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1.
Medicine (Baltimore) ; 99(11): e19457, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176077

RESUMO

BACKGROUND: Lumbar degenerative disease (LDD) is a very common disease. And decompression alone, posterior lumbar interbody fusion (PLIF), and interspinous device (Coflex) are generally accepted surgical techniques. However, the effectiveness and safety of the above techniques are still not clear. Network meta-analysis a comprehensive technique can compare multiple treatments based on indirect dates and all interventions are evaluated and ranked simultaneously. To figure out this problem and offer a better choice for LDD, we performed this network meta-analysis. METHODS: PubMed and WanFang databases were searched based on the following key words, "Coflex," "decompression," "PLIF," "Posterior Lumbar Interbody Fusion," "Coflex" "Lumbar interbody Fusion." Then the studies were sorted out on the basis of inclusion criteria and exclusion criteria. A network meta-analysis was performed using The University of Auckland, Auckland city, New Zealand R 3.5.3 software. RESULTS: A total of 10 eligible literatures were finally screened, including 946 patients. All studies were randomized controlled trials (RCTs). Compared with decompression alone group, there were no significant differences of Oswestry Disability Index (ODI) in Coflex and lumbar interbody fusion groups after surgery. However, Coflex and PLIF were better in decreasing Visual Analogue Scale (VAS) score compared with decompression alone. Furthermore, we found Coflex have a less complication incidence rate. CONCLUSION: Compared with decompression alone, Coflex and lumbar interbody fusion had the similar effectiveness in improving lumbar function and quality of life. However, the latter 2 techniques were better in relieving pain. Furthermore, Coflex included a lower complication incidence rate. So we suggested that Coflex technique was a better choice to cue lumbar spinal stenosis (LSS). LEVEL OF EVIDENCE: Systematic review and meta-analysis, level I.


Assuntos
Descompressão Cirúrgica , Fixadores Internos , Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Avaliação da Deficiência , Humanos , Dor Lombar/cirurgia , Manejo da Dor , Qualidade de Vida
2.
Med Sci Monit ; 26: e921507, 2020 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-32196483

RESUMO

BACKGROUND We compared the clinical and radiographic outcomes between interface fixation using absorbable screws and plate fixation in anterior cervical corpectomy and fusion (ACCF) to evaluate the effectiveness of these 2 fixation methods for the treatment of 2-level cervical spondylotic myelopathy (CSM). MATERIAL AND METHODS From January 2014 to December 2016, a total of 220 patients who received 2-level ACCF were retrospectively collected. Among them, 108 patients were treated with interface fixation using absorbable screws (Group A) and 112 patients underwent plate fixation (Group B). Japanese Orthopedic Association (JOA) score and Neck Disability Index (NDI) score were employed to compare the clinical improvement. Operative time, blood loss, surgical cost, cervical lordosis, complications, and fusion rate were also evaluated. RESULTS The average follow-up time were 35.2±4.5 months in Group A and 35.9±3.9 months in Group B. There was no difference in operative time and blood loss for both groups. The JOA scores and NDI scores were similar in each follow-up (p>0.05 in all). Group A cost an average of 30% less than Group B for the operation. Both groups achieved 100% in the fusion rate with the same conditions in cervical lordosis. Group A (5/108) had a significantly lower complication rate than Group B (17/112) (p<0.05). CONCLUSIONS ACCF with interface fixation using absorbable screws achieved similar clinical outcomes compared to ACCF with plate fixation for 2-level CSM. Moreover, the interface fixation using absorbable screws presented far fewer complications and cost less for the operation.


Assuntos
Parafusos Ósseos , Discotomia/instrumentação , Fusão Vertebral/instrumentação , Espondilose/cirurgia , Vertebroplastia/instrumentação , Placas Ósseas , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Discotomia/métodos , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia , Fusão Vertebral/métodos , Espondilose/diagnóstico por imagem , Vertebroplastia/métodos
3.
Khirurgiia (Mosk) ; (2): 21-31, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32105252

RESUMO

OBJECTIVE: To analyze advisability of intraoperative ultrasound during lumbar microdiscectomy. MATERIAL AND METHODS: We used intraoperative ultrasound to identify and localize various tissues and structures of the spinal canal, optimize surgical approach to the herniated disc and assess decompression of neural structures. The study was conducted in 48 patients with herniated discs of the lumbar spine who were operated for the period from 2014 to 2017. We used ultrasound devices BK Medical Pro Focus 2202 and BK Medical Flex Focus 400 with neurosurgical transducer Craniotomy 8862 and Burr-Hole 8863. Examinations were performed before and after flavotomy during neural decompression and after decompression. All patients underwent laboratory, clinical and instrumental survey. We analyzed changes of functional and neurological status and investigated various possibilities of intraoperative ultrasound and its impact on postoperative outcomes. RESULTS: Intraoperative ultrasound is valuable to verify various tissues and structures of the lumbar spine. On-line scanning gives a correct volumetric representation of the various anatomical structures and their spatial relationships that is essential for less traumatic and more radical surgery. CONCLUSION: Intraoperative ultrasound is easy, harmless, inexpensive and widely available method of intraoperative imaging. US data may be comparable with those of intraoperative CT and MRI. Intraoperative ultrasound during lumbar microdiscectomy results better postoperative outcomes.


