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OBJECTIVE: Radiotherapy is one of the important treatment options for metastatic spinal tumors but is not the definite intervention in all cases, as there are patients who still require surgical treatment because of severe pain or neurologic events after this treatment. We evaluated the perioperative effects of preoperative radiotherapy in these cases as a future guide for surgeons on critical considerations in this period. METHODS: We included 328 patients in this study who had undergone decompression and fusion surgery for metastatic spinal tumors. Patients who underwent surgery with preoperative radiotherapy were designated as the radiotherapy group (group RT, n = 81), and cases of surgery without preoperative radiotherapy were assigned to the non-radiotherapy group (group nRT, n = 247). We compared the demographic, intraoperative, and postoperative factors between these 2 groups. RESULTS: In terms of intraoperative factors, statistically significant differences were evident in operation time, estimated blood loss, and transfusion (RT vs. nRT: 188.1 ± 80.7 minutes vs. 231.2 ± 106.1 minutes, 607.2 ± 532.7 mL vs. 830.1 ± 1324.7 mL, and 30.9% vs. 43.3%, P < 0.001, P < 0.031, and P < 0.048, respectively). With regard to postoperative factors, the incidence of infection, wound problems, and local recurrence were statistically higher in group RT (RT vs. nRT: 6.2% vs. 0.8%, 12.3% vs. 0.8%, 23.4% vs. 13.7%, P = 0.004, P < 0.001, and P = 0.038, respectively). CONCLUSIONS: Preoperative radiotherapy has the intraoperative advantages of reducing bleeding and shortening the operating time, but postoperative caution is needed because of the possibility of infection, wound problems, and local recurrence increases.
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Neoplasias da Coluna Vertebral , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/radioterapia , Neoplasias da Coluna Vertebral/cirurgia , Idoso , Adulto , Cuidados Pré-Operatórios/métodos , Fusão Vertebral/métodos , Complicações Pós-Operatórias/epidemiologia , Descompressão Cirúrgica/métodos , Estudos Retrospectivos , Resultado do Tratamento , Perda Sanguínea Cirúrgica , Duração da Cirurgia , Recidiva Local de NeoplasiaRESUMO
OBJECTIVE: The aim of this study was to investigate the correlation between radiological indices of shoulder balance (SB) and cosmetic indices of shoulder deformity in patients with Lenke type 2 adolescent idiopathic scoliosis (AIS) and to determine the extent to which patient-reported outcomes (PROs) correlate with these measurements. Current management decisions and outcomes for SB in AIS are primarily based on radiological measurements. It is crucial to understand how these radiological parameters and cosmetic indices relate to patient satisfaction. METHODS: The authors analyzed the preoperative radiological and photographic indices of SB, along with PROs, in patients with Lenke type 2 AIS. Lateral SB parameters included the radiological shoulder height (RSH) and clavicle angle, while medial SB parameters included the first rib angle and T1 tilt angle. Photographic indices included the shoulder height angle (SHA), axilla height angle (AHA), and the left/right trapezius angle (LRTA) ratio. The authors assessed the self-image, mental health, and total score domains of the Korean version of the 22-item Scoliosis Research Society questionnaire. RESULTS: In their analysis of Lenke type 2 patients, the authors found that correlation coefficients between radiological measurements and photographic indices ranged from -0.25 to 0.47, among which only lateral SB including clavicle angle and RSH showed a significant correlation with anterior and posterior photographic indices. No statistically significant correlations were found between radiological measurements and PROs. Anterior photographic indices including SHA and AHA significantly correlated with all three PROs (p < 0.05). CONCLUSIONS: Radiological shoulder parameters did not accurately reflect the perceived SB. Anterior photographic indices were reliable for evaluating clinical SB in patients with Lenke type 2 AIS and correlated with PROs. Spine surgeons may benefit from paying more attention to anterior photographic indices when making surgical decisions regarding clinical SB.
