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Objective:To compare the postoperative adjacent segment degeneration (ASD) between the microscopically anterior cervical discectomy with fusion (ACDF) and anterior cervical corpectomy with fusion (ACCF) in the treatment of cervical spondylotic myelopathy and its influencing factors.Methods:Fifty patients with cervical spondylotic myelopathy treatment in the Qinzhou Second People′s Hospital from July 2018 to July 2020 were selected, they were divided into two groups, 25 patients performed ACDF (ACDF group), and 25 patients performed ACCF (ACCF group). The perioperative period, efficacy and incidence of ASD were compared between the two groups, and the influencing factors of ASD were analyzed.Results:The intraoperative blood loss, operation time, length of hospital stay and postoperative drainage in ACCF group were higher than those in ACDF group: (58.34 ± 8.61) ml vs. (46.77 ± 7.24) ml, (99.57 ± 10.72) min vs. (86.14 ± 9.64) min, (8.97 ± 1.43) d vs. (7.56 ± 1.24) d, (17.92 ± 2.95) ml vs. (14.28 ± 2.66) ml, there were statistical differences ( P<0.05). The postoperative Japanese Orthopaedic Association (JOA) scores and Neck Disability Index (NDI) scores in the two groups were improved significantly ( P<0.05), but the scores of JOA and NDI in the two groups had no significant differences ( P>0.05). The incidence of ASD in the two groups had no significant differences ( P>0.05). The Cox univariate analysis showed that age >59 years, intervertebral disc degeneration, number of fusion segments >2, osteoporosis and postoperative ASD were risk factors for ASD( P<0.05). Conclusions:The effect of microscopically ACDF is similar to that of ACCF in the treatment of cervical spondylotic myelopathy, but ACDF has the advantages of less trauma and quick recovery. The risk of postoperative ASD should be vigilant for patients with age >59 years old, intervertebral disc degeneration, number of fusion segments >2 or osteoporosis.
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OBJECTIVE@#To evaluate the application of surgical strategies for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) involving the C 2 segment.@*METHODS@#The literature about the surgery for cervical OPLL involving C 2 segment was reviewed, and the indications, advantages, and disadvantages of surgery were summarized.@*RESULTS@#For cervical OPLL involving the C 2 segments, laminectomy is suitable for patients with OPLL involving multiple segments, often combined with screw fixation, and has the advantages of adequate decompression and restoration of cervical curvature, with the disadvantages of loss of cervical fixed segmental mobility. Canal-expansive laminoplasty is suitable for patients with positive K-line and has the advantages of simple operation and preservation of cervical segmental mobility, and the disadvantages include progression of ossification, axial symptoms, and fracture of the portal axis. Dome-like laminoplasty is suitable for patients without kyphosis/cervical instability and with negative R-line, and can reduce the occurrence of axial symptoms, with the disadvantage of limited decompression. The Shelter technique is suitable for patients with single/double segments and canal encroachment >50% and allows for direct decompression, but is technically demanding and involves risk of dural tear and nerve injury. Double-dome laminoplasty is suitable for patients without kyphosis/cervical instability. Its advantages are the reduction of damage to the cervical semispinal muscles and attachment points and maintenance of cervical curvature, but there is progress in postoperative ossification.@*CONCLUSION@#OPLL involving the C 2 segment is a complex subtype of cervical OPLL, which is mainly treated through posterior surgery. However, the degree of spinal cord floatation is limited, and with the progress of ossification, the long-term effectiveness is poor. More research is needed to address the etiology of OPLL and to establish a systematic treatment strategy for cervical OPLL involving the C 2 segment.
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Humans , Longitudinal Ligaments/surgery , Ossification of Posterior Longitudinal Ligament/surgery , Treatment Outcome , Osteogenesis , Decompression, Surgical/methods , Cervical Vertebrae/surgery , Laminoplasty/methods , Kyphosis/surgery , Retrospective StudiesABSTRACT
RESUMEN Introducción: el white cord syndrome, conocido como una lesión por reperfusión de la médula espinal, es una rara complicación de la cirugía espinal para descompresión. Se define como un deterioro neurológico inmediato y súbito, luego de la cirugía de descompresión cervical. Objetivo: describir los elementos clínico-imagenológicos y estrategias de tratamiento del white cord syndrome. Métodos: se realizó la revisión de la literatura en bases de datos Pubmed y EMBASE, además en los servidores de preprints BioRxiv, MedRxiv y preprint.org, así como la plataforma ResearchGate. Se seleccionaron todos los artículos en inglés y español, con texto completo disponible. Se usaron los siguientes descriptores white cord syndrome AND cervical spondylotic myelopathy. Se excluyeron artículos editoriales, libros, revisiones, meta-análisis y aquellos sin carácter open-access. Luego de excluir artículos que no cumplían nuestros criterios, fueron seleccionadas 17 publicaciones para su revisión. Resultados: Se analizaron 17 artículos, con una muestra total de 24 pacientes reportados. Todos los pacientes mostraron afectación mielopática con defecto motor variable e hiperreflexia osteotendinosa. En diez artículos, la técnica quirúrgica empleada fue la descompresión posterior, con o sin fusión. Fue muy variable el empleo de dosis de esteroides, terapia física y las re-intervenciones quirúrgicas. Solo dos casos no mostraron recuperación neurológica al término del período de observación. Conclusiones: el reconocimiento de esta rara complicación es vital, ya que constituye una causa de defecto neurológico posterior a la cirugía. El diagnóstico se realiza luego de la exclusión de complicaciones trans-operatorias, y al observar hiperintensidad del cordón medular ponderado en T2 en las imágenes de resonancia magnética. El manejo radica en adecuada descompresión, uso de esteroides y rehabilitación.