Assuntos
Discotomia , Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Microcirurgia , Descompressão Cirúrgica , Discotomia/métodos , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares , Microcirurgia/métodos , Resultado do Tratamento , Ultrassonografia
4.
Medicine (Baltimore) ; 99(5): e19055, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000453

RESUMO

To investigate the outcomes and reliability of hybrid surgery (HS) versus anterior cervical discectomy and fusion (ACDF) for the treatment of multilevel cervical spondylosis and disc diseases.Hybrid surgery, combining cervical disc arthroplasty (CDA) with fusion, is a novel treatment to multilevel cervical degenerated disc disease in recent years. However, the effect and reliability of HS are still unclear compared with ACDF.To investigate the studies of HS versus ACDF in patients with multilevel cervical disease, electronic databases (Medline, Embase, Pubmed, Cochrane library, and Cochrane Central Register of Controlled Trials) were searched. Studies were included when they compared HS with ACDF and reported at least one of the following outcomes: functionality, neck pain, arm pain, cervical range of motion (ROM), quality of life, and incidence of complications. No language restrictions were used. Two authors independently assessed the methodological quality of included studies and extracted the relevant data.Seven clinical controlled trials were included in this study. Two trials were prospective and the other 5 were retrospective. The results of the meta-analysis indicated that HS achieved better recovery of NDI score (P = 0.038) and similar recovery of VAS score (P = 0.058) compared with ACDF at 2 years follow-up. Moreover, the total cervical ROM (C2-C7) after HS was preserved significantly more than the cervical ROM after ACDF (P = 0.000) at 2 years follow-up. Notably, the compensatory increase of the ROM of superior and inferior adjacent segments was significant in ACDF groups at 2-year follow-up (P < 0.01), compared with HS.The results demonstrate that HS provides equivalent outcomes and functional recovery for cervical disc diseases, and significantly better preservation of cervical ROM compared with ACDF in 2-year follow-up. This suggests the HS is an effective alternative invention for the treatment of multilevel cervical spondylosis to preserve cervical ROM and reduce the risk of adjacent disc degeneration. Nonetheless, more well-designed studies with large groups of patients are required to provide further evidence for the benefit and reliability of HS for the treatment of cervical disk diseases.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/métodos , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Humanos , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Espondilose/cirurgia
5.
Medicine (Baltimore) ; 99(7): e19037, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049800

RESUMO

RATIONALE: We present a rare case of a traumatic intradural ruptured disc associated with a mild vertebral body compression fracture along with a review of the relevant medical literature. An intradural ruptured disc often occurs due to chronic degenerative diseases and is rarely due to trauma. It can cause irreversible neurological complications if the appropriate treatment is not planned. PATIENT CONCERNS: A 32-year-old male presented with motor paraparesis (grade 3/5), right ankle dorsiflexion, and great toe dorsiflexion (grade 1/5), along with radiating pain at his right L4 and L5 sensory dermatome following a fall. DIAGNOSES: Computed tomography revealed a compression fracture of the L2 body. Lumbar magnetic resonance imaging showed an intradural mass-like lesion on the ventral side of his spinal cord and an epidural mass-like lesion on the dorsal side of his spinal cord, indicating a hematoma. INTERVENTIONS: An emergency L2 laminectomy was performed to remove the space-occupying lesions and to decompress the cauda equina and nerve root. The mass-like lesion was removed. No other lesions were found in the spinal canal. OUTCOMES: Pathologic examination of the intradural mass lesion revealed fibrocartilage similar to that found in disc material. The patient still continued to experience motor weakness at the 1-year follow-up examination. LESSONS: We report a rare case of a traumatic lumbar disc rupture into the dural sac associated with a mild vertebral body compression fracture. Early diagnosis and prompt surgical intervention are essential, as is performing a magnetic resonance imaging or computed tomography myelogram promptly to evaluate the spinal canal when there are unexplained neurologic symptoms. An intraspinal canal evaluation should be completed before the postural reduction of the vertebral body fracture to prevent any neurological complications.


Assuntos
Fraturas por Compressão/cirurgia , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Acidentes por Quedas , Adulto , Descompressão Cirúrgica , Fraturas por Compressão/diagnóstico por imagem , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Laminectomia , Imagem por Ressonância Magnética , Masculino , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
Medicine (Baltimore) ; 99(7): e19266, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049868

