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Costa F, Restelli F, Mazzapicchi E, Rubiu E, Bonomo G, Schiariti M, Innocenti N, Anania CD, Cardia A, Fornari M. Proposal of a new score system (Cervical Surgical Score) for management of degenerative cervical myelopathy. J Neurosurg Sci 2025; 69:158-166. [PMID: 38502522 DOI: 10.23736/s0390-5616.23.06165-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND To date, no shared algorithms with the aim of guiding surgical strategy in complex cases of degenerative cervical myelopathy (DCM) exist. Our purpose is to present the Cervical Surgical Score (CSS) which could help in identifying complex DCM cases, suggesting a surgical strategy. METHODS We created the CSS based on multidisciplinary and literature-focused discussions, based on eight parameters including number of levels of cervical pathology and myelopathy, type and predominance of compression and grade of clinical myelopathy. We prospectively enrolled surgical DCM patients in a 15-months period, collecting clinical and radiological data. During outpatient clinic a specific surgical indication was offered to DCM patients. To validate the score, each outpatient clinic surgical indication was compared a posteriori to the one that resulted from multidisciplinary CSS scoring, focusing on patients for which both an anterior and posterior approach were considered suitable. RESULTS A total of 100 patients operated on for DCM at our Institution between December 2021 and February 2023 were prospectively enrolled. In 53% of patients the pathology was present at more than two levels. According to CSS calculation, 14% of patients resulted in the "grey zone", where both an anterior and posterior approach were deemed feasible. Among them, in 42.8% of cases the CSS allowed a modification of the originally planned surgery. Looking at outcome, an improvement of m-JOA score in 62% of patients was disclosed. CONCLUSIONS This preliminary study showed the reliability and usefulness of CSS in detecting complex DCM cases, requiring further analysis by expert spine surgeons, suggesting a surgical strategy.
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Affiliation(s)
- Francesco Costa
- Spine Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
| | - Francesco Restelli
- Spine Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta, Milan, Italy -
| | - Elio Mazzapicchi
- Spine Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
| | - Emanuele Rubiu
- Spine Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
| | - Giulio Bonomo
- Spine Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
| | - Marco Schiariti
- Spine Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
| | - Niccolò Innocenti
- Spine Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
| | - Carla D Anania
- Department of Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Andrea Cardia
- Department of Neurosurgery, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
| | - Maurizio Fornari
- Department of Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
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Zhou M, Xu X, Chen H, Qi B. Comparing two surgical approaches for treating multilevel cervical spondylotic myelopathy: A meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3485-3496. [PMID: 37393420 DOI: 10.1007/s00586-023-07790-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE This meta-analysis aims to evaluate the therapeutic efficacy of anterior versus posterior surgical approaches for multisegment cervical spondylotic myelopathy (MCSM). METHODS Eligible studies published between the period of January 2001 and April 2022 and comparing the anterior and posterior surgical approaches for treating cervical spondylotic myelopathy were retrieved from the PubMed, Web of Science, Embase, and Cochrane databases. RESULTS A total of 17 articles were selected based on the inclusion and exclusion criteria. This meta-analysis failed to show any significant difference in the duration of surgery, the hospitalization time, or the improvement in the Japanese Orthopedic Association score between the anterior and posterior approaches. The anterior approach, however, exhibited increased efficacy in the improvement of the neck disability index, reduction in the visual analog scale for cervical pain, and improvement in the cervical curvature compared with the posterior approach. CONCLUSION Bleeding was also less with the anterior surgical approach. The posterior approach provided a significantly higher range of motion of the cervical spine and showed fewer postoperative complications compared with the anterior approach. While both the surgical approaches have good clinical outcomes and show postoperative neurological function improvement, the meta-analysis shows that both anterior and posterior approaches have certain merits and shortcomings. A meta-analysis of a larger number of randomized controlled trials with longer follow-up can conclusively determine which of the surgical approaches is more beneficial in the treatment of MCSM.
