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2.
Medicine (Baltimore) ; 103(27): e38816, 2024 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-38968494

RESUMO

Although anterior cervical discectomy and fusion (ACDF) is one of the most frequently performed spinal surgeries, there is no consensus regarding the necessity of prescribing a cervical brace after surgery. This study aimed to investigate any difference in radiological and clinical outcomes when wearing or not wearing cervical braces after single- or double-level ACDF. We examined 2 cohorts of patients who underwent single- or double-level ACDF surgery with and without a cervical brace: patients who underwent ACDF between March 2018 and December 2019 received a cervical brace, while patients who underwent ACDF between January 2020 and May 2021 did not. Each patient was evaluated radiologically and functionally using plain X-ray, modified Japanese Orthopedic Association score, and visual analog scale for neck and arm until 12 months after surgery. Fusion rate, subsidence, and postoperative complications were also evaluated. Eighty-three patients were included in the analysis: 38 were braced and 45 were not. The demographic characteristics and baseline outcome measures of both groups were similar. There was no statistically significant difference in any of the clinical measures at baseline. The modified Japanese Orthopedic Association score and visual analog scale for neck and arm were similar in both groups at all time intervals and showed statistically significant improvement when compared with preoperative scores. In addition, fusion rate, subsidence, and postoperative complications were similar in both groups. Our results suggest that the use of cervical braces does not improve the clinical outcomes of individuals undergoing single- or double-level ACDF.


Assuntos
Braquetes , Vértebras Cervicais , Discotomia , Fusão Vertebral , Humanos , Feminino , Masculino , Fusão Vertebral/métodos , Pessoa de Meia-Idade , Vértebras Cervicais/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Discotomia/métodos , Estudos Retrospectivos , Idoso , Complicações Pós-Operatórias/epidemiologia , Adulto , Resultado do Tratamento
3.
Medicine (Baltimore) ; 103(29): e39016, 2024 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-39029030

RESUMO

RATIONALE: Dysphagia after anterior cervical discectomy and fusion (ACDF) is a common postoperative complication. However, information regarding rehabilitation strategies for postoperative dysphagia is limited. Herein, we report a compensatory strategy for treating dysphagia after ACDF. PATIENT CONCERNS: A 65-year-old Asian male presented with left arm pain and weakness for more than 1 month. Magnetic resonance imaging of the cervical spine revealed degenerative disc lesions and spinal stenosis at the C3 to C7 levels. The patient underwent ACDF at the C3 to C5 levels and artificial disc replacement at the C5 to C7 levels by right side approach. After surgery, the patient complained of difficulty swallowing. A video fluoroscopic swallowing study (VFSS) detected swallowing dysfunction in the pharyngeal phase, revealing an asymmetric pharyngeal residue in the anterior-posterior view. DIAGNOSIS: The patient was diagnosed with dysphagia after ACDF. INTERVENTIONS: Based on the VFSS findings, the patient underwent swallowing rehabilitation therapy and compensatory techniques, such as head rotation to the weak right side and head tilting to the robust left side. OUTCOMES: After 2 months of rehabilitation with compensatory techniques, food moved smoothly towards the robust side, and the subjective symptoms of dysphagia improved. LESSONS: Consequently, swallowing function post-ACDF surgery must be assessed; if unilateral dysphagia is detected, compensatory techniques may prove beneficial. This case study showed that, based on the objective findings of the VFSS, an effective swallowing compensation strategy can be established and applied to patients with postoperative dysphagia.


Assuntos
Vértebras Cervicais , Transtornos de Deglutição , Discotomia , Complicações Pós-Operatórias , Fusão Vertebral , Humanos , Masculino , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/reabilitação , Idoso , Vértebras Cervicais/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Discotomia/efeitos adversos , Discotomia/métodos , Complicações Pós-Operatórias/etiologia , Estenose Espinal/cirurgia
4.
J Orthop Surg Res ; 19(1): 390, 2024 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-38965626

RESUMO

BACKGROUND: Poor neurological recovery in patients after anterior cervical discectomy and fusion has been frequently reported; however, no study has analyzed the preoperative imaging characteristics of patients to investigate the factors affecting surgical prognosis. The purpose of this study was to investigate the factors that affect the preoperative imaging characteristics of patients and their influence on poor neurologic recovery after anterior cervical discectomy and fusion. METHODS: We retrospectively analyzed the clinical data of 89 patients who met the criteria for anterior cervical discectomy and fusion for the treatment of single-level cervical spondylotic myelopathy and evaluated the patients' neurological recovery based on the recovery rate of the Japanese Orthopaedic Association (JOA) scores at the time of the final follow-up visit. Patients were categorized into the "good" and "poor" groups based on the JOA recovery rates of ≥ 50% and < 50%, respectively. Clinical information (age, gender, body mass index, duration of symptoms, preoperative JOA score, and JOA score at the final follow-up) and imaging characteristics (cervical kyphosis, cervical instability, ossification of the posterior longitudinal ligament (OPLL), calcification of herniated intervertebral discs, increased signal intensity (ISI) of the spinal cord on T2-weighted imaging (T2WI), and degree of degeneration of the discs adjacent to the fused levels (cranial and caudal) were collected from the patients. Univariate and binary logistic regression analyses were performed to identify risk factors for poor neurologic recovery. RESULTS: The mean age of the patients was 52.56 ± 11.18 years, and the mean follow-up was 26.89 ± 11.14 months. Twenty patients (22.5%) had poor neurological recovery. Univariate analysis showed that significant predictors of poor neurological recovery were age (p = 0.019), concomitant OPLL (p = 0.019), concomitant calcification of herniated intervertebral discs (p = 0.019), ISI of the spinal cord on T2WI (p <0.05), a high grade of degeneration of the discs of the cranial neighboring levels (p <0.05), and a high grade of discs of the caudal neighboring levels (p <0.05). Binary logistic regression analysis showed that ISI of the spinal cord on T2WI (p = 0.001 OR = 24.947) and high degree of degeneration of adjacent discs on the cranial side (p = 0.040 OR = 6.260) were independent risk factors for poor neurological prognosis. CONCLUSION: ISI of the spinal cord on T2WI and high degree of cranial adjacent disc degeneration are independent risk factors for poor neurological recovery after anterior cervical discectomy and fusion. A comprehensive analysis of the patients' preoperative imaging characteristics can help in the development of surgical protocols and the management of patients' surgical expectations.