RESUMO

Despite many clinical trials on cervical epidural steroid injections, the indications for and long-standing outcomes of this treatment remain controversial. We evaluated the outcomes and indications for transforaminal cervical epidural steroid injection (TCESI) in patients with moderate to severe disability.We prospectively gathered data from patients with 1 or 2-level cervical degenerative disease (herniated disc, foraminal stenosis) with moderate to severe disability (3.5 < initial visual analog scale < 6.5, 15 < Neck Disability Index < 35) and greater than 12 weeks of pain, despite conservative treatment. Patients with persistent disability and those who desired surgical intervention underwent decompression surgery. The clinical and demographic characteristics were compared between groups.Of the 309 patients who underwent TCESI, 221 (72%) did not receive surgical treatment during the 1-year follow-up period. The remaining 88 patients (28%) underwent surgery at a mean of 4.1 months after initial TCESI. Patients who underwent injection alone showed a significant decrease in disability and pain that persisted until the 1-year follow-up visit (P < .05). In patients who underwent surgery, the mean disability and pain scores after injection did not decrease for several months, although the scores significantly decreased up to 1 year after surgery (P < .05).The TCESI significantly decreased pain and disability in the moderate to severe disability group up to 1 year after injection. We recommend cervical TCESI as an initial treatment with moderate to severe disability patients.


Assuntos
Vértebras Cervicais , Dexametasona/administração & dosagem , Glucocorticoides/administração & dosagem , Degeneração do Disco Intervertebral/tratamento farmacológico , Feminino , Humanos , Injeções Epidurais , Degeneração do Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
7.
World Neurosurg ; 135: e716-e722, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31899389

RESUMO

BACKGROUND: Anterior lumbar interbody fusion (ALIF) is a commonly performed surgical procedure for the management of degenerative lumbar spine pathologic entities. Despite an increasing number of ALIFs performed nationally, to the best of our knowledge, no study has evaluated the costs associated with the 90-day episode of care postoperatively. METHODS: The 2007-2016 Humana Administrative Claims data set, a national database of commercial and Medicare Advantage (MA) beneficiaries, was queried using Current Procedural Terminology code 22558 for patients who had undergone single-level ALIF. The 90-day costs were defined using the following categories: facility, surgeon, anesthesia, other hospitalization costs and services, radiology, office visits, physical therapy/rehabilitation, emergency department visits, and readmissions. RESULTS: A total of 365 ALIF procedures (MA, n = 244; commercial, n = 121) were included in the analysis. The average 90-day cost of single-level ALIF was $25,568 and $51,741 for the MA and commercial enrollees, respectively. The major proportion of 90-day costs was attributable to facility reimbursement (74%-76%), followed by surgeon costs (9%-11%). Postacute care (i.e., office visits and physical therapy/rehabilitation) was not a major driver of the 90-day costs, consisting of only 0.7%-1.3% of the total 90-day reimbursement. Of patients who had required readmission, the costs of the readmission increased the average 90-day costs by 65%-66%. CONCLUSIONS: Facility costs were the major drivers of a stipulated 90-day reimbursement for patients undergoing single-level ALIF. Health policy makers and providers can use these data to better understand the distribution of costs in a stipulated bundled-payment model for ALIFs and allow them to identify areas in which cost reduction strategies can be performed.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Custos e Análise de Custo , Assistência à Saúde/economia , Cuidado Periódico , Instalações de Saúde/economia , Custos Hospitalares , Humanos , Degeneração do Disco Intervertebral/economia , Medicare/economia , Readmissão do Paciente/economia , Setor Privado/economia , Estudos Retrospectivos , Fusão Vertebral/economia , Cirurgiões/economia , Estados Unidos
8.
World Neurosurg ; 133: e68-e75, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31465851

RESUMO

BACKGROUND: Horner syndrome is an infrequently seen complication of anterior cervical discectomy and fusion (ACDF). Multicenter studies have reported a very low incidence, less than 0.1%. OBJECTIVE: To identify the incidence in, characteristics of, and postoperative course in patients in whom postoperative Horner syndrome developed after ACDF. METHODS: We performed a retrospective review of all patients who experienced Horner syndrome after ACDF for cervical degenerative disease at a single tertiary care institution between 2017 and 2018. A systematic review was then performed to identify studies investigating prevalence, diagnosis, and treatment of postoperative Horner syndrome after ACDF. RESULTS: Of 1116 patients at our institution who underwent ACDF, the incidence of Horner syndrome was 0.45%. C4/5 and C5/6 were the 2 most common surgical levels. The complication was noted to occur immediately after surgery, and at least partial improvement was identified in all patients an average 3.5 months after surgery (range, 10 days to 6 months). These findings were consistent with our systematic review of 21 studies that showed an incidence of 0.6% (range, 0.02% to 4.0%), the most common surgical level C5/6 (64%), and 82% of patients experiencing at least partial resolution of symptoms within 1 year (60.7% complete, 21.4% partial resolution). CONCLUSION: Horner syndrome occurs in 0.6% of patients undergoing ACDF. Careful postoperative examination should reveal this complication, which may be underdiagnosed or underreported in larger multicenter case series. The majority of patients experience complete resolution of symptoms within 6 months to 1 year and can be treated conservatively and expectantly.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Síndrome de Horner/etiologia , Degeneração do Disco Intervertebral/cirurgia , Complicações Intraoperatórias/etiologia , Fusão Vertebral/efeitos adversos , Idoso , Feminino , Síndrome de Horner/epidemiologia , Humanos , Incidência , Complicações Intraoperatórias/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sistema Nervoso Simpático/lesões , Centros de Atenção Terciária/estatística & dados numéricos , Resultado do Tratamento
9.
World Neurosurg ; 133: 358-365.e4, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31476471

