Predictive value of dynamic diffusion tensor imaging for surgical outcomes in patients with cervical spondylotic myelopathy.

BACKGROUND: Cervical spondylotic myelopathy (CSM) is the most common chronic spinal cord injury with poor surgical and neurologic recovery in the advanced stages of the disease. DTI parameters can serve as important biomarkers for CSM prognosis. The study aimed to investigate the predictive value of dynamic diffusion tensor imaging (DTI) for the postoperative outcomes of CSM. METHODS: One hundred and five patients with CSM who underwent surgery were included in this study. Patients were assessed using the Modified Japanese Orthopedic Association Score (mJOA) before and one year after surgery and then divided into groups with good (≥ 50%) and poor (< 50%) prognoses according to the rate of recovery. All patients underwent preoperative dynamic magnetic resonance imaging of the cervical spine, including T2WI and DTI in natural(N), extension (E), and flexion (F) positions. ROM, Cross-sectional area, fractional anisotropy (FA), and apparent diffusion coefficient (ADC) were measured at the narrowest level in three neck positions. Univariate and multivariate logistic regression were used to identify risk factors for poor postoperative recovery based on clinical characteristics, dynamic T2WI, and DTI parameters. Predictive models were developed for three different neck positions. RESULTS: Forty-four (41.9%) patients had a good postoperative prognosis, and 61 (58.1%) had a poor prognosis. Univariate analysis showed statistically significant differences in diabetes, number of compression segments, preoperative mJOA score, cross-sectional area ((Area-N), (Area-E), (Area-F)), ADC((ADC-N), (ADC-E), (ADC-F)) and FA (((FA-N), (FA-E), (FA-F)) (p < 0.05). Multivariable logistic regression showed that natural neck position: Area-N ([OR] 0.226; [CI] 0.069-0.732, p = 0.013),FA-N([OR]3.028;[CI]1.12-8.19,p = 0.029); extension ne-ck position: Area-E([OR]0.248;[CI]0.076-0.814,p = 0.021), FA-E([OR]4.793;[CI]1.737-13.228,p = 0.002);And flextion neck postion: Area-F([OR] 0.288; [CI] 0.095-0.87, p = 0.027),FA-F ([OR] 2.964; [CI] 1.126-7.801, p = 0.028) were independent risk factors for poor prognosis.The area under the curve (AUC) of the prediction models in the natural neck position, extension neck position, and flexion neck positions models were 0.708[(95% CI:0.608∼0.808), P < 0.001]; 0.738 [(95% CI:0.641∼0.835), P < 0.001]; 0.703 [(95% CI:0.602∼0.803), P < 0.001], respectively. CONCLUSION: Dynamic DTI can predict postoperative outcomes in CSM. Reduced FA in the extension position is a valid predictor of poor postoperative neurological recovery in patients with CSM.

[Efficacy comparison of robot-assisted versus freehand fluoroscopy-assisted minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar spinal diseases].

Objective: To compare the clinical and radiographic outcomes between robot-assisted minimally invasive transforaminal lumbar interbody fusion (RA MIS-TLIF) and fluoroscopy-assisted MIS-TLIF (FA MIS-TLIF) in patients with degenerative lumbar spinal diseases. Methods: The clinical data of 114 patients with lumbar degenerative diseases who underwent MIS-TLIF in Qilu Hospital of Shandong University from January 2019 to March 2022 were analyzed retrospectively. Fifty-eight patients underwent RA MIS-TLIF (robot group) and 56 patients received FA MIS-TLIF (freehand group). There were 16 males and 42 females in the robot group, with a mean age of (56.7±8.1) years. And there were 19 males and 37 females in the freehand group, with a mean age of (57.2±8.6) years. The clinical outcome parameters were the visual analog scale (VAS) of pain, Oswestry Disability Index (ODI) score, operative time, number of intraoperative fluoroscopies, blood loss, postoperative hospital stay and complications. The radiographic change measures were the accuracy of screw placement, facet joint violation (FJV), fusion status, and change in disc height at the proximal adjacent segment. All the patients were followed-up for 2-5 years. Results: There was no significant differences in the VAS and ODI scores, blood loss, or postoperative hospital stay between the two groups (all P>0.05). The operative time was longer in robot group than freehand group [(158.5±12.1) min vs (146.4±15.4) min, P<0.001]. There was no significant difference in the number of intraoperative fluoroscopies for patients between robot group and freehand group (P>0.05). The number of intraoperative fluoroscopies for the surgeon was significantly lower in robot group than freehand group (13.8±3.9 vs 74.7±6.8, P<0.001). The rate of a perfect screw position (grade A) was higher in robot group than freehand group [87.5%(203/232) vs 70.1%(157/224), P<0.001]. However, there was no significant difference in the proportion of clinically acceptable screws (grades A and B) between the two groups [98.3%(228/232) vs 96.9%(217/224), P=0.330]. The FJV grade was significantly higher in freehand group than robot group (0.43±0.68 vs 0.13±0.43, P<0.001). During at 2-year postoperative follow-up, there was no significant difference in the fusion status between the two groups (P>0.05); however, the decrease in disc height at the proximal adjacent segment was significantly less in robot group than freehand group [(0.63±0.38) mm vs (0.92±0.35) mm, P=0.001]. In the robotic group, a pedicle screw penetrated the outer wall of the vertebral pedicle in one patient, which was adjusted during surgery. In the freehand group, two screws were inserted too deeply and penetrated the anterior cortex, resulting in mild abdominal discomfort postoperatively, which resolved by the third day after surgery. Conclusions: Robot-assisted percutaneous pedicle screw placement is a safer and more accurate alternative to conventional freehand fluoroscopy-assisted pedicle screw insertion in MIS-TLIF. Compared with freehand MIS-TLIF, robot-assisted MIS-TLIF increases the operation time, but the accuracy of screw placement is higher, and the intraoperative radiation dose and the degree of adjacent segment degeneration are reduced.

