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1.
Koji Tamai Akinobu Suzuki Akito Yabu Shinji Takahashi Hiromitsu Toyoda Masatoshi Hoshino Hidetomi Terai Hiroaki Nakamura 《The spine journal》2019,19(2):246-252
Background Context
The impact of preoperative facet degeneration (FD) on surgical outcomes following laminoplasty has not been established.Purpose
To elucidate the influence of preoperative FD on pre and postoperative clinical symptoms and radiographic parameters.Study Design
Retrospective analysis of prospectively collected data.Patient Sample
A total of 135 consecutive patients who underwent laminoplasty for cervical spondylotic myelopathy with greater than 2 years follow-up.Outcome Measures
The cervical Japanese Orthopedic Association score, visual analog scale, Short Form-36, Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire, and radiographic parameters (C7 slope, C2–C7 sagittal vertical axis, C2–C7 lordotic angle, and scoring of FD).Methods
FD severity of the bilateral facets of C2–3 to C7–T1 was graded using preoperative computer tomography images. Patients were divided into two quantiles according to the mean score of their FD grading: mild (n=69) and severe FD groups (n=66). The preoperative clinical score and radiographic parameters of the two groups were compared. Variables with p<.05 were included in the multinomial logistic regression model. The changes in clinical scores and radiographic parameters between both groups (from the preoperative to 2-year postoperative period) were compared using a mixed-effect model, after adjusting for age and sex.Results
Mean age and neck pain visual analog scale were independently associated with FD severity (age: p=.004, neck pain: p=.004). However, the other preoperative clinical scores and radiographic parameters were not significantly different. In terms of the change in clinical scores 2 years postlaminoplasty, no significant differences between the severe and mild FD groups were noted. While the mild FD group had a reduced C2–C7 lordotic angle, the severe FD group demonstrated an increased C2–C7 lordotic angle 2 years postlaminoplasty (p=.044). The change in C7 slope and C2–C7 sagittal vertical axis showed no significant differences.Conclusions
Preoperative FD severity did not influence the 2-year surgical outcomes of laminoplasty, in terms of improvement in myelopathy, patient-oriented score of quality of life, physical and mental status, as well as neck pain. Furthermore, preoperative FD severity correlated with neither preoperative cervical imbalance nor balance deterioration after laminoplasty. These results may encourage physicians to consider laminoplasty for patients with cervical spondylotic myelopathy, regardless of the severity of FD. 相似文献2.
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3.
Brett D. Rosenthal Tyler J. Jenkins Arjun Ranade Surabhi Bhatt Wellington K. Hsu Alpesh A. Patel 《The spine journal》2019,19(1):157-162
Background Context
Despite the prevalence and importance of myelopathy, there is a paucity of objective and quantitative clinical measures. The most commonly used diagnostic tools available are nonquantitative physical exam findings (eg, pathologic reflexes, and gait disturbance) and subjective scoring systems (eg, modified Japanese Orthopaedic Association [mJOA]). A decline in fine motor coordination is a hallmark of early myelopathy, which may be useful for quantitative testing.Purpose
To identify if a novel tablet application could provide a quantitative measure of upper extremity dysfunction in cervical spondylotic myelopathy.Study Design/Setting
Prospective cohort study Patient Sample: Adult patients with a diagnosis of cervical spondylotic myelopathy from a board-certified, spine surgeon were compared with age-matched, healthy, and adult control patients. Outcome Measures: Self-reported function was assessed via the mJOA. Upper extremity function was measured via the fine motor skills (FiMS) tablet test.Methods
Subjects and controls prospectively completed the mJOA paper survey and the FiMS tablet testing, which consisted of four challenges.Results
After age-matching, 65 controls and 28 myelopathic patients were available for comparison. The mean mJOA was 13.5 ± 2.9 in the myelopathic cohort and 17.3 ± 1.1 in the control cohort (p < .0001). The average scores for challenges 1–4 in control patients were 24.4, 16.3, 3.2, and 6.6, respectively, whereas the average scores for the myelopathic patients were 16.6, 10.5, 1.4, and 1.8, respectively (p values for all four challenges <.001). Based upon the 15 control subjects who repeated FiMS testing four sequential times, intrarater reliability was excellent, yielding an interclass correlation coefficient of 0.88Conclusions
The FiMS tablet application produced significantly lower scores in a myelopathic cohort when compared with an age-matched control cohort. This is true for all four challenges in the FiMS tablet application. The test can be completed in 1.5 minutes, producing a reliable, quantitative measure of cervical myelopathy upper extremity function. In summary, the FiMS tablet application is a novel, easily administered, objectively quantifiable test for analyzing cervical spondylotic myelopathy. 相似文献4.
