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Clinical Spine Surgery Nov 2023It is not surprising that the utilization of hybrid constructs, combining cervical disc arthroplasty with anterior cervical disc arthroplasty, has steadily increased... (Review)
Review
It is not surprising that the utilization of hybrid constructs, combining cervical disc arthroplasty with anterior cervical disc arthroplasty, has steadily increased over the last decade. Known limitations exist with multi-level anterior cervical disc arthroplasty and cervical disc arthroplasty procedures. Hybrid surgery offers the possibility to address patient-specific pathology in a more tailored manner by restoring functional mobility and promoting fusion where appropriate. This review discusses the current evidence, both biomechanical and clinical, of hybrid surgery for 2-level and 3-level cervical disease.
Topics: Humans; Intervertebral Disc; Intervertebral Disc Degeneration; Diskectomy; Cervical Vertebrae; Spinal Fusion; Arthroplasty; Treatment Outcome
PubMed: 37752636
DOI: 10.1097/BSD.0000000000001538 -
Posterior Endoscope-Assisted Diskectomy Is an Effective Technique for Cervical Soft Disk Herniation.Journal of Neurological Surgery. Part... May 2021To evaluate the clinicoradiologic conditions of patients with a herniated cervical disk who were treated with percutaneous endoscope-assisted cervical diskectomy.
OBJECTIVE
To evaluate the clinicoradiologic conditions of patients with a herniated cervical disk who were treated with percutaneous endoscope-assisted cervical diskectomy.
MATERIALS AND METHODS
The medical data of 27 patients (16 men and 11 women; mean age: 40.9 years) who were operated on with the posterior endoscope-assisted cervical diskectomy method were reviewed retrospectively. The mean follow-up was 35.1 months, and the patients were assessed with combined preoperative and postoperative visual analog scale (VAS), Prolo Functional Economic Outcome Rating scale, MacNab scale, and clinical imaging.
RESULTS
The mean preoperative VAS level was 8.6 (range: 7-10), and mean Prolo score was 2.5 (range: 2-5). A postoperative assessment performed 1 week postsurgery found a mean VAS level of 2.1 (range: 0-4). At the final examination, the mean VAS level was 0.81 (range: 0-3), and the mean Prolo score was 4.5 (range: 3-5). The final MacNab scale scores were 62.9%, excellent; 25.9%, good; 7.4%, moderate; and 3.7%, poor.
CONCLUSION
Percutaneous endoscope-assisted cervical diskectomy is a suitable and effective treatment method for soft cervical disk herniation.
Topics: Adolescent; Adult; Cervical Vertebrae; Diskectomy; Endoscopes; Female; Humans; Intervertebral Disc Displacement; Male; Middle Aged; Pain Measurement; Postoperative Period; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 33406534
DOI: 10.1055/s-0040-1709166 -
The Journal of the American Academy of... Mar 2022The relationship between surgeon experience and cervical fusion outcomes has yet to be assessed. We investigate perioperative characteristics, patient-reported outcomes...
INTRODUCTION
The relationship between surgeon experience and cervical fusion outcomes has yet to be assessed. We investigate perioperative characteristics, patient-reported outcomes (PROMs), and minimal clinically important difference (MCID) achievement after anterior cervical diskectomy and fusion (ACDF) by the volume of cases done throughout an orthopaedic spine surgeon's career.
METHODS
ACDF procedures between 2005 and 2020 were identified. Group I included the first half of ACDF cases (#1-#321). PROMs were introduced in the second half of the ACDF cases; thus, the next 322 cases were subdivided to compare PROM and MCID between subgroups (cases #322 to #483 = group II and #484 to #645 = group III). PROMs, including VAS back/leg, Oswestry Disability Index (ODI), Short Form-12 Physical Composite Score, and PROMIS-PF, were collected preoperatively/postoperatively. Demographics, perioperative variables, mean PROMs, and MCID achievement were compared between groups and subgroups using the Student t-test and chi-square. Logistic regression evaluated MCID achievement using the established threshold values.
