Average Japanese Orthopaedic Association Score Research Articles

Anterior Cervical Discectomy and Fusion for the Treatment of Pincer Cervical Spondylotic Myelopathy: A Single-Center Retrospective Study

BackgroundAnterior and posterior compression of the cervical spinal cord is usually called pincer cervical spondylotic myelopathy (p-CSM), and surgery is generally recommended; however, there is some controversy about the choice of surgical approach because single anterior or posterior surgery cannot effectively relieve contralateral compression, and combined surgery may cause problems related to trauma and effects on cervical spine function. ObjectiveTo investigate the feasibility and indications of single anterior cervical discectomy and fusion (ACDF) for the treatment of p-CSM. MethodsThe data of twenty-one p-CSM patients who were treated with ACDF at a single center from 2019 to 2022 were collected. Neurological status was evaluated by the Japanese Orthopedic Association (JOA) scoring system. The radiological parameters included the percentage of space occupied by the spinal canal, the cervical sagittal Cobb angle, and the cross-sectional area of the spinal cord before and after the operation. Complications and spinal cord compression rates were also observed. Correlations between the decompressive effects and various prognostic factors were statistically analyzed. ResultsThe mean follow-up period was 24.1±3.55 months. The average JOA score significantly increased, with a mean recovery rate of 65.88±8.97%. The fusion rate was satisfactory. Correlation analysis revealed that the number of operation segments and age were important predictors of decompressive effects. There was no further deterioration of spinal cord function after the operation. ConclusionACDF is an effective method for treating pincer spinal cord compression in terms of neurological recovery, radiological parameters, fusion rates, and complications, especially for patients younger than 60 years of age with single operative segments.

Anterior cervical discectomy and fusion for the treatment of giant cervical disc herniation

ObjectiveGiant cervical disc herniation (GCDH) was defined as a herniated intervertebral disc that accounted for more than 50% of the spinal canal. The purpose of this study was to analyse the feasibility of anterior cervical discectomy and fusion (ACDF) for the treatment of GCDH.MethodsPatient demographic and imaging data, clinical results, and perioperative complications were analysed retrospectively.ResultsA total of 23 patients were included in the study. Spinal cord recovery pulsation was observed under a microscope in all cases. Postoperative magnetic resonance imaging showed complete decompression of the spinal cord and no residual intervertebral disc. The patients were followed up for 12 to 18 months. The average visual analogue scale score and Neck Disability Index decreased from 8.6 ± 0.5 and 86.0 ± 2.7% to 2.2 ± 0.2 and 26.7 ± 2.0%, respectively, three days after surgery. The average Japanese Orthopedic Association score increased from 6.9 ± 2.1 to 13.9 ± 1.1. The cervical spinal cord function improvement rate was 69.3%. No neurological complications after surgery were observed.ConclusionThis study shows that ACDF is feasible for the treatment of GCDH disease. The results indicate that this approach can be used to safely remove herniated disc fragments, effectively relieve compression of the spinal cord, and improve neurological function.

Posterior Decompression and Fixation for Thoracic Spine Ossification: A 10-Year Follow-Up Study.

Ossification of the posterior longitudinal ligament of the thoracic spine (T-OPLL) causes symptoms including leg and back pain, and motor and sensory deficits. This study retrospectively reviewed 32 patients who initially underwent posterior decompression with instrumented fusion (PDF) for T-OPLL between 2001 and 2012, with 20 qualifying for the final analysis after applying exclusion criteria. Exclusions included unknown preoperative neurological findings, follow-up less than 10 years, or prior spinal surgeries at other levels. Outcomes were assessed using the Japanese Orthopedic Association (JOA) score, recovery rate, and kyphotic angle. The average preoperative JOA score of 3.6 improved to 7.4 at 1 year post-surgery and remained at 7.4 at 10 years, with a recovery rate of 52%. The kyphotic angle at T4-12 increased from 26 degrees preoperatively to 29 degrees postoperatively and to 37 degrees at 10 years. At the fused levels, the angle remained at 26 degrees immediately post-operation and increased to 32 degrees at 10 years. Forty percent of patients required additional surgery, primarily for conditions related to cervical OPLL, such as myelopathy, or lumbar OPLL, such as radiculopathy, or cauda equina syndrome. In conclusion, PDF effectively reduces T-OPLL symptoms over the long term, but the high rate of additional surgeries calls for careful patient follow-up.

