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Uehara M, Ikegami S, Oba H, Miyaoka Y, Hatakenaka T, Kurogochi D, Fukuzawa T, Sasao S, Mimura T, Takahashi J. Impact of osteosclerosis on cervical pedicle screw insertion using preoperative CT-based navigation. 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 2024; 33:2298-2303. [PMID: 38573386 DOI: 10.1007/s00586-024-08230-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/20/2024] [Accepted: 03/13/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Preoperative computed tomography (CT)-based navigation is used for cervical pedicle screw (CPS) insertion to mitigate the risk of spinal cord and vertebral artery injury. In vertebrae with osteosclerosis due to degeneration or other factors, however, probing may not proceed easily, with difficulty creating the CPS insertion hole. This study investigated the impact of osteosclerosis on the accuracy of CPS insertion. METHODS A total of 138 patients with CPS inserted at the C3-C7 level using preoperative CT navigation were retrospectively analyzed. Pre- and postoperative CT was employed to investigate screw position and Hounsfield unit (HU) values at the lateral mass to evaluate the degree of osteosclerosis in the CPS insertion pathway. RESULTS Among 561 CPS insertions, the Grade 3 perforation rate was 1.8%, and the Grade 2 or higher perforation rate was 8.0%. When comparing insertions with and without CPS perforation, HU values were significantly higher in the perforation group (578 ± 191 vs. 318 ± 191, p < 0.01). The frequency of CPS insertion into the mid-cervical spine was also significantly greater in the perforation group (68.9% vs. 62.5%, p < 0.01). Logistic regression analysis revealed that a high HU value at the lateral mass (odds ratio 1.09, 95% confidence interval: 1.07-1.11, p < 0.01) was a significant independent factor associated with CPS deviation. CONCLUSIONS The screw perforation rate of Grade 2 or higher in CPS insertion using preoperative CT-based navigation was 8.0%. Since osteosclerosis was an independent factor related to CPS deviation, additional care may be required during insertion into affected vertebrae.
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Affiliation(s)
- Masashi Uehara
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hiroki Oba
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yoshinari Miyaoka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Terue Hatakenaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Daisuke Kurogochi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Takuma Fukuzawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Shinji Sasao
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Tetsuhiko Mimura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Yu Z, Xie H, Ouyang Z, Zhang H. Cervical single open-door laminoplasty with or without local lateral mass screw fixation and fusion to treat cervical spinal cord injuries accompanied by segmental spinal canal stenosis. Front Surg 2023; 9:1050308. [PMID: 36684349 PMCID: PMC9845616 DOI: 10.3389/fsurg.2022.1050308] [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] [Received: 09/21/2022] [Accepted: 11/28/2022] [Indexed: 01/05/2023] Open
Abstract
Study Design Retrospective. Objectives To investigate the efficacy of cervical single open-door laminoplasty with and without local lateral mass screw fixation and fusion as treatments for cervical spinal cord injuries accompanied by multisegmental spinal canal stenosis. Setting The Second Affiliated Hospital, School of Medicine, Zhejiang University. Methods Of all enrolled patients, 42 formed a stable group who underwent cervical single open-door laminoplasty alone and 14 formed an unstable group who underwent the procedure combined with lateral mass screw fixation and fusion. Neurological function was evaluated before surgery, at discharge, and at final follow-up using the American Spinal Cord Injury Association (ASIA) impairment scale and the Japanese Orthopedic Association (JOA) score. Results ASIA scores reflected improved neurological function in 52.5% of the stable group (15 with grade-D and 4 with grade-A injuries did not improve) and 45.5% of the unstable group (3 with grade-D and 3 with grade-A injuries did not improve). Postoperative JOA scores reflected 19.1% ± 21.6% improvement in the stable group and 18.6% ± 18.4% improvement in the unstable group (P > 0.05). Final follow-up JOA scores reflected 49.2% ± 31.7% improvement in the stable group and 47.1% ± 39.2% improvement in the unstable group (P > 0.05). Conclusions Laminoplasty combined with local fusion aided the treatment of unstable cervical spinal cord injuries and spinal stenosis. Such stenosis is the main pathological factor causing multiple spinal cord compressions in patients with cervical spinal cord injuries.
