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1.
Clin Nucl Med ; 49(6): e281-e283, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38619985

RESUMO

ABSTRACT: Cerebral amyloid angiopathy-related inflammation is a rare encephalopathy characterized by inflammation against amyloid protein accumulated in cerebral small vessels. A 50-year-old man was presented with a subacute consciousness disorder. Brain MRI revealed high intensity lesions in the white matter of the right parietal and occipital lobes on fluid-attenuated inversion recovery sequences and cerebral microbleeds in the right parietal and occipital lobes on T2*-weighted images. Pittsburgh compound B-PET demonstrated accumulation in the right temporoparietal lobe, confirming a potential diagnosis of probable cerebral amyloid angiopathy-related inflammation without brain biopsy. Steroid pulse therapy was initiated, with good results.


Assuntos
Compostos de Anilina , Angiopatia Amiloide Cerebral , Inflamação , Tomografia por Emissão de Pósitrons , Tiazóis , Humanos , Masculino , Angiopatia Amiloide Cerebral/diagnóstico por imagem , Angiopatia Amiloide Cerebral/complicações , Pessoa de Meia-Idade , Inflamação/diagnóstico por imagem
2.
Clin Spine Surg ; 37(4): 170-177, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38637924

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To compare the frequency of complications and outcomes between patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine and those with cervical spondylotic myelopathy (CSM) who underwent anterior surgery. SUMMARY OF BACKGROUND DATA: Anterior cervical spine surgery for OPLL is an effective surgical procedure; however, it is complex and technically demanding compared with the procedure for CSM. Few reports have compared postoperative complications and clinical outcomes after anterior surgeries between the 2 pathologies. METHODS: Among 1434 patients who underwent anterior cervical spine surgery at 3 spine centers within the same spine research group from January 2011 to March 2021, 333 patients with OPLL and 488 patients with CSM were retrospectively evaluated. Demographics, postoperative complications, and outcomes were reviewed by analyzing medical records. In-hospital and postdischarge postoperative complications were investigated. Postoperative outcomes were evaluated 1 year after the surgery using the Japanese Orthopaedic Association score. RESULTS: Patients with OPLL had more comorbid diabetes mellitus preoperatively than patients with CSM ( P <0.001). Anterior cervical corpectomies were more often performed in patients with OPLL than in those with CSM (73.3% and 14.5%). In-hospital complications, such as reoperation, cerebrospinal fluid leak, C5 palsy, graft complications, hoarseness, and upper airway complications, occurred significantly more often in patients with OPLL. Complications after discharge, such as complications of the graft bone/cage and hoarseness, were significantly more common in patients with OPLL. The recovery rate of the Japanese Orthopaedic Association score 1 year postoperatively was similar between patients with OPLL and those with CSM. CONCLUSION: The present study demonstrated that complications, both in-hospital and after discharge following anterior spine surgery, occurred more frequently in patients with OPLL than in those with CSM.


Assuntos
Vértebras Cervicais , Ossificação do Ligamento Longitudinal Posterior , Complicações Pós-Operatórias , Espondilose , Humanos , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Ossificação do Ligamento Longitudinal Posterior/complicações , Masculino , Complicações Pós-Operatórias/etiologia , Feminino , Vértebras Cervicais/cirurgia , Pessoa de Meia-Idade , Espondilose/cirurgia , Espondilose/complicações , Resultado do Tratamento , Idoso , Estudos Retrospectivos , Doenças da Medula Espinal/cirurgia
3.
Global Spine J ; : 21925682231196449, 2023 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-37596769

RESUMO

STUDY DESIGN: A multi-institutional retrospective study. OBJECTIVES: To investigate risk factors of mechanical failure in three-column osteotomy (3COs) in patients with adult spinal deformity (ASD), focusing on the osteotomy level. METHODS: We retrospectively reviewed 111 patients with ASD who underwent 3COs with at least 2 years of follow-up. Radiographic parameters, clinical data on early and late postoperative complications were collected. Surgical outcomes were compared between the low-level osteotomy group and the high-level osteotomy group: osteotomy level of L3 or lower group (LO group, n = 60) and osteotomy of L2 or higher group (HO group, n = 51). RESULTS: Of the 111 patients, 25 needed revision surgery for mechanical complication (mechanical failure). A lower t-score (odds ratio [OR] .39 P = .002) and being in the HO group (OR 4.54, P = .03) were independently associated with mechanical failure. In the analysis divided by the osteotomy level (LO and HO), no difference in early complications or neurological complications was found between the two groups. The rates of overall mechanical complications, rod failure, and mechanical failure were significantly higher in the HO group than in the LO group. After propensity score matching, mechanical complications and failures were still significantly more observed in the HO group than in the LO group (P = .01 and .029, respectively). CONCLUSIONS: A lower t-score and osteotomy of L2 or higher were associated with increased risks of mechanical failure. Lower osteotomy was associated with better correction of sagittal balance and a lower rate of mechanical complications.