Effect of vitamin D deficiency on surgical outcomes of degenerative cervical myelopathy

Due to its association with bone metabolic status and muscle strength/mass, vitamin D deficiency has the potential to affect neurological symptom recovery after surgery for degenerative cervical myelopathy (DCM). However, few studies have investigated the effects of vitamin D deficiency (serum 25(OH)D <20 ng/mL) on surgical outcomes in DCM patients. Herein, we investigated the prevalence of vitamin D deficiency in patients with DCM, and determined whether vitamin D deficiency affects surgical outcomes for DCM. In this retrospective observational study we assessed the recovery rate 1 year after surgery in 91 patients diagnosed with DCM who underwent surgery. First, we analyzed the correlation between vitamin D levels and various background factors. Then, patients were divided into 2 groups according to vitamin D sufficiency, and univariate analysis was performed on vitamin D and surgical outcomes. Finally, Spearman correlation analyses were performed to identify factors correlated with recovery rate after surgery for DCM. The average Japanese Orthopedic Association score for the assessment of cervical myelopathy (C-JOA score) improved postoperatively. Age was positively correlated with vitamin D levels, and parathyroid hormone levels were negatively correlated with vitamin D levels. Among the 91 patients, 79.1% of patients were diagnosed with vitamin D deficiency. No significant differences in recovery rate were found between the vitamin D-deficient and vitamin D-sufficient groups. Finally, the Spearman correlation analysis showed a positive correlation between the preoperative C-JOA motor dysfunction score in the lower extremities and the recovery rate, while age demonstrated a negative correlation with recovery rate. No association was found between vitamin D deficiency and clinical outcomes after surgery for DCM. The results of this study do not support the need to normalize vitamin D levels for achieving neurological improvements in patients with DCM.

Application of medical-nurse integration health education in aged patients undergoing percutaneous vertebroplasty.

This study was designed to explore the effect of medical-nurse integration health education in aged patients undergoing percutaneous vertebroplasty. A total of 72 aged patients with osteoporotic vertebral compression fractures, who obtained percutaneous vertebroplasty from June 2019 to May 2022 were selected in this study. Patients were divided into control group (n = 36) and experimental group (n = 36) according to the time of hospitalization. The patients in control group received routine health education, while the patients in the experimental group received medical-nurse integration health education. We evaluated participants on 4 key aspects, their understanding of relevant knowledge, compliance with functional exercise, residual lower back pain rate, and satisfaction with the health education received. Our study found that patients in the experimental group had a significantly higher mastery rate of health education knowledge compared to those in the control group (88.89% vs 50.00%, P < .001). Additionally, compliance with the functional exercise program was higher in the experimental group, with over 80% of patients fully compliant, compared to only about 44.4% in the control group (P = .001). The average Japanese Orthopaedic Association score of the observation group 1 week after operation was higher than that of the control group (P < .05). Moreover, most patients in the experimental group were very satisfied with the medical-nurse integration health education, while most patients in the control group were only satisfied (P < .001). For aged patients with osteoporotic vertebral compression fractures treated by percutaneous vertebroplasty, medical-nurse integration health education could be an effective method to improve the ability of patients to obtain relevant education, enhance the compliance of patients for functional exercise and increase patient satisfaction to the education, and reduce residual low back pain in patients.

Evaluation of Effect of Modic Changes on Treatment Outcomes of Nonspecific Low Back Pain Patients Presenting to 501 Hospitals Receiving Conservative Treatments

Background: Modic changes (MC) are among the pain generators in the lumbar spine and could affect back pain treatments. Objectives: The current study aimed to investigate the effect of MC on the treatment outcomes of low back pain (LBP) patients who underwent conservative treatments. Methods: This prospective cohort study was performed on 166 nonspecific LBP patients presenting to 501 Hospital receiving conservative treatments. The patients were categorized based on their MC status, which was determined using a magnetic resonance imaging scan at baseline. Japanese Orthopedic Association (JOA) score was considered a measure of back pain and disability using a valid and reliable questionnaire for each participant. The data were collected on the age, gender, and duration of pain for each participant. The follow-up JOA score was also calculated for each patient after 6-month conservative treatments. The patient was considered improved if the JOA change score was higher than 0. Results: The average baseline JOA score in MC patients was 14.3 (2.2); however, it was 14.4 (2.0) in patients without MC (P = 0.750). After 6-month conservative treatments, the average JOA score reached 16.7 (3.4) and 17.1 (2.9) in patients with and without MC, respectively. No statistically significant difference was observed in this regard (P = 0.540). The proportion of improved cases was 70.7%, 82.8%, 63.4%, and 50.0% in no MC, MC type I, MC type II, and MC type III, respectively, with no statistically significant difference among the groups (P = 0.561). Conclusions: A 6-month conservative treatment was a safe and effective approach to improving the clinical condition of patients with LBP. However, there was no association between the presence of MC or any specific type of MC and treatment outcomes.

A Comparative Clinical Study of Lateral Lumbar Interbody Fusion between Patients with Multiply Operated Back and Patients with First-Time Surgery.

