-
Medicine Dec 2023A retrospective comparative study. To compare and analyze the differences in the efficiency and safety of ROI-C and traditional titanium plate with fusion cage for the...
Comparison study of anterior cervical zero-profile fusion cage (ROI-C) and traditional titanium plate plus fusion technique for the treatment of spinal cord type cervical spondylosis.
A retrospective comparative study. To compare and analyze the differences in the efficiency and safety of ROI-C and traditional titanium plate with fusion cage for the treatment of CSM patients. Clinical data of 105 patients with CSM who underwent surgical treatment at our hospital from January 2019 to December 2020 were retrospectively reviewed. Patients were divided into ROI-C and traditional groups according to the different fusion methods. The operation time, intraoperative blood loss, preoperative and postoperative JOA score, NDI score, cervical Cobb angle, intervertebral space height, and postoperative complications were recorded and compared between the 2 groups. A total of 105 patients were included in this study, with 57 patients in the ROI-C group and 48 patients in the traditional group. The baseline data were similar between the 2 groups (P > .05). The operative time, intraoperative blood loss, and the incidence of postoperative dysphagia were significantly lower in the ROI-C group than in the traditional group (P < .05). There were no significant differences in the JOA score, NDI score, cervical Cobb angle, intervertebral space height, the incidence of postoperative axial symptoms, and adjacent segment degeneration between the 2 groups (P > .05). However, both groups showed significant improvement in the JOA score, NDI score, cervical Cobb angle, and intervertebral space height compared with before surgery (P < .05). The ROI-C zero-profile internal fixation system and traditional titanium plates with fusion cages can achieve satisfactory clinical treatment results for CSM patients. However, ROI-C has advantages of a shorter operative time, less blood loss, and less postoperative dysphagia. Therefore, the ROI-C zero-profile internal fixation system can be safely and effectively used to treat patients with CSM.
Topics: Humans; Retrospective Studies; Titanium; Blood Loss, Surgical; Deglutition Disorders; Diskectomy; Cervical Vertebrae; Spondylosis; Treatment Outcome; Spinal Cord; Spinal Fusion
PubMed: 38115244
DOI: 10.1097/MD.0000000000036651 -
Turkish Neurosurgery 2024To evaluate systemic immune inflammation index (SII), systemic inflammatory response index (SIRI), multi-inflammatory index (MII), and prognostic nutrition index (PNI),...
AIM
To evaluate systemic immune inflammation index (SII), systemic inflammatory response index (SIRI), multi-inflammatory index (MII), and prognostic nutrition index (PNI), and to compare them with the previously reported inflammation-related hematologic index in lumbar discectomy (LD).
MATERIAL AND METHODS
This was a retrospective, cross-sectional, single-center study with 105 consecutive patients who underwent surgery for LD. The study comprised three groups: Group I included data from healthy participants, Group II included data before LD, and Group III included data after LD. We analyzed mean platelet volume (MPV), platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), SIRI, SII, MII, and PNI, in comparison with the Roland-Morris Disability Questionnaire (RMDQ), Oswestry Disability Index (ODI), and Visual analog scale for leg (VASLeg).
RESULTS
CRP and MPV were similar for the preoperative and postoperative periods (p=0.489). In the postoperative measurements, NLR, PLR, SII, and SIRI increased (p < 0.0001). On the contrary, PNI decreased with LD (p < 0.0001). NLR (p < 0.001), SII (p < 0.001), and SIRI (p < 0.001) were the valuable indices for LD. PLR (p < 0.001), MII-1 (p=0.004), and MII-2 (p < 0.001) also predicted LD. ODI, RMDQ, and VASLeg correlated with MII-1, MII-2, and SIRI.
CONCLUSION
LD's most substantial and valuable indices were NLR, SII, and SIRI. Regarding superiority to SII and NLR, SIRI showed significant agreement with the scales and drew a more appropriate marker profile for LD than MII-1, MII-2, and PNI.
Topics: Humans; Cross-Sectional Studies; Nutrition Assessment; Prognosis; Retrospective Studies; Diskectomy; Inflammation; Systemic Inflammatory Response Syndrome
PubMed: 38497176
DOI: 10.5137/1019-5149.JTN.42769-22.2 -
BMC Surgery Aug 2023Enhanced recovery after surgery (ERAS) protocols are widely used worldwide. Recently, studies of the ERAS program in spinal surgery subspecialties have been reported....
BACKGROUND
Enhanced recovery after surgery (ERAS) protocols are widely used worldwide. Recently, studies of the ERAS program in spinal surgery subspecialties have been reported. The aim of this study was to evaluate the impacts of ERAS in minimally invasive microdiscectomy (MD) surgery.
