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Biswas S, Aizan LNB, Mathieson K, Neupane P, Snowdon E, MacArthur J, Sarkar V, Tetlow C, Joshi George K. Clinicosocial determinants of hospital stay following cervical decompression: A public healthcare perspective and machine learning model. J Clin Neurosci 2024; 126:1-11. [PMID: 38821028 DOI: 10.1016/j.jocn.2024.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/13/2024] [Accepted: 05/25/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVE Post-operative length of hospital stay (LOS) is a valuable measure for monitoring quality of care provision, patient recovery, and guiding hospital resource management. But the impact of patient ethnicity, socio-economic deprivation as measured by the indices of multiple deprivation (IMD), and pre-existing health conditions on LOS post-anterior cervical decompression and fusion (ACDF) is under-researched in public healthcare settings. METHODS From 2013 to 2023, a retrospective study at a single center reviewed all ACDF procedures. We analyzed 14 non-clinical predictors-including demographics, comorbidities, and socio-economic status-to forecast a categorized LOS: short (≤2 days), medium (2-3 days), or long (>3 days). Three machine learning (ML) models were developed and assessed for their prediction reliability. RESULTS 2033 ACDF patients were analyzed; 79.44 % had a LOS ≤ 2 days. Significant predictors of LOS included patient sex (HR:0.81[0.74-0.88], p < 0.005), IMD decile (HR:1.38[1.24-1.53], p < 0.005), smoking (HR:1.24[1.12-1.38], p < 0.005), DM (HR:0.70[0.59-0.84], p < 0.005), and COPD (HR:0.66, p = 0.01). Asian patients had the highest mean LOS (p = 0.003). Testing on 407 patients, the XGBoost model achieved 80.95 % accuracy, 71.52 % sensitivity, 85.76 % specificity, 71.52 % positive predictive value, and a micro F1 score of 0.715. This model is available at: https://acdflos.streamlit.app. CONCLUSIONS Utilizing non-clinical pre-operative parameters such as patient ethnicity, socio-economic deprivation index, and baseline comorbidities, our ML model effectively predicts postoperative LOS for patient undergoing ACDF surgeries. Yet, as the healthcare landscape evolves, such tools will require further refinement to integrate peri and post-operative variables, ensuring a holistic decision support tool.
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Affiliation(s)
- Sayan Biswas
- Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL Manchester, England, United Kingdom.
| | - Luqman Naim Bin Aizan
- Department of General Surgery, Warrington and Halton Foundation Trust, Warrington, United Kingdom
| | - Katie Mathieson
- Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL Manchester, England, United Kingdom
| | - Prashant Neupane
- Department of Vascular Surgery, Manchester Vascular Centre, Manchester Royal Infirmary, M13 9WL Manchester, United Kingdom
| | - Ella Snowdon
- Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL Manchester, England, United Kingdom
| | - Joshua MacArthur
- Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL Manchester, England, United Kingdom
| | - Ved Sarkar
- College of Letters and Sciences, University of California, Berkeley, CA 94720, United States of America
| | - Callum Tetlow
- Division of Data Science, The Northern Care Alliance NHS Group, M6 8HD Manchester, England, United Kingdom
| | - K Joshi George
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, M6 8HD Manchester, England, United Kingdom
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AlHashim M, AlDohailan F, AlGhuneem A, AlDandan A, AlHaddad M. Iatrogenic pharyngo-esophageal diverticulum post-anterior cervical discectomy and fusion: A case report and review of literature. Laryngoscope Investig Otolaryngol 2024; 9:e1253. [PMID: 38736940 PMCID: PMC11081416 DOI: 10.1002/lio2.1253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/19/2024] [Accepted: 04/07/2024] [Indexed: 05/14/2024] Open
Abstract
Objectives The purpose of this study is to report a case of iatrogenic pharyngoesophageal diverticulum post-anterior cervical discectomy and fusion (ACDF) surgery, its management and management of postoperative complications. We also did a thorough review of literature about iatrogenic pharyngoesophageal diverticulum which is a rarely encountered complication occurring after a commonly performed surgery; ACDF. Methods Here we describe a case of iatrogenic pharyngoesophageal diverticulum post-ACDF surgery. In this paper we also make comparisons to the 23 cases reported in the literature in terms of: presentations, clinical findings, management courses, and complications. This study was approved by the Institution Review Board of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. (Ref. no.: IRB-2023-01-473). The reported subject provided written informed consent before initiation of this study. Results Our case is a 45-year-old male with a history of ACDF surgery 8 years ago. He presented with dysphagia and regurgitations which started 1 year after ACDF. He was labeled as a case of Zenker's diverticulum and underwent multiple failed open and endoscopic surgeries prior to presenting to us. Upon presenting to our center, barium swallow showed the pharyngoesophageal diverticulum. Patient definitive diagnosis of iatrogenic rather than Zenker's diverticulum was established intra-operatively with esophagoscopy which revealed exposed hardware inside the diverticulum. He underwent open diverticulectomy and diverticulopexy. Postoperatively he developed pharyngocutanous fistula and right vocal fold palsy, both successfully managed conservatively. Conclusion Iatrogenic Pharyngoesophageal diverticulum is a rare complication following ACDF, however prolonged dysphagia shall warrant further investigation by contrast studies. Open diverticulectomy with muscle reinforcement is a good management modality. Due to the complicated anatomy secondary to previous operations, we recommend conservative management for patients with postoperative pharyngocutaneous fistula.
