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1.
Zhongguo Gu Shang ; 33(2): 136-9, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32133812

RESUMO

OBJECTIVE: To study the correlation and clinical value of the arc height of upper and lower endplates, the height of intervertebral space and osteophyte of posterior edge of intervertebral space in patients with cervical spondylosis. METHODS: A total of 108 patients with cervical spondylosis who underwent cervical spondylosis surgery from September 2017 to September 2018 were included in the study. Including 48 males with an average age of 52 years (30 to 72) and 60 females with an average age of 54 years (37 to 79). Among them, C2,3 of 6 cases, C3,4 of 15 cases, C4,5 of 32 cases, C5,6 of 42 cases, C6,7 of 13 cases. X-ray films of cervical spine were taken before and after operation. The images were accessed by PACS (Picture Archiving and Communication Systems) system. The lower and upper endplate arc heights (L1, L2), intervertebral space height (L3), and posterior osteophyte width (L4) were measured. Spearman was used to analyze the correlation between them. RESULTS: L1 was negatively correlated with L4 (r=-0.34, P<0.05), L3 was negatively correlated with L4 (r=-0.36, P<0.05). L1 was positively correlated with L3 (r=0.38, P<0.05), L2 was positively correlated with L3 (r=0.48, P<0.05). There was no significant difference between L 1 and L2 (P>0.05), L2 and L4 (P>0.05). CONCLUSION: The arc height of the lower endplate is negatively correlated with the width of osteophyte in the posterior margin of the intervertebral space. The cervical degeneration degree can be determined by measuring the arc height of the lower endplate, which has guiding significance for the early prevention and treatment of cervical spondylosis.


Assuntos
Disco Intervertebral , Osteófito , Espondilose , Adulto , Idoso , Vértebras Cervicais , Feminino , Humanos , Articulações , Masculino , Pessoa de Meia-Idade , Pescoço , Espondilose/cirurgia
2.
Medicine (Baltimore) ; 99(12): e19464, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195945

RESUMO

RATIONALE: The aim of this report is to present the technique of selective nerve root blockage combined with posterior percutaneous cervical endoscopic discectomy (PPECD) for cervical spondylotic radiculopathy (CSR). PATIENT CONCERNS: A 49-year-old female has pain in the skin area of the left scapular, pain in left elbow and limitation of left upper limb movement for 1.5 years. DIAGNOSIS: She was diagnosed with CSR and C6-7 double nerve root variation. INTERVENTIONS: We used selective nerve root block to determine the lesion segment and applied PPECD to relieve pressure on the patient's nerve roots. OUTCOMES: The pain symptoms disappeared after the patient was treated with C6-7 nerve root block. Endoscopic displayed C6-7 double nerve root variation on the left side of the spinal cord intraoperative. The neurological function was intact postoperatively and no recurrence of cervical disc herniation during the 5 months' follow-up period. The hospitalization time was 5 days, the operation time was 68.2 minutes and the bleeding volume was 52.6 ml. There was no change in cervical curvature and cervical disc height postoperatively. Japanese Orthopaedic Association score, SF-36 score and Visual Analogue Scale score improved significantly postoperatively. LESSONS: The application of selective nerve root blockage combined with PPECD for CSR could achieve satisfactory effect of position and decompression of the injured nerve root. Besides, we recommend that surgery be performed under general anesthesia to minimize patients' emotional stress and discomfort.


Assuntos
Discotomia/métodos , Pescoço/cirurgia , Bloqueio Nervoso/métodos , Espondilose/tratamento farmacológico , Espondilose/cirurgia , Terapia Combinada , Descompressão Cirúrgica/métodos , Discotomia/instrumentação , Endoscopia/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Pescoço/inervação , Pescoço/patologia , Radiculopatia/fisiopatologia , Espondilose/diagnóstico por imagem , Resultado do Tratamento
3.
Medicine (Baltimore) ; 99(12): e19550, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195963

