Clinical outcomes of 3D-printing stand-alone artificial vertebral body in anterior cer-vical surgeries / 北京大学学报(医学版)

Objective:To explore the short-term outcomes of 3D-printing stand-alone artificial vertebral body(AVB)in the surgical procedure of anterior cervical corpectomy and fusion(ACCF).Methods:Following the proposal of IDEAL(idea,development,exploration,assessment,and long-term follow-up)framework,we designed and conducted this single-armed,retrospective cohort study.The patients with cervical spondylotic myelopathy were recruited,and these patients exclusively received the surgical procedure of single-level ACCF in our single center.After the process of corpectomy,the size was tailored using different trials and the most suitable stand-alone AVB was then implanted.This AVB was manufactured by the fashion of 3D-printing.Two pairs of screws were inserted in an inclined way into the adjacent vertebral bodies,to stabilize the AVB.The participants were regularly followed-up after the operation.Their clinical data were thoroughly reviewed.We assessed the neurological status according to Japanese Orthopedic Association(JOA)scale.We determined the fusion based on imaging examination six months after the operation.The recorded clinical data were analyzed using specific software and they presented in suitable styles.Paired t test was employed in comparison analysis.Results:In total,there were eleven patients being recruited eventually.The patients were all followed up over six months after the operation.The mean age of the cohort was(57.2±10.2)years.The mean operation time was(76.1±23.1)min and the median bleeding volume was 150(100,200)mL.The postoperative course was uneventful for all the cases.Dysphagia,emergent hematoma,and deterioration of neurological func-tion did not occur.Mean JOA scores were 13.2±2.2 before the operation and 16.3±0.8 at the final follow-up,which were significantly different(P＜0.001).The mean recovery rate of neurological func-tion was 85.9％.By comparing the imaging examinations postoperatively and six months after the opera-tion,we found that the average subsidence length was(1.2±1.1)mm,and that there was only one ca-ses(9.1％)of the severe subsidence(＞3 mm).We observed significant improvement of cervical lor-dosis after the operation(P=0.013).All the cases obtained solid fusion.Conclusion:3D-printing stand-alone AVB presented favorable short-term outcome in one-level ACCF in this study.The fusion rate of this zero-profile prosthesis was satisfactory and the complication rate was relatively low.

Analysis on clinical efficacy of anterior cervical Hybrid surgery and posterior cervical expansive open-door laminopasty for multilevel cervical spondylotic myelopathy / 吉林大学学报(医学版)

Objective:To analyze the efficacy of anterior cervical Hybrid surgery and posterior cervical expansive open-door laminoplasty(EODL)in the treatment of multilevel cervical spondylotic myelopathy,and to discuss the selection of surgical methods for the patients with multilevel cervical spondylotic myelopathy.Methods:The retrospective analysis was conducted of 70 patients with multilevel cervical spondylotic myelopathy who underwent surgery at Affilated Beijing Traditional Chinese Medicine Hospital of Capital Medical University from July 2017 to July 2020.Based on the different surgical methods,the patients were divided into anterior group(n=35)and posterior group(n=35).The patients in anterior group underwent Hybrid surgery[anterior cervical discectomy and fusion(ACDF)combined with artificial cervical disc replacement(ACDR)],and the patients in posterior group underwent EODL.The hospitalization time,operation time,intraoperative blood loss,and postoperative drainage volume of the patients in two groups were recorded;the efficacy was evaluated by Japanese orthopaedic association(JOA)score,JOA improvement rate,neck disability index(NDI),visual analogue scale(VAS)for pain,and postoperative satisfaction score;the complications of the patients in two groups after surgery were recorded.Results:Compared with posterior group,the intraoperative blood loss,postoperative drainage volume,hospitalization time,and operation time of the patients in anterior group were significantly decreased(P<0.01),and the preoperative score had no significant difference(P>0.05).At the final follow-up after surgery,compared with posterior group,the JOA score and JOA improvement rate of the patients in anterior group were significantly increased(P<0.01),and the NDI score and VAS score were significantly decreased(P<0.01).Compared with before surgery,the JOA scores of the patients in two groups at the final follow-up after surgery were increased(P<0.01),and the NDI and VAS scores were significant decreased(P<0.01).The postoperative satisfaction of the patients in two groups was high based on the postoperative satisfaction score.There was no significant difference in the incidence of postoperative complication of the patients between two groups(P>0.05).Conclusion:Both the anterior cervical Hybrid surgery and EODL achieve the satisfactory results in the treatment of multilevel cervical spondylotic myelopathy.Hybrid surgery has the advantages of less bleeding and shorter surgery time,and the most suitable surgical method should be chosen clinically based on the actual situation of the patients.

Diagnostic value of cervical spine non-shared incentive diffusion weighted imaging technique in cervical spondylotic myelopathy / 实用放射学杂志

Objective To investigate the clinical application value of the non-shared incentive diffusion weighted imaging(ZOOM-DWI)technique at cervical level in diagnosis of cervical spondylotic myelopathy(CSM).Methods A total of 49 CSM patients(patient group),and 50 healthy volunteers(control group)were recruited.All subjects underwent conventional MRI and ZOOM-DWI of the cervical spine and neurologic modified Japanese Orthopaedic Association(mJOA)scores in patients with CSM.The apparent diffusion coefficient(ADC)value in the spinal cord at the narrowest area(C5-C6)of the compression site of patients,the ADC value at the disc level in each upper and lower level,and the spinal ADC value at the cervical level C2-C3 were measured.The ADC values of control group C2-C3,C3-C4,C4-C5,C5-C6,C6-C7 were measured.Within-group comparisons of the spinal cord ADC values for each segment between patient and control groups were performed using analysis of variance and post hoc comparisons(SNK-q).The ADC values at the narrowest point of the patient group and control group were tested by independent sample t-test.The Pearson correlation analysis was performed between patients'C5-C6 ADC values and mJOA scores.Results The mean ADC values showed no significantly different levels in the control group.Among the ADC values at each measurement level in the patient group,except for C4-C5 and C6-C7 where the difference was not statistically significant,the remaining pair-wise comparisons all showed statisti-cally significant differences(F=24.368,P＜0.001),with the highest ADC value at C5-C6.The C5-C6 ADC value in the patient group was significantly higher compared to the control group(t=9.414,P＜0.001),with statistical significance.The ADC values at the patient stenosis showed a significant negative correlation with the mJOA score(r=-0.493,P＜0.001).Conclusion Cervical ZOOM-DWI technique can be applied to diagnose CSM,and spinal ADC values can be used as reliable imaging data for diagnosing CSM.