ABSTRACT Introduction: white cord syndrome, known as spinal cord reperfusion injury, is a rare complication of spinal decompressive surgery. It is defined as an immediate and sudden neurological deterioration after cervical decompression surgery. Objective: to describe the clinical-imaging elements and treatment strategies of white cord syndrome. Methods: a literature review was performed in Pubmed and EMBASE databases, as well as in the preprint servers BioRxiv, MedRxiv and preprint.org, and the ResearchGate platform. All articles in English and Spanish, with full text available, were chosen. The following descriptors were used: White cord syndrome AND cervical spondyloticmyelopathy. The editorial articles, books, reviews, meta-analyses and those without open-access characteristics were excluded. After excluding articles that did not meet the criteria established, 17 publications were chosen to be reviewed. Results: seventeen articles were analyzed, with a total sample of 24 patients reported. All patients showed myelopathic involvement with variable motor defect and osteotendinous hyperreflexia. In ten articles, the surgical technique used was posterior decompression, with or without fusion. The use of steroid doses, physical therapy and surgical re-interventions was highly variable. Only two cases did not show neurological recovery at the end of the observation period. Conclusions: recognition of this rare complication is vital, since it constitutes a cause of neurological defect after surgery. The diagnosis is made after exclusion of trans-operative complications, and after observing T2-weighted spinal cord hyper-intensity in magnetic resonance images. Management is based on adequate decompression, application of steroid treatment and rehabilitation.
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Objective:To explore the use of anterior cervical corpectomy and fusion (ACCF) combined with anterior cervical discectomy and fusion (ACDF) in patients with multilevel cervical spondylopathy myelopathy (CSM).Methods:The clinical data of 83 patients with multi-segment CSM admitted to the Department of Spinal Surgery of Hubei Liuqi2 Orthopaedic Hospital of Integrated Traditional Chinese and Western Medicine from January 2018 to January 2021 were retrospectively analyzed. According to the different surgical methods used in their treatment, they were divided into group A and group B. In group A, 44 patients were treated with anterior cervical ACCF combined with ACDF, and 39 patients in group B were treated with posterior single-door laminoplasty. The general clinical indexes such as operation time, perioperative bleeding volume and hospitalization time were collected.The neurological function and cervical dysfunction improvement effect of the patients before and 6 months after operation were evaluated by using the Japanese Orthopaedic Association (JOA) score and neck disability index (NDI) scale. The cervical curvature of the patients before and 6 months after operation was compared, The complications of the two groups were observed 6 months after operation. The patients were divided into improved group (72 cases) and non improved group (11 cases). Comparison between count data groups χ 2 inspection. Independent sample t-test was used for comparison between measurement data groups conforming to normal distribution. According to the results of univariate analysis, the meaningful factors were included in the binary Logistic regression to analyze the influencing factors related to the surgical efficacy. Result:The perioperative blood loss ((153.36±10.68) mL) and hospital stay ((10.11±2.30) d) in group A were lower than those in group B ((171.47±11.32) mL, (15.58±3.76) d). There were significant differences between the two groups ( t values were 7.50 and 8.10; both P<0.001). Six months after operation, the JOA score (13.70±1.49, 12.94±1.63) and cervical curvature (22.10±3.23, 13.38±3.12) of patients in groups A and B were all higher than those before operation (9.40±1.32, 9.36±1.51; 11.16±2.60, 11.23±2.71), and group A was higher than group B, the difference was statistically significant (JOA scores before and after operation: t values were 14.33 and 10.07, respectively; cervical curvature: t values were 17.50 and 3.25, respectively; t values between groups were 2.22 and 12.47, respectively, and the P values were <0.001, <0.001, <0.001, 0.002, 0.029 and <0.001, respectively). Six months after the operation, the NDI indexes of groups A and B (11.38±4.76, 14.79±4.85) were lower than those before the operation (39.56±9.43, 39.74±9.51), and those in group A were lower than in group B, and the difference was statistically significant ( t values were 17.70, 14.60, and 3.23; all P<0.001). Binary Logistic regression showed that the duration of disease ≥6 months ( OR=59.045, 95% CI: 6.485-537.629), the presence of cervical spinal cord MRI signal changes ( OR=0.031, 95% CI: 0.002-0.587), the surgical approach (posterior approach single-door laminoplasty) ( OR=6.300, 95% CI: 1.269-31.273) was an independent risk factor affecting the surgical outcome ( P values were <0.001, 0.021, and 0.024, respectively). Conclusion:Anterior cervical ACCF combined with ACDF has an ideal surgical effect in the treatment of patients with multi-segment CSM, which can significantly improve the cervical spinal nerve function and cervical curvature, shorten the operation time and reduce the perioperative blood loss. It isstill necessary to pay attention to the patient's disease course, MRI signals changes of cervical spinal cord and the effect of surgical methods on their surgical outcomes.