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Affiliation(s)
- Mohammed AlHashim
- ENT DepartmentImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
| | - Fatima AlDohailan
- ENT DepartmentImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
| | - Aishah AlGhuneem
- Department of General SurgeryRoyal Medical Services, Bahrain Defense Force HospitalRiffaBahrain
| | - Ahmed AlDandan
- ENT DepartmentImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
| | - Mohammed AlHaddad
- ENT DepartmentImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
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Osunronbi T, Olukoya O, Jesuyajolu D, Alare K, Alemenzohu HO, Bello RO, Omoniyo T, Oyeyemi OV, Yakasai AN, Sharma H. The prognostic utility of neutrophil-lymphocyte ratio in spinal surgery: A systematic review and meta-analysis. J Clin Neurosci 2024; 121:161-168. [PMID: 38412749 DOI: 10.1016/j.jocn.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 02/18/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Neutrophil-lymphocyte ratio (NLR) is reportedly an effective prognostic tool across various medical and surgical fields, but its value in spinal surgery is unestablished. We aim to investigate the relationship between elevated baseline/postoperative NLR and patient outcomes in spinal surgery. MATERIALS AND METHODS We performed a systematic search in PubMed, EMBASE, and SCOPUS databases for studies investigating the prognostic value of NLR in spine patients.Odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were analysed on the RevMan 5.4 software. Where meta-analysis was not possible, we vote-counted the direction of the effect of elevated NLR. The GRADE framework for prognostic factor research was utilised to assess the certainty of the evidence for each outcome measure. RESULTS Five outcome measures (overall survival, mortality, disease-free survival, functional recovery and complications) were assessed across 16 studies involving 5471 patients. Elevated baseline NLR was associated with reduced overall survival (HR: 1.63, 95 % CI: 1.05 - 2.54) (GRADE: low) and worsened functional recovery (OR: 0.93, 95 % CI: 0.87 - 0.98) (GRADE: low). There was no association between baseline NLR and disease-free survival (HR: 2.42, 95 % CI: 0.49 - 11.83) (GRADE: very low) or mortality (OR: 1.39, 95 % CI: 0.41 - 4.75) (GRADE: very low). Elevated NLR levels measured on days 3-4 and days 6-7 postoperatively, but not NLR measured at baseline or on days 1-2 postoperatively, were associated with greater risks of complications (GRADE: low). CONCLUSIONS NLR is an objective tool with the potential to identify the patients that would benefit from surgery and facilitate shared decision-making.
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Affiliation(s)
- Temidayo Osunronbi
- Neurosurgery Section, Surgery Interest Group of Africa, Lagos, Nigeria; Department of Health Sciences, University of York, York, United Kingdom.