Clinical efficacy of refined nursing strategies on early rehabilitation training for postoperative patients with cervical spondylosis.

To investigate the effects of refined nursing strategies on postoperative quality of life, pain level, psychological condition, and other rehabilitation training of patients with cervical spondylosis. This study is a retrospective study, and 500 patients with cervical spondylosis admitted to our hospital from April 2022 to June 2023 were selected as the study objects. They were divided into a control group (250 cases) and an experimental group (250 cases) according to whether they received personalized intensive care. The control group received standard nursing care, while the experimental group was given personalized, high-quality nursing care. The refined nursing strategy comprises individualized rehabilitation training plans, psychological support, nutritional counseling, and pain management. Indicators such as pain level, cervical spine function, quality of life, complication statistics, and nursing satisfaction were employed to evaluate the clinical efficacy of 2 nursing methods. In the pain assessment, patients in the experimental and control groups had pain scores of (1.98 ±â€…0.84) and (5.78 ±â€…0.63), respectively, after the nursing intervention. The reduction in pain for patients in the experimental group was highly significant (P < .05) compared to pre-nursing care. Six months after the commencement of healthcare, the cervical spine function scores of the experimental and control groups were (93.36 ±â€…4.74) and (82.68 ±â€…5.42), respectively. Moreover, the cervical spine function recovery of the experimental group was deemed significant. The experimental group exhibited a lower probability of complications compared to the control group. Additionally, the quality of life was significantly higher in the experimental group than in the control group (P < .05). Improvement time and healing time were significantly shorter in the patients of the experimental group in comparison to the control group. In terms of nursing satisfaction, the experimental group had a significantly higher satisfaction rate of 87.57% than the control group (P < .05). The refined nursing strategy significantly improved the speed and quality of patients' functional recovery. Additionally, the implementation of personalized and comprehensive nursing techniques during postoperative treatment for cervical spondylosis resulted in a significant improvement in patient's quality of life and satisfaction with the treatment process.

Efficacy and safety of tranexamic acid use in elderly patients undergoing anterior cervical discectomy and fusion: a retrospective study.

OBJECTIVE: To evaluate the safety and efficacy of intravenous tranexamic acid (TXA) administration in anterior cervical discectomy fusion (ACDF) for the treatment of cervical spondylosis in the elderly. METHODS: Data from elderly patients who underwent ACDF between January 2020 and January 2023 were retrospectively reviewed. Patients who received 1 g intravenous TXA administration before skin incision (TXA group) were compared with patients who did not receive TXA (controls). Total and hidden blood loss were calculated, and the following outcomes were recorded: haemoglobin and haematocrit drop, operation time, drainage duration, drain volume, length of hospitalization, coagulation changes, and incidence of complications. RESULTS: A total of 114 patients were included (TXA group, n = 53 and controls, n = 61). Total blood loss, hidden blood loss, and postoperative drainage volume, haemoglobin and haematocrit drop were significantly lower in the TXA group than the control group. There were no significant differences in operation time, intraoperative blood loss, drainage duration, length of hospitalization, or coagulation function between the two groups. The incidence of complications did not differ significantly between the two groups during 3 months of follow-up. CONCLUSIONS: Intravenous TXA is effective in reducing perioperative blood loss in elderly patients undergoing ACDF without changing the coagulation function or increasing the risk of complications.

Cervical spondylotic myelopathy.

Cervical spondylotic myelopathy (CSM) is a progressive degenerative condition of the cervical spine and the most common cause of spinal cord injury in adults >55 years of age. Degenerative changes in the spine lead to spinal cord compression, resulting in symptoms such as gait instability, loss of dexterity in the hands, weakness, and sensory deficits. Diagnosis is delayed by 2,2-6,3 years and includes clinical examination and imaging such as MRI. Management of CSM is primarily surgical treatment. This review highligths the importance of early recognition and appropriate treatment in optimising patient outcomes.

Comparison of clinical outcomes and complications of biportal and uniportal endoscopic decompression for the treatment of cervical spondylotic radiculopathy: A systematic review and meta-analysis.

