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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 -
Journal of Orthopaedic Surgery and... Apr 2023Anterior cervical discectomy and fusion has been considered standard management for cervical myelopathy and radiculopathy. However, the option of using self-locking...
Clinical and imaging outcomes of self-locking stand-alone cages and anterior cage-with-plate in three-level anterior cervical discectomy and fusion: a retrospective comparative study.
BACKGROUND
Anterior cervical discectomy and fusion has been considered standard management for cervical myelopathy and radiculopathy. However, the option of using self-locking stand-alone cages or cage-with-plate in three-level anterior cervical discectomy and fusion still remains controversial. The aim of this study was to evaluate the clinical and imaging outcomes of the two procedures in multilevel anterior cervical discectomy and fusion.
METHODS
Sixty-seven patients who underwent three-level anterior cervical discectomy and fusion were enrolled in this study, of which 31 patients underwent surgery using self-locking stand-alone cages (group cage) and 36 patients using cage-with-plate (group plate). For the evaluation of clinical outcomes, modified Japanese Orthopedic Association scores, visual analogue scale for neck pain, neck disability index, Odom's criteria and dysphagia status were measured. Imaging outcomes were evaluated by cervical sagittal angle, fusion segmental Cobb's angle, fusion segmental height, range of motion, cage subsidence rate, fusion rate and adjacent segment degeneration. Statistical analyses were performed using the SPSS software (version 19.0).
RESULTS
Both groups showed improvement in modified Japanese Orthopedic Association scores, visual analogue scale for neck pain and neck disability index, after surgery, and there was no significant difference between the groups. The occurrence rate of dysphagia is significantly lower in the group cage compared with the group plate (p < 0.05). The postoperative cervical sagittal angle, fusion segmental Cobb's angle, fusion segmental height and cage subsidence rate in the group plate were significantly superior to that in the group cage (p < 0.05). However, the rate of adjacent segment degeneration was significantly lower in the group cage compared with the group plate (p < 0.05). Both groups showed no significant difference in terms of fusion rate (p > 0.05).
CONCLUSIONS
The self-locking stand-alone cages are effective, reliable and safe in anterior cervical discectomy and fusion for the treatment of cervical myelopathy and radiculopathy. Self-locking stand-alone cages showed a significantly lower rate of dysphagia and adjacent segment degeneration, while anterior cervical cage-with-plate could provide stronger postoperative stability and maintain better cervical spine alignment.
Topics: Humans; Retrospective Studies; Treatment Outcome; Neck Pain; Deglutition Disorders; Radiculopathy; Spinal Fusion; Spinal Cord Diseases; Diskectomy; Cervical Vertebrae
PubMed: 37020306
DOI: 10.1186/s13018-023-03726-4 -
Frontiers in Bioscience (Landmark... Apr 2022The defect of intervertebral disc (IVD) after discectomy may impair tissue healing and predispose patients to subsequent IVD degeneration, which is thought to be an...
BACKGROUND
The defect of intervertebral disc (IVD) after discectomy may impair tissue healing and predispose patients to subsequent IVD degeneration, which is thought to be an important cause of recurrence. Cell-based approaches for the treatment of IVD degeneration have shown promise in preclinical studies. However, most of these therapies have not been approved for clinical use due to the risks of abnormal differentiation and microorganism contamination of the culture-expanded cells. Selective cell retention (SCR) technology is non-cultivation technique, which can avoid those preambles in cell expansion. In this study, we used a commercially available BONE GROWTH PROMOTER device (BGP, FUWOSI, Chongqing, China) to concentrate mesenchymal stromal cells (MSCs) from bone marrow aspirate (BMA) through SCR technology.
METHODS
A small incision was made on the L2/3, L3/4 and L4/5 discs of goats and part of nucleus pulposus (NP) was removed to construct IVD defect model. The L2/3 disc was subjected to discectomy only (DO group), the L3/4 disc was implanted with enriched BMA-matrix (CE group), and the L4/5 disc was implanted cultured autologous bone marrow MSCs matrix (CC group). And the intact L1/2 disc served as a non-injured control (NC group). The animals were followed up for 24 weeks after operation. Spine imaging was analysis performed at 4 and 24 weeks. Histology, immunohistochemistry, gene expression and biomechanical analysis were performed to investigate the IVD morphology, content and mechanical properties at 24 weeks.
RESULTS
The CE and CC groups showed a significantly smaller reduction in the disc height and T2-weighted signal intensity, and a better spinal segmental stability than DO group. Histological analysis demonstrated that CE and CC groups maintained a relatively well-preserved structure compared to the DO group. Furthermore, real-time PCR and immunohistochemistry demonstrated that aggrecan and type II collagen were up-regulated in CE and CC groups compared to DO group.
