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1.
No Shinkei Geka ; 48(11): 1013-1019, 2020 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-33199658

RESUMO

OBJECTIVE: We aimed to investigate the characteristics and operative results of elderly patients with cervical spondylotic myelopathy(aged ≧80 years)treated using the posterior approach. METHODS: Between April 2010 and December 2018, 21 patients aged ≧80 years(older group:8 men and 13 women;age range, 80-90 years)who underwent laminoplasty were reviewed and compared with 23 patients aged <80 years(younger group;13 men and 10 women;age range, 42-79 years)who underwent laminoplasty. The following data were obtained from chart reviews:age;sex;cervical canal stenosis level;time to operation;symptoms(e.g., gait disturbance);comorbidities(hypertension, diabetes mellitus, cancer, heart disease, ischemic cerebrovascular disease, and lumbar canal stenosis);antithrombotic drug use;cardiac, pulmonary, and renal functions;operative time;volume of blood loss during the operation;postoperative delirium;and follow-up period. Neurological deficits before and after the surgery were assessed using the neurosurgical cervical spine scale(NCSS). Data were statistically analyzed, and p-values <0.05 were considered statistically significant. RESULTS: The operative time, symptoms(hypertension), renal function, and preoperative NCSS score were significantly different between the older and younger groups. Meanwhile, most variables showed no significant differences between the groups. Although the preoperative NCSS score was lower in the older group, there was no significant difference in the degree of improvement in the NCSS score after surgery. CONCLUSIONS: The findings of this study suggest that we should not hesitate to perform surgery for cervical spondylotic myelopathy in elderly patients with favorable cardiorespiratory function.


Assuntos
Laminoplastia , Doenças da Medula Espinal , Espondilose , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Espondilose/complicações , Espondilose/diagnóstico por imagem , Espondilose/cirurgia , Resultado do Tratamento
2.
Acta Chir Orthop Traumatol Cech ; 87(5): 333-339, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33146601

RESUMO

PURPOSE OF THE STUDY Artificial cervical disc replacement (CDR) has emerged as a viable treatment alternative to fusion for the management of symptomatic compressive radiculopathy and potentially for cervical myelopathy. The aim of our study was to evaluate the clinical and radiological outcomes of patients treated with a second generation semi-constrained CDR with a ceramicceramic articulation. MATERIAL AND METHODS A prospective cohort study of all patients undergoing a cervical disc replacement for cervical disc pathology, during the period from April 2007 to April 2011 using a ceramic-ceramic disc replacement comprised the study group. 52 patients were available for final clinical and radiological follow-up. Both, clinical and radiological evaluation were performed at each clinical visit at 6 weeks, 6 months, 12 months, 2 years, 5 years and 7 years. RESULTS There were a total of 52 patients, with 44 single level cases and 8 two level cases. The NDI improved significantly (p < 0.05) from a mean preoperative score of 56 % to a score of 20% at final follow-up. The mean preoperative mobility at the index level unit was 12.2 ± 4.5°, this decreased to 7.9 ± 3.2° at six weeks, but slightly increased to 12.9 ± 2.9° at final follow-up (gain not significant). Heterotrophic ossification (HO) was noted in 13 (25%) patients. CONCLUSIONS Cervical disc replacement with a ceramic-ceramic bearing surface is a viable option in the treatment of variety of cervical pathologies. This ceramic-ceramic interface may eliminate the potential problems of metallosis and poly-wear but further longer-term results should be studied. Key words: Cervical spine; disc replacement; ceramic articulation; neck disability; heterotrophic ossification.