Background and Objectives: Patients with multiply operated back (MOB) may suffer from persistent lower-back pain associated with back muscle damage and epidural fibrosis following repeated back surgery (Failed Back Spinal Syndrome). Lateral lumbar interbody fusion (LLIF) is considered to be favorable for MOB patients. However, little scientific research has been carried out for this issue due to variety of the pathogenesis. The purpose of this study was to compare the clinical results of MOB patients and first-time surgery patients who underwent LLIF for lumbar spinal stenosis with degenerative scoliosis and/or degenerative spondylolisthesis (spinal instability). Materials and Methods: LLIF was performed for lumbar spinal stenosis with spinal instability in 55 consecutive cases of single hospital (30 males, 25 females, average age: 69). Clinical outcomes were compared between the MOB patient group (MOB group) and the first surgical patient group (F group). We evaluated the Japanese Orthopaedic Association (JOA) scores and JOA Back Pain Evaluation Questionnaire (JOABPEQ) before and 2 years after surgery. MOB patients were defined as those who have had one or more lumbar surgery on the same intervertebral or adjacent vertebrae in the past. Results: There were 20 cases (12 males, 8 females, average age: 71) in MOB group, and 35 cases (19 males, 16 females, average age: 68) in the F group. There was no significant difference between the two groups in terms of age, sex, number of intervertebral fixations, modic change in fused intervertebral end plate, score of brief scale for evaluation of psychiatric problem, lumbar lordosis, and sagittal vertical axis before and after surgery. The preoperative JOA scores averaged 12.5 points in the MOB group and averaged 11.6 points in the F group. The postoperative JOA scores averaged 23.9 points in the MOB group and averaged 24.7 points in the F group. The preoperative JOABPEQ averaged 36.3 points in the MOB group and averaged 35.4 points in the F group. The postoperative average JOA score was 75.4 in the MOB group and 70.2 in the F group. Conclusions: Based on the results, there was no significant difference in clinical outcomes of the two groups, and there was no new residual lower-back pain. Thus, we considered that LLIF one option for patients with MOB.

Angled Ultrasonic Bone Curette-Assisted Circumferential Decompression for Thoracic Myelopathy Caused by Severely Anterior Ossification.

ObjectiveThoracic myelopathy caused by severe anterior ossification is often progressive and fails to respond to conservative treatment. Removal of the compressing ossification is the most effective method but is hard to operate. In this study, we describe a novel one‐stage posterior circumferential decompressive procedure assisted by an angled ultrasonic bone curette (UBC) for thoracic myelopathy caused by severe anterior ossification and evaluate its safety and efficacy.MethodsThe current study enrolled 15 consecutive patients (five men and 10 women) with thoracic myelopathy caused by severely anterior ossification between January 2017 and December 2019. All patients underwent posterior circumferential decompression assisted by angled UBC and segmental instrumentation with interbody fusion. At the time of surgery, the average age was 58.6 ± 6.3 years (47–70 years). Before and after surgery, the patient data, clinical manifestation, operative levels, blood loss, operative time, perioperative complications, Japanese Orthopaedic Association (JOA) score were recorded and analyzed retrospectively.ResultsAll patients had successful one‐stage posterior circumferential decompression to remove anterior ossifications directly. There were 12 cases of OPLL, two cases of a calcified giant herniated disc, and one case of osteophyte. The average operation time was 153.4 ± 53.4 min (77–242 min), with a mean blood loss of 463.5 ± 155.8 mL (240–780 mL). The average length of stay in the hospital was 14.3 ± 4.7 days (9–25 days) and the mean follow‐up duration was 20.8 ± 8.8 months (12–39 months). Almost all patients had subjective improvement in motor power and gait. The average preoperative JOA score was 4.5 ± 1.6, which improved to 9.0 ± 1.8 at the final follow‐up. Postoperative differences in the overall JOA scores showed significant improvement (F = 105.446, p < 0.01). The overall recovery rate at the final examination scored 70.9% ± 25.0%. According to Hirabayashi's classification, eight cases were rated as excellent, four as good, two as fair, and one as unchanged. No patient was graded as deteriorated. Two patients (13.3%) experienced intraoperative cerebrospinal fluid leakage, while two cases (13.3%) experienced unilateral intercostal neuralgia, and only one (6.7%) encountered acute neurological deterioration. All these patients were treated conservatively and their neurological function improved significantly. At the follow‐up, there was no evidence of neurological deterioration.ConclusionCircumferential decompression assisted by angled UBC can preserve more posterior elements of the involved levels, maintaining an intact pleura and reducing the operation time and blood loss for thoracic myelopathy caused by severe anterior ossification. It is a safe, effective, and technically feasible method to provide surgeons with a new option for thoracic spinal circumferential decompression.

Functional Impairment of Hip Joint and Activities of Daily Living Failure in Patients with Multiple Hereditary Exostoses.

