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1.
BMC Musculoskelet Disord ; 22(1): 981, 2021 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-34819053

RESUMO

BACKGROUND: The newly designed cervical disc prosthesis, Pretic-I, had been finished its limited clinical use for over 5 years. At a short-term follow-up of 2 years, we obtained satisfactory clinical results. The long-term clinical efficacy and safety of Pretic-I will now be analyzed. METHODS: Peri-operative parameters included intra-operative blood loss, operation time, off-bed time. Clinical parameters included visual analogue scale (VAS) for arm and neck, neck disability index (NDI), and Japanese Orthopaedic Association (JOA) score. Radiological parameters included C2-7 Cobb angle, Shell angle, and the range of motion (ROM) of C2-7, functional segment unit (FSU), and adjacent FSU. The CDA-related complications included adjacent segment degeneration (ASDeg), adjacent segment disease (ASDis), heterotopic ossification (HO), prosthesis subsidence, prosthesis displacement, and dysphagia. RESULTS: A total 64 patients from two independent centers received a single-level CDA with Discover (n = 32) and Pretic-I (n = 32), and all of patients finished a 5-year follow-up. There're no significant differences between two groups in peri-operative parameters. The clinical parameters improved greatly in Pretic-I group (p<0.0001), and there's no statistical difference from Discover group. Furthermore, Pretic-I could slightly improve the cervical curvature (15.08 ± 11.75 to 18.00 ± 10.61, p = 0.3079) and perfectly maintain the Shell angle (3.03 ± 3.68 to 2.23 ± 4.10, p = 0.1988), cervical ROM (52.48 ± 14.31 to 53.30 ± 11.71, p = 0.8062) and FSU ROM (12.20 ± 4.52 to 10.73 ± 4.45, p = 0.2002). The incidence of high-grade HO (Grade III-IV) at the final follow-up was significantly lower in Pretic-I group than in Discover group (12.50% vs. 34.38%, p = 0.0389, Statistical Power = 95.36%). The incidences of other CDA-related complications in Pretic-I group were also well-accepted, comparable to the Discover group, without significant differences. CONCLUSION: CDA with Pretic-I demonstrated a well-accepted and sustained clinical outcome, with a significantly lower incidence of high-grade HO. This newly designed prosthesis is expected to become an alternative choice for cervical disc prosthesis in the future.


Assuntos
Membros Artificiais , Degeneração do Disco Intervertebral , Disco Intervertebral , Substituição Total de Disco , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Seguimentos , Humanos , Disco Intervertebral/cirurgia , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Substituição Total de Disco/efeitos adversos , Resultado do Tratamento
2.
Neurosurg Clin N Am ; 32(4): 449-460, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34538471

RESUMO

This article reviews the available literature for novel cervical total disc replacement devices, including ones which are available inside and outside of the United States. It includes biomechanical consideration as well as design characteristics and clinical data when available.


Assuntos
Degeneração do Disco Intervertebral , Disco Intervertebral , Fusão Vertebral , Substituição Total de Disco , Vértebras Cervicais/cirurgia , Humanos , Disco Intervertebral/cirurgia , Degeneração do Disco Intervertebral/cirurgia , Estudos Prospectivos , Resultado do Tratamento , Estados Unidos
3.
Neurosurg Clin N Am ; 32(4): 493-504, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34538475

RESUMO

Prosthesis design has an influence on the quantity and quality of postoperative motion after cervical disc arthroplasty. Prostheses with built-in resistance to angular and translational motion may have an advantage in restoring physiologic motion. The ability of a prosthesis to work with remaining bony and soft tissues to restore motion and load-sharing is a function of the kinematic degrees of freedom DOF, axis of rotation for a given motion, and device stiffness. How these characteristics allow the prosthesis to work with the patient's anatomy will determine whether the prosthesis is successful at restoring motion and mitigating adjacent-level stresses.


Assuntos
Vértebras Cervicais , Disco Intervertebral , Artroplastia , Fenômenos Biomecânicos , Vértebras Cervicais/cirurgia , Humanos , Disco Intervertebral/cirurgia , Desenho de Prótese , Amplitude de Movimento Articular
4.
Neurosurg Focus ; 51(2): E17, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34333480

