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1.
Ahmad Fouad Abdelbaki Allam Tarek Abdalla Ahmed Abotakia Wael Koptan 《The spine journal》2018,18(7):1136-1142
Background Context
Cerebrolysin is a mixture containing 85% free amino acids and 15% biologically active low–molecular weight peptides that is believed to mimic the effects of endogenous neurotrophic factors to interact with the pathologic process cascade of neurodegenerative diseases. No study has examined the effect of Cerebrolysin on cervical myelopathic patients.Purpose
The objective of this study was to evaluate the effect of Cerebrolysin as a conservative modality on cervical spondylotic myelopathic patients.Study Design
This is a prospective randomized study.Patient Sample
A total of 192 patients with cervical spondylotic myelopathy (CSM) were subdivided blindly into two equal groups.Outcome Measures
Followed-up was performed at 1, 3, and 6 months comparing the recovery rate Japanese Orthopaedic Association (JOA) score for cervical myelopathy between the two groups.Methods
Group I received Cerebrolysin and Group II received placebo for 4 weeks; both groups received celecoxib 200?mg for 4 weeks.Results
Myelopathy improved in 92% and 52% of patients at 1 month in Groups I and II, respectively; these changed at 6 months to 87% and 33%; the remaining 13% in Group I neither improved nor deteriorated, whereas 60% in Group II neither improved nor deteriorated and 7% deteriorated with statistically significant differences when comparing the mean JOA recovery rate between the 2 groups at 1, 3, and 6 months.Conclusions
Cerebrolysin over 4 weeks is safe and effective for the improvement of CSM as compared with placebo, with no reported cases of neurologic deterioration over 6 months of follow-up. 相似文献2.
Dong-Ho Lee Jae Hwan Cho Choon Sung Lee Chang Ju Hwang Sung Hoon Choi Chul Gie Hong 《The spine journal》2018,18(6):1099-1105
Background Context
Conventional anterior decompression surgery for cervical myelopathy, including anterior corpectomy and fusion, is technically demanding and is known to be associated with a higher incidence of surgery-related complications, including cerebrospinal fluid (CSF) leakage, neurologic deterioration, and graft failure compared with posterior surgery.Purpose
We introduce a novel anterior decompression technique (vertebral body sliding osteotomy [VBSO]) for cervical myelopathy caused by ossification of posterior longitudinal ligament (OPLL) and evaluate the efficacy and safety of this procedure.Study Design
This is a case series for novel surgical technique.Patient Sample
Fourteen patients (M:F=11:3, mean age 56.9±10) with cervical myelopathy caused by OPLL who underwent VBSO by a single surgeon were included.Outcome Measures
The surgical outcome was evaluated according to the Japanese Orthopaedic Association score for cervical myelopathy (C-JOA score), and the recovery rate of the C-JOA score was calculated. Patients were also evaluated radiographically with plain and dynamic cervical spine radiographs and pre- and postoperative computed tomography images.Methods
Fourteen patients were followed up for more than 24 months, and operation time, estimated blood loss, neurologic outcomes, and surgery-related complications were investigated. Radiological measurements were also performed to analyze the following parameters: (1) canal-occupying ratio and postoperative canal widening, and (2) pre- and postoperative sagittal alignment.Results
The mean recovery rate of C-JOA score at the final follow-up was 68.65±17.8%. There were no perioperative complications, including neurologic deterioration, vertebral artery injury, esophageal injury, graft dislodgement, and CSF leaks, after surgery except for pseudarthrosis in one case. An average spinal canal compromised ratio by OPLL decreased from 61.5±8.1% preoperatively to 16.5±11.2% postoperatively. An average postoperative canal widening was 5.15±1.39?mm, and improvement of cervical alignment was observed in all patients, with average recovery angle of 7.3±6.1° postoperatively.Conclusions
The VBSO allows sufficient decompression of spinal cord and provides excellent neurologic outcomes. Because surgeons do not need to manipulate the OPLL mass directly, this technique could significantly decrease surgery-related complications. Furthermore, as VBSO is based on the multilevel discectomy and fusion technique, it would be more helpful to restore a physiological lordosis. 相似文献3.
