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Journal of Orthopaedic Surgery and... Feb 2024Using an anterior cervical fixation device in the anterior cervical discectomy and fusion (ACDF) has evolved to various systems of static and dynamic cervical plates...
INTRODUCTION
Using an anterior cervical fixation device in the anterior cervical discectomy and fusion (ACDF) has evolved to various systems of static and dynamic cervical plates (SCP and DCP). Dynamic cervical plates have been divided into three categories: the rotational (DCP-R), translational (DCP-T), and hybrid (DCP-H) joints. However, little studies have been devoted to systematically investigate the biomechanical differences of dynamic cervical plates.
MATERIALS AND METHODS
The biomechanical tests of load-deformation properties and failure modes between the SCP and DCP systems are implemented first by using the UHMWPE blocks as the vertebral specimens. The CT-based C2-C7 model simulates the strategies of cervical plate in ACDF surgery is developed with finite-element analyses. One intact, one SCP and two DCP systems are evaluated for their biomechanical properties of bone fusion and tissue responses.
RESULTS
In the situation of biomechanical test, The mean values of the five ACDSP constructs are 393.6% for construct stiffness (p < 0.05) and 183.0% for the first yielding load (p < 0.05) less than those of the SCP groups, respectively. In the situation of finite-element analysis, the rigid-induced ASD is more severe for the SCP, followed by the DCP-H, and the DCP-R is the least.
DISCUSSION AND CONCLUSIONS
Considering the degenerative degree of the adjacent segments and osteoporotic severity of the instrumented segments is necessary while using dynamic system. The mobility and stability of the rotational and translational joints are the key factors to the fusion rate and ASD progression. If the adjacent segments have been degenerative, the more flexible system can be adopted to compensate the constrained mobility of the ACDF segments. In the situation of the osteoporotic ACDF vertebrae, the stiffer system is recommended to avoid the cage subsidence.
Topics: Spinal Fusion; Cervical Vertebrae; Plastic Surgery Procedures; Diskectomy; Neck; Bone Plates; Finite Element Analysis; Biomechanical Phenomena; Range of Motion, Articular
PubMed: 38360695
DOI: 10.1186/s13018-024-04629-8 -
BMJ Open Sep 2023This study aimed to investigate the associations between general health expectations and patient satisfaction with treatment for the two common spine surgery procedures... (Observational Study)
Observational Study
Associations between future health expectations and patient satisfaction after lumbar spine surgery: a longitudinal observational study of 9929 lumbar spine surgery procedures.
OBJECTIVE
This study aimed to investigate the associations between general health expectations and patient satisfaction with treatment for the two common spine surgery procedures diskectomy for lumbar disk herniation (LDH) and decompression for lumbar spinal stenosis (LSS).
DESIGN
Register study with prospectively collected preoperative and 1-year postoperative data.
SETTING
National outcome data from Swespine, the national Swedish spine register.
PARTICIPANTS
A total of 9929 patients, aged between 20 and 85 years, who were self-reported non-smokers, and were operated between 2007 and 2016 for one-level LSS without degenerative spondylolisthesis, or one-level LDH, were identified in the national Swedish spine register (Swespine). We used SF-36 items 11c and 11d to assess future health expectations and present health perceptions. Satisfaction with treatment was assessed using the Swespine satisfaction item.
INTERVENTIONS
One-level diskectomy for LDH or one-level decompression for LSS.
PRIMARY OUTCOME MEASURES
Satisfaction with treatment.
RESULTS
For LSS, the year 1 satisfaction ratio among patients with negative future health expectations preoperatively was 60% (95% CI 58% to 63%), while it was 75% (95% CI 73% to 76%) for patients with positive future health expectations preoperatively. The corresponding numbers for LDH were 73% (95% CI 71% to 75%) and 84% (95% CI 83% to 85%), respectively.
CONCLUSIONS
Patients operated for the common lumbar spine diseases LSS or LDH, with negative future general health expectations, were significantly less satisfied with treatment than patients with positive expectations with regard to future general health. These findings are important for patients, and for the surgeons who counsel them, when surgery is a treatment option for LSS or LDH.
