Cervical spine alignment and clinical outcomes after multilevel anterior cervical decompression and fusion with or without plate: A minimal 5-year follow-up of a CONSORT-compliant article.

ABSTRACT: It was reported imperative on cervical sagittal alignment reconstruction after anterior multilevel procedures with self-locked stand-alone cage (SSC) or anterior cage-with-plate (ACP) system multilevel while there was little knowledge about the relationship on cervical alignment and clinical outcomes.To identify the importance of cervical sagittal alignment after 3-level anterior cervical discectomy and fusion on cervical spondylotic myelopathy with SSC and ACP system.Seventy-seven patients with SSC system (SSC group) and 52 cases with ACP system (ACP group) from February 2007 to September 2013 were enrolled with well-matched demographics. Cervical alignment included C2-7 lordosis (CL), operated-segment cervical lordosis (OPCL), upper and lower adjacent-segment cervical lordosis, range of motion of upper and lower adjacent segment at preoperation, immediate postoperation, and the final follow-up. Clinical outcomes contained the neck disability index (NDI), the Japanese Orthopaedic Association (JOA) score, visual analogous scale (VAS) of arm and neck and adjacent segment degeneration (ASD). Patients were then divided into CL improved subgroup (IM subgroup) and non-improved subgroup (NIM subgroup).There were improvements on CL and OPCL in both groups. The change of CL and OPCL larger in ACP group (P < .05) but upper adjacent-segment cervical lordosis/lower adjacent-segment cervical lordosis and range of motion of upper adjacent segment/range of motion of lower adjacent segment were of no significance. NDI, JOA, and VAS got improvement in both groups at immediate postoperation and the final follow-up while ASD was in no difference between SSC and ACP group. A total of 80 patients (39 vs 41) acquired CL improvement with a larger population in ACP group. There were no differences on the rate of ASD, NDI, JOA, VAS, and their change between IM and NIM subgroup. The changes of CL were not correlated to NDI, JOA, VAS, and their change.SSC and ACP group both provide improved OPCL and efficacy on 3-level cervical spondylotic myelopathy with little impact on adjacent segment. The change of CL is not correlated to clinical outcomes.

Cervical Spine Balance of Multilevel Total Disc Replacement, Hybrid Surgery, and Anterior Cervical Discectomy and Fusion With A Long-term Follow-up.

STUDY DESIGN: Comparative study. OBJECTIVE: The aim of this study was to compare cervical alignment among three-level total disc replacement (TDR), two prosthesis with one cage (2D1C), one prosthesis with two cages (1D2C), and anterior cervical discectomy and fusion (ACDF), then identify the importance of cervical balance of cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA: There were few long-term comparisons on cervical alignment and cervical balance among three-level TDR, 2D1C, 1D2C, and ACDF for CSM. METHODS: Twenty-eight patients with TDR, 15 with 2D1C, 36 with 1D2C, and 32 cases with ACDF were included with a mean follow-up of 90.9 ±â€Š8.9 months. C2-C7 cervical lordosis (CL), C2-C7 sagittal vertical axis (SVA), T1 slope (T1S) were measured on x-ray at preoperation, immediate postoperation, and final follow-up, as well as range of motion (ROM), upper/lower adjacent ROM (UROM/LROM), and adjacent segment degeneration (ASD); cervical balance was assessed by T1S minus CL (T1SCL; 20°). Clinical outcomes included neck disability index (NDI) and Japanese Orthopedic Association (JOA) score. RESULTS: NDI and JOA improved (P < 0.01)at postoperation and final-visit with no difference among four groups. ROM decreased mostly in ACDF group, although with a comparable inter-group UROM/LROM and ASD. All groups gained equal CL-improvement at final-visit. SVA and T1S together with their change were of no differences among groups (P > 0.05). There was a correlation among alignment parameters and between CL and ROM. The inter-group capacity of balance maintaining and imbalance correction was comparable (P > 0.05). The change of T1SCL was not correlated to NDI and JOA (P > 0.05). CONCLUSION: Adjacent segments were seldom affected. Cervical alignment was equivalently rebuilt among TDR, 2D1C, 1D2C, and ACDF. It was not essential to pay excessive attention to balance. LEVEL OF EVIDENCE: 3.

