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
It remains unclear whether cervical laminoplasty (LP) offers advantages over cervical laminectomy and fusion (LF) in patients undergoing posterior decompression for degenerative cervical myelopathy (DCM).
Purpose
The objective of this study is to compare outcomes of LP and LF.
Study Design/Setting
This is a multicenter international prospective cohort study.
Patient Sample
A total of 266 surgically treated symptomatic DCM patients undergoing cervical decompression using LP (N=100) or LF (N=166) were included.
Outcome Measures
The outcome measures were the modified Japanese Orthopaedic Association score (mJOA), Nurick grade, Neck Disability Index (NDI), Short-Form 36v2 (SF36v2), length of hospital stay, length of stay in the intensive care unit, treatment complications, and reoperations.
Methods
Differences in outcomes between the LP and LF groups were analyzed by analysis of variance and analysis of covariance. The dependent variable in all analyses was the change score between baseline and 24-month follow-up, and the independent variable was surgical procedure (LP or LF). In the analysis of covariance, outcomes were compared between cohorts while adjusting for gender, age, smoking, number of operative levels, duration of symptoms, geographic region, and baseline scores.
Results
There were no differences in age, gender, smoking status, number of operated levels, and baseline Nurick, NDI, and SF36v2 scores between the LP and LF groups. Preoperative mJOA was lower in the LP compared with the LF group (11.52±2.77 and 12.30±2.85, respectively, p=.0297). Patients in both groups showed significant improvements in mJOA, Nurick grade, NDI, and SF36v2 physical and mental health component scores 24 months after surgery (p<.0001). At 24 months, mJOA scores improved by 3.49 (95% confidence interval [CI]: 2.84, 4.13) in the LP group compared with 2.39 (95% CI: 1.91, 2.86) in the LF group (p=.0069). Nurick grades improved by 1.57 (95% CI: 1.23, 1.90) in the LP group and 1.18 (95% CI: 0.92, 1.44) in the LF group (p=.0770). There were no differences between the groups with respect to NDI and SF36v2 outcomes. After adjustment for preoperative characteristics, surgical factors and geographic region, the differences in mJOA between surgical groups were no longer significant. The rate of treatment-related complications in the LF group was 28.31% compared with 21.00% in the LP group (p=.1079).
Conclusions
Both LP and LF are effective at improving clinical disease severity, functional status, and quality of life in patients with DCM. In an unadjusted analysis, patients treated with LP achieved greater improvements on the mJOA at 24-month follow-up than those who received LF; however, these differences were insignificant following adjustment for relevant confounders. 相似文献
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
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. 相似文献
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
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
There have been no prospective studies comparing anterior surgery and posterior method in terms of long-term outcomes. The purposes of this study is to clarify whether there is any difference in long-term clinical and radiologic outcomes of anterior decompression with fusion (ADF) and laminoplasty (LAMP) for the treatment of cervical spondylotic myelopathy (CSM).
Methods
Ninety-five patients were prospectively treated with ADF or LAMP for CSM in our hospital from 1996 through 2003. On alternate years, patients were enrolled to receive ADF (1997, 1999, 2001, and 2003: ADF group, n = 45) or LAMP (1996, 1998, 2000, and 2002: LAMP group, n = 50). We excluded 19 patients who died during follow-up, and 25 who were lost to follow-up. Clinical outcomes were evaluated by the recovery rate of the Japanese Orthopaedic Association (JOA) score between the two groups. Sagittal alignment of the C2–7 lordotic angle and range of motion (ROM) in flexion and extension on plain X-ray were measured.
Results
Mean age at the time of surgery was 58.3 years in the ADF group and 57.9 years in the LAMP group. Mean preoperative JOA score was 10.0 and 10.5, respectively. Mean recovery rate of the JOA score at 3–5 years postoperatively was significantly higher in the ADF group (p < 0.05). Reoperation was required in 1 patient for pseudarthrosis and in 1 patient for recurrence of myelopathy in the ADF group; no patient in the LAMP group underwent a second surgery. There was a significant difference in maintenance of the lordotic angle in the ADF group compared with the LAMP group (p < 0.05), but not in ROM.
