Cervical Curvature Research Articles

Prevalence and risk factors of axial neck pain in patients undergoing multilevel anterior cervical decompression with fusion surgery

ObjectivesThe aim of this study was to explore the prevalence and risk factors for axial neck pain in patients undergoing multilevel anterior cervical decompression with fusion surgery.MethodsIn this study, 88 patients, who underwent multilevel anterior cervical decompression with fusion surgery from January 2012 to January 2017, were retrospectively reviewed. Based on the postoperative axial neck pain, the patients were classified into two groups: axial pain group and no axial pain group. The patients were followed up 3 weeks, 3 months, and 1 year after cervical anterior surgery for the early- and long-term clinical evaluation. The possible effect factors included demographic variables (age, sex, BMI, smoking, drinking, heart disease, hypertension, diabetes, preoperative kyphosis, preoperative axial neck pain, preoperative JOA scores, and ODI) and surgery-related variables (surgical option, vertebral lesions, spinal canal stenosis rate, superior fusion segment, presence of intramedullary high signal intensity).ResultsThe prevalence of axial neck pain was 27.3% (24 cases of 88). Our results showed that preoperative axial neck pain (62% vs 23%, P < 0.001) and preoperative kyphosis (42% vs 21.9%, P < 0.001) were risk factors for axial pain after multilevel anterior cervical surgery. Additionally, for patients with preoperative cervical kyphosis, compared to no axial pain group, the axial neck group was significantly more likely to exist a higher preoperative angle of C2–7 (13.31 ± 2.33 vs 7.33 ± 2.56, P < 0.001) and a higher correction range for kyphosis (20.24 ± 4.12 vs 12.34 ± 3.12, P < 0.001). However, for all the patients with postoperative axial symptoms, the improvement rate of axial pain was significantly higher for patients without cervical kyphosis at the early-term follow-up (3 weeks) (P = 0.032), no significant differences were found at the medium-term (P = 0.554) and long-term follow-up (P = 0.902), and improvements of clinical symptom have no obvious difference at the last follow-up.ConclusionsOverall, preoperative axial neck pain and kyphosis could predict axial neck pain for patients undergoing multilevel anterior cervical decompression with fusion surgery, and recovery of cervical kyphosis may contribute to the long-term recovery of neural function, but may also suffer from risk of short-term axial pain, which could be reduced through moderate cervical curvature recovery.

Preliminary analysis on X-ray in youth neck type of cervical spondylosis with upper crossed syndrome

To analyze the X-ray characteristics in youth neck type of cervical spondylosis with upper crossed syndrome(UCS). The patients who had a neck type of cervical spondylosis with or without UCS were selected from January to October 2017, 20 cases in each group, and 10 normal volunteers were chosen in the study. X-ray examination of lateral and hyperextension-hyperflexion of cervical spine were performed to observe cervical spine angle, angular displacement and adjacent vertebral body slip. The cervical spine angle was (-0.40±9.64)° in the UCS group, significantly less than (14.35±9.01)° in the normal group and (12.34±5.65)° in the non-UCS group(P<0.05). The change of angular displacement of the upper cervical vertebra in anterior flexion and posterior extension was (8.18±4.81)° in UCS group, which was also significantly less than (12.14±3.48)° in the normal group and (12.34±5.65)° in the non-UCS group(P<0.05). The slippage of the vertebral posterior margin of the lower cervical spine in the anterior flexion was 15.41±2.21 in the UCS group, which was significantly greater than 13.26±2.42 in normal group(P<0.05), and was not obviously different from 15.64±2.07 in non-UCS group(P>0.05). In young patients who has a neck type of cervical spondylosis with UCS, the cervical curvature prone to straighten or reverse, the upper cervical flexion and extension are limited, while the lower cervical is in a flexion.

Cervical Posture and Skeletal Malocclusions – Is there a Link?

Background: The present study was conducted in order to determine cervical posture in different skeletal sagittal malocclusions as well as to assess whether a correlation existed between cervical posture and skeletal relationships. Methods: Cervical curvature and inclination of 63 subjects was assessed using their lateral cephalometric radiographs. Cervical inclination was assessed using the cervicohorizontal postural variables namely OPT/HOR and CVT/HOR whereas cervical curvature was determined by measuring the angle OPT/CVT. Sagittally, the subjects were also categorized into skeletal Class I, II and III based on the angle ANB. One way ANOVA was used for the comparison of cervical posture in different skeletal sagittal malocclusions. Pearson’s correlation was used to evaluate the correlation of cervical posture with different skeletal sagittal jaw relations. Statistical significance level was set at p≤0.05. Results: Statistically significant differences were found between the different skeletal malocclusions for the cervical curvature angle OPT/CVT (p=0.025). A weak correlation of cervical curvature angle OPT/CVT (r=0.305, p=0.016) with sagittal malocclusion was found. Conclusions: Skeletal sagittal malocclusions differ in their cervical postures, especially cervical curvature. Skeletal Class III subjects have significantly straighter cervical columns than skeletal Class I subjects. Cervical curvature is correlated with sagittal jaw relations.&#x0D; Keywords: cervical curvature; cervical posture; skeletal sagittal malocclusions .&#x0D;

Relationship between Refractive Visual Errors and Cervical Spine Angles and Range of Motion

