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Lewandrowski KU, da Silva RCL, Elfar JC, Alhammoud A, Moghamis IS, Burkhardt BW, Oertel JM, Landgraeber S, Fiorelli RKA, de Carvalho PST, Abraham I, León JFR, Martinez E, Lorio MP. Disability-adjusted life years from bone and joint infections associated with antimicrobial resistance: an insight from the 2019 Global Burden of Disease Study. Int Orthop 2024:10.1007/s00264-024-06143-2. [PMID: 38502335 DOI: 10.1007/s00264-024-06143-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/24/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE Bone and joint infections, complicated by the burgeoning challenge of antimicrobial resistance (AMR), pose significant public health threats by amplifying the disease burden globally. We leveraged results from the 2019 Global Burden of Disease Study (GBD) to explore the impact of AMR attributed to bone and joint infections in terms of disability-adjusted life years (DALYs), elucidating the contemporary status and temporal trends. METHODS Utilizing GBD 2019 data, we summarized the burden of bone and joint infections attributed to AMR across 195 countries and territories in the 30 years from 1990 to 2019. We review the epidemiology of AMR in terms of age-standardized rates, the estimated DALYs, comprising years of life lost (YLLs) and years lived with disability (YLDs), as well as associations between DALYs and socio-demographic indices. RESULTS The GBD revealed that DALYs attributed to bone and joint infections associated with AMR have risen discernibly between 1990 and 2019 globally. Significant geographical disparities and a positive correlation with socio-demographic indicators were observed. Staphylococcus aureus infections, Group A Streptococcus, Group B Streptococcus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterobacter-related bone and joint infections were associated with the highest DALYs because of a high proportion of antimicrobial resistance. Countries with limited access to healthcare, suboptimal sanitary conditions, and inconsistent antibiotic stewardship were markedly impacted. CONCLUSIONS The GBD underscores the escalating burden of bone and joint infections exacerbated by AMR, necessitating urgent, multi-faceted interventions. Strategies to mitigate the progression and impact of AMR should emphasize prudent antimicrobial usage and robust infection prevention and control measures, coupled with advancements in diagnostic and therapeutic modalities.
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Affiliation(s)
- Kai-Uwe Lewandrowski
- Orthopedics Surgery Department, Center for Advanced Spine Care of Southern Arizona, Tucson, AZ, USA
| | | | - John C Elfar
- Orthopedics Surgery Department, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Abduljabbar Alhammoud
- Orthopedics Surgery Department, University of Arizona College of Medicine, Tucson, AZ, USA.
| | | | - Bendenikt W Burkhardt
- Wirbelsäulenzentrum Spine Center - WSC_Hirslanden klinik Zurich, Zurich, Switzerland
| | - Joachim M Oertel
- Department of Neurosurgery, Saarland University Hospital, Hamburg, Germany
| | - Stefan Landgraeber
- Department of Neurosurgery, Saarland University Hospital, Hamburg, Germany
| | | | | | - Ivo Abraham
- Clinical Translational Science, University of Arizona, Tucson, AZ, USA
| | | | - Ernesto Martinez
- Orthopedics Surgery Department, Reina Sofia Clinic, Bogotá, Colombia
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Burkhardt BW, Kerolus MG, Witiw CD, Oertel JM, Fessler RG. Anterior cervical discectomy and fusion with a dynamic translational plating versus a rigid carbon fiber reinforced PEEK plating system - a comparison study of radiographic parameters. Br J Neurosurg 2024; 38:99-103. [PMID: 34524041 DOI: 10.1080/02688697.2021.1976394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE In this study the authors compare the radiographic findings of patients undergoing 1-3 level ACDF a rigid CFRP plate and a translational titanium plate system with a focus on radiographic alignment. MATERIAL AND METHODS A retrospective review 70 consecutive patients undergoing a 1 to 3 level ACDF for cervical spondylosis was conducted. 2 groups depending on the cervical plating system were created including 38 patients in group 1 (dynamic plate) and 32 in group 2 (rigid CFRP plate). Plain neutral radiographs preoperatively, immediately after surgery and at most recent follow-up were used to assess parameters on sagittal alignment, fusion height, adjacent segment ossification (ASO), fusion rate and implant failure. RESULTS There were no significant differences between groups preoperatively. Both groups had a more than 12 months follow-up (p = 0.327). Improvement of C2-7 lordosis was seen in both groups but only in group 1 it reached statistical significance at final follow-up. Significant improvement in sagittal segmental alignment was noted in both groups following surgery. A significant sagittal correction of 5.5 ± 9.1 degrees (p = 0.002) was maintained through follow-up only in group 2. No significantly different was seen for segmental fusion rates and loss of fusion height. There were no instances of implant failure within both groups. Worsening of ASO was 20% for both groups. CONCLUSION ACDF allows for correction and maintenance of cervical alignment. Rigid rigid plate appears more effective at maintaining segmental lordotic correction. The fusion rate and implant failure was not different for both groups.
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Affiliation(s)
- Benedikt W Burkhardt
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Mena G Kerolus
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Christopher D Witiw
- Division of Neurosurgery, University of Toronto, St. Michael's Hospital, Toronto, Canada
| | - Joachim M Oertel
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Richard G Fessler
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA
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Abraham I, Lewandrowski KU, Elfar JC, Li ZM, Fiorelli RKA, Pereira MG, Lorio MP, Burkhardt BW, Oertel JM, Winkler PA, Yang H, León JFR, Telfeian AE, Dowling Á, Vargas RAA, Ramina R, Asefi M, de Carvalho PST, Defino H, Moyano J, Montemurro N, Yeung A, Novellino P, On Behalf Of Teams/Organizations/Institutions. Randomized Clinical Trials and Observational Tribulations: Providing Clinical Evidence for Personalized Surgical Pain Management Care Models. J Pers Med 2023; 13:1044. [PMID: 37511657 PMCID: PMC10381640 DOI: 10.3390/jpm13071044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 07/30/2023] Open
Abstract
Proving clinical superiority of personalized care models in interventional and surgical pain management is challenging. The apparent difficulties may arise from the inability to standardize complex surgical procedures that often involve multiple steps. Ensuring the surgery is performed the same way every time is nearly impossible. Confounding factors, such as the variability of the patient population and selection bias regarding comorbidities and anatomical variations are also difficult to control for. Small sample sizes in study groups comparing iterations of a surgical protocol may amplify bias. It is essentially impossible to conceal the surgical treatment from the surgeon and the operating team. Restrictive inclusion and exclusion criteria may distort the study population to no longer reflect patients seen in daily practice. Hindsight bias is introduced by the inability to effectively blind patient group allocation, which affects clinical result interpretation, particularly if the outcome is already known to the investigators when the outcome analysis is performed (often a long time after the intervention). Randomization is equally problematic, as many patients want to avoid being randomly assigned to a study group, particularly if they perceive their surgeon to be unsure of which treatment will likely render the best clinical outcome for them. Ethical concerns may also exist if the study involves additional and unnecessary risks. Lastly, surgical trials are costly, especially if the tested interventions are complex and require long-term follow-up to assess their benefit. Traditional clinical testing of personalized surgical pain management treatments may be more challenging because individualized solutions tailored to each patient's pain generator can vary extensively. However, high-grade evidence is needed to prompt a protocol change and break with traditional image-based criteria for treatment. In this article, the authors review issues in surgical trials and offer practical solutions.
