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Ricciardi L, Bongetta D, Piazza A, Norri N, Mangraviti A, Trungu S, Belli E, Zanin L, Lofrese G. Interscapular Pain after Anterior Cervical Discectomy and Fusion: Does Zygapophyseal Joints over Distraction Play a Role? J Clin Med 2024; 13:2976. [PMID: 38792516 PMCID: PMC11122480 DOI: 10.3390/jcm13102976] [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: 03/21/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Introduction: Anterior cervical discectomy and fusion (ACDF) for cervical disc herniation (CDH) is commonly performed. Specific post-operative complications include dysphagia, dysphonia, cervicalgia, adjacent segment disorder, cage subsidence, and infections. However, interscapular pain is commonly reported by these patients after surgery, although its mechanisms have not been clarified yet. Methods: This retrospective series of 31 patients undergoing ACDF for CDH at a single Academic Hospital. Baseline and post-operative clinical, radiological, and surgical data were analyzed. The linear regression analysis was conducted to identify any factor independently influencing the incidence rate of post-operative interscapular pain. Results: The mean age was 57.6 ± 10.8 years, and the M:F ratio was 2.1. Pre-operative mean VAS-arm was 7.15 ± 0.81 among the 20 patients reporting brachialgia, and mean VAS-neck was 4.36 ± 1.43 among those 9 patients reporting cervicalgia. At 1 month, interscapular pain was still reported by 8 out of the 17 patients who experienced it post-operatively, and it was recovered in all patients after 2 months. The regression analysis showed that interscapular pain was not directly associated with age (p = 0.74), gender (p = 0.46), smoking status (p = 0.44), diabetes (0.42), pre-operative brachialgia (p = 0.21) or cervicalgia (p = 0.48), symptoms duration (p = 0.13), baseline VAS-arm (p = 0.11), VAS-neck (p = 0.93), or mJOA (p = 0.63) scores, or disc height modification (p = 0.90). However, the post-operative increase in the mean zygapophyseal joint rim distance was identified as an independent factor in determining interscapular pain (p = 0.02). Conclusions: Our study revealed that the onset of interscapular pain following ACDF may be determined by over distraction of the zygapophyseal joint rim. Then, proper sizing of prosthetic implants could reduce this painful complication.
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Affiliation(s)
- Luca Ricciardi
- UOC di Neurochirurgia, AOU Sant’Andrea, Dipartimento NESMOS, Sapienza University of Rome, 00185 Roma, Italy; (A.P.); (N.N.); (A.M.); (S.T.)
| | - Daniele Bongetta
- SC Neurochirurgia, Ospedale Fatebenefratelli e Oftalmico, 20121 Milan, Italy;
| | - Amedeo Piazza
- UOC di Neurochirurgia, AOU Sant’Andrea, Dipartimento NESMOS, Sapienza University of Rome, 00185 Roma, Italy; (A.P.); (N.N.); (A.M.); (S.T.)
| | - Nicolò Norri
- UOC di Neurochirurgia, AOU Sant’Andrea, Dipartimento NESMOS, Sapienza University of Rome, 00185 Roma, Italy; (A.P.); (N.N.); (A.M.); (S.T.)
| | - Antonella Mangraviti
- UOC di Neurochirurgia, AOU Sant’Andrea, Dipartimento NESMOS, Sapienza University of Rome, 00185 Roma, Italy; (A.P.); (N.N.); (A.M.); (S.T.)
| | - Sokol Trungu
- UOC di Neurochirurgia, AOU Sant’Andrea, Dipartimento NESMOS, Sapienza University of Rome, 00185 Roma, Italy; (A.P.); (N.N.); (A.M.); (S.T.)