OBJECTIVES: This study aimed to compare the clinical efficacy and complication rates of decompression with unilateral biportal endoscopy (UBE) and percutaneous endoscopy (PE) in cervical spondylotic radiculopathy (CSR). MATERIALS AND METHODS: A comprehensive literature review was conducted up to April 2024 across multiple databases, including EMBASE, PubMed, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data, focusing on clinical studies that compare UBE with PE for posterior foraminotomy and discectomy decompression in CSR. The meta-analysis was performed with an emphasis on evaluating clinical outcomes such as operation time, blood loss, incision length, Neck Disability Index (NDI), Visual Analog Scale (VAS) for neck pain and arm pain, and complications. RESULTS: Out of an initial 1,041 studies identified from electronic databases, eight were deemed eligible based on title, abstract, and full-text screening. These studies involved 552 patients (269 males, 283 females; mean age: 53.9±11.4 years; range, 30 to 79 years), with 287 in the UBE group and 265 in the PE group. Meta-analysis indicated no significant difference in operation time between UBE and PE (mean difference [MD]=-3.68; 95% confidence interval [CI]:-19.38, 12.02; p=0.65). However, both blood loss (MD=17.01; 95% CI: 2.61, 31.41; p=0.02) and incision length (MD=11.62; 95% CI: 9.23, 14.01; p<0.00001) were significantly lower in the PE group compared to the UBE group. Regarding clinical outcomes, no significant differences were observed between the two groups in terms of NDI (MD=0.12; 95% CI:-0.10, 0.34; 0.28), VAS for neck pain (MD=-0.06; 95% CI:-0.19, 0.06; p=0.32), VAS for arm pain (MD=-0.14; 95% CI:-0.26, -0.01; p=0.84), or complications (OR=1.07; 95% CI: 0.54, 2.10; p=0.85). CONCLUSION: Our findings suggest that there are no significant disparities in clinical outcomes between UBE and PE, encompassing NDI, VAS for arm pain, and VAS for neck pain, as well as complication rates. Notably, compared to PE, UBE results in increased bleeding and longer incision lengths when treating CSR, without substantially reducing operation time.

Assessment of Increased T2 Signal Activity in Patients with Cervical Spondylotic Myelopathy Undergoing Posterior Cervical Fusion.

AIM: To compare the preoperative and postoperative increased signal intensity (ISI) outcomes of cervical spondylotic myelopathy (CSM) patients who underwent posterior decompression and fusion, and to assess the correlation between ISI changes and postsurgical clinical prognosis. MATERIAL AND METHODS: The results from 123 patients were evaluated. In addition to demographic data, such as age and gender, factors, including body mass index (BMI); smoking history; duration of symptoms; follow-up periods; levels of decompression and fusion; comorbidities, such as diabetes, coronary artery disease, and hypertension; ISI grading; cervical sagittal vertical axis; C2-7 cervical lordosis parameters; and Modified Japanese Orthopedic Association (mJOA) scores, were statistically analyzed preoperatively and postoperatively. RESULTS: ISI improved in 39 patients (31.7%), remained unchanged in 53 patients (latent, 43.1%), and deteriorated in 31 patients (25.2%). There were no statistically significant differences in terms of age, gender, BMI, or levels of decompression and fusion between patients with ISI improvement, latent ISI, and worsened ISI. Patients with ISI improvement had the highest postoperative C2-7 lordosis values and shortest duration of symptoms. There was no statistically significant difference in the mJOA scores between patients with and without ISI improvement. CONCLUSION: ISI improvement in CSM patients undergoing posterior cervical decompression and fusion is influenced by symptom duration and preoperative-postoperative cervical lordosis values. However, this study did not find a correlation between ISI improvement and clinical recovery based on the mJOA scores.

Effect of kinesiophobia on postoperative rehabilitation outcomes in patients with cervical spondylotic myelopathy: a cross-sectional study.

OBJECTIVE: This study aims to investigate the occurrence of postoperative kinesiophobia in patients with CSM and compare the postoperative recovery of patients with and without kinesiophobia to understand its influence on clinical outcomes in CSM. METHODS: Between November 2020 and November 2022, surgical treatment was performed in the neurosurgical wards of 2 Grade III Class A general public hospitals in the Fujian Province. The demographic and disease data of the patients were collected, and patients were divided into a kinesiophobia group and non-kinesiophobia group according to the Tampa kinesiophobia Scale (TSK). The cervical dysfunction index, cervical Japanese Orthopaedic Association (JOA) rating, self-anxiety rating, and activity of daily living rating scales were collected three months postoperatively. The influence of postoperative kinesiophobia on early rehabilitation was also analysed. RESULTS: A total of 122 patients were an average age of (55.2 ± 10.3) years included in this study. The average score of kinesophobia after surgery was 41.2 ± 4.5, with an incidence of 75.4%. Multivariate logistic regression analysis showed that age (OR = 1.105, 95% CI = 1.014-1.204), neck disability index (NDI) (OR = 1.268, 95% CI = 1.108-1.451), diabetes mellitus (OR = 0.026, 95% CI = 0.001-0.477), and Japanese Orthopaedic Association (JOA) score (OR = 0.698, 95% CI = 0.526-0.927) were associated with the occurren. CONCLUSION: Doctors should be aware of kinesiophobia in patients with CSM. Education regarding kinesiophobia, strategies to avoid it, and treatment strategies using a multidisciplinary approach can improve recovery outcomes.

[Curative effect analysis of anterior cervical discectomy and fusion in patients with cervical spondylosis of vertebral artery type].

