RESUMEN
This study aims to discuss the identification of the C1 nerve root as an effective surgical approach to successfully locate the shunting point of craniocervical junction spinal dural arteriovenous fistula (CCJ-SDAVF) intraoperatively. This study included all patients with CCJ-SDAVF who underwent surgical treatment using the far-lateral transcondylar approach at a single institution from January 2017 to June 2023. Data on patient demographics, clinical and angiographic characteristics of CCJ-SDAVF, surgical details, and treatment outcomes were collected. Follow-up assessments were conducted for all patients until December 31, 2023. The study included a total of 7 patients, comprising 5 men(71.4%) and 2 women (28.6%), with an average age of 57.6 years. Among them, 4 patients (57.1%) developed diffuse subarachnoid hemorrhage(SAH), while 2 patients (28.6%) experienced progressive cervical myelopathy. The shunting points of all CCJ-SDAVFs, which exhibited engorged veins, were identified next to the C1 root. Complete obliteration of CCJ-SDAVFs was successfully achieved in all patients, as confirmed by postoperative angiography one month later. No recurrent CCJ-SDAVFs were observed two years after the operation. Among the patients, 5 (71.4%) experienced good functional recovery, as indicated by an mRS score ranging from 0 to 1, while the remaining 2 patients (28.6%) showed incomplete functional recovery. The surgical interruption of CCJ-SDAVFs is the preferred treatment option, given its high obliteration rate and favorable functional recovery outcomes. We advocate the identification of C1 spinal nerve root as a crucial surgical step to identify the shunting points of CCJ- SDAVFs.
Asunto(s)
Malformaciones Vasculares del Sistema Nervioso Central , Raíces Nerviosas Espinales , Humanos , Persona de Mediana Edad , Masculino , Femenino , Malformaciones Vasculares del Sistema Nervioso Central/cirugía , Raíces Nerviosas Espinales/cirugía , Anciano , Estudios Retrospectivos , Adulto , Resultado del Tratamiento , Procedimientos Neuroquirúrgicos/métodos , Vértebras Cervicales/cirugía , Hemorragia Subaracnoidea/cirugía , Enfermedades de la Médula Espinal/cirugíaRESUMEN
Hangman's fracture occurs in the elderly following low kinetic energy fall from their height, or in the young during traffic accident. Classically described as bipedicular C2 fracture, Hangman's fracture results from oblique hyperextension-flexion vector forces which can lead to anterior dislocation of C1C2 complex over C3 vertebral body in case of associated damage to C2C3 disc and ligaments. Even though most cases of Hangman's fracture are not displaced (grade 1) and can be managed with orthopaedic treatment using cervical brace, highly displaced cases of Hangman's fractures (some grade 2, all grade 3) require surgical stabilization. Given the limited capabilities of reduction and the odds for mechanical failure of anterior C2C3 discectomy and fusion, we provide a reproducible method using a specific rod persuader on C1 screws aiming to realign and stabilize displaced cases of Hangman fracture using the C1C3 "Harms-Goel" procedure.
Asunto(s)
Vértebras Cervicales , Fracturas de la Columna Vertebral , Fusión Vertebral , Humanos , Fracturas de la Columna Vertebral/cirugía , Vértebras Cervicales/cirugía , Vértebras Cervicales/lesiones , Fusión Vertebral/métodos , Fijación Interna de Fracturas/métodos , Masculino , Anciano , Tornillos Óseos , Femenino , Resultado del TratamientoRESUMEN
A mismatch in footprints of cervical total disc arthroplasty (CTDA) implants occasionally occurred in Asian population and it had been attributed solely to ethnic factor. Yet, cervical degeneration process may play a role. Our purpose was to compare the cervical vertebra morphometric data with and without degeneration. The study included patients with CT scans of cervical spine from our hospital between January, 2019, and September, 2021. The total cervical degenerative index (TCDI) of each patient were collected by adding CDI score for 5 disc-levels. Patients were categorized into normal (TCDI 0-5) and degeneration groups (TCDI 6-60). Various measurements of the C3-C7 vertebral body and endplate were taken. Forty-nine patients in the normal group and 55 in the degeneration group were included. No significant difference was noted in gender, BH, BW, or BMI except age and TCDI (p < .001). During degeneration, disproportional endplate size changes were observed, with an increment ratio of 12-20% in the anteroposterior and 5-17% in the mediolateral plane throughout C3-C7, while vertebral body height remained constant. In conclusion, degeneration process, besides ethnic factor, causes the endplate size and shape mismatch. This information can help spine surgeon choose appropriate implants in CTDA surgery.