CONCLUSIONS
The strategy of MSCs enrichment combined with gelatin sponge by SCR technology provides a rapid, simple, and effective method for cell concentration and cell-carrier combination. This reparative strategy can be used in clinical treatment of IVD defect after discectomy.
CLINICAL TRIAL REGISTRATION
NCT03002207.
Topics: Animals; Diskectomy; Gelatin; Goats; Humans; Intervertebral Disc; Intervertebral Disc Degeneration; Mesenchymal Stem Cells
PubMed: 35468690
DOI: 10.31083/j.fbl2704131 -
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 -
Scientific Reports Mar 2022The elderly population has an increased risk of degenerative cervical myelopathy due to multilevel disease, causing motor and sensory dysfunctions and a poor quality of...
The elderly population has an increased risk of degenerative cervical myelopathy due to multilevel disease, causing motor and sensory dysfunctions and a poor quality of life. Multilevel anterior cervical discectomy and fusion (ACDF) is an alternative surgical treatment option, but has a perceived higher risk of complications. The goal of this study is to report the outcome. We retrospectively reviewed patients from 2006 to 2019 undergoing multilevel ACDF for degenerative cervical myelopathy and compared outcomes and complications between elder patients (aged 70 and above) and younger patients (below 70). The patients' comorbidities, and postoperative complications, radiographic parameters such as C2-C7 Cobb angle, C2-C7 sagittal vertical axis, inter-body height of surgical levels and fusion rate were recorded. Japanese Orthopaedic Association (JOA) score and modified Odom's score were collected. Included were 18 elderly (mean age 74, range 70-87) and 45 young patients (mean age 56, range 43-65) with a follow-up of 43.8 and 55.5 months respectively. Three-level ACDF was the most common. The ratios of ASA class III patients were 94.4% and 48.9% (p < 0.001). The Charlson comorbidity indexes were 4.3 ± 1.03 and 2.1 ± 1.11 (p < 0.001). The average lengths of hospital stays were 4.9 and 4.6 days. Eleven patients (61.1%) in the elderly group experienced at least one short-term complication, compared with 16 patients (35.6%) in the younger group (p < 0.05). The middle-term complications were comparable (22.2% and 20.0%). The JOA score, recovery rate and modified Odom score showed comparable result between groups. Despite its extensiveness, multilevel ACDF is feasible for the elder patients with good clinical outcome and fusion rate. When compared to younger cohort, there is a trend of lower preoperative JOA score and recovery rate. The short-term complication rate is higher in the elderly group.
Topics: Aged; Cervical Vertebrae; Child; Child, Preschool; Diskectomy; Humans; Quality of Life; Retrospective Studies; Spinal Cord Diseases; Spinal Fusion; Treatment Outcome
PubMed: 35296700
DOI: 10.1038/s41598-022-08243-8 -
Medicina (Kaunas, Lithuania) May 2022: The use of minimally invasive retractor systems has significantly decreased the amount of tissue dissection and blood loss, and the duration of post-operative recovery... (Review)
Review
: The use of minimally invasive retractor systems has significantly decreased the amount of tissue dissection and blood loss, and the duration of post-operative recovery after far-lateral disc herniations (FLDH). In this technical note, the technique of docking the tubular retractor on the caudal transverse process is described for an efficient approach with a decreased need for manipulation of the exiting nerve root. : The case reported is that of a woman affected by a right-sided FLDH at the L4-5 level causing an L4 radiculopathy with weakness and numbness. A review of the literature for FLDH regarding the key anatomy used during a far lateral approach was also performed. : The patient showed a significant improvement of her dorsiflexion weakness and radiating leg pain at her 2-week and 5-week post-operative visits, and at a 6-month follow-up she had near-complete relief of her symptoms, including resolution of foot numbness. Prior techniques for tubular microdiscectomy for FLDH report docking on the facet joint, pars interarticularis, and the cranial transverse process. : This technical note details that the utility of docking a tubular retractor at the caudal transverse process improves upon already established techniques for minimally invasive tubular discectomy for FLDH.
Topics: Diskectomy; Female; Humans; Hypesthesia; Intervertebral Disc Displacement; Lumbar Vertebrae; Microsurgery
PubMed: 35630057
DOI: 10.3390/medicina58050640 -
Medicine May 2021As the technology of combining with fusion and nonfusion procedure, cervical hybrid surgery (HS) is an efficacious alternative for treatment with cervical spondylotic... (Comparative Study)
Comparative Study Observational Study
Cervical balance and clinical outcomes in cervical spondylotic myelopathy treated by three-level anterior cervical discectomy and fusion and hybrid cervical surgery: A CONSORT-compliant study with minimum follow-up period of 5 years.
