intervention or augmentation. These interventions included pulsed electromagnetic field (PEMF) stimulation, telephone-supported home exercise program (HEP), early cervical spine stabilizer training, structured postoperative therapy, and a postoperative cervical collar. One level II study demonstrated that PEMF led to increased fusion rates at six months postoperatively compared to standard therapy alone, one level II study demonstrated that postoperative cervical therapy in addition to standard therapy was better than standard therapy alone in the improvement of neck pain intensity, one level IV study demonstrated home exercise therapy led to an improvement in neck pain, arm pain, and disability, and six level II studies reported no difference in clinical outcome measures between augmented or targeted therapy and standard postoperative therapy for DCS. In conclusion, there is moderate evidence to suggest that there is no significant difference in clinical and surgical outcomes between standard postoperative therapy and augmented or targeted postoperative therapy for cervical fusion in the setting of cervical spondylosis. However, there is some evidence to support that certain therapeutic modalities, such as PEMF stimulation, may lead to improved fusion rates, clinical outcomes, and patient satisfaction when compared to standard postoperative therapy protocols. There is no evidence to support a difference in effectiveness with different types of postoperative rehabilitation strategies between anterior and posterior fusions for DCS.
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Affiliation(s)
- Jeremiah Ling
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, USA
| | | | - Caleb Shin
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, USA
| | - Tiffany M Lee
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, USA
| | - Rex A W Marco
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, USA
| | - Takashi Hirase
- Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, USA
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Shabo E, Brandecker S, Rana S, Bara G, Scorzin JE, Eichhorn L, Vatter H, Banat M. Safety Evaluation of Cervical Dorsal Instrumentation in Geriatric Patients: Experience at a Level 1 Center for Spinal Surgery-A Single Center Cohort Study. Front Med (Lausanne) 2022; 9:824047. [PMID: 35665318 PMCID: PMC9157765 DOI: 10.3389/fmed.2022.824047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 04/14/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Dorsal instrumentation of the cervical spine is an established treatment in spine surgery. However, careful planning is required, particularly in elderly patients. This study evaluates early clinical outcomes in geriatric patients undergoing complex spine surgery. Methods In this retrospective, single center cohort study, we included all geriatric patients (aged ≥65 years) who underwent dorsal instrumentation between January 2013 and December 2020. We analyzed postoperative complications and the 30-day in-hospital mortality rate. Furthermore, the Charlson comorbidity index (CCI) and Clavien-Dindo grading system (CDG) were used to assess the patients' comorbidity burden. Results In total, 153 patients were identified and included. The mean age of patients was 78 years (SD ± 7). Traumatic injury (53.6%) was the most common reason for surgery. 60.8% of the patients underwent dorsal instrumentation with 3 or more levels. The most common comorbidities were arterial hypertension (64%), diabetes mellitus (22.2%), coronary heart disease and atrial fibrillation (19.6%). The most common adverse event (AE) was pneumonia (4%) and the most common surgery-related complication was wound infection (5.2%). Among patients categorized as high risk for AE (CCI > 5), 14.6% suffered a postoperative AE. In our univariate analysis, we found no risk factors for high rates of complications or mortality. Conclusion Our data demonstrates that older patients were at no significant risk of postoperative complications. The CCI/CDG scores may identify patients at higher risk for adverse events after dorsal instrumentation, and these assessments should become an essential component of stratification in this older patient population.
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Affiliation(s)
- Ehab Shabo
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Simon Brandecker
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Shaleen Rana
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Gregor Bara
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Jasmin E Scorzin
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Lars Eichhorn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Mohammed Banat
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
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Boehm BA, Njoku I, Furey CG. Single-Site Retrospective Assessment of Surgical Outcomes in Non-Ambulatory Patients with Degenerative Cervical Myelopathy. Spine (Phila Pa 1976) 2022; 47:331-336. [PMID: 34341319 DOI: 10.1097/brs.0000000000004185] [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] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study of surgical outcomes in patients with degenerative cervical myelopathy (DCM). OBJECTIVE To better characterize outcomes following cervical decompression in those with severe, non-ambulatory forms of DCM. SUMMARY OF BACKGROUND DATA DCM represents a collection of age-related degenerative processes of the cervical spine that can result in motor, sensory, and autonomic dysfunction, leading to significant reductions in quality of life. Individuals with severe, non-ambulatory forms of DCM are often treated with spinal decompression although the extent of neurological improvement for this patient population is unclear. METHODS A retrospective analysis of 48 non-consecutive non-ambulatory patients who underwent cervical decompression surgery between January 2007 and December 2018. Paired t tests and Wilcoxon signed rank tests were used to compare Nurick grade and modified Japanese Orthopedic Association (mJOA) score before and after surgery. Patient demographics, operative details, and postsurgical complications were analyzed using descriptive statistics. RESULTS Patients experienced significant improvements in both Nurick grade and mJOA score following cervical decompression surgery. The mean Nurick grade improved from 4.10 ± 0.31 to 2.21 ± 0.82 (P < 0.001, paired t test; 95% confidence interval [CI] -2.08 to -1.71), while the mean mJOA score improved from 10.58 ± 1.51 to 13.60 ± 1.58 (P < 0.001, paired t test; 95% CI 2.59-3.45). The average follow-up duration was 2.50 ± 1.83 years. Following surgery, 44 of the 48 patients in the study gained the ability to ambulate without the aid of a walking frame or someone else's assistance. CONCLUSION This study demonstrated that patients with severe forms of DCM experienced significant improvement in neurological function following cervical decompression surgery. These improvements indicate that cervical decompression surgery is effective in this patient population and has the potential to improve neurological status.Level of Evidence: 3.