RESUMO

OBJECTIVE: Today, minimally invasive procedures have become mainstream surgical procedures. Percutaneous endoscopic transforaminal discectomy for lumbar disc herniation (LDH) requires profound knowledge of the laparoscopic lumbar anatomy. Immersive virtual reality (VR) provides three-dimensional patient-specific models to help in the process of preclinical surgical preparation. In this study, the authors investigated the efficacy of VR application in LDH for training orthopedic residents and postgraduates. METHODS: VR images of the lumbar anatomy were created with immersive VR and mAnatomy software. The study was conducted among 60 residents and postgraduates. A questionnaire was developed to assess the effect of and satisfaction with this VR-based basic and clinical fused curriculum. The teaching effect was also evaluated through a postlecture test, and the results of the prelecture surgical examination were taken as baselines. RESULTS: All participants in the VR group agreed that VR-based education is practical, attractive, and easy to operate, compared to traditional teaching, and promotes better understanding of the anatomical structures involved in LDH. Learners in the VR group achieved higher scores on an anatomical and clinical fusion test than learners in the traditional group (84.67 ± 14.56 vs 76.00 ± 16.10, p < 0.05). CONCLUSIONS: An immersive VR-based basic and clinical fused curriculum can increase residents' and postgraduates' interest and support them in mastering the structural changes and complicated symptoms of LDH. However, a simplified operational process and more realistic haptics of the VR system are necessary for further surgical preparation and application.


Assuntos
Discotomia Percutânea , Deslocamento do Disco Intervertebral , Disco Intervertebral , Realidade Virtual , Currículo , Humanos , Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia
5.
Sci Rep ; 11(1): 16615, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34400738

RESUMO

This study describes a morphology-based unilateral cervical facet interlocking classification in an attempt to clarify the injury mechanism, instability, neurological deficits, radiological features, and determine optimum management strategies for these injuries. A total of 55 patients with unilateral cervical locked facet (UCLF) involving C3 to C7 were identified between January 1, 2012 and December 1, 2019. The injuries were classified into three types, and they were further divided into six subtypes using three-dimensional computed tomography. The injury mechanism, clinical features, neurological deficits, and imaging characteristics were analyzed, and the appropriate treatment strategies for UCLF were discussed. UCLFs were divided into the following six subtypes: UCLF without lateral mass-facet fracture (type I) in nine cases, with superior articular process fracture (type II A) in 22, with inferior articular process fracture (type II B) in seven, both superior and inferior articular process fractures (type II C) in four, with lateral mass splitting fracture (type III A) in three, and with lateral mass comminution fractures (type III B) in ten. A total of 22 (40.0%) of the 55 patients presented with radiculopathy, and 23 patients (41.8%) had spinal cord injuries. The subtype analyses showed high rates of radiculopathy in types II A (68.2%) and II C (75.0%), as well as significant spinal cord injury in types I (77.8%) and III (61.5%). Destruction of the facet capsule was observed in all patients, but the injury of disc, ligamentous complex, and vertebra had a significant difference among the types or subtypes. The instability parameters of the axial rotation angle, segmental kyphosis, and sagittal displacement showed significant differences in various types of UCLF. Closed reduction by preoperative and intraoperative general anesthesia traction was achieved in 27 patients (49.1%), and successful rate of closed reduction in type I (22.2%) was significantly lower than that in type II (51.5%) and type III (61.5%). A total of 35 of 55 patients underwent a single anterior fixation and fusion, 10 patients were treated with posterior pedicle and (or) lateral mass fixation, and combined surgery was performed in ten patients. Ten patients (18.2%) with a poor outcome were observed after first surgery. Among them, 3 patients treated with a single anterior surgery had persistent or aggravated radiculopathy and posterior approach surgery with ipsilateral facet resection, foramen enlargement, and pedicle and (or) lateral mass screw fixation was performed immediately, 5 patients treated with a short-segment posterior surgery showed mild late kyphosis deformity, and 2 patients with vertebral malalignment were encountered after anterior single-level fusion during the follow-up. This retrospective study indicated that UCLF is a rotationally unstable cervical spine injury. The classification proposed in this study will contribute to understanding the injury mechanism, radiological characteristics, and neurological deficits in various types of UCLF, which will help the surgeons to evaluate the preoperative closed reduction and guide the selection of surgical approach and fusion segment.


