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Subramanian T, Kaidi A, Shahi P, Asada T, Hirase T, Vaishnav A, Maayan O, Amen TB, Araghi K, Simon CZ, Mai E, Tuma OC, Eun Kim AY, Singh N, Korsun MK, Zhang J, Allen M, Kwas CT, Kim ET, Sheha ED, Dowdell JE, Qureshi SA, Iyer S. Practical Answers to Frequently Asked Questions in Anterior Cervical Spine Surgery for Degenerative Conditions. J Am Acad Orthop Surg 2024; 32:e919-e929. [PMID: 38709837 DOI: 10.5435/jaaos-d-23-01037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/15/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Surgical counseling enables shared decision making and optimal outcomes by improving patients' understanding about their pathologies, surgical options, and expected outcomes. Here, we aimed to provide practical answers to frequently asked questions (FAQs) from patients undergoing an anterior cervical diskectomy and fusion (ACDF) or cervical disk replacement (CDR) for the treatment of degenerative conditions. METHODS Patients who underwent primary one-level or two-level ACDF or CDR for the treatment of degenerative conditions with a minimum of 1-year follow-up were included. Data were used to answer 10 FAQs that were generated from author's experience of commonly asked questions in clinic before ACDF or CDR. RESULTS A total of 395 patients (181 ACDF, 214 CDR) were included. (1, 2, and 3) Will my neck/arm pain and physical function improve? Patients report notable improvement in all patient-reported outcome measures. (4) Is there a chance I will get worse? 13% (ACDF) and 5% (CDR) reported worsening. (5) Will I receive a significant amount of radiation? Patients on average received a 3.7 (ACDF) and 5.5 mGy (CDR) dose during. (6) How long will I stay in the hospital? Most patients get discharged on postoperative day one. (7) What is the likelihood that I will have a complication? 13% (8% minor and 5% major) experienced in-hospital complications (ACDF) and 5% (all minor) did (CDR). (8) Will I need another surgery? 2.2% (ACDF) and 2.3% (CDR) of patients required a revision surgery. (9 & 10) When will I be able to return to work/driving? Most patients return to working (median of 16 [ACDF] and 14 days [CDR]) and driving (median of 16 [ACDF] and 12 days [CDR]). CONCLUSIONS The answers to the FAQs can assist surgeons in evidence-based patient counseling.
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Affiliation(s)
- Tejas Subramanian
- From the Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY (Subramanian, Kaidi, Shahi, Asada, Hirase, Vaishnav, Maayan, Amen, Araghi, Simon, Mai, Tuma, Eun Kim, Singh, Korsun, Zhang, Allen, Kim, Sheha, Dowdell, Qureshi, and Iyer), and the Weill Cornell Medicine, New York, NY (Subramanian, Mai, Eun Kim, Qureshi, and Iyer)
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Chen ZD, Tu CQ, Jiang YJ, Zeng YZ, Huang ZZ, Cai TY, Lin B. Management of non-contiguous upper and lower cervical spine fractures. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06308-z. [PMID: 39242395 DOI: 10.1007/s00264-024-06308-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 08/28/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE Upper cervical fracture combined with non-contiguous lower cervical fracture are not uncommon but complicated. In order to outline a management principle for the upper cervical fracture combined with non-contiguous lower cervical fracture and assess its clinical characteristics, we retrospectively analyzed 59 cases of patients who underwent surgical treatment for upper cervical fracture combined with non-contiguous lower cervical fracture. METHODS 59 patients of upper cervical fracture combined with non-contiguous lower cervical fracture were treated by surgery in our hospital. According to the AO Spine classification for cervical fractures, there were 21 cases of type B atlas fractures, nine cases of type C atlas fractures; 15 cases of type B axis fractures, 14 cases of type C axis fractures; 19 cases of type B lower cervical fractures, 40 cases of type C lower cervical fractures. The operation time, intraoperative blood loss, complications, VAS scores, JOA scores, ASIA grades, and radiological evaluation of cervical lordosis and stability were collected and recorded. RESULTS Our results showed the segments of upper cervical fracture combined with non-contiguous lower cervical fracture are mainly concentrated in the atlas-axis and C6, C7 levels. There were 43 cases (72.88%) of associated injuries, mainly involving head trauma and thoracic injuries. Four patients underwent anterior approach surgery only, 43 patients underwent posterior approach surgery only, and 12 patients underwent combined anterior and posterior approach surgery in one stage. All patients had regular follow up with an average duration of 67.83 ± 11.25 months (range, 39 to 103 months). The VAS scores and JOA scores at 12 months postoperatively and at final follow-up showed significant improvement compared to preoperative scores (P < 0.05). At the final follow-up, ASIA grades had improved by 0 to 2 levels. The cervical lordosis at the final follow-up (24.71°±7.39°) showed no statistically significant difference compared to preoperative measurements (26.89°±13.32°). Surgical complications occurred in 17 patients. No cases of vertebral artery injury, screw loosening, or other internal fixation failures were found at final follow-up. CONCLUSIONS Upper cervical fracture combined with non-contiguous lower cervical fracture can result in varying extents of cervical spinal cord injury and combined trauma in other parts. Surgical treatment of these injuries can achieve favourable clinical and radiological outcomes in the medium to long term follow-up. More research is still needed to optimize clinical decision-making regarding surgical approach.
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Affiliation(s)
- Zhi-da Chen
- Department of Orthopaedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou, 363000, China
| | - Cheng-Quan Tu
- Department of Orthopaedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou, 363000, China
| | - Yuan-Jie Jiang
- Department of Orthopaedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou, 363000, China
| | - Yu-Zhe Zeng
- Department of Orthopaedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou, 363000, China
| | - Zhuan-Zhi Huang
- Department of Orthopaedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou, 363000, China
| | - Tao-Yi Cai
- Department of Orthopaedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou, 363000, China.
| | - Bin Lin
- Department of Orthopaedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou, 363000, China.
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Rahyussalim AJ, Putra MNS, Nasser MK, Kusuma BW, Kurniawati T, Canintika AF. Cervical tuberculosis treated with closed system abscess evacuation, and percutaneous laser disc decompression combined with secretome derived from umbilical cord mesenchymal stem cells: A case report. Int J Surg Case Rep 2024; 119:109764. [PMID: 38776822 PMCID: PMC11141440 DOI: 10.1016/j.ijscr.2024.109764] [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: 02/18/2024] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Minimal invasive surgery is preferred as it offers the same benefit with less tissue damage, especially in the cervical area where a lot of critical structure resides. Mesenchymal stem cells (MSCs) and its secretome provide a promising regenerative intervention to damaged tissue. We report a cervical spinal tuberculosis case with hemiparesis treated with minimally invasive surgery combined with a regenerative approach. CASE PRESENTATION A 13-year-old boy presented with weakness in his left arm and left leg, accompanied by hemiparesthesia. The patient was unable to get up from bed, run, and jumpRadiology examination showed compression fracture, intervertebral disc retropulsion, spinal cord compression, and paravertebral cold abscess. The patient was treated with a single minimal invasive surgery consisting of closed system abscess evacuation, and percutaneous laser disc decompression combined with umbilical cord-derived mesenchymal stem cells. CLINICAL DISCUSSION The pain, weakness, and numbness were gone two days after surgery. The patient could carry out normal activities, even doing sports such as mini soccer and badminton. This clinical improvement was obtained as he carried out some procedures. The cold abscess aspiration removed infection focus which prevents further vertebra destruction, PLDD which decompresses the retropulsed discs, and implantation of MSCs and secretomes which regenerate and strengthen the destructed bone and surrounding tissue. CONCLUSION Closed system abscess evacuation, and percutaneous laser disc degeneration combined with secretome derived from UC-MSC are minimally-invasive strategies with promising results. Further studies are required to investigate its efficacy.
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Affiliation(s)
- Ahmad Jabir Rahyussalim
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo National General Hospital and Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia; Stem Cells and Tissue Engineering Research Cluster, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Muhammad Nadhil Sunaryo Putra
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo National General Hospital and Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Mochammad Kamal Nasser
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo National General Hospital and Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Bagus Wijaya Kusuma
- Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Tri Kurniawati
- Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia; Stem Cells and Tissue Engineering Research Cluster, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Anissa Feby Canintika
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo National General Hospital and Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
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Godil J, Smith S, Wright C, Yoo JU. Risk Factors, Incidence and Mortality of Vertebral Artery Injury in Patients Undergoing Anterior Cervical Corpectomy: A Retrospective Large National Data Base Study. Global Spine J 2024; 14:889-893. [PMID: 36052427 PMCID: PMC11192100 DOI: 10.1177/21925682221125127] [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] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVE To determine the incidence of vertebral artery injury (VAI), risk factors, intervention, associated complications, and mortality in patients undergoing anterior cervical corpectomy. METHODS We performed a retrospective review of the incidence of VAI during anterior cervical corpectomy using the PearlDiver database from 2010-2017. The CPT code 63 081 to identify corpectomy patients. Patient data extracted included, incidence of VAI, demographic factors, intervention, and future complications of death and stroke. The risk were calculated compared with those patients who did not have VAI. RESULTS 26 126 patients were identified to have undergone cervical corpectomy. Multivariate analysis of risk factors showed that younger age and male sex were associate with higher rate of injury (t = -11.5; P < .0001 and t = 3.8; P = .0001, respectively). Vertebral artery injuries occurred in 78 patients at an incidence of .3%. 11 (14%) VAI patients had a cerebral infarction compared with 1705 (7%) for non-VAI patients (OR = 2.13; 95% CI = [1.18 - 3.85; P = .0179]) during the follow up period. 1-year mortality rates were higher in patients who suffered a VAI (14%) compared to those who did not suffer a VAI (4%; OR = 3.85; CI = [2.04 - 7.14]; P < .0001). CONCLUSION Consequence of VAI may not be known for months following the injury. Although the same admission mortality is rare with this injury, there is a significant increase in post-discharge complications. This study suggests that further investigations into long term health risk of VAI is needed.
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Affiliation(s)
- Jamila Godil
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Spencer Smith
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Christina Wright
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Jung U. Yoo
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
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Davidar AD, Jiang K, Weber-Levine C, Bhimreddy M, Theodore N. Advancements in Robotic-Assisted Spine Surgery. Neurosurg Clin N Am 2024; 35:263-272. [PMID: 38423742 DOI: 10.1016/j.nec.2023.11.005] [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] [Indexed: 03/02/2024]
Abstract
Applications and workflows around spinal robotics have evolved since these systems were first introduced in 2004. Initially approved for lumbar pedicle screw placement, the scope of robotics has expanded to instrumentation across different regions. Additionally, precise navigation can aid in tumor resection or spinal lesion ablation. Robot-assisted surgery can improve accuracy while decreasing radiation exposure, length of hospital stay, complication, and revision rates. Disadvantages include increased operative time, dependence on preoperative imaging among others. The future of robotic spine surgery includes automated surgery, telerobotic surgery, and the inclusion of machine learning or artificial intelligence in preoperative planning.
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Affiliation(s)
- A Daniel Davidar
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly Jiang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carly Weber-Levine
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meghana Bhimreddy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Orthopaedic Surgery & Biomedical Engineering, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Rai V, Sharma V, Kumar M, Thakur L. A systematic review of risk factors and adverse outcomes associated with anterior cervical discectomy and fusion surgery over the past decade. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:141-152. [PMID: 38957769 PMCID: PMC11216642 DOI: 10.4103/jcvjs.jcvjs_168_23] [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: 12/02/2023] [Accepted: 03/30/2024] [Indexed: 07/04/2024] Open
Abstract
Background Anterior cervical discectomy and fusion (ACDF) is one of the most frequently performed cervical surgeries in the world, yet there have been several reported complications. Objective To determine the actual incidence of complications related to ACDF as well as any risk variables that may have been identified in earlier research. Methods To evaluate the origin, presentation, natural history, and management of the risks and the complications, we conducted a thorough assessment of the pertinent literature. An evaluation of clinical trials and case studies of patients who experienced one or more complications following ACDF surgery was done using a PubMed, Cochrane Library, and Google Scholar search. Studies involving adult human subjects that were written in the English language and published between 2012 and 2022 were included in the search. The search yielded 79 studies meeting our criteria. Results The overall rates of complications were as follows: Dysphagia 7.9%, psudarthrosis 5.8%, adjacent segment disease (ASD) 8.8%, esophageal perforations (EPs) 0.5%, graft or hardware failure 2.2%, infection 0.3%, recurrent laryngeal nerve palsy 1.7%, cerebrospinal fluid leak 0.8%, Horner syndrome 0.5%, hematoma 0.8%, and C5 palsy 1.9%. Conclusion Results showed that dysphagia was a common postoperative sequelae with bone morphogenetic protein use and a higher number of surgical levels being the major risk factors. Pseudarthrosis rates varied depending on the factors such as asymptomatic radiographic graft sinking, neck pain, or radiculopathy necessitating revision surgery. The incidence of ASD indicated no data to support anterior cervical plating as more effective than standalone ACDF. EP was rare but frequently fatal, with no correlation found between patient age, sex, body mass index, operation time, or number of levels.