| | - Olatomiwa Olukoya
- Neurosurgery Section, Surgery Interest Group of Africa, Lagos, Nigeria
| | | | - Kehinde Alare
- Neurosurgery Section, Surgery Interest Group of Africa, Lagos, Nigeria
| | | | - Raheem O Bello
- Neurosurgery Section, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Taiwo Omoniyo
- Neurosurgery Section, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Opeyemi V Oyeyemi
- Neurosurgery Section, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Amina N Yakasai
- Neurosurgery Section, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Himanshu Sharma
- Southwest Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
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Huang L, Chun KS, Yu L, Lee JY, Soetikno A, Chen H, Jeong H, Barrett J, Martell K, Kang Y, Patel AA, Xu S. A Novel Method for Tracking Neck Motions Using a Skin-Conformable Wireless Accelerometer: A Pilot Study. Digit Biomark 2024; 8:40-51. [PMID: 38606345 PMCID: PMC11007253 DOI: 10.1159/000536473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/17/2023] [Indexed: 04/13/2024] Open
Abstract
Introduction Cervical spine disease is a leading cause of pain and disability. Degenerative conditions of the spine can result in neurologic compression of the cervical spinal cord or nerve roots and may be surgically treated with an anterior cervical discectomy and fusion (ACDF) in up to 137,000 people per year in the United States. A common sequelae of ACDF is reduced cervical range of motion (CROM) with patient-based complaints of stiffness and neck pain. Currently, tools for assessment of CROM are manual, subjective, and only intermittently utilized during doctor or physical therapy visits. We propose a skin-mountable acousto-mechanic sensor (ADvanced Acousto-Mechanic sensor; ADAM) as a tool for continuous neck motion monitoring in postoperative ACDF patients. We have developed and validated a machine learning neck motion classification algorithm to differentiate between eight neck motions (right/left rotation, right/left lateral bending, flexion, extension, retraction, protraction) in healthy normal subjects and patients. Methods Sensor data from 12 healthy normal subjects and 5 patients were used to develop and validate a Convolutional Neural Network (CNN). Results An average algorithm accuracy of 80.0 ± 3.8% was obtained for healthy normal subjects (94% for right rotation, 98% for left rotation, 65% for right lateral bending, 87% for left lateral bending, 89% for flexion, 77% for extension, 50% for retraction, 84% for protraction). An average accuracy of 67.5 ± 5.8% was obtained for patients. Discussion ADAM, with our algorithm, may serve as a rehabilitation tool for neck motion monitoring in postoperative ACDF patients. Sensor-captured vital signs and other events (extubation, vocalization, physical therapy, walking) are potential metrics to be incorporated into our algorithm to offer more holistic monitoring of patients after cervical spine surgery.
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Affiliation(s)
- Le Huang
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Lian Yu
- Sibel Health, Niles, IL, USA
| | | | - Alan Soetikno
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hope Chen
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hyoyoung Jeong
- Electrical and Computer Engineering, University of California Davis, Davis, CA, USA
| | - Joshua Barrett
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Knute Martell
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Youn Kang
- Department of Ocean System Engineering, Jeju National University, Jeju, South Korea
| | - Alpesh A. Patel
- Departments of Orthopaedic Surgery and Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Shuai Xu
- Sibel Health, Niles, IL, USA
- Electrical and Computer Engineering, University of California Davis, Davis, CA, USA
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Kang KC, Jang TS, Jung CH. Cervical Radiculopathy: Focus on Factors for Better Surgical Outcomes and Operative Techniques. Asian Spine J 2022; 16:995-1012. [PMID: 36599372 PMCID: PMC9827215 DOI: 10.31616/asj.2022.0445] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
For patients with cervical radiculopathy, most studies have recommended conservative treatment as the first-line treatment; however, when conventional treatment fails, surgery is considered. A better understanding of the prognosis of cervical radiculopathy is essential to provide accurate information to the patients. If the patients complain of persistent and recurrent arm pain/numbness not respond to conservative treatment, or exhibit neurologic deficits, surgery is performed using anterior or posterior approaches. Anterior cervical discectomy and fusion (ACDF) has historically been widely used and has proven to be safe and effective. To improve surgical outcomes of ACDF surgery, many studies have been conducted on types of spacers, size/height/position of cages, anterior plating, patients' factors, surgical techniques, and so forth. Cervical disc replacement (CDR) is designed to reduce the incidence of adjacent segment disease during long-term follow-up by maintaining cervical spine motion postoperatively. Many studies on excellent indications for the CDR, proper type/size/shape/height of the implants, and surgical techniques were performed. Posterior cervical foraminotomy is a safe and effective surgical option to avoid complications associated with anterior approach and fusion surgery. Most recent literature demonstrated that all three surgical techniques for patients with cervical radiculopathy have clear advantages and disadvantages and reveal satisfactory surgical outcomes under a proper selection of patients and application of appropriate surgical methods. For this, it is important to fully understand the factors for better surgical outcomes and to adequately practice the operative techniques for patients with cervical radiculopathy.