AbstractBackground: Myopia is one of the common Refractive Visual Errors (RVE) that produces musckeloskeltal complaines, such as stiffness, fatigue and muscular pain in the neck which in turn may affect cervical curvature and range of motion.Aim of Study: To investigate the relationship between refractive visual errors subjects and cervical curvature and cervical range of motion.Patients: Fifty participants 15-30 years old from Kasr Al-Aini Hospital in October 2016. They assigned in two equal groups refractive myopic and normal sighted).Methods: Cervical Range of Motion (CROM) was assessed by using O.B gonyometer, cervical angles (OC-C2, C1-C2, C2-C7) were measures by using corel draw program in X-ray.Results: Comparison between groups revealed no signif-icant different in OC-C1 and a significant different in C1-C2 and C2-C7, additionally there was a significant difference in flexion, extension, Rt. and Lt. rotation (p=0.007, 0.01, 0.0001, 0.001) between groups respectively, there was no significant correlation between right and left eye and cervical angles and range of ROM.Conclusion: Myopia causes changes in cervical curve and ROM but the degree of Myopia is not correlated to this changes of cervical curve and ROM.

Comparison of laminectomy and fusion vs laminoplasty in the treatment of multilevel cervical spondylotic myelopathy: A meta-analysis.

Purpose:The purpose of this study is to evaluate the clinical safety and efficacy between laminectomy and fusion (LF) versus laminoplasty (LP) for the treatment of multi-level cervical spondylotic myelopathy (CSM).Methods:The authors searched electronic databases using PubMed, MEDLINE, Embase, Cochrane Controlled Trial Register, and Google Scholar for relevant studies that compared the clinical effectiveness of LF and LP for the treatment of patients with multilevel CSM. The following outcome measures were extracted: the Japanese Orthopaedic Association (JOA) scores, cervical curvature index (CCI), visual analog scale (VAS), Nurich grade, reoperation rate, complications, rate of nerve palsies. Newcastle Ottawa Quality Assessment Scale (NOQAS) was used to evaluate the quality of each study. Data analysis was conducted with RevMan 5.3.Results:A total of 14 studies were included in our meta-analysis. No significant difference was observed in terms of postoperative Japanese Orthopaedic Association score (P = .29), visual analog scale neck pain (P = .64), cervical curvature index (P = .24), Nurich grade (P = .16) and reoperation rate (P = .21) between LF and LP groups. Compared with LP group, the total complication rate (OR 2.60, 95% CI 1.85, 3.64, I2 = 26%, P < .00001) and rate of nerve palsies (OR 3.18, 95% CI 1.66, 6.11, I2 = 47%, P = .0005) was higher in the LF group.Conclusions:Our meta-analysis reveals that surgical treatments of multilevel CSM are similar in terms of most clinical outcomes using LF and LP. However, LP was found to be superior than LF in terms of nerve palsy complications. This requires further validation and investigation in larger sample-size prospective and randomized studies.

Comparison of clinical outcomes and safety between laminectomy with instrumented fusion versus laminoplasty for the treatment of multilevel cervical spondylotic myelopathy.

Study design:Systematic review and meta-analysis.Objectives:Posterior laminectomy with instrumented fusion and laminoplasty are widely used for the treatment of multilevel cervical spondylotic myelopathy (MCSM). There is great controversy over the preferred surgical method. The purpose of this study is to evaluate the clinical outcomes and safety between laminectomy with instrumented fusion and laminoplasty for the treatment of MCSM.Methods:Related studies that compared the effectiveness of laminectomy with instrumented fusion and laminoplasty for the treatment of MCSM were acquired by a comprehensive search in PubMed, Embase, the Cochrane library, CNKI, VIP, and WANFANG up to April 2018. Included studies were evaluated according to eligibility criteria. The main endpoints included: preoperative and postoperative Japanese Orthopedic Association (JOA) scores, preoperative and postoperative visual analog scale (VAS), preoperative and postoperative cervical range of motion (ROM), preoperative and postoperative cervical curvature index (CCI), overall complication rate, C5 nerve palsy rate, axial symptoms rate, operation time and blood loss.Results:A total of 15 studies were included in this meta-analysis. All of the selected studies were of high quality as indicated by the Newcastle–Ottawa scale (NOS). Among 1131 patients, 555 underwent laminectomy with instrumented fusion and 576 underwent laminoplasty. The results of this meta-analysis indicated no significant difference in preoperative and postoperative JOA scores, preoperative and postoperative VAS, preoperative and postoperative CCI, preoperative ROM and axial symptoms rate. However, compared with laminoplasty, laminectomy with instrumented fusion exhibited a higher overall complication rate [RR = 1.99, 95% confidence intervals (CI) (1.24, 3.21), P <.05], a higher C5 palsy rate [RR = 2.22, 95% CI (1.30, 3.80), P <.05], a decreased postoperative ROM [SMD = −1.51, 95% CI (−2.14, −0.88), P <.05], a longer operation time [SMD = 0.51, 95% CI (0.12, 0.90), P <.05] and increased blood loss [SMD = 0.47, 95% CI (0.30, 0.65), P <.05].Conclusion:These results suggested that both posterior laminectomy with instrumented fusion and laminoplasty were determined to be effective for MCSM. However, laminoplasty appeared to allow for a greater ROM, lower overall complication and C5 palsy rates, shorter operation time and lower blood loss. Future well-designed, randomized controlled trials are still needed to further confirm our results.