Conclusions
Both ADF and LAMP provided similar good outcomes at 10-year time-point whereas ADF could achieve more satisfactory outcomes and better sagittal alignment at the middle-term. However, the incidence of reoperation and complication in the ADF group were higher than those in the LAMP group.
Study design
A prospective comparative study (not randomized). 相似文献
Physical therapy is commonly sought by people with lumbar disc herniation and associated radiculopathy. It is unclear whether physical therapy is effective for this population.
Purpose
To determine the effectiveness of physical therapist-delivered individualized functional restoration as an adjunct to guideline-based advice in people with lumbar disc herniation and associated radiculopathy.
Study Design
This is a preplanned subgroup analysis of a multicenter parallel group randomized controlled trial.
Patient Sample
The study included 54 participants with clinical features of radiculopathy (6-week to 6-month duration) and imaging showing a lumbar disc herniation.
Outcome Measures
Primary outcomes were activity limitation (Oswestry Disability Index) and separate 0–10 numerical pain rating scales for leg pain and back pain. Measures were taken at baseline and at 5, 10, 26, and 52 weeks.
Methods
The participants were randomly allocated to receive either individualized functional restoration incorporating advice (10 sessions) or guideline-based advice alone (2 sessions) over a 10-week period. Treatment was administered by 11 physical therapists at private clinics in Melbourne, Australia.
Results
Between-group differences for activity limitation favored the addition of individualized functional restoration to advice alone at 10 weeks (7.7, 95% confidence interval [CI] 0.3–15.1) and 52 weeks (8.2, 95% CI 0.7–15.6), as well as back pain at 10 weeks (1.4, 95% CI 0.2–2.7). There were no significant differences between groups for leg pain at any follow-up. Several secondary outcomes also favored individualized functional restoration over advice.
Conclusions
In participants with lumbar disc herniation and associated radiculopathy, an individualized functional restoration program incorporating advice led to greater reduction in activity limitation at 10- and 52-week follow-ups compared with guideline-based advice alone. Although back pain was significantly reduced at 10 weeks with individualized functional restoration, this effect was not maintained at later timepoints, and there were no significant effects on leg pain, relative to guideline-based advice. 相似文献
In clinical practice, the diagnosis of cervical radiculopathy is based on information from the patient's history, physical examination, and diagnostic imaging. Various physical tests may be performed, but their diagnostic accuracy is unknown.
Purpose
This study aimed to summarize and update the evidence on diagnostic performance of tests carried out during a physical examination for the diagnosis of cervical radiculopathy.
Study Design
A review of the accuracy of diagnostic tests was carried out.
Study Sample
The study sample comprised diagnostic studies comparing results of tests performed during a physical examination in diagnosing cervical radiculopathy with a reference standard of imaging or surgical findings.
Outcome Measures
Sensitivity, specificity, likelihood ratios are presented, together with pooled results for sensitivity and specificity.
Methods
A literature search up to March 2016 was performed in CENTRAL, PubMed (MEDLINE), Embase, CINAHL, Web of Science, and Google Scholar. The methodological quality of studies was assessed using the QUADAS-2.
Results
Five diagnostic accuracy studies were identified. Only Spurling's test was evaluated in more than one study, showing high specificity ranging from 0.89 to 1.00 (95% confidence interval [CI]: 0.59–1.00); sensitivity varied from 0.38 to 0.97 (95% CI: 0.21–0.99). No studies were found that assessed the diagnostic accuracy of widely used neurological tests such as key muscle strength, tendon reflexes, and sensory impairments.