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Affiliation(s)
- Vikramaditya Rai
- Department of Orthopedics, Dr. Rajendra Prasad Government Medical College and Hospital, Kangra, Himachal Pradesh, India
| | - Vipin Sharma
- Department of Orthopedics, Dr. Rajendra Prasad Government Medical College and Hospital, Kangra, Himachal Pradesh, India
| | - Mukesh Kumar
- Department of Neurosurgery, Dr. Rajendra Prasad Government Medical College and Hospital, Kangra, Himachal Pradesh, India
| | - Lokesh Thakur
- Department of Orthopedics, Dr. Rajendra Prasad Government Medical College and Hospital, Kangra, Himachal Pradesh, India
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Alsoof D, Perry J, Yang DS, Zhang AS, McDonald CL, Kuris EO, Daniels AH. Risk of Dysphagia and Dysphonia in Patients With Prior Thyroidectomy Undergoing Anterior Cervical Discectomy and Fusion. Global Spine J 2024; 14:494-502. [PMID: 35835538 PMCID: PMC10802520 DOI: 10.1177/21925682221111095] [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] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study using PearlDiver database. OBJECTIVES To evaluate the effect of prior thyroidectomy on complications of Anterior Cervical Discectomy and Fusion (ACDF) surgery. METHODS PearlDiver was used to identify patients without prior dysphagia or dysphonia undergoing ACDF between the years 2010-2020Q1. Patients with and without prior thyroidectomy were matched by levels of fusion, alcohol use, and gastroesophageal reflux disease in a 1:5 ratio. Postoperative outcomes were assessed for each cohort with multivariable logistic regression, controlling for age, sex, and Elixhauser Comorbidity Index. RESULTS Between 2010 and 2019, matched cohorts of 792 ACDF patients with prior thyroidectomy and 3960 ACDF only patients were included in the study. Of patients with previous thyroidectomy undergoing ACDF, 16.3% experienced dysphagia at 1-year compared with 10.6% for patients undergoing ACDF only (aOR=1.39, P=.004). Patients with previous thyroidectomy also had higher odds of dysphonia at 1-year following ACDF, as compared to patients with ACDF alone (2.7% vs 1.2%, aOR=1.74, P= .048). Patients undergoing ACDF with prior thyroidectomy did not have increased risk of revision at 1 year (aOR=1.10, P=.698), 2 years (aOR=1.16, P=.457), or 5 years (aOR=1.20, P=.255) following surgery. There were no differences in postoperative opioid utilization rates at 1 month (aOR=2.07, P=.138), 3 months (aOR=2.45, P=.095), 6 months (aOR=1.34, P=.520), and 12 months (aOR=1.69, P=.202). Prior thyroidectomy was not associated with reintubation following ACDF (P=.995). CONCLUSIONS Patients with prior thyroidectomy undergoing ACDF surgery experience increased odds of dysphagia and dysphonia at 1-year follow-up compared to those without prior thyroidectomy.
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Affiliation(s)
- Daniel Alsoof
- Alpert Medical School of Brown University, Providence, RI, USA
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - Justin Perry
- Alpert Medical School of Brown University, Providence, RI, USA
| | - Daniel S. Yang
- Alpert Medical School of Brown University, Providence, RI, USA
| | - Andrew S. Zhang
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - Christopher L. McDonald
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - Eren O. Kuris
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - Alan H. Daniels
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA
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Mohammadi E, Khan AF, Villeneuve LM, Hameed S, Haynes G, Muhammad F, Smith ZA. Systematic review protocol for complications following surgical decompression of degenerative cervical myelopathy. PLoS One 2024; 19:e0296809. [PMID: 38285684 PMCID: PMC10824432 DOI: 10.1371/journal.pone.0296809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/19/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Degenerative Cervical Myelopathy (DCM) is one of the most common degenerative disorders of cervical spine and sources of cord dysfunction in adults. It usually manifests with neurologic presentations such as loss of dexterity and gait issues. Treatment for moderate and severe cases of DCM is surgical decompression of the region. There are many approaches available for surgical intervention which could be categorized into anterior and posterior based on the side of neck where operation takes place. Additionally, for certain cases the hybridized anterior-posterior combined surgery is indicated. While there are many technical differences between these approaches with each having its own advantages, the complications and safety profiles of them are not fully disclosed. This protocol aims to systematically search for current reports on complications of surgical decompression methods of DCM and pool them for robust evidence generation. METHOD Search will be carried out in PubMed, Scopus, and Cochrane databases for retrospective and prospective surgical series, cohorts, or trials being performed for DCM with at least a sample size of 20 patients. Query strings will be designed to capture reports with details of complications with no year limit. Studies not being original (e.g., review articles, case reports, etc.), not in English, having patients younger than 18-years-old, and not reporting at least one complication will be excluded. Two independent reviewers will review the titles and abstracts for first round of screening. Full text of retrieved studies from previous round will be screened again by the same reviewers. In case of discrepancy, the third senior reviewer will be consulted. Eligible studies will then be examined for data extraction where data will be recorded into standardized form. Cumulative incidence and 95% confidence intervals of complication will be then pooled based on generalized linear mixed models with consideration of approach of surgery as subgroups. Heterogeneity tests will be performed for assessment of risk of bias. DISCUSSION This systematic review is aimed at providing practical information for spine surgeons on the rates of complications of different surgical approaches of DCM decompression. Proper decision-making regarding the surgical approach in addition to informing patients could be facilitated through results of this investigation.
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Affiliation(s)
- Esmaeil Mohammadi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
- Neuroscience Program, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Ali Fahim Khan
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Lance M. Villeneuve
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Sanaa Hameed
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Grace Haynes
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, United States of America
| | - Fauziyya Muhammad
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
- Neuroscience Program, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Zachary A. Smith
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
- Neuroscience Program, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
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Bergamaschi JPM, de Brito MBS, de Araújo FF, Graciano RS, Utino ET, Lewandrowski KU, Wirth F. Surgical Technique of Central and Over-the-Top Full-Endoscopic Decompression of the Cervical Spine: A Technical Note. J Pers Med 2023; 13:1508. [PMID: 37888119 PMCID: PMC10608411 DOI: 10.3390/jpm13101508] [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: 08/30/2023] [Revised: 09/27/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Endoscopic surgery of the cervical spine is constantly evolving and the spectrum of its indications has expanded in recent decades. Full-endoscopic techniques have standardized the procedures for posterior and anterior access. The full-endoscopic approach was developed to treat degenerative diseases with the least possible invasion and without causing instability of the cervical spine. The posterior full-endoscopic approach is indicated for the treatment of diseases of the lateral part of the vertebral segment, such as herniations and stenoses of the lateral recess and vertebral foramen. There has been little discussion of this approach to the treatment of central stenosis of the cervical spine. This technical note describes a step-by-step surgical technique for central and over-the-top full-endoscopic decompression in the cervical spine, using a 3.7 mm working channel endoscope. This technique has already been shown to be effective in a recent case series with a 4.7 mm working channel endoscope, and may represent a new treatment option for central or bilateral lateral recess stenosis. There is also the possibility of a bilateral full-endoscopic approach, but this may be associated with greater muscle damage and a longer operative time. Case series and comparative studies should be encouraged to confirm the safety and utility of this technique.
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Affiliation(s)
- João Paulo Machado Bergamaschi
- Atualli Spine Care Clinic, 745 Alameda Santos, Cj. 71, São Paulo 01419-001, Brazil; (F.F.d.A.); (R.S.G.)
- Atualli Academy, 2504 Brigadeiro Luís Antônio, Cj. 172, São Paulo 01402-000, Brazil; (E.T.U.); (F.W.)
| | | | - Fernando Flores de Araújo
- Atualli Spine Care Clinic, 745 Alameda Santos, Cj. 71, São Paulo 01419-001, Brazil; (F.F.d.A.); (R.S.G.)
| | - Ricardo Squiapati Graciano
- Atualli Spine Care Clinic, 745 Alameda Santos, Cj. 71, São Paulo 01419-001, Brazil; (F.F.d.A.); (R.S.G.)
| | - Edgar Takao Utino
- Atualli Academy, 2504 Brigadeiro Luís Antônio, Cj. 172, São Paulo 01402-000, Brazil; (E.T.U.); (F.W.)
| | | | - Fernanda Wirth
- Atualli Academy, 2504 Brigadeiro Luís Antônio, Cj. 172, São Paulo 01402-000, Brazil; (E.T.U.); (F.W.)
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Park EJ, Jeong BG, Min WK. Anatomical Consideration for Anterior Approach of Cervicothoracic Junction: A Computed Tomography Image Analysis. Clin Orthop Surg 2023; 15:818-825. [PMID: 37811505 PMCID: PMC10551693 DOI: 10.4055/cios22394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/08/2023] [Accepted: 04/13/2023] [Indexed: 10/10/2023] Open
Abstract
Background In the cervicothoracic junction (CTJ), there is limited working space to perform the posterior-only approach. Therefore, a combined anterior approach is required in some cases. However, the great vessels and sternum obstruct the anterior corridor and make the anterior approach difficult. We analyzed relevant anatomical structures encountered during the anterior approach in the CTJ and evaluated the feasibility of previously reported surgical corridors. Methods We retrospectively examined 49 patients who underwent neck computed tomography angiography between January 2015 and May 2020. Using the coronal images, we measured the intercarotid artery angle (ICAA), intercarotid artery distance (ICAD), shape of the brachiocephalic trunk (BCT), and position of the BCT base. We then measured the most cranial level requiring manubriotomy for the anterior approach (ML), the most caudal level accessible through the superior corridor (SC), and the most caudal level through the inferior corridor (IC) according to the surgeon's line of sight using the sagittal axis image. Results The mean ICAA and ICAD were 50.83° ± 15.23° and 33.38 ± 12.11 mm, respectively. Notably, BCT shape was of the convex type in most cases (42.9%), followed by the straight type (36.7%). In addition, the base of BCT was most commonly located inside the body (49%). Moreover, ICAA and ICAD were significantly greater in men. Although men mostly had the BCT base inside the body (64.3%), female mostly had it on the edge of the body (47.6%). Notably, ML showed the highest frequency (16.3%) in the T1 lower and upper bodies. Furthermore, through SC and IC, it was possible to approach the T4 lower body and T6 midbody, respectively. SC showed the highest frequency (16.3%) in the T3 lower body, and IC showed the highest frequency (20.4%) in the T5 midbody. Conclusions ICAA and ICAD were larger and higher in men. BCT was convex and located inside the body in most cases. The accessible level of ML, SC, and IC were T1, T3, and T5, respectively. For the anterior approach in the CTJ, preoperative vascular and accessible level analysis of corridors is essential to decide on the appropriate corridor and reduce complications.
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Affiliation(s)
- Eugene J. Park
- Department of Orthopedic Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Bo-Gil Jeong
- Department of Orthopedic Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Woo-Kie Min
- Department of Orthopedic Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
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Choi SR, Kwon JW, Suk KS, Kim HS, Moon SH, Park SY, Moon SE, Lee BH. Effectiveness of Toothbrushing Technique for Biofilm Removal and Postoperative Infection Control after Spinal Fusion Surgery: A Retrospective Study. Bioengineering (Basel) 2023; 10:1143. [PMID: 37892873 PMCID: PMC10604172 DOI: 10.3390/bioengineering10101143] [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: 09/02/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
This retrospective study was designed to investigate the effectiveness of using a toothbrush, which is commonly used in our daily life, for biofilm removal and infection control in the treatment of spinal infections occurring after spinal fusion surgery. Currently, a biofilm is thought to form on the surface of the metal inserted during spine fusion surgery. We aim to determine the differences in clinical outcomes between using and not using a toothbrush to remove biofilm while performing conventional drainage, curettage, and debridement. A total of 1081 patients who underwent anterior or posterior spinal fusion surgery between November 2018 and October 2022 were screened. The study included 60 patients who developed surgical site infection and underwent incision and drainage surgery either with a toothbrush (n = 20) or without a toothbrush (n = 40). Failure of infection control that requires revision surgery occurred in 2 patients (10%) in the Toothbrush group and in 14 patients (35%) in the No-Toothbrush group (p = 0.039). Thus, the rate of additional surgery was significantly lower in the Toothbrush group. Additionally, normalization of c-reactive protein levels occurred significantly faster in the Toothbrush group (p = 0.044). Therefore, using a toothbrush to treat spinal infections following spinal fusion surgery appears to have beneficial mechanical debridement effects, resulting in improved clinical results, which were also confirmed based on the electron microscopic images.
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Affiliation(s)
- Sung-Ryul Choi
- Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Ji-Won Kwon
- Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Kyung-Soo Suk
- Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Hak-Sun Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Seong-Hwan Moon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Si-Young Park
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Seung-Eon Moon
- Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Byung-Ho Lee
- Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
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12
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Sakellariou E, Benetos IS, Evangelopoulos DS, Galanis A, Alevrogianni F, Vavourakis M, Marougklianis V, Tsalimas G, Pneumaticos S. Incidence of vertebral artery injury in patients undergoing cervical spine trauma surgery in correlation with surgical approach: A review. Medicine (Baltimore) 2023; 102:e34653. [PMID: 37713867 PMCID: PMC10508423 DOI: 10.1097/md.0000000000034653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/18/2023] [Indexed: 09/17/2023] Open
Abstract
Spinal cord injuries at the cervical spine level represent the most consequential of the related injuries at all levels of the spine. They can trigger permanent unilateral or bilateral damage with conspicuous disability. Regarding unstable injuries, the gold standard approach is open reduction and osteosynthesis, which can select between anterior and posterior surgical access. Each of the aforementioned approaches demonstrates both advantages and disadvantages; thus, it is up to the surgeon to determine the optimal option concerning the patient's safety. Diligent intraoperative control of anatomical reduction is pivotal to obtaining the best feasible postoperative outcomes. Literature data delineate copious complications following surgical intervention in the cervical spine. Indubitably, the most crucial intraoperative complication accounts for vascular injuries, with the most preponderant being the corrosion of the vertebral artery, as it is potentially life-threatening. This paper aims to provide a succinct and compendious review of the existing literature regarding cervical spinal cord injuries and to deduce many inferences concerning the incidence of iatrogenic vertebral artery injuries in relation to the surgical approach for fracture reduction.