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Affiliation(s)
- Ivo Abraham
- Pharmacy Medicine, and Clinical Translational Sciences, University of Arizona, Roy P. Drachman Hall, Rm. B306H, Tucson, AZ 85721, USA
| | - Kai-Uwe Lewandrowski
- Center for Advanced Spine Care of Southern Arizona, Tucson, AZ 85712, USA
- Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá 111321, Colombia
- Department of Orthopedics, Hospital Universitário Gaffre e Guinle, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro 20270-004, Brazil
| | - John C Elfar
- Department of Orthopaedic Surgery, College of Medicine-Tucson Campus, Health Sciences Innovation Building (HSIB), University of Arizona, 1501 N. Campbell Avenue, Tower 4, 8th Floor, Suite 8401, Tucson, AZ 85721, USA
| | - Zong-Ming Li
- Department of Orthopaedic Surgery, College of Medicine-Tucson Campus, Health Sciences Innovation Building (HSIB), University of Arizona, 1501 N. Campbell Avenue, Tower 4, 8th Floor, Suite 8401, Tucson, AZ 85721, USA
| | - Rossano Kepler Alvim Fiorelli
- Department of General and Specialized Surgery, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 20270-004, Brazil
| | - Mauricio G Pereira
- Faculty of Medicine, University of Brasilia, Federal District, Brasilia 70919-900, Brazil
| | - Morgan P Lorio
- Advanced Orthopaedics, 499 E. Central Pkwy, Ste. 130, Altamonte Springs, FL 32701, USA
| | - Benedikt W Burkhardt
- Wirbelsäulenzentrum/Spine Center-WSC, Hirslanden Klinik Zurich, Witellikerstrasse 40, 8032 Zurich, Switzerland
| | - Joachim M Oertel
- Klinik für Neurochirurgie, Universität des Saarlandes, Kirrberger Straße 100, 66421 Homburg, Germany
| | - Peter A Winkler
- Department of Neurosurgery, Charite Universitaetsmedizin Berlin, 13353 Berlin, Germany
| | - Huilin Yang
- Orthopaedic Department, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou 215031, China
| | - Jorge Felipe Ramírez León
- Minimally Invasive Spine Center Bogotá D.C. Colombia, Reina Sofía Clinic Bogotá D.C. Colombia, Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá 110141, Colombia
| | - Albert E Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Álvaro Dowling
- Department of Orthopaedic Surgery, University of São Paulo, Ribeirão Preto 14071-550, Brazil
| | - Roth A A Vargas
- Department of Neurosurgery, Foundation Hospital Centro Médico Campinas, Campinas 13083-210, Brazil
| | - Ricardo Ramina
- Neurological Institute of Curitiba, Curitiba 80230-030, Brazil
| | - Marjan Asefi
- Department of Biology, Nano-Biology, University of North Carolina, Greensboro, NC 27413, USA
| | | | - Helton Defino
- Department of Orthopaedic Surgery, University of São Paulo, Ribeirão Preto 14071-550, Brazil
| | - Jaime Moyano
- La Sociedad Iberolatinoamericana De Columna (SILACO), The Spine Committee of the Ecuadorian Society of Orthopaedics and Traumatology (Comité de Columna de la Sociedad Ecuatoriana de Ortopedia y Traumatología), Quito 170521, Ecuador
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56124 Pisa, Italy
| | - Anthony Yeung
- Desert Institute for Spine Care, Phoenix, AZ 85020, USA
| | - Pietro Novellino
- Guinle and State Institute of Diabetes and Endocrinology, Rio de Janeiro 20270-004, Brazil
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Oertel JM, Burkhardt BW. Microendoscopic Surgery for Degenerative Disorders of the Cervical and Lumbar Spine: The Influence of the Tubular Workspace on Instrument Angulation, Clinical Outcome, Complications, and Reoperation Rates. J Pers Med 2023; 13:912. [PMID: 37373901 DOI: 10.3390/jpm13060912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Long-term clinical outcomes with microendoscopic spine surgery (MESS) are poorly investigated. The effect of instrument angulation on clinical outcomes has yet to be assessed. METHODS A total of 229 consecutive patients operated on via two MESS systems were analyzed. Instrument angulation for both MESS systems, which differ from each other regarding the working space for instruments, was assessed using a computer model. Patients' charts and endoscopic video recordings were reviewed to determine clinical outcomes, complications, and revision surgery rates. At a minimum follow-up of two years, clinical outcomes were assessed employing the Neck Disability Index (NDI) and Oswestry Disability Index (ODI). RESULTS A total of 52 posterior cervical foraminotomies (PCF) and 177 lumbar decompression procedures were performed. The mean follow-up was six years (range 2-9 years). At the final follow-up, 69% of cervical and 76% of lumbar patients had no radicular pain. The mean NDI was 10%, and the mean ODI was 12%. PCF resulted in excellent clinical outcomes in 80% of cases and 87% of lumbar procedures. Recurrent disc herniations occurred in 7.7% of patients. The surgical time and repeated procedure rate were significantly lower for the MESS system with increased working space, whereas the clinical outcome and rate of complication were similar. CONCLUSIONS MESS achieves high success rates for treating degenerative spinal disorders in the long term. Increased instrument angulation improves access to the compressive pathology and lowers the surgical time and repeated procedure rate.
