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2.
BMC Musculoskelet Disord ; 22(1): 777, 2021 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-34511102

RESUMO

BACKGROUND: Biomechanical studies have demonstrated that uncovertebral joint contributes to segment mobility and stability to a certain extent. Simultaneously, osteophytes arising from the uncinate process are a common cause of cervical spondylotic radiculopathy (CSR). For such patients, partial uncinatectomy (UT) may be required. However, the clinical efficacy and sagittal alignment of partial UT during anterior cervical discectomy and fusion (ACDF) have not been fully elucidated. METHODS: A total of 87 patients who had undergone single level ACDF using a zero-profile device from July 2014 to December 2018 were included. Based on whether the foraminal part of the uncovertebral joint was resected or preserved, the patients were divided into the ACDF with UT group (n = 37) and the ACDF without UT group (n = 50). Perioperative data, radiographic parameters, clinical outcomes, and complications were compared between the two groups. RESULTS: The mean follow-up was 16.86 ± 5.63 and 18.36 ± 7.51 months in the ACDF with UT group and ACDF without UT group, respectively (p > 0.05). The average preoperative VAS arm score was 5.89 ± 1.00 in the ACDF with UT group and 5.18 ± 1.21 in the ACDF without UT group (p = 0.038). However, the average VAS arm score was 4.22 ± 0.64, 4.06 ± 1.13 and 1.68 ± 0.71, 1.60 ± 0.70 at 1 week post operation and at final follow up, respectively, (p > 0.05). We also found that the C2-7 SVA and St-SVA at the last follow-up and their change (last follow-up value - preoperative value) in the ACDF with UT group were significantly higher than ACDF without UT group (p < 0.05). No marked differences in the other cervical sagittal parameters, fusion rate or complications, including dysphagia, ASD, and subsidence, were observed. CONCLUSIONS: Our result indicates that ACDF using a zero-p implant with or without partial UT both provide satisfactory clinical efficacy and acceptable safety. However, additional partial UT may has a negative effect on cervical sagittal alignment.


Assuntos
Radiculopatia , Fusão Vertebral , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Seguimentos , Humanos , Radiculopatia/diagnóstico por imagem , Radiculopatia/cirurgia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
3.
Ann Transl Med ; 9(13): 1060, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34422972

RESUMO

Background: The surgical outcomes of individual patient with ossification of the posterior longitudinal ligament (OPLL) can vary depending on various patient-related factors. Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) is a well-developed tool for outcome measurement and considers both disease-specific and general health aspects. This study aimed to investigate the reliability, validity, and responsiveness of the JOACMEQ in patients with OPLL in mainland China and to compare post-operative outcomes of OPLL patients between mainland China and Japan. Methods: This multicenter trial was performed between July 2009 and June 2019. The procedure for the JOACMEQ translation followed Beaton's guidelines. All patients enrolled were diagnosed with OPLL and had completed the JOACMEQ, the modified Japanese Orthopaedic Association (mJOA) scale, and the 36-Item Short Form Health Survey (SF-36) before and after surgery. The reliability (Cronbach's α and Pearson's correlation), construct validity (factor analysis), concurrent validity (Spearman's correlation with SF-36) and responsiveness (effect sizes) of JOACMEQ were evaluated. A mixed-model analytic approach was used to analyze differences in postoperative outcomes between the 2 countries. Results: Ninety-one patients from mainland China and ninety-one patients from Japan were recruited. JOACMEQ showed satisfactory internal consistency (Cronbach's α=0.75). In test-retest reliability evaluation, except for the bladder function domain, the JOACMEQ domains had good test-retest reliability (0.89-0.96). In factor analysis, most of the items (19/24) were well clustered. Regarding clinical validity, all 5 domains were found to have moderate correlations with the physical component summary (PCS) of SF-36 (r=0.25-0.50), and the bladder function and quality of life domains also had moderate correlations (r=0.25-0.50) with the mental component summary (MCS) of SF-36. JOACMEQ showed a variable responsiveness in different domains (effect size =0.17-0.84; standardized response means =0.15-0.85). Regarding postoperative improvements in the JOACMEQ score, mixed-model analysis revealed a significant difference in the quality of life domain between Chinese and Japanese patients (16.0±18.7 vs. 7.8±17.7, P<0.05). Conclusions: JOACMEQ generally shows good reliability, good validity and mild responsiveness, and can identify the post-operative improvements in patients with OPLL in mainland China. Chinese OPLL patients showed a significantly larger improvement in postoperative quality of life compared to their Japanese counterparts.