Dong-Ho Lee Jae Hwan Cho Chang Ju Hwang Choon Sung Lee Chunghwan Kim Jung-Ki Ha 《The spine journal》2018,18(3):414-421
Background Context
Conventional laminoplasty is useful for expanding a stenotic spinal canal. However, it has limited use for the decompression of accompanying neural foraminal stenosis. As such, an additional posterior foraminotomy could be simultaneously applied, although this procedure carries a risk of segmental kyphosis and instability.Purpose
The aim of this study was to elucidate the long-term surgical outcomes of additional posterior foraminotomy with laminoplasty (LF) for cervical spondylotic myelopathy (CSM) with radiculopathy.Study Design/Setting
A retrospective comparative study was carried out.Patient Sample
Ninety-eight consecutive patients who underwent laminoplasty for CSM with radiculopathy between January 2006 and December 2012 were screened for eligibility. This study included 66 patients, who were treated with a laminoplasty of two or more levels and followed up for more than 2 years after surgery.Outcome Measures
The Neck Disability Index (NDI), Japanese Orthopedic Association (JOA) scores, JOA recovery rates, and visual analog scale (VAS) were used to evaluate clinical outcomes. The C2–C7 sagittal vertical axis distance, cervical lordosis, range of motion (ROM), and angulation and vertebral slippage at the foraminotomy level were used to measure radiological outcomes using the whole spine anterioposterior or lateral and dynamic lateral radiographs.Methods
Sixty-six patients with CSM with radiculopathy involving two or more levels were consecutively treated with laminoplasty and followed up for more than 2 years after surgery. The first 26 patients underwent laminoplasty alone (LA group), whereas the next 40 patients underwent an additional posterior foraminotomy at stenotic neural foramens with radiating symptoms in addition to laminoplasty (LF group). In the LF group, the foraminotomy with less resection than 50% of facet joint to avoid segmental kyphosis and instability was performed at 78 segments (unilateral-to-bilateral ratio=57:21) and 99 sites. Clinical and radiographic data were assessed preoperatively and at 2-year follow-up and compared between the groups.Results
The NDI, JOA scores, JOA recovery rates, and VAS for neck and arm pain were improved significantly in both groups after surgery. The improvement in the VAS for arm pain was significantly greater in the LF group (from 5.55±2.52 to 1.85±2.39) than the LA group (from 5.48±2.42 to 3.40±2.68) (p<.001). Although cervical lordosis and ROM decreased postoperatively in both groups, there were no significant differences in the degree of reduction between the LF and LA groups. Although the postoperative focal angulation and slippage were slightly increased in the LF group, this was not to a significant degree. Furthermore, segmental kyphosis and instability were not observed in the LF group, regardless of whether the patient underwent a unilateral or bilateral foraminotomy.Conclusions
Additional posterior foraminotomy with laminoplasty is likely to improve arm pain more significantly than laminoplasty alone by decompressing nerve roots. Also, performing posterior foraminotomy via multiple levels or bilaterally did not significantly affect segmental malalignment and instability. Therefore, when a laminoplasty is performed for CSM with radiculopathy, an additional posterior foraminotomy could be an efficient and safe treatment that improves both myelopathy symptoms and radicular arm pain. 相似文献4.
5.
Ting-kui Wu Yang Meng Bei-yu Wang Ying Hong Xin Rong Chen Ding Hua Chen Hao Liu 《The spine journal》2018,18(12):2171-2180
Background Context
Hybrid surgery (HS), consisting of cervical disc arthroplasty (CDA) at the mobile level, along with anterior cervical discectomy and fusion at the spondylotic level, could be a promising treatment for patients with multilevel cervical degenerative disc disease (DDD). An advantage of this technique is that it uses an optimal procedure according to the status of each level. However, information is lacking regarding the influence of the relative location of the replacement and the fusion segment in vivo.Purpose
We conducted the present study to investigate whether the location of the fusion affected the behavior of the disc replacement and adjacent segments in HS in vivo.Study Design
This is an observational study.Patient Sample
The numbers of patients in the arthroplasty-fusion (AF) and fusion-arthroplasty (FA) groups were 51 and 24, respectively.Outcome Measures
The Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and Visual Analog Scale (VAS) scores were evaluated. Global and segmental lordosis, the range of motion (ROM) of C2–C7, and the operated and adjacent segments were measured. Fusion rate and radiological changes at adjacent levels were observed.Methods
Between January 2010 and July 2016, 75 patients with cervical DDD at two contiguous levels undergoing a two-level HS were retrospectively reviewed. The patients were divided into AF and FA groups according to the locations of the disc replacement. Clinical outcomes were evaluated according to the JOA, NDI, and VAS scores. Radiological parameters, including global and segmental lordosis, the ROM of C2–C7, the operated and adjacent segments, and complications, were also evaluated.Results
Although the JOA, NDI, and VAS scores were improved in both the AF and the FA groups, no significant differences were found between the two groups at any follow-up point. Both groups maintained cervical lordosis, but no difference was found between the groups. Segmental lordosis at the fusion segment was significantly improved postoperatively (p<.001), whereas it was maintained at the arthroplasty segment. The ROM of C2–C7 was significantly decreased in both groups postoperatively (AF p=.001, FA p=.014), but no difference was found between the groups. The FA group exhibited a non-significant improvement in ROM at the arthroplasty segment. The ROM adjacent to the arthroplasty segment was increased, although not significantly, whereas the ROM adjacent to the fusion segment was significantly improved after surgery in both groups (p<.001). Fusion was achieved in all patients. No significant difference in complications was found between the groups.Conclusions
In HS, cephalic or caudal fusion segments to the arthroplasty segment did not affect the clinical outcomes and the behavior of CDA. However, the ROM of adjacent segments was affected by the location of the fusion segment; segments adjacent to fusion segments had greater ROMs than segments adjacent to arthroplasty segments. 相似文献6.
Yang Hou Jingchuan Sun Jiangang Shi Yongfei Guo Yuan Wang Guodong Shi Guohua Xu 《The spine journal》2018,18(6):998-1004
Background Context
The tethered cord syndrome (TCS) characterized by urination dysfunction has long been a worldwide clinical problem, of which clinical effects remains controversial.Purpose
The objective of this study was to evaluate the clinical effects of an innovative surgical method for the treatment of TCS.Study Design
This is a retrospective clinical study.Patient Sample
There were 15 patients included in this study.Outcome Measures
The visual analog scale (VAS) and the Japanese Orthopaedic Association (JOA) scores were evaluated. The incidence of complications after surgery was also analyzed.Materials and Methods
A total of 15 patients including 9 men and 6 women with TCS underwent homogeneous spinal-shortening axial decompression (HSAD) from September 2011 to February 2015. The average age at the time of surgery was 38.1±17.7 years. The average postoperative follow-up period was 21.5±7.5 months. The VAS and JOA scores were used to evaluate the clinical effects of the new operational procedure. In addition, the incidence of complications was also recorded and analyzed.Results
The VAS scores decreased from 3.93±2.52 to 1.80±1.21 at the final follow-up after surgery with a significant statistical difference (p=.006). The JOA scores also significantly increased from 9.93±3.43 to 21.20±4.18 at the final follow-up (p<.001). Fourteen cases (93.3%) with bladder dysfunction and 7 cases with sensory dysfunction of the lower limbs (87.5%) had a significant improvement postoperatively. Complications such as infection, pulmonary embolism, nerve injury, and broken rod were not observed during the follow-up period.Conclusions
The operation of HSAD was an effective and safe surgical method for TCS, which can achieve direct decompression of the tethered spinal cord. 相似文献7.
