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STUDY DESIGN: A technical note and retrospective case series. OBJECTIVE: Highly upward-migrated lumbar disc herniation (LDH) is challenging due to its problematic access and incomplete removal. The most used interlaminar approach may cause extensive bony destruction. We developed a novel translaminar approach using the unilateral portal endoscopic (UBE) technique, emphasizing effective neural decompression, and preserving the facet joint's integrity. METHODS: This retrospective study included six patients receiving UBE translaminar discectomy for highly upward-migrated LDHs from May 2019 to June 2021. The migrated disc was removed through a small keyhole on the lamina of the cranial vertebra. The treatment results were evaluated by operation time, hospital stays, complications, visual analog scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score, and modified MacNab criteria. RESULTS: The mean pre-operative VAS for back pain (5.0 ± 4.9), VAS for leg pain (9.2 ± 1.0), JOA score (10.7 ± 6.6), and ODI (75.7 ± 25.3) were significantly improved to 0.3 ± 0.5, 1.2 ± 1.5, 27.3 ± 1.8, 5.0 ± 11.3 respectively at the final follow-up. Five patients had excellent, and one patient had good outcomes according to the Modified MacNab criteria. The hospital stay was 2.7 ± 0.5 days. No complication was recorded. The MRI follow-up showed complete disc removal, except for one patient with an asymptomatic residual disc. CONCLUSIONS: UBE translaminar discectomy is a safe and effective minimally invasive procedure for highly upward-migrated LDH with satisfactory treatment outcomes and nearly 100% facet joint preservation.
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Discectomía , Endoscopía , Desplazamiento del Disco Intervertebral , Vértebras Lumbares , Humanos , Desplazamiento del Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Masculino , Estudios Retrospectivos , Femenino , Persona de Mediana Edad , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Resultado del Tratamiento , Adulto , Endoscopía/métodos , Discectomía/métodos , Anciano , Dimensión del DolorRESUMEN
BACKGROUND: The utility and risks associated with the use of cervical collars in the postoperative period after cervical spine surgery have been of debate. The purpose of this study was to systematically review the currently available evidence on the use of cervical collars after cervical spine surgery to assess their impact on outcomes. METHODS: A literature search of the PubMed database was performed using keywords "cervical collar," "anterior cervical discectomy and fusion (ACDF)," "posterior cervical decompression and fusion," "laminoplasty," "post-operative orthotic bracing," "cervical decompression," and "cervical orthosis" in all possible combinations. All English studies with the level of evidence of I to IV that were published from May 1, 1986, to December 3, 2023, were considered for inclusion. RESULTS: A total of 25 articles meeting the inclusion criteria were identified and reviewed. Regarding anterior and posterior fusion procedures, cervical collar use demonstrated improved short-term patient-reported outcomes and pain control. While surgeon motivation for collar use was to increase fusion rates, this is not well drawn out in the literature with the majority of studies demonstrated no significant difference in fusion rates between patients who wore a cervical collar and those who did not. Regarding motion-preserving procedures such as cervical laminoplasty, patients with prolonged postoperative cervical collar use demonstrated increased rates of axial neck pain and decreased final range of motion (ROM). CONCLUSION: Surgeon motivation for postoperative cervical collar immobilization after completion of fusion procedures is to increase fusion rates and improve postoperative pain and disability despite this not being fully drawn out in the literature. After completion of motion-sparing procedures, the benefits of collar immobilization diminish with their prolonged use which could lead to increased rates of axial neck pain and decreased ROM. Cervical collar immobilization in the postoperative period should be considered its own intervention, with its own associated risk-benefit profile. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Vértebras Cervicales , Fusión Vertebral , Humanos , Vértebras Cervicales/cirugía , Descompresión Quirúrgica , Discectomía , Aparatos OrtopédicosRESUMEN
BACKGROUND: We hypothesized that ultrasound-guided selective nerve root block could play a role in the prediction of clinical outcomes in patients with multilevel cervical disease following selective anterior cervical discectomy and fusion. METHODS: Patients were randomized to receive ultrasound-guided selected nerve root block as a diagnostic tool (study group) or not (control group), but both groups had surgery. Pain evaluation for arm and neck pain was recorded. The Visual Analog Scale (VAS) pain scores, Neck Disability Index, and MRI results were compared between groups. They were assessed every two weeks for three months, postoperatively. The percentage of patients who showed ≥ 50% reduction in their pain levels and a VAS rating of ≤2 was deemed an acceptable surgical outcome. RESULTS: Patients in the study group had significantly lower VAS scores for pain intensity than control patients at nearly all periods. This baseline pain improved significantly in the study group. A more significant proportion of patients in the study group showed a ≥50% reduction in their pain scores from baseline at weeks four, eight, and 12, and this difference was significantly lower than in the control group (P<0.05). The study group improved significantly over baseline in Neck Disability Index scores compared to control patients. Patients were highly satisfied with no significant adverse events in the study group. CONCLUSIONS: In patients with multilevel cervical disease, ultrasound-guided selective nerve root block is an excellent, safe, non-radiating, and reliable test to determine the appropriate level for operation.
