81. Do patient expectations represent a more important clinical difference: a study of surgical outcomes in the cervical spine

2021 ◽  
Vol 21 (9) ◽  
pp. S40
Author(s):  
Conor Lynch ◽  
Caroline Jadczak ◽  
Shruthi Mohan ◽  
Cara Geoghegan ◽  
Elliot Cha ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Surgical Outcomes ◽  
Patient Expectations ◽  
Clinical Difference

Congenital Cervical Spine Stenosis in a Multicenter Global Cohort of Patients With Degenerative Cervical Myelopathy: An Ambispective Report Based on a Magnetic Resonance Imaging Diagnostic Criterion

Neurosurgery ◽  
2018 ◽  
Vol 83 (3) ◽  
pp. 521-528 ◽  
Author(s):  
Aria Nouri ◽  
Lindsay Tetreault ◽  
Satoshi Nori ◽  
Allan R Martin ◽  
Anick Nater ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Cervical Spine ◽  
Magnetic Resonance ◽  
Surgical Outcomes ◽  
Cervical Myelopathy ◽  
Spinal Canal ◽  
Resonance Imaging ◽  
Baseline Severity ◽  
Degenerative Cervical Myelopathy

Abstract BACKGROUND Congenital spinal stenosis (CSS) of the cervical spine is a risk factor for acute spinal cord injury and development of degenerative cervical myelopathy (DCM). OBJECTIVE To develop magnetic resonance imaging (MRI)-based criteria to diagnose preexisting CSS and evaluate differences between patients with and without CSS. METHODS A secondary analysis of international prospectively collected data between 2005 and 2011 was conducted. We examined the data of 349 surgical DCM patients and 27 controls. Spinal canal and cord anteroposterior diameters were measured at noncompressed sites to calculate spinal cord occupation ratio (SCOR). Torg–Pavlov ratios and spinal canal diameters from radiographs were correlated with SCOR. Clinical and MRI factors were compared between patients with and without CSS. Surgical outcomes were also assessed. RESULTS Calculation of SCOR was feasible in 311/349 patients. Twenty-six patients with CSS were identified (8.4%). Patients with CSS were younger than patients without CSS (P = .03) and had worse baseline severity as measured by the modified Japanese Orthopedic Association score (P = .04), Nurick scale (P = .05), and Neck Disability Index (P < .01). CSS patients more commonly had T2 cord hyperintensity changes (P = .09, ns) and worse SF-36 Physical Component scores (P = .06, ns). SCOR correlated better with Torg–Pavlov ratio and spinal canal diameter at C3 than C5. Patients with SCOR ≥ 65% were also younger but did not differ in baseline severity. CONCLUSION SCOR ≥ 70% is an effective criterion to diagnose CSS. CSS patients develop myelopathy at a younger age and have greater impairment and disability than other patients with DCM. Despite this, CSS patients have comparable duration of symptoms, MRI presentations, and surgical outcomes to DCM patients without CSS.

scholarly journals Which factors predict the loss of cervical lordosis following cervical laminoplasty? A review of various indices and their clinical implications

2019 ◽  
Vol 10 ◽  
pp. 147 ◽  
Author(s):  
Ravi Sharma ◽  
Sachin A. Borkar ◽  
Revanth Goda ◽  
Shashank S. Kale
Keyword(s):  
Cervical Spine ◽  
Surgical Outcomes ◽  
Thoracic Kyphosis ◽  
Clinical Implications ◽  
Cervical Laminoplasty ◽  
Cervical Lordosis ◽  
Radiological Parameters ◽  
Increased Risk ◽  
Cobb’S Angle ◽  
The Relationship

Background: Many patients undergoing laminoplasty develop postoperative loss of cervical lordosis or kyphotic alignment of cervical spine despite sufficient preoperative lordosis. This results in poor surgical outcomes. Methods: Here, we reviewed the relationship between multiple radiological parameters of cervical alignment that correlated with postoperative loss of cervical lordosis in patients undergoing laminoplasty. Results: Patient with a high T1 slope (T1S) has more lordotic alignment of the cervical spine preoperatively and is at increased risk for the loss of cervical lordosis postlaminoplasty. Those with lower values of difference between T1S and Cobb’s angle (T1S-CL) and CL-T1S ratio have higher risks of developing a loss of the cervical lordosis postoperatively. Alternatively, C2-C7 lordosis, neck tilt, cervical range of motion, and thoracic kyphosis had no role in predicting the postlaminoplasty kyphosis. Conclusion: Among various radiological parameters, the preoperative T1S is the most important factor in predicting the postoperative loss of the cervical lordosis/alignment following laminoplasty.