Assuntos
Vértebras Cervicais , Discotomia , Recuperação de Função Fisiológica , Fusão Vertebral , Humanos , Discotomia/métodos , Discotomia/efeitos adversos , Fusão Vertebral/métodos , Fusão Vertebral/efeitos adversos , Masculino , Feminino , Pessoa de Meia-Idade , Vértebras Cervicais/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Idoso , Adulto , Espondilose/cirurgia , Espondilose/diagnóstico por imagem , Imageamento por Ressonância Magnética , Seguimentos , Resultado do Tratamento
5.
Acta Neurochir (Wien) ; 166(1): 280, 2024 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-38960897

RESUMO

INTRODUCTION: Anterior Cervical Discectomy and Fusion (ACDF) and Anterior Cervical Corpectomy and Fusion (ACCF) are both common surgical procedures in the management of pathologies of the subaxial cervical spine. While recent reviews have demonstrated ACCF to provide better decompression results compared to ACDF, the procedure has been associated with increased surgical risks. Nonetheless, the use of ACCF in a traumatic context has been poorly described. The aim of this study was to assess the safety of ACCF as compared to the more commonly performed ACDF. METHODS: All patients undergoing ACCF or ACDF for subaxial cervical spine injuries spanning over 2 disc-spaces and 3 vertebral-levels, between 2006 and 2018, at the study center, were eligible for inclusion. Patients were matched based on age and preoperative ASIA score. RESULTS: After matching, 60 patients were included in the matched analysis, where 30 underwent ACDF and ACCF, respectively. Vertebral body injury was significantly more common in the ACCF group (p = 0.002), while traumatic disc rupture was more frequent in the ACDF group (p = 0.032). There were no statistically significant differences in the rates of surgical complications, including implant failure, wound infection, dysphagia, CSF leakage between the groups (p ≥ 0.05). The rates of revision surgeries (p > 0.999), mortality (p = 0.222), and long-term ASIA scores (p = 0.081) were also similar. CONCLUSION: Results of both unmatched and matched analyses indicate that ACCF has comparable outcomes and no additional risks compared to ACDF. It is thus a safe approach and should be considered for patients with extensive anterior column injury.


Assuntos
Vértebras Cervicais , Discotomia , Complicações Pós-Operatórias , Fusão Vertebral , Traumatismos da Coluna Vertebral , Humanos , Fusão Vertebral/métodos , Fusão Vertebral/efeitos adversos , Vértebras Cervicais/cirurgia , Vértebras Cervicais/lesões , Masculino , Feminino , Pessoa de Meia-Idade , Discotomia/métodos , Discotomia/efeitos adversos , Adulto , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Traumatismos da Coluna Vertebral/cirurgia , Idoso , Estudos Retrospectivos , Resultado do Tratamento
6.
Acta Neurochir (Wien) ; 166(1): 284, 2024 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-38976059

RESUMO

PURPOSE: Post-operative pain after video-assisted thoracoscopic surgery is often treated using thoracic epidural analgesics or thoracic paravertebral analgesics. This article describes a case where a thoracic disc herniation is treated with a thoracoscopic microdiscectomy with post-operative thoracic epidural analgesics. The patient developed a bupivacaine pleural effusion which mimicked a hemothorax on computed tomography (CT). METHODS: The presence of bupivacaine in the pleural effusion was confirmed using a high performance liquid chromatography method. RESULTS: The patient underwent a re-exploration to relieve the pleural effusion. The patient showed a long-term recovery similar to what can be expected from an uncomplicated thoracoscopic microdiscectomy. CONCLUSION: A pleural effusion may occur when thoracic epidural analgesics are used in patents with a corridor between the pleural cavity and epidural space.


