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Lindsey MH, Lightsey HM, Xiong GX, Goh B, Simpson AK, Hershman SH. What Happens to Sagittal Alignment Following Laminoplasty Versus Laminectomy and Fusion? World Neurosurg 2024; 184:e211-e218. [PMID: 38266988 DOI: 10.1016/j.wneu.2024.01.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE Laminectomy and fusion (LF) and laminoplasty (LP) are 2 sucessful posterior decompression techniques for cervical myelo-radiculopathy. There is also a growing body of evidence describing the importance of cervical sagittal alignment (CSA) and its importance in outcomes. We investigated the difference between pre- and postoperative CSA parameters in and between LF or LP. Furthermore, we studied predictive variables associated with change in cervical mismatch (CM). METHODS This is a retrospective cohort study of adults with cervical myeloradiculopathy in a single healthcare system. The primary outcomes are intra- and inter-cohort comparison of LF versus LP radiographic parameters at pre- and postoperative time points. A secondary multivariable analysis of predictive factors was performed evaluating factors predicting postoperative CM. RESULTS Eighty nine patients were included; 38 (43%) had LF and 51 (57%) underwent LP. Both groups decreased in lordosis (LF 11.4° vs. 4.9°, P = 0.01; LP 15.2° vs. 9.1°, P < 0.001), increased in cSVA (LF 3.4 vs. 4.2 cm, P = 0.01; LP 3.2 vs. 4.2 cm, P < 0.001), and increased in CM (LF 22.0° vs. 28.5°, P = 0.02; LP 16.8° vs. 22.3°, P = 0.002). There were no significant differences in the postoperative CSA between groups. No significant predictors of change in pre- and postoperative CM were found. CONSLUSIONS There were no significant pre-or postoperative differences following the 2 procedures, suggesting radiographic equipoise in well indicated patients. Across all groups, lordosis decreased, cSVA increased, and cervical mismatch increased. There were no predictive factors that led to change in cervical mismatch.
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Affiliation(s)
- Matthew H Lindsey
- Department of Orthopaedic Spine Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Harry M Lightsey
- Department of Spine Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Grace X Xiong
- Department of Spine Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Brian Goh
- Division of Spine Surgery, Emory Orthopaedics & Spine Center, Atlanta, Georgia, USA
| | - Andrew K Simpson
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stuart H Hershman
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Lightsey HM, Georgakas PJ, Lindsey MH, Yeung CM, Schwab JH, Fogel HA, Hershman SH, Tobert DG, Hwang KM. Inpatient opioid use varies by construct length among laminoplasty versus laminectomy and fusion patients. N Am Spine Soc J 2023; 16:100229. [PMID: 37915966 PMCID: PMC10616422 DOI: 10.1016/j.xnsj.2023.100229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/23/2023] [Accepted: 04/28/2023] [Indexed: 11/03/2023]
Abstract
Background Laminoplasty (LP) and laminectomy and fusion (LF) are utilized to achieve decompression in patients with symptomatic degenerative cervical myelopathy (DCM). Comparative analyses aimed at determining outcomes and clarifying indications between these procedures represent an area of active research. Accordingly, we sought to compare inpatient opioid use between LP and LF patients and to determine if opioid use correlated with length of stay. Methods Sociodemographic information, surgical and hospitalization data, and medication administration records were abstracted for patients >18 years of age who underwent LP or LF for DCM in the Mass General Brigham (MGB) health system between 2017 and 2019. Specifically, morphine milligram equivalents (MME) of oral and parenteral pain medication given after arrival in the recovery area until discharge from the hospital were collected. Categorical variables were analyzed using chi-squared analysis or Fisher exact test when appropriate. Continuous variables were compared using Independent samples t tests and Mann-Whitney U tests. Results One hundred eight patients underwent LF, while 138 patients underwent LP. Total inpatient opioid use was significantly higher in the LF group (312 vs. 260 MME, p=.03); this difference was primarily driven by higher postoperative day 0 pain medication requirements. Furthermore, more LF patients required high dose (>80 MME/day) regimens. While length of stay was significantly different between groups, with LF patients staying approximately 1 additional day, postoperative day 0 MME was not a significant predictor of this difference. When operative levels including C2, T1, and T2 were excluded, the differences in total opioid use and average length of stay lost significance. Conclusions Inpatient opioid use and length of stay were significantly greater in LF patients compared to LP patients; however, when constructs including C2, T1, T2 were excluded from analysis, these differences lost significance. Such findings highlight the impact of operative extent between these procedures. Future studies incorporating patient reported outcomes and evaluating long-term pain needs will provide a more complete understanding of postoperative outcomes between these 2 procedures.
