Incidence Of Axial Symptoms Research Articles

The Effect of a Cervical Brace on Postoperative Axial Symptoms Following Single-level Anterior Cervical Discectomy and Fusion.

Retrospective study. This study aims to investigate the effect of cervical brace utilization on postoperative axial symptoms in patients undergoing single-segment anterior cervical discectomy and fusion (ACDF). Anterior cervical discectomy and fusion (ACDF) is the most commonly used surgical method in the treatment of cervical spondylosis. For patients with single-segment ACDF. The absence of a neck brace after surgery is safe and does not affect the outcome of surgery. However, the effect on the incidence of AS is unclear. Patients who underwent anterior cervical single-segment ACDF between May 2020 and August 2021 were retrospectively analyzed. Participants were divided into brace group and nonbraced groups. The incidence of axial symptoms, cervical mobility, and postoperative quality of life were then compared between the 2 groups. A total of 121 patients were included in this study: 62 in the brace group and 59 in the nonbraced group. There were no statistically significant variations observed in the overall demographic characteristics, including age, sex, body mass index, smoking status, and disease duration. The study findings showed that there was a significant decrease in the occurrence of axial symptoms among patients in nonbraced group, in addition to a considerable increase in cervical mobility 1 month following the surgery. The omission of a cervical brace following surgery in patients undergoing single-segment ACDF reduced the incidence of early postoperative axial symptoms, improved their overall quality of life, and facilitated the recovery of postoperative cervical mobility.

Safety and Effectiveness of Modified Expansive Open-door Laminoplasty Using a Ultrasonic Bone Scalpel Compared With a High-speed Drill.

This was a retrospective study. Our study aimed to compare the effectiveness and safety of ultrasonic bone scalpel (UBS) and high-speed drill (HSD) in modified expansive open-door laminoplasty. The traditional methods of decompression mostly use HSD and laminectomy forceps to lift the lamina. As a new type of bone cutting instrument, UBS has the advantages of good tissue selectivity, bone cutting accuracy, good hemostasis, cold cutting, and easy operation, leading to its popular use in surgery. Forty-two patients who underwent modified expansive open-door laminoplasty for multilevel cervical spondylotic myelopathy were included in this study. They were divided into HSD and UBS groups (n=18 and 24, respectively). Data on demographics, operation duration, blood loss, postoperative drainage, extubation time, length of stay, cost of hospitalization, and complications were collected and compared. Modified Japanese Orthopedic Association score, visual analog scale, Neck Disability Index, and axial symptoms were also recorded and analyzed. The blood loss in the UBS group was 255.4±217.5 mL, which was lower than that in the HSD group (490.6±389.4 mL, P=0.030). The cost of hospitalization was similar between the 2 groups. The operative time and postoperative drainage did not significantly differ (P>0.05). The modified Japanese Orthopedic Association score, visual analog scale score, and Neck Disability Index score after surgery were better than those before surgery (P<0.05), but no significant difference existed between the 2 groups in each period (P>0.05). No significant difference existed in the incidence of axial symptoms and other complications (P>0.05). The application of the UBS to modified open-door laminoplasty resulted in a safe and effective decompression effect and reduced blood loss without increasing cost benefit.

C3 laminectomy combined with modified unilateral laminoplasty and in situ reconstruction of the midline structures maintained cervical sagittal balance: a retrospective matched-pair case-control study