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Affiliation(s)
- Kyung-Chung Kang
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Tae Su Jang
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea,Corresponding author: Tae Su Jang Department of Orthopaedic Surgery, Kyung Hee University Medical Center, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea Tel: +82-2-958-8346, Fax: +82-2-964-3865, E-mail:
| | - Cheol Hyun Jung
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
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Patel MR, Jacob KC, Nie JW, Hartman TJ, Vanjani N, Pawlowski H, Prabhu M, Amin KS, Singh K. The Effect of the Preoperative Severity of Neck Pain on Patient-Reported Outcome Measures and Minimum Clinically Important Difference Achievement After Anterior Cervical Discectomy and Fusion. World Neurosurg 2022; 165:e337-e345. [PMID: 35718277 DOI: 10.1016/j.wneu.2022.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare patient-reported outcome measure (PROM) scores and minimum clinically important difference (MCID) achievement rates among patients undergoing single-level anterior cervical discectomy and fusion (ACDF) in patients with varying severity of preoperative visual analog scale (VAS) neck score. METHODS Patients with ACDF were grouped: severity of preoperative VAS neck score ≤8 or >8. Demographic/perioperative variables and PROMs (Patient-Reported Outcomes Measurement Information System Physical Function [PROMIS PF] score, 12-Item Short Form [SF-12] Mental Component Score [MCS], VAS neck/arm score, and Neck Disability Index [NDI]) were collected preoperatively/postoperatively. MCID attainment comparison by grouping was evaluated using χ2 analysis. RESULTS A total of 137 patients were included (103 VAS neck preoperative score ≤8; 34 VAS neck preoperative score >8). The VAS neck preoperative score ≤8 cohort did not improve: 6 weeks PROMIS-PF score, 6 weeks SF-12 Physical Component Score [PCS], 12 weeks/1 year/2 years SF-12 MCS, 2 years VAS neck score, and 1 years/2 years VAS arm score (P ≤ 0.015, all). VAS neck preoperative score >8 did not improve: 6 weeks/12 weeks/2 years PROMIS-PF score, all time points SF-12 PCS, 6 weeks/12 weeks/1 year/2 years SF-12 MCS, and 2 years VAS arm score (P ≤ 0.013, all). VAS neck preoperative score >8 had inferior PROMIS-PF scores all time points except 1 year (P ≤ 0.036, all), lower SF-12 PCS 6 weeks/6 months (P ≤ 0.043, both), inferior SF-12 MCS at preoperative to 6 months (P ≤ 006, all), higher VAS neck score from preoperative to 6 months (P ≤ 0.018), higher VAS arm score preoperative/12 weeks/6 months (P ≤ 0.020, all), and higher NDI at preoperative/12 weeks/6 months (P ≤ 0.030, all). MCID attainment rates for VAS neck preoperative score >8 were greater for NDI 2 years (P = 0.040), lower for PROMIS-PF score 2 years, and overall (P = 0.018), lower for SF-12 MCS 12 weeks (P = 0.046), lower for VAS neck score 12 weeks to 1 year and overall (P ≤ 0.032, all), and lower for VAS arm score 6 weeks/1 year (P ≤ 0.030, both). CONCLUSIONS Patients with single-level ACDF presenting with greater baseline neck pain showed poorer physical function/pain/disability/mental health at preoperative/intermediate postoperative time points, but had comparable long-term PROMs by 2 years. MCID attainment was lower among patients with greater preoperative neck pain; MCID among the VAS neck score >8 cohort were only significantly inferior for neck pain.
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Affiliation(s)
- Madhav R Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kevin C Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nisheka Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kanhai S Amin
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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Cha EDK, Lynch CP, Jacob KC, Patel MR, Parrish JM, Jenkins NW, Geoghegan CE, Jadczak CN, Mohan S, Singh K. Workers' Compensation Association With Clinical Outcomes After Anterior Cervical Diskectomy and Fusion. Neurosurgery 2022; 90:322-328. [PMID: 35006206 DOI: 10.1227/neu.0000000000001820] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Research has suggested that workers' compensation (WC) status can result in poor outcomes after anterior cervical diskectomy and fusion (ACDF). OBJECTIVE To determine the influence WC status has on postoperative clinical outcomes after ACDF. METHODS A surgical database was reviewed for patients undergoing primary or revision single-level ACDF. Patients were grouped into WC vs Non-WC, and differences in baseline characteristics were assessed. Postoperative improvement was assessed for differences in mean scores between WC subgroups for visual analog scale (VAS) arm, VAS neck, 12-item Short Form Physical Composite Score, Patient-Reported Outcomes Measurement Information System physical function (PF), and Neck Disability Index (NDI) at preoperative and postoperative time points. Minimum clinically important difference (MCID) achievement was compared between groups. RESULTS The patient cohort included 44 with WC and 95 without. The cohort was 40% female with an average age of 48 years and mean body mass index of 30. Mean VAS arm, VAS neck, NDI, 12-item Short-Form Physical Composite Score, and Patient-Reported Outcomes Measurement Information System PF scores differed between groups; however, the difference was not sustained at the 1-yr time point. MCID achievement among WC subgroups was different for VAS arm (6 wk through 6 mo, P = .005), VAS neck (3 and 6 mo, P < .01), and NDI (3 and 6 mo, P < .05). No statistically significant difference was noted between cohorts for overall rates of MCID achievement for all patient-reported outcome measures collected. CONCLUSION WC patients reported similar preoperative and 1-yr postoperative neck and arm pain compared with non-WC patients after ACDF. One-yr MCID achievement rates were similar between cohorts for disability and PF scores.