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Affiliation(s)
- Zihao Yu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China,Orthopedics Research Institute, Zhejiang University, Hangzhou, China,Key Laboratoryof Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Hongwei Xie
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China,Orthopedics Research Institute, Zhejiang University, Hangzhou, China,Key Laboratoryof Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Ziyu Ouyang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China,Orthopedics Research Institute, Zhejiang University, Hangzhou, China,Key Laboratoryof Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Hua Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China,Orthopedics Research Institute, Zhejiang University, Hangzhou, China,Key Laboratoryof Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China,Correspondence: Hua Zhang
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Uehara M, Ikegami S, Kuraishi S, Oba H, Takizawa T, Munakata R, Hatakenaka T, Takahashi J. Ten-year clinical and radiographic results of computer-assisted cervical pedicle screw fixation combined with laminoplasty. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Xue X, Wang Y, Ji J, Han Y, Sun Q, Miao J. [Clinical application of cervical pedicle screw implantation technique under regional method]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1515-1520. [PMID: 33319528 DOI: 10.7507/1002-1892.202004128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of cervical pedicle screw implantation technique under regional method. Methods The clinical data of 85 patients who met the selection criteria between April 2010 and May 2018 were retrospectively analyzed. There were 57 males and 28 females, aged 35-68 years, with an average of 57.6 years. Among them, there were 10 cases of ossification of posterior longitudinal ligament, 68 cases of cervical spondylosis with multilevel stenosis, 3 cases of cervical tumor, 1 case of congenital malformation, and 3 cases of cervical trauma; the lower cervical spine lesions involved C 3-C 7. Preoperative Frankel spinal cord injury grading: 2 cases of grade C, 51 cases of grade D, and 32 cases of grade E. Cervical pedicle screw implantation technique under regional method was performed with a total of 618 pedicle screws. Postoperative changes in neurological symptoms were observed; cervical mouth opening anteroposterior and lateral X-ray films and cervical CT examinations were performed to evaluate the pedicle screws position. Results The operation time was 2.5-4.0 hours, with an average of 3.0 hours. The intraoperative blood loss was 180-550 mL, with an average of 345 mL. No intraoperative vascular or nerve injury occurred. The patients with neurological symptoms were relieved to varying degrees. There were 2 cases of superficial incision infection after operation, the wound healed after enhanced dressing change. The postoperative hospital stay was 5-14 days, with an average of 8.4 days. At discharge, Frankel neurological grading was grade D in 26 patients and grade E in 59 patients. All the patients were followed up 6-24 months, with an average of 13 months. At last follow-up, cervical X-ray films showed the good pedicle screw fixation without loosening. Cervical CT evaluated the position of pedicle screws: 523 pedicle screws (84.7%) in grade Ⅰ, 80 (12.9%) in grade Ⅱ, and 15 (2.4%) in grade Ⅲ; the accuracy rate of the screw position was 97.6%. Conclusion Cervical pedicle screw implantation technique under regional method can significantly improve the success rate of screw implantation. It is easy to operate, does not destroy the bone cortex, and has stable fixation.
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Affiliation(s)
- Xiaobei Xue
- Graduate School of Tianjin Medical University, Tianjin, 300350, P.R.China
| | - Yubing Wang
- Department of Orthopedics, the Seventh People's Hospital of Hebei Province, Baoding Hebei, 071000, P.R.China
| | - Jingtao Ji
- Department of Spinal Surgery, Tianjin Hospital, Tianjin, 300350, P.R.China
| | - Yue Han
- Department of Spinal Surgery, Tianjin Hospital, Tianjin, 300350, P.R.China
| | - Quan Sun
- Department of Orthopedics, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou Guangdong, 510120, P.R.China
| | - Jun Miao
- Department of Spinal Surgery, Tianjin Hospital, Tianjin, 300350, P.R.China
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Wang S, Yang G, Zhu C, Kang J, Wang Q. Morphological analysis for subaxial cervical pedicle screw insertion in developmental and non-developmental canal stenosis. BMC Musculoskelet Disord 2019; 20:205. [PMID: 31077170 PMCID: PMC6511180 DOI: 10.1186/s12891-019-2577-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 04/16/2019] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to evaluate the safety and feasibility of subaxial cervical pedicle screw (CPS) insertion by comparing the morphological parameters between developmental canal stenosis (DCS) and non-developmental canal stenosis (NDCS) patients. Methods A total of 120 Chinese patients who had undergone cervical spinal multiplanar CT imaging from September 2010 to December 2014 were included in this study. According to the Pavlov ratio (PR), participants were classified into a DCS group (PR < 0.82) and an NDCS group (PR ≥0.82). CT reconstruction images of the cervical pedicles from C3 to C7 were selected for further analysis, and detailed morphological parameters for subaxial CPS insertion including pedicle outer width (POW), tiny cervical pedicle (TCP), pedicle transverse angle (PTA), and range of safe angle (RSA) were measured and compared in these two groups. Results A total of 600 images (1200 pedicles) from these 120 patients were measured. The POW in the DCS group was wider than that in the NDCS group at each level, while the number of TCPs in the DCS group was significantly less than that in the NDCS group at the C3, C4, and C5 vertebrae. There was no significant difference in PTA at any level between the two groups, however the RSA in the DCS group was greater than that in the NDCS group from C4 to C7. Conclusions Subaxial CPS for DCS patients may be safer and more feasible than that for NDCS patients. However, as the subaxial cervical pedicle is relatively small, CPS insertion is difficult and preoperative CT evaluation is recommended for both DCS and NDCS patients.
