Anterior Cervical Corpectomy Research Articles

K-line guided approach selection and outcomes assessment for Cervical Ossification of Posterior Longitudinal Ligament (OPLL): A case series with literature review from Pakistan

Objectives: To analyze the efficacy of K-line in surgical planning of approach selection for ossification of posterior longitudinal ligament (OPLL) and outcomes assessment by Nurick grading and Modified Japanese Orthopaedic Association (mJOA) scores. Methods: This is a retrospective case series study conducted at the Departments of Neurosurgery, Punjab Institute of Neurosciences, Lahore in the months of January and February 2024. Patients with complete records were considered. Google Form was used for data. Nurick grading and Modified Japanese Orthopaedic Association (mJOA) scores were calculated for each patient pre- and post-operatively. K-line assessment was done on computerized tomography (CT). Data analysis was performed using Microsoft excel in terms of frequency and percentages. Results: This study included ten patients with the mean age at presentation was 48.20 ± 9.37 years. Preoperative Nurick grading in our patients was Grade-V (five patients), Grade-IV (two patients) and Grade-III (three patients) with mean of 4.2 ± 0.91 SD whereas six months follow-up Nurick grading was Grade-V (three patients), Grade-IV (three patients) and Grade-III (four patients) with the mean of 3.90 ± 0.87 SD, which indicates neurological improvement. Types of OPLL present in our patients were segmental (4, 40%), continuous (3, 30%), mixed (2, 20%) and localized/others (1, 10%). There were 2 (20%) K-line (+) and 8 (80%) K-line (-) cases. Anterior approach was used in 2 (20%) cases whereas posterior approach was used for the rest of 8 (80%) cases. Mean preoperative mJOA was 10.30 ± 2.45 and mean postoperative mJOA was12.40 ± 2.01 at 6-month follow up, which indicates improvement in our cases. Conclusion: K-line is a useful radiological indicator in selecting anterior versus posterior approach for patients with cervical OPLL in terms of Nurick grading and mJOA scores. List of Abbreviations: OPLL: Ossified Posterior Longitudinal Ligament, DISH: Diffuse Idiopathic Skeletal Hyperostosis, CT: Computed Tomography, mJOA: Modified Japanese Orthopaedic Association, BMP: Bone Morphogenetic Protein, TGF-b: Transforming Growth Factor Beta, ACCF: Anterior Cervical Corpectomy and Fusion. doi: https://doi.org/10.12669/pjms.40.12(PINS).11094 How to cite this: Qadri HM, Khan M, Ansari N, Khizar A, Bukhari SFA, Bashir A. K-line guided approach selection and outcomes assessment for Cervical Ossification of Posterior Longitudinal Ligament (OPLL): A case series with literature review from Pakistan. Pak J Med Sci. 2024;40(12):S63-S68. doi: https://doi.org/10.12669/pjms.40.12(PINS).11094 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Novel Algorithm for Surgical Management of Cervical Ossification of Posterior Longitudinal Ligament: A Retrospective Cohort Study With 2-Year Follow-Up.

With the development of new technologies, the surgical algorithm for ossification of posterior longitudinal ligament (OPLL) in the cervical spine also needs to be updated. The aim of this study is to elucidate a new surgical classification algorithm to guide the choice of surgical approaches for cervical OPLL based on its location and extent. In this algorithm, anterior controllable antedisplacement and fusion (ACAF) will be used as a new surgical option. This is a single-centered, retrospective, cohort study utilizing a novel algorithm based on the following three criteria: (1) the positional relationship between ossification and uncinate process (UP), (2) the K-line, and (3) the ossification segment for surgical decision-making. Patients diagnosed with cervical OPLL who received surgical intervention guided by the algorithm were included. Patient demographics, Japanese Orthopedic Association (JOA) scores, surgical time, imaging data before and 2 years after surgery, and the occurrence of complications were extracted from the database. Paired t-test was used for intragroup comparison, and one-way ANOVA test was used for the intergroup analyses. Based on this novel algorithm, 15 patients with Type I, 8 patients with Type II a, 2 patients with Type II b1, 5 patients with Type II b2 were included. The decision-making for the surgical techniques used in each patient followed the recommendation of the novel algorithm. The postoperative JOA scores of all types of patients improved significantly (p < 0.05), and the invasion rates of vertebral canal had also been significantly reduced (p < 0.05). In terms of restoring cervical curvature, patients with Type I (receiving ACAF) and Type II b2 (receiving laminectomy with instrumented fusion) benefited more from surgery (p < 0.05). A new algorithm guiding the choice of surgical approach for cervical OPLL was validated in a series of 30 patients. Through this analysis, we obtained on their clinical outcomes and complications. ACAF surgery is an ideal choice for Type I patients, with ossification located between UPs, while for patients with ossification exceeding UPs, it is better to perform anterior cervical corpectomy and fusion or posterior surgery.