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Affiliation(s)
- Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Muth-Seng C, Huneidi M, Heidsieck C, Laporte S, Le Coz JY, Gille O, Skalli W. Personalised gravitational loading of the cervical spine from biplanar X-rays for asymptomatic and clinical subjects in neutral standing position. Clin Biomech (Bristol, Avon) 2022; 92:105577. [PMID: 35042094 DOI: 10.1016/j.clinbiomech.2022.105577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND As a leading cause of disability with a high societal and economic cost, it is crucial to better understand risk factors of neck pain and surgical complications. Getting subject-specific external loading is essential for quantifying muscle forces and joint loads but it requires exertion trials and load cells which are uncommon in clinical settings. METHODS This paper presents a method to compute the gravitational loading at four levels of the cervical spine (C3C4, C4C5, C5C6, C6C7) in neutral standing position from biplanar radiographs exclusively. The resulting load was decomposed in local disc frames and its components were used to compare different populations: 118 asymptomatic subjects and 46 patients before and after surgery (anterior cervical discectomy and fusion or total disc replacement). Comparisons were performed at C6C7 and the upper level adjacent to surgery. FINDINGS Significant changes in gravitational loading were observed with age in healthy subjects as well as in patients after surgery and have been associated with changes in posture. INTERPRETATION This approach quantifies the influence of postural changes on gravitational loading on the cervical spine. It represents a simple way to obtain necessary input for muscle force quantification models in clinical routine and to use them for patient evaluation. The study of the subsequent subject-specific spinal loading could help further the understanding of cervical spine biomechanics, degeneration mechanisms and complications following surgery.
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Affiliation(s)
- Christophe Muth-Seng
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris, France.
| | - Maxime Huneidi
- Service de chirurgie orthopédique et traumatologique, Groupe Hospitalier Pellegrin, CHU de Bordeaux, Bordeaux 33076, France
| | - Cécile Heidsieck
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris, France
| | - Sébastien Laporte
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris, France
| | - Jean-Yves Le Coz
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris, France
| | - Olivier Gille
- Service de chirurgie orthopédique et traumatologique, Groupe Hospitalier Pellegrin, CHU de Bordeaux, Bordeaux 33076, France
| | - Wafa Skalli
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris, France
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Sommaruga S, Camara-Quintana J, Patel K, Nouri A, Tessitore E, Molliqaj G, Panchagnula S, Robinson M, Virojanapa J, Sun X, Melnikov F, Kolb L, Schaller K, Abbed K, Cheng J. Clinical Outcomes between Stand-Alone Zero-Profile Spacers and Cervical Plate with Cage Fixation for Anterior Cervical Discectomy and Fusion: A Retrospective Analysis of 166 Patients. J Clin Med 2021; 10:jcm10143076. [PMID: 34300241 PMCID: PMC8305235 DOI: 10.3390/jcm10143076] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/28/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022] Open
Abstract
Stand-alone (SA) zero-profile implants are an alternative to cervical plating (CP) in anterior cervical discectomy and fusion (ACDF). In this study, we investigate differences in surgical outcomes between SA and CP in ACDF. We conducted a retrospective analysis of 166 patients with myelopathy and/or radiculopathy who had ACDF with SA or CP from Jan 2013-Dec 2016. We measured surgical outcomes including Bazaz dysphagia score at 3 months, Nurick grade at last follow-up, and length of hospital stay. 166 patients (92F/74M) were reviewed. 92 presented with radiculopathy (55%), 37 with myelopathy (22%), and 37 with myeloradiculopathy (22%). The average operative time with CP was longer than SA (194 ± 69 vs. 126 ± 46 min) (p < 0.001), as was the average length of hospital stay (2.1 ± 2 vs. 1.5 ± 1 days) (p = 0.006). At 3 months, 82 patients (49.4%) had a follow-up for dysphagia, with 3 patients reporting mild dysphagia and none reporting moderate or severe dysphagia. Nurick grade at last follow-up for the myelopathy and myeloradiculopathy cohorts improved in 63 patients (85%). Prolonged length of stay was associated with reduced odds of having an optimal outcome by 0.50 (CI = 0.35-0.85, p = 0.003). Overall, we demonstrate that there is no significant difference in neurological outcome or rates of dysphagia between SA and CP, and that both lead to overall improvement of symptoms based on Nurick grading. However, we also show that the SA group has shorter length of hospital stay and operative time compared to CP.
