scholarly journals Establishing the minimum clinically important difference in Neck Disability Index and modified Japanese Orthopaedic Association scores for adult cervical deformity

2020 ◽  
Vol 33 (4) ◽  
pp. 441-445
Author(s):  
Alex Soroceanu ◽  
Justin S. Smith ◽  
Darryl Lau ◽  
Michael P. Kelly ◽  
Peter G. Passias ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Deformity Correction ◽  
Minimum Clinically Important Difference ◽  
Cervical Deformity ◽  
Clinically Important Difference ◽  
Significant Difference ◽  
The Mean ◽  
Neck Disability

OBJECTIVEIt is being increasingly recognized that adult cervical deformity (ACD) is correlated with significant pain, myelopathy, and disability, and that patients who undergo deformity correction gain significant benefit. However, there are no defined thresholds of minimum clinically important difference (MCID) in Neck Disability Index (NDI) and modified Japanese Orthopaedic Association (mJOA) scores.METHODSPatients of interest were consecutive patients with ACD who underwent cervical deformity correction. ACD was defined as C2–7 sagittal Cobb angle ≥ 10° (kyphosis), C2–7 coronal Cobb angle ≥ 10° (cervical scoliosis), C2–7 sagittal vertical axis ≥ 4 cm, and/or chin-brow vertical angle ≥ 25°. Data were obtained from a consecutive cohort of patients from a multiinstitutional prospective database maintained across 13 sites. Distribution-based MCID, anchor-based MCID, and minimally detectable measurement difference (MDMD) were calculated.RESULTSA total of 73 patients met inclusion criteria and had sufficient 1-year follow-up. In the cohort, 42 patients (57.5%) were female. The mean age at the time of surgery was 62.23 years, and average body mass index was 29.28. The mean preoperative NDI was 46.49 and mJOA was 13.17. There was significant improvement in NDI at 1 year (46.49 vs 37.04; p = 0.0001). There was no significant difference in preoperative and 1-year mJOA (13.17 vs 13.7; p = 0.12). Using multiple techniques to yield MCID thresholds specific to the ACD population, the authors obtained values of 5.42 to 7.48 for the NDI, and 1.00 to 1.39 for the mJOA. The MDMD was 6.4 for the NDI, and 1.8 for the mJOA. Therefore, based on their results, the authors recommend using an MCID threshold of 1.8 for the mJOA, and 7.0 for the NDI in patients with ACD.CONCLUSIONSThe ACD-specific MCID thresholds for NDI and mJOA are similar to the reported MCID following surgery for degenerative cervical disease. Additional studies are needed to verify these findings. Nonetheless, the findings here will be useful for future studies evaluating the success of surgery for patients with ACD undergoing deformity correction.

scholarly journals Anterior Controllable Antedisplacement and Fusion (ACAF) technique for the treatment of multilevel cervical spondylotic myelopathy with spinal stenosis (MCSMSS): a retrospective study of 45 cases

2019 ◽  
Author(s):  
Xi Luo ◽  
Kaiqiang Sun ◽  
Jingchuan Sun ◽  
Shunmin Wang ◽  
Yuan Wang ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Cervical Spondylotic Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Operation Time ◽  
Significant Difference ◽  
Csf Leakage ◽  
One Year ◽  
Neck Disability ◽  
Multilevel Cervical Spondylotic Myelopathy

Abstract Background To investigate the clinical effect of anterior controllable antedisplacement and fusion (ACAF) technique for the treatment of multilevel cervical spondylotic myelopathy with spinal stenosis (MCSMSS), and compare ACAF with hybrid decompression fixation (HDF). Methods A retrospective analysis of 85 cases with MCSMSS was carried out. 45 patients were treated with ACAF, while 40 patients were treated with HDF. The operation time, intraoperative bleeding volume, postoperative complications, Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) score, Computed Tomography (CT) transverse measurement, cervical curvature and Kang's grade were compared between two groups. Results The patients were followed up for 12 to 17 months. Compared with HDF, ACAF group achieved better decompression according to CT measurement and Kang’s grade (P < 0.05), and recovered to a greater cervical Cobb’s angle (P < 0.05). However, JOA score and NDI index showed no significant difference one year after surgery (P＞0.05). Additionally, ACAF presented longer operation time and greater intraoperative blood loss (P < 0.05). As to complications, ACAF developed less incidences of cerebrospinal fluid examination (CSF) leakage, neurologic deterioration, epidural hematoma and C5 palsy by comparing with HDF. Conclusions ACAF is an effective method for the treatment of MCSMSS. Compared with HDF, ACAF has the advantages of significant decompression, increasing cervical curvature, and reducing the incidences of complications.