An Unusual Case of Esophageal Perforation Following C5-C7 Anterior Cervical Corpectomy and Fusion Managed Surgically With Esophageal Repair and Long-Segment Cervical Fusion

An Unusual Case of Esophageal Perforation Following C5-C7 Anterior Cervical Corpectomy and Fusion Managed Surgically With Esophageal Repair and Long-Segment Cervical Fusion

Risk Factors for Early Subsidence of 3D-Printed Artificial Vertebral After Anterior Cervical Corpectomy and Fusion

ObjectiveThe subsidence of vertebral body replacement may occur after anterior cervical corpectomy and fusion (ACCF) , which may lead to cervical kyphosis, spinal cord compression and neurological dysfunction. The authors aim to investigate the risk factors for early subsidence of 3D printed artificial vertebral (3D-PAVB) after ACCF surgery and to provide guidance for clinical practice. MethodsA retrospective analysis was conducted on the data of consecutive patients with cervical spondylosis who underwent ACCF surgery at Bethune Hospital of Shanxi from 2017 to 2020. The statistical data included age, gender, disease type, body mass index (BMI), surgical segment, vertebral height, Cobb Angle, and Hounsfeld Units (HU) values of the vertebral body and endplate. The clinical efficacy of the surgery was evaluated using Visual Analog Scale (VAS), Japanese Orthopedic Association (JOA), and Neck Disability Index (NDI). Follow-up data, such as VAS, JOA, NDI, and Cobb Angle, were obtained using a repeated-measures ANOVA analysis. Univariate analysis was conducted to identify the factors contributing to the early subsidence of the3D-PAVB, and independent risk factors were determined using logistic regression. The HU value was analyzed using the Receiver Operating Characteristic (ROC) curve and the area under the Area Under Curve (AUC) to predict the subsidence of the 3D-PAVB. ResultsA total of 66 patients were included in the study, out of which 19 patients experienced subsidence of 3D-PAVB,resulting in an incidence rate of 28.8%. The postoperative JOA, VAS, and NDI scores showed significant improvement in both the subsidence and non-subsidence groups. Upon conducting univariate analysis, significant differences were observed between the two groups in terms of age, diabetes, smoking, and lower vertebral Computed Tomography (CT) values. The average HU value of the subsidence group (251.39±52.615, n=19) was significantly lower than that of the non-subsidence group (317.06±73.587, n=47, p＜0.01). Multivariate analysis revealed that smoking and HU of the lower vertebra were independent risk factors for 3D-PAVB subsidence, with an AUC of 0.772 and an optimal threshold of 272 for HU (sensitivity 78.9%, specificity 74.5%). ConclusionThe occurrence of early subsidence of 3D-PAVB post ACCF surgery is influenced by two independent risk factors - smoking and low HU. To predict the likelihood of this outcome, it is advisable to consider smoking history and measure CT HU value prior to surgery. A lower CT HU value is indicative of a greater risk of subsidence.

Meta-Analysis of Treatment for Adjacent Two-Segment Cervical Spondylotic Myelopathy: A Comparison Between Anterior Cervical Corpectomy and Fusion and Anterior Cervical Discectomy and Fusion.

A systematic review and meta-analysis comparing the outcomes of Anterior Cervical Discectomy and Fusion (ACDF) vs Anterior Cervical Corpectomy and Fusion (ACCF) in treating adjacent two-segment cervical spondylotic myelopathy. To assess the clinical effectiveness and safety of ACDF compared to ACCF. A literature search was conducted in Cochrane Library, Web of Science, PubMed, and Embase up to December 2023. Studies included were prospective and observational involving ACDF or ACCF for adjacent two-segment cervical spondylotic myelopathy. Data were analyzed using RevMan 5.4 software. Ten studies (nine case-control and one RCT) were included. ACDF showed a shorter hospital stay (SMD = -0.29, 95% CI: -0.53 to -0.04, P < 0.05), better Cobb angle (SMD = 0.52, 95% CI: 0.31 to 0.74, P < 0.01), and improved T1S (SMD = 0.54, 95% CI: 0.28 to 0.80, P < 0.01). No significant differences were found in upper limb VAS, neck VAS, JOA scores, NDI, fusion rates, C2-7 SVA, total complications, blood loss, and operation time. ACDF and ACCF are both effective for adjacent two-segment cervical spondylotic myelopathy, with ACDF offering advantages in hospitalization duration and cervical curvature restoration, making it the preferred surgical approach. Further research is needed to validate these findings.

