scholarly journals A Follow-up Study on the Degeneration of Adjacent Segments After TLIF and Foraminal Endoscopy

2021 ◽  
Author(s):  
wang shunmin ◽  
xi luo ◽  
yuan wang ◽  
yongfei guo ◽  
jiangang shi
Keyword(s):  
Japanese Orthopaedic Association ◽  
Operation Time ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Intervertebral Foramen ◽  
Improvement Rate ◽  
Average Hospital ◽  
Significant Difference ◽  
Endoscopic Discectomy

Abstract Objective To compare the clinical outcomes of transforaminal lumbar interbody fusion (TLIF) and endoscopic discectomy in the treatment of postoperative adjacent segment degeneration in patients with lumbar disc herniation (LDH). Methods From 2014 to 2017, 87 patients who were diagnosed with single-levelLDH and received surgery of TLIF (group X, n = 43) or endoscopic discectomy (group F, n = 44) were retrospectively analyzed. X-ray, MRI, CT and clinical symptoms were recorded before operation and at the last follow-up. The neurological function was originally evaluated by the Japanese Orthopaedic Association (JOA) score. Radiological evaluation included the height of intervertebral space (HIS), intervertebral foramen height (FH), intervertebral foramen area (FA), lumbar lordosis (CA) and intervertebral disc degeneration Pfirrmann score.Results There was no significant difference in average operation age, JOA improvement rate, reoperation rate and complications between the two groups. The average blood loss, average hospital stays and average operation time in group F were lower than those in group X. During the last follow-up, HIS, CA and FA decreased in both groups, and the changes in group X were more significant than those in group F (P < 0.05). There was no significant difference in postoperative FH between the two groups, but it decreased more in group X (P < 0.05).Conclusion Both TLIF and endoscopic surgery can achieve good results in the treatment of LDH, but the risk of lumbar adjacent segment degeneration after intervertebral foraminal surgery is lower.

Is the Effect of Intervertebral Foramen Endoscopic Surgery on Adjacent Segmental Degeneration Better Than That of Open Surgery?

2021 ◽  
Author(s):  
wang shunmin ◽  
kaiqiang sun ◽  
aigang liu ◽  
rongzi chen ◽  
xi luo ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Endoscopic Surgery ◽  
Lumbar Disc ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Intervertebral Foramen ◽  
Significant Difference ◽  
Endoscopic Discectomy

Abstract Background To compare the clinical outcomes of transforaminal lumbar interbody fusion (TLIF) and endoscopic discectomy in the treatment of postoperative adjacent segment degeneration in patients with lumbar disc herniation. Methods From 2014 to 2017, 87 patients who were diagnosed with single-level lumbar disc herniation (LDH) and received surgery of TLIF (group X, n = 43) or endoscopic discectomy (group F, n = 44) were retrospectively analyzed. X-ray, MRI, CT and clinical symptoms were recorded before operation and at the last follow-up. The neurological function was originally evaluated by the (JOA) score of the Japanese Orthopaedic Association. Radiological evaluation included the height of intervertebral space (HIS), intervertebral foramen height (FH), intervertebral foramen area (FA), lumbar lordosis (CA) and intervertebral disc degeneration pfirrmann score.Results There was no significant difference in average operation age, JOA improvement rate, reoperation rate and complications between the two groups. The average blood loss, average hospital stays and average operation time in group F were lower than those in group X. During the last follow-up, HIS, CA and FA decreased in both groups, and the changes in group X were more significant than those in group X (P < 0.05). There was no significant difference in postoperative FH between the two groups, but it decreased more in group X (P < 0.05).Conclusion Both TLIF and endoscopic surgery can achieve good results in the treatment of LDH, but the risk of lumbar adjacent segment degeneration after intervertebral foraminal surgery is lower.

scholarly journals A Modified Method to Treat Severe Asymptomatic Pre-existing Degeneration of Adjacent Segment: A Retrospective Case-Control Study