A strategy of combining posterior occipitocervical angle with occipital-C 2 angle for adjustment of occipitocervical fixation angle in posterior instrumented occipitocervical fusion

To assess the application and the effectiveness of a strategy of combining posterior occipitocervical angle (POCA) with occipital-C 2 (O-C 2) angle for adjustment of occipitocervical fixation angle in posterior instrumented occipitocervical fusion. The clinical data of 22 patients undergoing posterior instrumented occipitocervical fusions between March 2013 and January 2016 were retrospectively analysed, and all patients were performed by using a strategy combining with POCA and O-C 2 angle for adjustment of occipitocervical fixation angle. All patients suffered from occipitocervical instability, including 7 males and 15 females with an average age of 44.4 years (range, 20-63 years). The patients were diagnosed as skull base depression with atlantoaxial dislocation in 20 cases and rheumatoid arthritis in 2 cases. The preoperative Japanese Orthopaedic Association (JOA) score was 13.2±2.0, and the visual analogue scale (VAS) score was 6.3±0.9. The POCA was first used to guide the pre-bending of the nail-rod system during the operation, so that POCA of 12 patients with abnormal preoperative POCA could be restored to the normal range; then intraoperative fluoroscopy was used to confirm whether the O-C 2 angle was within the normal range (4 cases were abnormal and 2 cases needed intraoperative adjustment); finally, POCA and O-C 2 angles were within normal range after adjustment. The postoperative complications were recorded, and the JOA and VAS scores were used to evaluate the recovery of spinal nerve function and the degree of pain relief after operation. The radiological data were collected to evaluate the bone graft fusion, the changes of postoperative POCA, O-C 2 angle, and lower cervical curvature (Cobb angle). All 22 patients were followed up 12-48 months, with an average of 24 months. No serious complications and reoperation occurred. At last follow-up, the VAS score and JOA score were 2.9±0.8 and 15.4±0.9 respectively, which were significantly improved when compared with preoperative ones ( t=15.870, P=0.000; t=6.587, P=0.000). Imaging examination showed that 22 patients had occipitocervical osseous fusion, good position of internal fixator without loosening or fracture, and good occipitocervical stability. The POCA and O-C 2 angles were within the normal range at 3 days after operation and at last follow-up, and there were significant differences when compared with preoperative ones ( P<0.05); but no significant difference was found in POCA and O-C 2 angles between at 3 days after operation and at last follow-up ( P>0.05). There was no significant difference in Cobb angle of lower cervical spine between before and after operation ( P>0.05). The strategy of combination POCA and O-C 2 angle for adjustment of occipitocervical fixation angle during operation can ensure a better effectiveness.

Correlation between syrinx resolution after posterior fossa decompression and cervical sagittal profile change in adolescents with Chiari malformation and syringomyelia

Objective: To evaluate the long term change of the cervical sagittal profile in adolescent Chiari malformation type Ⅰ (CMI)/syringomyelia undergoing posterior fossa decompression (PFD) and to further evaluate the correlation between the syrinx resolution and cervical sagittal profile. Methods: A retrospective radiographic study was performed in 32 adolescents undergoing PFD for CMI/syringomyelia from October 2011 to August 2015 with a minimum 2-year follow-up. There were 23 males and 9 females, with a mean age of (13.7±2.8) years (range, 10-16 years). The following parameters including upper cervical angle (C(0)-C(2)), lower cervical angle (C(2)-C(7)), sagittal balance (C(2)-C(7)SVA), cervical curvature index (CCI), syrinx size and length were compared preoperatively and at the last follow-up. The correlation of syrinx resolution and cervical sagittal parameters were further analyzed with Pearson correlation analysis. Results: All patients received a followed-up for 2.0-6.5 years [mean (3.9±1.1) years]. The lower cervical angle and CCI were-29.8°±11.4° and 29.1%±7.1% at the last follow-up, respectively, which were significantly higher than those before surgery (-15.2°±8.8°, 13.4%±4.2%)(t=2.917, 2.902, both P<0.05). The syrinx size and length were also obviously decreased at the last follow-up. No significant difference was found in the upper cervical angle and C(2)-C(7)SVA before operation and at the last follow-up (t=0.302, 0.871, both P>0.05). There were significantly positive correlations between the differences of syrinx width and the lower cervical angle, and the CCI before and after surgery (r=0.611, 0.652, both P<0.05). Significantly positive correlations were also observed between the differences of syrinx length and the lower cervical angle, and the CCI before and after surgery (r=0.504, 0.514, both P<0.05). Conclusions: The cervical lordosis can be restored after PFD in adolescents with CMI/syringomyelia. The resolution of syrinx may play an important role in restoring the cervical sagittal alignment.