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Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Escoliose , Ombro , Humanos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Adolescente , Feminino , Masculino , Ombro/diagnóstico por imagem , Ombro/fisiopatologia , Equilíbrio Postural/fisiologia , Radiografia , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Even minor sacral slanting can influence T1 tilt and shoulder balance. Yet, the relationship between sacral slanting and postoperative shoulder imbalance (PSI) has not been previously explored. To determine risk factors for PSI in Lenke 2A adolescent idiopathic scoliosis (AIS) patients, with an emphasis on sacral slanting. METHODS: The study encompassed 96 consecutive patients who had undergone posterior correction and fusion surgery for Lenke type 2A AIS. Patients were grouped into PSI(+) and PSI(-) based on postoperative outcomes. Additionally, they were classified into left-sided slanting, no slanting, and right-sided slanting groups according to the degree of sacral slanting. Various radiological measures were compared. RESULTS: Patients in the PSI(+) group exhibited a smaller preoperative proximal thoracic curve and a higher main thoracic curve correction rate than those in the PSI(-) group. The presence or absence of sacral slanting did not exhibit a significant variation in PSI occurrence. However, the right-sided sacral slanting group showed a larger delta radiologic shoulder height compared to the other 2 groups (7.1 mm vs. 1.5 & 3.3 mm). CONCLUSION: Sacral slanting was not directly linked to the development of PSI. Despite the common postoperative elevation of the left shoulder, the shoulder height differences decreased over the follow-up period. Especially in cases with a right-sided tilted sacrum, the PSI demonstrated progressive improvement, with an associated increase in the rightward distal wedging angle, leading to distal adding-on.
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A 74-year-old woman with ankylosing spondylitis presented with back pain and complete paraplegia after a fall. A radiologic finding of a bamboo spine, a characteristic feature of ankylosing spondylitis, was observed on computed tomography, along with a fracture-dislocation involving T10 and T11 (chalk-stick fracture) and compression of the descending thoracic aorta due to the caudal bony column. The patient underwent an open reduction and T8-L3 posterior fusion in the operating room. A complete cross-section of the spinal cord was observed during surgery. Post operation, a decrease in blood pressure led to a thoracotomy and thoracic endovascular aortic repair due to a crack in the descending aorta wall. Thoracolumbar fracture-dislocations, particularly in patients with ankylosing spondylitis, are characterized by instability and can be further complicated by concurrent vascular and spinal cord injuries. It is crucial therefore to recognize the potential for vascular and spinal cord injuries early on in such cases.
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Fraturas Ósseas , Traumatismos da Medula Espinal , Fraturas da Coluna Vertebral , Espondilite Anquilosante , Feminino , Humanos , Idoso , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/cirurgia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Carbonato de Cálcio , Fraturas Ósseas/complicações , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Vértebras Torácicas/lesõesRESUMO
BACKGROUND CONTEXT: Patients scheduled for L4-5 PLIF often have FS at L5-S1. However, data on the clinical and radiographic outcomes of cases with mild-to-moderate L5-S1 FS are lacking, which may affect clinical outcomes or require additional surgery after L4-5 fusion. PURPOSE: To evaluate the clinical and radiographic outcomes of L4-5 PLIF in patients with and without mild-to-moderate L5-S1 FS, with a primary focus on the association between L5-S1 FS and postoperative clinical outcomes including back pain, leg pain, and scores on the oswestry disability index (ODI) and EuroQol 5-dimension (EQ-5D). STUDY DESIGN: Retrospective comparative study. PATIENT SAMPLE: A retrospective review of patients who underwent L4-5 PLIF from 2014 to 2018. The patients were divided according to the presence of mild-to-moderate FS at L5-S1. OUTCOME MEASURES: Clinical assessment included the pain visual analog scale (VAS), ODI, and EQ-5D score. Radiographic assessments included spinopelvic parameters and grades for central and foraminal stenosis. METHODS: Clinical outcomes were assessed using validated outcome measures at preoperative, 6-month, 12-month, and 36-month follow-up visits. Radiographic evaluations were performed using preoperative and postoperative radiographs. Foraminal stenosis was assessed qualitatively using MRI with a grading system from none to severe and quantitatively by measuring changes in the foraminal area on CT. RESULTS: Among 186 patients, 55 were categorized as the FS group and 131 as the non-FS group. The FS group was older (p=0.039) and had more severe central stenosis at L5-S1 (p=0.007) as well as more severe FS at both L4-5 and L5-S1 (both p<0.001). Preoperative disc height (p<0.001), C7-S1 sagittal vertical axis (p=0.003), lumbar lordosis (p=0.005), and pelvic incidence-lumbar lordosis mismatch (p=0.026) were more aggravated in the FS group. The FS group showed inferior clinical outcomes at the final follow-up in terms of back pain (p=.010) and ODI score (p=.003). CONCLUSION: The presence of mild-to-moderate FS at L5-S1 was associated with more aggravated sagittal balance in terms of smaller preoperative disc height, larger sagittal vertical axis, smaller lumbar lordosis, and larger pelvic incidence-lumbar lordosis mismatch. Patients with L5-S1 FS also had poorer clinical outcomes including back pain and ODI score after L4-5 PLIF. Patients with L5-S1 FS need to be carefully examined before L4-5 fusion considering their adverse outcomes due to underlying degenerative changes.