Serum differential proteomics between developmental cervical spinal stenosis and cervical spondylotic myelopathy / 中国组织工程研究

BACKGROUND:Previous studies have found that qi deficiency and blood stasis syndrome is the main syndrome among various TCM syndromes of cervical spondylotic myelopathy.However,there is no report on proteomic markers as early diagnosis indicators for the transformation of developmental cervical spinal stenosis with qi deficiency and blood stasis syndrome to cervical spondylotic myelopathy. OBJECTIVE:To explore serum proteomics difference between developmental cervical spinal stenosis and cervical spondylotic myelopathy and to find and identify the potential serum biomarkers between them. METHODS:Serum samples of nine patients with cervical spondylotic myelopathy of qi deficiency and blood stasis syndrome(experimental group)and nine patients with developmental cervical spinal stenosis of qi deficiency and blood stasis syndrome(control group)were collected.The proteomic analysis was carried out by Tandem Mass Tag combined with liquid chromatography tandem mass spectrometry,so as to find and identify differentially expressed proteins. RESULTS AND CONCLUSION:A total of 1027 significantly differential proteins were initially screened by TMT technology and 89 significantly differential proteins were finally identified(P<0.05).Compared with the control group,there were 45 up-regulated proteins in the experimental group,such as α-actinin-4,α-actinin-1,cell division control protein 42 homolog,integrin-linked protein kinase and B-actin.Conversely,there were 44 down-regulated proteins in the experimental group compared with the control group,such as fibronectin,fibrinogen γ chain,fibrinogen α chain,fibrinogen β chain.Gene ontology enrichment analysis indicated that these differential proteins were involved in signal receptor binding,kinase binding,protein kinase activity,integrin binding,actin filament binding and other molecular functions.Based on the Kyoto Encyclopedia of Genes and Genomes pathway analysis,20 common differential signal/metabolic pathways were identified,including Rap1 signaling pathway,adherens junction,tight junction,platelet activation,and regulation of actin cytoskeleton.Protein-protein interaction analysis showed that ILK,FGA,FGB,FGG,FN1,Cdc42,ACTN1,ACTN4 and ACTB were located at the nodes of protein-protein interaction network and were closely related to bone formation and destruction system,nervous system,coagulation system,cellular inflammation and other systems.To conclude,the serum differentially expressed proteins between developmental cervical spinal stenosis and cervical spondylotic myelopathy can be successfully screened by Tandem Mass Tag combined with liquid chromatography tandem mass spectrometry.ILK,FN1,CDC42 and ACTN 4 are identified as specific markers for the transformation of developmental cervical spinal stenosis with qi deficiency and blood stasis syndrome into cervical spondylotic myelopathy.These findings provide a basis for further clarifying the transformation mechanism.

Effect of neutral position magnetic resonance imaging on cervical discs herniation volume and cervical curvature / 中国组织工程研究

BACKGROUND:Cervical neutral position magnetic resonance imaging is widely used for the diagnosis and treatment of cervical spondylotic myelopathy.However,it is not possible for patients to maintain the exact same position of the head and neck during repeated cervical magnetic resonance imaging examinations.The cervical spine undergoes minor flexion and extension movements in the sagittal plane,and the head may have a certain degree of variation in flexion and extension.Whether these changes in the neutral position of the cervical spine affect the volume of cervical discs herniation and cervical curvature is unclear. OBJECTIVE:Using artificial intelligence-assisted measurement,this study aimed to analyze the accuracy and reliability of magnetic resonance imaging examinations for measuring the volume of cervical discs herniation and cervical curvature in patients with cervical spondylotic myelopathy undergoing two consecutive cervical neutral positions in the short term. METHODS:A retrospective study was conducted on patients with cervical spondylotic myelopathy who underwent conservative treatment and underwent two consecutive cervical magnetic resonance imaging examinations within three months between June 2012 and June 2023.We proposed the use of occipital-thoracic distance and occipital-thoracic angle to evaluate the variation in flexion and extension of the head in the neutral position of the cervical spine.Based on the changes in occipital-thoracic angle,patients were divided into occipital-thoracic angle increase group and occipital-thoracic angle decrease group.Cervical discs herniation volume,C2-6 Cobb angle,and cervical(C3-C7)curvature were measured using artificial intelligence-assisted measurement software.Normal distribution data were represented by mean±SD,while non-normal distribution data were represented by the median(interquartile range).Spearman's rank correlation coefficient was used to analyze the correlation between changes in Cobb angle,cervical(C3-C7)curvature,and cervical discs herniation volume. RESULTS AND CONCLUSION:(1)A total of 104 patients and 326 cervical discs herniation were included in the study.There were 47 patients in the occipital-thoracic angle increase group and 57 patients in the occipital-thoracic angle decrease group.(2)Extension and flexion index of the head:There were no significant differences in occipital-thoracic distance and occipital-thoracic angle during the initial diagnosis and follow-up examination.The variation of occipital-thoracic distance was 0.035(3.23)mm,and the variation of occipital-thoracic angle was-0.31(3.28)°.The deviation range of occipital-thoracic distance and occipital-thoracic angle was small,and there was no significant correlation.(3)Cervical curvature index:There were no significant differences in C2-6 Cobb angle and C3-C7 curvature during the initial diagnosis and follow-up examination.There were no significant differences in C2-6 Cobb angle and C3-C7 curvature between the occipital-thoracic angle increase group and occipital-thoracic angle decrease group.(4)There was no significant difference in volume of cervical discs herniation during the initial diagnosis and follow-up examination.There was no significant difference in volume of cervical discs herniation between the occipital-thoracic angle increase group and occipital-thoracic angle decrease group.There was no significant correlation between the change of cervical discs herniation volume and the change of C2-6 Cobb angle and the cervical(C3-C7)curvature.(5)These results indicate that in the neutral position of the cervical spine,there were negligible minor flexion and extension movements in the sagittal plane,and the head was limited to a specific position.Although the head has a certain range of flexion and extension variation,it does not affect the accuracy and reliability of parameters including cervical discs herniation volume,C2-6 Cobb angle,and cervical(C3-C7)curvature.

