scholarly journals Optimal Time Period of Wearing Protective Collar after Anterior Cervical Discectomy and Fusion

Author(s):  
Qian Y ◽  
◽  
Yu Z ◽  
Liu Z ◽  
Duan W ◽  
...  

Objective: There is still no consensus on the time period of wearing protective collar after Anterior Cervical Discectomy and Fusion (ACDF). We aim to investigate the optimal time period of wearing collar after ACDF. Methods: We retrospectively reviewed patients with cervical spondylosis who underwent one or two segment ACDF during January 2016 and December 2017, and included 97 patients who met inclusion and exclusion criteria. Patients were divided into three groups, 1-4 week group, 5-8 week group and 9-12 week group, according to the actual time period of wearing collar after ACDF. We analyzed Japanese Orthopedic Association (JOA) score, Axial Symptom (AS) score and Neck Disability Index (NDI) before surgery and at post-operative 3 months to investigate the optimal time period of wearing collar after ACDF procedure. Results: 1) JOA score: All three groups have a better post-operative JOA score compared with that before surgery (paired t test, p<0.05). There is no significant difference among the three groups with respect to post-operative JOA (ANOVA, p>0.05). 2) AS score: The post-operative AS scores of 1-4 week group and 5-8 week group were significantly better than that before surgery (paired t test, p>0.05). While the post-operative AS score of 9-12 week group was significantly worse than preoperative AS score (paired t test, p<0.05). 3) NDI: All three groups have a better post-operative NDI compared with that before surgery (McNemar test, p<0.05). Of note, in 5-8 weeks group, the percentage of no deficit increased by 45%, and the percentage of mild deficit decreased by 45% accordingly. That percentage is 26% and 31% in 1-4 week group and 9-12 week group, respectively. There was significant difference among these three groups (Fisher’s exact probability test, p<0.05). Conclusion: For cervical spondylosis patients who underwent 1 or 2 segment ACDF, the optimal time period of wearing protective is 5-8 weeks. This time period results in comparable neurological outcome, least risk of axial symptoms, and highest chance of no deficit with neck function.

2020 ◽  
Author(s):  
Yu Qian ◽  
Zhiwei Yu ◽  
Zhenlei Liu ◽  
Wanru Duan ◽  
Zhongjing Zhao ◽  
...  

Abstract Background: There is still no consensus on the time period of wearing collar after anterior cervical discectomy and fusion (ACDF). We aim to investigate the optimal time period of wearing protective collar.Methods: We retrospectively reviewed patients with cervical spondylosis who underwent one to two segment ACDF during January 2016 and December 2017, and included 97 patients who meet inclusion and exclusion criterion. Patients were divided into three groups according to the actual time period of wearing collar after ACDF including 1-4 week group, 5-8 week group, and 9-12 week group. We analyzed Japanese Orthopedic Association (JOA) score, Axial Symptom (AS) score and Neck Disability Index (NDI) before surgery and at post-operative 3 months to investigate the optimal time period of wearing collar.Results: JOA score: All three groups have a better post-operative JOA score compared with that before surgery (paired t test, p<0.05). There is no significant difference among the three groups with respect to post-operative JOA (ANOVA, p>0.05).AS score: The post-operative AS scores of 1-4 week group and 5-8 week group were significantly better than that before surgery (paired t test, p>0.05). While the post-operative AS score of 9-12 week group was significantly worse than preoperative AS score (paired t test, p<0.05).NDI: All three groups have a better post-operative NDI compared with that before surgery (McNemar test, p<0.05). Of note, in 5-8 week group, the percentage of no deficit increased by 45%, and the percentage of mild deficit decreased by 45% accordingly. That percentage is 26% and 31% in 1-4 week group and 9-12 week group, respectively. There was significant difference among these three groups (Fisher's exact probability test, p<0.05)Conclusions: For cervical spondylosis patients who underwent 1-2 segment ACDF, the optimal time period of wearing protective is 5-8 weeks. This time period results in comparable neurological outcome, least axial symptom risk, and highest chance of no deficit on neck function.