Identifying Factors for Predicting Postoperative Segmental Motor Paralysis in Patients Undergoing Anterior Cervical Spine Surgery: A Multicenter Study.

Retrospective cohort study. To investigate the incidence of and risk factors for segmental motor paralysis after anterior cervical spine surgery. Segmental motor paralysis is a potential complication following both anterior and posterior cervical decompression procedures; however, previous studies investigating risk factors for segmental motor paralysis after anterior cervical spine surgery were limited by small sample sizes. Consequently, the exact pathogenesis and risk factors for this complication remain poorly understood, highlighting the need for larger-scale investigations focused exclusively on anterior cervical spine surgeries. We retrospectively reviewed the clinico-demographic and operative factors and postoperative outcomes of 1,428 patients undergoing anterior cervical spine surgery at three spine centers in Japan. Postoperative segmental motor paralysis was defined as deterioration of upper extremity muscle strength by ≥1 grade; recovery was defined as a return to preoperative muscle strength levels. Univariate and multivariate analyses were performed to identify risk factors. Ninety-nine patients (6.9%) developed segmental motor paralysis, mostly involving the C5 segment (81.8%), the incidence being highest in patients with ossification of the posterior longitudinal ligament (OPLL) and those undergoing anterior cervical corpectomy and fusion or hybrid fusion (discectomy + corpectomy). Older age, male sex, higher body mass index, OPLL, and cervical corpectomy were independent risk factors for paralysis, with these patients having significantly worse clinical outcomes at 1 year postoperatively. Most patients (74/99, 79.6%) regained preoperative muscle strength levels an final follow up. This study identified important clinico-demographic and operative risk factors for segmental motor paralysis after anterior cervical spine surgery. Patients undergoing corpectomy, with or without OPLL, were found to be at particularly high risk. While most patients recover well, worse outcomes with segmental motor paralysis highlight the importance of preventing this complication, particularly for OPLL patients and corpectomy procedures. III.

Anterior cervical controllable Antedisplacement and Fusion (ACAF) versus Anterior Cervical Corpectomy and Fusion (ACCF) for ossification of the cervical posterior longitudinal ligament (OPLL) in Chinese population:a systematic review and meta-analysis.

This study aimed to systematically review and compare the efficacy and safety of anterior cervical controllable antedisplacement and fusion (ACAF) versus anterior cervical corpectomy and fusion (ACCF) in treating ossification of the cervical posterior longitudinal ligament (OPLL), focusing on surgery-related indicators and postoperative outcomes.This review was conducted and reported in accordance with the Cochrane Handbook for Systematic Reviews of Interventions guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting standards. The methodological quality of this systematic review was assessed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) checklist. A detailed search strategy was implemented to retrieve literature from electronic databases, including PubMed, EMBASE, and the Cochrane Library, followed by quality assessment and data extraction for eligible studies.A total of 5 studies involving 366 participants were included. ACAF was associated with significantly fewer complications (OR = 0.25, 95% CI [0.12, 0.51], p = 0.000), including a lower incidence of cerebrospinal fluid (CSF) leakage (OR = 0.20, 95% CI [0.08, 0.52], p = 0.000). ACAF also showed better outcomes in postoperative neck disability index (NDI) scores (SMD = -0.48, 95% CI [-0.81, -0.15], p = 0.020), C2-C7 angle (SMD = 1.29, 95% CI [0.56, 2.03], p = 0.000), spinal canal area (SCA) (SMD = 0.93, 95% CI [0.56, 1.29], p = 0.000), and diameter of the spinal cord (DSC) (SMD = 0.38, 95% CI [0.11, 0.66], p = 0.010). Additionally, ACAF improved The Japanese Orthopedic Association (JOA) scores (SMD = 0.29, 95% CI [0.01, 0.57], p = 0.040) but required longer operation time (SMD = 1.08, 95% CI [0.01, 2.15], p = 0.049). No significant differences were found in blood loss (SMD = 0.23, 95% CI [-0.34, 0.79], p = 0.431), hospital stay (SMD = 0.65, 95% CI [-1.46, 2.76], p = 0.547), and improvement rate (IR) (SMD = 0.38, 95% CI [-0.10, 0.86], p = 0.118).The current meta-analysis indicated that ACAF surgery can effectively reduce the incidence of complications, significantly increase the spinal canal area and improve the spatial conditions of the spinal cord compared to those associated with ACCF surgery. This is more advantageous for the postoperative neurological recovery of patients. Nonetheless, it is crucial to approach these findings with a degree of caution.