Assuntos
Vértebras Cervicais/lesões , Fraturas da Coluna Vertebral/diagnóstico por imagem , Articulação Zigapofisária/lesões , Adulto , Parafusos Ósseos , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Feminino , Seguimentos , Humanos , Imageamento Tridimensional , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/lesões , Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Radiculopatia/etiologia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Tomografia Computadorizada por Raios X , Tração , Articulação Zigapofisária/diagnóstico por imagem , Articulação Zigapofisária/cirurgia
6.
J Mech Behav Biomed Mater ; 122: 104689, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34298452

RESUMO

One-piece bearing is the latest type of total disc replacement (TDR) design that is used for the treatment of lumbar degenerative disc disease (DDD). Due to the unique properties of the shape memory polymers (SMPs), such as self-healing, shape-memory, adhesion control, and self-deployable ability, they may be a good candidate for the core of such a design. The purpose of the present study is to use an analytical method combined with a numerical analysis (finite element analysis (FEA)) to determine the mechanical responses of an SMP intervertebral disc (IVD) model, under pure torsion (axial rotation) and pure compression, two loading conditions to which natural intervertebral discs (IVDs) are subjected in vivo. We considered the SMP IVD model to be positioned at L4-L5 because most cases of lumbar DDD are reported at this segment. For the analytical method, an appropriate constitutive equation for an SMP was determined and, then, an analytical solution for the torsional response of a circular SMP IVD model, in a full cycle of stress-free strain recovery, was derived. The developed equations were implemented in finite element modeling to determine responses of the IVD disc model under pure torsion. Additionally, responses of the SMC IVD model, under a compressive load, and different conditions were determined. The analytical and FEA results were compared to experimental results give in the literature for intact lumbar spine segments as the core in a one-piece lumbar TDR. Based on this study, we suggest that SMPs can be used for TDR, as they are strong enough to bear the torsional and compressive loads that IVD is subjected through its life.


Assuntos
Degeneração do Disco Intervertebral , Disco Intervertebral , Materiais Inteligentes , Substituição Total de Disco , Fenômenos Biomecânicos , Análise de Elementos Finitos , Humanos , Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia
7.
J Clin Neurosci ; 89: 365-374, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34088576

RESUMO

An understanding of the common MRI findings observed after decompression surgery is important. However, to date, no study addressing this has been published. The aim of this study was to analyze and describe the immediate postoperative MRI findings after lumbar decompression surgery. We retrospectively analyzed the immediate postoperative MRIs of 121 consecutive patients who underwent lumbar decompression surgery between July 2017 and June 2018. Changes in stenosis at the decompressed and adjacent levels, epidural fat edema, epidural and subdural fluid collections, nerve root swelling, facet joint effusions, intervertebral disc signal, and paravertebral muscle edema were correlated with clinical characteristics. Both groups had reduced central canal stenosis postoperatively (p < 0.001) but worsened stenosis at adjacent segments. Fluid collection, hemorrhagic or non-hemorrhagic, at the laminectomy site was the commonest finding (one-level: 73.8%, two-level: 88.5%), with a higher percentage of severe central canal compromise in the two-level decompression group (p = 0.003). Other postoperative MRI findings, such as epidural fat edema, nerve root swelling, subdural fluid collection, and facet joint effusion, were noted without statistical significance. In conclusion, even with successful decompression for lumbar canal stenosis, increased central canal stenosis at adjacent segments is common on immediate postoperative MRI scans, showing no statistically significant correlation with the immediate postoperative outcome. Postoperative fluid collection at the laminectomy site is the commonest imaging finding, and higher rates of hemorrhagic fluid and more severe central canal compromise occur in two-level decompression, but rarely cause clinical problems.


Assuntos
Descompressão Cirúrgica/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Estenose Espinal/cirurgia , Idoso , Descompressão Cirúrgica/efeitos adversos , Espaço Epidural/cirurgia , Humanos , Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/patologia
8.
Acta Orthop Traumatol Turc ; 55(3): 246-252, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34100366

RESUMO

OBJECTIVE: The aim of this study was to explore the alterations in levels of pro-inflammatory and catabolic mediators following vertebral fusion in a rabbit model of intervertebral disc degeneration. METHODS: In this study, 24 female New Zealand albino rabbits (aged 4 to 5 months and weighing 3 to 3.5 kg) were used. All the animals were randomly categorized into four groups, and dorsal spinal exposure of all lumbar vertebrae was routinely performed in each group. While disc degeneration was created in groups B, C, and D, spinal fusion was added to disc degeneration in groups C and D. Disc degeneration was typically created by puncturing the discs with an 18-gauge needle under the guidance of C-arm imaging. Fusion was achieved with posterior/posterolateral decortication and iliac bone grafts. The rabbits in groups A, B, and C were euthanized, and the discs were removed in the first week after the surgery. The rabbits in Group D were sacrificed, and the discs were harvested at 5 weeks after the surgery. The levels of Interleukin (IL)-1ß, IL-6, Nitric Oxide (NO), Matrix Metalloproteinase (MMP)-3, MMP-13, and Tissue Inhibitor of Metalloproteinases-1 (TIMP-1) in the discs were analyzed using enzyme-linked immunosorbent assay kits. RESULTS: Significant increase was observed in the protein levels of both pro-inflammatory and catabolic mediators in disc degeneration groups (Group B, C, and D) compared to Group A. In the fusion groups (Group C and D), these increased mediators decreased, compared to non-fusion group (Group B), (IL1-ß P = 0.017, TIMP-1 P = 0.03, NO P = 0.03). However, there was no statistically significant difference in mediator levels between the short- and long-term fusion (Group C versus D). CONCLUSION: The results of this study have shown that a significant decrease in pro-inflammatory and catabolic mediators may be expected after vertebral fusion whereas there may be no significant difference between the first and fourth week of fusion surgery. These findings may contribute to clarifying the mechanism of action of vertebral fusion in the treatment of low back pain.