Assuntos
Anestesia Epidural , Bupivacaína , Discotomia , Hemotórax , Deslocamento do Disco Intervertebral , Derrame Pleural , Humanos , Anestesia Epidural/efeitos adversos , Anestesia Epidural/métodos , Discotomia/efeitos adversos , Discotomia/métodos , Bupivacaína/efeitos adversos , Deslocamento do Disco Intervertebral/cirurgia , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/cirurgia , Hemotórax/etiologia , Hemotórax/cirurgia , Hemotórax/induzido quimicamente , Hemotórax/diagnóstico , Hemotórax/diagnóstico por imagem , Cirurgia Torácica Vídeoassistida/métodos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Diagnóstico Diferencial , Anestésicos Locais/efeitos adversos , Anestésicos Locais/administração & dosagem , Vértebras Torácicas/cirurgia , Masculino , Dor Pós-Operatória/tratamento farmacológico , Pessoa de Meia-Idade , Feminino
7.
Adv Gerontol ; 37(1-2): 50-59, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38944773

RESUMO

The purpose of the study was a comparative analysis the effectiveness of microsurgical discectomy and minimally invasive transforaminal lumbar interbody fusion in the treatment of disk herniation adjacent to the anomaly of the lumbosacral junction segment in elderly patients. The study included 80 elderly patients (over 60 years old), divided into two groups: the 1st-(n=39) who underwent microsurgical discectomy; the 2nd- patients (n=41) operated on using minimally invasive transforaminal interbody fusion and percutaneous transpedicular stabilization (MI-TLIF). For the comparative analysis, we used gender characteristics (gender, age), constitutional characteristics (BMI), degree of physical status according to ASA, intraoperative parameters of interventions and the specificity of postoperative patient management, clinical data, and the presence of complications. Long-term outcomes were assessed at a minimum follow-up of 3 years. As a result, it was found that the use of MI-TLIF allows achieving better long-term clinical outcomes, fewer major complications in comparison with the microsurgical discectomy technique in the treatment of disc herniation adjacent to the anomaly of the lumbosacral junction segment in elderly patients.


Assuntos
Discotomia , Deslocamento do Disco Intervertebral , Vértebras Lombares , Microcirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Fusão Vertebral , Humanos , Masculino , Feminino , Fusão Vertebral/métodos , Fusão Vertebral/efeitos adversos , Deslocamento do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/diagnóstico , Discotomia/métodos , Discotomia/efeitos adversos , Idoso , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Microcirurgia/métodos , Pessoa de Meia-Idade , Resultado do Tratamento , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/diagnóstico
8.
Turk Neurosurg ; 34(4): 686-694, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38874251

RESUMO

AIM: To report our institutional experience with full-endoscopic lumbar discectomy (FELD) and analyzed the pertinent literature. MATERIAL AND METHODS: We retrospectively enrolled 100 patients who had undergone full-endoscopic discectomy for lumbar disc herniation using either an interlaminar (IL) or transforaminal (TF) approach. All patients underwent pre-operative imaging. Before and after surgery, patients' pain and disability levels were measured using visual analog scale (VAS) and Oswestry disability index (ODI) respectively. Clinical outcomes were assessed using the modified MacNab criteria. Patients were divided into two groups, Group 1 (cases 1-50) and Group 2 (cases 51-100), and their learning curve factors were compared using a Student's t-test. RESULTS: Sixtynine cases were operated via an IL approach and the remaining 31 cases using a TF approach. There were 4 early conversions in microdiscectomy. The mean operative time of the 96 procedures was 57 min. In Group 1, the mean operative time was 61.7 minutes (range: 35-110); in Group 2, it was 52.3 minutes (range: 25-75). The difference between the two groups was statistically significant (p=0.009). No significant differences were found in conversions, early operations, and recurrences between Groups 1 and 2. Both groups experienced a significant reduction in postoperative VAS and ODI compared to preoperative scores. CONCLUSION: The findings support previously reported information on the safety and effectiveness of the FELD. Herein, we share some practical tips and tricks based on our initial experience and on the review of the available literature, which could facilitate new users. In experienced hands endoscopic techniques make treatment of herniated discs feasible independently of patient age, anatomy, and/or targeted pathology features. Conversely, thoughtful patient selection and careful preoperative planning are highly recommended for new users.


Assuntos
Discotomia , Endoscopia , Deslocamento do Disco Intervertebral , Vértebras Lombares , Humanos , Estudos Retrospectivos , Masculino , Feminino , Vértebras Lombares/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Adulto , Pessoa de Meia-Idade , Endoscopia/métodos , Resultado do Tratamento , Discotomia/métodos , Idoso , Adulto Jovem , Medição da Dor , Duração da Cirurgia
9.
J Orthop Surg Res ; 19(1): 363, 2024 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-38898467

RESUMO

BACKGROUND: The zero-profile implant system (Zero-P) and conventional plates have been widely used in anterior cervical discectomy and fusion (ACDF) to treat cervical spondylosis. The purpose of this study was to compare the effects of the application of Zero-P and new conventional plates (ZEVO, Skyline) in ACDF on the sagittal imaging parameters of cervical spondylosis patients and to analyze their clinical efficacy. METHODS: We conducted a retrospective study on 119 cervical spondylosis patients from January 2018 to December 2021, comparing outcomes between those receiving the Zero-P device (n = 63) and those receiving a novel conventional plate (n = 56, including 46 ZEVO and 10 Skyline plates) through ACDF. Cervical sagittal alignment was assessed pre- and postoperatively via lateral radiographs. The Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and visual analog scale (VAS) scores were recorded at baseline, after surgery, and at the 2-year follow-up to evaluate patient recovery and intervention success. RESULTS: There were significant differences in the postoperative C0-C2 Cobb angle and postoperative sagittal segmental angle (SSA) between patients in the novel conventional plate group and those in the Zero-P group (P < 0.05). Postoperatively, there were significant changes in the C2‒C7 Cobb angle, C0‒C2 Cobb angle, SSA, and average surgical disc height (ASDH) compared to the preoperative values in both patient groups (P < 0.05). Dysphagia in the immediate postoperative period was lower in the Zero-P group than in the new conventional plate group (0% in the Zero-P group, 7.14% in the novel conventional plate group, P = 0.046), and the symptoms disappeared within 2 years in both groups. There was no statistically significant difference between the two groups in terms of complications of adjacent spondylolisthesis (ASD) at 2 years postoperatively (3.17% in the Zero-P group, 8.93% in the novel conventional plate group; P = 0.252). According to the subgroup analysis, there were significant differences in the postoperative C2‒C7 Cobb angle, C0‒C2 Cobb angle, T1 slope, and ASDH between the ZEVO group and the Skyline group (P < 0.05). Compared with the preoperative scores, the JOA, NDI, and VAS scores of all groups significantly improved at the 2-year follow-up (P < 0.01). According to the subgroup analysis, the immediate postoperative NDI and VAS scores of the ZEVO group were significantly better than those of the Skyline group (P < 0.05). CONCLUSION: In ACDF, both novel conventional plates and Zero-P can improve sagittal parameters and related scale scores. Compared to the Zero-P plate, the novel conventional plate has a greater advantage in correcting the curvature of the surgical segment, but the Zero-P plate is less likely to produce postoperative dysphagia.


