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Jiang Z, Davies B, Zipser C, Margetis K, Martin A, Matsoukas S, Zipser-Mohammadzada F, Kheram N, Boraschi A, Zakin E, Obadaseraye OR, Fehlings MG, Wilson J, Yurac R, Cook CE, Milligan J, Tabrah J, Widdop S, Wood L, Roberts EA, Rujeedawa T, Tetreault L. The Frequency of Symptoms in Patients With a Diagnosis of Degenerative Cervical Myelopathy: Results of a Scoping Review. Global Spine J 2024; 14:1395-1421. [PMID: 37917661 DOI: 10.1177/21925682231210468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
STUDY DESIGN Delayed diagnosis of degenerative cervical myelopathy (DCM) is associated with reduced quality of life and greater disability. Developing diagnostic criteria for DCM has been identified as a top research priority. OBJECTIVES This scoping review aims to address the following questions: What is the diagnostic accuracy and frequency of clinical symptoms in patients with DCM? METHODS A scoping review was conducted using a database of all primary DCM studies published between 2005 and 2020. Studies were included if they (i) assessed the diagnostic accuracy of a symptom using an appropriate control group or (ii) reported the frequency of a symptom in a cohort of DCM patients. RESULTS This review identified three studies that discussed the diagnostic accuracy of various symptoms and included a control group. An additional 58 reported on the frequency of symptoms in a cohort of patients with DCM. The most frequent and sensitive symptoms in DCM include unspecified paresthesias (86%), hand numbness (82%) and hand paresthesias (79%). Neck and/or shoulder pain was present in 51% of patients with DCM, whereas a minority had back (19%) or lower extremity pain (10%). Bladder dysfunction was uncommon (38%) although more frequent than bowel (23%) and sexual impairment (4%). Gait impairment is also commonly seen in patients with DCM (72%). CONCLUSION Patients with DCM present with many different symptoms, most commonly sensorimotor impairment of the upper extremities, pain, bladder dysfunction and gait disturbance. If patients present with a combination of these symptoms, further neuroimaging is indicated to confirm the diagnosis of DCM.
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Affiliation(s)
- Zhilin Jiang
- King's College Hospital, NHS Foundation Trust, London, UK
| | | | - Carl Zipser
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Konstantinos Margetis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Allan Martin
- Department of Neurosurgery, University of California Davis, Davis, CA, USA
| | - Stavros Matsoukas
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Najmeh Kheram
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Andrea Boraschi
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Elina Zakin
- Department of Neurology, New York UniversityLangone, New York, NY, USA
| | | | - Michael G Fehlings
- Division of Neurosurgery and Spinal Program, University of Toronto, Toronto, ON, Canada
| | - Jamie Wilson
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Ratko Yurac
- Professor of Orthopedics and Traumatology, University del Desarrollo, Clinica Alemana de Santiago, Santiago, Chile
| | - Chad E Cook
- Duke University Medical Center, Durham, NC, USA
| | - Jamie Milligan
- Department of Family Medicine, McMaster University, Hamilton, ON, USA
| | - Julia Tabrah
- Hounslow and Richmond Community Healthcare, London, UK
| | | | - Lianne Wood
- Nottingham University Hospital, Nottingham, UK
| | | | | | - Lindsay Tetreault
- Department of Neurology, New York UniversityLangone, New York, NY, USA
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Dong J, Liang B, Sun Y, Li X, Han P, Wang C, Song Y, Wu H, Liu R, Huang S, Yu S, Jin L, Yu Z, Fan L, Song H, Zhang C, He X. Biomechanics of a novel artificial cervical vertebra from an in vivo caprine cervical spine non-fusion model. J Orthop Translat 2022; 37:61-68. [PMID: 36225948 PMCID: PMC9523198 DOI: 10.1016/j.jot.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/12/2022] [Accepted: 07/10/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Anterior cervical corpectomy and fusion (ACCF) has been widely used in the treatment of cervical spondylotic myelopathy (CSM) but is accompanied by unavoidable motion loss and destruction of vertebra. We aim to evaluate the range of motion (ROM) of caprine cervical spine constructs implanted with cervical artificial disc and vertebra system (ADVS). The purpose of this study was to investigate the biomechanical properties of the ADVS from an in vivo caprine cervical spine non-fusion model. Methods Twelve goats were randomly divided into ADVS or control group, with 6 animals in each group. The animals in the ADVS group were implanted with ADVS at the C4 level. The cervical spine constructs were harvested 6 months after the operation. The ROM of cervical spine specimens in the ADVS group was recorded. Biomechanical testing of the specimens