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Vértebras Cervicales , Discectomía , Bloqueo Nervioso , Ultrasonografía Intervencional , Humanos , Femenino , Masculino , Persona de Mediana Edad , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Adulto , Bloqueo Nervioso/métodos , Método Simple Ciego , Resultado del Tratamiento , Dimensión del Dolor , Desplazamiento del Disco Intervertebral/cirugía , Raíces Nerviosas Espinales/diagnóstico por imagen , Degeneración del Disco Intervertebral/cirugía , Degeneración del Disco Intervertebral/diagnóstico por imagenRESUMEN
BACKGROUND: Knowledge of patient lived experiences of functioning and disability is limited. This study aims to address the gap in the literature by exploring patient lived experiences of functioning and disability following lumbar discectomy. METHOD: A secondary analysis, reported in line with the Standards for Reporting Qualitative Research, was conducted of qualitative data exploring patient journeys following lumbar discectomy surgery (DiscJourn). Adult patients (≥ 16 years) undergoing elective or emergency primary lumbar discectomy were recruited from one National Health Service secondary care centre in the UK. Semi-structured interviews were conducted at 1-3 weeks and 1-year post surgery. Participants who completed both semi-structured interviews were eligible for the secondary analysis. Transcripts from the semi-structured interviews were analysed using interpretative phenomenological analysis (IPA). IPA involved two independent reviewers identifying themes for individual data sets followed by an iterative process involving the wider research team to identify overarching themes that represented the whole date set. Subthemes generated from the IPA were mapped against the International Classification of Functioning, Disability and Health (ICF) framework at the level of chapters, in order to ascertain the ICF's utility in capturing experiences of functioning and disability. Strategies to enhance trustworthiness of data analysis included blind coding, peer examination and debrief, declaration of pre-conceived beliefs and active reflexivity throughout the study. RESULTS: Nine participants met the eligibility criteria and their interview transcripts were analysed. Patient lived experiences of functioning and disability were captured by three overarching themes: Immediate impact following surgery, Multiple roads to recovery over 1 year, and Functioning influenced by personal loci of control. Each theme consisted of three subthemes which were subsequently mapped onto the ICF. Three subthemes mapped to the ICF's body component, 1 to activity and participation and 3 to environment. Two subthemes themes did not map onto the ICF. CONCLUSION: Findings provide valuable insights into patient experiences of functioning and disability following lumbar discectomy. Convergence in experiences of functioning and disability were identified immediately following surgery. Divergence in such experiences were identified with regards to the roads to recovery over 1 year and the individuals' locus of control. Findings build on the body of literature exploring patients functioning and disability following discectomy and make recommendations for future research and clinical practice.
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Discectomía , Vértebras Lumbares , Investigación Cualitativa , Humanos , Discectomía/psicología , Femenino , Masculino , Adulto , Vértebras Lumbares/cirugía , Persona de Mediana Edad , Evaluación de la Discapacidad , Personas con Discapacidad/psicología , Entrevistas como AsuntoRESUMEN
Dysphagia after anterior cervical spine surgery has a 5% to 15% incidence beyond 1-year postsurgery, often attributed to mechanical factors such as pharyngeal thickening and epiglottis inversion. Despite normal neurological examination and electromyography, nerve distortion related to stretching also remains a possibility in these patients and may cause allodynia resulting in odynophagia and dysphagia. Current treatment options for dysphagia after anterior cervical discectomy and fusion are limited to local intraoperative steroid injections and tracheal traction exercises. In our patient, a glossopharyngeal nerve block was effectively used to manage the glossopharyngeal allodynia, thereby reducing the odynophagia and dysphagia, ultimately enhancing oral tolerance.
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Vértebras Cervicales , Trastornos de Deglución , Discectomía , Bloqueo Nervioso , Fusión Vertebral , Humanos , Trastornos de Deglución/etiología , Trastornos de Deglución/terapia , Vértebras Cervicales/cirugía , Bloqueo Nervioso/métodos , Nervio Glosofaríngeo , Masculino , Persona de Mediana Edad , Femenino , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapiaRESUMEN
The problem of patients' rehabilitation after spinal surgery remains relevant. The use of therapeutic physical factors, both preformed and natural, including pelotherapy, is very important. The application of the latter requires to develop new techniques in this pathology, one of which is low temperature exposure. OBJECTIVE: To study the possibility and to assess the effectiveness of resource-saving nonthermal pelotherapy techniques in patients' rehabilitation, who underwent surgeries for intervertebral discs' herniation. MATERIAL AND METHODS: The number of patients equal 88, including 39 males and 49 females, after lumbar microdiscectomy, was examined in this study. The patients were divided into 3 groups. Control group (28 patients) received a basic rehabilitation complex (therapeutic gymnastics, massage, low-frequency magnetotherapy); the 1st study group (30 patients) - basic complex and procedures of thin layer applications with peat muds preparation (Tomed-applikat) at 20-24 °C; the 2nd study group (30 patients) - basic complex and procedures of fluctuoresis of 2% solution of peat mud Tomed-aqua preparation. RESULTS: There was a significant reduction of pain syndrome, recovery of sensitivity and motor activity, decrease of Oswestry index, characterizing the degree of vital activity disturbance, in patients of the study group compared to the control group after treatment. CONCLUSION: The inclusion of nonthermal resource-saving techniques of pelotherapy in rehabilitation complex of patients who underwent spinal surgery is effective and pathogenetically justified.