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Vértebras Cervicales , Degeneración del Disco Intervertebral , Reeemplazo Total de Disco , Humanos , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Masculino , Femenino , Degeneración del Disco Intervertebral/cirugía , Degeneración del Disco Intervertebral/diagnóstico por imagen , Persona de Mediana Edad , Reeemplazo Total de Disco/métodos , Adulto , Tomografía Computarizada por Rayos X , Disco Intervertebral/cirugía , Disco Intervertebral/diagnóstico por imagen , Disco Intervertebral/patología , Anciano , EtnicidadRESUMEN
OBJECTIVE: To propose a screw algorithm and investigate the anatomical feasibilities and clinical outcomes of five distinct fixation methods for C2-3 fused vertebra with high-ridding vertebral arteries (VA) (HRVA) when the C2 pedicle screw placement is unfeasible. METHODS: Thirty surgical patients with congenital C2-3 fusion, HRVA, and atlantoaxial dislocation (AAD) were included. We designed a algorithm for alternative screw implantation into C2-3 fused vertebrae, including C2 pedicle screw with in-out-in (passing VA groove) technique (in-out-in screw), subfacetal screw, translaminar screw, lateral mass screw, C3 pedicle screw. VA diameter and position, C2 and C3 pedicles, superior facets, fused lamina, and fused lateral mass dimensions were evaluated for screw implantation indication. Implant failure, reduction loss, implant placement accuracy were investigated by computed tomography. RESULTS: A total of 5 VAs were identified as distant VAs; a total of 2 VAs were categorized as occlusive VAs. Sufficient dimension of lateral mass and lamina provided the broadest indications for screw implantation, while the distant or occlusive VA provided the most limited indications for in-out-in screw. The indications of five alternative methods ranged from narrowest to widest as follows: in-out-in screw, C3 pedicle screw, subfacetal screw, translaminar screw, lateral mass screw. The translaminar screws and the lateral mass screws increased the probability of implant failure. All patients who received in-out-in screws, C3 pedicle screws, and subfacetal screws achieved fusion. The accuracy ranged from lowest to highest as follows: C3 pedicle screw, lateral mass screw, in-out-in screw, subfacetal screw, translaminar screw. No translaminar screws deviated. CONCLUSIONS: The algorithm proved to be a valuable tool for screw selection in cases of C2-3 fused vertebrae with HRVAs. The subfacetal screw, boasting broad indications, a high fusion rate, and exceptional accuracy, stood as the primary preferred alternative.
Asunto(s)
Algoritmos , Tornillos Pediculares , Fusión Vertebral , Arteria Vertebral , Humanos , Masculino , Fusión Vertebral/métodos , Femenino , Adulto , Arteria Vertebral/cirugía , Persona de Mediana Edad , Resultado del Tratamiento , Adulto Joven , Adolescente , Vértebras Cervicales/cirugía , Articulación Atlantoaxoidea/cirugía , Tornillos Óseos , AncianoRESUMEN
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
Mechanical testing machines are used to evaluate kinematics, kinetics, wear, and efficacy of spinal implants. The simulation of "physiological" spinal loading conditions necessitates the simultaneous use of multiple actuators. The challenge in achieving a desired loading profile lies in achieving close synchronization of these actuators. Errors in load application can be attributed to both the control system and the intrinsic sample response. Moreover, the presence of friction in the setup can have an impact on the measured outcome. The optimization of setup parameters can substantially improve the ability to simulate spinal loading conditions and obtain reliable data on implant performance. In this study, a reproducible kinematic test protocol was developed to evaluate the sensitivity of the kinetic response (i.e., measured loads, moments, and stiffnesses) of a cervical disc prosthesis to several testing parameters. In this context, five ceramic ball and socket sample implants were mounted in a 6 DOF material testing machine and tested with a constant axial compressive force of 100 N in two motion modes: 1) flexion-extension (±7.5°) and 2) lateral bending (±6°). Parameters including rotation rate, slider friction, friction between the samples' articulating surfaces, and moment arm were considered to determine their effects on measured kinetic parameters. The sensitivity analysis indicated that all setup parameters except friction between the samples' articulating surfaces had a substantial effect on the results. The findings were then compared to predictions from a free body diagram to determine the optimal setup parameters. Consequently, the setup with the lowest rotation rate and employing passive sliders yielded results that were consistent with the free body diagram. This study demonstrated the significance of a comprehensive setup evaluation for reliable and reproducible testing of spinal implants, also for comparison between labs.
