scholarly journals Chronic infectious lesions of the cervical spine in adults: monocentric cohort analysis and literature review

2021 ◽  
Vol 18 (3) ◽  
pp. 68-76
Author(s):  
D. G. Naumov ◽  
S. G. Tkach ◽  
A. Yu. Mushkin ◽  
M. E. Makogonova
Keyword(s):  
Cervical Spine ◽  
Surgical Treatment ◽  
Sagittal Balance ◽  
Cohort Analysis ◽  
Pain Syndrome ◽  
Vertical Axis ◽  
Sagittal Vertical Axis ◽  
Comorbidity Index ◽  
Anterior Reconstruction ◽  
Infectious Spondylitis

Objective. To analyze the results of surgical treatment of chronic infectious cervical spondylitis and literature data.Material and Methods. Design: retrospective monocentric cohort study for 2017–2020. The study included medical history and clinical and instrumental data of 25 patients who underwent 28 reconstructive surgeries on the suboccipital (n1 = 3) and subaxial (n2 = 25) spine. The average follow-up period was 1 year 2 months ± 4 months. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS), version 22.0.Results. The effect of the duration of the therapeutic pause (p = 0.043) and the T1 slope (T1S) (p = 0.022) on the intensity of vertebrogenic pain syndrome was established. When assessing the parameters of the sagittal balance a direct relationship between the age of patients and the value of cervical sagittal vertical axis (CSVA) (p = 0.035) was revealed, while CSVA (p = 0.514) and neck tilt angle (NTA) (p = 0.617) did not significantly affect the intensity of vertebral pain syndrome. The extent of vertebral destruction did not affect either the intensity of vertebral pain (p = 0.872) or the indices of the sagittal balance: CSVA (p = 0.116), T1S (p = 0.154), and NTA (p = 0.562). A significant predictor of postoperative complications is the level of comorbidity with an index of 7 or more (p = 0.027) according to the Charlson scale.Conclusion. The leading predictors of complications of surgical treatment of cervical infectious spondylitis are the Charlson comorbidity index (7 points or more) and the variant of anterior reconstruction (the use of a blocked extraspinal plate). The factors influencing the intensity of vertebrogenic pain syndrome in this pathology are the duration of the therapeutic pause and the magnitude of T1S compensation. Anterior reconstruction of the cervical spine in the presence of infectious spondylitis provides a correction of the sagittal balance parameters, with the possibility of long-term maintaining the achieved values.

scholarly journals Lumbar Level Significantly Influences Postoperative Global Sagittal Balance Following Pedicle Subtraction Osteotomy

2021 ◽  
pp. 219256822110325
Author(s):  
Athan G. Zavras ◽  
T. Barrett Sullivan ◽  
Navya Dandu ◽  
Howard S. An ◽  
Christopher J. DeWald ◽  
...  
Keyword(s):  
Sagittal Balance ◽  
Sagittal Alignment ◽  
Adult Spinal Deformity ◽  
Vertical Axis ◽  
Pedicle Subtraction Osteotomy ◽  
Current Evidence ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Lumbar Level ◽  
Global Sagittal Alignment

Study Design: Retrospective cohort study. Objectives: The current evidence regarding how level of lumbar pedicle subtraction osteotomy (PSO) influences correction of sagittal alignment is limited. This study sought to investigate the relationship of lumbar level and segmental angular change (SAC) of PSO with the magnitude of global sagittal alignment correction. Methods: This study retrospectively evaluated 53 consecutive patients with adult spinal deformity who underwent lumbar PSO at a single institution. Radiographs were evaluated to quantify the effect of PSO on lumbar lordosis (LL), thoracic kyphosis (TK), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), T1-spinopelvic inclination (T1SPI), T1-pelvic alignment (TPA), and sagittal vertical axis (SVA). Results: Significant correlations were found between PSO SAC and the postoperative increase in LL ( r = 0.316, P = .021) and PT ( r = 0.352, P = .010), and a decrease in TPA ( r = −0.324, P = .018). PSO level significantly correlated with change in T1SPI ( r = −0.305, P = .026) and SVA ( r = −0.406, P = .002), with more caudal PSO corresponding to a greater correction in sagittal balance. On multivariate analysis, more caudal PSO level independently predicted a greater reduction in T1SPI (β = −3.138, P = .009) and SVA (β = −29.030, P = .001), while larger PSO SAC (β = −0.375, P = .045) and a greater number of fusion levels (β = −1.427, P = .036) predicted a greater reduction in TPA. Conclusion: This study identified a gain of approximately 3 degrees and 3 cm of correction for each level of PSO more caudal to L1. Additionally, a larger PSO SAC predicted greater improvement in TPA. While further investigation of these relationships is warranted, these findings may help guide preoperative PSO level selection.