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Vértebras Lombares , Fusão Vertebral , Estenose Espinal , Humanos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Vértebras Lombares/cirurgia , Vértebras Lombares/diagnóstico por imagem , Pessoa de Meia-Idade , Masculino , Estenose Espinal/cirurgia , Feminino , Estudos Retrospectivos , Idoso , Resultado do Tratamento , Sacro/cirurgia , Sacro/diagnóstico por imagem , Medição da DorRESUMO
OBJECTIVE: Recombinant human bone morphogenetic protein-2 (rhBMP-2) is effective for promoting robust fusion for long-level cervical deformity and revision surgeries. However, only a few studies have reported its efficacy and complications in posterior cervical fusion (PCF). METHODS: Therefore we evaluated the efficacy and complications of rhBMP-2 application in PCF surgery by searching 3 electronic databases (PubMed, Cochrane Database, and EMBASE) for studies that evaluated the use of rhBMP-2 in PCF. Five studies (1 prospective and 4 retrospective) were included in the meta-analysis. RESULTS: The quality of each study was assessed, and data on pseudarthrosis, wound infection, neurologic, and immediate medical complications were extracted and analyzed. We found that the use of rhBMP-2 in PCF showed significant benefits in terms of pseudarthrosis and no significant increases in the risk for neurologic and immediate medical complications regardless of the dose. However, high-dose (>2.1 mg/level) rhBMP-2 was a risk factor for wound infection after PCF. CONCLUSIONS: Our meta-analysis of the currently available literature suggests that patients with PCF may benefit from BMP-2 usage without increasing the risk of complications. However, dose control and containment are important to ensure a low risk of complications.
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Pseudoartrose , Doenças da Coluna Vertebral , Fusão Vertebral , Infecção dos Ferimentos , Humanos , Estudos Retrospectivos , Pseudoartrose/complicações , Estudos Prospectivos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Proteína Morfogenética Óssea 2/efeitos adversos , Fator de Crescimento Transformador beta/efeitos adversos , Fusão Vertebral/efeitos adversos , Doenças da Coluna Vertebral/cirurgia , Vértebras Cervicais/cirurgia , Proteínas Recombinantes/efeitos adversosRESUMO
BACKGROUND: Proximal thoracic curve (PTC) correction has been considered to prevent lateral shoulder imbalance in Lenke Type 2 adolescent idiopathic scoliosis (AIS) patients; however, postoperative shoulder imbalance (PSI) commonly occurs despite these strategies with PTC correction. We investigated the hypothesis that PTC correction would not directly affect PSI in the majority of Lenke type 2 AIS cases. Furthermore, we investigated the risk factors for lateral PSI after corrective surgery. METHODS: This study examined the records for AIS patients with Lenke type 2 who underwent corrective surgery and followed up for >2 years. Patients were categorized into PSI (-); radiologic shoulder height (RSH)<15 mm, and PSI (+); RSH≥15 mm. Repeated measures analysis of variance was performed at preoperatively, postoperatively, 1 month, and final follow-up. Postoperative lateral shoulder imbalance was predicted by the identification of univariate analysis and multivariate analysis. RESULTS: Among the 151 patients reviewed, 29 (19.2%) showed PSI at final follow-up. Lateral shoulder balance parameters showed different directionalities between PSI (-) and (+) groups at postoperatively, 1 month, and final follow-up ( P <0.01 each). Preoperative PTC, middle thoracic curve (MTC) curve and MTC correction showed strong correlations with the RSH ( P =0.01, 0.03, and 0.04, respectively). However, PTC correction did not show a significant correlation with the RSH. Moreover, only a smaller MTC curve and larger MTC correction rate were related to lateral PSI in multivariate analysis. CONCLUSIONS: In Lenke type 2 AIS curves, the MTC curve and its correction predominantly influence lateral shoulder imbalance after corrective surgery, irrespective of the PTC correction extent. Consequently, overemphasizing the correction of the PTC curve may not necessarily lead to an improved lateral shoulder balance. When MTC curve is smaller, surgeons should be more careful for MCT overcorrection leading to a lateral shoulder imbalance. LEVEL OF EVIDENCE: Level III.