in the control group were conducted to evaluate the ROM of the cervical spine specimens under intact and fixed condition (C3-C5) by an anterior plate, respectively. Results The biomechanical outcomes showed that the ROM of the levels (C3-C5) implanted with ADVS was maintained. The ROM in the adjacent level (C2-3) did not increase significantly comparing with intact group. Conclusions In general, ADVS could preserve the ROM of operative levels and could reconstruct the height of the vertebra. ADVS did not increase the ROM of upper adjacent level. This device provides a non-fusion method for the treatment of patients suffering from CSM. However, improvements on the design of ADVS are still needed. Translational potential statement This study introduced a novel cervical spinal implant, which was designed to have the ability of motion preservation and vertebra construction. Our study provided a non-fusion procedure in the treatment of CSM after ACCF.
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Affiliation(s)
- Jun Dong
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Baobao Liang
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University, No. 157, West Five Road, Xi'an, 710004, China
| | - Yuan Sun
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Xi Li
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Pei Han
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Chen Wang
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Yabing Song
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Hao Wu
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Ruoxi Liu
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Sihua Huang
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Sen Yu
- Department of Biomaterials, Northwest Institute for Nonferrous Metal Research, No. 96, Wei Yang Road, Xi'an, 710016, China
| | - Lei Jin
- Department of Biomaterials, Northwest Institute for Nonferrous Metal Research, No. 96, Wei Yang Road, Xi'an, 710016, China
| | - Zhentao Yu
- Institute of Advanced Wear & Corrosion Resistant and Functional Materials, Jinan University, Guangzhou, 510632, China
| | - Liying Fan
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Huanjin Song
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Chun Zhang
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
| | - Xijing He
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, No 157, West Five Road, Xi'an, 710004, China
- Department of Orthopaedics, Xi'an International Medical Center Hospital, No. 777, Xitai Road, Xi'an, 710000, PR China
- Corresponding author. Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Five Road, Xincheng District, Xi'an, Shaanxi Province, 710004, PR China.
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Tetreault L, Nakashima H, Kato S, Kryshtalskyj M, Nagoshi N, Nouri A, Singh A, Fehlings MG. A Systematic Review of Classification Systems for Cervical Ossification of the Posterior Longitudinal Ligament. Global Spine J 2019; 9:85-103. [PMID: 30775213 PMCID: PMC6362555 DOI: 10.1177/2192568217720421] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
DESIGN Systematic review. OBJECTIVE To conduct a systematic review to (1) summarize various classification systems used to describe cervical ossification of the posterior longitudinal ligament (OPLL) and (2) evaluate the diagnostic accuracy of various imaging modalities and the reliability of these classification systems. METHODS A search was performed to identify studies that used a classification system to categorize patients with OPLL. Furthermore, studies were included if they reported the diagnostic accuracy of various imaging modalities or the reliability of a classification system. RESULTS A total of 167 studies were deemed relevant. Five classification systems were developed based on X-ray: the 9-classification system (0.60%); continuous, segmental, mixed, localized or focal, circumscribed and others (92.81%); hook, staple, bridge, and total types (2.40%); distribution of OPLL (2.40%); and K-line classification (4.19%). Six methods were based on computed tomography scans: free-type, contiguous-type, and broken sign (0.60%); hill-, plateau-, square-, mushroom-, irregular-, or round-shaped (5.99%); rectangular, oval, triangular, or pedunculate (1.20%); centralized or laterally deviated (1.80%); plank-, spindle-, or rod-shaped (0.60%); and rule of nine (0.60%). Classification systems based on 3-dimensional computed tomography were bridging and nonbridging (1.20%) and flat, irregular, and localized (0.60%). A single classification system was based on magnetic resonance imaging: triangular, teardrop, or boomerang. Finally, a variation of methods was used to classify OPLL associated with the dura mater (4.19%). CONCLUSIONS The most common method of classification was that proposed by the Japanese Ministry of Health, Labour and Welfare. Other important methods include K-line (+/-), signs of dural ossification, and patterns of distribution.
