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Reddy DV, Satapathy D, Raja BS, Maley DK, Ahuja K, Yalamanchili RK, Lakkireddy M, Ifthekar S. A comparison of clinical and radiological outcomes following laminectomy and laminectomy with fusion in patients of cervical spondylotic myelopathy: A systematic review and meta-analysis. Neurosurg Rev 2024; 47:861. [PMID: 39562413 DOI: 10.1007/s10143-024-03098-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 11/05/2024] [Accepted: 11/11/2024] [Indexed: 11/21/2024]
Abstract
To conduct a systematic review and meta-analysis comparing the functional and radiological outcomes in cervical spondylotic myelopathy (CSM) when treated by Laminectomy (LC) vs. laminectomy with instrumented fusion (LCF). The systematic review was conducted in accordance with PRISMA guidelines. A systematic electronic search was performed in PubMed, EMBASE, and CENTRAL databases. All Studies comparing clinical and radiological outcomes in patients with CSM when treated with LCF and LC were included in the systematic review. Neuromuscular function measured by modified Japanese orthopaedic association (mJOA), Cervical lordosis measured by C2-C7 Cobb's angle, and data on complications were retrieved from the studies. Random effect meta-analysis was used to account for heterogeneity. Quality assessment was performed using ROBINS-I and ROB-2 tools. Certainty of evidence was assessed using the GRADE working group recommendations. A total of 3985 articles were retrieved from the databases, of which 9 articles (1 RCT, 8 controlled comparative trials; n = 1146) met the eligibility criteria. The improvement in mJOA showed results favouring laminectomy with fusion with an SMD of 0.45 (95% CI, 0.07-0.84; p = 0.02). The loss of cervical lordosis was significantly lesser in the laminectomy with fusion group with an SMD of - 0.454 (95% CI, (- 0.12) - (- 0.79), p = 0.01). The complication rate in the LCF group was lower (LogOR = - 0.92; 95% CI: (- 1.30) - (- 0.55); p = < 0.05). In CSM, laminectomy with fusion is superior to standalone laminectomy in terms of improvement in m-JOA, maintenance of cervical lordosis and reduction in complications.
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Affiliation(s)
- Duddukunta Vishal Reddy
- Department of Orthopedic Surgery, AIIMS (All India Institute of Medical Sciences) -Bibinagar, Hyderabad Metropolitan Region, Telangana, India
| | - Deepankar Satapathy
- Department of Orthopedic Surgery, AIIMS (All India Institute of Medical Sciences) -Bibinagar, Hyderabad Metropolitan Region, Telangana, India
| | | | - Deepak Kumar Maley
- Department of Orthopedic Surgery, AIIMS (All India Institute of Medical Sciences) -Bibinagar, Hyderabad Metropolitan Region, Telangana, India
| | - Kaustubh Ahuja
- All India Institute of Medical Sciences, Rishikesh, India
| | - Ranjith Kumar Yalamanchili
- Department of Orthopedic Surgery, AIIMS (All India Institute of Medical Sciences) -Bibinagar, Hyderabad Metropolitan Region, Telangana, India
| | - Maheshwar Lakkireddy
- Department of Orthopedic Surgery, AIIMS (All India Institute of Medical Sciences) -Bibinagar, Hyderabad Metropolitan Region, Telangana, India
| | - Syed Ifthekar
- Department of Orthopedic Surgery, AIIMS (All India Institute of Medical Sciences) -Bibinagar, Hyderabad Metropolitan Region, Telangana, India.
