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Drain JP, Alvarez P, Spiker WR, Yu E. Deformity Considerations in Cervical Laminoplasty: A Narrative Review. Clin Spine Surg 2024:01933606-990000000-00340. [PMID: 39056550 DOI: 10.1097/bsd.0000000000001666] [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] [Received: 03/11/2023] [Accepted: 06/28/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVES We discuss the incidence of postoperative kyphosis following laminoplasty and its impact on outcomes, as well as critical radiographic parameters, intraoperative technical factors, and postoperative protocols that can be used to improve results. SUMMARY OF BACKGROUND DATA When appropriately selected, cervical laminoplasty is a motion-sparing treatment option for cervical myelopathy and is a valid alternative to laminectomy and fusion procedures. However, like other posterior-based cervical decompression techniques, laminoplasty can cause postoperative kyphosis. METHODS A PubMed search was performed to gather articles that focus on cervical deformity in the context of cervical laminoplasty. RESULTS The reported conversion rates of lordotic to kyphotic cervical alignment after laminoplasty range from 5.2% to 11.3%. Kyphosis likely reduces the benefit from the operation as measured by postoperative mJOA scores. A surgeon can minimize the risk of causing a clinically significant reduction in lordosis by screening out patients with certain radiographic characteristics. Intraoperative decisions such as dissection techniques, levels chosen, and hybrid constructs can preserve the cervical tension band. Certain postoperative protocols can improve cervical posture. CONCLUSIONS Cervical laminoplasty is an effective tool for treating degenerative cervical myelopathy. Careful radiographic screening, intraoperative decision-making, and postoperative protocols can minimize the development of postoperative cervical deformity and improve outcomes. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Joseph P Drain
- Department of Orthopaedics, The Ohio State University, Columbus
| | - Paul Alvarez
- Department of Orthopaedics, The Ohio State University, Columbus
| | | | - Elizabeth Yu
- Department of Orthopaedics, The Ohio State University, Columbus
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Kim DH, Hong JT, Hur JW, Kim IS, Lee HJ, Lee JB. Clinical and Radiological Outcomes in C2 Recapping Laminoplasty for the Pathologies in the Upper Cervical Spine. Neurospine 2024; 21:565-574. [PMID: 38955529 PMCID: PMC11224761 DOI: 10.14245/ns.2347270.635] [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: 11/22/2023] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE To evaluate C2 muscle preservation effect and the radiological and clinical outcomes after C2 recapping laminoplasty. METHODS Fourteen consecutive patients who underwent C2 recapping laminoplasty around C1-2 level were enrolled. To evaluate muscle preservation effect, the authors conducted a morphological measurement of extensor muscles between the operated and nonoperated side. Two surgeons measured the cross-sectional area (CSA) of obliquus capitis inferior (OCI) and semispinalis cervicis (SSC) muscle before and after surgery to determine atrophy rates (ARs). Additionally, we examined range of motion (ROM), sagittal vertical axis (SVA), neck visual analogue scale (VAS), Neck Disability Index (NDI), and Japanese Orthopaedic Association (JOA) score to assess potential changes in alignment and consequent clinical outcomes following posterior cervical surgery. RESULTS We measured the CSA of OCI and SSC before surgery, and at 6 and 12 months postoperatively. Based on these measurements, the AR of the nonoperated SSC was 0.1% ± 8.5%, the AR of the operated OCI was 2.0% ± 7.2%, and the AR of the nonoperated OCI was -0.7% ± 5.1% at the 12 months after surgery. However, the AR of the operated side's SSC was 11.2% ± 12.5%, which is a relatively higher value than other measurements. Despite the atrophic change of SSC on the operated side, there were no prominent changes observed in SVA, C0-2 ROM, and C2-7 ROM between preoperative and 12 months postoperative measurements, which were 11.8 ± 10.9 mm, 16.3° ± 5.9°, and 48.7° ± 7.7° preoperatively, and 14.1 ± 11.6 mm, 16.1° ± 7.2°, and 44.0° ± 10.3° at 12 months postoperative, respectively. Improvement was also noted in VAS, NDI, and JOA scores after surgery with JOA recovery rate of 77.3% ± 29.6%. CONCLUSION C2 recapping laminoplasty could be a useful tool for addressing pathologies around the upper cervical spine, potentially mitigating muscle atrophy and reducing postoperative neck pain, while maintaining sagittal alignment and ROM.
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Affiliation(s)
- Dong Hun Kim
- Department of Neurosurgery, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jae Taek Hong
- Department of Neurosurgery, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jung Woo Hur
- Department of Neurosurgery, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Il Sup Kim
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, Suwon, Korea
| | - Ho Jin Lee
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jong Beom Lee
- Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Korea
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Lee DH, Lee HR, Riew KD. An Algorithmic Roadmap for the Surgical Management of Degenerative Cervical Myelopathy: A Narrative Review. Asian Spine J 2024; 18:274-286. [PMID: 38146052 PMCID: PMC11065509 DOI: 10.31616/asj.2023.0413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023] Open
Abstract
Degenerative cervical myelopathy (DCM) is a leading cause of disability, and its surgical management is crucial for improving patient neurological outcomes. Given the varied presentations and severities of DCM, treatment options are diverse. Surgeons often face challenges in selecting the most appropriate surgical approach because there is no universally correct answer. This narrative review aimed to aid the decision-making process in treating DCM by presenting a structured treatment algorithm. The authors categorized surgical scenarios based on an algorithm, outlining suitable treatment methods for each case. Four primary scenarios were identified based on the number of levels requiring surgery and K-line status: (1) K-line (+) and ≤3 levels, (2) K-line (+) and ≥3 levels, (3) K-line (-) and ≤3 levels, and (4) K-line (-) and ≥3 levels. This categorization aids in determining the appropriateness of anterior or posterior approaches and the necessity for fusion, considering the surgical level and K-line status. The complexity of surgical situations and diversity of treatment methods for DCM can be effectively managed using an algorithmic approach. Furthermore, surgical techniques that minimize the stages and address challenging conditions could enhance treatment outcomes in DCM.
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Affiliation(s)
- Dong-Ho Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Hyung Rae Lee
- Department of Orthopaedic Surgery, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu,
Korea
| | - Kiehyun Daniel Riew
- Department of Orthopaedic Surgery, New York-Presbyterian Och Spine Hospital, Columbia University, New York, NY,
USA
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Macki M, Chryssikos T, Meade SM, Aabedi AA, Letchuman V, Ambati V, Krishnan N, Tawil ME, Tichelaar S, Rivera J, Chan AK, Tan LA, Chou D, Mummaneni P. Multilevel Laminoplasty for CSM: Is C3 Laminectomy Better Than C3 Laminoplasty at the Superior Vertebra? J Clin Med 2023; 12:7594. [PMID: 38137663 PMCID: PMC10743713 DOI: 10.3390/jcm12247594] [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: 10/28/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION In a multilevel cervical laminoplasty operation for patients with cervical spondylotic myelopathy (CSM), a partial or complete C3 laminectomy may be performed at the upper level instead of a C3 plated laminoplasty. It is unknown whether C3 technique above the laminoplasty affects loss of cervical lordosis or range of motion. METHODS Patients undergoing multilevel laminoplasty of the cervical spine (C3-C6/C7) at a single institution were retrospectively reviewed. Patients were divided into two cohorts based on surgical technique at C3: C3-C6/C7 plated laminoplasty ("C3 laminoplasty only", N = 61), C3 partial or complete laminectomy, plus C4-C6/C7 plated laminoplasty (N = 39). All patients had at least 1-year postoperative X-ray treatment. RESULTS Of 100 total patients, C3 laminoplasty and C3 laminectomy were equivalent in all demographic data, except for age (66.4 vs. 59.4 years, p = 0.012). None of the preoperative radiographic parameters differed between the C3 laminoplasty and C3 laminectomy cohorts: cervical lordosis (13.1° vs. 11.1°, p = 0.259), T1 slope (32.9° vs. 29.2°, p = 0.072), T1 slope-cervical lordosis (19.8° vs. 18.6°, p = 0.485), or cervical sagittal vertical axis (3.1 cm vs. 2.7 cm, p = 0.193). None of the postoperative radiographic parameters differed between the C3 laminoplasty and C3 laminectomy cohorts: cervical lordosis (9.4° vs. 11.2°, p = 0.369), T1 slope-cervical lordosis (21.7° vs. 18.1°, p = 0.126), to cervical sagittal vertical axis (3.3 cm vs. 3.6 cm, p = 0.479). In the total cohort, 31% had loss of cervical lordosis >5°. Loss of lordosis reached 5-10° (mild change) in 13% of patients and >10° (moderate change) in 18% of patients. C3 laminoplasty and C3 laminectomy cohorts did not differ with respect to no change (<5°: 65.6% vs. 74.3%, respectively), mild change (5-10°: 14.8% vs. 10.3%), and moderate change (>10°: 19.7% vs. 15.4%) in cervical lordosis, p = 0.644. When controlling for age, ordinal regression showed that surgical technique at C3 did not increase the odds of postoperative loss of cervical lordosis. C3 laminectomy versus C3 laminoplasty did not differ in the postoperative range of motion on cervical flexion-extension X-rays (23.9° vs. 21.7°, p = 0.451, N = 91). CONCLUSION There was no difference in postoperative loss of cervical lordosis or postoperative range of motion in patients who underwent either C3-C6/C7 plated laminoplasty or C3 laminectomy plus C4-C6/C7 plated laminoplasty.