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Affiliation(s)
- Samuel Sommaruga
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06519, USA; (S.S.); (J.C.-Q.); (K.P.); (A.N.); (S.P.); (J.V.); (X.S.); (L.K.); (K.A.)
- Department of Neurosurgery, Geneva University Hospital, 1205 Geneva, Switzerland; (E.T.); (G.M.); (K.S.)
| | - Joaquin Camara-Quintana
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06519, USA; (S.S.); (J.C.-Q.); (K.P.); (A.N.); (S.P.); (J.V.); (X.S.); (L.K.); (K.A.)
| | - Kishan Patel
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06519, USA; (S.S.); (J.C.-Q.); (K.P.); (A.N.); (S.P.); (J.V.); (X.S.); (L.K.); (K.A.)
| | - Aria Nouri
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06519, USA; (S.S.); (J.C.-Q.); (K.P.); (A.N.); (S.P.); (J.V.); (X.S.); (L.K.); (K.A.)
- Department of Neurosurgery, Geneva University Hospital, 1205 Geneva, Switzerland; (E.T.); (G.M.); (K.S.)
| | - Enrico Tessitore
- Department of Neurosurgery, Geneva University Hospital, 1205 Geneva, Switzerland; (E.T.); (G.M.); (K.S.)
| | - Granit Molliqaj
- Department of Neurosurgery, Geneva University Hospital, 1205 Geneva, Switzerland; (E.T.); (G.M.); (K.S.)
| | - Shreyas Panchagnula
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06519, USA; (S.S.); (J.C.-Q.); (K.P.); (A.N.); (S.P.); (J.V.); (X.S.); (L.K.); (K.A.)
| | - Michael Robinson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0515, USA;
| | - Justin Virojanapa
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06519, USA; (S.S.); (J.C.-Q.); (K.P.); (A.N.); (S.P.); (J.V.); (X.S.); (L.K.); (K.A.)
| | - Xin Sun
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06519, USA; (S.S.); (J.C.-Q.); (K.P.); (A.N.); (S.P.); (J.V.); (X.S.); (L.K.); (K.A.)
| | - Fjodor Melnikov
- Yale Center for Green Chemistry and Engineering, New Haven, CT 06511, USA;
| | - Luis Kolb
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06519, USA; (S.S.); (J.C.-Q.); (K.P.); (A.N.); (S.P.); (J.V.); (X.S.); (L.K.); (K.A.)
| | - Karl Schaller
- Department of Neurosurgery, Geneva University Hospital, 1205 Geneva, Switzerland; (E.T.); (G.M.); (K.S.)
| | - Khalid Abbed
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06519, USA; (S.S.); (J.C.-Q.); (K.P.); (A.N.); (S.P.); (J.V.); (X.S.); (L.K.); (K.A.)
| | - Joseph Cheng
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06519, USA; (S.S.); (J.C.-Q.); (K.P.); (A.N.); (S.P.); (J.V.); (X.S.); (L.K.); (K.A.)