4.
J Clin Med ; 12(8)2023 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-37109235

RESUMO

Anterior decompression and fusion (ADF) using the floating method for cervical ossification of the posterior longitudinal ligament (OPLL) is an ideal surgical technique, but it has a specific risk of insufficient decompression caused by the impingement of residual ossification. Augmented reality (AR) support is a novel technology that enables the superimposition of images onto the view of a surgical field. AR technology was applied to ADF for cervical OPLL to facilitate intraoperative anatomical orientation and OPLL identification. In total, 14 patients with cervical OPLL underwent ADF with microscopic AR support. The outline of the OPLL and the bilateral vertebral arteries was marked after intraoperative CT, and the reconstructed 3D image data were transferred and linked to the microscope. The AR microscopic view enabled us to visualize the ossification outline, which could not be seen directly in the surgical field, and allowed sufficient decompression of the ossification. Neurological disturbances were improved in all patients. No cases of serious complications, such as major intraoperative bleeding or reoperation due to the postoperative impingement of the floating OPLL, were registered. To our knowledge, this is the first report of the introduction of microscopic AR into ADF using the floating method for cervical OPLL with favorable clinical results.

5.
J Clin Med ; 12(5)2023 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-36902561

RESUMO

We prospectively investigated the postoperative dysphagia in cervical posterior longitudinal ligament ossification (C-OPLL) and cervical spondylotic myelopathy (CSM) to identify the risk factors of each disease and the incidence. A series of 55 cases with C-OPLL: 13 anterior decompression with fusion (ADF), 16 posterior decompression with fusion (PDF), and 26 laminoplasty (LAMP), and a series of 123 cases with CSM: 61 ADF, 5 PDF, and 57 LAMP, were included. Vertebral level, number of segments, approach, and with or without fusion, and pre and postoperative values of Bazaz dysphagia score, C2-7 lordotic angle (∠C2-7), cervical range of motion, O-C2 lordotic angle, cervical Japanese Orthopedic Association score, and visual analog scale for neck pain were investigated. New dysphagia was defined as an increase in the Bazaz dysphagia score by one grade or more than one year after surgery. New dysphagia occurred in 12 cases with C-OPLL; 6 with ADF (46.2%), 4 with PDF (25%), 2 with LAMP (7.7%), and in 19 cases with CSM; 15 with ADF (24.6%), 1 with PDF (20%), and 3 with LAMP (1.8%). There was no significant difference in the incidence between the two diseases. Multivariate analysis demonstrated that increased ∠C2-7 was a risk factor for both diseases.

6.
Global Spine J ; 13(4): 1005-1010, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-33949218

RESUMO

STUDY DESIGN: Retrospective single-center study. OBJECTIVES: K-line is a decision-making tool to determine the appropriate surgical procedures for patients with cervical ossification of the posterior longitudinal ligament (C-OPLL). Laminoplasty (LAMP) is one of the standard surgical procedures indicated on the basis of K-line measurements (+: OPLL does not cross the K-line). We investigated the impact of K-line tilt, a radiographic parameter of cervical sagittal balance measured using the K-line, on surgical outcomes after LAMP. METHODS: The study included 62 consecutive patients with K-line (+) C-OPLL who underwent LAMP. The following preoperative and postoperative radiographic measurements were evaluated: (1) the K-line, (2) K-line tilt (an angle between the K-line and vertical line), (3) center of gravity of the head -C7 sagittal vertical axis, (4) C2-C7 lordotic angle, (5) C7 slope, and (6) C2-C7 range of motion. Clinical results were evaluated using the Japanese Orthopedic Association scoring system for cervical myelopathy (C-JOA score). RESULTS: All the patients had non-kyphotic cervical alignment (CL ≥ 0°) preoperatively; however, kyphotic deformity (CL < 0°) was observed in 6 patients (9.7%) postoperatively. The recovery rate of the C-JOA scores was poor in the kyphotic deformity (+) group (7.8%) than in the kyphotic deformity (-) group (47.5%). The K-line tilt was identified to be a preoperative risk factor in the multivariate analysis, and the cutoff K-line tilt for predicting the postoperative kyphotic deformity was 20°. CONCLUSIONS: LAMP is not suitable for K-line (+) C-OPLL patients with K-line tilts >20°.

