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Neurologia Medico-chirurgica May 2024Airway complications that occur after anterior cervical spine surgery pose a life-threatening risk, which encompasses complications including prolonged intubation,... (Observational Study)
Observational Study
Airway complications that occur after anterior cervical spine surgery pose a life-threatening risk, which encompasses complications including prolonged intubation, unplanned reintubation, and/or necessity of tracheostomy. The present study aimed to identify the surgical risks associated with postoperative airway complications in neurosurgical training institutes. A retrospective, multicenter, observational review of data from 365 patients, who underwent anterior cervical spine surgery between 2018 and 2022, at three such institutes was carried out. Postoperative airway complication was defined as either the need for prolonged intubation on the day of surgery or the need for unplanned reintubation. The perioperative medical information was obtained from their medical records. The average age of the cohort was over 60 years, with males comprising approximately 70%. Almost all surgeries predominantly involved anterior cervical discectomy and fusion or anterior cervical corpectomy and fusion, with most surgeries occurring at the level of C5/6. In total, 363 of 365 patients (99.5%) were extubated immediately after surgery, and the remaining two patients were kept under intubation because of the risk of airway complications. Of the 363 patients who underwent extubation immediately after surgery, two (0.55%) required reintubation because of postoperative airway complications. Patients who experienced airway complications were notably older and exhibited a significantly lower body mass index. The results of this study suggested that older and frailer individuals are at an elevated risk for postoperative airway complications, with immediate postoperative extubation generally being safe but requiring careful judgment in specific cases.
Topics: Humans; Male; Retrospective Studies; Middle Aged; Cervical Vertebrae; Female; Postoperative Complications; Aged; Airway Management; Spinal Fusion; Adult; Neurosurgical Procedures; Intubation, Intratracheal; Diskectomy; Aged, 80 and over
PubMed: 38569916
DOI: 10.2176/jns-nmc.2023-0283 -
Journal of Orthopaedic Surgery and... Apr 2024The goal of this study is to propose a classification system with a common nomenclature for radiographic observations of periprosthetic bone changes following cTDR.
BACKGROUND
The goal of this study is to propose a classification system with a common nomenclature for radiographic observations of periprosthetic bone changes following cTDR.
METHODS
Aided by serial plain radiographs from recent cTDR cases (34 patients; 44 devices), a panel of experts assembled for the purpose of creating a classification system to aid in reproducibly and accurately identifying bony changes and assessing cTDR radiographic appearance. Subdividing the superior and inferior vertebral bodies into 3 equal sections, observed bone loss such as endplate rounding, cystic erosion adjacent to the endplate, and cystic erosion not adjacent to the endplate, is recorded. Determining if bone loss is progressive, based on serial radiographs, and estimating severity of bone loss (measured by the percentage of end plate involved) is recorded. Additional relevant bony changes and device observations include radiolucent lines, heterotopic ossification, vertebral body olisthesis, loss of core implant height, and presence of device migration, and subsidence.
RESULTS
Serial radiographs from 19 patients (25 devices) implanted with a variety of cTDR designs were assessed by 6 investigators including clinicians and scientists experienced in cTDR or appendicular skeleton joint replacement. The overall agreement of assessments ranged from 49.9% (95% bootstrap confidence interval 45.1-73.1%) to 94.7% (95% CI 86.9-100.0%). There was reasonable agreement on the presence or absence of bone loss or radiolucencies (range: 58.4% (95% CI 51.5-82.7%) to 94.7% (95% CI 86.9-100.0%), as well as in the progression of radiolucent lines (82.9% (95% CI 74.4-96.5%)).
CONCLUSIONS
The novel classification system proposed demonstrated good concordance among experienced investigators in this field and represents a useful advancement for improving reporting in cTDR studies.