Conclusions
There is limited evidence for accuracy of physical examination tests for the diagnosis of cervical radiculopathy. When consistent with patient history, clinicians may use a combination of Spurling's, axial traction, and an Arm Squeeze test to increase the likelihood of a cervical radiculopathy, whereas a combined results of four negative neurodynamics tests and an Arm Squeeze test could be used to rule out the disorder. 相似文献
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
Cement augmentation techniques are standard treatments for osteoporotic vertebral fractures. Compared with vertebroplasty, kyphoplasty is associated with lower rates of cement leak and better deformity correction; however, posterior wall fractures are relative, but not absolute; contraindications for both techniques and hence treatment practices vary among spine centers.
Purpose
The primary aim of this study was to assess our center's incidence of posterior cement leakage in osteoporotic vertebral fractures with posterior wall injury treated by balloon kyphoplasty (BKP). Secondarily, physiological results, pain relief, complication rates, and non-posterior cement leakage were also evaluated.
Study Design
This is a prospective cohort study done in a high-volume spine center in Germany.
Patient Sample
Eighty-two patients with 98 osteoporotic vertebral fractures with posterior wall cortical injury were studied from 2012 to 2016.
Outcome Measures
The following were the outcome measures: (1) physiological measures: standing plain x-rays (anteroposterior and lateral views), with the following parameters evaluated: cement leak behind the posterior vertebral body border, Cobb angle for local sagittal deformity, vertebral wedge angle, and anterior vertebral height; (2) cement volume injected in each vertebra; and (3) self-report measures: visual analog scale (VAS).
Methods
All patients underwent BKP using a bipedicular approach. Preoperative clinical and neurologic evaluations were done. Radiological evaluations included plain X-ray images, computed tomography scans and magnetic resonance imaging. The average follow-up period was 18 months.
Results
No cement leakage into the spinal canal occurred in any of the patients. Asymptomatic leakage into other sites was seen in 22 vertebrae (22.45%). There was significant improvement in the Cobb angle, the vertebral wedge angle, and the anterior vertebral height in all cases. The mean preoperative VAS was 8.1, and this improved to 2.3 on the third postoperative day.
Conclusion
Balloon kyphoplasty is a viable option for the treatment of osteoporotic vertebral fractures even with posterior wall involvement. 相似文献
To clarify whether there is any difference in mid-term clinical and radiologic outcomes between bone-grafted laminoplasty (BG LAMP) and non-bone-grafted laminoplasty (non-BG LAMP) when used to treat cervical spondylotic myelopathy.
Background
Conventional BG LAMP includes bone grafting at the lamina hinge site to prevent closure of the lamina postoperatively, but it often results in segmental fusion and sometimes causes loss of cervical mobility and lordotic alignment. Non-BG LAMP can now be performed to address this problem and preserve mobility postoperatively. However, there have been no studies comparing BG LAMP and non-BG LAMP to date.
Methods
Forty-one patients who underwent BG LAMP (n = 24) or non-BG LAMP (n = 17) and had 5 years of follow-up were enrolled in the study. Neurological status was assessed preoperatively and postoperatively using the Japanese Orthopedic Association (JOA) scoring system. The Numeric Rating Scale (NRS) was used to assess neck pain after surgery at the final visit. Radiographic parameters were evaluated at 1, 3, and 5 years after surgery. Postoperative segmental fusion was defined as the level at which the segmental flexion–extension range of motion was <1°.
Results
There was no significant difference in JOA score or recovery rate between the groups. NRS score was significantly lower in the BG group, indicating less neck pain (P < .01). The lordotic angle and range of motion at C2-C7 were significantly decreased in the BG group (P < .05). The segmental fusion was evident from 1 year postoperatively in both groups, but the fusion rate was significantly higher in the BG group (P < .05).
Conclusions
Neurologic outcomes were similar between the two groups, whereas axial symptom was lower in the BG group than in the non-BG group.