In this study, we focused on the hip joints and examined pain and functional impairment, and their relationship with anatomical characteristics in MHE patients. Patients with MHE followed up in our hospital from January 2020 to December 2020 were enrolled. Clinical hip functional outcomes were evaluated using the Japanese Orthopedic Association (JOA) hip score and hip range of motion (ROM). Proximal femur geometric measurements were evaluated using radiography. A total of 39 patients (78 hips) with a median age of 25.6years and average JOA score of 94.0 ± 10.5 were included. Eight patients felt pain in their hip joints. The average ROM score was 18.2 ± 2.5, and 47.4% of the patients with MHE had ROM limitation. The average score of ability to walk was 19.6 ± 1.8, and three patients had some problems with walking. The average ADL score was 18.2 ± 2.5, and 51.3% of patients with MHE had some failures in ADL. The hip flexion and internal rotation were markedly restricted compared with the normal values. When patients were grouped according to their ADL scores, we found that the ADL failure group had a significantly lower ROM score than the no ADL failure group (p < 0.0001), and there were significant differences between the groups in terms of femoral neck widening (p = 0.0001). We found that half of MHE patients had some failures in their ADL due to hip functional impairment. The study results also suggest that femoral neck widening affected ADL failure and ROM limitation.

Anterior decompression through a posterior approach for thoracic myelopathy caused by ossification of the posterior longitudinal ligament: a novel concept in anterior decompression and technical notes with the preliminary outcomes.

Various surgical procedures are used to manage thoracic myelopathy due to ossification of the posterior longitudinal ligament (OPLL). However, the outcomes of surgery for thoracic OPLL are generally unfavorable in comparison to surgery for cervical OPLL. Previous studies have shown a significant risk of perioperative complications in surgery for thoracic OPLL. Thus, a safe and secure surgical method to ensure better neurological recovery with less perioperative complications is needed. The authors report a novel concept of anterior decompression through a posterior approach aimed at anterior shift of the OPLL during surgery rather than extirpation or size reduction of the OPLL. This surgical technique can securely achieve anterior shift of the OPLL using a curved drill, threadwire saw, and curved rongeur. The preliminary outcomes were investigated to evaluate the safety and efficacy of this technique. This study included 10 consecutive patients who underwent surgery for thoracic OPLL. Surgical outcomes, including the ambulatory status, Japanese Orthopaedic Association (JOA) score, and perioperative complications, were investigated retrospectively. In this surgery, pedicle screws are introduced at least three levels above and below the corresponding levels. The laminae, facet joints, transverse processes, and pedicles are then removed bilaterally at levels wherein subsequent anterior decompression is performed. For anterior decompression, the OPLL and posterior portion of the vertebral bodies are partially resected using a high-speed drill with a curved burr, enabling the removal of osseous tissues just ventral to the spinal cord without retracting the dural sac. To securely shift the OPLL anteriorly, the intact PLL and posterior portion of the vertebral bodies cranial and caudal to the lesion are completely resected using a threadwire saw and/or curved rongeur. Rods are connected to the screws, and bone grafting is performed for posterolateral fusion. Five patients were nonambulatory before surgery, but all were able to walk at the final follow-up. The average JOA score before surgery and at the final follow-up was 3.2 and 8.8 points, respectively. Notably, the mean recovery rate of JOA score was 72%. Furthermore, no patients showed neurological deterioration postoperatively. The surgical technique is a useful alternative for safely achieving sufficient anterior decompression through a posterior approach and may consequently reduce the risk of postoperative neurological deterioration and improve surgical outcomes in patients with thoracic OPLL.

Foraminal Stenosis at L5-S1 as an Overlooked Pathology of Bilateral Radiculopathy: A Case Series.

The classical symptom of foraminal stenosis is unilateral radiculopathy. Bilateral radiculopathy caused purely by foraminal stenosis is rare. Here, we report five cases of bilateral L5 radiculopathy caused purely by L5-S1 foraminal stenosis and describe the clinical and radiological features of these patients in detail. Among the five patients, two were men and three were women with an average age of 69 years. Four patients had undergone surgeries at L4-5 level, previously. All the patients showed an improvement in symptoms in the post-operative period. After a certain period, the patients complained of bilateral leg pain and numbness. An additional surgery was performed in two patients; however, there was no improvement in symptoms. One patient, who did not undergo surgery, was treated conservatively for 3 years. All the patients had been suffering from bilateral leg symptoms before their first visit to our hospital. The neurological findings in these patients were consistent with bilateral L5 radiculopathy. The average pre-operative Japanese Orthopedic Association (JOA) score was 13 out of 29 points. Bilateral foraminal stenosis at L5-S1 level was confirmed using a three-dimensional magnetic resonance imaging or computed tomography. Posterior lumbar interbody fusion was performed in one patient and bilateral lateral fenestration using Wiltse's approach was performed in four patients. The neurological symptoms recovered immediately after surgery. The average JOA score at 2-year follow-up was 25 points. Spine surgeons may overlook the pathology of foraminal stenosis, particularly in patients with bilateral radiculopathy. Familiarity with the clinical and radiological features of symptomatic lumbar foraminal stenosis is necessary to properly diagnose bilateral foraminal stenosis at L5-S1 level.

