Objective To establish the mode of anterior cervical surgery in outpatient setting, and evaluate its preliminary effectiveness. Methods A clinical data of patients who underwent anterior cervical surgery between January 2022 and September 2022 and met the selection criteria was retrospectively analyzed. The surgeries were performed in outpatient setting (n=35, outpatient setting group) or in inpatient setting (n=35, inpatient setting group). There was no significant difference between the two groups (P>0.05) in age, gender, body mass index, smoking, history of alcohol drinking, disease type, the number of surgical levels, operation mode, as well as preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale score of neck pain (VAS-neck), and visual analogue scale score of upper limb pain (VAS-arm). The operation time, intraoperative blood loss, total hospital stay, postoperative hospital stay, and hospital expenses of the two groups were recorded; JOA score, VAS-neck score, and VAS-arm score were recorded before and immediately after operation, and the differences of the above indexes between pre- and post-operation were calculated. Before discharge, the patient was asked to score satisfaction with a score of 1-10. Results The total hospital stay, postoperative hospital stay, and hospital expenses were significantly lower in the outpatient setting group than in the inpatient setting group (P<0.05). The satisfaction of patients was significantly higher in the outpatient setting group than in the inpatient setting group (P<0.05). There was no significant difference between the two groups in operation time and intraoperative blood loss (P>0.05). The JOA score, VAS-neck score, and VAS-arm score of the two groups significantly improved at immediate after operation when compared with those before operation (P<0.05). There was no significant difference in the improvement of the above scores between the two groups (P>0.05). The patients were followed up (6.67±1.04) months in the outpatient setting group and (5.95±1.90) months in the inpatient setting group, with no significant difference (t=0.089, P=0.929). No surgical complications, such as delayed hematoma, delayed infection, delayed neurological damage, and esophageal fistula, occurred in the two groups. Conclusion The safety and efficiency of anterior cervical surgery performed in outpatient setting were comparable to that performed in inpatient setting. Outpatient surgery mode can significantly shorten the postoperative hospital stay, reduce hospital expenses, and improve the patients’ medical experience. The key points of the outpatient mode of anterior cervical surgery are minimizing damage, complete hemostasis, no drainage placement, and fine perioperative management.
Objective To evaluate the results of laminoplasty and foraminotomy in treatment of cervical radiculopathy. Methods Of 29 patients, there were 16 males and 13 females,aged 38 to 72 years with an average of 59 years. The reasons of intervertebral foramen stenosis were：prolapse of intervertebral disc, osteophyte formation of Luschka joint, spinal canal stenosis combined with thicknessof flavum ligmentum and facet joint hypertrophy. The most frequently affected intervertebral foramen were C5,6 and C6,7. The mostsignifcant symptoms after impairment of nerve root were reduced sensation, muscle weakness and diminished reflexes. On the basis of laminoplasty, theforaminotomy was performed on the stenotic foramen, including grade Ⅰ decompression on 13 occasions, degree Ⅱ on 21 occasions; and double level decompressions were performed on 5 patients.Results After operation, reduced sensation was recovered most significantly andquickly, and the recovery of muscle weakness followed, while the recovery of diminished reflexes was the slowest and worst. In the followed-up patients, the percentage of excellent and good results was 97%.Conclusion In the cervical spondylotic patients who also have foraminar stenosis, performing laminoplasty with foraminotomy can getgood results. If the indication are chosen properly, it can be used widely in clinic.
ObjectiveTo analyze the clinical outcome of anterior cervical discectomy and fusion using a Zero-profile interbody fusion and fixation device (Zero-P) for cervical spondylotic myelopathy. MethodsBetween April 2011 and September 2013, 26 cases of cervical spondylotic myelopathy underwent anterior cervical discectomy and fusion with the Zero-P. Of 26 cases, 12 were male and 14 were female, aged 43-82 years (mean, 58.3 years). The disease duration was from 3 months to 10 years (mean, 5.9 years). The involved segments included C3,4 in 5 cases, C4,5 in 3 cases, C5,6 in 6 cases, and C6,7 in 12 cases. The clinical outcome was evaluated using visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and Neck Disability Index (NDI) score before operation and after operation. ResultsThe operations were successful and the operation time was 75-140 minutes (mean, 105 minutes); and blood loss was 20-150 mL (mean, 45 mL). There was no complications of infection, neural injury, esophageal fistula, prevertebral hematoma, or leakage of cerebrospinal. Dysphagia occurred in 1 case within 1 week after operation,and disappeared after 1 month. All patients were followed up for an average of 15.3 months (range, 12-18 months). The clinical symptoms were relieved after operation. During follow-up, no implant displacement or subsidence, screw breakage, and cervical instability were observed. At 3 and 12 months after operation, the VAS score and NDI reduced significantly (P<0.05); the JOA score increased significantly (P<0.05); and the intervertebral space height and the cervical Cobb angle improved significantly (P<0.05). But there was no significantly difference between at 3 and 12 months (P>0.05). According to JOA evaluation, the results were excellent in 14 cases, good in 10 cases, and fair in 2 cases, with an excellent and good rate of 92.3% at last follow-up. ConclusionThe clinical outcome of anterior cervical discectomy and fusion using a Zero-P is satisfactory and reliable in the treatment of cervical spondylotic myelopathy. It can restore the cervical physiological curve and the intervertebral space height and decrease the incidence of postoperative dysphagia.