Topics: Humans; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Patient Satisfaction; Motivation; Spine; Diskectomy; Longitudinal Studies
PubMed: 37748852
DOI: 10.1136/bmjopen-2023-074072 -
Journal of Orthopaedic Surgery and... Jan 2024To evaluate clinical effectiveness and radiologic results of anterior cervical diskectomy with fusion (ACDF) comparing with laminoplasty (LP) in treating multilevel...
Comparison of anterior cervical diskectomy with fusion (ACDF) and laminoplasty treating multilevel cervical spondylotic myelopathy with developmental canal stenosis: a retrospective study.
PURPOSE
To evaluate clinical effectiveness and radiologic results of anterior cervical diskectomy with fusion (ACDF) comparing with laminoplasty (LP) in treating multilevel cervical spondylotic myelopathy (MCSM) with developmental canal stenosis (DCS).
METHODS
This was a retrospective analysis of 41 patients who had MCSM with DCS treated with ACDF or LP from December 2018 to April 2023. Patients were split into ACDF and LP groups for comparison, and patients were further separated into subgroups based on whether or not a reserving canal space was present. The operation time, hemoglobin, hospital stay, modified Japanese Orthopaedic Association (mJOA) score, and visual analog scale (VAS) score were used to assess clinical efficacy. The C2-C7 Cobb angle, C2-C7 sagittal vertical axis, T1 slope, and cervical range of motion were applied to evaluate imaging changes.
RESULTS
Of the 41 patients, 19 received ACDF, and 22 received LP. At the final follow-up, both groups' mJOA scores significantly improved, and the intercomparison showed no differences; the VAS score was much lower in the ACDF group but remained unchanged in the LP group. At the final follow-up, the C2-C7 Cobb angle and T1 slope had significantly increased in the ACDF group, while the LP group showed no change; the cervical range of motion had significantly decreased in both groups, with the ACDF group exhibiting a more marked reduction. Within the ACDF subgroup, there was no postoperative symptom improvement for those with reserving space, whereas there was postoperative symptom resolution for those with non-reserving space; however, postoperative symptom in the LP subgroup was resolved.
CONCLUSIONS
Both ACDF and LP were efficacious for MCSM patients with DCS. While ACDF could improve cervical lordosis and alleviate neck pain more effectively, it can also result in cervical sagittal imbalance and decreased mobility. Furthermore, the recovery from LP was superior to that from ACDF for patients with reserving space. In contrast, the recovery from both decompression techniques was comparable for individuals in non-reserving space.
Topics: Humans; Retrospective Studies; Laminoplasty; Constriction, Pathologic; Diskectomy; Spinal Fusion; Spinal Cord Diseases; Cervical Vertebrae; Treatment Outcome; Spondylosis
PubMed: 38172985
DOI: 10.1186/s13018-023-04510-0 -
Journal of Orthopaedic Surgery and... Jan 2024A retrospective study.
STUDY DESIGN
A retrospective study.
OBJECTIVE
The aim of this study was to compare clinical and radiological outcomes of the anterior cervical discectomy and fusion (ACDF) with a novel zero-profile variable-angle (Zero-P VA) spacer and a traditional poly-ether-ether-ketone (PEEK) cage and plate system in cases pertaining to cervical radiculopathy/myelopathy. There are two conventional types of ACDF procedures aimed at treating symptomatic cervical spondylosis. The first one involves an uninstrumented "stand-alone" approach utilizing bone graft/cage, while the second incorporates bone graft/cage in conjunction with a front plate positioned before the vertebral bodies. Both procedures have their own inherent advantages and disadvantages. The Zero-P VA spacer, however, represents a unique synthesis by amalgamating the advantages of both traditionally typical procedures. Notably, this spacer can potentially circumvent the issue related to prevertebral soft-tissue disturbance and reduce the occurrence of dysphagia.