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Affiliation(s)
- Song Wang
- Department of Spine Surgery, the Affiliated Hospital of Southwest Medical University, No. 25 Taiping St., Luzhou, 646000, Sichuan, China
| | - Gangyi Yang
- Department of Orthopedics, Mianyang Central Hospital, Mianyang, 621000, Sichuan, China
| | - Ce Zhu
- Department of Spine Surgery, the Affiliated Hospital of Southwest Medical University, No. 25 Taiping St., Luzhou, 646000, Sichuan, China
| | - Jianping Kang
- Department of Spine Surgery, the Affiliated Hospital of Southwest Medical University, No. 25 Taiping St., Luzhou, 646000, Sichuan, China
| | - Qing Wang
- Department of Spine Surgery, the Affiliated Hospital of Southwest Medical University, No. 25 Taiping St., Luzhou, 646000, Sichuan, China.
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Clinical and Radiological Outcomes of Anterior Approach Microscopic Surgery for the Pincer Mechanism in Cervical Spondylotic Myelopathy. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9175234. [PMID: 31016204 PMCID: PMC6446116 DOI: 10.1155/2019/9175234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/20/2019] [Accepted: 02/07/2019] [Indexed: 11/17/2022]
Abstract
Objective We aimed to evaluate the efficacy of anterior approach microscopic surgery for patients with the pincer mechanism in cervical spondylotic myelopathy. Methods The clinical data of pincer cervical spondylotic myelopathy that received anterior cervical decompression and fusion in our hospital from Aug 2014 to Dec 2017 were analyzed retrospectively, including 12 males and 9 females, with an average age of 64.3 years (range 46-81 years). Occupying rate, anterior occupying rate, and posterior occupying rate were measured on pre- and postoperative mid-sagittal MRIs. Pre- and postoperative Japanese Orthopedic Association (JOA) scores, intervertebral space height, and C2 to C7 Cobb's angle were analyzed. Result Duration of follow-up was six months. The pre- and postoperative anterior occupying rate were averagely 38.6±8.5% and 12.9±5.5%, respectively, the posterior occupying rates were averagely 27.4±7.2% and 13.1±6.6%, respectively, and Cobb's angle changed from 15.3±8.0° to 22.7±7.9°. The intervertebral space height increased from 4.6±0.4mm to 6.5±0.4mm. JOA scores improved significantly by 59.4±34.0% at six months after surgery. Conclusion Decompression by anterior microscopic surgery can increase spinal canal volume directly, recover intervertebral space height, and resize Cobb's angle, but decrease the posterior compression by ligament Flava indirectly. Anterior decompression under the microscope may provide an alternative surgical option for partial patients with the pincer mechanism in cervical spondylotic myelopathy.