OBJECTIVE: To investigate the clinical effect of anterior cervical discectomy and fusion (ACDF) in the treatment of cervical spondylosis of vertebral artery type(CSA). METHODS: The clinical data of 42 patients with CSA from January 2020 to January 2022 were retrospectively analyzed. There were 25 males and 17 females, aged from 30 to 74 years old with an average of (53.9±11.0) years old. There were 18 cases with single-segment lesions, 17 cases with two-segment lesions, and 7 cases with three-segment lesions. The American Academy of Otolaryngology-Head and Neck Surgery's Hearing and Balance Committee score (CHE), the Neck Disability Index (NDI) and the cervical curvature Cobb angle were recorded before surgery and after surgery at 6 months. RESULTS: All 42 ACDF patients were followed up for 6 to 30 months with an average of (14.0±5.2) months. The operative time ranged from 95 to 220 min with an average of (160.38±36.77) min, the intraoperative blood loss ranged from 30 to 85 ml with an average of (53.60±18.98) ml. Tow patients had mild postoperative dysphagia, which improved with symptomatic treatment such as nebulized inhalation. CHE score decreased from (4.05±0.96) preoperatively to (2.40±0.70) at 6 months postoperatively (t=12.97, P<0.05). The number of improved vertigo at 6 months postoperatively was 38, with an improvement rate of 90.5%. NDI score was reduced from (34.43±8.04) preoperatively to (20.76±3.91) at 6 months postoperatively (t=11.83, P<0.05). The cervical curvature Cobb angle improved from (8.04±6.70)° preoperatively to (12.42±5.23)° at 6 months postoperatively (t=-15.96, P<0.05). CONCLUSION: The ACDF procedure has outstanding clinical efficacy in treating CSA. The operation can rapidly relieve patients' episodic vertigo symptoms by relieving bony compression and reconstructing cervical curvature. However, it is necessary to strictly grasp the indications for surgery and clarify the causes of vertigo in patients, and ACDF surgery is recommended for CSA patients for whom conservative treatment is ineffective.

Pre-operative spinal cord perfusion quantified by DSC MRI as a predictor of post-operative prognosis in patients with cervical spondylotic myelopathy.

OBJECTIVE: This study aims to investigate the potential of preoperative blood supply condition measured by dynamic susceptibility contract (DSC) MRI in prediction of postoperative outcomes for patients with cervical spondylotic myelopathy (CSM). MATERIALS AND METHOD: Thirty-nine patients (Age: 61 ± 7, male: 23, female: 16) with CSM who underwent laminoplasty were enrolled. All patients received DSC MRI before the operation. Five parameters include Enhance, rEnhance, full width at half maxima (FWHM), Slope1 and Slope2 in DSC MRI, were calculated at all the compressed spinal cord segments. Clinical outcomes were evaluated by modified Japanese Orthopaedic Association (mJOA) scores. Patients were divided into two groups based on mJOA recovery rate of 5 years: good recovery (> 50%) or poor recovery (≤ 50%). The difference between two groups were compared. The value of DSC MRI to CSM was evaluated by logistic and receiver operating characteristic (ROC) curve analysis. RESULTS: There were 26 patients in good recovery group and 13 patients in poor recovery group. The baseline characteristics, including age, gender, preoperative mJOA score, and smoking status showed no significant difference between the two groups (all p > 0.05). The FWHM was significantly higher in the poor recovery group (9.77 ± 2.78) compared to the good recovery group (6.64 ± 1.65) (p = 0.002). Logistic regression analysis indicated that an increased FWHM was a significant risk factor for poor prognosis recovery (p = 0.013, OR = 0.392, 95%CI: 0.187-0.822). The AUC of FWHM for ROC was 0.843 (95% CI: 0.710-0.975) with a p value of 0.001. In addition, an FWHM greater than 5.87, with a sensitivity of 92.3% and specificity of 69.2%, was found to be an independent risk factor for poor postoperative recovery in patients with CSM. CONCLUSION: In this study, we successfully quantified the spinal cord blood supply condition by DSC MRI technique. We found that an increase in FWHM was an independent risk factor for poor postoperative recovery in CSM patients. Specifically, patients with FWHM > 5.87 have a poor postoperative recovery.

Exploring the Relationship Between Subcutaneous Fat Index and Neck Pain in Patients with Spinal Cervical Spondylosis: A Retrospective Cohort Study.

STUDY DESIGN: Retrospective Cohort Study. OBJECTIVES: This study measures the subcutaneous fat index (SFI) of the cervical spine in patients with spinal cervical spondylosis using cervical magnetic resonance imaging and explores its relationship with neck pain in patients with spinal cervical spondylosis. METHODS: In this single-center retrospective study, 298 patients hospitalized for spinal cervical spondylosis between January and June 2021 were initially considered. After applying inclusion and exclusion criteria, 93 patients were enrolled. The cervical magnetic resonance imaging data for these patients were analyzed using A-Site software. The SFI was measured at the median sagittal plane on T2-weighted images. Patients were categorized into 2 groups based on their admission complaints: those with cervical pain and those without it. Differences between these groups were then statistically analyzed. RESULTS: The mean SFIs with standard deviations for the neck and non-neck pain groups were 36.4% ± 7.7% and 27.0% ± 7.9%, respectively, with a significant difference (P < 0.0001). The SFI was consistently higher across all neck segments in the neck pain group compared to the nonneck pain group (P < 0.05). The 2 groups had no statistically significant difference in the body mass index. CONCLUSIONS: The SFI provides a more precise assessment of muscle and fat distribution in the posterior cervical region than body mass index and is generally higher in patients with spinal cervical spondylosis who experience neck pain. These findings suggest the importance of early functional exercises postsurgery for potentially improving surgical outcomes in this patient population.

Mid-term clinical effect of resecting posterior longitudinal ligament in anterior approach for cervical spondylosis with sympathetic symptoms: retrospective cohort analysis.