RESUMO

The aim of our study was to explore risk factors of cage nonunion after anterior cervical discectomy and fusion (ACDF).295 patients underwent ACDF in our hospital between Jan. 2014 and Jan. 2017. Of them, 277 patients suffered cage union (union group, UG) after 6-month follow-up and 18 did not (nonunion group, NG). We collected possible factors including gender, history of smoking, alcohol, hypertension, heart disease, diabetes, body mass index, diagnose, and preoperative visual analog scale -neck, visual analog scale-arm, neck disability index (NDI) and Japanese Orthorpaedic Association, surgical duration, blood loss, fusion levels, superior fusion segment, angle of C2-C7, range of motion for C2-C7, C2-C7 sagittal vertical axis and T1 slope. We performed univariable and multivariable analysis to compare data in 2 groups.The rate of cage nonunion after ACDF was 6.1% (18 of 295) in our study. The outcome of univariable analysis showed that age (63.5 ±â€Š10.1), angle of C2-C7 (18.0 ±â€Š4.6), range of motion of C2-C7 (32.5 ±â€Š7.7), C2-C7 sagittal vertical axis (17.9 ±â€Š4.3) and T1 slope (22.1 ±â€Š5.3) were higher in NG than these (59.4 ±â€Š9.2, 16.2 ±â€Š4.5, 30.2 ±â€Š6.9,16.1 ±â€Š4.0, 20.9 ±â€Š4.9) in UG. Additionally, patients with osteoporosis had markedly higher rate of cage nonunion after ACDF than those without. What's more, the multivariable analysis implied the same results with univariable analysis.Many factors could predict cage nonunion after ACDF. Cervical sagittal parameters play an important role in cage nonunion after ACDF. We hope that we can provide some guidance for spine surgeon before performing ACDF.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Fusão Vertebral/métodos , Espondilose/cirurgia , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/patologia , Discotomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/patologia , Pescoço/cirurgia , Osteoporose/epidemiologia , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Fatores de Risco , Espondilose/diagnóstico por imagem , Escala Visual Analógica
4.
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
5.
Medicine (Baltimore) ; 99(7): e19215, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049859

RESUMO

This study compared the surgical outcomes of two surgical methods for treating multilevel cervical spondylotic myelopathy (MCSM) combined with cervical kyphotic deformity (CKD): (1) the ELTA method consisted of expansive open-door laminoplasty (EOLP) followed by three-segment anterior cervical discectomy fusion (ACDF), and (2) the LAPI method consisted of long-segment ACDF followed by long-level posterior instrumented fusion (PIF). Surgical treatment of CKD combined with MCSM remains challenging. Surgical considerations should include adequate spinal cord decompression and restoration of satisfactory cervical sagittal alignment (CSA). In certain situations, a solid PIF structure is vital to prevent failure.We included 105 patients who underwent the aforementioned surgical methods for MCSM combined with CKD from January 2013 to December 2017. The minimum follow-up period was 1 year. Comparative analysis was performed to compare the two surgical strategies' preoperative and postoperative functional outcomes, including a visual analog scale for neck pain, neck disability index, the Japanese Orthopedic Association cervical myelopathy score, and the Nurick score, as well as the CSA radiographic outcomes, including C2-7 Cobb angle, C2-7 sagittal vertical axis, and C7 slope. The risk factors related to reduced improvement in functional status were analyzed.A total of 63 patients underwent ELTA and 42 patients underwent LAPI. Improvements in functional outcomes were considerable in both groups. The mean C2-7 Cobb angle was restored from 7.4°â€Š±â€Š2.1° kyphosis to 8.8°â€Š±â€Š4.7° lordosis in the ELTA group and from 15.3°â€Š±â€Š4.2° kyphosis to 15.8°â€Š±â€Š8.1° lordosis in the LAPI group. The maximal correction angle was 22.6° in the ELTA group and 42.6° in the LAPI group.Although changes in CSA seemed to be significantly correlated with improvements of functional status, the ELTA and LAPI methods were both effective for treating MCSM combined with CKD, when appropriately selected. The ELTA method was indicated for MCSM patients who had a low degree of CKD, whereas the LAPI method was indicated for MCSM patients who had poor function scores and a high degree of CKD.


Assuntos
Vértebras Cervicais/cirurgia , Cifose/cirurgia , Procedimentos Ortopédicos/estatística & dados numéricos , Doenças da Medula Espinal/cirurgia , Espondilose/cirurgia , Idoso , Feminino , Humanos , Cifose/complicações , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Estudos Retrospectivos , Doenças da Medula Espinal/etiologia , Espondilose/complicações
6.
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
7.
World Neurosurg ; 133: e225-e232, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31493599

RESUMO

OBJECTIVE: To identify and reveal the sensitivity and efficiency of dynamic somatosensory evoked potentials (DSSEPs) in the diagnosis of cervical spondylotic myelopathy (CSM). METHODS: This retrospective study included 31 CSM and 15 control patients. All patients received SSEP examination with stimulation of median and ulnar nerves at neutral, flexed, and extended cervical positions; latency and amplitude were recorded at the C2 and C5 spinous processes and in the scalp over the primary sensory area (C3'/4'). The percentage changes in latency and amplitude with dynamic motion were examined for each lead and compared between groups; the diagnostic cutoff values were determined using receiver operating characteristic curve analysis. RESULTS: All the patients with CSM received surgeries and were followed up for 1 year. Amplitude parameters varied with a dynamic position in both groups; all recorded dynamic SSEP indices except right median stimulus recorded at C5 spinous process, right ulnar stimulus recorded at scalp point C3, and right ulnar stimulus recorded at C2 spinous process were significantly different between groups (P < 0.05), but latency was not (P > 0.05). At the neutral position, the amplitude of left media stimulus recorded at C2 spinous process (LMC2) was associated with CSM, but with low diagnostic accuracy (area under the curve = 0.199). At a dynamic position, the percentage change in amplitude of LMC2 and of left ulnar stimulus recorded at C2 spinous process (LUC2) were determined to be diagnostic of CSM (P < 0.05), with areas under the curve of 0.891 and 0.912, respectively. Both records had high sensitivity and specificity in the diagnosis of CSM; the diagnostic cutoff values of LMC2 and LUC2 were calculated as 10.2% and 19.25%, respectively. CONCLUSIONS: The percentage change in amplitude was obvious during cervical dynamic motion, with records from LMC2 and LUC2 being predictive of CSM diagnosis; dynamic SSEPs provided a simple, accurate, and noninvasive supplementary test for the diagnosis of complicated CSM.


