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BMC Surgery Mar 2022The efficacy and safety of anterior cervical discectomy and fusion (ACDF) through mini-incision and posterior laminoplasty for long-level cervical spondylosis were...
Efficacy and safety of anterior cervical discectomy and fusion (ACDF) through mini-incision and posterior laminoplasty (LAMP) for treatment of long-level cervical spondylosis: a retrospective cohort study.
BACKGROUND
The efficacy and safety of anterior cervical discectomy and fusion (ACDF) through mini-incision and posterior laminoplasty for long-level cervical spondylosis were investigated.
METHOD
From January 2018 to September 2019, clinical patients data with 3-4 segments (C3-7) cervical spondylotic radiculopathy, cervical spondylotic myelopathy, or mixed cervical spondylosis who received ACDF (42 cases) throughwith mini-incision or LAMP (36 cases) treatment were retrospectively collected and analyzed. The operative time, bleeding volume, incisive length, and hospital stay were recorded. Moreover, the intervertebral height, functional segment height, cervical lordosis, cervical hyperextension and hyperflexion range-of-motion (ROM) and ROM in all directions of the cervical spine before and after the operation were measured. Additionally, all relevant postoperative complications were also recorded. Then, the therapeutic effects of both surgical methods were investigated.
RESULTS
Patients in the ACDF group had less bleeding, shorter incision, and fewer hospitalization days than the LAMP group. There was no significant difference in JOA, VAS score of the upper limb, NDI score after surgery between two groups. Postoperative intervertebral height and functional segment height in the ACDF group were significantly higher than those before the operation, and postoperative functional segment height of the ACDF group was significantly higher than that of the LAMP group. Moreover, the postoperative cervical lordosis angle in the ACDF group was significantly larger than the LAMP group. There was no significant difference between preoperative and postoperative ROM in all directions of the cervical spine for the two groups.
CONCLUSIONS
Both ACDF through mini-incision and LAMP are effective treatments for long-level cervical spondylosis. However, ACDF through mini-incision shows minor trauma, less bleeding, fast recovery, and it is beneficial for cervical lordosis reconstruction.
Topics: Diskectomy; Humans; Laminoplasty; Retrospective Studies; Spinal Fusion; Spondylosis
PubMed: 35337311
DOI: 10.1186/s12893-022-01567-2 -
Orthopaedics & Traumatology, Surgery &... Feb 2013Discectomy for lumbar discal herniation is the most commonly performed spinal surgery. The basic principle of the various techniques is to relieve the nerve root... (Review)
Review
Discectomy for lumbar discal herniation is the most commonly performed spinal surgery. The basic principle of the various techniques is to relieve the nerve root compression induced by the herniation. Initially, the approach was a unilateral posterior 5-cm incision: the multifidus was detached from the vertebra, giving access through an interlaminar space in case of posterolateral herniation; an alternative paraspinal approach was used for extraforaminal herniation. Over the past 30 years, many technical improvements have decreased operative trauma by reducing incision size, thereby reducing postoperative pain and hospital stay and time off work, while improving clinical outcome. Magnification and illumination systems by microscope and endoscope have been introduced to enable minimally invasive techniques. Several comparative studies have analyzed the clinical results of these various techniques. Although the methodology of most of these studies is debatable, all approaches seem to provide clinical outcomes of similar quality. At all events, minimally invasive techniques reduce hospital stay. While technical proficiency is essential, the final result depends on strict compliance with a prerequisite for surgical indication: close correlation between clinical symptoms and radiological findings. It is essential to discuss the risk/benefit ratio and explain the pros and cons of the recommended technique to the patient.