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Couch BK, Patel SS, Talentino SE, Buldo-Licciardi M, Evashwick-Rogler TW, Oyekan AA, Gannon EJ, Shaw JD, Donaldson WF, Lee JY. To Cross the Cervicothoracic Junction? Terminating Posterior Cervical Fusion Constructs Proximal to the Cervicothoracic Junction Does Not Impart Increased Risk of Reoperation in Patients With Cervical Spondylotic Myelopathy. Global Spine J 2023; 13:2379-2386. [PMID: 35285337 PMCID: PMC10538346 DOI: 10.1177/21925682221083926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To evaluate the effect of caudal instrumentation level on revision rates following posterior cervical laminectomy and fusion. METHODS A retrospective review of a prospectively collected database was performed. Minimum follow-up was one year. Patients were divided into two groups based on the caudal level of their index fusion construct (Group 1-cervical and Group 2- thoracic). Reoperation rates were compared between the two groups, and preoperative demographics and radiographic parameters were compared between patients who required revision and those who did not. Multivariate binomial regression analysis was performed to determine independent risk factors for revision surgery. RESULTS One hundred thirty-seven (137/204) patients received fusion constructs that terminated at C7 (Group 1), while 67 (67/204) received fusion constructs that terminated at T1 or T2 (Group 2). The revision rate was 8.33% in the combined cohort, 7.3% in Group 1, and 10.4% in Group 2. There was no significant difference in revision rates between the 2 groups (P = .43). Multivariate regression analysis did not identify any independent risk factors for revision surgery. CONCLUSION This study shows no evidence of increased risk of revision in patients with fusion constructs terminating in the cervical spine when compared to patients with constructs crossing the cervicothoracic junction. These findings support terminating the fusion construct proximal to the cervicothoracic junction when indicated. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Brandon K. Couch
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stuti S. Patel
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | | | - Anthony A. Oyekan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Emmett J. Gannon
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jeremy D. Shaw
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - William F. Donaldson
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joon Y. Lee
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Niu Y, Liu J, Qin H, Liu Y, Huang N, Jiang J, Chen Y, Chen S, Bai T, Yang C, Cao Y, Liu S, Yuan H. Development of an innovative minimally invasive primate spinal cord injury model: A case report. IBRAIN 2023; 9:349-356. [PMID: 37786753 PMCID: PMC10527794 DOI: 10.1002/ibra.12117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 10/04/2023]
Abstract
Spinal cord injury (SCI) animal models have been widely created and utilized for repair therapy research, but more suitable experimental animals and accurate modeling methodologies are required to achieve the desired results. In this experiment, we constructed an innovative dorsal 1/4 spinal cord transection macaque model that had fewer severe problems, facilitating postoperative care and recovery. In essence, given that monkeys and humans share similar genetics and physiology, the efficacy of this strategy in a nonhuman primate SCI model basically serves as a good basis for its prospective therapeutic use in human SCI.
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Affiliation(s)
- Yong‐Min Niu
- Institute of NeuroscienceKunming Medical UniversityKunmingYunnanChina
| | - Jin‐Xiang Liu
- Institute of NeuroscienceKunming Medical UniversityKunmingYunnanChina
| | - Hao‐Yue Qin
- Department of AnesthesiologySouthwest Medical UniversityLuzhouSichuanChina
| | - Yi‐Fan Liu
- Yunnan Cancer HospitalThe Third Affiliated Hospital of Kunming Medical UniversityYunnanChina
| | - Ni‐Jiao Huang
- Department of Orthopaedic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Ji‐Li Jiang
- Institute of NeuroscienceKunming Medical UniversityKunmingYunnanChina
| | - Yan‐Qiu Chen
- School of Preclinical MedicalZunyi Medical UniversityZunyiGuizhouChina
| | - Si‐Jing Chen
- Nursing SchoolZunyi Medical UniversityZunyiGuizhouChina
| | - Tao Bai
- School of Preclinical MedicalKunming Medical UniversityKunmingYunnanChina
| | - Chang‐Wei Yang
- Department of Nuclear MedicineAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Yu Cao
- Department of Nuclear MedicineAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Sheng Liu
- Pharmacology InstituteHeidelberg UniversityHeidelbergGermany
| | - Hao Yuan
- Department of Orthopaedic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
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Holistic Approach to the Diagnosis and Treatment of Patients with Tumor Metastases to the Spine. Cancers (Basel) 2022; 14:cancers14143480. [PMID: 35884541 PMCID: PMC9317366 DOI: 10.3390/cancers14143480] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/10/2022] [Accepted: 07/15/2022] [Indexed: 01/04/2023] Open
Abstract
The treatment of neoplastic spine metastases requires multi-faceted assessment and an interdisciplinary approach to patients. The metastases do not show specific symptoms but are often the first confirmation of the presence of a primary tumor in a patient. The diagnostic process includes imaging and invasive procedures, e.g., biopsy. It is essential to qualify the patient for an appropriate treatment using dedicated scales. Decompression of the spinal cord is a critical issue to save or restore neurological function in a patient with spine metastases. Surgical treatment ought to meet three criteria: release spinal cord and nerve roots, restore the spine’s anatomical relations, and ensure the internal stabilization of the spine. A good result from surgical treatment enables the continuation of radiotherapy, chemotherapy, hormone therapy, and targeted molecular therapy. Stereotactic radiosurgery and stereotactic body radiotherapy are more effective ways of treating spine metastases than conventional external beam radiotherapy. They allow higher doses of radiation, concentrated precisely at the tumor site. Our review summarizes the established and emerging concepts in the treatment of spine metastases. A holistic approach to the patient enables the selection of the appropriate therapy.
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Lockey SD, Trent SM, Kalantar SB. Cervical Myelopathy: An Update on Posterior Decompression. Clin Spine Surg 2022; 35:E87-E93. [PMID: 34379613 DOI: 10.1097/bsd.0000000000001126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 11/07/2020] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a narrative review. OBJECTIVE The aim was to discuss current methods and review updated outcome studies regarding posterior decompression in the management of cervical myelopathy. SUMMARY OF BACKGROUND DATA Progressive myelopathy in the cervical segments is an indication for urgent surgical management. Although nonoperative treatment is an option in mild to moderate cases, the majority of patients will experience deterioration in neurological function requiring surgical decompression. METHODS A review of the literature was performed using PubMed to provide updated information regarding posterior cervical decompression in the management of myelopathy. RESULTS There are numerous studies comparing outcome data between cervical laminectomy and fusion with laminoplasty. While each technique has advantages and disadvantages, both provide adequate decompression and good long-term outcomes in patients meeting appropriate criteria. CONCLUSIONS Posterior decompression is an important approach for spine surgeons to have in their toolkits when treating cervical myelopathy.