RESULTS
A total of 642 patients were included (320 in group I, 161 in group II, and 161 in group III). The latter cases had significantly decreased surgical time, blood loss, and postoperative length of stay in comparison of groups and subgroups (P ≤ 0.002, all). CT-confirmed 1-year arthrodesis rates were increased among the latter cases (P = 0.045). Group II had significantly higher arthrodesis rates than group III (P = 0.039). The postoperative complication rates were lower in the latter cases (P < 0.001, all), whereas subgroup analysis revealed lower incidence of urinary retention and other complications in group III (P ≤ 0.031, all). Mean PROMs were significantly inferior in group II versus group III for VAS neck at 6 months (P = 0.030), Neck Disability Index at 6 months preoperatively (P ≤ 0.022, both), Short Form-12 Physical Composite Score at 12 weeks/2 years (P ≤ 0.047, both), and PROMIS-PF at 12 weeks/6 months (P ≤ 0.036, both). The MCID attainment rates were higher among group III for VAS neck/Neck Disability Index at 2 years (P ≤ 0.005) and overall achievement across all PROMs (P ≤ 0.015, all).
DISCUSSION
Increased ACDF case volume may lead to markedly decreased surgical time, blood loss, and length of postoperative stay as well as improved clinical outcomes in pain, disability, and physical function.
Topics: Cervical Vertebrae; Diskectomy; Humans; Retrospective Studies; Spinal Fusion; Surgeons; Treatment Outcome
PubMed: 34979519
DOI: 10.5435/JAAOS-D-21-01080 -
Operative Orthopadie Und Traumatologie Aug 2019Management of the intradural structures safely, closure of the dura according to the tear, and minimizing the epidural dead space. (Review)
Review
OBJECTIVE
Management of the intradural structures safely, closure of the dura according to the tear, and minimizing the epidural dead space.
INDICATIONS
Incidental durotomy (ID).
CONTRAINDICATIONS
None.
SURGICAL TECHNIQUE
1. Bone removal until whole dural tear is visible (if necessary); 2. intradural inspection; 3. reposition the fibers; 4. perform an inside patch (if ID > 5 mm); 5. dural closure; 6. outside patch; 7. Valsalva maneuver; 8. epidural pedicled muscle flap; 9. multilayer wound closure; 10. lumbar drainage of cerebrospinal fluid (if necessary).
POSTOPERATIVE MANAGEMENT
Bed rest up to 48 h; analgesics.
RESULTS
The intraspinal part of 4020 surgeries performed with the aid of a microscope were evaluated. The overall prevalence of ID was 4.4%. The prevalence was lowest in virgin microdiscectomies (1.7%) and varied from 3.6% in decompression for spinal canal stenosis up to 14.5% in revision procedures. Of the overall 195 IDs, 127 occurred in primary surgeries and 68 in revision surgeries. In 107 primary surgeries, the individual surgical technique (InT) achieved a single stage closure of the ID in 96 procedures (89.7%). Among 20 virgin surgeries, the ten-step technique (10 ST) was successful in all cases (P = 0.21). Among 42 revision procedures following failed attempts to stop the CSF leakage, the InT achieved single-stage closure in 36 procedures (85.7%), whereas after introduction of the 10 ST, closure was successful in all 26 cases (P = 0.03).
Topics: Decompression, Surgical; Diskectomy; Dura Mater; Humans; Postoperative Complications; Reoperation; Treatment Outcome
PubMed: 31324953
DOI: 10.1007/s00064-019-0618-4 -
Clinical Spine Surgery Feb 2022An analysis of a National Database.
STUDY DESIGN
An analysis of a National Database.
OBJECTIVE
The objective of this study was to evaluate the rate of dysphagia for Parkinson disease (PD) patients undergoing cervical spine surgery for cervical myelopathy.