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Introduction and Importance Neurological deterioration due to buckling of the ligamentum flavum (LF) is an uncommon complication after anterior cervical corpectomy or discectomy with fusion. Case Presentation In this report, we present the case of a 66-year-old male who underwent anterior cervical partial corpectomy of C5 and discectomy of prolapsed C5- C6 with fusion. Postsurgery, the patient displayed signs of neurological deterioration. Upon immediate cervical magnetic resonance imaging (MRI), posterior canal stenosis and severe compression with cord signal due to LF buckling were detected. A posterior laminectomy procedure and canal decompression at the C5-C6 level with bone fusion were performed. Clinical Discussion Patient presented with walking difficulty, then walking disability, followed by bilateral upper and lower limb paresthesia with burning sensation. Examination showed â muscle strength in both handgrips. Further investigation showed brisk deep tendon reflexes, positive Hoffman sign unilaterally, equivocal Babinski sign, and progressive quadriparesis. Magnetic resonance imaging showed mild and diffuse building of some cervical discs, with spinal cord progression. We performed an anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF); a titanium mesh with plates and screws was used for fusion, with removal of a calcified and herniated subligamentous disc. Postoperatively, upper and lower limb strength deteriorated; immediate cervical and thoracic MRI showed LF buckling, which caused canal stenosis and severe compression. Urgent posterior laminectomy and canal decompression with bone fusion was scheduled on the same day. The patient underwent physiotherapy and regained upper and lower limb strength and his ability to walk. Conclusion This indicates the possibility of neurological deterioration as a result of LF buckling, whichmay be a result of LF thickening accompanied by hyperextension in the cervical region. In this regard, immediate imaging following signs of neurological complications after anterior cervical corpectomy or discectomy warrants early detection, which results in a better prognosis.
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Humans , Male , Aged , Spinal Cord Compression/surgery , Spinal Cord Compression/complications , Ligamentum Flavum/physiopathology , Spinal Cord Compression/diagnostic imaging , Spinal Fusion/methods , Cervical Vertebrae , Treatment Outcome , Diskectomy/methods , Spondylosis , Laminectomy/methodsABSTRACT
BACKGROUND: Cervical spondylotic myelopathy is a common degenerative disease of the cervical spine in spinal surgery. Surgical decompression is the most effective method to prevent the further development of the disease. However, patients are often accompanied by residual neurological symptoms such as sensory and motor dysfunction after surgery. Currently, the drug treatment for postoperative neurological recovery of patients is still unclear clinically. OBJECTIVE: To investigate the effect of mecobalamine combined with mouse nerve growth factor on the recovery of nerve function after cervical spondylotic myelopathy surgery. METHODS: A total of 82 cases of cervical spondylotic myelopathy from June 2017 to September 2018 in the Affiliated Hospital of Xuzhou Medical University were enrolled in this study. All the patients were randomly divided into observation group and control group with 41 cases in each. Mouse nerve growth factor injection was applied to the control group, and mecobalamine injection was added to the research group. All the patients were treated for 2 weeks. The symptoms and signs in both groups were respectively recorded before and after the treatment, and postoperative residual neurological symptoms were evaluated by Neck Disability Index (NDI) scores and Japanese Orthopedic Association scores. RESULTS AND CONCLUSION: At 1 month, 3 months, 6 months and 1 year after the operation, the NDI scores of the two groups were lower than those before the treatment, and the JOA scores were both getting higher than those before the treatment. The NDI scores in the observation group at 6 months and 1 year after the operation were significantly lower than those in the control group, and as well, the Japanese Orthopedic Association scores were significantly higher than those in the control group. These findings indicate that the combination of mecobalamine and mouse nerve growth factor is helpful to the recovery of nerve function in patients after cervical spondylotic myelopathy surgery, and the effect is better than that of mouse nerve growth factor alone.