METHODS
Using our surgical database, the authors systematically conducted a retrospective analysis encompassing all patients who underwent single-level ACDF between January 2018 and January 2019, with a minimum two-year follow-up. Patients either received a Zero-P VA implant or PEEK cage coupled with plating. The Japanese Orthopedic Association (JOA) score and Visual Analogue Scale (VAS) for arm and neck pain were documented. Dysphagia was evaluated using the Eating Assessment Tool-10 (ETA-10). Additional parameters such as cervical alignment, fusion rate and the incidence of postoperative complications were assessed.
RESULTS
According to the outcomes of the statistical analysis, there was no substantial disparity that emerged in the advancements observed in the JOA and VAS metrics between the two study cohorts. Noteworthy, however, the ETA-10 scores were statistically significantly reduced in the Zero-P VA group compared to the cage and plating group (p < 0.05). At the final follow-up, there were no statistically significant differences in the height of the operated segment, Cobb angle of the fused segment, C2-C7 Cobb angle and fusion rate between the two groups (p > 0.05). However, postoperative complications were slightly lower in patients with the Zero-P VA group (7.69%) as compared to the cage and plating group (16.67%).
CONCLUSION
The clinical outcomes observed with the Zero-P VA spacer used for single-level ACDF were found to be satisfactory. The performance of this device is comparable or even superior to the traditional cage and plating method in preventing postoperative dysphagia and mitigating potential complications associated with the use of a plate.
Topics: Humans; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Deglutition Disorders; Ketones; Postoperative Complications; Cervical Vertebrae; Diskectomy; Ethers; Spinal Fusion; Benzophenones; Polymers
PubMed: 38212759
DOI: 10.1186/s13018-024-04539-9 -
Asian Spine Journal Dec 2023Prospective study.
STUDY DESIGN
Prospective study.
PURPOSE
To propose a scoring system for predicting the need for surgery in patients with lumbar disc herniation (LDH).
OVERVIEW OF LITERATURE
The indications for surgery in patients with LDH are well established. However, the exact timing of surgery is not. According to surgeons, patients with failed conservative treatment who underwent delayed surgery, often after 6 months postsymptom initiation, have poor functional recovery and outcome.
METHODS
The current study included patients with symptomatic LDH. Patients with an indication for emergent surgery such as profound or progressive motor deficit, cauda equina syndrome, and diagnoses other than single-level LDH were excluded from the analysis. All patients followed a conservative treatment regimen (a combination of physical therapy, pain medications, and/or spinal epidural steroid injections). Surgery was indicated for patients who continuously experienced pain despite maximal conservative therapy.
RESULTS
In total, 134 patients met the inclusion and exclusion criteria. Among them, 108 (80.6%) responded to conservative management, and 26 (19.4%) underwent unilateral laminotomy and microdiscectomy. The symptom duration, disc degeneration grade on magnetic resonance imaging (Pfirrmann disc grade), herniated disc location and type, fragment size, and thecal sac diameter significantly differed between patients who responded to conservative treatment and those requiring surgery. The area under the receiver operating characteristic curve of the scoring system based on the anteroposterior size of the herniated disc fragment and herniated disc location and type was 0.81.
CONCLUSIONS
A scoring system based on herniated disc/fragment size, location, and type can be applied to predict the need for surgery in patients with LDH. In the future, this tool can be used to prevent unnecessarily prolonged conservative management (>4-8 weeks).
PubMed: 37946334
DOI: 10.31616/asj.2023.0023 -
Pain Physician Jan 2024Posterior percutaneous endoscopic cervical discectomy (PPECD) has been proven safe and effective for foraminal cervical disc herniation (CDH). However, central CDH has...
BACKGROUND
Posterior percutaneous endoscopic cervical discectomy (PPECD) has been proven safe and effective for foraminal cervical disc herniation (CDH). However, central CDH has long been considered as the contraindication of PPECD, because the path is obstructed by the spinal cord and nerve root.
OBJECTIVES
To preliminarily assess the feasibility, safety, and effectiveness of PPECD for single-level soft, huge central CDH.
STUDY DESIGN
A retrospective cohort study.
SETTING
Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College).
