The clinical effect of different vertebral body height restoration rates after percutaneous kyphoplasty for osteoporotic vertebral compression fractures.

OBJECTIVE: This study aimed to evaluate the clinical effect of different vertebral body heights restoration rate after percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures (OVCF). METHODS: The patients were divided into two groups according to the height restoration rate of the anterior edge of the vertebral body fracture after PKP operation using X-Ray imaging. The group A was below 80%, and the group B was above 80%. Clinical preoperative and postoperative efficacy (1st day, 1st month, 6th month, and 12th month after surgery) were evaluated according to VAS, Oswestry Disability Index(ODI), Quality of Life Questionnaire of the European Foundation for Osteoporosis(QUALEFFO), and Back Pain Life Disorder Questionnaire(RQD). Simultaneously, the preoperative and postoperative local Cobb angles and changes in the injured vertebrae in the two groups were calculated and analyzed. RESULTS: The postoperative Cobb angle in group A was significantly higher than that in group B. The correction rate in group B was significantly better than that in group A. The VAS, ODI, QUALEFFO, and RQD scores of group B patients were significantly lower than those of patients in group A at each follow-up time point. The correlation coefficients of vertebral body height restoration rate and VAS, ODI, QUALEFFO, and RQD scores at the last follow-up were - 0.607 (P < 0.01), -0.625 (P < 0.01), -0.696 (P < 0.01), and - 0.662 (P < 0.01), respectively. CONCLUSIONS: The results of the correlation analysis between the vertebral body height restoration rate and the above clinical efficacy scores show that increasing the vertebral body anterior height restoration rate is beneficial for pain relief and improves the clinical efficacy of patients. Simultaneously, improving the height restoration rate of the anterior edge of the vertebral body and restoring the normal spinal structure is beneficial for reducing the incidence of refracture of the adjacent vertebral body.

Axial Symptoms After Conventional and Modified Laminoplasty: A Meta-analysis.

PURPOSE: The study aims to evaluate the impact of procedural variations in single-door laminoplasty on axial symptoms (AS) and neurologic outcomes. METHODS: A comprehensive literature search was conducted across PubMed, EMBASE, and the Cochrane Library, adhering to specific inclusion criteria. We extracted data on the prevalence of AS in both the modified and conventional laminoplasty groups from the selected studies. Neurologic outcomes were assessed using the Japanese Orthopedic Association (JOA) recovery rate, which was subsequently converted to Hedge's g for analysis. Forest plots were generated to visualize the effect sizes, and publication bias was assessed using both funnel plots and Egger's test. RESULTS: Fourteen studies comprising 1201 patients were included in this meta-analysis focused on AS. The aggregated SMD was -0.891 with a 95% CI of -1.146 to -0.631 (P < 0.01), denoting a statistically significant reduction in AS in the modified laminoplasty group compared with the conventional approach. Of the 14 studies, 10, encompassing 898 patients, contributed data for JOA recovery rate analysis. The overall effect size was 0.089, with a 95% CI ranging from -0.090 to 0.267, and a P value of 0.2901, indicating no significant difference in neurologic outcomes between the 2 techniques. No evidence of publication bias was detected. CONCLUSIONS: This meta-analysis demonstrates that modified laminoplasty is associated with a significant reduction in the incidence and severity of axial symptoms, without compromising neurologic functionality.

Are surgical outcomes for one level anterior decompression and fusion associated with MRI parameters for degenerative cervical myelopathy?

Background: Our study is to determine the correlation between preoperative MRI parameters of spinal cord compression and the effects of anterior surgery in patients with degenerative cervical myelopathy (DCM). Methods: 24 normal subjects with no evident abnormalities were selected as group A. 79 patients with DCM underwent single-segment (C4-5/C5-6) ACDF surgery formed the operation group, and separated into group B (without high signal) and group C (with high signal) according to the absence or presence of high signal in the spinal cord on preoperative T2-weighted MRI respectively. MRI parameters (MCC, maximum canal compromise; MSCC, maximum spinal cord compression; CR, spinal cord compression rate; RCSCDS, ratio of cervical spinal cord to dura sac) were measured. The JOA score was used to evaluate cervical spinal cord function and recovery rate (RR) was used to evaluate postoperative efficacy. The relationship between preoperative MRI parameters and postoperative efficacy was analyzed. Results: The preoperative JOA score and RR of group B were higher than that of group C. MCC and MSCC in group B were significantly lower than those in groups C. The multiple linear regression equation was the fitted postoperative JOA score = 13.371-2.940 * MCC -5.660 * RCSCDS +0.471 * preoperative JOA score. The fitted RR = 1.451-0.472 * MCC -1.313 * RCSCDS. Conclusion: The occurrence of high signal on T2-weighted images could reflect more serious spinal cord injury. The postoperative JOA score was significantly correlated with MCC, RCSCDS, and preoperative JOA score, while RR was significantly associated with MCC and RCSCDS.

Finite Element Analysis of Spinal Cord Stress in a Single Segment Cervical Spondylotic Myelopathy.

Background: Spinal cord ischemia is largely caused by cervical spondylotic myelopathy (CSM), which has a corresponding biomechanical basis. Finite element analysis of spinal cord stress in diseased segments of CSM was performed to provide a biomechanical basis for the pathogenesis of CSM. Methods: A single segment (C4-5) in a patient with CSM was selected for mechanical simulation of three-dimensional (3D) computed tomography scanning, and a 3D finite element model of the cervical vertebra was constructed. Based on the patient's age, sex, height, weight, and other parameters, a finite element analysis model of an individual with healthy cervical vertebrae in our hospital was selected as the control to compare the stress changes between the patient and control groups in the analysis of the cervical vertebrae under anterior flexion, posterior extension, lateral flexion, and rotating load in the diseased spinal cord segment. Results: In the CSM patient, the diseased segment was C4-5. Under loading conditions of forward flexion, posterior extension, left flexion, right flexion, left rotation, and right rotation, the maximum stress on the spinal cord in the control group was 0.0044, 0.0031, 0.00017, 0.00014, 0.0011, and 0.001 MPa, respectively, whereas those in the spinal cord in the CSM group were 0.039, 0.024, 0.02, 0.02, 0.0194, and 0.0196 MPa, respectively. Conclusion: The maximum stress on the diseased segments of the spinal cord in the CSM group was higher than that in the control group, which contributed to verifying the imaging parameters associated with spinal cord compression stress.