4.
World Neurosurg ; 154: e822-e829, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34391953

RESUMO

OBJECTIVE: To compare clinical and imaging outcomes after cervical disc replacement (CDR) in patients with different Hounsfield units (HU). METHODS: We performed a retrospective study of patients with cervical degenerative disc disease treated by 1-level and 2-level Prestige-LP arthroplasty. The patients were divided into group A (HU <320), group B (HU 320-347), and group C (HU >347) according to the results of cervical vertebral HU measurement in the literature, and the clinical and radiographic results were compared among the 3 groups. RESULTS: A total of 127 patients were reviewed, comprising 13 patients in group A, 31 patients in group B, and 83 patients in group C. The clinical parameters were significantly improved postoperatively in the 3 groups (P < 0.05). However, no significant differences were found among the 3 groups at the final follow-up (P > 0.05). The mean postoperative intervertebral space height (ISH) was 4.76 ± 0.45 mm, 5.23 ± 0.81 mm, and 6.26 ± 1.12 mm in the 3 groups, respectively. The postoperative ISH in group C was significantly higher than those in the other groups at the final follow-up (P < 0.001). One patient in group A and 1 patient in group B had implant subsidence, and degeneration at the inferiorly adjacent level was radiographically identified in 30.77% patients in group A, 16.13% patients in group B, and 9.64% patients in group C. However, there were only significant differences between group A and group C in subsidence (P = 0.011) and occurrence of adjacent level degeneration (P = 0.032). CONCLUSIONS: The HU value has a large variation range among the patients with T-score ≥ -2.5. We found significantly increased rates of implant subsidence, loss of ISH, and adjacent segment degeneration in patients with lower HU value undergoing CDR. However, these radiographic complications did not predispose patients with lower HU value to worse clinical outcomes. Routine application of HU combined with dual-energy X-ray absorptiometry measurement to evaluate bone quality may help to screen the optimal candidates for CDR and reduce the implant-related complications.

5.
BMC Musculoskelet Disord ; 22(1): 628, 2021 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-34273965

RESUMO

OBJECTIVE: To preliminarily evaluate the safety and efficacy of the uncovertebral joint fusion cage in a goat model of cervical spine interbody fusion. METHODS: Twenty-four healthy adult goats were randomly assigned to one of the two following groups: Group A, goats were implanted with an uncovertebral joint fusion cage combined with a local autograft and Group B, goats were implanted with a non-profile cage filled with a local autograft. The goats were prospectively evaluated for 24 weeks and then were sacrificed for evaluation. X-rays, CT and micro-CT scanning, and undecalcified bone histological analysis were used for the evaluation of fusion. RESULTS: 75.0% (9/12) of the goats in Group A were evaluated as having fusion at 12 weeks, compared to 41.7% (5/12) in Group B. 83.3% (10/12) of the goats in Group A were evaluated as having fusion at 24 weeks compared to 58.3% (7/12) in Group B. The fusion grading scores in Group A were significantly higher than that in Group B both at 12 weeks and 24 weeks (P < 0.05). Micro-CT scanning and undecalcified bone histological analysis showed that new bone formation can be obviously found in the bilateral uncovertebral joint. The bone volume fraction (BV/ TV) in Group A (23.59 ± 4.43%) was significantly higher than Group B (16.16 ± 4.21%), with P < 0.05. CONCLUSIONS: Preliminary results of this study demonstrated that uncovertebral joint fusion cage is effective for achieving early bone formation and fusion without increase of serious complications.


Assuntos
Fusão Vertebral , Articulação Zigapofisária , Animais , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Discotomia , Cabras
7.
BMC Musculoskelet Disord ; 22(1): 543, 2021 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-34126981