Finite element analysis of characteristics of spinal cord compression in patients with early cervical spondylotic myelopathy under dynamic position / 中国组织工程研究

BACKGROUND:Cervical spondylotic myelopathy is a progressive disease leading to dysfunction in the middle-aged and elderly,and early diagnosis is difficult.In recent years,some clinical scholars have found that dynamic magnetic resonance imaging technology can detect spinal cord compression in a dynamic position earlier,but its specific biomechanical mechanism needs to be clarified. OBJECTIVE:To investigate the biomechanical compression characteristics of early cervical spondylotic myelopathy in hyperextension and flexion position,and to verify the effectiveness of dynamic magnetic resonance imaging in the diagnosis of early cervical spondylotic myelopathy. METHODS:A retrospective analysis was made on the patients who underwent cervical dynamic magnetic resonance imaging in the Department of Orthopedics of First Affiliated Hospital of Guangxi University of Chinese Medicine from January to June 2022.16 subjects were selected and divided into two groups.The pathological group included 8 patients with early cervical spondylotic myelopathy with hypertrophy of ligamentum flavum as the main sign,with 5 male patients and 3 female patients.The normal group included 8 normal degenerative people,with 4 male patients and 4 female patients.All patients were photographed with cervical CT plain scan,magnetic resonance imaging plain scan,and dynamic magnetic resonance imaging plain scan.This study was divided into the following three parts:(1)collect the dynamic magnetic resonance imaging image DCOM data of two groups of subjects,and collect the cervical vertebra CT and neutral magnetic resonance imaging image DCOM data to understand the bone and soft tissue of the two groups of subjects in the neutral position.(2)Based on the DCOM data of magnetic resonance imaging and CT plain scan,the three-dimensional finite element models of lower cervical vertebra(C3-7)of normal degenerative population and early cervical spondylotic myelopathy patients were established by reverse engineering software.The equivalent stress and equivalent elastic strain of the spinal cord and posterior dura were analyzed,and the distribution of stress and strain was observed.(3)After obtaining the stress and strain data,the data between groups were compared to analyze the mechanical characteristics of spinal cord compression caused by early cervical spondylotic myelopathy in a dynamic position and to verify the effectiveness of dynamic magnetic resonance imaging in the diagnosis of early cervical spondylotic myelopathy. RESULTS AND CONCLUSION:(1)When simulating the posterior extension,flexion and neutral position of the lower cervical vertebrae(C3-7)in the two groups,the values of stress and strain in the posterior part of the spinal cord were in the following order:extension>flexion>neutral(P<0.05).The strain values from large to small were as follows:extension>flexion>neutral(P<0.05).(2)Compared with the normal degenerative population model,the equivalent stress and strain of the spinal cord in the pathological group were higher than those in the normal group under two degrees of freedom of flexion and extension(P<0.05).The distribution area of stress and strain in the posterior part of the spinal cord was irregular.(3)In the neutral position,there was no significant difference in the strain value of the spinal cord between the two groups(P>0.05),and the strain distribution was uniform and regular.(4)It is indicated that in the cervical extension position,the dural sac and the posterior part of the spinal cord were compressed and deformed in the early cervical spondylotic myelopathy patients with the hypertrophy of ligamentum flavum as the main sign,and the degree of compression deformation of the spinal cord was significantly higher than that in the anterior flexion position and neutral position.In the neutral position,there were no obvious signs of spinal cord deformation in patients with early cervical spondylotic myelopathy.This study verified the role of dynamic magnetic resonance imaging in the diagnosis of early cervical spondylotic myelopathy from the point of view of biomechanics.

Effect of different fusion devices on cervical sagittal parameters after anterior cervical discectomy and fusion for cervical spondylotic myelopathy / 中国组织工程研究