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Affiliation(s)
- Stephen D Lockey
- Department of Orthopaedic Surgery, Medstar Georgetown University Hospital
| | | | - Seyed Babak Kalantar
- Department of Orthopaedic Surgery, Spine Surgery Division, Medstar Georgetown University Hospital, Washington, DC
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Kurihara K, Iba K, Teramoto A, Emori M, Hirota R, Oshigiri T, Ogon I, Iesato N, Terashima Y, Takashima H, Yoshimoto M, Takebayashi T, Yamashita T. Effect of Minimally Invasive Selective Laminectomy for Cervical Spondylotic Myelopathy on Degenerative Spondylolisthesis. Clin Spine Surg 2022; 35:E242-E247. [PMID: 33769983 DOI: 10.1097/bsd.0000000000001161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective analysis of prospectively collected observational data. OBJECTIVE This study aimed to evaluate the slippage, sagittal alignment, and range of motion (ROM) after selective laminectomy (SL) in patients who had cervical spondylotic myelopathy (CSM) with degenerative spondylolisthesis (DS). SUMMARY OF BACKGROUND DATA Clinical outcomes have been reported for both decompression and fusion surgeries for DS of the lumbar spine. However, only a few reports have examined cervical spine spondylolisthesis. MATERIALS AND METHODS This study included 178 patients who underwent SL for CSM. Those with ossification of the posterior longitudinal ligament were excluded. Slippage >2 mm was defined as spondylolisthesis, and spondylolisthesis progression was defined as an additional displacement >2 mm on a neutral radiograph. The slippage, translational motion, C2-C7 angle, local kyphosis, and ROM were examined before and ≥2 years after surgery. Radiologic parameters were evaluated according to the slip direction and the number of laminae removed. RESULTS DS was observed in 29 patients (16.3%); 24 patients, comprising 9 and 15 in the anterolisthesis and retrolisthesis groups, respectively, were successfully followed up for more than 2 years. Preoperative and postoperative radiologic changes in slippage, translational motion, C2-C7 angle, local kyphosis, and ROM were not remarkable in either group regardless of the number of laminae removed. Revision surgery for the progression of DS and alignment deterioration was not required in any patient of either group. CONCLUSIONS SL does not affect DS, sagittal alignment, or ROM irrespective of the slip direction and the number of laminae removed, even after >2 years after surgery. Given the preservation of the posterior elements, SL may be an effective treatment for CSM with DS. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Kota Kurihara
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
| | - Kousuke Iba
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
| | - Makoto Emori
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
| | - Ryosuke Hirota
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
| | - Tsutomu Oshigiri
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
| | - Izaya Ogon
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
| | - Noriyuki Iesato
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
| | - Yoshinori Terashima
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
| | - Hiroyuki Takashima
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
| | - Mitsunori Yoshimoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
| | - Tsuneo Takebayashi
- Department of Orthopaedic Surgery, Sapporo Maruyama Orthopaedic Hospital, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine
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Meng DH, Wang JQ, Yang KX, Chen WY, Pan C, Jiang H. Surgical resection of intradural extramedullary tumors in the atlantoaxial spine via a posterior approach. World J Clin Cases 2022; 10:62-70. [PMID: 35071506 PMCID: PMC8727239 DOI: 10.12998/wjcc.v10.i1.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/30/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The anatomical features of the atlantoaxial spine increase the difficulty of complete and safe removal of atlantoaxial intradural extramedullary (IDEM) tumors. Studies concerning surgical interventions via a posterior approach are limited.
AIM To investigate the safety and efficacy of atlantoaxial IDEM tumor resection using a one-stage posterior approach.
METHODS We retrospectively analyzed clinical databases for one-stage atlantoaxial IDEM tumor resection via a posterior approach between January 2008 and January 2018. The analyzed data included tumor position, histopathological type, pre- and post-operative Japanese Orthopedic Association (JOA) scores and Nurick grades, postoperative complication and recurrence status.
RESULTS A total of 13 patients who underwent C1-C2 Laminectomy and/or unilateral facetectomy via the posterior approach were enrolled in the study. In all cases reviewed, total tumor resection and concomitant C1-C2 fusion were achieved. The average follow-up was 35.3 ± 6.9 mo (range, 26-49 mo). A statistically significant difference was noted between the preoperative JOA score (11.2 ± 1.1) and the score at the last final follow-up (15.6 ± 1.0) (P < 0.05). A statistically significant difference was noted between the preoperative Nurick grade (2.3 ± 0.9) and that at the last follow-up (1.2 ± 0.4) (P < 0.05). However, no statistically significant difference was noted between the preoperative and last follow-up C1-2 Cobb angle and C2-7 Cobb angle (P > 0.05). No mortalities, severe complications or tumor recurrence were observed during the follow-up period.