Association of findings on preoperative extension lateral cervical radiography with osteotomy type, approach, and postoperative cervical alignment after cervical deformity surgery

2021 ◽  
pp. 1-6
Author(s):  
Hai V. Le ◽  
Joseph B. Wick ◽  
Renaud Lafage ◽  
Gregory M. Mundis ◽  
Robert K. Eastlack ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Surgical Approach ◽  
Vertical Axis ◽  
Spine Deformity ◽  
Lower Grade ◽  
Cervical Lordosis ◽  
Sagittal Vertical Axis ◽  
T1 Slope ◽  
Radiographic Parameters ◽  
Cervical Spine Radiography

OBJECTIVE The authors’ objective was to determine whether preoperative lateral extension cervical spine radiography can be used to predict osteotomy type and postoperative alignment parameters after cervical spine deformity surgery. METHODS A total of 106 patients with cervical spine deformity were reviewed. Radiographic parameters on preoperative cervical neutral and extension lateral radiography were compared with 3-month postoperative radiographic alignment parameters. The parameters included T1 slope, C2 slope, C2–7 cervical lordosis, cervical sagittal vertical axis, and T1 slope minus cervical lordosis. Associations of radiographic parameters with osteotomy type and surgical approach were also assessed. RESULTS On extension lateral radiography, patients who underwent lower grade osteotomy had significantly lower T1 slope, T1 slope minus cervical lordosis, cervical sagittal vertical axis, and C2 slope. Patients who achieved more normal parameters on extension lateral radiography were more likely to undergo surgery via an anterior approach. Although baseline parameters were significantly different between neutral lateral and extension lateral radiographs, 3-month postoperative lateral and preoperative extension lateral radiographs were statistically similar for T1 slope minus cervical lordosis and C2 slope. CONCLUSIONS Radiographic parameters on preoperative extension lateral radiography were significantly associated with surgical approach and osteotomy grade and were similar to those on 3-month postoperative lateral radiography. These results demonstrated that extension lateral radiography is useful for preoperative planning and predicting postoperative alignment.

scholarly journals Analysis of the Sagittal Balance in Patients with Adult Spinal Deformity: Modified Sagittal Vertical Axis

2021 ◽  
Author(s):  
Yang Yu ◽  
Bing Wu ◽  
Zhaohan Wang ◽  
Junyao Cheng ◽  
Bo Li ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Orthopedic Surgery ◽  
Sagittal Balance ◽  
Adult Spinal Deformity ◽  
Pearson Correlation ◽  
Vertical Axis ◽  
Sagittal Vertical Axis ◽  
Life Score ◽  
Pearson Correlation Analysis

Abstract Objective: The overall sagittal balance of patient with adult spinal deformity (ASD) is crucial for satisfactory postoperative outcome. SVA is the parameter often used to assess the sagittal balance. However, pelvis often rotates backward to compensate for sagittal imbalance in patients with ASD. In the case, SVA cannot reflect the real sagittal balance. Modified sagittal vertical axis (MSVA) is the parameter we found to better assess the real sagittal balance in patients with ASD. And we want to explore the relationship between MSVA and the quality of life. Methods: We used sample of 60 patients with ASD who underwent long-segment orthopedic surgery (≥4 vertebrae) between the period of 2015 and 2018. The paired-sample t test and Pearson correlation analysis were used for statistical analysis. P value <0.05 was considered significant. Results: SVA, TK, TLK, LL, SS, PT, PI-LL and MSVA were significantly changed in 60 patients preoperatively and postoperatively (p<0.05). The ODI, SRS22, VAS scores were significantly improved postoperatively (p<0.05). Pearson correlation analysis was used to conclude that postoperative SVA, postoperative MSVA and postoperative quality of life score were related. Postoperative MSVA has the strongest correlation with the quality-of-life score. Conclusions: Through spinal orthopedic surgery, the postoperative spinal parameters and quality of life of patients with ASD were significantly improved. MSVA is of great significance for evaluating postoperative sagittal balance and quality of life of patients with ASD.