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Affiliation(s)
- Joachim M Oertel
- Klinik für Neurochirurgie, Universität des Saarlandes, Kirrbergerstrasse 100, 66421 Homburg-Saar, Germany
| | - Benedikt W Burkhardt
- Wirbelsäulenzentrum/Spine Center-WSC, Klinik Hirslanden, Witellikerstrasse 40, 8032 Zurich, Switzerland
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Lewandrowski KU, Elfar JC, Li ZM, Burkhardt BW, Lorio MP, Winkler PA, Oertel JM, Telfeian AE, Dowling Á, Vargas RAA, Ramina R, Abraham I, Assefi M, Yang H, Zhang X, Ramírez León JF, Fiorelli RKA, Pereira MG, de Carvalho PST, Defino H, Moyano J, Lim KT, Kim HS, Montemurro N, Yeung A, Novellino P. The Changing Environment in Postgraduate Education in Orthopedic Surgery and Neurosurgery and Its Impact on Technology-Driven Targeted Interventional and Surgical Pain Management: Perspectives from Europe, Latin America, Asia, and The United States. J Pers Med 2023; 13:852. [PMID: 37241022 PMCID: PMC10221956 DOI: 10.3390/jpm13050852] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Personalized care models are dominating modern medicine. These models are rooted in teaching future physicians the skill set to keep up with innovation. In orthopedic surgery and neurosurgery, education is increasingly influenced by augmented reality, simulation, navigation, robotics, and in some cases, artificial intelligence. The postpandemic learning environment has also changed, emphasizing online learning and skill- and competency-based teaching models incorporating clinical and bench-top research. Attempts to improve work-life balance and minimize physician burnout have led to work-hour restrictions in postgraduate training programs. These restrictions have made it particularly challenging for orthopedic and neurosurgery residents to acquire the knowledge and skill set to meet the requirements for certification. The fast-paced flow of information and the rapid implementation of innovation require higher efficiencies in the modern postgraduate training environment. However, what is taught typically lags several years behind. Examples include minimally invasive tissue-sparing techniques through tubular small-bladed retractor systems, robotic and navigation, endoscopic, patient-specific implants made possible by advances in imaging technology and 3D printing, and regenerative strategies. Currently, the traditional roles of mentee and mentor are being redefined. The future orthopedic surgeons and neurosurgeons involved in personalized surgical pain management will need to be versed in several disciplines ranging from bioengineering, basic research, computer, social and health sciences, clinical study, trial design, public health policy development, and economic accountability. Solutions to the fast-paced innovation cycle in orthopedic surgery and neurosurgery include adaptive learning skills to seize opportunities for innovation with execution and implementation by facilitating translational research and clinical program development across traditional boundaries between clinical and nonclinical specialties. Preparing the future generation of surgeons to have the aptitude to keep up with the rapid technological advances is challenging for postgraduate residency programs and accreditation agencies. However, implementing clinical protocol change when the entrepreneur-investigator surgeon substantiates it with high-grade clinical evidence is at the heart of personalized surgical pain management.
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Affiliation(s)
- Kai-Uwe Lewandrowski
- Center For Advanced Spine Care of Southern Arizona, 4787 E Camp Lowell Drive, Tucson, AZ 85719, USA
- Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá 111321, Colombia
| | - John C. Elfar
- Department of Orthopaedic Surgery, College of Medicine—Tucson Campus, Health Sciences Innovation Building (HSIB), University of Arizona, 1501 N. Campbell Avenue, Tower 4, 8th Floor, Suite 8401, Tucson, AZ 85721, USA;
| | - Zong-Ming Li
- Departments of Orthopaedic Surgery and Biomedical Engineering, College of Medicine—Tucson Campus, Health Sciences Innovation Building (HSIB), University of Arizona, 1501 N. Campbell Avenue, Tower 4, 8th Floor, Suite 8401, Tucson, AZ 85721, USA;
| | - Benedikt W. Burkhardt
- Wirbelsäulenzentrum/Spine Center—WSC, Hirslanden Klinik Zurich, Witellikerstrasse 40, 8032 Zurich, Switzerland;
| | - Morgan P. Lorio
- Advanced Orthopaedics, 499 E. Central Pkwy, Ste. 130, Altamonte Springs, FL 32701, USA;
| | - Peter A. Winkler
- Department of Neurosurgery, Charite Universitaetsmedizin Berlin, 13353 Berlin, Germany;
| | - Joachim M. Oertel
- Klinik für Neurochirurgie, Universitätsdes Saarlandes, Kirrberger Straße 100, 66421 Homburg, Germany;
| | - Albert E. Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA;
| | - Álvaro Dowling
- Orthopaedic Surgery, University of São Paulo, Brazilian Spine Society (SBC), Ribeirão Preto 14071-550, Brazil; (Á.D.); (H.D.)
| | - Roth A. A. Vargas
- Department of Neurosurgery, Foundation Hospital Centro Médico Campinas, Campinas 13083-210, Brazil;
| | - Ricardo Ramina
- Neurological Institute of Curitiba, Curitiba 80230-030, Brazil;
| | - Ivo Abraham
- Clinical Translational Sciences, University of Arizona, Roy P. Drachman Hall, Rm. B306H, Tucson, AZ 85721, USA;
| | - Marjan Assefi
- Department of Biology, Nano-Biology, University of North Carolina, Greensboro, NC 27413, USA;
| | - Huilin Yang
- Orthopaedic Department, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou 215031, China;
| | - Xifeng Zhang
- Department of Orthopaedics, First Medical Center, PLA General Hospital, Beijing 100853, China;
| | - Jorge Felipe Ramírez León
- Minimally Invasive Spine Center Bogotá D.C. Colombia, Reina Sofía Clinic Bogotá D.C. Colombia, Department of Orthopaedics Fundación Universitaria Sanitas, Bogotá 0819, Colombia;
| | - Rossano Kepler Alvim Fiorelli
- Department of General and Specialized Surgery, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 20270-004, Brazil;
| | - Mauricio G. Pereira
- Faculty of Medecine, University of Brasilia, Federal District, Brasilia 70919-900, Brazil;
| | | | - Helton Defino
- Orthopaedic Surgery, University of São Paulo, Brazilian Spine Society (SBC), Ribeirão Preto 14071-550, Brazil; (Á.D.); (H.D.)