Background contextOpen-door laminoplasty often results in postoperative complications such as loss of cervical lordosis, limitations of cervical motion, and axial symptoms. However, current modified laminoplasty techniques such as muscle-sparing type or spinous process splitting technique are not as effective as expected. PurposeTo evaluate the radiological and clinical outcomes of C3 laminectomy combined with modified unilateral laminoplasty (preservation of posterior muscle-ligament complex and reconstruction of the midline structures) versus traditional open door laminoplasty in treating cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament. Study designRetrospective case-control study. Patient sampleOne hundred and eleven patients with multilevel cord compression and myelopathic symptoms. Outcome measuresThe outcome parameters were operation time, blood loss volume, complications, osseous fusion status, C0–C2 and C2–C7 Cobb angles, T1 slope, cervical sagittal vertical axis (cSVA), cervical curvature index (CCI), range of motion (ROM), cross-sectional area (CSA) of the semispinalis cervicis, axial symptoms, visual analog scale (VAS) score, Japanese Orthopedic Association (JOA) score, and neck disability index (NDI). MethodsWe matched 37 patients who underwent modified laminoplasty with 74 patients treated by traditional open door laminoplasty (ratio, 1:2) according to age, sex, body mass index, compromised level, and radiographic characteristics. Preoperative and postoperative cervical parameters, namely, the C2–C7 Cobb angle, ROM, and CCI were measured on X-ray films. The CSA of the semispinalis cervicis was assessed on magnetic resonance images, and osseous fusion status of the hinge side and the osteotomy site was evaluated by computed tomography. We used the JOA and VAS scores, and the NDI to evaluate clinical outcomes. ResultsThe average follow-up period in the modified group was 24.1 months (range, 18–37 months) compared with 24.7 months (range, 18–38 months) in the control group. At the final follow-up, C0–C2 Cobb angle, T1 slope, and cSVA increased in the control group and were unchanged in the modified group. The C2–C7 Cobb angle decreased significantly in the control group and did not change in the modified group. ROM and CCI loss rate did not change in the modified group but decreased significantly in the control group. The CSA loss in the semispinalis cervicis was 222.90±79.56 mm2 in the control group and 49.11±75.93 mm2 in the modified group, with a significant difference (p<.001). The final CSA of the semispinalis cervicis at C2 and C4–C7 levels showed no significant difference in the modified group and decreased significantly in the control group compared with preoperation. Changes in the C2–C7 Cobb angle and cSVA were both correlated with the CSA loss of the semispinalis cervicis (r=0.282, p=.003; r=0.267, p=.005, respectively). Moreover, the CSA loss of the semispinalis cervicis also correlated with the CCI loss rate and the changes in ROM (r=0.312, p=.001; r=0.287, p=.002, respectively). Clinical outcomes such as VAS and NDI scores, improved significantly more in the modified group versus the controls (p<.001 and p=.005, respectively), while JOA scores improved similarly in both groups (p=.132). The incidence of axial symptoms was significantly lower in the modified group versus controls (5.4% vs 9.5%, respectively; p=.023). ConclusionsC3 laminectomy combined with modified unilateral laminoplasty is effective for treating patients with multilevel cord compression. This modified technique reconstructs the midline structures and may lead to improved alignment and less axial pain.

Clinical and Radiographic Outcomes of Modified Unilateral Open-door Laminoplasty with Posterior Muscle-Ligament Complex Preservation for Cervical Spondylotic Myelopathy.

A retrospective comparative study. The aim of this study was to evaluate the efficacy of modified unilateral open-door laminoplasty with posterior muscle-ligament complex preservation in treating cervical spondylotic myelopathy (CSM). The prevalence of axial symptoms after open-door laminoplasty ranges from 5% to 86%. Current modified laminoplasty techniques cannot satisfactorily reduce postoperative axial symptoms. From June 2014 to July 2016, 36 patients with CSM underwent modified laminoplasty with posterior muscle-ligament complex preservation (modified group) and 27 patients underwent traditional laminoplasty (control group). The demographics, operation duration, blood loss volume, cervical curvature, cervical curvature index (CCI), range of motion (ROM), cervical posterior muscle volume on magnetic resonance imaging (MRI), axial symptoms, visual analog scale (VAS) score, Japanese Orthopedic Association (JOA) score, neck disability index (NDI), and complications were recorded and analyzed before operation, after operation, and at the final follow-up. Cervical flexion curvature, cervical curvature, ROM, and CCI were better in the modified group than in controls at the final follow-up (P < 0.01). Postoperative VAS and NDI scores were significantly reduced in the modified group compared with controls (1.15 ± 0.76 vs. 2.63 ± 1.06, 5.67 ± 2.57 vs. 8.89 ± 5.37, respectively) (P < 0.01). Posterior muscle volume at the hinge side in the modified group was not different at final follow-up relative to that before the operation, whereas it was reduced in controls (P < 0.01). Finally, the incidence of axial symptoms was significantly lower in the modified group than in controls (6% vs. 22%) (P = 0.03). Modified unilateral open-door laminoplasty with posterior muscle-ligament complex preservation is effective for treating CSM with good recovery of neurological functions and satisfactory maintenance of cervical curvature and ROM. Furthermore, it reduces the incidence of postoperative axial symptoms compared with conventional open-door laminoplasty. 3.