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Affiliation(s)
- Evangelos Sakellariou
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Ioannis S. Benetos
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | | | - Athanasios Galanis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | | | - Michail Vavourakis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Vasilios Marougklianis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Georgios Tsalimas
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Spiros Pneumaticos
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
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Mazmudar A, Paziuk T, Tran KS, Henry T, Oh S, Purtill C, Habbal D, Yalla G, Harrill Q, Sherrod B, Bisson E, Brodke D, Kepler C, Schroeder G, Vaccaro A, Hilibrand A, Rihn JA. Evaluating Dysphagia Duration and Severity After ACDF in Patients With Underlying Dysphagia - A Prospective, Multicenter Study. Global Spine J 2023:21925682231201249. [PMID: 37671756 DOI: 10.1177/21925682231201249] [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] [Indexed: 09/07/2023] Open
Abstract
STUDY DESIGN Prospective Cohort Study. OBJECTIVES The purpose of this study was to prospectively evaluate the impact of preoperative dysphagia on the postoperative incidence and severity of dysphagia in patients undergoing ACDF at multiple institutions. METHODS After IRB approval, patients over 18 years of age who underwent an elective ACDF for degenerative conditions were prospectively enrolled at two academic centers from 2018 to 2021. Preoperative dysphagia was self-reported by patients through a pre-operative questionnaire on a binary basis. Patients completed dysphagia surveys (Bazaz, Dysphagia Short Questionnaire, 10-item Eating Assessment Tool) to assess dysphagia severity during their preoperative visit, and these dysphagia surveys were repeated immediately postoperatively, at two weeks and again at six, 12, and 24 weeks postoperatively. Patients were stratified into three subgroups based on dysphagia status preoperatively and immediately postoperatively and compared using ANOVA tests or Kruskal-Wallis tests for continuous variables and Pearson chi-square analysis or Fisher's Exact test for categorical variables. RESULTS A total of 168 patients (23 with preoperative dysphagia, 145 without preoperative dysphagia) met study criteria and were enrolled in the study. Patients with preoperative dysphagia had less frequent alcohol consumption (23.8% vs 53.7%, P = .0210), and higher rates of dysphagia at 2-weeks (77.8% vs 38.7%, P = .004) and 24-weeks (43.8% vs 14.8%, P = .010) postoperatively. These patients also had higher severity scores for dysphagia on the Bazaz (P = .001), DSQ (P = .012), EAT10 (P = .022) questionnaires at the 2-week follow-up period, higher DSQ scores (P = .036) at the 6-week follow-up period, higher EAT-10 scores (P = .009) at the 12-week follow-up period, and higher Bazaz (P = .001), DSQ (P = .002), and EAT-10 (P = .005) scores at the 24-week follow-up period. There were no differences in demographic, medical history, surgical variables, rates of ENT consultation, length of stay, or other in-hospital events between groups. CONCLUSIONS Patients undergoing ACDF who had preoperative dysphagia have prolonged postoperative dysphagia and greater dysphagia severity. Surgeons should be aware of the risk of prolonged dysphagia severity that may persist past 24 weeks after surgery when discussing clinical decisions with patients.
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Affiliation(s)
- Aditya Mazmudar
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Taylor Paziuk
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Khoa S Tran
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Tyler Henry
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Samuel Oh
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Caroline Purtill
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Daniel Habbal
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Goutham Yalla
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Quinlin Harrill
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Brandon Sherrod
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Erica Bisson
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Darrel Brodke
- Department of Orthopaedic Surgery, University Orthopaedic Center, University of Utah, Salt Lake City, UT, USA
| | - Christopher Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Alan Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
| | - Jeffrey A Rihn
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute and Thomas Jefferson University, Philadelphia, PA, USA
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14
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Zhao Y, Zhang B, Yuan B. Effect of T1 Slope on Disappearance of Cervical Lordosis after Posterior Cervical Double-Door Laminoplasty Based on Medical Informatics. Brain Sci 2023; 13:1189. [PMID: 37626545 PMCID: PMC10452326 DOI: 10.3390/brainsci13081189] [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: 05/03/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
Cervical sagittal balance plays a pivotal role in spine surgeries as it has a significant impact on the clinical outcomes in cervical spine surgery. Image processing techniques have significantly improved the accuracy and precision of cervical surgical techniques. This study aims to investigate the effects of T1 slope (T1s) on the disappearance of cervical lordosis after posterior cervical double-door laminoplasty using medical informatics and radiographic measures. To do so, we determined and measured the loss of T1s and cervical lordosis during the postoperative follow-up period in patients with double-door posterior cervical laminoplasty. Patients (n = 40) who underwent posterior cervical double-door laminoplasty participated in this study. For all patients, the difference between the preoperative T1s (angle between the upper edge of T1 and the horizontal line) and preoperative and postoperative cervical lordosis (Cobb method) was estimated, and the linear relationship between the two was statistically analyzed to observe the influence of preoperative T1s on postoperative cervical lordosis disappearance. The average preoperative T1s was 23.54°, and the average preoperative cervical lordosis angle was 8.50°. After 1-20 months of follow-up (mean = 9.53 months), the average postoperative cervical lordosis was 8.50°, and the average loss of cervical lordosis was 0.22°. Twenty cases had different degrees of lordosis angle loss after the operation, with an average loss of 9.31°. All patients were divided into groups A and B, according to a mean value of T1s = 23.54°, of which T1S > 23.54° was group A and T1s < 23.54 was group B. Cervical lordosis was quantified by the C2-C7 Cobb angle. The Cobb angle difference of cervical lordosis was measured before and after the operation, and its correlation with preoperative T1s was assessed. The preoperative Cobb angle and cervical curvature changes in the two groups were statistically compared, and the difference between the two groups was statistically significant (p < 0.05). The group with a T1s > 23.54° had greater loss of preoperative Cobb angle and cervical curvature. In group A, the mean preoperative cervical disability index (NDI) was 32.4 ± 3.4, and the mean postoperative NDI score was 16.5 ± 2.1. The mean preoperative VAS scores of neck pain and neck pain were 5.41 ± 1.1 and 5.55 ± 0.3, respectively, and the improvement in neck pain was -0.2%. The mean preoperative NDI in group B was 30.1 ± 2.9, and the mean postoperative NDI score was 11.5 ± 3.1. The mean VAS score for preoperative neck pain was 5.11 ± 1.2, that for postoperative neck pain was 4.18 ± 0.7, and that for neck pain improved by 18%. There was a significant difference between the two groups (p < 0.05). The disappearance of cervical lordosis after posterior cervical double-door laminoplasty is an important cause of postoperative cervical spine pain. The T1s is meaningful for predicting the loss of postoperative curvature in patients undergoing posterior cervical double-door laminoplasty. This is especially true for patients with good preoperative cervical curvature without ankylosis and kyphosis but with a wide T1s.
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Affiliation(s)
| | | | - Baisheng Yuan
- Department of Orthopedics, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, No. 758 Hefei Road, Qingdao 266035, China; (Y.Z.); (B.Z.)
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15
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Wilson JP, Vallejo JB, Kumbhare D, Guthikonda B, Hoang S. The Use of Intraoperative Neuromonitoring for Cervical Spine Surgery: Indications, Challenges, and Advances. J Clin Med 2023; 12:4652. [PMID: 37510767 PMCID: PMC10380862 DOI: 10.3390/jcm12144652] [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: 04/11/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Intraoperative neuromonitoring (IONM) has become an indispensable surgical adjunct in cervical spine procedures to minimize surgical complications. Understanding the historical development of IONM, indications for use, associated pitfalls, and recent developments will allow the surgeon to better utilize this important technology. While IONM has shown great promise in procedures for cervical deformity, intradural tumors, or myelopathy, routine use in all cervical spine cases with moderate pathology remains controversial. Pitfalls that need to be addressed include human error, a lack of efficient communication, variable alarm warning criteria, and a non-standardized checklist protocol. As the techniques associated with IONM technology become more robust moving forward, IONM emerges as a crucial solution to updating patient safety protocols.
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Affiliation(s)
- John Preston Wilson
- Department of Neurosurgery, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA
| | - Javier Brunet Vallejo
- Department of Neurosurgery, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA
| | - Deepak Kumbhare
- Department of Neurosurgery, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA
| | - Bharat Guthikonda
- Department of Neurosurgery, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA
| | - Stanley Hoang
- Department of Neurosurgery, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA
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16
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Chang MC, Kim DY, Choi JW, Choi HY, Park JS, Park D. Association between Anterior Surgical Approach and Dysphagia Severity in Patients with Cervical Spinal Cord Injury. J Clin Med 2023; 12:jcm12093227. [PMID: 37176665 PMCID: PMC10179226 DOI: 10.3390/jcm12093227] [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: 12/10/2022] [Revised: 03/04/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION Early detection and management of dysphagia are essential for preventing aspiration pneumonia and reducing mortality in patients with cervical spinal cord injury (C-SCI). In this study, we identified risk factors for dysphagia in patients with C-SCI by analyzing the correlation between the clinical factors and the severity of dysphagia, not the presence or absence of dysphagia. Combined with the analysis results of previous studies, we thought that this additional analysis method could more accurately reveal the risk factors for dysphagia in patients with C-SCI. METHODS The presence and severity of dysphagia in patients with C-SCI was evaluated using a modified videofluoroscopic dysphagia scale (mVDS) and penetration-aspiration scale (PAS). All included patients with C-SCI performed a video fluoroscopic swallowing study (VFSS). Clinical factors such as age, sex, the presence of tracheostomy, spinal cord independence measure (SCIM), pulmonary function test (PFT), including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FVC/FEV1, maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP), American Spinal Cord Injury Association (ASIA) score, Berg Balance Scale (BBS), and operation method were investigated. RESULTS In the multivariate regression analysis, the anterior surgical approach was the only clinical factor that had a significant correlation in both mVDS and PAS, which represents the severity of dysphagia in C-SCI patients (p < 0.05). CONCLUSION The anterior surgical approach was correlated with the severity of dysphagia in patients with C-SCI. Considering this, as one of the risk factors affecting dysphagia in patients with C-SCI, surgical method may also need to be considered. Additionally, we recommend that clinicians should pay particular attention to the potential for development of dysphagia in patients who received anterior cervical surgery. However, further prospective studies with larger sample sizes are needed for more accurate generalization.
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Affiliation(s)
- Min Cheol Chang
- Department of Rehabilitation Medicine, Yeungnam University Hospital, Daegu 42415, Republic of Korea
| | - Dae Yeong Kim
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea
| | - Jin-Woo Choi
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea
| | - Ho Yong Choi
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul 05278, Republic of Korea
| | - Jin-Sung Park
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41944, Republic of Korea
| | - Donghwi Park
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Ayangro 99, Dong gu, Daegu 41199, Republic of Korea
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17
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Chandra AA, Vaishnav A, Shahi P, Song J, Mok J, Alluri RK, Chen D, Gang CH, Qureshi S. The Role of Intraoperative Neuromonitoring Modalities in Anterior Cervical Spine Surgery. HSS J 2023; 19:53-61. [PMID: 36776519 PMCID: PMC9837402 DOI: 10.1177/15563316221110572] [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: 03/14/2022] [Accepted: 05/20/2022] [Indexed: 02/14/2023]
Abstract
Background: Intraoperative neuromonitoring (IONM) is frequently used during spine surgery to mitigate the risk of neurological injuries. Yet, its role in anterior cervical spine surgery remains controversial. Without consensus on which anterior cervical spine surgeries would benefit the most from IONM, there is a lack of standardized guidelines for its use in such procedures. Purpose: We sought to assess the alerts generated by each IONM modality for 4 commonly performed anterior cervical spinal surgeries: anterior cervical diskectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), cervical disk replacement (CDR), or anterior diskectomy. In doing so, we sought to determine which IONM modalities (electromyography [EMG], motor evoked potentials [MEP], and somatosensory evoked potentials [SSEP]) are associated with alert status when accounting for procedure characteristics (number of levels, operative level). Methods: We conducted a retrospective review of IONM data collected by Accurate Neuromonitoring, LLC, a company that supports spine surgeries conducted by 400 surgeons in 8 states, in an internally managed database from December 2009 to September 2018. The database was queried for patients who underwent ACCF, ACDF, anterior CDR, or anterior diskectomy in which at least 1 IONM modality was used. The IONM modalities and incidence of alerts were collected for each procedure. The search identified 8854 patients (average age, 50.6 years) who underwent ACCF (n = 209), ACDF (n = 8006), CDR (n = 423), and anterior diskectomy (n = 216) with at least 1 IONM modality. Results: Electromyography was used in 81.3% (n = 7203) of cases, MEP in 64.8% (n = 5735) of cases, and SSEP in 99.9% (n = 8844) of cases. Alerts were seen in 9.3% (n = 671), 0.5% (n = 30), and 2.7% (n = 241) of cases using EMG, MEP and SSEP, respectively. In ACDF, a significant difference was seen in EMG alerts based on the number of spinal levels involved, with 1-level ACDF (6.9%, n = 202) having a lower rate of alerts than 2-level (10.0%, n = 272), 3-level (15.2%, n = 104), and 4-level (23.4%, n = 15). Likewise, 2-level ACDF had a lower rate of alerts than 3-level and 4-level ACDF. A significant difference by operative level was noted in EMG use for single-level ACDF, with C2-C3 having a lower rate of use than other levels. Conclusions: This retrospective review of anterior cervical spinal surgeries performed with at least 1 IONM modality found that SSEP had the highest rate of use across procedure types, whereas MEP had the highest rate of nonuse. Future studies should focus on determining the most useful IONM modalities by procedure type and further explore the benefit of multimodal IONM in spine surgery.