RESUMO

BACKGROUND: The effects of postoperative intervertebral height (IH) changes on the clinical and radiological outcomes after anterior cervical decompression and fusion (ACDF) surgery using a zero-profile device remain unclear. METHODS: We retrospectively reviewed patients who had undergone ACDF using a zero-profile device from March 2012 to February 2016 at our institution. Based on the postoperative IH variation, the patients were divided into group A with postoperative IH 0 to 2 mm, group B with postoperative IH 2 to 4 mm, and group C with postoperative IH greater than 4 mm. Clinical efficacy was evaluated using JOA, VAS, and NDI scores in the groups. Imaging parameters including the IH, cervical lordosis, fusion rate, intervertebral foramen (IVF) diameter and complications such as subsidence, dysphagia, and ASD were also compared across the three groups. RESULTS: The average IH increased significantly from 6.72 mm preoperatively to 10.46 mm 1 week after surgery, and then gradually decreased to 7.48 mm at the final follow-up. The fusion rate was 61.90% in group A, 63.23% in group B, 53.57% in group C at 3 months, 73.81% in group A, 79.41% in group B, 67.86% in group C at 6 months, 90.48% in group A, 95.59% in group B, 92.86% in group C 1 year after surgery, and at the last follow-up, the fusion rate of three groups was all 100%. The IVF diameter was 6.52 ± 1.80 mm in group A, 9.55 ± 2.36 mm in group B, and 9.34 ± 1.62 mm in group C. ASD at the superior and inferior levels affected 11.90 and 16.67% patients in group A, 5.88 and 7.38% in group B, and 14.28 and 10.71% in group C. Regarding the 3 groups, the subsidence rates were 7.14, 4.41, and 14.29%, respectively. CONCLUSIONS: No clear correlation was found between IH changes and clinical efficacy within a year of surgery. However, the IH may affect various complications after ACDF. If postoperative IH changes are maintained at 2 to 4 mm after a year, a satisfactory imaging parameters and relatively low complications may be achieved after ACDF surgery using a zero-profile device.


Assuntos
Degeneração do Disco Intervertebral , Fusão Vertebral , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Discotomia , Seguimentos , Humanos , Degeneração do Disco Intervertebral/cirurgia , Medição da Dor , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
8.
Clin Neurol Neurosurg ; 207: 106759, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34175643

RESUMO

OBJECTIVES: Cervical disc replacement (CDR) has been established as an alternative to anterior cervical discectomy and fusion (ACDF) for treating cervical degenerative pathologies over the past decade. However, swallowing difficulties challenge patient safety due to the increased risk of malnutrition, dehydration and aspiration pneumonia after CDR. Currently, there are limited studies focusing on the incidences, severity and associated risk factors for dysphagia after CDR. This paucity, therefore, necessitated this retrospective study on post-operative dysphagia after one- and two-level CDR. PATIENTS AND METHODS: One hundred and fourteen patients underwent one-level CDR and forty eight patients underwent two-level CDR were recruited with a mean follow-up of 21 months (ranging from 14 to 30 months). The prevalence and severity of dysphagia was evaluated by the Bazaz grading system during the follow-up time. Regression analyses were done to identify risk factors associated with post-operative dysphagia after CDR. RESULTS: The overall dysphagia occurrences in the one- and two-level CDR groups were 17.54% and 35.41% at week one, 12.28% and 25% after one month, 9.65% and 18.75% after three months, 6.14% and 14.58% after six months, 4.39% and 6.25% after one year, and 3.51% and 4.17% at the final follow-up, respectively. The identified risk factors for dysphagia after CDR were advanced age, C4/5 surgery, two-level surgery, dC2-C7 angle ≥ - 5° and ≥ 6 mm changes in the prevertebral soft tissue swelling (dPSTS). CONCLUSION: The patients who experienced two-level CDR may have poor swallowing functions in the early post-operative term. However, these patients also can recover well with increasing length of follow-up. In addition, patients with advanced age, C4/5 surgery, dC2-C7 angle ≥ - 5° and ≥ 6 mm changes in dPSTS may prone to occur dysphagia after CDR.

10.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(1): 26-32, 2021 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-33448195