BACKGROUND:The impact of anterior cervical surgery on the sagittal balance parameters of the cervical spine is gradually being paid attention to.Currently,there is a lack of clear and feasible clinical guidelines for the selection of surgical methods for two-level cervical spondylosis,aiming to find the most suitable fixation method that is more beneficial for this type of patient. OBJECTIVE:To compare the effects of different fusion devices for anterior cervical decompression on the changes of cervical sagittal parameters after surgery for adjacent two-level cervical spondylotic myelopathy. METHODS:A total of 44 patients with adjacent two-level cervical spondylotic myelopathy underwent anterior cervical discectomy and fusion from March 2018 to September 2020 in Liaocheng People's Hospital were retrospectively analyzed in the study,and they were divided into zero-p group(23 cases)and cage group(21 cases).All patients underwent anteroposterior X-ray,three-dimensional CT reconstruction and MRI examination before operation.At the last follow-up,the anteroposterior X-ray films of cervical spine were taken.The sagittal balance parameters of the cervical spine were measured before and after surgery,including cervical lordotic angle(C2-7 Cobb),C2-C7 sagittal vertical axis,segmented lordotic angle and T1 slope.The surgical time,intraoperative bleeding,last follow-up intervertebral fusion,and postoperative swallowing disorders were recorded,and Japanese Orthopaedic Association score on the patient was evaluated before and after surgery.The changes in cervical sagittal parameters before and after surgery were calculated and their differences were compared between the two groups. RESULTS AND CONCLUSION:(1)Both groups of patients successfully completed the surgery and received follow-up.The zero-p group had shorter surgical time and less intraoperative bleeding compared to the cage group,but the difference was not statistically significant(P>0.05).(2)The incidence rate of postoperative swallowing disorders in the cage group(7/21,33%)was higher than that in the zero-p group(3/23,13%),and the difference was statistically significant(P<0.05).(3)At the last follow-up,the clinical efficacy of the two groups was the same;all patients had bone fusion.Comparison within the group showed that the sagittal parameters of the cervical spine in both groups improved compared to before surgery(P<0.05).There was no statistically significant difference in sagittal parameters between groups(P>0.05),and there was no statistically significant difference in changes in C2-C7 sagittal vertical axis,C2-7 Cobb angle,and T1 slope between the two groups(P>0.05).However,the segmented lordotic angle changes in the zero-p group were smaller than those in the cage group,and the difference was statistically significant(P<0.05).(4)It is indicated that the use of zero-p and titanium plate combined with cage during anterior cervical discectomy and fusion surgery can effectively improve cervical sagittal balance.Titanium plate combined with cage intervertebral fusion can better reconstruct the patient's cervical lordosis and curvature.The selection of fusion devices should also comprehensively consider the occurrence of surgical complications.

Clinical guidelines for diagnosis and treatment of cervical spondylotic myelopathy with the integrated traditional Chinese and Western medicine(2023) / 中国骨伤

The "Clinical Guidelines for Diagnosis and Treatment of Cervical Spondylotic Myelopathy with the Integrated Traditional Chinese and Western Medicine" were formulated by the Orthopedic and Traumatology Professional Committee of the Chinese Association of Integrative Medicine in accordance with the principles of evidence-based medicine and expert consensus, and provide clinicians with academic guidance on clinical diagnosis and treatment of CSM. The main content includes diagnostic points, disease grading assessment, TCM syndrome differentiation, surgical indications and timing, integrated traditional Chinese and Western medicine treatment, and postoperative rehabilitation. This guideline proposes for the first time that the treatment of CSM should follow the principle of grading, clarify the timing and methods of surgical treatment, establish common TCM syndrome differentiation and classification, attach importance to postoperative integrated rehabilitation of Chinese and Western medicine, and strengthen daily follow-up management. It hopes to promote the standardization, effectiveness, and safety of clinical treatment of CSM.

Advances in surgical strategies for ossification of posterior longitudinal ligament involving the C 2 segment / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the application of surgical strategies for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) involving the C 2 segment.@*METHODS@#The literature about the surgery for cervical OPLL involving C 2 segment was reviewed, and the indications, advantages, and disadvantages of surgery were summarized.@*RESULTS@#For cervical OPLL involving the C 2 segments, laminectomy is suitable for patients with OPLL involving multiple segments, often combined with screw fixation, and has the advantages of adequate decompression and restoration of cervical curvature, with the disadvantages of loss of cervical fixed segmental mobility. Canal-expansive laminoplasty is suitable for patients with positive K-line and has the advantages of simple operation and preservation of cervical segmental mobility, and the disadvantages include progression of ossification, axial symptoms, and fracture of the portal axis. Dome-like laminoplasty is suitable for patients without kyphosis/cervical instability and with negative R-line, and can reduce the occurrence of axial symptoms, with the disadvantage of limited decompression. The Shelter technique is suitable for patients with single/double segments and canal encroachment >50% and allows for direct decompression, but is technically demanding and involves risk of dural tear and nerve injury. Double-dome laminoplasty is suitable for patients without kyphosis/cervical instability. Its advantages are the reduction of damage to the cervical semispinal muscles and attachment points and maintenance of cervical curvature, but there is progress in postoperative ossification.@*CONCLUSION@#OPLL involving the C 2 segment is a complex subtype of cervical OPLL, which is mainly treated through posterior surgery. However, the degree of spinal cord floatation is limited, and with the progress of ossification, the long-term effectiveness is poor. More research is needed to address the etiology of OPLL and to establish a systematic treatment strategy for cervical OPLL involving the C 2 segment.

The postoperative adjacent segment degeneration between the microscopically anterior cervical discectomy with fusion and anterior cervical corpectomy with fusion in the treatment of cervical spondylotic myelopathy and the influencing factors analysis of / 中国医师进修杂志

Objective:To compare the postoperative adjacent segment degeneration (ASD) between the microscopically anterior cervical discectomy with fusion (ACDF) and anterior cervical corpectomy with fusion (ACCF) in the treatment of cervical spondylotic myelopathy and its influencing factors.Methods:Fifty patients with cervical spondylotic myelopathy treatment in the Qinzhou Second People′s Hospital from July 2018 to July 2020 were selected, they were divided into two groups, 25 patients performed ACDF (ACDF group), and 25 patients performed ACCF (ACCF group). The perioperative period, efficacy and incidence of ASD were compared between the two groups, and the influencing factors of ASD were analyzed.Results:The intraoperative blood loss, operation time, length of hospital stay and postoperative drainage in ACCF group were higher than those in ACDF group: (58.34 ± 8.61) ml vs. (46.77 ± 7.24) ml, (99.57 ± 10.72) min vs. (86.14 ± 9.64) min, (8.97 ± 1.43) d vs. (7.56 ± 1.24) d, (17.92 ± 2.95) ml vs. (14.28 ± 2.66) ml, there were statistical differences ( P<0.05). The postoperative Japanese Orthopaedic Association (JOA) scores and Neck Disability Index (NDI) scores in the two groups were improved significantly ( P<0.05), but the scores of JOA and NDI in the two groups had no significant differences ( P>0.05). The incidence of ASD in the two groups had no significant differences ( P>0.05). The Cox univariate analysis showed that age >59 years, intervertebral disc degeneration, number of fusion segments >2, osteoporosis and postoperative ASD were risk factors for ASD( P<0.05). Conclusions:The effect of microscopically ACDF is similar to that of ACCF in the treatment of cervical spondylotic myelopathy, but ACDF has the advantages of less trauma and quick recovery. The risk of postoperative ASD should be vigilant for patients with age >59 years old, intervertebral disc degeneration, number of fusion segments >2 or osteoporosis.

