Objective To investigate whether preoperative T1 slope (T1S) in MRI can predict the changes of cervical curvature after expansive open-door laminoplasty (EOLP) in patients with cervical spondylotic myelopathy, so as to make up for the shortcomings of difficult measurement in X-ray film. Methods The clinical data of 36 patients with cervical spondylotic myelopathy who underwent EOLP were retrospectively analysed. There were 21 males and 15 females with an average age of 55.8 years (range, 37-73 years) and an average follow-up time of 14.3 months (range, 12-24 months). The preoperative X-ray films at dynamic position, CT, and MRI of cervical spine before operation, and the anteroposterior and lateral X-ray films at last follow-up were taken out to measure the following sagittal parameters. The parameters included C2-C7 Cobb angle and C2-C7 sagittal vertical axis (C2-C7 SVA) in all patients before operation and at last follow-up; preoperative T1S were measured in MRI, and the patients were divided into larger T1S group (T1S>19°, group A) and small T1S group (T1S≤19°, group B) according to the median of T1S, and the preoperative T1S, C2-C7 Cobb angle, C2-C7 SVA, and the C2-C7 Cobb angle and C2-C7 SVA at last follow-up, difference in axial distance (the difference of C2-C7 SVA before and after operation), postoperative curvature loss (the difference of C2-C7 Cobb angle before and after operation), the number of patients whose curvature loss was more than 5° after operation, and the number of patients whose kyphosis changed (C2-C7 Cobb angle was less than 0° after operation). Results The C2-C7 Cobb angle at last follow-up was significantly decreased when compared with preoperative value (t=8.000, P=0.000), but there was no significant difference in C2-C7 SVA between pre- and post-operation (t=–1.842, P=0.074). The preoperative T1S was (19.69±3.39)°; there were 17 cases in group A and 19 cases in group B with no significant difference in gender and age between 2 groups (P>0.05). The preoperative C2-C7 Cobb angle in group B was significantly lower than that in group A (t=–2.150, P=0.039), while there was no significant difference in preoperative C2-C7 SVA between 2 groups (t=0.206, P=0.838). At last follow-up, except for the curvature loss after operation in group B was significantly lower than that in group A (t=–2.723, P=0.010), there was no significant difference in the other indicators between 2 groups (P>0.05). Conclusion Preoperative larger T1S (T1S>19°) in MRI had a larger preoperative lordosis angle, but more postoperative physiological curvature was lost; preoperative T1S in MRI can not predict postoperative curvature loss, but preoperative larger T1S may be more prone to kyphosis.
Objective To investigate correlation between preoperative C2 slope (C2S) and effectiveness at 2 years after short-segment anterior cervical discectomy and fusion (ACDF), with the aim of providing reliable indicators for predicting effectiveness. Methods One hundred and eighteen patients with cervical spondylotic myelopathy, who received short-segment ACDF between January 2018 and December 2022 and met the selection criteria, were enrolled in the study. There were 46 males and 72 females, aged from 26 to 80 years, with a mean age of 53.6 years. The operative duration was (127.6±33.46) minutes and the intraoperative blood loss was (34.75±30.40) mL. All patients were followed up 2 years. The pre- and post-operative Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) score, and visual analogue scale (VAS) score for pain were recorded. Based on the anteroposterior and lateral cervical X-ray films, the sagittal parameters of the cervical spine were measured [C2-C7 Cobb angle, C0-C2 Cobb angle, T1 slope, C2S, sagittal segmental angle (SSA) of the surgical segment, and average surgical disc height (ASDH) of the surgical segment]. Statistical analyses were performed to assess the differences in these indicators between pre- and post-operation, as well as the correlations between the preoperative C2S and the JOA score, NDI, and VAS score at 2 years after operation. The patients were allocated into group A (C2S >11.73°) and group B (C2S≤ 11.73°) according to the median value of the preoperative C2S (11.73°). The JOA score, NDI, and VAS score before operation and at 2 years after operation, as well as the differences between pre- and post-operative values (change values), were compared between the two groups. ResultsThe T1 slope, C2-C7 Cobb angle, C0-C2 Cobb angle, SSA, and ASDH at immediate after operation and JOA score, NDI, and VAS score at 2 years after operation significantly improved in 118 patients when compared with preoperative ones (P<0.05). Pearson correlation analysis showed that preoperative C2S was not correlated with JOA score and NDI at 2 years after operation (P>0.05), but negatively correlated with VAS score (P<0.05). There were 59 patients with preoperative C2S>11.73° (group A) and 59 with C2S≤11.73° (group B). There was no significant difference in preoperative JOA score, NDI, and VAS score between the two groups (P>0.05). There were significant differences in VAS score at 2 year after operation and the change value between the two groups (P<0.05); there was no significant difference in the JOA score and NDI (P>0.05). Conclusion Patients with cervical spondylotic myelopathy and a higher preoperative C2S exhibited superior long-term pain relief and effectiveness following short-segment ACDF.
