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1.
Eur Spine J ; 33(3): 915-923, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38363366

RESUMO

PURPOSE: The objective of this study was to examine the relationships between BMI and intervertebral disc degeneration (DD), disc herniation (DH) and spinal stenosis (SS) using a large, prospectively recruited and heterogeneous patient population. METHODS: Patients were recruited through the European Genodisc Study. An experienced radiologist scored MRI images for DD, DH and SS. Multivariate linear and logistic regression analyses were used to model the relationship between these variables and BMI with adjustment for patient and MRI confounders. RESULTS: We analysed 1684 patients with a mean age of 51 years and BMI of 27.2 kg/m2.The mean DD score was 2.6 (out of 5) with greater DD severity with increasing age (R2 = 0.44). In the fully adjusted model, a 10-year increase in age and a 5 kg/m2 increase in BMI were associated, respectively, with a 0.31-unit [95% CI 0.29,0.34] and 0.04-unit [CI 0.01,0.07] increase in degeneration. Age (OR 1.23 [CI 1.06,1.43]) and BMI (OR 2.60 [CI 2.28,2.96]) were positively associated with SS. For DH, age was a negative predictor (OR 0.70 [CI 0.64,0.76]) but for BMI (OR 1.19 [CI 1.07,1.33]), the association was positive. BMI was the strongest predictor of all three features in the upper lumbar spine. CONCLUSIONS: While an increase in BMI was associated with only a slight increase in DD, it was a stronger predictor for DH and SS, particularly in the upper lumbar discs, suggesting weight loss could be a useful strategy for helping prevent disorders associated with these pathologies.


Assuntos
Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Disco Intervertebral , Dor Lombar , Estenose Espinal , Humanos , Pessoa de Meia-Idade , Pré-Escolar , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/epidemiologia , Dor Lombar/etiologia , Dor Lombar/complicações , Estenose Espinal/complicações , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/patologia , Obesidade/complicações , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/epidemiologia , Imageamento por Ressonância Magnética/métodos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Disco Intervertebral/patologia
2.
Spine Deform ; 11(6): 1453-1460, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37341954

RESUMO

PURPOSE: 7% of adolescent idiopathic scoliosis (AIS) patients also present with a pars defect. To date, there are no available data on the results of fusion ending proximal to a spondylolysis in the setting of AIS. The aim of this study was to analyze the outcomes of posterior spinal fusion (PSF) in this patient cohort, to investigate if maintaining the lytic segment unfused represents a safe option. METHODS: Retrospective review of all patients who received PSF for AIS, presented with a spondylolysis or spondylolisthesis and had a min. 2-year follow-up. Demographic data, instrumented levels, and preoperative radiographic data were collected. Mechanical complications, coronal or sagittal parameters, amount of slippage, and pain levels were evaluated. RESULTS: Data from 22 patients were available (age 14.4 ± 2.5 years), 18 Lenke 1-2 and 4 Lenke 3-6. 5 patients (24%) had an isthmic spondylolisthesis, all Meyerding I. The mean preoperative Cobb angle of the instrumented curves was 58 ± 13°. For 18 patients, the lowest instrumented vertebra (LIV) was the last touched vertebra (LTV); for 2, LIV was distal to the LTV; for 2, LIV was one level proximal to the LTV. The number of segments between the LIV and the lytic vertebra ranged from 1 to 6. At the last follow-up, no complications were observed. The residual curve below the instrumentation measured 8.5 ± 6.4°, the lordosis below the instrumented levels was 51.4 ± 13°. The magnitude of the isthmic spondylolisthesis remained constant for all included patients. Three patients reported minimal occasional low back pain. CONCLUSION: The LTV can be safely used as LIV when performing PSF for the management of AIS in patients with L5 spondylolysis.

