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Orthopaedic Surgery Jun 2022To compare the clinical efficacy and radioactivity of the bridge-type zero-profile anchored spacer (ROI-C) interbody fusion cage and anterior cervical discectomy and...
Comparing the Bridge-Type Zero-Profile Anchored Spacer (ROI-C) Interbody Fusion Cage System and Anterior Cervical Discectomy and Fusion (ACDF) with Plating and Cage System in Cervical Spondylotic Myelopathy.
OBJECTIVE
To compare the clinical efficacy and radioactivity of the bridge-type zero-profile anchored spacer (ROI-C) interbody fusion cage and anterior cervical discectomy and fusion with plating and cage system (ACDF) for cervical spondylotic myelopathy (CSM).
METHODS
This is a retrospective contrastive study. We recruited 35 patients who received ROI-C (ROI-C group) and 34 patients who received ACDF (ACDF group), between January 2014 to January 2019, at our treatment center. The ROI-C group comprised of 11 males and 24 females with a mean age of 61.59 ± 8.21 years (range, 51-71 years). The ACDF group comprised of 12 males and 22 females with a mean age of 60.15 ± 7.52 years (range, 52-74 years). Neck Disability Index (NDI), Japanese Orthopaedic Association score (JOA), Odom's score, cervical Cobb angle, fusion rate, adjoining ossification, and dysphagia.
RESULTS
A total of 69 patients met the inclusion criteria, and these patients received more than two years of follow-up. There were significant differences in surgical duration (101 ± 22 min vs. 118 ± 29 min) and blood loss (102 ± 46 ml vs. 145 ± 58 ml) between two groups (P < 0.05). The JOA and NDI of these two groups of patients significantly improved, when compared with those before the operation (P < 0.05). Twenty-nine of 35 patients in the ROI-C group and 27 of 34 patients in ACDF group achieved good or excellent outcomes according to Odom's criteria. The cervical lordosis of both two groups significantly increased, when compared with those before the operation (P < 0.05). In the ROI-C group, the postoperative fusion rate was 85.7% at the 3-month follow-up and 100% at the final follow-up. In the ACDF group, the postoperative fusion rate was 82.4% at the 3-month follow-up and 100% at the final follow-up. The dysphagia incidence of the ACDF group was higher than that of the ROI-C group postoperatively and at the one month after surgery (P < 0.05), but no significant difference was found in the incidence of dysphagia at final follow-up (P > 0.05).
CONCLUSION
Both ROI-C and ACDF achieved good therapeutic effects. However, ROI-C can reduce the operation time and postoperative complications.
Topics: Aged; Cervical Vertebrae; Deglutition Disorders; Diskectomy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Retrospective Studies; Spinal Cord Diseases; Spinal Fusion; Spondylosis; Treatment Outcome
PubMed: 35478487
DOI: 10.1111/os.13268 -
Musculoskeletal Science & Practice Apr 2023Lumbar disc disease is a leading cause of low back pain. Lumbar discectomy (LD) may be indicated if symptoms are not managed conservatively. Rehabilitation has...
BACKGROUND
Lumbar disc disease is a leading cause of low back pain. Lumbar discectomy (LD) may be indicated if symptoms are not managed conservatively. Rehabilitation has traditionally been delivered postoperatively; however, there is increasing delivery preoperatively. There are few data concerning perceptions and experiences of preoperative rehabilitation. Exploring experiences of preoperative rehabilitation may help in the development and delivery of effective care for patients.
OBJECTIVES
To develop an understanding of patient and healthcare provider (HCP) experiences, perspectives and preferences of preoperative LD rehabilitation, including why patients do not attend.
DESIGN
A qualitative interpretive approach using focus groups and individual interviews.
METHODS
Data were collected from; a) patients listed for surgery and attended the preoperative rehabilitation (October 2019 to March 2020), b) patients listed for surgery but did not attend rehabilitation, and c) HCPs involved in the delivery of rehabilitation. Data were transcribed verbatim and analysed using thematic analysis.
RESULTS/FINDINGS
Twenty participants were included, twelve patients and eight HCPs. The preoperative class was a valuable service for both patients and HCPs. It provided a solution to staffing and time pressures. It provided the required education and exercise content helping the patients along their surgery pathway. Travel distance, transportation links, parking difficulty and cost, lack of knowledge about the class aims, and previous negative experiences were barriers to patient attendance.