7.
Spine (Phila Pa 1976) ; 48(1): 15-20, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36083514

RESUMO

STUDY DESIGN: A prospective comparative study. OBJECTIVE: To investigate the benefits of postoperative application of lumbosacral orthosis after single-level discectomy for lumbar disk herniation (LDH). SUMMARY OF BACKGROUND DATA: Although many surgeons use postoperative lumbosacral orthosis for patients with LDH, there is no clear evidence to support or deny its effectiveness. MATERIALS AND METHODS: Ninety-nine consecutive patients who underwent the microscopic discectomy were included. They were divided into two groups: orthosis group and nonorthosis group, before surgery. The recurrence rate and reoperation rate were compared between the two groups at four-week, six-month, and one-year follow-up. Japanese Orthopaedic Association Score for lumbar spine (L-JOA score) at two-week and one-year follow-up, lower extremities and low back pain's visual analog scale (VAS) and Oswestry Disability Index (ODI) at six-month and one-year follow-up were compared. RESULTS: Forty-two patients in the orthosis group and 39 patients in the nonorthosis group were followed up for at least one-year after surgery. Recurrence occurred in three patients (7.1%) in the orthosis group and six (15.4%) in the nonorthosis group within one-year. Two patients (4.8%) in the orthosis group and two patients (5.1%) in the nonorthosis group underwent reoperation. There were no significant intergroup differences in the recurrence rate and in the reoperation rate. No significant difference was also observed between the two groups in L-JOA score, ODI, VAS of low back pain, and leg pain at one-year after surgery. Furthermore, at any other follow-up period, no significant differences were observed between the two groups in recurrence rate, reoperation rate, L-JOA score, VAS of low back/leg pain, or ODI. CONCLUSIONS: The use of a postoperative orthosis did not reduce recurrence or reoperation rates, nor did it improve postoperative clinical symptoms. The routine use of an orthosis may not be necessary after single-level lumbar discectomy.


Assuntos
Discotomia Percutânea , Deslocamento do Disco Intervertebral , Dor Lombar , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Estudos Prospectivos , Dor Lombar/cirurgia , Discotomia , Vértebras Lombares/cirurgia , Resultado do Tratamento , Estudos Retrospectivos
8.
Spine Surg Relat Res ; 6(6): 581-588, 2022 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-36561158

RESUMO

Introduction: In Japan, cervical total disc replacement (TDR) was approved in 2017. However, because of its short history, no comparative study between cervical TDR and anterior cervical discectomy with fusion (ACDF) has been conducted in the country. Therefore, we examined and compared the surgical outcomes of TDR and ACDF for one-level cervical degenerative diseases. Methods: In total, 50 patients who had received anterior surgeries for one-level cervical degenerative diseases were investigated. Among them, 25 underwent TDR (Prestige LP; Medtronic), whereas the other 25 patients underwent ACDF. ACDF samples were selected from cases conducted before the approval of TDR (-2017.9) and were retrospectively judged to be indicated for TDR. Before and at 1 year after surgery, clinical and radiological outcomes were evaluated. Results: No significant differences in terms of patient demographics between the two groups were observed. A longer operative time was observed in the TDR group than in the ACDF group. Postoperatively, no differences in the Japanese Orthopaedic Association score for cervical myelopathy (C-JOA) score, neck pain visual analog scale, C2-7 angle, and C2-7 range of motion (ROM) were determined. TDR tended to show better neck disability index (NDI) scores postoperatively when compared with ACDF. The local angle at operative level was larger in ACDF. In TDR, the local ROMs were maintained postoperatively; however, in ACDF, the local ROM at the operative level was decreased, and the local ROMs at adjacent levels were increased postoperatively. In the TDR group, although heterotopic ossification was observed in 11 patients (44.0%), and anterior bone loss was identified in 14 patients (56.0%), these issues did not affect surgical outcomes. Conclusions: Conclusively, no differences in terms of C-JOA score and neck pain between patients treated through TDR and ACDF were observed. However, a trend of better NDI scores was identified with TDR. While TDR maintained postoperative ROMs, ACDF showed an increase in the local ROMs at adjacent levels.