Assuntos
Degeneração do Disco Intervertebral , Disco Intervertebral , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Animais , Mediadores da Inflamação/análise , Interleucina-1beta/análise , Interleucina-6/análise , Disco Intervertebral/metabolismo , Disco Intervertebral/cirurgia , Degeneração do Disco Intervertebral/imunologia , Degeneração do Disco Intervertebral/metabolismo , Degeneração do Disco Intervertebral/cirurgia , Dor Lombar/etiologia , Dor Lombar/imunologia , Dor Lombar/prevenção & controle , Metaloproteinase 3 da Matriz/análise , Metabolismo , Óxido Nítrico/análise , Coelhos
9.
Med Eng Phys ; 93: 35-41, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34154773

RESUMO

One-in-five people suffer from chronic low back pain (LBP). The incidence of this disease has doubled since 1950s and affects not only the elderly, but also the young population. However, the mechanism of LBP is still unknown. A possible location where the LBP may develop is the facet joint and it has been revealed that the intervertebral disc (IVD) nucleotomy may be a trigger for LBP. The aim of the present study was to investigate the influence of IVD nucleotomy on the load sharing in the spinal facet joint under the loading scenarios of different postures. Finite element (FE) models of the intact and nucleotomised L4 - L5 spinal segments were generated from the clinical CT images. Seven human postures, including upright, 5° extension, 5° flexion, ± 6° lateral bending and ± 2° axial rotation, were simulated. The resultant forces in the fact joint were compared between the intact and the nucleotomised cases. It was revealed that the IVD nucleotomy significantly increased the forces in the facet joints under the loading scenarios of upright, 5° extension and 5° flexion. The IVD nucleotomy increased the force in the ipsilateral facet joint but decreased the force on the contralateral side under the loading scenarios of ± 2° axial rotation. However, the IVD nucleotomy made little influence on the resultant forces in both facet joints in the postures of ± 6° lateral bending. In conclusion, the IVD nucleotomy can cause an increase in the overall force in the facet joint, and thus may serve as a possible explanation for the LBP and a main contributing factor for the pain complaints.


Assuntos
Disco Intervertebral , Articulação Zigapofisária , Idoso , Fenômenos Biomecânicos , Análise de Elementos Finitos , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Postura , Amplitude de Movimento Articular , Suporte de Carga , Articulação Zigapofisária/diagnóstico por imagem , Articulação Zigapofisária/cirurgia
10.
World Neurosurg ; 151: e927-e934, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33991730

RESUMO

OBJECTIVE: Cervical chest pain (CCP), as 1 atypical symptom associated with cervical spondylosis, often overlaps with other chest-related diseases. CCP obviously relieved after ultrasound-guided cervical nerve root block near a herniated disc should be considered as a potential pathologic source. The purpose of this study is to investigate whether coblation discoplasty can alleviate CCP after positive ultrasound-guided nerve root block. METHODS: From August 2016 to September 2019, 21 patients with high suspicion of CCP experienced over 50% pain relieve after ultrasound-guided diagnostic nerve root block. Through 12 months of follow-up, the primary efficacy was assessed with visual analogue scale (VAS) of CCP, and secondary outcomes included: neck pain VAS, neck disability index (NDI), the proportion of significant CCP relief, the rating of CCP alleviation, the patient satisfaction index (PSI), and analgesic consumption. Adverse events were recorded to evaluate safety. RESULTS: Following postoperative 12 months, a time-course analysis confirmed a robust decline in VAS of CCP (P < 0.0001), and a similar recovery trend was shown in VAS of neck pain and NDI (P < 0.0001). After treatment, the number of patients taking analgesics decreased (P < 0.0001), and around 60% of patients reported notable relief and satisfaction with treatment. No serious complications were observed. CONCLUSIONS: After positive ultrasound-guided nerve root block, coblation discoplasty can provide up to 12 months of relief for intractable CCP.