2020 ◽  
Author(s):  
Xinliang Zhang ◽  
Jinwen Zhu ◽  
Yibing Li ◽  
Dingjun Hao ◽  
Wenjie Gao
Keyword(s):  
Interbody Fusion ◽  
Operation Time ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Retrospective Case ◽  
Modified Method ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background: Pre-existing degeneration of adjacent segment is an important risk factor for adjacent segment degeneration (ASD), but limited and controversial studies have addressed its management.Methods: Patients with symptomatic degeneration of the L5/S1 segment warranting surgical interference and severe asymptomatic degeneration of the L4/5 segment were retrospectively analyzed. Among them, those who underwent interbody fusion in the causative (L5/S1) segment and distraction of the intervertebral space and facet fusion in the adjacent L4/5 segment were included as Group A (n=103). Patients who underwent interbody fusion in both L5/S1 and L4/5 segments were included as Group B (n=81). Clinical and radiographic outcomes were evaluated.Results: Mean follow-up was 58.5 months (range, 48-75 m). No significant difference in clinical outcomes or the incidence of adjacent segment degeneration in L3/4 segment was found between Groups A and B. Compared with Group B, less bleeding (315±84 vs. 532±105 ml), shorter operation time (107±34 vs. 158±55 min) and lower costs (13,830±2640 vs. 16,020±3380 US$) were found in Group A (P<0.05). In Group A, disc height ratio (DHR) of L4/5 segment was significantly increased from preoperative value of 0.40±0.13 to last follow-up value of 0.53±0.18 (P<0.05), while the degree of canal stenosis (DCS) was decreased from preoperative value of 34.3±11.2% to last follow-up value of 15.9±9.3% (P<0.05). Conclusions: This modified method could be effective in treating severe asymptomatic pre-existing degeneration of adjacent segment in lumbar spine.

scholarly journals A modified method to treat severe asymptomatic pre‐existing degeneration of adjacent segment: a retrospective case‐control study

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xinliang Zhang ◽  
Jinwen Zhu ◽  
Yibing Li ◽  
Dingjun Hao ◽  
Wenjie Gao
Keyword(s):  
Interbody Fusion ◽  
Operation Time ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Retrospective Case ◽  
Modified Method ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background Pre-existing degeneration of adjacent segment is an important risk factor for adjacent-segment degeneration (ASD), but only limited and controversial studies have addressed its management. Methods We retrospectively analyzed patients with symptomatic degeneration of the L5/S1 segment warranting surgical interference and severe asymptomatic degeneration of the L4/5 segment. Of these patients, those who underwent interbody fusion of the causative (L5/S1) segment and distraction of the intervertebral space and facet fusion of the adjacent L4/5 segment were included in Group A (n = 103), while those who underwent interbody fusion of both the L5/S1 and L4/5 segments were included in Group B (n = 81). Clinical and radiographic outcomes were evaluated. Results Mean follow-up time was 58.5 months (range, 48–75 months). We found no significant difference in clinical outcomes or incidence of ASD in the L3/4 segment between Groups A and B. Compared with Group B, Group A experienced less bleeding (315 ± 84 ml vs. 532 ± 105 ml), shorter operation time (107 ± 34 min vs. 158 ± 55 min) and lower costs (US $13,830 ± $2640 vs. US $16,020 ± $3380; P < 0.05). In Group A, the disc height ratio (DHR) of the L4/5 segment was significantly increased from a preoperative value of 0.40 ± 0.13 to a last–follow-up value of 0.53 ± 0.18 (P < 0.05), while the degree of canal stenosis (DCS) was decreased from a preoperative value of 34.3 ± 11.2% to a last–follow-up value of 15.9 ± 9.3 % (P < 0.05). Conclusions This modified method could be effective in treating severe asymptomatic pre-existing degeneration of adjacent segment in the lumbar spine.

scholarly journals A New Method to Treat Severe Asymptomatic Pre-existing Degeneration of Adjacent Segment: a Retrospective Case-control Study