scholarly journals Fulfillment of Patient Expectations Two Years after Cervical Spine Surgery

2016 ◽  
Vol 6 (1_suppl) ◽  
pp. s-0036-1582945-s-0036-1582945
Author(s):  
Darren Lebl ◽  
Andrew Sama ◽  
Carol A. Mancuso ◽  
Frank P. Cammisa ◽  
Alex P. Hughes ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Patient Expectations ◽  
Cervical Spine Surgery

scholarly journals Surgical outcomes and risk factors for poor outcomes in patients with cervical spine metastasis: a prospective study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yutaro Kanda ◽  
Kenichiro Kakutani ◽  
Yoshitada Sakai ◽  
Zhongying Zhang ◽  
Takashi Yurube ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cervical Spine ◽  
Surgical Outcomes ◽  
Univariate Analysis ◽  
Palliative Surgery ◽  
Spine Metastasis ◽  
Cervicothoracic Junction ◽  
Poor Outcome ◽  
The Impact

Abstract Background Few studies have addressed the impact of palliative surgery for cervical spine metastasis on patients’ performance status (PS) and quality of life (QOL). We investigated the surgical outcomes of patients with cervical spine metastasis and the risk factors for a poor outcome with a focus on the PS and QOL. Methods We prospectively analyzed patients with cervical spine metastasis who underwent palliative surgery from 2013 to 2018. The Eastern Cooperative Oncology Group PS (ECOGPS) and EuroQol 5-Dimension (EQ5D) score were assessed at study enrollment and 1, 3, and 6 months postoperatively. Neurological function was evaluated with Frankel grading. Univariate and multivariate analyses were performed to identify the risk factors for a poor surgical outcome, defined as no improvement or deterioration after improvement of the ECOGPS or EQ5D score within 3 months. Results Forty-six patients (mean age, 67.5 ± 11.7 years) were enrolled. Twelve postoperative complications occurred in 11 (23.9%) patients. The median ECOGPS improved from PS3 at study enrolment to PS2 at 1 month and PS1 at 3 and 6 months postoperatively. The mean EQ5D score improved from 0.085 ± 0.487 at study enrolment to 0.658 ± 0.356 at 1 month and 0.753 ± 0.312 at 3 months. A poor outcome was observed in 18 (39.1%) patients. The univariate analysis showed that variables with a P value of < 0.10 were sex (male), the revised Tokuhashi score, the new Katagiri score, the level of the main lesion, and the Frankel grade at baseline. The multivariate analysis identified the level of the main lesion (cervicothoracic junction) as the significant risk factor (odds ratio, 5.00; P = 0.025). Conclusions Palliative surgery for cervical spine metastasis improved the PS and QOL, but a cervicothoracic junction lesion could be a risk factor for a poor outcome.

scholarly journals Cervical Spine Surgery: Improved Surgical Outcomes Using Enhanced Recovery After Surgery (ERAS) Pathways

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Ryan P Monaghan ◽  
Mary K Robertson ◽  
Scott C Robertson
Keyword(s):  
Cervical Spine ◽  
Length Of Stay ◽  
Spine Surgery ◽  
Surgical Outcomes ◽  
Enhanced Recovery ◽  
Care Pathway ◽  
Activity Level ◽  
Published Data ◽  
Cervical Spine Surgery ◽  
One Year