Genki Okita Tetsuro Ohba Tomohiro Takamura Shigeto Ebata Ryo Ueda Hiroshi Onishi Hirotaka Haro Masaaki Hori 《The spine journal》2018,18(2):268-275
Background Context
Surgical outcome and the severity of cervical spondylotic myelopathy (CSM) are unpredictable and cannot be estimated by conventional anatomical magnetic resonance imaging (MRI). The utility of diffusion tensor imaging (DTI) to quantify the severity of CSM and to assess postoperative neurologic recovery has been investigated. However, whether conventional DTI should be applied in a clinical setting remains controversial. Neurite orientation dispersion and density imaging (NODDI) is a recently introduced model-based diffusion-weighted MRI technique that quantifies specific microstructural features related directly to neuronal morphology. However, there are as yet few clinical applications of NODDI reported. Indeed, there are no reports to indicate NODDI is useful for diagnosing CSM.Study Design
This is a retrospective cohort study using consecutive patients.Purpose
The objective of this study was to evaluate the utility of NODDI and conventional DTI for detecting changes in the spinal cord microstructure. In particular, this study aimed to quantify the preoperative severity of CSM and to assess postoperative neurologic recovery from this myelopathy.Patient Sample
We included 27 consecutive patients with a nontraumatic cervical lesion from CSM who underwent laminoplasty at a single institution between April 2012 and April 2015. The patients underwent MRI before and approximately 2 weeks after surgery.Outcome Measures
In addition to conventional DTI metrics, we evaluated the intracellular volume fraction (ICVF) and the orientation dispersion index (ODI), which are metrics derived from NODDI. The 10-second grip and release test and the Japanese Orthopaedic Association scoring system were used before and 1 year after surgery to assess neurologic outcome.Materials and Methods
Neurite orientation dispersion and density imaging and conventional DTI values were measured at the C2–C3 intervertebral level (control value) and at the most compressed levels (C3–C7 intervertebral levels) were measured. The changes in these values pre- and postoperative were demonstrated. Correlations between NODDI and conventional DTI values and clinical outcome were determined.Results
Preoperative fractional anisotropy was significantly correlated with the severity of neural damage, but not with postoperative neurologic recovery. No significant correlation could be found between the preoperative ICVF, the ODI, the apparent diffusion coefficient, and the severity of the preoperative neurologic dysfunction. Preoperative ICVF was most strongly correlated with the severity of neurologic dysfunction and postoperative neurologic recovery.Conclusions
Conventional DTI may be applied clinically to assess the severity of myelopathy. Neurite orientation dispersion and density imaging may be more valuable than conventional DTI to predict outcome following surgery in patients with CSM. 相似文献8.
Shoji Seki Norikazu Hirano Isao Matsushita Yoshiharu Kawaguchi Masato Nakano Taketoshi Yasuda Hiraku Motomura Kayo Suzuki Yasuhito Yahara Kenta Watanabe Hiroto Makino Tomoatsu Kimura 《The spine journal》2018,18(1):99-106
Background Context
Although the cervical spine is only occasionally involved in rheumatoid arthritis (RA), involvement of the lumbar spine is even less common. A few reports on lumbar spinal stenosis in patients with RA have appeared. Although disc space narrowing occurs in aging, postoperative adjacent segment disease (ASD) in patients with RA has not been subject to much analysis.Purpose
The objective of this study was to investigate differences in ASD and clinical outcomes between lumbar spinal decompression with and without fusion in patients with RA.Study Design/Setting
This is a retrospective comparative study.Patient Sample
A total of 52 patients with RA who underwent surgery for lumbar spinal disorders were included. Twenty-seven patients underwent decompression surgery with fusion and 25 underwent decompression surgery alone.Outcome Measures
Intervertebral disc space narrowing and spondylolisthesis of the segment immediately cranial to the surgical site were measured using a three-dimensional volume rendering software. Pre- and postoperative evaluation of RA activity and Japanese Orthopaedic Association (JOA) scores were conducted.Materials and Methods
All patients had preoperative and annual postoperative lumbar radiographs and were followed up for a mean of 5.1 years (range 3.5–10.9 years). Pre- and postoperative (2 years after surgery) JOA scores were recorded and any postoperative complications were investigated. Degrees of intervertebral disc narrowing and spondylolisthesis at the adjacent levels were evaluated on radiographs and were compared between the two groups. Analysis was performed to look for any correlation between ASD and RA disease activities.Results
Postoperative JOA scores were significantly improved in both groups. The rate of revision surgery was significantly higher in the fusion group than that in the non-fusion group. The rate of ASD was significantly greater in the fusion group than that in the non-fusion group at the final follow-up examination. Both matrix metalloproteinase 3 (MMP-3) and the 28-joint disease activity score incorporating C-reactive protein levels (DAS28-CRP) were significantly associated with the incidence and severity of ASD.Conclusions
Adjacent segment disease and the need for revision surgery were significantly higher in the fusion group than those in the non-fusion group. A preoperative high MMP-3 and DAS28-CRP are likely to be associated with postoperative ASD. 相似文献9.