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Affiliation(s)
| | - Avani Vaishnav
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Pratyush Shahi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Junho Song
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jung Mok
- Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - R. Kiran Alluri
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Darren Chen
- Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Catherine Himo Gang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sheeraz Qureshi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, NY, USA
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18
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Robertson SC, Ashley MR. Complications of Anterior Cervical Discectomy and Fusion. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 130:169-178. [PMID: 37548736 DOI: 10.1007/978-3-030-12887-6_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Anterior cervical discectomy and fusion (ACDF) is the most common surgery performed on the cervical spine, and the number of its cases has tripled over the last two decades. Although this intervention is typically safe and effective, it carries an inherent complication risk, which should not be underestimated. Improvements in surgical techniques and advances in interbody fusion devices and plating systems have certainly reduced the rate of postoperative morbidity, but despite such progress, surgeons need to beware consistently of the potential complications, inform the patient of their possibility, and have a management strategy as they develop. This review discusses postoperative morbidity encountered in recently reported large studies on ACDF and highlights the senior author's own single-surgeon experience with 2579 such procedures performed between 1998 and 2017. In his clinical series, which is the largest one reported to date, the overall complication rate was 7.0% (180 cases), and dysphagia (1.9% of cases), graft/hardware failures (1.3% of cases), and postoperative hematomas (0.9% of cases) were noted most frequently. Understanding of the risk and clinical impact of complications after ACDF is very important and every effort should be put on their possible avoidance and on appropriate management when they do occur.
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19
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Lantz JM, Roberts C, Formanek B, Michener LA, Hah RJ, Wang JC, Buser Z. Incidence of complications associated with cervical spine surgery and post-operative physical therapy and implications for timing of initiation of post-operative physical therapy: a retrospective database study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:382-388. [PMID: 36401668 DOI: 10.1007/s00586-022-07466-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/19/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE To describe the incidence of complications associated with cervical spine surgery and post-operative physical therapy (PT), and to identify if the timing of initiation of post-operative PT impacts the incidence rates. METHODS MOrtho PearlDiver database was queried using billing codes to identify patients who had undergone Anterior Cervical Discectomy and Fusion (ACDF), Posterior Cervical Fusion (PCF), or Cervical Foraminotomy and post-operative PT from 2010-2019. For each surgical procedure, patients were divided into three 12-week increments for post-operative PT (starting at post-operative weeks 2, 8, 12) and then matched based upon age, gender, and Charlson Comorbidity Index score. Each group was queried to determine complication rates and chi-square analysis with adjusted odds ratios, 95% confidence intervals, and p-values were used. RESULTS Following matching, 3,609 patients who underwent cervical spine surgery at one or more levels and had post-operative PT (ACDF:1784, PCF:1593, and cervical foraminotomy:232). The most frequent complications were new onset cervicalgia (2-14 weeks, 8-20 weeks, 12-24 weeks): ACDF (15.0%, 14.0%, 13.0%), PCF (18.8%, 18.0%, 19.9%), cervical foraminotomy (16.8%, 16.4%, 19.4%); revision: ADCF (7.9%, 8.2%, 7.4%), PCF (9.3%, 10.6%, 10.2%), cervical foraminotomy (11.6%, 10.8% and 13.4%); wound infection: ACDF (3.3%, 3.4%, 3.1%), PCF (8.3%, 8.0%,7.7%), cervical foraminotomy (5.2%, 6.5%, < 4.7%). None of the comparisons were statistically significant. CONCLUSION The most common post-operative complications included new onset cervicalgia, revision and wound infection. Complications rates were not impacted by the timing of initiation of PT whether at 2, 8, or 12 weeks post-operatively.
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Affiliation(s)
- Justin M Lantz
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, 1640 Marengo St, HRA 102, Los Angeles, CA, 90033, USA. .,USC Spine Physical Therapy Fellowship Program, University of Southern California, Los Angeles, CA, USA.
| | - Callie Roberts
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, 1640 Marengo St, HRA 102, Los Angeles, CA, 90033, USA
| | - Blake Formanek
- Department of Orthopaedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, CA, USA
| | - Lori A Michener
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, 1640 Marengo St, HRA 102, Los Angeles, CA, 90033, USA
| | - Raymond J Hah
- Department of Orthopaedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, CA, USA
| | - Zorica Buser
- Department of Orthopaedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, CA, USA
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20
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Suk KS, Jimenez KA, Jo JH, Kim HS, Lee HM, Moon SH, Lee BH. Anterior Plate-Screws and Lower Postoperative T1 Slope Affect Cervical Allospacer Failures in Multi-Level ACDF Surgery: Anterior Versus Posterior Fixation. Global Spine J 2023; 13:89-96. [PMID: 33648356 PMCID: PMC9837507 DOI: 10.1177/2192568221991515] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN Prospective observational study. OBJECTIVE In ACDF, graft failure and subsidence are common complications of surgery. Depending on the cervical fixation, different biomechanical characteristics are applied on the grafts. This aims to describe the incidence of cervical spacer failure in patients with cervical degenerative condition according to the cervical fixation method and sagittal balance. METHOD From November 2011 to December 2015, 262 patients who underwent cervical spine surgery were enrolled prospectively. Patients were divided into 3 groups based on fixation method: anterior plate/screw (APS), posterior lateral mass screw (LMS), pedicle screw (PPS) groups. Serial X-rays and CT scans were utilized to evaluate radiologic outcomes. RESULTS Mean patient ages were 56.1 years in the APS group, 61.5 years in the LMS group, and 57.6 years in the PPS group (P = 0.002). Allospacer failure was most common in the APS group, compared to the LMS and PPS groups (chi-square, P = 0.038). Longer fusion level was associated with greater allospacer failure (Baseline 2 level surgery; Odds ratio (OR) 3.4 in 3 level, 15.2 in 4 level, P = 0.036,0.013). Higher T1 slope was correlated with less allospacer failure (OR 0.875, P = 0.001). ORs of allospacer failure in the LMS and PPS groups were 0.04 and 0.02, respectively, (P = 0.01, 0.01), compared with the APS group. CONCLUSION This study was able to show that allospacer failure in multi-level ACDF surgery is more common with a longer fusion length, less postoperative T1 slope, and an anterior plate-screws technique. Pedicle screws provided the best biomechanical stability among the 3 constructs.
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Affiliation(s)
- Kyung-Soo Suk
- Department of Orthopedic Surgery, Yonsei
University College of Medicine, Seoul, Korea
| | - Kathryn Anne Jimenez
- Department of Orthopedic Surgery, Yonsei
University College of Medicine, Seoul, Korea
| | - Je Hyung Jo
- Department of Orthopedic Surgery, Yonsei
University College of Medicine, Seoul, Korea
| | - Hak-Sun Kim
- Department of Orthopedic Surgery, Yonsei
University College of Medicine, Seoul, Korea
| | - Hwan-Mo Lee
- Department of Orthopedic Surgery, Yonsei
University College of Medicine, Seoul, Korea
| | - Seong-Hwan Moon
- Department of Orthopedic Surgery, Yonsei
University College of Medicine, Seoul, Korea
| | - Byung Ho Lee
- Department of Orthopedic Surgery, Yonsei
University College of Medicine, Seoul, Korea,Byung Ho Lee, Department of Orthopedic
Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu,
Seoul, 120-752, Korea.
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21
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Passias PG, Ahmad W, Oh C, Imbo B, Naessig S, Pierce K, Lafage V, Lafage R, Hamilton DK, Protopsaltis TS, Klineberg EO, Gum J, Schoenfeld AJ, Line B, Hart RA, Burton DC, Bess S, Schwab FJ, Smith JS, Shaffrey CI, Ames CP. Development of Risk Stratification Predictive Models for Cervical Deformity Surgery. Neurosurgery 2022; 91:928-935. [PMID: 36250700 DOI: 10.1227/neu.0000000000002136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 06/29/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As corrective surgery for cervical deformity (CD) increases, so does the rate of complications and reoperations. To minimize suboptimal postoperative outcomes, it is important to develop a tool that allows for proper preoperative risk stratification. OBJECTIVE To develop a prognostic utility for identification of risk factors that lead to the development of major complications and unplanned reoperations. METHODS CD patients age 18 years or older were stratified into 2 groups based on the postoperative occurrence of a revision and/or major complication. Multivariable logistic regressions identified characteristics that were associated with revision or major complication. Decision tree analysis established cutoffs for predictive variables. Models predicting both outcomes were quantified using area under the curve (AUC) and receiver operating curve characteristics. RESULTS A total of 109 patients with CD were included in this study. By 1 year postoperatively, 26 patients experienced a major complication and 17 patients underwent a revision. Predictive modeling incorporating preoperative and surgical factors identified development of a revision to include upper instrumented vertebrae > C5, lowermost instrumented vertebrae > T7, number of unfused lordotic cervical vertebrae > 1, baseline T1 slope > 25.3°, and number of vertebral levels in maximal kyphosis > 12 (AUC: 0.82). For developing a major complication, a model included a current smoking history, osteoporosis, upper instrumented vertebrae inclination angle < 0° or > 40°, anterior diskectomies > 3, and a posterior Smith Peterson osteotomy (AUC: 0.81). CONCLUSION Revisions were predicted using a predominance of radiographic parameters while the occurrence of major complications relied on baseline bone health, radiographic, and surgical characteristics.
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Affiliation(s)
- Peter G Passias
- Department of Orthopedic and Neurosurgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, New York, USA
| | - Waleed Ahmad
- Department of Orthopedic and Neurosurgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, New York, USA
| | - Cheongeun Oh
- Department of Orthopedic and Neurosurgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, New York, USA
| | - Bailey Imbo
- Department of Orthopedic and Neurosurgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, New York, USA
| | - Sara Naessig
- Department of Orthopedic and Neurosurgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, New York, USA
| | - Katherine Pierce
- Department of Orthopedic and Neurosurgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, New York, USA
| | - Virginie Lafage
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Renaud Lafage
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - D Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Themistocles S Protopsaltis
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, NYU Langone Health, New York, New York, USA
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Davis, California, USA
| | - Jeffrey Gum
- Department of Orthopedic Surgery, Norton Leatherman Spine Center, Louisville, Kentucky, USA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Breton Line
- Denver International Spine Center, Denver, Colorado, USA
| | - Robert A Hart
- Swedish Neuroscience Institute, Seattle, Washington, USA
| | - Douglas C Burton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Shay Bess
- Swedish Neuroscience Institute, Seattle, Washington, USA
| | - Frank J Schwab
- Department of Orthopedics, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | | | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
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22
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Seth NH, Joshi MV, Phansopkar P. C5 Nerve Root Palsy: An Uncommon Postoperative Complication and Its Management. Cureus 2022; 14:e28988. [PMID: 36249642 PMCID: PMC9548415 DOI: 10.7759/cureus.28988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/09/2022] [Indexed: 11/05/2022] Open
Abstract
The standard treatment for multiple levels of cervical prolapsed intervertebral disk (PIVD) is anterior cervical decompression and fusion. Although it is associated with positive outcomes, it is also fraught with complications. In this report, we present an unusual postoperative case of a 58-year-old male who underwent anterior decompression and cervical fusion at two levels - C4-C5 and C5-C6 - for traumatic PIVD and developed a postoperative complication of unilateral C5 motor palsy, making it difficult for the patient to elevate the shoulder. This postoperative complication had no known cause, but it could be iatrogenic or due to structural variation. There is sparse research on possible ways to avoid this complication. Physiotherapy management is critical in improving the patient's functional recovery. The neck and upper extremity functional measure scale and Neurogenic Claudication Outcome Score (NCOS) scale were used for measuring outcomes. The patient also had a two-year history of tingling and numbness in both lower extremities, which was treated conservatively. The difficulties that physiotherapists encounter in managing this uncommon postoperative complication in addition to the lumbar PIVD make it unique. The key to a better prognosis is early detection and management.