Assuntos
Degeneração do Disco Intervertebral , Substituição Total de Disco , Cerâmica , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Seguimentos , Humanos , Degeneração do Disco Intervertebral/cirurgia , Estudos Prospectivos , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(35): e22026, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871958

RESUMO

BACKGROUND: The objective of this meta-analysis was to summarize and identify the available evidence from these studies to estimate which device was better for multilevel cervical spondylotic myelopathy (MCSM). And provides clinicians with evidence on which to base their clinical decision making. METHODS: This review will include all studies comparing the new Zero-profile versus cage-plate interbody fusion system in anterior cervical discectomy and fusion (ACDF) for the treatment of MCSM. The search strategy will be performed in 9 databases. We will not establish any limitations to language and publication status, published from inception to the July, 2020. Two reviewers will screen, select studies, extract data, and assess quality independently. Outcome is operative time, blood loss, clinical function outcome, radiologic outcomes, and complications. The methodological quality including the risk of bias of the included studies will be evaluated. We will carry out statistical analysis using RevMan 5.3 software. RESULTS: This study will summarize current evidence to assess the efficacy and safety of Zero-profile versus cage-plate interbody fusion system in ACDF for the treatment of MCSM. CONCLUSION: The findings of this study will provide helpful evidence for the clinician, and will promote further studies, as well as comparing the 2 devices in ACDF for MCSM REGISTRATION NUMBER:: INPLASY202070095 (DOI number: 10.37766/inplasy2020.7.0095).


Assuntos
Vértebras Cervicais/cirurgia , Discotomia , Fusão Vertebral/instrumentação , Espondilose/cirurgia , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
5.
Medicine (Baltimore) ; 99(36): e21994, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899045

RESUMO

BACKGROUND: Cervical spondylotic myelopathy (CSM) is the most serious type of cervical spondylosis, which is often treated surgically in patients with progressive neurological symptoms following ineffective conservative treatment. However, some patients have residual symptoms such as neck pain, stiffness, and C5 nerve palsy after surgery. The Qishe pill can effectively relieve the symptoms of neck pain and numbness, but there is no evidence showing the efficacy and safety of the Qishe pill in treating symptoms after spinal cord surgery. METHODS/DESIGN: A multicenter, randomized controlled clinical trial will be conducted to evaluate the efficacy and safety of the Qishe Pill. A total of 330 patients with CSM who receive surgical treatment will be randomly divided into 2 groups, treated for 12 weeks and with a 1-year follow-up. The primary outcome will be Japanese Orthopaedic Association score from the baseline to 4 weeks, 12 weeks, 24 weeks, and 48 weeks after surgery. Secondary outcomes will include Visual Analogue Scale score, Neck Disability Index, and imaging indicators (including magnetic resonance imaging and X-ray). Additionally, adverse reactions will be observed and recorded as safety indicators. DISCUSSION: Although the Qishe pill can effectively improve the discomfort of the neck and upper limbs in clinical applications, there is a lack of clinical research on postoperative patients. This study will investigate the efficacy and safety of the Qishe pill in treating postoperative symptoms of CSM. TRIAL REGISTRATION: Clinical Trials.gov ID: ChiCTR1900028173. Registered on 17 December 2019.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Dor Pós-Operatória/prevenção & controle , Vértebras Cervicais/cirurgia , Humanos , Estudos Multicêntricos como Assunto , Fitoterapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/cirurgia , Espondilose/complicações
6.
Medicine (Baltimore) ; 99(38): e22184, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957345

RESUMO

The aim of study was to investigate the complications of cervical disc arthroplasty (CDA) and to discuss the factors affecting the mobility of the prosthesis and the measures to prevent these complications. Hundred and five patients who underwent CDA between 2009 and 2016 were enrolled. The clinical and radiographic outcomes were used to assess and the complications were recorded as well.All the patients were followed-up with an average of 41.30 ±â€Š16.90 months with an average age of 47.90 ±â€Š9.22 years. The visual analogue scale (VAS), neck disability index (NDI), and Japanese Orthopaedic Association (JOA) scores improved significantly at the final follow-up (FU) compared with the preoperative values. At the final FU, the overall incidence of heterotopic ossification (HO) was 51.42%. The distribution of different grades of HO was low-level HO (53.7%) and high-level HO (46.3%). No significant differences were found in the NDI, VAS, or JOA scores between patients with HO and those without HO (P > .05). In the high-level HO patients, the range of mobility (ROM) was significantly reduced compared with the low-level HO patients and those without HO (P < .05). The anterior displacement, subsidence, and instability were observed in 1 patient respectively and the segmental kyphosis, adjacent segment degeneration in 3 patients respectively. The patient of CDA instability also suffered severe neck pain and the revision surgery was performed.Postoperative complications in CDA such as HO, segmental kyphosis, and prosthesis displacement are prone to occur, affecting prosthesis mobility. Surgical indications should be strictly controlled, and intraoperative and postoperative treatments should be given great attention in order to reduce prosthesis-related complications.