scholarly journals Outcomes of Surgical Treatment of High-Grade Spondylolisthesis (Monocenter Cohort and Literature Review)

2019 ◽  
Vol 25 (3) ◽  
pp. 100-111
Author(s):  
S. O. Ryabykh ◽  
D. M. Savin ◽  
E. Yu. Filatov ◽  
A. O. Kotelnikov ◽  
M. S. Sayfutdinov
Keyword(s):  
Surgical Treatment ◽  
Sagittal Balance ◽  
Life Quality ◽  
Pain Syndrome ◽  
Lower Limbs ◽  
Sagittal Imbalance ◽  
High Grade ◽  
X Rays ◽  
Level Of Evidence ◽  
Severity Grade

Purpose — to evaluate outcomes of surgical treatment for high-grade spondylolisthesis using bone-disc-bone osteotomy, reduction and fixation through the dorsal approach. Materials and Methods. The authors retrospectively examined a monocenter five-year cohort (IV level of evidence). The study included 10 patients aging from 7 to 22 years (Me — 12 years, M±m — 13.1±4.1 years) who underwent surgery due to high-grade spondylolysis antelisthesis in the period from 2012 to 2017. Displacement was located in L5-S1 segments and corresponded to types 4-6 by AO Spine SDSG classification in all patients. Catamnesis was followed for the period from 1 to 5 years. Surgical procedures included bone-disc-bone osteotomy, L5 reduction and dorsal instrumental multi-bearing (from 2 to 5 spinal motion segments) using reduction transpedicular screws. The following parameters were evaluated: pain syndrome prior and after surgery, sagittal balance, spondylolisthesis mobility on the functional x-rays or CYs, severity grade of anterior spondylolysis, criteria of spontaneous muscular activity and MEPs as well as structure of postoperative complications. Results. L5 displacement prior to surgery was 92.6±25.2%, after surgery — 25.4±16.6% (Z = -2.805, p = 0.005). Patients with sagittal imbalance demonstrated normalization after the surgery allowing to re-classify pathology as “balanced spondylolisthesis”: PI from 67.9±8.6 to 67.5±8.7 (Z = 0,000, p = 1,000), PT from 26.8±13.3 to 20.1±7.1 (Z = -2,090, p = 0.037), SS from 41.3±8.7 to 47.3±9.7 (Z = -1.886, p = 0.059), SA from 34.9±36.3° to 8.6±7.1° (Z = -2.803, p = 0.005). 3 cases of transient L5 radiculopathy with full regress after conservative 6 months’ treatment were reported in the early follow up period (on day 3 after procedure). Pain syndrome dynamics on VAS scale prior to and after the surgery were as follows: spine 8.1±1.0 and 0.5±0.5 (Z = -2.814, p = 0.005), lower limbs 6.8±1.5 and 0.4±0.7 (Z = -2.812, p = 0.005), respectively. Life quality indices by SRS-24 score prior to and after the surgery were 62.6±7.9 and 90.7±12.4 (Z = -2.803, p = 0.005). Mobility of spondylolisthesis was observed in 9 patients. Spondylolisthesis severity by Bridwell classification in late period scored from 1 to 3 points. Conclusion. Use of AO Spine SDSG classification along with assessment of sagittal balance as well as severity of neurological deficit and pain syndrome allow to define the severity grade of spondylolisthesis, while normalization of parameters after the surgery speaks for positive treatment outcome. Extensive release during bone-disc-bone osteotomy at L5-S1 level along with altering tilt angle of the sacrum is the key factor for mobilization and radical correction of pelvic balance in high-grade spondylolisthesis. Outcomes of surgical treatment in the analyzed cohort demonstrate significant improvement in life quality (by SRS-24 score) and reduced pain syndrome (by VAS) in patients. At the same time precise compliance to the procedure protocol and intraoperative neuro-monitoring of MEPs allow to decrease risk of complications. 

scholarly journals Significance of various risk factors for proximal junctional kyphosis and instability of instrumentation in surgical treatment for adult spinal deformities