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Cifose , Escoliose , Fusão Vertebral , Humanos , Adolescente , Ombro/diagnóstico por imagem , Ombro/cirurgia , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Escoliose/etiologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Cifose/etiologia , Fenolftaleína , Resultado do TratamentoRESUMO
STUDY DESIGN: Retrospective study. OBJECTIVES: In our recent study, we observed some cases of symptomatic normal vocal cord motility instead of asymptomatic vocal cord palsy (VCP) in preoperative laryngoscopy of a revision anterior cervical spine surgery (ACSS) cohort. We assumed the intrinsic muscle atrophy caused by recurrent laryngeal nerve injury could cause vocal cord-related symptoms. Thus, radiological examinations were reviewed in relation to the posterior cricoarytenoid (PCA) muscle, one of the intrinsic muscles. METHODS: We retrospectively analyzed 64 patients who underwent a revision ACSS. Patients with vocal cord-related symptoms were classified as symptomatic group (group S, n = 11), and those without symptoms as asymptomatic group (group AS, n = 53). The bilateral size and signal intensity of the PCA muscles in these patients were measured in the axial view with preoperative computed tomography (CT) and magnetic resonance imaging (MRI) evaluations. Since the size and signal intensity values were different on each image, the ratios of the contralateral and ipsilateral muscle values were analyzed for each modality. RESULTS: There was no VCP on laryngoscopy study. However, the mean ratio of the PCA muscle size on CT was 1.40 ± .37 in group S and 1.02 ± .12 in group AS (P = .007). These values on the MRI were 1.49 ± .45 in group S and 1.02 ± .14 in group AS, which was also a significant difference (P = .008). CONCLUSIONS: Evaluating the size of the PCA muscle before revision ACSS may predict a previous recurrent laryngeal nerve injury. Careful planning for the appropriate approach should be undertaken if vocal cord-related symptoms and atrophy of PCA muscle are evident.
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BACKGROUND CONTEXT: Prior study has shown that 70% of cervical pseudarthrosis after anterior cervical discectomy and fusion (ACDF) detected at 1 year will go on to fusion by 2 year. Pseudarthrosis detected 2 years after ACDF may have different bone healing potential compared to nonunion detected 1 year after surgery. Therefore, it might have a different clinical significance. PURPOSE: To examine the radiographic and clinical prognosis of pseudarthrosis detected 2 years after ACDF with a minimum follow-up of 5 years. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENTS SAMPLE: A total of 249 patients who completed a 5-year follow-up after ACDF. OUTCOMES MEASURES: Clinical outcomes such as neck pain visual analogue scale (VAS), arm pain VAS, and neck disability index (NDI) and radiographic assessment such as X-ray, computed tomography (CT) scan. METHODS: A total of 249 patients who completed a 5-year follow-up after ACDF were retrospectively reviewed. Patients who were diagnosed with pseudarthrosis at 2 years postoperatively were included. Fusion, neck pain VAS, arm pain VAS, and NDI were assessed. The results were compared between the union group (patients who achieved union), and the nonunion group (patients with pseudarthrosis) at 5 years postoperatively. RESULTS: Among the patients who had pseudarthrosis at 2 years postoperatively, the fusion rate at 5 years was 32.6% (14/43). While the union group showed continued improvements in neck pain VAS, arm pain VAS, and NDI until 5 years, the nonunion group showed significant worsening of arm pain VAS and NDI at 5 years, with the values of neck pain VAS, arm pain VAS, and NDI being significantly worse than those of the union group at 5 years. CONCLUSION: The incidence of pseudarthrosis detected at 2 years postoperatively after ACDF was 67.4%, and it remained unfused at 5 years postoperatively. Nonunion identified 2 years after ACDF may be considered a poor prognostic factor because it has less potential to achieve fusion with further follow-up and a higher chance of worsening clinical symptoms. Therefore, the presence of fusion at the 2-year follow-up can be considered an indicator of the success of the surgery.