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Affiliation(s)
- Blake A Boehm
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Innocent Njoku
- University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Christopher G Furey
- Case Western Reserve University School of Medicine, Cleveland, OH
- University Hospitals Cleveland Medical Center, Cleveland, OH
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Johansen TO, Vangen-Lønne V, Holmberg ST, Salvesen ØO, Solberg TK, Gulati AM, Nygaard ØP, Gulati S. Surgery for degenerative cervical myelopathy in the elderly: a nationwide registry-based observational study with patient-reported outcomes. Acta Neurochir (Wien) 2022; 164:2317-2326. [PMID: 35852626 PMCID: PMC9427907 DOI: 10.1007/s00701-022-05282-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/06/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to investigate whether clinical outcomes in patients aged ≥ 70 undergoing decompressive surgery for degenerative cervical myelopathy (DCM) differ from those of younger patients (50-70 years) at 1 year. METHODS Data were obtained from the Norwegian Registry for Spine Surgery (NORspine). Among 651 patients included, 177 (27.2%) were ≥ 70 years old. The primary outcome was change in the Neck Disability Index (NDI). Secondary outcomes were changes in the European Myelopathy Score (EMS), quality of life (EuroQoL EQ-5D), numeric rating scales (NRS) for headache, neck pain, and arm pain, and complications. RESULTS Significant improvements in all patient-reported outcomes (PROMs) were detected for both age cohorts at 1 year. For the two age cohorts combined, there was a statistically significant improvement in the NDI score (mean 9.2, 95% CI 7.7 to 10.6, P < 0.001). There were no differences between age cohorts in mean change of NDI (- 8.9 vs. - 10.1, P = 0.48), EQ-5D (0.13 vs. 0.17, P = 0.37), or NRS pain scores, but elderly patients experienced a larger improvement in EMS (0.7 vs. 1.3, P = 0.02). A total of 74 patients (15.6%) in the younger cohort and 43 patients (24.3%) in the older cohort experienced complications or adverse effects within 3 months of surgery, mainly urinary and respiratory tract infections. CONCLUSION Surgery for DCM was associated with significant improvement across a wide range of PROMs for both younger and elderly patients. Surgery for DCM should not be denied based on age alone.
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Affiliation(s)
- Tonje Okkenhaug Johansen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway ,Department of Neurosurgery, St. Olavs Hospital, NO-7006 Trondheim, Norway
| | - Vetle Vangen-Lønne
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway ,Department of Neurosurgery, St. Olavs Hospital, NO-7006 Trondheim, Norway
| | - Siril T. Holmberg
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway ,Department of Neurosurgery, St. Olavs Hospital, NO-7006 Trondheim, Norway
| | - Øyvind O. Salvesen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway
| | - Tore K. Solberg
- Department of Neurosurgery and the Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø, Norway ,Institute for Clinical Medicine, UNN The Arctic University of Norway, Tromsø, Norway
| | - Agnete M. Gulati
- Department of Rheumatology, St. Olavs Hospital, NO-7006 Trondheim, Norway
| | - Øystein P. Nygaard
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway ,Department of Neurosurgery, St. Olavs Hospital, NO-7006 Trondheim, Norway ,National Advisory Unit On Spinal Surgery, St. Olavs Hospital, NO-7006 Trondheim, Norway
| | - Sasha Gulati
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway ,Department of Neurosurgery, St. Olavs Hospital, NO-7006 Trondheim, Norway
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First neurological symptoms in degenerative cervical myelopathy: does it predict the outcome? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:327-333. [PMID: 34822020 DOI: 10.1007/s00586-021-07060-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/27/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Degenerative cervical myelopathy (DCM) is the most common non-traumatic cause of spinal cord dysfunction. Prediction of the neurological outcome after surgery is important. The aim of this study was to analyze the relationship between first symptoms of DCM and the neurological outcome after surgery. METHODS A retrospective analysis over a period of 10 years was performed. First symptoms such as cervicobrachial neuralgia, sensory and motor deficits and gait disturbances were evaluated regarding the postoperative neurological outcome. The modified Japanese Orthopedic Association Score (mJOA Score) was used to evaluate neurological outcome. RESULTS In total, 411 patients (263 males, 64%) with a median age of 62.6 ± 12.1 years were included. Cervicobrachial neuralgia was described in 40.2%, gait disturbance in 31.6%, sensory deficits in 19% and motor deficits in 9.2% as first symptom. Patients with cervicobrachial neuralgia were significantly younger (median age of 58 years, p = 0.0005) than patients with gait disturbances (median age of 68 years, p = 0.0005). Patients with gait disturbances and motor deficits as first symptom showed significantly lower mJOA Scores than other patients (p = 0.0005). Additionally, motor deficits and gait disturbance were negative predictors for postoperative outcome according to the mJOA Score. CONCLUSION Motor deficits and gait disturbances as the first symptom of DCM are negative predictors for postoperative neurological outcome. Nevertheless, patients with motor deficits and gait disturbance significantly profit from the surgical treatment despite poor preoperative mJOA Score.