2018 ◽  
Vol 51 (4) ◽  
pp. 173
Author(s):  
Vita Previa Indirayana ◽  
Gita Gayatri ◽  
N. R. Yuliawati Zenab

Background: Model analysis constitutes an essential aspect of orthodontic diagnostic practice. Pavan has developed an application to simplify the mathematical calculations employed in orthodontic model analysis. Purpose: This study was conducted to obtain the differences in results and time periods of model analysis using conventional means and iModelAnalysis. Methods: The research represented a comparative analytic study. The populations comprised dental casts dating from 2014 in the Orthodontics Laboratory of Padjadjaran University. The samples comprised 31 dental casts which were subjected to a total sampling method consisting of two treatments; a conventional method calculation and one using iModelAnalysis. A normality test was conducted and processed using a paired t-test with α=0.05. Results: The means of arch length discrepancies were 1.64±2.63 mm and 1.37±3.07 mm for the conventional methods and 1.65±2.43mm and 1.42±3.04mm for iModelAnalysis. The results of a Bolton analysis for conventional methods were 78.05±2.69% and 91.93±1.29%, while those for iModelAnalysis were 77.91±2.70% and 91.96±2.13%. A Howes analysis of conventional methods produced a result of 45.56±2.83%, while for an iModelAnalysis one of 45.56±2.85%. Pont analysis for conventional methods was 39.35±0.04 mm and 49.17±2.55 mm, while for iModelAnalysis it was 39.35±0.07 mm and 49.19±2.57mm. The mean of the duration of analysis using conventional methods was 1703.81±56.46 seconds, while for iModelAnalysis it was 990.06±34.87 seconds. A normality test confirmed that the data was normally distributed (p>0.05). The results of a paired sample t-test with p>0.05 showed that there was no significant difference between the results of each analysis, while there was significant difference in the time period of analysis. Conclusion: There was no difference in the analysis results. However, there was difference in the time period of analysis between conventional methods and that of iModelAnalysis.


2014 ◽  
Vol 21 (2) ◽  
pp. 217-222 ◽  
Author(s):  
Rudolph J. Schrot ◽  
Jesna S. Mathew ◽  
Yueju Li ◽  
Laurel Beckett ◽  
Hyun W. Bae ◽  
...  

Object The authors analyzed headache relief after anterior cervical discectomy. Headache may be relieved after anterior cervical discectomy, but the mechanism is unknown. If headaches were directly referred from upper cervical pathology, more headache relief would be expected from surgery performed at higher cervical levels. If spinal kinesthetics were the mechanism, then headache relief may differ between arthroplasty and fusion. Headache relief after anterior cervical discectomy was quantified by the operated disc level and by the method of operation (arthroplasty vs arthrodesis). Methods The authors performed a post hoc analysis of an artificial disc trial. Data on headache pain were extracted from the Neck Disability Index (NDI) questionnaire. Results A total of 260 patients underwent single-level arthroplasty or arthodesis. Preoperatively, 52% reported NDI headache scores of 3 or greater, compared with only 13%–17% postoperatively. The model-based mean NDI headache score at baseline was 2.5 (95% CI 2.3–2.7) and was reduced by 1.3 points after surgery (95% CI 1.2–1.4, p < 0.001). Higher cervical levels were associated with a greater degree of preoperative headache, but there was no association with headache relief. There was no significant difference in headache relief between arthroplasty and arthrodesis. Conclusions Most patients with symptomatic cervical spondylosis have headache as a preoperative symptom (88%). Anterior cervical discectomy with both arthroplasty and arthrodesis is associated with a durable decrease in headache. Headache relief is not related to the level of operation. The mechanism for headache reduction remains unclear.


2019 ◽  
Vol 10 ◽  
pp. 246
Author(s):  
Seokchun Lim ◽  
Sameah Haider ◽  
Hesham Zakaria ◽  
Victor Chang

Background: Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure to address cervical myeloradiculopathy. However, 30-day outcomes after additional plating/instrumentation are not very clear. Methods: The authors reviewed The National Surgical Quality Improvement Program database to identify all elective ACDF cases with or without instrumentation for patients having cervical spondylosis with or without myelopathy from 2011 to 2013 using current procedural terminology and International Classification of Disease-9 codes. We identified 2352 cases and subdivided these into two cohorts based on instrumentation procedures (588 cases without instrumentation and 1764 cases with instrumentation). Baseline differences in two cohorts were adjusted by propensity score matching analysis, yielding well-matched 583 pairs. Results: Following propensity matching, the authors observed no significant difference in 30-day complication rates (prematch, 2.4% vs. 2.4%; and postmatch, 2.4% vs. 1.7%), readmission (prematch, 4.1% vs. 3.2%; and postmatch, 3.9% vs. 3.3%), and reoperation (prematch 0.9% vs. 1.8%; and postmatch 0.9% vs. 1.5%). Conclusion: Our results demonstrate similar 30-day outcomes in both cohorts and suggest that instrumentation can be safely implemented in the setting of ACDF.