Selective blocking laminoplasty in cervical laminectomy and fusion to prevent postoperative C5 palsy
BACKGROUND CONTEXT
Cervical laminectomy and fusion (CLF) is a common surgical option for multilevel cord compression. Postoperative C5 palsy occurrence after CLF has been a vexing problem for spine physicians. The posterior shift of the cord following laminectomy has been implicated as a major factor for postoperative C5 palsy, but attempts by spine surgeons to mitigate excessive shift while providing sufficient decompression have not been well reported.PURPOSE
To compare the incidence of postoperative C5 palsy after performing selective blocking laminoplasty concurrently with CLF to those of conventional CLF.STUDY DESIGN
A retrospective comparative study of prospectively collected data.PATIENT SAMPLE
Of 116 cervical myelopathy patients with degenerative cervical myelopathy, ossification of the posterior longitudinal ligament, and multilevel disc herniation, 93 patients (69 in group A [CLF group] and 24 in group B [selective blocking laminoplasty with CLF, CLF-S group]) were included in the study.OUTCOME MEASURES
The primary outcome measure was the occurrence of postoperative C5 palsy. Secondary end points included (1) clinical outcomes based on pain intensity, neck disability index (NDI), Japanese Orthopaedic Association (JOA) score, (2) radiologic outcomes including cervical alignment and fusion rate at 1 year and hardware complications, and (3) perioperative data (hospital stay, blood loss, and operative times).METHODS
We compared the occurrence of postoperative C5 palsy, as well as clinical, radiologic, and surgical outcomes, between the two groups at 1-year follow-up.RESULTS
The patients in both groups were statistically similar between the groups with respect to demographic characteristics such as age, sex, smoking status, body mass index, preoperative pathology, surgical segments, and the degree of the cervical lordosis. Postoperative C5 palsy developed in 9 of 61 patients (14%) in group A and in 0 of 24 patients (0%) in group B (CLF-S group) (p=.03). Postoperative neck pain, NDI, and JOA improvement were not significantly different between the two groups (p=.93, 0.90, and 0.79, respectively). Perioperative data did not differ significantly between the two groups.CONCLUSIONS
This study showed that performing selective blocking laminoplasty might lead to reducing the incidence of postoperative C5 palsy in CLF surgery. 相似文献5.
Shota Ikegami Jun Takahashi Hiromichi Misawa Takahiro Tsutsumimoto Mutsuki Yui Shugo Kuraishi Toshimasa Futatsugi Masashi Uehara Hiroki Oba Hiroyuki Kato 《The spine journal》2018,18(5):755-761
Background Context
There is little information on the relationship between magnetic resonance imaging (MRI) T2-weighted high signal change (T2HSC) in the spinal cord and surgical outcome for cervical myelopathy. We therefore examined whether T2HSC regression at 1 year postoperatively reflected a 5-year prognosis after adjustment using propensity scores for potential confounding variables, which have been a disadvantage of earlier observational studies.Purpose
The objective of this study was to clarify the usefulness of MRI signal changes for the prediction of midterm surgical outcome in patients with cervical myelopathy.Study Design/Setting
This is a retrospective cohort study.Patient Sample
We recruited 137 patients with cervical myelopathy who had undergone surgery between 2007 and 2012 at a median age of 69 years (range: 39–87 years).Outcome Measures
The outcome measures were the recovery rates of the Japanese Orthopaedic Association (JOA) scores and the visual analog scale (VAS) scores for complaints at several body regions.Materials and Methods
The subjects were divided according to the spinal MRI results at 1 year post surgery into the MRI regression group (Reg+ group, 37 cases) with fading of T2HSC, or the non-regression group (Reg? group, 100 cases) with either no change or an enlargement of T2HSC. The recovery rates of JOA scores from 1 to 5 years postoperatively along with the 5-year postoperative VAS scores were compared between the groups using t test. Outcome scores were adjusted for age, sex, diagnosis, symptom duration, and preoperative JOA score by the inverse probability weighting method using propensity scores.Results
The mean recovery rates in the Reg? group were 35.1%, 34.6%, 27.6%, 28.0%, and 30.1% from 1 to 5 years post surgery, respectively, whereas those in the Reg+ group were 52.0%, 52.0%, 51.1%, 49.0%, and 50.1%, respectively. The recovery rates in the Reg+ group were significantly higher at all observation points. At 5 years postoperatively, the VAS score for pain or numbnessin the arms or hands of the patients in the Reg+ group (24.7?mm) was significantly milder than that of the patients in the Reg? group (42.2?mm).Conclusions
Spinal T2HSC improvement at 1 year postoperatively may predict a favorable recovery until up to 5 years after surgery. 相似文献6.