9.
J Orthop Sci ; 27(1): 89-94, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33468342

RESUMO

BACKGROUND: Several studies have reported that overweightness and obesity are associated with higher complication rates in lumbar spine surgery. However, little is known about the effect of obesity on postoperative complications in adult spinal deformity (ASD) surgery, especially in the elderly. This study aimed to examine the effect of body mass index (BMI) on surgical outcomes and postoperative complications in elderly ASD patients undergoing surgical correction in Japan. METHODS: We conducted a retrospective, multicenter, observational study of 234 consecutive patients diagnosed with ASD who underwent corrective surgery. Patients were divided into two groups according to BMI, BMI <25 (153 patients, mean age 71.9 years) and BMI ≥ 25 (overweight/obese, 81 patients, mean age 73.3 years). Radiographic results and perioperative complications were compared between the two groups. RESULTS: Surgical complications occurred in approximately 20% of patients in each group; complications did not significantly differ between the two groups. A greater proportion of patients in the BMI ≥ 25 group experienced mechanical failure and DJK, although the difference was not significant. Preoperative mean lumbar lordosis (LL), pelvic incidence (PI) minus LL, sacral slope (SS) and sagittal vertical axis (SVA) were similar in the BMI < 25 and BMI ≥ 25 groups. However, the BMI ≥25 group had lower mean LL (p = 0.015) and higher PI minus LL (p = 0.09) postoperatively. The BMI ≥25 groups also had significantly smaller LL (p = 0.026), smaller SS (p = 0.049) and higher SVA (p = 0.041) at the final follow-up, compared to the BMI < 25 group. CONCLUSIONS: In the present study, no difference in medical or surgical complications after ASD surgery was found between overweight/obese patients (BMI ≥ 25) and those with BMI < 25. However, correction of LL and SVA was smaller in patients with overweight/obese patients.


Assuntos
Lordose , Adulto , Idoso , Índice de Massa Corporal , Humanos , Lordose/diagnóstico por imagem , Lordose/etiologia , Estudos Retrospectivos , Sacro , Resultado do Tratamento
10.
J Orthop Sci ; 27(6): 1228-1233, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34579989

RESUMO

BACKGROUND: Few studies have directly compared anterior and posterior surgical approaches in cervical spondylotic myelopathy (CSM) patients with short-segment disease. We aimed to examine and compare surgical outcomes of anterior cervical discectomy with fusion (ACDF) and selective laminoplasty (S-LAMP) in CSM patients with 1- or 2-level disease. METHODS: Forty-six patients, who received surgeries for CSM, were prospectively investigated; 24 underwent ACDF and 22 underwent S-LAMP. Average follow-up was 3.5 years. The following pre- and postoperative radiographic measurements were recorded: (1) C2-7 angle, (2) local angle (lordotic Cobb angle at operative level), (3) cervical sagittal vertical axis (SVA) (center of gravity of the head-C7 SVA), and (4) C7 slope. Outcomes were evaluated using the Japanese Orthopedic Association scoring system for cervical myelopathy (C-JOA score), neck pain visual analog scale, and neck disability index (NDI). RESULTS: There were no significant differences in patient demographics between the two groups. Postoperatively, C2-7 angle, local angle, cervical SVA, C7 slope, C-JOA score, and neck pain and NDI scores were not significantly different between the two groups; however, the recovery rate of the C-JOA score was superior in the ACDF group (57.5%) compared to the S-LAMP group (42.1%). The recovery rate of the C-JOA score in the local lordosis subgroup (local angle ≥ 0°) showed no significant difference between the two surgical groups. However, in the local kyphosis subgroup (local angle < 0°), C-JOA score recovery rate was worse after S-LAMP (20.4%) than ACDF (57.9%); local angle also worsened postoperatively after S-LAMP. CONCLUSIONS: In patients with local lordosis at the segments of cervical spondylosis and spinal cord compression, S-LAMP showed equivalent surgical outcomes (neurological recovery, neck pain and NDI scores, and cervical alignment) to ACDF. However, in patients with local kyphosis, S-LAMP worsened the kyphosis and resulted in worse neurological recovery.


Assuntos
Doenças do Desenvolvimento Ósseo , Cifose , Laminoplastia , Lordose , Doenças da Medula Espinal , Fusão Vertebral , Espondilose , Humanos , Laminoplastia/métodos , Cervicalgia , Discotomia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Fusão Vertebral/métodos , Espondilose/complicações , Espondilose/diagnóstico por imagem , Espondilose/cirurgia , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Cifose/cirurgia , Doenças do Desenvolvimento Ósseo/cirurgia , Resultado do Tratamento , Estudos Retrospectivos
11.
J Orthop Sci ; 27(6): 1208-1214, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34598845