As the technology of combining with fusion and nonfusion procedure, cervical hybrid surgery (HS) is an efficacious alternative for treatment with cervical spondylotic myelopathy. While studies on cervical alignment between 3-level HS and anterior cervical discectomy and fusion (ACDF) were seldom reported. The effects of cervical imbalance on its related clinical outcomes are yet undetermined as well.Patients with cervical spondylotic myelopathy, who underwent 3-level ACDF or HS, were included to compare cervical alignment parameters after surgery and then explore the relationship between cervical balance and clinical outcomes.Forty-one patients with HS (HS group) and 32 patients who with ACDF (ACDF group) were reviewed from February 2007 to September 2013 with the mean follow-up of 90.3 ± 25.5 (m) and 86.3 ± 28.9 (m), respectively. Cervical alignments parameters including the C2 to C7 cervical lordosis (CL), C2 to C7 sagittal vertical axis, T1 slope. and T1SCL (T1 slope minus CL), and the clinical outcomes like neck disability index (NDI) and Japanese Orthopedic Association (JOA) score were measured and recorded preoperatively (PreOP), intraoperatively, and on the first preoperative day and the last follow-up (FFU). The balance and imbalance groupings were sorted based on the T1SCL: T1SCL≤20°,balance; T1SCL > 20°, imbalance.We found significant improvements (P < .001) in NDI and JOA at intraoperatively and FFU after ACDF and HS, and no difference on cervical alignment and clinical outcomes between the 2 procedures on the basis of intergroup comparisons. By between-subgroups comparisons, however, we found significant differences in CL and T1SCL at PreOP (P < .05). Nonetheless, there was no significant difference on the clinical outcomes between balance and imbalance subgroups at FFU at PreOP (P > .05), indicating that the change of T1SCL was not correlated to NDI and JOA at FFU.Both HS and ACDF groups showed significant clinical improvements after surgery. There was no correlation between cervical balance and clinical symptoms.
Topics: Cervical Vertebrae; Diskectomy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neck; Postural Balance; Quality of Life; Spinal Cord Diseases; Spinal Fusion; Spondylosis; Treatment Outcome
PubMed: 33950989
DOI: 10.1097/MD.0000000000025824 -
Neurologia Medico-chirurgica Oct 2020Anterior cervical foraminotomy (ACF) is a surgical procedure for cervical radiculopathy to avoid fusion and adjacent segment disease (ASD), but its long-term outcome has...
Anterior cervical foraminotomy (ACF) is a surgical procedure for cervical radiculopathy to avoid fusion and adjacent segment disease (ASD), but its long-term outcome has yet to be investigated. It is also unclear whether ACF enables preservation of range of motion (ROM) and decreases ASD compared with anterior cervical discectomy and fusion (ACDF). This study included nine patients who underwent ACF, and 12 who underwent ACDF and with follow-up period of at least 5 years (average follow-up: 8.7 years). Preoperative and postoperative radiological findings were investigated, comparing the changes in ACF versus ACDF. All disc height (DH) levels (C2/3-C7/Th1) were measured preoperatively and postoperatively in all 21 patients to compare with the change due to the natural history. The ACF group experienced significant loss of DH (0.6 mm, 13.5%, p <0.01) and ROM (p <0.01) at the operated level postoperatively. However, loss of DH was not significantly different from natural changes at unaffected levels, and ROM was maintained. The ACDF group experienced a significant increase in the ROM of the cranial adjacent segment from 6.46 mm to 7.45 mm (p <0.01), and the dislocation in dynamic X-ray was also significantly increased from 1.61 mm to 2.89 mm (p <0.01), indicating radiological ASD. The ACF group had no significant increase in ROM and dislocation. ACF causes significant loss of DH and ROM, but this change is not significantly different compared with natural changes at unaffected levels. Furthermore, ACF causes less ASD than ACDF in the long term.
Topics: Adult; Aged; Cervical Vertebrae; Diskectomy; Female; Follow-Up Studies; Foraminotomy; Humans; Male; Middle Aged; Postoperative Complications; Radiculopathy; Radiography; Range of Motion, Articular; Spinal Diseases; Spinal Fusion; Time Factors; Treatment Outcome
PubMed: 32908084
DOI: 10.2176/nmc.oa.2020-0053 -
Journal of the American Academy of... Apr 2022Adjacent segment disease (ASD) of the cervical spine is a common disabling phenomenon that often requires surgical intervention. The goal of this study was to evaluate...