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.
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
Background Context
The timed 30-m walking test (30MWT) is used in clinical practice and in research to objectively quantify gait impairment. The psychometric properties of 30MWT have not yet been rigorously evaluated.Purpose
This study aimed to determine test-retest reliability, divergent and convergent validity, and responsiveness to change of the 30MWT in patients with degenerative cervical myelopathy (DCM).Study Design/Setting
A retrospective observational study was carried out.Patient Sample
The sample consisted of patients with symptomatic DCM enrolled in the AOSpine North America or AOSpine International cervical spondylotic myelopathy studies at 26 sites.Outcome Measures
Modified Japanese Orthopaedic Association scale (mJOA), Nurick scale, 30MWT, Neck Disability Index (NDI), and Short-Form-36 (SF-36v2) physical component score (PCS) and mental component score (MCS) were the outcome measures.Methods
Data from two prospective multicenter cohort myelopathy studies were merged. Each patient was evaluated at baseline and 6 months postoperatively.Results
Of 757 total patients, 682 (90.09%) attempted to perform the 30MWT at baseline. Of these 682 patients, 602 (88.12%) performed the 30MWT at baseline. One patient was excluded, leaving601 in the analysis. At baseline, 81 of 682 (11.88%) patients were unable to perform the test, and their mJOA, NDI, and SF-36v2 PCS scores were lower compared with those who performed the test at baseline. In patients who performed the 30MWT at baseline, there was very high correlation among the three baseline 30MWT measurements (r=0.9569–0.9919). The 30MWT demonstrated good convergent and divergent validity. It was moderately correlated with the Nurick (r=0.4932), mJOA (r=?0.4424), and SF-36v2 PCS (r=?0.3537) (convergent validity) and poorly correlated with the NDI (r=0.2107) and SF-36v2 MCS (r=?0.1984) (divergent validity). Overall, the 30MWT was not responsive to change (standardized response mean [SRM]=0.30). However, for patients who had a baseline time above the median value of 29 seconds, the SRM was 0.45.Conclusions
The 30MWT shows high test-retest reliability and good divergent and convergent validity. It is responsive to change only in patients with more severe myelopathy. The 30MWT is a simple, quick, and affordable test, and should be used as an ancillary test to evaluate gait parameters in patients with DCM. 相似文献9.
Michael G. Fehlings Carlo Santaguida Lindsay Tetreault Paul Arnold Giuseppe Barbagallo Helton Defino Shashank Kale Qiang Zhou Tim S. Yoon Branko Kopjar 《The spine journal》2017,17(1):102-108
Background Context
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10.