Assuntos
Dor no Peito/etiologia , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/cirurgia , Ultrassonografia de Intervenção/métodos , Técnicas de Ablação/métodos , Adulto , Idoso , Vértebras Cervicais , Dor no Peito/diagnóstico , Eletrocirurgia/métodos , Feminino , Humanos , Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Estudos Retrospectivos , Raízes Nervosas Espinhais , Espondilose/complicações , Espondilose/cirurgia
11.
J Orthop Surg Res ; 16(1): 298, 2021 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-33952278

RESUMO

OBJECTIVE: We aimed to evaluate reliability, radiological outcomes, and the impacts of anterior cervical hybrid construction on the adjacent segments for the multilevel cervical degenerative disc disease (mCDDD) and spondylotic spinal stenosis (SSS). METHODS: A retrospective analysis was performed using data extracted from the medical files of 195 patients (105 males, 90 females; mean age: 47.7 years). From 2008 to 2018, these patients underwent anterior cervical hybrid construction for symptomatic contiguous at least 2-level cervical degenerative disc diseases and cervical spondylosis. Clinical and radiological data including Neck Disability Index (NDI), visual analogue scale (VAS), local cervical degenerative disk disease in adjacent segments on magnetic resonance imaging (MRI) views, and complications were reviewed. RESULTS: The mean clinical and radiological follow-up was 45.2 months (range 24 to 102). Radiculopathy and/or myelopathy were the main clinical problems in all patients. The mean VAS scores of HC for arm pain were 7.4 ± 0.8 preoperatively; 2.8 ± 0.6, 1 month after surgery; 2.3 ± 0.6, 6 months after surgery; 1.8 ± 0.6, 12 month after surgery; and 1.6 ± 0.6, 24 months after surgery. The mean NDI scores (mean ± SD) of HC significantly improved after surgery (on admission, 57.2 ± 5.5%; 1 month after surgery, 27.35 ± 5.3%; 6 month after surgery, 21.43 ± 2.8%; 12 months after surgery, 21.9 ± 2.3%; 24 months after surgery, 20.6 ± 2.6%, p = 0.006). Hoarseness and dysphagia were the most common complications and osteophyte formation was the most frequent radiographic change. CONCLUSION: Anterior cervical hybrid construction appears to be an acceptable option in the management of multilevel cervical degenerative disc diseases and spondylotic spinal stenosis.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/métodos , Discotomia/métodos , Degeneração do Disco Intervertebral/cirurgia , Disco Intervertebral/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estenose Espinal/cirurgia , Espondilose/cirurgia , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/etiologia , Espondilose/complicações , Espondilose/diagnóstico por imagem , Resultado do Tratamento
12.
PLoS One ; 16(4): e0250270, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33857243

RESUMO

The quadrilateral anterior cervical plate (ACP) is used extensively in anterior cervical discectomy and fusion (ACDF) to reconstruct the stability of the cervical spine and prevent cage subsidence. However, there have been no comparison studies on the biomechanical performance of quadrilateral ACP and triangular ACP. The objective of this study is to investigate the functional outcomes of quadrilateral ACP and triangular ACP usage in ACDF surgery. In this study, a finite element model of intact C1-C7 segments was established and verified. Additionally, two implant systems were built; one using triangle anterior cervical plates (TACP) and another using quadrilateral orion anterior cervical plate (QACP). Both models were then compared in terms of their postoperative biomechanical performance, under normal and excessive motion. Compared to QACP, the peak stress of the TACP screws and plates occurred at 359.2 MPa and 97.2 MPa respectively and were the highest during over extension exercises. Alternately, compared to TACP, the endplate peak stress and the cage displacement of QACP were the largest at over extension, with values of 7.5 MPa and 1.2 mm, respectively. Finally, the average stress ratio of bone grafts in TACP was relatively high at 31.6%. In terms of biomechanical performance, TACP can share the load more flexibly and reduce the risks of cage subsidence and slippage but the screws have high peak stress value, thereby increasing the risk of screw slippage and fracture. This disadvantage must be considered when designing a TACP based implant for a potential patient.


