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Orthopaedic Surgery Apr 2024The connection between alterations in the disc structure following percutaneous endoscopic lumbar discectomy (PELD) and symptoms in patients postsurgery has not been...
OBJECTIVE
The connection between alterations in the disc structure following percutaneous endoscopic lumbar discectomy (PELD) and symptoms in patients postsurgery has not been reported yet. The purpose of the present study was to discuss the potential correlation between the changes in the morphological characteristics of various reference surfaces of the intervertebral disc after percutaneous endoscopic lumbar discectomy (PELD) and clinical outcomes, to identify the morphological parameters that affect efficacy and provide an evidence-based foundation for assessing postoperative efficacy.
METHODS
From October 2019 to October 2021, after percutaneous endoscopic lumbar discectomy (PELD), 98 individuals were enrolled. MRI DICOM data of the lumbar spine were obtained before and after surgery, specifically around 3 months. The morphological parameters of the operated and adjacent segments of the discs were measured using T2-weighted images from three reference planes. Outcomes were assessed using the Oswestry disability index (ODI), visual analogue pain scores for the back and leg (VAS-back/VAS-leg), Japanese Orthopaedic Association (JOA) scores, and recovery rates. Postoperative changes in disc parameters and outcomes were compared between patients with different severity and types of LDH based on the MSU staging. Patients completed the questionnaire during outpatient follow-up appointments 3, 6, and 12 months after the surgery. The follow-up period was 14.69 ± 4.21 months, ranging from 12 to 24 months.
RESULTS
Parameters such as area and circumference of intervertebral discs in the cross-section were not associated with the change in the efficacy index. Postoperatively, a negative correlation between the variation of the disc height, disc height index, and protrusion distance and the difference in VAS scores for low back pain at 3 and 6 months was observed among the two sagittal change parameters. Differences between changes in disc imaging parameters and postoperative efficacy were not statistically significant between various types of lumbar disc herniation.
CONCLUSION
For the patients after percutaneous endoscopic lumbar discectomy, the changes in parameters such as disc area and circumference in the cross-sectional plane are not associated with efficacy, and the changes in disc height and herniation distance in the sagittal plane provide a morphologic basis for the assessment of short-term postoperative efficacy. In addition, the changes in disc morphologic parameters and postoperative efficacy do not differ between various types of lumbar disc herniation.
Topics: Humans; Follow-Up Studies; Intervertebral Disc Displacement; Diskectomy, Percutaneous; Cross-Sectional Studies; Endoscopy; Lumbar Vertebrae; Treatment Outcome; Retrospective Studies; Diskectomy
PubMed: 38384172
DOI: 10.1111/os.14013 -
International Wound Journal Apr 2024The objective of this study was to investigate the risk factors associated with surgical site infection (SSI) after percutaneous endoscopic lumbar discectomy (PELD) in...
The objective of this study was to investigate the risk factors associated with surgical site infection (SSI) after percutaneous endoscopic lumbar discectomy (PELD) in patients with lumbar disc herniation (LDH). A retrospective analysis was performed on a cohort of 335 patients who underwent PELD between January 2016 and January 2023. Data were derived from the Hospital Information System (HIS), and a comprehensive statistical assessment was performed using IBM SPSS Statistics version 25.0. Both univariate and multivariate logistic regression analyses assessed a range of risk determinants, such as age, body mass index (BMI), comorbidities, laboratory test parameters and surgery-related variables. The incidence of SSI after PELD was 2.7% (9/335). Univariate analysis highlighted BMI, diabetes mellitus, long-term corticosteroid consumption, surgical time and cerebrospinal fluid leakage as significant predictors of SSI. Multivariate logistic regression identified BMI, diabetes mellitus, long-term corticosteroid consumption, surgical time and cerebrospinal fluid leakage as significant risk factors for SSI after PELD. High BMI, diabetes mellitus, long-term corticosteroid consumption, long surgical time and postoperative cerebrospinal fluid leakage are predisposing factors for SSI in patients undergoing PELD. Precise interventions focused on such risk components, including careful preoperative assessment and strategic postoperative care, are essential to reduce the incidence of SSI and improve surgical efficacy.
Topics: Humans; Retrospective Studies; Intervertebral Disc Displacement; Surgical Wound Infection; Diskectomy, Percutaneous; Lumbar Vertebrae; Risk Factors; Diabetes Mellitus; Adrenal Cortex Hormones; Cerebrospinal Fluid Leak; Treatment Outcome
PubMed: 38149500
DOI: 10.1111/iwj.14605 -
World Neurosurgery Jan 2024Cervical conjoined nerve root is rare, and medical imaging, such as magnetic resonance imaging and computed tomography, cannot give an accurate preoperative diagnosis....