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Okunlola AI, Okunlola CK, Babalola OF, Orewole TO, Akinmade A, Kofoworola OO. Geriatric neurosurgery in a suburban community: A preliminary review of a single neurosurgeon experience. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sánchez-Calderón MD, Córdoba-Mosqueda ME, Aguilar-Calderón JR, Domínguez-Herz CR, Ochoa-Cacique D, Vega-Moreno DA, Reyes-Rodriguez VA, García-González U, Ibarra-de la Torre A, Efraín Hernández-Reséndiz R. Anterior and Posterior Approach Results for Treatment of Cervical Myelopathy in the Elderly: A 10-Year Experience in a Mexican Institution. OPEN JOURNAL OF ORTHOPEDICS 2021; 11:207-219. [DOI: 10.4236/ojo.2021.117020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
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11
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Anterior Cervical Decompression and C5 Palsy: A Systematic Review and Meta-analysis of Three Reconstructive Surgeries. Spine (Phila Pa 1976) 2020; 45:1587-1597. [PMID: 32756281 DOI: 10.1097/brs.0000000000003637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A systematic review and meta-analysis were performed with the literature including the case of C5 palsy following anterior cervical decompression surgery. OBJECTIVE The aim of this study was to compare three reconstructive procedures of anterior cervical decompression, the incidences of delayed C5 palsy and other complications were assessed. SUMMARY OF BACKGROUND DATA Delayed C5 palsy is now a well-known complication after cervical decompression surgery. The etiology of C5 palsy has been studied, especially after posterior surgery. However, in anterior surgery there has been a lack of investigation due to procedure variation. Additionally, limited evidence exists regarding the risk of C5 palsy in surgical procedures. METHODS We performed an extensive literature search for C5 palsy and other complications with ACDF, ACCF, and their combination (Hybrid). Gross incidences of C5 palsy after these three procedures were compared, and specific superiorities (or inferiorities) were investigated via comparison of binary outcomes between two of three groups using odds ratios (OR). RESULTS Twenty-six studies met the inclusion criteria. A total of 3098 patients were included and 5.8% of those developed C5 palsy. Meta-analyses demonstrated that ACDF had a lower risk of palsy than ACCF (OR 0.36, 95% confidence interval [CI] 0.16-0.78), whereas ACDF versus Hybrid (OR 0.60, 95% CI 0.24-1.51) and Hybrid versus ACCF (OR 1.11, 95% CI 0.29-4.32) were not significantly different. Although these differences were not observed in shorter lesion subgroups, there were significant differences between the three procedures in longer lesion subgroups (P = 0.0005). Meta-analyses revealed that in longer lesions, ACDF had a significantly lower incidence than ACCF (OR 0.42, 95% CI 0.22-0.82). Additionally, Hybrid surgery was noninferior for palsy occurrence compared to ACCF, and suggested a trend for reduced rates of other complications compared to ACCF. CONCLUSION ACDF may yield better outcomes than Hybrid and ACCF. Furthermore, Hybrid may have advantages over ACCF in terms of surgical complications. LEVEL OF EVIDENCE 3.
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Jiang Z, Wang A, Wang C, Kong W. Analysis of compliance and efficacy of integrated management of whole process in the choice of percutaneous full-endoscopic surgery for patients with cervical disc herniation. J Orthop Surg Res 2020; 15:381. [PMID: 32887632 PMCID: PMC7650293 DOI: 10.1186/s13018-020-01920-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022] Open
Abstract
Background Percutaneous spinal endoscopy is a new type of surgery for the treatment of cervical disc herniation. It can avoid the complications of the classic anterior cervical discectomy and fusion (ACDF) approach and the risk of adjacent spondylosis. How can we effectively improve patients’ awareness of spinal endoscopy and their election of endoscopic techniques? Objective To analyze the compliance and clinical effect of the integrated management of the whole process in the choice of percutaneous full-endoscopic surgery for patients with cervical disc herniation. Methods Retrospective analysis of 72 patients with cervical disc herniation undergoing surgery in our hospital from August 2015–August 2017 was performed. The whole-process integrated management model was used for all the patients. The 36 patients in the experimental group were treated by percutaneous full-endoscopic cervical discectomy, and the 36 patients in the control group were treated by ACDF. The postoperative feeding time, time to get out of bed, length of hospital stay, compliance, clinical efficacy, and recurrence rate of neck pain were observed. Changes between the preoperative and postoperative pain visual analog scale (VAS) scores and neurological function Japan Orthopaedic Association (JOA) scores were assessed. Results The postoperative feeding time in the experimental group was 8.319 ± 1.374 h, the postoperative time to get out of bed was 16.64 ± 3.728 h, and the hospitalization time was 6.403 ± 0.735 days. The excellent and good clinical efficacy rate was 91.67%, the compliance rate was 88.89%, and the neck pain recurrence rate was 5.56%. The postoperative feeding time in the control group was 26.56 ± 9.512 h, the postoperative time to get out of bed was 45.06 ± 9.027 h, and the length of hospital stay was 8.208 ± 0.865 days. The excellent and good clinical efficacy rate was 88.89%, the compliance rate was 69.4%, and the neck pain recurrence rate was 8.33%. There was no significant difference between the two groups in the excellent efficacy rate and the neck pain recurrence rate, p > 0.05. The compliance rate in the experimental group was better than that in the control group, and the difference was statistically significant, p < 0.05. The hospitalization time of the experimental group was significantly lower than that of the control group, and the difference was statistically significant, p < 0.05. The postoperative VAS scores and JOA scores of the two groups were significantly better than the preoperative scores, and the difference was statistically significant, p < 0.05; there was no significant difference between the two groups, p > 0.05. Conclusion The integrated management of the whole course can effectively improve the compliance of patients with cervical disc herniation receiving endoscopic treatment, yield the same treatment effect as the classic operation, shorten the hospitalization time, speed up the turnover of hospital beds, and improve satisfaction with medical quality and is worthy of clinical application.