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Singrakhia MD, Malewar NR, Deshmukh S, Deshmukh S. Clinical and Radiological Outcomes of Day-care Posterior Foraminotomy and Decompression of the Cervical Spine. Asian J Neurosurg 2018; 13:1118-1122. [PMID: 30459879 PMCID: PMC6208244 DOI: 10.4103/ajns.ajns_14_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Anterior cervical procedures are associated with many intra- and post-operative complications leading to long-term patient morbidity. In this study, we have evaluated the clinical and radiological Outcome of day care posterior cervical foraminotomy in patients with single-level cervical radiculopathy with or without neurodeficit. MATERIALS AND METHODS Seventeen patients underwent single-level posterior cervical foraminotomy for radicular symptoms were studied between June 2011 and May 2016. Clinical outcome was studied by visual analog scale (VAS) score, neck disability index (NDI), and Odom's criteria. Adjacent segment degeneration was evaluated on lateral cervical radiograph at every follow-up by calculating the focal and global angulation of the cervical spine and disc height at the operated level and adjacent segments. Dynamic lateral cervical spine radiograph was done to evaluate segmental instability. RESULTS After a mean follow-up duration of 30.64 months, 13 patients had excellent, three patients had good, and one patient had fair outcome as per Odom's criteria. The mean VAS score for radicular pain, neck pain, and NDI was significantly reduced postoperatively (P < 0.001). The mean focal angulation, mean global angulation, the disc height at operated and adjacent level were not changed significantly (P > 0.05). There was no instability noted postoperatively on lateral dynamic cervical spine radiographs. There was no complication in our study. CONCLUSION Posterior cervical foraminotomy is an effective surgical method for treatment of patients with single-level cervical radiculopathy and helps to achieve good clinical and radiological outcome, prevents postoperative adjacent segment degeneration and instability with minimal complications.
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Affiliation(s)
| | | | - Sonal Deshmukh
- Department of Anaesthesia, Shanta spine Institute, Nagpur, Maharastra, India
| | - Shivaji Deshmukh
- Department of Anaesthesia, Shanta spine Institute, Nagpur, Maharastra, India
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Zhao CM, Chen Q, Zhang Y, Huang AB, Ding WY, Zhang W. Anterior cervical discectomy and fusion versus hybrid surgery in multilevel cervical spondylotic myelopathy: A meta-analysis. Medicine (Baltimore) 2018; 97:e11973. [PMID: 30142827 PMCID: PMC6113029 DOI: 10.1097/md.0000000000011973] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE A meta-analysis was performed to compare the radiographic and surgical outcomes between anterior cervical discectomy and fusion (ACDF) and hybrid surgery (HS, corpectomy combined with discectomy) in the treatment for multilevel cervical spondylotic myelopathy (mCSM). SUMMARY OF BACKGROUND DATA Both ACDF and HS are used to treat mCSM, however, which one is better treatment for mCSM remains considerable controversy. METHODS An extensive search of literature was searched in PubMed/Medline, Embase, the Cochrane library, CNKI, and WANFANG databases on ACDF versus HS treating mCSM from January 2011 to December 2017. The following variables were extracted: blood loss, operation time, fusion rate, Cobb angles of C2-C7, total complications, dysphagia, hoarseness, C5 palsy, infection, cerebral fluid leakage, epidural hematoma, and graft subsidence. Data analysis was conducted with RevMan 5.3 and STATA 12.0. RESULTS A total of 4 studies including 669 patients were included in our study. The pooled analysis showed that there were no significant difference in the operation time, fusion rate, Cobb angles of C2-C7, dysphagia, hoarseness, C5 palsy, infection, cerebral fluid leakage, epidural hematoma, and graft subsidence. However, there were significant difference between 2 groups in blood loss [P < .00001, SMD = -30.29 (-45.06, -15.52); heterogeneity: P = .38, I = 0%= and total complications [P = .04, OR = 0.66 95%CI (0.44, 0.98); heterogeneity: P = .37, I = 4%]. CONCLUSIONS Based on our meta-analysis, except for blood loss and total complications, both ACDF and hybrid surgery are effective options for the treatment of multilevel cervical spondylotic myelopathy.