Assuntos
Vértebras Cervicais , Potenciais Somatossensoriais Evocados , Compressão da Medula Espinal/diagnóstico , Espondilose/complicações , Espondilose/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica , Discotomia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Tempo de Reação , Estudos Retrospectivos , Sensibilidade e Especificidade , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/fisiopatologia , Compressão da Medula Espinal/cirurgia , Fusão Vertebral , Espondilose/cirurgia
8.
Medicine (Baltimore) ; 98(38): e16655, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567931

RESUMO

In this study, we first reported of a modified hybrid fixation method in expansive open-door laminoplasty (EOLP) in order to reduce medical costs. The purpose of the present study is to compare the surgical outcomes and cost-effectiveness of the modified fixation with all levels miniplate fixation in EOLP for multilevel cervical spondylotic myelopathy.Data of 67 patients who underwent EOLP from July 2015 to June 2016 were retrospectively analyzed, with 33 in the modified group and 34 in the all miniplate group based on their surgical approaches. Laminae were kept open with alternate levels miniplate and anchor fixation in the modified group, while with all levels miniplate fixation in the all miniplate group. Medical costs and clinical results including Japanese Orthopedic Association (JOA) scores, Visual Analogue Scale (VAS) scores and occurrences of complications were investigated and compared between the 2 groups. After evaluation on X-ray, CT, and MRI, radiographic data reflecting cervical alignments, spinal canal enlargement and spinal cord decompression were collected and compared within each group and between the 2 groups.After a follow-up period of about 18 months, no significant differences in operation time, intraoperative blood loss, complication rates, VAS scores, neurological recovery rates and postoperative hospital stays were observed between the 2 groups. However, EOLP with the modified fixation costed less. When comparing the 2 groups, cervical curvature index (CCIs) which reflected cervical alignments and anteroposterior diameters (APDs) reflecting spinal canal enlargement at all the follow-ups had no significant differences. Postoperative open angles which reflected spinal cord decompression of C4 and C6 were significantly smaller in the modified group. However, that difference was no longer detected at the final follow-up. Within each group, APDs increased significantly after surgery. However, no significant differences in CCIs and open angles at different follow-ups were observed in each group.Compared with all miniplate fixation, the modified hybrid fixation in EOLP showed almost the same clinical and radiographic results. However, the modified hybrid fixation method could reduce costs.


Assuntos
Placas Ósseas , Vértebras Cervicais/cirurgia , Laminoplastia/métodos , Espondilose/cirurgia , Adulto , Idoso , Desenho de Equipamento , Feminino , Humanos , Laminoplastia/economia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espondilose/diagnóstico por imagem , Resultado do Tratamento , Escala Visual Analógica
9.
J Neurosurg Spine ; 31(3): 299-309, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31473666

RESUMO

OBJECTIVE: Cervical spondylotic myelopathy (CSM) has become a prevalent cause of spinal cord dysfunction among the aging population worldwide. Although great strides have been made in spine surgery in past decades, the optimal timing and surgical strategy to treat CSM have remained controversial. In this article the authors aimed to analyze the current trends in studies of CSM and to summarize the recent advances of surgical techniques in its treatment. METHODS: The PubMed database was searched using the keywords pertaining to CSM in human studies that were published between 1975 and 2018. Analyses of both the bibliometrics and contents, including the types of papers, authors, affiliations and countries, number of patients, and the surgical approaches were conducted. A systematic review of the literature was also performed with emphasis on the diagnosis and treatment of mild CSM. RESULTS: A total of 1008 papers published during the span of 44 years were analyzed. These CSM studies mainly focused on the natural history, diagnosis, and treatment, and only a few prospective randomized trials were reported. For the authors and affiliations, there was a shift of clustering of papers toward Asian countries in the past decades. Regarding the treatment for CSM, there was an exponential growth of surgical series published, and there was a trend toward slightly more anterior than posterior approaches through the past decade. Patients with CSM had increased risks of neurological deterioration or spinal cord injury with nonoperative management. Because surgery might reduce the risks, and early surgery was likely to be correlated with better outcomes, there was a trend toward attention to mildly symptomatic CSM. CONCLUSIONS: There is emerging enthusiasm for research on CSM worldwide, with more publications originating in Asian countries over the past few decades. The surgical management of CSM is evolving continuously toward early and anterior approaches. More prospective investigations on the optimal timing and choices of surgery are therefore needed.