| | - Jaime Moyano
- La Sociedad Iberolatinoamericana De Columna (SILACO), and the Spine Committee of the Ecuadorian Society of Orthopaedics and Traumatology (Comité de Columna de la Sociedad Ecuatoriana de Ortopedia y Traumatología), Quito 170521, Ecuador;
| | - Kang Taek Lim
- Good Doctor Teun Teun Spine Hospital, Anyang 14041, Republic of Korea;
| | - Hyeun-Sung Kim
- Department of Neurosurgery, Nanoori Hospital, Seoul 06048, Republic of Korea;
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56124 Pisa, Italy;
| | - Anthony Yeung
- Desert Institute for Spine Care, Phoenix, AZ 85020, USA;
| | - Pietro Novellino
- Guinle and State Institute of Diabetes and Endocrinology, Rio de Janeiro 20270-004, Brazil;
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Burkhardt BW, Baumann L, Simgen A, Wagenpfeil G, Hendrix P, Reith W, Oertel JM. Long-term follow-up MRI shows no hastening of adjacent segment degeneration following cervical disc arthroplasty. Sci Rep 2022; 12:13318. [PMID: 35922473 PMCID: PMC9349281 DOI: 10.1038/s41598-022-17652-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/28/2022] [Indexed: 11/28/2022] Open
Abstract
Cervical disc arthroplasty is an established procedure, but studies with data on long-term clinical outcome, reoperation for symptomatic adjacent segment degeneration (sASD), and degenerative changes based on MRI findings are rare. Thus, a file review was performed and patients with complete documentation of neurological status at preoperative, postoperative, 12 month, 3–4 years follow-up including surgical reports for reoperation with a minimum follow-up of 9 years were included. Final follow-up assessment included a physical examination, assessment of pain levels, Odoms criteria, Neck disability index. The degeneration of each cervical segment at preoperative and at final follow-up was assessed using an MRI. Forty-six out of 68 included patients participated, the mean follow-up was 11 (range 9–15) years, at which 71.7% of patients were free of arm pain, 52.2% of patients were free of neck pain, 63% of patients had no sensory dysfunction, and full motor strength was noted in 95.6% of patients. The clinical success rate was 76.1%, the mean NDI was 12%. Overall repeated procedure rate was 17%, the reoperation rate for sASD was 9%, and removal of CDA was performed in 4%. MRI showed progressive degeneration but no significant changes of SDI from preoperative to final follow-up.
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Affiliation(s)
- Benedikt W Burkhardt
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany. .,Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstrasse 100, Gebäude 90.5, 66421, Homburg-Saar, Germany.
| | - Lukas Baumann
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany
| | - Andreas Simgen
- Department of Neuroradiology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany
| | - Gudrun Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics (IMBEI), Saarland University Faculty of Medicine, Homburg-Saar, Germany
| | - Philipp Hendrix
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany
| | - Wolfgang Reith
- Department of Neuroradiology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany
| | - Joachim M Oertel
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany
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Burkhardt BW, Bullinger Y, Mueller SJ, Oertel JM. The Surgical Treatment of Pyogenic Spondylodiscitis using Carbon-Fiber-Reinforced Polyether Ether Ketone Implants: Personal Experience of a Series of 81 Consecutive Patients. World Neurosurg 2021; 151:e495-e506. [PMID: 33905911 DOI: 10.1016/j.wneu.2021.04.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Pyogenic spondylodiscitis (PSD) is a complex disorder that often required postoperative imaging. Carbon-fiber-reinforced polyether ether ketone (CFRP) is radiolucent and offers an optimal assessability of anatomic structures. METHODS A retrospective file review of patients who were operated on for PSD using CFRP implants was performed to assess the clinical outcome, implant-associated complications, and revision surgery. A minimum follow-up of 3 months was required for evaluation of clinical and radiographic data, which included computed tomography and magnetic resonance imaging (MRI) assessment, to determine implant stability and assessability of soft tissue and nerve structures using a grading system. RESULTS Eighty-one consecutive patients with a mean of 69.5 years were identified. Debridement and stabilization were performed in 8 cervical, 17 thoracic, and 57 lumbar procedures; 72 interbody fusion procedures using cages were performed. Intraoperatively, no implant-associated complication was noted. The mean follow-up was 7 months, at which 52 patients attended. Improved mobility and reduced pain levels were reported by 87%, and MRI assessability was graded ideal. Residual sign of infection was seen in 5 cases, which influenced antibiotic therapy. Asymptomatic radiolucent zones were identified in 13 patients (16%) and screw loosening in 2 (2.4%). In 1 patient, the pedicle screw tip broke and remained within the vertebral body. A repeated procedure because of progressive vertebral body destruction, implant loosening, or subsidence was performed in 5 patients (6.1%). CONCLUSIONS The surgical treatment of PSD using CFRP is safe. The repeat procedure rate as a result of implant loosening is 6.1%. Minimal artifacts offer ideal assessability of soft tissue structures on an MRI.
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Affiliation(s)
- Benedikt W Burkhardt
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany.
| | - Yannik Bullinger
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany
| | - Simon J Mueller
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany
| | - Joachim M Oertel
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany
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Burkhardt BW, Oertel JM. Is Decompression and Partial Discectomy Advantageous Over Decompression Alone in Microendoscopic Decompression Of Monosegmental Unilateral Lumbar Recess Stenosis? Int J Spine Surg 2021; 15:94-104. [PMID: 33900962 PMCID: PMC7931747 DOI: 10.14444/8013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Endoscopic techniques are well accepted as surgical technique for decompression of lumbar lateral recess stenosis (LRS). It is uncertain if there is a difference in clinical outcome for decompression alone (DA) or decompression with partial discectomy (DPD) for the treatment of LRS. METHODS All files of patients who underwent an endoscopic procedure for lumbar LRS were identified from a prospectively collected database. Preoperative magnetic resonance imaging and endoscopic video were analyzed with special focus on the technique of nerve root decompression. Clinical outcome was assessed via a personal examination, a standardized questionnaire including the numeric rating scale (NRS) for leg and back pain, the Oswestry disability index (ODI), and the modified MacNab criteria to assess functional outcome and clinical success. RESULTS Sixty-six patients were identified of which 57 attended for evaluation (86.4%). DA was performed in 15 (26.3%) patients and DPD in 42 patients (73.7%). The mean follow-up was 45.0 months (range: 16-82 months). Fifty-two patients reported to be free of leg pain (91.1%), 42 patients had no noticeable back pain (73.7%), 49 patients had full muscle strength (85.9%), and 48 patients had no sensory disturbance (84.2%). The mean NRS for leg pain was 1, the mean NRS for back pain was 2, mean ODI was 16% (range: 0%-60%). Clinical success was noted in 49 patients (85.9%) and it was significantly higher for patients following DPD (P = .024). The overall repeat procedure rate was 12% with reoperation rate at the index segment in 10.5% of cases. There were no significant differences with respect to leg and back pain, ODI, and reoperation between both groups. CONCLUSION Microendoscopic DPD of LRS achieves a 92% clinical success rate which is significantly higher compared to 67% clinical success achieved by DA. There was no significant difference for the rate of reoperation, leg and back pain, and ODI. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Benedikt W Burkhardt
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Joachim M Oertel
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
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Burkhardt BW, Oertel JM. Annular closure device breakage due to recurrent lumbar disc herniation: a case report. Acta Neurochir (Wien) 2021; 163:269-273. [PMID: 33222009 DOI: 10.1007/s00701-020-04651-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
Detailed surgical management, magnetic resonance imaging (MRI), and computer tomography (CT) images of a broken annular closure device (ACD) have not been reported yet. In this case, a 28-year-old male presented with a new onset of radiculopathy three years after lumbar discectomy and placement of an ACD. The CT-myelography and MRI revealed a recurrent disc herniation (RDH) and dislocation of a broken ACD. ACD removal was performed and confirmed breakage due to RDH with scarring around the RDH and displaced ACD. Implant-associated complications and management should be reported in detail in order to enhance knowledge on device-related complications.