STUDY DESIGN: Retrospective cohort analysis. OBJECTIVE: The purpose of this study is to investigate whether the removal of the posterior longitudinal ligament (PLL) affects the mid-term outcome of anterior cervical fusion for cervical spondylosis with sympathetic symptoms(CSSS). METHODS: From January 2012 to July 2013, 66 patients who were diagnosed with CSSS with ≥ 10-year follow-up at our institution were assessed. All patients were divided into two groups: Group A (36 cases) in which patients underwent anterior cervical fusion with PLL resection and Group B (30 cases) in which patients underwent anterior cervical fusion without PLL resection. The sympathetic symptom 20-point system was used to evaluate the sympathetic symptoms, such as tinnitus, headache and vertigo, etc. And the neurological status was assessed by the Japanese Orthopedic Association (JOA) scores. Clinical and radiologic data were evaluated preoperatively, 9 days, 3 months, 6 months, 12 months, 24 months, 60 months, and 120 months postoperatively. Data collected included all perioperative complications as morbidities that occurred during the period of follow-up. RESULTS: The postoperative JOA scores and 20-point score can be significantly improved compared with preoperative whether the PLL is removed in both groups. However, the postoperative 20-point score of patients in group A was significantly different from that in group B. No loosening and displacement of prosthesis occurred. CONCLUSION: A better clinical effect could be attained when resecting the PLL in the operation. The PLL may play an important role in CSSS. The mid-term outcomes of anterior cervical fusion with PLL resection were satisfied in treating CSSS.

Unilateral biportal endoscopic decompression versus anterior cervical decompression and fusion for unilateral cervical radiculopathy or coexisting cervical myelopathy: a prospective, randomized, controlled, noninferiority trial.

BACKGROUND: Cervical spondylosis (CS), including myelopathy and radiculopathy, is the most common degenerative cervical spine disease. This study aims to evaluate the clinical outcomes of unilateral biportal endoscopy (UBE) compared to those of conventional anterior cervical decompression and fusion (ACDF) for treating unilateral cervical radiculopathy or coexisting cervical myelopathy induced by unilateral cervical herniated discs. METHODS: A prospective, randomized, controlled, noninferiority trial was conducted. The sample consisted of 131 patients who underwent UBE or ACDF was conducted between September 2021 and September 2022. Patients with cervical nerve roots or coexisting spinal cord compression symptoms and imaging-defined unilateral cervical radiculopathy or coexisting cervical myelopathy induced by unilateral cervical herniated discs were randomized into two groups: a UBE group (n = 63) and an ACDF group (n = 68). The operative time, blood loss, length of hospital stay after surgery, and perioperative complications were recorded. Preoperative and postoperative modified Japanese Orthopaedic Association (mJOA) scale scores, visual analog scale (VAS) scores, neck disability index (NDI) scores, and recovery rate (RR) of the mJOA were utilized to evaluate clinical outcomes. RESULTS: The hospital stay after surgery was significantly shorter in patients treated with UBE than in those treated with ACDF (p < 0.05). There were no significant differences in the neck or arm VAS score, NDI score, mJOA score, or mean RR of the mJOA between the two groups (p < 0.05). Only mild complications were observed in both groups, with no significant difference (p = 0.30). CONCLUSION: UBE can significantly relieve pain and disability without severe complications, and most patients are satisfied with this technique. Consequently, this procedure can be used safely and effectively as an alternative to ACDF for treating unilateral cervical radiculopathy or coexisting cervical myelopathy induced by unilateral cervical herniated discs. TRIAL REGISTRATION: This study was registered in the Chinese Clinical Trial Registry on 02/08/2023 ( http://www.chictr.org.cn , #ChiCTR2300074273).

Risk factors for poor neurological recovery after anterior cervical discectomy and fusion: imaging characteristics.

BACKGROUND: Poor neurological recovery in patients after anterior cervical discectomy and fusion has been frequently reported; however, no study has analyzed the preoperative imaging characteristics of patients to investigate the factors affecting surgical prognosis. The purpose of this study was to investigate the factors that affect the preoperative imaging characteristics of patients and their influence on poor neurologic recovery after anterior cervical discectomy and fusion. METHODS: We retrospectively analyzed the clinical data of 89 patients who met the criteria for anterior cervical discectomy and fusion for the treatment of single-level cervical spondylotic myelopathy and evaluated the patients' neurological recovery based on the recovery rate of the Japanese Orthopaedic Association (JOA) scores at the time of the final follow-up visit. Patients were categorized into the "good" and "poor" groups based on the JOA recovery rates of ≥ 50% and < 50%, respectively. Clinical information (age, gender, body mass index, duration of symptoms, preoperative JOA score, and JOA score at the final follow-up) and imaging characteristics (cervical kyphosis, cervical instability, ossification of the posterior longitudinal ligament (OPLL), calcification of herniated intervertebral discs, increased signal intensity (ISI) of the spinal cord on T2-weighted imaging (T2WI), and degree of degeneration of the discs adjacent to the fused levels (cranial and caudal) were collected from the patients. Univariate and binary logistic regression analyses were performed to identify risk factors for poor neurologic recovery. RESULTS: The mean age of the patients was 52.56 ± 11.18 years, and the mean follow-up was 26.89 ± 11.14 months. Twenty patients (22.5%) had poor neurological recovery. Univariate analysis showed that significant predictors of poor neurological recovery were age (p = 0.019), concomitant OPLL (p = 0.019), concomitant calcification of herniated intervertebral discs (p = 0.019), ISI of the spinal cord on T2WI (p <0.05), a high grade of degeneration of the discs of the cranial neighboring levels (p <0.05), and a high grade of discs of the caudal neighboring levels (p <0.05). Binary logistic regression analysis showed that ISI of the spinal cord on T2WI (p = 0.001 OR = 24.947) and high degree of degeneration of adjacent discs on the cranial side (p = 0.040 OR = 6.260) were independent risk factors for poor neurological prognosis. CONCLUSION: ISI of the spinal cord on T2WI and high degree of cranial adjacent disc degeneration are independent risk factors for poor neurological recovery after anterior cervical discectomy and fusion. A comprehensive analysis of the patients' preoperative imaging characteristics can help in the development of surgical protocols and the management of patients' surgical expectations.