CONCLUSIONS
For most patients and HCPs, the preoperative class was valuable. Addressing the challenges and barriers could improve attendance. Future research should focus on management of patient expectations and preferences preoperatively.
Topics: Humans; Preoperative Exercise; Qualitative Research; Focus Groups; Health Personnel; Diskectomy
PubMed: 36958123
DOI: 10.1016/j.msksp.2023.102740 -
Scientific Reports Aug 2022Simulation in surgical training is a growing field and this study aims to understand the force and torque experienced during lumbar spine surgery to design simulator...
Simulation in surgical training is a growing field and this study aims to understand the force and torque experienced during lumbar spine surgery to design simulator haptic feedback. It was hypothesized that force and torque would differ among lumbar spine levels and the amount of tissue removed by ≥ 7%, which would be detectable to a user. Force and torque profiles were measured during vacuum curette insertion and torsion, respectively, in multiple spinal levels on two cadavers. Multiple tests per level were performed. Linear and torsional resistances of 2.1 ± 1.6 N/mm and 5.6 ± 4.3 N mm/°, respectively, were quantified. Statistically significant differences were found in linear and torsional resistances between all passes through disc tissue (both p = 0.001). Tool depth (p < 0.001) and lumbar level (p < 0.001) impacted torsional resistance while tool speed affected linear resistance (p = 0.022). Average differences in these statistically significant comparisons were ≥ 7% and therefore detectable to a surgeon. The aforementioned factors should be considered when developing haptic force and torque feedback, as they will add to the simulated lumbar discectomy realism. These data can additionally be used inform next generation tool design. Advances in training and tools may help improve future surgeon training.
Topics: Computer Simulation; Diskectomy; Humans; Lumbar Vertebrae; Spinal Diseases; Surgical Instruments; Vacuum
PubMed: 35933556
DOI: 10.1038/s41598-022-17512-5 -
Journal of Orthopaedic Surgery (Hong... 2023The retrospective study was conducted to compare the efficacy of anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) for... (Review)
Review
Comparison of anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in the treatment of localized ossification of the posterior longitudinal ligament.
BACKGROUND
The retrospective study was conducted to compare the efficacy of anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) for localized ossification of the posterior longitudinal ligament (OPLL) by evaluating clinical and radiologic outcomes.
METHODS
We reviewed 151 patients to assess the effects of treatment for one or two levels localized OPLL. Perioperative parameters, such as blood loss, operation time and complications, were recorded. Radiologic outcomes, such as the occupying ratio (OR), fusion status, cervical lordosis angle, segmental angle, disc space height, T1 slope, and C2-C7 sagittal vertical axis (SVA), were assessed. Clinical indices, such as the JOA scores and VAS scores, were investigated to compare the two surgical options.
RESULTS
There were no significant differences in the JOA scores or VAS scores between the two groups ( > 0.05). The operation time, volume of blood loss and incidence of dysphagia were significantly less in the ACDF group than in the ACCF group ( < 0.05). In addition, cervical lordosis, segmental angle and disc space height were significantly different from their preoperative evaluations. No adjacent segment degenerated in the ACDF group. The subsidence rates of implants were 5.2% in the ACDF group and 28.4% in the ACCF group. The degeneration of the ACCF group was 4.1%. The incidence of CSF leaks was 7.8% in the ACDF group and 13.5% in the ACCF group. All the patients ultimately achieved successful fusion.
CONCLUSION
Although both options achieved satisfactory primary clinical and radiographic efficacies, ACDF was associated with a shorter surgical procedure, less intraoperative blood loss, better radiologic outcomes, and lower incidence of dysphagia than ACCF.
Topics: Humans; Longitudinal Ligaments; Lordosis; Osteogenesis; Retrospective Studies; Deglutition Disorders; Spondylosis; Treatment Outcome; Cervical Vertebrae; Diskectomy; Ossification of Posterior Longitudinal Ligament; Spinal Fusion
PubMed: 36972216
DOI: 10.1177/10225536231167704 -
Cirugia Y Cirujanos 2024To evaluate the clinical-surgical results of the tubular vs. mini-open approach in lumbar discoidectomy. The tubular approach promises to reduce the number of rest days... (Comparative Study)
Comparative Study
OBJECTIVE
To evaluate the clinical-surgical results of the tubular vs. mini-open approach in lumbar discoidectomy. The tubular approach promises to reduce the number of rest days and an earlier return to daily activities and work.