Assuntos
Placas Ósseas , Parafusos Ósseos , Transplante Ósseo/instrumentação , Vértebras Cervicais/cirurgia , Modelos Anatômicos , Fusão Vertebral/métodos , Fenômenos Biomecânicos , Vértebras Cervicais/diagnóstico por imagem , Discotomia/métodos , Análise de Elementos Finitos , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/cirurgia , Amplitude de Movimento Articular/fisiologia , Fusão Vertebral/instrumentação , Estresse Mecânico , Tomografia Computadorizada por Raios X
13.
J Orthop Surg Res ; 16(1): 274, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33882995

RESUMO

OBJECTIVE: To develop and validate a nomogram useful in predicting recurrent lumbar disk herniation (rLDH) within 6 months after percutaneous endoscopic lumbar discectomy (PELD). METHODS: Information on patients' lumbar disk herniation (LDH) between January 2018 and May 2019 in addition to 26 other features was collected from the authors' hospital. The least absolute shrinkage and selection operator (LASSO) method was used to select the most important risk factors. Moreover, a nomogram was used to build a prediction model using the risk factors selected from LASSO regression. The concordance index (C-index), the receiver operating characteristic (ROC) curve, and calibration curve were used to assess the performance of the model. Finally, clinical usefulness of the nomogram was analyzed using the decision curve and bootstrapping used for internal validation. RESULTS: Totally, 352 LDH patients were included into this study. Thirty-two patients had recurrence within 6 months while 320 showed no recurrence. Four potential factors, the course of disease, Pfirrmann grade, Modic change, and migration grade, were selected according to the LASSO regression model. Additionally, the C-index of the prediction nomogram was 0.813 (95% CI, 0.726-0.900) and the area under receiver operating characteristic curve (AUC) value was 0.798 while the interval bootstrapping validation C-index was 0.743. Hence, the nomogram might be a good predictive model. CONCLUSION: Each variable, the course of disease, Pfirrmann grade, Modic change, and migration grade in the nomogram had a quantitatively corresponding risk score, which can be used in predicting the overall recurrence rate of rLDH within 6 months.


Assuntos
Discotomia Percutânea/métodos , Endoscopia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Nomogramas , Adulto , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Risco , Fatores de Risco , Fatores de Tempo
14.
J Orthop Surg Res ; 16(1): 280, 2021 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-33906692

RESUMO

OBJECTION: The overarching goal of our research was to compare the clinical and radiological outcomes with different sizes of cages implantation in anterior cervical discectomy and fusion (ACDF), and to evaluate the effects on surgical and adjacent segmental intervertebral foramina. METHODS: The clinical data of 61 patients were analyzed retrospectively. The radiological data included the surgical intervertebral disk space height before (H0) and after surgery (H), the preoperative mean height of adjacent segments (Hm), the area and height of the surgical and adjacent segment foramen, the surgical segmental Cobb angle (α1), and C2-7Cobb angle (α2). The calculation of clinical data was conducted by Japanese Orthopaedic Association Scores (JOA), the recovery rate of JOA scores and visual analog scales (VAS). In accordance with the different ranges of distraction (H/Hm), patients were classified into three groups: group A (H/Hm<1.20, n=13), group B (1.20≤H/Hm≤1.80, n=37), and group C (H/Hm>1.80, n=11). RESULTS: After the operation and at the final follow-up, our data has demonstrated that the area and height of surgical segmental foramen all increased by comparing those of preoperation in three groups (all P<0.05). However, except for a decrease in group C (all P<0.05), the adjacent segmental foramina showed no significant changes (all P>0.05). The area and height of the surgical segment foramen and the distraction degree were positively correlated (0

Assuntos
Vértebras Cervicais/cirurgia , Discotomia/métodos , Disco Intervertebral/cirurgia , Desenho de Prótese , Ajuste de Prótese , Implantação de Prótese/métodos , Canal Medular/cirurgia , Fusão Vertebral/métodos , Adulto , Feminino , Seguimentos , Humanos , Disco Intervertebral/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Canal Medular/diagnóstico por imagem , Canal Medular/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
J Orthop Surg Res ; 16(1): 251, 2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33849588

RESUMO

OBJECTIVE: The aim of this retrospective study is to review our experience in the diagnosis and role of transforaminal percutaneous endoscopic discectomy (TPED) for symptomatic gas-filled discal cysts. METHODS: Between May 2014 and June 2017, 3 patients from Lishui Center Hospital (Lishui China), who underwent TPED for symptomatic gas-filled discal cysts, were analyzed. The clinical features, imaging findings, operative findings, and treatment outcomes are presented. In addition, relevant literature regarding gas-filled discal cysts was searched using PubMed, and their characteristics, clinical features, therapeutic strategies, and survival outcomes were reviewed. RESULTS: The median age of the patients was 56.7 years (range, 55-60 years). In all patients, a discal cyst was located in the lumbar region, and the patients presented with backache and numbness in the lower extremities. The diagnosis was made by lumbar 3-dimensional computed tomography (3D-CT) or magnetic resonance imaging (MRI). All patients underwent TPED. All patients recovered successfully and were eventually discharged. Eighteen articles were identified from the searches of the database, and a total of 42 patients were included. There were 28 males and 14 females. The mean age was 56.8 years, ranging from 27 to 85 years. Lower back pain was the major symptom. Twenty-two patients underwent surgery, 4 patients underwent percutaneous needle aspiration, 2 patients underwent drug therapy, 13 patients received nonoperative treatment, and 1 patient was unknown. CONCLUSION: TPED for gas-filled discal cysts is feasible, effective, and successful, although it should be performed by an experienced surgeon with awareness of the potential risk of severe nerve root injury.