Topics: Humans; Treatment Outcome; Diskectomy; Total Disc Replacement; Cervical Vertebrae; Neck; Intervertebral Disc Degeneration
PubMed: 38566203
DOI: 10.1186/s13018-024-04679-y -
Orthopaedic Surgery May 2024Compared with traditional open surgery, percutaneous endoscopic lumbar discectomy (PELD) has the advantages of less trauma, faster recovery, and less postoperative pain,... (Comparative Study)
Comparative Study
OBJECTIVE
Compared with traditional open surgery, percutaneous endoscopic lumbar discectomy (PELD) has the advantages of less trauma, faster recovery, and less postoperative pain, so it has been widely used in the field of spinal surgery. However, it still has the defect of intraoperative fluoroscopy occurrences, complications, and even the risk of damage to the spinal cord and nerve. This study aims to compare the clinical efficacy of modified percutaneous endoscopic interlaminar discectomy (MPEID) with percutaneous endoscopic transforaminal discectomy (PETD) in treating L4/5 lumbar disc herniation (LDH) and to evaluate the effectiveness and safety of MPEID.
METHODS
Thirty-four L4/5 LDH patients treated at the Second Affiliated Hospital of Nanchang University from June 2020 to June 2021 were studied retrospectively. Seventeen underwent MPEID and seventeen PETD. Variables analyzed included demographics, operative duration, intraoperative fluoroscopy occurrences, and surgical outcomes. Effectiveness was evaluated using the visual analogue scale (VAS), Oswestry disability index (ODI), and modified MacNab criteria. Lumbar Magnetic Resonance Imaging (MRI) was used to assess radiological outcomes. A paired t-test was performed to compare intragroup pre- and postoperative clinical data, VAS, and ODI scores.
RESULTS
The average operative time in PETD group was 91.65 ± 14.04 min, and the average operative time in MPEID group was 65.41 ± 12.61 min (p < 0.001). In PETD group, the fluoroscopy occurrences averaged 9.71 ± 1.05 times, with fluoroscopy occurrences averaging 6.47 ± 1.00 times (p < 0.001) in MPEID group. At 12 months follow-up, the clinical effect showed significant improvement in both two groups. The MPEID group showed a decrease in average VAS-back score from 5.41 ± 2.18 to 1.76 ± 1.09 (p < 0.001) and VAS-leg score from 6.53 ± 1.66 to 0.82 ± 0.64 (p < 0.001). The ODI scores decreased from 51.35 ± 10.65 to 11.71 ± 2.91 (p < 0.001). In the PETD group, the VAS-back score decreased from 4.94 ± 1.98 to 2.06 ± 1.25 (p < 0.001), VAS-leg score from 7.12 ± 1.73 to 1.12 ± 0.60 (p < 0.001), and ODI scores from 48.00 ± 11.62 to 12.24 ± 2.56 (p < 0.001). According to the modified MacNab criteria, MPEID had 15 excellent and two good results; PETD had 12 excellent and 5 good (p = 0.23). No nerve root injuries, dural tears, or significant complications were reported.
CONCLUSION
MPEID and PETD effectively treat L4/5 LDH, with MPEID showing shorter operative times and fewer fluoroscopies. Furthermore, the MPEID group can provide excellent clinical efficacy as the PETD group in the short term.
Topics: Humans; Retrospective Studies; Intervertebral Disc Displacement; Diskectomy, Percutaneous; Male; Female; Middle Aged; Adult; Endoscopy; Lumbar Vertebrae; Disability Evaluation; Pain Measurement
PubMed: 38556483
DOI: 10.1111/os.14031 -
Acta Neurochirurgica Mar 2024To evaluate patient demographics, surgery characteristics, and patient-reported clinical outcomes related to the implementation of lumbar PTED in Denmark by surgeons...
PURPOSE
To evaluate patient demographics, surgery characteristics, and patient-reported clinical outcomes related to the implementation of lumbar PTED in Denmark by surgeons novice to the PTED technique.