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23
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Oitment C, Thornley P, Koziarz F, Jentzsch T, Bhanot K. A Review of Strategies to Improve Biomechanical Fixation in the Cervical Spine. Global Spine J 2022; 12:1596-1610. [PMID: 35020520 PMCID: PMC9393983 DOI: 10.1177/21925682211063855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Review the surgical techniques and construct options aimed at improving the biomechanical strength of cervical constructs. METHODS A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of the MEDLINE, Embase, and Cochrane Library databases was performed to identify all studies examining biomechanical strategies utilized in the osteoporotic cervical spine. Screening was performed in duplicate for all stages of the review process. RESULTS An initial search returned 3887 articles. After deletion of duplications and review of abstracts and full text, 39 articles met inclusion criteria. Overall, the surgical techniques reviewed aimed at obtaining rigid fixation in the setting of poor bone quality, or dispersing the forces at the bone-implant interface. We identified 6 key techniques to improve biomechanical fixation. These include bicortical fixation, appropriate screw selection (size and trajectory), PMMA augmentation, load sharing techniques, consideration of ancillary fixation around the occipitocervical junction, and supplementing the construct with post-operative collar or halo. CONCLUSION The summation of the literature highlights a framework of modalities available to surgeons to improve biomechanical fixation in the cervical spine. While these may improve construct strength in the setting of osteoporosis, there is a paucity of evidence available to make recommendations in this patient population.
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Affiliation(s)
- Colby Oitment
- Division of Orthopedic Surgery, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada,Dr Colby Oitment, MD, McMaster University, Department of Orthopedic Surgery, Hamilton General HospitalAffiliation, McMaster University, 1200 Main St West, Hamilton, ON L8S 4L8, Canada.
| | - Patrick Thornley
- Division of Orthopedic Surgery, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada
| | - Frank Koziarz
- Department of Graduate Studies, Health Research Methodology (HRM), and Epidemiology, McMaster University, Hamilton, ON, Canada
| | - Thorsten Jentzsch
- Division of Orthopaedic Surgery, St Michael’s Hospital, Toronto, ON, Canada,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Kunal Bhanot
- Division of Orthopaedic Surgery, St Michael’s Hospital, Toronto, ON, Canada,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
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24
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Kim HJ, Yao YC, Shaffrey CI, Smith JS, Kelly MP, Gupta M, Albert TJ, Protopsaltis TS, Mundis GM, Passias P, Klineberg E, Bess S, Lafage V, Ames CP. Neurological Complications and Recovery Rates of Patients With Adult Cervical Deformity Surgeries. Global Spine J 2022; 12:1091-1097. [PMID: 33222533 PMCID: PMC9210226 DOI: 10.1177/2192568220975735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE This study aims to report the incidence, risk factors, and recovery rate of neurological complications (NC) in patients with adult cervical deformity (ACD) who underwent corrective surgery. METHODS ACD patients undergoing surgery from 2013 to 2015 were enrolled in a prospective, multicenter database. Patients were separated into 2 groups according to the presence of neurological complications (NC vs no-NC groups). The types, timing, recovery patterns, and interventions for NC were recorded. Patients' demographics, surgical details, radiographic parameters, and health-related quality of life (HRQOL) scores were compared. RESULTS 106 patients were prospectively included. Average age was 60.8 years with a mean of 18.2 months follow-up. The overall incidence of NC was 18.9%; of these, 68.1% were major complications. Nerve root motor deficit was the most common complication, followed by radiculopathy, sensory deficit, and spinal cord injury. The proportion of complications occurring within 30 days of surgery was 54.5%. The recovery rate from neurological complication was high (90.9%), with most of the recoveries occurring within 6 months and continuing even after 12 months. Only 2 patients (1.9%) had continuous neurological complication. No demographic or preoperative radiographic risk factors could be identified, and anterior corpectomy and posterior foraminotomy were found to be performed less in the NC group. The final HRQOL outcome was not significantly different between the 2 groups. CONCLUSIONS Our data is valuable to surgeons and patients to better understand the neurological complications before performing or undergoing complex cervical deformity surgery.
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Affiliation(s)
- Han Jo Kim
- Spine Service, Hospital for Special Surgery, New York, NY, USA,Han Jo Kim, Spine Service, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
| | - Yu-Cheng Yao
- Spine Service, Hospital for Special Surgery, New York, NY, USA,Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Beitou District, Taipei, Taiwan
| | | | - Justin S. Smith
- Department of Neurosurgery, University of Virginia Health Sciences Center, Charlottesville, VA, USA
| | - Michael P. Kelly
- Department of Orthopaedic Surgery, Washington University in St. Louis, MO, USA
| | - Munish Gupta
- Department of Orthopaedic Surgery, Washington University in St. Louis, MO, USA
| | - Todd J. Albert
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| | | | | | - Peter Passias
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Shay Bess
- Paediatric and Adult Spine Surgery, Rocky Mountain Hospital for Children, Presbyterian St Luke’s Medical Center, Denver, CO, USA
| | - Virginie Lafage
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Christopher P. Ames
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
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25
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Tang AR, Steinle AM, Chanbour H, Emeka-Ibe G, Stephens BF, Zuckerman SL, Abtahi AM. Barbed Suture versus Interrupted Suture in Posterior Cervical Spine Surgery: Are They Equivalent? Spine Surg Relat Res 2022; 6:645-653. [PMID: 36561159 PMCID: PMC9747217 DOI: 10.22603/ssrr.2022-0076] [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: 03/30/2022] [Accepted: 05/06/2022] [Indexed: 12/25/2022] Open
Abstract
Introduction Posterior cervical spine approaches have been associated with increased rates of wound complications compared to anterior approaches. While barbed suture wound closure for lumbar spine surgery has been shown to be safe and efficacious, there is no literature regarding its use in posterior cervical spine surgery. In a cohort of patients undergoing elective posterior cervical spine surgery, we sought to compare postoperative complication rates between barbed and traditional interrupted suture closure. Methods A retrospective review of demographics, past medical history, and operative and postoperative variables collected from a prospective registry between July 1, 2016, and June 30, 2020 was undertaken. All patients 18 years old and above undergoing elective posterior cervical fusion were included. The primary outcome of interest was wound complications, including surgical site infection (SSI), dehiscence, or hematoma. In addition, numerical rating scale (NRS) neck pain (NP), NRS arm pain (AP), Neck Disability Index (NDI), and operative time were collected. A variety of statistical tests were used to compare the two suture groups. Results Of 117 patients undergoing posterior cervical fusion, 89 (76%) were closed with interrupted suture and 28 (24%) with barbed suture. The interrupted cohort were more likely to have >1 comorbidity (p<0.001), diabetes mellitus (p=0.013), and coronary artery disease (p=0.002). No difference in postoperative wound complications between interrupted/barbed sutures was observed after univariate (OR 1.07, 95% CI: 0.27-4.25, p=0.927) and multivariable logistic regression analysis (OR 0.77, 95% CI: 0.15-4.00, p=0.756). Univariate logistic regression revealed no differences in achieving minimal clinically important difference (MCID) NRS-NP (OR 0.73, 95% CI: 0.28-1.88, p=0.508) or NRS-AP (OR 0.68, 95% CI: 0.25-1.90, p=0.464) at 3 months between suture groups. The interrupted suture group was less likely to achieve MCID NDI at 3 months (OR 0.29, 95% CI: 0.11-0.80, p=0.016). Conclusions Barbed suture closure in posterior cervical spine surgery does not lead to higher rates of postoperative wound complications/SSI compared to traditional interrupted fascial closure.
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Affiliation(s)
- Alan R. Tang
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, United States
| | - Anthony M. Steinle
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, United States
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, United States
| | - Godwin Emeka-Ibe
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, United States
| | - Byron F. Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, United States,Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, United States,Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, United States
| | - Scott L. Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, United States,Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, United States
| | - Amir M. Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, United States,Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, United States,Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, United States
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26
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Chiapparelli E, Bowen E, Okano I, Salzmann SN, Reisener MJ, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Spinal Cord Medial Safe Zone for C2 Pedicle Instrumentation: An MRI Measurement Analysis. Spine (Phila Pa 1976) 2022; 47:E101-E106. [PMID: 34091562 DOI: 10.1097/brs.0000000000004137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVE The aim of this study was to investigate the spinal cord safety margins for C2 instrumentation. SUMMARY OF BACKGROUND DATA Intraoperative spinal cord injury during C2 spine surgery is a rare, but potentially life-threatening complication. Preoperative planning for C2 instrumentation mainly focuses on C2 pedicle bony dimensions on CT and the vertebral artery location and few studies have evaluated C2 spinal cord safety margins. METHODS We measured two distances in C2 bilaterally: C2 pedicle to dura distance (P-D), defined as a transverse line that measured the shortest distance between the medial wall of the C2 pedicle and the dural sac, and C2 pedicle to spinal cord (P-SC), defined as a transverse line that measured the shortest distance between the medial wall of the C2 pedicle and spinal cord. We defined the distances >4 mm as safe for instrumentation. RESULT A total of 146 patients (mean age 71.2, 50.7% female) were included. The average distances were 5.5 mm for C2 left PD, 5.9 mm for C2 right P-D, 10.1 mm for C2 left P-SC, and 10.6 mm for C2 right P-SC. Twenty-eight (21.4%) patients had C2 P-D distances <4 mm and of those two (7%) patients had distances <2 mm. There were more female patients with C2 P-D distances under 4 mm compared to males. No patient had C2 P-SC distances <4 mm. CONCLUSION We demonstrated that around 20% of patients had C2 P-D distance <4 mm, but no patient had C2 P-SC distance <4 mm. Since a lateral misplacement can lead to a potentially fatal vertebral artery injury, medial screw trajectory is recommended for C2 pedicle instrumentation with consideration of these safety margins.Level of Evidence: 3.
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27
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Nunna RS, Khalid S, Chiu RG, Parola R, Fessler RG, Adogwa O, Mehta AI. Anterior vs Posterior Approach in Multilevel Cervical Spondylotic Myelopathy: A Nationwide Propensity-Matched Analysis of Complications, Outcomes, and Narcotic Use. Int J Spine Surg 2022; 16:88-94. [PMID: 35314510 PMCID: PMC9519084 DOI: 10.14444/8198] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND There is unclear evidence regarding the optimal surgical approach for multilevel cervical spondylotic myelopathy (CSM). The objective of this study was to compare complications, outcomes, and narcotic use in anterior discectomy and fusion (ACDF) vs posterior decompression and fusion (PCDF) in CSM patients. STUDY DESIGN Registry-based retrospective cohort analysis. METHODS Patients undergoing 3-level ACDF or PCDF for CSM between 2007 and 2017 were identified from the Humana Claims Database using relevant procedure codes. Propensity score-matched groups were compared in regards to complications, outcomes, and narcotic use. RESULTS Propensity score matching generated equal cohorts of 6124 patients. The posterior fusion group had a higher rate of urinary tract infection (OR 2.47, P < 0.0001), deep vein thrombosis (OR 1.90, P < 0.0001), and pulmonary embolism (OR 1.75, P < 0.0001). In regards to 30-day outcomes, the posterior approach demonstrated higher rates of stroke (OR 1.68, P < 0.0001), wound dehiscence (OR 5.59, P < 0.0001), Surgical site infection (SSI) (OR 4.76, P < 0.0001), wound revision surgery (OR 3.02, P < 0.0001), and all-cause readmission (OR 2.01, P < 0.0001). One-year outcomes revealed higher rates of pseudarthrosis (4.7% vs 2.0%, OR 2.43, P < 0.0001) and revision or extension surgery (OR 2.33, P < 0.0001) in the posterior fusion cohort. These patients also demonstrated significantly higher mean morphine milligram equivalent used at 30 days (OR 1.19, P < 0.0001), as well as 60 (OR 1.20, P < 0.0001), 90 (OR 1.21, P < 0.0001), and 120 (OR 1.21, P < 0.0001) days. CONCLUSIONS This nationwide propensity-matched analysis of multilevel CSM patients found the posterior approach to be associated with increased rates of inpatient complications, wound complications, 30-day readmission, 1-year pseudarthrosis, and 1-year revision or extension surgery. These patients also demonstrated higher levels of narcotic use up to 120 days after surgery. CLINICAL RELEVANCE The posterior approach for treatment of CSM may be associated with increased rates of short- and long-term complications in addition to increased narcotic consumption in comparison to the anterior approach.