Assuntos
Cistos/cirurgia , Discotomia Percutânea/métodos , Endoscopia/métodos , Gases/metabolismo , Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Doenças da Coluna Vertebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistos/metabolismo , Estudos de Viabilidade , Feminino , Humanos , Disco Intervertebral/metabolismo , Vértebras Lombares/metabolismo , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças da Coluna Vertebral/metabolismo , Resultado do Tratamento
16.
Int J Mol Sci ; 22(8)2021 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-33921913

RESUMO

Degenerated intervertebral discs (IVDs) were treated with autologous adipose-derived stem cells (ASC) loaded into an injectable collagen scaffold in a sheep model to investigate the implant's therapeutic potential regarding the progression of degeneration of previously damaged discs. In this study, 18 merino sheep were subjected to a 3-step minimally invasive injury and treatment model, which consisted of surgically induced disc degeneration, treatment of IVDs with an ASC-loaded collagen hydrogel 6 weeks post-operatively, and assessment of the implant's influence on degenerative tissue changes after 6 and 12 months of grazing. Autologous ASCs were extracted from subcutaneous adipose tissue and cultivated in vitro. At the end of the experiment, disc heights were determined by µ-CT measurements and morphological tissue changes were histologically examined.Histological investigations show that, after treatment with the ASC-loaded collagen hydrogel implant, degeneration-specific features were observed less frequently. Quantitative studies of the degree of degeneration did not demonstrate a significant influence on potential tissue regeneration with treatment. Regarding disc height analysis, at both 6 and 12 months after treatment with the ASC-loaded collagen hydrogel implant a stabilization of the disc height can be seen. A complete restoration of the intervertebral disc heights however could not be achieved.The reported injection procedure describes in a preclinical model a translational therapeutic approach for degenerative disc diseases based on adipose-derived stem cells in a collagen hydrogel scaffold. Further investigations are planned with the use of a different injectable scaffold material using the same test model.


Assuntos
Colágeno/uso terapêutico , Hidrogéis/química , Degeneração do Disco Intervertebral/cirurgia , Disco Intervertebral/cirurgia , Animais , Colágeno/administração & dosagem , Modelos Animais de Doenças , Feminino , Medicina Regenerativa/métodos , Ovinos
17.
J Orthop Surg Res ; 16(1): 207, 2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33752710

RESUMO

STUDY DESIGN: A bibliometric review of the literature. OBJECTIVE: To identify the most frequently cited articles relating to the repair of intervertebral disc (IVD) and to summarize the key points and findings of these highly cited works, to quantify their impact on the developments of the disc disease treatment. IVD repair is an ever-growing and multi-disciplinary innovating treatment method for disc diseases. There are numerous literatures and related studies about it, promoting the development of the field. A comprehensive review and analysis of the most influential articles can help clarify the most effective strategy of IVD repair, and discover the promising directions for future research. METHODS: The Thomson Reuters Web of Knowledge was searched for citations of all literatures relevant to IVD repair. The number of citations, key points, categories, authorships, years, journals, countries, and institutions of publications were analyzed. RESULTS: The most highly cited articles in IVD Repair were published over 30 years, between 1991 and 2017. Most works (No. 41) were published between 2005 and 2009. The most-cited article was Sakai's 2003 article which described the possibility of combining MSC and gel to repair IVD. The three most popular categories involved were Orthopedics [44], Clinical Neurology [34], Engineering, and Biomedical [24]. The three most common topics were regenerative medicine and the progenitor cells [33], biomaterials and cellular scaffolds [29], application of growth factors [25]. Author Masuda and the partners have 4 articles in the top 100 list. The Rush University has 12 articles in the top 100 list. CONCLUSION: This report identifies the top 100 articles in IVD repair and acknowledges those individuals who have contributed the most to the study of the IVD repair and the body of knowledge used to the repair strategy making. It allows insight into the trends of this innovative and interdisciplinary subspecialty of spine surgery.