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Burkhardt BW, Csokonay A, Oertel JM. 3D-exoscopic visualization using the VITOM-3D in cranial and spinal neurosurgery. What are the limitations? Clin Neurol Neurosurg 2020; 198:106101. [PMID: 32781375 DOI: 10.1016/j.clineuro.2020.106101] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/28/2020] [Accepted: 07/18/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE 3D exoscopic visualization in neurosurgical procedures is of interest for several reasons. The VITOM-3D exoscopic system is cheaper compared to the operating microscope (OM) and offers each person involved in the procedure the same image of the operative field. Little is known of limitations of this visualization technique. PATIENTS AND METHODS Prospectively, a consecutive series 34 procedures were assessed with focus on the following aspects: intraoperative limitation and the cause for a switch to the OM or endoscopy. A standardized questionnaire was answered by each individual involved in the procedure to assess the image quality, illumination, and magnification of the operative field. Intraoperative video recording and pre- and postoperative MRI and CT-scan were analyzed to assess the dimensions of the surgical approach. RESULTS Sixteen cranial and 18 spinal procedures (10 intra-axial, 6 extra-axial, 6 cervical, and 12 lumbar) were performed by seven neurosurgical attendings, twelve residents and twelve scrub nurses who all completed a standardized questionnaire after each procedure. Handling and identification of anatomical structures was rated equal or superior to the OM in 62 % and over 80 % of cases, respectively. The illumination and magnification of the operative field on the surface was rate in equal od superior in all cases and on the depth it was rated inferior to the OM over 60 % of cases. In one spinal and five cranial procedures a switch to the OM or endoscope were performed for the following reasons: poor illumination (4 cases), tissue identification (1 case), need for fluorescence imaging (1 case). CONCLUSION 3D exoscopic visualization using the VITOM-3D is best suited for spinal procedures and for extra-axial cranial procedures. In case of small approach dimensions, the illumination and magnification of the depth of the operative field is rated inferior to the OM which resulted in difficulty of tissue identification and a switch to the OM.
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Affiliation(s)
- Benedikt W Burkhardt
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Saar, Germany.
| | - Akos Csokonay
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Saar, Germany.
| | - Joachim M Oertel
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Saar, Germany.
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Burkhardt BW, Oertel JM. Endoscopic Posterior Cervical Foraminotomy: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 18:E41. [PMID: 31245821 DOI: 10.1093/ons/opz131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/13/2019] [Indexed: 11/14/2022] Open
Abstract
In the 1940s, the posterior cervical foraminotomy (PCF) was first described. At that time, this technique represented a big step ahead for the treatment of cervical radiculopathy. Rightly, a multitude of studies demonstrated that open microsurgical posterior foraminotomy is an effective treatment for cervical radiculopathy. Open posterior approaches have still the disadvantage of detaching the extensor cervical muscles from the laminae and the spinous processes, which can lead to severe collateral tissue and muscle damage, followed by postoperative complications, such as axial neck pain, shoulder pain, loss of lordosis, or even spinal instability. Minimally invasive techniques have been developed to reduce the approach related trauma. Initially, these techniques have been performed using endoscopic visualization and applied to the lumbar spine with great success. With this in mind, spine surgeons have extended the spectrum of indication and applied endoscopic techniques to treat degenerative cervical spine disorders. Indications for PCF are single-level or multilevel unilateral lateral disc herniation, osseous foraminal stenosis secondary to isolated facet hypertrophy, and persistent radicular symptoms following an anterior cervical spine procedure. Depending on the underlying pathology, clinical success rates from 75% to 96% for the treatment of cervical radiculopathy have been reported. Mainly, there are 2 different endoscopic techniques to perform PCF. The so-called full-endoscopic techniques are performed under continuous irrigation in single-handed technique. The endoscopic tubular assisted technique is performed in bimanual fashion with microsurgical instruments. The purpose of this video is to describe the endoscopic tubular assisted technique in detail. Patient consent was obtained prior to preparation of the video.
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Affiliation(s)
- Benedikt W Burkhardt
- Department of Neurosurgery, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Joachim M Oertel
- Department of Neurosurgery, Saarland University Medical Center, Saarland University, Homburg, Germany
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Burkhardt BW, Simgen A, Wagenpfeil G, Hendrix P, Dehnen M, Reith W, Oertel JM. Is there a difference in the grade of degeneration at the cervical spine following anterior cervical fusion with respect to clinical outcome, diagnosis, and repeat procedure? An MRI study of 102 patients with a mean follow-up of 25 years. J Neurosurg Spine 2019; 32:1-9. [PMID: 31783354 DOI: 10.3171/2019.9.spine19887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/10/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is currently no consensus on whether adjacent-segment degeneration (ASD), loss of disc height (DH), and loss of sagittal segmental angle (SSA) are due to anterior cervical discectomy and fusion (ACDF). The purpose of the present study was to assess the grade of segmental degeneration after ACDF and to analyze if there is a difference with respect to clinical outcome, diagnosis, and number of operated levels. METHODS A total of 102 patients who underwent ACDF with a minimum follow-up of 18 years were retrospectively identified. At final follow-up, the clinical outcome according to Odom's criteria, the Neck Disability Index (NDI), and reoperation for symptomatic ASD (sASD) was assessed. MRI was performed, and DH, SSA, and the segmental degeneration index (SDI, a 5-step grading system that includes disc signal intensity, anterior and posterior disc protrusion, narrowing of the disc space, and foraminal stenosis) were assessed for evaluation of the 2 adjacent and 4 adjoining segments to the ACDF. MRI findings were compared with respect to clinical outcome (NDI: 0%-20% vs > 20%; Odom's criteria: success vs no success), reoperation for sASD, initial diagnosis (cervical disc herniation [CDH] vs cervical spondylotic myelopathy [CSM] and spondylosis), and the number of operated levels (1 vs 2-4 levels). RESULTS The mean follow-up was 25 years (range 18-45 years), and the diagnosis was CDH in 74.5% of patients and CSM/spondylosis in 25.5%. At follow-up, the mean NDI was 12.4% (range 0%-36%), the clinical success rate was 87.3%, and the reoperation rate for sASD was 15.7%. For SDI, no significant differences were seen with respect to NDI, Odom's criteria, and sASD. Patients diagnosed with CDH had significantly more degeneration at the adjacent segments (cranial, p = 0.015; caudal, p = 0.017). Patients with a 2- to 4-level procedure had less degeneration at the caudal adjacent (p = 0.011) and proximal adjoining (p = 0.019) segments. Aside from a significantly lower DH at the proximal cranial adjoining segment in cases of CSM/spondylosis and without clinical success, no further differences were noted. The degree of SSA was not significantly different with respect to clinical outcome. CONCLUSIONS No significant differences were seen in the SDI grade and SSA with respect to clinical outcome. The SDI is higher after single-level ACDF and with the diagnosis of CDH. The DH was negligibly different with respect to clinical outcome, diagnosis, and number of operated levels.
