Functional Outcome Of Anterior Cervical Decompression And Fusion Surgery In Cervical Compressive Diseases:A 6 Months Follow Up

Background: Neck pain with radiculopathy and neurodeficit is a common problem in working population. Methods: 50 patients underwent ACDF with C5-C6 the commonest level to be affected. The cases were analyzed preoperatively and at 3 months, 6 months using NDI and VAS. Decrease in pre operative and 1 year post operative VAS score, Preoperative and postoperative NDI was statistically significant.Conclusion: Symptoms of neck pain, tingling, and weakness reduced after 1 year follow up. Discussion: From our study, it is evident that there is significant decrease in parameters like neck pain, tingling and radiculopathy postoperatively also there was significant decrease in NDI at 6 months follow-up.

Radiologic Features and Surgical Outcome of Juxtafacet Cyst Associated with Degenerative Lumbar Disease / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the radiologic features of juxtafacet cyst and determine the correlation between these features and clinical outcome. MATERIALS AND METHODS: We analyzed a total of 23 patients. The degree of facet joint degeneration was classified using the Fujiwara method. The facet joint angles were measured with an magnetic resonance imaging to determine whether there was a difference between the cystic lesion that was occupied and the cystic lesion that was not occupied. Disc degeneration was measured by the Pfirrmann classification method. The clinical result was evaluated using the Oswestry disability index score and visual analogue scale. RESULTS: The L4–5 level of juxtafacet cyst was mostly affected, as found in previous studies. Facet joint arthritis was more severe within the side with the cystic lesion. Significant correlation was found between disc degeneration and juxtafacet joint cyst. All patients underwent wide decompression and fusion. Clinical result was excellent. No patients had signs of recurrence during the follow-up periods. CONCLUSION: Juxtafacet cyst has a significant correlation with facet joint degeneration. Therefore, aggressive surgical treatment—not just simple cyst excision—should be considered as the treatment option for juxtafacet cyst associated with degenerative lumbar disease.

Clinical efficacy of two skip-level anterior cervical discectomy and fusion in treatment of two-level noncontiguous cervical spondylotic myelopathy / 局解手术学杂志

Objective To evaluate the clinical and radiological outcomes of skip-level anterior cervical discectomy and fusion(ACDF) for the treatment of two-level noncontiguous cervical spondylotic myelopathy(CSM).Methods There were 34 patients with two-level noncontiguous CSM underwent skip-level ACDF in our department from January 2014 to December 2016.The clinical outcome including surgery time, intraoperative blood loss,Japanese Orthopaedic Association(JOA) scores,Neck dysfunction index(NDI),the improvement rate of JOA,segment lordosis,fusion rate and Odom's criteria were evaluted.Results The surgery time was from 92 minutes to 125 minutes,mean operative time 103.28 minutes;the intraoperative blood loss was 50 to 150 mL,with average blood loss of 90 mL.The cervical spine lateral radiographs showed that the cervical physiological curvature had restored.The patients were followed up for average 6 months.The fusion rate of was 94.1％ at the lastest follow-up.No cages subside,implant failure or migration and infection occured.The JOA and NDI scores at the latest follow-up were(14.21±0.732) and (3.26±1.14),respectively,the JOA scores improvement rates was 58.62％.The segmental lordosis before surgery was(10.75±1.132)°,the one after surgery was(15.61±1.312)°,the difference was significant(P<0.05).The Odom's criteria at the lastest follow-up showed that excellent in 21 patients,good in 9 patients and fair in 4 patients,with excellent and good rate of 88.2％.Conclusion Skip-level ACDF can achieve good clinical and radiological outcomes including a high fusion rate and well maintainence of spinal curvature and intervertebral height for patients with two-level noncontiguous CSM.

