1
|
Turcotte JJ, Brennan JC, Johnson AH, Patton CM. Mid-term Outcomes of Revision Anterior Fusion versus Cervical Disc Arthroplasty in Patients with Prior Single-Level Anterior Cervical Fusion. Spine J 2025:S1529-9430(25)00239-6. [PMID: 40324483 DOI: 10.1016/j.spinee.2025.05.007] [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: 12/02/2024] [Revised: 04/03/2025] [Accepted: 05/01/2025] [Indexed: 05/07/2025]
Abstract
BACKGROUND CONTEXT Revision cervical surgery presents unique challenges due to altered anatomy and biomechanics from the previous fusion. Revision anterior cervical discectomy and fusion (ACDF) offers the benefit of immediate stability but further reduces cervical mobility and may increase stress on remaining segments, potentially leading to additional degeneration. By performing a cervical disc arthroplasty (CDA) in the presence of a prior ACDF, a hybrid surgery (HS) construct is created, potentially combining the benefits of fusion stability with CDA motion preservation. PURPOSE To compare the outcomes of one-level ACDF or CDA in patients with a history of prior one-level ACDF. STUDY DESIGN Retrospective cohort study. PATIENT SAMPLE Patients undergoing one-level ACDF or CDA with a history of prior one-level ACDF, with records in the PearlDiver database from 2010 to April 30, 2023. All patients had 1-year minimum follow-up; surgeries for trauma, infection, or neoplasm, and those with concomitant cervical procedures were excluded. OUTCOME MEASURES The primary outcome was any cervical reoperation at 2-years and 5-years postoperatively. Types of reoperations, 90-day complications, 2-year complications, and 2-year cost were evaluated. METHODS The ACDF and CDA groups were propensity score matched in a 3:1 ratio. Univariate analyses (chi-square and independent samples t-tests) were performed to compare demographics, comorbidities, and outcomes after matching. Kaplan Meir analysis was performed to compare 5-year reoperation-free survival between the ACDF and CDA groups; survival rates were compared using the Log Rank test. RESULTS After matching, 792 ACDF and 264 CDA patients were included. No significant differences in demographics or comorbidities were observed. The overall rate of 90-day complications was 3.9% in the ACDF and 3.0% in the CDA group; no significant differences in complication rates were found. ACDF patients experienced higher rates of pseudoarthrosis (6.4 vs. 1.1%, p=0.001) at 2-years postoperatively. Overall, two-year reoperation rates were similar between groups (ACDF: 10.7 vs. CDA: 7.6%, p=0.172). Over the 5-year postoperative period, no significant differences in ACDF, ACDF or CDA, other cervical, or any cervical reoperations were observed. The rate of any cervical reoperation was 13.5% in the ACDF group and 13.3% in the CDA group (p=1.000). No significant differences in 5-year reoperation-free survival were found between ACDF and CDA patients. CONCLUSIONS Both single-level ACDF and CDA yielded similar complication and reoperation rates at 2- and 5-years postoperatively in patients with a history of prior single-level ACDF. Either approach appears to be a viable treatment strategy in patients requiring reoperation after single-level ACDF. However, future studies are required to validate these findings in more homogenous patient populations, and to compare the functional and radiographic outcomes of ACDF and CDA in the revision setting.
Collapse
Affiliation(s)
- Justin J Turcotte
- Luminis Health Anne Arundel Medical Center, Annapolis MD, Department of Orthopedics, Study performed at Luminis Health Anne Arundel Medical Center.