Sung Hyun Noh Kyung Hyun Kim Dong Ah Shin Jeong Yoon Park Seong Yi Sung Uk Kuh Keung Nyun Kim Dong Kyu Chin Keun Su Kim Do Heum Yoon Yong Eun Cho 《The spine journal》2019,19(2):276-284
BACKGROUND CONTEXT
Because of the scarcity of atypical spinal meningioma, there is a lack of research on this type of tumor or its associated metastases.PURPOSE
The aim of this study was to investigate the biological behavior of atypical spinal meningioma and identify its prognostic factors by reviewing surgical and clinical outcomes of patients with these tumors.STUDY DESIGN
A retrospective chart review was performed.PATIENT SAMPLE
We retrospectively reviewed the data from all patients who underwent spinal cord tumor excision between 1994 and 2017. Seventeen patients were pathologically proven to have atypical spinal meningioma.OUTCOME MEASURES
We examined patients’ neurologic status by determining their Nurick scores before and after surgery. Moreover, imaging studies, laboratory data, and the employed surgical method were analyzed retrospectively, as was the Ki-67 index and prognosis following postoperative radiation therapy.METHODS
The ranges, locations, and pathologic diagnoses of the tumors were extracted from the radiological and pathological records of each patient. The extent of surgery and progression of disease were confirmed using postoperative enhanced magnetic resonance imaging. Patients were divided into two atypical spinal meningioma groups: primary and metastatic. The demographics, age, sex, presenting symptom duration, tumor location, Simpson resection grade, Ki-67, radiotherapy, recurrence, overall survival, and progression-free survival of patients in both groups were compared.RESULTS
Seventeen patients were included in the analysis, of whom 12 (70%), 4 (24%), and 1 (6%) had tumors in the thoracic, cervical, and sacral regions, respectively. Complete and subtotal resections were achieved in 15 (88%) and 2 (12%) patients, respectively. Overall and progression-free survival rates in patients who underwent complete resection were longer than those in patients who underwent subtotal resection (p<.001). Four patients (24%) had metastatic meningiomas in the brain, among whom three were administered adjuvant radiotherapy after surgery. Two patients with intramedullary atypical spinal meningioma had metastatic tumors and experienced poorer prognoses. The 5-year overall and progression-free survival rates were 84.4% and 85.2%, respectively. The Simpson resection grade, Ki-67 index, and preoperative neurologic status were found to be important prognostic factors on univariate Cox regression analysis (p<.05).CONCLUSIONS
Complete resection should be considered as a primary treatment modality for individuals with atypical spinal meningioma. If subtotal resection is performed, adjuvant therapy can be administered. 相似文献11.
Sarat P. Chandra Pankaj Singh Rajender Kumar Deepak Agarwal Vivek Tandon Sharad S. Kale Chitra Sarkar 《The spine journal》2019,19(1):131-143
Background
Vertebral body hemangiomas with myelopathy are difficult to manage.Objective
The objective of this study was to evaluate the role of intraoperative ethanol embolization, surgical decompression, and instrumented short-segment fusion in vertebral hemangioma (VH) with myelopathy and long-term outcome (>24 months).Clinical Materials and Methods
This prospective study included symptomatic VH with cord compression with myelopathy. Pathologic fractures and deformity or multilevel pathologies were excluded from the study. Surgery consisted of intraoperative bilateral pedicular absolute alcohol (<1% hydrated ethyl alcohol) injection, laminectomy, and cord decompression at the level of pathology followed by a short-segment instrumented fusion using pedicle screws.Results
The study included 33 patients (mean 26.9±13.2, range: 10–68 years, 18 females). The clinical features of the study were myelopathy in all patients (5 paraplegic), sphincter involvement (13), and mid back or lower back pain (7). The preoperative American Spinal Injury Association (ASIA) scores were A (7), B (11), C (6), D (8), and E (1). Majority of the patients had single vertebral involvement (30) and three patients had multiple-level involvement. Six patients underwent surgery earlier (one underwent alcohol embolization). The mean surgical time was 124±39 minutes, and the average blood loss was 274±80?cc. The mean amount of absolute alcohol injected was 14.6±5.7?cc (two patients required 20 and 25?cc). Immediate embolization was achieved in all patients, allowing laminectomy and easy removal of soft-tissue hemangioma. Post surgery, one patient had transient deterioration, and the condition of the rest of the patients improved (sphincters improved in nine patients) at a follow-up ranging 28–103 months (mean 47.6±22.3). Follow-up ASIA scores were E (26), D (4), B (2), and C (1). All patients showed evidence of bone sclerosis and relief of cord compression on follow-up imaging.Conclusions
This is the largest study in literature showing excellent improvement, low reoperation rates after ethanol embolization, and short-segment fixation. 相似文献12.