3.
Spine (Phila Pa 1976) ; 47(16): 1151-1156, 2022 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-35853174

RESUMO

STUDY DESIGN: A retrospective review of operative patients at a single institution. OBJECTIVE: The aim was to validate a novel method of detecting pseudarthrosis on dynamic radiographs. SUMMARY OF BACKGROUND DATA: A common complication after anterior cervical discectomy and fusion is pseudarthrosis. A previously published method for detecting pseudarthrosis identifies a 1 mm difference in interspinous motion (ISM), which requires calibration of images and relies on anatomic landmarks difficult to visualize. An alternative is to use angles between spinous processes, which does not require calibration and relies on more visible landmarks. MATERIALS AND METHODS: ISM was measured on dynamic radiographs using the previously published linear method and new angular method. Angles were defined by lines from screw heads to dorsal points of spinous processes. Angular cutoff for fusion was calculated using a regression equation correlating linear and angular measures, based on the 1 mm linear cutoff. Pseudarthrosis was assessed with both cutoffs. Sensitivity, specificity, inter-reliability and intrareliability of angular and linear measures used postoperative computed tomography (CT) as the reference. RESULTS: A total of 242 fused levels (81 allograft, 84 polyetheretherketone, 40 titanium, 37 standalone cages) were measured in 143 patients (mean age 52.0±11.5, 42%F). 36 patients (66 levels) had 1-year postoperative CTs; 13 patients (13 levels) had confirmed pseudarthrosis. Linear and angular measurements closely correlated ( R =0.872), with 2.3° corresponding to 1 mm linear ISM. Potential pseudarthroses was found in 28.0% and 18.5% levels using linear and angular cutoffs, respectively. Linear cutoff had 85% sensitivity, 87% specificity; angular cutoff had 85% sensitivity, 96% specificity for detecting CT-validated pseudarthrosis. Interclass correlation coefficients were 0.974 and 0.986 (both P <0.001); intrarater reliability averaged 0.953 and 0.974 ( P <0.001 for all) for linear and angular methods, respectively. CONCLUSIONS: The angular measure for assessing potential pseudarthrosis is as sensitive as and more specific than published linear methods, has high interobserver reliability, and can be used without image calibration. LEVEL OF EVIDENCE: 3.


Assuntos
Pseudoartrose , Fusão Vertebral , Adulto , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Discotomia/métodos , Humanos , Pessoa de Meia-Idade , Pseudoartrose/diagnóstico por imagem , Pseudoartrose/etiologia , Pseudoartrose/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Resultado do Tratamento
4.
Int J Spine Surg ; 16(3): 450-457, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35772976

RESUMO

OBJECTIVE: To assess whether surgical cervical deformity (CD) patients meet spinopelvic age-adjusted alignment targets, reciprocal, and lower limb compensation changes. STUDY DESIGN: Retrospective review. METHODS: CD was defined as C2-C7 lordosis >10°, cervical sagittal vertical angle (cSVA) >4 cm, or T1 slope minus cervical lordosis (TS-CL) >20°. Inclusion criteria were age >18 years and undergoing surgical correction with complete baseline and postoperative imaging. Published formulas were used to create age-adjusted alignment target for pelvic tilt (PT), pelvic incidence and lumbar lordosis (PI-LL), sagittal vertical angle (SVA), and lumbar lordosis and thoracic kyphosis (LL-TK). Actual alignment was compared with age-adjusted ideal values. Patients who matched ±10-year thresholds for age-adjusted targets were compared with unmatched cases (under- or overcorrected). RESULTS: A total of 120 CD patients were included (mean age, 55.1 years; 48.4% women; body mass index, 28.8 kg/m2). For PT, only 24.4% of patients matched age-adjusted alignment, 51.1% overcorrected for PT, and 24.4% undercorrected. For PI-LL, only 27.6% of CD patients matched age-adjusted targets, with 49.4% overcorrected and 23% undercorrected postoperatively. Forty percent of patients matched age-adjusted target for SVA, 41.3% overcorrected, and 18.8% undercorrected. CD patients who had worsened in TS-CL or cSVA postoperatively displayed increased TK (-41.1° to -45.3°, P = 1.06). With lower extremity compensation, CD patients decreased in ankle flexion angle postoperatively (6.1°-5.5°, P = 0.036) and trended toward smaller sacrofemoral angle (199.6-195.6 mm, P = 0.286) and knee flexion (2.6° to -1.1°, P = 0.269). CONCLUSIONS: In response to worsening CD postoperatively, patients increased in TK and recruited less lower limb compensation. Almost 75% of CD patients did not meet previously established spinopelvic alignment goals, of whom a subset of patients were actually made worse off in these parameters following surgery. This finding raises the question of whether we should be looking at the entire spine when treating CD.