| | - Jane C Brennan
- Luminis Health Anne Arundel Medical Center, Annapolis MD, Department of Orthopedics, Study performed at Luminis Health Anne Arundel Medical Center
| | - Andrea H Johnson
- Luminis Health Anne Arundel Medical Center, Annapolis MD, Department of Orthopedics, Study performed at Luminis Health Anne Arundel Medical Center
| | - Chad M Patton
- Luminis Health Anne Arundel Medical Center, Annapolis MD, Department of Orthopedics, Study performed at Luminis Health Anne Arundel Medical Center
| |
Collapse
|
2
|
Lee SJ, Hwang J, Kang MG, Cho M, Ha Y, Cho SR. Predictive Factors for Postoperative Outcomes of Cervical Spondylotic Myelopathy in Individuals With Cerebral Palsy. Global Spine J 2025:21925682251337396. [PMID: 40315352 PMCID: PMC12048400 DOI: 10.1177/21925682251337396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2025] [Revised: 04/02/2025] [Accepted: 04/09/2025] [Indexed: 05/04/2025] Open
Abstract
Study DesignRetrospective cohort study.ObjectivesThis study aimed to identify factors influencing postoperative outcomes of cervical spondylotic myelopathy (CSM) in individuals with cerebral palsy (CP).MethodsData from admitted individuals were retrospectively reviewed. Individuals whose modified Barthel index score, assessed at least 6 months after surgery, declined by 1 or more grades compared to their preoperative score were classified into the poor outcome (PO) group. Multivariate logistic regression analysis was performed to assess risk factors for poor postoperative outcomes.ResultsOf the 73 participants, 15 were in the PO group and 58 in the non-PO group. Duration (OR 1.99, 95% CI 1.25-3.65, P = .01), signal change grade 2 (OR 10.44, 95% CI 1.32-118.01, P = .034), and spinal cord compression ratio, M2 (OR 0.85, 95% CI, 0.73-0.96, P = .02) on preoperative MRI were identified as significant factors associated with the risk of poor postoperative outcomes. Based on the receiver operating characteristic curve analysis, the cutoff values for duration and cord compression metric were determined as 2 years (AUC = 0.689, 95% CI 0.532-0.845) and 76.2% (AUC = 0.841, 95% CI 0.696-0.987), respectively.ConclusionsThis study identified key predictors of poor postoperative outcomes in individuals with CP undergoing surgery for CSM. Symptom duration exceeding 2 years, signal change grade 2, and spinal cord compression ratio below 76.2% on preoperative MRI were found to be predictors of poor outcome. These results underscore the importance of early intervention and detailed preoperative radiological assessment to improve surgical outcomes in this population.
Collapse
Affiliation(s)
- Su Ji Lee
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jihye Hwang
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Gyu Kang
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Minjae Cho
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Rae Cho
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Republic of Korea
- Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, Republic of Korea
- Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
- Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Biohealth Engineering, Division of Regenerative Medicine, Graduate School of Transdisciplinary Health Sciences, Yonsei University, Seoul, Republic of Korea
| |
Collapse
|
3
|
Shah AA, Devana SK, Lee C, Olson TE, Upfill-Brown A, Sheppard WL, Lord EL, Shamie AN, van der Schaar M, SooHoo NF, Park DY. Development and External Validation of a Risk Calculator for Prediction of Major Complications and Readmission After Anterior Cervical Discectomy and Fusion. Spine (Phila Pa 1976) 2023; 48:460-467. [PMID: 36730869 PMCID: PMC10023283 DOI: 10.1097/brs.0000000000004531] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/22/2022] [Indexed: 02/04/2023]
Abstract
STUDY DESIGN A retrospective, case-control study. OBJECTIVE We aim to build a risk calculator predicting major perioperative complications after anterior cervical fusion. In addition, we aim to externally validate this calculator with an institutional cohort of patients who underwent anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA The average age and proportion of patients with at least one comorbidity undergoing ACDF have increased in recent years. Given the increased morbidity and cost associated with perioperative complications and unplanned readmission, accurate risk stratification of patients undergoing ACDF is of great clinical utility. METHODS This is a retrospective cohort study of adults who underwent anterior cervical fusion at any nonfederal California hospital between 2015 and 2017. The primary outcome was major perioperative complication or 30-day readmission. We built standard and ensemble machine learning models for risk prediction, assessing discrimination, and calibration. The best-performing model was validated on an external cohort comprised of consecutive adult patients who underwent ACDF at our institution between 2013 and 2020. RESULTS A total of 23,184 patients were included in this study; there were 1886 cases of major complication or readmissions. The ensemble model was well calibrated and demonstrated an area under the receiver operating characteristic curve of 0.728. The variables most important for the ensemble model include male sex, medical comorbidities, history of complications, and teaching hospital status. The ensemble model was evaluated on the validation cohort (n=260) with an area under the receiver operating characteristic curve of 0.802. The ensemble algorithm was used to build a web-based risk calculator. CONCLUSION We report derivation and external validation of an ensemble algorithm for prediction of major perioperative complications and 30-day readmission after anterior cervical fusion. This model has excellent discrimination and is well calibrated when tested on a contemporaneous external cohort of ACDF cases.