Topics: Diskectomy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae
PubMed: 23352565
DOI: 10.1016/j.otsr.2012.11.005 -
European Spine Journal : Official... Feb 2010The study design includes a systematic literature review. The objective of the study was to evaluate the effectiveness of transforaminal endoscopic surgery and to... (Comparative Study)
Comparative Study Review
The study design includes a systematic literature review. The objective of the study was to evaluate the effectiveness of transforaminal endoscopic surgery and to compare this with open microdiscectomy in patients with symptomatic lumbar disc herniations. Transforaminal endoscopic techniques for patients with symptomatic lumbar disc herniations have become increasingly popular. The literature has not yet been systematically reviewed. A comprehensive systematic literature search of the MEDLINE and EMBASE databases was performed up to May 2008. Two reviewers independently checked all retrieved titles and abstracts and relevant full text articles for inclusion criteria. Included articles were assessed for quality and outcomes were extracted by the two reviewers independently. One randomized controlled trial, 7 non-randomized controlled trials and 31 observational studies were identified. Studies were heterogeneous regarding patient selection, indications, operation techniques, follow-up period and outcome measures and the methodological quality of these studies was poor. The eight trials did not find any statistically significant differences in leg pain reduction between the transforaminal endoscopic surgery group (89%) and the open microdiscectomy group (87%); overall improvement (84 vs. 78%), re-operation rate (6.8 vs. 4.7%) and complication rate (1.5 vs. 1%), respectively. In conclusion, current evidence on the effectiveness of transforaminal endoscopic surgery is poor and does not provide valid information to either support or refute using this type of surgery in patients with symptomatic lumbar disc herniations. High-quality randomized controlled trials with sufficiently large sample sizes are directly needed to evaluate if transforaminal endoscopic surgery is more effective than open microdiscectomy.
Topics: Diskectomy; Endoscopy; Humans; Intervertebral Disc; Intervertebral Disc Displacement; Lumbar Vertebrae; Minimally Invasive Surgical Procedures; Outcome Assessment, Health Care; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 19756781
DOI: 10.1007/s00586-009-1155-x -
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 -
Orthopaedic Surgery Feb 2022This retrospective case-control study aimed to evaluate and compare the clinical outcomes of full-endoscopic visualized foraminoplasty and discectomy (FEVFD) with...
OBJECTIVE
This retrospective case-control study aimed to evaluate and compare the clinical outcomes of full-endoscopic visualized foraminoplasty and discectomy (FEVFD) with microdiscectomy (MD) for lumbar disc herniation (LDH).
METHODS
Data from 198 patients who presented with LDH between January 2016 and December 2017 treated by either FEVFD or MD were retrospectively analyzed. The inclusion criteria were single-level LDH, unilateral radiating leg pain with or without positive Lasegue's sign, and failure of standard conservative treatment for at least 12 weeks. The patients were categorized into an FEVFD group (n = 102) or an MD group (n = 96), according to the surgical procedure performed. Operative time, time in bed after surgery, postoperative hospitalization time, complications, and reoperations were recorded. Visual analog scales (VAS) for leg and back pain, Oswestry Disability index (ODI), 36-Item Short-Form Health Survey physical function (SF36-PF), and bodily pain (SF36-BP) scores were assessed and compared between the two groups.
RESULTS
The demographic data and baseline characteristics of the two groups were not significantly different. Operative time for the FEVFD group (73.82 ± 20.73 min) was longer than that for the MD group (64.74 ± 17.37 min) (P = 0.003), and fluoroscopy time for the FEVFD group (1.71 ± 0.58s) was longer than that for the MD group (1.30 ± 0.33s) (P < 0.001). However, time in bed experienced in the FEVFD group (8.51 ± 2.10 h) was less than that in the MD group (9.24 ± 2.01 h) (P = 0.014), and postoperative hospitalization time experienced in the FEVFD group (2.89 ± 0.83d) was also shorter than that in the MD group (4.94 ± 1.35d) (P < 0.001). All patients completed 24 months of follow-up. Postoperative scores at each follow-up for the VAS for leg and back pain, ODI, SF36-PF, and SF36-BP all improved significantly for both groups, as compared to the preoperative data (P < 0.05). The mean preoperative and postoperative scores for the VAS for leg and back pain, ODI, SF36-PF, and SF36-BP were not significantly different between the two groups. According to the modified MacNab criteria, the outcomes of the procedures were rated as excellent or good by 92.16% and 93.75% of the patients in the FEVFD and MD groups, respectively. One patient suffered a nerve root injury during the discectomy, one patient suffered from a dural tear, and two patients suffered from a residual herniation in the FEVFD group. One patient in the MD group suffered from poor wound healing. Moreover, recurrence happened in two cases in the FEVFD group, and in one case in the MD group.