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Affiliation(s)
- Lindsay Tetreault
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada,These authors contributed equally to this work
| | - Hiroaki Nakashima
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada,Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan,These authors contributed equally to this work
| | - So Kato
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Michael Kryshtalskyj
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Nagoshi Nagoshi
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada,Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Aria Nouri
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Anoushka Singh
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Michael G. Fehlings
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada,Michael G. Fehlings, Toronto Western Hospital, 399 Bathurst St, Toronto, Ontario, Canada M5T 2S8.
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Moon BJ, Kim D, Shin DA, Yi S, Kim KN, Yoon DH, Ha Y. Patterns of short-term and long-term surgical outcomes and prognostic factors for cervical ossification of the posterior longitudinal ligament between anterior cervical corpectomy and fusion and posterior laminoplasty. Neurosurg Rev 2019; 42:907-913. [PMID: 30610499 DOI: 10.1007/s10143-018-01069-x] [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: 05/16/2018] [Revised: 11/24/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
To compare short-term and long-term surgical outcome patterns between anterior cervical corpectomy and fusion (ACCF) and laminoplasty (LP) in patients diagnosed with cervical ossification of the posterior longitudinal ligament (OPLL) and identify factors affecting surgical outcomes based on follow-up duration. During short-term follow-up period, surgical outcomes between ACCF and LP were similar. However, there were several reports that long-term surgical outcomes were superior in the ACCF compared with LP. Surgical outcomes between ACCF and LP according to follow-up period changed. This study enrolled 70 patients who underwent ACCF and 63 patients who underwent LP between 2005 and 2012. Patterns of surgical outcomes were analyzed in accordance with surgical procedures. Furthermore, these patients were divided into two subgroups in respect of follow-up duration: the short-term group (less than 48 months) and the long-term group (more than 48 months) group. Occupying ratio, type of OPLL, shape of ossified lesion, cervical sagittal alignment, grade of signal intensity on MRI, and Japanese Orthopedic Association (JOA) score were examined. Surgical outcomes of ACCF went into reverse at 48-month follow-up period. In the short-term group, JOA recovery rate had no difference between ACCF and LP. In the long-term group, the ACCF recovery rate (78.5 ± 31.0) was significantly higher than the LP recovery rate (48.4 ± 54.9) (P = 0.008). In the short-term group, old age (p = 0.011), hill shape (p = 0.013), and high grade of MRI signal intensity (p = 0.040) had negative effects on recovery rate. On the other hand, in the long-term group, LP (p = 0.021) and a high grade of MR signal intensity (p = 0.017) independently and negatively affected recovery rate. Long-term surgical outcomes of ACCF became better than those of LP at more than 48-month follow-up period. High-grade MRI signal changes and the LP surgical procedure were independent negative factors for long-term surgical outcomes in patients with OPLL. Direct decompression of the spinal cord with ACCF provides better long-term stable neurologic outcomes than LP.