Assuntos
Artroplastia/efeitos adversos , Vértebras Cervicais/cirurgia , Falha de Prótese/etiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
Zhongguo Gu Shang ; 33(9): 841-7, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32959572

RESUMO

OBJECTIVE: To explore the clinical effects of anterior cervical discectomy with fusion (ACDF) and anterior cervical corpectomy with fusion (ACCF) in treating adjacent two-segment cervical spondylotic myelopathy (CSM). METHODS: The clinical data of 37 patients with adjacent two segment CSM treated from January 2016 to December 2017 were retrospectively analyzed, including 15 males and 22 females, aged from 43 to 69 years old with an average of 54.6 years. The patients were divided into ACDF group (group A, n=17) and ACCF group (group B, n=20) according to the different surgery. The operation time and intraoperative blood loss were recorded;the Cobb angle and cervical curvature in the cervical fusion segments before surgery and 1, 12 months after surgery were observed;Japanese Orthopaedic Association (JOA) score was used to evaluate the surgical efficacy, and the postoperative complications were analyzed. RESULTS: All patients were followed up for 12 to 24 months with an average of 18.5 months. Operation time and intraoperative blood loss in group A were (106.3±22.6) min, (52.2±26.4) ml, respectively, while were (115.6±16.8) min, ( 61.7±20.7) ml in group B. There was no statistically significant in operation time between two groups(P>0.05);intraoperative blood loss in group B was larger than group A(P<0.05). The preoperative and postoperative 1 and 12 months, cervical curvature and Cobb angle of cervical fusion segment in group A were (11.28±1.40)°, (17.56±1.90)°, (16.64±1.80)° and (4.93±4.20) °, (9.44±2.60)°, (9.25±2.80)°, respectively, and in group B were (10.59± 1.20)°, (16.26±2.10)°, (15.76±2.50)° and (4.75±3.90)°, (7.98±2.10)°, (7.79±3.00)°. The cervical curvature and Cobb angle in all cervical fusion segments at 1, 12 months after surgery were obviously improved, and group A recovered more significantly than group B (P<0.05). The JOA scores in group A were 9.46±1.70, 11.56±1.40, 14.86±1.20 before operation and 1 and 12 months after operation, and group B were 9.11±1.50, 11.40±1.30, 15.12±1.60, respectively. The postoperative JOA scores of the two groups were significantly improved (P<0.05), and there was no statistically significant difference between two groups at the same time (P>0.05). At the final follow up, in group A, dysphagia occurred in 2 cases, cage displacement in 1 case, and no titanium plate screw loose was found;and in group B, dysphagia occurred in 4 cases, titanium mesh collapse in 2 cases, titanium plate screw loose in 1 case. CONCLUSION: Two types of anterior cervical decompression and fusion for the treatment of two segment cervical spondylotic myelopathy can effectively decompress and improve the Cobb angle and cervical curvature of the affected vertebra. The ACDF surgical procedure can directly removethe compressive thing at intervertebral level, which will lead to little vertebral body damage and favorably recovered cervical curvature. The ACCF surgical procedure has a large operation space, which can easily remove the posterior vertebral osteophyte and the calcified posterior longitudinal ligament. Long-term follow-up shows that ACDF and ACCF have good surgical procedures, mature technology, and close efficacy.