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OBJECTIVE@#To compare the efficacy of microscope assisted anterior cervical discectomy and fusion with conventional surgical approach in the treatment of single-segment cervical spondylotic myelopathy.@*METHODS@#The clinical data of 89 patients with single-segment cervical spondylotic myelopathy treated from March 2015 to March 2019 were retrospectively analyzed. There were 55 males and 34 females, with an average of (52.00±11.36) years old. Among the patients, 34 cases were treated with conventional anterior cervical discectomy with fusion (conventional group), including C@*RESULTS@#Intraoperative blood loss and hospital stay in microscope group were less than those in conventional group (@*CONCLUSION@#Both methods can achieve satisfactory effect in treating single-segment cervical spondylotic myelopathy. However, microscope-assisted anterior cervical discectomy and fusion has advantages of clear vision, less bleeding and fewer intraoperative complications.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Cervical Vertebrae/surgery , Diskectomy , Retrospective Studies , Spinal Cord Diseases/surgery , Spinal Fusion , Spondylosis/surgery , Treatment OutcomeABSTRACT
Background: Cervical spondylotic myelopathy (CSM) is a commonly seen spinal cord disease. There are no well-defined indications and optimal timing for surgical intervention. Therefore, defining predictors for outcome after surgical intervention will have great advantage in taking decisions for interventions.Methods: A consecutive series of all patients having signs and symptoms of cervical spondylotic myelopathy admitted to Department of Neurosurgery, Medical College, Thiruvananthapuram who underwent decompressive surgery with or without stabilization in one year were studied. Pre-operative magnetic resonance imaging (MRI) findings were correlated with post-operative surgical outcomes (Nurick grade) after 3 months of follow up. The pattern of spinal cord signal intensity was classified as: group A (MRI N/N) - no SI T1WI or T2WI, group B (MRI N/Hi) - no SI T1WI and high SI on T2WI and, group C (MRI Lo/Hi) - low SI T1WI and high SI on T2WI. CSM clinical outcomes were evaluated using Nurick grading system, which was used pre- and post-operatively (pre op and post op).Results: Post operatively improvement was seen in 75% of group A and 61.35 % of group B patients, but among group C only 25% patient improved according to Nurick grading pre op and post op.Conclusions: Patients with high intramedullary signal intensity on T2WI may experience a good surgical outcome. A less favorable surgical outcome is predicted by the presence of low intramedullary signal on T1WI.
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Objective:To observe the relationship between cervical curvature and spinal drift distance after laminectomy with lateral mass screw fixation, and its effect on clinical outcome. Methods:From January, 2017 to October, 2018, a total of 117 patients with cervical spondylotic myelopathy (CSM) underwent laminectomy with lateral mass screw fixation, and 90 of them completed the follow-up. According to the patients' cervical curvature (CC), they were divided into three groups: those CC between 0° to 5° were in Group A (n = 28), 5° to 16.5° in Group B (n = 36) and CC > 16.5° in Group C (n = 26). The spinal drift distance, nerve recovery, axial symptoms and C5 palsy were recorded and analyzed. Results:There were significant differences in CC and spinal drift distance (F > 152.119,P < 0.001), and no significant difference was found in laminectomy width and incidence of C5 palsy (P > 0.05) among three groups. The Japanese Orthopaedic Association (JOA) score significantly increased in all the groups post operation and at the last follow-up (t > 8.869,P < 0.001), and no significant difference was found among there groups at the same time (P > 0.05), as well as the incidence of C5 palsy (F = 0.472,P = 0.625). There was significant difference in the score of Visual Analogue Scale of axial symptoms among three groups (F > 34.800,P < 0.001), which was lower in groups B and C than in group A (t > 5.845,P< 0.001), and no significant differene was found between group B and group C. Conclusion:On the basis of the same laminectomy width, the greater the CC was, the more favorable the spinal drift went backwards. The loss of CC was related to the occurrence of axial symptoms, but was not correlated with the neurological recovery and C5 palsy.
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BACKGROUND: Recent clinical studies have found that during the implantation of biomaterials, the internal environment of the body will change to a certain extent, and different levels of immunity and stress responses will occur. There are also obvious differences in the immune and stress responses of different biological materials. OBJECTIVE: To investigate the effect of 3D printed interbody fusion cage on patients with cervical spondylosis of spinal cord type and its effect on serum cortisol and norepinephrine levels. METHODS: Sixty-three patients with cervical spondylotic myelopathy who were admitted to the Affiliated Hospital of Chengde Medical University from July 2015 to July 2018 were selected, including 40 males and 23 females, aged 30-78 years old. The patients were randomly divided into a research group (n=31) and a control group (n=32) according to a random number table. All patients received anterior cervical decompression and bone graft fusion and internal fixation. Patients in the research group were implanted with 3D printed intervertebral fusion cage during operation. The patients in the control group were implanted with polyetheretherketone interbody fusion cage and allogeneic bone. The operation and complications of the two groups were compared. Serum cortisol and norepinephrine levels were detected before and 1 and 3 days after operation. Cervical curvature and intervertebral height were measured before surgery, 1 week, and 6 months after surgery. Axial symptoms were counted at 6 months after surgery. The trial was approved by the Ethics Committee of the Affiliated Hospital of Chengde Medical University. RESULTS AND CONCLUSION: (1) Operation time, intraoperative blood loss and hospitalization time were not significantly different between the two groups (P > 0.05). (2) Among 31 cases, there were 1 case of screw loosening and 1 case of implant movement in the research group. Among 32 cases, there were 3 cases of screw loosening, 3 cases of immune rejection, 2 cases of implant movement, and 1 case of implant collapse in the control group. The incidence of complications was lower in the research group than that in the control group (P < 0.05). (3) At 1 and 3 days after operation, the levels of cortisol and norepinephrine were higher in both groups than those before surgery (P < 0.05), but above levels were lower in the research group than in the control group (P < 0.001). (4) The cervical curvature and intervertebral height at 1 week and 6 months after operation in both groups were higher than those before surgery (P < 0.05), and above indexes were higher in the research group than in the control group (P < 0.05). (5) The axial symptom in the research group was lighter than that in the control group at 6 months after operation (P < 0.05). (6) The results show that the application of 3D printed interbody fusion cage to cervical spondylotic myelopathy can reduce complications, promote the recovery of cervical curvature and intervertebral height, and improve the stability of cervical spine, and the body’s stress response and axial symptoms are mild.