Long-Term Follow-Up of Multilevel Thoracic Ossification of the Posterior Longitudinal Ligament Following Circumferential Decompression via Posterior Approach: A Retrospective Study.

ObjectiveTo examine the postoperative progression of multilevel thoracic posterior longitudinal ligament (OPLL) at circumferential decompression (CD) levels and evaluate the long‐term results after CD via the posterior approach.MethodsClinical data from 16 patients with thoracic myelopathy secondary to OPLL who underwent CD at a single center were evaluated retrospectively from 2007 to 2014 and were followed up for more than 60 months. Patients of all sexes and ages were included in the study. Thin‐slice computed tomography scans obtained at the time of surgery and the most recent follow‐up were analyzed. The ossified area was measured on the axial reconstructed scan of the most obvious protrusion of ossification at the CD level. The neurological outcomes were evaluated using modified Japanese Orthopaedic Association (JOA) scores and Hirabayashi recovery rates (HRRs). Continuous variables were presented as the mean ± standard deviation and were analyzed using the Student's t‐test, while categorical variables were tested using Fisher's exact test.ResultsAmong all patients, the most predominant type was the mixed type (9/16, 56.3%), while the circumscribed type was only found in two patients (12.5%), and the continuous type was found in five patients (31.2%). Six cases were associated with ossification of the ligamentum flavum, and two cases were combined with cervical OPLL. The OPLL area at the CD level increased in all patients. The mean follow‐up period was 5.5 ± 0.92 years (range 5–8 years). The mean area of ossification increased from 35.63 ± 39.23 mm2 at the time of surgery to 99.94 ± 65.39 mm2 at the last follow‐up visit (P < 0.01). There was no internal fixation disorder on any computed tomography scan after the operation. The average JOA score of all patients improved from 4.2 ± 2.2 points before surgery to 8.4 ± 2.6 points at the final follow‐up (P < 0.01). The overall HRR was 61.8%. None of the patients exhibited any neurological deterioration due to OPLL progression. One patient developed a severe gait disturbance due to worsening lumbar canal stenosis, an unrelated cause, but the other 15 experienced gait disturbance improvements.ConclusionsAccording to the long‐term follow‐up results, although OPLL progression did not decrease or stop after removing the OPLL mass, CD is a safe and effective procedure that can provide adequate reserve ventral space to cope with postoperative OPLL progression.

Anterior Cervical Discectomy and Fusion Combined with Foraminotomy Assisted by High-Definition 3-Dimensional Exoscope in the Treatment of Cervical Spondylotic Radiculopathy Secondary to Bony Foraminal Stenosis.

ObjectiveTo evaluate the outcomes of cervical spondylotic radiculopathy secondary to bony foraminal stenosis treated with anterior cervical discectomy and fusion (ACDF) combined with anterior cervical foraminotomy (ACF) assisted by High‐Definition 3‐Dimensional Exoscope.MethodsIn this retrospective study, a total of 19 consecutive patients (12 males and seven females, with an average of 49.2 years, range from 40 to 59 years) with spondylotic radiculopathy caused by bony foraminal stenosis underwent ACDF combined with ACF assisted by High‐Definition 3‐Dimensional Exoscope in our hospital between January 2019 and December 2019 were included in this study. All patients signed the consent form before the surgery. The patient baseline information such as gender, age, body mass index (BMI), surgery time, blood loss, hospital stay, lesion segment, side, follow‐up time and postoperative complications were recorded. The Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and Visual Analogue Scale (VAS) were measured and compared before surgery, 1 months and final follow‐up after surgery. The radiographic outcomes were evaluated using the C2‐C7 angel, disc height, foraminal height, superior diagonal distance, inferior diagonal distance, and foraminal area.ResultsThe involved levels included C4‐C5 (six cases), C5‐C6 (10 cases), C6‐C7 (three cases). The mean duration of the surgery, mean blood loss, mean hospital stay, and mean follow‐up were 100 ± 11.10 min, 19.4 ± 7.05 mL, 7.1 ± 0.99 days, and 12.1 ± 2.25 months, respectively. The average preoperative JOA score was 11.9 ± 1.31, then improved to 15.7 ± 0.73 (t = −13.45, P < 0.001) and 16.2 ± 0.74 (t = −14.39, P < 0.001) at 1 month after operation and at last follow‐up, respectively. The average preoperative NDI score was 27.3 ± 3.36, then decreased to 5.1 ± 1.79 (t = 20.63, P < 0.001) and 4.5 ± 1.21 (t = 25.53, P < 0.001) 1 month after operation and at last follow‐up, respectively. The average preoperative VAS score was 6.7 ± 0.93, then decreased to 2.4 ± 0.69 (t = 15.05, P < 0.001) and 1.9 ± 0.78 (t = 16.40, P < 0.001) 1 month after operation and at last follow‐up, respectively. As compared with the condition before surgery, there was a significant improvement in the C2‐C7 angel, disc height, foraminal height, and foraminal area (P < 0.05). None of the patients developed postoperative vascular injury, nerve injury, loosening and rupture of the internal fixation, displacement of interbody fusion cage, and pseudarthrosis.ConclusionACDF combined with ACF assisted by High‐Definition 3‐Dimensional Exoscope is effective and safe for the treatment of CSR caused by secondary to bony foraminal stenosis.