METHODS
All adult patients treated with a lumbar PTED from our first surgery in October 2020 to December 2021 were included. Data was generated by journal audit and telephone interview.
RESULTS
A total of 172 adult patients underwent lumbar PTED. Surgery duration was a median of 45.0 (35.0-60.0) minutes and patients were discharged a median of 0 (0-1.0) days after. Per operatively one procedure was converted to open microdiscectomy due to profuse bleeding. Post operatively one patient complained of persistent headache (suggestive of a dural tear), two patients developed new L5 paresthesia, and three patients had a newly developed dorsal flexion paresis (suggestive of a root lesion). Sixteen patients did not complete follow-up and 24 (14.0%) underwent reoperation of which 54.2% were due to residual disk material. Among the remaining 132 patients, lower back and leg pain decreased from 7.0 (5.0-8.5) to 2.5 (1.0-4.5) and from 8.0 (6.0-9.1) to 2.0 (0-3.6) at follow-up, respectively (p < 0.001). Additionally, 93.4% returned to work and 78.8% used less analgesics. Post hoc analysis comparing the early half of cases with the latter half did not find any significant change in surgery time, complication and reoperation rates, nor in pain relief, return to work, or analgesia use.
CONCLUSION
Clinical improvements after lumbar PTED performed by surgeons novel to the technique are satisfactory, although the reoperation rate is high, severe complications may occur, and the learning curve can be longer than expected.
Topics: Adult; Humans; Retrospective Studies; Intervertebral Disc Displacement; Treatment Outcome; Lumbar Vertebrae; Endoscopy; Diskectomy; Diskectomy, Percutaneous; Pain; Denmark
PubMed: 38538955
DOI: 10.1007/s00701-024-06038-6 -
Cirugia Y Cirujanos 2024This study aims to compare the effects of microscopic microdiscectomy and microendoscopic discectomy on pain, disability, fear of falling, kinesiophobia, anxiety,...
OBJECTIVE
This study aims to compare the effects of microscopic microdiscectomy and microendoscopic discectomy on pain, disability, fear of falling, kinesiophobia, anxiety, quality of life in patients with lumbar disc herniation (LDH).
METHODS
A total of 90 patients who underwent microscopic microdiscectomy (n = 40) and microendoscopic discectomy (n = 50) for LDH were included in this study. The patients' pain, disability, fear of falling, kinesiophobia, anxiety, and quality of life were evaluated before the surgery, in the early postoperative period and three months after.
RESULTS
In patients who underwent microendoscopic discectomy, the results of pain, disability, fear of falling, kinesiophobia and anxiety were statistically decreased compared with the microscopic microdiscectomy in the early postoperative period and three months later (p < 0.05). Also, a statistically higher increase was observed in the general health perception of patients who underwent microendoscopic discectomy three months after the operation (p < 0.01).
CONCLUSION
Microendoscopic microdiscectomy, remains the most effective and widely applied method with advantages on pain, quality of life, and improved physical functions.
Topics: Humans; Intervertebral Disc Displacement; Quality of Life; Accidental Falls; Treatment Outcome; Fear; Lumbar Vertebrae; Diskectomy; Pain; Anxiety; Endoscopy; Retrospective Studies
PubMed: 38537237
DOI: 10.24875/CIRU.23000415 -
Orthopaedic Surgery May 2024Lumbar degenerative diseases (LDDs) with huge herniation in the left lateral recess or central canal present challenges for oblique lateral lumbar interbody fusion... (Comparative Study)
Comparative Study
Comparison of the Medium-term Outcomes of Anterior Lumbar Discectomy and Fusion with Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Retrospective Cohort Study.
OBJECTIVE
Lumbar degenerative diseases (LDDs) with huge herniation in the left lateral recess or central canal present challenges for oblique lateral lumbar interbody fusion (OLIF) or endoscope-assisted OLIF procedures. Currently, minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is the primary approach for this issue. This study aims to provide a standardized technical description of the anterior lumbar discectomy and fusion (ALDF) and evaluate the medium-term clinical effectiveness of both ALDF and MIS-TLIF techniques.