Visualization and analysis of the status of research on surgical treatment of multilevel cervical spondylotic myelopathy in the English literature of Web of Science database using Citespace soft-ware / 中国脊柱脊髓杂志

Objectives:To analyze visually the current research status,hot spots and trends of surgical treatment of multilevel cervical spondylotic myelopathy(MCSM)collected in Web of Science(WOS)core database by collecting relevant English literature via Citespace software and creating knowledge maps,in order to provide direction and reference for further research in this field.Methods:The literature related to re-search on surgical treatment of MCSM with the subject of"Cervical Spondylotic Myelopathy"OR"Cervical Myelopathy"AND"Multilevel"OR"MCSM"OR"CSM"AND"Surgery"OR"Operation",published from January 1,2000 to December 31,2022 was retrieved from Web of Science(WOS).The literature included was Article and Review,and duplicate literature was excluded with the Remove Duplicates function of Citespace(6.1.R6)software for bibliometric analysis.The authors,institutions and keywords of the included literature were analyzed and displayed visually.Results:A total of 372 literature was included in the study.The sta-tistical analysis of annual publication volume showed that overall foreign research in this field had been on the rise in the last 20 years or so,and there had been a surge in literature and a continuous popularity ever since 2016.The co-occurrence analysis of authors showed that there were 550 authors,including 23 core au-thors,and the top 3 in terms of number of publications were Ding Wenyuan,Fehlings Michael G,and Yuan Wen.The co-occurrence analysis of institutions showed that research institutions in this field were concentrat-ed in domestic and foreign universities and hospitals,and the top 3 in terms of publications were Soochow Univ,Second Mil Med Univ,and Sun Yat Sen Univ.The keyword analysis showed 7 major clusters were ob-tained,and the hot topic of research was the comparative evaluation of the efficacy and safety of different surgical procedures for MCSM.Conclusions:Surgical treatment of multilevel cervical spondylotic myelopathy is of increasing research concern year by year,and it remains a hot spot worthy of research in the future.Further in-depth research to optimize and improve existing surgical procedures and explore new procedures by combining new materials and technologies is a feasible path for future study.

White cord syndrome: rara complicación luego de la cirugía de descompresión cervical / White cord syndrome: a rare complication after cervical decompressive surgery

RESUMEN Introducción: el white cord syndrome, conocido como una lesión por reperfusión de la médula espinal, es una rara complicación de la cirugía espinal para descompresión. Se define como un deterioro neurológico inmediato y súbito, luego de la cirugía de descompresión cervical. Objetivo: describir los elementos clínico-imagenológicos y estrategias de tratamiento del white cord syndrome. Métodos: se realizó la revisión de la literatura en bases de datos Pubmed y EMBASE, además en los servidores de preprints BioRxiv, MedRxiv y preprint.org, así como la plataforma ResearchGate. Se seleccionaron todos los artículos en inglés y español, con texto completo disponible. Se usaron los siguientes descriptores white cord syndrome AND cervical spondylotic myelopathy. Se excluyeron artículos editoriales, libros, revisiones, meta-análisis y aquellos sin carácter open-access. Luego de excluir artículos que no cumplían nuestros criterios, fueron seleccionadas 17 publicaciones para su revisión. Resultados: Se analizaron 17 artículos, con una muestra total de 24 pacientes reportados. Todos los pacientes mostraron afectación mielopática con defecto motor variable e hiperreflexia osteotendinosa. En diez artículos, la técnica quirúrgica empleada fue la descompresión posterior, con o sin fusión. Fue muy variable el empleo de dosis de esteroides, terapia física y las re-intervenciones quirúrgicas. Solo dos casos no mostraron recuperación neurológica al término del período de observación. Conclusiones: el reconocimiento de esta rara complicación es vital, ya que constituye una causa de defecto neurológico posterior a la cirugía. El diagnóstico se realiza luego de la exclusión de complicaciones trans-operatorias, y al observar hiperintensidad del cordón medular ponderado en T2 en las imágenes de resonancia magnética. El manejo radica en adecuada descompresión, uso de esteroides y rehabilitación.

ABSTRACT Introduction: white cord syndrome, known as spinal cord reperfusion injury, is a rare complication of spinal decompressive surgery. It is defined as an immediate and sudden neurological deterioration after cervical decompression surgery. Objective: to describe the clinical-imaging elements and treatment strategies of white cord syndrome. Methods: a literature review was performed in Pubmed and EMBASE databases, as well as in the preprint servers BioRxiv, MedRxiv and preprint.org, and the ResearchGate platform. All articles in English and Spanish, with full text available, were chosen. The following descriptors were used: White cord syndrome AND cervical spondyloticmyelopathy. The editorial articles, books, reviews, meta-analyses and those without open-access characteristics were excluded. After excluding articles that did not meet the criteria established, 17 publications were chosen to be reviewed. Results: seventeen articles were analyzed, with a total sample of 24 patients reported. All patients showed myelopathic involvement with variable motor defect and osteotendinous hyperreflexia. In ten articles, the surgical technique used was posterior decompression, with or without fusion. The use of steroid doses, physical therapy and surgical re-interventions was highly variable. Only two cases did not show neurological recovery at the end of the observation period. Conclusions: recognition of this rare complication is vital, since it constitutes a cause of neurological defect after surgery. The diagnosis is made after exclusion of trans-operative complications, and after observing T2-weighted spinal cord hyper-intensity in magnetic resonance images. Management is based on adequate decompression, application of steroid treatment and rehabilitation.