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BACKGROUND: Blood oxygenation level dependent functional MRI (BOLD-fMRI) has proven to be a powerful tool for studying the functional change of the brain. In task-state fMRI study, the functional reorganization of sensory and motor cortex has been observed in patients with cervical spondylotic myelopathy. OBJECTIVE: To discuss the correlations between task-state fMRI measurements with clinical symptoms and surgical outcomes of cervical spondylotic myelopathy. METHODS: Eighty-two patients with cervical spondylotic myelopathy undergoing posterior cervical decompression (cervical spondylotic myelopathy group) and forty-five healthy volunteers (normal group) were recruited from January 2018 to January 2019. All subjects underwent fMRI and performed a finger-tapping paradigm with the right hand. The Japanese Orthopaedic Association score was used to evaluate the function of the spinal cord. Japanese Orthopaedic Association score recovery rate less than 50% was defined as a poor result. RESULTS AND CONCLUSION: (1) Japanese Orthopaedic Association score was significantly improved after surgery in the cervical spondylotic myelopathy group compared with that before surgery (P 0.05). Before surgery, VOA ratio (left precentral gyrus/left postcentral gyrus) was significantly higher in the cervical spondylotic myelopathy group than in normal group (P 0.05). VOA ratio was significantly decreased compared with that preoperatively (P < 0.05). (4) Correlation analysis revealed that the VOA in the left precentral gyrus and left postcentral gyrus and VOA ratio were significantly correlated with preoperative Japanese Orthopaedic Association score and postoperative Japanese Orthopaedic Association score recovery rate (P < 0.05). The absolute value of correlation coefficient of VOA ratio with preoperative Japanese Orthopaedic Association score and postoperative recovery rate was largest. (5) Receiver operating characteristic curve analysis showed that the area under the curve value for the VOA ratio was 0.803, indicating strong predictive discrimination, and the cut-off value was 3.621. The area under the curve value for Japanese Orthopaedic Association score was 0.751, and the cut-off value was 8. The predictive effect of VOA ratio was higher than Japanese Orthopaedic Association score. (6) The results indicate that the VOA in the left precentral gyrus and left postcentral gyrus was negatively correlated with severity of clinical symptoms (Japanese Orthopaedic Association score). Preoperative VOA ratio can effectively predict the recovery of spinal cord function after operation in patients with cervical spondylotic myelopathy.
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BACKGROUND: Self-locking self-stabilizing zero-profile cage ROI-C is advanced from the traditional titanium plate fusion cage, but the systematic studies on ROI-C internal fixation system applied in the comprehensive evaluation of two-level cervical spondylotic myelopathy are few. OBJECTIVE: To comprehensively evaluate the clinical efficacy of small-incision anterior cervical self-locking self-stabilizing zero-profile cage ROI-C in the treatment of two-level cervical spondylotic myelopathy. METHODS: Fifty-seven patients with two-level cervical spondylotic myelopathy at the First Affiliated Hospital of Guangdong Pharmaceutical University from September 2016 to March 2018 were selected, including 30 males and 27 females, aged 34-77 years old. Of which, 33 patients underwent small-incision anterior cervical self-locking self-stabilizing zero-profile fusion cage ROI-C implantation (observation group), and another 24 patients received small-incision cervical anterior titanium internal fixation (control group). The JOA score, Neck Disability Index, Odom criteria, Visual Analogue Scale score, dysphagia degree, Cobb angle of cervical lordosis, angle of fusion segment, and disc height and cervical fusion rate were assessed at 2 weeks and 1, 3, 6, and 12 months after surgery. The study was approved by the Ethics Committee of the First Affiliated Hospital of Guangdong Pharmaceutical University. RESULTS AND CONCLUSION: (1) There was no significant difference in the Odoms criteria between two groups (P > 0.05). All 57 patients were followed up for 12 months after surgery. No internal fixation loosening or vertebral structure changes were found. No complications such as loosen and broken of titanium plate occurred. (2) Postoperative JOA score, Neck Disability Index, and Visual Analogue Scale in the two groups were significantly improved compared with those before surgery (P 0.05). (3) The incidence of dysphagia at 2 weeks and 1 month in the observation group was significantly lower than that in the control group (P 0.05). (4) The Cobb angle of cervical lordosis, angle of fusion segment, and disc height were significantly improved in both groups after surgery (P 0.05). (5) The cervical fusion rate at the last follow-up in both groups was > 95%, and the fusion effect was good. There was no significant difference in the fusion rate at different time points between two groups (P > 0.05). (6) These results indicate that the small-incision anterior cervical self-locking self-stabilizing Zero-profile interbody fusion ROI-C and anterior titanium plate internal fixation exert significant effects in the treatment of two-level cervical spondylotic myelopathy. However, ROI-C can reduce the incidence of postoperative dysphagia.
