scholarly journals Is it Safe and Effective to Treat Complex Cervical Spondylotic Myelopathy Using Piezosurgery in Anterior Cervical Discectomy and Fusion?

2021 ◽  
Author(s):  
Yuwei Li ◽  
Shixin Zhao ◽  
Haijiao Wang ◽  
Peng Zhou ◽  
Wei Cui ◽  
...  
Keyword(s):  
Blood Loss ◽  
Surgical Complications ◽  
Cervical Spondylotic Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Anterior Cervical Discectomy ◽  
Intraoperative Blood Loss ◽  
Traditional Group ◽  
Improvement Rate ◽  
Cervical Discectomy ◽  
Operative Duration

Abstract Objective To investigate the safety and efficacy of piezosurgery in anterior cervical discectomy and fusion (ACDF) for treating patients with cervical spondylotic myelopathy (CSM) coincident retrovertebral body osteophytes adjacent to the endplate or a free nucleus pulposus migrated to the vertebral body, posteriorly; known as complex cervical spondylotic myelopathy (cCSM) here.Methods Forty-seven patients with cCSM underwent ACDF surgery from 2014 to 2017. Among these patients, 26 underwent ACDF using piezosurgery (group A) and 21 underwent ACDF by traditional tools such as air drill, bone curet and gun-shaped bone forceps (group B). Average operative duration, intraoperative blood loss, surgical complications, preoperative and postoperative Japanese Orthopaedic Association (JOA) scores and improvement rate were measured.Results Average operative duration and intraoperative blood loss were significantly lower in the piezosurgery group than those in the traditional group (P < 0.01). The incidences of surgical complications were 3.8% and 23.8% in the piezosurgery and traditional groups (P < 0.05), respectively. Whereas JOA scores and improvement rate were insignificantly different at each data collection period (P > 0.05); preoperative, postoperative 3 days and postoperative 1 year follow-up were included.Conclusion For treating cCSM, both the piezosurgery and traditional tools led to significant neurological improvement. However, the piezosurgery was superior to the traditional tools in terms of operative duration, blood loss, and complication rate. Hence, the piezosurgery was a safe and effective adjunct for ACDF treating cCSM.

A comparison study between hybrid surgery and anterior cervical discectomy and fusion for the treatment of multilevel cervical spondylosis

2020 ◽  
Vol 102-B (8) ◽  
pp. 981-996
Author(s):  
Yong-Dong Yang ◽  
He Zhao ◽  
Yi Chai ◽  
Ding-Yan Zhao ◽  
Li-Jun Duan ◽  
...  
Keyword(s):  
Blood Loss ◽  
Japanese Orthopaedic Association ◽  
Anterior Cervical Discectomy ◽  
Sensitivity Analyses ◽  
Cervical Disc ◽  
Symptom Improvement ◽  
Adjacent Segment ◽  
Hybrid Surgery ◽  
Cervical Discectomy ◽  
Hospitalization Time

Aims Whether to perform hybrid surgery (HS) in contrast to anterior cervical discectomy and fusion (ACDF) when treating patients with multilevel cervical disc degeneration remains a controversial subject. To resolve this we have undertaken a meta-analysis comparing the outcomes from HS with ACDF in this condition. Methods Seven databases were searched for studies of HS and ACDF from inception of the study to 1 September 2019. Both random-effects and fixed-effects models were used to evaluate the overall effect of the C2-C7 range of motion (ROM), ROM of superior/inferior adjacent levels, adjacent segment degeneration (ASD), heterotopic ossification (HO), complications, neck disability index (NDI) score, visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, Odom’s criteria, blood loss, and operating and hospitalization time. To obtain more credible results contour-enhanced funnel plots, Egger’s and Begg’s tests, meta-regression, and sensitivity analyses were performed. Results In total, 17 studies involving 861 patients were included in the analysis. HS was found to be superior to ACDF in maintaining C2-C7 ROM and ROM of superior/inferior adjacent levels, but HS did not reduce the incidence of associated level ASD. Also, HS did not cause a higher rate of HO than ACDF. The frequency of complications was similar between the two techniques. HS failed to achieve more favourable outcomes than ACDF using the NDI, VAS, JOA, and Odom’s scores. HS did not show any more advantages in operating or hospitalization time but did show reduction in blood loss. Conclusion Although HS maintained cervical kinetics, it failed to reduce the incidence of ASD. This finding differs from previous reports. Moreover, patients did not show more benefits from HS with respect to symptom improvement, prevention of complications, and clinical outcomes. Cite this article: Bone Joint J 2020;102-B(8):981–996.