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Affiliation(s)
- Mohamed Macki
- Cleveland Clinic Center for Spine Health, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
| | - Timothy Chryssikos
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
| | - Seth M. Meade
- Cleveland Clinic Center for Spine Health, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Alexander A. Aabedi
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
| | - Vijay Letchuman
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
| | - Vardhaan Ambati
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
| | - Nishanth Krishnan
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
- University of California San Francisco Medical School, University of California San Francisco, San Francisco, CA 94143, USA
| | - Michael E. Tawil
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
| | - Seth Tichelaar
- Department of Neurosurgery, Stanford University, Stanford, CA 94305, USA
| | - Joshua Rivera
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
| | - Andrew K. Chan
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
| | - Lee A. Tan
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
| | - Dean Chou
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
| | - Praveen Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
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Lee DH, Park S, Cho JH, Hwang CJ, Yang JJ, Lee CS. Risk Factors for Postoperative Loss of Lordosis, Cervical Kyphosis, and Sagittal Imbalance After Cervical Laminoplasty. World Neurosurg 2023; 180:e324-e333. [PMID: 37757942 DOI: 10.1016/j.wneu.2023.09.068] [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: 08/31/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE A retrospective cohort study was undertaken to elucidate the risk factors of loss of cervical lordosis (LCL), kyphotic deformity, and sagittal imbalance after cervical laminoplasty. METHODS A total of 108 patients who underwent laminoplasty to treat cervical myelopathy and were followed for ≥2 years were included. Logistic regression analysis and multiple regression analysis were performed to identify preoperative risk factors of LCL, kyphotic deformity (cervical lordosis <0°), and sagittal imbalance (sagittal vertical axis >40 mm) at postoperative 2 years. RESULTS Within multivariate multiple regression analysis, C2-C7 lordosis (P = 0.002), and C2-C7 extension capacity (P<0.001) showed significant association with LCL. Furthermore, age (P = 0.043) and C2-C7 lordosis (P = 0.038) were significantly associated with postoperative kyphosis. Receiver operating characteristic curve analysis for postoperative kyphosis showed that preoperative C2-C7 lordosis of 10.5° had a sensitivity and specificity of 81.3% and 82.4%, respectively. Preoperative K-line tilt (P = 0.034) showed a significant association with postoperative cervical sagittal imbalance at postoperative 2 years. Receiver operating characteristic curve analysis showed that a K-line tilt cutoff value of 12.5° had a sensitivity and specificity of 78.6% and 77.7%, respectively, for predicting postoperative sagittal imbalance. CONCLUSIONS Higher preoperative C2-C7 lordosis and less preoperative cervical extension capacity were risk factors of LCL. Small preoperative C2-C7 lordosis <10.5° and younger age were risk factors of postoperative kyphosis. Furthermore, a greater K-line tilt would increase the risk of postoperative sagittal imbalance, with a cutoff value of 12.5°.
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Affiliation(s)
- Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sehan Park
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Jun Yang
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido, Republic of Korea
| | - Choon Sung Lee
- Department of Orthopedic Surgery, Gangnam Saint Peter's Hospital, Seoul, Republic of Korea
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Varol E. Influence of Spinopelvic Alignment on the Clinical Outcomes Following Decompression Surgery for Lumbar Stenosis. Cureus 2023; 15:e46302. [PMID: 37790867 PMCID: PMC10544506 DOI: 10.7759/cureus.46302] [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: 09/28/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction The role of sagittal spinopelvic alignment in lumbar spinal stenosis (LSS) patients and its potential influence on post-decompression surgery outcomes is a topic of growing interest. Lumbar spinal stenosis is a prevalent degenerative condition, and with an aging population, the frequency of surgical interventions for LSS has risen. While decompression surgery aims to relieve symptoms, the potential impact of preoperative spinopelvic alignment on postoperative results remains controversial. This study examined the correlation between sagittal spinopelvic parameters and clinical outcomes in LSS patients undergoing decompression surgery. Methods This study included 100 patients with LSS who underwent decompression surgery between 2021 and 2023 and 100 healthy individuals as a control group. The LSS group comprised 50 men and 50 women, with a mean age of 55.8±12.41 years, while the control group consisted of 50 men and 50 women, with a mean age of 55.17±13.39 years. Sagittal spinopelvic alignment parameters, including pelvic tilt (PT), pelvic incidence-lumbar lordosis mismatch, and sagittal vertical axis, were assessed preoperatively. Postoperative clinical outcomes were evaluated using the visual analog scale (VAS) and Oswestry disability index (ODI) scores. Results In the cohort of 200 participants, 100 were diagnosed with lumbar spinal stenosis (LSS), and 100 were healthy controls. Both groups had an equal gender distribution (50 males and 50 females). The mean age was 55.8 (±12.4) years for the LSS group and 55.2 (±13.4) years for the control group. Among the analyzed radiographic parameters, only lumbar lordosis (LL) levels showed a significant difference between groups, notably lower in the LSS group (p=0.020). Preoperative VAS scores in LSS patients averaged 7.58±1.32, which postoperatively dropped to 2.22±1.95 (p<0.001). Similarly, ODI (%) declined from a preoperative average of 55.76±11.65 to 18.62±18.17 postoperatively (p<0.001). Patients with postoperative ODI levels exceeding 20% had higher preoperative scores and significantly altered radiographic measurements. The receiver operating characteristic (ROC) analysis indicated PT as the most predictive radiographic parameter, with an area under the curve (AUC) of 0.945. Multivariate logistic regression pinpointed PT and LL as key predictors associated with increased risks for postoperative Oswestry disability levels exceeding 20%. Conclusion Our study suggests that sagittal spinopelvic alignment plays an important role in the development and progression of LSS. Addressing sagittal alignment may be crucial for achieving optimal clinical outcomes after decompression surgery. Further research is needed to elucidate the mechanisms underlying the relationship between sagittal alignment and LSS.
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Affiliation(s)
- Eyüp Varol
- Neurological Surgery, Umraniye Training and Research Hospital, Istanbul, TUR
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Jimbayashi H, Iida K, Kazu K, Saiwai H, Kawaguchi K, Matsumoto Y, Nakashima Y. Cases requiring reoperation for recurrence of myelopathy by lamina closure after a double-door laminoplasty using a modified Kirita-Miyazaki suture method. J Orthop 2023; 44:12-16. [PMID: 37649794 PMCID: PMC10462786 DOI: 10.1016/j.jor.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/30/2023] [Accepted: 07/21/2023] [Indexed: 09/01/2023] Open
Abstract
Background Progression of kyphosis after laminoplasty sometimes results in the recurrence of myelopathy with lamina closure. However, only a few case reports have been published on the reoperation of double-door laminoplasty using the suture method. This study investigated the incidence and clinical features of reoperation cases caused by the recurrence of myelopathy with lamina closure after double-door laminoplasty using a modified Kirita-Miyazaki suture method. Methods A total of 169 patients who underwent double-door laminoplasty were included in this study, with a mean follow-up duration of 6.6 years (range: 2-16). All surgeries were double-door laminoplasties in which the open lamina was sutured to the paravertebral muscle. The reoperation rate for myelopathy recurrence due to lamina closure and the associated risk factors were investigated. The risk factors included age, history, cervical alignment, C2-7 lordosis, the cervical sagittal vertical axis, and C7 slope. Results The reoperation rate for recurrence of myelopathy by lamina closure was 3.0% (5/169). All patients showed kyphosis progression after surgery; the spinal cord was more compressed by closed lamina than before the initial surgery. The reoperation group had more patients with neuromuscular or psychiatric disorders (60% [3/5] vs. 2% [4/164]; p < 0.001), kyphotic alignments (60% [3/5] vs. 10% [16/164]; p < 0.001), and cases with less than -10° of C2-7 lordosis (60% [3/5] vs. 7% [11/164]; p < 0.001). Conclusions Double-door laminoplasty with the suture method may not be suitable for patients with a neuromuscular or psychiatric disease or those with preoperative C2-7 lordosis less than -10°.
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Affiliation(s)
- Hideki Jimbayashi
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Keiichiro Iida
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kobayakawa Kazu
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hirokazu Saiwai
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kenichi Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Du W, Wang HX, Lv J, Wang S, Shen Y, Zhang X, Chen R, Zhang L. Cervical alignment and clinical outcome of anterior cervical discectomy and fusion vs. anterior cervical corpectomy and fusion in local kyphotic cervical spondylotic myelopathy. Heliyon 2023; 9:e19106. [PMID: 37636480 PMCID: PMC10450976 DOI: 10.1016/j.heliyon.2023.e19106] [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: 01/28/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023] Open
Abstract
Background Cervical local kyphosis (CLK) is a common degenerative disorder with a potentially debilitating and intractable condition. Currently, there is still debate on the optimal treatment of local kyphotic cervical spondylotic myelopathy (LKCSM) via different anterior approaches. Objective The objective of this study was to evaluate the surgical efficacy of anterior cervical discectomy and fusion (ACDF) vs. anterior cervical corpectomy and fusion (ACCF) for the treatment of LKCSM. In addition, the cervical sagittal alignment parameters and axial symptoms (AS) severity after CLK correction were analyzed. Materials and methods From January 2016 and December 2020, 104 patients who suffered LKCSM were retrospectively reviewed. These patients underwent ACDF (n = 53) and ACCF (n = 51). Pre- and postoperatively, cervical sagittal alignment parameters were measured on the lateral X-rays, including local kyphotic angles (LKA), C2-7 Cobb angle, T1 slope, and C2-7 sagittal vertical axis (C2-7 SVA). The neurological recovery rate was calculated according to the Japanese Orthopedic Association (JOA) score. The AS severity was evaluated using Neck Disability Index (NDI). Results Significant differences (P < 0.05) were demonstrated between ACDF and ACCF groups regarding LKA, LKA correction, C2-7 Cobb angle, T1 slope, C2-7 SVA, NDI, NDI recovery and NDI ranking system. However, no significant differences (P > 0.05) existed in JOA score, recovery rate, and neurological recovery rate grade. In both groups, significant differences (P < 0.05) were demonstrated between pre- and postoperative LKA, T1 slope, C2-7 Cobb angle, C2-7 SVA, JOA score, and NDI. LKA correction showed the positive correlations with the recovery rate (r = 0.48, P < 0.001), and with the NDI recovery in ACDF group (r = 0.49, P < 0.001) and in ACCF group (r = 0.55, P < 0.001). Conclusions LKCSM with ≤3 segments of spinal cord compression can be improved with either ACDF or ACCF, resulting in satisfactory neurological outcomes. CLK correction can significantly improve the neurological function and AS, and increase the T1 slope and C2-7 SVA. However, ACDF was more favorable than ACCF in the CLK correction.
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Affiliation(s)
- Wei Du
- Department of Orthopedics, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, China
| | - Hai-Xu Wang
- Department of Orthopedics, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, China
| | - Jie Lv
- Department of Oral and Maxillofacial Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, China
| | - Shuai Wang
- Department of Orthopedics, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, China
| | - Yong Shen
- Department of Orthopedics, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, China
| | - Xu Zhang
- Department of Orthopedics, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, China
| | - Rong Chen
- Department of Neurology, Hebei Key Laboratory of Vascular Homeostasis and Hebei Collaborative Innovation Center for Cardio-cerebrovascular Disease, The Second Hospital of Hebei Medical University, 215 Hepingxi Road, 050000, Shijiazhuang, China
| | - Li Zhang
- Department of Orthopedics, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, China
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Merrill RK, Clohisy JC, Albert TJ, Qureshi SA. Concepts and Techniques to Prevent Cervical Spine Deformity After Spine Surgery: A Narrative Review. Neurospine 2023; 20:221-230. [PMID: 37016868 PMCID: PMC10080418 DOI: 10.14245/ns.2244780.390] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/22/2022] [Indexed: 04/03/2023] Open
Abstract
Adult cervical spine deformity is associated with decreased health-related quality of life, disability, and myelopathy. A number of radiographic parameters help to characterize cervical deformity and aid in the diagnosis and treatment. There are several etiologies for cervical spine deformity, the most common being iatrogenic. Additionally, spine surgery can accelerate adjacent segment degeneration which may lead to deformity. It is therefore important for all spine surgeons to be aware of the potential to cause iatrogenic cervical deformity. The aim of this review is to highlight concepts and techniques to prevent cervical deformity after spine surgery.