Cervical conjoined nerve root is rare, and medical imaging, such as magnetic resonance imaging and computed tomography, cannot give an accurate preoperative diagnosis. Treatment of cervical radiculopathy with root anomaly can be challenging. We report here a case of cervical conjoined nerve root with a 2-dimensional video. A 41-year-old woman without systemic disease presented with a 2-month history of neck and bilateral shoulder pain, upper back tightness, and left upper limb painful numbness, especially of the first to third fingers. The visual analog scale scores of the neck and left upper limb were 4 and 8, respectively. The Neck Disability Index was 26. The diagnosis of retrolisthesis at C5-C6 and cervical disk herniation with severe neuroforaminal narrowing at the left C5-C6 and C6-C7 levels were made with radiographs and magnetic resonance imaging. Posterior percutaneous endoscopic cervical diskectomy at the left C5-C6 and C6-C7 levels via an interlaminar shoulder approach was performed. During operation, a left-sided conjoined nerve root at the C6-C7 level was found (Video 1). Upon removal of a calcified disk and osteophytes at the C6-C7 level, the dura was torn slightly with traction without nerve root exposure or cerebrospinal fluid leakage. The 3-month postoperative follow-up visual analog scale scores of the neck and left upper limb were 0 and 0, respectively. The 3-month postoperative follow-up Neck Disability Index was 1. Posterior percutaneous endoscopic cervical diskectomy has become a favored treatment for cervical disk herniation because it offers sufficient decompression, smaller incisions, minimal blood loss, shorter hospital stay, and less postoperative pain. Nonetheless, if unexpected variation of the nerve root is noted during decompressive procedures, iatrogenic nerve root injury is a risk. Seven cases of cervical nerve root anomalies have been reported; all were found during posterior cervical surgery, which may indicate that the posterior approach provides better visualization of nerve root variants, especially in endoscopic surgery..
Topics: Female; Humans; Adult; Intervertebral Disc Displacement; Diskectomy; Neck; Diskectomy, Percutaneous; Decompression, Surgical; Radiculopathy; Cervical Vertebrae; Treatment Outcome
PubMed: 37774782
DOI: 10.1016/j.wneu.2023.09.074 -
Journal of Orthopaedic Surgery and... Apr 2024Anterior cervical discectomy and fusion (ACDF) is the standard procedure for the treatment of cervical spinal stenosis (CSS), but complications such as adjacent segment...
Full endoscopic laminotomy decompression versus anterior cervical discectomy and fusion for the treatment of single-segment cervical spinal stenosis: a retrospective, propensity score-matched study.
OBJECTIVE
Anterior cervical discectomy and fusion (ACDF) is the standard procedure for the treatment of cervical spinal stenosis (CSS), but complications such as adjacent segment degeneration can seriously affect the long-term efficacy. Currently, posterior endoscopic surgery has been increasingly used in the clinical treatment of CSS. The aim of this study was to compare the clinical outcomes of single-segment CSS patients who underwent full endoscopic laminotomy decompression or ACDF.
METHODS
138 CSS patients who met the inclusion criteria from June 2018 to August 2020 were retrospectively analyzed and divided into endoscopic and ACDF groups. The propensity score matching (PSM) method was used to adjust the imbalanced confounding variables between the groups. Then, perioperative data were recorded and clinical outcomes were compared, including functional scores and imaging data. Functional scores included Visual Analog Scale of Arms (A-VAS) and Neck pain (N-VAS), Japanese Orthopedic Association score (JOA), Neck Disability Index (NDI), and imaging data included Disc Height Index (DHI), Cervical range of motion (ROM), and Ratio of grey scale (RVG).
RESULTS
After PSM, 84 patients were included in the study and followed for 24-30 months. The endoscopic group was significantly superior to the ACDF group in terms of operative time, intraoperative blood loss, incision length, and hospital stay (P < 0.001). Postoperative N-VAS, A-VAS, JOA, and NDI were significantly improved in both groups compared with the preoperative period (P < 0.001), and the endoscopic group showed better improvement at 7 days postoperatively (P < 0.05). The ROM changes of adjacent segments were significantly larger in the ACDF group at 12 months postoperatively and at the last follow-up (P < 0.05). The RVG of adjacent segments showed a decreasing trend, and the decrease was more marked in the ACDF group at last follow-up (P < 0.05). According to the modified MacNab criteria, the excellent and good rates in the endoscopic group and ACDF group were 90.48% and 88.10%, respectively, with no statistically significant difference (P > 0.05).