2021 ◽  
Vol 18 (1) ◽  
pp. 14-23
Author(s):  
I. V. Basankin ◽  
D. A. Ptashnikov ◽  
S. V. Masevnin ◽  
A. A. Afaunov ◽  
A. A. Giulzatyan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Lumbar Lordosis ◽  
Significant Risk ◽  
Vertical Axis ◽  
Type I ◽  
Proximal Junctional Kyphosis ◽  
Sagittal Vertical Axis ◽  
Transpedicular Instrumentation ◽  
Junctional Kyphosis

Objective. To analyze the significance of the influence of various risk factors on the development of proximal junctional kyphosis (PJK) and instability of instrumentation.Material and Methods. The results of surgical treatment of 382 patients with scoliotic deformities of the lumbar spine of type I and IIIb according to Aebi were analyzed. Patients were operated on through the posterior approach using the TLIF-PLIF technique with extended rigid transpedicular instrumentation. Potential risk factors influencing the development of proximal junctional kyphosis and instability of instrumentation were analyzed.Results. It was found that only three risk factors significantly affect the development of PJK: correction of lumbar lordosis more than 30° (p = 0.036) increases the likelihood of its development by 1.5 times, osteoporosis (p = 0.001) – by 2.5 times, and proximal junctionalangle ≥10° (p = 0.001) – by 3.5 times. Three factors showed a statistically significant effect on the incidence of instrumentation instability: correction of lumbar lordosis more than 30° (p = 0.034) increases the likelihood of its occurrence by 1.7 times, osteoporosis (p = 0.018) – by 1.8 times, and deviation of the sagittal vertical axis by more than 50 mm (p = 0.001) – by 3.3 times.Conclusion. The most significant risk factors for the occurrence of PJK and instability of instrumentation are osteoporosis, correction of lumbar lordosis more than 30°, an increase in the proximal junctional angle ≥10°, and an anterior deviation of sagittal vertical axis more than 50 mm. Consideration of these factors in the preoperative period, as well as during surgery, can decrease likelihood of the occurrence of PJK and instability of instrumentation.

scholarly journals RADIOGRAPHIC ALIGNMENT OF CERVICAL SPINE ON A SAMPLE OF ASYMPTOMATIC SUBJECTS

2017 ◽  
Vol 16 (1) ◽  
pp. 13-16 ◽  
Author(s):  
MOHAMED AHMED NASREDDINE ◽  
RAPHAEL DE REZENDE PRATALI ◽  
CARLOS EDUARDO GONÇALES BARSOTTI ◽  
FRANCISCO PRADO EUGENIO DOS SANTOS ◽  
CARLOS EDUARDO ALGAVES SOARES DE OLIVEIRA
Keyword(s):  
Cervical Spine ◽  
Population Sample ◽  
Inverse Correlation ◽  
Vertical Axis ◽  
Panoramic Radiograph ◽  
Brazilian Population ◽  
The Other ◽  
Sagittal Vertical Axis ◽  
Radiographic Parameters ◽  
Significant Difference

ABSTRACT Objective: To present normality parameters for the cervical spine in a sample of the Brazilian population and its distribution by sex and age. Methods: This was a prospective study considering 94 asymptomatic individuals evaluated by panoramic radiograph of the spine for the analysis of the following parameters: cervical lordosis (CL), C2 sagittal vertical axis (SVA-C2), cervical sagittal vertical axis (cSVA), and T1 Slope (TA-T1). The parameter values were compared according to sex and age of individuals. Results: The mean CL was -16.5° (SD: ± 10.8°), SVA-C2 was -3.9 mm (SD: ± 29.2 mm), cSVA was 16.9 mm (SD: ± 10.6 mm) and TA-T1 was 24.8° (SD: ± 7.0°). There was no significant difference between the radiographic parameters when considered with respect to sex and age of individuals (P>0.05). The analysis of correlation among the radiographic parameters showed that the TA-T1 presented the highest correlation with the other parameters, including CL (r= 0.367, P<0.01), SVA-C2 (r= 0.434, P<0.001) and cSVA (r= 0.441, P<0.001). There was also a correlation between SVA-C2 and cSVA (r= 0.32, P= 0.001) and inverse correlation between CL and the cSVA (r= -0.242, P= 0.019). Conclusio: We introduced normality data of the cervical spine alignment in a Brazilian population sample. There was significant correlation among the analyzed parameters, especially considering TA-T1 in relation to the other parameters.