Asunto(s)
Vértebras Cervicales , Ensayo de Materiales , Cinética , Vértebras Cervicales/cirugía , Vértebras Cervicales/fisiología , Prótesis e Implantes , Disco Intervertebral/fisiología , Disco Intervertebral/cirugía , Fenómenos Biomecánicos , Fricción , Pruebas Mecánicas , Humanos , Soporte de PesoRESUMEN
PURPOSE: Instrumentation of the C1 vertebra requires either mobilization or transection of the C2 nerve root. This study investigates clinical and radiological outcomes and incidences of C2 neuropathic pain after posterior instrumented fusion in the cranio-cervical junction with or without division of the C2 nerve roots. METHODS: This retrospective study compared two cohorts of patients who underwent instrumented fusion in the cranio-cervical junction. Fifty patients (22 males and 28 females) were operated with complete resection of C2 nerve root ganglion (Ex group), and fifty-one patients (30 men, 21 women) with C2 nerve roots preservation (No group). RESULTS: The incidence of postoperative C2 neuropathy was eight times lower in the Ex group compared to the No group that was statistical significant, p = 0.039. Surgical time was significantly shorter in the No group (p = 0.001). The fusion rates were very high for both groups, without difference between groups (p = 1.0). Autografting from the iliac crest (p = 0.001) as well as postoperative immobilisation with a hard collar (p < 0.001) were required in fewer patients in the Ex group. Also, patients in the Ex group were mobilised faster after surgery (p = 0.49). Overall, complication rates were similar between groups, but the Ex group demonstrated fewer major medical complications (16% vs 31%). Male sex and iliac bone harvesting demonstrated significantly higher OR for development of postoperative complications (p = 0.023 and p = 0.034 respectively) and postoperative mobilization demonstrated significant higher OR for development of postoperative major complications (p = 0.042). CONCLUSIONS: Resection of the C2 nerve root ganglion during posterior instrumented fusion of the cranio-cervical junction is safe and rarely leads to C2 neuropathy. The technique tends to mitigate the odds of developing postoperative complications.
Asunto(s)
Vértebras Cervicales , Fusión Vertebral , Raíces Nerviosas Espinales , Humanos , Masculino , Femenino , Persona de Mediana Edad , Fusión Vertebral/métodos , Estudios Retrospectivos , Raíces Nerviosas Espinales/cirugía , Raíces Nerviosas Espinales/diagnóstico por imagen , Anciano , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Adulto , Fluoroscopía/métodos , Resultado del Tratamiento , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Neuralgia/etiología , Imagenología Tridimensional/métodosRESUMEN
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: Machine learning (ML) is extensively employed for forecasting the outcome of various illnesses. The objective of the study was to develop ML based classifiers using a stacking ensemble strategy to predict the Japanese Orthopedic Association (JOA) recovery rate for patients with degenerative cervical myelopathy (DCM). METHODS: A total of 672 patients with DCM were included in the study and labeled with JOA recovery rate by 1-year follow-up. All data were collected during 2012-2023 and were randomly divided into training and testing (8:2) sub-datasets. A total of 91 initial ML classifiers were developed, and the top 3 initial classifiers with the best performance were further stacked into an ensemble classifier with a supported vector machine (SVM) classifier. The area under the curve (AUC) was the main indicator to assess the prediction performance of all classifiers. The primary predicted outcome was the JOA recovery rate. RESULTS: By applying an ensemble learning strategy (e.g., stacking), the accuracy of the ML classifier improved following combining three widely used ML models (e.g., RFE-SVM, EmbeddingLR-LR, and RFE-AdaBoost). Decision curve analysis showed the merits of the ensemble classifiers, as the curves of the top 3 initial classifiers varied a lot in predicting JOA recovery rate in DCM patients. CONCLUSIONS: The ensemble classifiers successfully predict the JOA recovery rate in DCM patients, which showed a high potential for assisting physicians in managing DCM patients and making full use of medical resources.
