Unilateral Percutaneous Kyphoplasty with O-Arm Navigation for the Treatment of Kümmell's Disease.

PURPOSE: To evaluate the efficacy and safety of unilateral O-arm navigation-assisted percutaneous kyphoplasty (PKP) for the treatment of Kümmell's disease. METHODS: The clinical data from patients with Kümmell's disease who attended our hospital between January 2015 and January 2019 were retrospectively analyzed. For each patient, the visual analog scale (VAS) score, anterior height of the vertebral body, sagittal kyphotic angle, Oswestry Disability Index (ODI), and postoperative cement leakage rate were recorded before and after surgery. Any surgical complications were documented. RESULTS: The patients were followed up for 12 to 18 months. The average preoperative VAS score, kyphotic angle, and ODI decreased from 8.6 ± 0.5, 18.0 ± 3.7°, and 86.027%, respectively, to 2.2 ± 0.2, 5.8 ± 0.8°, and 26.720% three days after surgery. The anterior height of the vertebral body increased significantly from 14.5 ± 1.2 mm preoperatively to 19.4 ± 1.2 mm three days after surgery, and this improvement was maintained until the last follow-up. After surgery, bone cement leakage occurred in one vertebral body; this patient exhibited leakage to the intervertebral disc space, a complete pedicle and spinal canal structure, no clinical symptoms, and required no treatment. CONCLUSION: This study shows that unilateral PKP assisted by O-arm navigation is safe and effective. Moreover, the observed improvements can be maintained over the longer term.

Clinical validity of the smallest oblique sagittal area of the neural foramen in patients with suspected cervical spondylotic radiculopathy.

OBJECTIVE: To evaluate the smallest oblique sagittal area of the neural foramen in detecting cervical spondylotic radiculopathy (CSR) and to determine its potential significance for treatment decisions. METHODS: The subjects of the study were patients with CSR who visited the spine surgery from 2016 to 2019. All patients were compared according to the minimum oblique sagittal area and the cut-off point value, and they were divided into positive and negative parameters. The changes in neck disability index (NDI), Japanese Orthopaedic Association score (JOA), and visual analog scale (VAS) during the two treatment groups from baseline to at least 24 months of follow-up were compared. RESULTS: In the surgery group, there was no significant difference in symptom improvement between patients with positive and negative parameters. In the non-surgical group, for patients with positive parameters, NDI decreased by 2.35, JOA increased by 0.88, and neck VAS score improved by 0.42. For patients with negative parameters, NDI decreased by 10.32, JOA increased by 2.86 on average, and neck VAS score improved by 2.46 points on average (both p<0.01 on t test). CONCLUSIONS: Patients with both positive and negative parameters showed significant improvement in their symptoms after surgery, and the smallest oblique sagittal area of the neural foramen seems to be unable to predict the outcome of the surgery. However, in non-surgical patients, symptomatic improvement was more limited in patients with positive parameters than in those with negative parameters. This suggests that patients with positive parameters may be more suitable for surgery and those with negative parameters are more suitable for conservative treatment.

Surgical versus Nonsurgical Treatment for Adult Spinal Deformity: A Systematic Review and Meta-Analysis.

OBJECTIVE: To systematically evaluate the efficacy and safety of surgical and nonsurgical methods for the treatment of adult spinal deformity (ASD). METHODS: The PubMed, Embase, and Cochrane Library databases were searched for relevant controlled studies of surgical and nonsurgical approaches for the treatment of ASD; all studies reported from database creation to October 2021 were eligible for inclusion. Stata 11.0 software was used for the meta-analysis. Publication bias was assessed using a Begg test. Heterogeneity was assessed using the I2 test, and fixed-effects or random-effects models were used, as appropriate. Meta-regression was used to determine the cause of heterogeneity. Subgroup analyses were performed to assess the effects of age on the outcomes. RESULTS: Eleven articles comprising 1880 participants met the inclusion criteria. Meta-analysis showed that surgical treatment was associated with a better improvement in function than was nonsurgical treatment (Scoliosis Research Society 22 questionnaire score change value: weighted mean difference = 0.696; 95% confidence interval [CI], 0.686-0.705; P < 0.0001; Oswestry Dysfunction Index change value: WMD = 11.222; 95% CI, 10.801-11.642; P < 0.0001). Surgical treatment was more effective in relieving pain and correcting the deformity (numeric rating scale pain score: WMD = 3.341; 95% CI, 2.832-3.85; P < 0.0001; Cobb angle change value: WMD = 15.036°; 95% CI, 13.325-16.747; P < 0.0001). The complication rate in the surgical group was 17.6%-80.3%. CONCLUSIONS: Surgical treatment is better than nonsurgical methods for improving the function of patients with ASD and achieving good pain improvement and deformity correction. Elderly patients with ASD can also obtain good symptomatic improvement through surgery.

Clinical significance of microsurgical excision of the posterior longitudinal ligament using a high-frequency electrosurgical excision procedure in anterior cervical discectomy and fusion.

INTRODUCTION: Anterior cervical decompression and fusion surgery using traditional methods to remove the posterior longitudinal ligament often causes massive bleeding, increasing the risk of surgery. However, the use of a high-frequency electrotome under the microscope can significantly reduce bleeding and reduce the risk of surgery. AIM: To explore the clinical significance of electrosurgical excision of the posterior longitudinal ligament in the cervical anterior approach under the microscope. MATERIAL AND METHODS: From December 2015 to December 2017, patients who underwent anterior cervical discectomy and fusion at our hospital were followed up. We enrolled 73 men and 50 women who were 30 to 74 years old (mean, 49.96 years). Among 67 patients in group A treated with a high-frequency electrosurgical knife under the microscope, 58 were followed up; among 73 patients in group B treated with a traditional cervical hook knife under the microscope, 65 were followed up. Clinical data, operative time, intraoperative bleeding volume, VAS score, and Japanese Orthopaedic Association (JOA) improvement rate were retrospectively analyzed. RESULTS: There were significant differences in the mean operative time and intraoperative bleeding volume between the two groups (p < 0.05); however, no significant differences were found in the incidence of cerebrospinal fluid leakage, JOA improvement rate at 3 months postoperatively, and VAS score at 3 months postoperatively between the two groups (p > 0.05). CONCLUSIONS: Electrosurgical resection of the posterior longitudinal ligament of the cervical vertebrae under the microscope can significantly reduce intraoperative bleeding and shorten the operative time and has obvious advantages compared with traditional methods.