Assuntos
Doenças da Medula Espinal/cirurgia , Fusão Vertebral , Espondilose/cirurgia , Adulto , Idoso , Vértebras Cervicais/cirurgia , Discotomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
8.
Medicine (Baltimore) ; 99(33): e20955, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871974

RESUMO

We conducted a retrospective study to compare the clinical and radiological results of anterior cervical discectomy and fusion (ACDF) and posterior laminoplasty for two-level localized ossification of the posterior longitudinal ligament (OPLL).ACDF and posterior laminoplasty are performed for localized OPLL at the disc and vertebral body levels, respectively.Eighty six patients with two-level localized OPLL who underwent surgery from January 2011 to December 2016 were retrospectively investigated (41, ACDF group; 45, laminoplasty group). Clinical outcomes were reviewed, and radiologic results such as occupying ratio (OR), space available in the spinal cord, cranial and caudal OPLL-to-disc distance (ODD)/posterior body height (PBH) ratios, segmental angle, C2-C7 Cobb angle, T1 slope, C2-C7 sagittal vertical axis (SVA), and range of motion were investigated.Patients were followed-up for an average of 42.7 ±â€Š10.5 months. Clinical outcomes, postoperative OR, and space available in the spinal cord were significantly improved at the final follow-up in both groups. Preoperatively, the OR and cranial and caudal ODD/PBH ratios were not significantly different between the groups. Compared to pre-operative values, differences in the segmental and C2-C7 Cobb angles at the final follow-up were statistically significant for the ACDF group (P < .05). The mean operative time, bleeding volume, and the duration of hospitalization were significantly lower in the ACDF group than in the laminoplasty group (P < .05). Complications occurred in 1 ACDF case and in 5 laminoplasty cases.Both ACDF and laminoplasty provided satisfactory clinical and radiologic outcomes for two-level localized OPLL. However, ACDF was associated with a lower operation time, bleeding loss, duration of hospitalization, and complications.


Assuntos
Discotomia , Laminoplastia , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/cirurgia , Fusão Vertebral , Adulto , Idoso , Perda Sanguínea Cirúrgica , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Feminino , Humanos , Laminoplastia/métodos , Tempo de Internação , Ligamentos Longitudinais/diagnóstico por imagem , Ligamentos Longitudinais/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Ossificação do Ligamento Longitudinal Posterior/complicações , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Complicações Pós-Operatórias , Amplitude de Movimento Articular , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Fusão Vertebral/métodos , Resultado do Tratamento
9.
Zhongguo Gu Shang ; 33(8): 735-40, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32875764

RESUMO

OBJECTIVE: To explore the clinical efficacy of C3 expanded half lamina excision combined with unilateral open door laminoplasty for multiple segmental cervical spinal cord compression syndrome. METHODS: The clinical data of 58 patients with multiple segmental cervical spinal cord compression syndrome underwent surgical treatment between September 2014 and May 2018 were retrospectively analyzed. There were 34 males and 24 females with a mean age of 64.4 years old (ranged from 46 to 78 years old). Among them, 28 cases received the surgery of C3 expanded half lamina excision combined with C4-C7 unilateral open-door laminoplasty (improvedgroup), and 30 cases received a single C3-C7 unilateral open-door laminoplasty (traditional group). Operation time, intraoperative blood loss, complications including C5 nerve root palsy and axial symptoms were compared between two groups. To evaluate the situation of the imaging indicators by measuring the space available for the spinal cord through cross sectional MRI of cervical spine at the narrowest segment of C3 (including intervertebral disc levels of C3, 4). Pre- and post-operative Japanese Orthopedic Association(JOA) score, Neck Disability Index(NDI) score, and improvement rate of neurological function, were recorded and analyzed between the two groups. RESULTS: All the patients were followed up for 12 to 18 months with an average of(14.5±1.8) months for improved group and (14.5±1.9) months for traditional group, and no significant difference was found between the two groups (P>0.05). There was no significant difference in intraoperative blood loss and C5 nerve root palsy between the two groups (P>0.05). The operation time (119±10) min vs (126±12) min and axial symptoms 7.1%(2/28) vs 26.6%(8/30) was significant difference between the two groups (P<0.05). Preoperative and postoperative space available for the spinal cord of C3 was (93.61±9.02) mm3 and (153.50±12.76) mm3 respectively, which was obtained obvious improvement in all patients(P<0.05). At the final follow up, JOA scores of improved group and traditional group were 14.36±1.70 and 14.03±1.82 respectively, and NDI scores were 10.36±2.55 and 12.47±3.46 respectively, there was significant difference between two groups (P<0.05). However, there was no significant difference between two groups for the improvement rate (68.36±0.12)%VS (65.01±0.12)%of neurological function(P>0.05). CONCLUSION: C3 expanded half lamina excision combined with unilateral open-door laminoplasty is an effective method to treat multiple segmental cervical spinal cord compression syndrome, for it can not only fully relieved spinal cord compression, but also achievedgood effect in preventing complications such as axial symptoms by reducing stripping of muscles from C2 spinous process.


