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Yang X, Zhang S, Su J, Guo S, Ibrahim Y, Zhang K, Tian Y, Wang L, Yuan S, Liu X. Comparison of Clinical and Radiographic Outcomes Between Transforaminal Endoscopic Lumbar Discectomy and Microdiscectomy: A Follow-up Exceeding 5 Years. Neurospine 2024; 21:303-313. [PMID: 38317550 PMCID: PMC10992631 DOI: 10.14245/ns.2347026.513] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE To compare the long-term clinical and radiographic outcomes of transforaminal endoscopic lumbar discectomy (TELD) versus microdiscectomy (MD). METHODS The data of 154 patients with lumbar disc herniation (LDH) who underwent TELD (n = 89) or MD (n = 65) were retrospectively analyzed. The patients' clinical outcomes were evaluated using visual analogue scales for leg and low back pain, the Japanese Orthopaedic Association (JOA) score, and the Oswestry Disability Index (ODI). The evolution of radiographic manifestations was observed during follow-up. Potential risk factors for a poor clinical outcome were investigated. RESULTS During a mean follow-up of 5.5 years (range, 5-7 years), the recurrence rate was 4.49% in the TELD group and 1.54% in the MD group. All scores significantly improved from preoperatively to postoperatively in both groups (p < 0.01). The improvement in the ODI and JOA scores was significantly greater in the TELD than MD group (p < 0.05). Forty-seven patients (52.8%) in the TELD group and 32 (49.2%) in the MD group had Modic changes before surgery, most of which showed no changes at the last follow-up. The degeneration grades of 292 discs (71.0%) were unchanged at the last follow-up, while 86 (20.9%) showed improvement, mostly at the upper adjacent segment. No significant difference was observed in the intervertebral height index or paraspinal muscle-disc ratio. CONCLUSION Both TELD and MD provide generally satisfactory long-term clinical outcomes for patients with LDH. TELD can be used as a reliable alternative to MD with less surgical trauma. Modic type II changes, decreased preoperative intervertebral height, and a high body mass index are predictors of a poor prognosis.
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Affiliation(s)
- Xinyu Yang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
- Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shijun Zhang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Junxiao Su
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
- Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Sai Guo
- Photography Department, School of Journalism and Communication, Tianjin Normal University, Tianjin, China
| | - Yakubu Ibrahim
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
- Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Kai Zhang
- Department of Orthopedics, The Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yonghao Tian
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Lianlei Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Suomao Yuan
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Xinyu Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
- Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Dhar UK, Menzer EL, Lin M, Hagerty V, O'Connor T, Tsai CT, Vrionis FD. Factors influencing cage subsidence in anterior cervical corpectomy and discectomy: a systematic review. Eur Spine J 2023; 32:957-68. [PMID: 36708398 DOI: 10.1007/s00586-023-07530-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/05/2022] [Accepted: 01/06/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE Various factors have been examined in relation to cage subsidence risk, including cage material, cage geometry, bone mineral density, device type, surgical level, bone graft, and patient age. The present study aims to compare and synthesize the literature of both clinical and biomechanical studies to evaluate and present the factors associated with cage subsidence. METHODS A comprehensive search of the literature from January 2003 to December 2021 was conducted using the PubMed and ScienceDirect databases by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Following the screening for inclusion and exclusion criteria, a total of 49 clinical studies were included. Correlations between clinical and biomechanical studies are also discussed. RESULTS Patients treated with the cage and plate combination had a lower subsidence rate than patients with the stand-alone cage. Overall, Polyetheretherketone material was shown to have a lower subsidence rate than titanium and other materials. The subsidence rate was also higher when the surgery was performed at levels C5-C7 than at levels C2-C5. No significant correlation was found between age and cage subsidence clinically. CONCLUSIONS Cage subsidence increases the stress on the anterior fixation system and may cause biomechanical instability. Severe cage subsidence decreases the Cobb angle and intervertebral height, which may cause destabilization of the implant system, such as screw/plate loosening or breakage of the screw/plate. Various factors have been shown to influence the risk of cage subsidence. Examining clinical research alongside biomechanical studies offers a more comprehensive understanding of the subject.