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Affiliation(s)
- Ravi S Nunna
- Department of Neurosurgery, Swedish Medical Center, Seattle, WA, USA
| | - Syed Khalid
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Ryan G Chiu
- Department of Neurosurgery, University of Illinois-Chicago Medical Center, Chicago, IL, USA
| | - Rown Parola
- Department of Neurosurgery, University of Illinois-Chicago Medical Center, Chicago, IL, USA
| | - Richard G Fessler
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois-Chicago Medical Center, Chicago, IL, USA
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Gatam AR, Gatam L, Phedy ., Mahadhipta H, Luthfi O, Ajiantoro ., Husin S, Aprilya D. Full Endoscopic Posterior Cervical Foraminotomy in Management of Foraminal Disc Herniation and Foraminal Stenosis. Orthop Res Rev 2022; 14:1-7. [PMID: 35125894 PMCID: PMC8812322 DOI: 10.2147/orr.s349701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/30/2021] [Indexed: 11/23/2022] Open
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29
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Ghatge S, Shah R, Surya N, sankhala S, Unadkat C, Khan G, Modi D. Ozone disc nucleolysis in cervical intervertebral disc herniation: A nonrandomized prospective analysis in 246 patients. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:114-120. [PMID: 35837424 PMCID: PMC9274671 DOI: 10.4103/jcvjs.jcvjs_46_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/08/2022] [Indexed: 11/04/2022] Open
Abstract
Background: Inherent complications associated with surgery and limited success of percutaneous minimally invasive procedures make researches wanting for an ideal treatment for cervical disc herniation. Objective: We prospectively study the role of ozone disc nucleolysis in cervical intervertebral disc herniation. Patients and Methods: From January 2008 to December 2020, we prospectively study 246 consecutive patients of cervical disc herniation treated by a single session of intradiscal injection of ozone–oxygen mixture (ozone disc nucleolysis). There were 55% of females and 45% of males. Age ranged from 28 to 68 years with a mean of 47. The outcome was measured on visual analog scale (VAS) scale and neck disability index (NDI) along with Mcnab method. Results: The mean baseline VAS score was 7.87 which became 3.09 at 1 month, 1.42 at 3 months, 1.40 at 6 months, and 1.35 at 1 year. The mean NDI was 36.27 at baseline which improved to 9.24 at 1 month, 6.25 at 3 months, 6.20 at 6 months, and 6.22 at 1 year. This was found to be significant with P < 0.05. Modified McNab criterion showed excellent recovery in 138 (56.10%), good recovery in 50 (20.32%), and fair recovery in 22 (8.94%), resulting in a successful rate of 85.36%. Mediocre recovery was seen in the remaining 36 patients amounting to a 14.64% failure rate. Conclusion: This study showed that ozone disc nucleolysis significantly reduces the pain related to cervical disc herniation along with a significant reduction in disability.
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DEMİREL C, TÜRKÖZ D, YİLMAZ T. Experimental Comparison of Autograft and DBM Flex (Grafton) for Spinal Lumbar Fusion in Rabbits. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2021. [DOI: 10.25000/acem.963125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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31
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An unusual acute onset hard and small volume epidural blood clotting after anterior cervical discectomy with tetraparetic neurological findings. MARMARA MEDICAL JOURNAL 2021. [DOI: 10.5472/marumj.1013491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ku J, Ku J, Chang HK, Wu JC. Cervical disc arthroplasty at C2–3: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21320. [PMID: 36131581 PMCID: PMC9563647 DOI: 10.3171/case21320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 06/09/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Since the beginning of the 21st century, cervical disc arthroplasty (CDA) has been accepted as an alternative to anterior cervical discectomy and fusion for surgical management of disc problems. The published clinical trials of CDA have included patients with radiculopathy or myelopathy caused by one- or two-level disc herniation at C3–7. However, it remains uncertain whether CDA is a viable option for C2–3 disc herniation.
OBSERVATIONS
In this report, a 52-year-old man presented with hand numbness, arm pain, and myelopathic symptoms that were refractory to medical treatment for more than 6 months. The magnetic resonance images demonstrated herniated discs at C2–3, C3–4, and C4–5, causing stenosis. There was no ossification of posterior longitudinal ligament and the spine was mobile, so he received anterior discectomies with artificial disc replacement at each of the C2–3, C3–4, and C4–5 levels. The surgery went smoothly, and his neurological symptoms were promptly relieved. The postoperative radiographs at 24 months demonstrated a preserved range of motion at each level.
LESSONS
To date, this was the first report of CDA performed at C2–3, which also involved three consecutive levels of disc replacement. The report suggested that both C2–3 and three-consecutive-level CDA may be a viable option for cervical disc disease.
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Affiliation(s)
- Jason Ku
- Department of Life Sciences, University of California, Los Angeles, California
| | - Johnson Ku
- Department of Life Sciences, University of California, Los Angeles, California
| | - Hsuan-Kan Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine
- Department of Biomedical Imaging and Radiological Sciences, and
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Baker JD, Baig Y, Siyaji ZK, Hornung AL, Zavras AG, Mallow GM, Zbeidi S, Shepard NA, Sayari AJ. Assessing the Quality and Credibility of Publicly Available Videos on Cervical Fusion: Is YouTube a Reliable Educational Tool? Int J Spine Surg 2021; 15:669-675. [PMID: 34266929 DOI: 10.14444/8088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND YouTube has become a popular source for patient education, though there are concerns regarding the quality and reliability of videos related to orthopaedic and neurosurgical procedures. This study aims to evaluate the credibility and educational content of videos on YouTube related to cervical fusion. Secondarily, the study aims to identify factors predictive of higher or lower quality videos. METHODS A YouTube query using the search terms "cervical fusion" was performed, and the first 50 videos were included for analysis. Reliability was assessed using the Journal of the American Medical Association (JAMA) criteria. Educational quality was assessed using the Global Quality Score (GQS) and the Cervical Fusion Content Score (CFCS). Videos were stratified by content and source, and differences in JAMA, GQS, and CFCS scores were assessed. Multivariable linear regression was used to identify predictors of higher or lower JAMA, GQS, and CFCS scores. Statistical significance was established at P < 0.05. RESULTS Total number of views was 6 221 816 with a mean of 124 436.32 ± 412 883.32 views per video. Physicians, academic, and medical sources had significantly higher mean JAMA scores (P = 0.042). Exercise training and nonsurgical management videos had significantly higher mean CFCS scores (P = 0.018). Videos by physicians (β = 0.616; P = 0.025) were independently associated with higher JAMA scores. Advertisements were significant predictors of worse CFCS (β = -3.978; P = 0.030), and videos by commercial sources predicted significantly lower JAMA scores (β = -1.326; P = 0.006). CONCLUSIONS While videos related to cervical fusion amassed a large viewership, they were poor in both quality and reliability. Videos by physicians were associated with higher reliability scores relative to other sources, whereas commercial sources and advertisements had significantly lower reliability and educational content scores. Currently, YouTube seems to be an unreliable source of information on cervical fusion for patients. LEVEL OF EVIDENCE 4. CLINICAL RELEVANCE The results of this study aid surgeons in counseling patients interested in cervical fusion, and suggest that publicly available videos regarding cervical fusion may not be an adequate tool for patient education at this time.
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Affiliation(s)
- James D Baker
- Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
| | - Younus Baig
- Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
| | - Zakariah K Siyaji
- Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
| | - Alexander L Hornung
- Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
| | - Athan G Zavras
- Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
| | - G Michael Mallow
- Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
| | - Shadi Zbeidi
- Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
| | - Nicholas A Shepard
- Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
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Kim HJ, Yao YC, Bannwarth M, Smith JS, Klineberg EO, Mundis GM, Protopsaltis TS, Charles-Elysee J, Bess S, Shaffrey CI, Passias PG, Schwab FJ, Ames CP, Lafage V. Cervicothoracic Versus Proximal Thoracic Lower Instrumented Vertebra Have Comparable Radiographic and Clinical Outcomes in Adult Cervical Deformity. Global Spine J 2021; 13:1056-1063. [PMID: 34013765 DOI: 10.1177/21925682211017478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Comparative cohort study. OBJECTIVE Factors that influence the lower instrumented vertebra (LIV) selection in adult cervical deformity (ACD) are less reported, and outcomes in the cervicothoracic junction (CTJ) and proximal thoracic (PT) spine are unclear. METHODS A prospective ACD database was analyzed using the following inclusion criteria: LIV between C7 and T5, upper instrumented vertebra at C2, and at least a 1-year follow-up. Patients were divided into CTJ (LIV C7-T2) and PT groups (LIV T3-T5) based on LIV levels. Demographics, operative details, radiographic parameters, and the health-related quality of life (HRQOL) scores were compared. RESULTS Forty-six patients were included (mean age, 62 years), with 22 and 24 patients in the CTJ and PT groups, respectively. Demographics and surgical parameters were comparable between the groups. The PT group had a significantly higher preoperative C2-C7 sagittal vertical axis (cSVA) (46.9 mm vs 32.6 mm, P = 0.002) and T1 slope minus cervical lordosis (45.9° vs 36.0°, P = 0.042) than the CTJ group and was more likely treated with pedicle-subtraction osteotomy (33.3% vs 0%, P = 0.004). The PT group had a larger correction of cSVA (-7.7 vs 0.7 mm, P = 0.037) and reciprocal change of increased T4-T12 kyphosis (8.6° vs 0.0°, P = 0.001). Complications and reoperations were comparable. The HRQOL scores were not different preoperatively and at 1-year follow-up. CONCLUSIONS The selection of PT LIV in cervical deformities was more common in patients with larger baseline deformities, who were more likely to undergo pedicle-subtraction osteotomy. Despite this, the complications and HRQOL outcomes were comparable at 1-year follow-up.
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Affiliation(s)
- Han Jo Kim
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Yu-Cheng Yao
- Spine Service, Hospital for Special Surgery, New York, NY, USA.,Department of Orthopaedic, 46615Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mathieu Bannwarth
- Spine Service, Hospital for Special Surgery, New York, NY, USA.,Neurosurgery, University Hospital Reims, Reims, France
| | - Justin S Smith
- Department of Neurosurgery, 2358University of Virginia Health Sciences Center, Charlottesville, VA, USA
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA
| | | | | | | | - Shay Bess
- Department of Orthopaedic Surgery, Denver International Spine Center, Denver, CO, USA
| | | | - Peter G Passias
- Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY, USA
| | - Frank J Schwab
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Virginie Lafage
- Spine Service, Hospital for Special Surgery, New York, NY, USA
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Pereira BDA, Heller JE, Lehrman JN, Sawa AGU, Kelly BP. Biomechanics of Circumferential Cervical Fixation Using Posterior Facet Cages: A Cadaveric Study. Neurospine 2021; 18:188-196. [PMID: 33819945 PMCID: PMC8021845 DOI: 10.14245/ns.2040552.276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/28/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Anterior cervical discectomy and fusion (ACDF) is a common procedure for the treatment of cervical disease. Circumferential procedures are options for multilevel pathology. Potential complications of multilevel anterior procedures are dysphagia and pseudarthrosis, whereas potential complications of posterior surgery include development of cervical kyphosis and postoperative chronic neck pain. The addition of posterior cervical cages (PCCs) to multilevel ACDF is a minimally invasive option to perform circumferential fusion. This study evaluated the biomechanical performance of 3-level circumferential fusion with PCCs as supplemental fixation to anteriorly placed allografts, with and without anterior plate fixation. METHODS Nondestructive flexibility tests (1.5 Nm) performed on 6 cervical C2-7 cadaveric specimens intact and after discectomy (C3-6) in 3 instrumented conditions: allograft with anterior plate (G+P), PCC with allograft and plate (PCC+G+P), and PCC with allograft alone (PCC+G). Range of motion (ROM) data were analyzed using 1-way repeated-measures analysis of variance. RESULTS All instrumented conditions resulted in significantly reduced ROM at the 3 instrumented levels (C3-6) compared to intact spinal segments in flexion, extension, lateral bending, and axial rotation (p < 0.001). No significant difference in ROM was found between G+P and PCC+G+P conditions or between G+P and PCC+G conditions, indicating similar stability between these conditions in all directions of motion. CONCLUSION All instrumented conditions resulted in considerable reduction in ROM. The added reduction in ROM through the addition of PCCs did not reach statistical significance. Circumferential fusion with anterior allograft, without plate and with PCCs, has comparable stability to ACDF with allograft and plate.
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Affiliation(s)
- Bernardo de Andrada Pereira
- Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | | | - Jennifer N Lehrman
- Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Anna G U Sawa
- Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Brian P Kelly
- Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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36
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Byvaltsev VA, Kalinin AA, Goloborodko VY, Shepelev VV, Pestryakov YY, Konovalov NA. [Effectiveness of simultaneous and staged minimally invasive dorsal decompression-stabilization procedures in patients with lumbar spine degenerative diseases]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2021; 85:36-46. [PMID: 33560619 DOI: 10.17116/neiro20218501136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Minimally invasive procedures reduce the trauma of spine surgery. However, they are associated with high complexity of manipulations, long learning curve, need for expensive equipment for intraoperative navigation and significant irradiation. Various options for surgical approaches are being developed to reduce irradiation of medical staff and patients, surgery time and the number of drugs administered for general anesthesia. Simultaneous surgical interventions (SiSI) is one of these options. OBJECTIVE To compare the effectiveness of simultaneous and staged minimally invasive dorsal decompression-stabilization procedures in patients with lumbar spine degenerative diseases. MATERIAL AND METHODS A prospective study included 67 patients (41 men and 26 women) aged 48 (34; 56) years who underwent a single-level minimally invasive spinal root decompression and transforaminal interbody fusion via Wiltse posterior-lateral approach. Two study groups were distinguished: group I (simultaneous surgical interventions, SiSI) (n=29), in which guide spokes and transpedicular screws were installed simultaneously by two surgeons within one x-ray session from two sides; group II (staged surgical interventions, StSI) (n=38), in which staged transpedicular stabilization was performed (decompression side followed by contralateral side). Mean follow-up was 14 months in group I and 20 months in group II. We considered intraoperative fluoroscopy and irradiation dose, duration of surgery and anesthesia with calculation of doses of opioid drugs, blood loss, time of activation, hospital-stay and perioperative morbidity. Clinical outcomes were studied in long-term postoperative period. RESULTS Simultaneous approach ensured less time of intraoperative fluoroscopy (p=0.029) and irradiation dose (p=0.035), duration of surgery (p=0.01) and anesthesia (p=0.02), amount of opioid drugs during anesthesia (p=0.017). Blood loss, duration of activation and hospitals-stay were similar in both groups (p=0.35, p=0.12 and p=0.57, respectively). There was comparable improvement in VAS score of pain in the lumbar spine and lower extremities in both groups (p=0.63 and p=0.31, respectively). According to SF-36 questionnaire, there was no between-group difference in physical and psychological components (p=0.44 and p=0.72, respectively). There was significantly greater number of adverse effects of anesthesia in the StSI group (26.2% vs. 6.8%, p=0.003). At the same time, the number of surgical postoperative complications was similar in both groups (3.4% vs. 5.3%, p=0.62). CONCLUSION Simultaneous minimally invasive dorsal decompression-stabilization procedures have some significant advantages over staged approach regarding intraoperative parameters and adverse effects of anesthesia in patients with lumbar spine degenerative diseases. Nevertheless, there were similar clinical data and small incidence of surgical perioperative complications.