Dong-Ho Lee Jae Hwan Cho Nam-Heun Kim Sunghoo Kim Jeonghyun Choi Chang Ju Hwang Choon Sung Lee 《The spine journal》2018,18(7):1116-1121
Background Context
Research shows the progression of ossification of the posterior longitudinal ligament (OPLL) following decompressive surgery for cervical myelopathy, particularly in cases presenting with continuous or mixed radiographic types. To date, no study has investigated OPLL progression within each motion segment.Purpose
To evaluate progression of cervical OPLL in each motion segment using a novel system of classification, and to identify risk factors for OPLL progression following laminoplasty.Study Design/Setting
Retrospective case series.Patient Sample
This study included 34 patients (86 segments) with cervical myelopathy secondary to OPLL.Outcome Measures
Clinical and radiological data (plain radiographs and computed tomography [CT]) were obtained.Methods
Clinical data from 34 patients (86 segments) with cervical myelopathy secondary to OPLL were evaluated retrospectively. All subjects had undergone laminoplasty at a single center. Sagittal reconstructive CT images were used to measure OPLL thickness in each segment. Ossified masses were classified into four types according to the degree of disc space involvement: type 1 (no involvement); type 2 (involving disc space but not crossing); type 3 (crossing disc space but not fused); and type 4 (complete bridging). Range of motion (ROM) for each segment was measured using dynamic radiographs. Statistical analyses were performed to determine the degree of OPLL progression according to the four disc space involvement types and ROM.Results
Mean OPLL progression was significantly higher in types 2 (1.3?mm) and 3 (1.5?mm) than in type 1 (0.5?mm) (p<.001). Severe progression (change in thickness >2?mm) was more frequent in types 2 (8 of 29) and 3 (7 of 16) than in types 1 (1 of 35) or 4 (0 of 6) (p=.002). In types 2 or 3, ROM>5° was correlated with severe OPLL progression (52% vs. 8%; p=.035).Conclusions
Type 2 or 3 disc involvement and segmental ROM>5° were risk factors for OPLL progression. Classification of cervical OPLL according to disc involvement may help predict OPLL progression following laminoplasty. Close follow-up is warranted in cases of type 2 or 3 with greater segmental motion. 相似文献10.
Jetan H. Badhiwala Christopher D. Witiw Farshad Nassiri Blessing N.R. Jaja Muhammad A. Akbar Alireza Mansouri Zamir Merali George M. Ibrahim Jefferson R. Wilson Michael G. Fehlings 《The spine journal》2018,18(12):2220-2231
Background Context
Predictors of outcome after surgery for degenerative cervical myelopathy (DCM) have been determined previously through hypothesis-driven multivariate statistical models that rely on a priori knowledge of potential confounders, exclude potentially important variables because of restrictions in model building, cannot include highly collinear variables in the same model, and ignore intrinsic correlations among variables.Purpose
The present study aimed to apply a data-driven approach to identify patient phenotypes that may predict outcomes after surgery for mild DCM.Study Design
This is a principal component analysis of data from two related prospective, multicenter cohort studies.Patient Sample
The study included patients with mild DCM, defined by a modified Japanese Orthopaedic Association score of 15–17, undergoing surgical decompression as part of the AOSpine CSM-NA or CSM-I trials.Outcome Measures
Patient outcomes were evaluated preoperatively at baseline and at 6 months, 1 year, and 2 years after surgery. Quality of life (QOL) was evaluated by the Neck Disability Index (NDI) and Short Form-36 version 2 (SF-36v2). These are both patient self-reported measures that evaluate health-related QOL, with NDI being specific to neck conditions and SF-36v2 being a generic instrument.Materials and Methods
The analysis included 154 patients. A heterogeneous correlation matrix was created using a combination of Pearson, polyserial, and polychoric regressions among 67 variables, which then underwent eigen decomposition. Scores of significant principal components (PCs) (with eigenvalues>1) were included in multivariate logistic regression analyses for three dichotomous outcomes of interest: achievement of the minimum clinically important difference [MCID] in (1) NDI (≤?7.5), (2) SF-36v2 Physical Component Summary (PCS) score (≥5), and (3) SF-36v2 Mental Component Summary (MCS) score (≥5).Results
Twenty-four significant PCs accounting for 75% of the variance in the data were identified. Two PCs were associated with achievement of the MCID in NDI. The first (PC 1) was dominated by variables related to surgical approach and number of operated levels; the second (PC 21) consisted of variables related to patient demographics, severity and etiology of DCM, comorbid status, and surgical approach. Both PC 1 and PC 21 also correlated with SF-36v2 PCS score, in addition to PC 4, which described patients' physical profile, including gender, height, and weight, as well as comorbid renal disease; PC 6, which received large loadings from variables related to cardiac disease, impaired mobility, and length of surgery and recovery; and PC 9, which harbored large contributions from features of upper limb dysfunction, cardiorespiratory disease, surgical approach, and region. In addition to PC 21, a component profiling patients' socioeconomic status and support systems and degree of physical disability (PC 24) was associated with achievement of the MCID in SF-36 MCS score.Conclusions
Through a data-driven approach, we identified several phenotypes associated with disability and physical and mental health-related QOL. Such data reduction methods may separate patient-, disease-, and treatment-related variables more accurately into clinically meaningful phenotypes that may inform patient care and recruitment into clinical trials. 相似文献11.