Assuntos
Placas Ósseas , Vértebras Cervicais , Discotomia , Fusão Vertebral , Espondilose , Humanos , Feminino , Estudos Retrospectivos , Masculino , Fusão Vertebral/métodos , Fusão Vertebral/instrumentação , Pessoa de Meia-Idade , Discotomia/métodos , Discotomia/instrumentação , Vértebras Cervicais/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Resultado do Tratamento , Espondilose/cirurgia , Espondilose/diagnóstico por imagem , Idoso , Adulto , Equilíbrio Postural/fisiologia , Seguimentos
10.
Am J Case Rep ; 25: e943823, 2024 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-38851881

RESUMO

BACKGROUND Cervical spondylolysis with spondylolisthesis is a rare disorder. According to previous reports, the spondylolisthesis is usually Meyerding Grade I, with only a limited number of cases receiving surgical treatment. We hereby report a special case of cervical spondylolysis with Grade-II spondylolisthesis, treated with single-level anterior cervical discectomy and fusion (ACDF), and present a literature review related to this problem. CASE REPORT Here, we report the case of a 52-year-old man who complained of posterior neck pain and numbness of the bilateral upper limbs. Radiological examination showed bilateral spondylolysis of the C6 and Meyerding Grade-II spondylolisthesis of C6 on C7 with instability. The patient underwent a single-level C6/C7 ACDF surgery. The symptoms of neck pain and bilateral upper-limb numbness were relieved immediately after surgery. The immediate postoperative radiological examination showed successful restoration of sagittal alignment. At 3-month follow-up, the patient had returned to normal life without any symptoms. At 2-year follow-up, computed tomography showed that C6-C7 fusion had been achieved and alignment was maintained. CONCLUSIONS Cervical spondylolysis, as an uncommon spinal disorder, has been regarded as a congenital abnormity, and has unique radiological characteristics. For most of the cases with cervical spondylolysis, even with Grade-II spondylolisthesis, single-level ACDF can achieve good clinical and radiological outcomes.


Assuntos
Vértebras Cervicais , Discotomia , Fusão Vertebral , Espondilolistese , Espondilólise , Humanos , Masculino , Espondilolistese/cirurgia , Fusão Vertebral/métodos , Pessoa de Meia-Idade , Discotomia/métodos , Vértebras Cervicais/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Espondilólise/cirurgia
11.
Acta Neurochir (Wien) ; 166(1): 267, 2024 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-38877339

RESUMO

OBJECTIVE: To compare the costotransversectomy (CTV) and transpedicular (TP) approaches versus the transfacet (TF) approach for the surgical treatment of calcific thoracic spine herniations (cTDH), in terms of surgical and clinical outcomes. BACKGROUND: Surgical approaches for cTDH are debated. Anterior approaches are recommended, while posterolateral approaches are preferred for non-calcific, paramedian, and lateral hernias. Currently, there is limited evidence about the superiority of a more invasive surgical approach, such as CTV or TP, over TF, a relatively less invasive approach, in terms of neurological outcome, pain, and surgical complications, for the treatment of cTDH. METHODS: A retrospective, observational, monocentric study was conducted on patients who underwent posterolateral thoracic approaches for symptomatic cTDH, between 2010 and 2023, at our institute. Three groups were drafted, based on the surgical approach used: TF, TP, and CTV. All procedures were assisted by intraoperative CT scan, spinal neuronavigation, and intraoperative neuromonitoring. Analyzed factors include duration of surgery, amount of bone removal, intraoperative blood loss, CSF leak, need of instrumentation for iatrogenic instability, degree of disc herniation removal, myelopathy recovery. Afterwards, a statistical analysis was performed to investigate the bony resection of the superior posterior edge of the vertebral soma. The primary outcome was the partial or total herniation removal. RESULTS: This study consecutively enrolled 65 patients who underwent posterolateral thoracic surgery for cTDH. The TF approach taking the least, and the CTV the longest time (p < 0.01). No statistical difference was observed between the three mentioned approaches, in terms of intraoperative blood loss, dural leakage, post-resection instrumentation, total herniation removal, or myelopathy recovery. An additional somatic bony resection was successful in achieving total herniation removal (p < 0.01), and the extent of bony resection was directly proportional to the extent of hernia removal (p < 0.01). CONCLUSIONS: No statistically significant differences were highlighted between the TP, TF, and CTV regarding the extent of cTDH removal, the postoperative complications, and the neurological improvement. The described somatic bone resection achieved significant total herniation removal and was directly proportional to the preop against postop anteroposterior diameter difference.