Frontal-Mental Line Inclination Test for assessment of cervical curvature: validation and applicability

Abstract Introduction: Alternative testing for X-rays in the assessment of the spine have the advantage of not causing radiation problems, but need to be validated. Objective: To propose a clinical test for assessment of the cervical spine based on the frontal-mental line inclination, identifying its concurrent validity in relation to the gold standard and determining its clinical applicability. Method: The present study was separated into two phases: (1) Test of Frontal-mental Line Inclination’s (TFMLI) validation protocol (evaluation of head position using X-ray analysis and computerized photogrammetry and assessment of cervical curvature using X-ray analysis and the TFMLI) (n = 35); (2) testing the possibility of performing the TFMLI with a universal goniometer (n = 23). Results: In phase 1, for the evaluation of head position, the gold standard and photogrammetry showed high and significant correlation (r = 0.602; p &lt; 0.001). When evaluating cervical curvature, the gold standard and the TFMLI showed high and significant correlation (r = 0.597; p = 0.019). In phase 2, for the evaluation of head position, photogrammetry and goniometry showed high and significant correlation (rs = 0.662; p &lt; 0.001). For the evaluation of cervical curvature, the TFMLI performed with photographs and with goniometry showed almost perfect and significant correlation (r = 0.969; p &lt; 0.001). Conclusion: The TFMLI is suitable for an initial evaluation of the cervical spine posture of individuals with anterior head position and can be applied in clinical practice with the use of a universal goniometer.

Efficacy of Neck Stabilization and Postural Correction Exercise on Pain, Posture, Disability, Respiratory Dysfuntions and Mental Status in Desk Job Workers-A Randomised Controlled Double Blinded Study

Objective: The study aims to analyse and compare the efficacy of neck stabilization exercise and postural correction exercise over conventional exercises on pain, disability, posture, Respiratory dysfunction in desk job workers with neck pain. Background of The Study: Neck pain is a common disorder mainly caused by awkward posture, tightness in both the neck and upper back muscles and prolonged sitting while using computers, twisting and bending of the trunk. Rounded shoulder is a condition characterized by protracted shoulder girdle from its normal. Imbalance between agonist and antagonist results in muscle imbalance affecting the cervical curvature resulting in pain. Materials and Methods: Once the study is approved by Institutional Review Board Ref no: IV C – 018 / PHYSIO / IRB /2017-2018 50 samples were selected from 60 volunteers based on the inclusion criteria. The study was conducted is the outpatient department of physiotherapy & took nearly 3months (Jan 2018 – May 2018) to complete the study.. Group A received Neck Stabilization exercise and postural correction exercise with deep breathing exercise. Group B received stretch and strengthening exercise with deep breathing exercise. Pre and post-test measured with NDI-Neck disability index, CSBQ-Cervical Spine Bournemouth Questionnaire, SEBQ-Self-Evaluation Breathing Questionnaire, DST-Double square test. Result: On comparing Pre-test and Post-test within Group A and Group B on Double Square Test(Right and Left), Neck Disability Index, Cervical Spine Bournemouth Questionnaire, Self-Evaluation of Breathing Questionnaire shows significant decrease in the post test Mean values but Group A which has the Lower Mean value is more effective than Group B at P ≤ 0.001.

Establishment and verification of a surgical prognostic model for cervical spinal cord injury without radiological abnormality.

Some studies have suggested that early surgical treatment can effectively improve the prognosis of cervical spinal cord injury without radiological abnormality, but no research has focused on the development of a prognostic model of cervical spinal cord injury without radiological abnormality. This retrospective analysis included 43 patients with cervical spinal cord injury without radiological abnormality. Seven potential factors were assessed: age, sex, external force strength causing damage, duration of disease, degree of cervical spinal stenosis, Japanese Orthopaedic Association score, and physiological cervical curvature. A model was established using multiple binary logistic regression analysis. The model was evaluated by concordant profiling and the area under the receiver operating characteristic curve. Bootstrapping was used for internal validation. The prognostic model was as follows: logit(P) = -25.4545 + 21.2576VALUE + 1.2160SCORE - 3.4224TIME, where VALUE refers to the Pavlov ratio indicating the extent of cervical spinal stenosis, SCORE refers to the Japanese Orthopaedic Association score (0-17) after the operation, and TIME refers to the disease duration (from injury to operation). The area under the receiver operating characteristic curve for all patients was 0.8941 (95% confidence interval, 0.7930-0.9952). Three factors assessed in the predictive model were associated with patient outcomes: a great extent of cervical stenosis, a poor preoperative neurological status, and a long disease duration. These three factors could worsen patient outcomes. Moreover, the disease prognosis was considered good when logit(P) ≥ -2.5105. Overall, the model displayed a certain clinical value. This study was approved by the Biomedical Ethics Committee of the Second Affiliated Hospital of Xi'an Jiaotong University, China (approval number: 2018063) on May 8, 2018.

