International and Multicenter Prospective Controlled Study of Dysphagia After Anterior Cervical Spine Surgery.

BACKGROUND: In the context of anterior approach to the cervical spine, dysphagia is a common complication and still without a clear distinction of risk factors. OBJECTIVE: To analyze the risk factors of dysphagia after cervical spine surgery. METHODS: Multicenter prospective study evaluated patients who underwent anterior cervical spine surgery for degenerative pathologies, studying surgical, anesthesia, base disease, and radiological variables (preoperatively, 24 hours, 1 and 3 weeks, and 6 months after surgery), with control group matched. Postoperative dysphagia was assessed by Swallowing Satisfaction Index and Swallowing Questionnaire; besides, based on multiple logistic regression model, a risk factor analysis correlation was applied. RESULTS: In total, 233 cervical patients were evaluated; most common level approached was C5-C6 (71.8%). All showed same decreasing trade for dysphagia incidence-with more cases on cervical group ( P < .05); severe cases were rare. At postoperative day 1, identified risk factors were approach to C3-C4 (4.11, P < .01), loss of preoperative cervical lordosis (2.26, P < .01), intubation attempts ≥2 (3.10, P < .01), and left side approach (1.85, P = .02); at day 7, body mass index ≥30 (2.29, P = .02), C3-C4 (3.42, P < .01), and length of surgery ≥90 minutes (2.97, P = .005); and at day 21, C3-C4 were kept as a risk factor (3.62, P < .01). CONCLUSION: A high incidence level of dysphagia was identified, having a clear decreasing trending (number of cases and severity) through postoperative time points; considering possible risk factors, strongest correlation was the approach at the C3-C4 level-statistically significant at the 24 hours, 7 days, and 21 days assessment.

Clinical evaluation of a new kyphoplasty technique with directed cement flow.

STUDY DESIGN: Prospective, single-center 2-year study. OBJECTIVE: The long-term clinical performance of a new cement-directing kyphoplasty system was evaluated for treatment of painful osteoporotic compression fractures. SUMMARY OF BACKGROUND DATA: Cement leakage is a common clinical complication of vertebroplasty and kyphoplasty procedures. Balloon kyphoplasty restricts cement flow and reduces leakage by injection of high-viscosity cement into a compacted bone cavity. Biomechanical reinforcement of surrounding bone is limited, leaving the vertebral body vulnerable to continued collapse. METHODS: The patient population consisted of 20 patients at least 50 years of age with up to 3 painful osteoporotic vertebral compression fractures between T4-L5. The cement-directing kyphoplasty system procedure was performed unipedicularly using a curved drill and reamer to create a central cavity. The cement-directing implant was positioned inside the cavity and cement was injected through it. A total of 37 levels were treated. Pain relief was assessed using a verbal pain scale. The Roland-Morris Questionnaire was used to evaluate disability. Cement leakage was determined from radiographs (anterior/posterior and lateral) obtained within 24 hours of the procedure. RESULTS: : Significant pain relief was achieved immediately after the procedure, as shown by a decrease in the mean pain scores from 8.20 (±1.40) measured preoperatively to 2.85 (±2.13) measured postoperatively. Pain relief was sustained throughout the 2-year follow-up period. Mean Roland-Morris Questionnaire scores improved from 21.8 (±3.5) measured preoperatively to 11.6 (±5.6) measured 6 weeks postoperatively. The investigators reported 1 moderate cortical leak (2.7%) and an independent reviewer identified 8 additional minor segmental vein and cortical leaks (24.3%). None of the leaks was symptomatic. CONCLUSIONS: Directed cement flow allows cement to fill the anterior vertebral body, stabilizing fractures and supporting biomechanical loading. Control of cement flow may help minimize the risk of posterior leakage into the basivertebral vein or spinal canal.

Minimally invasive extracavitary approach for thoracic discectomy and interbody fusion: 1-year clinical and radiographic outcomes in 13 patients compared with a cohort of traditional anterior transthoracic approaches.

OBJECT: Open transthoracic approaches, considered the standard in treating thoracic disc herniation (TDH), are associated with significant comorbidities. The authors describe a minimally invasive lateral extracavitary tubular approach for discectomy and fusion (MIECTDF) to treat TDH. METHODS: In 13 patients (5 men, 8 women; mean age 51.8 years) with myelopathy and 15 noncalcified TDHs, the authors achieved a far-lateral trajectory by dilating percutaneously to a 20-mm working portal docked at the transverse process-facet junction, which then provided a corridor for a near-total discectomy, bilateral laminotomies, and interbody arthrodesis requiring minimal cord retraction. A cohort of 11 demographically comparable patients treated via transthoracic approaches was used as control. RESULTS: Preoperative Frankel grades were B in 1 patient, C in 4, D in 5, and E in 3, whereas at mean of 10 months, 11 had Grade E function and 2 had Grade D function. Mean surgical metrics were operating room time 93.75 minutes, blood loss 33 ml, and hospital stay 3.1 days. Complications included 4 transient paresthesias, 1 CSF leak, 1 abdominal wall weakness, and 3 nonwound infections. One-year follow-up MR imaging revealed full decompression in all cases and no cage migration. Mean visual analog scales scores preoperative, at 6 weeks, 3 months, and 1 year were 5.6, 4.5, 3.2, and 1.2, respectively. No differences existed in preoperative clinical and radiographic profile of the study and control groups. Compared with controls, the MIECTDF group achieved superior scores in all metrics (p < 0.01) except for equivalent 1-year neurological outcomes. CONCLUSIONS: Compared with transthoracic procedures, MIECTDF effectively decompressed the spinal canal, yielding identical 1-year radiographic and clinical outcomes to those seen in controls, while producing superior clinical scores in the interim. Thus, MIECTDF is the authors' treatment of choice for TDH.