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Lu X, Li D, Wang H, Xia X, Ma X, Lv F, Zou F, Jiang J. Biomechanical effects of interbody cage height on adjacent segments in patients with lumbar degeneration: a 3D finite element study. J Orthop Surg Res 2022; 17:325. [PMID: 35729647 PMCID: PMC9210615 DOI: 10.1186/s13018-022-03220-3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/07/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To investigate the biomechanical effects of interbody cage height on adjacent segments in patients with lumbar degeneration undergoing transforaminal lumbar interbody fusion (TLIF) surgery, so as to provide references for selection of interbody cage. Methods The finite element model of normal lower lumbar spine (L3–S1) was built and validated, then constructed three different degenerative segments in L3–L4, and the cages with different height (8, 10, 12, 14 mm) were implanted into L4–L5 disc. All the twelve models were loaded with pure moment of 7.5 N m to produce flexion, extension, lateral bending and axial rotation motions on lumbar spine, and the effects of cage height on range of motion (RoM) and intervertebral pressure in lumbar spine were investigated. Results The RoM of adjacent segments and the maximum stress of intervertebral discs increased with the increase in cage height, but this trend was not obvious in mild and moderate degeneration groups. After implantation of four different height cages (8, 10, 12, 14 mm), the RoM of L3/L4 segment reached the maximum during extension. The RoM of mild degeneration group was 2.07°, 2.45°, 2.48°, 2.54°, that of moderate degeneration group was 1.79°, 1.97°, 2.05°, 2.05°, and that of severe degeneration group was 1.43°, 1.66°, 1.74°, 1.74°. The stress of L3–L4 intervertebral disc reached the maximum during flexion. The maximum stress of L3–L4 intervertebral disc was 20.16 MPa, 20.28 MPa, 20.31 MPa and 20.33 MPa in the mild group, 20.58 MPa, 20.66 MPa, 20.71 MPa and 20.75 MPa in the moderate group, and 21.27 MPa, 21.40 MPa, 21.50 MPa and 21.60 MPa in the severe group. Conclusion For patients with mild-to-moderate lumbar degenerative disease who need to undergo TLIF surgery, it is recommended that the height of fusion cage should not exceed the original intervertebral space height by 2 mm, while for patients with severe degeneration, a fusion cage close to the original intervertebral height should be selected as far as possible, and the intervertebral space should not be overstretched.
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Affiliation(s)
- Xiao Lu
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi Road, Jing'an District, Shanghai, 200040, China
| | - Dachuan Li
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi Road, Jing'an District, Shanghai, 200040, China
| | - Hongli Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi Road, Jing'an District, Shanghai, 200040, China
| | - Xinlei Xia
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi Road, Jing'an District, Shanghai, 200040, China
| | - Xiaosheng Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi Road, Jing'an District, Shanghai, 200040, China
| | - Feizhou Lv
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi Road, Jing'an District, Shanghai, 200040, China
| | - Fei Zou
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi Road, Jing'an District, Shanghai, 200040, China.
| | - Jianyuan Jiang
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi Road, Jing'an District, Shanghai, 200040, China.
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Abudouaini H, Huang C, Liu H, Hong Y, Wang B, Ding C, Meng Y, Wu T. Change in the postoperative intervertebral space height and its impact on clinical and radiological outcomes after ACDF surgery using a zero-profile device: a single-Centre retrospective study of 138 cases. BMC Musculoskelet Disord 2021; 22:543. [PMID: 34126981 PMCID: PMC8204480 DOI: 10.1186/s12891-021-04432-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 06/06/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The effects of postoperative intervertebral height (IH) changes on the clinical and radiological outcomes after anterior cervical decompression and fusion (ACDF) surgery using a zero-profile device remain unclear. METHODS We retrospectively reviewed patients who had undergone ACDF using a zero-profile device from March 2012 to February 2016 at our institution. Based on the postoperative IH variation, the patients were divided into group A with postoperative IH 0 to 2 mm, group B with postoperative IH 2 to 4 mm, and group C with postoperative IH greater than 4 mm. Clinical efficacy was evaluated using JOA, VAS, and NDI scores in the groups. Imaging parameters including the IH, cervical lordosis, fusion rate, intervertebral foramen (IVF) diameter and complications such as subsidence, dysphagia, and ASD were also compared across the three groups. RESULTS The average IH increased significantly from 6.72 mm preoperatively to 10.46 mm 1 week after surgery, and then gradually decreased to 7.48 mm at the final follow-up. The fusion rate was 61.90% in group A, 63.23% in group B, 53.57% in group C at 3 months, 73.81% in group A, 79.41% in group B, 67.86% in group C at 6 months, 90.48% in group A, 95.59% in group B, 92.86% in group C 1 year after surgery, and at the last follow-up, the fusion rate of three groups was all 100%. The IVF diameter was 6.52 ± 1.80 mm in group A, 9.55 ± 2.36 mm in group B, and 9.34 ± 1.62 mm in group C. ASD at the superior and inferior levels affected 11.90 and 16.67% patients in group A, 5.88 and 7.38% in group B, and 14.28 and 10.71% in group C. Regarding the 3 groups, the subsidence rates were 7.14, 4.41, and 14.29%, respectively. CONCLUSIONS No clear correlation was found between IH changes and clinical efficacy within a year of surgery. However, the IH may affect various complications after ACDF. If postoperative IH changes are maintained at 2 to 4 mm after a year, a satisfactory imaging parameters and relatively low complications may be achieved after ACDF surgery using a zero-profile device.