RESUMO

Objective: To explore the influence factors of anterior bone loss (ABL) after cervical disc arthroplasty (CDA) and effects of ABL on the clinical and radiographic outcomes. Methods: One hundred and fifty-five patients who underwent single-level Prestige-LP CDA between January 2008 and December 2017 and met the inclusive criteria were enrolled in the study. Perioperative data of patients were collected. The Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), and the visual analogue scale (VAS) score were used for clinical outcomes evaluation. Radiographic parameters including cervical lordosis, C 2-7 range of motion (ROM), disc angle, segmental ROM, and the lengths of the upper and lower endplates were assessed on the X-ray films. Device-related complications, including ABL, subsidence, radiographic adjacent segment pathology, and heterotopic ossification, were recorded. Univariate analysis was used to analyze the related factors, and logistic regression analysis was used to screen the influence factors. Patients were grouped according to whether ABL occurred after operation, and the differences in clinical and imaging evaluation parameters were compared. Results: There were 94 cases (60.6%) in the ABL group and 61 cases (39.4%) in the non-ABL group. Univariate analysis showed the significant differences in age, body mass index (BMI), and intraoperative blood loss between the two groups ( P<0.05). However, there was no significant difference in gender, bone mineral density (T value), preoperative blood calcium level, preoperative blood phosphorus level, preoperative alkaline phosphatase level, operative segment, operative time, and follow-up time between the two groups ( P>0.05). Multivariate analysis showed that the age and BMI were influence factors for ABL after CDA ( P<0.05). The JOA score, NDI, and VAS score significantly improved in both groups at 3 months after operation ( P<0.05), and the scores were further improved at last follow-up ( P<0.05). There was no significant difference in JOA score, NDI, and VAS score between the two groups before and after operation ( P>0.05). The preoperative cervical lordosis was significantly smaller in the ABL group than in the non-ABL group ( t=-2.402, P=0.018). At last follow-up, the segmental ROM was significantly greater in the ABL group than in the non-ABL group ( P<0.05), and the lengths of the upper and lower endplates were less in the ABL group than in the non-ABL group ( P<0.05). No significant difference in the other radiographic parameters between the two groups were found ( P>0.05). Prosthesis subsidence occurred in 5 cases (3.2%), including 3 cases in the ABL group and 2 cases in the non-ABL group; the difference between the two groups was not significant ( P=1.000). Heterotopic ossification occurred in 67 cases (43.2%), including 32 cases in the ABL group and 35 cases in the non-ABL group; the difference between the two groups was significant ( χ 2=8.208, P=0.004). High-grade heterotopic ossification was detected in 26 cases (13 cases in the ABL group and 13 cases in the non-ABL group). Twenty-nine cases (18.7%) had radiographic adjacent segment pathology, including 15 cases in the ABL group and 14 cases in non-ABL group; the difference between the two groups was not significant ( χ 2=1.190, P=0.276). Conclusion: The incidence of ABL after CDA was relatively high, which mainly occurred within 3 months after operation, and no longer progressing with stable radiographic features after the first 12 months. Age and BMI were independent influence factors for ABL. ABL does not affect the clinical outcomes but may preserve more ROM of prostheses.


Assuntos
Degeneração do Disco Intervertebral , Substituição Total de Disco , Artroplastia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Seguimentos , Humanos , Degeneração do Disco Intervertebral/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
11.
Dysphagia ; 36(4): 743-753, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33387002

RESUMO

To investigate whether dysphagia differs between one-level and two-level anterior cervical discectomy and fusion (ACDF) with the Zero Profile (Zero-P) Implant System. A retrospective analysis of 208 patients who underwent ACDF with the Zero-P Implant System and had at least one year of follow-up was performed from January 2013 to December 2018. The patients were divided into two groups based on the number of operated levels (one-level group, N = 86; two-level group, N = 122). Dysphagia was assessed based on the Bazaz grading system. The incidence of dysphagia and the severity of dysphagia at each follow-up were compared between the two groups. The patients were divided into two groups (nondysphagia group, N = 160; dysphagia group, N = 48), and covariates were obtained for multivariate analysis, including demographic parameters, surgical parameters, and radiographic parameters. The results showed that the incidence and severity of postoperative dysphagia in the two-level group were significantly greater at 1 week, 1 month and 3 months postoperatively than those in the one-level group. The results of ordinal logistic regression showed that older age, two-level surgery, greater prevertebral soft tissue swelling (PSTS) and the difference between the postoperative and preoperative C2-7 angle (dC2-7A) were significantly associated with a higher incidence of dysphagia after ACDF with the Zero-P. Two-level ACDF with the Zero-P can result in a significantly greater incidence and severity of transient postoperative dysphagia. Older age, greater PSTS and the dC2-7A were also associated with postoperative dysphagia after ACDF with the Zero-P.