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Affiliation(s)
- V A Byvaltsev
- Irkutsk State Medical University, Irkutsk, Russia.,Private Healthcare Institution «Clinical Hospital» Russian Railways-Medicine, Irkutsk, Russia.,Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - A A Kalinin
- Irkutsk State Medical University, Irkutsk, Russia.,Private Healthcare Institution «Clinical Hospital» Russian Railways-Medicine, Irkutsk, Russia
| | - V Yu Goloborodko
- Private Healthcare Institution «Clinical Hospital» Russian Railways-Medicine, Irkutsk, Russia
| | - V V Shepelev
- Irkutsk State Medical University, Irkutsk, Russia
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Yan C, Jia HC, Tan HY, Yu XW, Li M, Zhou XY, Yang MY, Song DW, Zhao QH, Li GZ, Tang SH, Yu BS, Li LT, Sun JC, Shi JG. How much space of the spinal canal should be restored by hoisting the vertebrae-OPLL complex for sufficient decompression in anterior controllable antedisplacement and fusion? A multicenter clinical radiological study. Spine J 2021; 21:273-283. [PMID: 32966909 DOI: 10.1016/j.spinee.2020.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/31/2020] [Accepted: 09/16/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Anterior controllable antedisplacement and fusion (ACAF) is a novel surgical technique for the treatment of ossification of the posterior longitudinal ligament (OPLL). Its prognostic factors for decompression have not been well studied. Additionally, no detailed radiological standard has been set for hoisting the vertebrae-OPLL complex (VOC) in ACAF. PURPOSE To identify the possible prognostic factors for decompression outcomes after ACAF for cervical OPLL, to determine the critical value of radiological parameters for predicting good outcomes, and to establish a radiological standard for hoisting the VOC in ACAF. STUDY DESIGN This was a retrospective multicenter study. PATIENT SAMPLE A total of 121 consecutive patients with OPLL who underwent ACAF at a point between January 2017 and June 2018 at any one of seven facilities and were monitored for at least 1 year afterward were enrolled in a multicenter study. OUTCOME MEASURES Japanese Orthopedic Association (JOA) scores, recovery rate (RR) of neurologic function, and surgical complications were used to determine the effectiveness of ACAF. METHODS Patients were divided into two groups according to their RR for neurologic function. Patients with an RR of ≥50% and an RR of <50% were designated as having good and poor decompression outcomes, respectively. The relationship between various possible prognostic factors and decompression outcomes was assessed by univariate and multivariate analysis. The receiver operating characteristic curve was used to determine the optimal cutoff value of the radiological parameters for prediction of good decompression outcomes. Next, the patients were redivided into three groups according to the cutoff value of the selected radiological parameter (postoperative anteroposterior canal diameter [APD] ratio). Patients with postoperative APD ratios of ≤80.7%, 80.7%-100%, and ≥100% were defined as members of the incomplete, optimal, and excessive antedisplacement groups, respectively. Differences in decompression outcomes among the three groups were compared to verify the reliability of the postoperative APD ratio and assess the necessity of excessive antedisplacement. RESULTS Multivariate logistic regression analysis showed that patients' age at surgery (odds ratio [OR]=1.18; 95% confidence interval [CI]=1.08-1.29; p<.01) and postoperative APD ratio (OR=0.83; 95% CI=0.77-0.90; p<.01) were independently associated with decompression outcomes. The optimal cutoff point of the postoperative APD ratio was calculated at 80.7%, with 86.2% sensitivity and 73.5% specificity. There were no significant differences in the postoperative JOA scores and RRs between the excessive antedisplacement group and optimal antedisplacement group (p>.05). However, a lower incidence of cerebrospinal fluid leakage and screw slippage was observed in the optimal antedisplacement group (p<.05). CONCLUSIONS Patients' age at surgery and their postoperative APD ratio are the two prognostic factors of decompression outcomes after ACAF. The postoperative APD ratio is also the most accurate radiological parameter for predicting good outcomes. Our findings suggest that it is essential for neurologic recovery to restore the spinal canal to more than 80.7% of its original size (postoperative APD ratio >80.7%), and restoration to less than its original size (postoperative APD ratio <100%) will help reduce the incidence of surgical complications. This may serve as a valuable reference for establishment of a radiological standard for hoisting the VOC in ACAF.
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Affiliation(s)
- Chen Yan
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, China, 200001
| | - Huai-Cheng Jia
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, China, 200001
| | - Hao-Yuan Tan
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, China, 200001
| | - Xue-Wei Yu
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, China, 200001
| | - Ming Li
- Department of Spine Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, China, 200433
| | - Xiao-Yi Zhou
- Department of Spine Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, China, 200433
| | - Ming-Yuan Yang
- Department of Spine Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, China, 200433
| | - Dian-Wen Song
- Department of Spine Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University, 85 Wujin Rd, Shanghai, China, 200080
| | - Qing-Hua Zhao
- Department of Spine Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University, 85 Wujin Rd, Shanghai, China, 200080
| | - Guo-Zheng Li
- Department of Orthopedics, Linzhou Hospital of Traditional Chinese Medicine, 244 Taihang Rd, Linzhou, China, 456550
| | - Sheng-Hui Tang
- Department of Orthopedics, Fifth Hospital of Southern Medical University, Southern Medical University, 566 Congcheng Ave, Guangzhou, China, 510900
| | - Bin-Sheng Yu
- Department of Spine Surgery, Shenzhen Hospital of Beijing University, 1120 Lianhua Rd, Shenzhen, China, 518036
| | - Lin-Tao Li
- Department of Spine Surgery, General Hospital of Nanjing Military Command, 305 East Zhongshan Rd, Nanjing, China, 210000
| | - Jing-Chuan Sun
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, China, 200001.
| | - Jian-Gang Shi
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, China, 200001
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Ghaith AK, Yolcu YU, Alvi MA, Bhandarkar AR, Sebastian AS, Freedman BA, Bydon M. Rate and Characteristics of Vertebral Artery Injury Following C1-C2 Posterior Cervical Fusion: A Systematic Review and Meta-Analysis. World Neurosurg 2021; 148:118-126. [PMID: 33516865 DOI: 10.1016/j.wneu.2020.12.165] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intraoperative vascular injuries in the cervical spine are rare, but carry significant morbidity and mortality when they do occur. There is a need to better characterize the risk of vertebral artery injury (VAI) after posterior C1-C2 fusion. The aim of this study was to investigate the rate of VAI in patients undergoing posterior C1-C2 cervical fusion. METHODS An electronic database search was performed to identify studies that reported rates of VAI following posterior cervical fusion at C1-C2 level. Patient-specific risk factors, surgical indication, surgical technique, and other data were collected for each study. Forest plots were created to outline the pooled ratios of VAI in the literature. RESULTS Eleven studies with 773 patients were identified. Mean age of patients was 48.47 years (range, 6-78 years), and most patients were female (61.7%, n = 399). Trauma was the most frequent indication for surgery (18.8%, n = 146), followed by inflammatory processes affecting the vertebrae (13.2%, n = 102). The rate of VAI per patient was 2% (95% confidence interval = 1%-4%) among 773 patients, while injury rate per screw was 1% (95% confidence interval = 0%-2%) among 2238 screws placed. CONCLUSIONS The rate of VAI after C1-C2 posterior cervical fusion was found to be 2% for each operated patient and 1% for each screw placed.
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Affiliation(s)
- Abdul Karim Ghaith
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Yagiz U Yolcu
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammed Ali Alvi
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Archis R Bhandarkar
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Arjun S Sebastian
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brett A Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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Mubark I, Abouelela A, Hassan M, Genena A, Ashwood N. Sub-Axial Cervical Facet Dislocation: A Review of Current Concepts. Cureus 2021; 13:e12581. [PMID: 33575145 PMCID: PMC7870112 DOI: 10.7759/cureus.12581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Cervical facet dislocation is a serious injury that carries risks of short- and long-term morbidity. The optimal management of these injuries remains controversial with the ongoing debate regarding indications and requirements for closed reduction, timing, type of surgical approach and method of fixation. This review gives an update on the relevant anatomy, classification systems for sub-axial cervical facet dislocation and an overview of the current concepts regarding their management, including surgical approaches and the choice of implants.
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Affiliation(s)
- Islam Mubark
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, GBR
| | - Amr Abouelela
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, GBR
| | - Mohammed Hassan
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, GBR
| | - Ahmed Genena
- Trauma and Orthopaedics, Faculty of Medicine, Helwan University, Helwan, EGY.,Trauma and Orthopaedics, James Paget University Hospitals NHS Foundation Trust, Norwich, GBR
| | - Neil Ashwood
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, GBR
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40
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The Cutting Edge: Esophageal Perforation Secondary to Spinal Hardware. ACG Case Rep J 2020; 7:e00500. [PMID: 33324717 PMCID: PMC7725246 DOI: 10.14309/crj.0000000000000500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/24/2020] [Indexed: 12/14/2022] Open
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41
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Kwok SSS, Cheung JPY. Surgical decision-making for ossification of the posterior longitudinal ligament versus other types of degenerative cervical myelopathy: anterior versus posterior approaches. BMC Musculoskelet Disord 2020; 21:823. [PMID: 33292175 PMCID: PMC7724709 DOI: 10.1186/s12891-020-03830-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/25/2020] [Indexed: 12/02/2022] Open
Abstract
Background The debate between anterior or posterior approach for pathologies such as cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) have drawn heated debate but are still inconclusive. Main body of the abstract A narrative review was performed specifically to study the differences pertaining to OPLL and other causes of degenerative cervical myelopathy (DCM). Current evidence suggests that anterior approach is preferred for K-line (−) OPLL, K-line (+) with canal occupying ratio > 60% and DCM with pre-existing cervical kyphosis. Posterior approach is preferred for K-line (+) OPLL with canal-occupying ratio < 50–60%, and multi-level CSM. No particular advantage for either approach was observed for DCM in a lordotic cervical spine. Anterior approach is generally associated with more complications and thus needs to be weighed carefully during decision-making. The evidence is not convincing for comparing single versus multi-level involvement, and the role of patients' co-morbidity status, pre-existing osteoporosis and co-existent spinal pathologies in influencing patient outcome and surgical options. This should be a platform for future research directives. Conclusion From this review, evidence is still inconclusive but there are some factors to consider, and DCM and OPLL should be considered separately for decision-making. Anterior approach is considered for pre-existing cervical kyphosis in DCM, for K-line (−) regardless of canal-occupying ratio, and K-line (+) and canal-occupying ratio > 60% for OPLL patients. Posterior approach is considered for patients with multi-level pathology for DCM, and K-line (+) and canal-occupying ratio < 50–60% for OPLL.
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Affiliation(s)
- Suzanna Sum Sum Kwok
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China.
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Anterior Decompression and Fusion Versus Laminoplasty for Cervical Myelopathy Caused by Soft Disk Herniation: A Long-term Prospective Multicenter Study. Clin Spine Surg 2020; 33:E478-E485. [PMID: 32282403 DOI: 10.1097/bsd.0000000000000986] [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 A prospective multicenter study. OBJECTIVE The purpose of this study was to determine whether laminoplasty (LP) is comparable for myelopathy caused by cervical disk herniation (CDH). SUMMARY OF BACKGROUND DATA Anterior decompression and fusion (ADF) has conventionally been used for myelopathy caused by CDH with stable outcomes. However, recurrence of myelopathy due to adjacent segment degeneration are its drawbacks. The efficacy of LP without discectomy has been sporadically reported, but no long-term prospective study has been conducted to verify it. MATERIALS AND METHODS Patients with cervical myelopathy caused by CDH were studied. The first 30 patients and the next 30 patients were treated with ADF and LP, respectively. The outcomes were compared between the 22 ADF patients and the 20 LP patients who had completed the follow-up examination scheduled 10 years after surgery. RESULTS There was no statistically significant difference in the postoperative severity or recovery rate of myelopathy between the 2 groups 10 years after surgery. One patient in the ADF group underwent LP for secondary myelopathy due to adjacent segment degeneration 2 years after the surgery. Reoperation was not required for patients in the LP group. Postoperative neck pain was significantly more severe in the LP group than in the ADF group. CONCLUSIONS ADF and LP for cervical myelopathy caused by CDH achieve similarly favorable outcomes. Recurrence of myelopathy caused by adjacent segment degeneration is a disadvantage of ADF while residual neck pain is a disadvantage of LP.