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Affiliation(s)
- Chun-Ming Zhao
- Department of Orthopaedic Surgery, The Affiliated Taizhou People's Hospital of Nantong University, Taizhou, Jiangsu
| | - Qian Chen
- Department of Orthopaedic Surgery, The Affiliated Taizhou People's Hospital of Nantong University, Taizhou, Jiangsu
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yu Zhang
- Department of Orthopaedic Surgery, The Affiliated Taizhou People's Hospital of Nantong University, Taizhou, Jiangsu
| | - Ai-Bing Huang
- Department of Orthopaedic Surgery, The Affiliated Taizhou People's Hospital of Nantong University, Taizhou, Jiangsu
| | - Wen-Yuan Ding
- Department of Orthopaedic Surgery, The Affiliated Taizhou People's Hospital of Nantong University, Taizhou, Jiangsu
| | - Wei Zhang
- Department of Orthopaedic Surgery, The Affiliated Taizhou People's Hospital of Nantong University, Taizhou, Jiangsu
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Combined Laminoplasty and Posterior Fusion for Cervical Spondylotic Myelopathy Treatment: A Literature Review. Asian Spine J 2018; 12:446-458. [PMID: 29879772 PMCID: PMC6002171 DOI: 10.4184/asj.2018.12.3.446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/08/2017] [Accepted: 10/02/2017] [Indexed: 12/11/2022] Open
Abstract
Study Design A literature review. Purpose To explore the utility of laminoplasty in combination with instrumented fusion, with a focus on neurological outcomes and changes in kyphotic deformity. Overview of Literature Management of cervical spondylotic myelopathy (CSM) to reduce morbidity within the neurosurgical population. Methods A US National Library of Medicine PubMed search was conducted for manuscripts pertaining to cervical laminoplasty and fusion for the management of CSM. Several relevant studies were shortlisted for review, and the bibliographies of the articles were searched for additional references. The search was limited to human studies, English-language literature, and reports on more than one patient. Results Combined laminoplasty and fusion was found to provide at least comparable, if not superior, neurological outcomes in specific patient populations with CSM. The Japanese Orthopedic Association scores, local kyphosis, and C2–C7 angle have been reviewed in several manuscripts, and improvement in each of these categories was found with laminoplasty and fusion. Conclusions The treatment of CSM necessitates an individualized approach based on the pathoanatomical variation. Laminoplasty and fusion can be appropriately used for patients with CSM in a setting of local kyphotic deformity, ossification of the posterior longitudinal ligament, associated segmental instability, and the need for strong stabilization.
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Hou Y, Shi J, Lin Y, Chen H, Yuan W. Virtual surgery simulation versus traditional approaches in training of residents in cervical pedicle screw placement. Arch Orthop Trauma Surg 2018; 138:777-782. [PMID: 29497839 DOI: 10.1007/s00402-018-2906-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The cervical screw placement is one of the most difficult procedures in spine surgery, which often needs a long period of repeated practices and could cause screw placement-related complications. We performed this cadaver study to investigate the effectiveness of virtual surgical training system (VSTS) on cervical pedicle screw instrumentation for residents. MATERIALS AND METHODS A total of ten novice residents were randomly assigned to two groups: the simulation training (ST) group (n = 5) and control group (n = 5). The ST group received a surgical training of cervical pedicle screw placement on VSTS and the control group was given an introductory teaching session before cadaver test. Ten fresh adult spine specimens including 6 males and 4 females were collected, and were randomly allocated to the two groups. The bilateral C3-C6 pedicle screw instrumentation was performed in the specimens of the two groups, respectively. After instrumentation, screw positions of the two groups were evaluated by image examinations. RESULTS There was significantly statistical difference in screw penetration rates between the ST (10%) and control group (62.5%, P < 0.05). The acceptable rates of screws were 100 and 50% in the ST and control groups with significant difference between each other (P < 0.05). In addition, the average screw penetration distance in the ST group (1.12 ± 0.47 mm) was significantly lower than the control group (2.08 ± 0.39 mm, P < 0.05). CONCLUSIONS This study demonstrated that the VSTS as an advanced training tool exhibited promising effects on improving performance of novice residents in cervical pedicle screw placement compared with the traditional teaching methods.
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Affiliation(s)
- Yang Hou
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China
| | - Jiangang Shi
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China
| | - Yanping Lin
- School of Mechanical Engineering, State Key Laboratory of Mechanical System and Vibration, Institute of Biomedical Manufacturing and Life Quality Engineering, Shanghai, 200240, China
| | - Huajiang Chen
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China
| | - Wen Yuan
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Rd, Shanghai, 200003, China.