Does Obesity Correlate With Worse Patient-Reported Outcomes Following Elective Anterior Cervical Discectomy and Fusion?

Neurosurgery ◽  
2016 ◽  
Vol 79 (1) ◽  
pp. 69-74 ◽  
Author(s):  
John A. Sielatycki ◽  
Chotai Silky ◽  
Kay Harrison ◽  
David Stonko ◽  
Matthew McGirt ◽  
...  
Keyword(s):  
Scale Score ◽  
Patient Reported Outcomes ◽  
Minimal Clinically Important Difference ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Japanese Orthopaedic Association Score ◽  
Association Score ◽  
Clinically Important Difference ◽  
Patient Reported ◽  
Neck Disability

Abstract BACKGROUND Studies have investigated the impact of obesity in thoracolumbar surgery; however, the effect of obesity on patient-reported outcomes (PROs) following anterior cervical discectomy and fusion (ACDF) is unknown. OBJECTIVE To examine the relationship between obesity and PROs following elective ACDF. METHODS Consecutive patients undergoing ACDF for degenerative conditions were evaluated. Patients were divided into groups with a body mass index ≥35. The EuroQol-5D, Short-Form 12 (SF-12), modified Japanese Orthopaedic Association score, and Neck Disability Index were used. Correlations between PROs and obesity were calculated at baseline and 1 year. RESULTS A total of 299 patients were included, with 80 obese (27%) and 219 nonobese (73%). patients At baseline, obesity was associated with worse myelopathy (modified Japanese Orthopaedic Association score: 10.7 vs 12.2, P = .01), general physical health (SF-12 physical component scale score: 28.7 vs 31.8, P = .02), and general mental health (SF-12 mental component scale score: 38.9 vs 42.3, P = .04). All PROs improved significantly following surgery in both groups. There was no difference in absolute scores and change scores for any PRO at 12 months following surgery. Furthermore, there was no difference in the percentage of patients achieving a minimal clinically important difference for the Neck Disability Index (52% vs 56%, P = .51) and no difference in patient satisfaction (85% vs 85%, P = .85) between groups. CONCLUSION Obesity was not associated with less improvement in PROs following ACDF. There was no difference in the proportion of patients satisfied with surgery and those achieving a minimal clinically important difference across all PROs. Obese patients may therefore achieve meaningful improvement following elective ACDF.

scholarly journals Can segmental mobility be increased by cervical arthroplasty?

2017 ◽  
Vol 42 (2) ◽  
pp. E3 ◽  
Author(s):  
Hsuan-Kan Chang ◽  
Chih-Chang Chang ◽  
Tsung-Hsi Tu ◽  
Jau-Ching Wu ◽  
Wen-Cheng Huang ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Range Of Motion ◽  
Clinical Outcomes ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Cervical Disc ◽  
Segmental Mobility ◽  
Arm Pain ◽  
The Mean ◽  
The Difference

OBJECTIVE Many reports have successfully demonstrated that cervical disc arthroplasty (CDA) can preserve range of motion after 1- or 2-level discectomy. However, few studies have addressed the extent of changes in segmental mobility after CDA or their clinical correlations. METHODS Data from consecutive patients who underwent 1-level CDA were retrospectively reviewed. Indications for surgery were medically intractable degenerative disc disease and spondylosis. Clinical outcomes, including visual analog scale (VAS)–measured neck and arm pain, Neck Disability Index (NDI), and Japanese Orthopaedic Association (JOA) scores, were analyzed. Radiographic outcomes, including C2–7 Cobb angle, the difference between pre- and postoperative C2–7 Cobb angle (ΔC2–7 Cobb angle), sagittal vertical axis (SVA), the difference between pre- and postoperative SVA (ΔSVA), segmental range of motion (ROM), and the difference between pre- and postoperative ROM (ΔROM), were assessed for their association with clinical outcomes. All patients underwent CT scanning, by which the presence and severity of heterotopic ossification (HO) were determined during the follow-up. RESULTS A total of 50 patients (mean age 45.6 ± 9.33 years) underwent a 1-level CDA (Prestige LP disc) and were followed up for a mean duration of 27.7 ± 8.76 months. All clinical outcomes, including VAS, NDI, and JOA scores, improved significantly after surgery. Preoperative and postoperative ROM values were similar (mean 9.5° vs 9.0°, p > 0.05) at each indexed level. The mean changes in segmental mobility (ΔROM) were −0.5° ± 6.13°. Patients with increased segmental mobility after surgery (ΔROM > 0°) had a lower incidence of HO and HO that was less severe (p = 0.048) than those whose ΔROM was < 0°. Segmental mobility (ROM) was significantly lower in patients with higher HO grade (p = 0.012), but it did not affect the clinical outcomes. The preoperative and postoperative C2–7 Cobb angles and SVA remained similar. The postoperative C2–7 Cobb angles, SVA, ΔC2–7 Cobb angles, and ΔSVA were not correlated to clinical outcomes after CDA. CONCLUSIONS Segmental mobility (as reflected by the mean ROM) and overall cervical alignment (i.e., mean SVA and C2–7 Cobb angle) had no significant impact on clinical outcomes after 1-level CDA. Patients with increased segmental mobility (ΔROM > 0°) had significantly less HO and similarly improved clinical outcomes than those with decreased segmental mobility (ΔROM < 0°).