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BACKGROUND: Cervical spondylotic myelopathy is one of the most serious types of cervical spondylosis. The histopathological study of cervical spondylotic myelopathy is not very clear, mainly because of the lack of ideal animal models. OBJECTIVE: To review the common methods of making cervical spondylotic myelopathy model, and analyze and evaluate the different methods of making the model, so as to promote the improvement and perfection of cervical spondylotic myelopathy animal models in the future. METHODS: The “cervical spondylotic myelopathy, cervical spinal compression, animal model” in Chinese and English, respectively were used as keywords. The first author retrieved the literature concerning construction methods of cervical spondylotic myelopathy animal model in CNKI, Wanfang, VIP, PubMed, Medline and Embase databases from 2000 to 2019, and all data were filtered for analysis and evaluation. RESULTS AND CONCLUSION: (1) There are many construction methods of cervical spondylotic myelopathy animal model at present, which can be divided into two types: dynamic modeling methods and static modeling methods, and their advantages and disadvantages coexist. (2) Screw compression is the most common construction method of cervical spondylotic myelopathy animal models, which has the advantages of strong controllability and short modeling cycle, but the damage to cervical spinal cord of animals is more serious and has a high fatality rate. The technology of expansion material compression method is difficult, but it has a high success rate and high reliability. It needs to be further improved and promoted. (3) At present, the construction methods of cervical spondylotic myelopathy animal model still have many disadvantages, and need to be improved on the basis of previous modeling by researchers, so as to realize good reproducibility, repeatable and scalable animal model making and provide a better clinical theoretical basis for cervical spondylotic myelopathy in the future.
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Objective@#To investigate the relationship between cervical curvature (CC) and spinal drift distance after laminectomy with lateral mass screw fixation and the influence on the operative effect.@*Methods@#From October 2016 to December 2017, a total of 85 patients with cervical spondylotic myelopathy (CSM) underwent laminectomy with lateral mass screw fixation in handan central hospital, and 78 patients were followed up completely.After the operation, according to the Harrison method, they were divided into 2 groups(Group A (43 cases, 0°≤CC≤16.5°); Group B (35 cases, CC>16.5°)). The spinal drift distance, nerve recovery, axial symptoms and C5 palsy in the groups were recorded and analyzed.@*Results@#The CC was 8.5°±3.8° in group A and 19.6°±3.0° in group B (t=14.071, P=0.000). The laminectomy width in group A was (22.1±1.7) mm, in group B was (21.8±1.5) mm, the difference between the two groups was not statistically significant (P>0.05). The distance of spinal cord backward movement was (1.7±0.4) mm in group A and (3.2±0.7) mm in group B. There was significant difference between the two groups (t=11.879, P<0.001). At the end of one year, the improvement rates of nerve function in the two groups were (63.3±13.1)% and (65.1±13.9)% respectively, there was no significant difference between the two groups (t=0.587, P=0.559). The VAS score of group A was (5.2±1.3) at one week and (3.5±0.6) at one month after operation, and that of group B was (3.8±0.8) and (2.4±0.4) respectively.There were statistically significant differences between groups at different time points (t=5.567, P<0.001; t=9.289, P<0.001). The incidence of C5 paralysis was 7.0% (3/43) in group A and 11.4% (4/35) in group B. There was no significant difference between the two groups (P>0.05).@*Conclusion@#The greater the curvature of cervical spine is, the more fully the spinal cord moves backward.The loss of curvature of cervical spine is related to the occurrence of axial symptoms.The curvature of cervical spine is not related to the recovery of nerve function and the occurrence of C5 nerve paralysis.