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Vértebras Cervicales , Aprendizaje Automático , Humanos , Vértebras Cervicales/cirugía , Masculino , Femenino , Persona de Mediana Edad , Resultado del Tratamiento , Anciano , Enfermedades de la Médula Espinal/cirugía , Máquina de Vectores de Soporte , Recuperación de la Función , Estudios de Seguimiento , PredicciónRESUMEN
INTRODUCTION: Current guidelines recommend that the International Normalized Ratio (INR) be less than 1.5 prior to spine intervention. Recent studies have shown that an INR > 1.25 is associated worse outcomes following anterior cervical surgery. We sought to determine the risk of complications associated with an INR > 1.25 following elective posterior cervical surgery. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried. Patients undergoing elective posterior cervical surgery from 2012 to 2016 with an INR level within 24 h of surgery were included. Primary outcomes were hematoma requiring surgery, 30-day mortality, and transfusions within 72-hours. There were 815 patients in the INR ≤ 1 cohort (Cohort A), 410 patients in the 1 < INR ≤ 1.25 cohort (Cohort B), and 33 patients in the 1.25 < INR ≤ 1.5 cohort (Cohort C). RESULTS: Cohort C had a higher rate of transfusion (4% Cohort A; 6% Cohort B; 12% Cohort C; p = 0.028) and the rate of mortality within 30 days postoperatively trended toward significance (0.4% Cohort A; 0.5% Cohort B; 3% Cohort C; p = 0.094). There was no significant difference in the rate of postoperative hematoma formation requiring surgery (0.2% Cohort A; 0% Cohort B; 0% Cohort C; p = 0.58). On multivariate analysis, increasing INR was not associated with an increased risk of developing a major complication. CONCLUSION: An INR > 1.25 but ≤ 1.5 may be safe for posterior cervical surgery. An INR > 1.25 but ≤ 1.5 was associated with a significantly higher rate of transfusions. However, increasing INR was not significantly associated with increased risk of any of the major complications.
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Vértebras Cervicales , Relación Normalizada Internacional , Complicaciones Posoperatorias , Humanos , Femenino , Vértebras Cervicales/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Anciano , Resultado del Tratamiento , Estudios de Cohortes , Transfusión Sanguínea/estadística & datos numéricos , Hematoma/etiología , Hematoma/epidemiología , Adulto , Estudios Retrospectivos , Periodo Preoperatorio , Procedimientos Quirúrgicos Electivos/efectos adversosRESUMEN
BACKGROUND: Congenital craniovertebral deformity, including basilar invagination (BI) and atlantoaxial instability (AAI), are often associated with three-dimensional (3D) deformity, such as C1-2 rotational deformity, craniocervical kyphosis, C1 lateral inclination, among other abnormalities. Effective management of these conditions requires the restoration of the 3D alignment to achieve optimal reduction. Recently, 3D printing technology has emerged as a valuable tool in spine surgery, offering the significant advantage of allowing surgeons to customize the prosthesis design. This innovation provides an ideal solution for precise 3D reduction in the treatment of craniovertebral deformities. OBJECTIVE: This study aims to describe our approach to individualized computer-simulated reduction and the design of C1-2 intra-articular 3D printed porous titanium alloy cages for the quantitative correction of craniovertebral junction deformities. METHODS: A retrospective analysis was conducted on patients with craniovertebral deformities treated at our institution using individualized 3D-printed porous titanium alloy cages. Preoperative CT data were used to construct models for 3D realignment simulations. Cage designs were tailored to the simulated joint morphology following computer-assisted realignment. Preoperative and postoperative parameters were statistically analyzed. RESULTS: Fourteen patients were included in the study, with a total of 28 3D-printed porous titanium alloy cages implanted. There were no cases of C2 nerve root resection or vertebral artery injury. All patients experienced symptom relief and stable implant fixation achieved in all cases. No implant-related complications were reported. CONCLUSION: The use of individualized computer-simulated reduction and the design of C1-2 intra-articular 3D printed porous titanium alloy cage facilitates precise 3D realignment in patients with craniovertebral deformities, demonstrating effectiveness in symptom relief and stability.