Assuntos
Calcinose , Deslocamento do Disco Intervertebral , Vértebras Torácicas , Humanos , Vértebras Torácicas/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Masculino , Feminino , Pessoa de Meia-Idade , Deslocamento do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Estudos Retrospectivos , Adulto , Idoso , Calcinose/cirurgia , Calcinose/diagnóstico por imagem , Resultado do Tratamento , Discotomia/métodos
12.
Medicine (Baltimore) ; 103(25): e37908, 2024 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-38905436

RESUMO

BACKGROUND: Gabapentin supplementation may have some potential in pain control after lumbar laminectomy and discectomy, and this meta-analysis aims to explore the impact of gabapentin supplementation on postoperative pain management for lumbar laminectomy and discectomy. METHODS: PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched, and we included randomized controlled trials assessing the effect of gabapentin supplementation on the pain control of lumbar laminectomy and discectomy. RESULTS: Five randomized controlled trials were finally included in the meta-analysis. Overall, compared with control intervention for lumbar laminectomy and discectomy, gabapentin supplementation was associated with significantly lower pain scores at 2 hours (MD = -2.75; 95% CI = -3.09 to -2.41; P < .00001), pain scores at 4 hours (MD = -2.28; 95% CI = -3.36 to -1.20; P < .0001), pain scores at 24 hours (MD = -0.70; 95% CI = -0.86 to -0.55; P < .00001) and anxiety score compared to control intervention (MD = -1.32; 95% CI = -1.53 to -1.11; P < .00001), but showed no obvious impact on pain scores at 12 hours (MD = -0.58; 95% CI = -1.39 to 0.22; P = .16). In addition, gabapentin supplementation could significantly decrease the incidence of vomiting in relative to control intervention (OR = 0.31; 95% CI = 0.12-0.81; P = .02), but they had similar incidence of nausea (OR = 0.51; 95% CI = 0.15-1.73; P = .28). CONCLUSIONS: Gabapentin supplementation benefits to pain control after lumbar laminectomy and discectomy.


Assuntos
Analgésicos , Discotomia , Gabapentina , Laminectomia , Vértebras Lombares , Dor Pós-Operatória , Gabapentina/uso terapêutico , Gabapentina/administração & dosagem , Humanos , Laminectomia/efeitos adversos , Laminectomia/métodos , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Discotomia/efeitos adversos , Discotomia/métodos , Analgésicos/uso terapêutico , Analgésicos/administração & dosagem , Vértebras Lombares/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Aminas/uso terapêutico , Aminas/administração & dosagem , Medição da Dor , Manejo da Dor/métodos
13.
Clin Spine Surg ; 37(4): 149-154, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38706112

RESUMO

STUDY DESIGN: Retrospective observational study of consecutive patients. OBJECTIVE: The purpose of the study was to evaluate VBQ as a predictor of interbody subsidence and to determine threshold values that portend increased risk of subsidence. SUMMARY OF BACKGROUND DATA: Many risk factors have been reported for the subsidence of interbody cages in anterior cervical discectomy and fusion (ACDF). MRI Vertebral Bone Quality (VQB) is a relatively new radiographic parameter that can be easily obtained from preoperative MRI and has been shown to correlate with measurements of bone density such as DXA and CT Hounsfield Units. METHODS: All patients who underwent 1- to 3-level ACDF using titanium interbodies with anterior plating between the years 2018 and 2020 at our tertiary referral center were included. Subsidence measurements were performed by 2 independent reviewers on CT scans obtained 6 months postoperatively. VBQ was measured on pre-operative sagittal T1 MRI by 2 independent reviewers, and values were averaged. RESULTS: Eight-five fusion levels in 44 patients were included in the study. There were 32 levels (38%) with moderate subsidence and 12 levels with severe subsidence (14%). The average VBQ score in those patients with severe subsidence was significantly higher than those without subsidence (3.80 vs. 2.40, P<0.01). A threshold value of 3.2 was determined to be optimal for predicting subsidence (AUC=0.99) and had a sensitivity of 100% and a specificity of 94.1% in predicting subsidence. CONCLUSIONS: VBQ strongly correlates with the subsidence of interbody grafts after ACDF. A threshold VBQ score value of 3.2 has excellent sensitivity and specificity for predicting subsidence. Spine surgeons can use VBQ as a readily available screening tool to identify patients at higher risk for subsidence. LEVEL OF EVIDENCE: Level-IV.