Exploration on sagittal alignment and clinical outcomes after consecutive three-level hybrid surgery and anterior cervical discectomy and fusion: a minimum of a 5-year follow-up.

PURPOSE: To compare sagittal alignment and clinical outcomes between three-level hybrid surgery (HS) and anterior cervical discectomy and fusion (ACDF) on cervical spondylotic myelopathy (CSM) over a 5-year follow-up. METHOD: The study included 32 patients with ACDF, 36 patients with 1 prosthesis and 2 cages (HS1 group), and 25 cases with 2 prostheses and 1 cage (HS2 group). Alignment parameters included C2-C7 cervical lordosis (CL), C2-C7 sagittal vertical axis (SVA), T1 slope (T1S), and T1S minus CL (T1SCL). Radiographic parameters were range of motion (ROM), upper and lower adjacent ROM (UROM and LROM), and operated-segment lordosis (OPCL), as well as adjacent segment degeneration (ASD). Clinical outcomes included the neck disability index (NDI) and Japanese Orthopedic Association (JOA) score. RESULTS: Three groups were well-matched in demographics. All groups gained comparable improvement on NDI and JOA (P < 0.01). All groups gained CL improvement at the final visit (P < 0.05). There were no statistical differences on SVA and T1SCL among the groups and among preoperation, 1 week later, and final follow-up (P > 0.05) while T1S improved at 1 week later and final follow-up with HS2. The final change of all alignment parameters among the three groups was of no differences. ROM decreased and OPCL increased in all groups at the final follow-up (P < 0.05). UROM and LROM increased with ACDF but kept stable with HS1 and HS2. There was no inter-group difference on the incidence of ASD (P > 0.05). CONCLUSION: Cervical alignment was comparably improved. HS and ACDF provided identified mid-term efficacy, and it was not necessary to have to use prosthesis on three-level CSM.

Blood Loss of Posterior Lumbar Interbody Fusion on Lumbar Stenosis in Patients With Rheumatoid Arthritis: A Case-Control Study.

STUDY DESIGN: Case-control study. OBJECTIVE: To compare intraoperative bleeding, drainage, and hidden blood loss (HBL) of posterior lumbar interbody fusion (PLIF) on lumbar spinal stenosis (LSS) in patients with rheumatoid arthritis (RA) and non-RA and identify the risk factors of HBL with RA. SUMMARY OF BACKGROUND DATA: Exploration on PLIF on LSS and HBL has been reported before while the comparison on total blood loss (TBL), especially HBL of PLIF or PLF on LSS between patients with RA and without RA has not been studied. METHODS: Sixty-one patients diagnosed LSS with RA (RA group) and 87 matched patients without RA (NRA group) were enrolled and demographic characteristics, RA-related parameters, operation and blood loss information were extracted. Intraoperative blood loss, drainage, and HBL were primary outcomes and secondary measures included operation time, hematocrit (Hct) and hemoglobin (Hb), the number of anemia and blood transfusion. RESULTS: There was no statistical difference in total blood loss (TBL), intraoperative blood loss, and postoperative drainage while HBL and the proportion of HBL in TBL were lower in NRA group (P < 0.001 and P = 0.012, respectively). Stratified analysis based on the number of surgical levels suggested HBL and the proportion of HBL in NRA group was superior in long-segment surgery (>2 segments). The secondary outcomes showed the change of Hct was lower in NRA group (P = 0.021) but not the reduction of Hb. In addition, there was no significant difference in neoformative and grade-aggravated anemia, as well as the number of allogeneic blood transfusion and operation time showed Steinbroker classification, disease-modifying anti-rheumatic drugs (DMARDs), hange of Hb and allogeneic blood transfusion were risk factors for HBL with RA. CONCLUSION: There was no difference in TBL, intraoperative bleeding, and operation time, but HBL were higher in RA patients particularly in long-segmental operation. Steinbroker classification, DMARDs, the change of Hb, and allogeneic blood transfusion were independent risk factors for HBL in RA patients. LEVEL OF EVIDENCE: 3.