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Aleaciones , Impresión Tridimensional , Titanio , Humanos , Masculino , Femenino , Estudios Retrospectivos , Adulto , Adolescente , Adulto Joven , Articulación Atlantoaxoidea/cirugía , Articulación Atlantoaxoidea/diagnóstico por imagen , Articulación Atlantoaxoidea/anomalías , Porosidad , Persona de Mediana Edad , Niño , Diseño de Prótesis , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/anomalíasRESUMEN
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
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
Ossification of the posterior longitudinal ligament (OPLL) is a common cause of degenerative cervical myelopathy (DCM) in Asian populations. Characterization of OPLL progression following laminoplasty remains limited in the literature. 29 patients with OPLL received cervical laminoplasty and a minimum of 2-years follow-up. Clinical and radiological surveillance occurred at 3-months, 6-months, 12-months post-op and then at yearly intervals. Transverse (anteroposterior) diameter and sagittal length of OPLL in relation to their cervical vertebral level of localisation was assessed upon immediate post-op radiographs compared to those obtained at subsequent follow-up. OPLL progression was defined as an increase in transverse dimensions and/or length by ≥ 2 mm. The average period of clinical follow-up was 6.7 ± 3.3 years. Upon latest follow-up, 79% of patients demonstrated at least 2 mm of transverse or longitudinal progression of OPLL. This corresponded to 2-years and 5-year progression rates of 54% and 71% respectively. OPLL located over C5 demonstrated the greatest transverse progression rate at (0.24 ± 0.34 mm / year). The mean overall longitudinal progression rate was 1.61 ± 2.06 mm / year. No patients experienced neurological decline resulting from OPLL progression requiring revision decompression during the period of post-operative observation. Characterizing transverse and longitudinal progression by cervical level via radiographs has implications in surgical planning for OPLL and should be consolidated upon post-operative CT/MRI scans as well as larger sample sizes.
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Vértebras Cervicales , Progresión de la Enfermedad , Laminoplastia , Osificación del Ligamento Longitudinal Posterior , Humanos , Osificación del Ligamento Longitudinal Posterior/cirugía , Osificación del Ligamento Longitudinal Posterior/diagnóstico por imagen , Laminoplastia/métodos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Estudios de Seguimiento , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Resultado del Tratamiento , AdultoRESUMEN
Objective: To investigate the efficacy of one-stage anterior debridement and bone graft fusion for the treatment of cervical pyogenic spondylodiscitis. Methods: This is a retrospective case series study. Retrospective analysis of clinical data from 23 patients with cervical pyogenic spondylodiscitis treated with one-stage anterior approach debridement and bone graft fusion was performed in the Department of Spinal Surgery, the First Affiliated Hospital of Xinjiang Medical University from January 2015 to January 2020. There were 14 males and 9 females,aged (51.9±12.8) years (range:26 to 82 years). Preoperatively, 14 patients had neurological deficits, classified according to the American Spinal Injury Association (ASIA) impairment scale as follows: grade A in 1 case, grade B in 1 case, grade C in 5 cases, and grade D in 7 cases. All patients underwent the one-stage anterior debridement and fusion procedure. The surgical time, blood loss, hospital stay, fusion time, and surgical complications were documented. Clinical efficacy was assessed using the visual analogue scale (VAS), the neck disability index (NDI), and the ASIA impairment scale. Preoperative and postoperative data were compared using paired sample t tests, repeated measures analysis of variance, and generalized estimating equations. Results: All the 23 patients underwent the operative procedures successfully. The operation time was (102.8±19.8) minutes (range:60 to 140 minutes), blood loss was (84.4±40.2) ml (range:30 to 160 ml), and the length of hospital stay was (17.4±6.0) days (range:10 to 30 days). Blood cultures were positive for the causative pathogen in 14 cases (60.8% positivity rate), while 9 cases had negative results. Irrigation fluid cultures yielded the causative pathogen in 19 cases (82.6% positivity rate), with 4 cases negative. All patients were followed up for more than 12 months, with a follow-up duration of (19.0±5.9) months (range:12 to 36 months). At the final follow-up, VAS improved from (5.9±1.1) points preoperatively to (0.8±0.3) points; NDI improved from (38.3±6.0)% preoperatively to (9.3±3.0)%, with statistically significant differences (both P<0.01). All patients experienced improvement in neurological function, with the exception of one patient in grade C and two in grade D, all other patients recovered to grade E. The C2-7 Cobb angle and the affected segment Cobb angle were corrected. white blood cell, erythrocyte sedimentation rate and C-reactive protein levels returned to normal. All patients achieved bony fusion, with a fusion time of (8.9±1.9) months (range:6 to 12 months). Two diabetic patients developed postoperative incision infection; no other surgery-related complications occurred in the remaining patients. Conclusion: One-stage anterior debridement and bone graft fusion can correct kyphosis, restore normal alignment, and improve neurological function in the treatment of single and double segment cervical pyogenic spondylodiscitis, representing a viable treatment option for cervical pyogenic spondylodiscitis.
