Radiologic Cervical Parameters To Determine Ligamentous Injuries in Patients With Ankylosing Spondylitis – Are They Different?

Introduction: Cervical ligamentous injuries in patients with ankylosing spondylitis (AS) may be difficult to detect, even with the utilization of computed tomography (CT) scans. The purpose of this study was to investigate the influence AS has on various radiologic parameters used to detect traumatic and degenerative pathologies of the cervical spine. Methods: A matched, case-control retrospective analysis of patients with AS and controls without AS admitted at two level-1 trauma centers was performed. All patients were admitted via shock room and received a polytrauma CT. Study patients were included if they had no injury to the cervical spine. Twenty-four CT parameters of atlanto-occipital dislocation/ instability, traumatic and degenerative spondylolisthesis, basilar invagination, and prevertebral soft-tissue swelling were assessed. Study patients were matched by age and sex. Results: A total of 78 patients were included (AS group, n=39; control group, n=39). The evaluated cervical radiologic parameters were largely within normal limits and showed no significant clinical or morphologic differences between the two groups. Conclusion: In this analysis, CT measurements pertaining to various cervical pathologies were not different between patients with and without ankylosing spondylitis. Parameters to assess for atlanto-occipital dislocation/ instability, spondylolisthesis, or basilar invagination may reliably be used in patients with AS.

Teardrop Fracture of the Axis: An Evaluation of Vertebral Instability and Individualized Treatment

Background: Teardrop fractures of the axis (TDFAs) are avulsion fractures of the anterior-inferior part of the axis. Whether conservative or surgical treatment is better for TDFAs is controversial. Previously, image-based evaluations of the fractures have mainly focused on the teardrop fragment, the intervertebral disc and the prevertebral soft tissue. The treatment plan depends on the doctor's evaluation of fracture stability based on personal experience. Methods: From January 2012 to December 2018, a total of 12 patients with TDFA were included in this prospective study. The stability of the TDFA vertebral body was evaluated by lateral X-ray measurements. Based on the evaluation of vertebral body stability, as well as the disease characteristics of the patients, individualized treatment schemes were adopted. Results: Through the classification and treatment process, 6 patients with absolute instability and 6 patients with relative instability were identified. A total of 8 patients underwent surgery, and 4 patients were treated conservatively. A total of 12 patients finally achieved osseous fusion. Conclusion: The treatment for TDFA should be determined by considering both the instability of the axial vertebra and the disease characteristics of the patient. With an appropriate classification and treatment process, both surgery and conservative treatment can yield good clinical outcomes.

A Novel Technique Using Ultrasonography in Upper Airway Management After Anterior Cervical Decompression and Fusion

The aim is to describe an ultrasound procedure that evaluates the prevertebral soft tissue (PST) and upper airway and investigate the compatibility between X-ray and ultrasonography in PST evaluation. We included 11 radiculopathy/myelopathy patients who underwent anterior cervical decompression and fusion involving C5/6, C6/7, or both segments. The condition of the PST and upper airway was evaluated over 14 days. The Bland–Altman method was used to evaluate the degree of agreement between the PST values obtained using radiography versus ultrasonography. The Pearson correlation coefficient was used to determine the relationship between the PST measurement methods. Single-level anterior cervical decompression and fusion (ACDF) was performed in 8 cases and double-level ACDF, in 3 cases. PST and upper airway thickness peaked on postoperative day 3, with no airway complications. The Bland–Altman bias was within the prespecified clinically nonsignificant range—0.13 ± 0.36 mm (95%CI 0.04–0.22 mm). Ultrasonography effectively captured post-ACDF changes in PST and upper airway thickness and detected airway edema. Ultrasonography can help continuously assess the PST and upper airway as it is simple and has no radiation exposure risk. Therefore, radiography alone is insufficient for post-ACDF detection of airway complications and including ultrasonography may be beneficial.

Spontaneous retropharyngeal haematoma with direct oral anticoagulant medication

A 79-year-old man presented to the emergency department following a 1-week history of dyspnoea, dysphonia, dysphagia and a nonproductive cough. Previous medical history included atrial fibrillation, for which he was taking rivaroxaban, hypertension and obstructive sleep apnoea. On assessment, there was a mild stridor, swelling of the anterior aspect of the neck and submandibular bruising. CT of the neck demonstrated prevertebral soft tissue swelling extending from C1 to C6 levels, approximately 88 mm in length with a maximum depth of 25 mm. A diagnosis of spontaneous retropharyngeal haematoma was made: the airway was secured with fibreoptic nasal intubation and the patient admitted to the intensive care unit. Direct and fibreoptic assessment of the airway on day 3 confirmed that the haematoma had significantly reduced in size. The patient was extubated on day 4 and made a good recovery.