Background Context
Resulting from recent studies that suggest a benefit of implant design on the achievement of fusion and stability in cervical spinal disease management, manufacturing development has increased over the past years. This article attempts to describe how the development of patient-specific implants, which are used during the procedures of anterior cervical corpectomy and vertebral body replacement (VBR), impacts the outcomes of cervical spondylotic myelopathy (CSM) management.Materials and Methods
This prospective clinical study included six patients who were implanted with patient-specific VBR for single-level or multilevel CSM. The following clinical scores were collected: visual analog scale (VAS), modified Japanese Orthopaedic Association (mJOA), Neck Dysfunction Index (NDI), and European myelopathy score (EMS), along with radiological measurements.Results
Six patients reached a mean follow-up date of 21months (12–24). Angle measurements remained constant during follow-up, including the C2–C7 Cobb angle and the corpectomy Cobb angle. Furthermore, no deformations, such as hyperlordosis or kyphosis, were detected. The anterior height (Ha) and the posterior height (Hp) of the corpectomy segment remained constant (ratio close to 1) with no severe subsidence (>3?mm) at the last follow-up. No height differences were detected between the preoperative and the last follow-up dates, neither for the upper Hp and Ha (0.97±0.09 and 1.00±0.06, respectively) nor for the lower adjacent vertebrate Hp and Ha (0.96±0.04 and 1.02±0.12). The mean mJOA and EMS recovery rates were 60.4% (standard deviation [SD] 20.4) and 77.0% (SD 29.7), respectively, at last the follow-up. An EMS of at least 16 of 18 was observed in 83% (5 of 6) of the patients. We recorded a preoperative NDI score at 47.1% (SD 18.6) that improved to 11.2% (SD 4.1) at the last follow-up (p<.01). The preoperative VAS neck (6.3, range 4–7) and the VAS arm (6.1, range 3– 9) scores improved to 1.3 (range 0–3) and 2.8 (range 0–5), respectively, at the last follow-up.Conclusions
This preliminary report suggests a possible benefit of the use of patient-specific implants in CSM treatment. The favorable clinical and radiological outcomes were associated with a correct achievement rate; these are promising elements toward the development of the concept of personalized therapy. Nonetheless, these encouraging results have to be confirmed now with a longer follow-up and a larger cohort. 相似文献12.
Kyoung-Tae Kim Dae-Chul Cho Joo-Kyung Sung Chi Heon Kim Hyun Kang Du Hwan Kim 《The spine journal》2017,17(2):203-210
Background Context
Lumbar spinal stenosis (LSS) can hinder a patient's physical activity, which in turn can impair glucose tolerance and body weight regulation in patients with type 2 diabetes mellitus (DM-2). Therefore, successful lumbar surgery could facilitate glycemic control and body weight regulation.Purpose
This study aimed to evaluate the effects of postoperative improvement in physical activity on body mass index (BMI) and hemoglobin A1c (HbA1c) level in patients with LSS and DM-2 over a 2-year follow-up period.Study Design
Prospective longitudinal observational study.Patient Sample
Patients with LSS and DM-2.Outcome Measures
Visual analogue scale (VAS) scores for back pain and leg pain, Oswestry Disability Index (ODI) scores, Japanese Orthopaedic Association (JOA) scores, JOA Back Pain Evaluation Questionnaire (JOABPEQ) sections, BMI, and blood analysis for HbA1c were carried out.Methods
A total of 119 patients were enrolled for analysis of the effect of successful decompression surgery on changes in HbA1c levels and BMI. The VAS score, ODI score, JOA score, JOABPEQ, BMI, HbA1c were reassessed at 6 months, 1 year, and 2 years after surgery. Additionally, correlations between changes in HbA1c and changes in the ODI, JOA, JOABPEQs, and BMI were analyzed.Results
The overall values of HbA1c before and at 6 months, 1 year, and 2 years after the surgery were 7.08±0.94%, 6.58±0.87%, 6.59±0.79%, and 6.59±0.79%, respectively (p-values; 6 months: .024; 1 year: .021; 2 years: .038). In the not well-controlled sugar (non-WCS) group (preoperative HbA1c>6.5%), the difference between pre- and postoperative HbA1c was highly statistically significant (p<.01). The overweight group (preoperative BMI≥25) showed statistically significant BMI reduction in the second year after surgery (p=.034). The postoperative HbA1c changes are strongly correlated with the improvements of ODI, JOA, and JOABPEQ after surgery.Conclusions
The present study demonstrates that in patients with DM-2 and LSS, successful lumbar surgery may facilitate glycemic control by enabling an increase in the patient's level of physical activity. Additionally, it could help reduce body weight in overweight (BMI>25) patients with DM-2 and LSS. 相似文献13.