Assuntos
Laminoplastia , Compressão da Medula Espinal , Idoso , Vértebras Cervicais/cirurgia , Estudos Transversais , Feminino , Humanos , Laminectomia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
10.
Niger J Clin Pract ; 23(8): 1167-1171, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32788497

RESUMO

Background: Spine tumors could affect the bony elements and/or its neural contents. Clinical manifestations are underlined by their biological behaviors. Aim: This study aims to identify the pattern of presentation and surgical management of spine tumors in southeast Nigeria over a 10-year period. Patients and Methods: A retrospective analysis of patients who were managed surgically for the spine and spinal cord neoplastic lesions over a 10-year period. All patients had pre-and post-operative magnetic resonance imaging (MRI) and histological diagnosis. Relevant clinical, radiological, and histological data were extracted and analyzed using Statistical Package for the Social Sciences (SPSS) for windows version 21. Results: Four hundred and seventy-two spine procedures performed within the study period, 39 cases of histologically proven primary spinal cord tumors (PSCT) and non-PSCT were identified. These represented 8.3% of spine procedures. Seventeen were PSCT (3.6% of spine procedures), while 22 (4.7%) had non-PSCT, mean age for the PSCT group was 45 yrs and non-PSCT 59.5 years. A total of 56.5% of tumors are involved in the thoracic region, 43.7% in the cervical region. PSCT was likely to affect the cervical spine; while bony spine tumors, thoracic spine [odds ratio (OR) 4.9, P value 0.019]. A total of 84.6% of non-PSCT affected the bony spine, mainly the vertebral body. The histological result showed metastatic adenocarcinoma to be the most common tumor (33.3%). PSCT was likely to be benign than non-PSCT (P value < 0.00001). Gross total resection (GTR) was done in 100% of PSCT, and 50% in non-PSCT. Thirteen (40.6%) patients improved and 11 (34.4%) patients remained the same. Conclusions: Metastatic adenocarcinoma was the most common tumor of the spine. There was restricted ability at a GTR for non-PSCT compared to PSCT. Grossly 75% had improved/same neurological status, as such adjudged as a good outcome.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/cirurgia , Coluna Vertebral/diagnóstico por imagem , Adenocarcinoma/patologia , Adolescente , Adulto , Vértebras Cervicais/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica/patologia , Procedimentos Neurocirúrgicos/métodos , Nigéria , Estudos Retrospectivos , Doenças da Medula Espinal , Neoplasias da Medula Espinal/patologia , Neoplasias da Coluna Vertebral/patologia , Resultado do Tratamento , Adulto Jovem
11.
Bone Joint J ; 102-B(8): 981-996, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731832