Riluzole for Degenerative Cervical Myelopathy: A Secondary Analysis of the CSM-PROTECT Trial.

Importance: The modified Japanese Orthopaedic Association (mJOA) scale is the most common scale used to represent outcomes of degenerative cervical myelopathy (DCM); however, it lacks consideration for neck pain scores and neglects the multidimensional aspect of recovery after surgery. Objective: To use a global statistical approach that incorporates assessments of multiple outcomes to reassess the efficacy of riluzole in patients undergoing spinal surgery for DCM. Design, Setting, and Participants: This was a secondary analysis of prespecified secondary end points within the Efficacy of Riluzole in Surgical Treatment for Cervical Spondylotic Myelopathy (CSM-PROTECT) trial, a multicenter, double-blind, phase 3 randomized clinical trial conducted from January 2012 to May 2017. Adult surgical patients with DCM with moderate to severe myelopathy (mJOA scale score of 8-14) were randomized to receive either riluzole or placebo. The present study was conducted from July to December 2023. Intervention: Riluzole (50 mg twice daily) or placebo for a total of 6 weeks, including 2 weeks prior to surgery and 4 weeks following surgery. Main Outcomes and Measures: The primary outcome measure was a difference in clinical improvement from baseline to 1-year follow-up, assessed using a global statistical test (GST). The 36-Item Short Form Health Survey Physical Component Score (SF-36 PCS), arm and neck pain numeric rating scale (NRS) scores, American Spinal Injury Association (ASIA) motor score, and Nurick grade were combined into a single summary statistic known as the global treatment effect (GTE). Results: Overall, 290 patients (riluzole group, 141; placebo group, 149; mean [SD] age, 59 [10.1] years; 161 [56%] male) were included. Riluzole showed a significantly higher probability of global improvement compared with placebo at 1-year follow-up (GTE, 0.08; 95% CI, 0.00-0.16; P = .02). A similar favorable global response was seen at 35 days and 6 months (GTE for both, 0.07; 95% CI, -0.01 to 0.15; P = .04), although the results were not statistically significant. Riluzole-treated patients had at least a 54% likelihood of achieving better outcomes at 1 year compared with the placebo group. The ASIA motor score and neck and arm pain NRS combination at 1 year provided the best-fit parsimonious model for detecting a benefit of riluzole (GTE, 0.11; 95% CI, 0.02-0.16; P = .007). Conclusions and Relevance: In this secondary analysis of the CSM-PROTECT trial using a global outcome technique, riluzole was associated with improved clinical outcomes in patients with DCM. The GST offered probability-based results capable of representing diverse outcome scales and should be considered in future studies assessing spine surgery outcomes.

Clinical observation of ultrasound-guided acupotomy assisting percutaneous cervical disc nucleoplasty in the treatment of cervical spondylotic radiculopathy. / è¶ å£°å¼•å¯¼ä¸‹é’ˆåˆ€ç–—æ³•è¾ åŠ©å°„é¢‘æ¶ˆèžæœ¯æ²»ç–—ç¥žç»æ ¹åž‹é¢ˆæ¤Žç— çš„ä¸´åºŠè§‚å¯Ÿ.

OBJECTIVES: To observe the clinical efficacy and safety of ultrasound-guided acupotomy in adjuvant treatment of residual symptoms after percutaneous cervical disc nucleoplasty (PCDN) for cervical spondylotic radiculopathy (CSR). METHODS: A total of 70 CSR patients were divided into treatment group and control group according to random number table, with 35 cases in each group. Patients in the control group received PCDN, while patients in the treatment group further received ultrasound-guided acupotomy, which was performed once every 5 to 7 days for a total of 4 to 6 times (adjusted according to the condition of patients). The visual analog score (VAS), neck dysfunction index (NDI), Japanese Orthopaedic Association cervical spondylosis scale (JOA score), and Tanaka Yasuhisa 20-point scale were adopted in the assessment before PCDN and 1 day, 1 month, 3 months, 6 months after PCDN. The clinical efficacy, postoperative adverse reactions and complications of the 2 groups were evaluated. RESULTS: Compared with those before PCDN, the VAS score and NDI score of the 2 groups were decreased (P<0.05), JOA score and Tanaka Yasuhisa 20-point score were increased (P<0.05) at 1 day and 1, 3 and 6 months after surgery. Compared with same group 1 day after surgery, the VAS score and NDI score of the treatment group were decreased (P<0.05), while JOA score and Tanaka Yasuhisa 20-point score were increased (P<0.05) at 1, 3 and 6 months after surgery. Compared with the control group at the same time points, the VAS score and NDI score of the treatment group were decreased (P<0.05), while JOA score and Tanaka Yasuhisa 20-point score were increased (P<0.05) at 1, 3 and 6 months after operation. The effective rate and excellent rate of the treatment group 1, 3 and 6 months after PCDN were higher than those of the control group (P<0.05). Follow-up to 1 year after surgery, no significant postoperative adverse reactions and complications were found in both groups. CONCLUSIONS: Ultrasound-guided acupotomy can significantly improve the residual symptoms after PCDN for CSR patients, and the clinical efficacy is significantly better than that of PCDN alone, and this therapy is safe and reliable.

