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Romani MD, Zhang HQ, Gao QL, Liu SH, Deng A. Cervical Sagittal Alignment and Related Factor Analysis and Prediction Model in Patients Undergoing Revision Surgery After Anterior Cervical Fusion. J Am Acad Orthop Surg 2024; 32:e585-e595. [PMID: 38595101 PMCID: PMC11111316 DOI: 10.5435/jaaos-d-23-00565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 02/03/2024] [Accepted: 02/17/2024] [Indexed: 04/11/2024] Open
Abstract
INTRODUCTION Patients with myelopathy or radiculopathy commonly undergo anterior cervical fusion surgery (ACFS), which has a notable failure rate on occasion. The goal of this study was to compare revision and nonrevision surgery patients in cervical sagittal alignment (CSA) subsequent to ACFS; additionally, to identify the best CSA parameters for predicting clinical outcome after ACFS; and furthermore, to create an equation model to assist surgeons in making decisions on patients undergoing ACFS. METHODS The data of 99 patients with symptomatic cervical myelopathy/radiculopathy who underwent ACFS were analyzed. Patients were divided into group A (underwent revision surgery after the first surgery failed) and group B (underwent only the first surgery). We measured and analyzed both preoperative and postoperative CSA parameters, including C2 slope, T1 slope, cervical lordosis C2-C7 (CL), C2-C7 sagittal vertical axis (C2C7 SVA), occiput-C2 lordosis angle (C0-C2), and chin brow vertical angle, and we further computed the correlation between the CSA parameters and created a prediction model. RESULTS The (T1S-CL)-C2S mismatch differed significantly between groups A and B ([9.95 ± 9.95] 0 , [3.79 ± 6.58] 0 , P < 0.05, respectively). A significant correlation was observed between C2 slope and T1CL in group B relative to group A postoperatively (R 2 = 0.42 versus R 2 = 0.09, respectively). Compared with group B, patients in group A had significantly higher C2C7SVA values, more levels of fusion, and more smokers. The sensitivity, specificity, accuracy, and discrimination of the model were, respectively, 73.5%, 84%, 78.8%, and 85.65%. CONCLUSION The causes of revision surgery in cervical myelopathic patients after anterior cervical corpectomy and fusion/anterior cervical diskectomy and fusion are multifactorial. (T1S-CL)-C2S mismatch and high C2C7SVA are the best cervical sagittal parameters that increase the odds of revision surgery, and the effect is more enhanced when comorbidities such as smoking, low bone-mineral density, and increased levels of fusion are taken into account.
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Affiliation(s)
- Manini Daudi Romani
- From the Department of spine surgery and Orthopedics, Xiangya Hospital, Central South University, Changsha, China (Romani, Zhang, Qi-Le Gao, Liu, Deng), and the National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China (Romani, Zhang, Qi-Le Gao, Liu, and Deng)
| | - Hong-Qi Zhang
- From the Department of spine surgery and Orthopedics, Xiangya Hospital, Central South University, Changsha, China (Romani, Zhang, Qi-Le Gao, Liu, Deng), and the National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China (Romani, Zhang, Qi-Le Gao, Liu, and Deng)
| | - Qi-Le Gao
- From the Department of spine surgery and Orthopedics, Xiangya Hospital, Central South University, Changsha, China (Romani, Zhang, Qi-Le Gao, Liu, Deng), and the National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China (Romani, Zhang, Qi-Le Gao, Liu, and Deng)
| | - Shao-Hua Liu
- From the Department of spine surgery and Orthopedics, Xiangya Hospital, Central South University, Changsha, China (Romani, Zhang, Qi-Le Gao, Liu, Deng), and the National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China (Romani, Zhang, Qi-Le Gao, Liu, and Deng)
| | - Ang Deng
- From the Department of spine surgery and Orthopedics, Xiangya Hospital, Central South University, Changsha, China (Romani, Zhang, Qi-Le Gao, Liu, Deng), and the National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China (Romani, Zhang, Qi-Le Gao, Liu, and Deng)