Degenerative changes in the cervical spine occur in an age-dependent manner. As the US population continues to age, the incidence of age-dependent, multilevel, degenerative cervical pathologies is expected to increase. Similarly, the average age of patients with cervical spondylotic myelopathy (CSM) will likely trend upward. Posterior cervical fusion (PCF) is often the treatment modality of choice in the management of multilevel cervical spine disease. Although outcomes following anterior cervical fusion for degenerative disease have been studied among older patients (aged 80 years and older), it is unknown if these results extend to octogenarian patients undergoing PCF for the surgical management of CSM.
Purpose
The present study aimed to quantify surgical outcomes following PCF for the treatment of CSM among the octogenarian patient population compared with patients younger than 80 years old.
Study Design/Setting
This was a retrospective study that used the National Surgical Quality Improvement Program (NSQIP).
Patient Sample
The sample included patients aged 60–89 who had CSM and who underwent PCF from 2012 to 2014.
Outcome Measures
The outcome measures were multimorbidity, prolonged length of stay (LOS), discharge disposition (to home or skilled nursing/rehabilitation facility), 30-day all-cause readmission, and 30-day reoperation.
Methods
The NSQIP database was queried for patients with CSM (International Classification of Disease, Ninth Revision, Clinical Modification code 721.1) aged 60–89 who underwent PCF (Current Procedural Terminology code 22600) from 2012 to 2014. Cohorts were defined by age group (60–69, 70–79, 80–89). Data were collected on gender, race, elective or emergent status, inpatientor outpatient status, where patients were admitted from (home vs. skilled nursing facility), American Society of Anesthesiologists class, comorbidities, and single- or multilevel fusion. After controllingfor these variables, logistic regression analysis was used to compare outcome measures in the different age groups.
Results
A total of 819 patients with CSM who underwent PCF (416 aged 60–69, 320 aged 70–79, and 83 aged 80–89) were identified from 2012 to 2014. Of the PCF procedures, 79.7% were multilevel. There were no significant differences in the odds of multimorbidity, prolonged LOS, readmission, or reoperation when comparing octogenarian patients with CSM with patients aged 60–69 or 70–79. Patients aged 60–69 and 70–79 were significantly more likely to be discharged to home than patients over 80 (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.8–10.4, p<.0001, and OR 2.7, 95% CI 1.1–6.4, p=.0005, respectively).
Conclusions
Compared with patients aged 60–69 and 70–79, octogenarian patients with CSM were significantly more likely to be discharged to a location other than home following PCF. After controlling for patient comorbidities and demographics, 80- to 89-year-old patients with CSM who underwent PCF did not differ in other outcomes when compared with the other age cohorts. These results can improve preoperative risk counseling and surgical decision-making. 相似文献
Laminectomy with posterior lumbar interbody fusion (PLIF) has been shown to achieve satisfactory clinical outcomes, but it leads to potential adverse consequences associated with extensive disruption of posterior bony and soft tissue structures.
Purpose
This study aimed to compare the clinical and radiographic outcomes of bilateral decompression via a unilateral approach (BDUA) with transforaminal lumbar interbody fusion (TLIF) and laminectomy with PLIF in the treatment of degenerative lumbar spondylolisthesis (DLS) with stenosis.
Study Design
This is a prospective cohort study.
Patient Sample
This study compared 43 patients undergoing BDUA+TLIF and 40 patients undergoing laminectomy+PLIF.
Outcome Measures
Visual analog scale (VAS) for low back pain and leg pain, Oswestry Disability Index (ODI), and Zurich Claudication Questionnaire (ZCQ) score.
Methods
The clinical outcomes were assessed, and intraoperative data and complications were collected. Radiographic outcomes included slippage of the vertebra, disc space height, segmental lordosis, and final fusion rate. This study was supported by a grant from The National Natural Science Foundation of China (81572168).
Results
There were significant improvements in clinical and radiographic outcomes from before surgery to 3 months and 2 years after surgery within each group. Analysis of leg pain VAS and ZCQ scores showed no significant differences in improvement between groups at either follow-up. The mean improvements in low back pain VAS and ODI scores were significantly greater in the BDUA+TLIF group than in the laminectomy+PLIF group. No significant difference was found in the final fusion rate at 2-year follow-up. The BDUA+TLIF group had significantly less blood loss, shorter length of postoperative hospital stay, and lower complication rate compared with the laminectomy+PLIF group.