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Affiliation(s)
- Bong Ju Moon
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, South Korea
| | - Doyoung Kim
- Department of Neurosurgery, Spine and Spinal Cord Research Institute, Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Research Institute, Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Research Institute, Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea
| | - Keung Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Research Institute, Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea
| | - Do Heum Yoon
- Department of Neurosurgery, Spine and Spinal Cord Research Institute, Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Research Institute, Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea.
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Rathod AK, Dhake RP, Muttha MN, Singh AI, Thakur DV. Application and use of subcutaneous stay sutures in anterior cervical spine surgeries with a transverse neck incision: A technical report. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2018; 9:96-100. [PMID: 30008527 PMCID: PMC6024742 DOI: 10.4103/jcvjs.jcvjs_153_17] [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] [Indexed: 11/15/2022] Open
Abstract
Objective/Purpose: The objective of this study is to describe our experience with the use of stay sutures and transverse neck incision for anterior cervical spine surgeries involving multiple levels. Summary of Background Data: Transverse incisions on neck usually heal with minimal fibrosis resulting in cosmetically acceptable scars whereas vertical incision, although provides greater exposure, heals with extensive fibrosis resulting in ugly scars. Transverse incision is thus highly recommended. However, the fear of nonextensibility of transverse incision for multilevel fusion has led to the preference of vertical incision, development of techniques for identifying the optimal level of the incision, or has suggested the usage of two transverse incisions. Materials and Methods: Seventy-six patients underwent anterior cervical spine surgeries using a transverse neck incision for single or multilevel discectomy/corpectomy and fusion. Having divided the platysma, dissection was carried down to the anterior surface of the cervical spine between the carotid sheath laterally and the trachea and esophagus medially. Stay sutures were taken through the platysma and subcutaneous tissue, converting the transverse incision into a quadrilateral window providing access for as much as three-level corpectomy or five levels of fixation. Results: All the wounds healed with no evidence of wound-related complications, leaving a cosmetically acceptable scar. Conclusion: Using appropriately placed stay sutures, a transverse neck incision taken in the middle of the field of work can provide enough of a surgical window to perform multilevel fusion surgeries. Its simplicity and cost-effectiveness make it easily implementable, addressing the underlying pathology adequately with best possible cosmetic results.
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Ma L, Liu FY, Huo LS, Zhao ZQ, Sun XZ, Li F, Ding WY. Comparison of laminoplasty versus laminectomy and fusion in the treatment of multilevel cervical ossification of the posterior longitudinal ligament: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e11542. [PMID: 30024545 PMCID: PMC6086468 DOI: 10.1097/md.0000000000011542] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Laminoplasty (LP) and laminectomy with fusion (LF) were recognized as two reliable and effective way in treating multilevel cervical ossification of the posterior longitudinal ligament (OPLL). However, there was no clear conclusion on which method is better. A meta-analysis was conducted to evaluate the clinical results between LP and LF in the treatment of multilevel cervical OPLL. METHODS An extensive search of literature was performed in PubMed, Embase, the Cochrane library, CNKI (Chinese database), and WANFANG (Chinese database). The following outcomes were extracted: the Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS), cervical lordosis, cervical range of motion (ROM), complications, blood loss, and operation time. Data analysis was conducted with RevMan 5.3. RESULTS A total of 11 studies were included in the final analysis. The results indicated that no significant differences between LP and LF group in terms of preoperative JOA scores (P = .58), postoperative JOA scores (P = .60), JOA scores improvement rate (P = 0.64), preoperative VAS (P = .34), postoperative VAS (P=.20), preoperative range of motion (ROM) (P = .10), postoperative ROM (P = .18), preoperative cervical lordosis (P = .56), C5 palsy (P = .16), and axial pain (P = .21). LF group showed larger postoperative cervical lordosis than LP group [standardized mean difference (SMD) = 1.13 (2.03, 0.24), P = .01]. However, LP group showed lower operation time [mean difference (MD) = 19.42 (26.87, 11.97), P < .001] and blood loss [MD = 94.78 (179.05, 10.51), P = .03] than LF group. CONCLUSION Both LP and LF can achieve clinical improvement in the treatment of multilevel cervical OPLL. LF was superior to LP in maintaining cervical lordosis. However, LP showed lower surgical trauma than LF. Kyphosis line (K-line) may be a good criterion in the selection of posterior surgery. LP was performed for the patients with K-line (+) and LF for K-line (-).