scholarly journals Can posterior stand-alone expandable cages safely restore lumbar lordosis? A minimum 5-year follow-up study

2020 ◽  
Author(s):  
Seung-Kook Kim ◽  
Ogeil Mubarak Elbashier ◽  
Su-chan Lee ◽  
Woo-jin Choi
Keyword(s):  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Vertical Axis ◽  
Control Group ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Expandable Cage ◽  
Cage Group

Abstract Background: Lumbar lordosis (LL) can be restored, and screw-related complications may be avoided with the stand-alone expandable cage method. However, the long-term spinopelvic changes and safety remain unknown. We aimed to elucidate the long-term radiologic outcomes and safety of this technique. Methods: Data from patients who underwent multi-level stand-alone expandable cage fusion and 80 patients who underwent screw-assisted fusion between February 2007 and December 2012, with at least 5 years of follow-up, were retrospectively analyzed. Segmental angle and translation, short and whole LL, pelvic incidence, pelvic tilt, sacral slope (SS), sagittal vertical axis, thoracic kyphosis, and presence of subsidence, pseudoarthrosis, retropulsion, cage breakage, proximal junctional kyphosis (PJK), and screw malposition were assessed. The relationship between local, lumbar, and spinopelvic effects was investigated. The implant failure rate was considered a measure of procedure effectiveness and safety. Results: In total, 69 cases were included in the stand-alone expandable cage group and 150 cases in the control group. The stand-alone group showed shorter operative time (58.48±11.10 versus 81.43±13.75, P=.00028), lower rate of PJK (10.1% versus 22.5%, P=.03), and restoration of local angle (4.66±3.76 versus 2.03±1.16, P=.000079) than the control group. However, sagittal balance (0.01±2.57 versus 0.50 ±2.10, P=.07) was not restored, and weakness showed higher rate of subsidence (16.31% versus 4.85 %, P=.0018), pseudoarthrosis (9.92% versus 2.42%, P=.02), cage, and retropulsion (3.55% versus 0, P=.01) than the control group.Conclusions: Stand-alone expandable cage fusion can restore local lordosis; however, global sagittal balance was not restored. Furthermore, implant safety has not yet been proven.

scholarly journals Cervical intervertebral disc denervation during rotator cuff tendon plasty

2021 ◽  
Vol 18 (1) ◽  
pp. 39-46
Author(s):  
A. V. Peleganchuk ◽  
O. N. Leonova ◽  
A. A. Alekperov
Keyword(s):  
Cervical Spine ◽  
Surgical Treatment ◽  
Rotator Cuff ◽  
Intervertebral Disc ◽  
Rotator Cuff Tear ◽  
Functional Activity ◽  
Shoulder Joint ◽  
Pain Syndrome ◽  
Intervertebral Discs ◽  
Cuff Tear

Objective. To analyze the effect of denervation of intervertebral discs in the cervical spine on the results of surgical treatment of patients with injuries to rotator cuff tendons of the shoulder joint.Material and Methods. Study design: descriptive hypothesis-generating study. The study included patients requiring surgical treatment of rotator cuff tear.  Two groups were identified: Group A included 28 patients who underwent plastic repair of rotator cuff tear with additional denervation of intervertebral discs, and Group B – 30 patients who underwent only plastic surgery for rotator cuff tear. The intensity of pain according to the VAS, functional activity due to neck pain (NDI), functionality of the shoulder joint (UCLA), and the degree of intervertebral disc degeneration according to MRI were assessed, and the effectiveness of treatment was determined. Statistical calculations were performed using the RStudio program.Results. In the group of patients with denervation of intervertebral discs, a more pronounced decrease in the intensity of pain syndrome at 3, 6, and 12 months (p < 0.001; p < 0.001; and p = 0.002), a more proportion of effectively treated patients at 3 months (p = 0.003), and significant increase in functional activity according to NDI at 3, 6 and 12 months of follow-up period (p < 0.001; p = 0.010; and p = 0.045) were observed.Conclusions. There is an underestimation of the role of degenerative cervical spine pathology in the occurrence of shoulder joint pain. In the case of rotation cuff plasty the additional denervation reduces the intensity of pain syndrome in the shoulder joint in the postoperative period.

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