Analysis of correlative factors of spinal cord posterior displacement after single door laminoplasty

To observe the open angle (OA), cervical curvature angle (CA), preoperative spinal cord compression rate(PSCR), postoperative spinal cord shift (PSCS) in patients with chronic compressive cervical myelopathy undergoing C3-7 single open laminoplasty, and to explore the possible mechanism and influencing factors of postoperative average spinal cord drift, so as to provide objective basis for predicting PSCS. From May 2012 to July 2016, 32 patients with multi-segmental chronic compressive cervical myelopathy who underwent single-door laminoplasty in our department were analyzed retrospectively, including 14 cases of cervical spondylotic myelopathy, 8 cases of developmental cervical spinal stenosis with cervical myelopathy, and 10 cases of ossification of posterior longitudinal ligament. The OA of cervical spine was measured on CT, the CA was measured on X-ray, the PSCR and PSCS were measured on MRI. The patients were divided into two groups according to PSCS(group A>=2.5 mm, group B<2.5 mm). In the group A, there were 11 males and 6 females, with an average age of (56.58±9.80) years old, a mean course of the disease of (23.52±7.86) months; while in group B, there were 6 males and 9 females, with an average age of (58.46±12.53) years old, a mean course of disease of (21.13±7.75) months. The correlation analysis between PSCS and OA, CA and PSCR was performed, and multiple linear analysis of correlated parameters was carried out. The OA in group A was (40.47±9.45) °, in group B was (27.84±5.67) °. The OA in group A was higher than that in group B (P<0.01), and OA was moderately correlated with PSCS (r=0.794, P=0.000). The CA was(11.56± 4.99) ° in group A and(6.64±3.28) ° in group B . The CA in group A was higher than that in group B (P<0.01), and CA was moderately correlated with PSCS (r=0.632, P=0.000). The PSCR was (27.70±2.92) % in group A , was (24.59±2.80) % in group B . The PSCR in group A was higher than that in group B(P<0.01), PSCR was moderately correlated with PSCS(r=0.667, P=0.000). The CA dependent variable was kicked out(P>0.1), and the partial regression coefficients of OA and PSCR were 0.113 and 0.059 respectively. PSCS is the result of OA, CA and PSCR, among which PSCR has the most important influence, OA is the second, CA is the least. PSCS can be predicted by 0.059×OA+0.113×PSCR-2.266 equation, which provides a theoretical basis for preoperative evaluation of spinal cord decompression after surgery.

The NECK trial: Effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation; a double-blinded randomized controlled trial

BACKGROUNDMotion preserving anterior cervical disc arthroplasty (ACDA) in patients with cervical radiculopathy was introduced to prevent symptomatic adjacent disc degeneration as compared with anterior cervical discectomy and fusion (ACDF). Prior reports suggest that ACDF is not more effective than anterior cervical discectomy (ACD) alone for the treatment of cervical radiculopathy. PURPOSETo evaluate whether patients with cervical radiculopathy due to a herniated disc benefit more from undergoing ACDA, ACDF, or ACD in terms of clinical outcome measured by the neck disability index (NDI). STUDY DESIGNDouble-blinded randomized controlled trial. METHODSOne hundred-nine patients with one level herniated disc were randomized to one of the following treatments: ACDA, ACDF with intervertebral cage, ACD without fusion. Clinical and radiological outcome was measured by NDI, Visual Analogue Scale (VAS) neck pain, VAS arm pain, SF36, EQ-5D, patients’ self-reported perceived recovery, radiographic cervical curvature, and adjacent segment degeneration parameters at baseline and until two years after surgery. BBraun Medical paid €298.837 to cover the costs for research nurses. RESULTSThe NDI declined from 41 to 47 points at baseline to 19 ± 15 in the ACD group, 19 ± 18 in the ACDF group, and 20 ± 22 in the ACDA group after surgery (p=.929). VAS arm and neck pain declined to half its baseline value and decreased below the critical value of 40 mm. Quality of life, measured by the EQ-5D, increased in all three groups. Adjacent segment degeneration parameters were comparable in all three groups as well. No statistical differences were demonstrated between the treatment groups. CONCLUSIONSThe hypothesis that ACDA would lead to superior clinical outcome in comparison to ACDF or ACD could not be confirmed during a 2-year follow-up time period. Single level ACD without implanting an intervertebral device may be a reasonable alternative to ACDF or ACDA.

Clinical effect of modified open-door laminoplasty with preservation of the unilateral paraspinal muscle ligament com-plex in treating ossification of posterior longitudinal ligament of the cervical spine