Collapse
Affiliation(s)
- Akash A. Shah
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sai K. Devana
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Changhee Lee
- Department of Artificial Intelligence, Chung-Ang University, Seoul, South Korea
| | - Thomas E. Olson
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Alexander Upfill-Brown
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - William L. Sheppard
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Elizabeth L. Lord
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Arya N. Shamie
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Mihaela van der Schaar
- Department of Electrical and Computer Engineering, University of California, Los Angeles, CA
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, United Kingdom
| | - Nelson F. SooHoo
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Don Y. Park
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| |
Collapse
|
4
|
Magomedov SS, Mytyga PG. [Repeated cervical laminoplasty for progressive ossification of posterior longitudinal ligament: a case report]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:90-95. [PMID: 36763559 DOI: 10.17116/neiro20238701190] [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: 02/11/2023]
Abstract
Posterior longitudinal ligament ossification is a progressive disease resulting in severe multilevel spinal stenosis with myelopathy. Decompression via anterior or posterior approach is the main treatment option. Decompressive laminoplasty is currently considered the most effective and safest method. This procedure provides favorable outcomes with low trauma and short surgery time. Redo surgeries are rare and most often performed within 2 years after primary laminoplasty. The most common causes are progressive spinal stenosis following posterior longitudinal ligament ossification, insufficient primary decompression and progressive cervical spine kyphosis. Considering few data on redo laminoplasty, we present a patient with progressive ossification of posterior longitudinal ligament who underwent redo surgery at the same level in 10 years after primary laminoplasty.
Collapse
Affiliation(s)
- Sh Sh Magomedov
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russia
| | - P G Mytyga
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russia
| |
Collapse
|
5
|
Kwon SY, Shim JH, Kim YH, Lim CS, An SB, Han I. Efficacy for Whitlockite for Augmenting Spinal Fusion. Int J Mol Sci 2021; 22:12875. [PMID: 34884680 PMCID: PMC8657587 DOI: 10.3390/ijms222312875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 01/21/2023] Open
Abstract
Whitlockite (WH) is the second most abundant inorganic component of human bone, accounting for approximately 25% of bone tissue. This study investigated the role of WH in bone remodeling and formation in a mouse spinal fusion model. Specifically, morphology and composition analysis, tests of porosity and surface area, thermogravimetric analysis, an ion-release test, and a cell viability test were conducted to analyze the properties of bone substitutes. The MagOss group received WH, Group A received 100% beta-tricalcium phosphate (β-TCP), Group B received 100% hydroxyapatite (HAp), Group C received 30% HAp/70% β-TCP, and Group D received 60% HAp/40% β-TCP (n = 10 each). All mice were sacrificed 6 weeks after implantation, and micro-CT, hematoxylin and eosin (HE) staining, and Masson trichome (MT) staining and immunohistochemistry were performed. The MagOss group showed more homogeneous and smaller grains, and nanopores (<500 nm) were found in only the MagOss group. On micro-CT, the MagOss group showed larger fusion mass and better graft incorporation into the decorticate mouse spine than other groups. In the in vivo experiment with HE staining, the MagOss group showed the highest new bone area (mean: decortication group, 9.50%; A, 15.08%; B, 15.70%; C, 14.76%; D, 14.70%; MagOss, 22.69%; p < 0.0001). In MT staining, the MagOss group demonstrated the highest new bone area (mean: decortication group, 15.62%; A, 21.41%; B, 22.86%; C, 23.07%; D, 22.47%; MagOss, 26.29%; p < 0.0001). In an immunohistochemical analysis for osteocalcin, osteopontin, and CD31, the MagOss group showed a higher positive area than other groups. WH showed comparable bone conductivity to HAp and β-TCP and increased new bone formation. WH is likely to be used as an improved bone substitute with better bone conductivity than HAp and β-TCP.
