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Objective To analyze the relationship between cervical lordosis and the development of dysphagia after anterior cervical spine surgery.Methods From June 2007 to May 2010,data of 172 successive patients who had undergone ACDF operation in our hospital were reviewed in this study.The presence and duration of postoperative dysphagia were recorded via face-to-face questioning or telephone interview at least one year after the procedure.Plain cervical radiographs before and after surgery were collected.The C2-7 angle was measured.The change of C2-7 angle was defined as dC2-7 angle=postoperative C2-7-preoperative C2-7 angle.The correlation between postoperative dysphagia and dC2-7 angle was studied.Results There were 22 patients in dysphagia group,including 17 males and 5 females.Their age ranged from 25 to 70 years old,and average was 47.7±5.4.The average of BMI was 25.0±2.9 kg/m2.150 patients were in non-dysphagia group,including 101 males and 49 females.Their age ranged from 18 to 72 years old,and average age was 49.2±4.8.The average of BMI was 24.4±3.4 kg/m2.There was no statistical difference in gender,age,and BMI between two groups.The dC2-7 angle of dysphagia group ranged from-1 °-20.5°,and average was 8.6°±4.0°.The dC2-7 angle of non-dysphagia group ranged from-13°-28.5°,and average was 5.0°±4.3°.There was significant difference in dC2 7 angle between dysphagia and non-dysphagia group.Spearman Analysis revealed that there was strong correlativity between dC2-7 angle and postoperative dysphagia.When dC2-7 angle was greater than 5°,the chance of developing postoperative dysphagia significantly increased (19.3％ [17/88] vs 6.0％ [5/84]).What's more,Spearman Analysis also revealed that there was no correlativity between dC2 7 angle and degree of operative dysphagia.There was no significant difference in gender,age,and BMI between dysphagia and non-dysphagia group.There was no statistical difference in operative time,blood loss revision surgery,revision surgery ratio,most cephalic operative level and number of operative levels between dysphagia with non-dysphagia group.Logistic regression model showed that an increased likelihood of postoperative dysphagia persists with increasing dC2-7 angle,but had no relationship with operative time,blood loss,revision surgery,most cephalic operative level and number of operative levels.Conclusion dC2-7 angle may play an important role in the development of postoperative dysphagia.We found no statistical difference in operative time,blood loss revision surgery,revision surgery ratio,most cephalic operative level and number of operative levels between dysphagia and non-dysphagia group.Intraoperative measurement of the dC2-7 angle is practical and essential for reducing the postoperative dysphagia.
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<p><b>BACKGROUND</b>Percutaneous pedicle screw use has a high rate of cranial facet joint violations (FVs) because of the facet joint being indirectly visualized. Computer-assisted navigation shows the anatomic structures clearly, and may help to lower the rate of FVs during pedicle screw insertion. This study used computed tomography (CT) to evaluate and compare the incidence of FVs between percutaneous and open surgeries employing computer-assisted navigation for the implantation of pedicle screw instrumentation during lumbar fusions.</p><p><b>METHODS</b>A prospective study, including 142 patients having lumbar and lumbosacral fusion, was conducted between January 2013 and April 2014. All patients had bilateral posterior pedicle screw-rod instrumentation (top-loading screws) implanted by the same group of surgeons; intraoperative 3-dimensional computer navigation was used during the procedures. All patients underwent CT examinations within 6 months postoperation. The CT scans were independently reviewed by three reviewers blinded to the technique used.</p><p><b>RESULTS</b>The cohort comprised 68 percutaneous and 74 open cases (136 and 148 superior-level pedicle screw placements, respectively). Overall, superior-level FVs occurred in 20 patients (20/142, 14.1%), involving 27 top screws (27/284, 9.5%). The percutaneous technique (7.4% of patients, 3.7% of top screws) had a significantly lower violation rate than the open procedure (20.3% of patients, 14.9% of top screws). The open group also had significantly more serious violations than did the percutaneous group. Both groups had a higher violation rate when the cranial fixation involved the L5. A 1-level open procedure had a higher violation rate than did the 2- and 3-level surgeries.</p><p><b>CONCLUSIONS</b>With computer-assisted navigation, the placement of top-loading percutaneous screws carries a lower risk of adjacent-FVs than does the open technique; when FVs occur, they tend to be less serious. Performing a single-level open lumbar fusion, or the fusion of the L5-S1 segment, requires caution to avoid cranial adjacent FVs.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Lumbar Vertebrae , General Surgery , Minimally Invasive Surgical Procedures , Pedicle Screws , Prospective Studies , Zygapophyseal Joint , General SurgeryABSTRACT
Objective To evaluate the mid-term tollow-up results of cervical artificial disc replacement (CADR) for cervical degenerative disc disease,and to explore whether it can reduce the occurrence of adjacent segment degeneration (ASD).Methods A prospective comparative study of 93 patients who underwent CADR or anterior cervical decompression and fusion (ACDF) for cervical degenerative disc disease were conducted.All patients were followed up for more than 6 years.The Japanese Orthopaedic Association (JOA) score,neck disability index (NDI),Odom's scale,X-rays and magnetic resonance imaging (MRI) were used to evaluate the clinical and radiologic results.Results Twenty eight patients who underwent CADR and 35 patients who underwent ACDF had complete follow-up data.At final follow-up,the JOA score and NDI improved significantly in both groups.Between the two groups,there was no significant difference in terms of JOA score,NDI and Odom's scale.The sagittal alignment was well maintained in both groups.The total cervical spine range of motion (ROM) had no significant change for the CADR group,whereas,it significantly decreased for the ACDF group.The ROM at the replacement level of CADR patients decreased from 9.5° ± 3.7° before operation to 7.0° ± 3.0° 3 months after operation,and it was maintained to 6.6° ± 4.1° at final follow-up without significant decrease.Lateral radiographs and T2-weighted MRI showed the incidence of ASD in CADR group was significantly lower than that in ACDF group.Conclusion The six-year follow-up results of CADR are basically satisfactory.Compared with ACDF,it could better preserve physiological motion and biomechanics of cervical spine,and reduce the incidence of ASD.
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ObjectiveTo Compare the clinical results between microscope and loupes which used in microsurgical discectomy.MethodsA prospective randomized controlled trial of 93 patients who had undergone microsurgical discectomy from January 2007 to December 2010 was performed.Clinical results were assessed by comparing the following parameters between patients who had undergone the surgery by microscope and loupes:length of stay,hospitalization cost,operative time,estimated blood loss,Japanese Orthopaedic Association (JOA) score and JOA recovery rate,Odom's standard.ResultsForty-nine patients underwent surgery by microscope,and forty-four patients underwent surgery by loupes.Eighty patients received outpatient or telephone follow-up.The follow-up period was 6.17 to 52.90 months with an average of (29.64±13.05) months,and the follow-up rate was 86.02％.According preoperative data,the two groups didn't differ with respect to age,gender,level of radiculopathy,or preoperative JOA score and JOA recovery rate.No statistically significant differences were identified in postoperative JOA score and JOA recovery rate,length of stay,hospitalization cost,length of follow-up,or relapse rate.Statistically significant differences were identified in operative time,estimated blood loss,and follow-up JOA score and JOA recovery rate.Conclusion Microscope can provide relatively more clear and comfortable vision for the surgery.It can short the operative time,decrease blood loss,reduce the potential risk of nerve injury,and retain more normal tissue,which can ensure better clinical results.