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Affiliation(s)
- Min Zhou
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Xin Xu
- Cardiovascular Medicine Department, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Hairen Chen
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Baiwen Qi
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
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Shangguan Z, Chen G, Liu W, Li J. Clinical outcomes of modified versus traditional expansive open-door laminoplasty for cervical spondylotic myelopathy: A single-institution experience. J Orthop Surg (Hong Kong) 2023; 31:10225536231209556. [PMID: 38006252 DOI: 10.1177/10225536231209556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2023] Open
Abstract
PURPOSE To compare the surgical outcomes of modified expansive open-door laminoplasty (EOL) (C4-C6) and traditional EOL (C3-C7) in patients with cervical spondylotic myelopathy (CSM). METHODS One hundred and two CSM patients were retrospectively recruited from Fujian Medical University Union Hospital between March 2012 and December 2019. Seventy-one patients with CSM underwent modified EOL, and 31 patients underwent traditional EOL. The primary endpoint was axial symptoms. RESULTS Patients who underwent modified EOL had a significantly lower incidence of axial symptoms (odds ratio: 0.273; 95% confidence interval: 0.184-0.691; p = .002). The length of hospital stay (p = .263), and intraoperative blood loss (p = .402) were not significantly different between the groups. Significantly more postoperative drainage was observed in patients who underwent modified EOL (p < .001), while the cost of hospitalization in patients treated with traditional EOL was higher (p = .011). There were significant differences between modified and traditional EOL for the changes in range of motion (p < .001), modified Japanese Orthopaedic Association score (p = .001), and the Nurick grade (p = .014), while the changes of visual analogue scale (p = .250), and the neck disability index (p = .134) were not significantly different between the groups. CONCLUSION This study found modified EOL may decrease the incidence of axial symptoms in patients with CSM compared to traditional EOL.
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Affiliation(s)
| | - Gang Chen
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Wenge Liu
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Jiandong Li
- Fujian Medical University Union Hospital, Fuzhou, China
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Ma Y, Xin Z, Kong W, Zhang L, Du Q, Liao W. Transcorporeal decompression using a fully-endoscopic anterior cervical approach to treat cervical spondylotic myelopathy: surgical design and clinical application. BMC Musculoskelet Disord 2022; 23:1031. [PMID: 36451136 PMCID: PMC9710048 DOI: 10.1186/s12891-022-06001-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/18/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) is a common procedure for treating cervical spondylotic myelopathy (CSM), however, ACDF may cause pseudoarthrosis, accelerated degeneration of adjacent segments, loss of activity of fused segments and other complications. The full-endoscopic technique can treat CSM, without the aforementioned complications above. Therefore, it is of great clinical value to investigate the surgical scheme of anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord (APFETDSC). METHODS A total of 28 cases with single-segment Cervical spondylotic myelopathy (CSM) from April 2017 to July 2019 were involved in this study. The size of the disc-osteophyte complex was measured using imaging data prior to the operation. The diameter and direction of the bony passage was determined according to the size and central position of the complex, respectively. Twenty-eight patients underwent the above scheme for CSM. The clinical outcome evaluations included Visual Analog Scale (VAS) scores, Japanese Orthopedic Association (JOA) scores. The imaging assessment included MRI, CT and X-rays. RESULTS The diameter of the designed bony passage was about 6.9 mm, and directed toward the lower edge of the diseased lower vertebral body oblique to the center of the disc-osteophyte complex. All patients successfully completed the operation. The postoperative neck pain VAS and JOA were significantly improved compared to preoperative values (p < 0.01). Postoperative MRI indicated complete decompression of the spinal cord. CT scanning 1 year after the operation revealed an almost healed bony passage and X-ray imaging showed satisfactory physiological curvature of the cervical spine, without cervical instability. CONCLUSION Based on the diameter and direction of the bony passage, as determined by the size and position of the disc-osteophyte complex, indicated by MRI and CT scanning, anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord offers good decompression of the spinal cord and ensures excellent therapeutic outcome.