METHOD
A case-control study of patients operated on for disc herniation using tubular surgery (case) and mini-open (control) was carried out. The variables investigated were as follow: radicular and lumbar pain, sex, age, failure in conservative treatment, single-level lumbar hernia, surgical time, bleeding, length of hospital stay, persistence of symptoms, complications, occupational activity, and reintegration into everyday activities.
RESULTS
Through 100 surgeries performed, two groups were created, tubular and mini-open, with 50 patients each, with L4-L5 or L5-S1 disc herniation, respectively. The most affected level was L4-L5 (69%). Of the total cases, a significant improvement was found (p < 0.05) at 15 postoperative days in the VAS and ODI scale in the tubular group with respect to mini-open. Complications such as surgical wound infection, durotomy, and persistent pain occurred.
CONCLUSIONS
The tubular approach is a safe and effective option for herniated discs of the lumbar segment, and reduces surgical times, bleeding, and the time of reinsertion to daily activities of the patient.
Topics: Humans; Male; Female; Case-Control Studies; Lumbar Vertebrae; Adult; Intervertebral Disc Displacement; Middle Aged; Diskectomy; Treatment Outcome; Postoperative Complications; Operative Time; Length of Stay
PubMed: 38782382
DOI: 10.24875/CIRU.22000429 -
Journal of Orthopaedic Surgery and... Jan 2022The clinical outcomes of using a zero-profile for anterior cervical decompression and fusion were evaluated by comparison with anterior cervical plates. (Meta-Analysis)
Meta-Analysis Review
Comparison of outcomes between Zero-p implant and anterior cervical plate interbody fusion systems for anterior cervical decompression and fusion: a systematic review and meta-analysis of randomized controlled trials.
PURPOSE
The clinical outcomes of using a zero-profile for anterior cervical decompression and fusion were evaluated by comparison with anterior cervical plates.
METHODS
All of the comparative studies published in the PubMed, Cochrane Library, Medline, Web of Science, EBSOChost, and EMBASE databases as of 1 October 2021 were included. All outcomes were analysed using Review Manager 5.4.
RESULTS
Seven randomized controlled studies were included with a total of 528 patients, and all studies were randomized controlled studies. The meta-analysis outcomes indicated that the use of zero-profile fixation for anterior cervical decompression and fusion was better than anterior cervical plate fixation regarding the incidence of postoperative dysphagia (P < 0.05), adjacent-level ossification (P < 0.05), and operational time (P < 0.05). However, there were no statistically significant differences in intraoperative blood loss, Visual Analogue Scale, Neck Disability Index, or Japanese Orthopaedic Association scale (all P > 0.05) between the zero-profile and anterior cervical plate groups.
CONCLUSIONS
The systematic review and meta-analysis indicated that zero-profile and anterior cervical plates could result in good postoperative outcomes in anterior cervical decompression and fusion. No significant differences were found in intraoperative blood loss, Visual Analogue Scale, Neck Disability Index, or Japanese Orthopaedic Association scale. However, the zero-profile is superior to the anterior cervical plate in the following measures: incidence of postoperative dysphagia, adjacent-level ossification, and operational time. PROSPERO registration CRD42021278214.
Topics: Blood Loss, Surgical; Bone Plates; Cervical Vertebrae; Decompression; Deglutition Disorders; Diskectomy; Humans; Randomized Controlled Trials as Topic; Spinal Fusion; Treatment Outcome
PubMed: 35078496
DOI: 10.1186/s13018-022-02940-w -
Neurologia Medico-chirurgica Jul 2023This study aims to compare the outcomes of interlaminar and transforaminal approaches for full-endoscopic discectomy (FED) for treating L4/5 lumbar disc herniation...
This study aims to compare the outcomes of interlaminar and transforaminal approaches for full-endoscopic discectomy (FED) for treating L4/5 lumbar disc herniation (LDH).A retrospective study of patients with L4/5 LDH treated with interlaminar endoscopic lumbar discectomy (IELD, n = 19) or transforaminal endoscopic lumbar discectomy (TELD, n = 105) was conducted. Patient background, radiological findings, and operative data were collected. Oswestry Disability Index (ODI) and European Quality of Life-5 Dimension (EQ-5D) scores were recorded preoperatively and 1 and 2 years postoperatively.Although ODI and EQ-5D scores 1 and 2 years postoperatively improved statistically in the IELD and TELD groups, there were no statistical differences between the groups. IELD was predominantly performed in patients who were taller and heavier. The mean operative times and the frequency of laminectomy for IELD and TELD were 67.2 and 44.6 min and 63.2 and 17.1%, respectively (P < 0.001). The radiological findings showed that the concave configuration of the L4 lamina, interlaminar space width, and foraminal width were statistically different between the groups. There were no complications in either of the groups. Reoperation was required for recurrence in two and five patients in the IELD and TELD groups (P = 0.29), respectively.Operative outcomes were identical between the two groups. Although the operative time was longer in the IELD group, both approaches were safely and effectively performed. Depending on the patient's physique and preoperative radiological findings, the more suitable approach for L4/5 LDH should be chosen.