Conclusions
When compared with the conventional laminectomy+PLIF procedure, the BDUA+TLIF procedure achieves similar and satisfactory effects of decompression and fusion for DLS with stenosis. The BDUA+TLIF procedure appears to be associated with less postoperative low back discomfort and quicker recovery. 相似文献
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
The long-term results of heterotopic ossification (HO) following lumbar total disc replacement (TDR) and the corresponding clinical and radiological outcomes are unclear.
Purpose
This study aimed to report the long-term results of HO following lumbar TDR and to analyze the clinical and radiological outcomes.
Study Design/Setting
A retrospective case review was performed for the consecutive patients who underwent lumbar TDR.
Patient Sample
The study included 48 patients (60 segments) who underwent lumbar TDR.
Outcome Measures
The time and location of HO development, segmental range of motion (ROM) of index level, the visual analog scale (VAS), and the Oswestry Disability Index (ODI) were analyzed.
Methods
Forty-eight patients (60 segments) were divided into HO and non-HO groups, and radiographs were used to measure the time and location of HO development. We compared segmental ROM between two groups using flexion-extension radiographs. Clinical outcomes were assessed using the VAS and the ODI. Furthermore, the segmental ROM, VAS, and ODI scores of each HO class were compared with those of the non-HO group.
Results
The mean follow-up duration was 104.4 months. Heterotopic ossification was detected in 30 of 60 segments following lumbar TDR, and HO progression was noted in six segments. The mean segmental ROM was significantly lower in the HO group than in the non-HO group. The mean VAS and ODI scores were not significantly different between the two groups. Segmental ROM was significantly lower in the class III and IV of the HO group than in the non-HO group. The VAS and ODI scores were not significantly different among the different classes.
Conclusions
We found that the incidence of HO is the highest within 12 months after lumbar TDR, and the incidence might increase 5 years after surgery. Furthermore, HO progressed over time. Segmental ROM was decreased in the HO groups; however, the limitation in motion might have little clinical influence. 相似文献
Revision posterior decompression and fusion surgery for patients with symptomatic adjacent segment degeneration (ASD) is associated with significant morbidity and is technically challenging. The use of a stand-alone lateral lumbar interbody fusion (LLIF) in patients with symptomatic ASD may prevent many of the complications associated with revision posterior surgery.
Purpose
The objective of this study was to assess the clinical and radiographic outcomes of patients who underwent stand-alone LLIF for symptomatic ASD.
Study Design
This is a retrospective case series.
Patient Sample
We retrospectively reviewed patients with a prior posterior instrumented fusion who underwent a subsequent stand-alone LLIF for ASD by a single surgeon. All patients had at least 18 months of follow-up. Patients were diagnosed with symptomatic ASD if they had a previous lumbar fusion with the subsequent development of back pain, neurogenic claudication, or lower extremity radiculopathy in the setting of imaging, which demonstrated stenosis, spondylolisthesis, kyphosis, or scoliosis at the adjacent level.
Outcome Measures
Patient-reported outcomes were obtained at preoperative and final follow-up visits using the Oswestry Disability Index [ODI], visual analog scale (VAS)—back, and VAS—leg. Radiographic parameters were measured, including segmental and overall lordoses, pelvic incidence-lumbar lordosis mismatch, coronal alignment, and intervertebral disc height.
Methods
Clinical and radiographic outcomes were compared between preoperative and final follow-up using paired t tests.