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Desplazamiento del Disco Intervertebral , Peloterapia , Humanos , Femenino , Masculino , Peloterapia/métodos , Persona de Mediana Edad , Desplazamiento del Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/rehabilitación , Desplazamiento del Disco Intervertebral/terapia , Adulto , Discectomía/rehabilitación , Discectomía/métodos , Vértebras Lumbares/cirugíaRESUMEN
INTRODUCTION: Subaxial cervical spine injuries (SCSI) can lead to disastrous consequences such as quadriplegia, with/without respiratory paralysis (RP) and hemodynamic instability (HDI). Till date, there is no literature available for reporting outcomes of SCSI patients specifically pertaining to those presenting with RP/HDI and ours is the first study to document the same. METHODS: Retrospective 6-year study from a tertiary trauma centre database including patients >/= 18 years of operated SCSI. Only patients with ASIA A grade with admission RP/HDI and unstable injuries (fractures, subluxations) were included. Patients with ASIA grade B and above, patients with non-osseous injuries (such as disc herniation, central cord syndrome etc.) were excluded. RESULTS: 24 cases were analysed. C5 and C6 levels were the commonest. Vertebral listhesis/subluxation was the predominant radiological finding. The mean age was 47.4 years (22-79 years) and all, except one were males. Fall from height and road traffic accident (RTA) were the most common mechanisms of injury. The most common surgery was anterior discectomy and fusion followed by corpectomy. The overall mortality rate was 22/24 (92)%. Cord edema and hemorrhage had significant association with survival. None of the grade A survivors with HDI/RP showed improvement. The mean FU duration was 18.5 months (range, 16.5-20.5 months). CONCLUSIONS: Subaxial ASIA A cervical spine injuries with pre-operative RP/HDI is an indicator for non-improvement. This is the first study documenting outcome in such patients. The mortality rate in these patients is very high and is an extremely poor prognostic factor for recovery. Hence, surgery in such patients need to be decided judiciously, especially in developing countries that has a significant financial impact on the family members.
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Vértebras Cervicales , Parálisis Respiratoria , Humanos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Vértebras Cervicales/cirugía , Estudios Retrospectivos , Anciano , Parálisis Respiratoria/etiología , Resultado del Tratamiento , Adulto Joven , Hemodinámica/fisiología , Traumatismos Vertebrales/cirugía , Traumatismos Vertebrales/complicaciones , Fusión Vertebral/métodos , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/cirugía , Discectomía/métodos , Accidentes de Tránsito , Fracturas de la Columna Vertebral/cirugía , Fracturas de la Columna Vertebral/complicacionesRESUMEN
To compare the clinical efficacy of interlaminar endoscopic surgical system delta (iLESSYS-Delta) discectomy with that of classical fenestration discectomy for treating lumbar disc herniation. Patients who underwent iLESSYS-Delta or fenestration discectomy were enrolled in this study. Baseline information and clinical indicators were collected. The baseline data were matched using propensity score matching. Fifty-two patients were in each group. In the iLESSYS-Delta cohort, the volume of intraoperative bleeding was 18.17 ± 4.20 ml, the length of postoperative hospital stay was 4.16 ± 2.29 days, and the length of postoperative off-bed activity was 1.58 ± 0.88 days. In contrast, in the fenestration group, the volume of intraoperative bleeding was 32.50 ± 17.13 ml, the length of postoperative hospital stay was 6.66 ± 2.44 days, and the length of postoperative off-bed activity was 3.18 ± 1.28 days. The difference between the two groups was statistically significant (P < 0.05). The operation time was 88.90 ± 19.14 min in the iLESSYS-Delta group and 67.63 ± 19.32 min in the fenestration group, and the difference between the two groups was statistically significant (P < 0.05). Regarding the pain visual analogue scale scores at 24, 48, and 72 h after surgery, patients in the iLESSYS-Delta group had less pain than did those in the fenestration group (P < 0.05). The Oswestry disability indices of postoperative patients in both groups significantly improved at 3 months after surgery and at the last follow-up (P < 0.05); however, there was no statistically significant difference in the postoperative ODI scores between the two surgery groups (P > 0.05). The two groups showed no significant differences in clinical effects, postoperative recurrence rates, or perioperative complications. iLESSYS-Delta can cause less intraoperative bleeding and faster recovery than fenestration discectomy.