Analysis of the effect and influencing factors of different surgical methods in the treatment of multi-level cervical spondylotic myelopathy / 中国综合临床

Objective:To explore the use of anterior cervical corpectomy and fusion (ACCF) combined with anterior cervical discectomy and fusion (ACDF) in patients with multilevel cervical spondylopathy myelopathy (CSM).Methods:The clinical data of 83 patients with multi-segment CSM admitted to the Department of Spinal Surgery of Hubei Liuqi2 Orthopaedic Hospital of Integrated Traditional Chinese and Western Medicine from January 2018 to January 2021 were retrospectively analyzed. According to the different surgical methods used in their treatment, they were divided into group A and group B. In group A, 44 patients were treated with anterior cervical ACCF combined with ACDF, and 39 patients in group B were treated with posterior single-door laminoplasty. The general clinical indexes such as operation time, perioperative bleeding volume and hospitalization time were collected.The neurological function and cervical dysfunction improvement effect of the patients before and 6 months after operation were evaluated by using the Japanese Orthopaedic Association (JOA) score and neck disability index (NDI) scale. The cervical curvature of the patients before and 6 months after operation was compared, The complications of the two groups were observed 6 months after operation. The patients were divided into improved group (72 cases) and non improved group (11 cases). Comparison between count data groups χ 2 inspection. Independent sample t-test was used for comparison between measurement data groups conforming to normal distribution. According to the results of univariate analysis, the meaningful factors were included in the binary Logistic regression to analyze the influencing factors related to the surgical efficacy. Result:The perioperative blood loss ((153.36±10.68) mL) and hospital stay ((10.11±2.30) d) in group A were lower than those in group B ((171.47±11.32) mL, (15.58±3.76) d). There were significant differences between the two groups ( t values were 7.50 and 8.10; both P<0.001). Six months after operation, the JOA score (13.70±1.49, 12.94±1.63) and cervical curvature (22.10±3.23, 13.38±3.12) of patients in groups A and B were all higher than those before operation (9.40±1.32, 9.36±1.51; 11.16±2.60, 11.23±2.71), and group A was higher than group B, the difference was statistically significant (JOA scores before and after operation: t values were 14.33 and 10.07, respectively; cervical curvature: t values were 17.50 and 3.25, respectively; t values between groups were 2.22 and 12.47, respectively, and the P values were <0.001, <0.001, <0.001, 0.002, 0.029 and <0.001, respectively). Six months after the operation, the NDI indexes of groups A and B (11.38±4.76, 14.79±4.85) were lower than those before the operation (39.56±9.43, 39.74±9.51), and those in group A were lower than in group B, and the difference was statistically significant ( t values were 17.70, 14.60, and 3.23; all P<0.001). Binary Logistic regression showed that the duration of disease ≥6 months ( OR=59.045, 95% CI: 6.485-537.629), the presence of cervical spinal cord MRI signal changes ( OR=0.031, 95% CI: 0.002-0.587), the surgical approach (posterior approach single-door laminoplasty) ( OR=6.300, 95% CI: 1.269-31.273) was an independent risk factor affecting the surgical outcome ( P values were <0.001, 0.021, and 0.024, respectively). Conclusion:Anterior cervical ACCF combined with ACDF has an ideal surgical effect in the treatment of patients with multi-segment CSM, which can significantly improve the cervical spinal nerve function and cervical curvature, shorten the operation time and reduce the perioperative blood loss. It isstill necessary to pay attention to the patient's disease course, MRI signals changes of cervical spinal cord and the effect of surgical methods on their surgical outcomes.

Analysis of Myelomalacia and Posterior Longitudinal Ligament Ossification as Prognostic Factors in Patients with Cervical Spondylotic Myelopathy Submitted to Laminoplasty / Análise de mielomalácia e ossificação do ligamento longitudinal posterior como fatores prognósticos em pacientes com mielopatia espondilótica cervical submetidos a laminoplastia

Background Cervical spondylotic myelopathy is a degenerative disease of the intervertebral disc and the vertebral body of the spine that causes cervical spinal cord injury due to central vertebral canal stenosis. Its prevalence is higher in the elderly. Treatment is usually surgical when the spinal cord is affected either clinically with pyramidal release or radiologically with the altered spinal cord. Objective The goal of the present study is to analyze the myelomalacia and the ossification of the posterior longitudinal ligament as prognostic factors in the postoperative evolution of patients with cervical canal compression who underwent laminoplasty with the open- or French-door techniques. Methods We performed a retrospective analysis of 18 surgical cases of spondylotic cervical myelopathy of the same senior neurosurgeon, using the chi-squared test to analyze prognostic factors for patients' postoperative evolution in the Nurick scale, after open-door or French-door laminoplasty. Findings The comparison between the pre and postoperative showed an improvement of 71.43% in cases that did not have ligament ossification compared with 45.45% of cases that presented posterior longitudinal ligament ossification. Also, there was a better prognosis in patients without myelomalacia, as 71.43% of them improved their condition against only 45.45% of improvement in those with myelomalacia. Conclusion There is a need for further studies with larger samples to expressively prove that the presence of longitudinal ligament ossification and the previous presence of myelomalacia are factors that can lead to worse prognosis in the postoperative evolution of patients with cervical spondylotic myelopathy submitted to laminoplasty.