Assuntos
Vértebras Cervicais , Discotomia , Imageamento por Ressonância Magnética , Fusão Vertebral , Humanos , Vértebras Cervicais/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Estudos Retrospectivos , Adulto , Densidade Óssea
14.
J Orthop Surg Res ; 19(1): 318, 2024 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-38807224

RESUMO

BACKGROUND: Nonfusion technologies, such as motion-preservation devices, have begun a new era of treatment options in spine surgery. Motion-preservation approaches mainly include total disc replacement for anterior cervical discectomy and fusion. However, for multisegment fusion, such as anterior cervical corpectomy and fusion, the options are more limited. Therefore, we designed a novel 3D-printed motion-preservation artificial cervical corpectomy construct (ACCC) for multisegment fusion. The aim of this study was to explore the feasibility of ACCC in a goat model. METHODS: Goats were treated with anterior C3 corpectomy and ACCC implantation and randomly divided into two groups evaluated at 3 or 6 months. Radiography, 3D CT reconstruction and MRI evaluations were performed. Biocompatibility was evaluated using micro-CT and histology. RESULTS: Postoperatively, all goats were in good condition, with free neck movement. Implant positioning was optimal. The relationship between facet joints was stable. The range of motion of the C2-C4 segments during flexion-extension at 3 and 6 months postoperatively was 7.8° and 7.3°, respectively. The implants were wrapped by new bone tissue, which had grown into the porous structure. Cartilage tissue, ossification centres, new blood vessels, and bone mineralization were observed at the porous metal vertebrae-bone interface and in the metal pores. CONCLUSIONS: The ACCC provided stabilization while preserving the motion of the functional spinal unit and promoting bone regeneration and vascularization. In this study, the ACCC was used for anterior cervical corpectomy and fusion (ACCF) in a goat model. We hope that this study will propel further research of motion-preservation devices.


Assuntos
Vértebras Cervicais , Cabras , Impressão Tridimensional , Fusão Vertebral , Animais , Vértebras Cervicais/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Fusão Vertebral/métodos , Amplitude de Movimento Articular , Modelos Animais , Materiais Biocompatíveis , Teste de Materiais/métodos , Fatores de Tempo , Discotomia/métodos
15.
BMC Musculoskelet Disord ; 25(1): 401, 2024 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-38773464

RESUMO

BACKGROUND: The frequency of anterior cervical discectomy and fusion (ACDF) has increased up to 400% since 2011, underscoring the need to preoperatively anticipate adverse postoperative outcomes given the procedure's expanding use. Our study aims to accomplish two goals: firstly, to develop a suite of explainable machine learning (ML) models capable of predicting adverse postoperative outcomes following ACDF surgery, and secondly, to embed these models in a user-friendly web application, demonstrating their potential utility. METHODS: We utilized data from the National Surgical Quality Improvement Program database to identify patients who underwent ACDF surgery. The outcomes of interest were four short-term postoperative adverse outcomes: prolonged length of stay (LOS), non-home discharges, 30-day readmissions, and major complications. We utilized five ML algorithms - TabPFN, TabNET, XGBoost, LightGBM, and Random Forest - coupled with the Optuna optimization library for hyperparameter tuning. To bolster the interpretability of our models, we employed SHapley Additive exPlanations (SHAP) for evaluating predictor variables' relative importance and used partial dependence plots to illustrate the impact of individual variables on the predictions generated by our top-performing models. We visualized model performance using receiver operating characteristic (ROC) curves and precision-recall curves (PRC). Quantitative metrics calculated were the area under the ROC curve (AUROC), balanced accuracy, weighted area under the PRC (AUPRC), weighted precision, and weighted recall. Models with the highest AUROC values were selected for inclusion in a web application. RESULTS: The analysis included 57,760 patients for prolonged LOS [11.1% with prolonged LOS], 57,780 for non-home discharges [3.3% non-home discharges], 57,790 for 30-day readmissions [2.9% readmitted], and 57,800 for major complications [1.4% with major complications]. The top-performing models, which were the ones built with the Random Forest algorithm, yielded mean AUROCs of 0.776, 0.846, 0.775, and 0.747 for predicting prolonged LOS, non-home discharges, readmissions, and complications, respectively. CONCLUSIONS: Our study employs advanced ML methodologies to enhance the prediction of adverse postoperative outcomes following ACDF. We designed an accessible web application to integrate these models into clinical practice. Our findings affirm that ML tools serve as vital supplements in risk stratification, facilitating the prediction of diverse outcomes and enhancing patient counseling for ACDF.


Assuntos
Vértebras Cervicais , Discotomia , Internet , Aprendizado de Máquina , Complicações Pós-Operatórias , Fusão Vertebral , Humanos , Discotomia/métodos , Discotomia/efeitos adversos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Vértebras Cervicais/cirurgia , Masculino , Feminino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Pessoa de Meia-Idade , Tempo de Internação/estatística & dados numéricos , Resultado do Tratamento , Idoso , Readmissão do Paciente/estatística & dados numéricos , Adulto , Bases de Dados Factuais
16.
Cir Cir ; 92(2): 248-254, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38782382

RESUMO

OBJECTIVE: To evaluate the clinical-surgical results of the tubular vs. mini-open approach in lumbar discoidectomy. The tubular approach promises to reduce the number of rest days and an earlier return to daily activities and work. METHOD: A case-control study of patients operated on for disc herniation using tubular surgery (case) and mini-open (control) was carried out. The variables investigated were as follow: radicular and lumbar pain, sex, age, failure in conservative treatment, single-level lumbar hernia, surgical time, bleeding, length of hospital stay, persistence of symptoms, complications, occupational activity, and reintegration into everyday activities. RESULTS: Through 100 surgeries performed, two groups were created, tubular and mini-open, with 50 patients each, with L4-L5 or L5-S1 disc herniation, respectively. The most affected level was L4-L5 (69%). Of the total cases, a significant improvement was found (p < 0.05) at 15 postoperative days in the VAS and ODI scale in the tubular group with respect to mini-open. Complications such as surgical wound infection, durotomy, and persistent pain occurred. CONCLUSIONS: The tubular approach is a safe and effective option for herniated discs of the lumbar segment, and reduces surgical times, bleeding, and the time of reinsertion to daily activities of the patient.