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0515, USA;
- Correspondence: ; Tel.: +1-(513)-558-3556
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10
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Bergin SM, Wang TY, Park C, Rajkumar S, Goodwin CR, Karikari IO, Abd-El-Barr MM, Shaffrey CI, Yarbrough CK, Than KD. Pseudarthrosis rate following anterior cervical discectomy with fusion using an allograft cellular bone matrix: a multi-institutional analysis. Neurosurg Focus 2021; 50:E6. [PMID: 34062497 DOI: 10.3171/2021.3.focus2166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The use of osteobiologics, engineered materials designed to promote bone healing by enhancing bone growth, is becoming increasingly common for spinal fusion procedures, but the efficacy of some of these products is unclear. The authors performed a retrospective, multi-institutional study to investigate the clinical and radiographic characteristics of patients undergoing single-level anterior cervical discectomy with fusion performed using the osteobiologic agent Osteocel, an allograft mesenchymal stem cell matrix. METHODS The medical records across 3 medical centers and 12 spine surgeons were retrospectively queried for patients undergoing single-level anterior cervical discectomy and fusion (ACDF) with the use of Osteocel. Pseudarthrosis was determined based on CT or radiographic imaging of the cervical spine. Patients were determined to have radiographic pseudarthrosis if they met any of the following criteria: 1) lack of bridging bone on CT obtained > 300 days postoperatively, 2) evidence of instrumentation failure, or 3) motion across the index level as seen on flexion-extension cervical spine radiographs. Univariate and multivariate analyses were then performed to identify independent preoperative or perioperative predictors of pseudarthrosis in this population. RESULTS A total of 326 patients met the inclusion criteria; 43 (13.2%) patients met criteria for pseudarthrosis, of whom 15 (34.9%) underwent revision surgery. There were no significant differences between patients with and those without pseudarthrosis, respectively, for patient age (54.1 vs 53.8 years), sex (34.9% vs 47.4% male), race, prior cervical spine surgery (37.2% vs 33.6%), tobacco abuse (16.3% vs 14.5%), chronic kidney disease (2.3% vs 2.8%), and diabetes (18.6% vs 14.5%) (p > 0.05). Presence of osteopenia or osteoporosis (16.3% vs 3.5%) was associated with pseudarthrosis (p < 0.001). Implant type was also significantly associated with pseudarthrosis, with a 16.4% rate of pseudarthrosis for patients with polyetherethereketone (PEEK) implants versus 8.4% for patients with allograft implants (p = 0.04). Average lengths of follow-up were 27.6 and 23.8 months for patients with and those without pseudarthrosis, respectively. Multivariate analysis demonstrated osteopenia or osteoporosis (OR 4.97, 95% CI 1.51-16.4, p < 0.01) and usage of PEEK implant (OR 2.24, 95% CI 1.04-4.83, p = 0.04) as independent predictors of pseudarthrosis. CONCLUSIONS In patients who underwent single-level ACDF, rates of pseudarthrosis associated with the use of the osteobiologic agent Osteocel are higher than the literature-reported rates associated with the use of alternative osteobiologics. This is especially true when Osteocel is combined with a PEEK implant.
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11
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Toll BJ, Samdani AF, Pahys JM, Amanullah AA, Hwang SW. Crossing the cervicothoracic junction in complex pediatric deformity using anterior cervical discectomy and fusion: a case series. Childs Nerv Syst 2021; 37:1957-1964. [PMID: 33730238 DOI: 10.1007/s00381-021-05109-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Proximal instrumentation failure is a challenge in posterior spinal fusions (PSFs) crossing the cervicothoracic junction. High rates of proximal junctional kyphosis (PJK) and loss of fixation have been reported. In this single-center retrospective cohort study, we evaluate the utility of anterior cervical discectomy and fusion (ACDF) in addition to traditional PSF crossing the cervicothoracic junction in order to mitigate implant-related complications. METHODS All patients who underwent PSF across the cervicothoracic junction with ACDF with 2 years of follow-up data were reviewed. We analyzed clinical, surgical, and radiographic measures such as operative details, presence of PJK, complications, instrumentation migration, curve angles, and vertebral translation. Measurements were compared statistically using paired samples t-tests. RESULTS Ten patients (6 girls, 4 boys) met inclusion criteria with a mean age at surgery of 12.8 ± 3.3 years and follow-up of 3.38 ± 0.9 years. All patients underwent ACDF (range 1-3 levels), and 8 (80%) underwent traction. The average number of levels fused posteriorly was 16.7 ± 4.7 and anteriorly was 2.4 ± 0.7. The major coronal curve averaged 48.8 ± 34.7° preoperatively and 23.3±13.3° postoperatively (p = 0.028). The average major sagittal curve was 83.5 ± 24.2° preoperatively, resolving to 53.9 ± 25.5° (p=0.001). One patient suffered rod breakage at T7, and another developed symptomatic PJK 19 months postoperatively. CONCLUSION Our data suggest that ACDF procedures added to PSFs crossing the cervicothoracic junction offer promise for reducing risk for instrumentation-related complications. ACDF also significantly helps improve and maintain both coronal and sagittal correction over 2 years. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Brandon J Toll
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
| | - Amer F Samdani
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA.