5.
Oper Neurosurg (Hagerstown) ; 22(6): 380-386, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35383691

RESUMO

BACKGROUND: Three-dimensional (3D) imaging represents a novel way to assess surgical derotation maneuvers in adolescent idiopathic scoliosis (AIS). OBJECTIVE: To assess the following in patients with AIS undergoing derotation surgery with Lenke type 1/2 curves using 3D imaging: (1) the primary outcome of thoracic apical vertebral rotation (T-AVR) and (2) secondary outcomes of thoracic kyphosis (TK), lumbar AVR (L-AVR), and rotation of each thoracic/lumbar vertebrae. METHODS: A retrospective, pilot study of type 1/2 AIS patients from 2017 to 2018 was performed. All patients received posterior pedicle screw/rod constructs with consistent direct vertebral derotational maneuvers and received full length SterEOS imaging with 3D reconstruction. The primary outcome of interest was T-AVR. Secondary outcomes included TK, L-AVR, and rotation at each thoracic/lumbar vertebrae. RESULTS: Fifteen patients (mean age 15.7 ± 1.2 years, 67.0% female) were studied. The mean preoperative/postoperative Cobb angle of the major curve was 51.8° ± 14.9° (range 39.8-62.0) and 11.0° ± 5.1° (range 3.7-20.7). Mean level fused was 10.5 ± 1.2. The primary outcome of T-AVR showed significant improvement (13.8° ± 12.5° vs 9.2° ± 8.6°, P = .015) after surgery, along with secondary outcome of TK (T1-12/T4-12, P = .008/.027). Significant spontaneous rotational improvement was seen in L-AVR (P = .016). Significant improvement was also seen in 11 of 17 (64.7%) individual vertebrae (T3-8/T11-L3) (P < .05). CONCLUSION: In Lenke Type 1/2 AIS patients undergoing surgical derotation and fusion, 3D imaging techniques captured improvements in rotation. Significant postoperative improvement was seen in T-AVR, TK, L-AVR, and rotation of the individual vertebrae T3-8/T11-L3. These pilot results warrant the study of 3D imaging in all patients with AIS and other scoliosis populations.


Assuntos
Cifose , Escoliose , Fusão Vertebral , Adolescente , Feminino , Humanos , Masculino , Projetos Piloto , Radiografia , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia
6.
Int J Spine Surg ; 15(2): 243-250, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33900981

RESUMO

BACKGROUND: The pedicle screw is the most common device used to achieve fixation in fusion of spondylolistheses. Safe and accurate placement with this technique relies on a thorough understanding of the bony anatomy. There is a paucity of literature comparing the surgically relevant osseous anatomy in patients with a degenerative spondylolisthesis (DS) and an isthmic spondylolisthesis (IS). The goal of this study was to determine the differences in the osseous anatomy in patients with a DS and those with an IS. METHODS: A retrospective comparative cohort study was conducted on patients with a single-level, symptomatic L4-L5 DS or a single-level, symptomatic L5-S1 IS. Magnetic resonance imaging for these patients was reviewed. Morphometries of the pedicle and vertebral body were analyzed by 2 independent observers for the levels from L3 to S1, and radiographic parameters were compared between groups. RESULTS: A total of 572 levels in 143 patients were studied, including 103 patients with a DS and 40 with an IS. After accounting for confounders, IS and DS had an independent effect on transverse vertebral body width, pedicle height and width, and sagittal pedicle angle. Patients with an IS had a smaller pedicle height (P < .001) and pedicle width (P = .001) than patients with DS. In addition, the angulation of the pedicles varied on the basis of the diagnosis. CONCLUSIONS: The osseous anatomy is significantly different in patients with a DS than with an IS. Patients with an IS have smaller pedicles in the lumbar spine. Also, the L4 and L5 pedicles are more caudally angulated and the S1 pedicle is less medialized. LEVEL OF EVIDENCE: 3. CLINICAL RELEVANCE: Understanding the differences in pedicle anatomy is important for the safe placement of pedicle screws.