Prediction of additional hospital days in patients undergoing cervical spine surgery with machine learning methods.

BACKGROUND: Machine learning (ML), a subset of artificial intelligence (AI), uses algorithms to analyze data and predict outcomes without extensive human intervention. In healthcare, ML is gaining attention for enhancing patient outcomes. This study focuses on predicting additional hospital days (AHD) for patients with cervical spondylosis (CS), a condition affecting the cervical spine. The research aims to develop an ML-based nomogram model analyzing clinical and demographic factors to estimate hospital length of stay (LOS). Accurate AHD predictions enable efficient resource allocation, improved patient care, and potential cost reduction in healthcare. METHODS: The study selected CS patients undergoing cervical spine surgery and investigated their medical data. A total of 945 patients were recruited, with 570 males and 375 females. The mean number of LOS calculated for the total sample was 8.64 ± 3.7 days. A LOS equal to or <8.64 days was categorized as the AHD-negative group (n = 539), and a LOS > 8.64 days comprised the AHD-positive group (n = 406). The collected data was randomly divided into training and validation cohorts using a 7:3 ratio. The parameters included their general conditions, chronic diseases, preoperative clinical scores, and preoperative radiographic data including ossification of the anterior longitudinal ligament (OALL), ossification of the posterior longitudinal ligament (OPLL), cervical instability and magnetic resonance imaging T2-weighted imaging high signal (MRI T2WIHS), operative indicators and complications. ML-based models like Lasso regression, random forest (RF), and support vector machine (SVM) recursive feature elimination (SVM-RFE) were developed for predicting AHD-related risk factors. The intersections of the variables screened by the aforementioned algorithms were utilized to construct a nomogram model for predicting AHD in patients. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve and C-index were used to evaluate the performance of the nomogram. Calibration curve and decision curve analysis (DCA) were performed to test the calibration performance and clinical utility. RESULTS: For these participants, 25 statistically significant parameters were identified as risk factors for AHD. Among these, nine factors were obtained as the intersection factors of these three ML algorithms and were used to develop a nomogram model. These factors were gender, age, body mass index (BMI), American Spinal Injury Association (ASIA) scores, magnetic resonance imaging T2-weighted imaging high signal (MRI T2WIHS), operated segment, intraoperative bleeding volume, the volume of drainage, and diabetes. After model validation, the AUC was 0.753 in the training cohort and 0.777 in the validation cohort. The calibration curve exhibited a satisfactory agreement between the nomogram predictions and actual probabilities. The C-index was 0.788 (95% confidence interval: 0.73214-0.84386). On the decision curve analysis (DCA), the threshold probability of the nomogram ranged from 1 to 99% (training cohort) and 1 to 75% (validation cohort). CONCLUSION: We successfully developed an ML model for predicting AHD in patients undergoing cervical spine surgery, showcasing its potential to support clinicians in AHD identification and enhance perioperative treatment strategies.

Zero-profile implant system versus novel plate systems after ACDF for comparison of sagittal balance parameters and clinical efficacy analysis.

BACKGROUND: The zero-profile implant system (Zero-P) and conventional plates have been widely used in anterior cervical discectomy and fusion (ACDF) to treat cervical spondylosis. The purpose of this study was to compare the effects of the application of Zero-P and new conventional plates (ZEVO, Skyline) in ACDF on the sagittal imaging parameters of cervical spondylosis patients and to analyze their clinical efficacy. METHODS: We conducted a retrospective study on 119 cervical spondylosis patients from January 2018 to December 2021, comparing outcomes between those receiving the Zero-P device (n = 63) and those receiving a novel conventional plate (n = 56, including 46 ZEVO and 10 Skyline plates) through ACDF. Cervical sagittal alignment was assessed pre- and postoperatively via lateral radiographs. The Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and visual analog scale (VAS) scores were recorded at baseline, after surgery, and at the 2-year follow-up to evaluate patient recovery and intervention success. RESULTS: There were significant differences in the postoperative C0-C2 Cobb angle and postoperative sagittal segmental angle (SSA) between patients in the novel conventional plate group and those in the Zero-P group (P < 0.05). Postoperatively, there were significant changes in the C2‒C7 Cobb angle, C0‒C2 Cobb angle, SSA, and average surgical disc height (ASDH) compared to the preoperative values in both patient groups (P < 0.05). Dysphagia in the immediate postoperative period was lower in the Zero-P group than in the new conventional plate group (0% in the Zero-P group, 7.14% in the novel conventional plate group, P = 0.046), and the symptoms disappeared within 2 years in both groups. There was no statistically significant difference between the two groups in terms of complications of adjacent spondylolisthesis (ASD) at 2 years postoperatively (3.17% in the Zero-P group, 8.93% in the novel conventional plate group; P = 0.252). According to the subgroup analysis, there were significant differences in the postoperative C2‒C7 Cobb angle, C0‒C2 Cobb angle, T1 slope, and ASDH between the ZEVO group and the Skyline group (P < 0.05). Compared with the preoperative scores, the JOA, NDI, and VAS scores of all groups significantly improved at the 2-year follow-up (P < 0.01). According to the subgroup analysis, the immediate postoperative NDI and VAS scores of the ZEVO group were significantly better than those of the Skyline group (P < 0.05). CONCLUSION: In ACDF, both novel conventional plates and Zero-P can improve sagittal parameters and related scale scores. Compared to the Zero-P plate, the novel conventional plate has a greater advantage in correcting the curvature of the surgical segment, but the Zero-P plate is less likely to produce postoperative dysphagia.