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Affiliation(s)
- Zhongyan Jiang
- Department of Orthopedics Surgery, Affiliated Hospital of Zunyi Medical University, No.149 Dalian Road, Zunyi, 563000, Guizhou, China
| | - Ansu Wang
- Department of Orthopedics Surgery, Affiliated Hospital of Zunyi Medical University, No.149 Dalian Road, Zunyi, 563000, Guizhou, China
| | - Chong Wang
- Department of Orthopedics Surgery, Affiliated Hospital of Zunyi Medical University, No.149 Dalian Road, Zunyi, 563000, Guizhou, China
| | - Weijun Kong
- Department of Orthopedics Surgery, Affiliated Hospital of Zunyi Medical University, No.149 Dalian Road, Zunyi, 563000, Guizhou, China. .,Department of Orthopedics Surgery, The Second Affiliated Hospital of Zunyi Medical University, No.1 Xinpu Road, Zunyi, 563000, Guizhou, China.
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Associated risk factors for extended length of stay following anterior cervical discectomy and fusion for cervical spondylotic myelopathy. Clin Neurol Neurosurg 2020; 195:105883. [DOI: 10.1016/j.clineuro.2020.105883] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 12/27/2022]
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Ko S, Bae J, Lee SH. Transthoracic microsurgical anterior decompression without fusion for ossification of the posterior longitudinal ligament in the thoracic spine. J Neurosurg Spine 2020. [DOI: 10.3171/2020.5.spine20277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe authors aimed to analyze outcomes following transthoracic microsurgical anterior decompression of thoracic ossification of the posterior longitudinal ligament (T-OPLL), which was causing myelopathy, and determine the predictive factors for surgical outcomes.METHODSPatients who underwent transthoracic microsurgical anterior decompression without fusion for the treatment of T-OPLL from December 2014 to May 2019 were included. Demographic, radiological, and perioperative data and clinical outcomes of 35 patients were analyzed. The modified Japanese Orthopaedic Association (mJOA) score and recovery rate were used to evaluate functional outcomes.RESULTSA total of 35 consecutive patients (8 men and 27 women; mean age 52.2 ± 10.8 years) were enrolled in this study, and the mean follow-up period was 65.5 ± 51.9 months. The mean mJOA score significantly improved after surgery (5.9 ± 1.8 vs 8.3 ± 1.5, p < 0.001), with a mean recovery rate of 47.7% ± 24.5%. The visual analog scale (VAS) score significantly improved after surgery (7.3 ± 1.3 vs 4.3 ± 0.7, p < 0.001). The outcome was excellent in 4 patients (11.4%), good in 21 patients (60.0%), fair in 4 patients (11.4%), unchanged in 5 patients (14.3%), and worsened in 1 patient (2.9%). There were 12 cases of CSF leakage, 1 case of epidural hematoma, 1 case of pleural effusion, and 1 case of pneumothorax. Age, preoperative kyphotic angle, anteroposterior length of T-OPLL at the maximally affected level, and mass occupying rate were identified as predictors associated with postoperative outcome. A multivariate regression analysis revealed that age and preoperative kyphotic angle were independent risk factors for postoperative outcomes.CONCLUSIONSTransthoracic microsurgical anterior decompression without fusion achieved favorable clinical and radiological outcomes for treating T-OPLL with myelopathy. Patient age and preoperative kyphotic angle were independent risk factors for lower recovery rate.
