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Xia C, Shi F, Chen C, Lv J, Chen Q. Clinical Efficacy and Safety of Anterior Cervical Decompression versus Segmental Fusion and Posterior Expansive Canal Plasty in the Treatment of Multilevel Cervical Spondylotic Myelopathy. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7696209. [PMID: 35449847 PMCID: PMC9017450 DOI: 10.1155/2022/7696209] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/21/2022] [Indexed: 12/13/2022]
Abstract
Objective To compare the clinical efficacy and safety of anterior cervical decompression and segmental fusion and posterior expansive canal plasty in the treatment of multisegment cervical myelopathy. Methods Retrospective analysis was performed of 56 cases of multisegment cervical myelopathy patients admitted from July 2018 to June 2021, 32 male patients and 24 females, aged 56.9 ± 12.8 years with an average duration of 10.6 ± 3.2 years. All patients' preoperative imaging examination revealed multiple-segmented cervical disc herniation and had clinical manifestations of cervical myelopathy. Results No neurovascular complications occurred in both groups, and 24 to 36 months of follow-up (mean 28.6 months) were obtained. The height of the cervical spondylosis segment was higher than that 2 weeks after surgery (p < 0.05), and the curvature of the cervical spine was significantly lower than that before surgery. There was no statistical significance in the height of the anterior column and curvature of the cervical vertebra at 2 weeks after surgery and at the last follow-up (p > 0.05). There were statistically significant differences in anterior curvature of the cervical spine between the two groups at 2 weeks after surgery and the last follow-up (p < 0.05). Japanese Orthopaedic Association (JOA) scores in both groups recovered significantly after surgery. At 3 months and the last follow-up, the improvement rate of JOA score in the anterior approach group was significantly higher than that in the posterior approach group (p < 0.05), and the improvement rate of JOA score in the anterior approach group was also better than that in the posterior approach group (p < 0.05). Conclusion This segmented anterior fusion procedure can effectively restore the anterior cervical column height and can significantly improve spinal cord function compared with posterior spinal canal enlargement plasty, thus could be considered an effective option for the treatment of multisegment cervical myelopathy.
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Affiliation(s)
- Chen Xia
- Department of Orthopedics, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, Hangzhou 310014, China
| | - Fangfang Shi
- Department of Hematology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, Hangzhou 310014, China
| | - Chuyong Chen
- Department of Orthopedics, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, Hangzhou 310014, China
| | - Jun Lv
- Department of Orthopedics, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, Hangzhou 310014, China
| | - Qi Chen
- Department of Orthopedics, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, Hangzhou 310014, China
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Evaniew N, Cadotte DW, Dea N, Bailey CS, Christie SD, Fisher CG, Paquet J, Soroceanu A, Thomas KC, Rampersaud YR, Manson NA, Johnson M, Nataraj A, Hall H, McIntosh G, Jacobs WB. Clinical predictors of achieving the minimal clinically important difference after surgery for cervical spondylotic myelopathy: an external validation study from the Canadian Spine Outcomes and Research Network. J Neurosurg Spine 2020; 33:129-137. [PMID: 32276258 DOI: 10.3171/2020.2.spine191495] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Recently identified prognostic variables among patients undergoing surgery for cervical spondylotic myelopathy (CSM) are limited to two large international data sets. To optimally inform shared clinical decision-making, the authors evaluated which preoperative clinical factors are significantly associated with improvement on the modified Japanese Orthopaedic Association (mJOA) scale by at least the minimum clinically important difference (MCID) 12 months after surgery, among patients from the Canadian Spine Outcomes and Research Network (CSORN). METHODS The authors performed an observational cohort study with data that were prospectively collected from CSM patients at 7 centers between 2015 and 2017. Candidate variables were tested using univariable and multiple binomial logistic regression, and multiple sensitivity analyses were performed to test assumptions about the nature of the statistical models. Validated mJOA MCIDs were implemented that varied according to baseline CSM severity. RESULTS Among 205 patients with CSM, there were 64 (31%) classified as mild, 86 (42%) as moderate, and 55 (27%) as severe. Overall, 52% of patients achieved MCID and the mean change in mJOA score at 12 months after surgery was 1.7 ± 2.6 points (p < 0.01), but the subgroup of patients with mild CSM did not significantly improve (mean change 0.1 ± 1.9 points, p = 0.8). Univariate analyses failed to identify significant associations between achieving MCID and sex, BMI, living status, education, smoking, disability claims, or number of comorbidities. After adjustment for potential confounders, the odds of achieving MCID were significantly reduced with older age (OR 0.7 per decade, 95% CI 0.5-0.9, p < 0.01) and higher baseline mJOA score (OR 0.8 per point, 95% CI 0.7-0.9, p < 0.01). The effects of symptom duration (OR 1.0 per additional month, 95% CI 0.9-1.0, p = 0.2) and smoking (OR 0.4, 95% CI 0.2-1.0, p = 0.06) were not statistically significant. CONCLUSIONS Surgery is effective at halting the progression of functional decline with CSM, and approximately half of all patients achieve the MCID. Data from the CSORN confirmed that older age is independently associated with poorer outcomes, but novel findings include that patients with milder CSM did not experience meaningful improvement, and that symptom duration and smoking were not important. These findings support a nuanced approach to shared decision-making that acknowledges some prognostic uncertainty when weighing the various risks, benefits, and alternatives to surgical treatment.
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Affiliation(s)
- Nathan Evaniew
- 1University of Calgary Spine Program, University of Calgary, Alberta
| | - David W Cadotte
- 1University of Calgary Spine Program, University of Calgary, Alberta
| | - Nicolas Dea
- 2Vancouver Spine Surgery Institute, University of British Columba, Vancouver, British Columbia
| | | | - Sean D Christie
- 4Department of Surgery, Dalhousie University, Halifax, Nova Scotia
| | - Charles G Fisher
- 2Vancouver Spine Surgery Institute, University of British Columba, Vancouver, British Columbia
| | | | - Alex Soroceanu
- 1University of Calgary Spine Program, University of Calgary, Alberta
| | - Kenneth C Thomas
- 1University of Calgary Spine Program, University of Calgary, Alberta
| | | | - Neil A Manson
- 4Department of Surgery, Dalhousie University, Halifax, Nova Scotia
- 7Canada East Spine Centre, Saint John, New Brunswick
| | - Michael Johnson
- 8Department of Surgery, University of Manitoba, Winnipeg, Manitoba
| | - Andrew Nataraj
- 9Department of Surgery, University of Alberta, Edmonton, Alberta; and
| | - Hamilton Hall
- 6Department of Surgery, University of Toronto, Ontario
| | - Greg McIntosh
- 10Canadian Spine Outcomes and Research Network, Markdale, Ontario, Canada
| | - W Bradley Jacobs
- 1University of Calgary Spine Program, University of Calgary, Alberta
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