scholarly journals Effect of an intensive cervical traction protocol on mid-term disability and pain in patients with cervical radiculopathy: An exploratory, prospective, observational pilot study

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255998
Author(s):  
Thomas Rulleau ◽  
Sophie Abeille ◽  
Lydie Pastor ◽  
Lucie Planche ◽  
Pascale Allary ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Primary Outcome ◽  
Neck Disability Index ◽  
Neck Region ◽  
Minimum Clinically Important Difference ◽  
Cervical Radiculopathy ◽  
Clinically Important Difference ◽  
Medication Consumption ◽  
Cervical Traction ◽  
Neck Disability

Background Cervical radiculopathy is a relatively common and disabling condition involving local pain in the neck region and pain that radiates into the upper limb. Recent data suggest that cervical traction may effectively reduce disability and pain, with a dose-response relationship. The main aim of this study was therefore to evaluate the mid-term effect of an intensive cervical traction protocol for patients with cervical radiculopathy on disability, and to compare the effects with those reported by non-intensive protocols in the literature. Methods We conducted a prospective open observational study of 36 patients referred by their general practitioner for symptoms suggestive of cervical radiculopathy. All patients underwent the same treatment: a 30-minute cervical traction protocol, twice a day, for five consecutive days. The main objective was the evaluation of disability at 3 months. We evaluated at baseline (D1), the end of the protocol (D5) and at mid-term (M3) disability, cervical pain, radiating pain, pain on motor imagery, presence of neuropathic pain and medication consumption. The primary outcome was the proportion of patients for whom the Neck Disability Index improved by more than the minimum clinically important difference of 7 points by M3. Results Thirty-six patients were included in this study. The Neck Disability Index improved by more than the minimum clinically important difference in 48.3% at M3. Mean Neck Disability Index (p < .001), mean cervical VAS (p < .001), mean radiating VAS (p < .001), and mean VAS for imagined lateral flexion and rotation (p < .002) improved significantly from D1 to D5 and from D1 to M3. Consumption of medication reduced at each time point. The proportion of patients with neuropathic pain reduced from 61.1% at D1 to 33.3% at D5 and 48.3% at M3. Conclusion Disability reduced by more than the minimum clinically important difference in almost half of the participants following the intensive traction protocol. These results are encouraging and suggest that this complex condition can be treated with relatively simple methods.

scholarly journals Comparison of Two Reconstructive Techniques in the Surgical Management of Four-Level Cervical Spondylotic Myelopathy

2015 ◽  
Vol 2015 ◽  
pp. 1-7
Author(s):  
FengNing Li ◽  
ZhongHai Li ◽  
Xuan Huang ◽  
Zhi Chen ◽  
Fan Zhang ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Cervical Spondylotic Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Group A ◽  
Neck Disability ◽  
Cervical Spine Alignment