RESUMO

BACKGROUND: Surgical procedures for cervical myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) are often chosen based on OPLL size and cervical spine alignment. Recently, cervical sagittal alignment based on sagittal vertical axis (SVA) has received increased attention as an important determinant of radiological and clinical outcomes after surgery. This study aimed to investigate the impact of SVA-based cervical sagittal alignment on surgical treatment for cervical OPLL by reviewing a previous retrospective cohort in which its concept was not taken into account in the surgical procedure choices. METHODS: We reviewed a total of 96 consecutive patients who underwent surgery for cervical myelopathy caused by OPLL from 2008 to 2014. We performed anterior decompression with fusion (ADF) or posterior decompression with fusion (PDF) on patients with massive OPLL or kyphotic alignment, and we performed laminoplasty (LAMP) on patients without massive OPLL or kyphotic alignment. CSVA (center of gravity of the head - C7 SVA), CL (C2-7 lordotic angle) and C7 slope were measured in cervical X-ray at standing position. Clinical results were evaluated using C-JOA score. We divided patients into two subgroups based on the preoperative CSVA: the Low-CSVA (CSVA <40 mm) and High-CSVA (CSVA ≥40 mm) subgroups. RESULTS: In the Low-CSVA subgroup, none of the three operations had an effect on the CL. In contrast, in the High-CSVA subgroup, while ADF and PDF had no effect on the CL, LAMP worsened the CL postoperatively. The recovery rates of the C-JOA scores in the Low-CSVA subgroup showed no significant differences among the three operations; however in the High-CSVA subgroup, LAMP resulted in worse recovery rate of the C-JOA score than ADF or PDF. CONCLUSIONS: LAMP is not suitable for patients with cervical myelopathy caused by OPLL who have high CSVA alignment, even in cases without massive OPLL or kyphotic alignment.


Assuntos
Cifose , Laminoplastia , Ossificação do Ligamento Longitudinal Posterior , Doenças da Medula Espinal , Humanos , Ligamentos Longitudinais , Estudos Retrospectivos , Osteogênese , Ossificação do Ligamento Longitudinal Posterior/complicações , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Laminoplastia/métodos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Cifose/diagnóstico por imagem , Cifose/etiologia , Cifose/cirurgia , Resultado do Tratamento , Descompressão Cirúrgica/métodos
12.
J Clin Med ; 10(20)2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34682860

RESUMO

Lateral lumbar interbody fusion (LLIF) is increasingly performed as corrective surgery for patients with adult spinal deformity (ASD). This paper compares the surgical results of LLIF and conventional posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) in ASD using a propensity score matching analysis. We retrospectively reviewed patients with ASD who received LLIF and PLIF/TLIF, and investigated patients' backgrounds, radiographic parameters, and complications. The propensity scores were calculated from patients' characteristics, including radiographic parameters and preoperative comorbidities, and one-to-one matching was performed. Propensity score matching produced 21 matched pairs of patients who underwent LLIF and PLIF/TLIF. All radiographic parameters significantly improved in both groups at the final follow-up compared with those of the preoperative period. The comparison between both groups demonstrated no significant difference in terms of postoperative pelvic tilt, lumbar lordosis (LL), or pelvic incidence-LL at the final follow-up. However, the sagittal vertical axis tended to be smaller in the LLIF at the final follow-up. Overall, perioperative and late complications were comparable in both procedures. However, LLIF procedures demonstrated significantly less intraoperative blood loss and a smaller incidence of postoperative epidural hematoma compared with PLIF/TLIF procedures in patients with ASD.

13.
BMC Musculoskelet Disord ; 22(1): 357, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33863320

RESUMO

BACKGROUND: Parkinson's disease (PD) has been found to increase the risk of postoperative complications in patients with adult spinal deformity (ASD). However, few studies have investigated this by directly comparing patients with PD and those without PD. METHODS: In this multicenter retrospective cohort study, we reviewed all surgically treated ASD patients with at least 2 years of follow-up. Among them, 27 had PD (PD+ group). Clinical data were collected on early and late postoperative complications as well as any revision surgery. Radiographic parameters were evaluated before and immediately after surgery and at final follow-up, including sagittal vertical axis (SVA), thoracic kyphosis, lumbar lordosis, sacral slope, and pelvic tilt. We compared the surgical outcomes and radiographic parameters of PD patients with those of non-PD patients. RESULTS: For early complications, the PD+ group demonstrated a higher rate of delirium than the PD- group. In terms of late complications, the rate of non-union was significantly higher in the PD+ group. Rates of rod failure and revision surgery due to mechanical complications also tended to be higher, but not significantly, in the PD+ group (p = 0.17, p = 0.13, respectively). SVA at final follow-up and loss of correction in SVA were significantly higher in the PD+ group. CONCLUSION: Extra attention should be paid to perioperative complications, especially delirium, in PD patients undergoing surgery for ASD. Furthermore, loss of correction and rate of non-union were greater in these patients.