CONCLUSION Total resection of atlantoaxial IDEM tumors is feasible and effective via a posterior approach. Surgical reconstruction should be considered to avoid iatrogenic kyphosis and improve spinal stability and overall clinical outcomes.
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Affiliation(s)
- Di-Hua Meng
- Department of Spine Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
| | - Jia-Qi Wang
- Department of Spine Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
| | - Kun-Xue Yang
- Department of Spine Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
| | - Wei-You Chen
- Department of Spine Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
| | - Cheng Pan
- Department of Spine Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
| | - Hua Jiang
- Department of Spine Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
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Laminectomy alone versus laminectomy with fusion for degenerative cervical myelopathy: a long-term study of a national cohort. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:334-345. [PMID: 34853923 DOI: 10.1007/s00586-021-07067-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/14/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare patient-reported 5-year clinical outcomes between laminectomy alone versus laminectomy with instrumented fusion in patients with degenerative cervical myelopathy in a population-based cohort. METHODS All patients in the national Swedish Spine Register (Swespine) from January 2006 until March 2019, with degenerative cervical myelopathy, were assessed. Multiple imputation and propensity score matching based on clinicodemographic and radiographic parameters were used to compare patients treated with laminectomy alone with patients treated with laminectomy plus posterior-lateral instrumented fusion. The primary outcome measure was the European Myelopathy Score, a validated patient-reported outcome measure. The scale ranges from 5 to 18, with lower scores reflecting more severe myelopathy. RESULTS Among 967 eligible patients, 717 (74%) patients were included. Laminectomy alone was performed on 412 patients (mean age 68 years; 149 women [36%]), whereas instrumented fusion was added for 305 patients (mean age 68 years; 119 women [39%]). After imputation, the propensity for smoking, worse myelopathy scores, spondylolisthesis, and kyphosis was slightly higher in the fusion group. After imputation and propensity score matching, there were on average 212 pairs patients with a 5-year follow-up in each group. There were no important differences in patient-reported clinical outcomes between the methods after 5 years. Due to longer hospitalization times and implant-related costs, the mean cost increase per instrumented patient was approximately $4700 US. CONCLUSIONS Instrumented fusions generated higher costs and were not associated with superior long-term clinical outcomes. These findings are based on a national cohort and can thus be regarded as generalizable.
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Asif H, Tohidi M, Hopman W, Yen D. Association between pre-operative sagittal alignment and radiographic measures of decompression following cervical laminectomy: a retrospective cohort study. JOURNAL OF SPINE SURGERY 2021; 7:376-384. [PMID: 34734142 DOI: 10.21037/jss-21-41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/06/2021] [Indexed: 11/06/2022]
Abstract
Background The primary purpose of this study was to determine the association between pre-operative cervical sagittal alignment and the extent of cord decompression in the form of increased spinal cord width and cerebrospinal fluid (CSF) space in front of and behind the cord in patients undergoing laminectomy for cervical spondylotic myelopathy (CSM). Secondary objectives included an assessment of the correlation between increasing numbers of levels decompressed and the post-operative cervical spine sagittal alignment, the effect of laminectomy on the change in alignment, as well as effect of laminectomy on pre-existing spinal cord signal abnormality. Methods This retrospective cohort study included patients who underwent cervical laminectomies, without fusion, between 2015 and 2020. Chart review was used to collect baseline variables. Cervical sagittal alignment, width of the spinal cord, and the CSF space in-front and behind the cord was measured pre-operatively and post-operatively using magnetic resonance imaging (MRI) scans for each patient. The correlation between change in measured parameters and pre-operative cervical sagittal alignment was assessed using Spearman's correlation. Results Thirty-five patients were included. Average age was 65.29±10.98 years old. The majority of patients (80%) underwent laminectomies at 3-4 levels. Average pre-operative sagittal alignment determined by the Cobb angle was 6.05°±14.17°, while the average post-operative Cobb angle was 3.15°±16.64°. The change in Cobb angle was not statistically significant (P=0.998). Eleven patients (32%) had pre-operative kyphotic sagittal alignment. The average time from surgery to post-operative MRI scan was 20.44±13.18 months (range, 3-39; median, 18.5; IQR, 23.5). There was no statistically significant association between increasing levels of decompression and change in alignment (P=0.546). Cord signal abnormality persisted after decompression. There was a moderate correlation between lordotic pre-operative cervical sagittal alignment and change in space in-front of the cord (correlation coefficient 0.337, P=0.048) and change in cord width (correlation coefficient 0.388, P=0.021). Conclusions Severity of pre-operative kyphotic sagittal alignment is associated with decreased spinal cord drift and extent of decompression. The pre-operative sagittal alignment is not significantly associated with the change in post-operative alignment. Increasing number of levels decompressed does not worsen a kyphotic cervical spine sagittal alignment.