MRI-based endplate bone quality score independently predicts cage subsidence after anterior cervical corpectomy fusion.

To reduce the amount of radiation that patients receive during surgery, surgeons can evaluate the quality of the bone prior to surgery using computed tomography (CT) or dual-energy X-ray absorptiometry. Recently, lumbar spine vertebral bone quality has been evaluated using an MRI-based scoring system. However, few studies have investigated the connection between cage subsidence in patients following cervical interbody fusion and site-specific MRI bone evaluation. It is unknown how cage subsidence following anterior cervical corpectomy decompression and fusion is related to MRI-based endplate bone quality assessment. To create a similar MRI-based cervical spine scoring system (C-EBQ) and to investigate the predictive value of the MRI cervical endplate bone quality (C-EBQ) score for cage subsidence after ACCF. The patients' demographic, surgical, and radiological data were collected. Cage subsidence was defined as fusion segment height loss ≥ 3mm. Multivariate logistic regression models were developed to determine correlations between potential risk factors and subsidence, and simple linear regression analyses of statistically significant indicators were performed. Among the patients who underwent single-level ACCF, 72 met the requirements for inclusion. The C-VBQ scores also improved from 2.28 ± 0.12, indicating no subsidence, to 3.27 ± 0.35, which indicated subsidence, and the C-EBQ scores improved in both the nonsubsidence group (1.95 ± 0.80) and the subsidence group (2.38 ± 0.54). There was a statistically significant difference (p < 0.05) among the groups. Higher C-EBQ scores were strongly correlated with subsidence in the multivariate analysis (odds ratio [OR] = 17.249, 95% CI = 2.269 to 7.537, P < 0.001), and the C-VBQ score was the major independent predictor of subsidence following ACCF ([OR] = 4.752, 95% CI = 3.824 to 8.781, P < 0.05). The C-EBQ score outperformed the C-VBQ score (75.6%) in terms of predictive accuracy, with a ROC curve indicating an 89.4% score. After ACCF, cage subsidence was strongly correlated with higher C-EBQ scores on preoperative MRI. Assessing C-EBQ before ACCF may be a useful way to estimate the likelihood of postoperative subsidence.

Successful Management of Traumatic Cervical Spondyloptosis with Incomplete Neurological Deficit in a Child: A Case Report

Abstract Background: Spondyloptosis is a condition in which one vertebral body is completely displaced over the corpus of the adjacent one. It is more common in the lumbar region of the spine, but it very rarely occurs in the cervical spine. In this study, we report a case of post-traumatic cervical spine spondyloptosis in a child. Case Report: We describe a case of a 14-year-old male, who was admitted for cervicalgia with incomplete neurological deficit as a result of falling from a tree. Computed tomography (CT) of the neck revealed a posterior C5–C6 spondyloptosis with anterior spondylolisthesis of C7–T1. Surgical intervention was performed by the anterior approach only. The patient recovered completely after 2 months. Conclusion: Traumatic cervical spondyloptosis is an injury with rare occurrence with varied clinical presentations. Until now, there is no consensus concerning the most effective treatment for spondyloptosis. Satisfactory clinical and good outcomes can be obtained by anterior cervical corpectomy and fusion.

Application of the "Klotski Technique" in Cervical Ossification of the Posterior Longitudinal Ligament With En Bloc Type Dura Ossification.

The anterior controllable antedisplacement and fusion (ACAF) technique is a new procedure for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) that requires management of the disc adjacent to the ossification. This study describes a novel technique to reduce the number of fixed segments, namely, the "Klotski technique." The efficacy of ACAF using the Klotski technique was compared with that of anterior cervical corpectomy and fusion (ACCF) in the treatment of OPLL with en bloc type dural ossification (DO). The clinical data of 25 patients with severe OPLL and en bloc type DO who were treated by the ACAF Klotski technique or ACCF at our hospital from January 2020 to January 2022 were retrospectively analyzed. In the Klotski technique, the number of segments fused within the OPLL is limited. The antedisplacement space was designed according to the shape of the vertebrae-OPLL-DO complex (VODC). Then, the entire VODC was antedisplaced as in Klotski. Neurological function and image examination were assessed preoperatively and postoperatively. Complications associated with surgery were recorded. Patients were followed up for 24-36 months. There were 11 patients who were treated with ACAF and 14 patients who were treated with ACCF. At 2 weeks after surgery, the incidence of neurological deterioration was 21.4% (3 of 14) in the ACCF group and 9.1% (1 of 11) in the ACAF group. The incidence of intraoperative cerebrospinal fluid leakage (CFL) was 35.7% (5 of 14) in the ACCF group and 9.1% (1 of 11) in the ACAF group. The postoperative follow-up JOA scores of the patients in both groups were significantly better than their preoperative JOA scores (p<0.05). The Klotski technique for ACAF is a good option for the treatment of patients with en bloc type OPLL-DO, as it limits the number of fused segments, has a low incidence of CFL and neurologic deficits and is associated with good neurological recovery.