2019 ◽  
Author(s):  
Wenjie Gao ◽  
Xinliang Zhang ◽  
Jinwen Zhu ◽  
Zhen Chang ◽  
Yibing Li ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Operation Time ◽  
Adjacent Segment Degeneration ◽  
New Method ◽  
Adjacent Segment ◽  
Retrospective Case ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background Pre-existing degeneration of adjacent segment is an important risk factor for adjacent segment degeneration (ASD), but limited and controversial studies have addressed its management. Methods Patients with symptomatic degeneration of the L5/S1 segment warranting surgical interference and severe asymptomatic degeneration of the L4/5 segment were retrospectively analyzed. Among them, those who underwent interbody fusion in the causative (L5/S1) segment and distraction of the intervertebral space and facet fusion in the adjacent L4/5 segment were included as Group A (n=103). Patients who underwent interbody fusion in both L5/S1 and L4/5 segments were included as Group B (n=81). Clinical and radiographic outcomes were evaluated. Results Mean follow-up was 58.5 months (range, 48-75 m). No significant difference in clinical outcomes or the incidence of adjacent segment degeneration in L3/4 segment was found between Groups A and B. Compared with Group B, less bleeding (315±84 vs. 532±105 ml), shorter operation time (107±34 vs. 158±55 min) and lower costs (13,830±2640 vs. 16,020±3380 US$) were found in Group A (P<0.05). In Group A, disc height ratio (DHR) of L4/5 segment was significantly increased from preoperative value of 0.40±0.13 to last follow-up value of 0.53±0.18 (P<0.05), while the degree of canal stenosis (DCS) was decreased from preoperative value of 34.3±11.2% to last follow-up value of 15.9±9.3% (P<0.05). Conclusions This new method could be effective in treating severe asymptomatic pre-existing degeneration of adjacent segment in lumbar spine.

scholarly journals A Modified Method to Treat Severe Asymptomatic Pre-Existing Degeneration of Adjacent Segment: A Retrospective Case-Control Study

2020 ◽  
Author(s):  
Xinliang Zhang ◽  
Jinwen Zhu ◽  
Yibing Li ◽  
Dingjun Hao ◽  
Wenjie Gao
Keyword(s):  
Interbody Fusion ◽  
Operation Time ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Retrospective Case ◽  
Modified Method ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background: Pre-existing degeneration of adjacent segment is an important risk factor for adjacent segment degeneration (ASD), but limited and controversial studies have addressed its management.Methods: Patients with symptomatic degeneration of the L5/S1 segment warranting surgical interference and severe asymptomatic degeneration of the L4/5 segment were retrospectively analyzed. Among them, those who underwent interbody fusion in the causative (L5/S1) segment and distraction of the intervertebral space and facet fusion in the adjacent L4/5 segment were included as Group A (n=103). Patients who underwent interbody fusion in both L5/S1 and L4/5 segments were included as Group B (n=81). Clinical and radiographic outcomes were evaluated.Results: Mean follow-up was 58.5 months (range, 48-75 m). No significant difference in clinical outcomes or the incidence of adjacent segment degeneration in L3/4 segment was found between Groups A and B. Compared with Group B, less bleeding (315±84 vs. 532±105 ml), shorter operation time (107±34 vs. 158±55 min) and lower costs (13,830±2640 vs. 16,020±3380 US$) were found in Group A (P<0.05). In Group A, disc height ratio (DHR) of L4/5 segment was significantly increased from preoperative value of 0.40±0.13 to last follow-up value of 0.53±0.18 (P<0.05), while the degree of canal stenosis (DCS) was decreased from preoperative value of 34.3±11.2% to last follow-up value of 15.9±9.3% (P<0.05). Conclusions: This modified method could be effective in treating severe asymptomatic pre-existing degeneration of adjacent segment in lumbar spine.

scholarly journals Predicting factors of adjacent segment degeneration after long-segment spinal fusion: spinopelvic parameters analysis