CONCLUSION
FEVFD and MD are both reliable techniques for the treatment of symptomatic LDH. FEVFD resulted in a more rapid recovery and equivalent clinical outcomes after 24 months of follow-up.
Topics: Case-Control Studies; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Retrospective Studies; Treatment Outcome
PubMed: 34914186
DOI: 10.1111/os.13087 -
Medicine Aug 2018A meta-analysis was performed to compare the radiographic and surgical outcomes between anterior cervical discectomy and fusion (ACDF) and hybrid surgery (HS, corpectomy... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
A meta-analysis was performed to compare the radiographic and surgical outcomes between anterior cervical discectomy and fusion (ACDF) and hybrid surgery (HS, corpectomy combined with discectomy) in the treatment for multilevel cervical spondylotic myelopathy (mCSM).
SUMMARY OF BACKGROUND DATA
Both ACDF and HS are used to treat mCSM, however, which one is better treatment for mCSM remains considerable controversy.
METHODS
An extensive search of literature was searched in PubMed/Medline, Embase, the Cochrane library, CNKI, and WANFANG databases on ACDF versus HS treating mCSM from January 2011 to December 2017. The following variables were extracted: blood loss, operation time, fusion rate, Cobb angles of C2-C7, total complications, dysphagia, hoarseness, C5 palsy, infection, cerebral fluid leakage, epidural hematoma, and graft subsidence. Data analysis was conducted with RevMan 5.3 and STATA 12.0.
RESULTS
A total of 4 studies including 669 patients were included in our study. The pooled analysis showed that there were no significant difference in the operation time, fusion rate, Cobb angles of C2-C7, dysphagia, hoarseness, C5 palsy, infection, cerebral fluid leakage, epidural hematoma, and graft subsidence. However, there were significant difference between 2 groups in blood loss [P < .00001, SMD = -30.29 (-45.06, -15.52); heterogeneity: P = .38, I = 0%= and total complications [P = .04, OR = 0.66 95%CI (0.44, 0.98); heterogeneity: P = .37, I = 4%].
CONCLUSIONS
Based on our meta-analysis, except for blood loss and total complications, both ACDF and hybrid surgery are effective options for the treatment of multilevel cervical spondylotic myelopathy.
Topics: Adult; Cervical Vertebrae; Combined Modality Therapy; Diskectomy; Female; Humans; Male; Middle Aged; Postoperative Complications; Spinal Cord Diseases; Spinal Fusion; Spondylosis; Treatment Outcome
PubMed: 30142827
DOI: 10.1097/MD.0000000000011973 -
American Journal of Veterinary Research Dec 2020To determine whether a customized unilateral intervertebral anchored fusion device combined with (vs without) an intervertebral spacer would increase the stability of...
Comparison of the biomechanical performance of a customized unilateral locking compression plate with and without an intervertebral spacer applied to the first and second lumbar vertebrae after intervertebral diskectomy in canine cadaveric specimens.
OBJECTIVE
To determine whether a customized unilateral intervertebral anchored fusion device combined with (vs without) an intervertebral spacer would increase the stability of the L1-L2 motion segment following complete intervertebral diskectomy in canine cadaveric specimens.
SAMPLE
Vertebral columns from T13 through L3 harvested from 16 skeletally mature Beagles without thoracolumbar disease.