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Affiliation(s)
- Hamza Asif
- Department of Surgery, Queen's University, Kingston, ON, Canada.,School of Medicine, Queen's University, Kingston, ON, Canada
| | - Mina Tohidi
- Department of Surgery, Queen's University, Kingston, ON, Canada.,Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Wilma Hopman
- Department of Surgery, Queen's University, Kingston, ON, Canada.,Kingston Health Sciences Centre, Kingston, ON, Canada
| | - David Yen
- Department of Surgery, Queen's University, Kingston, ON, Canada.,Kingston Health Sciences Centre, Kingston, ON, Canada
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The Relative Merits of Posterior Surgical Treatments for Multi-Level Degenerative Cervical Myelopathy Remain Uncertain: Findings from a Systematic Review. J Clin Med 2021; 10:jcm10163653. [PMID: 34441949 PMCID: PMC8397218 DOI: 10.3390/jcm10163653] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/21/2022] Open
Abstract
Objectives: To assess the reporting of study design and characteristics in multi-level degenerative cervical myelopathy (DCM) treated by posterior surgical approaches, and perform a comparison of clinical and radiographic outcomes between different approaches. Methods: A literature search was performed in Embase and MEDLINE between 1995–2019 using a sensitive search string combination. Studies were selected by predefined selection criteria: Full text articles in English, with >10 patients (prospective) or >50 patients (retrospective), reporting outcomes of multi-level DCM treated by posterior surgical approach. Results: A total of 75 studies involving 19,510 patients, conducted worldwide, were identified. Laminoplasty was described in 56 studies (75%), followed by laminectomy with (36%) and without fusion (16%). The majority of studies were conducted in Asia (84%), in the period of 2016–2019 (51%), of which laminoplasty was studied predominantly. Twelve (16%) prospective studies and 63 (84%) retrospective studies were identified. The vast majority of studies were conducted in a single centre (95%) with clear inclusion/exclusion criteria and explicit cause of DCM. Eleven studies (15%) included patients with ossification of the posterior longitudinal ligament exclusively with cohorts of 57 to 252. The clinical and radiographic outcomes were reported with heterogeneity when comparing laminoplasty, laminectomy with and without fusion. Conclusions: Heterogeneity in the reporting of study and sample characteristics exists, as well as in clinical and radiographic outcomes, with a paucity of studies with a higher level of evidence. Future studies are needed to elucidate the clinical effectiveness of posterior surgical treatments.
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Davies BM, Francis JJ, Butler MB, Mowforth O, Goacher E, Starkey M, Kolias A, Wynne-Jones G, Hutton M, Selvanathan S, Thomson S, Laing RJC, Hutchinson PJ, Kotter MRN. Current surgical practice for multi-level degenerative cervical myelopathy: Findings from an international survey of spinal surgeons. J Clin Neurosci 2021; 87:84-88. [PMID: 33863541 DOI: 10.1016/j.jocn.2021.01.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 12/23/2020] [Accepted: 01/29/2021] [Indexed: 12/15/2022]
Abstract
Degenerative cervical myelopathy (DCM) results from compression of the cervical spine cord as a result of age related changes in the cervical spine, and affects up to 2% of adults, leading to progressive disability. Surgical decompression is the mainstay of treatment, but there remains significant variation in surgical approaches used. This survey was conducted in order to define current practice amongst spine surgeons worldwide, as a possible prelude to further studies comparing surgical approaches. METHODS An electronic survey was developed and piloted by the investigators using SurveyMonkey. Collected data was categorical and is presented using summary statistics. Where applicable, statistical comparisons were made using a Chi-Squared test. The level of significance for all statistical analyses was defined as p < 0.05. All analysis, including graphs was performed using R (R Studio). RESULTS 127 surgeons, from 30 countries completed the survey; principally UK (66, 52%) and North America (15, 12%). Respondents were predominantly Neurosurgeons by training (108, 85%) of whom 84 (75%) reported Spinal Surgery as the principal part of their practice. The majority indicated they selected their surgical procedure for multi-level DCM on a case by case basis (62, 49%). Overall, a posterior approach was more popular for multi-level DCM (74, 58%). Region, speciality or annual multi-level case load did not influence this significantly. However, there was a trend for North American surgeons to be more likely to favour a posterior approach. CONCLUSIONS A posterior approach was favoured and more commonly used to treat multi-level DCM, in an international cohort of surgeons. Posterior techniques including laminectomy, laminectomy and fusion or laminoplasty appeared to be equally popular.