Permsak Paholpak Alexander Nazareth Patrick C. Hsieh Zorica Buser Jeffrey C. Wang 《The spine journal》2017,17(9):1272-1284
Background Context
T1 slope is a novel thoracic parameter used to assess cervical spine sagittal balance. Thoracic index (TI) parameters including T1 slope and cervical sagittal alignment parameters may play an important role in degenerative cervical spondylolisthesis (DCS). Current literature regarding the relationship between TI and cervical sagittal alignment parameters in patients with DCS is limited.Purpose
(1) To evaluate the T1 slope, cervical sagittal alignment, and thoracic inlet parameter in patients with DCS using kinematic magnetic resonance imaging (kMRI), and (2) to find a correlation between the T1 slope, TI, and other cervical sagittal parameters in patients with DCS.Design/Setting
Retrospective kMRI study, Level III.Patient Sample
Fifty-two patients with DCS from 1,128 patients from a cervical kMRI database.Outcome Measures
T1 slope, C2–C7 angle, sagittal vertical axis C2–C7 (SVA C2–C7), cranial tilt, cervical tilt, neck tilt, and thoracic inlet angle (TIA).Methods
Cervical spine kMRIs of 52 patients with DCS (mean age 51.7±standard deviation) were analyzed in neutral, flexion, and extension positions. Patients with DCS were divided into two groups: anterolisthesis (N=33) and retrolisthesis (N=19). Each listhesis group was subclassified into grade 1 (slip 2–3?mm) and grade 2 (slip>3?mm).Results
Grade 2 retrolisthesis had the largest T1 slope followed by grade 1 retrolisthesis, grade 2 anterolisthesis, and grade 1 anterolisthesis. Significant differences were found between the anterolisthesis and the retrolisthesis groups in the neutral position (p=.025). The flexion position had the largest T1 slope and showed a significant difference with anterolisthesis in the neutral position (p=.041). Sagittal vertical axis C2–C7 showed strong correlation with cranial tilt in all DCS groups and all positions.Conclusions
In our study, T1 slope was larger in grade 2 DCS, and the retrolisthesis group had larger T1 slope than the anterolisthesis group. Presence of larger T1 slope was significantly correlated with larger cervical lordosis curvature. Furthermore, cranial tilt was strongly correlated with SVA C2–C7. 相似文献14.
Harald Krenzlin Tan Ta-Chih Christina Lampe Christian Lampe Markus Knuf Peter Horn Manfred Schwarz 《The spine journal》2018,18(8):1455-1459
Background Context
In patients with mucopolysaccharidosis (MPS), glycosaminoglycan deposits in the dura mater and supporting ligaments cause spinal cord compression and consecutive myelopathy, predominantly at the craniocervical junction. Disease characteristics of craniocervical stenosis (CCS) in patients with MPS differ profoundly from other hereditary and degenerative forms. Because of high periprocedural morbidity and mortality, patients with MPS pose a substantial challenge to the inexperienced medical care provider. As literature remains scarce, we present our experience with a large cohort of patients with MPS treated for CCS without atlanto-occipital instrumentation.Purpose
The present study aimed to describe a safe and least traumatic approach for treating CCS in children with MPS, avoiding primary instrumentation.Study Design
This is a prospective follow-up (cohort) study.Patient Samples
We report 15 consecutive patients with CCS related to MPS, who were treated with stand-alone cervical decompression.Outcome Measures
Myelopathy was assessed using magnetic resonance imaging (MRI), somatosensory evoked potentials, and clinical evaluation. Cervical instability was evaluated using plain x-ray and MRI. The disability status is quantified using either the Karnofsky or Lansky Performance Score.Methods
We describe 15 consecutive patients treated with craniocervical decompression. Data were collected prospectively. The mean follow-up is 6 years (5 standard deviation). The technique and treatment principles are described.Results
The overall clinical outcome in this patient cohort is good (mean Karnofsky Performance Score of 80). No patient developed signs of C0-C1-C2 instability or progressive myelopathy. Restenosis occurred in seven patients, requiring a total of eight reoperations.Conclusions
Surgery in patients with MPS is associated with high morbidity and mortality of up to 4.2%. Because of the unique nature of the disease, recurring stenosis is inevitable. To shorten the procedure time and simplify the anticipated reoperation, we provide data that craniocervical decompression is feasible without the necessity of primary osteosynthesis. In the absence of craniocervical instability, decompression surgery without occipitocervical stabilization yields good postoperative results and challenges the long-standing paradigm of prophylactic craniocervical fixation. 相似文献15.
R. Kirk Owens Leah Y. Carreon Erica F. Bisson Mohamad Bydon Eric A. Potts Steven D. Glassman 《The spine journal》2018,18(9):1632-1636
Background Context
Although lumbar disc herniation (LDH) classically presents with lower extremity radiculopathy, there are patients who have substantial associated back pain.Purpose
The present study aims to determine if patients with LDH with substantial back pain improve with decompression alone.Study Design
This is a longitudinal observational cohort study.Patient Sample
Patients enrolled in the Quality and Outcomes Database with LDH and a baseline back pain score of ≥5 of 10 who underwent single- or two-level lumbar discectomy only.Outcome Measures
Back and leg pain scores (0–10), Oswestry Disability Index (ODI), and EuroQoL 5D were measured.Methods
Standard demographic and surgical variables were collected, as well as patient-reported outcomes at baseline and at 3 and 12 months postoperatively.Results
The mean age of the cohort was 49.8 years and 1,195 (52.8%) were male. Mean body mass index was 30.1?kg/m2. About half of the patients (1,103, 48.8%) underwent single-level discectomy and the other half (1,159, 51.2%) had two-level discectomy. Average blood loss was 44?cc. Most of the patients (2,217, 98%) were discharged home with routine postoperative care. The average length of stay was 0.53 days. At 3 and 12 months postoperatively, there were statistically significant (p<.000) improvements in back pain (from 7.7 to 2.9 to 3.2), leg pain (from 7.5 to 2.3 to 2.5), and ODI (from 26.2 to 11.6 to 11.2). Patients with a single-level discectomy, compared with patients with a two-level discectomy, had similar improvements in 3- and 12-month back pain, leg pain, and ODI scores.Conclusions
Patients with LDH who have substantial back pain can be counseled to expect improvement in their back pain scores 12 months after a discectomy. 相似文献16.