BACKGROUND
The pattern of linear graph schematized by visual analogue scale (VAS) score displaying pain worsening between 2 days and 2 weeks after selective nerve root block (SNRB) is called rebound pain.PURPOSE
The purpose of this study was to determine if sodium hyaluronate and carboxymethyl cellulose solution (HA-CMC sol) injection could reduce the occurrence of rebound pain at 3 days to 2 weeks after SNRB in patients with radiculopathy compared with injection with corticosteroids and local anesthetics alone.STUDY DESIGN/SETTING
Double blinded randomized controlled clinical trial.PATIENT SAMPLE
A total of 44 patients (23 of 24 patients in the Guardix group and 21 of 24 patients in the control group) who finished the follow-up session were subjects of this study.OUTCOME MEASUREMENT
Patients were asked to write down their average VAS pain scores daily for 12 weeks. Functional outcomes were assessed by Oswestry Disability Index, Roland Morris Disability Questionnaire , and Short Form-36.METHOD
A cocktail of corticosteroids, 1% lidocaine, 0.5% Bupivacaine, and 1 mL of normal saline was used for the control group whereas a cocktail of corticosteroids, 1% lidocaine, 0.5% Bupivacaine, and 1 mL of HA-CMC solution was used for the G group. Study participants were randomized into one of two treatment regimens. They were followed up for 3 months.RESULTS
VAS score at 2 weeks after the procedure was 4.19±1.32 in the control group, which was significantly (p<.05) higher than that (2.43±1.24) in the G group. VAS score at 6 weeks after the procedure was 4.00±1.23 in the control group and 3.22±1.45 in the G group, showing no significant (p=.077) difference between the two groups. There were no significant differences in functional outcomes at 6 or 12 weeks after the procedure.CONCLUSIONS
Compared with conventional cocktail used for SNRB, addition of HA-CMC sol showed effective control of rebound pain at 3 days to 2 weeks after the procedure. 相似文献13.
Study Design
A report of two cases with complex cervical spondylotic myelopathy (CSM) and review of the literature.Objective
To describe two unique patients with complex CSM due to simultaneous anomalies as anteroposterior compressions of the spinal cord in both upper and lower cervical spine, caused by hypertrophic transverse ligament of atlas (TLA), dysplasia of the posterior arch of atlas, disc herniation, hypertrophic ligamentum flavum and osteophytes.Methods
We present such two cases with clinical, imageological presentations, and describe the surgical procedure, to which both patients responded favorably.Results
The neurological functions of both patients gradually improved according to the JOA scores and VAS scores in preoperative clumsiness and gait disturbance during the mean follow-up period lasted for 18 months. The latest plain radiographs and computed tomography (CT) revealed good fusion without instrumental failure and magnetic resonance imaging (MRI) showed good decompression of C1–7 spinal cord of both patients. Both patients are progressively followed-up.Conclusion
Posterior surgical approach as C1–7 laminectomy with fixations or occipital-cervical fusions may obtain better reconstructions of the cervical spine and good neurological recovery for the patients with complex CSM we present. However, the incidence and ethnic predisposition for the patients with complex CSM are still unclear.14.