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Pseudoartrose , Fusão Vertebral , Humanos , Resultado do Tratamento , Seguimentos , Estudos Retrospectivos , Cervicalgia/etiologia , Cervicalgia/cirurgia , Pseudoartrose/diagnóstico por imagem , Pseudoartrose/etiologia , Pseudoartrose/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Discotomia/métodos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodosRESUMO
BACKGROUND: Several patients complained of residual symptoms following lumbar decompressive surgery for lumbar degenerative disease (LDD). However, few studies analyze this dissatisfaction by focusing on preoperative patients' symptoms. This study was conduct to determine the factors that could predict the patients' postoperative complaints by focusing on their preoperative symptoms. METHODS: Four hundred and seventeen consecutive patients who underwent lumbar decompression and fusion surgery for LDD were included. Postoperative complaint was defined by at least twice same complaint during the outpatient follow-up of 6,12, 18 and 24 months after surgery. A comparative analysis was performed between complaint group (group C, N = 168) and non-complaint group (group NC, N = 249). Demographic, operative, symptomatic, and clinical factors were compared between the groups by univariate and multivariate analyses. RESULTS: The main preoperative chief complaints were radiating pain (318/417, 76.2%). However, most common postoperative complaint was residual radiating pain (60/168, 35.7%) followed by tingling sensation (43/168, 25.6%). The presence of psychiatric disease (adjusted odds ratio [aOR], 4.666; P = 0.017), longer pain duration (aOR, 1.021; P < 0.001), pain to below the knee (aOR, 2.326; P = 0.001), preoperative tingling sensation (aOR, 2.631; P < 0.001), preoperative sensory and motor power decrease (aOR, 2.152 and 1.678; P = 0,047 and 0.011, respectively) were significantly correlated with postoperative patients' complaints in multivariate analysis. CONCLUSIONS: The postoperative patients' complaints could be predicted and explained in advance by checking the preoperative characteristics of patients' symptoms, including the duration and site carefully. This could be helpful to enhance the understanding of the surgical results preoperatively, which could control the anticipation of the patients.
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OBJECTIVE: To identify the risk factors for the aggravation of sagittal alignment after single-level L5-S1 PLIF. METHODS: Eighty-six patients who underwent L5-S1 PLIF were divided into 2 groups according to the postoperative changes in the segmental angle (SA; group I: increase; group D: decrease). The 2 groups were compared in terms of demographic, clinical, and radiological outcomes. Multivariate logistic regression analysis was performed to identify the risk factors for aggravation of sagittal alignment. RESULTS: Of the study patients, 39 (45%) were categorized as group I and 47 (55%) as group D. The demographic and clinical parameters were not significantly different between the 2 groups. Group D showed postoperative deteriorations in the local sagittal parameters, including lumbar lordosis (LL; P = 0.034), sacral slope (P = 0.012), and pelvic tilt (P = 0.003). In contrast, group I showed improved LL after surgery (P = 0.021). Large preoperative values of lumbosacral angle (LSA; odds ratio [OR], 1.287; P = 0.001), SA (OR, 1.448; P < 0.001), and flexion LSA (OR, 1.173; P = 0.011) were independent risk factors for the aggravation of sagittal balance. CONCLUSIONS: Surgeons treating patients with large preoperative SA, LSA, and flexion LSA at L5-S1 level should be cautious of the possible aggravation of sagittal balance after L5-S1 PLIF and may consider different surgical approaches such as anterior or oblique lumbar interbody fusion.
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Lordose , Fusão Vertebral , Espondilolistese , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Espondilolistese/cirurgia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Lordose/diagnóstico por imagem , Lordose/cirurgia , Lordose/etiologia , Fatores de RiscoRESUMO
Posterior ring hypoplasia of the atlas (C1) is not common and in most cases is found by chance without symptoms. This disorder is sometimes accompanied by a mild C1-C2 instability or the presence of a space-occupying lesion such as ossification of posterior longitudinal ligament, pannus, or retro-odontoid pseudo-tumor, which are indications for surgery if symptomatic cord compression is present. A C1 posterior arch resection has been the procedure of choice but is associated with several fatal complications. We here present a novel posterior arch decompression technique that is relatively safer and easier and that involves mobilization and posterior translation of the posterior arch as a whole, similar to a vertebral body sliding osteotomy.