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Affiliation(s)
- Haimiti Abudouaini
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Rd, Chengdu, 610041, Sichuan, China
| | - Chengyi Huang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Rd, Chengdu, 610041, Sichuan, China
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Rd, Chengdu, 610041, Sichuan, China.
| | - Ying Hong
- Department of Anesthesia and Operation Center / West China School of Nursing, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Beiyu Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Rd, Chengdu, 610041, Sichuan, China
| | - Chen Ding
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Rd, Chengdu, 610041, Sichuan, China
| | - Yang Meng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Rd, Chengdu, 610041, Sichuan, China
| | - Tingkui Wu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Rd, Chengdu, 610041, Sichuan, China
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Kim WB, Hyun SJ, Choi H, Kim KJ, Jahng TA, Kim HJ. Long-Term Follow-Up Results of Anterior Cervical Inter-Body Fusion with Stand-Alone Cages. J Korean Neurosurg Soc 2016; 59:385-91. [PMID: 27446521 PMCID: PMC4954888 DOI: 10.3340/jkns.2016.59.4.385] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 03/25/2016] [Accepted: 05/06/2016] [Indexed: 12/03/2022] Open
Abstract
Objective The purpose of this study was to evaluate long-term follow-up radiologic/clinical outcomes of patients who underwent anterior cervical discectomy and inter-body fusion (ACDF) with stand-alone cages (SAC) in a single academic institution. Methods Total 99 patients who underwent ACDF with SAC between February 2004 and December 2012 were evaluated retrospectively. A total of 131 segments were enrolled in this study. Basic demographic information, radiographic [segmental subsidence rate, fusion rate, C2–7 global angle, and segmental angle changes)/clinical outcomes (by Odom's criteria and visual analog score (VAS)] and complications were evaluated to determine the long-term outcomes. Results The majority were males (55 vs. 44) with average age of 53.2. Mean follow-up period was 62.9 months. The segmental subsidence rate was 53.4% and fusion rate was 73.3%. In the subsidence group, anterior intervertebral height (AIH) had more tendency of subsiding than middle or posterior intervertebral height (p=0.01). The segmental angle led kyphotic change related to the subsidence of the AIH. Adjacent segmental disease was occurred in 18 (18.2%) patients. Total 6 (6%) reoperations were performed at the index level. There was no statistical significance between clinical and radiological outcomes. But, overall long-term clinical outcome by Odom's criteria was unsatisfactory (64.64%). The neck and arm VAS score were increased by over time. Conclusion Long-term outcomes of ACDF with SAC group were acceptable but not satisfactory. For optimal decision making, more additional comparative long-term outcome data is needed between ACDF with SAC and ACDF with plating.
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Affiliation(s)
- Woong-Beom Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hoyong Choi
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Tae-Ahn Jahng
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyun-Jib Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Chang H, Baek DH, Choi BW. The Relationship between Increased Intervertebral Disc Height and Development of Postoperative Axial Neck Pain after Anterior Cervical Fusion. J Korean Neurosurg Soc 2014; 55:343-7. [PMID: 25237430 PMCID: PMC4166330 DOI: 10.3340/jkns.2014.55.6.343] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/25/2014] [Accepted: 06/11/2014] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the relationship between postoperative increase in intervertebral disc space height (IVH) and posterior axial neck in cases of degenerative cervical disease treated with anterior cervical discectomy and fusion (ACDF). Methods A total of 155 patients who underwent ACDF with more than 1 year follow up were included. Radiologically, IVH and interfacet distance (IFD) of the operated segment were measured preoperatively and postoperatively. We clinically evaluated neck and arm pains according to visual analogue scale (VAS) scores and assessed neck disability index (NDI) scores preoperatively, postoperatively, at 3 months, 6 months, and 1 year postoperatively. The relationship between radiological parameters, and clinical scores were analyzed using a regression analysis. Results The mean increase in IVH was 2.62 mm, and the mean increase in IFD was 0.67 mm. The VAS scores for neck pain preoperatively, postoperatively, and at 3 months, 6 months, 1 year postoperatively were 4.46, 2.11, 2.07, 1.95, and 1.29; those for arm pain were 5.89, 3.24, 3.20, 3.03, and 2.18. The NDI scores were improved from 18.52 to 7.47. No significant relationship was observed between the radiological evaluation results regarding the increase in intervertebral height or interfacet distance and clinical changes in VAS or NDI scores. Conclusion The increase in intervertebral space or interfacet distance by the insertion of a large graft material while performing ACDF for the treatment of degenerative cervical disease was not related with the change in VAS scores for neck and arm pains and NDI scores postoperatively and during the follow-up period.
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Affiliation(s)
- Han Chang
- Department of Orthopedic Surgery, Busan Korea Hospital, Busan, Korea
| | - Dong-Hoon Baek
- Department of Orthopedic Surgery, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Byung-Wan Choi
- Department of Orthopedic Surgery, Inje University Haeundae Paik Hospital, Busan, Korea
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