RESUMO

AIMS: Whether to perform hybrid surgery (HS) in contrast to anterior cervical discectomy and fusion (ACDF) when treating patients with multilevel cervical disc degeneration remains a controversial subject. To resolve this we have undertaken a meta-analysis comparing the outcomes from HS with ACDF in this condition. METHODS: Seven databases were searched for studies of HS and ACDF from inception of the study to 1 September 2019. Both random-effects and fixed-effects models were used to evaluate the overall effect of the C2-C7 range of motion (ROM), ROM of superior/inferior adjacent levels, adjacent segment degeneration (ASD), heterotopic ossification (HO), complications, neck disability index (NDI) score, visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, Odom's criteria, blood loss, and operating and hospitalization time. To obtain more credible results contour-enhanced funnel plots, Egger's and Begg's tests, meta-regression, and sensitivity analyses were performed. RESULTS: In total, 17 studies involving 861 patients were included in the analysis. HS was found to be superior to ACDF in maintaining C2-C7 ROM and ROM of superior/inferior adjacent levels, but HS did not reduce the incidence of associated level ASD. Also, HS did not cause a higher rate of HO than ACDF. The frequency of complications was similar between the two techniques. HS failed to achieve more favourable outcomes than ACDF using the NDI, VAS, JOA, and Odom's scores. HS did not show any more advantages in operating or hospitalization time but did show reduction in blood loss. CONCLUSION: Although HS maintained cervical kinetics, it failed to reduce the incidence of ASD. This finding differs from previous reports. Moreover, patients did not show more benefits from HS with respect to symptom improvement, prevention of complications, and clinical outcomes. Cite this article: Bone Joint J 2020;102-B(8):981-996.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/métodos , Degeneração do Disco Intervertebral/cirurgia , Amplitude de Movimento Articular/fisiologia , Fusão Vertebral/métodos , Substituição Total de Disco/métodos , Adulto , Idoso , Bases de Dados Factuais , Avaliação da Deficiência , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Japão , Masculino , Pessoa de Meia-Idade , Cervicalgia/etiologia , Cervicalgia/fisiopatologia , Cervicalgia/cirurgia , Medição da Dor , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Espondilose/diagnóstico por imagem , Espondilose/cirurgia , Resultado do Tratamento
12.
PLoS One ; 15(8): e0237350, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32780779

RESUMO

OBJECTIVE: To compare changes in foraminal motion at two time points post-surgery between artificial disc replacement (ADR) and anterior cervical discectomy and fusion (ACDF). METHODS: Eight ACDF and 6 ADR patients (all single-level C5-6) were tested at 2 years (T1) and 6.5 years (T2) post-surgery. The minimum foraminal height (FH.Min) and width (FW.Min) achieved during neck axial rotation and extension, and the range of these dimensions during motion (FH.Rn and FW.Rn, respectively) were measured using a biplane dynamic x-ray system, CT imaging and model-based tracking while patients performed neck axial rotation and extension tasks. Two-way mixed ANOVA was employed for analysis. RESULTS: In neck extension, significant interactions were found between year post-surgery and type of surgery for FW.Rn at C5-6 (p<0.006) and C6-7 (p<0.005), and for FH.Rn at C6-7 (p<0.01). Post-hoc analysis indicated decreases over time in FW.Rn for ACDF (p<0.01) and increases in FH.Rn for ADR (p<0.03) at the C6-7 adjacent level. At index level, FW.Rn was comparable between ACDF and ADR at T1, but was smaller for ACDF than for ADR at T2 (p<0.002). In axial rotation, differences were found between T1 and T2 but did not depend on type of surgery (p>0.7). CONCLUSIONS: Changes were observed in the range of foraminal geometry at adjacent levels from 2 years to 6.5 years post-surgery that were different between ACDF and ADR for neck extension. These changes are contrary to the notion that motion at adjacent levels continue to increase following ACDF as compared to ADR over the long term.


Assuntos
Vértebras Cervicais/fisiopatologia , Discotomia/efeitos adversos , Degeneração do Disco Intervertebral/cirurgia , Amplitude de Movimento Articular , Fusão Vertebral/efeitos adversos , Substituição Total de Disco/efeitos adversos , Adulto , Idoso , Fenômenos Biomecânicos , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Feminino , Seguimentos , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Tomografia Computadorizada por Raios X , Substituição Total de Disco/instrumentação , Resultado do Tratamento
14.
Spine (Phila Pa 1976) ; 45(16): E1047-E1051, 2020 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-32701738