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Naylor RM, Lenartowicz KA, Graff-Radford J, Jones DT, Cutsforth-Gregory JK, Graff-Radford NR, Elder BD. High prevalence of cervical myelopathy in patients with idiopathic normal pressure hydrocephalus. Clin Neurol Neurosurg 2020; 197:106099. [PMID: 32702575 DOI: 10.1016/j.clineuro.2020.106099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Both idiopathic normal pressure hydrocephalus (iNPH) and cervical myelopathy may result in progressive gait impairment. Some patients who do not respond to shunting despite a positive tap test may have gait dysfunction from cervical myelopathy. The objective of this study was to determine the prevalence of cervical myelopathy in patients with iNPH. METHODS A consecutive series of patients undergoing shunt placement for iNPH were screened for cervical stenosis. Clinical manifestations of iNPH and cervical myelopathy, grade of cervical stenosis, cervical spine surgical intervention, timing of intervention, and outcomes were recorded. RESULTS Fifty-two patients shunted for treatment of iNPH were included for analysis. 58 % were male with a mean age of 75.2 years (SD 7.3 years). All patients presented with gait disturbances. 39/52 (75 %) had cervical stenosis, and 9/52 (17.3 %) had significant (grade 2-3) cervical stenosis with myelopathy and were subsequently treated with surgical decompression. There was an association between increasing grade of stenosis and disproportionately enlarged subarachnoid space hydrocephalus (DESH). All patients with grade 2-3 cervical stenosis and symptoms of cervical myelopathy in addition to iNPH underwent cervical decompression surgery. CONCLUSIONS Clinically significant cervical myelopathy was prevalent in patients with iNPH and was associated with increased rate of DESH, a finding that requires validation in a larger cohort. Based on these results, cervical imaging could be considered preoperatively in patients with iNPH, particularly when upper motor neuron findings are identified. Additionally, concomitant cervical stenosis should be ruled out in patients whose gait does not improve after shunt placement.
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Affiliation(s)
- Ryan M Naylor
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, United States
| | | | | | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Benjamin D Elder
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, United States; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States; Department of Biomedical Engineering, Mayo Clinic, Rochester, MN, United States.
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Gembruch O, Jabbarli R, Rashidi A, Chihi M, El Hindy N, Wetter A, Hütter BO, Sure U, Dammann P, Özkan N. Degenerative Cervical Myelopathy in Higher-Aged Patients: How Do They Benefit from Surgery? J Clin Med 2019; 9:jcm9010062. [PMID: 31888031 PMCID: PMC7019793 DOI: 10.3390/jcm9010062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/17/2019] [Accepted: 12/24/2019] [Indexed: 01/16/2023] Open
Abstract
Background: Degenerative cervical myelopathy (DCM) is the most common reason for spinal cord disease in elderly patients. This study analyzes the preoperative status and postoperative outcome of higher-aged patients in comparison to young and elderly patients in order to determine the benefit to those patients from DCM surgery. Methods: A retrospective analysis of the clinical data, radiological findings, and operative reports of 411 patients treated surgically between 2007 and 2016 suffering from DCM was performed. The preoperative and postoperative neurological functions were evaluated using the modified Japanese Orthopedic Association Score (mJOA Score), the postoperative mJOA Score improvement, the neurological recovery rate (NRR) of the mJOA Score, and the minimum clinically important difference (MCID). The Charlson Comorbidity Index (CCI) was used to evaluate the impact of comorbidities on the preoperative and postoperative mJOA Score. The comparisons were performed between the following age groups: G1: ≤50 years, G2: 51–70 years, and G3: >70 years. Results: The preoperative and postoperative mJOA Score was significantly lower in G3 than in G2 and G1 (p < 0.0001). However, the mean mJOA Score’s improvement did not differ significantly (p = 0.81) between those groups six months after surgery (G1: 1.99 ± 1.04, G2: 2.01 ± 1.04, G: 2.00 ± 0.91). Furthermore, the MCID showed a significant improvement in every age-group. The CCI was evaluated for each age-group, showing a statistically significant group effect (p < 0.0001). Analysis of variance revealed a significant group effect on the delay (weeks) between symptom onset and surgery (p = 0.003). The duration of the stay at the hospital did differ significantly between the age groups (p < 0.0001). Conclusion: Preoperative and postoperative mJOA Scores, but not the extent of postoperative improvement, are affected by the patients’ age. Therefore, patients should be considered for DCM surgery regardless of their age.
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Affiliation(s)
- Oliver Gembruch
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
- Correspondence: ; Tel.: +49-(0)201-723-1201; Fax: +49-(0)201-723-5909
| | - Ramazan Jabbarli
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Ali Rashidi
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Mehdi Chihi
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Nicolai El Hindy
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
- Spine-Center Werne, Katholisches Klinikum Lünen/Werne GmbH, St. Christophorus-Krankenhaus, Am See 1, 59368 Werne, Germany
| | - Axel Wetter
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Bernd-Otto Hütter
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Neriman Özkan
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
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Chen YC, Kuo CH, Cheng CM, Wu JC. Recent advances in the management of cervical spondylotic myelopathy: bibliometric analysis and surgical perspectives. J Neurosurg Spine 2019; 31:299-309. [DOI: 10.3171/2019.5.spine18769] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/06/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVECervical spondylotic myelopathy (CSM) has become a prevalent cause of spinal cord dysfunction among the aging population worldwide. Although great strides have been made in spine surgery in past decades, the optimal timing and surgical strategy to treat CSM have remained controversial. In this article the authors aimed to analyze the current trends in studies of CSM and to summarize the recent advances of surgical techniques in its treatment.METHODSThe PubMed database was searched using the keywords pertaining to CSM in human studies that were published between 1975 and 2018. Analyses of both the bibliometrics and contents, including the types of papers, authors, affiliations and countries, number of patients, and the surgical approaches were conducted. A systematic review of the literature was also performed with emphasis on the diagnosis and treatment of mild CSM.RESULTSA total of 1008 papers published during the span of 44 years were analyzed. These CSM studies mainly focused on the natural history, diagnosis, and treatment, and only a few prospective randomized trials were reported. For the authors and affiliations, there was a shift of clustering of papers toward Asian countries in the past decades. Regarding the treatment for CSM, there was an exponential growth of surgical series published, and there was a trend toward slightly more anterior than posterior approaches through the past decade. Patients with CSM had increased risks of neurological deterioration or spinal cord injury with nonoperative management. Because surgery might reduce the risks, and early surgery was likely to be correlated with better outcomes, there was a trend toward attention to mildly symptomatic CSM.CONCLUSIONSThere is emerging enthusiasm for research on CSM worldwide, with more publications originating in Asian countries over the past few decades. The surgical management of CSM is evolving continuously toward early and anterior approaches. More prospective investigations on the optimal timing and choices of surgery are therefore needed.