| | - Evaristo Belli
- UO di Chirurgia Maxillo-Facciale, AOU Sant’Andrea, Dipartimento NESMOS, Sapienza University of Rome, 00185 Roma, Italy;
| | - Luca Zanin
- Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy;
| | - Giorgio Lofrese
- UOC di Neurochirurgia, Ospedale Bufalini di Cesena, 47521 Cesena, Italy;
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Suzuki M, Nagano A, Ueshima J, Saino Y, Kawase F, Kobayashi H, Murotani K, Inoue T, Nagami S, Maeda K. Prevalence of dysphagia in patients after orthopedic surgery. Arch Gerontol Geriatr 2024; 119:105312. [PMID: 38101112 DOI: 10.1016/j.archger.2023.105312] [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: 09/12/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVES Oropharyngeal dysphagia is one of the most prevalent health complications in older adults. The prevalence of postoperative dysphagia is expected to rise with the increasing number of older patients undergoing orthopedic surgery; however, the specific prevalence and contributing factors remain unclear. This scoping review aimed to identify the prevalence and factors related to postoperative dysphagia in older orthopedic patients. METHODS This review included studies published up to September 2022 on postoperative patients aged ≥ 60 years who underwent orthopedic surgery. We searched MEDLINE, EMBASE, CINAHL, CENTRAL, Web of Science, and Ichushi-Web. RESULTS In total, 21 of the 2158 identified studies were reviewed. The studies were classified into the three categories according to the surgical site: cervical spine disease (n = 12), hip fracture (n = 7), and others (n = 2). The estimated dysphagia prevalence rates [95 % confidence interval] of cervical spine disease, hip fractures, and others were 16 % [8-27], 32 % [15-54], and 6 % [4-8], respectively. Factors related to postoperative dysphagia included cervical alignment in cervical spine disease, being older within the cohort, preoperative health status, malnutrition, and sarcopenia in hip fractures. CONCLUSIONS The prevalence of postoperative dysphagia after orthopedic surgery was highest for hip fractures, followed by cervical spine and others. These results suggest non-neurogenic dysphagia in older patients undergoing orthopedic surgery and indicate that sarcopenia may contribute to postoperative dysphagia in this population. Therefore, further research should clarify the trajectory of postoperative dysphagia and the effectiveness of rehabilitation for postoperative dysphagia after orthopedic surgery.
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Affiliation(s)
- Mizue Suzuki
- Department of Rehabilitation, Faculty of Allied Health Sciences, Yamato university, Osaka, Japan
| | - Ayano Nagano
- Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, Hyogo, Japan
| | - Junko Ueshima
- Department of Nutritional Service, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yoko Saino
- Department of Clinical Nutrition, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Fumiya Kawase
- Department of Nutrition, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Aichi, Japan
| | - Haruko Kobayashi
- General Incorporated Association Manabi Public Library, Aichi, Japan
| | | | - Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Shinsuke Nagami
- Department of Speech-Language Pathology and Audiology, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Okayama, Japan
| | - Keisuke Maeda
- Nutrition Therapy Support Center, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan.
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Lofrese G, Trungu S, Scerrati A, De Bonis P, Cultrera F, Mongardi L, Montemurro N, Piazza A, Miscusi M, Tosatto L, Raco A, Ricciardi L. Two-Level Corpectomy and Fusion vs. Three-Level Anterior Cervical Discectomy and Fusion without Plating: Long-Term Clinical and Radiological Outcomes in a Multicentric Retrospective Analysis. Life (Basel) 2023; 13:1564. [PMID: 37511938 PMCID: PMC10381458 DOI: 10.3390/life13071564] [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: 05/30/2023] [Revised: 06/23/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) represent effective alternatives in the management of multilevel cervical spondylotic myelopathy (CSM). A consensus on which of these techniques should be used is still missing. METHODS The databases of three centers were reviewed (January 2011-December 2018) for patients with three-level CSM, who underwent three-level ACDF without plating or two-level ACCF with expandable cage (VBRC) or mesh (VBRM). Demographic data, surgical strategy, complications, and implant failure were analyzed. The Neck Disability Index (NDI), the Visual Analog Scale (VAS), and the cervical lordosis were compared between the two techniques at 3 and 12 months. Logistic regression analyses investigated independent factors influencing clinical and radiological outcomes. RESULTS Twenty-one and twenty-two patients were included in the ACDF and ACCF groups, respectively. The median follow-up was 18 months. ACDFs were associated with better clinical outcomes at 12 months (NDI: 8.3% vs. 19.3%, p < 0.001; VAS: 1.3 vs. 2.6, p = 0.004), but with an increased risk of loss of lordosis correction ≥ 1° (OR = 4.5; p = 0.05). A higher complication rate in the ACDF group (33.3% vs. 9.1%; p = 0.05) was recorded, but it negatively influenced only short-term clinical outcomes. ACCFs with VBRC were associated with a higher risk of major complications but ensured better 12-month lordosis correction (p = 0.002). No significant differences in intraoperative blood loss were noted. CONCLUSIONS Three-level ACDF without plating was associated with better clinical outcomes than two-level ACCF despite worse losses in lordosis correction, which is ideal for fragile patients without retrovertebral compressions. In multilevel CSM, the relationship between the degree of lordosis correction and clinical outcome advantages still needs to be investigated.