RESUMO

STUDY DESIGN: Case report. OBJECTIVE: To describe a modified posterior approach for decompression and excision of a multiloculated atlanto-axial cyst. SUMMARY OF BACKGROUND DATA: Atlanto-axial cyst with myelopathy is rare. A direct decompression through anterior approach or an indirect decompression through posterior approach has been proposed. We report a rare multiloculated large C1-C2 cyst extending down to C3 body with myelopathy that created a dilemma in choice of approach. A modified posterior approach was adopted for decompression. METHODS: A 72-year-old lady, known case of Rheumatoid arthritis, presented with cervical myelopathy which was rapidly progressive since 2 months being her to wheel chair bound. She had clumsiness of gait and bilateral grip weakness. Both upper and lower extremities had nonfunctional power (medical research council scale grade 2). Deep tendon reflexes were exaggerated. Sensation was reduced in trunk and both extremities. Magnetic resonance imaging and computed tomography scan showed a large multiloculated cyst compressing spinal cord. Here author used modified posterior approach from the right side to access the cyst. The C2 ganglion excision, vertebral artery isolation, and resection of the pars allowed an approach similar to transforaminal decompression in the lumbar spine. A large antero-lateral epidural part of the cyst was excised. The retro-dental cyst was decompressed by puncturing cyst. Biopsy confirmed a synovial cyst. RESULT: The patient showed rapid neurological recovery after surgery. Postoperative magnetic resonance imaging at 3 months showed complete resolution of cyst. At 2-year follow-up, there was a complete neurological recovery with residual spasticity. CONCLUSION: A customized posterior approach allowed near total excision of a rare multiloculated large C1-2 cyst extending to the C3 body. This allowed visualisation anterior to the spinal cord without undue retraction that saved an additional anterior decompression. LEVEL OF EVIDENCE: 5.


Assuntos
Descompressão Cirúrgica/métodos , Doenças da Medula Espinal/cirurgia , Cisto Sinovial/cirurgia , Idoso , Artrite Reumatoide/complicações , Vértebras Cervicais/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Período Pós-Operatório , Cisto Sinovial/diagnóstico por imagem , Tomografia Computadorizada por Raios X
17.
Spine (Phila Pa 1976) ; 45(14): 952-959, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32609465

RESUMO

STUDY DESIGN: A prospective randomized multicenter trial. OBJECTIVE: To investigate the effects of surgery with either structured postoperative physiotherapy or standard postoperative approach on neck-related headache in patients with cervical radiculopathy. Secondary, to investigate associations between change in neck-related headache and change in neck muscle endurance, neck mobility, or neck pain. SUMMARY OF BACKGROUND DATA: The effect of physiotherapy on individuals with neck-related headache after surgery for cervical radiculopathy due to magnetic resonance imaging-verified disc disease is unknown. METHODS: One hundred six patients with neck-related headache and participating in a randomized controlled trial evaluating the additional effects of physiotherapy after surgery for cervical radiculopathy were included. Patients were randomized preoperatively to structured postoperative physiotherapy (n = 51) or the standard postoperative approach (n = 55). Outcome measures were headache intensity and neck pain intensity, neck muscle endurance, and neck mobility. Measures were obtained preoperatively and at 6 weeks, 3 months, 6 months, and 1 year postoperatively. RESULTS: Headache intensity significantly changed from baseline to 1 year postoperatively (P < 0.001) in both groups. Post-hoc tests showed a significant difference between baseline and 6 weeks (P ≤ 0.05). No significant differences were found between groups (P > 0.05) or between-group differences in changes over time (P > 0.05). The change in current headache intensity over time was associated with a change in current neck pain intensity over time (P = 0.003, ß = 0.40). CONCLUSION: There was a significant improvement in headache intensity 1 year postoperatively in patients with cervical radiculopathy and neck-related headache, but there were no differences between groups over time. Change in current headache intensity was only associated with a change in current neck pain intensity. LEVEL OF EVIDENCE: 2.


Assuntos
Vértebras Cervicais/cirurgia , Cefaleia , Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Modalidades de Fisioterapia , Complicações Pós-Operatórias , Seguimentos , Humanos , Degeneração do Disco Intervertebral/fisiopatologia , Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/terapia , Imagem por Ressonância Magnética , Cervicalgia/cirurgia , Estudos Prospectivos , Radiculopatia/fisiopatologia , Radiculopatia/terapia , Amplitude de Movimento Articular , Resultado do Tratamento
19.
Spine (Phila Pa 1976) ; 45(15): E903-E908, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675600