Objective To evaluate the application of surgical strategies for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) involving the C2 segment. Methods The literature about the surgery for cervical OPLL involving C2 segment was reviewed, and the indications, advantages, and disadvantages of surgery were summarized. Results For cervical OPLL involving the C2 segments, laminectomy is suitable for patients with OPLL involving multiple segments, often combined with screw fixation, and has the advantages of adequate decompression and restoration of cervical curvature, with the disadvantages of loss of cervical fixed segmental mobility. Canal-expansive laminoplasty is suitable for patients with positive K-line and has the advantages of simple operation and preservation of cervical segmental mobility, and the disadvantages include progression of ossification, axial symptoms, and fracture of the portal axis. Dome-like laminoplasty is suitable for patients without kyphosis/cervical instability and with negative R-line, and can reduce the occurrence of axial symptoms, with the disadvantage of limited decompression. The Shelter technique is suitable for patients with single/double segments and canal encroachment >50% and allows for direct decompression, but is technically demanding and involves risk of dural tear and nerve injury. Double-dome laminoplasty is suitable for patients without kyphosis/cervical instability. Its advantages are the reduction of damage to the cervical semispinal muscles and attachment points and maintenance of cervical curvature, but there is progress in postoperative ossification. Conclusion OPLL involving the C2 segment is a complex subtype of cervical OPLL, which is mainly treated through posterior surgery. However, the degree of spinal cord floatation is limited, and with the progress of ossification, the long-term effectiveness is poor. More research is needed to address the etiology of OPLL and to establish a systematic treatment strategy for cervical OPLL involving the C2 segment.
ObjectiveTo evaluate the effectiveness of cervical disc replacement for cervical myelopathy. MethodsBetween October 2006 and October 2008, 20 patients (26 segments) with cervical myelopathy underwent single-level (14 segments) or bi-level (6 segments) cervical disc replacement. There were 8 males and 12 females with an average age of 46 years (range, 26-65 years). The disease duration ranged 2-18 months (mean, 7 months). The effectiveness was evaluated using visual analogue scale (VAS) score, cervical range of motion (ROM), and the Odom et al. criteria. Heterotopic ossification (HO), osteophyte formation, and prosthesis loosening were observed. ResultsAll incisions healed by first intention, with no severe complication. Twenty patients were followed up 30-48 months (mean, 34 months). At 28 months after operation, according to Odom et al. criteria, the results were excellent in 17 cases and good in 3 cases. The VAS scores of the neck, shoulder, and upper limb were significantly improved when compared with preoperative scores (P lt; 0.05). At 30 months after operation, X-ray films showed that 20 replaced segments were mobile and ROM was (10.6 ± 4.5)°, showing no significant difference (P gt; 0.05) when compared with that of upper adjacent segment (10.8 ± 3.7)° and lower adjacent segment (7.5 ± 4.2)°. HO occurred in 10 cases (13 segments). No displacement, subsidence, or loosening occurred except 1 case of retrodisplacement of the prosthesis. ConclusionCervical disc replacement can obtain good effectiveness. It can maintain normal cervical ROM and physiological curvature. But it needs further long-term follow-up to evaluate the function and the influence on the adjacent segments.