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Affiliation(s)
| | - Andreas Simgen
- 2Neuroradiology, Saarland University Medical Center and Saarland University Faculty of Medicine; and
| | - Gudrun Wagenpfeil
- 3Institute for Medical Biometry, Epidemiology and Medical Informatics (IMBEI), Saarland University Faculty of Medicine, Homburg-Saar, Germany
| | | | | | - Wolfgang Reith
- 2Neuroradiology, Saarland University Medical Center and Saarland University Faculty of Medicine; and
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Burkhardt BW, Simgen A, Dehnen M, Wagenpfeil G, Reith W, Oertel JM. Is there an impact of cervical plating on the development of adjacent segment degeneration following Smith-Robinson procedure? A magnetic resonance imaging study of 84 patients with a 24-year follow-up. Spine J 2019; 19:587-596. [PMID: 30195935 DOI: 10.1016/j.spinee.2018.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 09/01/2018] [Accepted: 09/04/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Anterior cervical discectomy and fusion (ACDF) without and with cervical plating (ACDF+CP) are accepted surgical techniques for the treatment of degenerative cervical disc disorders. The effect of CP on the development of adjacent segment degeneration (ASD) remains unclear. PURPOSE To assess whether CP accelerates the degeneration of the adjacent and adjoining segments. STUDY DESIGN/SETTING This is an imaging cohort study. PATIENT SAMPLE Retrospectively, a total of 84 patients who underwent ACDF or ACDF+CP were identified. At final follow-up, an MRI was performed and evaluated in this study. MATERIALS AND METHODS An MRI of 84 patients who underwent ACDF (46 patients) and ACDF+PS (38 patients) was performed. The mean follow-up was 24 years (17-45 years). None of the patients had a repeat procedure in the cervical spine. The grade of degeneration of the segments adjacent and adjoining to the fusion was assessed via a five-step grading system (segmental degeneration index, or SDI) that includes disc signal intensity, anterior and posterior disc protrusion, narrowing of the disc space, and foraminal stenosis. Furthermore, the disc height (DH) and sagittal segmental angle (SSA) of fused segments were measured. RESULTS A significantly (p<.001) greater SDI was identified at the caudal adjacent segment following ACDF compared to ACDF+CP. No other significant differences were identified in patients following ACDF and ACDF+CP. Between 50% and 96% of all segments showed severe degenerative changes according to SDI. There was no significant difference in DH between the patients following ACDF and ACDF+CP. The SSA in patients who underwent ACDF+CP was significantly greater than in the ACDF patients (p=.002). CONCLUSIONS In this cohort of patients, cervical plating had no significant impact on segmental degeneration and decrease of DH in the adjacent and adjoining segments. ACDF+CP seem to preserve the lordotic alignment more with respect to the SSA than ACDF.
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Affiliation(s)
- Benedikt W Burkhardt
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany.
| | - Andreas Simgen
- Department of Neuroradiology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany.
| | - Matthias Dehnen
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany.
| | - Gudrun Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics (IMBEI), Saarland University Faculty of Medicine, Homburg-Saar, Germany.
| | - Wolfgang Reith
- Department of Neuroradiology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany.
| | - Joachim M Oertel
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany.
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Abstract
Purpose: To assess whether the instrument handling and image quality of endoscopic spinal decompression procedures is adequate and effects the treatment of degenerative spinal disorders. Material and Methods: Forty-six patients underwent endoscopic procedures for radicular pain or sensorimotor deficit due to a degenerative disorder using a 15mm tubular retractor. Endoscopic video recordings were reviewed with focus on instrument handling and intraoperative complication. At final follow-up the clinical outcome was assessed via a standardized questionnaire including the Oswestry Disability Index (ODI) Neck Disability Index (NDI), Odoms criteria and a personal examination focusing on pain, and sensorimotor deficits. Results: Forty out of 46 patients attended a final follow-up (86.9%). The mean follow-up time was 51.8 month (range 15-84 month). At final follow-up, of patients who were operate at the lumbar spine 93.9% and at the cervical spine 85.7% were free of radicular pain, no weakness was documented in 84.9% of cases after lumbar and 85.7% after cervical spine procedure, and according to Odoms criteria clinical success was noted in 84.5% and 100%, respectively. The mean ODI was 9.0% and mean NDI was 11.7%. The dural tear rate was 4.3%, all dural tear were closed endoscopically. The recurrent disc herniation rate was 6.1%. Conclusions: Endoscopic decompression using a 15m tubular retractor offers a good view onto the surgical field and a high clinical success rate. The decompression of degenerative pathologies in bimanual technique is not limited by a 15mm tubular retractor.