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Affiliation(s)
- Robert K. Merrill
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - John C. Clohisy
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Todd J. Albert
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sheeraz A. Qureshi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Corresponding Author Sheeraz A. Qureshi Department of Orthopedic Surgery, Minimally Invasive Spine Surgery, Hospital for Special Surgery, 535 East 70th Street, 4th Floor, New York, NY 10021, USA
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Preoperative Decreased Hounsfield Unit Values of Cervical Vertebrae and the Relative Cross-Sectional Area of Flexion/Extension Paraspinal Muscles Are Novel Risk Factors for the Loss of Cervical Lordosis after Open-Door Laminoplasty. J Clin Med 2023; 12:jcm12062119. [PMID: 36983121 PMCID: PMC10058530 DOI: 10.3390/jcm12062119] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
Open-door laminoplasty is widely used for patients with cervical spondylotic myelopathy (CSM). However, the loss of cervical lordosis (LCL) seems to be unavoidable in the long-term follow-up after surgery, which may affect the clinical outcomes. The risk factors for this complication are still unclear. In this study, patients who underwent open-door laminoplasty between April 2016 and June 2021 were enrolled. Cervical X-rays were obtained to measure the C2–7 Cobb angle, C2–7 sagittal vertical axis (SVA), T1 slope (T1S) and ranges of motion (ROM). Cervical computed tomography (CT) scans and magnetic resonance imaging (MRI) were collected to evaluate the cervical Hounsfield unit values (HU) and the relative cross-sectional area (RCSA) of paraspinal muscles, respectively. A total of 42 patients were included and the average follow-up period was 24.9 months. Among the patients, 24 cases (57.1%) had a LCL of more than 5° at a 1-year follow-up and were labeled as members of the LCL group. The follow-up JOA scores were significantly lower in the LCL group (13.9 ± 0.6 vs. 14.4 ± 0.8, p = 0.021) and the mean JOA recovery rate was negatively correlated with LCL (r = −0.409, p = 0.007). In addition, LCL was positively correlated to the preoperative T1S, flexion ROM, flexion/extension ROM and the RCSA of flexion/extension muscles, while it was negatively correlated to extension ROM and the HU value of cervical vertebrae. Furthermore, multiple linear regression showed that preoperative T1S, mean HU value of cervical vertebrae, flexion/extension ROM and the flexion/extension RCSA were independent risk factors for LCL. Spine surgeons should consider these parameters before performing open-door laminoplasty.
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Du W, Wang S, Wang H, Zhang J, Wang F, Zhang X, Shen Y. Cervical alignment and clinical outcome of open-door laminoplasty vs. laminectomy and instrumentation in kyphotic multilevel cervical degenerative myelopathy. Arch Orthop Trauma Surg 2023; 143:1429-1440. [PMID: 35066642 DOI: 10.1007/s00402-021-04316-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 12/13/2021] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The aim of this study was to determine whether the sagittal lordotic alignment, clinical outcomes and axial symptoms (AS) could be improved by kyphotic correction through the posterior approach for the treatment of multilevel cervical degenerative myelopathy (CDM) and to further analyze the changes of cervical spinal alignment parameters after correction of kyphosis. The hypothesis was that correction of kyphosis can improve the severity of AS and neurological recovery. MATERIALS AND METHODS We retrospectively reviewed 109 patients who suffered from multilevel CDM combined with kyphosis. The patients had undergone open-door laminoplasty (Group LP, 53 patients) and laminectomy with instrumentation (Group LI, 56 patients) between January 2014 and December 2018. Cervical spinal alignment parameters, including curvature index (CI), T1 slope, C2-7 Cobb angle, C2-7 SVA, were measured on the pre- and postoperative lateral radiographs. The recovery rate was calculated based on the Japanese Orthopedic Association (JOA) score. AS severity was quantified using Neck Disability Index (NDI). A P value less than 0.05 was considered to be significant. RESULTS Analyses of postoperative follow-up data showed significant differences (P < 0.001) in CI, correction of CI, C2-7 Cobb angle, T1 slope, C2-7 SVA and NDI between Group LP and LI, but no significant differences in JOA score (P = 0.23) and recovery rate (P = 0.13). There were significant differences (P < 0.001) in CI, T1 slope, C2-7 Cobb angle, C2-7 SVA, JOA score, and NDI between pre- and postoperative follow-up in both groups. Correction of CI showed negative correlation with AS severity (r = -0.51, P < 0.001), and no association with recovery rate (r = 0.14, P = 0.15). CONCLUSIONS Satisfied neurological improvement was achieved by LP and LI for multilevel CDM combined with kyphosis. Cervical kyphotic correction produced significant improvement of AS and increase of T1 slope and C2-7 SVA. However, the kyphotic correction may not be associated with better neurological recovery in the short-term postoperative period.
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Affiliation(s)
- Wei Du
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Shuai Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Haixu Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Jingtao Zhang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Feng Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Xu Zhang
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Yong Shen
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China.
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Lee HR, Lee DH, Seok SY, Lee WS, Kim M, Cho JH, Hwang CJ, Lee CS. Predictable factors for aggravation of cervical alignment after posterior cervical foraminotomy. J Neurosurg Spine 2023; 38:174-181. [PMID: 36208429 DOI: 10.3171/2022.8.spine22462] [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: 04/27/2022] [Accepted: 08/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to investigate the risk factors for aggravation of cervical alignment after posterior cervical foraminotomy (PCF) and to identify their relationships with kyphotic changes in cervical curvature. METHODS Ninety-eight patients who underwent PCF for unilateral radiculopathy and received follow-up for more than 2 years were retrospectively reviewed. Segmental Cobb angle (SA), cervical Cobb angle (CA), Pfirrmann grade, foraminal stenosis, and clinical outcomes including neck pain, arm pain, and Neck Disability Index scores were assessed. Radiological and clinical outcomes were compared between groups C (control group with kyphotic change in CA < 5°) and K (kyphotic group with kyphotic change in CA ≥ 5°). Multivariate regression analysis was performed to determine the risk factors for kyphotic change ≥ 5° after PCF. RESULTS Group K was significantly older than group C (p = 0.002) and had a higher Pfirrmann grade (p = 0.025). In group K, neck pain had significantly increased at last follow-up (p < 0.001). Multivariate linear regression analysis revealed that kyphotic changes in CA were related to older age (p = 0.016, B = 0.420) and Pfirrmann grade of the operative levels (p = 0.032, B = 4.560). Preoperative hypolordosis was not an independent risk factor for kyphotic changes in CA. Receiver operating characteristic curve analysis showed that the cutoff value for kyphotic changes in patients with CA ≥ 5° was Pfirrmann grade 3.417 (p = 0.008). CONCLUSIONS Contrary to previous studies, preoperative hypolordosis was not a risk factor for kyphotic changes in CA after PCF. Older patients with disc degeneration of Pfirrmann grade IV or greater for should be carefully considered.
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Affiliation(s)
- Hyung Rae Lee
- 1Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Uijeongbu-si, Gyeonggi-do, Republic of Korea
| | - Dong-Ho Lee
- 2Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; and
| | - Sang Yun Seok
- 3Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Daejeon, Republic of Korea
| | - Woon Sang Lee
- 2Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; and
| | - Minsoo Kim
- 2Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; and
| | - Jae Hwan Cho
- 2Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; and
| | - Chang Ju Hwang
- 2Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; and
| | - Choon Sung Lee
- 2Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; and
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Baker JD, Sayari AJ, Tao Y, Louie PK, Basques BA, Galbusera F, Niemeyer F, Wilke HJ, An HS, Samartzis D. Endplate abnormalities, Modic changes and their relationship to alignment parameters and surgical outcomes in the cervical spine. J Orthop Res 2023; 41:206-214. [PMID: 35398932 DOI: 10.1002/jor.25333] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/04/2022] [Accepted: 03/22/2022] [Indexed: 02/04/2023]
Abstract
Modic changes (MC) and endplate abnormalities (EA) have been shown to impact preoperative symptoms and outcomes following spinal surgery. However, little is known about how these phenotypes impact cervical alignment. This study aimed to evaluate the impact that these phenotypes have on preoperative, postoperative, and changes in cervical alignment in patients undergoing anterior cervical discectomy and fusion (ACDF). We performed a retrospective study of prospectively collected data of ACDF patients at a single institution. Preoperative magnetic resonance imagings (MRIs) were used to assess for the MC and EA. Patients were subdivided into four groups: MC-only, EA-only, the combined Modic-Endplate-Complex (MEC), and patients without either phenotype. Pre and postoperative MRIs were used to assess alignment parameters. Associations with imaging phenotypes and alignment parameters were assessed, and statistical significance was set at p < 0.5. A total of 512 patients were included, with 84 MC-only patients, 166 EA-only patients, and 71 patients with MEC. Preoperative MC (p = 0.031) and the MEC (p = 0.039) had significantly lower preoperative T1 slope compared to controls. Lower preoperative T1 slope was a risk factor for MC (p = 0.020) and MEC (p = 0.029) and presence of MC (Type II) and the MEC (Type III) was predictive of lower preoperative T1 slope. There were no differences in postoperative alignment measures or patient reported outcome measures. MC and endplate pathologies such as the MEC appear to be associated with worse cervical alignment at baseline relative to patients without these phenotypes. Poor alignment may be an adaptive response to these degenerative findings or may be a risk factor for their development.