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Affiliation(s)
- Yanyan Ma
- grid.413390.c0000 0004 1757 6938Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099 Guizhou China ,Rehabilitation Department, Guizhou Provincial Orthopedics Hospital, Sixian street, Guiyang, 550007 China
| | - Zhijun Xin
- grid.413390.c0000 0004 1757 6938Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099 Guizhou China
| | - Weijun Kong
- grid.413390.c0000 0004 1757 6938Orthopaedics, The Second Affiliated Hospital of Zunyi Medical University, Intersection between Xinpu Avenue and Xinlong Avenue, Zunyi, 563006 China
| | - Longsheng Zhang
- grid.413390.c0000 0004 1757 6938Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099 Guizhou China
| | - Qian Du
- grid.413390.c0000 0004 1757 6938Orthopaedics, The Second Affiliated Hospital of Zunyi Medical University, Intersection between Xinpu Avenue and Xinlong Avenue, Zunyi, 563006 China
| | - Wenbo Liao
- grid.413390.c0000 0004 1757 6938Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099 Guizhou China
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Wang XZ, Liu H, Li JQ, Sun Y, Zhang F, Guo L, Zhang P, Dou CH, Zhang W. Comparison of Anterior Cervical Discectomy and Fusion with Cervical Laminectomy and Fusion in the Treatment of 4-Level Cervical Spondylotic Myelopathy. Orthop Surg 2021; 14:229-237. [PMID: 34904370 PMCID: PMC8867437 DOI: 10.1111/os.13058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To assess and compare the therapeutic effects of Anterior Cervical Discectomy and Fusion (ACDF) and Cervical Laminectomy and Fusion (CLF) in the treatment of 4‐level cervical. Methods We performed a retrospective review on 39 patients with 4‐level CSM who underwent ACDF or CLF in the Third Hospital of Hebei Medical University from January 2010 to December 2018. The patients were divided into ACDF group and CLF group according to the treatment. The operative index was evaluated based on intraoperative blood loss and operation time. The functional outcomes including Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) of axial pain were compared. The Cobb angle, Cobb angle improvement rate, range of motion (ROM) and ROM loss ratio were measured for radiographic evaluation. Results No major complications or deaths occurred. The average age at baseline was 55 years. There was no significant difference between the ACDF and CLF group in follow‐up time (26.29 months, 25.39 months, P > 0.05). The intraoperative blood loss was higher in the CLF group than in the ACDF group (692.67 ± 38.68 vs 392.14 ± 128.06, P < 0.05). The operation time was longer in the CLF group than in the ACDF group (206.60 ± 49.37 vs 172.64 ± 31.96, P < 0.05). Significant improvements in the VAS and JOA scores were observed in both groups (P < 0.05). No significant difference in VAS was found between the ACDF and CLF groups (P < 0.05). There was a significantly larger improvement rate of JOA score in the ACDF group than in the CLF group (60.9% ± 9.57% vs 31.5% ± 15.70%, P < 0.05). There were two (9.6%) cases with complications In the ACDF group, including one (4.8%) case of dysphagia and one (4.8%) case of pharyngodynia. In the CLF group, two patients (11.1%) developed C5 palsy. No significant difference in the incidence of complications, ROM loss ratio and Cobb angle improvement rate was found between group ACDF and group CLF (all P < 0.05). Conclusion Both ACDF and CLF were effective in the treatment of multi‐level cervical spondylosis and ACDF is more suitable for patients with 4‐level CSM.
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Affiliation(s)
- Xian-Zheng Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huanan Liu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jia-Qi Li
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yapeng Sun
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fei Zhang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lei Guo
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Peng Zhang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chen-Hao Dou
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Zhang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
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Liu B, Wang Y, Zhang Y. Efficacy of Posterior Cervical Laminectomy and Decompression plus Lateral Mass Screw-Rod Internal Fixation in the Treatment of Multisegment Cervical Spinal Canal Stenosis and Effects on Cervical Curvature and Range of Motion Parameters. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:6001877. [PMID: 34691219 PMCID: PMC8536437 DOI: 10.1155/2021/6001877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the clinical effects of posterior laminectomy and decompression plus lateral mass screw-rod internal fixation for the treatment of multisegment cervical spinal canal stenosis and the improvement of cervical curvature and range of motion in patients. METHODS A total of 68 patients with multisegment cervical spinal stenosis who were treated in our hospital from January 2019 to June 2020 were selected and randomly divided into the control group and the observation group according to the random number table, with 34 patients in each group. The patients in the control group were treated with traditional posterior cervical open-door laminoplasty with silk suture fixation, while those in the observation group were treated with posterior cervical laminectomy and decompression plus lateral mass screw-rod internal fixation. The perioperative index of patients in the two groups was recorded, and the clinical efficacy of patients was evaluated. The patient's JOA score, cervical physiological curvature, and cervical range of motion were evaluated. The occurrence of complications was recorded during follow-up. RESULTS The amount of intraoperative bleeding and postoperative rehabilitation training time in the observation group was less than that in the control group (P < 0.05). There was no significant difference in operation time between the two groups (P > 0.05). The total effective rate of the observation group was significantly higher than that of the control group (P < 0.05). The JOA scores at 1 week, 6 months, and 12 months after operation in the observation group were higher than those in the control group (P < 0.05). The physiological curvature of cervical spine in the observation group at 1 week, 6 months, and 12 months after operation was higher than that in the control group (P < 0.05). The cervical range of motion at 12 months after operation in the observation group was significantly higher than that in the control group (P < 0.05). The incidence of postoperative complications in patients of the observation group was significantly lower than that of the control group (P < 0.05). CONCLUSION Posterior laminectomy and decompression plus lateral mass screw-rod internal fixation can help patients to improve various clinical symptoms caused by nerve compression and obtain better improvement of cervical curvature and range of motion. It is an ideal surgical method for the treatment of multisegment cervical spinal canal stenosis, and it is conducive to improving the clinical efficacy of patients.