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Affiliation(s)
- Benedikt W Burkhardt
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine , Homburg/Saar , Germany
| | - Joachim M Oertel
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine , Homburg/Saar , Germany
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Burkhardt BW, Müller SJ, Wagner AC, Oertel JM. Anterior cervical spine surgery for the treatment of subaxial cervical spondylodiscitis: a report of 30 consecutive patients. Neurosurg Focus 2019; 46:E6. [DOI: 10.3171/2018.10.focus18464] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/22/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEInfection of the cervical spine is a rare disease but is associated with significant risk of neurological deterioration, morbidity, and a poor response to nonsurgical management. The ideal treatment for cervical spondylodiscitis (CSD) remains unclear.METHODSHospital records of patients who underwent acute surgical management for CSD were reviewed. Information about preoperative neurological status, surgical treatment, peri- and postoperative processes, antibiotic treatment, repeated procedure, and neurological status at follow-up examination were analyzed.RESULTSA total of 30 consecutive patients (17 male and 13 female) were included in this retrospective study. The mean age at procedures was 68.1 years (range 50–82 years), with mean of 6 coexisting comorbidities. Preoperatively neck pain was noted in 21 patients (70.0%), arm pain in 12 (40.0%), a paresis in 12 (40.0%), sensory deficit in 8 (26.7%), tetraparesis in 6 (20%), a septicemia in 4 (13.3%). Preoperative MRI scan revealed a CSD in one-level fusion in 21 patients (70.0%), in two-level fusions in 7 patients (23.3%), and in three-level fusions in 2 patients (6.7%). In 16 patients an antibiotic treatment was initiated prior to surgical treatment. Anterior cervical discectomy and fusion with cervical plating (ACDF+CP) was performed in 17 patients and anterior cervical corpectomy and fusion (ACCF) in 12 patients. Additional posterior decompression was performed in one case of ACDF+CP and additional posterior fixation in ten cases of ACCF procedures. Three patients died due to multiple organ failure (10%). Revision surgery was performed in 6 patients (20.7%) within the first 2 weeks postoperatively. All patients received antibiotic treatment for 6 weeks. At the first follow-up (mean 3 month) no recurrent infection was detected on blood workup and MRI scans. At final follow-up (mean 18 month), all patients reported improvement of neck pain, all but one patients were free of radicular pain and had no sensory deficits, and all patients showed improvement of motor strength. One patient with preoperative tetraparesis was able to ambulate.CONCLUSIONSCSD is a disease that is associated with severe neurological deterioration. Anterior cervical surgery with radical debridement and appropriate antibiotic treatment achieves complete healing. Anterior cervical plating with the use of polyetheretherketone cages has no negative effect of the healing process. Posterior fixation is recommended following ACCF procedures.
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Müller SJ, Burkhardt BW, Oertel JM. Management of Dural Tears in Endoscopic Lumbar Spinal Surgery: A Review of the Literature. World Neurosurg 2018; 119:494-499. [PMID: 29902608 DOI: 10.1016/j.wneu.2018.05.251] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/31/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The incidental dural tear is a common complication in lumbar spine surgery. It has been reported that the incidence of dural tears is much greater in endoscopic procedures. Primary closure via suturing remains challenging in endoscopic procedures. The objective of this study was to conduct a literature review on the surgical technique for dural closure and repair in endoscopic spine surgery. METHODS A systematic literature search was performed using the database PubMed. In total, 12 studies reported specifically about the surgical treatment for dural tear in percutaneous and tubular assisted endoscopic technique. The dural tear rate, the technique of dural closure, postoperative time of bed rest, postoperative symptoms related to cerebrospinal fluid fistula, and revision surgery were assessed. RESULTS The overall rate of dural tears in endoscopic spinal surgery was 2.7%, with a range from 0% to 8.6%. The incidence of a dural tear was much greater in cases with lumbar stenosis (3.7%) than in lumbar disc herniation (2.1%). The greatest rate was accompanied by resecting synovial cysts. In addition, the risk of dural tear is greater in bilateral decompression procedures via a unilateral approach. There is no consensus about the ideal technique for dural closure in endoscopic procedures. Furthermore, there is a debate whether dural tear requires surgical treatment or not. CONCLUSIONS An autologous muscle or fat graft in combination with fibrin glue or a fibrin-sealed collagen sponge seems to be a good and safe method for the management of dural tear in lumbar endoscopic spine surgery.
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Affiliation(s)
- Simon J Müller
- Department of Neurosurgery, Saarland University Medical Center and Faculty of Saarland University, Homburg-Saar, Germany
| | - Benedikt W Burkhardt
- Department of Neurosurgery, Saarland University Medical Center and Faculty of Saarland University, Homburg-Saar, Germany
| | - Joachim M Oertel
- Department of Neurosurgery, Saarland University Medical Center and Faculty of Saarland University, Homburg-Saar, Germany.
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Oertel JM, Burkhardt BW. Endoscopic Intralaminar Approach for the Treatment of Lumbar Disc Herniation. World Neurosurg 2017; 103:410-418. [DOI: 10.1016/j.wneu.2017.03.132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 11/26/2022]
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Burkhardt BW, Brielmaier M, Schwerdtfeger K, Oertel JM. Clinical outcome following anterior cervical discectomy and fusion with and without anterior cervical plating for the treatment of cervical disc herniation-a 25-year follow-up study. Neurosurg Rev 2017. [PMID: 28646343 DOI: 10.1007/s10143-017-0872-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Extreme long-term clinical outcome studies following anterior cervical discectomy and fusion (ACDF) with an autologous iliac crest with and without Caspar plating (ACDF + CP) for the treatment of radiculopathy caused by cervical disc herniation (CDH) are extremely rare. Hospital records of patients who underwent ACDF or ACDF + CP for the treatment of CDH at least 17 years ago were reviewed. Information about diagnosis, surgery, pre- and postoperative clinical process, and repeated procedure was analyzed. At final follow-up, patients were reviewed with a standardized questionnaire including the current neurological status, Neck Disability Index (NDI), Odom's criteria, a modified EQ-5D, and limitations in quality of life. One hundred twenty-two patients with a mean follow-up of 25 years were evaluated. ACDF was performed in 80 and ACDF + CP in 42 patients, respectively. At final follow-up, 81.1% of patients were free of radicular pain and had no repeated procedure. According to Odom's criteria, 86.1% of good to excellent functional recovery was noted. The mean NDI and EQ-5D was 14% and 5 points, respectively. There was no significant difference in the assessed clinical outcome parameters between patients treated with ACDF and ACDF + CP. The rate for repeated procedure due to degenerative cervical disorders was 10.7 and 7.4% due to symptomatic adjacent segment disease with 25 years. ACDF and ACDF + CP achieved a high rate radicular pain relief (89.3%) and clinical success (86.1%) for the treatment of CDH within a 25 years follow-up. No statistical difference concerning clinical outcome and rate of repeated procedure was detected.
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Affiliation(s)
- Benedikt W Burkhardt
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Saar, Germany.
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstraße 100, Gebäude 90.5, 66421, Homburg, Germany.
| | - Moritz Brielmaier
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Saar, Germany
| | - Karsten Schwerdtfeger
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Saar, Germany
| | - Joachim M Oertel
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Saar, Germany
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Burkhardt BW, Simgen A, Wagenpfeil G, Reith W, Oertel JM. Adjacent Segment Degeneration After Anterior Cervical Discectomy and Fusion With an Autologous Iliac Crest Graft: A Magnetic Resonance Imaging Study of 59 Patients With a Mean Follow-up of 27 Years. Neurosurgery 2017; 82:799-807. [DOI: 10.1093/neuros/nyx304] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/04/2017] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Anterior cervical decompression and fusion (ACDF) is a widely accepted surgical technique for the treatment of degenerative disc disease. ACDF is associated with adjacent segment degeneration (ASD).