A novel cervical vertebral bone quality score can independently predict cage subsidence after anterior cervical corpectomy and fusion

ObjectivesTo optimize cervical vertebral bone quality (C-VBQ) score and explore its effectiveness in predicting cage subsidence in Anterior Cervical Corpectomy and Fusion (ACCF) and identify a new method for evaluating subsidence without different equipment and image scale interference.MethodsCollecting demographic, imaging, and surgical related information. Measuring Cage Subsidence with a new method. Multifactorial logistic regression was used to identify risk factors associated with subsidence. Pearson’s correlation was used to determine the relationship between C-VBQ and computed tomography (CT) Hounsfield units (HU). The receiver operating characteristic (ROC) curve was used to assess C-VBQ predictive ability. Correlations between demographics and C-VBQ scores were analyzed using linear regression models.Results92 patients were included in this study, 36 (39.1%) showed subsidence with a C-VBQ value of 2.05 ± 0.45, in the no-subsidence group C-VBQ Value was 3.25 ± 0.76. The multifactorial logistic regression showed that C-VBQ is an independent predictor of cage subsidence with a predictive accuracy of 93.4%. Pearson’s correlation analysis showed a negative correlation between C-VBQ and HU values. Linear regression analysis showed a positive correlation between C-VBQ and cage subsidence. Univariate analyses showed that only age was associated with C-VBQ.ConclusionsThe C-VBQ values obtained using the new measurements independently predicted postoperative cage subsidence after ACCF and showed a negative correlation with HU values. By adding the measurement of non-operated vertebral heights as a control standard, the results of cage subsidence measured by the ratio method are likely to be more robust, perhaps can exclude unavoidable errors caused by different equipment and proportional.

Comparison of Titanium Mesh Cage, Nano-Hydroxyapatite/Polyamide Cage, and 3D-Printed Vertebral Body for Anterior Cervical Corpectomy and Fusion.

A prospective non-randomized controlled study. To compare the clinical and radiographic outcomes of anterior cervical corpectomy and fusion (ACCF) using titanium mesh cages (TMC), nanohydroxyapatite/polyamide66 (n-HA/PA66) cages, and 3D-printed vertebral bodies (3d-VBs). Postoperative subsidence of TMCs in ACCF had been widely reported. Newer implants such as n-HA/PA66 cages and 3d-VBs using biocompatible titanium alloy powder (Ti6Al4V) had been introduced to address this issue, but their outcomes remain controversial. We enrolled 60 patients undergoing ACCF using TMCs, n-HA/PA66 cages, or 3d-VBs from January 2020 to November 2021. For each group, there were 20 patients. Follow-up was conducted for minimum two years. Clinical outcomes, including Japanese Orthopaedic Associationscores (JOA), Neck Disability Index (NDI) and Visual Analogue Scale (VAS) scores and radiographic outcomes, including FSU height, fusion rate, and cervical alignment were collected pre-operatively and at each follow-up. A loss of FSU height equal or greater than 3mm was deemed implant subsidence. One-way analysis of variance was used for comparisons of mean values at different time points within the same group, with pairwise comparisons performed using the LSD method. The Mann-Whitney test was used for comparisons between groups. Categorical data such as gender, smoking status, implant subsidence and pathology level were analyzed using the chi-square test. Postoperative function of spinal unit (FSU) height loss at 2 years differed significantly among the TMC, n-HA/PA66, and 3d-VB groups, measuring 3.07±1.25mm, 2.11±0.73mm, and 1.46±0.71mm, respectively (P<0.001). The rates of implant subsidence were 45%, 20%, and 10%, respectively (P=0.031). All patients obtained solid fusion at 2-year follow-up. We observed statistically significant differences in VAS and JOA scores at 3 months postoperatively, and JOA scores at 2 years postoperatively among the three groups. At two-year follow-up, the n-HA/PA66 and the 3d-VBs groups exhibited less FSU height loss, lower subsidence rates and demonstrated better cervical lordosis than the TMC group. No severe postoperative complications were observed in any of the patients, and no patient required reoperation. At two-year follow-up after ACCF, the n-HA/PA66 and the 3d-VBs groups exhibited less FSU height loss, lower subsidence rates and demonstrated better cervical lordosis than the TMC group. Longer term observation of implant subsidence in ACCF using TMC, n-HA/PA66, and 3d-VB, is necessary. Therapeutic Level III.