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Affiliation(s)
- Harry M Lightsey
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, United States
| | - Peter J Georgakas
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, United States
| | - Matthew H Lindsey
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, United States
| | - Caleb M Yeung
- Rothman Orthopaedic Institute/Thomas Jefferson University Spine Fellowship Program, Philadelphia, PA, United States
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, 55 Fruit St, Boston, MA 02114, United States
| | - Harold A Fogel
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, 55 Fruit St, Boston, MA 02114, United States
| | - Stuart H Hershman
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, 55 Fruit St, Boston, MA 02114, United States
| | - Daniel G Tobert
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, 55 Fruit St, Boston, MA 02114, United States
| | - Kevin M Hwang
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, 55 Fruit St, Boston, MA 02114, United States
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Li XY, Wang Y, Zhu WG, Liu CX, Kong C, Lu SB. Cervical sagittal alignment changes following anterior cervical discectomy and fusion, laminectomy with fusion, and laminoplasty for multisegmental cervical spondylotic myelopathy. J Orthop Surg Res 2023; 18:190. [PMID: 36906572 PMCID: PMC10007737 DOI: 10.1186/s13018-023-03640-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/23/2023] [Indexed: 03/13/2023] Open
Abstract
OBJECTIVE Cervical sagittal alignment changes (CSACs) influence outcomes and health-related quality-of-life. Anterior cervical discectomy and fusion (ACDF), laminectomy with fusion (LCF), and laminoplasty (LP) are common treatments for multisegmental cervical spondylotic myelopathy; however, these approaches need to be compared. METHODS Our study included 167 patients who underwent ACDF, LCF, or LP. Patients were divided into four groups according to C2-C7 Cobb angle (CL): kyphosis (CL < 0°), straight (0° ≤ CL < 10°), lordosis (10° ≤ CL < 20°), and extreme lordosis (20° ≤ CL) groups. CSACs consist of two parts. CSAC from the preoperative period to the postoperative period is surgical correction change (SCC). CSAC from the postoperative period to the final follow-up period is postoperative lordosis preserving (PLP). Outcomes were evaluated using the Japanese Orthopaedic Association score and the neck disability index. RESULTS ACDF, LCF, and LP had equivalent outcomes. ACDF had greater SCC than LCF and LP. During follow-up, lordosis decreased in the ACDF and LCF groups but increased in the LP group. For straight alignment, ACDF had greater CSAC and greater SCC than the LCF and LP groups but similar PLP. For lordosis alignment, ACDF and LP had positive PLP, and LCF had negative PLP. For extreme lordosis, ACDF, LP, and LCF had negative PLP; however, cervical lordosis in the LP group was relatively stable during follow-up. CONCLUSIONS ACDF, LCF, and LP have different CSAC, SCC, and PLP according to a four-type cervical sagittal alignment classification. Preoperative cervical alignment is an important consideration in deciding the type of surgical treatment in CSM.
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Affiliation(s)
- Xiang-Yu Li
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.,National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Yu Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.,National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Wei-Guo Zhu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.,National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Cheng-Xin Liu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.,National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.,National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Shi-Bao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China. .,National Clinical Research Center for Geriatric Diseases, Beijing, China.