Assuntos
Doenças da Medula Espinal/cirurgia , Espondilose/cirurgia , Bibliometria , Vértebras Cervicais , Gerenciamento Clínico , Humanos
10.
World Neurosurg ; 132: e274-e282, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31491573

RESUMO

OBJECTIVE: To compare the change in cervical range of motion (CROM) after the 2 most widely used techniques for multilevel cervical spondylotic myelopathy (CSM): anterior cervical corpectomy and fusion (ACCF) and laminoplasty. METHODS: Patients with multilevel CSM treated in our hospital between 2014 and 2018 were divided into an ACCF group and a laminoplasty (LAMP) group according to the treatment received. Their demographic data, preoperative and postoperative Japanese Orthopedic Association (JOA) scores, and CROM, measured using the Coda Motion system, were analyzed and compared. RESULTS: A total of 53 patients were enrolled, including 29 patients in the ACCF group and 24 patients in the LAMP group. Age, sex, duration of follow-up, and preoperative and postoperative JOA scores were comparable in the 2 groups. Compared with preoperative measurements, ACCF group lost an average of 9.8%, 28.5%, 8.9%, 9.9%, 10.6%, and 7.8% of their CROM in flexion, extension, left and right lateral flexion, and left and right rotation, respectively, at the latest follow-up. For the LAMP group, these average losses were 3.5%, 16.4%, 3.2%, 6.3%, 7.0%, and 5.7%, respectively. Thus, the ACCF group exhibited greater average CROM loss than the LAMP group in all directions at the latest follow-up. CONCLUSIONS: Both ACCF and laminoplasty cause significant CROM loss in patients with multilevel CSM. The laminoplasty technique preserved more CROM than ACCF in all 6 directions after at least 1 year of follow-up. These results can be used when counseling patients undergoing surgery.


Assuntos
Imagem Tridimensional/métodos , Laminoplastia , Amplitude de Movimento Articular/fisiologia , Doenças da Medula Espinal/cirurgia , Fusão Vertebral , Adulto , Vértebras Cervicais/cirurgia , Feminino , Humanos , Laminoplastia/efeitos adversos , Laminoplastia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Espondilose/cirurgia
11.
World Neurosurg ; 132: e852-e861, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31394355

RESUMO

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is the most common procedure for single-level cervical spondylotic myelopathy (CSM); however, for multilevel CSM, some patients may also undergo anterior cervical corpectomy and fusion (ACCF). We sought to assess differences in clinical outcomes between patients undergoing ACDF and those undergoing ACCF for multilevel CSM. METHODS: The National Surgical Quality Improvement Program (NSQIP) database was queried from 2007 to 2017 to identify patients diagnosed with CSM undergoing 1- or 2-level ACCF and 2- or 3-level ACDF. Three-to-one propensity scoring was used to match patients undergoing 1-level ACCF to those undergoing 2-level ACDF. Multivariable regression was performed to compare 30-day clinical outcomes between ACCF and ACDF recipients. RESULTS: A total of 3708 patients undergoing 1-level ACCF (n = 729; 18.7%) or 2-level ACDF (n = 3179; 81.3%) were identified. On multivariable regression, 1-level ACCF was associated with significantly longer length of stay (coefficient, 0.79; 95% confidence interval [CI], 0.46-1.11; P < 0.001), longer operative time (coefficient, 19.01; 95% CI, 11.94-26.08; P < 0.001), decreased odds of readmissions (odds ratio [OR], 0.95; 95% CI, 0.91-0.99; P = 0.018), and increased odds of complications (OR, 1.02; 95% CI, 1.00-1.04; P = 0.028) compared with those undergoing 2-level ACDF. A total of 939 patients undergoing either 2-level ACCF (n = 348; 37.1%) or 3-level ACDF (n = 591; 62.9%) were identified. On multivariable regression, 2-level ACCF was associated with significantly longer length of stay (coefficient, 1.17; 95% CI, 0.55-1.79; P < 0.001) and increased risk of complications (OR, 1.05; 95% CI, 1.01-1.08; P = 0.004) compared with 3-level ACDF. CONCLUSIONS: Our analyses indicate that ACCF may be associated with worse clinical outcomes than ACDF following multilevel treatment for CSM.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/métodos , Compressão da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Espondilose/cirurgia , Idoso , Bases de Dados Factuais , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Duração da Cirurgia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Pontuação de Propensão , Compressão da Medula Espinal/etiologia , Espondilose/complicações , Resultado do Tratamento
12.
World Neurosurg ; 131: e514-e520, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31394365