INTRODUCTION
Adjacent segment disease (ASD) of the cervical spine is a common disabling phenomenon that often requires surgical intervention. The goal of this study was to evaluate the economic impact of revision operations for cervical ASD.
METHODS
Consecutive adults who underwent revision cervical spine surgery for ASD at a single institution between 2014 and 2017 were retrospectively reviewed. Direct costs were identified from medical billing data and calculated for each revision surgery for ASD. Incomplete cost data for revision operations were used as a criterion for exclusion. Cost data were stratified based on the approach of the index and revision operations.
RESULTS
Eighty-five patients (average age 57 ± 10 years) underwent revisions for cervical ASD, which summed to $2 million (average $23,702). Revisions consisted of 45 anterior operations (anterior cervical diskectomy and fusion, 34; corpectomy, 10; and cervical disk arthroplasty, 1), 32 posterior operations (posterior cervical fusion, 14; foraminotomy, 14; and laminoplasty, 4), and 8 circumferential operations. Circumferential revisions had notably higher average direct costs ($57,376) than single approaches (anterior, $20,084 and posterior, $20,371). Of posterior revisions, foraminotomies had the lowest average direct costs ($5,389), whereas posterior cervical fusion had the highest average direct costs ($35,950). Of anterior revisions, corpectomies ($30,265) had notably greater average direct costs than anterior cervical diskectomy and fusion ($17,514). Costs were not notably different for revision approaches based on the index operations' approach.
DISCUSSION
Revision operations for cervical ASD are highly heterogeneous and associated with an average direct cost of $27,702. Over 3 years, revisions for 85 patients with cervical ASD represented a notable economic expense (greater than $2.0 million).
DATA AVAILABILITY
Deidentified data may be provided by request to the corresponding author.
Topics: Adult; Aged; Cervical Vertebrae; Diskectomy; Humans; Middle Aged; Retrospective Studies; Spinal Diseases; Spinal Fusion; Treatment Outcome
PubMed: 35452424
DOI: 10.5435/JAAOSGlobal-D-22-00058 -
Clinical Biomechanics (Bristol, Avon) Aug 2020Conditions requiring cervical decompression and stabilization are commonly treated using anterior cervical discectomy and fusion using an anterior cage-plate construct....
BACKGROUND
Conditions requiring cervical decompression and stabilization are commonly treated using anterior cervical discectomy and fusion using an anterior cage-plate construct. Anterior zero profile integrated cages are an alternative to a cage-plate construct, but literature suggests they may result in less motion reduction. Interfacet cages may improve integrated cage stability. This study evaluated the motion reduction of integrated cages with and without supplemental interfacet fixation. Motion reduction of integrated cages were also compared to published cage-plate results.
METHODS
Seven cadaveric (C2-T1) spines were tested in flexion-extension, lateral bending, and rotation. Specimens were tested: 1) intact, 2) C6-C7 integrated cage, 3) C6-C7 integrated cage + interfacet cages, 4) additional integrated cages at C3-C4 and C4-C5, 5) C3-C4, C4-C5 and C6-C7 integrated cages + interfacet cages. Motion, lordosis, disc and neuroforaminal height were assessed.
FINDINGS
Integrated cage at C6-C7 decreased flexion-extension by 37% (P = .06) and C3-C5 by 54% (P < .01). Integrated + interfacet cages decreased motion by 89% and 86% compared to intact (P < .05). Integrated cages increased lordosis at C4-C5 and C6-C7 (P < .01). Integrated + interfacet cages returned C3-C5 lordosis to intact values, while C6-C7 remained more lordotic (P = .02). Compared to intact, neuroforaminal height increased after integrated cages at C3-C5 (P ≤ .01) and at all levels after interfacet cages (P < .01).
INTERPRETATION
Anterior integrated cages provides less stability than traditional cage-plate constructs while supplemental interfacet cages improve stabilization. Integrated cages provide more lordosis at caudal levels and increase neuroforaminal height more at cranial levels. After interfacet cages, posterior disc height and neuroforaminal height increased more at the caudal segments.
Topics: Biomechanical Phenomena; Bone Plates; Cadaver; Cervical Vertebrae; Diskectomy; Female; Humans; Middle Aged; Range of Motion, Articular; Rotation; Spinal Fusion
PubMed: 32585556
DOI: 10.1016/j.clinbiomech.2020.105078