OBJETIVO: Evaluar los resultados clínico-quirúrgicos del abordaje tipo tubular en comparación con el mini-open en la discoidectomía lumbar. El abordaje tubular promete reducir el número de días de reposo y una reincorporación más temprana a las actividades diarias y laborales. MÉTODO: Se realizó un estudio de casos y controles de pacientes operados por hernia discal mediante cirugía tubular (casos) o mini-open (controles). Las variables investigadas fueron: dolor radicular y lumbar, sexo, edad, falla en el tratamiento conservador, hernia lumbar de un solo nivel, tiempo quirúrgico, sangrado, tiempo de estancia hospitalaria, persistencia de síntomas, complicaciones, tipo de actividad ocupacional y reinserción a las actividades cotidianas. RESULTADOS: Se realizaron 100 cirugías y se crearon dos grupos, tubular y mini-open, con 50 pacientes cada uno, con hernia discal de L4-L5 o L5-S1, respectivamente. El nivel más afectado fue L4-L5 (69%). Del total de los casos, se encontró mejoría significativa (p < 0.05) a los 15 días posquirúrgicos en la escala EVA y ODI en el grupo tubular con respecto al mini-open. Ocurrieron complicaciones como infección de herida quirúrgica, durotomía y dolor persistente. CONCLUSIONES: El abordaje tubular es una opción segura y efectiva para hernias discales del segmento lumbar, y reduce los tiempos quirúrgicos, el sangrado y el tiempo de reinserción a las actividades cotidianas del paciente.


Assuntos
Discotomia , Deslocamento do Disco Intervertebral , Vértebras Lombares , Humanos , Masculino , Feminino , Estudos de Casos e Controles , Vértebras Lombares/cirurgia , Adulto , Deslocamento do Disco Intervertebral/cirurgia , Pessoa de Meia-Idade , Discotomia/métodos , Resultado do Tratamento , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Duração da Cirurgia , Tempo de Internação/estatística & dados numéricos
17.
J Coll Physicians Surg Pak ; 34(5): 551-555, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38720215

RESUMO

OBJECTIVE: To compare the radiological outcome and development of heterotopic ossification (HO) following single-segment anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) for cervical disc herniation and evaluate their impact on surgical success. STUDY DESIGN: Descriptive comparative study. Place and Duration of the Study: Neurosurgery Department at Bozyaka Education and Research Hospital, Izmir, Turkiye, between January 2020 and June 2022. METHODOLOGY: Patients aged 18-70 years with radicular neck pain unresponsive to conventional medical treatment and an MRI-confirmed diagnosis were included. Patients with osteoporosis (OP) were excluded. Patients were randomised into two treatment groups (ACDF and CDR) and stratified by age and symptom severity. Radiographic assessments and HO classification according to McAfee were performed. RESULTS: Among the included patients, 56 underwent ACDF and 45 underwent CDR. The mean patient age was 48.29 ± 9.530 and 41.84 ± 7.239 years in the ACDF and CDR groups, respectively (p <0.001). The postoperative disc height increased in both groups. The T1 slope was significantly higher preoperatively and in the early postoperative period in the CDR group than in the ACDF group (p = 0.001). HO was graded as 1, 2, 3, and 4 in 28 (27.7%), 6 (5.9%), 7 (6.9%), and 4 (3%) patients, respectively. CONCLUSION: ACDF and CDR provided similar improvements in radiological measurements and pain relief. Although both procedures significantly enhanced the patient's quality of life and disability scores, HO was more prevalent following CDR during long-term follow-up. KEY WORDS: Cervical disc replacement, Anterior cervical discectomy and fusion, Spinal surgery techniques, Heterotopic ossification.


Assuntos
Vértebras Cervicais , Discotomia , Deslocamento do Disco Intervertebral , Fusão Vertebral , Substituição Total de Disco , Humanos , Pessoa de Meia-Idade , Discotomia/métodos , Masculino , Feminino , Fusão Vertebral/métodos , Adulto , Vértebras Cervicais/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Substituição Total de Disco/métodos , Deslocamento do Disco Intervertebral/cirurgia , Resultado do Tratamento , Degeneração do Disco Intervertebral/cirurgia , Cervicalgia/cirurgia , Cervicalgia/etiologia , Idoso , Ossificação Heterotópica/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adulto Jovem , Adolescente
18.
Int Orthop ; 48(8): 2243-2250, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38777971

RESUMO

PURPOSE: To compare the clinical efficacy of mini-open (air/water medium) endoscopy-assisted anterior cervical discectomy and fusion (MOEA-ACDF) and anterior cervical decompression and fusion (ACDF) for cervical spondylotic myelopathy (CSM). METHODS: This study retrospectively analysed the clinical data of CSM patients who received surgical treatment from January 1, 2020, to December 31, 2022. Patients were divided into two groups according to the surgical method: the MOEA-ACDF group and the ACDF group. The preoperative and postoperative imaging results at one week and the last follow-up examination were compared between the two groups. The Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score and neck disability index (NDI) score were used to evaluate the clinical outcomes preoperatively, one week postoperatively and at the last follow-up examination. The minimum follow-up duration was 12 months. RESULTS: A total of 131 CSM patients who underwent surgery at our institution were included, including 61 patients in the MOEA-ACDF group and 70 patients in the ACDF group. In the MOEA-ACDF group, the postoperative C2-C7 Cobb angle and HAVB were significantly greater than the preoperative values (P < 0.05). In the ACDF group, the postoperative C2-C7 Cobb angle was also significantly greater than the preoperative value, and the C2-C7 ROM and HAVB significantly decreased (P < 0.05). The postoperative neurological function of the patients in both groups improved, and the postoperative VAS score and NDI score significantly decreased. Compared with ACDF, MOEA-ACDF is associated with a significantly larger postoperative C2-C7 Cobb angle and significantly better C2-C7 ROM and HAVB, as well as better clinical efficacy (P < 0.05). CONCLUSIONS: MOEA-ACDF combines endoscopic systems with ACDF technology to treat CSM, but its clinical efficacy is not inferior to that of ACDF in the short- to intermediate-term. It can effectively and safely restore the cervical intervertebral height, physiological curvature, and range of motion.