SUMMARY OF BACKGROUND DATA
Cervical spondylotic myelopathy (CSM) is an increasingly common problem in the aging population. Several surgical options exist to treat this condition including anterior, posterior and combined surgical approaches. Each approach carries its own set of postoperative complications. Little is known of the of outcomes after cervical spine surgery in PD.
MATERIALS AND METHODS
The National Inpatient sample was queried 1998 to 2016, all elective admissions with CSM were identified. Surgical treatments were identified as either: anterior cervical discectomy and fusion (ACDF), posterior laminectomies, posterior cervical fusion or combined anterior/posterior surgery. Preexisting PD was identified. Endpoints included mortality, length of stay (LOS), swallowing dysfunction measured by placement of feeding tube (NGT), and postprocedure pneumonia.
RESULTS
A total of 73,088 patients underwent surgical procedures for CSM during the study period. Of those, 552 patients (7.5%) had concomitant PD. The most common procedure was ACDF. Patients with PD had a higher rate of dysphagia (NGT placement) after surgery compared with those without PD (P<0.001). Multiple regression analysis showed that PD patients had a higher risk of having NGT placement or developing pneumonia [odds ratio 2.98 (1.7-5.2), P<0.001] after surgery.Patients with PD who underwent ACDF, posterior laminectomies or posterior cervical fusion had a longer LOS compared with those who did not have PD (P<0.001). There was no difference in LOS for patients who underwent combined anterior/posterior surgery. Inpatient mortality was higher in patients with PD who underwent ACDF or combined surgery (P<0.001).
CONCLUSIONS
While ACDF is the most commonly performed procedure for CSM in patients with PD, it is associated with longer LOS, higher incidence of postoperative dysphagia, and postprocedural pneumonia, as well as higher inpatient mortality compared with posterior cervical procedures.
LEVEL OF EVIDENCE
Level III.
Topics: Aged; Cervical Vertebrae; Deglutition Disorders; Diskectomy; Humans; Parkinson Disease; Postoperative Complications; Retrospective Studies; Spinal Fusion; Spondylosis; Treatment Outcome
PubMed: 34029260
DOI: 10.1097/BSD.0000000000001197 -
European Spine Journal : Official... Jul 2022To evaluate the impact of discectomy on back muscles (e.g. multifidus muscle (MM)) morphology in patients with lumbar disc herniation (LDH) following discectomy surgery,... (Meta-Analysis)
Meta-Analysis Review
The association between changes in multifidus muscle morphology and back pain scores following discectomy surgery for lumbar disc herniation: a systematic review and meta-analysis.
PURPOSE
To evaluate the impact of discectomy on back muscles (e.g. multifidus muscle (MM)) morphology in patients with lumbar disc herniation (LDH) following discectomy surgery, address the association of back muscles morphology with pain score preoperatively and post-operatively, and investigate the relationships between the changes from pre- to post-operative back muscles measurements and pain score (primary outcome) and disability score (secondary outcome) change following discectomy if any.
METHODS
We searched three online databases for randomized controlled trials (RCTs) and observational studies. In LDH patients, eligible for discectomy surgery, pre- and post-operative and the changes from pre- to post-operative of back and/or leg pain with Visual Analogue Scale (VAS) and multifidus muscle morphology, were considered as primary outcomes. Cochrane Risk-of-Bias 2 tool and Newcastle-Ottawa Scale (NOS) were used to assess the methodological quality of RCTs and observational studies, respectively. Standardize mean difference (SMD) with 95% confidence intervals (CI) was evaluated. A meta-regression analysis was conducted. GRADE approach was used to summarize the strength of evidence.
RESULTS
One RCT and five observational studies were included in the analysis of 489 patients with LDH undergoing discectomy surgery. The mean overall follow-up was 64.9 weeks (6 to 148.7 weeks). There was a significant negative relationship between the change from pre- to post-operative cross-sectional area (CSA) in MM and change in VAS back pain [regression coefficient = -0.01, (95% CI = -0.02, -0.01), p = 0.044] after discectomy surgery. No significant relationship between preoperative CSA in MM and preoperative/post-operative clinical (any of the follow-up periods) scores could be established.