Objective To compare the effectiveness of a zero-profile three-dimensiaonal (3D)-printed microporous titanium alloy Cage and a conventional titanium plate combined with a polyether-ether-ketone (PEEK)-Cage in the treatment of single-segment cervical spondylotic myelopathy (CSM) by anterior cervical discectomy and fusion (ACDF). Methods The clinical data of 83 patients with single-segment CSM treated with ACDF between January 2022 and January 2023 were retrospectively analyzed, and they were divided into 3D-ZP group (35 cases, using zero-profile 3D-printed microporous titanium alloy Cage) and CP group (48 cases, using titanium plate in combination with PEEK-Cage). There was no significant difference in gender, age, disease duration, surgical intervertebral space, and preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score, neck disability index (NDI), vertebral height at the fusion segment, Cobb angle, and other baseline data between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stay, complications, interbody fusion, and prosthesis subsidence were recorded and compared between the two groups. VAS score, NDI, and JOA score were used to evaluate the improvement of pain and function before operation, at 3 months after operation, and at last follow-up, and the vertebral height at the fusion segment and Cobb angle were measured by imaging. The degree of dysphagia was assessed by the Bazaz dysphagia scale at 1 week and at last follow-up. Results The operation was successfully completed in all the 83 patients. There was no significant difference in intraoperative blood loss and hospital stay between the two groups (P>0.05), but the operation time in the 3D-ZP group was significantly shorter than that in the CP group (P<0.05). Patients in both groups were followed up 24-35 months, with an average of 25.3 months, and there was no significant difference in the follow-up time between the two groups (P>0.05). The incidence and grade of dysphagia in CP group were significantly higher than those in 3D-ZP group at 1 week after operation and at last follow-up (P<0.05). There was no dysphagia in 3D-ZP group at last follow-up. There was no complication such as implant breakage or displacement in both groups. The intervertebral fusion rates of 3D-ZP group and CP group were 65.71% (23/35) and 60.42% (29/48) respectively at 3 months after operation, and there was no significant difference between the two groups [OR (95%CI)=1.256 (0.507, 3.109), P=0.622]. The JOA score, VAS score, and NDI significantly improved in the 3D-ZP group at 3 months and at last follow-up when compared with preoperative ones (P<0.05), but there was no significant difference between the two groups (P>0.05). There was no significant difference in the improvement rate of JOA between the two groups at last follow-up (P>0.05). At 3 months after operation and at last follow-up, the vertebral height at the fusion segment and Cobb angle significantly improved in both groups, and the two indexes in 3D-ZP group were significantly better than those in CP group (P<0.05). At last follow-up, the incidence of prosthesis subsidence in 3D-ZP group (8.57%) was significantly lower than that in CP group (29.16%) (P<0.05). ConclusionThe application of zero-profile 3D-printed Cage and titanium plate combined with PEEK-Cage in single-segment ACDF can both reconstruct the stability of cervical spine and achieve good effectiveness. Compared with the latter, the application of the former in ACDF can shorten the operation time, reduce the incidence of prosthesis subsidence, and reduce the incidence of dysphagia.
Objective To investigate the treatment methods and the cl inical therapeutic effects of symptomatic cervical vertebral hemangioma associated with cervical spondylotic myelopathy. Methods A retrospective analysis was performed in 18 patients (10 males and 8 females, aged 30-62 years with an average age of 45.3 years) with cervical vertebral hemangioma associated with cervical spondylotic myelopathy between January 2006 and September 2008. The disease duration was 10-26 months (mean, 15.6 months). All patients had single vertebral hemangioma, including 2 cases at C3, 3 cases at C4, 5 cases at C5, 5 cases at C6, and 3 cases at C7. The X-ray films showed a typical “pal isade” change. According to the cl inical and imaging features, there were 13 cases of type II and 5 cases of type IV of cervical hemangioma. The standard anterior cervical decompression and fusion with internal fixation were performed and then percutaneous vertebroplasty (PVP) was used. The cervical X-ray films were taken to observe bone cement distribution and the internal fixation after operation. The recovery of neurological function and the neck pain rel ief were measured by Japanese Orthopaedic Association (JOA) score and visual analogue scale (VAS) score. Results All operations were successful with no spinal cord and nerves injury, and the incisions healed well. Anterior bone cement leakage occurred in 2 cases without any symptoms. All cases were followed up 24-28 months (mean, 26 months) and the symptoms were improved at different degrees without fracture and collapse of vertebra or recurrence of hemangioma. During the follow-up, there was no implant loosening, breakage and displacement, and the mean fusion time was 4 months (range, 3-4.5 months). The JOA score and VAS score had a significant recovery at 3 months and at last follow-up when compared with preoperative values (P lt; 0.05). Based on JOA score at last follow-up, the results were excellent in 9 cases, good in 6 cases, fair in 2 cases, and poor in 1 case. Conclusion The anterior cervical decompression and fusion with internalfixation combined with PVP treatment is one of the ideal ways to treat symptomatic cervical vertebral hemangioma associated with cervical spondylotic myelopathy, which could completely decompress the spinal cord and effectively alleviate the cl inical symptoms caused by vertebral hemangioma.