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Trasplante Óseo , Vértebras Cervicales , Desbridamiento , Discitis , Fusión Vertebral , Humanos , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Trasplante Óseo/métodos , Vértebras Cervicales/cirugía , Adulto , Anciano , Desbridamiento/métodos , Discitis/cirugía , Fusión Vertebral/métodos , Resultado del Tratamiento , Anciano de 80 o más AñosRESUMEN
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
OBJECTIVES: To optimize cervical vertebral bone quality (C-VBQ) score and explore its effectiveness in predicting cage subsidence in Anterior Cervical Corpectomy and Fusion (ACCF) and identify a new method for evaluating subsidence without different equipment and image scale interference. METHODS: Collecting demographic, imaging, and surgical related information. Measuring Cage Subsidence with a new method. Multifactorial logistic regression was used to identify risk factors associated with subsidence. Pearson's correlation was used to determine the relationship between C-VBQ and computed tomography (CT) Hounsfield units (HU). The receiver operating characteristic (ROC) curve was used to assess C-VBQ predictive ability. Correlations between demographics and C-VBQ scores were analyzed using linear regression models. RESULTS: 92 patients were included in this study, 36 (39.1%) showed subsidence with a C-VBQ value of 2.05 ± 0.45, in the no-subsidence group C-VBQ Value was 3.25 ± 0.76. The multifactorial logistic regression showed that C-VBQ is an independent predictor of cage subsidence with a predictive accuracy of 93.4%. Pearson's correlation analysis showed a negative correlation between C-VBQ and HU values. Linear regression analysis showed a positive correlation between C-VBQ and cage subsidence. Univariate analyses showed that only age was associated with C-VBQ. CONCLUSIONS: The C-VBQ values obtained using the new measurements independently predicted postoperative cage subsidence after ACCF and showed a negative correlation with HU values. By adding the measurement of non-operated vertebral heights as a control standard, the results of cage subsidence measured by the ratio method are likely to be more robust, perhaps can exclude unavoidable errors caused by different equipment and proportional.
Asunto(s)
Vértebras Cervicales , Fusión Vertebral , Humanos , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Masculino , Fusión Vertebral/instrumentación , Fusión Vertebral/efectos adversos , Femenino , Persona de Mediana Edad , Anciano , Adulto , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Valor Predictivo de las Pruebas , Densidad Ósea , Factores de Riesgo , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnósticoRESUMEN
Spanning two decades since the 1st generation spinal robotics inception, the robot-assisted spine surgery (RSS) technology has evolved through generations, culminating in the 4th generation characterized by real-time visual navigation and wire-free screw placement. The fundamental principles of RSS technology include surgical planning, tracking, image registration, and robotic arm control technologies. Currently, RSS technology is maturely employed in thoracolumbar procedures and is progressively being applied in cervical surgeries, spinal tumor resections, and percutaneous operations, offering advantages in reducing tissue trauma and exposure to radiation, thereby improving patient outcomes. Emerging research also focuses on the cost-effectiveness of clinical applications and robot-specific complications. With the integration of artificial intelligence into surgical planning, RSS technology is poised to further incorporate emerging technologies and expand its application across a broader clinical spectrum.