Objective To investigate the clinical efficacy of modified open-door laminoplasty with preservation of the unilateral paraspinal muscle ligament complex in treating ossification of posterior longitudinal ligament (OPLL) of the cervical spine. Methods From June 2015 to July 2017, thirty-two patients with OPLL of the cervical spine who underwent modified open-door laminoplasty with preservation of the unilateral paraspinal muscle ligament complex were retrospectively analyzed (modified group). There were 20 males and 12 females with the average age of 61.72±8.41 years (range 46-75 years). The de-compression segment range included three cases of C2-C6, seven cases of C2-C7, eight cases of C3-C6, and fourteen cases of C3-C7. Moreover, twenty-three patients with OPLL of the cervical spine who underwent traditional unilateral open-door laminoplas-ty at the same time were included as controls (control group). The demographics, operation duration, and blood loss volume was recorded. The visual analogue scale (VAS), Japanese Orthopaedic Association scores (JOA), improvement rate of JOA score and neck disability index (NDI) were recorded and analyzed at preoperation, three months after operation, six months af-ter operation and at the final follow-up. The cervical curvature, cervical curvature index (CCI), range of motion (ROM) were measured and statistically analyzed on the lateral X-ray film of the cervical spine. The union rate of the lamina hinge and that of spinous process-lamina was measured on the cross section of the CT scan. Bilateral cervical posterior muscle volume was re-corded and analyzed at cross-section plane on MRI. Axial symptoms, C5 nerve root palsy and other complications were also re-corded. Results All the patients were followed-up for 6 to 18 months (mean, 13.04±4.67 months in control group, 11.81±4.93 months in modified group). At the final follow-up, the JOA, VAS and NDI scores improved from preoperatively 6.09±0.79 to 13.43±1.53, 4.22±1.04 to 2.83±1.15 and 25.48%±3.20% to 8.83%±5.41% in the control group, versus 6.28±1.05 to 13.88±1.48, 4.09±1.00 to 1.16±0.57 and 25.06%±3.24% to 5.66%±2.46% in the modified group. The postoperative JOA score and recovery rate of the two groups was not significantly different, whereas the VAS and NDI scores were significantly reduced in the modified group compared to the control group. The maximum cervical flexion angle, cervical curvature, ROM and CCI of control group were 6.26°±3.31°, 30.17°±4.56°, 11.39°±1.95° and 9.74%±4.05% at the final follow-up, which were reduced significantly compared to pre-op-eration. The maximum cervical flexion angle, cervical curvature, ROM and CCI of modified group were 10.06°±1.93°, 35.03°±5.01°, 17.03°±2.86° and 14.22%±5.00%, and there were no significant differences compared to pre-operation. There were signifi-cant differences among two groups. At the final follow-up, the posterior muscle volume of the two groups at open side was de-creased compared to preoperation, but there was no significant difference between the two groups. At the last follow-up, the posteri-or muscle volume at hinge side was not changed compared to preoperation in modified open-door laminoplasty group, while the vol-ume of the posterior muscle at hinge side in the traditional control group decreased compared to preoperation. The difference was statistically significant. A total of eight patients with axial symptom were present after operation. There were two patients (6%, 2/32) in the modified group and six patients (26%, 6/23) in the control group. The difference of axial symptoms incidence was statisti-cally significant between the two groups. Conclusion Modified open-door laminoplasty with preservation of the unilateral para-spinal muscle ligament complex is an effective technique in treating OPLL of the cervical spine. The technique not only guaran-teed to have good recovery of neurological function and to maintain cervical curvature and range of motion, but also contributed to decrease the occurrence of postoperative axial symptoms. Key words: Cervical vertebrae; Ossification of posterior longitudinal ligament; Decompression, surgical

Anterior cervical ossified posterior longitudinal ligament en bloc resection for the treatment of cervical ossification of posterior longitudinal ligament

Objective To evaluate theclinical efficacy and safety of anterior cervical ossified posterior longitudinal liga-ment en bloc resection (ACOE), and analyze the advantages of ACOE compared to the traditionally anterior cervical surgery. Methods The clinical datawith more than one year follow-up of 96 patients suffered from cervical ossification of the posterior longitu-dinal ligament(OPLL) from April 2010 to March 2017 was retrospectively analyzed, including 57 males and 39 females, aged 32-69 years, average 54.6±8.7 years. There were 29 cases of nodular type (30.2%), 48 cases of segmental type (50.0%), 5 cases of con-tinuous type(5.2%), and 14 cases of mixed type (14.6%). The neurological function assessments before and after operation were performed using the Japanese Orthopaedic Association (JOA) scoring system and the visual analogue scale (VAS) scoring system.The effect of ossified mass resection was observed by three-dimensional reconstruction CT scan. The spinal cord decompression was evaluated by MRI. The cervical curvature was compared before and after surgery by cervical lateral radiograph. The operation time, intraoperative blood loss, recovery rates of the JOA scores and complication rates of this group were compared with the cases of anterior cervical ossified posterior longitudinal ligament piecemeal resection (ACOP) reported by the recent literature to analyze the clinical efficacy, safety and advantages of ACOE. Results All the surgeries of 96 cases were successfully performed, in-cluding 57 cases (59.4%) with subtotal resectionof single vertebra, 31 cases (32.3%) with subtotal resectionof doublevertebras, 1 case (1.0%) with expanded intervertebral decompression, 4 cases (4.2%) with + subtotal resection,1 case (1.0%) with semi-vertebra + vertebra + subtotal resection, 2 cases with double vertebras + semi-verte-bra subtotal resection (2.1%). Ninty-six cases were followed up for 12 to 78 months, with an average of 28.0±9.3 months. The preoperative JOA score with (11.38±2.80) scores was increased to 15.32±1.62 scores at the last follow-up, and the recovery rate of JOA score was 74.63%±13.18%. The preoperative VAS score with 6.00±1.41 scores was reduced to 2.35±1.11 scores at the last follow-up. The cervical curvature increased from 10.4°±9.0° before surgery to 15.8°±8.1° at the last follow-up. CT showed that the ossified masses of the surgical segments were completely excised without residue; MRI showed that the com-pressionsof spinal cords and dural sacs were completely relieved, with nice morphology recovery. There was no neurological de-terioration in this group. There were 6cases of cerebrospinal fluid leakage (CSFL), 3 cases of C5 nerve palsy, 1 case of Horner syndrome, 2 cases of dysphagia and hoarseness, 1 case of titanium mesh subsidence with screw loosing. At the final follow-ups, except one case of occasional throat foreign body sensation, the above complications were all remittedat different follow-up periods. Compared with the cases of ACOP reported by the recent meta-analysis, the operation time, the intraoperative blood loss, the complication rate of dysphagia with hoarseness and neurological deterioration were lower than those reported in the literature. The recovery rate of JOA scorewas higher than which reported in the literature. Conclusion ACOE is safe and effective for the treatment of cervical OPLL, which may be superior to traditional anterior cervical surgery in terms of surgical safe-ty, controllability of cerebrospinal fluid leakage and improvement of neurological function. Key words: Cervical vertebrae; Ossification of posterior longitudinal ligament; Decompression, surgical; Spinal fusion