ObjectiveTo evaluate the effectiveness of cervical single open-door laminoplasty with the unilateral C4,5 foraminotomy for cervical myelopathy in preventing postoperative C5 palsy. MethodsBetween January 2008 and June 2012, 200 consecutive patients with cervical myelopathy and unilateral C4,5 foraminal stenosis were treated, and the clinical data were retrospectively analyzed. Of them, 89 patients underwent cervical single open-door laminoplasty combined with unilateral C4,5 foraminotomy (group A), and 111 patients underwent simple cervical single open-door laminoplasty (group B). There was no significant difference in gender, age, disease duration, segmental lesions, and diagnosis distribution between 2 groups (P>0.05). The operation time, intraoperative bleeding volume, and the incidence of C5 palsy were recorded. The Japanese Orthopaedic Association (JOA) score before and after operation was used for neurological assessment, and the JOA recovery rate was calculated. ResultsThe operation time was (122±29) minutes and the intraoperative bleeding volume was (165±50) mL in group A, which were significantly higher than those in group B[(109±31) minutes and (145±32) mL] (t=3.033, P=0.010;t=3.429, P=0.003). All patients were followed up; the follow-up time was 3-48 months (mean, 25 months) in group A, and was 4-50 months (mean, 27 months) in group B. C5 palsy occurred in 1 patient of group A (1.12%), and in 9 patients of group B (8.11%), showing significant difference between 2 groups (χ2=3.709, P=0.045). The JOA score was significantly improved at 2 weeks and last follow-up after operation when compared with preoperative JOA scores in 2 groups (P<0.05), but no significant was found between at 2 weeks and at last follow-up (P>0.05) in each group. Between group A and group B, no significant difference was found in JOA score and the recovery rate (P>0.05). During follow-up, no persistent axial pain for a long time and obvious spinal instability occurred in 2 groups. ConclusionCervical single open-door laminoplasty with unilateral C4,5 foraminotomy can reduce the incidence of the C5 palsy for patients with cervical myelopathy combined with unilateral C4,5 foraminal stenosis.
ObjectiveTo explore the feasibility of posterior debridement, decompression, bone grafting, and fixation in treatment of thoracic spinal tuberculosis with myelopathy, and investigate the effects of surgical timing on postoperative outcomes.MethodsThe clinical data of 26 patients with thoracic spinal tuberculosis with myelopathy between August 2012 and October 2015 was retrospectively analyzed. All patients underwent posterior unilateral transpedicular debridement, decompression, bone grafting, and fixation and were divided into two groups according to surgical timing. Group A included 11 patients with neurological dysfunction lasting less than 3 months; group B included 15 patients with neurological dysfunction lasting more than 3 months. No significant difference was found between the two groups in gender, age, involved segments, preoperative erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Cobb angle of involved segment, and preoperative American Spinal Injury Association (ASIA) classification (P>0.05). The operation time, intraoperative blood loss, hospitalization stay, perioperative complications, and bone fusion time were recorded and compared between the two groups. The change of pre- and post-operative Cobb angle of involved segments was calculated. Neurological function was assessed according to ASIA classification.ResultsAll patients were followed up 25-60 months (mean, 41.6 months). No cerebrospinal fluid leakage occurred intra- and post-operation. The hospitalization stay and perioperative complications in group A were significantly less than those of group B (P<0.05). There was no significant difference in operation time, intraoperative blood loss, and bone fusion time between the two groups (P>0.05). At last follow-up, there was no significant difference in ESR and CRP between groups A and B (P>0.05), but they were all significantly lower than those before operation (P<0.05). In group A, 1 patient with T6, 7 tuberculosis developed sinus that healed after dressing; the implants were removed at 20 months with bony union and no recurrence was found after 36 months of follow-up. One patient with T4, 5 tuberculosis in group B underwent revision because of recurrence and distal junctional kyphosis of the thoracic spine at 26 months after operation. There was no internal fixation-related complications or tuberculosis recurrence occurred in the remaining patients. At last follow-up, the Cobb angles in the two groups significantly improved compared with those before operation (P<0.05), but there was no significant difference in the Cobb angle and correction degree between the two groups (P>0.05). At last follow-up, the ASIA classification of spinal cord function was grade C in 1 case and grade E in 10 cases in group A, and grade D in 2 cases and grade E in 13 cases in group B; the ASIA classification results in the two groups significantly improved compared with preoperative ones (P<0.05), but no significant difference was found between the two groups (Z=–0.234, P=1.000).ConclusionPosterior unilateral transpedicular debridement, decompression, bone grafting, and fixation is effective in treatment of thoracic spinal tuberculosis with myelopathy. Early surgery can reduce the hospitalization stays and incidence of perioperative complications.