Assuntos
Vértebras Cervicais , Discotomia , Endoscopia , Fusão Vertebral , Espondilose , Humanos , Masculino , Fusão Vertebral/métodos , Fusão Vertebral/efeitos adversos , Feminino , Pessoa de Meia-Idade , Vértebras Cervicais/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Estudos Retrospectivos , Discotomia/métodos , Discotomia/efeitos adversos , Espondilose/cirurgia , Espondilose/diagnóstico por imagem , Endoscopia/métodos , Resultado do Tratamento , Idoso , Descompressão Cirúrgica/métodos , Descompressão Cirúrgica/efeitos adversos , Adulto , Doenças da Medula Espinal/cirurgia , Doenças da Medula Espinal/diagnóstico por imagem
19.
World Neurosurg ; 188: e540-e545, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38815923

RESUMO

BACKGROUND: Various methods and techniques have been developed for extraforaminal decompression, particularly for far lateral lumbar disc herniation. Distinct anatomical differences are noticeable in the upper levels of the lumbar spine, which may complicate the related surgical approach. This study aimed to determine the safety and efficiency of the far lateral extraforaminal approach for the upper lumbar disc. METHODS: L1-2 and L2-3 migrated lumbar disc herniations were defined as upper lumbar disc herniations. 31 consecutive patients with upper lumbar disk herniation who underwent extraforaminal lumbar microdiscectomy between January 2018 and March 2022 were retrospectively investigated. The patients were assessed using the interval history, follow-up lower back and leg pain visual analog scale scores (0-100 mm), the Oswestry Disability Index (%), and modified MacNab criteria. RESULTS: 31 consecutive patients with upper lumbar disk herniation (20 men and 11 women) with a mean age of 52.8 ± 10.8 years (range 31-70 years) underwent extraforaminal lumbar microdiscectomy. The preoperative and postoperative visual analog scale scores and Oswestry Disability Index were significantly different (P < 0.001). According to the modified MacNab criteria, 23 patients showed excellent improvement, 5 showed good improvement, and 3 showed fair improvement; thus, the rate of satisfactory improvement was 90.3% at the 2-year follow-up. No patients required reoperation at the operative level during follow-up. CONCLUSIONS: Extraforaminal lumbar microdiscectomy is a safe and effective minimally invasive surgical technique for treating upper lumbar disc herniation.


Assuntos
Discotomia , Deslocamento do Disco Intervertebral , Vértebras Lombares , Microcirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Vértebras Lombares/cirurgia , Discotomia/métodos , Idoso , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Retrospectivos , Microcirurgia/métodos , Resultado do Tratamento
20.
World Neurosurg ; 187: e714-e721, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38692566

RESUMO

BACKGROUND: Acute upper airway compromise is a rare but catastrophic complication after anterior cervical discectomy and fusion. This study aims to develop a score to identify patients at risk of acute postoperative airway compromise (PAC). METHODS: Potential risk factors for acute PAC were selected by a modified Delphi process. Ten patients with acute PAC were identified of 1466 patients who underwent elective anterior cervical discectomy and fusion between July 2014 and May 2019. A comparison group was created by a randomized selection process (non-PAC group). Factors associated with PAC and a P value of < 0.10 were entered into a logistic regression model and coefficients contributed to each risk factor's overall score. Calibration of the model was evaluated using the Hosmer-Lemeshow goodness-of-fit test. Quantitative discrimination was calculated, and the final model was internally validated with bootstrap sampling. RESULTS: We identified 18 potential risk factors from our Delphi process, of which 6 factors demonstrated a significant association with airway compromise: age >65 years, current smoking status, American Society of Anesthesiologists class >2, history of a bleeding disorder, surgery of upper subaxial cervical spine (above C4), and duration of surgery >179 minutes. The final prediction model included 5 predictors with very strong performance characteristics. These 5 factors formed the PAC score, with a range from 0 to 100. A score of 20 yielded the greatest balance of sensitivity (80%) and specificity (88%). CONCLUSIONS: The acute PAC score demonstrates strong performance characteristics. The PAC score might help identify patients at risk of upper airway compromise caused by surgical site abnormalities.


Assuntos
Vértebras Cervicais , Discotomia , Complicações Pós-Operatórias , Fusão Vertebral , Humanos , Vértebras Cervicais/cirurgia , Masculino , Feminino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Fusão Vertebral/efeitos adversos , Idoso , Discotomia/efeitos adversos , Fatores de Risco , Adulto , Técnica Delphi , Obstrução das Vias Respiratórias/etiologia
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