ZERO-PROFILE ANCHORED SPACER SYSTEM IN THE TREATMENT OF CERVICAL DEGENERATIVE DISEASE WITH A FOLLOW-UP OF 1 YEAROUR EXPERIENCE .

Objects: Anterior cervical plating decreases the risk of pseudarthrosis, increases rate of fusion following anterior cervical discectomy and fusion (ACDF). Dysphagia is a common complication of ACDF, with the anterior plate implicated as a potential contributor. A zero-prole, stand-alone interbody spacer has been postulated to minimize soft-tissue irritation and postoperative dysphagia, but studies are limited. We are reporting our ndings in term of clinico-radiological outcomes following the use of such devices in the treatment of cervical spine degenerative diseases with a focus on the course of postoperative prevertebral soft-tissue thickness and the incidence of dysphagia. The authors conducted a prospective analysis of all Methods: patients who had undergone ACDF between December 2018 and December 2019. All patients received a Zero-P implant (DePuy Synthes Spine).The Neck Disability Index (NDI),Modied Japanese Orthopaedic Association Score(mJOA) and visual analog scale (VAS) scores for arm and neck pain were documented. Dysphagia was determined using the Bazaz criteria. Prevertebral soft-tissue thickness, spinal alignment, intervertebral disc height were assessed as well. The nal outcome was assessed with Odom's criteria. Total 30 patients Results: were studied prospectively, and data were collected and analyzed. 17 male and 13 female consecutive patients, with a mean age of 48.28 ± 8.17 years, underwent ACDF with Zero-Prole spacer (42 total operated levels) in the dened study period. There were signicant improvements in neck and arm VAS scores, the NDI and mJOA scores following surgery at last follow up. The neck VAS score improved from a mean 7.34 ±1.87 to 1.04 ± 0.09 (p<0.01) . The arm VAS score improved from 7.22±2.03 to1.03±0.10 at latest follow up. NDI score improved signicantly from preoperative 31.94±6.73 to 12.87±5.24 and mJOAscore improved from preoperative 9.53±1.98 to 15.6±1.26 at last follow up. Immediate postoperative dysphagia was experienced by 36.67% of all patients. Complete resolution of dysphagia was demonstrated at the latest follow-up. Prevertebral soft-tissue thickness at postoperative 48 hrs decreased across all levels from a mean of 15.87 ±0.69 to 11.81 ± 0.53 mm at last follow up. Cervical alignment and intervertebral disc height were also improved signicantly after surgery. Radiographic fusion was achieved in 100% of implants. No correlation was found between prevertebral soft-tissue thickness and Bazaz dysphagia score. Majority of the patients had excellent outcomes in odom's criteria. Conclusions: Zero-Prole device is a safe and effective alternative for the treatment of cervical degenerative diseases. Chronic dysphagia rates are comparable to or better than those for previously published case series.

The effect of the difference in C2-7 angle on the occurrence of dysphagia after anterior cervical discectomy and fusion with the Zero-P Implant System

Objectives: To investigate the effect of the difference in C2-7 angle on dysphagia after anterior cervical discectomy and fusion (ACDF) with the Zero-P Implant System.Methods: A retrospective analysis of 181 patients who underwent ACDF with the Zero-P Implant System and had at least one year of follow-up from January 2011 to November 2018 was performed. All patients were divided into a non-dysphagia group and a dysphagia group to explore the effect of the difference between postoperative and preoperative C2-7 angle (dC2-7A) on postoperative dysphagia. At the same time, other possible related factors including the difference between postoperative and preoperative O-C2 angle (dO-C2A), sex, age, body mass index (BMI), intraoperative time, estimated blood loss, diabetes mellitus, hypertension, smoking, alcohol consumption, prevertebral soft-tissue swelling (PSTS), the highest segment involved in the surgery and the levels of surgery segments were analyzed.Results: In total, the non-dysphagia group comprised 139 patients and the dysphagia group comprised 42 patients. The single-factor analysis showed that smoking, PSTS and dC2-7A were significantly different between the two groups (P<0.05). Spearman’s correlation coefficient showed no significant correlation between the degree of dysphagia and dC2-7A (P>0.05). The results of the multiple-factor analysis with an ordinal logistic regression model showed that smoking, PSTS and dC2-7A were significantly associated with the incidence of dysphagia (P<0.05).Conclusions: The postoperative C2-7 angle has an important effect on the occurrence of dysphagia in patients undergoing Zero-P implant system interbody fusion surgery.