RESUMO

OBJECTIVE: We compared the safety and effectiveness of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) to open TLIF (O-TLIF) for lumbar degenerative disease. METHODS: We systematically searched Medline, Embase, and the Cochrane Central Register of Controlled Trials for randomized trials of MI-TLIF versus O-TLIF. The perioperative outcomes included the procedure time, fluoroscopy time, blood loss, complications, and hospital stay. The midterm outcomes included pseudarthrosis, the Oswestry Disability Index, and pain severity-all reported at 1-year minimum follow-up. RESULTS: A total of 7 randomized trials including 496 patients (246 MI-TLIF; 250 O-TLIF) were included in our review. No statistically significant group differences in procedure time (mean difference [MD], -4 minutes; P = 0.70) were found. However, the fluoroscopy time was significantly longer with MI-TLIF (MD, 48 seconds; P < 0.001). MI-TLIF resulted in less perioperative blood loss (MD, -200 mL; P < 0.001) and shorter hospitalization (MD, -2.2 days; P < 0.001) compared with O-TLIF. The risk of perioperative complications was comparable between the 2 groups (risk ratio, 1.03; P = 0.94). No group differences were found in the incidence of pseudarthrosis at the 1-year minimum follow-up (risk ratio, 0.84; P = 0.67). Pain severity at midterm follow-up was comparable between the 2 groups (MD, -1; P = 0.59), and the ODI was slightly lower in the MI-TLIF group (MD, -3; P = 0.01). CONCLUSION: Relative to O-TLIF, MI-TLIF was associated with less blood loss, a shorter hospital stay, and slightly less disability, at the expense of longer fluoroscopy times.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Fusão Vertebral/métodos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
10.
World Neurosurg ; 133: e205-e210, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31493606

RESUMO

BACKGROUND: Good short- and mid-term clinical efficacy of percutaneous cervical nucleoplasty (PCN) for cervical degenerative diseases (CDD) with neck pain has been reported. However, few studies have assessed its long-term influence in patients with both neck pain and cervical vertigo. This study aimed to evaluate the curative efficacy of PCN for CDD with neck pain and cervical vertigo with minimum of 6 years of follow-up. METHODS: Inpatients who underwent PCN for CDD with neck pain and cervical vertigo between April 2010 and March 2013 were enrolled. Clinical outcomes were assessed using the Cervical Vertigo Evaluation Scale (CVES); greater CVES scores reflected less impairment. Additional open surgeries were recorded. RESULTS: Among 40 patients, 100% completed the 1-year short-term and 3-year mid-term follow-up (FU); 85% completed the 6-year long-term FU. Clinical effective rates were 67.5%, 67.5%, and 52.94% at short-, mid-, and long-term FU, respectively. CVES scores were greater than the preoperative CVES scores at all FU timepoints (P < 0.01). However, the CVES score was lower at the final FU than at the 3-year FU (P < 0.05). The neck pain score significantly decreased over time and was lower than the cervical vertigo score at the final FU (P > 0.05). Reoperation rates were 1/40 (2.50%) and 3/34 (8.82%) at mid- and long-term FU, respectively. CONCLUSIONS: PCN in patients with CDD neck pain and cervical vertigo showed satisfactory clinical efficacy at short- and mid-term FU, and it was fair at long-term FU. Thus, PCN could be a complementary operation for CDD.


Assuntos
Discotomia Percutânea/métodos , Degeneração do Disco Intervertebral/cirurgia , Disco Intervertebral/cirurgia , Cervicalgia/cirurgia , Vertigem/cirurgia , Adulto , Idoso , Vértebras Cervicais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/etiologia , Reoperação , Vertigem/etiologia
11.
World Neurosurg ; 135: e671-e678, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31884124

RESUMO

OBJECTIVE: The purposes of the present study were to introduce an indirect decompression using oblique lateral lumbar interbody fusion combined with anterolateral screw fixation (OLIF-AF) for the treatment of lumbar degenerative disc disease and examine the clinical efficacy and radiographic outcomes. METHODS: A total of 65 patients had undergone single-level OLIF-AF at L2-L5 from December 2017 to August 2018. The cross-sectional area of the thecal sac was evaluated using magnetic resonance imaging. The disk height, foraminal height (FH), and degree of upper vertebral slippage were evaluated using computed tomography. The visual analog scale score and Oswestry disability index were recorded pre- and postoperatively. RESULTS: The visual analog scale scores and Oswestry disability index had significantly improved after surgery (P < 0.001). At 3 days postoperatively, the cross-sectional area had improved from 93.2 ± 14.4 mm2 to 124.2 ± 7.5 mm2 (P < 0.001), the disk height had increased from 9.9 ± 1.7 mm to 12.7 ± 1.0 mm (P < 0.001), the left FH had increased from 16.6 ± 2.0 mm to 19.6 ± 2.0 mm (P < 0.001). In contrast, the right FH had increased from 16.7 ± 2.1 mm to 19.9 ± 2.0 mm (P < 0.001), and the degree of upper vertebral slippage had decreased from 14.2% ± 3.1% to 4.6% ± 2.8% (P < 0.001), respectively. At the 12-month follow-up examination, these parameters showed no statistically significant differences compared with the values at 3 days postoperatively (P > 0.05). Adverse events were observed in 15 patients (23.1%) patients and included pain at the iliac bone donor site in 1 (1.5%), left thigh pain/numbness in 2 (3.1%), quadriceps weakness in 2 (3.1%), psoas weakness in 3 (4.6%), intraoperative endplate injury in 2 (3.1%) and cage subsidence in 5 (7.7%). CONCLUSIONS: Our results have shown that OLIF-AF surgery is a relatively safe and effective surgical option for LDDD at L2-L5. Cage subsidence was the most common operative complication.