Comparative efficacy of zero-profile implant and conventional cage-plate implant in the treatment of single-level degenerative cervical spondylosis: a systematic review and meta-analysis.

BACKGROUND: In recent years, the zero-profile implant (Zero-p) has emerged as a promising internal fixation technique. Although studies have indicated its potential superiority over conventional cage-plate implant (Cage-plate) in the treatment of degenerative cervical spondylosis, there remains a lack of definitive comparative reports regarding its indications, safety, and efficacy. METHODS: A computerized search was conducted on English and Chinese databases, including PubMed, Web of Science, Cochrane Library, EMBASE, CNKI, Wanfang and VIP. Additionally, a manual search was meticulously carried out on Chinese medical journals, spanning from the inception of the respective databases until August 2023. The meta-analysis utilized a case-control study approach and was executed through the utilization of RevMan 5.3 software. Stringent quality evaluation and data extraction procedures were implemented to guarantee the reliability and validity of the findings. RESULTS: Nine high-quality studies with 808 patients were included. Meta-analysis showed that the operation time (MD = - 13.28; 95% CI (- 17.53, - 9.04), P < 0.00001), intraoperative blood loss (MD = - 6.61; 95% CI (- 10.47, - 2.75), P = 0.0008), incidence of postoperative dysphagia at various time points: within the first month after surgery (OR = 0.36; 95% CI (0.22, 0.58), P < 0.0001), 1-3 months after surgery (OR = 0.20; 95% CI (0.08, 0.49), P = 0.0004), the final follow-up (OR = 0.21; 95% CI (0.05, 0.83), P = 0.003) and the rate of postoperative adjacent disc degeneration (OR = 0.46; 95% CI (0.25, 0.84), P = 0.01) were significantly lower in the Zero-p group than in the Cage-plate group. Additionally, was also significantly lower in the Zero-p group. However, there were no significant differences in the JOA score, the final follow-up NDI score, surgical segmental fusion rate, postoperative height of adjacent vertebrae, or postoperative subsidence rate between the two groups. CONCLUSION: In summary, when treating single-segment degenerative cervical spondylosis, both internal fixation techniques are reliable and effective. However, Zero-P  implant offer several advantages over cage-plate implant, including shorter operation duration, less intraoperative blood loss, reduced postoperative dysphagia, and slower adjacent disc degeneration. Additionally, Zero-P implant has a broader application space, making them a preferred choice in certain cases.

The efficacy and safety of mini-open (air/water medium) endoscopy-assisted anterior cervical discectomy and fusion for the treatment of cervical spondylotic myelopathy.

PURPOSE: To compare the clinical efficacy of mini-open (air/water medium) endoscopy-assisted anterior cervical discectomy and fusion (MOEA-ACDF) and anterior cervical decompression and fusion (ACDF) for cervical spondylotic myelopathy (CSM). METHODS: This study retrospectively analysed the clinical data of CSM patients who received surgical treatment from January 1, 2020, to December 31, 2022. Patients were divided into two groups according to the surgical method: the MOEA-ACDF group and the ACDF group. The preoperative and postoperative imaging results at one week and the last follow-up examination were compared between the two groups. The Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score and neck disability index (NDI) score were used to evaluate the clinical outcomes preoperatively, one week postoperatively and at the last follow-up examination. The minimum follow-up duration was 12 months. RESULTS: A total of 131 CSM patients who underwent surgery at our institution were included, including 61 patients in the MOEA-ACDF group and 70 patients in the ACDF group. In the MOEA-ACDF group, the postoperative C2-C7 Cobb angle and HAVB were significantly greater than the preoperative values (P < 0.05). In the ACDF group, the postoperative C2-C7 Cobb angle was also significantly greater than the preoperative value, and the C2-C7 ROM and HAVB significantly decreased (P < 0.05). The postoperative neurological function of the patients in both groups improved, and the postoperative VAS score and NDI score significantly decreased. Compared with ACDF, MOEA-ACDF is associated with a significantly larger postoperative C2-C7 Cobb angle and significantly better C2-C7 ROM and HAVB, as well as better clinical efficacy (P < 0.05). CONCLUSIONS: MOEA-ACDF combines endoscopic systems with ACDF technology to treat CSM, but its clinical efficacy is not inferior to that of ACDF in the short- to intermediate-term. It can effectively and safely restore the cervical intervertebral height, physiological curvature, and range of motion.