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Affiliation(s)
- Bo Liu
- Linfen People's Hospital, Orthopedics Department, Linfen, Shanxi 041000, China
| | - Yufei Wang
- Linfen People's Hospital, Orthopedics Department, Linfen, Shanxi 041000, China
| | - Yaning Zhang
- Linfen People's Hospital, Orthopedics Department, Linfen, Shanxi 041000, China
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Nishida N, Sakuramoto I, Fujii Y, Hutama RY, Jiang F, Ohgi J, Imajo Y, Suzuki H, Funaba M, Chen X, Sakai T. Tensile mechanical analysis of anisotropy and velocity dependence of the spinal cord white matter: a biomechanical study. Neural Regen Res 2021; 16:2557-2562. [PMID: 33907048 PMCID: PMC8374559 DOI: 10.4103/1673-5374.313059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In spinal cord injuries, external forces from various directions occur at various velocities. Therefore, it is important to physically evaluate whether the spinal cord is susceptible to damage and an increase in internal stress for external forces. We hypothesized that the spinal cord has mechanical features that vary under stress depending on the direction and velocity of injury. However, it is difficult to perform experiment because the spinal cord is very soft. There are no reports on the effects of multiple external forces. In this study, we used bovine spinal cord white matter to test and analyze the anisotropy and velocity dependence of the spinal cord. Tensile-vertical, tensile-parallel, shear-vertical, and shear-parallel tests were performed on the white matter in the fibrous direction (cranial to caudal). Strain rate in the experiment was 0.1, 1, 10, and 100/s. We calculated the Young's modulus of the spinal cord. Results of the tensile and shear tests revealed that stress tended to increase when external forces were applied parallel to the direction of axon fibers, such as in tensile-vertical and shear-vertical tests. However, external forces those tear against the fibrous direction and vertically, such as in tensile-parallel and shear-parallel tests, were less likely to increase stress even with increased velocity. We found that the spinal cord was prone to external forces, especially in the direction of the fibers, and to be under increased stress levels when the velocity of external forces increased. From these results, we confirmed that the spinal cord has velocity dependence and anisotropy. The Institutional Animal Care and Use Committee of Yamaguchi University waived the requirement for ethical approval.
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Affiliation(s)
- Norihiro Nishida
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Minami-Kogushi, Ube, Yamaguchi, Japan
| | - Itsuo Sakuramoto
- Department of Mechanical and Electrical Engineering, National Institute of Technology Tokuyama College, Gakuendai, Shunan, Yamaguchi, Japan
| | - Yoshihiro Fujii
- Department of Mechanical and Electrical Engineering, National Institute of Technology Tokuyama College, Gakuendai, Shunan, Yamaguchi, Japan
| | - Rudolf Yoga Hutama
- Department of Mechanical and Electrical Engineering, National Institute of Technology Tokuyama College, Gakuendai, Shunan, Yamaguchi, Japan
| | - Fei Jiang
- Faculty of Engineering, Yamaguchi University, Tokiwadai Ube, Yamaguchi, Japan
| | - Junji Ohgi
- Faculty of Engineering, Yamaguchi University, Tokiwadai Ube, Yamaguchi, Japan
| | - Yasuaki Imajo
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Minami-Kogushi, Ube, Yamaguchi, Japan
| | - Hidenori Suzuki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Minami-Kogushi, Ube, Yamaguchi, Japan
| | - Masahiro Funaba
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Minami-Kogushi, Ube, Yamaguchi, Japan
| | - Xian Chen
- Faculty of Engineering, Yamaguchi University, Tokiwadai Ube, Yamaguchi, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Minami-Kogushi, Ube, Yamaguchi, Japan
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Janka M, Handschu R, Merkel A, Schuh A. [Spinal stenosis]. MMW Fortschr Med 2020; 162:58-65. [PMID: 33140362 DOI: 10.1007/s15006-020-1459-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Michael Janka
- Klinikum Neumarkt\/Muskuloskelettales Zentrum, Nürnberger Straße 12, 92318, Neumarkt i.d. OPf., Germany.