CONCLUSION
The results of this study found very low-quality grade evidence for an association between higher reduction of CSA in MM and less reductions of back pain scores following discectomy surgery for patients with LDH. Due to the heterogeneity and methodological limitations, further studies will improve understanding and aid preoperative counselling.
Topics: Back Pain; Diskectomy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Paraspinal Muscles
PubMed: 35325300
DOI: 10.1007/s00586-022-07181-3 -
Journal of the American Academy of... Oct 2022Esophageal perforation associated with anterior cervical diskectomy and fusion (ACDF) is a rare but serious complication. ACDF-related esophageal perforations can be...
Esophageal perforation associated with anterior cervical diskectomy and fusion (ACDF) is a rare but serious complication. ACDF-related esophageal perforations can be acute or delayed. Delayed perforations more than 10 years after ACDF are exceedingly rare. Here, a delayed esophageal perforation discovered 12 years after a three-level ACDF is presented. This case highlights two main points. First, all diverticula after an ACDF warrant close clinical monitoring. Second, routine follow-up should be performed for patients with screw pullout to assist in early diagnosis of delayed esophageal perforation.
Topics: Cervical Vertebrae; Diskectomy; Esophageal Perforation; Humans; Spinal Fusion
PubMed: 36227832
DOI: 10.5435/JAAOSGlobal-D-22-00080 -
World Neurosurgery Aug 2020The aging population around the world leads to increasing incidence of degenerative spinal conditions. There is a need for a minimally invasive technique in treatment... (Review)
Review
The aging population around the world leads to increasing incidence of degenerative spinal conditions. There is a need for a minimally invasive technique in treatment for spinal conditions to meet the medical complexity and comorbidities that comes with aging. Principles of endoscopy are similar to minimally invasive surgery, which is to decrease pressure on soft tissue crushing from prolonged retraction, avoid soft tissue stripping and dissection, and bone and ligamentous preservation for optimal decompression without excessive destruction. Endoscopic spine surgery techniques started slowly in development in the 1970s to 2000s, with a rapid phase of development since the turn of the 21st century with endoscopic solutions developing in cervical, thoracic, and lumbar conditions with increasing complexity in nature of operation. Technological enhancement with progressively supportive literature is pushing boundaries of endoscopy from the early days of soft tissue procedure to current fusion procedures, endoscopic spine surgery techniques is covering more areas of spine than ever previously possible with good clinical results. We present a review on the current techniques available and postulated near future development for endoscopic spine surgery.
Topics: Cervical Vertebrae; Diskectomy; Foraminotomy; Humans; Lumbar Vertebrae; Neuroendoscopy; Spinal Diseases; Spinal Fusion; Thoracic Vertebrae
PubMed: 32797991
DOI: 10.1016/j.wneu.2020.03.111 -
The Journal of the American Academy of... Sep 2022This study compares perioperative and postoperative clinical outcomes in patients undergoing anterior cervical diskectomy and fusion (ACDF) or cervical disk replacement...
Level-specific Perioperative and Clinical Outcome Comparison: Cervical Disk Replacement Versus Anterior Cervical Diskectomy and Fusion at C5-C6 in Patients With Myeloradiculopathy.
INTRODUCTION
This study compares perioperative and postoperative clinical outcomes in patients undergoing anterior cervical diskectomy and fusion (ACDF) or cervical disk replacement (CDR) at C5-C6 in patients with myeloradiculopathy.
METHODS
Primary, elective, single-level CDR or ACDF procedures at C5-C6 for patients with myeloradiculopathy were included. Patient-reported outcome measures (PROMs) included visual analog scale (VAS) neck, VAS arm, Neck Disability Index (NDI), Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), and Short-Form 12-Item Physical Composite Score (SF-12 PCS) collected at preoperative/6-week/12-week/6-month/1-year time points. Surgical cohorts were assessed for differences in demographics/perioperative characteristics using the chi square test and unpaired Student t-test for categorical and continuous variables, respectively. Achievement of minimum clinically important difference (MCID) was determined by comparing ΔPROMs with established thresholds. Outcome measures were compared at postoperative time points with the Student t-test, and improvement from preoperative baseline was assessed with a paired sample t-test.