Topics: Humans; Intervertebral Disc Displacement; Retrospective Studies; Quality of Life; Diskectomy, Percutaneous; Treatment Outcome; Endoscopy; Diskectomy; Lumbar Vertebrae
PubMed: 37164700
DOI: 10.2176/jns-nmc.2022-0357 -
PloS One 2023Posterior full-endoscopic cervical foraminotomy (PECF) is one of minimally invasive surgical techniques for cervical radiculopathy. Because of minimal disruption of...
OBJECTIVE
Posterior full-endoscopic cervical foraminotomy (PECF) is one of minimally invasive surgical techniques for cervical radiculopathy. Because of minimal disruption of posterior cervical structures, such as facet joint, cervical kinematics was minimally changed. However, a larger resection of facet joint is required for cervical foraminal stenosis (FS) than disc herniation (DH). The objective was to compare the cervical kinematics between patients with FS and DH after PECF.
METHODS
Consecutive 52 patients (DH, 34 vs. FS, 18) who underwent PECF for single-level radiculopathy were retrospectively reviewed. Clinical parameters (neck disability index, neck pain and arm pain), and segmental, cervical and global radiological parameters were compared at postoperative 3, 6, and 12 months, and yearly thereafter. A linear mixed-effect model was used to assess interactions between groups and time. Any occurrence of significant pain during follow-up was recorded during a mean follow-up period of 45.5 months (range 24-113 months).
RESULTS
Clinical parameters improved after PECF, with no significant differences between groups. Recurrent pain occurred in 6 patients and surgery (PECF, anterior discectomy and fusion) was performed in 2 patients. Pain-free survival rate was 91% for DH and 83% for FS, with no significant difference between the groups (P = 0.29). Radiological changes were not different between groups (P > 0.05). Segmental neutral and extension curvature became more lordotic. Cervical curvature became more lordotic on neutral and extension X-rays, and the range of cervical motion increased. The mismatch between T1-slope and cervical curvature decreased. Disc height did not change, but the index level showed degeneration at postoperative 2 years.
CONCLUSION
Clinical and radiological outcomes after PECF were not different between DH and FS patients and kinematics were significantly improved. These findings may be informative in a shared decision-making process.
Topics: Humans; Foraminotomy; Intervertebral Disc Displacement; Retrospective Studies; Constriction, Pathologic; Biomechanical Phenomena; Cervical Vertebrae; Treatment Outcome; Diskectomy; Radiculopathy
PubMed: 36809260
DOI: 10.1371/journal.pone.0281926 -
Journal of Orthopaedic Surgery and... Jul 2022To evaluate the efficacy and feasibility of percutaneous endoscopic interlaminar discectomy (PEID) via the inner border of the inferior pedicle approach for downmigrated... (Review)
Review
OBJECTIVE
To evaluate the efficacy and feasibility of percutaneous endoscopic interlaminar discectomy (PEID) via the inner border of the inferior pedicle approach for downmigrated disc herniation.
METHODS
Seventeen patients who had downmigrated disc herniation were included in this study from May 2020 to February 2021. After PEID via the inner border of the inferior pedicle approach, a retrospective study was conducted on all patients. Radiologic findings were investigated, and based on the level of migration seen on preoperative magnetic resonance imaging (MRI), participants were divided into two types (high-grade and low-grade migrations). Preoperative, 1st post-operative day, 3rd post-operative month, and the final follow-up visual analogue scale (VAS) assessments for back and leg pain and preoperative, 3rd post-operative month, and the final follow-up Oswestry disability index (ODI) evaluations were performed. The clinical effects at the final follow-up were assessed by the modified MacNab criterion.