RESUMO

BACKGROUND: The cervicothoracic junction (CTJ) has often been identified as an area of biomechanical vulnerability; however, few studies have examined the relative merits of extending fusions across this area. In this study, we sought to investigate the tradeoffs involved in fusing across the CTJ in cases of elective posterior cervical laminectomy and fusion. METHODS: We conducted a single-institution retrospective cohort study of patients undergoing elective, multilevel, posterior cervical decompression and fusion for degenerative cervical stenosis. Data were collected on baseline clinical and radiographic variables as well any subsequent complications or reoperations. Outcomes measures were compared between those who received fusion stopping at C7 with those who received fusion crossing the CTJ, with multivariate logistic regression used to adjust for any known confounders. RESULTS: Patients whose fusion crossed the CTJ were found to have more levels fused (mean: 5.8 vs. 3.5 levels, P < 0.0001), longer surgical times (mean: 216 vs. 149 minutes, P < 0.0001), and higher estimated blood losses (mean: 475 vs. 116 mL, P < 0.0001) despite no significant differences in number of levels decompressed (mean: 4.2 vs. 4.3 levels, P = 0.63). The groups did not differ in overall reoperation rate (10.8% vs. 9.4%, P = 1.00), but crossing the CTJ was associated with a higher rate of wound dehiscence (7.8% vs. 0%, P = 0.03). This difference persisted in multivariate analysis (P < 0.001). CONCLUSIONS: Crossing the CTJ was associated with increased surgical time, estimated blood loss, and the rates of wound dehiscence. These tradeoffs should be considered in planning posterior cervical decompression and fusion procedures.


Assuntos
Vértebras Cervicais/cirurgia , Laminectomia/métodos , Compressão da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Espondilose/cirurgia , Vértebras Torácicas/cirurgia , Idoso , Perda Sanguínea Cirúrgica , Estudos de Coortes , Descompressão Cirúrgica , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Compressão da Medula Espinal/etiologia , Estenose Espinal/complicações , Espondilose/complicações
13.
Biomed Res Int ; 2019: 9369853, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31380443

RESUMO

Purpose: The endplate defects (EDs), Modic changes (MCs), disc degeneration (DD), facet orientation (FO), and facet tropism (FT) were demonstrated to be related to the low back pain (LBP). The aim of this study was to investigate possible correlations between them. Methods: 75 patients were reviewed to evaluate the degenerative change in vertebral bodies (EDs and MCs), intervertebral discs (DD), and facet joint degeneration (FO and FT). All patients were categorized into four groups based on the grade of EDs. Clinical outcomes were evaluated with the visual analog scale (VAS) and Oswestry disability index (ODI) before and after surgery. Results: There was no difference between the four groups in baseline characteristics except for gender and weight. FT is positively correlated with FO. The same rule exists between EDs, the size of MCs II, FO (left) and FO (right), and VAS and ODI. The grade of EDs is positively correlated with the grade of DD. L4-L5 can bear more load than other levels; thus, the grade of EDs is higher than that of other lumbar levels. The preoperative LBP was relieved in all groups in varying degrees. The change of pain and dysfunction is inversely proportional to the grade of EDs in the general trend. Conclusion: The relationship between weight, gender, and disc degeneration provided a mechanism by which increasing weight can predispose to DD. Different grades of EDs had different effects on patients with LBP. There was a significant correlation between EDs, MCs II, DD, FT, and FO.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Dor Lombar/cirurgia , Espondilose/cirurgia , Articulação Zigapofisária/cirurgia , Idoso , Feminino , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/fisiopatologia , Disco Intervertebral/cirurgia , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/fisiopatologia , Dor Lombar/diagnóstico por imagem , Dor Lombar/fisiopatologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/fisiopatologia , Região Lombossacral/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Espondilose/complicações , Espondilose/fisiopatologia , Escala Visual Analógica , Articulação Zigapofisária/diagnóstico por imagem , Articulação Zigapofisária/fisiopatologia
14.
World Neurosurg ; 132: e885-e890, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31382071