Jin Kyu Lee Hae-won Jeong Il-Han Joo Young-Il Ko Chang-Nam Kang 《The spine journal》2018,18(6):962-969
Background Context
Controversy exists regarding percutaneous balloon kyphoplasty (PBK) in patients with a very severe osteoporotic vertebral compression fracture (vsOVCF).Purpose
The study was conducted to investigate the clinical and radiological outcomes of PBK for the treatment of vsOVCF compared with those of non-vsOVCF.Study Design/Setting
This is a retrospective, case-control study.Patient Sample
A total of 167 consecutive patients (210 vertebral bodies) who underwent PBK for OVCF between March 2010 and January 2015 were assessed.Outcome Measures
Visual analog scale (VAS) scores for back pain, Korean Oswestry disability index (K-ODI) scores, vertebral body height variations, and kyphotic angles were evaluated preoperatively, postoperatively, and 1 year after treatment.Materials and Methods
Patients in the non-vsOVCF group (anterior vertebral compression of more than two-thirds on plain radiograph) who had undergone PBK where compared with those in the non-vsOVCF group (compression between 30% and two-thirds). Clinical and radiological outcomes were compared. In addition, complications were evaluated.Results
In total, 31 patients (33 vertebrae) in the vsOVCF group and 136 patients (177 vertebrae) in the non-vsOVCF group were treated with PBK. Both groups had significant postoperative improvements in the clinical and radiological outcomes (VAS score, K-ODI score, vertebral body height variation, and kyphotic angle). There was no difference regarding the VAS score and the K-ODI score between the two groups at the final follow-up (p>.05). The cement leakage occurred frequently in the vsOVCF group (26 vertebrae, 78.8%) than in the non-vsOVCF group (92 vertebrae, 52.0%), the difference was statistically significant (p<.05). But there was no case that showed neurologic complication or pulmonary embolism caused by cement leakage. The incidence of recollapse was significantly higher in the vsOVCF group (five vertebrae, 15.2%) than in the non-vsOVCF group (seven vertebrae, 4.0%) (p<.05). The incidence of an adjacent segment fracture (vsOVCF group, 6 vertebrae, 18.2%; non-vsOVCF group, 21 vertebrae, 11.9%) was not significantly different (p=.320).Conclusions
Percutaneous balloon kyphoplasty is a safe and effective procedure for the treatment of vsOVCF. 相似文献17.
Ram Haddas Sujal Patel Raj Arakal Akwasi Boah Theodore Belanger Kevin L. Ju 《The spine journal》2018,18(9):1645-1652
Background Context
Cervical spondylotic myelopathy (CSM) typically manifests with a slow, progressive stepwise decline in neurologic function, including hand clumsiness and balance difficulties. Gait disturbances are frequently seen in patients with CSM, with more advanced cases exhibiting a stiff, spastic gait.Purpose
To evaluate the spatiotemporal parameters and spine and lower extremity kinematics during the gait cycle of adult patients with CSM before surgical intervention.Study Design
Prospective cohort study.Patient Sample
Twenty-eight subjects with symptomatic CSM who have been scheduled for surgery and 30 healthy controls (HC).Outcome Measures
Spine and lower extremity kinematics and spatiotemporal parameters.Methods
Clinical gait analysis was performed for patients with CSM and HC. The data were analyzed with a one-way analysis of variance.Results
Patients with CSM have significantly more anterior pelvis tilt (CSM: 13.97°, HC: 5.56°), larger lumbar lordosis (CSM: 8.59°, HC: 2.7°), smaller cervical lordosis (CSM: 6.02°, HC: 11.35°), and less head flexion (CSM: 0.69°, HC: 8.66°) at the beginning of the gait cycle. There was a decrease in knee range of motion in patients with CSM compared with controls (CSM: 36.31°, HC: 50.17°). Furthermore, patients with CSM presented with slower walking speed (CSM: 0.81?m/s, HC: 1.05?m/s), decreased cadence (CSM: 95.57 step/m, HC: 107.64 step/m), increased double support time (CSM: 0.40?s, HC: 0.28?s) and stride time (CSM:1.28?s, HC: 1.13?s), shorter stride length (CSM: 1.04?m, HC: 1.18?m) and step length (CSM:0.51?m, HC: 0.58?m), and wider width (CSM: 0.14?m, HC:0.11?m).Conclusions
Our study shows that patients with CSM enter the gait cycle with a larger anterior pelvic tilt and lumbar lordosis as well as less cervical lordosis and head flexion. As a consequence of these abnormal spinal parameters at the onset of the gait cycle, lower extremity biomechanics are also altered. Our study is the first to demonstrate the relationship between aberrant spinal alignment and lower extremity function. Identification of this interrelationship as well as the specific gait and biomechanical disturbances seen in myelopathic patients can both inform our understanding of the disease and tailor rehabilitation protocols. 相似文献18.