Assuntos
Transtornos de Deglutição , Fusão Vertebral , Idoso , Vértebras Cervicais/cirurgia , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/etiologia , Discotomia/efeitos adversos , Humanos , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
12.
World Neurosurg ; 145: 108-113, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32931993

RESUMO

In recent years, clinicians have used virtual reality (VR) to simulate real-world environments for medical purposes. The use of VR systems in the field of cervical spine surgery can lead to effective surgical training programs without causing harm to patients. Moreover, both imaging and VR can be used before surgery to assist preoperative surgical planning. VR devices have a variety of built-in motion sensors, therefore kinematic data can be recorded while users are wearing VR devices and performing some actions for the evaluation of cervical spine activity and exercise ability. Therapists have also applied VR to cervical spine rehabilitation and showed good results. At present, the application of VR systems in cervical spine surgery has great potential, but current research is insufficient. Here, we review the latest advancements in VR technology used in cervical spine surgery and discuss potential directions for future work.


Assuntos
Vértebras Cervicais/cirurgia , Neurocirurgia/educação , Procedimentos Neurocirúrgicos/métodos , Realidade Virtual , Vértebras Cervicais/diagnóstico por imagem , Simulação por Computador , Humanos , Imageamento por Ressonância Magnética
13.
World Neurosurg ; 145: e61-e67, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32956887

RESUMO

BACKGROUND: Narrowing of intervertebral space height (ISH) is an important pathological change in degenerative spinal disease, and ideal intraoperative distraction and postoperative intervertebral space maintenance is one of the most expectant goals pursued by spinal surgeons. The effect of postoperative ISH changing on the clinical and radiological outcomes after cervical disc replacement is not fully understood, however. METHODS: In this study, the height variation and general trend of postoperative ISH in all patients were analyzed. The patients were divided into 3 groups based on the change of postoperative intervertebral space height (ISH)-group A (ISH <2 mm), group B (ISH 2-4 mm), and group C (ISH >4mm)-and the clinical and radiographic results compared among the 3 groups. RESULTS: A total of 120 consecutive patients with symptomatic cervical disc disease were included in this study. The results showed that the mean ISH increased significantly from 0.729 mm before surgery to 1.143 mm at 1 week, then gradually decreased to 1.032 mm at 3 months, 0.980 mm at 6 months, 0.760 mm at one year, and 0.750 mm at the final follow-up. The average postoperative Neck Disability Index (NDI) was 19.73 ± 0.81, 13.74 ± 4.94, 17.19 ± 4.22, respectively, in the 3 groups at 1 year after surgery and the average range of motion (ROM) was 5.44° ± 3.85° in group A, 9.34° ± 4.38° in group B, and 6.51° ± 4.38° in group C. The mean diameter of the intervertebral foramen was 6.54 ± 1.86 mm in group A, 9.63 ± 2.38 mm in group B, and 9.31 ± 1.68 mm in group C. Degeneration at the superiorly adjacent disc level was observed in 13.51% patients in group A, 9.37% in group B, and 21.05% in group C. Degeneration at the inferiorly adjacent level was radiographically identified in 21.62% in group A, 14.06% in group B, and 26.32% in group C. CONCLUSIONS: This study revealed that cervical disc replacement cannot maintain the intervertebral disc height obtained immediately after surgery. There is no obvious correlation between the change in intervertebral space height and clinical efficacy in the early postoperative stage. Nonetheless, the intervertebral disc height may affect the NDI index 1 year after surgery. If the postoperative intervertebral space height change can be maintained at 2-4 mm at 1 year, satisfactory ROM, intervertebral foramen diameter, and relatively low adjacent segment degeneration may be obtained after cervical disc replacement.


Assuntos
Disco Intervertebral , Substituição Total de Disco/métodos , Adulto , Vértebras Cervicais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
14.
BMC Musculoskelet Disord ; 21(1): 664, 2020 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-33032562