METHODS
Between 2017 and 2020, 31 patients diagnosed with single-level soft, huge central CDH were treated by PPECD. Primary outcomes included the measures of neck and radicular pain based on the numeric rating scale (NRS) and cervical neurologic status based on the Japanese Orthopedic Association (JOA) score. The global outcome was assessed using the Odom's criteria at one-year follow-up.
RESULTS
Compared to the baseline, there was a constant and significant reduction of NRS-rated pain and improvement of JOA-rated cervical neurologic status postoperatively (P < 0.01). According to the Odom's criteria, 96.8% (30/31) of patients had satisfactory postoperative clinical improvement (excellent or good outcomes) at one-year follow-up. Complications included C5 nerve root palsy and spinal cord injury. The total complication rate was 16.5% (2/31), but these complications were temporary and not catastrophic.
LIMITATIONS
The limitations of this study include the volume of the sample, a short follow-up period, and the lack of a control group.
CONCLUSIONS
Our preliminary experience indicates that PPECD is a feasible and promising alternative for symptomatic single-level soft, huge central CDH.
Topics: Humans; Intervertebral Disc Displacement; Retrospective Studies; Diskectomy; Diskectomy, Percutaneous; Pain
PubMed: 38285042
DOI: No ID Found -
Journal of Orthopaedic Surgery and... Mar 2024The clinical outcomes of patients who received a cervical collar after anterior cervical decompression and fusion were evaluated by comparison with those of patients who... (Meta-Analysis)
Meta-Analysis
PURPOSE
The clinical outcomes of patients who received a cervical collar after anterior cervical decompression and fusion were evaluated by comparison with those of patients who did not receive a cervical collar.
METHODS
All of the comparative studies published in the PubMed, Cochrane Library, Medline, Web of Science, and EMBASE databases as of 1 October 2023 were included. All outcomes were analysed using Review Manager 5.4.
RESULTS
Four studies with a total of 406 patients were included, and three of the studies were randomized controlled trials. Meta-analysis of the short-form 36 results revealed that wearing a cervical collar after anterior cervical decompression and fusion was more beneficial (P < 0.05). However, it is important to note that when considering the Neck Disability Index at the final follow-up visit, not wearing a cervical collar was found to be more advantageous. There were no statistically significant differences in postoperative cervical range of motion, fusion rate, or neck disability index at 6 weeks postoperatively (all P > 0.05) between the cervical collar group and the no cervical collar group.
CONCLUSIONS
This systematic review and meta-analysis revealed no significant differences in the 6-week postoperative cervical range of motion, fusion rate, or neck disability index between the cervical collar group and the no cervical collar group. However, compared to patients who did not wear a cervical collar, patients who did wear a cervical collar had better scores on the short form 36. Interestingly, at the final follow-up visit, the neck disability index scores were better in the no cervical collar group than in the cervical collar group. PROSPERO registration number: CRD42023466583.
Topics: Humans; Cervical Vertebrae; Decompression, Surgical; Diskectomy; Randomized Controlled Trials as Topic; Spinal Diseases; Spinal Fusion; Treatment Outcome
PubMed: 38454504
DOI: 10.1186/s13018-024-04661-8 -
Orthopaedic Surgery Sep 2023Full-endoscopic lumbar discectomy (FELD) is a popular operation for the treatment of lumbar disc herniation (LDH) and day surgery mode is increasingly popular. However,...
Does Immediate Postoperative Early Ambulation Affect Clinical Results of Full-Endoscopic Lumbar Discectomy? A Historical Control Study of Daytime Operation with a 8-Hour Hospital Stay versus Inpatient Operation.
OBJECTIVE
Full-endoscopic lumbar discectomy (FELD) is a popular operation for the treatment of lumbar disc herniation (LDH) and day surgery mode is increasingly popular. However, only a few studies have reported about day surgery patients undergoing Percutaneous endoscopic lumbar discectomy (PELD). This retrospective study was to evaluate and analyze the clinical outcomes of patients undergoing FELD for LDH as day surgery versus inpatient surgery.