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Laminoplastia , Ossificação do Ligamento Longitudinal Posterior , Compressão da Medula Espinal , Humanos , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Laminoplastia/métodos , Laminectomia/métodos , Descompressão Cirúrgica/métodos , Osteotomia/efeitos adversos , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Vértebras Cervicais/patologia , Resultado do Tratamento , Ossificação do Ligamento Longitudinal Posterior/cirurgiaRESUMO
OBJECTIVE: This study aimed to investigate the risk factors for aggravation of cervical alignment after posterior cervical foraminotomy (PCF) and to identify their relationships with kyphotic changes in cervical curvature. METHODS: Ninety-eight patients who underwent PCF for unilateral radiculopathy and received follow-up for more than 2 years were retrospectively reviewed. Segmental Cobb angle (SA), cervical Cobb angle (CA), Pfirrmann grade, foraminal stenosis, and clinical outcomes including neck pain, arm pain, and Neck Disability Index scores were assessed. Radiological and clinical outcomes were compared between groups C (control group with kyphotic change in CA < 5°) and K (kyphotic group with kyphotic change in CA ≥ 5°). Multivariate regression analysis was performed to determine the risk factors for kyphotic change ≥ 5° after PCF. RESULTS: Group K was significantly older than group C (p = 0.002) and had a higher Pfirrmann grade (p = 0.025). In group K, neck pain had significantly increased at last follow-up (p < 0.001). Multivariate linear regression analysis revealed that kyphotic changes in CA were related to older age (p = 0.016, B = 0.420) and Pfirrmann grade of the operative levels (p = 0.032, B = 4.560). Preoperative hypolordosis was not an independent risk factor for kyphotic changes in CA. Receiver operating characteristic curve analysis showed that the cutoff value for kyphotic changes in patients with CA ≥ 5° was Pfirrmann grade 3.417 (p = 0.008). CONCLUSIONS: Contrary to previous studies, preoperative hypolordosis was not a risk factor for kyphotic changes in CA after PCF. Older patients with disc degeneration of Pfirrmann grade IV or greater for should be carefully considered.
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Foraminotomia , Cifose , Radiculopatia , Humanos , Estudos Retrospectivos , Cervicalgia/diagnóstico por imagem , Cervicalgia/etiologia , Cervicalgia/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Resultado do Tratamento , Foraminotomia/efeitos adversos , Radiculopatia/diagnóstico por imagem , Radiculopatia/etiologia , Radiculopatia/cirurgia , Cifose/diagnóstico por imagem , Cifose/cirurgia , Cifose/etiologiaRESUMO
STUDY DESIGN: Retrospective study. OBJECTIVES: Due to anatomical variations in the semispinalis cervicis insertion in the C2 spinous process, complete preservation is not always possible when the C3 level is included in a cervical laminoplasty. Three-dimensional computed tomography was used to evaluate the relationship between the incidence of semispinalis cervicis injury and the C2 inter-spinous angle. METHODS: We included 95 patients who underwent a cervical laminoplasty that included a C3 laminectomy for cervical myelopathy. Patients with a C2 inter-spinous angle above and below 60° were classified into wide- and narrow-angled groups, respectively (n = 48 and n = 47). Whether the C2 semispinalis cervicis insertion was preserved, or detached and reattached was reviewed from surgical records. The pre and postoperative C2-C7 lordosis and range of motion (ROM) were measured, and clinical outcomes were obtained from the patient charts. RESULTS: The C2 semispinalis cervicis was preserved in 47 patients (97.9%) in the wide-angled group but only in 14 patients (29.8%) in the narrow-angled group (P < .001). The postoperative C2-C7 lordosis extension and ROM were significantly greater in the wide-angled (P = .048 and .036). Postoperative neck pain was significantly greater in the narrow-angled (P = .018). CONCLUSIONS: The morphology of the C2 spinous process indicates that a C2 semispinalis cervicis insertion preservation is possible during a cervical laminoplasty that includes a C3 laminectomy. A careful surgical procedure should be conducted when the C2 inter-spinous angle is above 60° to increase the likelihood of achieving this preservation and thereby obtaining a more favorable clinical outcomes.
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OBJECTIVE: Perioperative hypothermia can lead to various complications. Although various warming techniques have been used to prevent perioperative hypothermia, the effect of these techniques on surgical site infection (SSI) during posterior fusion surgery is unclear. The effects of warming devices on SSI rates were therefore analyzed using data complied by the Health Insurance and Review Assessment (HIRA) Service in Korea. METHODS: This study included 5,406 patients in the HIRA Service database who underwent posterior fusion surgery during the years 2014, 2015, and 2017. Factors related to SSI in these patients, including warming devices, antibiotics, and transfusion, were analyzed. RESULTS: The incidence of SSI was higher in patients who underwent forced air warming than in those who did not undergo active warming (odds ratio [OR], 1.73; p = 0.039), especially above 70 years old (OR, 4.11; p = 0.014). By contrast, the incidence of SSI was not significantly higher in patients who underwent device using conduction. Infection rates were higher in patients who received prophylactic antibiotics within 20 minutes before incision, than within 21 to 60 minutes (OR, 2.07; p = 0.001) and who received more blood transfusions (1 pint < volume ≤ 2 pint; OR, 1.75; p = 0.008, > 2 pint; OR, 2.73; p = 0.004). CONCLUSION: SSI rates were higher in patients who underwent warming with forced air devices than with devices using conduction, as well as being higher in patients who older age, received blood transfusions and administered antibiotics within 20 minutes before incision. Devices using conduction have more advantages in preventing SSI than forced air warming device. In addition, the reduction of other risk factors for SSI may improve postoperative results.