Objective To investigate an individualized treatment program of a patient with multilevel cervical spondylotic myelopathy by the method of evidence-based medicine. Methods One patient with multilevel cervical spondylotic myelopathy was admitted into West China Hospital on October 19th, 2015. After evaluating the patient’s condition adequately, we proposed the problem according to the " patient, intervention, control, and outcome” (PICO) principles. Then, we searched and evaluated the systematic reviews, randomized controlled trials (RCTs), cohort studies from Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Medline, Embase, PubMed, OVID ACP Journal Club, CNKI, Wanfang and so on. The search date was from January 1991 to December 2015. And the best evidences from the databases were utilized in clinical practice. Results Twelve studies (five systematic reviews, two RCTs, four cohort studies and one latest guideline) were listed. To patients with multilevel cervical spondylotic myelopathy with ossification of the posterior longitudinal ligament (OPLL), posterior laminoplasty was less traumatic and had less complication. Expansive open-door laminoplasty was better. And the use of mini-plate fixation also reduced the related complications. Conclusions Posterior expansive open-door laminoplasty with mini-plate fixation has less traumatic and complication incidence, which can treat multilevel cervical spondylotic myelopathy effectively. For the best results and avoiding adverse outcomes, the procedure should be preferred in patients with OPLL.
Objective To evaluate the cl inical outcomes and values of anterior segmental decompression and double-plate fixation (ASDDF) for treatment of ski p cervical spondylotic myelopathy (SCSM). Methods Between June 2005 and June 2008, 17 patients with SCSM were treated with ASDDF. There were 10 males and 7 females with an average age of 58.8 years (range, 41-74 years) and an average disease duration of 9.7 months (range, 6-39 months). According to JapaneseOrthopaedic Association (JOA) score system, 2 patients were rated as extreme severe condition, 7 as severe, 7 as moderate, and 1 as mild. MRI images showed 42 affected cervical disc levels, including 26 disc levels with high-intensity intramedullary lesions on T2, 4 with low-intensity intramedullary lesions on T1, and 12 with significant cord compression but no signal change; according to Nagata classification scale, there were 5 abnormal segments at class I, 21 at class II, and 16 at class III. The rate of fusion, the Cobb angle, and the range of motion (ROM) of the cervical spine were measured preoperatively and postoperatively by the X-ray examinations. The improvement of the neurological function was evaluated by the JOA score. Results The average time of follow-up was 28.6 months (range, 24-58 months). After operation, dysphagia occurred in 2 cases (symptom rel ief after 1 month), hoarseness in 1 case (symptom rel ief after 3 months of methylcobalamin treatment), and degeneration of adjacent segments without symptom in 3 cases. The X-ray films showed the fusion rate of 100% at 12 months after operation without displacement, resorption or collapse of bone graft, and without breakage or loosening of plate and screw. The Cobb angles were (13.3 ± 10.4)° preoperatively, (15.8 ± 10.8)° immediately postoperatively, and (15.4 ± 11.4)° at last follow-up; the ROM of the cervical spine were (41.3 ± 17.4)° preoperatively and (23.8 ± 18.8)° at last follow-up; and the JOA scores were 8.2 ± 2.9 preoperatively, 13.7 ± 3.0 at 12 months postoperatively, and 13.9 ± 2.8 at last follow-up. All indexes showed significant differences between before operation and after operation (P lt; 0.05). The results of JOA scores were excellent in 8 cases, good in 6, fair in 2, and poor in 1 with an average improvement rate of 66.8% (range, 14%-88%) for the neurological function. Conclusion Adequate decompression, high rate of fusion, sol id mechanical stabil ity, improvement of total cervical lordosis,and the neurological function can be achieved through ASDDF for treatment of SCSM.