To compare the clinical efficacy and radiological outcome of treating 4-level cervical spondylotic myelopathy (CSM) with either anterior cervical discectomy and fusion (ACDF) or “skip” corpectomy and fusion, 48 patients with 4-level CSM who had undergone ACDF or SCF at our hospital were analyzed retrospectively between January 2008 and June 2011. Twenty-seven patients received ACDF (Group A) and 21 patients received SCF. Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) score, and Cobb’s angles of the fused segments and C2-7 segments were compared in the two groups. The minimum patient follow-up was 2 years. No significant differences between the groups were found in demographic and baseline disease characteristics, duration of surgery, or follow-up time. Our study demonstrates that there was no significant difference in the clinical efficacy of ACDF and SCF, but ACDF involves less intraoperative blood loss, better cervical spine alignment, and fewer postoperative complications than SCF.

scholarly journals Clinical Validity of the Smallest Oblique Sagittal Area of the Neural Foramen in Patients With Suspected Cervical Spondylotic Radiculopathy

2021 ◽  
Author(s):  
Yukun Jia ◽  
Zhan Peng ◽  
Yuantian Qin ◽  
Jin Li ◽  
Guangye Wang
Keyword(s):  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Japanese Orthopaedic Association Score ◽  
Symptom Improvement ◽  
Neural Foramen ◽  
Treatment Groups ◽  
Vas Score ◽  
Cervical Spondylotic Radiculopathy ◽  
Significant Difference ◽  
Neck Disability

Abstract Objective To evaluate the smallest oblique sagittal area of the neural foramen in detecting cervical spondylotic radiculopathy and to determine its potential significance for treatment decisions. Methods The subjects of the study were patients with cervical spondylotic radiculopathy who visited the spine surgery from 2016 to 2019. All patients were compared according to the minimum oblique sagittal area and the cut-off point value, and they were divided into positive and negative parameters. The changes in neck disability index (NDI), Japanese Orthopaedic Association score (JOA) and visual analog scale (VAS) during the two treatment groups from baseline to at least 24 months of follow-up were compared.Results In the surgery group, there was no significant difference in symptom improvement between patients with positive and negative parameters. In the non-surgical group, for patients with positive parameters, NDI decreased by 2.35, JOA increased by 0.88, and neck VAS score improved by 0.42. For patients with negative parameters, NDI decreased by 10.32, JOA increased by 2.86 on average, and neck VAS score improved by 2.46 points on average (both p＜0.01 on t test).Conclusions In patients undergoing surgery, the symptoms of the patients have been significantly improved after surgery, and the smallest oblique sagittal area of the neural foramen seems to be unable to predict the outcome of the surgery. However, in non-surgical patients, the improvement of symptoms in the stenosis group was more limited. This may imply that surgery may be effective for patients who had positive parameters.

Effectiveness of static and intermittent cervical tractions in the management of patients with chronic non-specific neck pain: A pilot randomised trial

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Nazir Bashir Mukhtar ◽  
Zaharau Ado Sabari ◽  
Bashir Kaka
Keyword(s):  
Neck Pain ◽  
Range Of Motion ◽  
Analogue Scale ◽  
Randomised Trial ◽  
Neck Disability Index ◽  
Pain Disability ◽  
Significant Difference ◽  
Cervical Traction ◽  
The Mean ◽  
Neck Disability

Background: Physiotherapists commonly employ cervical traction for patients with neck pain. There is a dearth of literature on the effects of static and intermittent cervical traction on pain, range of motion and disability among patients with chronic non-specific neck pain. Therefore, this study aims to compare the effect of static and intermittent cervical traction on pain, disability and range of motion among patients with chronic, non-specific neck pain.Methods: Twenty-four participants were randomised into two groups – Static and Intermittent cervical traction respectively. They were recruited from the Aminu Kano Teaching Hospital and the National Orthopaedic Hospital in Dala-Kano, Kano. Both groups received exercises and infrared treatment, in addition to Static and Intermittent cervical traction. Outcomes were assessed at the baseline and at the end of six weeks of intervention. Pain was assessed through the use of a Visual Analogue Scale, neck disability through a Neck Disability Index questionnaire and cervical range of motion with a goniometer. Data was analysed using descriptive and inferential statistics, and alpha was set at <0.05.Results: The mean ages of the participants were 46.00±7.81 and 36.00±15.02 for the groups Static and Intermittent respectively. Both groups were comparable at baseline (p>0.05). Both Static and Intermittent cervical traction was effective in reducing the disability (p<0.05) and pain (p<0.05). There was no significant difference between the groups at six weeks in terms of pain, disability and range of motion (P>0.05).Conclusion and recommendation: Both Static and Intermittent cervical traction effectively manages chronic, non-specific neck pain and neither is superior to the other. 

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.

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