Laminectomy with instrumented fusion vs. laminoplasty in the surgical treatment of cervical ossification of the posterior longitudinal ligament: A multicenter retrospective study.

Laminectomy with instrumented fusion (LF) has demonstrated better prevention of ossification of posterior longitudinal ligament (OPLL) growth compared to laminoplasty (LP). There remains uncertainty, however, as to which surgical approach is more beneficial with respect to clinical outcomes and complications. We retrospectively reviewed 273 cervical OPLL patients of more than 3 levels, from the two institutions' databases, who underwent LF or LP between January 1998 and January 2016. Each 273 patient (85 with LF, 188 with LP) was assessed for postoperative neurologic and radiologic outcomes, complications and reoperations. The mean length of follow-up was 40.11 months. There were baseline differences between cohorts. Overall, postoperative JOA recovery rate at last follow up was significantly better in the LP group with similar improvement in visual analog neck score. Postoperative C2-7 Cobb angle was decreased compared to baseline for both LF and LP cohorts, but there was no significant difference between groups. Complications occurred in 19 (22.35%) LF patients, and 11 (5.85%) LP patients, with higher incidence of C5 palsy and instrumentation failure in the LF group. Four LF patients (4.71%) and five LP patients (2.66%) underwent reoperation during the follow up period.

Surgical Strategies for Cervical Deformities Associated With Neuromuscular Disorders.

Neuromuscular disorders (NMDs) are diseases involving the upper and lower motor neurons and muscles. In patients with NMDs, cervical spinal deformities are a very common issue; however, unlike thoracolumbar spinal deformities, few studies have investigated these disorders. The patients with NMDs have irregular spinal curvature caused by poor balance and poor coordination of their head, neck, and trunk. Particularly, cervical deformity occurs at younger age, and is known to show more rigid and severe curvature at high cervical levels. Muscular physiologic dynamic characteristics such as spasticity or dystonia combined with static structural factors such as curvature flexibility can result in deformity and often lead to traumatic spinal cord injury. In addition, postoperative complication rate is higher due to abnormal involuntary movement and muscle tone. Therefore, it is important to control abnormal involuntary movement perioperatively along with strong instrumentation for correction of deformity. Various methods such as botulinum toxin injection, physical therapy, muscle division technique, or intrathecal baclofen pump implant may help control abnormal involuntary movements and improve spinal stability. Surgical management for cervical deformities associated with NMDs requires a multidisciplinary effort and a customized strategy.

Association of Frailty and Self-Care Activity With Sagittal Spinopelvic Alignment in the Elderly.

OBJECTIVE: To assess the relationship between frailty, activities of daily living (ADL), instrumental ADL (IADL), and sagittal spinopelvic parameters in the elderly. METHODS: To compare the characteristics based on the FRAIL scale status (robust, prefrail, frail), continuous variables were analyzed using ANOVA with Tukey post hoc tests, and categorical variables were analyzed using χ2 and Fisher's exact test. Multivariate linear regression was used to investigate cross-sectional association between sagittal alignment and FRAIL status. RESULTS: Comparison analysis of the 3 groups (robust, prefrail, frail) demonstrated that frailty scale had significant correlations with T1 pelvic angle (T1PA, P = 0.019), pelvic tilt (PT, P = 0.004), pelvic incidence minus lumbar lordosis (PI-LL, P = 0.004) and ADL (P = 0.017). Multiple regression analysis that controlled for confounding factors confirmed the correlations between frailty scale and spinopelvic parameters (C7 sagittal vertical axis [SVA], B = 17.49, P = 0.028; T1PA, B = 4.83, P = 0.029; PT, B = 4.62, P = 0.003; PI-LL value, B = 7.11, P = 0.005). In addition, the ADL was associated with T1PA (B = 4.06, P = 0.006); whereas the IADL was correlated with C7 SVA (B = 11.38, P = 0.005), T1PA (B = 3.36, P = 0.003), and PI-LL (B = 3.13, P = 0.018). CONCLUSIONS: Higher frailty score was associated with higher grades of sagittal spinopelvic malalignment and ADL in the elderly. Furthermore, higher ADL and IADL scores were associated with higher grades of sagittal spinopelvic malalignment. Frailty, ADL, IADL, and sagittal spinopelvic parameters were closely related to each other in the elderly.

Comparison of the effectiveness and safety of bioactive glass ceramic to allograft bone for anterior cervical discectomy and fusion with anterior plate fixation.

Recently, a bioactive glass ceramic (BGC) has been developed for use as intervertebral cages for anterior cervical discectomy and fusion (ACDF). However, the effectiveness and safety of BGC cages remain to be evaluated. We completed a retrospective comparison of the radiological and clinical outcomes of 36 patients (52 levels) who underwent ACDF with a BGC cage and 35 patients (54 levels) using allograft bone. The following variables were compared between the two groups: the visual analog (VAS) neck and arm pain score and the neck disability index (NDI), measured before surgery and 1 year after; the change in Cobb's angle, between the C2 and C7 vertebrae, the global sagittal angle, and disc height compared from before surgery to 1 year after; and the rate of spinal fusion and cage subsidence at 1 and 2 years after surgery. The VAS and NDI scores were not different between the two groups. Similarly, the spinal fusion rate was not different between the BGC and allograft bone group at 1 year (73% and 87%, respectively; p = 0.07) and 2 years (94% and 91%, respectively; p = 0.54) after surgery. However, the rate of cage subsidence was higher in the allograft bone (43%) than the BGC (19%) group (p = 0.03), as was the rate of instrument-related failure (p = 0.028), with a specifically higher incidence of implant fracture or failure in the allograft bone group (p = 0.025). Overall, our findings indicate that BGC cages provide a feasible and safe alternative to allograft bone for ACDF.

Delayed Bilateral C5 Palsy following Circumferential Decompression and Fusion in Patient with Cervical Spondylotic Myelopathy.

C5 palsy is a common complication after cervical decompressive surgery, which have 0 to 30% complication rate. A 61-year-old female patient with cervical spondylotic myelopathy showed bilateral C5 palsy following circumferential decompression and fusion. Unexpectedly, bilateral C5 palsy was noted in different time points on postoperative day 2 and 8, respectively. Steroid injection and physical therapy were performed, and her motor function is recovering. Surgeons should make an effort to prevent possible C5 palsy when performing cervical decompression surgery.