Assuntos
Doença de Parkinson , Fusão Vertebral , Adulto , Seguimentos , Humanos , Doença de Parkinson/complicações , Doença de Parkinson/epidemiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos
14.
Spine (Phila Pa 1976) ; 46(15): 999-1006, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-33399364

RESUMO

STUDY DESIGN: A retrospective case series. OBJECTIVE: The aim of this study was to investigate the incidence and clinical features of laminar closure in patients with cervical spondylotic myelopathy (CSM) based on prospectively collected data. SUMMARY OF BACKGROUND DATA: Laminar closure after single open-door laminoplasty (LAMP) has been reported to result in poor clinical outcomes. However, no studies to date have examined the underlying mechanisms and frequency of laminar closure after double-door LAMP. METHODS: This study prospectively enrolled 128 consecutive patients with CSM scheduled for double-door LAMP without a laminar spacer at our hospital between 2008 and 2013. Sagittal parameters including C2-7 angle, T1 slope, and cervical sagittal vertical axis (C-SVA), which is defined as the distance between the anterior margin of the external auditory canal plumb line and the posterior-cranial corner of the C7 vertebral body on x-ray, were calculated before and after the operation. Laminar angle was also measured on magnetic resonance images preoperatively and at 1 week and 1 year postoperatively. Laminar closure was defined as > 20% decrease in laminar angle at 1 year compared with that at 1 week postoperatively. The Japanese Orthopedic Association score for cervical myelopathy and the recovery rate determined from the preoperative and postoperative scores were evaluated as clinical outcomes. RESULTS: In total, 110 patients were completely followed up for at least 1 year (follow-up rate: 85.9%). Laminar closure was observed in six cases (5.5%) at the 1-year follow-up. The recovery rate in these six cases was significantly lower than in cases without laminar closure (16.6% vs. 45.1%, respectively). Logistic regression analysis revealed age and C-SVA as significant risk factors for postoperative laminar closure. CONCLUSION: This study is the first to investigate the incidence of laminar closure after double-door LAMP without a laminar spacer. Laminar closure occurred exclusively in elderly patients with kyphotic deformity after LAMP.Level of Evidence: 4.


Assuntos
Vértebras Cervicais/cirurgia , Laminoplastia , Doenças da Medula Espinal , Humanos , Laminoplastia/efeitos adversos , Laminoplastia/métodos , Imageamento por Ressonância Magnética , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/fisiopatologia , Doenças da Medula Espinal/cirurgia , Resultado do Tratamento
15.
J Orthop Sci ; 26(5): 733-738, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32868209

RESUMO

BACKGROUND: Decompression through an anterior approach is theoretically effective for the surgical treatment of cervical spondylotic amyotrophy (CSA), because the pathology usually locates at the anterior side. However, most previous studies investigated posterior surgery or a mix of anterior surgery and posterior surgery in their investigation. Only a few small case series have investigated the surgical outcomes of anterior decompression and fusion (ADF). Therefore, we conducted a multicenter retrospective study that included patients who underwent ADF for proximal-type CSA. METHODS: We analyzed the outcomes of 77 consecutive spinal surgeries performed on proximal-type CSA patients who underwent ADF. Preoperative and postoperative manual muscle tests (MMT) and the patients' backgrounds, radiological findings, and complications were reviewed. We divided the cases into two groups, good-outcome group (MMT improvement â‰§ 2 or improved to MMT 5) and poor-outcome group (others) and evaluated the prognostic factors for outcomes. RESULTS: Of the 77 patients, 48 (62%) showed good neurological outcome. Multiple compressive lesions at anterior horn (AH) and/or ventral nerve roots (VNRs) were detected in 66 patients (85.7%) on the magnetic resonance images. The patients with a single compressive lesion at VNR or AH tended to show good neurological recovery when compare to those with multiple lesions. Age and duration of symptoms were related to the poor outcome in univariate analysis. Duration of symptoms was an independent factor associated with postoperative neurological outcome. The cut-off value for poor outcome was 7.0 months for the symptom duration (sensitivity: 79%, specificity: 54%, area under the curve: 0.69). CONCLUSIONS: Patients with proximal-CSA were more likely to have multiple compressive lesions at an AH and/or a VNR. The prognostic factor for poor neurological outcome was duration of symptoms of ≥7 months.