2020 ◽  
Author(s):  
Ping-Yeh Chiu ◽  
Fu-Cheng Kao ◽  
Wen-Jer Chen ◽  
Chia-Wei Yu ◽  
Chi-Chien Niu ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Lumbar Fusion ◽  
Adjacent Segment Degeneration ◽  
Control Group ◽  
Sacral Slope ◽  
Adjacent Segment ◽  
Spinopelvic Parameters ◽  
Significant Difference ◽  
Adjacent Disc

Abstract Background We investigated whether spinopelvic parameters are important prognostic factors causing adjacent segment degeneration (ASD) after long instrumented spinal fusion for degenerative spinal disease. Methods This uncontrolled, randomized, single arm retrospective study included patients who underwent long instrumented lumbar fusion (fusion levels≥ 4) in the past 5 years with follow-up for at least 2 years. The inclusion criteria included adult patients (≥40 years of age) with a diagnosis of spinal degeneration who underwent instrumented corrective surgery. The exclusion criteria included preexisting adjacent disc degeneration, combined anterior reconstructive surgery, and distal ASD. Clinical and operative characters were evaluated. Angle of lumbar lordosis (LLA), sacral slope (SSA), pelvic tilt (PTA) and pelvic incidence (PIA) were compared preoperatively, postoperatively and at the final follow-up. Results From 2009 to 2014, 60 patients (30 ASD and 30 non-ASD) were enrolled. The average age was 66.82 ± 7.48 years for the study group and 67.97 ± 7.81 years for the control group. There was no statistically significant difference in clinical and operative characteristics. Among all spinopelvic parameters, only pre-, post-operative and final follow-up PIA in ASD group (53.9±10.4ﾟ, 54.6±14.0ﾟ, 54.3±14.1ﾟ) and non-ASD group (60.3±13.0ﾟ, 61.8±11.3ﾟ, 62.5±11.2ﾟ) showed statistically significant differences ( p <0.05). Conclusion This study confirms that preoperative, postoperative and final follow-up PIA is a significant factor contributing to the development of ASD after long instrumented spinal fusion.

Use of zero-profile device for contiguous three-level anterior cervical discectomy and fusion: comparison with cage and plate construct

2021 ◽  
pp. 1-8
Author(s):  
Zhipeng Chen ◽  
Shuizhong Cen ◽  
Jionglin Wu ◽  
Rui Guo ◽  
Zhenhua Liu ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Sagittal Alignment ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Patient Choice ◽  
Adjacent Segment ◽  
Radiographic Findings ◽  
Significant Difference ◽  
Patient Reported

OBJECTIVE The aim of this study was to compare a traditional cervical cage with a zero-profile (ZP) fixation device in patients who underwent three-level anterior cervical decompression and fusion (ACDF) in terms of patient-reported outcomes (visual analog scale [VAS], Japanese Orthopaedic Association [JOA], and Neck Disability Index [NDI] scores), radiographic findings (sagittal alignment 2 years after surgery and likelihood of fusion), and complications. METHODS This study was a retrospective case series. Between January 2012 and December 2016, 58 patients with cervical spondylotic myelopathy (CSM) who required three-level ACDF procedures, as identified by spinal surgeons, were treated with three-level ACDF and an anterior cage-plate construct (ACPC) (n = 38) or a three-level stand-alone ZP device (n = 20). On the basis of patient choice, patients were divided into two groups (ACPC group and ZP group). All patients completed a minimum of 2 years of follow-up. Patient-reported outcome scores included VAS, JOA, and NDI scores. The radiographic findings included sagittal alignment and likelihood of fusion 2 years after surgery. Data related to patient-reported outcomes and sagittal alignment were collected preoperatively, postoperatively, and at the final follow-up. Intraoperative and postoperative complications were also documented and analyzed. RESULTS The clinical outcomes, including VAS, JOA, and NDI scores, showed improvement in both groups, and no significant difference was observed between the two groups. Sagittal alignment and height of the fused segments were restored in all patients. However, the authors found no differences between the ZP and ACPC groups, and the groups exhibited similar fusion rates. The authors found no differences in complications, including dysphagia, adjacent-segment degeneration, and postoperative hematoma, between the groups. CONCLUSIONS Use of ZP implants yielded satisfactory long-term clinical and radiological outcomes that were similar to those of the standard ACPC. Additionally, the rates of complications between the groups were not significantly different. Although the best surgical option for multilevel CSM remains controversial, the results of this work suggest that ACDF with the ZP device is feasible, safe, and effective, even for multilevel CSM.