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Nishii T, Nishimura Y, Nagashima Y, Tanei T, Hara M, Takayasu M, Kanemura T, Saito R. Comparative Study of Surgical Outcomes of Occipitocervical and Atlantoaxial Fusion for Retro-Odontoid Pseudotumor. World Neurosurg 2023; 178:e230-e238. [PMID: 37479027 DOI: 10.1016/j.wneu.2023.07.038] [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: 05/05/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE To compare the surgical and radiographic outcomes of occipitocervical fusion (OCF) with those of atlantoaxial fusion (AAF) in patients with cervical myelopathy caused by retroodontoid pseudotumors (ROPs). METHODS This retrospective, comparative study included 26 patients; 12 underwent occipitocervical fusion (OCF) (group O) and 14 retroodontoid pseudotumor (AAF) (group A) with a minimum 2-year follow-up. Neurologic outcomes were evaluated using the Japanese Orthopedic Association (JOA) score. Radiologic assessment included the maximum anteroposterior (AP) diameter of the anteroposterior-retroodontoid pseudotumor (AP-ROP), C2-7 angle, O-C2 angle, C1-2 angle, atlantodental interval (ADI), range of motion (ROM) of the ADI, C2-C7 sagittal vertical axis (C2-7 SVA), and T1 slope. Global spinal alignments (pelvic incidence [PI] minus lumbar lordosis [LL] [PI-LL], pelvic tilt, sacral slope, and C7 sagittal vertical axis) were also compared between the groups. RESULTS Both groups had equally good clinical outcomes with equal complication rates. Three patients had a three-level fusion, 5 cases had a four-level fusion, and 4 cases had more than five-level fusion in group O. All cases had a single-level fusion in group A. Surgical time was significantly shorter in group A. AP-ROP was significantly downsized postoperatively in both groups and was more prominent in group O. C2-7 SVA was significantly increased and C2-7A ROM was significantly reduced in group O at the final follow-up. The PI-LL showed a significant increase in group O at the final follow-up. CONCLUSIONS Although OCF and AAF were similarly effective for cervical myelopathy with ROP, AAF was less invasive, and spinal alignment was better maintained postoperatively in AAF than OCF.
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Affiliation(s)
- Tomoya Nishii
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yusuke Nishimura
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
| | - Yoshitaka Nagashima
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takafumi Tanei
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masahito Hara
- Department of Neurosurgery, Aichi Medical University Graduate School of Medicine, Nagakute, Aichi, Japan
| | - Masakazu Takayasu
- Department of Neurosurgery, Inazawa Municipal Hospital, Inazawa, Aichi, Japan
| | | | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Yeh KL, Wu SH, Fuh CS, Huang YH, Chen CS, Wu SS. Cauda equina syndrome caused by the application of DuraSeal TM in a microlaminectomy surgery: A case report. World J Clin Cases 2022; 10:11178-11184. [PMID: 36338214 PMCID: PMC9631147 DOI: 10.12998/wjcc.v10.i30.11178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/29/2022] [Accepted: 09/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The management of dural tears is important. While a massive dura can be repaired with absorbable suture lines, cerebrospinal fluid leakage can be attenuated by dural sealant when an unintended tiny durotomy occurs intraoperatively. DuraSeal is often used because it can expand to seal tears. This case emphasizes the need for caution when DuraSeal is used as high expansion can cause complications following microlaminectomy.
CASE SUMMARY A 77-year-old woman presented with L2/3 and L3/4 lateral recess stenosis. She underwent microlaminectomy, foraminal decompression, and disk height restoration using an IntraSPINE® device. A tiny incident durotomy occurred intraoperatively and was sealed using DuraSealTM. However, decreased muscle power, urinary incontinence, and absence of anal reflexes were observed postoperatively. Emergent magnetic resonance imaging revealed fluid collection causing thecal sac indentation and central canal compression. Surgical exploration revealed that the gel-like DuraSeal had entrapped the hematoma and, consequently, compressed the thecal sac and nerve roots. While we removed all DuraSealTM and exposed the nerve root, the patient’s neurological function did not recover postoperatively.
CONCLUSION DuraSeal expansion must not be underestimated. Changes in neurological status require investigation for cauda equina syndrome due to expansion.
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Affiliation(s)
- Kuei-Lin Yeh
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City 600, Taiwan
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan
- Department of Long-Term Care and Management, WuFeng University, Chiayi County 621303, Taiwan
| | - Szu-Hsien Wu
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Chiou-Shann Fuh
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan
| | - Yi-Hung Huang
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City 600, Taiwan
| | - Chu-Song Chen
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan
| | - Shing-Sheng Wu
- Department of Orthopaedics, Shin Kong Wu-Ho Su Memorial Hospital, Taiepi 111, Taiwan
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