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Affiliation(s)
- Benjamin M Davies
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom.
| | - Jibin J Francis
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Max B Butler
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Oliver Mowforth
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Edward Goacher
- Department of Musculoskeletal, Spinal Unit, Royal Victoria Infirmary, Newcastle, United Kingdom
| | - Michelle Starkey
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Angelos Kolias
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Guy Wynne-Jones
- Department of Musculoskeletal, Spinal Unit, Royal Victoria Infirmary, Newcastle, United Kingdom
| | - Mike Hutton
- Royal Devon and Exeter Hospital, United Kingdom
| | | | | | - Rodney J C Laing
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Peter J Hutchinson
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Mark R N Kotter
- Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom; Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom
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Tu J, Vargas Castillo J, Das A, Diwan AD. Degenerative Cervical Myelopathy: Insights into Its Pathobiology and Molecular Mechanisms. J Clin Med 2021; 10:jcm10061214. [PMID: 33804008 PMCID: PMC8001572 DOI: 10.3390/jcm10061214] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 12/12/2022] Open
Abstract
Degenerative cervical myelopathy (DCM), earlier referred to as cervical spondylotic myelopathy (CSM), is the most common and serious neurological disorder in the elderly population caused by chronic progressive compression or irritation of the spinal cord in the neck. The clinical features of DCM include localised neck pain and functional impairment of motor function in the arms, fingers and hands. If left untreated, this can lead to significant and permanent nerve damage including paralysis and death. Despite recent advancements in understanding the DCM pathology, prognosis remains poor and little is known about the molecular mechanisms underlying its pathogenesis. Moreover, there is scant evidence for the best treatment suitable for DCM patients. Decompressive surgery remains the most effective long-term treatment for this pathology, although the decision of when to perform such a procedure remains challenging. Given the fact that the aged population in the world is continuously increasing, DCM is posing a formidable challenge that needs urgent attention. Here, in this comprehensive review, we discuss the current knowledge of DCM pathology, including epidemiology, diagnosis, natural history, pathophysiology, risk factors, molecular features and treatment options. In addition to describing different scoring and classification systems used by clinicians in diagnosing DCM, we also highlight how advanced imaging techniques are being used to study the disease process. Last but not the least, we discuss several molecular underpinnings of DCM aetiology, including the cells involved and the pathways and molecules that are hallmarks of this disease.
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Affiliation(s)
- Ji Tu
- Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW 2217, Australia; (J.T.); (A.D.D.)
| | | | - Abhirup Das
- Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW 2217, Australia; (J.T.); (A.D.D.)
- Spine Service, St. George Hospital, Kogarah, NSW 2217, Australia;
- Correspondence:
| | - Ashish D. Diwan
- Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW 2217, Australia; (J.T.); (A.D.D.)
- Spine Service, St. George Hospital, Kogarah, NSW 2217, Australia;
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Aydin AL, Sasani M, Erbulut DU, Oktenoglu T, Ozer AF. A new concept of motion preservation surgery of the cervical spine: PEEK rods for the posterior cervical region. Biomed Mater Eng 2020; 31:235-251. [PMID: 32894236 DOI: 10.3233/bme-206004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Laminectomy may cause kyphotic postoperative deformity in the cervical region leading to segmental instability over time. Laminoplasty may be an alternative procedure to laminectomy, as it protects the spine against post-laminectomy kyphosis; however, similar to laminectomy, laminoplasty may cause sagittal plane deformities by destructing or weakening the dorsal tension band. OBJECTIVE Using finite element analysis (FE), we attempted to determine whether a posterior motion preservation system (PEEK posterior rod system concept) could overcome the postoperative complications of laminectomy and laminoplasty and eliminate the side effects of rigid posterior stabilization in the cervical region. METHODS We compared PEEK rods in four different diameters with a titanium rod for posterior cervical fixation. The present study may lead to motion preservation systems of the cervical vertebra. RESULTS When PEEK rod is compared with titanium rod, considerable increase in range of motion is observed. CONCLUSIONS PEEK rod-lateral mass screw instrumentation systems may be useful in motion preservation surgery of the posterior cervical region.