scholarly journals Is the improvement of cervical alignment really essential after three-level anterior cervical discectomy and fusion? A minimal 5-year follow-up

2020 ◽  
Author(s):  
Yan Liang ◽  
Shuai Xu ◽  
Guanjie Yu ◽  
Zhenqi Zhu ◽  
Haiying Liu
Keyword(s):  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Adjacent Segment Degeneration ◽  
Anterior Cervical Discectomy ◽  
Adjacent Segment ◽  
Cervical Discectomy ◽  
Cervical Alignment ◽  
Neck Disability

Abstract Purpose: To identify the importance of sagittal alignment with self-locked stand-alone cage (SSC) and anterior cage-with-plate (ACP) system after 3-level anterior cervical discectomy and fusion (ACDF) on cervical spondylotic myelopathy (CSM) after minimal 5-year follow-up.Methods: 38 patients with SSC system (SSC group) and 26 with ACP system (ACP group) from February 2007 to September 2013 were enrolled. Cervical alignment were C2-7 lordosis (CL), operated-segment CL (OPCL), upper and lower adjacent-segment CL (UCL and LCL) at preoperation (POP), immediate postoperation (IPO) and final follow-up (FFU). Clinical outcomes contained the neck disability index (NDI), the Japanese Orthopaedic Association (JOA) score and adjacent segment degeneration (ASD). Patients were divides into CL improved subgroup (IM subgroup) and non-improved subgroup (NIM subgroup).Results: There were improvements on CL and OPCL in both groups. The change of CL and OPCL larger in ACP group (P<0.05) but UAL and LAL were of no significance. NDI and JOA got improvement in both groups at IPO and FFU while ASD was in no difference between SSC and ACP. A total of 40 patients (18 vs 22) acquired CL improvement with a larger population in ACP group. There were no differences on the rate if ASD, NDI, JOA and their change between IM and NIM subgroup and the change of CL were not correlated with NDI, JOA and their change.Conclusion: SSC and ACP both provide long-term efficacy on OPCL correction with little impact on adjacent segment. The improvement of CL after three-level ACDF seems not so essential.

scholarly journals Surgical Strategy and Clinical Efficacy Analysis of Adjacent Segment Disease After Anterior Cervical Discectomy and Fusion

2020 ◽  
Author(s):  
Yangyang Chen ◽  
Guofu Pi ◽  
Yu Han ◽  
Jianguang Sun ◽  
Shilei Huang ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Operation Time ◽  
Adjacent Segment ◽  
Intraoperative Blood Loss ◽  
Titanium Plate ◽  
Intervertebral Fusion ◽  
Plate Group ◽  
Significant Difference