scholarly journals Two-adjacent-level anterior cervical discectomy and fusion versus one-level corpectomy and fusion in cervical degenerative disc disease: a retrospective cohort study

2019 ◽  
Author(s):  
Dongying Wu ◽  
Shanzheng Wang ◽  
Feng Yuan ◽  
Weimin Fan ◽  
Jun Sun
Keyword(s):  
Blood Loss ◽  
Japanese Orthopaedic Association ◽  
Degenerative Disease ◽  
Anterior Cervical Discectomy ◽  
Adjacent Level ◽  
Vertebral Level ◽  
Cervical Discectomy ◽  
Hardware Failure ◽  
Arm Pain ◽  
Cervical Degenerative Disease

Abstract Background: The aim of the present study was to compare whether anterior cervical discectomy and fusion (ACDF) with a polyether ether ketone (PEEK) cage was superior to anterior cervical corpectomy and fusion (ACCF) with a titanium mesh cage (TMC) in the treatment of two-adjacent-level cervical degenerative disease. Methods: From May 2014 to December 2015, 47 patients with cervical degenerative disease who underwent ACDF with PEEK or ACCF with TMC were included in this retrospective analysis. Perioperative parameters (hospital stay, blood loss, operation time, and complications), clinical outcomes (Japanese Orthopaedic Association scores and visual analogue scale scores for neck and arm pain), and radiological outcomes (the overall cervical sagittal angle, segmental angle of the treated vertebral level, the height of the treated vertebral level, and fusion status) were evaluated. Results: The operative time was significantly shorter (P = 0.006) and blood loss was higher (P = 0.081) in the ACCF with TMC group. The early hardware failure rate was 4% and 0% in the ACCF with TMC group and the ACDF with PEEK group, respectively. The subsidence rate was higher in the ACCF with TMC group (8%) than in the ACDF with PEEK group (0%). Conclusions: The two procedures yielded comparable results in terms of clinical and radiological outcomes during 1-year follow-up. However, when compression at the vertebral level is mild to moderate, we suggest the use of ACDF than ACCF because of the possibility of early hardware failure. Allograft or heterotopic autograft can be avoided in both groups.

scholarly journals A comparative effectiveness study of patient-rated and radiographic outcome after 2 types of decompression with fusion for spondylotic myelopathy: anterior cervical discectomy versus corpectomy

2013 ◽  
Vol 35 (1) ◽  
pp. E4 ◽  
Author(s):  
Jan-Karl Burkhardt ◽  
Anne F. Mannion ◽  
Serge Marbacher ◽  
Patrick A. Dolp ◽  
Tamas F. Fekete ◽  
...  
Keyword(s):  
Blood Loss ◽  
Comparative Effectiveness ◽  
Cervical Spondylotic Myelopathy ◽  
The Other ◽  
Anterior Cervical Discectomy ◽  
Complication Rates ◽  
Effectiveness Study ◽  
Cervical Lordosis ◽  
Cervical Discectomy ◽  
Comparative Effectiveness Study