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Burcev AV, Pavlova OM, Diachkov KA, Diachkova GV, Ryabykh SO, Gubin AV. Easy method to simplify "freehand" subaxial cervical pedicle screw insertion. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2017; 8:390-395. [PMID: 29403258 PMCID: PMC5763603 DOI: 10.4103/jcvjs.jcvjs_92_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Study Design: Technical note. Objectives: The objective of this study is to check out safety and rationality of standardized and fast tricks to select trajectory of subaxial cervical pedicle screw (SCPS) insertion, based on simple angles to bony landmarks. Materials and Methods: Stage 1 – Computed tomography (CT)-morphometric analysis of C3–C7 vertebrae of ten patients with cervical degenerative diseases. Stage 2 – SCPS insertion in 6 cadavers, according to the developed technique (59 pedicle screws). Stage 3 – SCPS insertion in 6 patients, according to the developed technique (32 pedicle screws). Results: CT-morphometric analysis showed that the average length of C3–C7 pedicle channels was 32 mm, the average angle between a pedicle axis and an axis of contralateral lamina - 180°, the average angle between a pedicle axis and plane of a posterior surface of a lateral mass amounted to 90° and the coordinates of an optimal entry point – 2 mm from a lateral edge and 2 mm from an upper edge of the lateral mass posterior surface. During the cadaveric study, 39 screws had a satisfactory position (66.1%), 7 screws permissible (11.9%), and 13 screws unacceptable (22%). During the clinical study, 26 screws (81.25%) had satisfactory position, 4 (12.5%) had permissible position, and 2 (6.25%) unacceptable position. Conclusion: Developed and clinically approved a method for simplicity SCPS insertion is relatively safe and cheap. No doubt, it requires further investigation, but the results of primary analysis allow us to recommend it to wide practical application.
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Affiliation(s)
| | | | | | | | - Sergey O Ryabykh
- Division Spine Pathology and Rare Diseases, Russian Ilizarov Scientific Center, Kurgan, Russian
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Addressing Stretch Myelopathy in Multilevel Cervical Kyphosis with Posterior Surgery Using Cervical Pedicle Screws. Asian Spine J 2016; 10:1007-1017. [PMID: 27994775 PMCID: PMC5164989 DOI: 10.4184/asj.2016.10.6.1007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/09/2016] [Accepted: 04/09/2016] [Indexed: 11/25/2022] Open
Abstract
Study Design Technique description and retrospective data analysis. Purpose To describe the technique of cervical kyphosis correction with partial facetectomies and evaluate the outcome of single-stage posterior decompression and kyphosis correction in multilevel cervical myelopathy. Overview of Literature Kyphosis correction in multilevel cervical myelopathy involves anterior and posterior surgery. With the advent of cervical pedicle screw-rod instrumentation, single-stage posterior kyphosis correction is feasible and can address stretch myelopathy by posterior shortening. Methods Nine patients underwent single-stage posterior decompression and kyphosis correction for multilevel cervical myelopathy using cervical pedicle screw instrumentation from March 2011 to February 2014 and were evaluated preoperatively and postoperatively with modified Japanese Orthopaedic Association (mJOA) scoring and computed tomography scans for radiological measurements. Kyphosis assessment was made with Ishihara curvature index and C2–C7 Cobb's angle. The linear length of the spinal canal and the actual spinal canal length were also evaluated. The average follow-up was 40.56 months (range, 20 to 53 months). Results The average preoperative C2–7 Cobb's angle of 6.3° (1° to 12°) improved to 2° (10° to −9°). Ishihara index improved from −15.8% (−30.5% to −4.7%) to −3.66% (−14.5% to +12.6%). The actual spinal canal length decreased from 83.64 mm (range, 76.8 to 91.82 mm) to 82.68 mm (range, 75.85 to 90.78 mm). The preoperative mJOA score of 7.8 (range, 3 to 11) improved to 15.0 (range, 13 to 17). Conclusions Single-stage posterior decompression and kyphosis correction using cervical pedicle screws for multilevel cervical myelopathy may address stretch myelopathy, in addition to decompression in the transverse plane. However, cervical lordosis was not achieved with this method as predictably as by the anterior approach. The present study shows evidence of mild shortening of cervical spinal canal and a positive correlation between canal shortening and clinical improvement.