Results
Twenty-five patients met inclusion criteria. The mean age was 62.0±11.3 years. The average follow-up was 34.8±22.4 months. Fifteen (60%) underwent stand-alone LLIF surgery for radicular leg pain, 7 (28%) for symptoms of claudication, and 25 (100.0%) for severe back pain. Oswestry Disability Index scores significantly improved from preoperative values (46.6±16.4) to final follow-up (30.4±16.8, p=.002). Visual analog scale—back (preop 8.4±1.0, postop 3.2±1.9; p<.001), and VAS—leg (preop 3.6±3.4, postop 1.9±2.6; p<.001) scores significantly improved following surgery. Segmental and regional lordoses, as well as intervertebral disc height, significantly improved (p<.001) and remained stable (p=.004) by the surgery. Pelvic incidence-lumbar lordosis mismatch significantly improved at the first postoperative visit (p=.029) and was largely maintained at the most recent follow-up (p=.45). Six patients suffered from new-onset thigh weakness following LLIF surgery, but all showed complete resolution within 6 weeks. Three patients required subsequent additional surgeries, all of which were revised to include posterior instrumentation.
Conclusions
Stand-alone LLIF is a safe and effective approach with low morbidity and acceptable complication rates for patients with symptomatic ASD following a previous lumbar fusion. 相似文献
To investigate the effect of the preoperative cross-sectional area (CSA) of the semispinalis cervicis on postoperative loss of cervical lordosis (LCL) after laminoplasty.
Methods
A total of 144 patients who met the inclusion criteria between January 1999 and December 2015 were enrolled. Radiographic assessments were performed to evaluate the T1 slope, C2-7 sagittal vertical axis (SVA), cephalad vertebral level undergoing laminoplasty (CVLL), preoperative C2-7 Cobb angle, and preoperative CSA of the semispinalis cervicis.
Results
The T1 slope and the summation of the CSAs (SCSA) at each level of the semispinalis cervicis correlated with LCL, whereas the C2-7 SVA, CVLL, and preoperative C2-7 Cobb angle did not. Multiple regression analysis demonstrated that a high T1 slope and a low SCSA of the semispinalis cervicis were associated with LCL after laminoplasty in patients with cervical spondylotic myelopathy (CSM). The CSA of the semispinalis cervicis at the C6 level had the greatest association with LCL, which suddenly decreased with a LCL of 10°. The best cutoff point of the CSA of the semispinalis cervicis at the C6 level, which predicts LCL?>?10°, was 154.5 mm2 (sensitivity 74.3%; specificity 71.6%; area under the curve 0.828; 95% confidence interval 0.761–0.895).
Conclusion
Preoperative SCSA of the semispinalis cervicis was a risk factor for LCL after laminoplasty. Spine surgeons should evaluate semispinalis cervicis muscularity at the C6 level when planning laminoplasty for patients with CSM.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
Short-segment posterior spinal instrumentation for thoracolumbar burst fracture provides superior correction of kyphosis by an indirect reduction technique, but it has a high failure rate.
Purpose
The purpose of the study we report here was to compare outcomes for temporary short-segment pedicle screw fixation with vertebroplasty and for such fixation without vertebroplasty.
Study Design
This is a prospective multicenter comparative study.
Patient Sample
We studied 62 consecutive patients with thoracolumbar burst fracture who underwent short-segment posterior instrumentation using ligamentotaxis with Schanz screws with or without vertebroplasty.
Outcome Measures
Radiological parameters (Cobb angle on standing lateral radiographs) were used.
Methods
Implants were removed approximately 1 year after surgery. Neurologic function, kyphotic deformity, canal compromise, and fracture severity were evaluated prospectively.
Results
After surgery, all patients with neurologic deficit had improvement equivalent to at least one grade on the American Spinal Injury Association impairment scale and had fracture union. Kyphotic deformity was reduced significantly, and reduction of the vertebrae was maintained with and without vertebroplasty, regardless of load-sharing classification. Although no patient required additional anterior reconstruction, kyphotic change was observed at disc level mainly after implant removal with or without vertebroplasty.
Conclusions
Temporary short-segment fixation yielded satisfactory results in the reduction and maintenance of fractured vertebrae with or without vertebroplasty. Kyphosis recurrence may be inevitable because adjacent discs can be injured during the original trauma. 相似文献