| | - René Handschu
- Klinikum Neumarkt i.d. Oberpfalz, Nürnberger Str. 12, 92318, Neumarkt i.d.OPf., Germany
| | - Andreas Merkel
- , Nürnberger Straße 12, 92318, Neumarkt i.d. OPf., Germany
| | - Alexander Schuh
- Friedrich-Alexander-Univ. Erlangen-Nürnberg, Nürnberger Str. 12, 92318, Neumarkt i.d.OPf., Germany
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He X, Zhang JN, Liu TJ, Hao DJ. Is laminectomy and fusion the better choice than laminoplasty for multilevel cervical myelopathy with signal changes on magnetic resonance imaging? A comparison of two posterior surgeries. BMC Musculoskelet Disord 2020; 21:423. [PMID: 32615953 PMCID: PMC7331273 DOI: 10.1186/s12891-020-03435-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 06/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to compare the clinical outcomes and complications between laminectomy and fusion (LF) and laminoplasty (LP) for multi-level cervical spondylotic myelopathy (MCSM) with increased signal intensity (ISI) on T2-weighted images (T2WI). Methods In this retrospective cohort study, we analyzed 52 patients with MCSM with ISI on T2WI who underwent laminoplasty (LP group). The Japanese Orthopedic Association (JOA) score, the Visual Analogue Scale (VAS) score, the physical and mental component scores (PCS and MCS) of Short-Form 36 (SF-36), and the extension and flexion ranges of motion (ROMs) were recorded. As controls, propensity score matching identified 52 patients who underwent laminectomy and fusion (LF group) from January 2014 to June 2016 using 7 independent variables (preoperation): age, sex, JOA score, SF-36 PCS, SF-36 MCS, preoperative symptom duration and high signal intensity ratio (HSIR). Results The operative duration in the LF group was significantly higher than that in the LP group. At the last follow-up, the JOA score, VAS score, and SF-36 (PCS and MCS) scores were all significantly improved in both groups. The extension and flexion ROMs were decreased in both groups but significantly better in the LP group than in the LF group. Both groups demonstrated similar clinical improvements at the final follow-up. The complication rate was higher in the LF group. Conclusion The present study demonstrates that LP for MCSM with ISI on T2WI achieves similar clinical improvement as LF. However, longer operative durations, higher complication rates and lower extension and flexion ROMs were found in the LF group.
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Affiliation(s)
- Xin He
- Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Nanshao gate, Xi'an, 710054, Shaan'xi Province, China
| | - Jia Nan Zhang
- Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Nanshao gate, Xi'an, 710054, Shaan'xi Province, China.
| | - Tuan Jiang Liu
- Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Nanshao gate, Xi'an, 710054, Shaan'xi Province, China
| | - Ding Jun Hao
- Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Nanshao gate, Xi'an, 710054, Shaan'xi Province, China
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Yang HE, Kim SW, Yoo WK. Diffusion Metrics as a Potential Prognostic Biomarker in Cervical Myelopathy. BRAIN & NEUROREHABILITATION 2019. [DOI: 10.12786/bn.2019.12.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Hea-Eun Yang
- Department of Physical Medicine and Rehabilitation, VHS Medical Center, Seoul, Korea
| | - Seok Woo Kim
- Spine Center, Hallym University Sacred Heart Hospital, Anyang, Korea
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Anyang, Korea
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