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Discectomía , Endoscopía , Desplazamiento del Disco Intervertebral , Vértebras Lumbares , Humanos , Masculino , Femenino , Desplazamiento del Disco Intervertebral/cirugía , Estudios Retrospectivos , Persona de Mediana Edad , Endoscopía/métodos , Adulto , Discectomía/métodos , Discectomía/efectos adversos , Resultado del Tratamiento , Vértebras Lumbares/cirugía , Tiempo de Internación , Tempo OperativoRESUMEN
CASE: A 51-year-old woman, who had previously undergone C5-C7 anterior cervical discectomy and fusion, presented with symptomatic hardware failure and subsequently underwent instrumentation removal. Her postoperative course was complicated by an esophageal perforation. Despite initial repair using a rotational flap, the leak persisted, prompting esophageal reconstruction with a radial forearm free flap (RFFF). CONCLUSION: Persistent esophageal perforation is exceedingly rare and difficult to treat. This report discusses the surgical technique for RFFF, an excellent option for revising failed sternocleidomastoid rotational flaps. The decision between rotational repair and free flap reconstruction depends on factors such as defect size, vascularization, wound condition, and donor site morbidity.
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Vértebras Cervicales , Perforación del Esófago , Fusión Vertebral , Humanos , Femenino , Persona de Mediana Edad , Perforación del Esófago/cirugía , Perforación del Esófago/etiología , Vértebras Cervicales/cirugía , Fusión Vertebral/efectos adversos , Fusión Vertebral/instrumentación , Remoción de Dispositivos , Antebrazo/cirugía , Colgajos Tisulares Libres/efectos adversos , Discectomía/efectos adversos , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/etiologíaRESUMEN
BACKGROUND: Non-contiguous two-level Anterior Cervical Discectomy and Fusion (ACDF) may be a viable option for patients with degenerative cervical myelopathy and imaging-evident spine and radicular compression at two non-contiguous cervical levels. The risk of hastening degeneration and triggering Adjacent Segment Disease at the spine levels located between the fused levels is a putative adverse event, which was assessed in a few studies. The aim of this study is to investigate the clinical outcomes of patients undergoing non-contiguous two levels ACDF and to assess biomechanical modifications at non-fused segments. METHOD: We retrospectively reviewed all patients with noncontiguous two-level spine and radicular compression, who underwent simultaneous noncontiguous two-level ACDF at our center. We analyzed clinical and radiological outcomes and investigated the rate of adjacent segment disease. Radiographic parameters were calculated on pre- and postoperative images. RESULTS: Thirty-two patients underwent simultaneous noncontiguous two-level ACDF for cervical myelo-radiculopathy between 2015 and 2021 and were followed up for a mean period of 43.3 months. For all patients, the mJOA score significantly improved from 14.57 ± 2.3 to 16.5 ± 2.1 (p<0.01) and the NDI score significantly decreased from 21.45 ± 4.3 to 12.8 ± 2.3 (p<0.01) postoperatively. Cervical lordosis increased after surgery (from 9.65° ±9.47 to 15.12° ± 6.09); intermediate disc height decreased (5.68 mm ± 0.57 to 5.27 mm ±0.98); the ROMs of intermediate (from 12.45 ± 2.33 to 14.77 ± 1.98), cranial (from 14.63 ± 1.59 to 15.71 ± 1.02), and caudal (from 11.58 ± 2.32 to 13.33 ± 2.67) segments slightly increased. During follow-up assessment, in one patient the myelopathy worsened due to spine compression at the intermediate level. CONCLUSIONS: Simultaneous and non-contiguous two-level ACDF is a safe and effective procedure. The occurrence of postoperative adjacent and intermediate segment disease is rare.
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Vértebras Cervicales , Discectomía , Fusión Vertebral , Humanos , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Discectomía/métodos , Discectomía/efectos adversos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Anciano , Resultado del Tratamiento , Adulto , Enfermedades de la Médula Espinal/cirugía , Enfermedades de la Médula Espinal/diagnóstico por imagen , Compresión de la Médula Espinal/cirugía , Compresión de la Médula Espinal/diagnóstico por imagen , Compresión de la Médula Espinal/etiología , Radiculopatía/cirugía , Radiculopatía/etiología , Degeneración del Disco Intervertebral/cirugía , Degeneración del Disco Intervertebral/diagnóstico por imagenRESUMEN
BACKGROUND: The number of surgical trials is increasing but such trials can be complex to deliver and pose specific challenges. A multi-centre, Phase III, RCT comparing Posterior Cervical Foraminotomy versus Anterior Cervical Discectomy and Fusion in the Treatment of Cervical Brachialgia (FORVAD Trial) was unable to recruit to target. A rapid qualitative study was conducted during trial closedown to understand the experiences of healthcare professionals who participated in the FORVAD Trial, with the aim of informing future research in this area. METHODS: Semi-structured interviews were conducted with 18 healthcare professionals who had participated in the FORVAD Trial. Interviews explored participants' experiences of the FORVAD trial. A rapid qualitative analysis was conducted, informed by Normalisation Process Theory. RESULTS: Four main themes were generated in the data analysis: (1) individual vs. community equipoise; (2) trial set-up and delivery; (3) identifying and approaching patients; and (4) timing of randomisation. The objectives of the FORVAD trial made sense to participants and they supported the idea that there was clinical or collective equipoise regarding the two FORVAD interventions; however, many surgeons had treatment preferences and lacked individual equipoise. The site which had most recruitment success had adopted a more structured process for identification and recruitment of patients, whereas other sites that adopted more "ad hoc" screening strategies struggled to identify patients. Randomisation on the day of surgery caused both medico-legal and practical concerns at some sites. CONCLUSIONS: Organisation and implementation of a surgical trial in neurosurgery is complex and presents many challenges. Sites often reported low recruitment and discussed the logistical issues of conducting a complex surgical RCT. Future trials in neurosurgery may need to offer more flexibility and time during set-up to maximise opportunities for larger recruitment numbers. Rapid qualitative analysis informed by Normalisation Process Theory was able to quickly identify key issues with trial implementation so rapid qualitative analysis may be a useful approach for teams conducting qualitative research in trials. TRIAL REGISTRATION: ISRCTN, ISRCTN reference: 10,133,661. Registered 23rd November 2018.