A Meta-Analysis of Surgical Outcomes in 25727 Patients Undergoing Anterior Cervical Discectomy and Fusion or Anterior Cervical Corpectomy and Fusion for Cervical Deformity.

Systematic Review. To evaluate which cervical deformity correction technique between anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) produces better clinical, radiographic, and operative outcomes. We conducted a meta-analysis comparing studies involving ACDF and ACCF. Adult patients with either original or previously treated cervical spine deformities were included. Two independent reviewers categorized extracted data into clinical, radiographic, and operative outcomes, including complications. Clinical assessments included patient-reported outcomes; radiographic evaluations examined C2-C7 Cobb angle, T1 slope, T1-CL, C2-7 SVA, and graft stability. Surgical measures included surgery duration, blood loss, hospital stay, and complications. 26 studies (25727 patients) met inclusion criteria and were extracted. Of these, 14 studies (19077 patients) with low risk of bias were included in meta-analysis. ACDF and ACCF similarly improve clinical outcomes in terms of JOA and NDI, but ACDF is significantly better at achieving lower VAS neck scores. ACDF is also more advantageous for improving cervical lordosis and minimizing the incidence of graft complications. While there is no significant difference between approaches for most surgical complications, ACDF is favorable for reducing operative time, intraoperative blood loss, and length of hospital stay. While both techniques benefit cervical deformity patients, when both techniques are feasible, ACDF may be superior with respect to VAS neck scores, cervical lordosis, graft complications and certain perioperative outcomes. Further studies are recommended to address outcome variability and refine surgical approach selection.

A machine learning-based approach for individualized prediction of short-term outcomes after anterior cervical corpectomy.

A retrospective machine learning (ML) classification study for prognostic modeling after anterior cervical corpectomy (ACC). To evaluate the effectiveness of ML in predicting ACC outcomes and develop an accessible, user-friendly tool for this purpose. Based on our literature review, no study has examined the capability of ML algorithms to predict major shortterm ACC outcomes, such as prolonged length of hospital stay (LOS), non-home discharge, and major complications. The American College of Surgeons' National Surgical Quality Improvement Program database was used to identify patients who underwent ACC. Prolonged LOS, non-home discharges, and major complications were assessed as the outcomes of interest. ML models were developed with the TabPFN algorithm and integrated into an open-access website to predict these outcomes. The models for predicting prolonged LOS, non-home discharges, and major complications demonstrated mean areas under the receiver operating characteristic curve (AUROC) of 0.802, 0.816, and 0.702, respectively. These findings highlight the discriminatory capacities of the models: fair (AUROC >0.7) for differentiating patients with major complications from those without, and good (AUROC >0.8) for distinguishing between those with and without prolonged LOS and non-home discharges. According to the SHapley Additive Explanations analysis, single- versus multiple-level surgery, age, body mass index, preoperative hematocrit, and American Society of Anesthesiologists physical status repetitively emerged as the most important variables for each outcome. This study has considerably enhanced the prediction of postoperative results after ACC surgery by implementing advanced ML techniques. A major contribution is the creation of an accessible web application, highlighting the practical value of the developed models. Our findings imply that ML can serve as an invaluable supplementary tool to stratify patient risk for this procedure and can predict diverse postoperative adverse outcomes.

Anterior cervical corpectomy and fusion-derived adjacent segment disease managed via channel-repairing anterior endoscopic transcorporeal cervical discectomy: a case report

BackgroundManagement of anterior cervical corpectomy and fusion (ACCF)-derived adjacent segment disease (ASD) represented a challenge facing the surgeons.MethodsA 41-year man diagnosed as C3-4 level ASD derived from C5-level ACCF surgery 13 years ago was admitted to the hospital for numbness and pain in the right shoulder and upper limb. Percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) was performed, and pre- and postoperative clinical and imaging data were collected.ResultsThe operation was completed within 70 min, and no clinical or radiological complication was reported. The visual analog scale (VAS) score decreased from preoperative 5 points to postoperative 1 point. Numbness was relieved postoperatively and disappeared completely at postoperative 3 months. Imaging data indicated sufficient spinal cord decompression, good channel repairing and cervical alignment.ConclusionsChannel-repairing PEATCD was successfully performed to treat ACCF-derived ASD, nevertheless, the long-term efficacy remained tracing and further clinical trials were needed to validate its efficacy.