Treatment of cervical ossification of the posterior longitudinal ligament by modified laminoplasty with C3 laminectomy and C7 spinous process retention

Objective To observe the clinical efficacy of modified laminoplasty with C3 laminectomy and C7 spinous process retention in the treatment of cervical ossification of the posterior longitudinal ligament(OPLL). Methods From Febru-ary 2014 to March 2016, 133 cases of OPLL were admitted, and 42 OPLLs were included according to the inclusion and exclusion criteria. A case-control study was conducted. Twenty-two cases were included in modified group and 20 cases in traditional group. There were 13 males and 9 females in the modified surgery group, and the average age was 56.2±9.75 years (39-77 years).Modi-fied surgery was conducted with C3 laminectomy, C4-C6 laminoplasty, resection at the upper part of the C7 lamina and retaining the C7 spinous process. Meanwhile, there were 12 males and 8 females in the traditional surgery group, with an average age of 53.7±8.23 years (41-75 years). Patients in the traditional surgery group were treated with standard C3-C7 laminoplasty. The mean follow-up was 22.9±4.5 (15-29) months. The JOA, NDI scores of the two groups were recorded preoperatively and postoperatively. The physiological curvature and activity of the cervical spine before and after operation were observed, and the incidence of axonal symptoms and postoperative complications in both groups were recorded. Results The follow-up period was 15-28 months, with an average of (23.2 ± 4.8) months. There was no significant difference between the base line of two groups before operation. At the last follow-up, the JOA and NDI scores of the two groups were significantly improved. There was no difference of JOA scores be-tween the two groups at the last follow-up, while the NDI sores at the modified group(6.56±4.78) was superior to the traditional group(9.25±7.63). The VAS score at the first day after surgery in modified group was lower than that of the traditional group. The average cervical curvature of the patients in the modified surgery group and the standard surgery group were 12.32°±8.26° and 11.56°±8.05°, respectively. There was no significant difference between the two groups. The postoperative range of movement (ROM) of cervical spine was 39.68°±9.52° in modified group and 33.51°±10.39° in traditional group(P<0.05). Eight patients (19%) had augmentation of axial symptoms, including 3 patients in the modified surgery group(13.6%) and 5 patients in the stan-dard surgery group (30%). There was no significant difference between the two groups. During the follow-up period, there were no complications such as cerebrospinal fluid leakage, spinal cord injury, wound infection, laminar collapse, postoperative closure, in-ternal fixation loss or fracture. Conclusion The modified laminectomy with C3 laminectomy and C7 spinous process retentionis minimally invasive, whichachieved satisfactory decompression effect, reduced the incidence of postoperative axial symptoms and maintained the cervical ROM. Key words: Cervical vertebrae; Ossification of posterior longitudinal ligament; Decompression, surgical

Operative outcomes of patients with cervical spondylotic myelopathy at Cipto Mangunkusumo National Central Hospital 2014-2016

Introduction: Cervical spondylotic myelopathy (CSM) is the most common type of myelopathy with cervical spondylosis as the underlying disorder. To this date, there has been ongoing debate regarding operative approach in CSM treatment that there is still no established treatment proven superior one over the other. This study aims to investigate the operative outcomes of CSM. Methods: We retrospectively reviewed patients with CSM who had undergone anterior approach and posterior surgery at Cipto Mangunkusumo Hospital, Jakarta, Indonesia, between January 2014 and December 2016. The average followup time was 13-42 months, with an average of 27 months. The clinical data of patients were observed, including age, sex, operation records, pre- and post-operative Japanese Orthopaedic Association (JOA) scores, cervical spine canal stenosis, cervical curvature, and the presence of ossification of the posterior longitudinal ligament. Results: Eight patients (6 male, 2 female) with CSM were enrolled in this study with mean age of 55.6 ± 9 years. Two patients experienced minor complication, and one patient had major complication of Frankel grade decrement and phrenic nerve paralysis that led to prolonged intensive care. The preoperative cervical JOAs of the eight patients were 11.2 ± 2.81 and post operative JOAs were 13.1 ± 3.44. (p< 0.05). Seven patients were satisfied with the outcomes of their surgery. Conclusion: A definite conclusion could not be drawn regarding the most effective surgical approach for CSM. Further studies with larger number of samples and centres are required to investigate the comparison of best treatment choice for CSM.