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Vértebras Cervicales , Discectomía , Foraminotomía , Selección de Paciente , Investigación Cualitativa , Humanos , Discectomía/métodos , Vértebras Cervicales/cirugía , Foraminotomía/métodos , Entrevistas como Asunto , Equipoise Terapéutico , Resultado del Tratamiento , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Factores de TiempoRESUMEN
AIM: To evaluate the effects of surgical timing on the prognosis in far lateral disk herniations. MATERIAL AND METHODS: We retrospectively evaluated 171 patients diagnosed with far lateral disk herniation who underwent surgery between 2015 and 2021. Patients were divided into three groups: Those operated within the first 3 weeks, within 3-6 weeks, and after 6 weeks. Patients with progressive neurologic deficits and severe pain refractory to the analgesic treatment underwent surgery. RESULTS: The mean age was 57±3 (28-85) years. The patients consisted of 96 females and 75 males. Sixty-eight patients underwent surgery at the L4-L5, 45 at the L3-L4, 37 at the L5-S1, and 21 at L2-3 levels. All patients had low back and radicular leg pain. Lasegue test was positive in 67% of patients. Femoral nerve stretch test was positive in 68%. Motor deficits, patellar reflex loss, and sensory deficits were present in 76%, 80%, and 91% respectively. When the postoperative recovery rates of patients who underwent surgery in all three time periods were compared according to visual analog scale, Oswestry disability index, and MacNab criteria, notably, statistically significant improvements in recovery were observed among patients who underwent surgery in the preoperative short time period when compared to those in the other time periods. CONCLUSION: We believe that early surgery is important to prevent the progression of pain from acute to chronic neuropathic pain to promptly eliminate factors that activate the process and to provide faster and clearer symptom treatment.
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Desplazamiento del Disco Intervertebral , Humanos , Masculino , Femenino , Desplazamiento del Disco Intervertebral/cirugía , Persona de Mediana Edad , Anciano , Adulto , Estudios Retrospectivos , Pronóstico , Anciano de 80 o más Años , Resultado del Tratamiento , Vértebras Lumbares/cirugía , Dolor de la Región Lumbar/cirugía , Dolor de la Región Lumbar/etiología , Factores de Tiempo , Discectomía/métodosRESUMEN
AIM: To examine the effects of different retractor techniques for anterior cervical discectomy on cerebral oxygen saturation. MATERIAL AND METHODS: In this study, a prospective comparative design was employed to examine the effects of different retractor techniques on a cohort of 48 adult patients with ASA I-II classification who underwent anterior cervical discectomy under general anesthesia. The study was conducted under assessor-blinded conditions, and the patients were divided equally into two groups: the self-retaining retractor group and the hand-held retractor group. In addition to standard anaesthesia monitoring, the utilization of cerebral oximetry monitoring was implemented for all patients. A total of 7 measurements were obtained at various stages, including preoperative, during anaesthesia induction, surgical positioning, surgical retraction, release of retractors, after correction of extension position, and prior to extubation. The main objective of this study was to evaluate the impact of neck position and surgical retraction on brain perfusion, as measured by regional cerebral oximetry. RESULTS: Sociodemographic data, duration of operation, hemodynamic parameters, bilateral regional cerebral oxygen saturation (rScO2), and Mini Mental State Examination (MMSE) scores did not differ significantly between the two groups. In both groups, the bilateral rScO2 decreased significantly with positioning and the left rScO2 decreased significantly following the installation of retractors. Only the left rScO2 increased significantly upon the release of both retractors. Following the correction of the neck position, bilateral rScO2 increased significantly in both groups (p < 0.001). CONCLUSION: The rScO2 of the left carotid artery was shown to significantly decrease due to the indirect impact of the retractors. After extending the head and neck, bilateral rScO2 values decreased significantly in both groups. However, despite this decline, there was no significant decrease in brain perfusion that would result in ischemia. The absence of a statistically significant distinction between the groups implies that it is unlikely to have an impact on brain perfusion.