2021 ◽  
Author(s):  
Xusheng Li ◽  
Xuehua Zhan ◽  
Long Chang ◽  
Yongdong Qiao ◽  
Huiqiang Ding ◽  
...  

Abstract Background. Anterior cervical discectomy and fusion with instrumentation (ACDFI) have been widely used in the treatment of the degenerative disease or traumatic instability of the cervical spine. This study aimed to investigate the clinical efficacy of the autologous vertebral-filled polyetheretherketone (PEEK) cage in anterior cervical discectomy and fusion with instrumentation (ACDFI).Material and Methods. The clinical data of 368 patients who received ACDFI from September 2015 to September 2020 were retrospectively analyzed. According to the material that filled PEEK cage during the surgery, the patients were divided into two groups, the autologous vertebrate group (n = 185) and the autologous iliac group (n = 183). The operative time, operative blood loss, postoperative complications in two groups were recorded and analyzed. The bone graft fusion and postoperative functional outcomes, including scores of modified Japanese Orthopedic Association score (mJOA), Neck Disability Index (NDI), and visual analog scale (VAS) were compared.Results. Patients were followed-up for 14.04 ± 0.98 months. At a 6-months follow-up, the rate of spinal fusion was 96.29% (178/185) in the vertebral group and 95.94% (176/183) in the iliac group, there was no statistically significant difference between the two groups (P>0.05). The postoperative VAS, mJOA, and NDI scores were not significantly different between two groups during the follow-up (P>0.05). The operative time and blood loss in the vertebral group were significantly less than that of the iliac group (P<0.01). In the iliac group, all patients suffered pain in the iliac donor site, 65 patients suffered numbness, 12 patients had fat liquefaction in donor incision, while all patients in the vertebral group had no postoperative complications. Conclusion. The autologous vertebrae-filled PEEK cage can achieve the same clinical outcome as the autologous iliac, but the autologous vertebrae filled PEEK cage have the advantage of shorter operative time, less intraoperative blood loss, and postoperative complications.


Author(s):  
Adeleh Sadeghloo ◽  
Parna Shamsaee ◽  
Elham Hesari ◽  
Golbanhar Akhondzadeh ◽  
Hamid Hojjati

Abstract Introduction Thalassemia, as the most common chronic hereditary blood disorder in humans, can impose many adverse effects on parents and their affected children. On the other hand, positive thinking is the method or the result of a positive focus on a constructive issue, so by teaching positive thinking, we can improve physical and social function, and promote emotional health and overall quality of life. The aim of this study was to determine the effect of positive thinking training on the quality of life of parents of adolescents with thalassemia. Methods This quasi-experimental study was performed on 52 parents of adolescents with thalassemia who attended Taleghani Hospital in Golestan province, Iran in 2017. Samples were randomly assigned into two groups of intervention and control. The positive thinking training (based on the theory of Martin Seligman) was carried out in the intervention group in 10 (45–60 min) sessions over a 5-week period. Data collection tools in this study were the World Health Organization (WHO) quality of life questionnaire (WHOQOL-BREF) and a demographic information questionnaire. Data were analyzed by SPSS-16 software using independent t-test, the paired t-test and a covariance test. Results The results of paired t-test showed a significant difference in the score of quality of life in intervention group before and after the intervention (p < 0.001). However, this test did not show any significant difference in the control group (p = 0.11). The covariance test, after removing the pre-test score, showed a significant difference between the intervention and control groups in terms of the score of quality of life, so that 13% of the changes after the intervention were due to the intervention (p = 0.009, η = 0.13). Conclusion The positive thinking training increased the quality of life of parents of adolescents with thalassemia. Therefore, using this program can be an effective way of improving the quality of life of parents. Thus, positive thinking training is suggested to be used as an effective strategy for increasing the quality of life of parents with ill children.