RESUMO

BACKGROUND: In patients with neurological disorders, a divergence can exist between patients' perceptions regarding the outcomes and the objective neurological findings. Degenerative cervical myelopathy (DCM), a prevalent condition characterized by progressive compression of the cervical spinal cord, can produce debilitating symptoms and profound neurological findings. The purpose of the present study was to determine whether the physician-derived neurological examination findings, as recorded by American Spine Injury Association (ASIA) summary score, correlated with the patient-derived outcome measures for DCM. METHODS: A total of 78 patients underwent surgical management of DCM with completion of preoperative and 6-month follow-up assessments. Surgical management consisted of either anterior or posterior cervical decompression. All patients underwent a neurological evaluation, including an ASIA assessment before surgery and 6 months after surgery, and completed the modified Japanese Orthopaedic Association (mJOA), neck disability index (NDI), and Short-Form 36-item (SF-36) scales pre- and postoperatively to measure both disease-specific and general perceived outcomes. RESULTS: The objective physician-derived neurological testing (ASIA) did not correlate with the patient-derived scales (mJOA, NDI, and SF-36) pre- or postoperatively. Patients reported significant improvements (P < 0.001) at 6 months postoperatively in extremity functioning (mJOA), neck pain (NDI), overall physical health (SF-36), and objective strength and sensory functioning (ASIA). All patient-perceived outcome measures correlated with each other pre- and postoperatively (P < 0.01). CONCLUSIONS: Objective scoring of postoperative neurological function did not correlate with patient-perceived outcomes before and after surgery for DCM. Traditional testing of motor and sensory function as part of the neurological assessment may not be sensitive enough to assess the scope of neurological changes experienced by patients with DCM.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/métodos , Exame Neurológico , Medidas de Resultados Relatados pelo Paciente , Compressão da Medula Espinal/cirurgia , Espondilose/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/fisiopatologia , Espondilose/complicações , Espondilose/fisiopatologia
15.
World Neurosurg ; 132: e752-e758, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31415890

RESUMO

OBJECTIVE: To compare the cervical sagittal balance and surgical outcomes between anterior cervical discectomy and fusion (ACDF) and hybrid decompression and fusion (HDF; 1-level corpectomy combined with 1-level discectomy) for consecutive 3-level cervical spondylotic myelopathy (CSM). METHODS: From January 2013 to June 2016, 82 patients with 3-level CSM who underwent ACDF (n = 40) and HDF (n = 42) were retrospectively reviewed. Perioperative parameters, clinical outcomes, and radiologic sagittal alignment were analyzed and compared. RESULTS: Patients were followed up for 35.5 ± 6.5 months (range, 25-53 months). All patients had achieved significant improvement in Neck Disability Index and Japanese Orthopedic Association scores after operation, with similar clinical outcomes between both groups (P > 0.05). In the ACDF group, 2 patients were found with axial symptoms, and 1 with hoarseness. In the HDF group, 5 patients were found with axial symptoms, 1 with hoarseness, 1 with dysphagia, and 1 with pseudarthrosis. The ACDF group had less operation time and bleeding compared with the HDF group (P < 0.05). The restoration of segmental and C2-7 lordosis were significantly greater in the ACDF group than the HDF group (P < 0.05). The C2-7 sagittal vertical axis and T1 slope minus C2-7 lordosis decreased in the ACDF group at final follow-up (P < 0.05); however, there was no obvious change in those of the HDF group (P > 0.05). CONCLUSIONS: Both ACDF and HDF were safe and effective for the treatment of 3-level CSM. ACDF showed superiority to HDF in terms of less blood loss, shorter operation time, and better postoperative sagittal balance.


Assuntos
Descompressão Cirúrgica/métodos , Discotomia/métodos , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Espondilose/cirurgia , Adulto , Idoso , Placas Ósseas , Avaliação da Deficiência , Feminino , Humanos , Lordose/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Espondilose/diagnóstico por imagem , Resultado do Tratamento
16.
BMC Surg ; 19(1): 116, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31439029

RESUMO

BACKGROUND: The present study evaluated the clinical outcomes and safety of expansive open-door laminoplasty, when securing with C4 - C6 lateral mass screw and fusion. METHODS: A total of 110 patients with cervical spondylotic myelopathy (CSM) were enrolled. There were 88 male and 22 female, with mean age at 60.55 ± 10.95 years. All of the patients underwent expansive open-door laminoplasty with unilateral or bilateral C4-6 lateral mass screws fixation and fusion. Clinical data, including age, gender, operation-related information, pre- and post-operation Japanese Orthopedic Association (JOA) scores, and cervical curvatures were collected. RESULTS: The mean follow-up time of the cohort was 13.61 ± 9.53 months. Among the 110 patients, 33 of them were allocated to Unilateral group, and 77 of them were in Bilateral group. The mean JOA score of the 110 patients before surgery was 10.07 ± 2.39, and the score was improved significantly to 12.85 ± 2.45 after surgery. There were no reported cases of neurological deterioration or symptom worsening. Patients in both the Unilateral group and Bilateral groups had significant improvement of JOA scores. Among all patients, the most frequently observed complications were axial symptoms (n = 7). The average preoperative cervical curvature among all patients was 15.17 ± 5.26, and the post-surgery curvature was 14.41 ± 4.29. Similar observations were found between Unilateral and Bilateral groups. CONCLUSION: The modified surgical approach provided satisfactory clinical outcome in patients with CSM. The unilateral and bilateral fixation appeared to provide similar outcomes, in terms of cervical curvature maintenance and improvement of clinical symptoms. However, the examination of the exact differences between the two fixation methods await further biomechanical studies.