METHODS
From January 2020 to January 2022, a retrospective analysis of LDH patients treated with FELD either in day surgery unit (within 8-h hospital stay) or inpatient unit was carried out. All these patients were followed-up for at least 12 months, and were categorized into a FELD-I (inpatient surgery) group or a FELD-D (day surgery) group, according to where the surgical procedures were performed. We assessed and compared the postoperative stand and walk time, postoperative hospitalization stays, time of return to work, modified MacNab criteria, willingness to recommend surgery, complications, revision rate, as well as the visual analogue scale (VAS) and the Oswestry disability index score (ODI). Student t-test was used for continuous variables and chi-square test or Fisher's exact test was used for categorical variables.
RESULTS
There was no statistically significant difference in demographic data and baseline characteristics between two groups. And no significant differences were found in MacNab criteria between two groups. Postoperative VAS and ODI scores at one-day postoperation and final follow-up both improved significantly in both groups, as compared to the preoperative data (p < 0.001). However, no significant difference was found between the two groups on the pre, postoperative, or the last follow-up score for VAS and ODI (p > 0.05). The postoperative first ambulation time and postoperative hospital stays was much longer in FELD-I group than FELD-D group (p < 0.001). However, there were no significant differences in the perioperative complications, revision rate as well as satisfaction rate between two groups (p > 0.05). The overall time of return to work of young patients (<60 years-old) in the FELD-D group was significantly shorter than that in the FELD-I group (p = 0.001). Patients in the FELD-D group were more likely to recommend this kind of surgical model.
CONCLUSION
These data suggest that FELD-D can be effectively performed as day surgery (within 8 h hospital stay). Early ambulation after FELD-D did not affect the clinical outcomes and the revision rates. Day surgery patients are more likely to recommend this surgery mode to other patients and younger patients may be able to return to work earlier.
Topics: Humans; Middle Aged; Diskectomy, Percutaneous; Intervertebral Disc Displacement; Retrospective Studies; Length of Stay; Inpatients; Historically Controlled Study; Early Ambulation; Lumbar Vertebrae; Diskectomy; Endoscopy; Treatment Outcome
PubMed: 37519265
DOI: 10.1111/os.13814 -
BMC Surgery Jan 2024Sciatic scoliosis can be seen in patients with lumbar disc herniation. Percutaneous endoscopic lumbar discectomy (PELD) is a common surgical method for the treatment of...
OBJECTIVE
Sciatic scoliosis can be seen in patients with lumbar disc herniation. Percutaneous endoscopic lumbar discectomy (PELD) is a common surgical method for the treatment of lumbar disc herniation. The difference between single-segment lumbar disc herniation and double-segment lumbar disc herniation with Sciatic Scoliosis in adults after PELD needs further study. The aim of this study was to compare the imaging features of single-segment and double-segment lumbar disc herniation with Sciatic Scoliosis in adults and to further explore the clinical outcomes of functional improvement and scoliosis imaging parameters of the two groups after PELD.
METHODS
Adult patients with lumbar disc herniation with sciatic scoliosis who received PELD from January 2019 to June 2022 were analyzed retrospectively. According to the number of operative segments, the patients were divided into a single-segment group and a double-segment group. Perioperative parameters were observed and compared between the two groups. The Visual Analogue Scale (VAS) score, Oswestry dysfunction index (ODI), Japanese Orthopaedic Association scores (JOA) and imaging parameters of the two groups were recorded and compared before the operation and during the follow-up.
RESULTS
A total of 53 patients with single segments and 21 patients with double segments were included in this study. During the follow-up, the VAS score, ODI index and JOA score of the two groups were significantly improved as compared with those before the operation(P < 0. 05). Ninety-two point five percent of single-segment patients and 90.5% of double segment patients returned to normal scoliosis within 12 months after the operation. The operation time, number of intraoperative fluoroscopy times and the amount of intraoperative blood loss in single-segment patients were better than those in double-segment group(P < 0. 05). At the last follow-up, the AVT, CBD and SVA in the double-segment group were 5.2 ± 2.3, 5.1 ± 1.0 and 12.2 ± 3.0 mm, respectively, which were higher than those in the single-segment group (1.9 ± 0.4, 1.1 ± 1.6 and 3.9 ± 2.1 mm) (P < 0. 05).