Assuntos
Parafusos Ósseos , Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Transplante Ósseo/métodos , Descompressão Cirúrgica/métodos , Feminino , Humanos , Ílio/transplante , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/etiologia , Cuidados Pós-Operatórios/métodos , Implantação de Prótese/métodos , Estudos Retrospectivos , Estenose Espinal/cirurgia , Espondilolistese/cirurgia , Sítio Doador de Transplante , Resultado do Tratamento
12.
World Neurosurg ; 135: e702-e709, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31887466

RESUMO

PURPOSE: To determine how center of rotation (COR) changes and what affects changes in COR after cervical arthroplasty. METHODS: A systematic literature review of in vivo clinical studies comparing the location of the COR before and after cervical arthroplasty with different artificial prostheses was performed. Meta-analysis was performed using a fixed effects model where appropriate. RESULTS: A systematic review of the PubMed, EMBASE, and Cochrane Library databases was conducted. We initially identified 267 studies, of which 14 involved in vivo kinematics studies evaluating COR following cervical arthroplasty. We found that at the last follow-up, the COR location shifted anteriorly in patients from 4 studies including 85 segments, superiorly in patients from 4 studies including 98 segments, anterior-superiorly in patients from 4 studies including 290 segments, and anterior-inferiorly in patients from 1 study including 272 segments after cervical arthroplasty. The COR location showed no significant change in patients from 5 studies including 106 segments after cervical arthroplasty. Changes in COR showed a certain trend after cervical arthroplasty with different types of prostheses. CONCLUSIONS: Prosthesis design affects changes in COR after cervical arthroplasty. If a constrained or semiconstrained prosthesis is chosen (2-piece implant, ball-and-socket, or ball-in-trough design), the COR location tends to shift anteriorly and/or superiorly, whereas if a nonconstrained prosthesis is chosen (3-piece implant, mobile nucleus design), the COR tends to keep the same location as preoperation. In addition, the position of the prosthesis in the intervertebral space also can affect changes in COR after cervical arthroplasty.


Assuntos
Artroplastia de Substituição , Vértebras Cervicais/cirurgia , Degeneração do Disco Intervertebral/cirurgia , Adulto , Idoso , Discotomia/métodos , Humanos , Degeneração do Disco Intervertebral/fisiopatologia , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Desenho de Prótese , Rotação , Fusão Vertebral/métodos
13.
Bone Joint J ; 101-B(12): 1526-1533, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31786998

RESUMO

AIMS: Chronic low back pain due to degenerative disc disease is sometimes treated with fusion. We compared the outcome of three different fusion techniques in the Swedish Spine Register: noninstrumented posterolateral fusion (PLF), instrumented posterolateral fusion (IPLF), and interbody fusion (IBF). PATIENTS AND METHODS: A total of 2874 patients who were operated on at one or two lumbar levels were followed for a mean of 9.2 years (3.6 to 19.1) for any additional lumbar spine surgery. Patient-reported outcome data were available preoperatively (n = 2874) and at one year (n = 2274), two years (n = 1958), and a mean of 6.9 years (n = 1518) postoperatively and consisted of global assessment and visual analogue scales of leg and back pain, Oswestry Disability Index, EuroQol five-dimensional index, 36-Item Short-Form Health Survey, and satisfaction with treatment. Statistical analyses were performed with competing-risks proportional hazards regression or analysis of covariance, adjusted for baseline variables. RESULTS: The number of patients with additional surgery were 32/183 (17%) in the PLF group, 229/1256 (18%) in the IPLF group, and 439/1435 (31%) in the IBF group. With the PLF group as a reference, the hazard ratio for additional lumbar surgery was 1.16 (95% confidence interval (CI) 0.78 to 1.72) for the IPLF group and 2.13 (95% CI 1.45 to 3.12) for the IBF group. All patient-reported outcomes improved after surgery (p < 0.001) but were without statistically significant differences between the groups at the one-, two- and 6.9-year follow-ups (all p ≥ 0.12). CONCLUSION: The addition of interbody fusion to posterolateral fusion was associated with a higher risk for additional surgery and showed no advantages in patient-reported outcome Cite this article: Bone Joint J 2019;101-B:1526-1533.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Sistema de Registros , Reoperação , Fusão Vertebral/instrumentação , Resultado do Tratamento
14.
Medicine (Baltimore) ; 98(45): e17935, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702680