PROCEDURES
Complete diskectomy of the L1-2 disk was performed in each specimen. Unilateral stabilization of the L1-L2 motion segment was performed with the first of 2 implants: a unilateral intervertebral anchored fusion device that consisted of a locking compression plate with or without an intervertebral spacer. The resulting construct was biomechanically tested; then, the first implant was removed, and the second implant was applied to the contralateral side and tested. Range of motion in flexion and extension, lateral bending, and torsion was compared among intact specimens (prior to diskectomy) and constructs.
RESULTS
Compared with intact specimens, constructs stabilized with either implant were as stable in flexion and extension, significantly more stable in lateral bending, and significantly less stable in axial rotation. Constructs stabilized with the fusion device plus intervertebral spacer were significantly stiffer in lateral bending than those stabilized with the fusion device alone. No significant differences in flexion and extension and rotation were noted between implants.
CONCLUSIONS AND CLINICAL RELEVANCE
Findings did not support the use of this customized unilateral intervertebral anchored fusion device with an intervertebral spacer to improve unilateral stabilization of the L1-L2 motion segment after complete L1-2 diskectomy in dogs.
Topics: Animals; Biomechanical Phenomena; Cadaver; Diskectomy; Dog Diseases; Dogs; Lumbar Vertebrae; Range of Motion, Articular; Spinal Fusion
PubMed: 33251837
DOI: 10.2460/ajvr.81.12.915 -
Turkish Neurosurgery 2022To determine the effects of physical therapy and exercise programs that was performed after anterior cervical discectomy and fusion (ACDF) surgery on patient?s pain...
AIM
To determine the effects of physical therapy and exercise programs that was performed after anterior cervical discectomy and fusion (ACDF) surgery on patient?s pain treatment, a retrospective study was designed.
MATERIAL AND METHODS
Of the 127 patients without neurological deficit who underwent ACDF surgery in our clinic in 2019 and 2020 for single-level cervical disc herniation, 40 patients (including 23 men and 17 women) were enrolled. The mean age of the patients was 45.5 years. The patients were separated into two groups. Group A comprised 20 patients who did not apply for a post-ACDF physical therapy and exercise program. Group B comprised 20 patients who applied for a 6-month post-ACDF physical therapy and exercise program and complied with it. The Oswestry Deficiency Index (ODI), visual analog pain scale (VAS), and C2-7 cervical lordosis angle were evaluated. The C2-7 cervical lordosis angles were individually calibrated and calculated for each patient using Surgimap. The relationships between the results were compared using Wilcoxon biostatistics test.
RESULTS
The ODI, VAS, and C2-7 cervical lordosis angle parameters of Groups A and B were statistically compared. No significant differences in the ODI, VAS, and C2-7 cervical lordosis angle 2 days after surgery and C2-7 cervical lordosis angle 6 months after surgery were observed between the two groups; however, significant differences were observed in VAS and ODI values 6 months after physical therapy in Group B and in VAS and ODI values 6 months after surgery in Group A. No significant difference in C2-7 cervical lordosis angle 6 months after surgery was observed between post-physical therapy Group B and postoperative Group A.
CONCLUSION
Physical therapy and exercise program performed early after ACDF enhances and improves pain management and does not cause any changes in the restoration of cervical misalignment.
Topics: Cervical Vertebrae; Diskectomy; Female; Humans; Lordosis; Male; Middle Aged; Retrospective Studies; Spinal Fusion; Treatment Outcome
PubMed: 35253156
DOI: 10.5137/1019-5149.JTN.36243-21.2 -
European Spine Journal : Official... Nov 2012Disc herniation with sciatica accounts for five percent of low-back disorders but is one of the most common reasons for spine surgery. The goal of this study was to... (Review)
Review
INTRODUCTION
Disc herniation with sciatica accounts for five percent of low-back disorders but is one of the most common reasons for spine surgery. The goal of this study was to update the Cochrane review on the effect of surgical techniques for sciatica due to disc herniation, which was last updated in 2007.