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OBJECTIVE: To determine whether double transverse incisions could provide superior cosmetic and functional outcomes, including rates of dysphagia and dysphonia, compared with longitudinal incisions in patients undergoing anterior cervical spine surgery (ACSS) involving ≥ 3 levels. METHODS: A total of 62 consecutive patients who underwent ACSS involving ≥ 3 levels were included in this study. They consist of 33 with longitudinal incisions (L group) and 29 with double transverse incisions (DT group). We recorded functional outcome measures including the Bazaz score for postoperative dysphagia and the Voice Handicap Index-10 (VHI-10) for postoperative dysphonia. The Vancouver Scar Scale (VSS) and the patient and observer scar assessment scale (POSAS) were used to evaluate postoperative skin scarring. RESULTS: Cosmetic results, as assessed using the VSS and POSAS, were significantly better in the DT than in the L group at most follow-up time points (p < 0.01 each). Dysphagia rates were significantly lower in the DT group than in the L group during the late postoperative period from 6 months until final 2 years of follow-up (p < 0.01 each). There were no significant different results between the 2 groups in terms of dysphonia. CONCLUSION: A double transverse incision can be a feasible option when performing ACSS involving ≥ 3 levels, providing better cosmesis and lower rates of persistent dysphagia than with a longitudinal incision.
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PURPOSE: To describe the safety and feasibility of C2 medial window screw (C2MWS) as an alternative salvage method for C2 pedicle screws in cases of high-riding vertebral artery (HRVA) or narrow pedicle. METHODS: The C2MWS technique involves screw insertion by intentionally breaching the medial cortex of the pedicle to avoid vertebral artery injury. Twelve patients who underwent C2 screw insertion via the C2MWS were retrospectively reviewed. C2MWS was indicated in cases of high-riding vertebral artery (HRVA) or narrow pedicle (pedicle width ≤ 4 mm). The width of the canal breach by screw, vertebral artery groove (VAG) breach, solid fusion, neck pain visual analogue scale (VAS) score, and Japanese Orthopedic Association (JOA) score were assessed as outcome measurements. RESULTS: C2MWS was indicated due to both HRVA and narrow pedicle for 11 screws, narrow pedicle for one screw, and HRVA for two screws. No screw VAG breach or vertebral artery injury was noted postoperatively. The mean width of canal breach was 2.9 ± 1.3 mm. There were no cases demonstrating neurologic deterioration, and 11 patients (91.7%) demonstrated solid fusion at 1-year follow-up. Furthermore, neck pain VAS and JOA scores significantly improved after the surgery. CONCLUSIONS: The C2MWS technique can provide 3-column fixation while reliably avoiding VA injury. C2MWS could be considered as a salvage alternative method when the insertion of C2 pedicle screw is complicated by HRVA or a narrow pedicle, while there is a need to provide firmer fixation strength than that provided by pars or translaminar screws.
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Parafusos Pediculares , Fusão Vertebral , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Humanos , Cervicalgia/etiologia , Cervicalgia/cirurgia , Projetos de Pesquisa , Estudos Retrospectivos , Fusão Vertebral/métodos , Artéria Vertebral/cirurgiaRESUMO
OBJECTIVE: The objective of this study was to evaluate the feasibility and complications of the over-the-arch (OTA) technique for screw insertion into the C1 lateral mass in patients in whom conventional techniques (i.e., posterior arch [PA] and inferior lateral mass [ILM]) are not feasible due to 1) PA with a very small height (< 3.5 mm), 2) a caudally tilted PA blocking the inferior part of the C1 lateral mass, or 3) loss of height at the ILM (< 3.5 mm). METHODS: The authors reviewed the medical records of 60 patients who underwent C1 screw fixation with the OTA technique (13 screws) and the PA/ILM technique (107 screws) between 2011 and 2019. Vertebral artery (VA) injuries, screw malposition, and bony union were radiologically assessed. Clinical outcome measures, including Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) scale score, and occipital neuralgia, were recorded. RESULTS: Thirteen OTA screws were successfully inserted without any major complications. NDI and JOA scale scores did not show significant differences between the two groups at final follow-up. No VA injuries were recognized during screw insertion. There was no evidence of ischemic damage to the VA or bony erosion in the occiput or atlas. Medial wall violation was observed in 1 screw (7.7%); however, no C0-1, C1-2, or lateral wall violations were observed. No patients developed new-onset neuralgia postoperatively after C1 fixation with the OTA technique. CONCLUSIONS: The OTA technique was safe and useful for C1 screw fixation in patients in whom conventional techniques could not be employed.