The effect of the difference in C2–7 angle on the occurrence of dysphagia after anterior cervical discectomy and fusion with the zero-P implant system

Objectives To investigate the effect of the difference in C2–7 angle on dysphagia after anterior cervical discectomy and fusion (ACDF) with the Zero-P Implant System. Methods A retrospective analysis of 181 patients who underwent ACDF with the Zero-P Implant System and had at least one year of follow-up from January 2011 to November 2018 was performed. All patients were divided into a non-dysphagia group and a dysphagia group to explore the effect of the difference between postoperative and preoperative C2–7 angle (dC2–7A) on postoperative dysphagia. At the same time, other possible related factors including the difference between postoperative and preoperative O-C2 angle (dO-C2A), sex, age, body mass index (BMI), intraoperative time, estimated blood loss, diabetes mellitus, hypertension, smoking, alcohol consumption, prevertebral soft-tissue swelling (PSTS), the highest segment involved in the surgery and the levels of surgery segments were analyzed. Results In total, the non-dysphagia group comprised 139 patients and the dysphagia group comprised 42 patients. The single-factor analysis showed that smoking, PSTS and dC2–7A were significantly different between the two groups (P < 0.05). Spearman’s correlation coefficient showed no significant correlation between the degree of dysphagia and dC2–7A (P > 0.05). The results of the multiple-factor analysis with an ordinal logistic regression model showed that smoking, PSTS and dC2–7A were significantly associated with the incidence of dysphagia (P < 0.05). Conclusions The postoperative C2–7 angle has an important effect on the occurrence of dysphagia in patients undergoing Zero-P implant system interbody fusion surgery.

The effect of the difference in the C2-7 angle on the occurrence of dysphagia after anterior cervical discectomy and fusion with the Zero-P Implant System

Objectives: To investigate the effect of the difference in C2-7 angle on dysphagia after anterior cervical discectomy and fusion (ACDF) with the Zero-P Implant System.Methods: A retrospective analysis of 181 patients who underwent ACDF with the Zero-P Implant System and had at least one year of follow-up from January 2011 to November 2018 was performed. All patients were divided into a non-dysphagia group and a dysphagia group to explore the effect of the difference between postoperative and preoperative C2-7 angle (dC2-7A) on postoperative dysphagia. At the same time, other possible related factors including the difference between postoperative and preoperative O-C2 angle (dO-C2A), sex, age, body mass index (BMI), intraoperative time, estimated blood loss, diabetes mellitus, hypertension, smoking, alcohol consumption, prevertebral soft-tissue swelling (PSTS), the highest segment involved in the surgery and the levels of surgery segments were analyzed.Results: In total, the non-dysphagia group comprised 139 patients and the dysphagia group comprised 42 patients. The single-factor analysis showed that smoking, PSTS and dC2-7A were significantly different between the two groups (P<0.05). Spearman’s correlation coefficient showed no significant correlation between the degree of dysphagia and dC2-7A (P>0.05). The results of the multiple-factor analysis with an ordinal logistic regression model showed that smoking, PSTS and dC2-7A were significantly associated with the incidence of dysphagia (P<0.05).Conclusions: The postoperative C2-7 angle has an important effect on the occurrence of dysphagia in patients undergoing Zero-P implant system interbody fusion surgery.

The Effect of the Difference in the C2-7 Angle on the Occurrence of Dysphagia after Anterior Cervical Discectomy and Fusion with the Zero-P Implant System

Background: To investigate the effect of the difference in the C2-7 angle (C2-7A) on dysphagia after anterior cervical discectomy and fusion (ACDF) with the Zero-P Implant System.Methods: A retrospective analysis of 181 patients who underwent ACDF with the Zero-P Implant System and had at least one year of follow-up was performed from January 2011 to November 2018. All patients were divided into a non-dysphagia group and a dysphagia group to explore the effect of the difference between postoperative and preoperative C2-7As (dC2-7A) on postoperative dysphagia. Furthermore, other possible related factors including the difference between postoperative and preoperative O-C2 angles (dO-C2A), sex, age, body mass index (BMI), intraoperative time, estimated blood loss, diabetes mellitus, hypertension, smoking, alcohol consumption, prevertebral soft-tissue swelling (PSTS), the highest segment involved in the surgery and the levels of surgical segments were analyzed.Results: One hundred thirty-nine patients were included in the non-dysphagia group, and 42 patients were included in the dysphagia group. Single-factor analysis showed that smoking, PSTS and the dC2-7A were significantly different between the two groups (P<0.05). Spearman’s correlation coefficient showed no significant correlation between the degree of dysphagia and he dC2-7A (P>0.05). The results of multiple-factor analysis with an ordinal logistic regression model showed that smoking, PSTS and the dC2-7A were significantly associated with the incidence of dysphagia (P<0.05).Conclusions: The postoperative C2-7A has an important effect on the occurrence of dysphagia in patients undergoing interbody fusion surgery with the Zero-P Implant System.