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Li X, Yu H, Welle K, Gathen M, Zhang L, Xiao J, Kabir K. Comparative Effectiveness and Safety of Open-Door Laminoplasty, French-Door Laminoplasty, Laminectomy and Fusion, and Laminectomy Alone for Multilevel Degenerative Cervical Myelopathy: A Bayesian Network Analysis. Adv Ther 2022; 39:117-39. [PMID: 34812993 DOI: 10.1007/s12325-021-01980-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate the comparative effectiveness and safety of open-door laminoplasty (OLP), French-door laminoplasty (FLP), laminectomy and fusion (LF), and laminectomy alone (LA) in treating multilevel degenerative cervical myelopathy (MDCM). METHODS Embase, PubMed, and Cochrane library were searched from their inception date to 7 January 2021. Randomized controlled trials and cohort studies comparing OLP, FLP, LF, and LA were identified to perform a network meta-analysis (NMA). RESULTS A total of 30 studies with 2671 patients were included. Our NMA results showed no significant difference between LF and OLP, but both are superior to LA and FLP in the comparison of JOA (Japanese Orthopaedic Association) score improvement. LF showed a most unsatisfactory outcome in postoperative range of motion (ROM) compared with LA or OLP or with FLP. For the complication outcome, no significant differences were found. The surface under the cumulative ranking curves (SUCRA) for JOA improvement was as follows: LF, OPL, LA, and FLP. For ROM reduction it was LA, OPL, FPL, and LF. For complications it was LF, LA, OLP, and FLP. CONCLUSIONS Considering all the evaluated criteria, none of the procedures showed the best outcome with least complications and optimal efficacy. However, OLP can be most recommended because of its second-ranking spectra in both of JOA improvement and ROM reduction, also with an acceptable incidence of complications, with the third least.
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Scholz C, Masalha W, Naseri Y, Klingler JH, Hohenhaus M, Hubbe U. Laminectomy and fusion in multilevel degenerative cervical myelopathy - Correlation between objective and subjective postoperative restriction of cervical spine mobility. J Clin Neurosci 2021; 94:135-139. [PMID: 34863428 DOI: 10.1016/j.jocn.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 07/12/2021] [Accepted: 10/05/2021] [Indexed: 11/20/2022]
Abstract
For patients with multilevel degenerative cervical myelopathy (DCM), laminectomy and fusion is an established technique. A concomitant effect of multilevel fusion is a restriction of cervical spine mobility. This retrospective study on DCM-patients with at least 4 laminectomy and fusion levels, compares data between objective and subjective restriction of the postoperative cervical spine mobility. The patient-reported restriction of cervical spine mobility was acquired by a five-step score. Measurements of cervical range of motion were performed using the CROM device and were correlated with the subjective scores. Fusion was performed over 6 levels in most of the 36 patients. For the subjective cervical spine mobility, 52.8% reported none to medium, 38.9% severe and 8.3% complete restriction. Mean objective cervical range of motion was 45.0° for flexion-extension, 26.3° for total lateral flexion and 51.4° for total rotation and therefore evidently reduced compared to non-operated patient cohorts in literature. There was a significant medium, negative correlation between the objective measurements and the patient-reported general restriction of cervical spine mobility, and with the physical component summary of SF-8. The significant objective reduction of cervical range of motion after laminectomy and multilevel fusion correlates with the patient-reported assessment for general restriction.
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Affiliation(s)
- Christoph Scholz
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Waseem Masalha
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Yashar Naseri
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Jan-Helge Klingler
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Marc Hohenhaus
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Ulrich Hubbe
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Du L, Gao Y, Zhao C, Zhou T, Tian H, Zhang K, Zhao J. Laminoplasty with selective fusion at unstable segment versus laminectomy with fusion for multilevel cervical myelopathy: a case-control study. BMC Musculoskelet Disord 2021; 22:426. [PMID: 33962588 PMCID: PMC8105929 DOI: 10.1186/s12891-021-04297-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/16/2021] [Indexed: 11/20/2022] Open
Abstract
Background Segmental cervical instability is a risk factor for the progression of osteophytic bone spurs and development of myelopathy, and is treated as a relative contraindication of cervical laminoplasty. The aim of this study was to compare laminoplasty with selective fixation (LPSF) versus laminectomy with fusion (LCF) in patients with multilevel cervical myelopathy accompanied by segmental instability. Methods A case-control study was conducted by reviewing data from 63 patients who underwent LPSF (n = 30) or LCF (n = 33). Cervical alignment, range of motion (ROM), neurologic status and axial symptom severity pre-operation, 3-days after operation, and at the final follow-up (minimum 24 months) were measured and compared between groups. Results Postoperation, patients in the LPSF group lost 31.1 ± 17.3 % of cervical lordosis and 43.2 ± 10.9 % cervical ROM while patients in the LCF group lost 5.7 ± 8.2 % and 67.9 ± 15.5 %, respectively. Both LPSF and LCF groups significantly improved neurologic status and axial symptom severity at the final follow-up with similar between-group results(P > 0.05). Blood loss, operation time, hospital stay, and medical cost in the LPSF group were significantly less than in the LCF group(P < 0.05). Conclusions In 2 years of clinical observation, LPSF was effective in maintaining the stability of the cervical spine with less sacrifice of mobility and surgical trauma for multilevel myelopathy with segmental instability compared to LCF.