Relationship Between Sagittal Balance and Axial Symptoms in Patients with Cervical Spondylotic Myelopathy Treated with Anterior Cervical Discectomy and Fusion

Purpose: The purpose of this study was to investigate the sagittal balance of the cervical spine and the clinical outcomes of anterior cervical discectomy and fusion (ACDF) for the treatment of cervical spondylotic myelopathy and to explore whether sagittal balance is related to the incidence of postoperative axial symptoms. Methods: Sixty-seven consecutive patients who underwent ACDF for the treatment of cervical spondylotic myelopathy from January 2014 to December 2016 were enrolled in our study. Sagittal balance parameters (global lordotic angle, segmented lordotic angle, T1 slope, and C2–7 sagittal vertical axis [C2–7 SVA] were recorded in the preoperative period and at 1 month, 3 months, and 1 year postoperatively. Clinical outcomes (JOA and NDI scores) and incidence of axial symptoms were also evaluated before and after surgery. Subgroup analysis included 20 patients with preoperative abnormal sagittal balance group (C2–7 SVA larger than 20 mm), and these patients were divided into two groups, namely axial symptom group and nonaxial symptom group. Result: The sagittal balance parameters (global lordotic angle, segmented lordotic angle, and TI slope) and the clinical outcomes after surgery significantly improved. The subgroup analysis within the preoperative abnormal sagittal balance group showed significant differences in postoperative and change in C2–7 SVA between patients with and without postoperative axial symptoms. Conclusion: ACDF can be applied to restore the sagittal alignment of the cervical spine and effectively improve clinical outcomes for the treatment of cervical spondylotic myelopathy. Sagittal balance improvement may be associated with the low incidence of postoperative axial symptoms for patients with abnormal cervical sagittal balance before surgery.

Risk factors for axial symptoms after posterior cervical double door laminoplasty

Objective To explore and analyze the risk factors of axial symptoms after posterior cervical laminoplasty. Methods Retrospectively follow up the patients taking posterior cervical laminoplasty in Jishuitan Hospital during May 2005 to July 2011, due to multi-segmental cervical stenosis or (and) cervical ossification of posterior longitudinal ligament. All patients' gender, diagnosis, age, preoperative neck and shoulder pain, VAS score, course of disease, presence or absence of root symptoms, medical complications, operation time, operation method, blood loss, postoperative neck support time, presence or absence of C5 nerve root paralysis, preoperative JOA and postoperative best JOA, preoperative C2-C7 Cobb angle in neutral position, flexion position, post-extension and calculate the activity were collected. Record the process of axial symptoms in details and statistically analysis by SPSS. Results All of 146 patients were followed up for 58-134 months with an average of 89.5±18.4 months. There were 57 cases of axial symptoms, the overall incidence was 39.0%; except for 7 cases with symptom relief in 6 months, the other 50 cases (34.25% of the total number of follow-up) of the axial symptoms continued by the time of follow-up. 35 patients (23.97%) were characterized by stiffness and 22 patients (18.49%) showed pain, traction and tightness. 36 patients (24.66%) showed axial symptoms on the shoulder and back, 10 (6.85%) appeared around the wound and 11 (7.53%) appeared on both the shoulder and the wound. Univariate logistic regression analysis showed that intraoperative blood loss (P= 0.019, odds ratio(OR) 1.857, 95% CI 1.107-3.116) and postoperative best JOA score (P= 0.008, OR=0.780, 95% CI: 0.650-0.936) significantly affected the occurrence of postoperative axial symptoms. Multifactor Logistic regression analysis was carried out by stepwise forward method. It was found that besides the intraoperative blood loss and postoperative best JOA score, the following factors also affected the incidence of axial symptoms after operation (P<0.05): diagnosis, preoperative age, the extension of C2-C7 Cobb angle before operation, and the operation destruction of C7 spinous process muscle stops. The diagnosis of ossification of the posterior longitudinal ligament, preoperative age, and the extension of C2-C7 Cobb angle before operation were the protective factors for the axial symptoms, and the diagnosis of multiple segments of the cervical spinal stenosis and the operation destruction of C7 spinous process were the risk factors for the axial symptoms after the operation. Conclusion Younger, less preoperative C2-C7 Cobb extension, the operation destroys the C7 spinous process muscle stop point, more intraoperative blood loss, lower postoperative best JOA score and patients with multi-segment cervical stenosis more are more easily to have axial symptoms after posterior cervical double door laminoplasty. Key words: Cervical vertebrae; Spinal stenosis; Ossification of posterior longitudinal ligament; Postoperative complications; Risk factors