| | - Joshua M Pahys
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
| | - Amir A Amanullah
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
| | - Steven W Hwang
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
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12
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Anterior Cervical Arthrodesis With Polyetheretherketone Spacers: What is the Role of the Grafting Material? Clin Spine Surg 2020; 33:E539-E544. [PMID: 32324673 DOI: 10.1097/bsd.0000000000000995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a retrospective study of 2 surgeons' use of a single polyetheretherketone (PEEK) device. OBJECTIVE Our objective was to investigate the fusion adjunct placed within PEEK devices to examine the likelihood of an arthrodesis, regardless of the PEEK interbody device itself. SUMMARY OF BACKGROUND DATA The effectiveness of PEEK interbody devices in anterior cervical arthrodesis has been questioned. METHODS The authors retrospectively reviewed the results of 121 patients with demineralized bone matrix (DBM) and 96 with local autograft bone placed within identical PEEK devices for anterior cervical arthrodesis (from 2011 to 2018); 1 surgeon used DBM and another local autograft bone. Arthrodesis was determined independently by a surgeon and 2 blinded neuroradiologists. RESULTS For DBM versus autograft; mean age was 60 versus 61 years, smoking status 42.1% versus 31%, diabetes mellitus 18.2% versus 28%, mean body mass index 31 versus 30, and follow up averaged 17 months in both groups. For DBM versus autograft; a radiographic arthrodesis was observed in 22.3% versus 76% of patients. Refusion at the index level was required in 5.8% of the DBM and 0% of the autograft patients. CONCLUSIONS A PEEK interbody device filled with local autograft resulted in a higher radiographic fusion rate and a lower need for reoperation at the index level than an identical device filled with DBM. Caution is warranted in assigning fusion failure to the PEEK device alone in anterior cervical discectomy and fusion surgery.
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Krause KL, Obayashi JT, Bridges KJ, Raslan AM, Than KD. Fivefold higher rate of pseudarthrosis with polyetheretherketone interbody device than with structural allograft used for 1-level anterior cervical discectomy and fusion. J Neurosurg Spine 2019; 30:46-51. [PMID: 30485200 DOI: 10.3171/2018.7.spine18531] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/19/2018] [Indexed: 11/06/2022]
Abstract
In BriefThe authors examined fusion rates after single-level anterior cervical discectomy and fusion, comparing use of a structural allograft with use of polyetheretherketone (PEEK) interbody devices packed with bone graft. The results demonstrate superior results of structural allograft in terms of arthrodesis rates and reoperation rates. Currently, reimbursement rates substantially favor the use of PEEK and other synthetic devices, which the authors believe should be changed based on the results of this study.
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ACDF vs TDR for patients with cervical spondylosis - an 8 year follow up study. BMC Surg 2017; 17:113. [PMID: 29183306 PMCID: PMC5706295 DOI: 10.1186/s12893-017-0316-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/20/2017] [Indexed: 11/29/2022] Open
Abstract
Background ACDF has been considered as the gold standard in the treatment of single level cervical disk protrusion. However, it may cause adjacent level degeneration due to regional biomechanical changes. TDR has been applied with satisfactory results for over a decade, but there is no consensus if TDR is safer and more efficient than ACDF. The current study was carried out to compare the efficiency and safety of TDR and ACDF in the treatment of patients with single level cervical disk protrusion. Methods One hundred forty-five consecutive patients who underwent either TDR or ACDF in our center were included in the current study. Time of surgery, intraoperative blood loss, VAS arm and neck pain scores, ROM, ODI, SF36 and Patient satisfaction were compared before the surgery, after the surgery, and during follow up 1, 3, 5, 8 years after the surgery. Results The time of surgery was 64.6 ± 20.7 min in the ACDF group and 69.4 ± 19.3 min in the TDR group; intraoperative hemorrhage was 67.2 ± 14.3 ml in ACDF group and 70.7 ± 18.6 ml in TDR group. There were no significant differences between two groups concerning time of surgery and intraoperative blood loss. No differences were found concerning patient satisfaction between the two groups during the follow up (P > 0.05). Significant differences were found between the groups concerning VAS arm and neck pain scores, ROM, ODI and SF36 after the surgery and during the 8 year follow up. Conclusion TDR may be a more effective approach than ACDF for treating patients with single level cervical disk protrusion. Keywords Cervical disk herniation, ACDF, TDR, Retrospective study
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