Assuntos
Vértebras Cervicais/cirurgia , Laminoplastia/métodos , Fusão Vertebral/métodos , Espondilose/cirurgia , Idoso , Parafusos Ósseos , Feminino , Humanos , Laminoplastia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
17.
J Clin Neurosci ; 70: 127-131, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31427237

RESUMO

A comparative study to examine the surgical outcomes of traumatic cervical myelopathy (TCM) patients was designed. The study aim was to compare the surgical outcomes between TCM and degenerative cervical myelopathy (DCM) and to characterize the preoperative symptoms and postoperative residual symptoms in TCM patients. One hundred consecutive patients with TCM (81 men, 19 women; mean age, 57.7 years; range, 31-79 years) and 100 consecutive patients with DCM (88 men, 12 women; mean age, 58.4 years; range, 36-78 years) were included in this study. All patients were treated by laminoplasty. The pre- and postoperative neurological statuses were evaluated according to the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. The recovery rate (RR) of each function was compared between the two groups. The mean preoperative JOA scores of motor function of the upper extremity in the TCM and DCM groups were 1.9 and 2.3, respectively (P < 0.01). After surgery, the mean RRs of motor function of the upper extremity in the TDM and DCM groups were 36.4% and 55.7%, respectively (P < 0.01) and in the lower extremity were 32.3% and 46.5%, respectively (P < 0.05). The RR for sensory function of the lower extremity was significantly lower in TCM patients than in DCM patients (39.6 vs 68.2, respectively; P < 0.0001). Motor function impairments of the upper and lower extremities and sensory function impairments of the lower extremities after surgery were more persistent in the TCM group than in the DCM group.


Assuntos
Laminoplastia/métodos , Traumatismos da Medula Espinal/cirurgia , Espondilose/cirurgia , Resultado do Tratamento , Adulto , Idoso , Medula Cervical/patologia , Medula Cervical/cirurgia , Vértebras Cervicais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/etiologia , Espondilose/etiologia
18.
Spine (Phila Pa 1976) ; 44(19): E1122-E1129, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31261275

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To analyze complications associated with minimally invasive anterolateral retroperitoneal antepsoas lumbosacral fusion (MIS-ATP). SUMMARY OF BACKGROUND DATA: MIS-ATP provides anterolateral access to the lumbar spine allowing for safe anterior lumbar interbody fusions between T12-S1. Anecdotally, many surgeons believe that ATP approach is not feasible at L5-S1 level, predisposing to catastrophic vascular injuries. This approach may help overcome limitations associated with conventional straight anterior lumbar interbody fusions, MIS lateral lumbar interbody fusion, and oblique lateral interbody fusion. METHODS: A detailed retrospective chart review of patients who had underwent MIS-ATP approach for lumbar fusion between T12-S1 was performed. Available electronic data from surgeries performed between January 2008 and March 2017 was carefully screened for surgical patients treated for spondylolisthesis, spondylosis, stenosis, sagittal, and/or coronal deformity. Detailed review of electronic medical records including operative notes, progress notes, discharge summaries, laboratory results, imaging reports, and clinic visit notes performed by a single independent reviewer not involved in patient care for documented complications. A complication is defined as any adverse event related to the index spine procedure for which patient required specific intervention or treatment. RESULTS: Nine hundred forty patients with a total of 2429 interbody fusion levels performed via MIS-ATP were identified during the study period. Sixty-seven patients (7.2%) sustained one or more complications during the perioperative period, of which 25.5% were surgical and 74.5% were medical. Overall, 78 (8.2%) surgical complications pertaining to the index procedure were noted during a postoperative period of 1 year from the date of surgery. No major vascular or direct visceral injuries were encountered. CONCLUSIONS: MIS-ATP approach provides a safe access to anterolateral interbody fusions between T12-S1. The ATP approach is performed by the spine surgeon, does not require neuromonitoring, and warrants minimal to no psoas muscle retraction resulting in significantly reduced postoperative thigh pain and rare neurologic injuries. Additionally, the direct and clear visualization of the retroperitoneal vasculature provided by the ATP approach minimizes the risk of inadvertent vascular injury. LEVEL OF EVIDENCE: 4.