CONCLUSION
Full endoscopic laminotomy decompression is demonstrated to be an efficacious alternative technique to traditional ACDF for the treatment of single-segment CSS, with the advantages of less trauma, faster recovery, and less impact on cervical spine kinematics and adjacent segmental degeneration.
Topics: Humans; Retrospective Studies; Intervertebral Disc; Intervertebral Disc Degeneration; Laminectomy; Spinal Stenosis; Treatment Outcome; Follow-Up Studies; Propensity Score; Spinal Fusion; Diskectomy; Cervical Vertebrae; Decompression
PubMed: 38581052
DOI: 10.1186/s13018-024-04710-2 -
Journal of Orthopaedic Surgery and... Nov 2023Because previous studies have not focused on postoperative cervical collapse, the purpose of the present study was to introduce the overloaded vertebral body (OVB)...
PURPOSE
Because previous studies have not focused on postoperative cervical collapse, the purpose of the present study was to introduce the overloaded vertebral body (OVB) phenomenon following multilevel zero-profile anterior cervical discectomy and fusion (ACDF) as well as to investigate its effects on radiographic outcomes.
METHODS
We conducted a retrospective study involving patients who underwent ACDF. A total of 55 patients were included in the analysis, including 110 OVB and 110 non-OVB. The evaluated vertebral parameters included the vertebral cross-sectional area (CSA), wedge angle (WA), vertebral height [anterior (AH) and posterior (PH)] and anterior-posterior vertebral diameter [upper (UD) and lower (LD)].
RESULTS
The CSA and WA were significantly lower in the OVB group than in the non-OVB group at 3, 6, and 12 months after surgery as well as at the final follow-up (p < 0.01). The AH of the OVB group was significantly lower at 3, 6, and 12 months after surgery as well as at the final follow-up compared to 1 week after surgery (p < 0.01).
CONCLUSIONS
OVB, a new phenomenon following multilevel ACDF, is defined as the cervical vertebral body located in the middle of the surgical segments in multilevel anterior cervical spine surgery. Statistical analysis of vertebral parameters, including CSA, WA, AH, PH, UD, and LD, showed that OVB occurs mainly at the anterior edge of the vertebra and that its largest radiographic manifestation is the loss of height at the anterior edge of the vertebra in the early postoperative period.
Topics: Humans; Retrospective Studies; Vertebral Body; Treatment Outcome; Diskectomy; Cervical Vertebrae; Spinal Fusion; Follow-Up Studies
PubMed: 37980487
DOI: 10.1186/s13018-023-04365-5 -
Journal of Neurological Surgery. Part... Sep 2023Arthroplasty has been proven to be a safe and effective treatment for patients with cervical degenerative disk disease (DDD). Dynamic Cervical Implant (DCI) has...
BACKGROUND
Arthroplasty has been proven to be a safe and effective treatment for patients with cervical degenerative disk disease (DDD). Dynamic Cervical Implant (DCI) has emerged as a novel implantation device for cervical DDD. This study aimed to compare the outcomes of these procedures after 5 years of follow-up in the DCI and arthroplasty groups.
METHODS
This study retrospectively enrolled 79 consecutive cervical DDD patients with 41 DCI and 47 prostheses implanted. Radiographs were analyzed for intervertebral height and range of motion (ROM). Neural function of the patients was assessed using the Neck Disability Index score, visual analog scale, Japanese Orthopaedic Association score and 36-Item Short Form Survey.
RESULTS
The DCI group had statistically lesser flexion/extension and bilateral bending ROM than the arthroplasty group at the operated level(s) ( < 0.05). The DCI group but not the orthoplast group showed improved lordotic alignment of C2-C7 and operated functional spinal unit ( < 0.05). No statistical difference was observed in the neural function of the two groups. Heterotopic ossification was found in 7 and 14 patients in the DCI and arthroplasty groups, respectively.
CONCLUSION
The 5-year follow-up results were comparable between the two groups. We believe that DCI implantation is a safe and effective procedure and could possibly become an alternative treatment for cervical DDD.