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Affiliation(s)
- Lei Ma
- Department of Spine Surgery, The Third Hospital of Hebei Medical University
| | - Feng-Yu Liu
- Department of Spine Surgery, The Third Hospital of Shijiazhang
| | - Li-Shuang Huo
- Department of Endocrinology, The First Hospital of Shijiazhang
| | - Zheng-Qi Zhao
- Department of Spine Surgery, The Third Hospital of Shijiazhang
| | - Xian-Ze Sun
- Department of Spine Surgery, The Third Hospital of Shijiazhang
| | - Feng Li
- Department of Spine Surgery, The Third Hospital of Shijiazhang
| | - Wen-Yuan Ding
- Department of Spine Surgery, The Third Hospital of Hebei Medical University
- Hebei Provincial Key Laboratory of Orthopedic Biomechanics, Shijiazhuang, China
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7
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Puentes S, Kadone H, Kubota S, Abe T, Shimizu Y, Marushima A, Sankai Y, Yamazaki M, Suzuki K. Reshaping of Gait Coordination by Robotic Intervention in Myelopathy Patients After Surgery. Front Neurosci 2018; 12:99. [PMID: 29551960 PMCID: PMC5840280 DOI: 10.3389/fnins.2018.00099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 02/08/2018] [Indexed: 11/13/2022] Open
Abstract
The Ossification of the Posterior Longitudinal Ligament (OPLL) is an idiopathic degenerative spinal disease which may cause motor deficit. For patients presenting myelopathy or severe stenosis, surgical decompression is the treatment of choice; however, despite adequate decompression residual motor impairment is found in some cases. After surgery, there is no therapeutic approach available for this population. The Hybrid Assistive Limb® (HAL) robot suit is a unique powered exoskeleton designed to predict, support, and enhance the lower extremities performance of patients using their own bioelectric signals. This approach has been used for spinal cord injury and stroke patients where the walking performance improved. However, there is no available data about gait kinematics evaluation after HAL therapy. Here we analyze the effect of HAL therapy in OPLL patients in acute and chronic stages after decompression surgery. We found that HAL therapy improved the walking performance for both groups. Interestingly, kinematics evaluation by the analysis of the elevation angles of the thigh, shank, and foot by using a principal component analysis showed that planar covariation, plane orientation, and movement range evaluation improved for acute patients suggesting an improvement in gait coordination. Being the first study performing kinematics analysis after HAL therapy, our results suggest that HAL improved the gait coordination of acute patients by supporting the relearning process and therefore reshaping their gait pattern.