Modified Laminoplasty Preserving the Posterior Deep Extensor Insertion into C2 Improves Clinical and Radiologic Results Compared with Conventional Laminoplasty: A Meta-Analysis.

Whether modified laminoplasty is better than conventional laminoplasty is unclear. Thus, a meta-analysis comparing the outcomes of preserving or repairing the posterior deep extensor insertion to C2 in laminoplasty was conducted for patients with multilevel cervical spondylotic myelopathy (MCSM). Several electronic databases were chosen to search for relevant studies. The primary indices included preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, JOA recovery rate, muscle atrophy rate, preoperative and postoperative range of motion (ROM), ROM decrease rate, and incidence of axial pain. Results are expressed as odds ratios with 95% confidence intervals for the dichotomous outcomes and mean differences for continuous outcomes. Eight studies involving 763 patients were included in this study. The postoperative cervical ROM was significantly higher in the modified group (P= 0.01, MD= 3.0 [0.66, 5.35]), as was the cervical posterior muscle volume (P= 0.02, MD= 28.28 [4.42, 52.3]) and the operation time (MD=-45.04, 95% CI-49.79,-40.29; P < 0.01). The incidence of axial symptoms in the modified group was lower than that in the conventional group (P < 0.01, OR 0.28 [0.17, 0.46]), as was the rate of decrease of cervical ROM (P= 0.004, MD=-6.72 [-11.25, 2.19]). There was no significant difference (P > 0.05) between the groups in blood loss, preoperative and postoperative JOA score, or JOA recovery rate. Modified laminoplasty had shorter operation times, a lower incidence of axial pain, a higher cervical ROM, and a lower atrophy rate compared with conventional laminoplasty. The clinical and radiologic results of modified laminoplasty have been partly superior to those of conventional laminoplasty to date.

Comparison of the effects of different fixation methods on open-door side in posterior expansive open-door laminoplas-ty

Objective To investigate the clinical outcome and complications of different types of expansive open door laminoplasty in cervical spondylotic myelopathy. Methods From December 2008 to June 2012, 221 patients with cervical spondylotic myelopathy treated with expansive open-door laminoplasty were divided into micro-titanium plate fixed group (96 cases), wire hanging fixed group(66 cases), anchor suspension fixed group (59 cases). The clinical outcome was evaluated in-cluding JOA score, operation time, bleeding volume, spinal cord pressure (a/M), cervical range of motion (ROM), open door an-gle, posterior shift distance of spinal cord and postoperative complications. Results All patients were followed up for more than 2 years. There were no significant differences in general condition, operation time, intraoperative blood loss, preoperative and post-operative 2 years JOA score, JOA score improvement rate, spinal cord shift distance, spinal cord compression among three groups; In the incidence of C5 nerve root paralysis, there was no significant difference between the silk suspension fixation group (12.1%) and the anchored suspension group (11.9%). The incidence of C5 nerve root paralysis for microplate fixation group (2.1%) was sig-nificantly lower than that of the silk suspension fixation group and anchored suspension fixation group, and the difference was sta-tistically significant. There was no significant difference in the fusion rate between the 3-month and 6-month portal arteries in the group of silk suspension fixation group(65%, 82%) and anchor fixation group(61%, 82%). The fusion rate of the microtiter plate fix-ation group(90%, 98%) was significantly higher than that of the silk suspension group and the anchorage group at 3 months and 6 months after operation. There were no significant differences in the incidence of recurrence, the total amount of cervical spine loss and the incidence of axial symptoms after 6 months of operation in the suspension group and the anchor suspension group. The in-cidence of occlusion, the total amount of cervical spine loss and the incidence of axial symptoms were significantly lower in the mi-cro titanium plate fixation group than those in the silk suspension group and the anchorage fixation group, the difference was statis-tically significant. Conclusion Using micro-titanium plate to fix the side of open door could achieve full spinal cord decompres-sion and access to satisfactory neurological improvement rate. At the same time, compared with the traditional silk or anchor sus-pension, the use of micro-titanium plate is more conducive to the door axis bone healing, prevent the occurrence of reclosing, sig-nificantly reduce the loss of postoperative cervical range of motion, and reduce the incidence of axial symptoms with the satisfac-tion of the clinical outcome. Key words: Cervical vertebrae; Spinal cord compression; Decompression, surgical; Postoperative complications; Radicu-lopathy