METHODS
This was a retrospective cohort study of patients undergoing MD at a single center. From March 2018 to March 2021, 286 patients were in the ERAS group. A total of 140 patients from March 2017 to February 2018 were in the conventional group. The outcomes included length of stay (LOS), the postoperative numeric rating scale (NRS), complications, 30-day readmission rate, 30-day reoperation rate and cost. Moreover, perioperative factors were also evaluated.
RESULTS
Compared with the conventional group, the LOS and cost were reduced in the ERAS group. There were no significant differences in the NRS, complication rate, 30-day readmission or reoperation rates between the groups. Furthermore, postoperative drainage volume, and postoperative opioid use were lower in the ERAS group.
CONCLUSIONS
The ERAS protocol for MD surgery reduces LOS, cost and opioid use and accelerates patient recovery.
Topics: Humans; Analgesics, Opioid; Length of Stay; Retrospective Studies; Plastic Surgery Procedures; Diskectomy
PubMed: 37644499
DOI: 10.1186/s12893-023-02130-3 -
Neurologia I Neurochirurgia Polska 2024Change in the sagittal balance after anterior cervical discectomy with fusion (ACDF) is a phenomenon that has not yet been sufficiently studied. The aim of this study...
INTRODUCTION
Change in the sagittal balance after anterior cervical discectomy with fusion (ACDF) is a phenomenon that has not yet been sufficiently studied. The aim of this study was to assess such changes.
MATERIAL AND METHODS
28 patients who underwent ACDF for cervical spondylosis were examined. The study was divided into three stages: preoperative, early postoperative, and late postoperative. Sagittal alignments were analysed based on X-ray AP and lateral images: angles C1-C7, C2-C7, C1-C2, C1-C4, C4-C7 and cervical sagittal vertical axis (cSVA).
RESULTS
The cervical lordosis C2-C7 decreased by 13% in early monitoring, after which it increased by 60% in the late postoperative phase. Post hoc analysis showed that the measured values between early and late postoperative monitoring differed significantly. Cervical sagittal vertical axis (cSVA) increased by 23% in early control and then decreased by 18% in the late postoperative phase. Post hoc analysis showed that the measured values significantly differed between preoperative and early postoperative monitoring, and between early and late postoperative monitoring.
CONCLUSIONS
We have shown that the long-term effect of ACDF is correction of the sagittal balance of the cervical spine. Immediately after the procedure, a disturbance in the cervical spine curvature to the morphology of the entire spine is observed.
Topics: Humans; Retrospective Studies; Diskectomy; Spinal Fusion; Lordosis; Cervical Vertebrae
PubMed: 38305479
DOI: 10.5603/pjnns.96266 -
Medical Science Monitor : International... Dec 2023BACKGROUND Lumbar disc herniation surgery, specifically lumbar microdiscectomy, shows recurrence in 3-24% of patients, necessitating potential re-operations. This study...
BACKGROUND Lumbar disc herniation surgery, specifically lumbar microdiscectomy, shows recurrence in 3-24% of patients, necessitating potential re-operations. This study focuses on the outcomes and recurrence causes in 130 cases of lumbar disc herniations. These cases were managed by a single surgeon at a single center, offering a unique perspective on a common issue in neurosurgery. MATERIAL AND METHODS The study involved 130 patients treated for lumbar disc herniations. Analysis considered various factors: age, sex, symptoms, surgical level, complications, pre- and postoperative pain levels, and quality of life indices. RESULTS Of the 130 cases analyzed, all underwent initial surgery by the same surgeon or sought treatment from this surgeon after recurrence. Inclusion criteria were based on radiologic and clinical indications for re-operation. The demographic split was 76 males (56.4%) and 54 females (43.6%). A notable finding was a higher recurrence rate in males and patients under 45 years, although the sex difference was not statistically significant. The average age was 47.5 years. Significant changes were noted in the Oswestry Disability Index (ODI) levels during follow-ups (P<0.001). CONCLUSIONS This study underscores the effectiveness of lumbar microsurgery in treating recurrent lumbar disc herniations. Techniques such as medial facet utilization and laminectomy border expansion show promise. However, determining instability rates requires long-term patient follow-up. Our findings contribute valuable insights into surgical approaches and patient outcomes in recurrent lumbar disc herniation cases.