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Affiliation(s)
- Yu-Chun Chen
- 1School of Medicine, National Yang-Ming University, Taipei
- 2Department of Family Medicine, Taipei Veterans General Hospital
- 3Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei
| | - Chao-Hung Kuo
- 1School of Medicine, National Yang-Ming University, Taipei
- 4Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital; and
- 5Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Chieh-Ming Cheng
- 4Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital; and
| | - Jau-Ching Wu
- 1School of Medicine, National Yang-Ming University, Taipei
- 4Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital; and
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Abstract
OBJECTIVE Cervical spondylotic myelopathy is a common cause of neurological disability, especially in aging populations. There are several approaches to decompress the cervical spinal cord, including anterior cervical discectomy and fusion, corpectomy and fusion, arthroplasty, posterior cervical laminectomy with or without fusion, and laminoplasty. Less well described is minimally invasive cervical laminectomy. The authors report their technique and results for minimally invasive cervical laminectomy. MATERIALS AND METHODS The authors describe in detail their surgical technique and results of 30 consecutive cases. Preoperative and postoperative modified Japanese Orthopaedic Association (mJOA) myelopathy scores were recorded. RESULTS In total, 30 cases were included. Mean age was 69 years (range, 57-89 y). Twelve procedures were at C3-4, 4 at C4-5, 5 at C5-6, 4 at C7-T1, 3 at C3-4 and C4-5, 1 at C4-5 and C5-6, and 1 at C5-6 and C6-7. Mean preoperative mJOA score was 12.1 (range, 4-15). Average length of surgery was 142 minutes. Mean follow-up was 27 months (range, 3-64 mo). At 3 months, mean postoperative mJOA score was 14.0 (range, 5-17). Mean mJOA improvement of 1.9 was statistically significant (P<0.001). Seventeen patients had magnetic resonance imaging (MRI) available at 3 months postoperatively (5 patients had no MRI, 3 patients had MRI contraindications, and 5 are pending). No MRI findings led to further surgery. There were no durotomies and no wound infections. A single patient had an unexplained new neurological deficit that resolved over 6 months. CONCLUSIONS Minimally invasive laminectomy for cervical myelopathy is safe and effective and may be an underutilized procedure.
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Badran A, Davies BM, Bailey HM, Kalsi-Ryan S, Kotter MRN. Is there a role for postoperative physiotherapy in degenerative cervical myelopathy? A systematic review. Clin Rehabil 2018; 32:1169-1174. [DOI: 10.1177/0269215518766229] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To review peer-reviewed literature relating to postoperative physiotherapy for degenerative cervical myelopathy (DCM), to determine efficacy in improving clinical outcome and recovery. Data sources: MEDLINE, EMBASE, CENTRAL, PEDro, ISRCTN registry, WHO ICTRP and Clinicaltrials.gov . References and citations of relevant articles were searched. Methods: A systematic search was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO CRD42016039511) from the origins of the databases till 15 February 2018. Included were all studies investigating physiotherapy as an intervention after surgical treatment of DCM to determine effect on clinical outcome and recovery. Study quality was determined using the Grades of Recommendation, Assessment, Development and Evaluation guidelines. Results: In all, 300 records were identified through tailored systematic searches, after removing duplicates. After screening, only one investigated postoperative rehabilitation using physiotherapy for DCM; however, this was retrospective with no controls. This study suggested that rehabilitation including physiotherapy improved postoperative recovery. There are currently two registered trials investigating the use of postoperative physiotherapy for DCM. Conclusions: The literature provides insufficient evidence to make any evidence-based recommendations regarding postoperative physiotherapy use in DCM.