Topics: Humans; Follow-Up Studies; Retrospective Studies; Intervertebral Disc Degeneration; Arthroplasty; Treatment Outcome; Diskectomy; Cervical Vertebrae; Prostheses and Implants; Range of Motion, Articular; Spinal Fusion
PubMed: 34861706
DOI: 10.1055/a-1712-5386 -
Scientific Reports Feb 2024Bioactive glass-ceramic (BGC) cage is a substitute for polyether ether ketone (PEEK) cages in anterior cervical discectomy and fusion (ACDF). Only a few comparative...
Bioactive glass-ceramic (BGC) cage is a substitute for polyether ether ketone (PEEK) cages in anterior cervical discectomy and fusion (ACDF). Only a few comparative studies exist using PEEK and non-window-type BGC cages (CaO-SiO-PO-BO) in single-level ACDF. This study compared PEEK cages filled with autologous iliac bone grafts and BGC cages regarding clinical safety and effectiveness. A retrospective case series was performed on 40 patients who underwent single-level ACDF between October 2020 and July 2021 by a single orthopedic spine surgeon. The spacers used in each ACDF were a PEEK cage with a void filled with an autologous iliac bone graft and a non-window-type BGC cage in 20 cases. The grafts were compared pre-operatively and post-operatively at 6 weeks and 3, 6, and 12 months. Post-operative complications were investigated in each group. Clinical outcome was measured, including Visual Analog Scale (VAS) scores of neck and arm pains, Japanese Orthopedic Association score (JOA), and Neck Disability Index (NDI). Dynamic lateral radiographs were used to assess the inter-spinous motion (ISM) between the fusion segment and subsidence. The fusion status was evaluated using a computed tomography (CT) scan. Overall, 39 patients (19 and 20 patients in the PEEK and BGC groups, respectively) were recruited. Eighteen (94.7%) and 19 (95.0%) patients in the PEEK and BGC groups, respectively, were fused 12 months post-operatively, as assessed by ISM in dynamic lateral radiograph and bone bridging formation proven in CT scan. The PEEK and BGC groups showed substantial improvement in neck and arm VAS, JOA, and NDI scores. No substantial difference was found in clinical and radiological outcomes between the PEEK and BGC groups. However, the operation time was considerably shorter in the BGC group than in the PEEK group. In conclusion, a non-window-type BCG cage is a feasible substitute for a PEEK cage with an autologous iliac bone graft in single-level ACDF.
Topics: Humans; Silicon Dioxide; Retrospective Studies; Polyethylene Glycols; Benzophenones; Ketones; Diskectomy; Cervical Vertebrae; Ceramics; Treatment Outcome; Spinal Fusion; Polymers
PubMed: 38369553
DOI: 10.1038/s41598-024-54786-3 -
BMJ Open Sep 2023Lumbar degenerative disease (LDD) is one of the most common reasons for patients to present with low back pain. Proper evaluation and treatment of patients with LDD are...
INTRODUCTION
Lumbar degenerative disease (LDD) is one of the most common reasons for patients to present with low back pain. Proper evaluation and treatment of patients with LDD are important, which clinicians perform using a variety of predictors for guidance in choosing the most appropriate treatment. Because evidence on which treatment is best for LDD is limited, the purpose of this study is to establish a clinical prediction model based on machine learning (ML) to accurately predict outcomes of patients with LDDs in the early stages by their clinical characteristics and imaging changes.
METHODS AND ANALYSIS
In this study, we develop and validate a clinical prognostic model to determine whether patients will experience complications within 6 months after percutaneous endoscopic lumbar discectomy (PELD). Baseline data will be collected from patients' electronic medical records. As of now, we have recruited a total of 580 participants (n=400 for development, n=180 for validation). The study's primary outcome will be the incidence of complications within 6 months after PELD. We will use an ML algorithm and a multiple logistic regression analysis model to screen factors affecting surgical efficacy. We will evaluate the calibration and differentiation performance of the model by the area under the curve. Sensitivity (Sen), specificity, positive predictive value and negative predictive value will be reported in the validation data set, with a target of 80% Sen. The results of this study could better illustrate the performance of the clinical prediction model, ultimately helping both clinicians and patients.
ETHICS AND DISSEMINATION
Ethical approval was obtained from the medical ethics committee of the Affiliated Hospital of Gansu University of Traditional Chinese Medicine (Lanzhou, China; No. 2022-57). Findings and related data will be disseminated in peer-reviewed journals, at conferences, and through open scientific frameworks.