Introdução A mielopatia espondilótica cervical é uma doença degenerativa do disco intervertebral e do corpo da coluna vertebral que causa lesão da medula espinhal cervical devido à estenose do canal vertebral central. Sua prevalência é maior em idosos. O tratamento geralmente é cirúrgico quando a medula espinhal é afetada clinicamente com a liberação piramidal ou radiologicamente com a medula espinhal alterada. Objetivo Este estudo tem como objetivo analisar a mielomalácia e a ossificação do ligamento longitudinal posterior como fatores prognósticos na evolução pós-operatória de pacientes com compressão do canal cervical submetidos à laminoplastia pelas técnicas de porta aberta ou porta francesa. Métodos Foi realizada uma análise retrospectiva de 18 casos cirúrgicos de mielopatia espondilótica cervical do mesmo neurocirurgião sênior, utilizando o teste do quiquadrado para analisar os fatores prognósticos da evolução pós-operatória dos pacientes na escala de Nurick, após laminoplastia aberta ou francesa. Resultados A comparação entre o pré e pós-operatório mostrou uma melhora de 71,43% nos casos que não apresentavam ossificação ligamentar em comparação com 45,45% nos casos que apresentavam ossificação do ligamento longitudinal posterior. Além disso, houve um melhor prognóstico em pacientes sem mielomalácia, pois 71,43% deles melhoraram sua condição contra apenas 45,45% de melhora naqueles com mielomalácia. Conclusão Há necessidade de mais estudos com amostras maiores para comprovar expressivamente que a presença de ossificação ligamentar longitudinal e a presença prévia de mielomalácia são fatores de pior prognóstico na evolução pós-operatória de pacientes com mielopatia espondilótica cervical submetidos à laminoplastia.

Buckling of the Ligamentum Flavum as a Rare Complication of Anterior Cervical Corpectomy and Fusion: A Case Report

Introduction and Importance Neurological deterioration due to buckling of the ligamentum flavum (LF) is an uncommon complication after anterior cervical corpectomy or discectomy with fusion. Case Presentation In this report, we present the case of a 66-year-old male who underwent anterior cervical partial corpectomy of C5 and discectomy of prolapsed C5- C6 with fusion. Postsurgery, the patient displayed signs of neurological deterioration. Upon immediate cervical magnetic resonance imaging (MRI), posterior canal stenosis and severe compression with cord signal due to LF buckling were detected. A posterior laminectomy procedure and canal decompression at the C5-C6 level with bone fusion were performed. Clinical Discussion Patient presented with walking difficulty, then walking disability, followed by bilateral upper and lower limb paresthesia with burning sensation. Examination showed ⅘ muscle strength in both handgrips. Further investigation showed brisk deep tendon reflexes, positive Hoffman sign unilaterally, equivocal Babinski sign, and progressive quadriparesis. Magnetic resonance imaging showed mild and diffuse building of some cervical discs, with spinal cord progression. We performed an anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF); a titanium mesh with plates and screws was used for fusion, with removal of a calcified and herniated subligamentous disc. Postoperatively, upper and lower limb strength deteriorated; immediate cervical and thoracic MRI showed LF buckling, which caused canal stenosis and severe compression. Urgent posterior laminectomy and canal decompression with bone fusion was scheduled on the same day. The patient underwent physiotherapy and regained upper and lower limb strength and his ability to walk. Conclusion This indicates the possibility of neurological deterioration as a result of LF buckling, whichmay be a result of LF thickening accompanied by hyperextension in the cervical region. In this regard, immediate imaging following signs of neurological complications after anterior cervical corpectomy or discectomy warrants early detection, which results in a better prognosis.

Effect of mecobalamine combined with mouse nerve growth factor on nerve function recovery after cervical spondylotic myelopathy surgery / 中国组织工程研究

BACKGROUND: Cervical spondylotic myelopathy is a common degenerative disease of the cervical spine in spinal surgery. Surgical decompression is the most effective method to prevent the further development of the disease. However, patients are often accompanied by residual neurological symptoms such as sensory and motor dysfunction after surgery. Currently, the drug treatment for postoperative neurological recovery of patients is still unclear clinically. OBJECTIVE: To investigate the effect of mecobalamine combined with mouse nerve growth factor on the recovery of nerve function after cervical spondylotic myelopathy surgery. METHODS: A total of 82 cases of cervical spondylotic myelopathy from June 2017 to September 2018 in the Affiliated Hospital of Xuzhou Medical University were enrolled in this study. All the patients were randomly divided into observation group and control group with 41 cases in each. Mouse nerve growth factor injection was applied to the control group, and mecobalamine injection was added to the research group. All the patients were treated for 2 weeks. The symptoms and signs in both groups were respectively recorded before and after the treatment, and postoperative residual neurological symptoms were evaluated by Neck Disability Index (NDI) scores and Japanese Orthopedic Association scores. RESULTS AND CONCLUSION: At 1 month, 3 months, 6 months and 1 year after the operation, the NDI scores of the two groups were lower than those before the treatment, and the JOA scores were both getting higher than those before the treatment. The NDI scores in the observation group at 6 months and 1 year after the operation were significantly lower than those in the control group, and as well, the Japanese Orthopedic Association scores were significantly higher than those in the control group. These findings indicate that the combination of mecobalamine and mouse nerve growth factor is helpful to the recovery of nerve function in patients after cervical spondylotic myelopathy surgery, and the effect is better than that of mouse nerve growth factor alone.