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Affiliation(s)
- Lin Du
- Department of Spine Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, 7 Weiwu Road, 450000, Zhengzhou, Henan, People's Republic of China.,Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China
| | - Yanzheng Gao
- Department of Spine Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, 7 Weiwu Road, 450000, Zhengzhou, Henan, People's Republic of China
| | - Changqing Zhao
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China
| | - Tangjun Zhou
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China
| | - Haijun Tian
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China
| | - Kai Zhang
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China
| | - Jie Zhao
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China.
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Davies BM, Francis JJ, Butler MB, Mowforth O, Goacher E, Starkey M, Kolias A, Wynne-Jones G, Hutton M, Selvanathan S, Thomson S, Laing RJC, Hutchinson PJ, Kotter MRN. Current surgical practice for multi-level degenerative cervical myelopathy: Findings from an international survey of spinal surgeons. J Clin Neurosci 2021; 87:84-88. [PMID: 33863541 DOI: 10.1016/j.jocn.2021.01.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 12/23/2020] [Accepted: 01/29/2021] [Indexed: 12/15/2022]
Abstract
Degenerative cervical myelopathy (DCM) results from compression of the cervical spine cord as a result of age related changes in the cervical spine, and affects up to 2% of adults, leading to progressive disability. Surgical decompression is the mainstay of treatment, but there remains significant variation in surgical approaches used. This survey was conducted in order to define current practice amongst spine surgeons worldwide, as a possible prelude to further studies comparing surgical approaches. METHODS An electronic survey was developed and piloted by the investigators using SurveyMonkey. Collected data was categorical and is presented using summary statistics. Where applicable, statistical comparisons were made using a Chi-Squared test. The level of significance for all statistical analyses was defined as p < 0.05. All analysis, including graphs was performed using R (R Studio). RESULTS 127 surgeons, from 30 countries completed the survey; principally UK (66, 52%) and North America (15, 12%). Respondents were predominantly Neurosurgeons by training (108, 85%) of whom 84 (75%) reported Spinal Surgery as the principal part of their practice. The majority indicated they selected their surgical procedure for multi-level DCM on a case by case basis (62, 49%). Overall, a posterior approach was more popular for multi-level DCM (74, 58%). Region, speciality or annual multi-level case load did not influence this significantly. However, there was a trend for North American surgeons to be more likely to favour a posterior approach. CONCLUSIONS A posterior approach was favoured and more commonly used to treat multi-level DCM, in an international cohort of surgeons. Posterior techniques including laminectomy, laminectomy and fusion or laminoplasty appeared to be equally popular.
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Affiliation(s)
- Benjamin M Davies
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom.