Objective To comparatively analyze the efficacy differences between unilateral open-door laminoplasty and combined foraminoplasty in treating mixed (myelopathic and radiculopathic) cervical spondylopathy. Methods Patients with mixed (myelopathic and radiculopathic) cervical spondylopathy who underwent the two surgical procedures at the Third People’s Hospital of Chengdu between January 2017 and December 2023 were retrospectively selected. According to the surgical method, patients were divided into the open-door surgery group and the combined surgery group. The basic information, surgical related indicators, clinical efficacy scores, and complications between the two groups were compared. Results A total of 65 patients were included. Among them, there were 38 males and 27 females; 30 cases in the open-door surgery group and 35 cases in the combined surgery group; The average follow-up period was (18.6±6.8) months. There were no statistically significant differences in age, gender, surgical stage, and disease duration among the groups (P>0.05). Except for the operation time (P<0.05), there was no statistically significant difference in incision length and intraoperative bleeding between the two groups (P>0.05). There was no statistically significant difference in preoperative Visual Analogue Scale and Japanese Orthopaedic Association Score between the two groups (P>0.05). The difference in Visual Analogue Scale and Japanese Orthopaedic Association Score between the two groups six months after surgery was statistically significant (P<0.05). No severe complications such as surgical failure, uncontrollable hemorrhage, or intraoperative nerve/spinal cord injury occurred. No significant cervical instability occurred in either group. Conclusions For treating mixed (myelopathic and radiculopathic) cervical spondylopathy, unilateral open-door laminoplasty combined foraminoplasty may reduce the incidence of nerve root palsy and yield superior clinical outcomes compared to laminoplasty alone. This combined approach does not increase surgical risk and may potentially avoid the need for revision anterior cervical surgery.
Objective To investigate whether an internet-based neck-specific training program can alleviate pain and disability in participants with cervical spondylotic radiculopathy (CSR). Methods Patients diagnosed with CSR at West China Hospital of Sichuan University between March 2022 and September 2022 were randomly allocated to either an telehabilitation group or a traditional treatment group. The primary outcome measures included Visual Analogue Scale, Neck Disability Index, and patient satisfaction. Secondary outcome measures included the Euroqol group’s 5-Domain questionnaire, Fear-Avoidance Beliefs Questionnaire, Hospital Anxiety and Depression Scale, Tanaka Jingjiu cervical spondylosis symptom scale (20 points) and satisfaction. Quantitative outcome measures were collected at baseline, 12th and 24th weeks after the first intervention, while qualitative outcome measures were collected at 24th weeks after the first intervention. Results A total of 90 patients were included, with 45 in each group. There was no statistically significant difference between the two groups in terms of age, gender and other demography characteristics and general data (P>0.05). There is no interaction effect (group × time) for the Tanaka Jingjiu cervical spondylosis symptom scale (20 points) (P>0.05), the interaction effects (group × time) for other quantitative outcome measures were statistically significant (P<0.05). The time effect showed significant statistical differences across all quantitative outcome measures (P<0.001), while the group effect did not exhibit any significant statistical differences (P>0.05). The comparison results within the group showed that at different time points, the differences between the two groups were statistically significant (P<0.001). There were no significant statistical differences between the two groups in terms of qualitative outcome measures (P>0.05) . Conclusions An internet-based neck-specific training program or traditional treatment for 12 weeks can effectively reduce pain and disability among CSR patients, with significant long-term effects. There was no significant difference in treatment effectiveness between the two groups.
Objective To summarize the recent minimally invasive approach for cervical spondylotic radiculopathy (CSR). Methods The recent l iterature at home and abroad concerning minimally invasive approach for CSR was reviewed and summarized. Results There were two techniques of minimally invasive approach for CSR at peresent: percutaneous puncture techniques and endoscopic techniques. The degenerate intervertebral disc was resected or nucleolysis by percutaneouspuncture technique if CSR was caused by mild or moderate intervertebral disc herniations. The cervical microendoscopicdiscectomy and foraminotomy was an effective minimally invasive approach which could provide a clear view. The endoscopy techniques were suitable to treat CSR caused by foraminal osteophytes, lateral disc herniations, local l igamentum flavum thickening and spondylotic foraminal stenosis. Conclusion The minimally invasive procedure has the advantages of simple handl ing, minimally invasive and low incidence of compl ications. But the scope of indications is relatively narrow at present.