Assuntos
Bibliometria , Disco Intervertebral/cirurgia , Doenças da Coluna Vertebral/cirurgia , Materiais Biocompatíveis , Humanos , Peptídeos e Proteínas de Sinalização Intercelular , Neurologia , Procedimentos Ortopédicos , Medicina Regenerativa , Células-Tronco
18.
Spine (Phila Pa 1976) ; 46(19): E1022-E1030, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33660678

RESUMO

STUDY DESIGN: Micro-computed tomography- (micro-CT-) based finite element analysis of cadaveric human lumbar vertebrae virtually implanted with total disc arthroplasty (TDA) implants. OBJECTIVE: (1) Assess the relationship between vertebral porosity and maximum levels of bone-tissue stress following TDA; (2) determine whether the implant's loading mode (axial compression vs. sagittal bending) alters the relationship between vertebral porosity and bone-tissue stress. SUMMARY OF BACKGROUND DATA: Implant subsidence may be related to the bone biomechanics in the underlying vertebral body, which are poorly understood. For example, it remains unclear how the stresses that develop in the supporting bone tissue depend on the implant's loading mode or on typical inter-individual variations in vertebral morphology. METHODS: Data from micro-CT scans from 12 human lumbar vertebrae (8 males, 4 females; 51-89 years of age; bone volume fraction [BV/TV] = 0.060-0.145) were used to construct high-resolution finite element models (37 µm element edge length) comprising disc-vertebra-implant motion segments. Implants were loaded to 800 N of force in axial compression, flexion-, and extension-induced impingement. For comparison, the same net loads were applied via an intact disc without an implant. Linear regression was used to assess the relationship between BV/TV, loading mode, and the specimen-specific change in stress caused by implantation. RESULTS: The increase in maximum bone-tissue stress caused by implantation depended on loading mode (P < 0.001), increasing more in bending-induced impingement than axial compression (for the same applied force). The change in maximum stress was significantly associated with BV/TV (P = 0.002): higher porosity vertebrae experienced a disproportionate increase in stress compared with lower porosity vertebrae. There was a significant interaction between loading mode and BV/TV (P = 0.002), indicating that loading mode altered the relationship between BV/TV and the change in maximum bone-tissue stress. CONCLUSION: Typically-sized TDA implants disproportionately increase the bone-tissue stress in more porous vertebrae; this affect is accentuated when the implant impinges in sagittal bending.Level of Evidence: N/A.


Assuntos
Disco Intervertebral , Substituição Total de Disco , Fenômenos Biomecânicos , Osso e Ossos , Feminino , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Porosidade , Estresse Mecânico , Corpo Vertebral , Microtomografia por Raio-X
19.
Neurochirurgie ; 67(4): 346-349, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33757775

RESUMO

STUDY DESIGN: Retrospective analysis. OBJECTIVE: To define C2-C3 vertebral disc angle (VDA) in patients with and without cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA: C2-C3 VDA is a new radiological index of cervical spine alignment. Recent studies have suggested that high postoperative values are associated with greater mechanical complications in patients with cervical spondylotic myelopathy. However, normative values for patients without myelopathy has yet to be defined. METHODS: Patients with and without cervical myelopathy between 2017 and 2019 were included. Inclusion criteria were patients above 18 years of age with antero-posterior (AP) and lateral (LAT) cervical X-rays. In the non-myelopathic group, patients were excluded if they had neurological symptoms or deficits, presence of cervical axial pain, previous spinal surgery, or diagnosis of either spondylolisthesis or scoliosis. In the myelopathic group, patients were excluded if they had previous spinal surgery. Radiological indices evaluated include: C2-C3 disc angle, C2-C7 Cobb angle, C7 sagittal vertical axis, T1 slope. RESULTS: In total, 99 patients without myelopathy and 22 patients with myelopathy were identified and analyzed. In patients without myelopathy, the mean for C2-C3 VDA was 25.9±7.9. For patients with myelopathy, preoperative values were 24.4±10.0 and 27.1±7.9 postoperatively. No statistically significant differences were found between patients with and without myelopathy. C2-C3 disc angle was not correlated with age (R=-0.173). CONCLUSION: This study did not find statistically significant differences in C2-C3 VDA values between patients with and without cervical myelopathy. This study provides normative data for C2-C3 vertebral disc angle in patients with and without cervical spondylotic myelopathy. Furthermore, C2-C3 vertebral disc angle may be independent from age.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Disco Intervertebral/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Espondilose/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/cirurgia , Feminino , Humanos , Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Cervicalgia/diagnóstico por imagem , Cervicalgia/cirurgia , Estudos Retrospectivos , Doenças da Medula Espinal/cirurgia , Espondilose/cirurgia , Adulto Jovem
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