RESUMO

STUDY DESIGN: Cadaveric study on fresh unprocessed, nonpreserved, undyed specimens, which has not previously been reported. OBJECTIVE: Our aim was to explore the possible topographic correlation of the C5 nerve root with regards to its course and regional relation to C6 Chassaignac tubercle. SUMMARY OF BACKGROUND DATA: C5 palsy is reported amongst the most frequent postoperative complications of cervical spinal procedures. We hypothesized that etiologic mechanisms proposed thus far in the current literature, although with some plausible explanation, still cannot explain why the C5 nerve root and not any other level suffer a postoperative palsy. METHODS: Six fresh cadavers had extensive layer by layer dissection performed by two surgeons (one of whom has experience as an anatomy demonstrator and dissector). Roots of brachial plexus were exposed in relation to cervical transverse processes. Photographs were taken at each stage of the exposure. RESULTS: We observed a close relation of the path of the C5 nerve root with the C6 tubercle bilaterally. Moreover, we noted a steeper descent of C5 in comparison with the other adjacent roots. CONCLUSION: Steeper angle of the C5 nerve root and close proximity to C6 Chassaignac tubercle may play a role in predisposing it to neuropraxia. Detailed anatomical photographs on fresh unprocessed cadaveric specimens are novel. Peculiar anatomical features and recent experimental evidence discussed do highlight a postganglionic extraforaminal etiology corresponding well to the demographic meta-analysis data on clinical features of postoperative C5 palsy. Exploring an alternative unified "neurophysiologic stress and critical tipping point" etiological model that encompasses current theories and correlates known metanalyses observations, we believe further studies would be prudent to ascertain/refute these findings. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/efeitos adversos , Paralisia/etiologia , Raízes Nervosas Espinhais/lesões , Raízes Nervosas Espinhais/cirurgia , Cadáver , Vértebras Cervicais/patologia , Descompressão Cirúrgica/métodos , Dissecação/efeitos adversos , Feminino , Humanos , Masculino , Paralisia/patologia , Complicações Pós-Operatórias/etiologia , Raízes Nervosas Espinhais/patologia
20.
Spine (Phila Pa 1976) ; 45(15): 1024-1029, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675601

RESUMO

STUDY DESIGN: Retrospective analysis using data from RCTs. OBJECTIVE: This study aimed to report on the incidence of radiological adjacent segment degeneration (ASD) in patients with cervical radiculopathy due to a herniated disc that were randomized to receive cervical arthroplasty or arthrodesis. SUMMARY OF BACKGROUND DATA: Cervical disc prostheses were introduced to prevent ASD in the postsurgical follow-up. However, it is still a controversial issue. METHODS: Two hundred fifty-three patients were included in two randomized, double-blinded trials comparing anterior cervical discectomy with arthroplasty (ACDA), with intervertebral cage (ACDF), or without intervertebral cage (ACD) for one-level disc herniation. Neutral lateral radiographs were obtained preoperatively, at 1- and 2-year follow-up after surgery. Radiological ASD was evaluated on X-ray and defined by a decrease in disc height and the presence of anterior osteophyte formation on both the superior and the inferior level in relation to the target level. RESULTS: Radiological ASD was present in 34% of patients at baseline and increased to 59% at 2-year follow-up in the arthrodesis groups (ACD and ACDF combined), and to 56% in the arthroplasty group. Progression of radiological ASD was present in 29% of patients in the arthrodesis group and in 31% of patients in the arthroplasty group for 2-year follow-up. CONCLUSIONS: Radiological ASD occurs in a similar manner in patients who were subjected to arthrodesis in cervical radiculopathy and in patients who received arthroplasty to maintain motion. Current data tend to indicate that the advantage of cervical prosthesis in preventing radiological ASD is absent. LEVEL OF EVIDENCE: 2.


Assuntos
Artroplastia/tendências , Vértebras Cervicais/cirurgia , Discotomia/tendências , Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral/cirurgia , Implantação de Prótese/tendências , Adulto , Artroplastia/efeitos adversos , Vértebras Cervicais/diagnóstico por imagem , Discotomia/efeitos adversos , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/prevenção & controle , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Implantação de Prótese/efeitos adversos , Estudos Retrospectivos
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