Robert J. Rothrock Jeremy M. Steinberger Henry Badgery Andrew C. Hecht Samuel K. Cho John M. Caridi Stacie Deiner 《The spine journal》2019,19(1):104-112
Background Context
As increasing numbers of elderly Americans undergo spinal surgery, it is important to identify which patients are at highest risk for poor cognitive and functional recovery. Frailty is a geriatric syndrome that has been closely linked to poor outcomes, and short-form screening may be a helpful tool for preoperative identification of at-risk patients.Purpose
This study aimed to conduct a pilot study on the usefulness of a short-form screening tool to identify elderly patients at increased risk for prolonged cognitive and functional recovery following elective spine surgery.Study Design/Setting
This is a prospective, comparative cohort study.Patient Sample
The sample comprised 100 patients over age 65 who underwent elective spinal surgery (cervical or lumbar) at a single, large academic medical center from 2013 to 2014.Outcome Measures
Fatigue, Resistance, Ambulation, Illnesses, Loss of Weight (FRAIL) scale, Postoperative Quality of Recovery Scale (PQRS), and instrumental activities of daily living (IADL) scores were the outcome measures.Methods
Included patients were assessed with the FRAIL scale and stratified as robust, pre-frail, or frail. The PQRS and IADL scores were also obtained. Patients were re-examined at 1 day, 3 days, 1 month, and 3 months after surgery for cognitive recovery at 3 months, and secondarily, functional recovery at 3 months.Results
At 3 months, only 50% of frail patients had recovered to their cognitive baseline compared with 60.7% of pre-frail and 69.2% of robust patients (trend). At 3 months, 66.7% of frail patients had recovered to their functional baseline compared with 57% of pre-frail and 76.9% of robust patients (trend). Using multivariate regression modeling, at 3 months, frail patients were less likely to have recovered to their cognitive baseline compared with pre-frail and robust patients (odds ratio 0.39, confidence interval 0.131–1.161).Conclusions
This pilot study demonstrates a trend toward poorer cognitive recovery 3 months following elective spinal surgery for frail patients. Frailty screening can help preoperatively identify patients who may experience protracted cognitive and functional recovery. 相似文献15.
Takashi Hirai Toshitaka Yoshii Kenichiro Sakai Hiroyuki Inose Tsuyoshi Yamada Tsuyoshi Kato Shigenori Kawabata Yoshiyasu Arai Kenichi Shinomiya Atsushi Okawa 《Journal of orthopaedic science》2018,23(1):32-38
Background
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16.
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17.
Man Hung Charles L. Saltzman Maren W. Voss Jerry Bounsanga Richard Kendall Ryan Spiker Brandon Lawrence Darrel Brodke 《The spine journal》2019,19(1):34-40
BACKGROUND CONTEXT
The Patient-Reported Outcomes Information System (PROMIS) instruments are an important advancement in the use of PROs, but need to be evaluated with longitudinal data to determine whether they are responsive to change in specific clinical populations.PURPOSE
The purpose of this study was to assess the responsiveness of the PROMIS Physical Function (PF), PROMIS Pain Interference (PI), Neck Disability Index (NDI), and the Oswestry Disability Index (ODI).STUDY DESIGN/SETTING
This study entailed prospective data collection from consecutive patients aged 18 and older, visiting a university-based orthopaedic spine clinic between October 2013 and January 2017.PATIENT SAMPLE
A total of 763 participants in the sample had a mean age of 58 (SD?=?15) years and the sample was 50.2% male and 92.8% Caucasian.OUTCOME MEASURES
The PROMIS PF and PROMIS PI Computerized Adaptive Tests along with either the NDI or ODI instruments were administered on tablet computers before clinic visits. Global rating of change questions relating to pain and function levels was also administered.METHODS
Baseline scores were compared with follow-up scores at four different time-points from 3-months to 6-months and beyond. Patient demographics, mean scores, paired-sample t tests, Standardized Response Mean (SRM), and Effect Size (ES) were analyzed to determine instrument responsiveness. This project was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award number U01AR067138 and the authors have no conflicts of interest to disclose.RESULTS
The PROMIS instruments were strongly correlated with each other as well as with the NDI and ODI. Responsiveness was significant on all four instruments at every time-point assessed (paired sample t tests ranged from p?<?.001 to p?=?.049). SRM's were large and over 0.94 for every instrument at every time-point. Cohen's d ES were large and over 0.96 for all at all time-points, except for the NDI which had ES ranging from 0.74 to 0.83. This study showed large effect sizes and responsiveness of the PROMIS PF, PROMIS PI, NDI and ODI in a population of orthopaedic patients with spine pathologies.CONCLUSION
This study demonstrates strong responsiveness of the PROMIS PF and PROMIS PI in a spine clinic population. 相似文献18.
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19.
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20.
Ragnhild B. Wijma Marloes Emous Merel van den Broek Anke Laskewitz Anneke C. Muller Kobold André P. van Beek 《Surgery for obesity and related diseases》2019,15(1):73-81