Interspinous Motion Measurement Could Serve as a Quantitative Method for Assessing Bony Fusion after Anterior Cervical Corpectomy and Fusion (ACCF).

A retrospective diagnostic test study. To establish quantitative fusion criteria for ACCF. Currently, the criteria of fusion after ACCF remains controversial. Evaluation techniques such as observation of continuous bony trabeculae across the fusion site, were qualitative and conducted by naked eyes, limiting its accuracy. Dynamic fusion indicators such as interspinous motion (ISM), have been successfully utilized in anterior cervical discectomy and fusion (ACDF) for evaluating fusion and detecting pseudarthrosis. However, the accuracy of ISM in ACCF is unclear. Patients underwent ACCF in our hospital were reviewed. Imaging data including dynamic radiographs and computed tomography (CT) scans were collected. The distance and angle form of ISM (ISM-dis and ISM-ang) were measured on dynamic radiograph, with CT as the gold standard for fusion. The correlation between ISM methods was analyzed using Spearmann correlation. Receiver Operating Characteristic (ROC) curves were used to evaluate the accuracy and generate optimal cut-off values. Three observers independently measured the data twice to determine interobserver and intraobserver reliability. Our study included 178 imaging datasets. ISM-dis showed positive correlation with ISM-ang (r=0.914). The area under ROC (AUC) for ISM-dis and ISM-ang was 0.926 and 0.893. Applying a cutoff value of 1.50mm to ISM-dis yielded a sensitivity of 87.8% and specificity of 92.3% for detecting pseudarthrosis. For ISM-ang, a cutoff value of 1.75° resulted in a sensitivity of 79.1% and specificity of 92.3%. Intraobserver reliabilities for ISM-dis (0.986, 0.984 and 0.972) were higher than for ISM-ang (0.935, 0.963 and 0.935), as was interobserver reliability (0.985 for ISM-dis and 0.956 for ISM-ang). Fusion rates calculated using ISM-dis and ISM-ang were 52.4% and 61.9%. ISM can serve as an alternative to CT for assessing fusion, with ISM-dis at a 1.50mm cutoff and ISM-ang at 1.75° demonstrating high diagnostic accuracy.

A novel nanohydroxyapatite/polyamide 66 strut for reducing subsidence after one-level anterior cervical corpectomy and fusion: a finite-element study

BackgroundThe aim of this study is to introduce a novel nanohydroxyapatite/polyamide 66(n-HA/PA66)n strut to improve biomechanical performance and reduce subsidence.MethodsOne validated intact and 2 ACCF-simulated C3–C7 cervical spine models were developed (old strut: Group A, new strut: Group B). In the ACCF models, C5 underwent corpectomy and was fixed by an anterior cervical plate. Screw angles were categorized as 1 (0 ) and 2 (45 ) and divided into 4 groups, A1, A2, B1 and B2, for each model. An axial force of 74 N and a moment couple of 1.0 Nm were imposed on the C3 vertebra. The range of motion (ROM) of each segment and the stress distribution on the screw–vertebra interface, strut, and strut–endplate interface were recorded and analysed.ResultsThere was no significant difference in ROM between Group A and Group B during bending, extension and rotation under 74 N axial pressure. The stress concentration on the strut body in Group A was higher than that in Group B. The peak stress values at the screw–vertebral interface in Groups A1 and A2 were higher than those in Groups B1 and B2, except for during extension and lateral bending. Under axial pressure, the peak stress values at the strut body–endplate interface during bending, extension and rotation were lower in the A1 and A2 groups than in the B1 and B2 groups. The Group B model showed much higher graft stress than the Group A model.ConclusionsBased on finite-element analysis, compared with the old strut, the novel strut showed better biomechanical performance at the screw–vertebra interface.