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Affiliation(s)
- Ahmet Levent Aydin
- Neurosurgery Department, School of Medicine, Koç University, Istanbul, Turkey
| | - Mehdi Sasani
- Neurosurgery Department, School of Medicine, Koç University, Istanbul, Turkey
| | | | - Tunc Oktenoglu
- Neurosurgery Department, School of Medicine, Koç University, Istanbul, Turkey
| | - Ali Fahir Ozer
- Neurosurgery Department, School of Medicine, Koç University, Istanbul, Turkey
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14
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Xu Z, Sun B, Chen Y, Zhang Y, Wang JX, Shi CG, Zhang K, Wu HQ, Xie W, Wu XD. Thoracic de-kyphosis for revision surgery of a failure case of endoscopic discectomy: a case report and literature review. Br J Neurosurg 2020; 35:43-48. [PMID: 32279570 DOI: 10.1080/02688697.2020.1751069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Indications and clinical outcomes of percutaneous endoscopic thoracic discectomy(PETD) in treating thoracic disc herniation is rarely reported and still controversial. We reported an unsatisfied recovery of thoracic disc herniation with PETD, treated by a second posterior thoracic laminectomy and Ponte osteotomy. CASE DESCRIPTION A male presented with lower extremity weakness and stagger caused by T3/4 intervertebral disc herniation. The upper thoracic curve was in excessive kyphosis with T2-5 Cobb angle of 34.3 degrees. The preoperative ODI score was 34 and Roelzs's JOA score was 14. Percutaneous transforaminal endoscopic thoracic discectomy (PETD) from a posterior lateral approach was performed. At five-month follow-up, his thoracic back pain and staggering gait did not improve. The postoperative T2-5 Cobb angle was 32.1 degrees, the ODI score was 24 and Roelzs's JOA score was 14. A second posterior thoracic decompression this time with fixation was performed, but no disc herniation was detected. A Ponte osteotomy was performed to correct the kyphosis. One month after the second surgery, muscle strength of the lower limbs was improving with the T2-5 Cobb angle decreased to 19.4 degrees, the ODI score decreased to 10 and Roelzs's JOA score increase to 16. Six month later, the ODI score decreased to 0 and Roelzs's JOA score improved to 18. In review of the literature, PETD doesn't guarantee the patient a satisfactory neurological recovery for kyphotic thoracic disc herniation. Posterior decompression with Ponte osteotomy may be beneficial to release the tension and decompression of the spinal cord tension. CONCLUSIONS Thoracic disc herniation with kyphosis angle >20 degrees (T2-5), percutaneous endoscopic thoracic discectomy is not likely to get good neurologic results. Posterior laminectomy with ponte osteotomy might be beneficial for these patients to induce dorsal drifting of the spinal cord from anterior herniation.
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Affiliation(s)
- Zeng Xu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Bin Sun
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yu Chen
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ying Zhang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jian-Xi Wang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chang-Gui Shi
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ke Zhang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Hui-Qiao Wu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wei Xie
- Department of Orthopaedics, Songjiang Fangta Hospital of Traditional Chinese Medicine, Songjiang District, Shanghai, China
| | - Xiao-Dong Wu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
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15
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Short-term Outcomes Following Cervical Laminoplasty and Decompression and Fusion With Instrumentation. Spine (Phila Pa 1976) 2019; 44:E1018-E1023. [PMID: 30973510 DOI: 10.1097/brs.0000000000003057] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database years 2010 to 2015. OBJECTIVE Investigate which short-term outcomes differ for cervical laminoplasty and laminectomy and fusion surgeries. SUMMARY OF BACKGROUND DATA Conflicting reports exist in spine literature regarding short-term outcomes following cervical laminoplasty and posterior laminectomy and fusion. The objective of this study was to compare the 30-day outcomes for these two treatment groups for multilevel cervical pathology. METHODS Patients who underwent cervical laminoplasty or posterior laminectomy and fusion were identified in National Surgical Quality Improvement Program (NSQIP) based on Current Procedural Terminology (CPT) code: laminoplasty 63,050 and 63,051, posterior cervical laminectomy 63,015 and 63,045, and instrumentation 22,842. Propensity-adjusted multivariate regressions assessed differences in postoperative length of stay, adverse events, discharge disposition, and readmission. RESULTS Three thousand seven hundred ninety-six patients were included: 2397 (63%) underwent cervical laminectomy and fusion and 1399 (37%) underwent cervical laminoplasty. Both groups were similar in age, sex, body mass index (BMI), American Society of Anesthesiologist Classification (ASA), Charleston Comorbidity Index (CCI), and had similar rates of malnutrition, chronic kidney disease, diabetes, chronic obstructive pulmonary disease, and history for steroid use. Age more than 70 and age less than 50 were not associated with one treatment group over the other (P > 0.05). Compared with laminoplasty patients, laminectomy and fusion patients had increased lengths of stay (LOS) (4.5 vs. 3.7 d, P < 0.01) and increased rates of adverse events (41.7% vs. 35.9%, P < 0.01), discharge to rehab (16.4% vs. 8.6%, P < 0.01), and skilled nursing facilities (12.2% vs. 9.7%, P = 0.02), and readmission (6.2% vs. 4.5%, P = 0.05). Both groups experienced similar rates of death, pulmonary embolus, deep vein thrombosis, deep and superficial surgical site infection, and reoperation (P > 0.05 for all). CONCLUSION Posterior cervical laminectomy and fusion patients were found to have increased LOS, readmissions, and complications despite having similar pre-op demographics and comorbidities. Patients and surgeons should consider these risks when considering surgical treatment for cervical pathology. LEVEL OF EVIDENCE 3.