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Vértebras Cervicales , Discectomía , Oximetría , Accidente Cerebrovascular , Humanos , Discectomía/métodos , Discectomía/efectos adversos , Femenino , Masculino , Persona de Mediana Edad , Vértebras Cervicales/cirugía , Adulto , Oximetría/métodos , Accidente Cerebrovascular/etiología , Estudios Prospectivos , Saturación de Oxígeno/fisiología , Encéfalo/cirugíaRESUMEN
Background: Modic changes (MCs) are identified as an independent risk factor for low back pain. Different subtypes of MCs vary in their impact on postoperative pain relief. However, consensus on the transformation of postoperative MC fractions in patients with distinct MC subtypes is lacking. Methods: This comprehensive systematic review and meta-analysis searched English-language articles in PubMed, Cochrane Library, Web of Science, and Embase databases until January 2024. Studies included focused on patients transitioning between various microcrack subtypes post-discectomy. The primary outcome measure was the transformation between different postoperative microcrack fractions. Results: Eight studies with 689 participants were analyzed. Overall, there is moderate to high-quality evidence indicating differences in the incidence of MC conversion across MC subtypes. The overall incidence of MC conversion was 27.7%, with rates of 37.0%, 20.5%, and 19.1% for MC0, MC1, and MC2 subtypes, respectively. Thus, postoperative MC type transformation, particularly from preoperative MC0 to MC1 (17.7%) or MC2 (13.1%), was more common, with MC1 transformation being predominant. Patients with preoperative comorbid MC1 types (19.0%) exhibited more postoperative transitions than those with MC2 types (12.4%). Conclusion: This study underscores the significance of analyzing post-discectomy MCs in patients with lumbar disc herniation, revealing a higher incidence of MCs post-lumbar discectomy, particularly from preoperative absence of MC to MC1 or MC2. Preoperative MC0 types were more likely to undergo postoperative MC transformation than combined MC1 or MC2 types. These findings are crucial for enhancing surgical outcomes and postoperative care.
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Discectomía , Desplazamiento del Disco Intervertebral , Vértebras Lumbares , Humanos , Desplazamiento del Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/epidemiología , Discectomía/efectos adversos , Vértebras Lumbares/cirugía , Vértebras Lumbares/patología , Dolor de la Región Lumbar/etiología , Dolor de la Región Lumbar/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Factores de RiesgoRESUMEN
OBJECTIVES: The study aims to explore the management of two-level cervical disc disease and to compare outcomes of anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty (CDA), and hybrid surgery (HS). PATIENTS AND METHODS: Between December 2011 and December 2021, a total of 120 patients (76 males, 44 females; mean age: 44.8±8.1 years; range, 18 to 68 years) who were diagnosed as two-level cervical disc disease and underwent anterior cervical surgery were retrospectively analyzed. The patients were randomly divided into three groups as ACDF, CDA, and HS each consisting of 40 patients. The Neck Disability Index (NDI), Visual Analog Scale (VAS), clinical and radiological findings, and range of motion (ROM) data were evaluated. RESULTS: All of the groups showed a significant improvement according to clinical and radiological outcomes (p=0.01). The mean follow-up was 27.5±6.1 months for ACDF, 20.0±4.7 months for CDA, and 21.1±5.0 months for HS, showing consistency in monitoring post-surgery outcomes. The mean postoperative NDI scores were 13.4±5.6, 14.8±5.2 and 15.0±5.5 in the ACDF, CDA and HS groups, respectively (p=0.056). The mean postoperative ROM values were 20.82±5.66, 32.45±11.21 and 27.18±10.89, respectively (p=0.045). CONCLUSION: All three surgical techniques, ACDF, CDA, and HS, are safe and successful in the treatment of two-level cervical disc disease. However, HS and CDA may be more preferable over ACDF attributed to their motion-preserving benefits and effectively combining fusion and motion preservation techniques, with comparable clinical and radiological outcomes.