Assuntos
Fusão Vertebral , Espondilose , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica , Humanos , Prognóstico , Estudos Retrospectivos , Espondilose/complicações , Espondilose/diagnóstico por imagem , Espondilose/cirurgia , Resultado do Tratamento
16.
Spine (Phila Pa 1976) ; 46(8): 492-498, 2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33306616

RESUMO

STUDY DESIGN: Prospective observational cohort study. OBJECTIVE: To prospectively examine dysphagia after subaxial cervical spine surgery. SUMMARY OF BACKGROUND DATA: Although dysphagia after anterior cervical spine surgery is common and well-studied, it has rarely been examined in posterior subaxial cervical spine surgery. METHODS: This study analyzed 191 consecutive patients (132 male, 59 female; mean age, 64.9 yrs) who underwent subaxial cervical spine surgery for degenerative disease and completed 1 year of follow-up. Anterior decompression with fusion (ADF) was performed in 87 patients, posterior decompression with fusion (PDF) in 21, and laminoplasty (LAMP) in 83. Dysphagia was evaluated by a self-administered questionnaire using the Bazaz dysphagia scale before, 6 months, and 1 year after surgery. Diagnosis, levels and number of operative segments, C2-7 lordotic angle (CL), O-C2 angle (OC2A), C2-7 range of motion (ROM), Japanese Orthopedic Association for cervical myelopathy (C-JOA) score, and neck pain visual analog scale (VAS) were examined. RESULTS: Thirty-two patients (16.8%) reported dysphagia before surgery. New dysphagia after surgery, defined as more than or equal to 1 grade worsening of the Bazaz score after surgery compared with the preoperative status, was observed in 38 patients (19.9%) at 6 months and 32 patients (16.8%) at 1 year. The incidence of new dysphagia at 1 year was 25.3% in the ADF group, 23.8% in the PDF group, and 6.0% in the LAMP group. Fusion surgery (ACDF or PDF) and increased CL after surgery were found as risk factors at 1 year in multivariate analysis; receiver operating characteristic analysis determined a postsurgical change in CL cutoff of 5°. CONCLUSION: Fusion surgery and increased CL after surgery were risk factors for development of dysphagia after subaxial cervical spine surgery. Cervical alignment change due to anterior and posterior fusion surgery can cause postoperative dysphagia.Level of Evidence: 3.


Assuntos
Vértebras Cervicais/cirurgia , Transtornos de Deglutição/etiologia , Laminoplastia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/efeitos adversos , Adulto , Idoso , Vértebras Cervicais/fisiologia , Estudos de Coortes , Transtornos de Deglutição/diagnóstico , Feminino , Humanos , Laminoplastia/tendências , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Doenças da Medula Espinal/diagnóstico , Fusão Vertebral/tendências , Resultado do Tratamento
17.
Clin Neurophysiol ; 131(6): 1252-1266, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32299009

RESUMO

OBJECTIVE: Magnetospinography (MSG) has been developed for clinical application and is expected to be a novel neurophysiological examination. Here, we used an MSG system with sensors positioned in three orthogonal directions to record lumbar canal evoked magnetic fields (LCEFs) in response to peripheral nerve stimulation and to evaluate methods for localizing spinal cord lesions. METHODS: LCEFs from the lumbar area of seven rabbits were recorded by the MSG system in response to electrical stimulation of a sciatic nerve. LCEFs and lumbar canal evoked potentials (LCEPs) were measured before and after spinal cord compression induced by a balloon catheter. The lesion positions were estimated using LCEPs and computationally reconstructed currents corresponding to the depolarization site. RESULTS: LCEFs were recorded in all rabbits and neural activity in the lumbar spinal cord could be visualized in the form of a magnetic contour map and reconstructed current map. The position of the spinal cord lesion could be estimated by the LCEPs and reconstructed currents at the depolarization site. CONCLUSIONS: MSG can visualize neural activity in the spinal cord and localize the lesion site. SIGNIFICANCE: MSG enables noninvasive assessment of neural activity in the spinal canal using currents at depolarization sites reconstructed from LCEFs.