Abstract Background: There are relatively few studies on the treatment of symptomatic adjacent segment disease(ASD) after anterior cervical discectomy and fusion(ACDF). The purpose of this study to compare the clinical efficacy of zero-profile(zero-p) intervertebral fusion and titanium plate combined with cage fusion for treating ASD after ACDF. Methods: Retrospective analysis was performed on patients who underwent ACDF and readmission due to concurrent symptomatic ASD from October 2014 to June 2019. Among them, 12 cases underwent anterior cervical decompression with zero-p intervertebral fusion (zero-p group), and 14 cases underwent anterior cervical decompression with titanium plate combined with cage fusion (titanium plate group). Operative time, intraoperative blood loss, postoperative Japanese 0rthopaedic Association (JOA) score, visual analogue scale (VAS) scores, neck disability index (NDI), dysphagia Bazaz grade, bone graft fusion Eck grade, C2-C7 Cobb Angle, and related complications were compared between the two groups. Results: The intraoperative blood loss difference between the two groups was not statistically significant (P>0.05). The operation time of the zero-p group was shorter than that of the titanium plate group, with significant differences(P<0.05). The Bazaz classification of dysphagia in the zero-p group was superior to the titanium plate group 1 month after the operation, and the difference was statistically significant (P<0.05); However, there was no statistically significant difference between the two groups in the Bazaz classification of dysphagia and the bone graft fusion Eck grade at the last follow-up (P>0.05). At the last follow-up, the JOA score, VAS score, NDI index, C2-C7 Cobb Angle were significantly different between the zero-P group and the titanium plate group (P<0.05). However, no significant difference was found between the two groups (P>0.05). During the follow-up period, all the patients did not have a rupture of the settler screw and esophageal injury and other related diseases.Conclusions: Both methods can achieve good clinical efficacy in the treatment of symptomatic ASD, and can restore and maintain the physiological curvature of the cervical spine to a certain extent. However, the advantages of zero-p intervertebral fusion including shorter operation time, reducing soft tissue injury, and less postoperative dysphagia.

scholarly journals Pretic-I was a safe and effective artificial cervical disc prosthesis--a retrospective and comparative study with 5-year follow-up

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yingjun Guo ◽  
Hao Liu ◽  
Jianzhong Xu ◽  
Yuxiao Deng ◽  
Xiaoliang Tao ◽  
...  
Keyword(s):  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Operation Time ◽  
Cervical Disc ◽  
Adjacent Segment ◽  
Clinical Parameters ◽  
High Grade ◽  
Disc Prosthesis ◽  
Cervical Disc Prosthesis

Abstract Background The newly designed cervical disc prosthesis, Pretic-I, had been finished its limited clinical use for over 5 years. At a short-term follow-up of 2 years, we obtained satisfactory clinical results. The long-term clinical efficacy and safety of Pretic-I will now be analyzed. Methods Peri-operative parameters included intra-operative blood loss, operation time, off-bed time. Clinical parameters included visual analogue scale (VAS) for arm and neck, neck disability index (NDI), and Japanese Orthopaedic Association (JOA) score. Radiological parameters included C2–7 Cobb angle, Shell angle, and the range of motion (ROM) of C2–7, functional segment unit (FSU), and adjacent FSU. The CDA-related complications included adjacent segment degeneration (ASDeg), adjacent segment disease (ASDis), heterotopic ossification (HO), prosthesis subsidence, prosthesis displacement, and dysphagia. Results A total 64 patients from two independent centers received a single-level CDA with Discover (n = 32) and Pretic-I (n = 32), and all of patients finished a 5-year follow-up. There’re no significant differences between two groups in peri-operative parameters. The clinical parameters improved greatly in Pretic-I group (p<0.0001), and there’s no statistical difference from Discover group. Furthermore, Pretic-I could slightly improve the cervical curvature (15.08 ± 11.75 to 18.00 ± 10.61, p = 0.3079) and perfectly maintain the Shell angle (3.03 ± 3.68 to 2.23 ± 4.10, p = 0.1988), cervical ROM (52.48 ± 14.31 to 53.30 ± 11.71, p = 0.8062) and FSU ROM (12.20 ± 4.52 to 10.73 ± 4.45, p = 0.2002). The incidence of high-grade HO (Grade III-IV) at the final follow-up was significantly lower in Pretic-I group than in Discover group (12.50% vs. 34.38%, p = 0.0389, Statistical Power = 95.36%). The incidences of other CDA-related complications in Pretic-I group were also well-accepted, comparable to the Discover group, without significant differences. Conclusion CDA with Pretic-I demonstrated a well-accepted and sustained clinical outcome, with a significantly lower incidence of high-grade HO. This newly designed prosthesis is expected to become an alternative choice for cervical disc prosthesis in the future.

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