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Artroplastia , Vértebras Cervicales , Discectomía , Degeneración del Disco Intervertebral , Rango del Movimiento Articular , Fusión Vertebral , Humanos , Masculino , Femenino , Fusión Vertebral/métodos , Adulto , Persona de Mediana Edad , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Estudios Retrospectivos , Degeneración del Disco Intervertebral/cirugía , Discectomía/métodos , Resultado del Tratamiento , Anciano , Artroplastia/métodos , Adulto Joven , Adolescente , Desplazamiento del Disco Intervertebral/cirugía , Evaluación de la DiscapacidadRESUMEN
INTRODUCTION: Cervical spondylosis in the warfighter is a common musculoskeletal problem and can be career-ending especially if it requires fusion. Head-mounted equipment and increased biomechanical forces on the cervical spine have resulted in accelerated cervical spine degeneration. Current surgical gold standard is anterior cervical discectomy and fusion (ACDF). Posterior cervical foraminotomy (PCF) is a nonfusion surgical alternative, and this can be effective in alleviating radiculopathy from foraminal stenosis caused by disc-osteophyte complex. Biomechanical studies have not been done to analyze motion associated with military aircrew personnel following PCF. The aim of this study was to compare the biomechanical responses of the effects of ACDF and PCF with different grades of facet resection under simulated military aircrew conditions using range of motion, disc pressure, and facet loads at the index and adjacent levels. MATERIALS AND METHODS: A validated 3D finite element model of the human cervical spinal column was used to simulate various graded PCF and ACDF. All surgical simulations were performed at the most commonly operated level (C5-C6) in warfighters. Pure moment loading under flexion, extension, and lateral bending, and in vivo follower force of 75 N were applied to the intact spine. Hybrid loading protocol was used to achieve 134 degrees of combined flexion-extension and 83 degrees of lateral bending in intact and surgical models to reflect military loading conditions. Segmental motions, disc pressure, and facet load were obtained and normalized with respect to the intact model to quantify the biomechanical effect. RESULTS: Anterior cervical discectomy and fusion decreased range of motion at the index and increased motion at the adjacent levels, while all graded PCF responses had an opposite trend: increased motion at the index and decreased motion at adjacent levels. The magnitude of changes depended on the level of resection, spinal level, and loading mode. Disc pressure increased at the index level and decreased at the adjacent levels after PCF. These changes were exaggerated with increasing extent of facet resection. Facet load increased at the index level after PCF especially with extension and right (contralateral) lateral bending. Complete facetectomy led to facet load increases greater than ACDF at the adjacent levels in both flexion and extension. CONCLUSIONS: Posterior cervical foraminotomy is a motion-preserving implant-free surgical alternative to ACDF for warfighters with cervical radiculopathy after failure of conservative management. The treating surgeon must pay close attention to the extent of facet resection to avoid potential spinal instability and future disc and facet degeneration after PCF. Posterior cervical foraminotomy can be more advantageous than ACDF in terms of adjacent segment degeneration, motion preservation, reoperation rate, surgical cost, and retention of warfighters.
Asunto(s)
Vértebras Cervicales , Foraminotomía , Personal Militar , Rango del Movimiento Articular , Fusión Vertebral , Humanos , Vértebras Cervicales/cirugía , Fenómenos Biomecánicos/fisiología , Foraminotomía/métodos , Foraminotomía/instrumentación , Fusión Vertebral/métodos , Rango del Movimiento Articular/fisiología , Personal Militar/estadística & datos numéricos , Análisis de Elementos Finitos , Discectomía/métodosRESUMEN
INTRODUCTION: Biportal endoscopic spine surgery (BESS) has gained traction for lumbar laminectomy and diskectomy. To justify the transition to BESS, outcomes and the surgical learning curve should be known. This study evaluates rates of complications with BESS and how these rates change with increased surgeon experience. METHODS: A single surgeon's consecutive patients who underwent BESS were evaluated. Patients older than 18 years who underwent BESS for lumbar laminectomy and diskectomy were included. Patients with previous spine surgery, multiple levels, or BESS for fusion were excluded. Demographics, length of surgery, intraoperative complications, postoperative complications, and revision surgery were recorded. The learning phase group and mastery phase group were based on a cumulative summation analysis based on surgical time. RESULTS: A total of 63 patients, with 31 and 32 patients in the learning and mastery group, respectively, were included. Surgical time decreased from 87 to 52 minutes in the mastery phase. Conversion to open decreased from 3 to 0 cases (P = 0.1803), intraoperative complications decreased from 3 to 0 (P = 0.1803), postoperative complications decreased from 7 to 2 (P = 0.017), and rates of revision surgery decreased from 4 to 1 (P = 0.4233). CONCLUSION: This study suggests a learning curve of 31 cases for adequate performance of BESS for lumbar laminectomy and diskectomy.
Asunto(s)
Discectomía , Endoscopía , Laminectomía , Curva de Aprendizaje , Vértebras Lumbares , Tempo Operativo , Complicaciones Posoperatorias , Humanos , Laminectomía/métodos , Masculino , Femenino , Vértebras Lumbares/cirugía , Persona de Mediana Edad , Discectomía/métodos , Adulto , Anciano , Estudios Retrospectivos , Resultado del Tratamiento , Competencia Clínica , Reoperación , Estados UnidosRESUMEN
According to the literature, recurrent disc herniation of the lumbar spine occurs in 5-10% of cases. Objective. To develop an algorithm for surgical treatment of recurrent lumbar spine disc herniation based on analysis of risk factors of relapse and assessment of intra- and postoperative period. MATERIAL AND METHODS: The study included 61 patients with recurrent intervertebral disc herniation. Thirty patients underwent repeated microdiscectomy without transpedicular fixation, 31 patients - resection of recurrent disc herniation with transpedicular fixation (PLIF technique). The control group included 63 patients without recurrent disc herniation. Mean follow-up period was 3.5 years. RESULTS: Discectomy with transpedicular fixation is characterized by larger extent, prolonged surgery time and rehabilitation period. However, there is lower risk of recurrent disc herniation and CSF leakage. Repeated microdisectomy without transpedicular fixation is characterized by smaller extent and shorter surgery time, as well as faster recovery period. Nevertheless, we have higher risk of recurrent disc herniation and CSF leakage. We developed a method for assessing the probability of recurrent intervertebral disc herniation. This algorithm allows us to predict the probability of recurrent disc herniation in a particular patient with 86.7% accuracy. CONCLUSION: We proposed an algorithm for choosing surgical treatment of recurrent disc herniation. Microdiscectomy without fixation is advisable for the risk of recurrent disc herniation <30%, discectomy with transpedicular fixation - for risk of disc herniation >30%.