Topics: Male; Female; Humans; Middle Aged; Intervertebral Disc Displacement; Retrospective Studies; Treatment Outcome; Turkey; Quality of Life; Lumbar Vertebrae; Diskectomy
PubMed: 38158652
DOI: 10.12659/MSM.942012 -
Journal of Orthopaedic Surgery and... Aug 2023Zero-profile anchored spacers (ZAS) and plate-cage constructs (PCC) are currently employed when performing anterior cervical discectomy and fusion (ACDF). Nevertheless,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Zero-profile anchored spacers (ZAS) and plate-cage constructs (PCC) are currently employed when performing anterior cervical discectomy and fusion (ACDF). Nevertheless, the efficacy and safety of both devices in bilevel ACDF remain controversial. The goal of our meta-analysis is to assess the overall long-term efficacy and security among ZAS and PCC in bilevel ACDF.
METHODS
A search of four electronic databases was conducted to identify researches that compared ZAS with PCC for bilevel ACDF. Stata MP 17.0 software was used for this meta-analysis.
RESULTS
Nine researches with a total of 580 patients were involved. In comparison to PCC, ZAS significantly reduced intraoperative bleeding and postoperative dysphagia rates. No significant differences were found concerning operation time, JOA score, NDI score, cervical Cobb angle, fusion rates, the incidence of adjacent segmental degeneration (ASD) and implant sinking rates at last follow-up.
CONCLUSION
Compared to PCC, ZAS achieved similar efficacy and security in bilevel ACDF with respect to operative time, JOA score, NDI score, cervical Cobb angle, fusion rates, implant sinking rates and ASD rates at final follow-up. It is worth noting that ZAS offered considerable benefits over conventional PCC for the reduction of intraoperative bleeding and postoperative dysphagia. Therefore, for patients requiring bilevel ACDF, ZAS seems superior to PCC. Given the limitations of our study, larger prospective randomised controlled trials are needed to establish reliable proof to consolidate our conclusions.
Topics: Humans; Bone Plates; Deglutition Disorders; Diskectomy; Prospective Studies; Postoperative Complications; Cervical Vertebrae; Spinal Fusion
PubMed: 37653510
DOI: 10.1186/s13018-023-04134-4 -
Turkish Neurosurgery 2024To assess, and to compare the efficacy of anterior endoscopic cervical discectomy (AECD) and anterior cervical discectomy with fusion (ACDF).
AIM
To assess, and to compare the efficacy of anterior endoscopic cervical discectomy (AECD) and anterior cervical discectomy with fusion (ACDF).
MATERIAL AND METHODS
Major databases, registries, and other relevant material were screened for prospective trials directly comparing AECD and ACDF. No restrictions were imposed. Meta-analysis was not conducted due to high heterogeneity.
RESULTS
After screening a total of 1339 articles, 2 studies enrolling 225 patients were included. One of these is a randomizedcontrolled- trial, including 120 patients, with a 14% lost to follow-up, showing no statistically significant differences in clinical outcomes according to the visual analogue scale (VAS) of the neck/arm and the North American Spine Society criteria regarding pain/neurological status. Radiological follow-up showed no adjacent-segment disease, with both groups presenting a statistically non-significant progression of a pre-existing adjacent-disc degeneration, and no difference in kyphosis. Recurrence was registered in 7.4% and 6.1% of patients who underwent AECD and ACDF, respectively. No statistically apparent differences in complications were observed. The second is a cohort study, including 135 patients with a 14.8% lost to follow-up. No statistically significant difference was found in clinical outcomes assessed using the VAS of the neck/arm and the neck disability index. No radiological data were provided. Recurrence was reported in 4% and 2% of patients in the AECD and ACDF group, respectively. No remarkable differences in complications were reported. Both studies reported that the surgical time was statistically shorter in AECD.
CONCLUSION
A definitive conclusion cannot be drawn. Single-level AECD seems to have results equivalent to ACDF, presenting even some benefits. Technical limitations combined with required surgical skills and experience should be considered. We recommend cautious employment in anticipation of future updates.
Topics: Humans; Diskectomy; Spinal Fusion; Cervical Vertebrae; Endoscopy; Treatment Outcome; Intervertebral Disc Degeneration
PubMed: 38650569
DOI: 10.5137/1019-5149.JTN.44424-23.2 -
BMC Musculoskeletal Disorders Jan 2024There are insufficient in-depth studies on whether percutaneous lumbar nucleoplasty (PLN) is effective and safe for the treatment of uncontained lumbar disc herniation...
BACKGROUND
There are insufficient in-depth studies on whether percutaneous lumbar nucleoplasty (PLN) is effective and safe for the treatment of uncontained lumbar disc herniation (ULDH). This study aimed to investigate the clinical efficacy of PLN on radiating leg pain caused by ULDH.
METHODS
Patients who underwent PLN for ULDH and met the inclusion criteria between June 2018 and July 2022 were included. Clinical outcomes were evaluated using the numeric rating scale (NRS) for radiating pain preoperatively; at 1 day, 1 week, and 1 month postoperatively; and at the last follow-up. Patient satisfaction was assessed using MacNab criteria.