RESUMO

BACKGROUND: Recently, many kinds of cages for cervical fusion have been developed to avoid the related complications caused by tricortical iliac crest graft. The existing literature has reported the excellent clinical efficacy and superior fusion rate. However, various types of cages have their own disadvantages. Which bone graft material is the best choice for cage with the fewest complications? At present, there is still no conclusion. METHODS: By reviewing patients with 1 to 2-level cervical degenerative disease in our hospital with a novel cage made of allograft or polyetheretherketone (PEEK), we evaluated the efficacy and reliability of the new cage in anterior cervical discectomy and fusion (ACDF). From 2015 to 2016, a prospective review of 58 and 49 consecutive cases with spondylotic radiculopathy or myelopathy undergoing ACDF using allograft (group A) and PEEK (group B) cage were performed. The follow-up ranged from 12 to 40 months. Intraoperative index, clinical outcome and complications were recorded. Radiographs evaluated segmental and overall cervical lordosis, the height of the intervertebral space, interbody height ratio (IHR), cage positioning, and fusion state. RESULTS: A total of 134 cages were implanted. Compared to preoperatively, the visual analog scale (VAS) and neck disability index (NDI) were reduced postoperatively without any change during the subsequent follow-up in both groups. There was no migration or extrusion of the cages at the latest follow-up. There were 2 and 4 patients suffering dysphagia respectively. In both groups, the intervertebral height, IHR, segmental and overall cervical lordosis were significantly greater than pre-operation (P < .05) and were maintained at the last follow-up, but were not statistically significant (P > .05). The allograft group achieved a fusion rate of 100% (58/58) according to CT scans at 3 months post-operation, while PEEK group was 91.8% (45/49), which reached 95.9% (47/49) at 6 months and 100% at 12 months. In addition, the fusion state was maintained in all patients at the last follow-up. CONCLUSION: Our data showed that the new allograft cage is superior to the PEEK cage in providing a high fusion rate and fewer complications after 1-level and 2-level ACDF procedures. It may represent an excellent alternative to other cages.


Assuntos
Aloenxertos/transplante , Discotomia/métodos , Fixadores Internos , Degeneração do Disco Intervertebral/cirurgia , Cetonas/uso terapêutico , Polietilenoglicóis/uso terapêutico , Fusão Vertebral/métodos , Adulto , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Próteses e Implantes , Resultado do Tratamento
15.
Medicine (Baltimore) ; 98(44): e17685, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689790

RESUMO

To compare imaging indicators and clinical effects of extreme lateral interbody fusion (XLIF) using allogenic bone, autologous bone marrow + allogenic bone, and rhBMP-2 + allogenic bone as bone graft materials in the treatment of degenerative lumbar diseases.This was a retrospective study of 93 patients with lumbar interbody fusion who underwent the extreme lateral approach from May 2016 to December 2017. According to the different bone graft materials, patients were divided into allogenic bone groups (group A, 31 cases), rhBMP-2 + allogenic bone (group B, 32 cases), and autologous bone marrow + allogenic bone (group C, 30 cases). There were no significant differences in gender, age, lesion segment, preoperative intervertebral space height, and preoperative Oswestry Dysfunction Index (ODI) and visual analogue scale (VAS) scores among the 3 groups (P > .05). Intervertebral space height, bone graft fusion rate, and ODI and VAS scores were compared immediately after surgery, and at 3, 6, and 12 months after surgery.All groups were followed up for 12 months. The intervertebral space height was significantly higher in the 3 groups immediately after surgery and at 3, 6, and 12 months after surgery, in comparison to before surgery (P < .05). There was no significant difference in the intervertebral space height among the 3 groups immediately after surgery and at 3, 6, and 12 months after surgery (P > .05). The fusion rate of group B and C was higher than that of groups A at 3, 6, and 12 months after surgery (P < .05). In the 3 groups, the VAS and ODI scores at 3, 6, and 12 months after surgery were significantly improved compared with the preoperative scores (P < .05). The VAS and ODI scores in groups B and C were significantly higher than those in group A (P < .05), but there was no significant difference between groups B and C (P > .05).The rhBMP-2 + allograft bone combination had good clinical effects and high fusion rate in XLIF.