RESUMO

BACKGROUND: Hybrid surgery (HS) has become an alternative procedure for the treatment of multilevel cervical degenerative disc disease with satisfactory outcomes. However, some adverse outcomes have recently emerged, such as heterotopic ossification (HO) and anterior bone loss (ABL). Furthermore, HO was found mostly located in the posterior and lateral of the cervical intervertebral disc space. The mechanism of anterior heterotopic ossification (AHO) formation may be different, and its relationship with ABL was uncertain. METHODS: Radiographical and clinical outcomes of ninety-seven patients who had undergone contiguous two-level HS between December 2010 and December 2017 and with a minimum of 2-year follow-up were analyzed. Postoperative radiographs were evaluated and compared to the initial postoperative films to determine the incidence of ABL and AHO. RESULTS: The overall incidence rate of ABL was 44.3% (43/97). It was identified in 70.6% of AHO cases (33.3% mild, 41.7% moderate, 25.0% severe) and 38.8% of non-AHO cases (38.7% mild, 45.2% moderate, 16.1% severe). A significant association between ABL and AHO occurrence was found (P = 0.016). There was no significant difference in prosthesis-endplate depth ratio or disc space angle change between the AHO group and the non-AHO group (P > 0.05). Compared with data preoperatively, clinical outcome scores significantly improved after surgery in both the AHO and non-AHO groups, with no significant differences between the two groups (P > 0.05). CONCLUSION: ABL was common in HS, and it related to AHO. The formation of AHO could be an integral part of postoperative bone remodeling, as well as ABL.


Assuntos
Degeneração do Disco Intervertebral , Disco Intervertebral , Ossificação Heterotópica , Vértebras Cervicais , Seguimentos , Humanos , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/epidemiologia , Ossificação Heterotópica/etiologia , Próteses e Implantes , Estudos Retrospectivos , Resultado do Tratamento
15.
BMC Musculoskelet Disord ; 21(1): 649, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023551

RESUMO

OBJECTIVES: To investigate the effect of the difference in C2-7 angle on dysphagia after anterior cervical discectomy and fusion (ACDF) with the Zero-P Implant System. METHODS: A retrospective analysis of 181 patients who underwent ACDF with the Zero-P Implant System and had at least one year of follow-up from January 2011 to November 2018 was performed. All patients were divided into a non-dysphagia group and a dysphagia group to explore the effect of the difference between postoperative and preoperative C2-7 angle (dC2-7A) on postoperative dysphagia. At the same time, other possible related factors including the difference between postoperative and preoperative O-C2 angle (dO-C2A), sex, age, body mass index (BMI), intraoperative time, estimated blood loss, diabetes mellitus, hypertension, smoking, alcohol consumption, prevertebral soft-tissue swelling (PSTS), the highest segment involved in the surgery and the levels of surgery segments were analyzed. RESULTS: In total, the non-dysphagia group comprised 139 patients and the dysphagia group comprised 42 patients. The single-factor analysis showed that smoking, PSTS and dC2-7A were significantly different between the two groups (P < 0.05). Spearman's correlation coefficient showed no significant correlation between the degree of dysphagia and dC2-7A (P > 0.05). The results of the multiple-factor analysis with an ordinal logistic regression model showed that smoking, PSTS and dC2-7A were significantly associated with the incidence of dysphagia (P < 0.05). CONCLUSIONS: The postoperative C2-7 angle has an important effect on the occurrence of dysphagia in patients undergoing Zero-P implant system interbody fusion surgery.


Assuntos
Transtornos de Deglutição , Fusão Vertebral , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/etiologia , Discotomia/efeitos adversos , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
17.
Clin Neurol Neurosurg ; 198: 106226, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32947192