The prevention and cure of postoperative neck axial symptoms after open-door laminoplasty for cervical spondylotic myelopathy

Objective To evaluate the effectiveness of rehabilitative treatment after extended open-doorlaminoplasty of the cervical spine for cervical spondylotic myelopathy.Methods Sixty patients(mean age 61.7 ±12 years)who had undergone extended open-door laminoplasty of the cervical spine for cervical spondylotic myelopa-thy were studied for an average of 40.7 months.They are divided into a rehabilitation group and a control group with 30 patients in each.The patients in the rehabilitation group received systematic rehabilitation therapy pre-and post-operation.In both groups,the neurological recovery rate,the cross-sectional areas of the cervical posterior muscles,and the incidence of axial symptoms and post-operative complications were recorded and compared. Results The wounds of patients in the rehabilitation treatment group healed with no complicating infections,but the wounds of three patients in the control group became infected.There was no statistically significant difference in neurological recovery between the two groups.In the rehabilitation treatment group,the rate of atrophy and the cross-sectional areas of the cervical posterior muscles were significantly lower than in the control group.At the same time,the rate of neck axial symptoms was 23% in the rehabilitation group but 60%in the control group.a difference which was statistically significant. Conclusions Although rehabilitation treatment pre-and post-operation may not speed up neurological recovery,it may prevent postoperative atrophy of the cervical extensors and lower the incidence of neck axial symptoms. Key words: Cervical spondylotic myelopathy; Laminoplasty; Axial symptoms; Rehabilitation

Retrospective cohort study between selective and standard C3-7 laminoplasty. Minimum 2-year follow-up study.

A total of 64 patients with cervical spondylotic myelopathy (CSM) were assessed in this study. Forty-two patients underwent selective expansive open-door laminoplasty (ELAP). Twenty-two patients who underwent conventional C3-7 ELAP served as controls. There were no significant differences in recovery rate of JOA scores, C2-C7 angle or cervical range of motion between two groups. Incidence of axial symptoms and segmental motor paralysis in selective ELAP was significantly lower than those in the C3-7 ELAP. Size of anterior compression mass, postoperative spinal cord positions and decompression conditions were evaluated using preoperative or postoperative MRI in 50 of 64 patients. There was a positive correlation between number of expanded laminae and maximum anterior spaces of spinal cord. Incomplete decompression was developed in three of 37 patients in selective ELAP and in two of 13 patients in C3-7ELAP. Mean size of anterior compression mass at incomplete decompression levels was significantly greater than that at complete decompression levels. Since, there was less posterior movement of the spinal cord in selective ELAP than that in C3-7ELAP, minute concerns about size of anterior compression mass is necessary to decide the number of expanded laminae. Overall, selective ELAP was less invasive and useful in reducing axial symptoms and segmental motor paralysis. This new surgical strategy was effective in improving the surgical outcomes of CSM, and short-term results were satisfactory.