| | - Jibin J Francis
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Max B Butler
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Oliver Mowforth
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Edward Goacher
- Department of Musculoskeletal, Spinal Unit, Royal Victoria Infirmary, Newcastle, United Kingdom
| | - Michelle Starkey
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Angelos Kolias
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Guy Wynne-Jones
- Department of Musculoskeletal, Spinal Unit, Royal Victoria Infirmary, Newcastle, United Kingdom
| | - Mike Hutton
- Royal Devon and Exeter Hospital, United Kingdom
| | | | | | - Rodney J C Laing
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Peter J Hutchinson
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Mark R N Kotter
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom; Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom
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Scholz C, Klingler JH, Masalha W, Hohenhaus M, Volz F, Vasilikos I, Roelz R, Scheiwe C, Hubbe U. Long-Term Results after Multilevel Fusion of the Cervical Spine and the Cervicothoracic Junction: To Bridge or Not To Bridge? World Neurosurg 2021; 148:e556-e564. [PMID: 33476777 DOI: 10.1016/j.wneu.2021.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE For patients with multilevel degenerative cervical myelopathy, laminectomy and fusion are widely accepted techniques for ameliorating the disorder. However, the idea of whether one should bridge the cervicothoracic junction to prevent instrument failure or adjacent segment disease has been a subject of controversial discussion. In the present study, we compared the incidence of these complications and the revision rates in multilevel fusions extending to C7 or T1-T3. METHODS In the present single-center, retrospective cohort study, patients with multilevel degenerative cervical myelopathy treated with laminectomy and fusion to C7 or T1-T3 from 2004 to 2016 were included for evaluation. The primary outcome measure was radiologically proven complications at the most caudal level or the adjacent spinal fusion level. RESULTS Laminectomy and multilevel fusion were performed in 84 patients. After applying the exclusion criteria, 20 patients with fusion to C7 (treated from 2004 to 2012; follow-up, 124.6 ± 10.6 months) and 38 patients with fusion to T1-T3 (treated from 2008 to 2016; follow-up, 58.2 ± 15.7 months) were evaluated. The incidence of complications at the most caudal or adjacent level of fusion was twice as high (P = 0.087; NS) in the C7 group (11 of 20; 55.0%) compared with the T1-T3 group (11 of 38; 28.9%). In the C7 group, 9 of the 20 patients (45.0%) had required revision surgery compared with 2 of 38 patients (5.3%) in the T1-T3 group (P = 0.001). CONCLUSIONS We found that fewer revisions were necessary if the fusion had extended to the thoracic spine. Thus, we recommend bridging the cervicothoracic junction when fusion starts at C0-C3.
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Affiliation(s)
- Christoph Scholz
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Jan-Helge Klingler
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Waseem Masalha
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marc Hohenhaus
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Florian Volz
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ioannis Vasilikos
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Roland Roelz
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian Scheiwe
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ulrich Hubbe
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Lee JJ, Shin DA, Yi S, Kim KN, Yoon DH, Shin HC, Ha Y. Effect of posterior instrumented fusion on three-dimensional volumetric growth of cervical ossification of the posterior longitudinal ligament: a multiple regression analysis. Spine J 2018. [PMID: 29526640 DOI: 10.1016/j.spinee.2018.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Despite the fact that ossification of posterior longitudinal ligament (OPLL) is a three-dimensional disease, conventional studies have focused mainly on a two-dimensional measurement, and it is difficult to accurately determine the volume of OPLL growth and analyze the factors affecting OPLL growth after posterior decompression (laminoplasty or laminectomy and fusion). PURPOSE The present study aimed to investigate the factors affecting OPLL volume growth using a three-dimensional measurement. STUDY DESIGN/SETTING This was a retrospective case study. PATIENT SAMPLE Eighty-three patients with cervical OPLL who were diagnosed as having multilevel cervical OPLL of more than three levels on cervical computed tomography (CT) scans were retrospectively reviewed from June 1, 1998, to December 31, 2015. OUTCOME MEASURES The OPLL volume from the C1 vertebrae to the C7 vertebrae was measured on preoperative and the most recent follow-up CT scans. METHODS Eighty-three patients were retrospectively examined for age, gender, body mass index, hypertension, diabetes, type of OPLL, surgical method, preoperative cervical curvature, and preoperative and postoperative cervical range of motion. Preoperative cervical CT and the most recent follow-up cervical CT scans were converted to Digital Imaging and Communications in Medicine data, and the OPLL volume was three-dimensionally measured using the Mimics program (Materialise, Leuven, Belgium). The OPLL volume growth was analyzed using univariate and multivariate analyses. RESULTS The average follow-up period was 32.36 (±23.39) months. Patients' mean age was 54.92 (±8.21) years. In univariate analysis, younger age (p=.037) and laminoplasty (p=.012) were significantly associated with a higher mean annual growth rate of OPLL (%/y). In multivariate analysis, only laminoplasty (p=.027) was significantly associated with a higher mean annual growth rate of OPLL (%/y). The mean annual growth rate of OPLL was about seven times faster with laminoplasty (8.00±13.06%/y) than with laminectomy and fusion (1.16±9.23%/y). CONCLUSIONS Posterior instrumented fusion has the effect of reducing OPLL growth rate compared with motion-preserving laminoplasty. Patients' age and the surgical method need to be considered in surgically managing the multilevel OPLL.
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Affiliation(s)
- Jong Joo Lee
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Keung Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Do Heum Yoon
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Hyun Chul Shin
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
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