8.
J Clin Neurosci ; 84: 42-45, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33485597

RESUMO

Psychiatric diagnoses (PD) present a significant burden on elective surgery patients and may have potentially dramatic impacts on outcomes. As ailments of the spine can be particularly debilitating, the effect of PD on outcomes was compared between elective spine surgery patients and other common elective orthopedic surgery procedures. This study included 412,777 elective orthopedic patients who were concurrently diagnosed with PD within the years 2005 to 2016. 30.2% of PD patients experienced a post-operative complication, compared to 25.1% for non-PD patients (p < 0.001). Mood Disorders (bipolar or depressive disorders) were the most commonly diagnosed PD for all elective Orthopedic procedures, followed by anxiety, then dementia (p < 0.001). Logistic regression analysis found PD to be a significant predictor of higher cost to charge ratio (CCR), length of stay (LOS), and death (all p < 0.001). Between, hand, elbow, and shoulder specialties, spine patients had the highest odds of increased CCR and unfavorable discharge, and the second highest odds of death (all p < 0.001).


Assuntos
Procedimentos Cirúrgicos Eletivos/efeitos adversos , Transtornos Mentais/complicações , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/psicologia , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
9.
Clin Spine Surg ; 33(7): 258-264, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32235169

RESUMO

The management of acute spinal cord injury requires a multidisciplinary approach to maximize patient outcomes and potential. Treatment of this injury involves both surgical and medical intervention. Medical intervention in acute spinal cord injury is aimed at decreasing the neurotoxic environment that occurs as part of the secondary injury. New neuroregenerative therapies are being developed.


Assuntos
Traumatismos da Medula Espinal/cirurgia , Terapia Combinada , Descompressão Cirúrgica , Humanos , Traumatismos da Medula Espinal/reabilitação
10.
Clin Spine Surg ; 33(5): E206-E212, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31180993

RESUMO

In July of 2018, the Second International Consensus Meeting on Musculoskeletal Infection convened in Philadelphia, PA to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 7 focused on wound care, for which this article provides the recommendations, voting results, and rationales.


Assuntos
Antibacterianos/uso terapêutico , Procedimentos Ortopédicos/efeitos adversos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/prevenção & controle , Consenso , Humanos , Ortopedia , Philadelphia , Falha de Prótese , Sociedades Médicas , Coluna Vertebral/cirurgia , Cicatrização
11.
Clin Spine Surg ; 33(5): E191-E198, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31385851

RESUMO

In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 8 questions focused on general principles in spine surgery, for which this article provides the recommendations, voting results, and rationales.


Assuntos
Procedimentos Ortopédicos/efeitos adversos , Ortopedia/métodos , Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Antibacterianos/uso terapêutico , Consenso , Conferências de Consenso como Assunto , Humanos , Ortopedia/normas , Osteomielite/microbiologia , Philadelphia , Período Pós-Operatório , Propionibacterium acnes , Sociedades Médicas , Infecção da Ferida Cirúrgica/tratamento farmacológico
12.
Clin Spine Surg ; 33(5): E213-E225, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31464694

RESUMO

In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 11 focused on risk factors and prevention questions in spine surgery, for which this article provides the recommendations, voting results, and rationales.


Assuntos
Procedimentos Ortopédicos/efeitos adversos , Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Infecção da Ferida Cirúrgica/terapia , Algoritmos , Antirreumáticos , Consenso , Diarreia/prevenção & controle , Humanos , Staphylococcus aureus Resistente à Meticilina , Ortopedia , Período Perioperatório , Philadelphia , Propionibacterium acnes , Músculos Psoas/patologia , Medição de Risco , Fatores de Risco , Revisões Sistemáticas como Assunto , Tuberculose da Coluna Vertebral/complicações , Tuberculose da Coluna Vertebral/tratamento farmacológico
13.
Clin Spine Surg ; 33(4): 163-171, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31404014

RESUMO

In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 9 focused on implants questions in spine surgery, for which this article provides the recommendations, voting results, and rationales.