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OBJECTIVE@#To explore the clinical effects of anterior cervical discectomy with fusion (ACDF) and anterior cervical corpectomy with fusion (ACCF) in treating adjacent two-segment cervical spondylotic myelopathy (CSM).@*METHODS@#The clinical data of 37 patients with adjacent two segment CSM treated from January 2016 to December 2017 were retrospectively analyzed, including 15 males and 22 females, aged from 43 to 69 years old with an average of 54.6 years. The patients were divided into ACDF group (group A, =17) and ACCF group (group B, =20) according to the different surgery. The operation time and intraoperative blood loss were recorded;the Cobb angle and cervical curvature in the cervical fusion segments before surgery and 1, 12 months after surgery were observed;Japanese Orthopaedic Association (JOA) score was used to evaluate the surgical efficacy, and the postoperative complications were analyzed.@*RESULTS@#All patients were followed up for 12 to 24 months with an average of 18.5 months. Operation time and intraoperative blood loss in group A were (106.3±22.6) min, (52.2±26.4) ml, respectively, while were (115.6±16.8) min, ( 61.7±20.7) ml in group B. There was no statistically significant in operation time between two groups(>0.05);intraoperative blood loss in group B was larger than group A(0.05). At the final follow up, in group A, dysphagia occurred in 2 cases, cage displacement in 1 case, and no titanium plate screw loose was found;and in group B, dysphagia occurred in 4 cases, titanium mesh collapse in 2 cases, titanium plate screw loose in 1 case.@*CONCLUSION@#Two types of anterior cervical decompression and fusion for the treatment of two segment cervical spondylotic myelopathy can effectively decompress and improve the Cobb angle and cervical curvature of the affected vertebra. The ACDF surgical procedure can directly removethe compressive thing at intervertebral level, which will lead to little vertebral body damage and favorably recovered cervical curvature. The ACCF surgical procedure has a large operation space, which can easily remove the posterior vertebral osteophyte and the calcified posterior longitudinal ligament. Long-term follow-up shows that ACDF and ACCF have good surgical procedures, mature technology, and close efficacy.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Cervical Vertebrae , General Surgery , Diskectomy , Retrospective Studies , Spinal Cord Diseases , General Surgery , Spinal Fusion , Spondylosis , General Surgery , Treatment OutcomeABSTRACT
RESUMEN Las alteraciones degenerativas de la columna se engloban en el término de espondilosis cervical. La mielopatía espondilótica cervical (MEC) es la forma más común de disfunción del cordón espinal en mayores de 55 años. Se considera la intervención quirúrgica en la mayoría de los casos de mielopatía cervical espondilótica evidente desde el punto de vista clínico, dado el riesgo de deterioro neurológico. En la mayoría de los casos de mielopatía cervical, la descompresión de la médula espinal genera estabilización o mejoría de la función de los haces largos medulares. La función es mejor cuando se restablecen bien las dimensiones del conducto vertebral después de la descompresión, cuando la descompresión es más precoz y cuando no hay comorbilidad considerable.
ABSTRACT The degenerative alterations of the column are included in the term of cervical espondilosis. The cervical spondylotic myelopathy it is the form more common of disfuntion of the spinal cord in bigger than 55 years. It is considered the surgical intervention in most of the cases of cervical spondylotic myelopathy evident from the clinical, given point of view the risk of neurological deterioration. In most of the cases of cervical myelopathy, the decompression of the spinal marrow generates stabilization or improvement of the function of the medullary long sheaves. The function is better when they recover well the dimensions of the vertebral conduit after the decompression, when the decompression is more precocious and when there is not considerable comorbility.
Subject(s)
Humans , Male , Aged , Arthrodesis , Spinal Cord Diseases/surgery , Spinal Cord Diseases/complications , Spinal Cord Diseases/diagnosis , Spinal Cord Diseases/etiology , Spinal Cord Diseases/drug therapy , Spinal Cord Diseases/diagnostic imaging , Diskectomy , Spondylosis/diagnosis , Intervertebral Disc Degeneration/diagnosis , Spinal Canal/physiopathology , Magnetic Resonance Spectroscopy , NeurosurgeryABSTRACT
Background: Surgical outcome in patients with cervicalspondylotic myelopathy may affects by variety of factors.Different study outcome suggest that the number of symptomsand involved levels, symptom duration and posterior approachsignificantly increased with increasing age, whereaspreoperative Japanese Orthopedic Association scoredecreased among the different age groups.Objective: The goal of this study is to analyze the surgicaloutcome by comparing younger and elderly patient groups onthe basis of preoperative radiological and clinical data.Methods: To find out the surgical outcome the clinical andradiological data of 32 patients who underwent expansivelaminoplasty were reviewed after their surgery had beenperformed. All of the Patients were divided into two groups,group (a): younger patient group (<65 yr of age; n = 13) andan elderly patient group (≥65 yr of age; n = 19). Patients wereassessed by use of the Japanese Orthopaedic Associationscale (JOA) to know the neurological status of them. Computedtomographic myelography and magnetic resonance imagingexamined for radiological feature. Finally, the effects of theclinical and radio-logical findings on neurological outcome wereinvestigated.Results: The scores of preoperative and postoperative meanof (JOA) in elderly patients were significantly lower thanyounger patients. In the elderly patients cases, the transversearea of the spinal cord at the level of maximum compressionand symptom duration were the factors that predicted anexcellent recovery on the other hand the transverse area wasthe only predictor of excellent recovery in younger patients.Intensity change on the spinal cord and age, preoperativeJapanese Orthopaedic Association score, canal diameter werenot predictive in either age range.Conclusion: Both younger and elderly patient groups thetransverse area of the spinal cord may be a reliable predictor ofexcellent recovery. In case of elderly patients shorter symptomduration was an important factor in the excellent recovery.