Asunto(s)
Procedimientos Quirúrgicos Robotizados , Fusión Vertebral , Humanos , Inteligencia Artificial , Vértebras Cervicales/cirugía , Historia del Siglo XX , Historia del Siglo XXI , Vértebras Lumbares/cirugía , Procedimientos Quirúrgicos Robotizados/historia , Procedimientos Quirúrgicos Robotizados/instrumentación , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/tendencias , Enfermedades de la Columna Vertebral/cirugía , Fusión Vertebral/historia , Fusión Vertebral/instrumentación , Fusión Vertebral/métodos , Fusión Vertebral/tendencias , Neoplasias de la Columna Vertebral/cirugía , Columna Vertebral/cirugía , Vértebras Torácicas/cirugíaRESUMEN
OBJECTIVE: This study aims to investigate the anatomical structure of the C6 pedicle and lateral mass in children aged 0-14 years using CT imaging, providing detailed insights into their growth and development. METHODS: We conducted a comprehensive measurement of C6. Measurements included width, length, and height of the pedicles, as well as the length, width, and thickness of the lateral masses, and several angular metrics. Regression analysis was performed to understand the growth trends, and statistical analyses were carried out to identify differences between age groups, genders, and sides. RESULTS: In children younger than four years, the pedicle width exceeds its height, influencing the diameter of the pedicle screws. By age two to three, the pedicle height and lateral mass thickness reaches 3.0 mm, allowing for the use of 3.0 mm diameter screws. The pedicle transverse angle remains stable. Most parameters showed no significant differences between the left and right sides. Size parameters exhibited significant larger in males than females at ages 0-1, 3-7, and 10-12 years. Regression analysis revealed that the growth trends of size parameters follow cubic or polynomial curves. Most angular metrics follow cubic fitting curves without a clear trend of change with age. CONCLUSION: This study provides a detailed analysis of the anatomical development of the C6 pedicle and lateral masses in children, offering valuable insights for pediatric cervical spine surgeries. The findings highlight the importance of considering age-specific anatomical variations when planning posterior surgical fixation, specifically at C6. It is necessary for us to perform thin-layer CT scans on children and carefully measure various indicators before surgery.
Asunto(s)
Vértebras Cervicales , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Lactante , Niño , Preescolar , Adolescente , Tomografía Computarizada por Rayos X/métodos , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/anatomía & histología , Vértebras Cervicales/cirugía , Vértebras Cervicales/crecimiento & desarrollo , Recién Nacido , Tornillos Pediculares , Factores de EdadRESUMEN
BACKGROUND: Most patients with cervical radiculopathy improve within the first months without treatment or with non-surgical treatment. A systematic review concluded that these patients improve, regardless of their intervention. Still, many patients are offered surgery, despite limited evidence regarding the indications for surgical treatments. The aim of this article is to describe the intervention that is going to be followed in the non-surgical treatment arm of a randomised controlled trial (RCT) comparing the effectiveness of surgical and non-surgical treatment for patients with cervical radiculopathy. METHODS: The non-surgical intervention is a functional intervention within a cognitive approach founded on previous experiences, and current recommendations for best practice care of musculoskeletal pain and cervical radiculopathy. It is based on the biopsychosocial rather than a biomedical perspective, comprises an interdisciplinary approach (physicians, physiotherapy specialists), and includes brief intervention and graded activities. The intervention consists of 6 sessions over 12 weeks. The primary goals are first, to validate the patients´ symptoms and build a therapeutic alliance, second, to explore the understanding and promote alternatives, and third, to explore problems and opportunities based on patients´ symptoms and function. Motivational factors toward self-management are challenging. We will attempt shared decision-making in planning progress for the individual patient and emphasise learning of practical self-help strategies and encouragement to stay active (reinforcing the positive natural course). General physical activities such as walking will be promoted along with simple functional exercises for the neck- and shoulder region. We will also explore social activity, comorbidities, pain location, sleep, and work-related factors. The health providers will set individualised goals together with each patient. DISCUSSION: The aim of the intervention is to describe a functional intervention within a cognitive approach for patients with chronic cervical radiculopathy. The effectiveness of the present program will be compared to surgery in a randomised controlled trial.