Comparison of anchor screw fixation versus mini-plate fixation in unilateral expansive open-door laminoplasty for the treatment of multi-level cervical spondylotic myelopathy

Study design:Systematic review and meta-analysis.Background:Anchor screw fixation and mini-plate fixation are widely used in unilateral open-door laminoplasty. There is a great controversy over the preferred fixation method. The purpose of this study is to evaluate the clinical outcomes between anchor screw fixation and mini-plate fixation for the treatment of multilevel cervical spondylotic myelopathy (MCSM).Methods:Related studies that compared the clinical effectiveness of anchor screw fixation and mini-plate fixation in cervical laminoplasty for the treatment of MCSM were acquired by a comprehensive search in PubMed, Embase, the Cochrane library, CNKI, VIP, and WANFANG up to March, 2018. Included studies were evaluated according to eligibility criteria. The main end points included: preoperative Japanese Orthopedic Association (JOA) scores, postoperative JOA scores, JOA scores improvement rate, preoperative and postoperative cervical range of motion (ROM), preoperative and postoperative cervical curvature index (CCI), lamina open angle, operation time, blood loss, C5 nerve palsy rate and axial symptoms rate.Results:Papers in English and Chinese were searched for the initial review, but only 12 articles in Chinese were included in this meta-analysis. All of the selected studies were of high quality as indicated by the Newcastle–Ottawa scale (NOS). Among 809 patients, 372 underwent anchor screw fixation and 437 underwent mini-plate fixation. The results of this meta-analysis indicated that no significant difference was found in preoperative JOA score, JOA scores improvement rate, preoperative CCI, preoperative ROM, C5 palsy rate and blood loss. However, compared with mini-plate fixation, anchor screw fixation patients showed higher axial symptoms rate [RR = 1.75, 95% CI (1.31, 2.35), P <.05], lower postoperative JOA scores [SMD = −0.38, 95% CI (−0.62, −0.15), P <.05], lower postoperative CCI [SMD = −0.64, 95% CI (−0.94, −0.33), P <.05], lower postoperative ROM [SMD = −1.11, 95% CI (−2.18, −0.04), P <.05], smaller lamina open angle [SMD = −1.98, 95% CI (−3.71, −0.24), P <.05], shorter operation time [SMD = −0.33, 95% CI (−0.59, −0.07), P <.05].Conclusions:Compared with anchor screw fixation, mini-plate fixation in cervical laminoplasty appears to achieve better clinical and radiographic outcomes with fewer surgical complications. However, future well-designed, randomized controlled trials are still needed to further confirm our results.

Cervical osteophytosis and spine posture: contribution to swallow disorders and symptoms.

The article reviews the effects of cervical osteophytosis and spine posture on swallowing, and how they can cause dysphagia. Cerivical osteophytosis which is a bony overgrowth of the cervical spines, it affects the swallowing through different mechanisms, including direct mechanical compression of the pharynx and esophagus, disturbances of normal epiglottic tilt over the inlet of the larynx by the osteophytes at C3-C4 level, inflammatory reactions in the tissues around the esophagus and cricopharyngeal spasm. Also, cervical spine posture in normal individuals could affect the swallowing mechanism by disturbance of the sphincteric action of the larynx and upper esophageal sphincter. Cervical osteophytosis and abnormal cervical curvature may be overlooked by the Otolaryngologists as causes of swallowing disorders. The diagnosis is usually confirmed by radiologic study for the cervical spine. Cervical abnormality should be kept in mind while we are investigating patients with swallowing problem, and postural modification may help in treatment of such cases.

Clinical effects of the bridge-type ROI-C interbody fusion cage system in the treatment of cervical spondylosis with osteoporosis.

ObjectiveTo investigate the early and mid-term efficacy and safety of the bridge-type ROI-C interbody fusion cage system in the treatment of cervical spondylosis with osteoporosis during anterior cervical discectomy and fusion (ACDF).Patients and methodsThe clinical data from 24 cervical spondylosis patients with osteoporosis treated with ACDF were retrospectively analyzed. All patients were treated with ROI-C cage. Double-energy X-ray absorptiometry (DEXA) was used to measure the bone mineral density (BMD). The cervical sagittal radiographic parameters were measured and compared using X-ray including C2–C7 Cobb angle, segmental angle (SA), cervical vertebral bow depth, and height of operation segment (HOS). Postoperative dysphagia was recorded according to the Bazaz score. The Japanese Orthopedic Association (JOA) scores and Neck Disability Index (NDI) scores were used to evaluate the clinical outcomes at different time points. Odom and Vaccaro criteria were used to assess the surgical effects and to evaluate the fusion of the bone graft.ResultsThe mean duration of the postoperative follow-up was 27.4±5.7 months (ranging from 21 to 36 months). The JOA scores and NDI scores at 3 months post operation and at the time of final follow-up were significantly different from those before surgery (P<0.05). Two patients had mild dysphagia after surgery, but it disappeared after symptomatic treatment for 3–5 days. Sagittal radiographic outcomes were significantly improved at 3 months post operation (P<0.05). At the time of final follow-up, the radiographic parameters were well maintained and were not significantly different compared with 3 months post operation (P>0.05).ConclusionThe ROI-C cage system is safe and effective for use in patients undergoing anterior cervical spondylosis surgery for osteoporosis treatment. It results in a positive effect on bone graft fusion, is able to effectively improve cervical curvature, restores intervertebral height, and reduces the incidence of postoperative dysphagia. The clinical effects were positive at the early and middle postoperative stages.