Assuntos
Eletrodiagnóstico/métodos , Potenciais Evocados/fisiologia , Condução Nervosa/fisiologia , Medula Espinal/fisiologia , Animais , Estimulação Elétrica , Coelhos , Compressão da Medula Espinal/fisiopatologia
18.
Spine (Phila Pa 1976) ; 45(17): 1185-1192, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32205686

RESUMO

STUDY DESIGN: A retrospective multicenter observational study. OBJECTIVE: To investigate correction surgeries that were performed in relatively aged patients in terms of mechanical complications (MCs) and their predictive factors. SUMMARY OF BACKGROUND DATA: The risk factors associated with MCs have not yet been well examined, especially in aged populations. METHODS: We retrospectively reviewed 230 surgically treated ASD patients with an average age of 72.2 years. Twenty-eight patients with ASD caused by vertebral fractures were excluded. The minimum follow-up was 2 years. Postoperative MCs were defined as proximal junction kyphosis, distal junction kyphosis, pseudoarthrosis, rod breakage, and vertebral fractures. We divided all the ASD patients into two groups: patients with MC (the MC (+) group) and patients without MC (the MC (-) group). Radiographic parameters were evaluated before and immediately after surgery. The SRS-Schwab ASD classification and global alignment and proportion (GAP) score were also evaluated. RESULTS: Of the 202 patients, 91 (45.0%) had MCs. The age at surgery was significantly higher in the MC (+) group than in the MC (-) group. Regarding radiographic parameters, postoperative global tilt (GT), pre- and postoperative thoracolumbar kyphosis (TLK), and postoperative thoracic kyphosis were significantly higher in the MC (+) group than in the MC (-) group. Other parameters, such as the proposed ideal alignment target of PI-LL<10, did not significantly affect MC rates. The GAP score was high in both groups and not significantly related to a higher rate of MC. Forward stepwise logistic regression indicated that the age at surgery, postoperative GT, and preoperative TLK were significant risk factors for MCs. CONCLUSION: Older age, higher postoperative GT, and higher pre and postoperative TLK can be risk factors for MCs. The GAP score was high in both groups and not significantly related to a higher rate of MC. LEVEL OF EVIDENCE: 4.


Assuntos
Fenômenos Biomecânicos/fisiologia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Cifose/diagnóstico por imagem , Cifose/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/tendências , Complicações Pós-Operatórias/etiologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia
19.
Case Rep Orthop ; 2018: 7042829, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30050713

RESUMO

Spinal cord infarction is an uncommon but devastating disorder caused by various conditions. Aortic dissection is a possible etiological factor and is usually associated with severe chest or back pain. We encountered two cases of spinal cord infarction associated with aortic dissection that presented without typical severe pain, and each case resulted in a different clinical course. Aortic dissection should be considered a cause of spinal cord infarction even if there is little or no pain. The different outcomes in our two patients reflected a difference in their initial functional scores.

20.
Spine (Phila Pa 1976) ; 43(7): E430-E435, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-28767628

RESUMO

STUDY DESIGN: A retrospective single-center study. OBJECTIVE: To assess the diagnostic value of methicillin-resistant Staphylococcus aureus (MRSA) nasal swab and suction drain tip cultures. SUMMARY OF BACKGROUND DATA: The prognostic value of MRSA nasal swab and suction drain tip cultures has not been firmly established in spinal surgery. METHODS: This study retrospectively included 4573 consecutive patients who underwent spinal surgery between January 2008 and December 2014. Patients diagnosed with infectious disease were excluded. Prophylactic antibiotics were administered intraoperatively and postoperatively for 48 hours. MRSA nasal swab cultures were taken from all patients before surgery. Drains were removed when the volume of postoperative fluid drainage was less than 50 mL in the preceding 24 hours and cultures were made. Surgical site infection (SSI) was defined according to Centers for Disease Control and Prevention criteria. RESULTS: SSI was identified in 94 cases (2.1%) and bacteria were isolated in 87 cases (92.6%). Positive MRSA nasal swab cultures were identified in 49 cases (1.1%). There was no significant difference in the SSI positivity rate between the MRSA nasal swab culture (+) and (-) groups. Positive drain tip cultures were found in 382 cases (8.4%), 28 of which developed SSI. There was a significant difference in the SSI positivity rate between the drain tip culture (+) and (-) groups. The sensitivity of drain tip culture was 29.8% and the specificity was 92.1%. In 16 of the 28 patients in the SSI (+) group with positive drain cultures, the same bacteria were isolated from the surgical site, giving a bacteria matching rate of 57.1%. CONCLUSION: MRSA nasal swab and drain tip cultures were not useful for predicting SSI. However, drain tip culture had a high positivity rate in the SSI group and the coincidence rate for the causative pathogen was relatively high. LEVEL OF EVIDENCE: 4.


Assuntos
Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Meticilina/farmacologia , Infecções Estafilocócicas/tratamento farmacológico , Infecção da Ferida Cirúrgica/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Sensibilidade e Especificidade , Infecções Estafilocócicas/microbiologia
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