ABSTRACT
OBJECTIVE@#To evaluate the short-term curative effects of ARCH titanium plate fixation combined with expansive single open-door laminoplasty (EOLP) in treating cervical spondylotic myelopathy (CSM).@*METHODS@#EOLP with ARCH titanium plate as internal fixation material was applied in 32 patients with CSM from January to December 2016. There were 23 males and 9 females with an average age of 64.5 years ranging from 39 to 82 years. The course of disease ranged from 6 to 24 months with an average of 13.1 months. The clinical efficacy was evaluated by Japanese Orthopaedic Association (JOA) scoring method, which included upper and lower limb motor function, limb sensory function and bladder function. The sagittal diameter of the narrowest segment of vertebral canal was measured by imaging data before operation and 6 months after operation, and the improvement rate was calculated to determine the decompression effect.@*RESULTS@#All the patients were followed up from 6 to 20 months with an average of 12.2 months. Preoperative symptoms of 32 patients were improved to varying degrees, the JOA score increased from 9.78±1.34 before operation to 12.94±1.16 at 6 months after operation, the improvement rate of JOA was(44.09±11.06)% (<0.01). The spinal canal was significantly enlarged, the sagittal diameter of the narrowest vertebral canal was increased from (8.47±0.60) mm preoperatively to (12.51±0.78) mm 6 months postoperatively, the improvement rate was (48.27±11.81)% (<0.01). No loosening, displacement, rupture or "re-closure" of the internal fixator was found during the follow-up.@*CONCLUSIONS@#ARCH titanium plate fixation combined with EOLP in the treatment of CSM can significantly reduce the possibility of "re-closure" and other related postoperative complications and the short-term clinical efficacy is satisfactory.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bone Plates , Cervical Vertebrae , Laminoplasty , Retrospective Studies , Spinal Cord Diseases , Titanium , Treatment OutcomeABSTRACT
Cervical spondylotic myelopathy is the most serious subtype of cervical spondylosis and the most common cause of spinal cord injury. At present, it is considered that mechanical compression and ischemic changes caused by spinal stenosis constitute the pathophysiological basis of spinal stenosis, and the dynamic instability of cervical spine is also an important factor causing spinal cord injury. Its clinical manifestations and physical examinations are complex and varied, and often need to be differentiated from some geriatric diseases. In addition to the abnormal long bundle sign caused by upper motor neuron injury, about 51.9% of cervical spondylotic myelopathy patients also have root lesions. Magnetic resonance imaging is the preferred method of examination in patients with suspected cervical spondylotic myelopathy. Compared with magnetic resonance imaging, diffusion tensor imaging is much more sensitive in detecting early patients. It is suggested that, patients with moderate to severe cervical spondylotic myelopathy should receive surgery, and patients with mild cervical spondylotic myelopathy should consider conservative treatment within three years from the beginning of diagnosis.
ABSTRACT
Objective:To observe the efficacy of laminoplasty with reconstructing of cervical extensor attachment on cervical spondylotic myelopathy (CSM) involving C2 segment. Methods:From March, 2014 to January, 2017, 46 cases with CSM involving C2 accepted surgery in our hospital. They were divided into two groups according to the surgical methods. Control group (n = 21) accepted traditional laminoplasty, while observation group (n = 25) accepted laminoplasty with extensor muscle attachment point reconstruction. They were assessed with Japanese Orthopaedic Association (JOA) spinal scores, cervical range of motion (ROM), cervical curvature, areas of posterior cervical muscles and axial symptoms. Results:There was no significant difference at operative time and intraoperative blood loss (t < 0.863, P > 0.05) between groups. After surgery, the JOA score increased in both groups (F > 24.961, P < 0.001), but there was no significant difference between two groups (t < 0.282, P > 0.05). ROM varied little in both groups (F < 0.931, P > 0.05). The cervical neutral position curvature decreased in the control group (F = 8.241, P < 0.01), but not in the observation group (F = 2.705, P > 0.05). The areas of posterior muscle decreased in control group (t = 2.678, P < 0.05), but not in the observation group (t = 0.854, P > 0.05). The incidence of axial symptoms was less in the observation group than in the control group (Z = -2.192, P < 0.05). Conclusion:Laminoplasty could relieve the spinal compression at C2 segment and promote the recovery of neurological function, and it can do better in cervical curvature and posterior cervical muscle atrophy as combination with reconstruction of extensor muscle attachment, to reduce the axial symptoms.