Effect of Osteoporosis on Clinical and Radiological Outcomes Following One-Level Anterior Cervical Discectomy and Fusion

STUDY DESIGN

Retrospective study.

PURPOSE

This study aimed to evaluate how osteoporosis affected the clinical and radiological outcomes of patients who underwent anterior cervical discectomy and fusion (ACDF) with plating.

OVERVIEW OF LITERATURE

The incidence of complications associated with implants is high when ACDF is performed in patients with poor bone quality.

METHODS

In total, 101 patients without (T-score ≥1.0, group A) and 25 with (T-score ≤-2.5, group B) osteoporosis who underwent single-level ACDF with plating were followed up for >2 years. The clinical and radiological outcomes were compared between the two groups. The fusion rate and implant-related complications were evaluated.

RESULTS

Although clinical outcomes such as visual analog scale scores for the arm (2.0±2.3 vs. 2.4±2.9, p=0.490) and neck pain (1.4±1.9 vs. 1.8±2.2, p=0.343) and neck disability index (7.7±7.1 vs. 9.9±7.5, p=0.225) were slightly higher in group B, no statistically significant difference was noted. Cage subsidence (13.9% vs. 16.0%, p=0.755) and plate migration (7.9% vs. 8.0%, p=1.000) rates did not differ between the two groups. The fusion rate at 1 year postoperatively was higher in group A than in group B (80.3% vs. 68.2%, p=0.139) and slightly increased in both groups (94.6% vs. 86.4%, p=0.178) at the final follow-up.

CONCLUSIONS

Osteoporosis did not significantly affect the rate of cage subsidence or plate migration after cervical fusion. After ACDF, increased cage subsidence and implant migration rates had no significant effect on clinical outcomes.

If we should remove internal fixation devices for rib fractures?

BACKGROUND

Internal fixation for rib fractures has been widely carried out worldwide, and its surgical efficacy has been recognized. However, there is still controversy about whether implant materials need to be removed. At present, the research on this topic is still lacking at home and abroad. Therefore, in this study, the patients undergoing removal of internal fixation for rib fractures in our department within one year were followed up, to statistically analyze implant-related complications, postoperative complications and postoperative remission rate.

METHODS

A retrospective analysis was conducted on 143 patients undergoing removal of internal fixation for rib fractures from 2020 to 2021 in our center. The implant-related complications, postoperative complications and postoperative remission rate of patients with internal fixation were analyzed.

RESULTS

In this study, a total of 143 patients underwent removal of internal fixation, among which 73 suffered from preoperative implant-related complications (foreign-body sensation, pain, wound numbness, sense of tightness, screw slippage, chest tightness, implant rejection), and 70 had no post operative discomfort but asked for removal of internal fixation. The average interval between rib fixation and removal was 17 ± 9.00 (months), and the average number of removed materials was 5.29 ± 2.42. Postoperative complications included wound infection (n = 1) and pulmonary embolism (n = 1). of the 73 patients with preoperative implant-related complications, the mean postoperative remission rate was 82%. Among the 70 patients without preoperative discomfort, the proportion of discomforts after removal was 10%. No perioperative death occurred.

CONCLUSION

For patients with internal fixation for rib fractures, removal of internal fixation can be considered in the case of implant-related complications after surgery. The corresponding symptoms can be relieved after removal. The removal presents low complication rate, and high safety and reliability. For patients without obvious symptoms, it is safe to retain the internal fixation in the body. For the asymptomatic patients who ask for removal of internal fixation, the possible risk of complications should be fully informed before removal.

Construct Levels to Anchored Levels Ratio and Rod Diameter Are Associated With Implant-Related Complications in Traditional Growing Rods

INTRODUCTION

In addition to patient characteristics, consideration of length of construct to number of anchored levels ratio and rod diameter should be a part of preoperative planning to minimize implant-related complications (IRCs). IRCs including rod breakage, anchor dislodgement, and pullout are among the most common adverse events in traditional growing rods (TGRs). The current study hypothesized that anchor type and configuration are associated with IRC.

METHODS

Patients with (1) age ≤10 years at surgery; (2) spine-based dual TGR; (3) minimum 2-year follow-up; and (4) available imaging. Cephalad and caudal foundations were grouped based on the number of instrumented levels and anchor type. All radiographs were reviewed. Based on the results, a "construct levels / anchored levels" (CL/AL) ratio was calculated, which is the number of levels spanned by instrumentation divided by the number of levels with bone-anchor fixation. Receiver operating characteristic curve was used to define the CL/AL threshold.

RESULTS

274 patients divided into patients with complications (IRC+, n = 140) and without complications (IRC-, n = 134) groups. Mean follow-up was 6.3 years (2.1-18.0 years). No significant differences in age, gender, body mass index, ambulatory status, etiology, primary curve size, T1-S1 height, coronal and sagittal balance, and rod material were observed between the two groups. Comparative analysis showed that connector type, presence and location of crosslinks, number of levels instrumented, number and type of anchors, presence of pelvic fixation, and mirroring of cephalad and caudal foundations were not different. However, maximum kyphosis and rod diameter were significantly different. The CL/AL ratio threshold was 3.5. Multivariate analysis of kyphosis, rod diameter, and CL/AL ratio showed a significant association with IRC (p < .05).

DISCUSSION AND CONCLUSION

Although patient characteristics like kyphosis have been proven to be associated with instrumentation failure, it is a combination of characteristics that include rod diameter and CL/AL ratio that showed significant correlation with IRC. Validation of the CL/AL ratio is recommended.

Cervical corpectomies: results of a survey and review of the literature on diagnosis, indications, and surgical technique

OBJECTIVES

Cervical corpectomy is an uncommon procedure and there are only limited data on the procedure's indications, surgical approaches, and complications. The diagnosis, indications, surgical planning, and complications of cervical corpectomy were therefore surveyed to clarify the treatment strategies used by spinal surgeons in central Europe, with special attention to preoperative planning and decision-making for additional dorsal approaches in multilevel cases.

MATERIALS AND METHODS

An online survey with 18 questions on the preoperative, intraoperative, and postoperative management of cervical corpectomies was conducted. The relevant specialist societies in Germany and Austria provided 1137 contacts for surgeons, and the responses were compared with recent literature reports.

RESULTS

In all, 302 surgeons (27 %) completed the survey, with wide variability in the treatment options offered. Most (51 %) perform fewer than five anterior cervical corpectomy and fusion (ACCF) procedures per year; 35 % do 5-20 per year. Anterior cervical discectomy and fusion (ACDF) was preferred by 41 % of the participants to laminoplasty/laminectomy (19 %/16 %) and ACCF (12 %). Most indications for ACCF involved degenerative (27 %), traumatic (17 %), and neoplastic (20 %) conditions. Intraoperative and postoperative complications were mainly associated with hardware failure. One-third of the surgeons tend to use an additional dorsal approach to increase the corpectomy construct's stability for either two-level or three-level corpectomies.

CONCLUSIONS

There is no current consensus in central Europe on the treatment of complex cervical disease and cervical corpectomy. The procedure is still rare, and the need for additional dorsal fixation is unclear. Further studies are needed in order to establish evidence-based standards for patient care.