Safety of anterior cervical corpectomy and fusion (ACCF) for the treatment of subaxial cervical spine injuries, a single center comparative matched analysis

IntroductionAnterior Cervical Discectomy and Fusion (ACDF) and Anterior Cervical Corpectomy and Fusion (ACCF) are both common surgical procedures in the management of pathologies of the subaxial cervical spine. While recent reviews have demonstrated ACCF to provide better decompression results compared to ACDF, the procedure has been associated with increased surgical risks. Nonetheless, the use of ACCF in a traumatic context has been poorly described. The aim of this study was to assess the safety of ACCF as compared to the more commonly performed ACDF.MethodsAll patients undergoing ACCF or ACDF for subaxial cervical spine injuries spanning over 2 disc-spaces and 3 vertebral-levels, between 2006 and 2018, at the study center, were eligible for inclusion. Patients were matched based on age and preoperative ASIA score.ResultsAfter matching, 60 patients were included in the matched analysis, where 30 underwent ACDF and ACCF, respectively. Vertebral body injury was significantly more common in the ACCF group (p = 0.002), while traumatic disc rupture was more frequent in the ACDF group (p = 0.032). There were no statistically significant differences in the rates of surgical complications, including implant failure, wound infection, dysphagia, CSF leakage between the groups (p ≥ 0.05). The rates of revision surgeries (p > 0.999), mortality (p = 0.222), and long-term ASIA scores (p = 0.081) were also similar.ConclusionResults of both unmatched and matched analyses indicate that ACCF has comparable outcomes and no additional risks compared to ACDF. It is thus a safe approach and should be considered for patients with extensive anterior column injury.

Does the novel artificial cervical joint complex resolve the conflict between stability and mobility after anterior cervical surgery? a finite element study.

Our group has developed a novel artificial cervical joint complex (ACJC) as a motion preservation instrument for cervical corpectomy procedures. Through finite element analysis (FEA), this study aims to assess this prosthesis's mobility and stability in the context of physiological reconstruction of the cervical spine. A finite element (FE)model of the subaxial cervical spine (C3-C7) was established and validated. ACJC arthroplasty, anterior cervical corpectomy and fusion (ACCF), and two-level cervical disc arthroplasty (CDA) were performed at C4-C6. Range of motion (ROM), intervertebral disc pressure (IDP), facet joint stress (FJS), and maximum von Mises stress on the prosthesis and vertebrae during loading were compared. Compared to the intact model, the ROM in all three surgical groups demonstrated a decline, with the ACCF group exhibiting the most significant mobility loss, and the highest compensatory motion in adjacent segments. ACJC and artificial cervical disc prosthesis (ACDP) well-preserved cervical mobility. In the ACCF model, IDP and FJS in adjacent segments increased notably, whereas the index segments experienced the most significant FJS elevation in the CDA model. The ROM, IDP, and FJS in both index and adjacent segments of the ACJC model were intermediate between the other two. Stress distribution of ACCF instruments and ACJC prosthesis during the loading process was more dispersed, resulting in less impact on the adjacent vertebrae than in the CDA model. The biomechanical properties of the novel ACJC were comparable to the ACCF in constructing postoperative stability and equally preserved physiological mobility of the cervical spine as CDA without much impact on adjacent segments and facet joints. Thus, the novel ACJC effectively balanced postoperative stability with cervical motion preservation.

In vivo study of a novel 3D-printed motion-preservation artificial cervical corpectomy construct: short-term imaging and biocompatibility evaluations in a goat model

BackgroundNonfusion technologies, such as motion-preservation devices, have begun a new era of treatment options in spine surgery. Motion-preservation approaches mainly include total disc replacement for anterior cervical discectomy and fusion. However, for multisegment fusion, such as anterior cervical corpectomy and fusion, the options are more limited. Therefore, we designed a novel 3D-printed motion-preservation artificial cervical corpectomy construct (ACCC) for multisegment fusion. The aim of this study was to explore the feasibility of ACCC in a goat model.MethodsGoats were treated with anterior C3 corpectomy and ACCC implantation and randomly divided into two groups evaluated at 3 or 6 months. Radiography, 3D CT reconstruction and MRI evaluations were performed. Biocompatibility was evaluated using micro-CT and histology.ResultsPostoperatively, all goats were in good condition, with free neck movement. Implant positioning was optimal. The relationship between facet joints was stable. The range of motion of the C2-C4 segments during flexion–extension at 3 and 6 months postoperatively was 7.8° and 7.3°, respectively. The implants were wrapped by new bone tissue, which had grown into the porous structure. Cartilage tissue, ossification centres, new blood vessels, and bone mineralization were observed at the porous metal vertebrae-bone interface and in the metal pores.ConclusionsThe ACCC provided stabilization while preserving the motion of the functional spinal unit and promoting bone regeneration and vascularization. In this study, the ACCC was used for anterior cervical corpectomy and fusion (ACCF) in a goat model. We hope that this study will propel further research of motion-preservation devices.