RESUMO

BACKGROUND: Cervical spondylotic myelopathy (CSM) is a major cause of cervical spinal cord dysfunction in people over 55 years of age. Most patients with CSM usually present with chronic and phased compression, however, some patients with CSM develop rapid severe neurological dysfunction without any trauma. To our knowledge, markers that can be used for early identification of patients with potential to develop rapid neurological deterioration have not been totally identified. Here, we evaluate epidemiological, clinical and radiographic features associated with the development and prognosis of rapid progressive cervical spondylotic myelopathy (rp-CSM). METHODS: A retrospective study was carried out for 175 patients diagnosed with CSM between March 2011 and January 2017 at West China Hospital. Patients were divided into rp-CSM group and chronic CSM (c-CSM) group based on the time taken for neurological deterioration to occur and the severity of preoperative neurological dysfunction. The clinical outcomes were assessed using the Modified Japanese Orthopaedic Association (mJOA) score, and imaging parameters such as Torg-Pavlov Ratio (TPR), intervertebral disc level compression ratio and increased signal intensity (ISI) on T2W1. Multivariate analysis was used to compare the outcomes between the two groups and identify potential predictors for rapid neurological dysfunction in CSM patients. RESULTS: Out of the 175 patients enrolled in the study, 25 developed rp-CSM (18 males; median age 59.04 ± 12.81 years) and the remaining 75 (54 males; median age 56.88 ± 12.31 years) were used as controls for the study (c-CSM group). The average time taken to develop severe neurological deterioration was 0.8 month in rp-CSM group and 24 month in c-CSM group (p = 0.001), while the preoperative mJOA scores were 6 in rp-CSM patients and 12 in c-CSM patients (p = 0.014). In addition, rp-CSM patients demonstrated worse outcomes than the controls in one year after surgery (mJOA improvement rate 54.5 % and 80 %, respectively, p = 0.021). There were no differences in the clinical parameters evaluated between the two groups except for the history of diabetes and smoking. Analysis of radiographic parameters indicated that TPR MRI, intervertebral disc level compression ratio and increased signal intensity (ISI) on T2W1 were poor in rp-CSM patients compared to c-CSM patients. Regression analysis also showed that the history of diabetes, TPR MRI < 0.4, compression ratio ≥50 %, and the sagittal diameter of ISI ≥ 50 % of spinal canal diameter on T2W1 were strongly associated with the rapid progressive neurological dysfunction in patients with CSM. CONCLUSION: The prognosis of rapid progressive CSM is worse than that of common chronic CSM. The rapid neurological deterioration can be identified by TPR MRI (<0.4), compression ratio (≥50 %), sagittal diameter of ISI (≥50 % of spinal canal diameter). Besides, a history of diabetes is a risk factor for the development of rp-CSM.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Progressão da Doença , Doenças da Medula Espinal/diagnóstico por imagem , Espondilose/diagnóstico por imagem , Adulto , Idoso , Estudos de Casos e Controles , Vértebras Cervicais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Doenças da Medula Espinal/cirurgia , Espondilose/cirurgia , Fatores de Tempo , Resultado do Tratamento
19.
Spine (Phila Pa 1976) ; 45(24): E1653-E1660, 2020 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-32925690

RESUMO

STUDY DESIGN: Retrospective analysis. OBJECTIVE: The aim of this study was to investigate the relationship between bony fusion after anterior cervical discectomy and fusion (ACDF) and heterotopic ossification (HO) after cervical disc arthroplasty (CDA) in hybrid surgery (HS). SUMMARY OF BACKGROUND DATA: The mechanism of postoperative bone formation still remains unknown. It is considered a risk factor in CDA but is essential for a solid union in ACDF. With HS, we could directly study the mechanism and relationship of different forms of postoperative bone formation. METHODS: Clinical data of 91 patients who had undergone consecutive two-level HS between January 2011 and January 2018 and with a minimum of 2-year follow-up was analyzed. HO was assessed based on McAfee's classifications, whereas fusion success was evaluated according the Food and Drug Administration approved criteria. Clinical outcomes and radiographic parameters were collected and used for the relevant comparisons. RESULTS: HO was identified in 48.4% of patients (44/91). The fusion rates of patients in the HO group and the non-HO group at 3, 6, and 12 months postoperatively, and the final follow-up were 81.8% and 19.1%, 95.4% and 74.5%, 95.4% and 85.1%, and 97.7% and 93.6%, respectively. The fusion rates were significantly higher at 3 and 6 months after operation in the HO group than in the non-HO group (P < 0.05). Patients in both groups had significant improvements across all clinical outcomes at final follow-up. CONCLUSION: There was a significant relationship between bony fusion and occurrence of HO after HS, suggesting that both bony fusion and HO are reflections of individual osteogenic capacity. However, a reliable predictor of postoperative bone formation is needed in the future to guarantee a solid bony fusion after ACDF and to further take full advantage of the motion-preserving from CDA. LEVEL OF EVIDENCE: 3.


Assuntos
Artroplastia/tendências , Vértebras Cervicais/cirurgia , Discotomia/tendências , Degeneração do Disco Intervertebral/cirurgia , Ossificação Heterotópica/etiologia , Fusão Vertebral/tendências , Adulto , Artroplastia/efeitos adversos , Vértebras Cervicais/diagnóstico por imagem , Discotomia/efeitos adversos , Feminino , Seguimentos , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/diagnóstico por imagem , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
20.
Spine (Phila Pa 1976) ; 45(21): E1449, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32925691
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