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Luna LP, Dua SG, Kocak M, Lovblad KO, Fontes R, Guryildirim M. Imaging Evaluation of the Spinal Hardware: What Residents and Fellows Need to Know. Curr Probl Diagn Radiol 2020; 50:675-686. [PMID: 33143951 DOI: 10.1067/j.cpradiol.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/25/2020] [Accepted: 09/15/2020] [Indexed: 11/22/2022]
Abstract
We provide a comprehensive review of the purpose and expected imaging findings of different types of spinal instrumentation. We also demonstrate the imaging evaluation for optimal positioning and assessment of hardware failure.
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Affiliation(s)
- Licia P Luna
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD
| | - Sumeet G Dua
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL
| | - Mehmet Kocak
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL
| | - Karl-Olof Lovblad
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL
| | - Ricardo Fontes
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL
| | - Melike Guryildirim
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD.
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Effect of posterior cervical expansive open-door laminoplasty on cervical sagittal balance. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2831-2837. [PMID: 32776264 DOI: 10.1007/s00586-020-06563-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Posterior cervical expansive open-door laminoplasty (LAMP) is a mature surgical procedure for the treatment of cervical spondylotic myelopathy (CSM), but there are few studies on the changes in cervical sagittal balance. This study aimed to analyze the imaging and clinical data of patients who underwent LAMP and to explore the effect of this procedure on the cervical sagittal balance. METHODS This was a retrospective study of the patients who underwent LAMP between 01/2014 and 12/2017. The C0-C2 Cobb angle, sagittal vertical angle (SVA), C2-C7 Cobb angle, and T1-slope were measured. The Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), and visual analog scale (VAS) were used. RESULTS There were 69 males and 39 females. The mean age was 61.3 ± 5.3 years. The C0-C2 Cobb angle increased from 11.3 ± 5.5° to 26.8 ± 4.8° (P = 0.186). The C2-C7 Cobb angle decreased from 13.9 ± 8.6° to 10.65 ± 10.7° P = 0.016). SVA increased from 21.0 ± 5.8 mm to 25.4 ± 11.5 mm (P = 0.001). The preoperative average JOA score was 11.1 ± 2.2 points, and the postoperative score was 14.0 ± 2.1 points, with an average improvement rate of JOA of 46.5 ± 3.8%. The NDI score decreased from preoperative 15.6 ± 5.4 points to 11.3 ± 7.9 points, and the VAS score was decreased from 4.6 ± 1.8 points to 3.3 ± 1.6 points (all P < 0.05). CONCLUSION LAMP improved the neurological function and quality of life of patients with CSM. The cervical vertebrae show a tendency of tilting forward, suggesting that overextension of the upper cervical vertebra might be used to maintain the center of gravity of the skull and horizontal vision.
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Posterior Occipitocervical Fusion for Unstable Upper Cervical Trauma in Old and Elderly Population, Although Decreases Upper Cervical Rotation, Does Not Significantly Increase Neck Disability Index. Adv Orthop 2020; 2020:7906985. [PMID: 32802518 PMCID: PMC7416230 DOI: 10.1155/2020/7906985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/10/2020] [Indexed: 11/18/2022] Open
Abstract
Background Despite the research progress in the thoraco-lumbo-pelvic balance, cervical spine balance has only recently gained increasing interest. To our knowledge, there is a lack of research regarding sagittal occipitocervical spine balance restoration following posterior occipitocervical fusion (POCF). Purpose The primary outcome measure is the evaluation of sagittal cervical alignment roentgenographic parameters and the secondary is the functional outcome (NDI), following POCF for upper (C1 & C2) cervical trauma (UCT) in coexistence with upper cervical spine degeneration. Patients and Methods. Twenty old and elderly patients aged 62 ± 12 years with evident upper cervical degeneration, who received POCF for upper C1 & C2 unstable cervical spine injuries, were included. C2-C7 lordosis, C2-C7 SVA, spinocranial angle (SCA), T1-slope, neck tilt (NT), thorax inlet angle (TIA), cervical tilt (CT), cranial tilt (CrT), and C0-C1 angle were measured. The subfusion angle was used to study the behavior of the unfused cervical segments below fusion. The Neck Disability Index (NDI) was used for the functional outcome evaluation. 29 age-matched individuals were used as controls for radiographic analysis and self-reported functional status comparison. Results The roentgenographic data were measured 3 and 39 ± 12 months postoperatively. Twelve patients showed no disability, and eight showed mild disability. Postoperatively, the patients stood with less C2-C7 lordosis, SCA, and CT (P < 0.02) but with higher NT (P < 0.02) in comparison to the controls. The patient's neck disability (NDI) was increasing as TIA increases (P=0.023). Subfusion angle seems to adapt to C2-C7 lordosis (P < 0.0033) and C0-C2 angle (P < 0.003) without any changes till the last evaluation. Conclusions POCF sufficiently restored occipitocervical sagittal balance along with functional outcome similar to controls in adult and elderly individuals with evident upper cervical degeneration. We do not recommend POCF for young active individuals without occipitocervical pathology, but in contrary, we recommend the removal of the spinocranial connection hardware after cervical fusion is completed.
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Yeung KKL, Cheung PWH, Cheung JPY. Anterior cervical discectomy and fusion for cervical myelopathy using stand-alone tricortical iliac crest autograft: Predictive factors for neurological and fusion outcomes. J Orthop Surg (Hong Kong) 2020; 27:2309499019869166. [PMID: 31451033 DOI: 10.1177/2309499019869166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this article is to investigate the outcomes after anterior cervical discectomy and fusion (ACDF) surgery with stand-alone tricortical iliac crest autograft and to determine predictive factors for poor neurological recovery, non-union, graft collapse and loss of C2-C7 sagittal alignment. METHODS This was a retrospective study involving patients with cervical myelopathy who underwent ACDF surgery with stand-alone tricortical iliac autograft between 2006 and 2016, with a minimum 2-year postoperative follow-up. Outcomes included the change in Japanese Orthopaedic Association (JOA) scores clinically and timing of fusion, graft height and C2-7 angle measured on lateral radiographs. Any complication such as neurological deterioration, non-union, graft collapse or loss of angle was recorded. Delayed union was considered as radiological union identified only beyond postoperative 6 months. Risk factors including age, smoking, drinking, comorbidities and operative levels were analysed through a multivariate regression for their respective influences on the various outcomes. RESULTS Of the 69 patients studied, none of the patients had non-union, while 33 (47.1%) achieved fusion in 6 months. The most common complications were anterior protrusion of graft (5.8%) and hoarseness (2.9%). The 1-year mean change in JOA score was 3.9 ± 2.7. The C2-7 angle gradually became more kyphotic, despite an initial lordosis correction intraoperatively. The graft height also gradually collapsed during subsequent follow-ups. Multivariate regression model suggested that diabetics (cumulative odds ratio 7.4) and drinkers (cumulative odds ratio 8.6) were associated with delayed union. CONCLUSION ACDF using tricortical iliac crest autograft has satisfactory outcomes with low occurrence of complications. Diabetics and drinkers were predictors of delayed union.
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Affiliation(s)
- Kenneth Kam Leung Yeung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong
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Maron SZ, Neifert SN, Ranson WA, Nistal DA, Rothrock RJ, Cooke P, Lamb CD, Cho SK, Caridi JM. Elixhauser Comorbidity Measure is Superior to Charlson Comorbidity Index In-Predicting Hospital Complications Following Elective Posterior Cervical Decompression and Fusion. World Neurosurg 2020; 138:e26-e34. [DOI: 10.1016/j.wneu.2020.01.141] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/17/2020] [Accepted: 01/18/2020] [Indexed: 02/02/2023]
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Chan AKH, Yusof MI, Abdullah MS. Computed Tomographic Morphometric Analysis of C1 and C2 for Lamina Cross Screw Placement in Malay Ethnicity. Asian Spine J 2020; 15:1-8. [PMID: 32252193 PMCID: PMC7904487 DOI: 10.31616/asj.2019.0242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/02/2019] [Indexed: 12/04/2022] Open
Abstract
Study Design This is an observational study of computed tomography (CT) data. Purpose The C1 and C2 laminas in the Malaysian Malay population were analyzed for the feasibility of fitting 3.5-mm laminar screws in a cross configuration. Overview of Literature Morphometric analysis of the C1 and C2 laminas has been performed for various populations but not for the Malaysian Malay population. Methods A total of 330 CT cervical images were measured to establish the bicortical diameter of the C1 and C2 laminas as well as their height and length. The C1 posterior tubercle bicortical diameter and height were also determined from these images. All parameters were measured up to 0.1 mm, and statistical analysis was performed using IBM SPSS Statistics ver. 24.0 (IBM Corp., Armonk, NY, USA). An independent t -test and the Pearson chi-square test were used to determine the mean difference and screw acceptance. Results The means of the C1 lamina measurements were 5.79±1.19 mm in diameter, 9.76±1.51 mm in height, and 20.70±1.86 mm in length. The means of the measurements of the posterior tubercle were 7.20±1.88 mm in diameter and 10.51±1.68 mm in height. The means of the C2 lamina measurements were 5.74±1.31 mm in diameter, 11.76±1.69 mm in height, and 24.96±2.56 mm in length. Overall 65.5% of C1 and 80.3% of C2 laminas are able to accept 3.5-mm screws in a cross configuration. Screw acceptability is similar between the right and left sides (p>0.05). However, males have a higher screw acceptability compared with females (p<0.05), except for the C2 left lamina. Conclusions It is feasible to insert a 3.5-mm screw in a cross configuration in the C1 and C2 laminas of the Malaysian Malay population, especially in males. However, a CT scan should be performed prior to the operation to determine screw acceptability and to estimate screw sizes.
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Affiliation(s)
- Allan Kah Hay Chan
- Department of Orthopaedics, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Mohd Imran Yusof
- Department of Orthopaedics, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Mohd Shafie Abdullah
- Department of Radiology, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia
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Apostolakis S. Transcorporeal Tunnel Approach for Cervical Radiculopathy and Myelopathy: A Systematic Review and Meta-Analysis. World Neurosurg 2020; 138:318-327. [PMID: 32217171 DOI: 10.1016/j.wneu.2020.03.082] [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: 01/06/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The transcorporeal tunnel approach is a relatively new alternative of anterior cervical decompression and fusion for the treatment of cervical radiculopathy and myelopathy, with its main presumed advantage being the preservation of the intervertebral space. The aim of the present article is to present the outcomes of the systematic review and meta-analysis regarding the short-term outcomes of this surgical technique. METHODS A systematic review and a meta-analysis using the random-effects method of the available studies were performed to assess the safety and efficiency of the transcorporeal tunnel approach for cervical radiculopathy and myelopathy. RESULTS In total, 15 eligible studies were identified, with a cumulative number of 254 patients. Pooled data yielded a complication rate of 0.053 and a failure rate of the technique of 0.081; a patient-reported favorable outcome of 0.94 was documented. The available data did not allow for a definite conclusion on the effects of the technique on the intervertebral space height. CONCLUSIONS Although technically challenging, like all minimally invasive methods, the transcorporeal tunnel approach seems to be a safe and efficient option for the treatment of cervical radiculopathy and myelopathy, presenting comparable outcome profiles to alternative open or less invasive techniques.
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Badiee RK, Mayer R, Pennicooke B, Chou D, Mummaneni PV, Tan LA. Complications following posterior cervical decompression and fusion: a review of incidence, risk factors, and prevention strategies. JOURNAL OF SPINE SURGERY 2020; 6:323-333. [PMID: 32309669 DOI: 10.21037/jss.2019.11.01] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Posterior cervical decompression and fusion (PCF) is a common surgical technique used to treat various cervical spine pathologies. However, there are various complications associated with PCF that can negatively impact patient outcome. We performed a comprehensive literature review to identify the most common complications following PCF using PubMed, Cochrane Database of Systematic Reviews, and Google Scholar. The overall complication rates of PCF are estimated to range from about 15% to 25% in the current literature. The most common immediate complications include acute blood loss anemia, surgical site infection (SSI), C5 palsy, and incidental durotomy; the most common long-term complications include adjacent segment degeneration, junctional kyphosis, and pseudoarthrosis. Three principal mechanisms are thought to contribute to complications. First, higher number of fusion levels, obesity, and more complex pathologies can increase the invasiveness of the planned procedure, thus increase complications. Second, wound healing and arthrodesis may be impaired due to poor blood flow due to various patient factors such as smoking, diabetes, increased frailty, steroid use, and other medical comorbidities. Finally, increased biomechanical stress on the upper instrumented vertebra (UIV) and lowest instrumented vertebra (LIV) may predispose patient to chronic degeneration and result in adjacent level degeneration and/or junctional problems. Reducing the modifiable risk factors pre-operatively can decrease the overall complication rate. Neurologic deficits may be reduced with adequate intraoperative decompression of neural elements. SSI may be reduced with meticulous wound closure that minimizes dead space, drain placement, and the use of intra-wound antibiotics. Careful design of the fusion construct with consideration in spinal alignment and biomechanics can help to reduce the rate of junctional problems. Spine surgeons should be aware of these complications associated with PCF and the corresponding prevention strategies optimize patient outcomes.
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Affiliation(s)
- Ryan K Badiee
- School of Medicine, University of California, San Francisco, CA, USA
| | - Rory Mayer
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, CA, USA
| | - Brenton Pennicooke
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, CA, USA
| | - Dean Chou
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, CA, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, CA, USA
| | - Lee A Tan
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, CA, USA
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