TRIAL REGISTRATION NUMBER
Chinese Clinical Trial Register (www.chictr.org.cn) No. ChiCTR2200064421.
Topics: Humans; Prognosis; Diskectomy, Percutaneous; Models, Statistical; Intervertebral Disc Displacement; Lumbar Vertebrae
PubMed: 37669837
DOI: 10.1136/bmjopen-2023-072139 -
Scientific Reports Oct 2023Over-distraction has been shown to be a risk factor for cage subsidence and postoperative neck pain after anterior cervical discectomy and fusion (ACDF). Biomechanical...
Over-distraction has been shown to be a risk factor for cage subsidence and postoperative neck pain after anterior cervical discectomy and fusion (ACDF). Biomechanical studies have demonstrated increased adjacent segment intradiscal pressure after ACDF. The purpose of this study is to determine if over-distraction of the index disc has an effect on adjacent segment pathology. A consecutive series of 145 patients who received primary ACDF for cervical degenerative pathologies from January 2010 to December 2017 were retrospectively reviewed. The patients were divided into: (1) Over-distraction group (postoperative-preoperative index disc height ≥ 2 mm), and (2) No-distraction group (postoperative-preoperative index disc height < 2 mm). Outcome measures included radiographic parameters, Japanese Orthopaedic Association (JOA) score, and incidences of cage subsidence, radiological and clinical adjacent segment pathologies (RASP and CASP) were compared between the two groups preoperatively, postoperatively, and at the final follow-up. The two groups were comparable with respect to age, follow-up length, JOA score, incidence of CASP, and radiographic parameters. The Over-distraction group (83 patients; 115 levels) had smaller preoperative index disc height (4.5 vs. 5.2 mm, p < 0.001), but taller postoperative index disc height (7.7 vs. 6.6 mm, p < 0.001) than No-distraction group (62 patients; 90 levels) Furthermore, significantly higher incidences of cage subsidence (47% vs. 31%, p = 0.04) and RASP (any progression: 48% vs. 15%, p < 0.001; progress ≥ 2 grades: 25% vs. 7%, p = 0.001) were observed in the Over-distraction group. The multivariate analysis indicated that over-distraction and multilevel fusion were independent risk factors for RASP. There were no clinical outcome differences between the Over-distraction group and the No-distraction group in ACDF. Over-distraction of the index level of ≥ 2 mm should be avoided because it significantly increases the incidences of RASP and cage subsidence.
Topics: Humans; Treatment Outcome; Follow-Up Studies; Retrospective Studies; Diskectomy; Spinal Fusion; Cervical Vertebrae
PubMed: 37898696
DOI: 10.1038/s41598-023-44998-4 -
Asian Journal of Surgery Sep 2023Multilevel anterior cervical discectomy and fusion (ACDF), especially two-level ACDF, has been usually performed in the cervical degenerative disease, and the incidence...
PURPOSE
Multilevel anterior cervical discectomy and fusion (ACDF), especially two-level ACDF, has been usually performed in the cervical degenerative disease, and the incidence rate of complications is controversial. This study aimed to compare the outcomes of ACDF approach with cage alone and with plate fixation in multilevel discectomy.
METHODS
Patients who had undergone multilevel ACDF by the Smith-Robinson methods were included from 2018 to 2020. Data were collected using a questionnaire containing demographic characteristics, surgical complications, and outcome. All the patients were followed for 18 months post-surgery. Visual Analogue Scale (VAS), Neck Disability Index (NDI) and Nurick Grading scale were used to measure the pain degree, neck pain effect, and myelopathy grade, respectively. Bone fusion rate, subsidence and instrument failure were checked through radiography. Data were analyzed using SPSS, and the significant level was considered 0.05.
RESULTS
24 patients were included. There was no significant difference between the mean blood losses in the two groups. The rate of subsidence was much higher in group B after 18 months (60% vs 14.3%). As to the VAS score, NDI, and Nurick scale, trend change overtime was significantly improved in each group, but there was no significant difference between the groups. There was no significant difference between the two groups regarding bony fusion rate.
DISCUSSION
ACDF with plate leads to a more prolonged surgery with no significant benefits. Stand-alone cage approach could be suggested as the gold standard for anterior cervical discectomy.
Topics: Humans; Treatment Outcome; Retrospective Studies; Bone Plates; Diskectomy; Radiography
PubMed: 36822935
DOI: 10.1016/j.asjsur.2023.02.032