Microscope assisted anterior cervical discectomy and fusion for the treatment of single segment cervical spondylotic myelopathy / 中国骨伤

OBJECTIVE@#To compare the efficacy of microscope assisted anterior cervical discectomy and fusion with conventional surgical approach in the treatment of single-segment cervical spondylotic myelopathy.@*METHODS@#The clinical data of 89 patients with single-segment cervical spondylotic myelopathy treated from March 2015 to March 2019 were retrospectively analyzed. There were 55 males and 34 females, with an average of (52.00±11.36) years old. Among the patients, 34 cases were treated with conventional anterior cervical discectomy with fusion (conventional group), including C@*RESULTS@#Intraoperative blood loss and hospital stay in microscope group were less than those in conventional group (@*CONCLUSION@#Both methods can achieve satisfactory effect in treating single-segment cervical spondylotic myelopathy. However, microscope-assisted anterior cervical discectomy and fusion has advantages of clear vision, less bleeding and fewer intraoperative complications.

Magnetic resonance imaging predictors of outcome after surgical intervention for cervical spondylotic myelopathy

Background: Cervical spondylotic myelopathy (CSM) is a commonly seen spinal cord disease. There are no well-defined indications and optimal timing for surgical intervention. Therefore, defining predictors for outcome after surgical intervention will have great advantage in taking decisions for interventions.Methods: A consecutive series of all patients having signs and symptoms of cervical spondylotic myelopathy admitted to Department of Neurosurgery, Medical College, Thiruvananthapuram who underwent decompressive surgery with or without stabilization in one year were studied. Pre-operative magnetic resonance imaging (MRI) findings were correlated with post-operative surgical outcomes (Nurick grade) after 3 months of follow up. The pattern of spinal cord signal intensity was classified as: group A (MRI N/N) - no SI T1WI or T2WI, group B (MRI N/Hi) - no SI T1WI and high SI on T2WI and, group C (MRI Lo/Hi) - low SI T1WI and high SI on T2WI. CSM clinical outcomes were evaluated using Nurick grading system, which was used pre- and post-operatively (pre op and post op).Results: Post operatively improvement was seen in 75% of group A and 61.35 % of group B patients, but among group C only 25% patient improved according to Nurick grading pre op and post op.Conclusions: Patients with high intramedullary signal intensity on T2WI may experience a good surgical outcome. A less favorable surgical outcome is predicted by the presence of low intramedullary signal on T1WI.

Relationship between Cervical Curvature and Spinal Drift Distance after Laminectomy with Screw Fixation and Its Effect on Clinical Outcome / 中国康复理论与实践

Objective:To observe the relationship between cervical curvature and spinal drift distance after laminectomy with lateral mass screw fixation, and its effect on clinical outcome. Methods:From January, 2017 to October, 2018, a total of 117 patients with cervical spondylotic myelopathy (CSM) underwent laminectomy with lateral mass screw fixation, and 90 of them completed the follow-up. According to the patients' cervical curvature (CC), they were divided into three groups: those CC between 0° to 5° were in Group A (n = 28), 5° to 16.5° in Group B (n = 36) and CC > 16.5° in Group C (n = 26). The spinal drift distance, nerve recovery, axial symptoms and C5 palsy were recorded and analyzed. Results:There were significant differences in CC and spinal drift distance (F > 152.119,P < 0.001), and no significant difference was found in laminectomy width and incidence of C5 palsy (P > 0.05) among three groups. The Japanese Orthopaedic Association (JOA) score significantly increased in all the groups post operation and at the last follow-up (t > 8.869,P < 0.001), and no significant difference was found among there groups at the same time (P > 0.05), as well as the incidence of C5 palsy (F = 0.472,P = 0.625). There was significant difference in the score of Visual Analogue Scale of axial symptoms among three groups (F > 34.800,P < 0.001), which was lower in groups B and C than in group A (t > 5.845,P< 0.001), and no significant differene was found between group B and group C. Conclusion:On the basis of the same laminectomy width, the greater the CC was, the more favorable the spinal drift went backwards. The loss of CC was related to the occurrence of axial symptoms, but was not correlated with the neurological recovery and C5 palsy.

Relationship between different cervical curvature and spinal cord posterior movement after laminectomy with lateral mass screw fixation and its influence on the operative effect / 中国综合临床

Objective@#To investigate the relationship between cervical curvature (CC) and spinal drift distance after laminectomy with lateral mass screw fixation and the influence on the operative effect.@*Methods@#From October 2016 to December 2017, a total of 85 patients with cervical spondylotic myelopathy (CSM) underwent laminectomy with lateral mass screw fixation in handan central hospital, and 78 patients were followed up completely.After the operation, according to the Harrison method, they were divided into 2 groups(Group A (43 cases, 0°≤CC≤16.5°); Group B (35 cases, CC>16.5°)). The spinal drift distance, nerve recovery, axial symptoms and C5 palsy in the groups were recorded and analyzed.@*Results@#The CC was 8.5°±3.8° in group A and 19.6°±3.0° in group B (t=14.071, P=0.000). The laminectomy width in group A was (22.1±1.7) mm, in group B was (21.8±1.5) mm, the difference between the two groups was not statistically significant (P>0.05). The distance of spinal cord backward movement was (1.7±0.4) mm in group A and (3.2±0.7) mm in group B. There was significant difference between the two groups (t=11.879, P<0.001). At the end of one year, the improvement rates of nerve function in the two groups were (63.3±13.1)% and (65.1±13.9)% respectively, there was no significant difference between the two groups (t=0.587, P=0.559). The VAS score of group A was (5.2±1.3) at one week and (3.5±0.6) at one month after operation, and that of group B was (3.8±0.8) and (2.4±0.4) respectively.There were statistically significant differences between groups at different time points (t=5.567, P<0.001; t=9.289, P<0.001). The incidence of C5 paralysis was 7.0% (3/43) in group A and 11.4% (4/35) in group B. There was no significant difference between the two groups (P>0.05).@*Conclusion@#The greater the curvature of cervical spine is, the more fully the spinal cord moves backward.The loss of curvature of cervical spine is related to the occurrence of axial symptoms.The curvature of cervical spine is not related to the recovery of nerve function and the occurrence of C5 nerve paralysis.