RESULTS
Forty-one patients were enrolled. The mean age was 50.2 years (range 24-73 years). The mean and standard deviation of the preoperative NRS in 39 patients with radiating pain was 9.0 ± 1.2. The NRS scores at 1 day, 1 week, and 1 month postoperatively and at the last follow-up were 4.6 ± 3.2, 3.6 ± 3.3, 2.9 ± 3.2, and 1.4 ± 2.0, respectively, showing significant improvement (all, p < 0.001). The number of patients (percentage) with excellent or good satisfaction according to the MacNab criteria was 29 (70.7%). Major complications were not observed. Three patients underwent additional surgery after PLN because of persistent radiating pain.
CONCLUSIONS
PLN is a safe and feasible treatment option for ULDH. Treatment outcomes were favorable on average; however, the lack of consistency was a drawback.
Topics: Humans; Young Adult; Adult; Middle Aged; Aged; Intervertebral Disc Displacement; Retrospective Studies; Treatment Outcome; Pain; Patient Satisfaction; Diskectomy, Percutaneous; Lumbar Vertebrae; Endoscopy
PubMed: 38166911
DOI: 10.1186/s12891-023-07120-3 -
Journal of Korean Neurosurgical Society Mar 2024Some patients with disc herniation who underwent discectomy complain of back pain after surgery and are unsatisfied with the surgical results. This study aimed to...
OBJECTIVE
Some patients with disc herniation who underwent discectomy complain of back pain after surgery and are unsatisfied with the surgical results. This study aimed to evaluate the relationship between preoperative disc height (DH), postoperative DH, and pain score 12 months after surgery in patients who underwent microdiscectomy for herniated lumbar disc.
METHODS
This study enrolled patients who underwent microdiscectomy at a medical center between January 2012 and December 2020. Patients with X-ray or computed tomography and pain score assessment (visual analog scale score) prior to surgery, immediately post-op, and at 1, 6, and 12 months after surgery were included. The DH index was defined as DH/overlying vertebral width. The DH ratio was defined as the postoperative DH/preoperative DH. Simple linear regression and multivariate linear regression analyses were applied to assess the correlation between DHs and leg pain scores 12 months after surgery.
RESULTS
A total of 118 patients who underwent microdiscectomy were included. DH decreased up to 12 months after surgery. The DH ratio at 1, 6, and 12 months after discectomy showed a significant positive correlation with the pain scores at 12 months after discectomy (1 month : p=0.045, B=0.52; 6 months : p=0.008, B=0.78; 12 months : p=0.005, B=0.69). Multivariate linear regression analysis revealed that the level of surgery, sex, age, and body mass index had no significant relationship with back pain scores after 12 months.
CONCLUSION
In patients who underwent microdiscectomy, the DH ratios at 1, 6, and 12 months after surgery were prognostic factors for back pain scores at 12 months after surgery. Aggressive discectomy is recommended for lower postoperative DH ratios and Visual analog scale scores, leading to improved patient satisfaction.
PubMed: 37799026
DOI: 10.3340/jkns.2023.0110 -
Journal of Medicine and Life Oct 2023The precise evaluation of postoperative outcomes in patients with lumbar disc surgery is quite difficult since the pre-operative factors and patient responses differ....
The precise evaluation of postoperative outcomes in patients with lumbar disc surgery is quite difficult since the pre-operative factors and patient responses differ. Several questionnaires assess the outcome of herniated lumbar disc surgeries. However, the clinical outcome may vary widely, indicating the significance of precise preoperative assessments to ensure better outcome prediction. Previous long-term studies suggest fewer positive outcomes in cases with prolonged preoperative history. In the present retrospective study, we aimed to assess the outcome of patients with lumbar discectomy in Iraqi patients by evaluating the surgical outcome. This research was performed in the orthopedic center of the Teaching Hospital of Adiwaniyah Province, Iraq. The study was based on retrieving hospital records of patients who were subjected to surgical intervention for lumbar disc herniation from 2018 to 2022. The sample consisted of patients with lumbar disc herniation who were subjected to discectomy at one level even in cases where both approaches were used. Age, gender, income, education level, and degree of disc involvement did not significantly correlate with the type of surgical approach (p>0.05); however, there were significant positive correlations to body mass index and duration of disease (p<0.05). Therefore, the body mass index and duration of disease are significant predictors of prolonged postoperative follow-up and hospital stay duration.
Topics: Humans; Intervertebral Disc Displacement; Retrospective Studies; Follow-Up Studies; Outpatients; Treatment Outcome; Lumbar Vertebrae; Diskectomy; Endoscopy
PubMed: 38313164
DOI: 10.25122/jml-2023-0288