Philip K. Louie Steven M. Presciutti Stephanie E. Iantorno Daniel D. Bohl Kevin Shah Grant D. Shifflett Howard S. An 《The spine journal》2017,17(9):1264-1271
Background Context
Anterior cervical discectomy and fusion (ACDF) is a very common operative intervention for the treatment of cervical spine degenerative disease in those who have failed non-operative measures. However, studies examining long-term follow-up on patients who underwent ACDF reveal evidence of radiographic and clinical degenerative disc disease at the levels adjacent to the fusion construct. Consistent with other junctional regions of the spine, the cervicothoracic junction (CTJ) has significant morphologic variations. As a result, the CTJ undergoes significant static and dynamic stress. Given these findings, there has been some thought that ACDF down to C7 may experience additional risks for adjacent segment degeneration/disease (ASD) when compared with ASDFs that are cephalad to C7.Purpose
The goal of this study is to evaluate the rate of radiographic and clinical ASD in patients who have undergone single- or multilevel ACDF, down to C7.Study Design
This is a retrospective cohort study.Patient Sample
The sample included consecutive patients from a single orthopedic surgeon at one quaternary referral medical center who underwent an ACDF between January 2008 and November 2014. Indications for surgery included radiculopathy, myelopathy, or myeloradiculopathy in the setting of failed conservative treatments. Patients were excluded if they had an ACDF of which the caudal level was cephalad to C7 or if they had undergone a previous cervical fusion.Outcome Measures
Radiographic diagnosis of ASD was determined by the presence of disc space narrowing >50%, new or enlarged osteophytes, end plate sclerosis, or increased calcification of the anterior longitudinal ligament (ALL). Postoperatively, data were collected on the presence of new radicular or myelopathic symptoms indicative of pathology at C7–T1, indicating a diagnosis of clinical ASD.Methods
Demographic information was collected for all patients, which included age, sex, body mass index, smoking status, and Charleston Comorbidity Index (CCI). Several radiographic parameters were measured preoperatively, immediately postoperatively, and at the last follow-up: C2–C7 lordosis, sagittal vertical axis (SVA), thoracic inlet angle (TIA), and T1 slope C2–C7 lordosis were measured using the Cobb angle between the inferior end plate of C2 to the inferior end plate of C7. Radiographic and clinical factors associated with ASD were analyzed postoperatively.Results
Four patients (4.8%) presented with clinical evidence of ASD, all of whom also showed signs of radiographic ASD and improved with conservative measures. No patients underwent reoperation for ASD at the C7–T1 junction. Thirty patients (36.1%) presented radiographic evidence of ASD. These were generally older (54.4 vs. 48.4 years; p=.014). There were neither significant differences in radiographic parameters nor between single- versus multilevel ACDFs and the development of ASD.Conclusions
The cervicothoracic junction may present with vulnerability to ASD given the junctional biomechanics. However, this study provides evidence that an ACDF with the caudal level of C7 does not incur additional risk of ASD, showing similar outcomes to ACDFs at other levels. 相似文献19.
Yoshitaka Matsubayashi Hirotaka Chikuda Yasushi Oshima Yuki Taniguchi Yoh Fujimoto Takachika Shimizu Sakae Tanaka 《The spine journal》2017,17(5):622-626
Background Context
Previous studies have indicated that the T1 slope correlates with cervical lordosis. In contrast, the specific impact of the C7 sagittal vertical axis (C7SVA) on cervical lordosis remains unknown.Purpose
This study aimed to investigate the specific role of C7SVA in cervical lordosis.Study Design/Setting
This was a retrospective radiographic study.Patient Sample
Forty-eight consecutive patients who underwent lateral standing radiography of the entire spine were retrospectively reviewed.Outcome Measures
Radiographic parameters included occipito (Oc)-C7, Oc–C2, C2–C7, C2–C4, and C5–C7 angles; T1 slope; C7SVA; T1 pelvic angle (TPA); pelvic incidence; pelvic tilt; and sacral slope.Methods
The radiographs of 96 consecutive patients who underwent lateral standing radiography of the entire spine in June 2015 in our hospital were retrospectively reviewed. Patients having cervical deformities, having undergone cervical fusion, and under 18 years of age were excluded. A total of 48 Asian patients (14 men and 34 women; mean age, 54.6 years) were eligible. Pathologies included scoliosis, myelopathy, thoracolumbar deformity, and spondylosis. Spearman rank correlation coefficients were used to examine correlations between the parameters. The relationship between C5–C7 lordosis and the radiographic parameters was calculated using the forward stepwise multivariate regression analysis. The authors do not have financial associations relevant to this article.Results
C7SVA correlated with the Oc–C7 (r=0.42) and C2–C7 (r=0.50) angles. However, the correlation coefficient was smaller than that between the T1 slope and Oc–C7 (r=0.83) or C2–C7 (r=0.76) angles. When the C2–C7 angle was divided into C2–C4 and C5–C7 angles, C7SVA correlated with the C5–C7 (r=0.63) angle but not with the C2–C4 angle. The correlation coefficient between the C5–C7 angle and C7SVA was higher than that between the C5–C7 angle and T1 slope (r=0.53) or the C5–C7 angle and TPA (r=0.60). Using radiographic parameters and age, multiple regression analysis revealed that only C7SVA affected the C5–C7 angle.Conclusions
C7SVA was the only radiographic parameter that affected the C5–C7 angle. Both T1 slope and C7SVA are key to the shape of the cervical sagittal alignment. The results of this study can be a starting point to improve our understanding of cervical sagittal alignment. 相似文献20.
Parker E. Bohm Michael G. Fehlings Branko Kopjar Lindsay A. Tetreault Alexander R. Vaccaro Karen K. Anderson Paul M. Arnold 《The spine journal》2017,17(2):211-217