Object Both anterior cervical discectomy with fusion (ACDF) and anterior cervical corpectomy with fusion (ACCF) are used to treat cervical spondylotic myelopathy; however, there is currently no evidence for the superiority of one over the other in terms of patient-rated outcomes. This comparative effectiveness study compared the patient-rated and radiographic outcomes of 2-level ACDF versus 1-level ACCF. Methods This single-center study was nested within the EuroSpine Spine Tango data acquisition system. Inclusion criteria were the following: consecutive patients presenting with signs of cervical spondylotic myelopathy who underwent 2-level ACDF or 1-level ACCF between 2004 and 2011. Before and 12 months after surgery, patients completed the multidimensional Core Outcome Measures Index (COMI) and also rated global treatment outcome and satisfaction with care on 5-point Likert scales. Cervical lordosis, segmental height, and fusion rate were assessed radiographically before and immediately after surgery and at the last follow-up (20.4 ± 13.7 months, mean ± SD). Results In total, 118 consecutive patients (80 in the ACDF group and 38 in the ACCF group) were included. Age, sex, comorbidity, baseline symptoms, baseline radiographic data, operation duration, and complication rates did not differ significantly between the 2 groups. Blood loss was significantly (p < 0.04) lower in the ACDF group. Postoperative mean segmental height was significantly (p = 0.0006) greater for ACDF (42.0 ± 4.2 mm, mean ± SD) than for ACCF (39.0 ± 4.0 mm), and global average lordosis improved to a significantly (p = 0.003) greater extent in ACDF (by 1.6° ± 4.1°) than in ACCF (by −1.0° ± 4.0°). Fusion rates for ACDF were 97.5% and for ACCF were 94.7% (p = 0.59). The 12-month patient-rated outcomes did not differ significantly between ACDF and ACCF: 82.4% and 68.6% had a good global outcome (operation helped/helped a lot) (p = 0.10), 86.5% and 82.9% were satisfied/very satisfied with care (p = 0.62), and the reduction in the multidimensional COMI was 2.8 ± 2.7 and 2.2 ± 3 points (p = 0.30), respectively. The postoperative increase in lordosis angle showed low but significant correlations with the improvement in arm pain (r = 0.25, p = 0.014), highest pain (r = 0.25, p = 0.013), and function (r = 0.24, p = 0.016). Conclusions Both ACDF and ACCF are safe and effective in the treatment of cervical spondylotic myelopathy, indicated by similarly good patient-rated outcomes 1 year after surgery. This precludes any conclusions regarding the superiority of one technique over the other, although it should be noted that ACDF resulted in less blood loss and greater improvements in cervical lordosis and segmental height than ACCF. Patients with improved lordosis angle had a better clinical outcome.

scholarly journals Four-Level Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy

2016 ◽  
Vol 24 (3) ◽  
pp. 338-343 ◽  
Author(s):  
Shan-Jin Wang ◽  
Bin Ma ◽  
Yu-Feng Huang ◽  
Fu-Min Pan ◽  
Wei-Dong Zhao ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Cervical Spondylotic Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Disc Height ◽  
Anterior Cervical Discectomy ◽  
Radiographic Evaluation ◽  
Cervical Discectomy ◽  
Arm Pain ◽  
The Mean

Purpose To review the outcome of 32 consecutive patients who underwent 4-level anterior cervical discectomy and fusion (ACDF) with cages and plates and were followed up for at least 5 years. Methods Records of 19 men and 13 women aged 48 to 69 years who underwent 4-level ACDF with cages and plates for myelopathy (n=11) or myeloradiculopathy (n=21) at C3 to C7 by a single surgeon and were followed up for a minimum of 5 years were reviewed. Clinical outcome was assessed using the visual analogue scale (VAS), Neck Disability Index (NDI), and modified Japanese Orthopaedic Association (JOA) score for pain or myelopathic symptoms. Radiographic evaluation included fusion rate, range of motion, cervical lordosis (C2-to-C7 Cobb angle), and disc height. Results The mean follow-up was 66 months. All patients had good recovery of muscle strength and resolution of limb sensory disturbance, except for 4 who still had some numbness. The mean VAS for neck and arm pain improved from 14.2 to 6.84 (p=0.012); the mean NDI improved from 31.62 to 12.17 (p<0.01); and the mean JOA score improved from 10.1 to 13.9 (p=0.027). The mean percentage of recovery was 62.9. The mean Cobb angle improved from 10.24° to 1.28° (p=0.019); the mean disc height improved from 4.12 to 6.58 mm (p<0.01). 30 (94%) patients achieved solid fusion. Conclusion Multilevel ACDF using PEEK cages and plates is safe and effective for multilevel cervical spondylotic myelopathy and achieves satisfactory mid-term outcome.