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Wilson JR, Badhiwala JH, Moghaddamjou A, Martin AR, Fehlings MG. Degenerative Cervical Myelopathy; A Review of the Latest Advances and Future Directions in Management. Neurospine 2019; 16:494-505. [PMID: 31476852 PMCID: PMC6790745 DOI: 10.14245/ns.1938314.157] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 08/26/2019] [Accepted: 08/26/2019] [Indexed: 01/23/2023] Open
Abstract
The assessment, diagnosis, operative and nonoperative management of degenerative cervical myelopathy (DCM) have evolved rapidly over the last 20 years. A clearer understanding of the pathobiology of DCM has led to attempts to develop objective measurements of the severity of myelopathy, including technology such as multiparametric magnetic resonance imaging, biomarkers, and ancillary clinical testing. New pharmacological treatments have the potential to alter the course of surgical outcomes, and greater innovation in surgical techniques have made surgery safer, more effective and less invasive. Future developments for the treatment of DCM will seek to improve the diagnostic accuracy of imaging, improve the objectivity of clinical assessment, and increase the use of surgical technology to ensure the best outcome is achieved for each individual patient.
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Affiliation(s)
- Jamie R.F. Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Spinal Program, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Jetan H. Badhiwala
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Spinal Program, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Ali Moghaddamjou
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Spinal Program, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Allan R. Martin
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Spinal Program, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Spinal Program, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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Radiological Characteristics and Clinical Outcome of Ossification of Posterior Longitudinal Ligament Involving C2 After Posterior Laminoplasty and Instrumented Fusion Surgery. Spine (Phila Pa 1976) 2019; 44:E150-E156. [PMID: 30044366 DOI: 10.1097/brs.0000000000002807] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To analyze the radiological characteristics and surgical outcome of cervical ossification of posterior longitudinal ligament (OPLL) involving C2 level. SUMMARY OF BACKGROUND DATA The study and report focused on the OPLL involving C2 level are rare. Therefore, the radiological characteristics and surgical outcome remain unclear. METHODS The records of the patients with OPLL involving C2 level who underwent posterior surgery from July 2006 through October 2015 were retrospectively reviewed. The types, longitudinal and transverse extent, occupation ratio, K-line classification of OPLL, and high-intensity zone of spine cord on magnetic resonance imaging were analyzed to evaluate the radiological characteristics. All the cases received posterior open-door laminoplasty and instrumented fusion surgery. The Japanese Orthopedic Association (JOA) score and recovery rate (RR) were used to evaluate neurological function after surgery. RESULTS A total of 45 patients with OPLL involving C2 level were enrolled in the study. Their radiological data were carefully analyzed. The mixed (73.3%) and continuous type (24.5%) were observed. The mean number of involved segments was 5.1. The narrowest spinal canal mostly located in the level of C3-C4 and mean occupying ratio was 65.3%. Thirty-two patients were followed up for at least 2 years and the mean follow-up time was 46.2 months. The mean JOA score was 10.3 preoperatively and 15.2 at the final follow-up and the mean RR was 70.7%. The K-line (+) and (-) subgroups showed similar preoperative JOA score and RR. The high-intensity zone (+) subgroup showed lower preoperative JOA score but equal RR with (-) subgroup. CONCLUSION When OPLL involve C2 level, it often presented different radiological characteristics. The posterior open-door laminoplasty and instrumented fusion surgery could achieve favorable clinical outcomes. Further researches and long-term clinical follow-up are needed to better appreciate the OPLL involving C2 level. LEVEL OF EVIDENCE 4.
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Abstract
STUDY DESIGN Observational analysis of retrospectively collected data. OBJECTIVE A retrospective study was performed in order to compare the surgical profile of risk factors and perioperative complications for laminectomy and laminectomy with fusion procedures in the treatment of spinal epidural abscess (SEA). SUMMARY OF BACKGROUND DATA SEA is a highly morbid condition typically presenting with back pain, fever, and neurologic deficits. Posterior fusion has been used to supplement traditional laminectomy of SEA to improve spinal stability. At present, the ideal surgical strategy-laminectomy with or without fusion-remains elusive. METHODS Thirty-day outcomes such as reoperation and readmission following laminectomy and laminectomy with fusion in patients with SEA were investigated utilizing the American College of Surgeons National Quality Improvement Program database. Demographics and clinical risk factors were collected, and propensity matching was performed to account for differences in risk profiles between the groups. RESULTS Seven hundred thirty-eight patients were studied (608 laminectomy alone, 130 fusion). The fusion population was in worse health. The fusion population experienced significantly greater rate of return to the operating room (odds ratio [OR] 1.892), with the difference primarily accounted for by cervical spine operations. Additionally, fusion patients had significantly greater rates of blood transfusion. Infection was the most common reason for reoperation in both populations. CONCLUSION Both laminectomy and laminectomy with fusion effectively treat SEA, but addition of fusion is associated with significantly higher rates of transfusion and perioperative return to the operating room. In operative situations where either procedure is reasonable, surgeons should consider that fusion nearly doubles the odds of reoperation in the short-term, and weigh this risk against the benefit of added stability. LEVEL OF EVIDENCE 3.
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