OBJECTIVE
To assess whether physiological aging of the spine would overcome ASD by comparing adjacent to adjoining segments more than 18 yr after ACDF.
METHODS
Magnetic resonance imaging of 59 (36 male, 23 female) patients who underwent ACDF was performed to assess degeneration. The mean follow-up was 27 yr (18-45 yr). Besides measuring the disc height, a 5-step grading system (segmental degeneration index [SDI]) including disc signal intensity, anterior and posterior disc protrusion, narrowing of the disc space, and foraminal stenosis was used to assess the grade of adjacent and adjoining segments.
RESULTS
The SDI of cranial and caudal adjacent segments was significantly higher compared to adjoining segments (P < .001). The disc height of cranial and caudal adjacent segments was significantly lower compared to adjoining segments (P < .001, P < .01). The SDI of adjacent segments in patients with repeat cervical procedure was significantly higher than in patients without repeat procedure (P = .02, P = .01). The disc height of the cranial adjacent segments in patients with repeat procedure was significantly lower than in patients without repeat procedure (P = .01).
CONCLUSION
The physiological aging of the cervical spine does not overcome ASD. The disc height and the SDI in adjacent segment are significantly worse compared to adjoining segments. Patients who underwent repeat procedure had even worse findings of disc height and SDI.
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Affiliation(s)
- Benedikt W Burkhardt
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany
| | - Andreas Simgen
- Department of Neur-oradiology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany
| | - Gudrun Wagenpfeil
- Institute for Medical Biometry, Epid-emiology and Medical Informatics (IMBEI), Saarland University Faculty of Medicine, Homburg-Saar, Germany
| | - Wolfgang Reith
- Department of Neur-oradiology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany
| | - Joachim M Oertel
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany
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Oertel JM, Burkhardt BW. Vitom-3D for Exoscopic Neurosurgery: Initial Experience in Cranial and Spinal Procedures. World Neurosurg 2017; 105:153-162. [PMID: 28559068 DOI: 10.1016/j.wneu.2017.05.109] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/17/2017] [Accepted: 05/18/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The authors describe the application of a new exoscope that offers 3-dimensional (3D) visualization in cranial and spinal neurosurgery in detail. METHODS Five cranial and 11 spinal procedures were performed with a 3D exoscope. Instrument handling, repositioning of the exoscope, handling of the image control unit, the adjustment of magnification and focal length, the depth perception, the image quality, the illumination, and the comfort level of the posture during the procedure were assessed via a questionnaire. RESULTS The following procedures were performed: Microvascular decompression (n = 1), craniotomy and tumor resection (n = 4), anterior cervical discectomy and fusion with cervical plating (n = 2), cervical laminectomy and lateral mass fixation (n = 1), shear cervical lateral mass osteosynthesis (n = 1), lumbar canal decompression (n = 1), transforaminal lumbar interbody fusion (n = 2), thoracic intraspinal extradural tumor resection (n = 1), and lumbar discectomy (n = 3). Instrument handling, the intraoperative repositioning and handling of the VITOM-3D, and the comfort level of the intraoperative posture was rated excellent in 100% of procedures. The image quality was rated equal to the operating microscope in 68.75% of procedures. None of the procedures had to be stopped because of technical problems. No surgical complications were noted that could be related to the use of the exoscope. CONCLUSIONS The 3D-exoscopic system is safe and effective tool to perform spinal procedures and less demanding cranial procedures. The image quality and 3D visualization were comparable with the operating microscope. The technique harbors the unique advantage of excellent comfort for the involved surgical team during the procedure.
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Affiliation(s)
- Joachim M Oertel
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany.
| | - Benedikt W Burkhardt
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany
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Oertel JM, Burkhardt BW. Full endoscopic treatment of dural tears in lumbar spine surgery. Eur Spine J 2017; 26:2496-2503. [DOI: 10.1007/s00586-017-5105-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 03/26/2017] [Accepted: 04/17/2017] [Indexed: 11/27/2022]
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Burkhardt BW, Brielmaier M, Schwerdtfeger K, Sharif S, Oertel JM. Smith-Robinson Procedure with an Autologous Iliac Crest for Degenerative Cervical Disc Disease: A 28-Year Follow-Up of 95 Patients. World Neurosurg 2016; 92:371-377. [DOI: 10.1016/j.wneu.2016.05.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/15/2016] [Accepted: 05/17/2016] [Indexed: 11/16/2022]
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Burkhardt BW, Brielmaier M, Schwerdtfeger K, Sharif S, Oertel JM. Smith–Robinson Procedure with an Autologous Iliac Crest Graft and Caspar Plating: Report of 65 Patients with an Average Follow-up of 22 Years. World Neurosurg 2016; 90:244-250. [DOI: 10.1016/j.wneu.2016.02.074] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 02/12/2016] [Accepted: 02/13/2016] [Indexed: 11/25/2022]
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Antes S, Tschan CA, Oertel JM. An operative technique combining endoscopic third ventriculostomy and long-term ICP monitoring. Childs Nerv Syst 2014; 30:331-5. [PMID: 23989429 DOI: 10.1007/s00381-013-2269-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 08/13/2013] [Indexed: 01/11/2023]
Abstract
Neuroendoscopy has been well established in the treatment of many neurological and neurosurgical diseases. Especially its application in occlusive hydrocephalus to restore a physiological cerebrospinal fluid circulation has been extensively examined in the past. Although such procedures are believed to be safe and effective, complication as well as failure rates up to 20% have been described pointing to the importance of long-term postoperative care. Therefore, different and partly invasive procedures as ventricular drain insertions or complex cranial imaging methods have been proposed; however, associated pitfalls and restrictions often limited their prognostic value and long-term benefit. An operative technique combining endoscopic third ventriculostomy and telemetric increased intracranial pressure monitoring has now been developed to optimize the postoperative care management. The main intention is to provide sufficient brain pressure data for long-term observation and early recognition of endoscopy failures and complications. The new operative technique was applied in a series with 24 patients suffering from occlusive hydrocephalus. Surgical technique and future perspectives are presented.
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Affiliation(s)
- Sebastian Antes
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Kirrberger Straße, Gebäude 90.5, 66421, Homburg, Germany,
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