Author(s):  
Pooja A Mulchandani ◽  
Trupti Warude ◽  
Amrutkuvar Pawar

Objectives: To compare the effect of gluteal muscle strengthening along with conventional exercises versus conventional exercises alone on flat foot.Method: An experimental study conducted at Physiotherapy Department of Krishna Institute of Medical Sciences, Karad. A total of 52 subjects were equally divided into two groups using convenient sampling with random allocation (Groups A and B). Baseline treatment was given to both groups (intrinsic muscle strengthening). Group A was given intrinsic muscle strengthening alone while Group B was given gluteal muscle strengthening along with intrinsic muscle strengthening.Result: Statistical analysis was performed using paired t-test and unpaired t-test. In pre-intervention there was no statistically significant difference seen with p values for the navicular drop was 0.3563 and for Ink test was 0.7342. While on comparing the post-interventional values, the results between the two groups using paired t-test revealed that there was extremely significant difference seen with p-value for the navicular drop was <0.0001 and for Ink test was <0.0001.Conclusion: From the study, it can be concluded that there was a significant effect of gluteal muscle strengthening on the flat foot.


2017 ◽  
Vol 24 (8) ◽  
pp. 1126-1130 ◽  
Author(s):  
Neda Sattarnezhad ◽  
Samantha Farrow ◽  
Dorlan Kimbrough ◽  
Bonnie Glanz ◽  
Brian Healy ◽  
...  

Background: Visual symptoms are common in multiple sclerosis (MS). Low-contrast visual acuity (LCVA) testing using Sloan charts has demonstrated increased sensitivity for visual deficits compared to high-contrast acuity testing. Computerized testing of visual acuity may facilitate use in the clinic setting. Objectives: To evaluate the agreement between an iPad-based and Sloan testing of LCVA in a cohort of MS patients. Methods: A total of 38 patients with relapsing-remitting MS were enrolled after providing informed written consent at Partners MS Center, Brigham and Women’s hospital. Monocular LCVA was measured using retroilluminated Sloan chart and iPad-based LogMAR chart. Number of correct letters and agreement between two measurements were assessed for each eye using Bland–Altman analysis and paired t-test. Results: For both eyes, there was no significant difference in number correct between the two measurements using a paired t-test, and there was high correlation between two measurements (oculus dextrus (OD) r = 0.89, p < 0.001; oculus sinister (OS) r = 0.78, p < 0.001). The limits of agreement were −7.9 to +8.5 letters for the right eye and −10.9 to +11.2 letters for the left eye. Conclusion: An iPad-based LCVA test shows good agreement with Sloan testing in MS patients.


2013 ◽  
Vol 19 (5) ◽  
pp. 527-531 ◽  
Author(s):  
Myles Luszczyk ◽  
Justin S. Smith ◽  
Jeffrey S. Fischgrund ◽  
Steven C. Ludwig ◽  
Rick C. Sasso ◽  
...  

Object Although smoking has been shown to negatively affect fusion rates in patients undergoing multilevel fusions of the cervical and lumbar spine, the effect of smoking on fusion rates in patients undergoing single-level anterior cervical discectomy and fusion (ACDF) with allograft and plate fixation has yet to be thoroughly investigated. The objective of the present study was to address the effect of smoking on fusion rates in patients undergoing a 1-level ACDF with allograft and a locked anterior cervical plate. Methods This study is composed of patients from the control groups of 5 separate studies evaluating the use of an anterior cervical disc replacement to treat cervical radiculopathy. For each of the 5 studies the control group consisted of patients who underwent a 1-level ACDF with allograft and a locked cervical plate. The authors of the present study reviewed data obtained in a total of 573 patients; 156 patients were smokers and 417 were nonsmokers. A minimum follow-up period of 24 months was required for inclusion in this study. Fusion status was assessed by independent observers using lateral, neutral, and flexion/extension radiographs. Results An overall fusion rate of 91.4% was achieved in all 573 patients. A solid fusion was shown in 382 patients (91.6%) who were nonsmokers. Among patients who were smokers, 142 (91.0%) had radiographic evidence of a solid fusion. A 2-tailed Fisher exact test revealed a p value of 0.867, indicating no difference in the union rates between smokers and nonsmokers. Conclusions The authors found no statistically significant difference in fusion status between smokers and nonsmokers who underwent a single-level ACDF with allograft and a locked anterior cervical plate. Although the authors do not promote tobacco use, it appears that the use of allograft with a locked cervical plate in single-level ACDF among smokers produces similar fusion rates as it does in their nonsmoking counterparts.