Assuntos
Transplante de Medula Óssea/métodos , Proteína Morfogenética Óssea 2/administração & dosagem , Transplante Ósseo/métodos , Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Fator de Crescimento Transformador beta/administração & dosagem , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Desempenho Físico Funcional , Proteínas Recombinantes/administração & dosagem , Estudos Retrospectivos
16.
Spine (Phila Pa 1976) ; 44(21): 1471-1480, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31568185

RESUMO

STUDY DESIGN: A nonrandomized, prospective, and single-center clinical trial. OBJECTIVE: The aim of this study was to determine whether the prosthesis design, and especially changes in the primary anchoring mechanism between the keel-based ProDisc C and the spike-based ProDisc Vivo, affects the frequency of heterotopic ossification (HO) formation over time. SUMMARY OF BACKGROUND DATA: The occurrence of motion-restricting HO as well as underlying risk factors has so far been a widely discussed, but not well understand phenomenon. The anchoring mechanism and the opening of the anterior cortex may be possible causes of this unwanted complication. METHODS: Forty consecutive patients treated with the ProDisc C and 42 consecutive patients treated with the ProDisc Vivo were compared with respect to radiological and clinical outcome, with 2 years of follow-up. Clinical outcome scores included the Neck Disability Index (NDI), Visual Analogue Scale (VAS), and arm and neck pain self-assessment questionnaires. Radiological outcomes included the segmental lordosis and range of motion (ROM) of the index-segment as well as the occurrence of HO. RESULTS: The clinical outcome parameters improved in both groups significantly. [ProDisc C: VAS arm and neck pain from 6.3 and 6.2 preoperatively to 0.7 and 1.3; NDI from 23.0 to 3.7; ProDisc Vivo: VAS arm and neck pain from 6.3 and 4.9 to 1.4 and 1.6, NDI from 34.1 to 8.7; 2-year follow-up (FU)]. The ProDisc Vivo cohort demonstrated a significantly lower incidence of HO than the ProDisc C group at 1-year FU (P = 0.0005) and 2-year FU (P = 0.005). Specifically, high-grade HO occurred in 9% versus 31%. CONCLUSION: These findings demonstrate that prosthesis designs that allow primary anchoring without violation of the cortical surface help to reduce the incidence of severe ossification, possibly affecting the functionality and mobility of the artificial disc device over of time. LEVEL OF EVIDENCE: 3.


Assuntos
Ossificação Heterotópica/epidemiologia , Desenho de Prótese/instrumentação , Substituição Total de Disco/métodos , Adulto , Vértebras Cervicais/cirurgia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Incidência , Degeneração do Disco Intervertebral/cirurgia , Lordose/cirurgia , Masculino , Pessoa de Meia-Idade , Cervicalgia , Estudos Prospectivos , Radiografia , Amplitude de Movimento Articular , Inquéritos e Questionários , Resultado do Tratamento , Escala Visual Analógica
17.
Medicine (Baltimore) ; 98(43): e17420, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651845

RESUMO

BACKGROUND & AIMS: Open-transforaminal lumbar interbody fusion (O-TLIF) is regarded as the standard (S) approach which is currently available for patients with degenerative lumbar diseases patients. In addition, minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has proposed and gradually obtained popularity compared with O-TLIF procedures due to its beneficial outcomes in minimized tissue injury and quicker recovery. Nonetheless, debates exist concerning the use of MI-TLIF with its conflicting outcomes of clinical effect and safety in several publications. The purpose of the current study is to conduct an updated meta-analysis to provide eligible and systematical assessment available for the evaluation of the efficacy and safety of MI-TLIF in comparison with O-TLIF. METHODS: Publications on the comparison of O-TLIF and MI-TLIF in treating degenerative lumbar diseases in last 5 years were collected. After rigorous reviewing on the eligibility of publications, the available data was further extracted from qualified trials. All trials were conducted with the analysis of the summary hazard ratios (HRs) of the interest endpoints, including intraoperative and postoperative outcomes. RESULTS: Admittedly, it is hard to run a clinical RCT to compare the prognosis of patients undergoing O-TLIF and MI-TLIF. A total of 10 trials including non-randomized trials in the current study were collected according to our inclusion criteria. The pooled results of surgery duration indicated that MI-TLIF was highly associated with shorter length of hospital stay, less blood loss, and less complications. However, there were no remarkable differences in the operate time, VAS-BP, VAS-LP, and ODI between the 2 study groups. CONCLUSION: The quantitative analysis and combined results of our study suggest that MI-TLIF may be a valid and alternative method with safe profile in comparison of O-TLIF, with reduced blood loss, decreased length of stay, and complication rates. While, no remarkable differences were found or observed in the operate time, VAS-BP, VAS-LP, and ODI. Considering the limited available data and sample size, more RCTs with high quality are demanded to confirm the role of MI-TLIF as a standard approach in treating degenerative lumbar diseases.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Fusão Vertebral/métodos , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Duração da Cirurgia , Resultado do Tratamento
18.
J Clin Neurosci ; 70: 20-26, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31630917