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Affiliation(s)
- Abdul Badran
- Churchill College and University of Cambridge, Cambridge, UK
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
| | - Benjamin M Davies
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
| | - Heidi-Marie Bailey
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
| | - Sukhvinder Kalsi-Ryan
- Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Mark RN Kotter
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
- Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
- WT MRC Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK
- John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
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Madhavan K, Chieng LO, Gaynor BG, Levi AD. Transdural approach to resection of retro-odontoid cysts in elderly patients: report of 3 cases. J Neurosurg Spine 2018; 28:236-243. [DOI: 10.3171/2017.6.spine17429] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Retro-odontoid cysts that arise from the tectorial membrane are uncommon lesions that can occur in elderly patients. They arise secondary to degenerative changes, including calcium pyrophosphate deposition within the ligaments. Surgical treatment is indicated when these lesions result in intractable pain, instability, and/or myelopathy. Several surgical techniques to treat this condition exist, but the optimal approach in elderly patients with comorbidities remains controversial. Here, the authors present a case series of 3 patients who underwent successful resection of a retro-odontoid lesion performed through a transdural approach.The patients were 70, 81, and 74 years old and presented with symptoms of cervical myelopathy. In consideration of their advanced age and the location of their lesion, resection via a posterior approach was considered. A 1- to 2-cm suboccipital craniectomy and C-1 and partial C-2 laminectomy were performed. These lesions could not be accessed via an extradural posterolateral approach, and so a transdural approach was performed. In the first 2 patients, a preexisting deformity prompted an instrumented fusion. In the third patient, only a lesion resection was performed. In each case, the dural opening was made using a paramedian ipsilateral-sided incision, and the lesion was resected through an incision in the anterior dura mater. Only the posterior dura was closed primarily. MR imaging evidence of excellent spinal cord decompression was evident in follow-up examinations.Transdural resection of retro-odontoid cysts is a viable option for treating asymmetrical ventral extradural cysts. Results from this case series suggest that such an approach is safe and feasible and can provide an alternative to open or endoscopic anterior transpharyngeal approaches.
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Youn MS, Shin JK, Goh TS, Lee JS. Full endoscopic lumbar interbody fusion (FELIF): technical note. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:1949-1955. [PMID: 29445951 DOI: 10.1007/s00586-018-5521-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 01/17/2018] [Accepted: 02/10/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Interbody fusion by open discectomy is the usual treatment for degenerative lumbar disease but requires a relatively long recovery period. Prevalent several interbody fusion methods have shown limitations by its own character. Full endoscopic lumbar interbody fusion (FELIF) has advantages in direct decompression of pathology with minimal invasive technique. We report novel technique of endoscopic fusion method through full guided with endoscopic view monitoring system. METHODS The authors provide an introduction of FELIF technique followed by a description of the technical steps with discussion on its indications and advantages. In particular, tips to shorten operation time, simplify technical steps, and avoid complications are also presented. CONCLUSIONS FELIF is a safe and effective interbody fusion option to decompress the lumbar exiting nerve root and ventral side of dura directly with minimal invasive situation. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Myung Soo Youn
- Department of Orthopaedic Surgery, Myungeun Hospital, 184 World Cup-daero, Yeonje-gu, Busan, 47521, South Korea
| | - Jong Ki Shin
- Department of Orthopaedic Surgery, Myungeun Hospital, 184 World Cup-daero, Yeonje-gu, Busan, 47521, South Korea.
| | - Tae Sik Goh
- Department of Orthopaedic Surgery, Biomedical Research Institute, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 49241, South Korea
| | - Jung Sub Lee
- Department of Orthopaedic Surgery, Biomedical Research Institute, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 49241, South Korea
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Stricsek G, Gillick J, Rymarczuk G, Harrop JS. Managing the Complex Patient with Degenerative Cervical Myelopathy: How to Handle the Aging Spine, the Obese Patient, and Individuals with Medical Comorbidities. Neurosurg Clin N Am 2017; 29:177-184. [PMID: 29173431 DOI: 10.1016/j.nec.2017.09.014] [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] [Indexed: 11/18/2022]
Abstract
Degenerative cervical myelopathy (DCM) is the most common cause of nontraumatic spinal cord injury worldwide. Even relatively mild impairment in functional scores can significantly impact daily activities. Surgery is an effective treatment for DCM, but outcomes are dependent on more than technique and preoperative neurologic deficits.
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Affiliation(s)
- Geoffrey Stricsek
- Department of Neurological Surgery, Jack and Vickie Farber Institute for Neuroscience, Thomas Jefferson University, 909 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA
| | - John Gillick
- Spine Division, Department of Neurological Surgery, Jack and Vickie Farber Institute for Neuroscience, Thomas Jefferson University, 909 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA
| | - George Rymarczuk
- Spine Division, Department of Neurological Surgery, Jack and Vickie Farber Institute for Neuroscience, Thomas Jefferson University, 909 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA
| | - James S Harrop
- Division of Spine and Peripheral Nerve Surgery, Department of Neurological Surgery, Jack and Vickie Farber Institute for Neuroscience, Thomas Jefferson University, 909 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA.
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Takeshima Y, Matsuoka R, Nakagawa I, Nishimura F, Nakase H. Surgical Outcome of Laminoplasty for Cervical Spondylotic Myelopathy in an Elderly Population - Potentiality for Effective Early Surgical Intervention: A Meta-analysis. Neurol Med Chir (Tokyo) 2017; 57:366-373. [PMID: 28529246 PMCID: PMC5566709 DOI: 10.2176/nmc.ra.2016-0302] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A systematic review and meta-analysis was conducted to determine differences in surgical outcomes of laminoplasty for cervical spondylotic myelopathy (CSM) between elderly and non-elderly patients. PubMed and Google Scholar searches were performed using several key words and phrases related to cervical laminoplasty in elderly populations. Included studies were written in English, addressed laminoplasty for cervical spondylotic myelopathy, and evaluated outcomes of the treatment. Statistical analysis was performed using a random-effect model. The heterogeneity of the studies was assessed using Cochran's Q statistic and I2 statistic, and a funnel plot was constructed to evaluate publication bias. The search initially identified 255 articles on this topic. Nine clinical studies that met all inclusion criteria were included in the meta-analysis. A total of 1817 patients in these studies underwent cervical laminoplasty. Elderly patients had lower preoperative and postoperative Japanese Orthopedic Association (JOA) scores, and lower recovery rates based on JOA scores. Shorter operation times and reductions in intraoperative blood loss were found in the elderly group compared to the non-elderly group. The incidence of C5 palsy was not different between these groups. We here report the differences in surgical outcomes of laminoplasty for CSM through systematic review and meta-analysis. This report found poor surgical outcomes and lower preoperative JOA scores in elderly patients. Therefore, early surgical intervention may be recommended in elderly patients with CSM.