METHODS
A retrospective review was performed on LDDs who underwent ALDF and MIS-TLIF surgery from January 2018 to January 2020. The evaluation encompassed various clinical outcomes, such as the visual analogue scale (VAS) scores for back pain and leg pain (VAS-back, VAS-leg), the Oswestry disability index (ODI), the 36-item short-form health survey mental component summary (SF-36 MCS), and the physical component summary (SF-36 PCS). Additionally, radiological parameters, including disc height (DH), segmental disk angle (SDA), lumbar lordosis (LL), and cross-sectional area (CSA), were assessed. Data including radiculopathy, estimated blood loss, operation time, time of getting out of bed, fusion rate, and complications were recorded. Student's independent samples t test and Pearson's chi-square test were used to compare the differences between groups.
RESULTS
In total, 47 patients were treated by ALDF and 48 patients were treated by MIS-TLIF. The ALDF group exhibited statistically significant lower estimated blood loss and earlier time of getting out of bed compared to the MIS-TLIF group (p < 0.05). The ALDF group demonstrated lower VAS-back scores and a higher remission rate of low back pain 3 years after the surgery (p < 0.05). During the entire follow-up period, the ALDF group exhibited higher increases in DH and SDA compared to the MIS-TLIF group (p < 0.05). At 6 months, the fusion rate in the ALDF group was significantly higher than in the MIS-TLIF group (p < 0.05). The comparison revealed no statistically significant differences in complication rates between the two groups (p > 0.05).
CONCLUSION
The ALDF could be considered as a viable surgical alternative for the treatment of LDDs that necessitate ventral neural direct decompression. ALDF exhibited favorable medium-term outcomes in patients with LDDs, displaying advantages in facilitating expedited recovery, enhancing radiographic outcomes, and elevating the remission rate of low back pain. Although ALDF presents slightly higher complication rates compared to MIS-TLIF, it does not adversely affect clinical outcomes.
Topics: Humans; Spinal Fusion; Retrospective Studies; Lumbar Vertebrae; Middle Aged; Female; Male; Minimally Invasive Surgical Procedures; Diskectomy; Aged; Adult; Pain Measurement; Disability Evaluation; Intervertebral Disc Degeneration; Intervertebral Disc Displacement
PubMed: 38531809
DOI: 10.1111/os.14028 -
Pain Physician Mar 2024Lumbar disc herniation is a common spinal disease that causes low back pain; surgery is required when conservative treatment is ineffective. There is a growing demand... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Lumbar disc herniation is a common spinal disease that causes low back pain; surgery is required when conservative treatment is ineffective. There is a growing demand for minimally invasive surgery in younger patient populations due to their fear of significant damage and a long recovery period following standard open discectomy. The development history of minimally invasive surgery is relatively short, and no gold standard has been established.
OBJECTIVES
We aimed to find, via a network meta-analysis, the best treatment for low back pain in younger patient populations.
STUDY DESIGN
Network meta-analysis.
METHODS
The PubMed, Embase, Cochrane Library, and Web of Science databases were searched. Data quality was evaluated using RevMan 5.3 (The Nordic Cochrane Centre for The Cochrane Collaboration), while STATA 14.0 (StataCorp LLC) was used for the network meta-analysis and to merge data on the Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI) score, complication, blood loss, reoperation rate, and function score.
RESULTS
We included 50 randomized controlled trials, involving 7 interventions; heterogeneity and inconsistency were acceptable. Comparatively, microendoscopic discectomy and percutaneous endoscopic lumbar discectomy were the best surgical procedures from the aspects of VAS score and ODI score, while standard open discectomy was the worst one from the aspect of ODI score. Regarding complications, tubular discectomy was preferred with the fewest complications. Additionally, microendoscopic discectomy outperformed other surgical procedures in reducing blood loss and reoperation rate.