RESUMO

Little information is available on associations between different lumbar interbody fusion (LIF) surgeries and postoperative outcomes. The present study aims to comprehensively investigate whether different LIF techniques are associated with postoperative outcomes such as complications and length of hospital stay. The United States Nationwide Inpatient Sample (NIS) was searched for patients diagnosed with recurrent lumbar disc herniation who underwent lumbar interbody fusion (LIF) surgeries between 2005 and 2014. Patients were categorized based on LIF approaches: anterior lumbar interbody fusion (ALIF); lateral lumbar interbody fusion (LLIF); or posterior lumbar interbody fusion/transforaminal lumbar interbody fusion (PLIF/TLIF). A total of 2625 patients were included in this study. After adjusting for age, severity of illness, and comorbidities, patients who received LLIF and PLIF/TLIF approaches had significantly shorter hospital stays than those receiving ALIF (LLIF vs. ALIF, ß = -0.64; PLIF/TLIF vs. ALIF, ß = -0.40). In addition, patients who received LLIF and PLIF/TLIF approaches had significantly lower risk of digestive system complications compared to those receiving ALIF (LLIF vs. ALIF, aOR = 0.25; PLIF/TLIF vs. ALIF, aOR = 0.18). In conclusion, in patients with recurrent lumbar disc herniation, LLIF and PLIF/TLIF approaches are associated with shorter hospital stays and lower risk of digestive system complications than ALIF. However, LIF approaches do not correlate significantly with the risk of postoperative bleeding or nervous system complications.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Complicações Pós-Operatórias/etiologia , Fusão Vertebral/métodos , Feminino , Humanos , Pacientes Internados , Tempo de Internação , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos
19.
BMC Musculoskelet Disord ; 20(1): 430, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31521137

RESUMO

BACKGROUND: ASD is a relatively common degenerative alteration after cervical surgery which occurs above or below the fused segment. In addition, some patients may need reoperation to treat severe ASD after the primary surgery. It was considered that sagittal balance is correlated with postoperative clinical outcomes; however, few studies have reported the influence of sagittal balance on ASD. The present study is designed to investigate whether sagittal balance impacts the pathology of adjacent segment disease (ASD) in patients who undergo anterior cervical surgery for degenerative cervical disease. METHODS: Databases including Pubmed, Embase, Cochrane library, and Web of Science were used to search for literature published before June 2018. Review Manager 5.3 was used to perform the statistical analysis. Sagittal balance parameters before and after surgery were compared between patients with and without ASD. Weighted mean difference (WMD) was summarized for continuous data and P < 0.05 was set for the level of significance. RESULTS: A total of 221 patients with ASD and 680 patients without ASD from seven articles were studied in this meta-analysis. There were no significant differences in most sagittal balance parameters between the two groups, except for postoperative cervical lordosis (CL) (WMD -3.30, CI -5.91, - 0.69, P = 0.01). CONCLUSIONS: Some sagittal balance parameters may be associated with the development of ASD after anterior cervical surgery. Sufficient restoration of CL may decrease the incidence of ASD. The results in present study needed to be expanded carefully and further high-quality studies are warranted to investigate the impact of sagittal balance on ASD.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Lordose/complicações , Complicações Pós-Operatórias/fisiopatologia , Equilíbrio Postural/fisiologia , Fusão Vertebral/efeitos adversos , Vértebras Cervicais/patologia , Vértebras Cervicais/cirurgia , Humanos , Incidência , Disco Intervertebral/patologia , Disco Intervertebral/cirurgia , Degeneração do Disco Intervertebral/etiologia , Degeneração do Disco Intervertebral/fisiopatologia , Lordose/fisiopatologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Recidiva
20.
World Neurosurg ; 132: e14-e20, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31521753

RESUMO

OBJECTIVE: Age and comorbidity burden of patients going anterior cervical discectomy and fusion (ACDF) have increased significantly over the past 2 decades, resulting in increased expenditures. Non-home discharge after ACDF contributes to increased direct and indirect costs of postoperative care. The purpose of this study was to identify independent prognostic factors for discharge disposition in patients undergoing ACDF. METHODS: A retrospective review was conducted at 5 medical centers to identify patients undergoing ACDF for degenerative conditions. The primary outcome was non-home discharge. Additional outcomes considered included discharge to rehabilitation and home discharge with services. Bivariate and multivariable analyses were used to identify independent prognostic factors for non-home discharge. RESULTS: Of 2070 patients undergoing ACDF, 114 (5.5%) had non-home discharge and 63 (3.0%) had discharge to inpatient rehabilitation. Factors independently associated with non-home discharge included older age, marital status, Medicare insurance, Medicaid insurance, previous spine surgery, myelopathy, preoperative comorbidities (hemiplegia/paraplegia, congestive heart failure, cerebrovascular accident), anemia, and leukocytosis. C-statistic for the overall model was 0.85. Results were relatively similar for patients younger than the age of 65 years as well as for discharge to inpatient rehabilitation and discharge home with services. CONCLUSIONS: Numerous sociodemographic and clinical characteristics influence the risk of non-home discharge and discharge to inpatient rehabilitation in patients undergoing ACDF. Policy makers and payers should consider these factors when determining appropriate preoperative adjustment for risk-based reimbursements.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia Percutânea/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Fusão Vertebral/estatística & dados numéricos , Adulto , Fatores Etários , Comorbidade , Feminino , Humanos , Degeneração do Disco Intervertebral/reabilitação , Degeneração do Disco Intervertebral/cirurgia , Masculino , Estado Civil , Medicaid/estatística & dados numéricos , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia
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