Corticosteroid-associated osteonecrosis of the femoral head after orthotopic liver transplantation and the outcomes of subsequent total hip arthroplasty

BackgroundCorticosteroids are essential for immunosuppression after orthotopic liver transplantation (OLT), but also have many side effects. Osteonecrosis of the femoral head (ONFH) is one of the most serious complications requiring prostheses. However, few studies have investigated ONFH after OLT. The purpose of this study is to survey the incidence of corticosteroid-induced ONFH after OLT and the outcomes of total hip arthroplasty (THA). MethodsBetween January 2001 and December 2010, a series of 926 patients underwent OLT at our Hospital. A retrospective analysis was performed on a total of 738 patients who survived at least 2 years after OLT. The incidence of symptomatic ONFH, the interval from OLT to the initial diagnosis of ONFH, and the cumulative dose of corticosteroids were analyzed. The side effects related to OLT, such as other osteonecrosis lesions, osteoporotic fractures, and infection, were monitored. For patients who underwent THA, radiological findings and Japanese Orthopaedic Association (JOA) scores were evaluated. ResultsONFH occurred in 10 patients (13 hips) (6 men [7 hips], 4 women [6 hips]), with an incidence of 1.36%. The average age at OLT was 51.4 years (range, 31–61 years). The average interval from OLT to ONFH was 86.7 months (range, 22–155 months). The average cumulative dose of corticosteroids was 7274 mg (range, 1342–29,514 mg). Twenty patients suffered from side effects related to OLT. Seven patients (8 hips) underwent THA. No adverse events including infection arose during the perioperative process. One hip dislocated, and one femoral stem displayed a radiolucent line. The average JOA score improved from 45.4 (range, 25–76) preoperatively to 86.9 (range, 73–99) at final follow-up. No patients required revision surgery. ConclusionsThe incidence of symptomatic ONFH after OLT was 1.36%. Once the graft function becomes stable, THA can be a safe and effective treatment option for patients with ONFH after OLT.

Clinical observation of single-segment cervical adjacent segment disease treated with artificial cervical disc replacement

Objective: To investigate the clinical outcomes and radiographic results of artificial cervical disc replacement (ACDR) for cervical adjacent segment disease (ASD). Methods: The clinical data of 28 patients with single-segment cervical ASD treated with ACDR in Xi 'an Honghui Hospital from December 2013 to July 2016 were retrospectively analyzed. There were 19 males and 9 females with a mean age of (46±7) years (36-63 years). Preoperative, postoperative 1 month and postoperative 24 months of clinical and radiographic outcomes were recorded and compared. The clinical outcome mainly includes Japanese orthopedic association (JOA), Neck Disability Index (NDI%), Odom score and complications. Imaging assessment mainly included range of motion (ROM) of cervical spine, surgical segment ROM, Cobb angle of surgical segment, degree of adjacent disc degeneration, heterotopic ossification, and prosthesis related image parameters. Results: In terms of clinical outcome, the average JOA score was 12.7±1.5 before surgery, 14.0±1.0 one month after surgery, 15.8±0.9 24 months after surgery, and the improvement rate of JOA was 75%±19%. The mean NDI% was 27.0%±2.8% before surgery, 20.5%±1.6% one month after surgery, and 15.3%±2.8% 24 months after surgery; the difference before and after treatment was statistically significant (F=159.101, P<0.01). Twenty patients were classified with excellent Odom score and 8 patients with good Odom score at the final follow-up. The total ROM of cervical spine, operation segment ROM, operation segment Cobb angle were all improved significantly after the operation (F=4.633, 6.063, 26.952, all P<0.05). There was a statistical difference in Miyazaki classification between adjacent discs above ACDR and below the fusion segment 24 months after surgery (μ(c)=2.12, P=0.034). The incidence of heterotopic ossification was 14.3%. The results of displacement degree of prosthesis were as follow: coronal plane (0.30±0.11) mm, sagittal plane (0.28±0.10) mm; subsidence of the prosthesis: (0.27±0.09) mm. No prosthesis loosening was observed. Conclusions: The clinical outcome of revision of cervical ASD by ACDR is satisfactory. The risk of intervertebral disc degeneration in adjacent segments is significantly lower than that of ACDF due to the presence of certain motor function postoperatively.