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Affiliation(s)
- James D Baker
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois, USA
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois, USA
| | - Youping Tao
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Philip K Louie
- Department of Neurosurgery, Neuroscience Institute, Virginia Mason Franciscan Health, Seattle, Washington State, USA
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois, USA
| | | | - Frank Niemeyer
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Howard S An
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois, USA
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois, USA
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Pettersson SD, Skrzypkowska P, Ali S, Szmuda T, Krakowiak M, Počivavšek T, Sunesson F, Fercho J, Miękisiak G. Predictors for cervical kyphotic deformity following laminoplasty: a systematic review and meta-analysis. J Neurosurg Spine 2023; 38:4-13. [PMID: 36057129 DOI: 10.3171/2022.4.spine22182] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/05/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Laminoplasty is a common treatment for cervical spondylotic myelopathy (CSM) and for ossification of the posterior longitudinal ligament (OPLL). However, approximately 21% of patients undergoing laminoplasty develop cervical kyphotic deformity (KD). Because of the high prevalence rate of KD, several studies have sought to identify predictors for this complication, but the findings remain highly inconsistent. Therefore, the authors performed a systematic review and meta-analysis to establish reliable preoperative predictors of KD. METHODS PubMed, Scopus, and Web of Science databases were used to systematically extract potential references. The first phase of screening required the studies to be written in the English language, involve patients treated for CSM and/or OPLL via laminoplasty, and report postoperative cervical KD. The second phase required the studies to provide more than 10 patients and include a control group. The mean difference (MD) and odds ratio (OR) were calculated for continuous and dichotomous parameters. Study quality was evaluated using the Newcastle-Ottawa Scale. CSM and OPLL patients were further assessed by performing subgroup analyses. RESULTS Thirteen studies comprising patients who developed cervical KD (n = 296) and no KD (n = 1254) after receiving cervical laminoplasty for CSM or OPLL were included in the meta-analysis. All studies were retrospective cohorts and were rated as high quality. In the combined univariate analysis of CSM and OPLL patients undergoing laminoplasty, statistically significant predictors for postoperative KD included age (MD 2.22, 95% CI 0.16-4.27, p = 0.03), preoperative BMI (MD 0.85, 95% CI 0.06-1.63, p = 0.04), preoperative C2-7 range of flexion (MD 10.42, 95% Cl 4.24-16.59, p = 0.0009), preoperative C2-7 range of extension (MD -4.59, 95% CI -6.34 to -2.83, p < 0.00001), and preoperative center of gravity of the head to the C7 sagittal vertical axis (MD 26.83, 95% CI 9.13-44.52, p = 0.003). Additionally, among CSM patients, males were identified as having a greater risk for postoperative KD (OR 1.73, 95% CI 1.02-2.93, p = 0.04). CONCLUSIONS The findings from this study currently provide the largest and most reliable review on preoperative predictors for cervical KD after laminoplasty. Given that several of the included studies identified optimal cutoff points for the variables that are significantly associated with KD, further investigation into the development of a preoperative risk scoring system that can accurately predict KD in the clinical setting is encouraged. PROSPERO registration no.: CRD42022299795 (https://www.crd.york.ac.uk/PROSPERO/).
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Affiliation(s)
| | | | - Shan Ali
- 2Neurology Department, Mayo Clinic, Jacksonville, Florida; and
| | - Tomasz Szmuda
- 1Neurosurgery Department, Medical University of Gdansk, Poland
| | | | | | - Fanny Sunesson
- 1Neurosurgery Department, Medical University of Gdansk, Poland
| | - Justyna Fercho
- 1Neurosurgery Department, Medical University of Gdansk, Poland
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15
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Wei B, Liu W, Wu H. Analysis between preoperative cervical radiographic parameters represented by the K-line tilt and the short-term prognosis of laminoplasty for posterior longitudinal ligament ossification: A retrospective study. Front Surg 2022; 9:950707. [PMID: 36211268 PMCID: PMC9535077 DOI: 10.3389/fsurg.2022.950707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesTo investigate the relationship between preoperative radiographic parameters and the short-term prognosis of patients with cervical ossification of the posterior longitudinal ligament (OPLL) who underwent laminoplasty (LAMP).MethodsA retrospective analysis of Cervical OPLL 50 patients with K-line (+) OPLL with no cervical kyphosis who received LAMP was performed. Based on preoperative neutral position x-ray, the K-line tilt, C2–C7 SVA (sagittal vertical axis), CL (cervical lordosis), T1 slope, and T1 slope-CL were recorded. The JOA (Japanese orthopaedic association scores) score and the cervical kyphosis change were recorded 1 year after surgery. Patients were divided into good and poor prognosis groups according to the median (12.5) of the postoperative JOA score.ResultsThere were differences between the two groups in K-line tilt, C2–C7 SVA, and T1 slope (all ps < 0.05). There was a strong linear correlation between the three, K-Line tilt, JOA score, and C2–C7 SVA. The degree of influence of K-line tilt, C2–C7 SVA, T1 slope on postoperative JOA score was analyzed using multiple linear regression, and the absolute value of the standardized coefficient Beta were 0.550, 0.319, 0.185, respectively. There was no cervical kyphosis change 1 year after surgery.ConclusionAs preoperative cervical parameters, the influence of K-line tilt, C2–C7 SVA, and T1 slope on postoperative JOA score decreases in order. There was a linear relationship between preoperative K-line tilt and postoperative JOA score, implying that patients with cervical OPLL with high K-line tilt were not eligible for LAMP. K-line tilt was not predictive of cervical kyphosis change after LAMP in patients with OPLL at short-term follow-up.
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Affiliation(s)
- Baixing Wei
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Wanting Liu
- Department of Clinical Medicine, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Han Wu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
- Correspondence: Han Wu
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Zhu L, Miao Y, Mao Y, Zuo KK. Analysis of the Risk Factors for C5 Nerve Palsy After Cervical Posterior Open-Door Laminoplasty for Patients with Cervical Spondylotic Myelopathy-From the Perspective of Cervical Sagittal Parameters. World Neurosurg 2022; 165:e169-e174. [PMID: 35659591 DOI: 10.1016/j.wneu.2022.05.128] [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: 05/16/2022] [Accepted: 05/29/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study was performed to explore the sagittal radiological parameters related to the occurrence of C5 nerve palsy after cervical posterior open-door laminoplasty for the patients with cervical spondylotic myelopathy. METHODS Sixty-two patients who underwent cervical posterior open-door laminoplasty were reviewed retrospectively from March 2017 to March 2022. The C2-7 Cobb angle, C2-7 sagittal vertex axis, thoracic inlet angle, neck tilt, T1 slope, and encroachment ratio of ossification were measured on X-rays. The enrolled patients were divided into C5 nerve palsy and control groups. Logistic regression was performed to analyze the potential risk factors for the occurrence of C5 nerve palsy. The receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC) were used to evaluate the significance of the results and the optimal diagnostic value. RESULTS The results of logistic regression showed that only the T1 slope and encroachment ratio were variables that were responsible for C5 nerve palsy (P = 0.024; P = 0.04). The ROC curve analysis for the T1 slope showed that the cutoff value was 21.3° and the AUC was 0.796. The ROC curve analysis for the encroachment ratio revealed that the cutoff value was 0.21 and the AUC was 0.763. Both analyses demonstrated good diagnostic value for C5 nerve palsy. CONCLUSIONS The preoperative T1 slope and encroachment ratio were variables that were risk factors for C5 nerve palsy in patients who underwent cervical posterior open-door laminoplasty.
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Affiliation(s)
- Lei Zhu
- Department of Orthopedics, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
| | - Yu Miao
- Department of Orthopedics, Renmin Hospital of Yunyang District, Shiyan, Hubei, P.R. China
| | - Yan Mao
- Department of Pediatrics, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
| | - Kang-Kang Zuo
- Department of Orthopedics, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China.
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Noh SH, Takahashi T, Inoue T, Park SM, Hanakita J, Minami M, Kanematsu R, Shimauchi-Ohtaki H, Ha Y. Postoperative spinal deformity and instability after cervical spinal cord tumor resection in adults: A systematic review and meta-analysis. J Clin Neurosci 2022; 100:148-154. [DOI: 10.1016/j.jocn.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/11/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
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Liu B, Li Q, Xie H, Hu X, Pan X. Evaluation of Vertebral Function and Long-Term Quality of Life after Percutaneous Minimally Invasive Surgery in Patients with Thoracolumbar Spine Fractures. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2723542. [PMID: 35251297 PMCID: PMC8890886 DOI: 10.1155/2022/2723542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 11/29/2021] [Accepted: 01/17/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the changes in vertebral function after minimally invasive surgery in patients with thoracolumbar spinal fractures and investigate the impact of percutaneous minimally invasive surgery on patients' quality of life by following up the patients in the long term. METHODS A retrospective analysis was performed to select 80 patients with thoracolumbar spinal fractures treated in our hospital from April 2013 to October 2018, and the patients were divided into a study group and a control group according to the difference in their choice of procedure. The two groups were compared in terms of perioperative wound pain, serum creatine kinase (CK) activity, and C-reactive protein (CRP) levels, and the two groups were followed up for 2 years to compare the changes in anterior vertebral body height and Cobb's angle during the follow-up period and to compare the differences in quality of life between the two groups. RESULTS (1) The pain level of patients in the study group was significantly lower than that of the control group at the 1st and 3rd postoperative days (p < 0.05). (2) The CK activity and CPR level of patients in the study group were significantly lower than that of the control group at the 1st and 3rd postoperative days (p < 0.05). (3) Compared with the preoperative period, the height of the anterior border of the vertebral body and the Cobb's angle in both groups showed significant changes at 7 d, 6 months, one year, and two years after surgery (p < 0.05), suggesting that both procedures can significantly restore the height of the injured vertebra and improve the function of the vertebral body. (4) The somatic, physical, and psychological functions of patients in the study group were significantly greater than those in the control group at 6 months postoperatively (p > 0.05). CONCLUSION Compared to traditional open surgery, minimally invasive percutaneous surgery for thoracolumbar fractures can significantly reduce perioperative pain and improve perioperative stress in patients, while achieving better surgical outcomes and a significantly improved quality of life in patients at long-term follow-up.
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Affiliation(s)
- Bin Liu
- Department of Emergency Trauma Surgery, First People's Hospital of Yunnan Province (the Affiliated Hospital of Kunming University of Science and Technology), Kunming, Yunnan 650032, China
| | - QiaoHong Li
- Department of Emergency Trauma Surgery, First People's Hospital of Yunnan Province (the Affiliated Hospital of Kunming University of Science and Technology), Kunming, Yunnan 650032, China
| | - Hui Xie
- Department of Emergency Trauma Surgery, First People's Hospital of Yunnan Province (the Affiliated Hospital of Kunming University of Science and Technology), Kunming, Yunnan 650032, China
| | - XinPan Hu
- Department of Emergency Trauma Surgery, First People's Hospital of Yunnan Province (the Affiliated Hospital of Kunming University of Science and Technology), Kunming, Yunnan 650032, China
| | - XueKun Pan
- Department of Emergency Trauma Surgery, First People's Hospital of Yunnan Province (the Affiliated Hospital of Kunming University of Science and Technology), Kunming, Yunnan 650032, China
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Koo J, Hwang S, Yoon SH, Shin HJ, Cho BK. Progression of Ossification of Posterior Longitudinal Ligament After Anterior Cervical Discectomy and Fusion in Military Patients Exposed to Minor Trauma. Korean J Neurotrauma 2022; 18:254-267. [PMID: 36381449 PMCID: PMC9634320 DOI: 10.13004/kjnt.2022.18.e55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/06/2022] Open
Abstract
Objective Ossification of the posterior longitudinal ligament (OPLL) can progress even after cervical spine surgery and may cause neurological injury as a result of minor trauma. The purpose of this study was to investigate the preventive factors associated with OPLL progression after anterior cervical discectomy and fusion (ACDF), a procedure commonly performed in clinical practice. Methods We retrospectively investigated 295 male soldiers who underwent ACDF surgery between 2012 and 2017. Patients who were followed up for >12 months using dynamic radiography and computed tomography (CT) were included in the study. Radiological parameters investigated included OPLL progression, C2-C7 angles on dynamic radiography, segmental angles, C2-C7 cervical sagittal vertical axis (C2-C7 SVA), and the T1 slope. These parameters were measured preoperatively and 1 year postoperatively. Results A total of 49 patients were enrolled, and 10 patients were confirmed to have OPLL progression. Comparison between the OPLL progression and non-progression groups showed no statistically significant differences in pre- and postoperative cervical range of motion. However, statistically significant differences were observed in the postoperative neutral C2-C7 angle (progression -3.9°±6.4° vs. non-progression -13.4°±7.9°, p=0.001) and the SVA change (progression 5.8±7.9 mm vs. non-progression -3.7±6.3 mm, p=0.00). The cutoff values were -8.01° for the postoperative neutral C2-C7 angle and 1.4 mm for SVA changes. Conclusion Increased SVA (>1.4 mm) and a small postoperative neutral C2-C7 angle (>-8.01°) 1 year after ACDF were associated with OPLL progression. It is important to be mindful of these factors during follow-up after ACDF, because additional surgical treatment may be necessary for OPLL progression due to neurological injury caused by minor trauma.