The causes and prevention of C₅ nerve root palsy after anterior cervical decompression and fusion / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the causes of muscular paralysis due to C₅ nerve root injury after anterior cervical decompression and fusion (ACDF) and explore its prevention way.</p><p><b>METHODS</b>From January 2005 to December 2015, 310 patients underwent ACDF in our hospital. Of them, 9 cases occurred muscular paralysis due to C₅ nerve root injury after operation. The clinical data of 9 patients were retrospectively analyzed. There were 8 males and 1 female, aged from 51 to 84 years with an average of 64 years. Two cases underwent internal fixation and intervertebral fusion with one segment, 6 cases with two segments, 1 case with three segments. Simple deltoid muscle weakness, pain, numbness happened in 7 cases, simultaneously biceps brachii muscle weakness, pain, numbness in 2 cases. Muscle strength was 0 grade in 1 case, 1 grade in 3 cases, 2 grades in 4 cases, 3 grades in 1 case.</p><p><b>RESULTS</b>The follow up time of 9 patients was more than 12 months and the longest was 24 months with an average of 14 months. Muscle strength of 7 patients recovered to 4-5 grades. Recovering time after operation was directly proportional to the degree of injury, those patients with muscle strength level more than 2, usually could have significant improvement within 3 weeks. The JOA score improved from 10.89±1.89 preoperatively to 8.92±1.91 postoperative C₅ nerve root palsy to 14.48±2.10 at final follow up, with significant difference(<0.05).</p><p><b>CONCLUSIONS</b>More complicated factors result in C₅ nerve root injury after ACDF. Except those suffered severe grinding contusion and amputation, most of the patients can get satisfactory prognosis. Strict control of the operation indication, selection of the right surgical segment with accurate manipulation, control of the distraction of intervertebral space and the width of the multilevel anterior cervical corpectomy, are main methods to prevent the complication.</p>

Research progress of in-vivo kinematics after cervical arthrodesis / 天津医药

Related literature and studies concerning the kinematics in patients after cervical arthrodesis have extensive?ly reviewed and comprehensively analyzed in 4 terms of changes in adjacent segment range of motion, motion segment per?cent contributions, motion pattern of cervical facet joints, and deviated center of rotation at adjacent segments. These report?ed researches of in-vivo kinematics after cervical arthrodesis are almost on the sagittal plane. Few data have been reported on the 6DOF kinematics under physiological loading conditions. Whether adjacent segment pathology caused by hypermobili?ty remains controversial. Long-term follow-up of large sample randomized controlled studies and obtaining the accurate 6DOF kinematics are the best way to resolve controversy.

Prediction of Outcome of Operation for Cervicalspondylotic Radiculopathy with Somatosensory Evoked Potentials / 中国康复理论与实践

@#Objective To evaluate the neurological function of cervicalspondylotic radiculopathy by somatosensory evoked potentials (SEP) and provide an objective basis for selecting the best operation occasion. Methods 60 patients with C6 and C7 radiculopathies were divided into 3 groups according to the results of SEP: normal group (n=22), mildly abnormal group (n=30) and severely abnormal group (n=8). All the patients underwent anterior cervical decompression and fusion. They were assessed with Neck Disability Index (NDI) before and after treatment. Results The postoperative NDI scores of all the groups improved significantly (P<0.001), especially in the normal group.Conclusion SEP, which can reflect the severity of cervicalspondylotic radiculopathy objectively and predict prognosis.

Above two-level segment interbody fusion with double-way connection intervertebral fusion device / 中国组织工程研究

10.3969/j.issn.2095-4344.2013.26.007

Lumbar Spinal Stenosis Accompanied by Severe Osteoarthritis of Knee: Comparison between Staged Operations and Same-day Operations / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVE: To compare the peri-operative morbidity of patients who undergo same-day operations for lumbar spinal stenosis accompanied by severe osteoarthritis of knee with those who undergo staged operations . SUMMARY AND LITERATURE REVIEW: There is no report on the peri-operative morbidity of same-day operations for patients who have a concurrent lumbar spinal stenosis and severe osteoarthritis of the knee, even though elective surgery for lumbar spinal stenosis or total knee arthroplasty are safe procedures. MATERIALS AND METHODS: From January 1996 to December 2005, 11 patients who underwent staged operations for lumbar spinal stenosis and concomitant osteoarthritis of the knee (Group I) and 14 patients who underwent total knee arthroplasty and lumbar spinal decompression and fusion on the same-day (Group II) were compared in terms of the operative time, blood loss, perioperative complications and admission days. The data was analyzed statistically using a chi-square test through SPSS v.10.0. RESULTS: The mean surgery time in groups I and II was 266+/-34.4 minutes and 258+/-54.2 minutes, respectively. The estimated blood loss during operation of groups I and II was 1055+/-229.6 and 925+/-174.0. There was no statistical differences between the two groups. There were no life-threatening complications in any group. The admission period for group I and group II were 41.0+/-6.05 days and 30.1+/-5.10 days respectively, but there was no statistical significance. CONCLUSION: There was no difference in the surgical time, estimated blood loss, and complications between the group that underwent the staged operations and the group that underwent same-day operations. A possible surgical option is to perform both procedures on the same day.