Objective To analyse the correlation between cervical sagittal parameters of cervical spondylotic myelopathy in different sagittal curvature so as to find out representative cervical sagittal alignment parameters by measuring on MRI. Methods A retrospective analysis was made on the clinical data of 88 patients with cervical spondylotic myelopathy between July 2015 and January 2016. The C2-C7 Cobb angle, T1 slope (T1S), and C2-C7 sagittal vertical axis (C2-C7 SVA) were measured on T2-weight MRI. According to C2-C7 Cobb angle, the patients were divided into lordosis group (≥10° Cobb angle, 48 cases) and straightened group (0-10° Cobb angle, 40 cases). Intraclass correlation coefficient (ICC) was used for the reliability of measured data, Pearson correlation analysis for correlation between cervical sagittal parameters. Results ICC was 0.858-0.946, indicating good consistency of measurement parameters. The C2-C7 Cobb angle, T1S, and C2-C7 SVA were (5.6±2.4)°, (22.2±6.7)°, and (10.2±5.4) mm in straightened group, and were (20.1±8.2)°, (23.4±8.9)°, and (8.2±4.6) mm in lordosis group respectively. There was no correlation between the 3 parameters in straighten group (r=0.100,P=0.510 for T1S and C2-C7 Cobb angle;r=–0.100,P=0.500 for T1S and C2-C7 SVA;r=0.080,P=0.610 for C2-C7 Cobb angle and C2-C7 SVA). There was positive correlation between T1S and C2-C7 Cobb angle (r=0.540,P=0.000), negative correlation between T1S and C2-C7 SVA (r=–0.450,P=0.001), and no correlation between C2-C7 Cobb angle and C2-C7 SVA (r=–0.003,P=0.980). Conclusion For cervical spondylotic myelopathy in patients with cervical lordosis, only T1S measurement on MRI can be used as the main parameter to judge the sagittal curvature, but in patients with straightened cervical Cobb angle, measurements of T1S, C2-C7 Cobb angle, and C2-C7 SVA should be taken for the comprehensive evaluation of cervical sagittal curvature.
Objective To investigate the effect of ultrasonic bone curette in anterior cervical spine surgery. MethodsA clinical data of 63 patients with cervical spondylosis who were admitted between September 2019 and June 2021 and met the selection criteria was retrospectively analyzed. Among them, 32 cases were operated with conventional instruments (group A) and 31 cases with ultrasonic bone curette (group B). There was no significant difference between the two groups (P>0.05) in gender, age, surgical procedure, surgical segment and number of occupied cervical space, disease type and duration, comorbidities, and preoperative Japanese Orthopaedic Association (JOA) score, cervical dysfunction index (NDI), and pain visual analogue scale (VAS) score. The operation time, intraoperative bleeding, postoperative drainage, postoperative hospital stay, and the occurrence of postoperative complications were recorded in both groups. Before operation and at 1, 3, and 6 months after operation, the JOA score and NDI were used to evaluate the function and the postoperative JOA improvement rate was calculated, and VAS score was used to evaluate the pain improvement. The anteroposterior and lateral cervical X-ray films were taken at 1, 3, and 6 months after operation to observe whether there was any significant loosening and displacement of internal fixators. ResultsCompared with group A, group B had shorter operation time and postoperative hospital stay, less intraoperative bleeding and postoperative drainage, and the differences were significant (P<0.05). All incisions healed by first intention in the two groups, and postoperative complications occurred in 5 cases (15.6%) in group A and 2 cases (6.5%) in group B, showing no significant difference (P>0.05). All patients were followed up 6-12 months (mean, 7.9 months). The JOA score and improvement rate gradually increased in groups A and B after operation, while the VAS score and NDI gradually decreased. There was no significant difference in VAS score between 3 months and 1 month in group B (P>0.05), and there were significant differences between the other time points of each indicator in the two groups (P<0.05). At 1, 3, and 6 months after operation, the JOA score and improvement rate in group B were better than those in group A (P<0.05). X-ray films examination showed that there was no screw loosening or titanium plate displacement in the two groups after operation, and the intervertebral cage or titanium mesh significantly sank. ConclusionCompared with traditional instruments, the use of ultrasonic bone curette assisted osteotomy in anterior cervical spine surgery has the advantages of shorter operation time, less intraoperative bleeding, less postoperative drainage, and shorter hospital stay.