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Affiliation(s)
- Jungmyung Koo
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - SungHwan Hwang
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Sang Hoon Yoon
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Byung-Kyu Cho
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
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Shi L, Xue D, Wang Y, Chou D, Zhao Y, Zhang S, Zhang M, Wang L, Li P, Liu Y. Efficacy of a Lateral Mass Fusion Device Combined with a Three-Dimensional-Printed Model in the Treatment of Craniovertebral Junction Abnormalities. World Neurosurg 2021; 159:e120-e129. [PMID: 34896663 DOI: 10.1016/j.wneu.2021.12.012] [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: 10/16/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the efficacy of a lateral mass fusion device combined with a three-dimensional-printed model in treatment of craniovertebral junction abnormalities. METHODS This retrospective study comprised 56 patients with irreducible atlantoaxial dislocation who underwent posterior fixation between January 2016 and December 2019. Patients were divided into 2 groups according to whether or not cages were used-cage group and autograft group. Visual analog scale score, Japanese Orthopaedic Association score, health-related quality of life, American Spinal Injury Association spinal cord injury grade, atlas-dens interval, space available for the cord, cervicomedullary angle, and fusion rate were compared between groups. RESULTS Medical follow-up was >1 year. There was no statistical difference between groups in preoperative visual analog scale score, Japanese Orthopaedic Association score, 12-Item Short Form Health Survey score, American Spinal Injury Association grade, atlas-dens interval, space available for the cord, and cervicomedullary angle, and these indexes significantly improved after surgery (P < 0.05). Visual analog scale score and atlas-dens interval were lower in the cage group than in the autograft group (P < 0.05). Japanese Orthopaedic Association score, 12-Item Short Form Health Survey score, space available for the cord, and cervicomedullary angle were significantly higher in the cage group than in the autograft group (P < 0.05). Fusion rate of the cage group 4-6 months after surgery was higher than that of the autograft group (P = 0.068). American Spinal Injury Association grade was significantly higher in the cage group than in the autograft group (P < 0.05). CONCLUSIONS During 1-year follow-up, neurological function improvement and atlantoaxial joint reduction were satisfactory. The lateral mass fusion device combined with a three-dimensional printed model may be a clinically useful technique.
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Affiliation(s)
- Landa Shi
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Deng Xue
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuqiang Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dean Chou
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Yao Zhao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuhao Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Min Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Limin Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Pengfei Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yilin Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Diagnostic Accuracy of Magnetic Resonance Imaging for Sagittal Cervical Spine Alignment: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413033. [PMID: 34948643 PMCID: PMC8702200 DOI: 10.3390/ijerph182413033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Although radiography performed on the subject in an upright position is considered the standard method for assessing sagittal cervical alignment, it is frequently determined, or reported, based on MRI performed on the subject in a supine position. (2) Methods: Cervical alignment observed in both imaging modalities was assessed using four methods: the C2-7 Cobb angle, the absolute rotation angle (ARA), Borden’s method, and the sagittal vertical axis (SVA). Cervical alignment was determined (lordosis, kyphosis, and straight) based on radiography. Then, the diagnostic cut-off values for the MRI images and their corresponding diagnostic accuracies were assessed. (3) Results: The analysis included 142 outpatients. The determined diagnostic cut-off values for lordosis, using three measurements (Cobb angle, ARA, and Borden’s method), were −8.5°, −12.5°, and 3.5 mm, respectively, and the cut-off values for kyphosis were −4.5°, 0.5°, and −1.5 mm, respectively. The cut-off value for SVA > 40 mm was 19.5 mm. The Cobb angle, ARA, and Borden’s method, on MRI, showed high negative predictive values for determining kyphosis. The SVA on MRI measurements also showed high negative predictive values for determining >40 mm. (4) Conclusions: MRI measurements may be predictive of cervical alignment, especially for the exclusion of kyphosis and SVA > 40 mm. However, caution is needed in the other determinations using MRI, as their accuracies are limited.
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22
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Current concepts of spondylosis and posterior spinal motion preservation for radiologists. Skeletal Radiol 2021; 50:2169-2184. [PMID: 34131792 DOI: 10.1007/s00256-021-03840-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 02/02/2023]
Abstract
Spinal fusion is performed to eliminate motion at a degenerated or unstable segment. However, this is associated with loss of motion at the fused levels and increased stress on adjacent levels. Motion-preserving implants have been designed in effort to mitigate the limitations of fusion. This review will focus on posterior spinal motion-preserving technologies. In the cervical spine, laminoplasty is a posterior motion-preserving procedure used in the management of myelopathy/cord compression. In the lumbar spine, motion-sparing systems include interspinous process devices (also referred to as interspinous process spacers or distraction devices), posterior dynamic stabilization devices (also referred to as pedicle screw/rod fixation-based systems), and posterior element replacement systems (also referred to as total facet replacement devices). Knowledge of the intended physiologic purpose, hardware utilized, and complications is important in the assessment of imaging in those who have undergone posterior motion preservation procedures.
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23
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Ma Y, Wu H, Wang Y, Guo L. A feasibility study of modified self-efficacy for the improvement of adverse emotions and quality of life in traumatic fracture patients. Am J Transl Res 2021; 13:6507-6515. [PMID: 34306391 PMCID: PMC8290795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/01/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the changes in the adverse psychologies and psychological coping at the late stage of self-efficacy intervention in traumatic fracture patients. METHODS A total of 80 traumatic fracture patients admitted to our hospital were recruited as the study cohort and randomly divided into two groups. The control group (n=40) underwent conventional post-fracture nursing, and the study group (n=40) underwent self-efficacy intervention combined with conventional post-fracture nursing. After the intervention, the changes in the anxiety and depression, self-efficacy, quality of life, and the psychological coping scores were assessed and compared between the two groups. Finally, the correlations among the self-efficacy, adverse emotions, and psychological coping scores were analyzed. RESULTS Before the intervention, there was no marked difference in the anxiety and depression, self-efficacy, life satisfaction, and psychological coping scale scores between the two groups (P > 0.05). At 1, 3, and 6 months after the intervention, the study group had remarkably lower hospital anxiety and depression scale (HADS) scores and significantly higher self-efficacy, quality of life and psychological coping scale scores than the control group (P < 0.05). The correlation analysis showed that the general self-efficacy scale (GSES) scores were negatively correlated with the self-rating anxiety scale (SAS) and the self-rating depression scale (SDS) scores (r=-0.8623, r=-0.6895, P < 0.05) and were positively correlated with the psychological coping scale scores (r=0.7196, P < 0.05). CONCLUSION Self-efficacy intervention can markedly improve the adverse emotions and the self-efficacy and quality of life scores in traumatic fracture patients. The patients' self-efficacy is significantly positively correlated with the psychological coping scores. Therefore, self-efficacy intervention can be implemented to improve the traumatic coping abilities of traumatic fracture patients.
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Affiliation(s)
- Yanbo Ma
- Nursing Institute, Jinzhou Medical UniversityJinzhou, Liaoning Province, China
| | - Hongjing Wu
- Department of Thoracic Surgery, Fushun Central HospitalFushun, Liaoning Province, China
| | - Yanting Wang
- Department of Orthopedics, Fushun Central HospitalFushun, Liaoning Province, China
| | - Leilei Guo
- Nursing Institute Surgical Nursing Department, Jinzhou Medical UniversityJinzhou, Liaoning Province, China
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Lee SH, Son DW, Shin JJ, Ha Y, Song GS, Lee JS, Lee SW. Preoperative Radiological Parameters to Predict Clinical and Radiological Outcomes after Laminoplasty. J Korean Neurosurg Soc 2021; 64:677-692. [PMID: 34044492 PMCID: PMC8435653 DOI: 10.3340/jkns.2020.0294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/19/2020] [Indexed: 12/23/2022] Open
Abstract
Many studies have focused on pre-operative sagittal alignment parameters which could predict poor clinical or radiological outcomes after laminoplasty. However, the influx of too many new factors causes confusion. This study reviewed sagittal alignment parameters, predictive of clinical or radiological outcomes, in the literature. Preoperative kyphotic alignment was initially proposed as a predictor of clinical outcomes. The clinical significance of the K-line and K-line variants also has been studied. Sagittal vertical axis, T1 slope (T1s), T1s-cervical lordosis (CL), anterolisthesis, local kyphosis, the longitudinal distance index, and range of motion were proposed to have relationships with clinical outcomes. The relationship between loss of cervical lordosis (LCL) and T1s has been widely studied, but controversy remains. Extension function, the ratio of CL to T1s (CL/T1s), and Sharma classification were recently proposed as LCL predictors. In predicting postoperative kyphosis, T1s cannot predict postoperative kyphosis, but a low CL/T1s ratio was associated with postoperative kyphosis.