Assuntos
Ortopedia/normas , Próteses e Implantes/efeitos adversos , Desenho de Prótese , Falha de Prótese , Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Aloenxertos , Antibacterianos/uso terapêutico , Substitutos Ósseos , Humanos , Meningites Bacterianas/etiologia , Philadelphia , Período Pós-Operatório , Fatores de Risco , Infecção da Ferida Cirúrgica/terapia
14.
Clin Spine Surg ; 33(3): E116-E126, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31393278

RESUMO

In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 17 focused on the use of antibiotics in spine surgery, for which this article provides the recommendations, voting results, and rationales.


Assuntos
Antibacterianos/uso terapêutico , Guias de Prática Clínica como Assunto , Fusão Vertebral , Infecção da Ferida Cirúrgica/prevenção & controle , Humanos
15.
Clin Spine Surg ; 33(5): E199-E205, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31567424

RESUMO

In July 2018, the Second International Consensus Meeting on Musculoskeletal Infection convened in Philadelphia, PA to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 15 focused on the use of imaging, tissue sampling, and biomarkers in spine surgery, for which this article provides the recommendations, voting results, and rationales.


Assuntos
Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/diagnóstico por imagem , Infecção da Ferida Cirúrgica/prevenção & controle , Antibacterianos/uso terapêutico , Biomarcadores/metabolismo , Biópsia , Sedimentação Sanguínea , Proteína C-Reativa/metabolismo , Consenso , Conferências de Consenso como Assunto , Humanos , Imageamento por Ressonância Magnética , Ortopedia/normas , Philadelphia , Tomografia por Emissão de Pósitrons , Falha de Prótese , Fatores de Risco , Sociedades Médicas , Infecção da Ferida Cirúrgica/sangue , Tomografia Computadorizada por Raios X , Cicatrização
18.
J Neurosurg Spine ; : 1-4, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31443083

RESUMO

Total uncinate process resection or uncinectomy is often required in the setting of severe foraminal stenosis or cervical kyphosis correction. The proximity of the uncus to the vertebral artery, nerve root, and spinal cord makes this a challenging undertaking. Use of a high-speed burr or ultrasonic bone dissector can be associated with direct injury to the vertebral artery and thermal injury to the surrounding structures. The use of an osteotome is a safe and efficient method of uncinectomy. Here the authors describe their technique, which is illustrated with an intraoperative video.

19.
Spine (Phila Pa 1976) ; 44(18): 1287-1293, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31261272

RESUMO

STUDY DESIGN: Retrospective review of a prospectively maintained database. OBJECTIVE: Compare outcomes following anterior cervical decompression and fusion (ACDF) between patients with no adjacent level spondylolisthesis (NAS) and adjacent level spondylolisthesis (AS). SUMMARY OF BACKGROUND DATA: There are no prior studies evaluating the effect of preoperative adjacent-level cervical spondylolisthesis on outcomes following anterior cervical discectomy and fusion (ACDF). METHODS: A retrospective review of consecutive patients who underwent ACDF for degenerative cervical disease was performed. Adjacent level spondylolisthesis was defined on radiographs as anterior displacement (> 1 mm) of the vertebra in relation to an adjacent "to be fused" level. Patients were categorized as either AS or NAS. Preoperative and 1-year postoperative outcomes including Short Form-12 Physical and Mental Component Scores, Neck Disability Index, Visual Analog Score for arm and neck pain, and rate of revision surgery were compared between the two groups. Radiographic changes were also analyzed for patients with AS. RESULTS: A total of 264 patients met the inclusion criteria. There were 53 patients (20.1%) with AS and 211 patients (79.9%) with NAS. Both groups improved significantly from baseline with respect to all patient outcomes and there were no significant differences between the two groups. After accounting for confounding variables, the presence of an AS was not a predictor of any postoperative outcome. Revision rates did not differ between the two groups. CONCLUSION: Patients with an AS had similar postoperative clinical outcomes compared with NAS. Furthermore, the presence of an AS was not a predictor of poorer clinical outcomes. This is the first study to investigate the effect of AS in patients undergoing ACDF and suggests that an adjacent-level spondylolisthesis does not need to be included in a fusion construct if it is not part of the primary symptom generating pathology. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia , Fusão Vertebral , Espondilolistese/cirurgia , Adulto , Idoso , Descompressão Cirúrgica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/cirurgia , Cervicalgia/etiologia , Período Pós-Operatório , Radiografia , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
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