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Affiliation(s)
- Sandra Puentes
- Faculty of Engineering, Information and Systems, University of Tsukuba, Ibaraki, Japan.,Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Ibaraki, Japan
| | - Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Ibaraki, Japan
| | - Shigeki Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Kenji Suzuki
- Center for Cybernics Research, University of Tsukuba, Ibaraki, Japan
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Fehlings MG, Tetreault LA, Kurpad S, Brodke DS, Wilson JR, Smith JS, Arnold PM, Brodt ED, Dettori JR. Change in Functional Impairment, Disability, and Quality of Life Following Operative Treatment for Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis. Global Spine J 2017; 7:53S-69S. [PMID: 29164033 PMCID: PMC5684851 DOI: 10.1177/2192568217710137] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES The primary objective of this systematic review was to define the change in impairment, disability, and pain following surgical intervention in patients with degenerative cervical myelopathy (DCM). Secondary objectives included to assess the impact of preoperative disease severity and duration of symptoms on outcomes and to summarize complications associated with surgery. METHODS A systematic literature search was conducted to identify prospective studies evaluating the effectiveness and safety of operative treatment in patients with DCM. Outcomes of interest were functional status, disability, pain, and complications. The quality of each study was evaluated using the Newcastle-Ottawa Scale, and the strength of the overall body of evidence was rated using guidelines outlined by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. RESULTS Of the 385 retrieved citations, 32 met inclusion criteria and are summarized in this review. Based on our results, pooled standard mean differences showed a large effect for improvement in Japanese Orthopaedic Association or modified Japanese Orthopaedic Association score from baseline at short-, medium-, and long-term follow-up: 6 to 12 months (1.92; 95% confidence interval [CI] = 1.41 to 2.43), 13 to 36 months (1.40; 95% CI = 1.12 to 1.67), and ≥36 months (1.92; 95% CI = 1.14 to 2.69) (moderate evidence). Surgery also resulted in significant improvements in Nurick, Neck Disability Index, and Visual Analogue Scale scores (low to very low evidence). The cumulative incidence of complications was low (14.1%; 95% CI = 10.1% to 18.2%). CONCLUSION Surgical intervention for DCM results in significant improvements in functional impairment, disability, and pain and is associated with an acceptably low rate of complications.
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Affiliation(s)
- Michael G. Fehlings
- Toronto Western Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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9
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Singhatanadgige W, Limthongkul W, Valone F, Yingsakmongkol W, Riew KD. Outcomes following Laminoplasty or Laminectomy and Fusion in Patients with Myelopathy Caused by Ossification of the Posterior Longitudinal Ligament: A Systematic Review. Global Spine J 2016; 6:702-709. [PMID: 27781191 PMCID: PMC5077712 DOI: 10.1055/s-0036-1578805] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 01/07/2016] [Indexed: 12/05/2022] Open
Abstract
Study Design Systematic review. Objective To compare laminoplasty versus laminectomy and fusion in patients with cervical myelopathy caused by OPLL. Methods A systematic review was conducted using PubMed/Medline, Cochrane database, and Google scholar of articles. Only comparative studies in humans were included. Studies involving cervical trauma/fracture, infection, and tumor were excluded. Results Of 157 citations initially analyzed, 4 studies ultimately met our inclusion criteria: one class of evidence (CoE) II prospective cohort study and three CoE III retrospective cohort studies. The prospective cohort study found no significant difference between laminoplasty and laminectomy and fusion in the recovery rate from myelopathy. One CoE III retrospective cohort study reported a significantly higher recovery rate following laminoplasty. Another CoE III retrospective cohort study reported a significantly higher recovery rate in the laminectomy and fusion group. One CoE II prospective cohort study and one CoE III retrospective cohort study found no significant difference in pain improvement between patients treated with laminoplasty versus patients treated with laminectomy and fusion. All four studies reported a higher incidence of C5 palsy following laminectomy and fusion than laminoplasty. One CoE II prospective cohort and one CoE III retrospective cohort reported that there was no significant difference in axial neck pain between the two procedures. One CoE III retrospective cohort study suggested that there was no significant difference between groups in OPLL progression. Conclusion Data from four comparative studies was not sufficient to support the superiority of laminoplasty or laminectomy and fusion in treating cervical myelopathy caused by OPLL.
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Affiliation(s)
- Weerasak Singhatanadgige
- Department of Orthopaedics, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand,Address for correspondence Weerasak Singhatanadgige, MD, MS Department of Orthopaedics, Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalThai Red Cross Society, 1873 Rama IV Road, Pathumwan, BangkokThailand 10330
| | - Worawat Limthongkul
- Department of Orthopaedics, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Frank Valone
- Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri, United States
| | - Wicharn Yingsakmongkol
- Department of Orthopaedics, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - K. Daniel Riew
- Department of Orthopaedic Surgery, Columbia University, New York, New York, United States
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