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Affiliation(s)
- Su Hun Lee
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University, Busan, Korea
| | - Jun Jae Shin
- Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University, Busan, Korea
| | - Jun Seok Lee
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University, Busan, Korea
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Sagittal balance of the cervical spine: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1411-1439. [PMID: 33772659 DOI: 10.1007/s00586-021-06825-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 09/26/2020] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this systematic review and meta-analysis was to compare the cervical sagittal parameters between patients with cervical spine disorder and asymptomatic controls. METHODS Two independent authors systematically searched online databases including Pubmed, Scopus, Cochrane library, and Web of Science up to June 2020. Cervical sagittal balance parameters, such as T1 slope, cervical SVA (cSVA), and spine cranial angle (SCA), were compared between the cervical spine in healthy, symptomatic, and pre-operative participants. Where possible, we pooled data using random-effects meta-analysis, by CMA software. Heterogeneity and publication bias were assessed using the I-squared statistic and funnel plots, respectively. RESULTS A total of 102 studies, comprising 13,802 cases (52.7% female), were included in this meta-analysis. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of studies included in this review. Funnel plot and Begg's test did not indicate obvious publication bias. The pooled analysis reveals that the mean (SD) values were: T1 slope (degree), 24.5 (0.98), 25.7 (0.99), 25.4 (0.34); cSVA (mm), 18.7 (1.76), 22.7 (0.66), 22.4 (0.68) for healthy population, symptomatic, and pre-operative assessment, respectively. The mean value of the SCA (degree) was 79.5 (3.55) and 75.6 (10.3) for healthy and symptomatic groups, respectively. Statistical differences were observed between the groups (all P values < 0.001). CONCLUSION The findings showed that the T1 slope and the cSVA were significantly lower among patients with cervical spine disorder compared to controls and higher for the SCA. Further well-conducted studies are needed to complement our findings.
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26
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Jeon H, Kim HC, Kim TW, An SB, Shin DA, Yi S, Kim KN, Yoon DH, Borkar SA, Son DW, Ha Y. Prediction of angular kyphosis after cervical laminoplasty using radiologic measurements. J Clin Neurosci 2021; 85:13-19. [PMID: 33581783 DOI: 10.1016/j.jocn.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/22/2020] [Accepted: 12/06/2020] [Indexed: 01/08/2023]
Abstract
Angular kyphosis is an important complication after cervical laminoplasty. Previous reports have suggested that T1 slope (T1s) and extension function (EF) have key roles in kyphosis, and no different radiologic measuments which affects postoperative kyphosis were seen between ossification of the posterior longitudinal ligament (OPLL) or cervical spondylotic myelopathy (CSM). We tried to find preoperative radiologic measurements predicting angular kyphosis after laminoplasty according to disease entities. We retrospectively analyzed 133 patients with OPLL or CSM who underwent expansive laminoplasty. Preoperative neutral and extension C2-7 cobb angle (CA), T1s, C2-7 sagittal vertical axis, and C2-7 slope angle (SA) were measured. EF of C2-7 CA and C2-7 SA was defined as extension CA/SA minus neutral CA/SA. Significant angular kyphosis was defined as LCL less than -10° after surgery. Mean loss of lordosis was -3.23, and 16.5% of patients showed significant kyphosis. Preoperative EF-CA, EF-SA, and T1s were found to be predictive for angular kyphosis by Pearson correlation analysis. The receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of radiologic measurements could not reach 0.7. In patients with OPLL, the AUC of preoperative neutral CA was 0.716. However, in patients with CSM ROC curve analysis revealed that EF-CA and EF-SA could predict the significant angular kyphotic changes. Examining OPLL and CSM separately, preoperative radiologic measurements were found to influence postoperative cervical kyphosis, respectively. However, preoperative C2-7 neutral CA in OPLL patients and both EF-CA and EF-SA in CSM patients could predict significant angular kyphosis after cervical laminoplasty.
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Affiliation(s)
- Hyeongseok Jeon
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Cheol Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Woo Kim
- Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Seong Bae An
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong Yi
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Keung Nyun Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Do Heum Yoon
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sachin A Borkar
- Department of Neurosurgery, All India Institue of Medical Sciences, New Delhi, India
| | - Dong Wuk Son
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan, Republic of Korea.
| | - Yoon Ha
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Cervical Sagittal Imbalance after Cervical Laminoplasty in Elderly Patients. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8810540. [PMID: 33313319 PMCID: PMC7721504 DOI: 10.1155/2020/8810540] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 11/17/2022]
Abstract
Purpose To determine the effect of age on sagittal cervical alignment after cervical laminoplasty procedure so as to identify the group with the greatest degree of variation. Study Setting. Single-center retrospective chart review in a tertiary referral hospital. Outcome Measures. The sagittal vertical axis (SVA) (C2-7), T1 slope, and cervical lordosis. Methods We included patients who underwent cervical laminoplasty between 2014 and 2018 and divided 60 consecutive patients into two groups using the cut-off age of 65 years. The Paired t-test and Mann-Whitney U test were used to compare changes between preoperative radiographic cervical sagittal parameters and those 1 year after surgery. Results Mean patient ages in the older and younger groups were 71 years and 52 years, respectively. The difference of C2-7 SVA was greater in the older group. Conclusion Postoperative cervical balance can be worse when laminoplasty is performed in elderly patients.
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Abstract
STUDY DESIGN Retrospective study. OBJECTIVE The preoperative parameters for predicting the loss of lordosis after cervical laminoplasty were investigated in the present study. SUMMARY OF BACKGROUND DATA Cervical laminoplasty is an effective surgical method to decompress the cervical spinal cord. Maintaining cervical lordosis after laminoplasty is an important factor to ensure the successful surgical treatment. To know the preoperative parameters for predicting loss of lordosis after cervical laminoplasty is important for better outcome after laminoplasty. METHODS In this retrospective study, 106 patients who underwent cervical laminoplasty from 2011 to 2015 were reviewed. The preoperative parameters; T1 slope (TS), Cobb lordotic angle (CLA) and sagittal vertical axis (SVA) at C2-C7, relative cross-sectional area (RCSA), and fatty degeneration of deep extensor muscles (DEMs) were measured. Visual analogue scale (VAS) and modified Japanese Orthopedic Association (mJOA) scores were used for clinical assessment. Correlation analysis was performed between the postoperative CLA change and preoperative parameters. The patients were divided into the decreased- or maintained-lordosis groups based on the difference between postoperative and preoperative CLA. All preoperative parameters were compared between groups. RESULTS Based on correlation analysis, preoperative TS (P = 0.001), TS-CLA (P = 0.046), RCSA at C7-T1 (P < 0.001), and fatty degeneration of DEMs (P < 0.001) were correlated with loss of lordosis. Among the 106 patients, 68 showed decreased-lordosis and 38 maintained-lordosis. Preoperative TS (P = 0.003), SVA (P = 0.014), TS-CLA (P = 0.015), and RCSA at C7-T1 (P = 0.005) were significantly different between groups. In both correlation and comparative analyses, higher TS and TS-CLA and less RCSA at C7-T1 were associated with loss of lordosis. Neck pain VAS (P < 0.001) and mJOA scores (P < 0.001) were significantly improved in the maintained-lordosis group. CONCLUSION Maintaining cervical lordosis is important for clinical outcomes after laminoplasty. Preoperative higher TS, TS-CLA, and less RCSA at C7-T1 were considered as predictors for loss of lordosis. These characteristics should be considered when choosing the surgical method to help maintain cervical lordosis. LEVEL OF EVIDENCE 3.
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29
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Hong JT, Koller H, Abumi K, Yuan W, Falavigna A, Lee HJ, Lee JB, Le Huec JC, Park JH, Kim IS. SOF System; A New Nomenclature System for the Surgical Techniques of Cervical Spine Deformity. Neurospine 2020; 17:505-512. [PMID: 33022155 PMCID: PMC7538365 DOI: 10.14245/ns.2040472.236] [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: 08/03/2020] [Accepted: 08/25/2020] [Indexed: 12/05/2022] Open
Abstract
Although cervical spinal deformity (CSD) can have a profoundly negative impact on an individual’s quality of life and there have been many advances in surgical treatment of CSD in recent years, there exists no comprehensive classification system of surgical treatment that categorizes anterior and posterior surgery separately according to the grade of surgery. The objective of this study is to introduce the new classification system of various surgical treatments for CSD. We developed a new classification system (SOF system) for CSD surgery that describes the sequence of surgical approach (S), the grade of osteotomy (O), and the information of fixation (F) using alphanumeric codes. This new classification system can provide a consistent description of the various osteotomies performed in CSD surgery. Especially, regarding research, there has been a clear benefit to this classification. Having a standardized classification that allows for common frame for cervical deformity correction surgery, communication between surgeons and the evaluation of the CSD surgeries make it possible to conduct global comparative research about surgical outcome.
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Affiliation(s)
- Jae Taek Hong
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Heiko Koller
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
| | - Kuniyoshi Abumi
- Department of Orthopedic Surgery, Sapporo Orthopedic Hospital, Sapporo, Japan
| | - Wen Yuan
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Asdrubal Falavigna
- Department of Neurosurgery, University of Caxias do Sul, Caxias do Sul, RS, Brazil
| | - Ho Jin Lee
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jong Beom Lee
- Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Korea
| | - Jean-Charles Le Huec
- Department of Orthopedic Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Jong Hyuk Park
- Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
| | - Il Sup Kim
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
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Shrestha D, Jun M, Jidong Z, Qiang BJ. Effect of Titanium Miniplate Fixation on Hinge Fracture and Hinge Fracture Displacement Following Cervical Open-Door Laminoplasty. Int J Spine Surg 2020; 14:462-475. [PMID: 32986565 DOI: 10.14444/7061] [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] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Cervical spondylotic myelopathy is a neuromotor disorder responsible for functional limitations and decreased daily activities. Expansive open-door laminoplasty is the widely accepted procedure for the treatment of multilevel cervical spondylotic myelopathy. Among the various fixation procedures to secure the open lamina, miniplate fixation provides better clinical and radiological outcomes. However, the immediate effects on hinge fracture and hinge fracture displacement following miniplate fixation have not been proven until now. The purpose of our study was to elucidate the impact of cervical open-door angle on the status of spinal cord expansion and hinge fracture, hinge fracture displacement, and the role of implants used during surgery. METHODS For this retrospective study, 122 patients who had undergone surgery from September 2016 to November 2017 with preoperative and postoperative radiographs were enrolled. Clinical and radiological outcomes were assessed before and after surgery. RESULTS There were no significant differences in demographics, surgery time, blood loss, medical comorbidities, or perioperative and postoperative complications between 2 groups. The recovery rate and Nurick score before and at the follow-up show no statistical significance between the 2 groups, P value > .05 (P = .672) and P > .05 (P = .553), respectively. The statistical analysis shows that the mean hinge fracture in the miniplate group with a cervical open angle >30° was 2.42 ± 1.68 and with a <30° open angle, 0.05 ± 0.23; whereas, in the anchor group the mean hinge fracture in >30° cervical open angle was 2.227 ± 2.50 and in <30° was 0.409 ± 0.503. The results revealed statistical significance between 2 implant groups, P = .024 in the aspect of hinge fracture displacement and implant used. CONCLUSION Laminoplasty by titanium miniplate fixation holds the laminae securely, prevents hinge fracture displacement, and promotes spinal cord expansion better than suture anchor fixation.