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Wang T, Wang H, Liu S, An HD, Liu H, Ding WY. Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in multilevel cervical spondylotic myelopathy: A meta-analysis. Medicine (Baltimore) 2016; 95:e5437. [PMID: 27930523 PMCID: PMC5265995 DOI: 10.1097/md.0000000000005437] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Both anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are used to treat multilevel cervical spondylotic myelopathy (mCSM); however, which one is better treatment for mCSM remains considerable controversy. A meta-analysis was performed to compare clinical outcomes, radiographic outcomes, and surgical outcomes between ACDF and ACCF in treatment for mCSM. METHODS An extensive search of literature was performed in Pubmed/MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG databases on ACDF versus ACCF treatment for mCSM from January 2011 to August 2016. The following variables were extracted: length of hospital stay, blood loss, operation time, Japanese Orthopedic Association (JOA) scores, Neck Disability Index (NDI) score, fusion rate, Cobb angles of C2 to C7, dysphagia, hoarseness, C5 palsy, infection, cerebral fluid leakage, donor site pain, epidural hematoma, graft subsidence, graft dislodgment, pseudoarthrosis, and total complications. Data analysis was conducted with RevMan 5.3 and STATA 12.0. RESULTS A total of 8 studies containing 878 patients were included in our study. The results showed that ACDF is better than ACCF in the angle of C2 to C7 at the final follow-up (P < 0.00001, standardized mean difference = 4.76 [3.48, 6.03]; heterogeneity: P = 0.17, I = 43%), C5 plasy (P = 0.02, odds ratio [OR] 0.42, 95% confidence interval [CI] 0.21, 0.86; heterogeneity: P = 0.52, I = 0%), blood loss (P < 0.00001, standardized mean difference = -53.12, 95% CI -64.61, -41.64; heterogeneity: P = 0.29, I = 20%), fusion rate (P = 0.04, OR 2.54, 95% CI 1.05, 6.11; heterogeneity: P = 0.29, I = 20%), graft subsidence (P = 0.004, OR 0.11, 95% CI 0.02, 0.48; heterogeneity: P = 0.94, I = 0%), and total complications (P = 0.0009, OR 0.56, 95% CI 0.40, 0.79; heterogeneity: P = 0.29, I = 18%).However, there are no significant differences in length of hospital stay, operation time, JOA scores, NDI scores, preoperative angle of C2 to C7, dysphagia, hoarseness, infection, cerebral fluid leakage, donor site pain, epidural hematoma, graft dislodgment, and pseudoarthrosis (all P > 0.05). CONCLUSIONS Based on our meta-analysis, our results suggest that both ACDF and ACCF are good plans in clinical outcomes; however, ACDF is a better choice in radiographic outcomes and total complications for the treatment of multilevel CSM.
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Affiliation(s)
- Tao Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Hui Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Sen Liu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Huang-Da An
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Huan Liu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Wen-Yuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
- Hebei Provincial Key Laboratory of Orthopedic Biomechanics, Shijiazhuang, China
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Duetzmann S, Cole T, Ratliff JK. Cervical laminoplasty developments and trends, 2003-2013: a systematic review. J Neurosurg Spine 2015; 23:24-34. [PMID: 25909270 DOI: 10.3171/2014.11.spine14427] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Despite extensive clinical experience with laminoplasty, the efficacy of the procedure and its advantages over laminectomy remain unclear. Specific clinical elements, such as incidence or progression of kyphosis, incidence of axial neck pain, postoperative cervical range of motion, and incidence of postoperative C-5 palsies, are of concern. The authors sought to comprehensively review the laminoplasty literature over the past 10 years while focusing on these clinical elements. METHODS The authors conducted a literature search of articles in the Medline database published between 2003 and 2013, in which the terms "laminoplasty," "laminectomy," and "posterior cervical spine procedures" were used as key words. Included was every single case series in which patient outcomes after a laminoplasty procedure were reported. Excluded were studies that did not report on at least one of the above-mentioned items. RESULTS A total of 103 studies, the results of which contained at least 1 of the prespecified outcome variables, were identified. These studies reported 130 patient groups comprising 8949 patients. There were 3 prospective randomized studies, 1 prospective nonrandomized alternating study, 15 prospective nonrandomized data collections, and 84 retrospective reviews. The review revealed a trend for the use of miniplates or hydroxyapatite spacers on the open side in Hirabayashi-type laminoplasty or on the open side in a Kurokawa-type laminoplasty. Japanese Orthopaedic Association (JOA) scoring was reported most commonly; in the 4949 patients for whom a JOA score was reported, there was improvement from a mean (± SD) score of 9.91 (± 1.65) to a score of 13.68 (± 1.05) after a mean follow-up of 44.18 months (± 35.1 months). The mean preoperative and postoperative C2-7 angles (available for 2470 patients) remained stable from 14.17° (± 0.19°) to 13.98° (± 0.19°) of lordosis (average follow-up 39 months). The authors found significantly decreased kyphosis when muscle/posterior element-sparing techniques were used (p = 0.02). The use of hardware in the form of hydroxyapatite spacers or miniplates did not influence the progression of deformity (p = 0.889). An overall mean (calculated from 2390 patients) of 47.3% loss of range of motion was reported. For the studies that used a visual analog scale score (totaling 986 patients), the mean (cohort size-adjusted) postoperative pain level at a mean follow-up of 29 months was 2.78. For the studies that used percentages of patients who complained of postoperative axial neck pain (totaling 1249 patients), the mean patient number-adjusted percentage was 30% at a mean follow-up of 51 months. The authors found that 16% of the studies that were published in the last 10 years reported a C-5 palsy rate of more than 10% (534 patients), 41% of the studies reported a rate of 5%-10% (n = 1006), 23% of the studies reported a rate of 1%-5% (n = 857), and 12.5% reported a rate of 0% (n = 168). CONCLUSIONS Laminoplasty remains a valid option for decompression of the spinal cord. An understanding of the importance of the muscle-ligament complex, plus the introduction of hardware, has led to progress in this type of surgery. Reporting of outcome metrics remains variable, which makes comparisons among the techniques difficult.