LIMITATIONS
First, follow-up data were not reported in all included studies, and the follow-up time varied from several months to 8 years, which affected the results accuracy of our study to some extent. Second, there were some nonsurgical factors that also affected the self-reported outcomes, such as rehabilitation and pain management, which also brought a certain bias in our study results.
CONCLUSIONS
Compared to standard open discectomy, minimally invasive surgical procedures not only achieve satisfactory efficacy, but also microendoscopic discectomy and percutaneous endoscopic lumbar discectomy can obtain a more satisfactory short-term VAS score and ODI score. Microendoscopic discectomy has significant advantages in blood loss and reoperation rate, and tubular discectomy has fewer postoperative complications.
Topics: Humans; Intervertebral Disc Displacement; Network Meta-Analysis; Diskectomy, Percutaneous; Low Back Pain; Lumbar Vertebrae; Minimally Invasive Surgical Procedures; Diskectomy
PubMed: 38506677
DOI: No ID Found -
BMC Musculoskeletal Disorders Mar 2024Our study aimed to develop a day anterior cervical discectomy and fusion (ACDF) procedure to treat degenerative cervical spondylosis (DCS). The goal was to analyze its...
OBJECTIVE
Our study aimed to develop a day anterior cervical discectomy and fusion (ACDF) procedure to treat degenerative cervical spondylosis (DCS). The goal was to analyze its clinical implications, safety, and early effects to provide a better surgical option for eligible DCS patients.
METHODS
A retrospective analysis was performed to identify DCS patients who underwent day ACDF from September 2022 to August 2023. The operative time, intraoperative blood loss, postoperative drainage, preoperative and postoperative visual analog scale (VAS) scores, neck disability index (NDI) scores, Japanese Orthopedic Association (JOA) scores, JOA recovery rate (RR), incidence of dysphagia-related symptoms, 30-day hospital readmission rate, and incidence of other complications were recorded to evaluate early clinical outcomes. Radiography was performed to assess the location of the implants, neurological decompression, and cervical physiological curvature.
RESULTS
All 33 patients (23 women and 10 men) underwent successful surgery and experienced significant symptomatic and neurological improvements. Among them, 26 patients underwent one-segment ACDF, 5 underwent two-segment ACDF, and 2 underwent three-segment ACDF. The average operative time was 71.1 ± 20.2 min, intraoperative blood loss was 19.1 ± 6.2 mL, and postoperative drainage was 9.6 ± 5.8 mL. The preoperative VAS and NDI scores improved postoperatively (7.1 ± 1.2 vs. 3.1 ± 1.3 and 66.7% ± 4.8% vs. 24.1% ± 2.5%, respectively), with a significant difference (P < 0.01). Moreover, the preoperative JOA scores improved significantly postoperatively (7.7 ± 1.3 vs. 14.2 ± 1.4; P < 0.01) with an RR of 93.9% in good or excellent. Postoperative dysphagia-related symptoms occurred in one patient (3.0%). During the follow-up period, no patient was readmitted within 30 days after discharge; however, an incisional hematoma was reported in one patient on the 6th day after discharge, which was cured by pressure dressing. The postoperative radiographs revealed perfect implant positions and sufficient nerve decompression in all patients. Furthermore, the preoperative cervical physiological curvature improved significantly after the operation (14.5° ± 4.0° vs. 26.3° ± 5.4°; P < 0.01).
CONCLUSIONS
Day ACDF has good safety and early clinical efficacy, and it could be an appropriate choice for eligible DCS patients.
Topics: Male; Humans; Female; Retrospective Studies; Deglutition Disorders; Spinal Fusion; Cervical Vertebrae; Diskectomy; Spondylosis; Treatment Outcome; Follow-Up Studies
PubMed: 38504222
DOI: 10.1186/s12891-024-07356-7 -
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