RESULTS
One hundred thirty-seven patients were included, 43 CDR and 94 ACDF. CDR patients demonstrated significantly reduced surgical times (46.3 versus 55.1 minutes), estimated blood loss (24.4 versus 43.6 mL), revision surgery rates (0.0% versus 5.3%), postoperative length of stay (8.9 versus 23.0 hours), and postoperative narcotic consumption (P < 0.017, all). Complication rates and mean PROMs did not differ between cohorts. The CDR cohort markedly improved from baseline for all PROMs postoperatively except SF-12 PCS/PROMIS-PF at 6 weeks. The ACDF cohort markedly improved at each time point except VAS arm at 1 year, NDI at 6 weeks/1 year, and SF-12 PCS/PROMIS-PF at 6 weeks. A majority of both cohorts achieved overall MCID for VAS neck/NDI/PROMIS-PF. MCID achievement rates did not differ except NDI at 12 weeks/1 year and SF-12 PCS at 6 months, both favoring CDR.
DISCUSSION
Both procedural cohorts demonstrated similar long-term clinical outcomes for arm/neck pain and physical function; however, patients undergoing CDR at C5-C6 demonstrated an improved ability to maintain 1-year postoperative progress for neck disability with improved 1-year NDI MCID achievement. The CDR cohort, in addition, demonstrated an improved perioperative profile and reduced rate of revision surgery.
Topics: Cervical Vertebrae; Diskectomy; Humans; Neck Pain; Retrospective Studies; Spinal Cord Diseases; Spinal Fusion; Treatment Outcome
PubMed: 35984083
DOI: 10.5435/JAAOS-D-21-01276 -
Journal of Orthopaedic Surgery and... Jul 2023The clinical outcomes of using a tubular microdiscectomy for lumbar disc herniation were evaluated by comparison with conventional microdiscectomy. (Meta-Analysis)
Meta-Analysis Review
Comparison of outcomes between tubular microdiscectomy and conventional microdiscectomy for lumbar disc herniation: a systematic review and meta-analysis of randomized controlled trials.
PURPOSE
The clinical outcomes of using a tubular microdiscectomy for lumbar disc herniation were evaluated by comparison with conventional microdiscectomy.
METHODS
All of the comparative studies published in the PubMed, Cochrane Library, Medline, Web of Science, and EMBASE databases as of 1 May 2023 were included. All outcomes were analysed using Review Manager 5.4.
RESULTS
This meta-analysis included four randomized controlled studies with a total of 523 patients. The results showed that using tubular microdiscectomy for lumbar disc herniation was more effective than conventional microdiscectomy in improving the Oswestry Disability Index (P < 0.05). However, there were no significant differences in operating time, intraoperative blood loss, hospital stay, Visual Analogue Scale, reoperation rate, postoperative recurrence rate, dural tear incidence, and complications rate (all P > 0.05) between the tubular microdiscectomy and conventional microdiscectomy groups.
CONCLUSIONS
Based on our meta-analysis, it was found that the tubular microdiscectomy group had better outcomes than the conventional microdiscectomy group in terms of Oswestry Disability Index. However, there were no significant differences between the two groups in terms of operating time, intraoperative blood loss, hospital stay, Visual Analogue Scale, reoperation rate, postoperative recurrence rate, dural tear incidence, and complications rate. Current research suggests that tubular microdiscectomy can achieve clinical results similar to those of conventional microdiscectomy. PROSPERO registration number is: CRD42023407995.
Topics: Humans; Intervertebral Disc Displacement; Blood Loss, Surgical; Lumbar Vertebrae; Microsurgery; Randomized Controlled Trials as Topic; Diskectomy; Treatment Outcome
PubMed: 37400862
DOI: 10.1186/s13018-023-03962-8