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Affiliation(s)
- Stephan Duetzmann
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Tyler Cole
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - John K Ratliff
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
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Wen ZQ, Du JY, Ling ZH, Xu HD, Lin XJ. Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in the treatment of multilevel cervical spondylotic myelopathy: systematic review and a meta-analysis. Ther Clin Risk Manag 2015; 11:161-70. [PMID: 25673996 PMCID: PMC4321642 DOI: 10.2147/tcrm.s72699] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To date, the decision to treat multilevel cervical spondylotic myelopathy (CSM) with anterior cervical discectomy and fusion (ACDF) or anterior cervical corpectomy and fusion (ACCF) remains controversial. Therefore, we conducted a meta-analysis to quantitatively determine the efficacy of ACDF and ACCF in the treatment of multilevel CSM. METHODS We searched several databases for related research articles published in English or Chinese. We extracted and assessed the data independently. We determined the pooled data, data heterogeneity, and overall effect, respectively. RESULTS We identified 15 eligible studies with 1,368 patients. We found that blood loss and numbers of complications during surgery in ACDF were significantly less that in ACCF; however, other clinical outcomes, such as operation time, bone fusion failure, post Japanese Orthopedic Association scores, recovery rates, and visual analog scale scores between ACDF and ACCF with multilevel CSM were not significantly different. CONCLUSION Our results strongly suggest that surgical treatments of multilevel CSM are similar in terms of most clinical outcomes using ACDF or ACCF.
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Affiliation(s)
- Zhi-Qiang Wen
- Department of Orthopaedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Jing-Yu Du
- Department of Orthopaedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Zhi-Heng Ling
- Department of Orthopaedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Hai-Dong Xu
- Department of Spine Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, People's Republic of China
| | - Xiang-Jin Lin
- Department of Orthopaedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
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Mid-term results of computer-assisted cervical pedicle screw fixation. Asian Spine J 2014; 8:759-67. [PMID: 25558318 PMCID: PMC4278981 DOI: 10.4184/asj.2014.8.6.759] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/29/2014] [Accepted: 02/04/2014] [Indexed: 11/19/2022] Open
Abstract
Study Design A retrospective study. Purpose The present study aimed to evaluate mid-term results of cervical pedicle screw (CPS) fixation for cervical instability. Overview of Literature CPS fixation has widely used in the treatment of cervical spinal instability from various causes; however, there are few reports on mid-term surgical results of CPS fixation. Methods Record of 19 patients who underwent cervical and/or upper thoracic (C2-T1) pedicle screw fixation for cervical instability was reviewed. The mean observation period was 90.2 months. Evaluated items included Japanese Orthopaedic Association (JOA) score and C2-7 lordotic angle before surgery and at 5 years after surgery. Postoperative computerized tomography was used to determine the accuracy of screw placement. Visual analog scale (VAS) for neck pain and radiological evidence of adjacent segment degeneration (ASD) at the 5-year follow-up were also evaluated. Results Mean JOA score was significantly improved from 9.0 points before surgery to 12.8 at 5 years after surgery (p=0.001). The C2-7 lordotic angle of the neutral position improved from 6.4° to 7.8° at 5 years after surgery, but this was not significant. The major perforation rate was 5.0%. There were no clinically significant complications such as vertebral artery injury, spinal cord injury, or nerve root injury caused by any screw perforation. Mean VAS for neck pain was 49.4 at 5 years after surgery. The rate of ASD was 21.1%. Conclusions Our mid-term results showed that CPS fixation was useful for treating cervical instability. Severe complications were prevented with the assistance of a computed tomography-based navigation system.
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