Effect of posterior cervical expansive open-door laminoplasty on cervical sagittal balance.

Posterior cervical expansive open-door laminoplasty (LAMP) is a mature surgical procedure for the treatment of cervical spondylotic myelopathy (CSM), but there are few studies on the changes in cervical sagittal balance. This study aimed to analyze the imaging and clinical data of patients who underwent LAMP and to explore the effect of this procedure on the cervical sagittal balance. This was a retrospective study of the patients who underwent LAMP between 01/2014 and 12/2017. The C0-C2 Cobb angle, sagittal vertical angle (SVA), C2-C7 Cobb angle, and T1-slope were measured. The Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), and visual analog scale (VAS) were used. There were 69 males and 39 females. The mean age was 61.3 ± 5.3years. The C0-C2 Cobb angle increased from 11.3 ± 5.5° to 26.8 ± 4.8° (P = 0.186). The C2-C7 Cobb angle decreased from 13.9 ± 8.6° to 10.65 ± 10.7° P = 0.016). SVA increased from 21.0 ± 5.8mm to 25.4 ± 11.5mm (P = 0.001). The preoperative average JOA score was 11.1 ± 2.2 points, and the postoperative score was 14.0 ± 2.1 points, with an average improvement rate of JOA of 46.5 ± 3.8%. The NDI score decreased from preoperative 15.6 ± 5.4 points to 11.3 ± 7.9 points, and the VAS score was decreased from 4.6 ± 1.8 points to 3.3 ± 1.6 points (all P < 0.05). LAMP improved the neurological function and quality of life of patients with CSM. The cervical vertebrae show a tendency of tilting forward, suggesting that overextension of the upper cervical vertebra might be used to maintain the center of gravity of the skull and horizontal vision.

Anterior cervical discectomy and fusion with recombinant human bone morphogenetic protein-2-adsorbed \u03b2-tricalcium phosphate granules: a preliminary report

BackgroundAnterior cervical discectomy and fusion (ACDF) is an alternative to conservative therapy in the treatment of cervical spondylopathy. This study evaluated the clinical outcome of ACDF with BMP-2-adsorbed β-tricalcium phosphate granules.MethodsThirty-two patients with cervical spondylopathy received treatment of ACDF with BMP-2-adsorbed β-tricalcium phosphate granules. The clinical outcomes were evaluated with the Japanese Orthopedic Association (JOA) scores and Neck Disability Index (NDI). Meanwhile, the cervical curvature and intervertebral heights were obtained through lateral cervical X-ray films pre- and postoperatively at each interval, and the precision of cervical fusion was assessed by three-dimensional computed tomography scan.ResultsThe follow-up averaged 15.2 months (range 13–18). Average JOA scores significantly increased from a preoperative point (7.4 ± 1.2) to each interval after surgery (P < 0.05). NDI decreased from preoperative point (43.1 ± 9.0) to each interval after surgery (P < 0.05). The angles of cervical curvature and intervertebral heights were improved postoperatively and kept throughout the follow-up period. CT scan demonstrated a fusion rate of 82.9% at 6 months postoperatively and was improved to 100% at 12 months postoperatively. In all cases, no complications appeared and reported due to any lapse in surgical procedure skills throughout the follow-up period.ConclusionsOur preliminary findings suggest that BMP-2-adsorbed β-tricalcium phosphate granules will be an effective alternative to autogenous bone grafting for cervical fusion in treating cervical spondylopathy. Our surgical procedure usingβ-tricalcium phosphate granules could improve neurological function, recover intervertebral height and cervical curvature, and could be potentially exploitable in the clinical setting.

Long-Term Clinical Outcomes and Pain Assessment after Posterior Lumbar Interbody Fusion for Recurrent Lumbar Disc Herniation.