CONCLUSION
PELD is an effective treatment for single-segment and double-segment lumbar disc herniation with Sciatic scoliosis. Double-segment patients can enjoy similar clinical efficacy to single-segment patients, avoiding complications caused by decompression, fusion, and internal fixation. Scoliosis was corrected spontaneously within 12 months after operation, and the sagittal curve was significantly improved in both groups. The improvement of coronal and sagittal balance in double -segment patients may take longer.
Topics: Adult; Humans; Intervertebral Disc Displacement; Retrospective Studies; Diskectomy, Percutaneous; Scoliosis; Endoscopy; Lumbar Vertebrae; Diskectomy; Treatment Outcome
PubMed: 38297255
DOI: 10.1186/s12893-024-02314-5 -
BMC Surgery Apr 2024The surgical resection of very highly migrated lumbar disc herniation (VHM-LDH) is technically challenging owing to the absence of technical guidelines. Hence, in the...
BACKGROUND
The surgical resection of very highly migrated lumbar disc herniation (VHM-LDH) is technically challenging owing to the absence of technical guidelines. Hence, in the present study, we introduced the transforaminal endoscopic lumbar discectomy (TELD) with two-segment foraminoplasty to manage VHM-LDH and evaluated its radiographic and midterm clinical outcomes.
MATERIALS AND METHODS
The present study is a retrospective analysis of 33 consecutive patients with VHM-LDH who underwent TELD with two-segment foraminoplasty. The foraminoplasty was performed on two adjacent vertebrae on the basis of the migration direction of disc fragments to fully expose the disc fragments and completely decompress the impinged nerve root. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. Additionally, imageological observations were evaluated immediately after the procedure via magnetic resonance image and computerized tomography. Clinical outcomes were evaluated by calculating the visual analog scale (VAS) score and Oswestry Disability Index (ODI). The MacNab criterion was reviewed to assess the patients' opinions on treatment satisfaction. The resection rate of bony structures were quantitatively evaluated on postoperative image. The segmental stability was radiologically evaluated at least a year after the surgery. Additionally, surgery-related and postoperative complications were evaluated.
RESULTS
The average age of the patients was 56.87 ± 7.77 years, with a mean follow-up of 20.95 ± 2.09 months. The pain was relieved in all patients immediately after the surgery. The VAS score and ODI decreased significantly at each postoperative follow-up compared with those observed before the surgery (P < 0.05). The mean operation duration, blood loss, and hospital stay were 56.17 ± 16.21 min, 10.57 ± 6.92 mL, and 3.12 ± 1.23 days, respectively. No residual disc fragments, iatrogenic pedicle fractures, and segmental instability were observed in the postoperative images. For both up- and down- migrated herniation in the upper lumbar region, the upper limit value of resection percentage for the cranial SAP, caudal SAP, and pedicle was 33%, 30%, and 34%, respectively; while those in the lower lumbar region was 42%, 36%, and 46%, respectively. At the last follow-up, the satisfaction rate of the patients regarding the surgery was 97%. Surgery-related complications including dural tear, nerve root injury, epidural hematoma, iatrogenic pedicle fractures, and segmental instability were not observed. One patient (3%) suffered from the recurrence of LDH 10 months after the initial surgery and underwent revision surgery.
CONCLUSIONS
The TELD with two-segment foraminoplasty is safe and effective for VHM-LDH management. Proper patient selection and efficient endoscopic skills are required for applying this technique to obtain satisfactory outcomes.
Topics: Humans; Middle Aged; Intervertebral Disc Displacement; Retrospective Studies; Diskectomy, Percutaneous; Treatment Outcome; Lumbar Vertebrae; Endoscopy; Diskectomy; Postoperative Complications; Iatrogenic Disease
PubMed: 38627693
DOI: 10.1186/s12893-024-02379-2