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Affiliation(s)
| | - Sokol Trungu
- NESMOS Department, "Sapienza" University of Rome, Sant'Andrea Hospital, 00185 Rome, Italy
- Neurosurgery Unit, Cardinale G. Panico Hospital, 73039 Tricase, Italy
| | - Alba Scerrati
- Department of Neurosurgery, S. Anna University Hospital, 44124 Ferrara, Italy
| | - Pasquale De Bonis
- Department of Neurosurgery, S. Anna University Hospital, 44124 Ferrara, Italy
| | | | - Lorenzo Mongardi
- Department of Neurosurgery, S. Anna University Hospital, 44124 Ferrara, Italy
| | | | - Amedeo Piazza
- NESMOS Department, "Sapienza" University of Rome, Sant'Andrea Hospital, 00185 Rome, Italy
| | - Massimo Miscusi
- NESMOS Department, "Sapienza" University of Rome, Sant'Andrea Hospital, 00185 Rome, Italy
| | | | - Antonino Raco
- NESMOS Department, "Sapienza" University of Rome, Sant'Andrea Hospital, 00185 Rome, Italy
| | - Luca Ricciardi
- NESMOS Department, "Sapienza" University of Rome, Sant'Andrea Hospital, 00185 Rome, Italy
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Visocchi M, Marino S, Ducoli G, Barbagallo GMV, Pasqualino C, Signorelli F. Hybrid Implants in Anterior Cervical Spine Surgery: The State of the Art and New Trends for Multilevel Degenerative Disc Disease. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:253-257. [PMID: 38153478 DOI: 10.1007/978-3-031-36084-8_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) still represents the first surgical option in the treatment of cervical degenerative disc disease (DDD) but is still burdened by several complications secondary to the loss of mobility at the treated segment and adjacent segment diseases (ASDs). To overcome those complications, hybrid surgery (HS) incorporating ACDF and cervical disc arthroplasty (CDA) is increasingly performed for DDD. METHODS We retrospectively reviewed the clinical, surgical, and outcome data of 85 consecutive patients (M/F, 41/44) harboring cervical disc herniation with or without osteophytes, with radiculopathy and with or without myelopathy, who underwent the anterior approach to a cervical discectomy on two or more levels with at least one disc prosthesis, along with a cage and plate or an O Profile screwed plate. RESULTS All the patients improved regardless of the cervical construct used. No significant relationship between different kinds of prosthesis and their surgical level; the number of cages; and the site of the cages (screwed and/or plated) was found concerning immediate stability, dynamic prosthesis effectiveness, and clinical improvement in all the patients up to the maximum follow-up time. CONCLUSIONS Although the optimal surgical technique for cervical DDD remains controversial, HS represents a safe and effective procedure in select patients with multilevel cervical DDD, as demonstrated by biomechanical and clinical studies and the present series.
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Affiliation(s)
| | - Salvatore Marino
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Giorgio Ducoli
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Giuseppe M V Barbagallo
- Department of Neurological Surgery, Policlinico Gaspare Rodolico University Hospital, Catania, Italy
| | - Ciappetta Pasqualino
- Research Center and Master II Degree Surgical Approaches Craniovertebral Junction, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Francesco Signorelli
- Institute of Neurosurgery, Catholic University of Rome, Rome, Italy
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
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