RESUMO
OBJECTIVES: Considering sagittal balance is particularly important in adjacent segment disease (ASD) patients because they frequently show hypolordotic prior fusion. Therefore, the purpose of this study was to identify risk factors for aggravation of sagittal imbalance after posterior lumbar fusion in ASD patients. METHODS: Fifty-nine patients who underwent revision posterior surgery for ASD between 2014 and 2018 were included. Patients were divided into 2 groups according to postoperative sagittal balance status determined by the pelvic incidence minus lumbar lordosis (PI-LL) value, based on the age-adjusted Schwab classification (group A: ideal correction, n = 20; group B: under-correction, n = 39). Several radiographic parameters were measured in plain radiographs. Clinical results were analyzed using a visual analog scale, Oswestry Disability Index, and EuroQol 5-domain. RESULTS: Better preoperative PI-LL (P = 0.001), slippage of the vertebral body (P = 0.022), higher disc height (P = 0.048), and absence of L4-5-S1 fusion (P = 0.041) in the index surgery were significantly correlated with better postoperative sagittal balance in multivariate analysis. The PI-LL improved postoperatively from 19.4 to 12.5 in group A (P = 0.019) and remained unchanged (from 38.6 to 38.6, P = 1.000) in group B. Although clinical outcomes improved postoperatively in both groups, no intergroup differences were observed. CONCLUSIONS: Preoperative sagittal imbalance, rigid affected segments, and previously fused lower lumbar segment (L4-L5-S1) are independent risk factors for aggravation of sagittal imbalance in ASD patients. Surgeons should strive to restore sagittal balance after ASD surgery under the above-mentioned conditions.
Assuntos
Lordose , Fusão Vertebral , Animais , Humanos , Lordose/diagnóstico por imagem , Lordose/etiologia , Lordose/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Estudos Retrospectivos , Fatores de Risco , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodosRESUMO
STUDY DESIGN: Retrospective study. OBJECTIVES: The aim was to evaluate the exact incidence of vocal cord palsy (VCP) caused by previous anterior cervical spine surgery (ACSS) and aid surgeons in deciding the approach direction in revision ACSS. SUMMARY OF BACKGROUND DATA: The incidence of VCP detected by preoperative laryngoscopic screening before revision ACSS appeared to be much higher in previous reports than in our experience. MATERIALS AND METHODS: We reviewed the data of 64 patients who underwent revision ACSS. Preoperative laryngoscopy was performed in all patients to detect VCP and/or structural abnormalities of the vocal cords. The patients' characteristics, laryngoscopy results, and symptoms before revision surgery that were potentially caused by previous recurrent laryngeal nerve injuries (voice change, foreign body sensation, and chronic aspiration) were recorded. RESULTS: Laryngoscopy demonstrated no complete VCP or decreased vocal cord motility. Eleven patients (17.2%) showed vocal cord-related symptoms and 13 patients (20.3%) showed abnormal laryngoscopic findings without VCP. Four patients (6.2%) showed vocal cord-related symptoms and abnormal laryngoscopic findings simultaneously. At the initial operative level, no significant differences in vocal cord-related symptoms were observed between the upper and lower levels (C3-4-5 vs. C5-6-7). However, the frequency of vocal cord-related symptoms was significantly high at the larger number of levels (≥3 segments) (P=0.010). CONCLUSIONS: In contrast to previous reports, this study demonstrated that VCP is rarely detected before revision ACSS. Therefore, deciding the approach direction with only vocal cord motility can be dangerous, and more attention is required in setting the approach direction in patients who show both vocal cord-related symptoms and abnormal laryngoscopic finding. In other cases, a contralateral approach which has a low risk of bilateral VCP could be utilized if necessary.