MATERIALS AND METHODS
In April 2011, we conducted a comprehensive search in CENTRAL, MEDLINE, EMBASE, CINAHL, PEDRO, ICL, and trial registries. We also checked the reference lists and citation tracking results of each retrieved article. Only randomized controlled trials (RCT) of the surgical management of sciatica due to disc herniation were included. Comparisons including chemonucleolysis and prevention of scar tissue or comparisons against conservative treatment were excluded. Two review authors independently selected studies, assessed risk of bias of the studies and extracted data. Quality of evidence was graded according to the GRADE approach.
RESULTS
Seven studies from the original Cochrane review were included and nine additional studies were found. In total, 16 studies were included, of which four had a low risk of bias. Studies showed that microscopic discectomy results in a significantly, but not clinically relevant longer operation time of 12 min (95% CI 2-22) and shorter incision of 24 mm (95% CI 7-40) compared with open discectomy, but did not find any clinically relevant superiority of either technique on clinical results. There were conflicting results regarding the comparison of tubular discectomy versus microscopic discectomy for back pain and surgical duration.
CONCLUSIONS
Due to the limited amount and quality of evidence, no firm conclusions on effectiveness of the current surgical techniques being open discectomy, microscopic discectomy, and tubular discectomy compared with each other can be drawn. Those differences in leg or back pain scores, operation time, and incision length that were found are clinically insignificant. Large, high-quality studies are needed, which examine not only effectiveness but cost-effectiveness as well.
Topics: Diskectomy; Humans; Intervertebral Disc Displacement; Sciatica
PubMed: 22814567
DOI: 10.1007/s00586-012-2422-9 -
Journal of Orthopaedic Surgery and... Oct 2018Anterior cervical discectomy and fusion (ACDF) has been widely used in cervical spondylosis, but adjacent segment degeneration/disease (ASD) was inevitable. Cervical... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Anterior cervical discectomy and fusion (ACDF) has been widely used in cervical spondylosis, but adjacent segment degeneration/disease (ASD) was inevitable. Cervical total disc replacement (TDR) could reduce the stress of adjacent segments and retard ASD in theory, but the superiority has not been determined yet. This analysis aimed that whether TDR was superior to ACDF for decreasing adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis).
METHODS
A meta-analysis was performed according to the guidelines of the Cochrane Collaboration with PubMed, EMBASE, Cochrane Library and CBM (China Biological Medicine) databases. It included randomized controlled trials (RCTs) that reported ASDeg, ASDis, and reoperation on adjacent segments after TDR and ACDF. Two investigators independently selected trials, assessed methodological quality, and evaluated the quality of this meta-analysis using the grades of recommendation, assessment, development, and evaluation (GRADE) approach.
RESULTS
Eleven studies with 2632 patients were included in the meta-analysis. The overall rate of ASD in TDR group was lower than ACDF group (OR = 0.6; 95% CI [0.38, 0.73]; P < 0.00001). Both the incidence of ASDeg and the reoperation rate were statistically lower in the TDR group than in the ACDF group (OR = 0.58, P < 0.00001; OR = 0.52, P = 0.01, respectively). Subgroup analysis was performed according to the follow-up time and trial site; the rate of ASDeg was lower in patients underwent TDR no matter the follow-up time, and TDR tended to increase the superiority across time. The rate of ASDeg was also lower with TDR both in the USA and China (P < 0.0001, P = 0.03, respectively). But the cost-effectiveness result might be prone to neither of the two surgery approaches. According to GRADE, the overall quality of this meta-analysis was moderate.
CONCLUSIONS
TDR decreased the rates of ASDeg and reoperation compared with that of ACDF, and the superiority may become more apparent over time. We cautiously and slightly suggest adopting TDR according to the GRADE but may not believe it excessively.
Topics: Cervical Vertebrae; Diskectomy; Humans; Intervertebral Disc Degeneration; Randomized Controlled Trials as Topic; Reoperation; Spinal Fusion; Total Disc Replacement; Treatment Outcome
PubMed: 30285807
DOI: 10.1186/s13018-018-0940-9