Abstract INTRODUCTION Enhanced recover after surgery (ERAS) programs have been utilized by surgeons across the globe, but its implementation in cervical spine surgery (CSS) has been limited. ERAS programs have been associated with beneficial patient outcomes, shorter hospital stays, and quicker recovery periods. We developed a cervical spine care pathway which was applied to all outpatients undergoing surgery. In principle the CSS pathway should minimize complications, reduce the length of stay, and improve the outcomes of cervical spine surgery patients. METHODS The pathway was divided into 3 phases preoperative, perioperative and postoperative. We looked at LOS, mortality, complications, and 30-d readmissions. One year of data was collected and compared to national published data. Outcome measurements and demographics were retrieved from the electronic health record (EHR) of each patient by a blinded independent reviewer. All surgeries were performed by a single surgeon at a single institution. RESULTS There were 144 cervical cases that were included in this study. Out of the 144 total patients, 43 had a single-level procedure, while 101 had a multi-level procedure. Patients who followed the Cervical Spinal Pathways were found to have significantly reduced LOS, mortality, complications, and readmission rates compared to national averages. LOS was significantly affected by preoperative activity level and postoperative complications. Patients who were not ambulatory preoperative had a longer length of stay while inpatient rehab placement was arranged. CONCLUSION CSS pathways should be used in spinal surgeries to improve post-surgical outcomes. Individual items within the ERAS pathway need to be studied independently to determine the significance of each factor on surgical outcomes.

A single-center retrospective analysis of 3- or 4-level anterior cervical discectomy and fusion: surgical outcomes in 66 patients

2021 ◽  
Vol 34 (1) ◽  
pp. 45-51
Author(s):  
Jesse J. McClure ◽  
Bhargav D. Desai ◽  
Leah M. Shabo ◽  
Thomas J. Buell ◽  
Chun-Po Yen ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Surgical Outcomes ◽  
Anterior Cervical Discectomy ◽  
Lateral Flexion ◽  
Disc Disease ◽  
Exclusion Criteria ◽  
Cervical Discectomy ◽  
Initial Symptoms ◽  
Flexion Extension ◽  
Spine Pathology

OBJECTIVEAnterior cervical discectomy and fusion (ACDF) is a safe and effective intervention to treat cervical spine pathology. Although these were originally performed as single-level procedures, multilevel ACDF has been performed for patients with extensive degenerative disc disease. To date, there is a paucity of data regarding outcomes related to ACDFs of 3 or more levels. The purpose of this study was to compare surgical outcomes of 3- and 4-level ACDF procedures.METHODSThe authors performed a retrospective chart review of patients who underwent 3- and 4-level ACDF at the University of Virginia Health System between January 2010 and December 2017. In patients meeting the inclusion/exclusion criteria, demographics, fusion rates, time to fusion, and reoperation rates were evaluated. Fusion was determined by < 1 mm of change in interspinous distance between individual fused vertebrae on lateral flexion/extension radiographs and lack of radiolucency between the grafts and vertebral bodies. Any procedure requiring a surgical revision was considered a failure.RESULTSSixty-six patients (47 with 3-level and 19 with 4-level ACDFs) met the inclusion/exclusion criteria of having at least one lateral flexion/extension radiograph series ≥ 12 months after surgery. Seventy percent of 3-level patients and 68% of 4-level patients had ≥ 24 months of follow-up. Ninety-four percent of 3-level patients and 100% of 4-level patients achieved radiographic fusion for at least 1 surgical level. Eighty-eight percent and 82% of 3- and 4-level patients achieved fusion at C3–4; 85% and 89% of 3- and 4-level patients achieved fusion at C4–5; 68% and 89% of 3- and 4-level patients achieved fusion at C5–6; 44% and 42% of 3- and 4-level patients achieved fusion at C6–7; and no patients achieved fusion at C7–T1. Time to fusion was not significantly different between levels. Revision was required in 6.4% of patients with 3-level and in 16% of patients with 4-level ACDF. The mean time to revision was 46.2 and 45.4 months for 3- and 4-level ACDF, respectively. The most common reason for revision was worsening of initial symptoms.CONCLUSIONSThe authors’ experience with long-segment anterior cervical fusions shows their fusion rates exceeding most of the reported fusion rates for similar procedures in the literature, with rates similar to those reported for short-segment ACDFs. Three-level and 4-level ACDF procedures are viable options for cervical spine pathology, and the authors’ analysis demonstrates an equivalent rate of fusion and time to fusion between 3- and 4-level surgeries.

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