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Affiliation(s)
- Deepak Shrestha
- Nepal Orthopedic Hospital, Kathmandu, Nepal.,Spine-2 Department, Tianjin Hospital, Tianjin China
| | - Miao Jun
- Spine-2 Department, Tianjin Hospital, Tianjin China
| | - Zhang Jidong
- Spine-2 Department, Tianjin Hospital, Tianjin China
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Xu C, Zhang Y, Dong M, Wu H, Yu W, Tian Y, Cao P, Chen H, Wang X, Shen X, Liu Y, Yuan W. The relationship between preoperative cervical sagittal balance and clinical outcome of laminoplasty treated cervical ossification of the posterior longitudinal ligament patients. Spine J 2020; 20:1422-1429. [PMID: 32474225 DOI: 10.1016/j.spinee.2020.05.542] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/10/2020] [Accepted: 05/20/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Laminoplasty is a common surgical method used to treat patients with cervical ossification of the posterior longitudinal ligament (OPLL). Although laminoplasty is preferred over traditional laminectomy, the factors affecting the complications and outcomes are unclear. Recently, sagittal balance indexes have been revealed to be predictors of clinical outcomes in patients with cervical degenerative diseases, but their relationships with laminoplasty-treated OPLL outcomes remains unknown. PURPOSE The purpose of this study is to evaluate the relationship of preoperative cervical sagittal balance indexes and clinical outcome in laminoplasty treated OPLL patients. STUDY DESIGN This is a retrospective case study. PATIENT POPULATION Between January 2015 and January 2017, 181 consecutively included patients who underwent cervical laminoplasty for OPLL were enrolled (male:female ratio=126:75; mean age=60.2 years). Cervical spine lateral radiographs in neutral, flexion, and extension positions were taken before and 2 years after the surgery. OUTCOME MEASURES The C2-C7 Cobb angle, T1 slope, C1-C7 sagittal vertical axis (SVA), C2-C7 SVA, CGH (center of gravity of the head)-C7 SVA, cervical JOA (Japanese Orthopedic Association) score, and neck VAS (visual analogue scale) score were measured preoperatively and postoperatively at the 2-year follow-up. METHODS The patients were divided into two groups according to changes in the lordotic angle or the recovery rate of the JOA score. The relationships between the postoperative lordosis loss or the clinical outcome and the preoperative variables, including the patient's age, JOA score, C2-C7 Cobb angle, T1 slope, C1-C7 SVA, C2-C7 SVA, and CGH-C7 SVA, were investigated. RESULTS The patients were divided into two groups according to the postoperative change in the C2-C7 Cobb angle. There were no differences in the age, preoperative C2-C7 Cobb angle, C1-C7 SVA, or C2-C7 SVA; there was only a difference in the preoperative CGH-C7 SVA and T1 slope level (p=.038, p=.042). The postoperative JOA and JOA recovery rate were related to the postoperative lordosis loss in cervical alignment (p=.048, p=.031). We again divided the patients into two groups according to the JOA recovery rate and found that only the preoperative CGH-C7 SVA and C1-C7 SVA were related to the neurological outcome (p=.011, p=.047). According to the multivariate logistic regression analysis, higher preoperative CGH-C7 SVA levels were significantly associated with decreases in the lordosis angle postoperatively and the clinical outcome (p=.018, OR=1.225; p=.034, OR=1.654). The ROC (receiver operating characteristic) analysis revealed that the proper cutoff value of preoperative CGH-C7 SVA for predicting the postoperative loss of lordosis and clinical outcomes is 3.8 cm. CONCLUSION Preoperative cervical sagittal balance indexes are related to the outcomes of OPLL patients after laminoplasty. Patients with high preoperative CGH-C7 SVA levels have a high probability of developing sagittal imbalances and neurological symptoms of the cervical spine, and this measurement can be used as a predictor of outcomes in laminoplasty-treated cervical OPLL patients.
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Affiliation(s)
- Chen Xu
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China
| | - Yizhi Zhang
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China
| | - Minjie Dong
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China
| | - Huiqiao Wu
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China
| | - Wenchao Yu
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China
| | - Ye Tian
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China
| | - Peng Cao
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China
| | - Huajiang Chen
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China
| | - Xinwei Wang
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China
| | - Xiaolong Shen
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China
| | - Yang Liu
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China.
| | - Wen Yuan
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China.
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Patel PD, Arutyunyan G, Plusch K, Vaccaro A, Vaccaro AR. A review of cervical spine alignment in the normal and degenerative spine. JOURNAL OF SPINE SURGERY 2020; 6:106-123. [PMID: 32309650 DOI: 10.21037/jss.2020.01.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
With recent advancements in surgical spine technology and techniques, the importance of regional and global spine alignment has become an important factor in surgical planning. Our review aims to consolidate the current literature on cervical and global alignment parameters and its relationship to cervical symptomatology, quality of life (QOL), requirements for surgery, potential surgical complications and health-related quality of life (HRQOL) outcomes.
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Affiliation(s)
- Parthik D Patel
- Department of Orthopaedics, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Grigoriy Arutyunyan
- Department of Orthopaedics, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Kyle Plusch
- Department of Orthopaedics, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Alexander Vaccaro
- Department of Orthopaedics, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Department of Orthopaedics, Rothman Orthopaedic Institute, Philadelphia, PA, USA
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Zhang L, Cheng Z, Zhang T, Ding J, Ma J, Ren Z, Cui Z, Zhang X. Correlation between C 7 slope and cervical lordosis in patients after expansive open-door laminoplasty. Br J Neurosurg 2020; 34:419-422. [PMID: 32297527 DOI: 10.1080/02688697.2020.1751066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose of the article: To investigate the correlation between C7 slope and cervical lordosis in patients after expansive open-door laminoplasty (EOLP).Material and methods: We retrospectively analyzed 57 patients who underwent EOLP between June 2013 and January 2017 in the Department of Spinal Surgery of our hospital. The operation time, intraoperative blood loss and follow-up time were recorded. The C7 slope, C2-7 sagittal vertical axis, and C2-7 Cobb angle were measured anteroposterior radiograph of the cervical spine preoperatively and postoperatively. All patients were divided into two groups according to the preoperative C7 slope (C7 slope ≤20° group and C7 slope >20° group).Results: The amount of intraoperative bleeding was 220.2 ± 180.9ml, and the operation time was 143.4 ± 51.2min. The average follow-up time was 24.9 ± 10.3months (range12-48 months). The C2-7 Cobb angle was 13.49 ± 10.46°at the final follow-up, which was significantly lower than that preoperatively (p = .026). But, The C7 slope and C2-7 sagittal vertical axis showed no significant difference between preoperatively and postoperatively. Preoperative and postoperative C7 slope and C2-7 Cobb angle were positively correlated to age and significant difference was observed. In the group of C7 slope >20°, significant difference was observed in term of the change of the C2-7 Cobb angle and C2-7SVA postoperatively (p = .009 and p= .020). However, there was no statistically significant difference detected in these two parameters in the group of C7 slope ≤20°.Conclusion: This study indicated that C7 slope could be used as an indicator of the change in the curvature of the cervical spine after EOLP. The loss of cervical curvature after surgery was prone to occur when C7 slope was greater than 20°, which should be noted in clinical practice.
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Affiliation(s)
- Lilong Zhang
- No. 1 Department of Spine Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Zhaojun Cheng
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Tongxing Zhang
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Ji Ding
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Junfeng Ma
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Zhishuai Ren
- No. 1 Department of Spine Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Zijian Cui
- No. 1 Department of Spine Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Xueli Zhang
- No. 1 Department of Spine Surgery, Tianjin Union Medical Center, Tianjin, China
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Miyazaki M, Ishihara T, Abe T, Kanezaki S, Notani N, Sato S, Kataoka M, Tsumura H. Analysis of the reciprocal changes in upper cervical profile and the risk factors for increasing cervical sagittal vertical axis after laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine. Clin Neurol Neurosurg 2020; 194:105788. [PMID: 32222651 DOI: 10.1016/j.clineuro.2020.105788] [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: 12/27/2019] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to elucidate the reciprocal changes in the upper cervical profile and the risk factors for increasing cervical sagittal vertical axis (cSVA) after laminoplasty for ossification of the posterior longitudinal ligament (OPLL) of the cervical spine. PATIENTS AND METHODS This retrospective study included thirty-nine consecutive patients (30 men and 9 women) with cervical OPLL who underwent cervical laminoplasty. We recorded the operative time, blood loss, Japanese Orthopaedic Association (JOA) score recovery rate. Radiological measurements were performed to analyze the following parameters: pre and 1- year postoperative chin-brow vertical angle (CBVA), McGregor's slope (McGS), occiput to C2 Cobb angle (O-C2 angle), C2-C7 Cobb angle (C2-C7 angle), T1-slope (T1S), C2-C7 sagittal vertical axis (cSVA) and calculated the change (Δ). Patients were divided into two groups according to ΔcSVA: positive (ΔcSVA ≥ 0) and negative (ΔcSVA < 0). RESULTS Postoperative O-C2 angle (P = 0.028), ΔO-C2 angle (P = 0.019), ΔC2-C7 angle (P = 0.030) and T1S (P = 0.009) diff ;ered between the two groups. ΔcSVA showed a positive correlation with ΔO-C2 (R = 0.365, P = 0.022) and T1S (R = 0.472, P = 0.002). ΔO-C2 showed a positive correlation with T1S (R = 0.478, P = 0.002) and a negative correlation with ΔC2-C7 (R=-0.443, P = 0.005). ΔC2-C7 showed a negative correlation with T1S (R=-0.415, P = 0.009). Stepwise multiple linear regression analysis showed that ΔcSVA increased by 0.757 mm for each T1 slope and increased by 0.905 mm for each ΔMcGS. CONCLUSION Increasing the lordosis in the O-C2 segment compensates for the loss of lordosis in the C2-C7 segment after cervical laminoplasty. Higher T1S is a risk factor for increasing cSVA after laminoplasty for OPLL of the cervical spine.