Assuntos
Região Lombossacral/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Complicações Pós-Operatórias , Fusão Vertebral/efeitos adversos , Humanos , Estudos Retrospectivos , Espondilose/cirurgia
19.
Spine (Phila Pa 1976) ; 44(20): 1403-1411, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31261277

RESUMO

STUDY DESIGN: A nonrandomized, prospective, and single-center clinical trial. OBJECTIVE: The aim of this study was to investigate the clinical and radiographic efficacy of ProDisc Vivo cervical total disc replacement (cTDR) in patients with clinical and radiographic documented cervical spondylotic myelopathy (CSM), due to degenerative changes at the index level. SUMMARY OF BACKGROUND DATA: Decompression and fusion is still the gold standard in patients with cervical myelopathy. Very limited data are available regarding the application of cTDR in patients with clinical and radiological documented CSM in context of clinical and radiographic outcomes. METHODS: Clinical outcome scores included the Neck Disability Index (NDI), Visual Analogue Scale (VAS), arm and neck pain self-assessment questionnaires as well as the Nurick grade and the Japanese Orthopaedic Association (JOA) score. The radiological outcome included the range of motion (ROM), the segmental and global (C2-C7) lordosis, and the occurrence of heterotopic ossifications. RESULTS: Eighteen consecutive patients (10 males, 8 females) with documented clinical and radiological signs of myelopathy were included in this investigation. The study population had a mean age of 52.4 years and a follow-up period of 20.3 months in average (range 3-48 months). The mean range ROM of the index level stayed consistent with 6.8° preoperatively and 7.2° (P = 0.578) at the last follow-up; the global lordosis in neutral position changed from 3.5° to 14.2° significantly (P = 0.005) in mean. The JOA score improved from 11.3 to 16.6 (P < 0.001) as well as the NDI 36.7 to 10.3 (P < 0.001) and the VAS score from 5.7/6.1 (arm/neck) to 1.3/2.0 (P < 0.001/P < 0.001). The mean Nurick grade was 1.33 preoperatively and dropped down in all cases to Nurick grade of 0 (P < 0.001). CONCLUSION: cTDR (with ProDisc Vivio) in patients with CSM yielded good clinical and radiographic outcomes and found as a reliable, safe, and motion-preserving surgical treatment option, although its indication is very limited due to numerous exclusion criteria. LEVEL OF EVIDENCE: 4.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Degeneração do Disco Intervertebral/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Espondilose/diagnóstico por imagem , Substituição Total de Disco/tendências , Adulto , Idoso , Vértebras Cervicais/cirurgia , Feminino , Seguimentos , Humanos , Degeneração do Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Cervicalgia/diagnóstico por imagem , Cervicalgia/cirurgia , Estudos Prospectivos , Doenças da Medula Espinal/cirurgia , Espondilose/cirurgia , Substituição Total de Disco/métodos , Resultado do Tratamento
20.
World Neurosurg ; 131: e108-e115, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31323410

RESUMO

OBJECTIVE: To investigate correlations between radiologic measurements and clinical outcomes in patients with basilar invagination (BI). METHODS: The medical records and radiologic data of 46 patients (27 women) who had undergone posterior atlantoaxial fusion or occipitocervical fusion for BI from January 2010 to June 2018 were retrospectively analyzed. Patients under 15 years old or with a polytraumatic, tumorous, or infectious pathology were excluded. The modified Ranawat method (MRM) and the Redlund-Johnell method (RJM) were used to obtain radiographic measurements of basilar invagination preoperatively, subacute postoperatively, and at 3-month and last follow-up. Visual analogue scale, Neck Disability Index, and Japanese Orthopedic Association (JOA) scores were also assessed. Correlations between MRM and RJM measurements and clinical outcomes were evaluated. RESULTS: Mean age of patients was 59.9 ± 16.5 years, mean body mass index was 23.5 ± 4.6 kg/m2, and mean follow-up was 37.9 ± 23.8 months. Postoperative radiologic measurements increased about 36% of preoperative radiologic measurements. Subsidence at the C1-2 joint occurred in most patients at 3 months postoperatively, but clinical outcomes did not deteriorate. JOA scores were linearly correlated with percentage increases in both radiologic measurements subacute postoperatively (P < 0.05), but this significance was not maintained until the last follow-up. Occipital numbness and neuralgia were most common postoperative complications. One case of neurovascular injury and 3 cases of postoperative dysphagia occurred postoperatively. CONCLUSIONS: The subacute postoperative neurological outcomes of BI patients are significantly related to the amount of vertical reduction.


Assuntos
Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoccipital/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Fusão Vertebral , Adulto , Idoso , Artrite Reumatoide/cirurgia , Articulação Atlantoaxial/cirurgia , Articulação Atlantoccipital/cirurgia , Feminino , Forame Magno , Humanos , Masculino , Pessoa de Meia-Idade , Anormalidades Musculoesqueléticas/cirurgia , Processo Odontoide , Prolapso , Estudos Retrospectivos , Doenças da Coluna Vertebral/cirurgia , Coluna Vertebral/anormalidades , Espondilose/cirurgia , Resultado do Tratamento
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