Collapse
Affiliation(s)
- Su Yeon Kwon
- Department of Neurosurgery, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam-si 13496, Gyeonggi-do, Korea; (S.Y.K.); (C.S.L.)
| | - Jung Hee Shim
- R&D Center, OSFIRM Co., Ltd., Seongnam-si 13620, Gyeonggi-do, Korea; (J.H.S.); (Y.H.K.)
| | - Yu Ha Kim
- R&D Center, OSFIRM Co., Ltd., Seongnam-si 13620, Gyeonggi-do, Korea; (J.H.S.); (Y.H.K.)
| | - Chang Su Lim
- Department of Neurosurgery, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam-si 13496, Gyeonggi-do, Korea; (S.Y.K.); (C.S.L.)
| | - Seong Bae An
- Department of Neurosurgery, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam-si 13496, Gyeonggi-do, Korea; (S.Y.K.); (C.S.L.)
| | - Inbo Han
- Department of Neurosurgery, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam-si 13496, Gyeonggi-do, Korea; (S.Y.K.); (C.S.L.)
| |
Collapse
|
6
|
Kim HC, Jeon H, Jeong YH, Park S, An SB, Heo JH, Shin DA, Yi S, Kim KN, Ha Y, Cho SR. Factors Affecting Postoperative Complications and Outcomes of Cervical Spondylotic Myelopathy with Cerebral Palsy : A Retrospective Analysis. J Korean Neurosurg Soc 2021; 64:808-817. [PMID: 34503314 PMCID: PMC8435654 DOI: 10.3340/jkns.2021.0012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/10/2021] [Indexed: 12/02/2022] Open
Abstract
Objective Cervical surgery in patients with cervical spondylotic myelopathy (CSM) and cerebral palsy (CP) is challenging owing to the complexities of the deformity. We assessed factors affecting postoperative complications and outcomes after CSM surgery in patients with CP.
Methods Thirty-five consecutive patients with CP and CSM who underwent cervical operations between January 2006 and January 2014 were matched to 35 non-cerebral palsy (NCP) control patients. Postoperative complications and radiologic outcomes were compared between the groups. In the CP group, the Japanese Orthopaedic Association score; Oswestry neck disability index; modified Barthel index; and values for the grip and pinch, Box and Block, and Jebsen-Taylor hand function tests were obtained preand postoperatively and compared between those with and without postoperative complications.
Results Sixteen patients (16/35%) in the CP group and seven (7/35%) in the NCP group (p=0.021) had postoperative complications. Adjacent segment degeneration (p=0.021), postoperative motor weakness (p=0.037), and revisions (p=0.003) were significantly more frequent in the CP group than in the NCP group; however, instrument-related complications were not significantly higher in the CP group (7/35 vs. 5/35, p=0.280). The number of preoperative fixed cervical deformities were significantly higher in CP with postoperative complications (5/16 vs. 1/19, p=0.037). In the CP group, clinical outcomes were almost similar between those with and without postoperative complications.
Conclusion The occurrence of complications during the follow-up period was high in patients with CP. However, postoperative complications did not significantly affect clinical outcomes.
Collapse
Affiliation(s)
- Hyung Cheol Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeongseok Jeon
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yeong Ha Jeong
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sangman Park
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Bae An
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Hyun Heo
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Graduate Program of NanoScience and Technology, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Keung Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Rae Cho
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Graduate Program of NanoScience and Technology, Yonsei University College of Medicine, Seoul, Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.,Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|