2018 ◽  
Vol 2 (02) ◽  
pp. 151
Author(s):  
Devi Yulita Metasari ◽  
Akhmad Hasanuddin ◽  
Dewi Junita Koesoemawati

Laston AC-WC is the outer layer of the pavement that is directly related to the outside, so a strong mixture is required. One of the major effects is the aggregate gradation.This experiment aims to find out the comparison of Laston AC-WC performance between mixtures used aggregat egradation above and below the restriction zone. Each mixture used 6 variations of asphalt content and there were 3 specimens on each variation of bitumen content. The asphalt contents used were 5,5%; 6%; 6,5%; 7%; 7,5% dan 8%. From the results of the experiments, the mixture with the aggregate above the restriction zone at 7% and 7.5% asphalt content had a density value of 2.13 gr / cc and 2.12 gr / cc respectively; VMA value of 15.49% and 15.91%; VFA values ​​of 80.48% and 79.98%; VIM value of 3.16% and 3.18%; stability value of 3013.58 kg and 2332.57 kg; flow value of 2.47 mm and 2.18 mm; as well as MQ values ​​of 1222.25 kg / mm and 1184.59 kg / mm. While on the mixture with the aggregate under the restriction zone in the asphalt content of 7% and 7.5% obtained density value of 2.11 gr / cc and 2.14 gr / cc; VMA value of 17.21% and 16.3%; VFA value of 71.21% and 78.65%; VIM value of 4.99% and 3.49%; stability value of 2518,75 kg and 3234,72 kg; flow values ​​of 2 mm and 2.07 mm; as well as the MQ value of 1259.37 kg / mm and 1623.54 kg / mm. From the results are analyzed Paired T test and found that the value of flow has a significant difference. The high flow rate was found in the mixture with the aggregate above the restriction zone at 7% asphalt content, so this mixture is more durable due to good flexibility. Laston AC-WC merupakan lapisan terluar perkerasan yang berhubungan langsung dengan keadaan luar, sehingga dibutuhkan campuran yang kuat. Salah satu yang berpengaruh besar adalah gradasi agregat yang digunakan. Penelitian ini bertujuan untuk mengetahui perbandingan kinerja laston AC-WC antara campuran yang menggunakan gradasi di atas dengan di bawah daerah larangan. Penelitian ini dilakukan terhadap campuran laston AC-WC. Masing-masing campuran menggunakan 6 variasi kadar aspal dan terdapat 3 benda uji pada setiap kadar aspal. Kadar aspal yang digunakan adalah 5,5%; 6%; 6,5%; 7%; 7,5% dan 8%. Dari hasil penelitian, campuran dengan agregat di atas daerah larangan pada kadar aspal 7% dan 7,5% memiliki nilai density berturut-turut sebesar 2,13 gr/cc dan 2,12 gr/cc; nilai VMA sebesar 15,49% dan 15,91%; nilai VFA sebesar 80,48% dan 79,98%; nilai VIM sebesar 3,16% dan 3,18%; nilai stabilitas sebesar 3013,58 kg dan 2332,57 kg; nilai flow sebesar 2,47 mm dan 2,18 mm; serta nilai MQ sebesar 1222,25 kg/mm dan 1184,59 kg/mm. Sedangkan pada campuran dengan agregat di bawah daerah larangan pada kadar aspal 7% dan 7,5% didapatkan nilai density sebesar 2,11 gr/cc dan 2,14 gr/cc; nilai VMA sebesar 17,21% dan 16,3%; nilai VFA sebesar 71,21% dan 78,65%; nilai VIM sebesar 4,99% dan 3,49%; nilai stabilitas sebesar 2518,75 kg dan 3234,72 kg; nilai flow sebesar 2 mm dan 2,07 mm; serta nilai MQ sebesar 1259,37 kg/mm dan 1623,54 kg/mm. Dari hasil tersebut dilakukan analisa Uji T Berpasangan dan didapatkan bahwa nilai flow memiliki perbedaan yang signifikan. Nilai flow yang tinggi terdapat pada campuran dengan agregat di atas daerah larangan pada kadar aspal 7%, sehingga campuran ini lebih tahan lama dikarenakan memiliki kelenturan yang baik.


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