Surgical Treatment for Lumbar Spinal Stenosis with Fracture in Multiple Osteoporotic Compression Fractures / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVE: To analyze the outcome of the surgical treatment for lumbar spinal stenosis with fracture in multiple osteoporotic vertebral body compression fractures. SUMMARY OF LITERATURE REVIEW: An osteoporotic vertebral compression fracture, without neurological symptom, has mainly been treated with conservative care. Sometimes, vertebroplasty or kyphoplasty has been used as a surgical treatment. In the case of a single thoracolumbar fracture with neurological symptoms, not improved by conservative care, decompression, fusion and instrumentation through an anterior or a posterior approach has been attempted. MATERIALS AND METHODS: 10 patients, who had received surgical treatment for symptomatic lumbar spinal stenosis with fracture out of those with multiple osteoporotic vertebral body compression fractures, and over the age of 60, were assessed. The surgical treatment was performed on the patient with all of the following five criteria; (1) severe back pain caused by fractures, (2) neurological symptoms of lumbar spinal stenosis, (3) radiological evidences of stenosis by lumbar fracture, (4) no response to conservative treatment for over 3 months, and (5) adequate physical ability for daily living without a severe medical condition. The surgical procedure included: decompressive laminectomy, posterior instrumentation using pedicle screw fixation, and fusion in situ. The pedicle screws were located 2-3 above and below the most cephalad and caudad fractured vertebral bodies. RESULTS: Clinically, favorable results were obtained in 8 of the 10 patients. In the roentgenographic assessment, the operated states were well maintained, without the metallic failure or instability. Halos around the pedicle screws were seen in 4 patients, but there was no significant evidence of loosening. There were no serious medical and systemic complications in the peri- and postoperative periods. Additional vertebral body fractures and pain were seen in 5 patients, but they had been well managed, conservatively. CONCLUSION: Favorable clinical results could be expected for the surgical treatment of lumbar spinal stenosis, with fracture, in the patients with multiple osteoporotic vertebral fractures, as long as the surgical treatment was indicated exactly and carefully.

Six Cases of Thoraco-lumbar Tuberculosis Treated by Anterior Decompression and Fusion with or withought Instrumentation

The anterior decompression and fusion have been the choice of surgical treatment for spinal tuberculosis since 1960. From April 1995 to April 1996, we operated on six patients of thoraco-lumbar tuberculosis. The procedure consisted of anterior decompression through corpectomy, stabilization with anterior instrument and bone graft with or without Titanium MESH. MRI provides a valuable information about the extent of the disease in multiple planes, thereby helping surgeons in planning of the operation. The thoracic spine was involed in four patients, the lumbar spine in two. On average, two vertebral bodies were involved. Anterior and middle column of spine were involved in all patients, but posterior column was intact in all patients. Disc space involvement was seen in all patients. Paraspinal abscess was observed in three patients. Epidural compression of the spinal cord or cauda equina was noted in all patients. Four patients showed neurological improvements and relief of pain. However, the recovery of two remaning paraplegic patients was not remarkable. There was no single case associated with persistence or recurrence of infection after instrumentation.

Clinical Analyzed of Thoracic Level Spinal Cord Injured Patients

We analyzed 10 cases who had received surgery for acute injuries of the thoracic spine complicated by paralysis. Of those 10 cases, 4 patients had a complete and remaining 6 had an incomplete lesion of the spinal cord. Of the 4 patients who had a complete lesion of the spinal cord, significant neurologic function did not recover in 3, regardless of the type and timing of the surgery. In one of 4 patients who had a complete lesion, there was some improvement of sensation. Of the 6 patients who had an incomplete lesion of the spinal cord, 4 received a surgery within 24 hours of injury, and remaining 2 had surgery on posttrauma 30th and 35th days respectively. Average neurologic improvement was 1.75 Frankel grades per patient in the early surgery group and was 1 Frankel grade in the delayed surgery group. Of 6 patients with incomplete lesion, 4 were treated with laminectomy and fusion with instrumentation, and they improved by average 1.75 Frankel grades. And remaining 2 were treated by laminectomy or anterior transthoracic decompression and fusion respectively and they improved by 1 Frankel grade respectively. Based on the results of this study and other references, we suggest that early surgical intervention improves neurologic recovery in comparison to late surgical intervention and that posterior surgical instrumentation is indicated in acute unstable bursting fracture and flexion-dislocation injury. Also we suggest that anterior transthoracic decompression and fusion is indicated in cases of neural compression by bone or disc fragments.