scholarly journals Intraoperative Nice knots assistance for reduction in displaced comminuted clavicle fractures

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Fangning Hu ◽  
Xi Liu ◽  
Fanxiao Liu ◽  
Honglei Jia ◽  
Xiaolong Lv ◽  
...  
Keyword(s):  
Blood Loss ◽  
Rating Scale ◽  
Clavicle Fracture ◽  
Operation Time ◽  
Clinical Results ◽  
Intraoperative Blood Loss ◽  
Traditional Group ◽  
Significant Difference ◽  
Clavicle Fractures ◽  
Displaced Clavicle Fracture

Abstract Purpose The Nice knots have been widely used in orthopedic surgeries to fix torn soft tissue and fracture in recent years. The study aims to investigate the clinical efficacy and prognosis of intraoperative and postoperative Nice Knots-assisted reduction in the treatment of displaced comminuted clavicle fracture. Methods From Jan 2014 to Dec 2019, 75 patients diagnosed with unilateral closed displaced comminuted clavicle fracture were treated with open reduction and internal fixation (ORIF) in this study. Nice knot group (the NK group) included 38 patients and the other 37 patients were in the traditional group (the TK group). The time of operation and the amount of bleeding during operation were recorded. Post-operative clinical outcomes and radiographic results were recorded and compared between these two groups. The Visual Analogue Scale (VAS), Neer score, Rating Scale of the American Shoulder and Elbow Surgeons, Constant-Murley score and complications such as infection, nonunion, implant loosening, fragment displacement and hardware pain were observed in the two groups. Results In the comparison between the two groups, there was no significant difference in age, sex, the cause of displaced clavicle fracture, and other basic information between the two groups. The operation time, intraoperative fluoroscopy time, and intraoperative blood loss were significantly reduced in the NK group (P < 0.01). There were 2 cases of plate fracture in the TK group. The follow-up results showed that there was no significant difference in VAS, Neer score, ASES, and Constant-Murley scores between the two groups. Conclusion The use of Nice knot, in comminuted and displaced clavicle fractures can reduce intraoperative blood loss, shorten operation time, facilitate intraoperative reduction, and achieve satisfactory postoperative clinical results. This study demonstrates that Nice knot is a simple, safe, practical and effective auxiliary reduction method.

Use of a nano-hydroxyapatite/polyamide composite in anterior cervical subtotal corpectomy and fusion

2021 ◽  
Vol 11 (9) ◽  
pp. 1491-1496
Author(s):  
Xiaojiang Li ◽  
Xudong Zhang ◽  
Shanshan Dong ◽  
Haijun Li ◽  
Chunlan Wang ◽  
...  
Keyword(s):  
Bone Graft ◽  
Vertebral Body ◽  
Cervical Spondylotic Myelopathy ◽  
Interbody Fusion ◽  
Japanese Orthopaedic Association ◽  
Fusion Rate ◽  
Graft Material ◽  
Improvement Rate ◽  
Fusion Surgery ◽  
Cervical Vertebral Body

This study aimed to explore the safety and efficacy of using nano-hydroxyapatite/polyamide (N-HA/PA) composite in anterior cervical vertebral body subtotal corpectomy and interbody fusion. Total 50 patients with cervical spondylotic myelopathy were enrolled to undergo anterior cervical spondylectomy. Bone graft pedicles were compounded with N-HA/PA and intervertebral body fusion was performed. Study outcomes included surgical efficacy and the degree of fusion. Patients in whom vertebral body fusion was performed with N-HA/PA composite pedicles had significantly improved symptoms. The postoperative Japanese Orthopaedic Association scores increased to 18.56±4.37 from 11.37±3.52, reflecting an improvement rate of 87.3%. The composite pedicle fusion rate was 96.4%. Therefore, N-HA/PA composite pedicle as a bone graft material in fusion surgery provides significant therapeutic efficacy. Moreover, the composite pedicle fusion rate is high, making it ideal for anterior cervical vertebral body subtotal corpectomy and fusion.

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