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Affiliation(s)
| | - Ryuta Matsuoka
- Department of Neurosurgery, Nara Medical University School of Medicine
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University School of Medicine
| | | | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University School of Medicine
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Sohn HM, Hwang JY, Ryu JH, Kim J, Park S, Park JW, Han SH. Simvastatin protects ischemic spinal cord injury from cell death and cytotoxicity through decreasing oxidative stress: in vitro primary cultured rat spinal cord model under oxygen and glucose deprivation-reoxygenation conditions. J Orthop Surg Res 2017; 12:36. [PMID: 28241838 PMCID: PMC5330028 DOI: 10.1186/s13018-017-0536-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/15/2017] [Indexed: 01/21/2023] Open
Abstract
Background Ischemia and the following reperfusion damage are critical mechanisms of spinal cord injury. Statins have been reported to decrease ischemia–reperfusion injury in many organs including the spinal cord. Anti-oxidative effect is one of the main protective mechanisms of statin against neuronal death and cytotoxicity. We hypothesized that statins’ anti-oxidative property would yield neuroprotective effects on spinal cord ischemia–reperfusion injury Methods Primary cultured spinal cord motor neurons were isolated from Sprague–Dawley rat fetuses. Ischemia–reperfusion injury model was induced by 60 min of oxygen and glucose deprivation (OGD) and 24 h of reoxygenation. Healthy and OGD cells were treated with simvastatin at concentrations of 0.1, 1, and 10 μM for 24 h. Cell viability was assessed using water-soluble tetrazolium salt (WST)-8, cytotoxicity with LDH, and production of free radicals with DCFDA (2′,7′-dichlorofluorescein diacetate). Results OGD reduced neuronal viability compared to normoxic control by 35.3%; however, 0.1–10 μM of simvastatin treatment following OGD improved cell survival. OGD increased LDH release up to 214%; however, simvastatin treatment attenuated its cytotoxicity at concentrations of 0.1–10 μM (p < 0.001 and p = 0.001). Simvastatin also reduced deteriorated morphological changes of motor neurons following OGD. Oxidative stress was reduced by simvastatin (0.1–10 μM) compared to untreated cells exposed to OGD (p < 0.001). Conclusions Simvastatin effectively reduced spinal cord neuronal death and cytotoxicity against ischemia–reperfusion injury, probably via modification of oxidative stress.
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Affiliation(s)
- Hye-Min Sohn
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Jin-Young Hwang
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jung-Hee Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Jinhee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Seongjoo Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Jin-Woo Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Sung-Hee Han
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
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Surgical treatment of multilevel cervical spondylosis in patients with or without a history of syringomyelia. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:948-957. [PMID: 28190207 DOI: 10.1007/s00586-017-4977-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/05/2017] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Cervical spondylotic myelopathy (CSM) is the commonest spinal cord disease in adults. This paper compares patients who developed CSM after successful treatment of syringomyelia to those with CSM exclusively related to degenerative spinal disease. METHODS In this prospective study, 70 consecutive patients with CSM and spondylotic changes in at least three levels underwent 73 operations between 2005 and 2015 (mean follow-up: 39 ± 36 months). Patients with treated syringomyelia (group A, n = 30) and those without (group B, n = 40) were distinguished. Japanese Orthopaedic Association (JOA) and European Myelopathy scores (EMS), Karnofksy scores, and scores for individual symptoms were compared. Long-term outcomes were analyzed with progression-free survival rates. RESULTS Patients of group A were significantly younger with a significantly longer history and lower functional scores compared to group B. 59 laminectomies C3-C6 plus lateral mass fixations, six ventral decompressions with fusion, and eight combined approaches were performed. In both groups, mean JOA (A 9.5 ± 4.3-10.0 ± 4.7; B 11.3 ± 3.7-12.3 ± 4.3), EMS (A 11.4 ± 2.9-12.0 ± 3.1; B 12.2 ± 3.1-13.5 ± 3.3), and Karnofsky scores (A 59 ± 18-62 ± 18; B 68 ± 13-72 ± 15) increased in the first postoperative year with lower scores in group A throughout. Rates for progression-free survival for 5 years were similar in both groups (A 64.2%, B 65.6%). CONCLUSION Patients with CSM benefit from decompressive surgery. Surgery should be advocated early for all symptomatic patients with a history of syringomyelia. These patients are at risk for diagnostic delay and worse postoperative results.
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