ObjectivesThe aim of this study was to investigate the long term effects of posterior lumbar interbody fusion (PLIF), applied after recurrent lumbar disc herniation (rLDH), on pain relief and clinical outcome improvement.MethodsThe current study is a retrospective study. We observed 22 cases from 85 patients that had undergone PLIF during February 2003 to October 2012 and all patients were followed for at least 5 years. The average age of those patients were 53 years, among them there were eight men and 14 women. Plain radiography and dynamic plain films were obtained, pre‐operation, for every patient. Magnetic resonance imaging (MRI) or computed tomography (CT) was conducted to confirm the diagnosis of rLDH before the operation. All surgeries were performed from posterior approach by the same surgeon using PLIF. Quality of life (QOL) and clinical outcomes were assessed by Numerical Rating Scale (NRS), Japanese Orthopaedic Association (JOA) scoring system, and Oswestry Disability Index (ODI) before revision surgery and at 1 week, 3 months, 12 months, and 24 months postoperative. These were also examined every time they came back to the hospital for a review.ResultsAll patients were discharged and no serious comorbidities occurred. Three cases with wound infections and one case with dural laceration were cured and discharged. The end point of follow‐up was August 2018 and the mean follow‐up after revision surgery was 85 months. There were significant differences in NRS. It decreased from 7.32 ± 1.17 to 2.77 ± 1.31 (P < 0.05). The mean postoperative NRS score was 2.27 ± 1.48 (P < 0.05), 1.90 ± 1.51 (P < 0.05), and 2.36 ± 1.36 (P < 0.05) at 3, 12, and 24 months after surgery. There were no statistically significant differences (P > 0.05) in ODI scores. The average JOA score improved from 5.00 ± 1.08 to 8.18 ± 1.59 (P < 0.05) 1 week after revision surgery. RR was between 50% and 70%. Overall satisfaction rates were beyond 80%. Only one patient required subsequent lumber surgery during the follow‐up period.ConclusionIf surgical indications are mastered, undergoing PLIF after rLDH may induce efficient pain relief and major improvements in clinical outcome scores, as well as quality of life scores.

The effect of peri-operative hyperbaric oxygen therapy on the recovery of neurologic function of patients with cervical spondylotic myelopathy: A diffusion tensor imaging study

Objective To observe the clinical effect of hyperbaric oxygen therapy on cervical spondylotic myelopathy (CSM) in the peri-operative period, and to explore its neural mechanism. Methods Eighty patients who underwent surgical decompression for CSM were randomly divided into a hyperbaric oxygen group (n=40) and a control group (n=40). Both groups received cervical laminoplasty and systematic rehabilitation treatment after the surgery, while the hyperbaric oxygen group was additionally provided with hyperbaric oxygen therapy in the peri-operative period. The patients′ neurological status was evaluated using Japanese Orthopaedic Association (JOA) scores. Both groups received conventional MRI and diffusion tensor imaging (DTI) before and 6 months after the surgery. Results After the surgery, both groups gained significant improvement in their average JOA score, with the improvement of the hyperbaric oxygen group significantly greater than in the control group. Pearson correlation analysis showed that the average pre-operative JOA score was significantly correlated with the anisotropic fraction (FA) and the apparent dispersion coefficient (ADC) of the compressed spinal cord. Six months after the surgery such correlation still persisted. During the six months, significant increase was observed in the average FA and significant decrease in the average ADC in both groups, with the average FA of the hyperbaric oxygen group (0.726±0.087) significantly higher at the end of the 6 months than that in the control group. The average ADC (1.148±0.079)×10-3 mm2/s) was significantly lower. Conclusions DTI′s quantitative indicators can objectively show changes in the microstructure and pathological state of spinal cords. Exposure to hyperbaric oxygen may relieve ischemia and hypoxia of the spinal cord, promoting the repair of injured neurons and accelerating the regeneration of nerve fibers. Key words: Hyperbaric oxygen; Cervical spine; Spondylosis; Myelopathy; Laminoplasty; Diffusion tensor imaging

Clinical application of para-split laminotomy in the treatment of lumbar spinal canal tumors

Objective To explore the feasibility and effectiveness of para-split laminotomy in the treatment of lumbar spinal canal tumors. Methods We retrospectively reviewed the clinical data of 15 patients with lumbar spinal canal tumors who underwent tumor resection following para-split laminotomy at Department of Neurosurgery, Clinical Medical College of Yangzhou University from October 2016 to May 2018. Observation indicators included intraoperative blood loss, surgical duration, tumor resection, tumor pathological results and complications.Neurological functions of the spinal cord evaluated based on JOA (Japanese Orthopedic Association) scoring system. The follow-up situations included tumor recurrence, spinal stability evaluation and bone fusion of laminae. Results All lumbar spinal canal tumors were resected completely. The mean blood loss was 95.3±58.2 ml and the mean duration of the surgical procedure was 176.7±35.2 min. In this group, the average preoperative JOA score was 15.5±4.9 and the average postoperative JOA score was 24.0±3.5, which was improved significantly (P<0.01). There were no operative complications occurring. The CT examination showed no pedicle or vertebral fractures. During the follow-up period of 6-18 months (average: 10.8±3.9 months), no tumor recurrence or spinal deformation was found according to the imaging examination. CT examination showed that the split laminae tended to heal in the operative area. Conclusion The para-split laminotomy shows minimally invasive damage to the posterior spinal tension band and helps to protect the stability of the spine. It is feasible and effective to apply the para-split laminotomy in the operation of lumbar spinal canal tumors. Key words: Spinal canal; Neoplasms; Neurosurgical procedures; Laminotomy