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Affiliation(s)
- Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan.
| | - Toshinobu Ishihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Tetsutaro Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Shozo Kanezaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan; Acute Trauma and Critical Care Center, Oita University Hospital, Oita, Japan
| | - Naoki Notani
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan; Acute Trauma and Critical Care Center, Oita University Hospital, Oita, Japan
| | - Shota Sato
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Masashi Kataoka
- Physical Therapy Course of Study, Faculty of Welfare and Health Sciences, Oita University, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
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Li Q, Han X, Wang R, Zhang Y, Liu P, Dong Q. Clinical recovery after 5 level of posterior decompression spine surgeries in patients with cervical spondylotic myelopathy: A retrospective cohort study. Asian J Surg 2019; 43:613-624. [PMID: 31481282 DOI: 10.1016/j.asjsur.2019.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/14/2019] [Accepted: 08/05/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND/OBJECTIVE The selection of surgical technique in patients with cervical spondylotic myelopathy relies on the surgeon(s) and patients' conditions. The objectives of the study were to test the hypotheses that French-door laminoplasty recovers faster than laminectomy and has good outcome measures. METHODS Data regarding surgical, radiological, and clinical outcome measures of 330 patients with cervical spondylotic myelopathy operated under French-door laminoplasty (fdLP group, n = 110), open-door laminoplasty (odLP group, n = 110), or laminectomy (LC group, n = 110) were collected from the records of institute and analyzed. RESULTS Patients of fdLP group (p < 0.0001, q = 11.65) and odLP group (p < 0.0001, q = 11.27) both had significantly improved modified Rankin scale score than those of LC group. In addition, patients of fdLP group had minimum blood loss during operations and that was maximum for patients of the LC group. Unlike patients of fdLP group (p < 0.0001, q = 80) and LC group (p < 0.0001, q =122), those of odLP group had lost more amount of cervical lordotic after surgery. Open-door laminoplasty had significantly reduced cervical range of motion than laminectomy (p < 0.0001, q = 15.45) and French-door laminoplasty (p < 0.0001, q = 13.45). After 12-months, fdLP group had higher bone union rate than odLP group (p = 0.007, q = 3.395) and LC group (p = 0.007, q = 4.243). French door laminoplasty had a better postoperative quality of life. CONCLUSIONS Among the posterior decompression spine surgeries, French-door laminoplasty is superior surgical procedure than laminectomy and could be superior surgical technique than open-door laminoplasty.
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Affiliation(s)
- Qiaomei Li
- Department of Operating and Anesthesiology, Ankang Hospital of Traditional Chinese Medicine, Ankang, Shaanxi, 725000, China.
| | - Xiaoqiang Han
- Department of Orthopedic, Ankang Hospital of Traditional Chinese Medicine, Ankang, Shaanxi, 725000, China.
| | - Renqiang Wang
- Department of Operating and Anesthesiology, Ankang Hospital of Traditional Chinese Medicine, Ankang, Shaanxi, 725000, China.
| | - Yuanyuan Zhang
- Department of Operating and Anesthesiology, Ankang Hospital of Traditional Chinese Medicine, Ankang, Shaanxi, 725000, China.
| | - Puke Liu
- Department of Operating and Anesthesiology, Ankang Hospital of Traditional Chinese Medicine, Ankang, Shaanxi, 725000, China.
| | - Qingqing Dong
- Department of Outpatient, Ankang Hospital of Traditional Chinese Medicine, Ankang, Shaanxi, 725000, China.
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Tundo F, Avila MJ, Willard L, Fanous S, Curri C, Hussain I, Baaj AA. Spinal alignment, surgery, and outcomes in cervical deformity: A practical guide to aid the spine surgeon. Clin Neurol Neurosurg 2019; 185:105496. [PMID: 31473432 DOI: 10.1016/j.clineuro.2019.105496] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/04/2019] [Accepted: 08/17/2019] [Indexed: 12/20/2022]
Abstract
Compared to the thoracolumbar spine, the literature on cervical spine alignment is scarce. While a consistent number of articles have been published, few analyze the ideal surgical approaches for each type of deformity and the optimal amount of correction to achieve. This paper provides a comprehensive review of current literature on cervical spinal deformities (with or without myelopathy) and their surgical management; it is our goal to create a framework on which surgical planning can be made. A general assessment of the actually utilized parameters and correlation between the cervical and thoracolumbar spine alignment is presented. Moreover, we provide an analysis of cervical surgical approaches (anterior, posterior, or combined), techniques (laminoplasty, laminectomy and fusion, anterior cervical discectomy and fusion, corpectomy), and their indications. Finally, a complete evaluation of outcomes and postoperative health-related quality of life (HRQOL) measures based on questionnaires (NDI, VAS, SF-36, mJOA) is discussed. Several prospective studies would be useful in understanding how cervical alignment may be important in the assessment and treatment of cervical deformities with or without myelopathy. In particular, future works should concentrate on the correlation between cervical alignment parameters, disability scores, and myelopathy outcomes. We propose, via comprehensive literature review, a guide of practical key points on surgical techniques, cervical alignment, and symptom improvement goals surgeons should aim to achieve for each patient.
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Affiliation(s)
- Frederico Tundo
- Department of Orthopaedic and Locomotor Diseases, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Mauricio J Avila
- Division of Neurosurgery, University of Arizona, Tucson, AZ, USA
| | - Laura Willard
- Department of Orthopedics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Sandra Fanous
- Department of Orthopedics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Cloe Curri
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Ibrahim Hussain
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Ali A Baaj
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
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Li X, Yang L, Ni J, Zhang Y. Four-year pain relief after coblation combined with active exercise for cervical discogenic pain: Case report. Medicine (Baltimore) 2019; 98:e16409. [PMID: 31305455 PMCID: PMC6641694 DOI: 10.1097/md.0000000000016409] [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] [Indexed: 11/04/2022] Open
Abstract
RATIONALE Coblation of intervertebral disc is an effective and safe minimally invasive technology for treating discogenic pain. The inactivation of neural ingrowth around annulus and tissue ablation and coagulation are currently considered to be the major causes for success of this treatment. However, it has been found by clinical researchers that its long-term clinical outcome is not optimistic. This report has given us favorable information that this situation can be improved with multimodal therapy. PATIENT CONCERNS A 61-year-old man presented with right severe neck and shoulder pain in 2014 which could not be relieved by medications. DIAGNOSES According to his symptoms and signs, this patient was diagnosed with cervical discogenic pain. And discography confirmed the diagnosis. INTERVENTIONS The patient underwent coblation of cervical intervertebral disc 4-5 (C4-5) and got apparently pain relief after surgery. After 1 month, he began to perform active exercise at least 30 min every day. OUTCOMES The right neck and shoulder pain completely relieved for 4 years. The cervical lordosis of this patient was restored in 2018 which was confirmed by MRI compared in 2014 and NDI (neck disability index) decreased from 58 to 10%. LESSONS This report demonstrated that it was important and essential for clinicians to educate patients with discogenic pain to perform active exercise after minimally invasive surgery.
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Affiliation(s)
- Xiuhua Li
- School of Medicine, Tsinghua University, Haidian District
| | - Liqiang Yang
- Department of Pain Management, Xuanwu Hospital of Capital Medical University
| | - Jiaxiang Ni
- Department of Pain Management, Xuanwu Hospital of Capital Medical University
| | - Yuqi Zhang
- Clinical Neuroscience Institute, Yuquan Hospital, Medical Center, Tsinghua University, Beijing, P.R. China
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Yang S, Yang D, Ma L, Wang H, Ding W. Clinical efficacy of laminectomy with instrumented fixation in treatment of adjacent segmental disease following ACCF surgery: a retrospective observational study of 48 patients. Sci Rep 2019; 9:6551. [PMID: 31024046 PMCID: PMC6483981 DOI: 10.1038/s41598-019-43114-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/16/2019] [Indexed: 11/16/2022] Open
Abstract
This study was designed to investigate the clinical efficacy of laminectomy with instrumented fixation in treatment of adjacent segmental diseases following anterior cervical corpectomy and fusion (ACCF) surgery. Between January 2008 and December 2015, 48 patients who underwent laminectomy with instrumented fixation to treat adjacent segmental diseases following ACCF surgery, were enrolled into this study. The patients were followed up at least 2 years. Pain assessment was determined by visual analogue scale (VAS) score and Neck Disability Index (NDI) score; neurological impairment was evaluated by Japanese Orthopaedic Association (JOA) score; and radiographic parameters were also compared. All comparisons were determined by paired t test with appropriate Bonferronni correction. VAS score preoperatively and at last follow-up was 5.28 ± 2.35 vs 1.90 ± 1.06 (P < 0.001). JOA score preoperatively and at last follow-up was 8.2 ± 3.6 vs 14.5 ± 1.1 (P < 0.001). NDI score preoperatively and at last follow-up was 30.5 ± 12.2 vs 10.6 ± 5.8 (P < 0.001). Moreover, the losses of cervical lordosis and C2-C7 range of motion after laminectomy were significant (both P < 0.005), but not sagittal vertical axis distance. Postoperative complications were few or mild. In conclusion, clinical effectiveness and safety can be guaranteed when the patients undergo laminectomy with instrumented fixation to treat adjacent segmental diseases following ACCF surgery.
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Affiliation(s)
- Sidong Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Dalong Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Lei Ma
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Hui Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Wenyuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China. .,Hebei Provincial Key Laboratory of Orthopedic Biomechanics, Shijiazhuang, 050051, China.
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Does Extension Dysfunction Affect Postoperative Loss of Cervical Lordosis in Patients Who Undergo Laminoplasty? Spine (Phila Pa 1976) 2019; 44:E456-E464. [PMID: 30260831 DOI: 10.1097/brs.0000000000002887] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To investigate whether loss of cervical lordosis (LCL) after laminoplasty can be predicted from specific preoperative dynamic radiograph measurements. SUMMARY OF BACKGROUND DATA Recent studies have focused on the correlation between LCL after laminoplasty and T1 slope. These studies explain this correlation through the injury of the posterior neck muscular-ligament complex (PMLC); however, this muscle injury model could not explain the less kyphotic change in high T1s patients, as reported in some studies as controversy. We have focused on the PMLC constriction reservoir which was represented by extension function (EF). METHODS We retrospectively analyzed 50 consecutive patients who underwent open-door laminoplasty (>1-year follow-up). EF is defined as extension C2-7 Cobb angle (CA) minus neutral C2-7 CA (Ext CA - CA). LCL is defined as follow-up CA minus preoperative CA (CA [FU] - CA [PRE]), and significant kyphotic change was defined as LCL smaller than -10°. RESULTS The distribution of LCL was -3.70 ± 7.98 and the significant kyphotic change occurred in 20% of the patients (10/50). EF, C2-7 sagittal vertical axis (PRE), and C2 slope (PRE) were found to be risk factors for LCL by multiple linear regression analysis. The receiver operating characteristic curve analysis revealed that EF could predict the significant kyphotic change well than previously known risk factors. The cutoff value of EF was 14°. No significant kyphotic change occurred at EF greater than or equal to 14°. Upon limiting the number of patients with preoperative straight curvature (n = 28), there is also no significant kyphotic change occurred in any patient whose EF was greater than or equal to 14°. CONCLUSION In our study sample, we found that there is no relation between T1 slope and LCL. We have identified a new factor, EF, that could predict LCL after laminoplasty. No significant kyphotic changes after laminoplasty occurred particularly when the EF was greater than or equal to 14°. LEVEL OF EVIDENCE 3.
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Luo W, Li Y, Zhao J, Zou Y, Gu R, Li H. Skip Laminectomy Compared with Laminoplasty for Cervical Compressive Myelopathy: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 120:296-301. [DOI: 10.1016/j.wneu.2018.08.231] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
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