Asunto(s)
Discectomía , Desplazamiento del Disco Intervertebral , Vértebras Lumbares , Recurrencia , Humanos , Desplazamiento del Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Masculino , Femenino , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Factores de Riesgo , Adulto , Persona de Mediana Edad , Discectomía/métodos , AlgoritmosRESUMEN
OBJECTIVE: To investigate the clinical effect of anterior cervical discectomy and fusion (ACDF) in the treatment of cervical spondylosis of vertebral artery type(CSA). METHODS: The clinical data of 42 patients with CSA from January 2020 to January 2022 were retrospectively analyzed. There were 25 males and 17 females, aged from 30 to 74 years old with an average of (53.9±11.0) years old. There were 18 cases with single-segment lesions, 17 cases with two-segment lesions, and 7 cases with three-segment lesions. The American Academy of Otolaryngology-Head and Neck Surgery's Hearing and Balance Committee score (CHE), the Neck Disability Index (NDI) and the cervical curvature Cobb angle were recorded before surgery and after surgery at 6 months. RESULTS: All 42 ACDF patients were followed up for 6 to 30 months with an average of (14.0±5.2) months. The operative time ranged from 95 to 220 min with an average of (160.38±36.77) min, the intraoperative blood loss ranged from 30 to 85 ml with an average of (53.60±18.98) ml. Tow patients had mild postoperative dysphagia, which improved with symptomatic treatment such as nebulized inhalation. CHE score decreased from (4.05±0.96) preoperatively to (2.40±0.70) at 6 months postoperatively (t=12.97, P<0.05). The number of improved vertigo at 6 months postoperatively was 38, with an improvement rate of 90.5%. NDI score was reduced from (34.43±8.04) preoperatively to (20.76±3.91) at 6 months postoperatively (t=11.83, P<0.05). The cervical curvature Cobb angle improved from (8.04±6.70)° preoperatively to (12.42±5.23)° at 6 months postoperatively (t=-15.96, P<0.05). CONCLUSION: The ACDF procedure has outstanding clinical efficacy in treating CSA. The operation can rapidly relieve patients' episodic vertigo symptoms by relieving bony compression and reconstructing cervical curvature. However, it is necessary to strictly grasp the indications for surgery and clarify the causes of vertigo in patients, and ACDF surgery is recommended for CSA patients for whom conservative treatment is ineffective.
Asunto(s)
Vértebras Cervicales , Discectomía , Fusión Vertebral , Espondilosis , Arteria Vertebral , Humanos , Masculino , Femenino , Persona de Mediana Edad , Discectomía/métodos , Fusión Vertebral/métodos , Espondilosis/cirugía , Anciano , Adulto , Vértebras Cervicales/cirugía , Arteria Vertebral/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
In response to the national opioid crisis, there have been increasing efforts to decrease opioid usage in favor of nonopioid alternatives. We compared post-discharge opioid and nonopioid pain medication prescriptions in lumbar microdiscectomy (MLD) patients before and after implementation of an opioid-sparing pathway for outpatient spine surgery. Patients were grouped into pre-implementation (pre) and post-implementation (post) cohorts based on date of surgery relative to pathway implementation on September 1, 2018. Primary outcomes were the average daily morphine milligram equivalent (MME) of opioids and percentages of nonopioids prescribed at 2-week, 6-week, and 3-month follow-up. Two hundred consecutive MLD patients (100 pre, 100 post) were evaluated. Pre-implementation, average daily MME significantly decreased from 19.59 at 2 weeks, to 1.73 at 6 weeks, to 0.11 at 3 months postoperatively (p < 0.001); post-implementation, average daily MME was 14.12, 1.31, and 0.27, respectively (p < 0.001). Average daily MME at 2-week follow-up decreased by 5.48 (p < 0.001) following implementation, while the rate of nonopioid prescriptions increased from 59% to 79% (p = 0.002) overall, specifically for acetaminophen (8% vs. 47%, p < 0.001) and nonsteroidal anti-inflammatory drugs (36% vs. 61%, p < 0.001). There were no significant differences at 6-week and 3-month follow-up. Opioid usage decreased while nonopioid pain medication usage increased from discharge to 2 weeks postoperatively. Beyond 2 weeks, opioid usage decreased significantly but were comparable between pre-implementation and post-implementation.