RESULTS
All patients successfully completed surgery. There were 10 males and 7 females in the group. These patients were 42 years old on average (range, 25-68 years). Four and 13 patients had downmigrated disc herniation with high-grade and low-grade, respectively, on MRI. The mean follow-up duration was 10.47 ± 1.84 months (range, 8-14 months). The mean VAS score for back and leg improved from 5.18 ± 0.81 preoperatively to 1.35 ± 0.49 at the final follow-up (P < 0.05) and 6.94 ± 0.66 preoperatively to 1.47 ± 0.51 at the final follow-up (P < 0.05), respectively. The mean ODI score improved from 48.00 ± 3.64 preoperatively to 18.71 ± 1.31 at the final follow-up (P < 0.05). According to the modified MacNab criterion, 15 patients (88.2%) obtained excellent, while the rest 2 patients (11.8%) reported good outcomes.
CONCLUSION
PEID via the inner border of the inferior pedicle approach could be a good alternative option for the treatment of downmigrated disc herniation.
Topics: Adult; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Retrospective Studies; Treatment Outcome
PubMed: 35864515
DOI: 10.1186/s13018-022-03245-8 -
Trials Apr 2022Lumbar disc herniation (LDH) is a common chronic musculoskeletal disorder that seriously affects quality of life. The percutaneous endoscopic lumbar diskectomy (PELD)...
Study on the efficacy and safety of the combination of Shi's manual therapy and percutaneous endoscopic lumbar diskectomy for lumbar disc herniation with radiculopathy: study protocol for a multicenter randomized controlled trial.
BACKGROUND
Lumbar disc herniation (LDH) is a common chronic musculoskeletal disorder that seriously affects quality of life. The percutaneous endoscopic lumbar diskectomy (PELD) technique was developed to address spinal nerve root compression through direct visualization of pathological findings while minimizing tissue destruction upon exposure. It is an effective and safe treatment for LDH. However, recurrent LDH is a major concern after lumbar discectomy for primary LDH. A considerable number of clinical studies have reported that patients with LDH with radiculopathy could benefit from manual therapy. Shi's manual therapy (SMT) was established based on traditional Chinese medicine (TCM) theory and has been shown to have a superior effect in alleviating muscle tension and loosening joints to improve lumbar and leg pain, radiculopathy, stiffness, activity discomfort, and related disorders. However, there is a lack of high-quality clinical evidence to support this conclusion. The purpose of this study is to evaluate the efficacy and safety of the combination of Shi's manual therapy (SMT) and PELD for LDH with radiculopathy.
METHODS/DESIGN
A multicenter randomized controlled trial (RCT) with a 1-year follow-up period will be performed. A total of 510 participants with LDH with radiculopathy will be recruited from four clinical centers. The sample size was estimated, and statistical analysis will be performed and supervised by biostatisticians from an independent third-party research institution. Two hundred fifty-five subjects will be randomly allocated to each group. The subjects in the control group will undergo PELD. Participants in the intervention group will be treated with a combination of SMT and PELD. Recurrence rate is the primary endpoint and the survival analysis of recurrence rate is the secondary endpoint, and the primary analysis of recurrence rate is the chi-square test and the secondary analysis of recurrence rate is survival analysis. The primary outcome measure is the recurrence rate of LDH with radiculopathy at the 1-year follow-up after treatment. The secondary outcome measures will be the ODI score, the VAS score for pain for the lumbar spine and lower limbs, the straight leg raise angle, the stability of the operated lumbar segment, and the SF-36 scores. Assessments will occur at baseline, postoperation, and 1 week, 4 weeks, 13 weeks, 26 weeks, and 1 year postoperation. In addition, adverse events related to clinical symptoms and signs and the results of laboratory tests will be documented during the clinical trials.
DISCUSSION
This study will provide reliable evidence of the effectiveness and safety of the combination of SMT and PELD for LDH with radiculopathy. If the results are favorable, it is expected that patients with LDH with radiculopathy will benefit from this study, and many patients could gain a good alternative treatment for LDH with radiculopathy.
TRIAL REGISTRATION
China Registered Clinical Trial Registration Center ChiCTR2000036515 . Registered on 13 November 2020.
Topics: Diskectomy; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Multicenter Studies as Topic; Musculoskeletal Manipulations; Pain; Radiculopathy; Randomized Controlled Trials as Topic; Retrospective Studies; Treatment Outcome
PubMed: 35461259
DOI: 10.1186/s13063-022-06195-y