Japan Orthopedic Association Score Research Articles

Influence of preoperative symptom duration on effectiveness of cervical disc arthroplasty in cervical spondylotic radiculopathy patients

To investigate the influence of preoperative symptom duration on effectiveness of cervical disc arthroplasty (CDA) in cervical spondylotic radiculopathy (CSR) patients. The clinical data of 90 CSR patients who underwent single-segment CDA between January 2008 and March 2020 and met the selection criteria were retrospectively analyzed. Based on preoperative symptom duration, patients were divided into an early intervention group (preoperative symptom duration <24 months) and a late intervention group (preoperative symptom duration ≥24 months). There was no significant difference in baseline data between the two groups ( P>0.05), including age, gender, body mass index, smoking status, surgical segment, preoperative neck disability index (NDI), visual analogue scale (VAS) score, cervical lordosis (CL), C 2-C 7 range of motion (ROM), disc angle (DA), disc ROM (DROM), and disc intervertebral height (DIH). The early intervention group had a slightly higher preoperative Japan Orthopedic Association (JOA) score than the late intervention group ( P<0.05). Perioperative indicators such as operation time, intraoperative blood loss, and postoperative hospital stay were recorded. The changes of JOA score, NDI, and VAS score at last follow-up compared with those before operation were used to evaluate the clinical efficacy, and the imaging evaluation of CL, C 2-C 7 ROM, DA, DROM, and DIH was performed before operation, immediately after operation, and at last follow-up. The incidence of prosthesis-related complications, including heterotopic ossification (HO), anterior bone loss (ABL), and prosthesis subsidence, was also assessed at last follow-up. Patients in both groups were followed up 24-120 months, with an average of 53.4 months. There was no significant difference in operation time, intraoperative blood loss, or follow-up duration between the groups ( P>0.05). However, the late intervention group had significantly longer postoperative hospital stay compared to the early intervention group ( P<0.05). At last follow-up, there was no significant difference in the changes of JOA score, NDI, and VAS score between the two groups before and after operation ( P>0.05). During the follow-up, there was no surgical revision in the two groups, and there was no significant difference in the incidence of HO, ABL, and prosthesis subsidence between the two groups at last follow-up ( P>0.05). Imaging evaluation showed that there was no significant difference in CL, C 2-C 7 ROM, DA, DROM, and DIH between the two groups at each time point before and after operation ( P>0.05). The intra-group comparison showed that the early intervention group could maintain the immediate postoperative CL at last follow-up, while the late intervention group had recovered to the preoperative level. Additionally, the C 2-C 7 ROM, DROM, and DA had all recovered to preoperative levels at last follow-up in both groups; meanwhile, the DIH significantly increased immediately after operation and sustained until the last follow-up. Preoperative symptom duration significantly affects the effectiveness of CDA in CSR patients. Patients with preoperative symptom duration ≥24 months have longer postoperative hospital stays and potentially poorer ability to maintain CL compared with patients with preoperative symptom duration <24 months.

Impact of Surgical Resection Without Spinal Fusion for Thoracic Dumbbell Tumors on Postoperative Global Spinal Sagittal Alignment and Clinical Outcomes.

A retrospective comparative study. This study investigated radiographical changes in global spinal sagittal alignment (GSSA) and clinical outcomes after tumor resection without spinal fusion in patients with thoracic dumbbell tumors. Thirty patients with thoracic dumbbell tumors who were followed up for at least 3 years were included in this study. Variations in the outcome variables were analyzed using individual GSSA parameters measured on radiography. Clinical outcomes were assessed using the modified McCormick scale (MMCS), Japan Orthopaedic Association (JOA) score, and visual analog scale (VAS). To assess the impact of the affected levels on these outcomes, we divided the patients into three groups according to the location of the tumor (upper [T1-4], middle [T5-8], or lower [T9-12] thoracic spine). The GSSA parameters (cervical lordosis, T1 slope, thoracic kyphosis [global, upper, middle, and lower], thoracolumbar kyphosis, lumbar lordosis, sacral slope, pelvic incidence, and pelvic tilt) of all the patients did not change significantly after surgery. Eleven of thirty patients had preoperative gait disturbances but they could walk without support (MMCS grade I or II) at the final follow-up. The JOA score and VAS showed significant postoperative improvements. No statistically significant differences were observed in each postoperative sagittal profile or clinical outcome between the upper, middle, and lower groups. Tumor resection without spinal fusion did not affect the various GSSA parameters and resulted in satisfactory clinical outcomes, indicating that spinal fusion may not always be necessary when resecting thoracic dumbbell tumors.

Management of Postoperative Discitis with Debridement and Novel Technique of Local Antibiotic Instillation: Functional Outcomes from a Resource-Limited Setting

Patients in low- and middle-income countries (LMICs) have substantial treatment abandonment and non-adherence with outpatient oral medications. This work sought to investigate outcomes of postoperative discitis treated with debridement and a novel technique focused on reducing outpatient antibiotic requirement in an LMIC setting. This study, conducted and reported following STROBE guidelines, reviewed outcomes of all patients with postoperative discitis who had been debrided by 1 neurosurgeon in a resource-limited setting during 2008-2020. Patients had undergone single-level L4-L5 or L5-S1 discectomy elsewhere, later developing magnetic resonance imaging-confirmed discitis. After non-response or deterioration following intravenous antibiotics, patients underwent early debridement, followed by in-patient antibiotic instillation into disc space for 2 weeks via drain. Study outcomes were modified Kirkaldy-Willis Grade, Japan Orthopaedic Association (JOA) score, and visual analog scale (VAS) score, all assessed at 1 year. Twelve patients were included, 10 male and 2 female, with median age of 46 (IQR 3.5) years. Debridement was done after median 82.5 (IQR 35) days and took median time of 105 (IQR 17.5) minutes. VAS scores (mean ± SD) decreased from 9.25 ± 0.75 preoperatively to 0.67 ± 0.89 1 year postoperatively (mean difference 8.58, 95% CI 8.01-9.15, P < 0.001). JOA scores (mean ± SD) improved from 4.5 ± 2.94 to 26.42 ± 1.31 1 year postoperatively (mean difference 21.92, 95% CI 20.57-23.26, P < 0.001). Kirkaldy-Willis grade was excellent in 6 (50%) patients, good in 5 (41.7%), and fair in 1 (8.3%). Patients became ambulatory within 2 weeks, with no major complications during 4.15 (IQR 3.45) years of median follow-up. In LMICs, patients with medically refractory postoperative discitis potentially have good outcomes after debridement plus 2-week local antibiotic instillation.

Effect of hardware removal and second-look arthroscopy after open-wedge high tibial osteotomy.

Open-wedge high tibial osteotomy (OWHTO) is the standard and safe procedure for medial compartment osteoarthritis. Although hardware removal (HWR) is performed after post-OWHTO bone union, the effects of HWR on OWHTO have been rarely reported. We hypothesised that HWR would improve range of motion (ROM) and implant-related complications. Thus, this study aimed to investigate the effects of HWR on postoperative ROM, the Japan Orthopaedic Association (JOA) score/visual analogue scale (VAS) score and hardware-related complications after OWHTO. Patients who underwent OWHTO between January 2016 and June 2018 and HWR were retrospectively reviewed. To perform OWHTO, locking plates and prosthetic bone were used to achieve optimal stabilisation of biplanar osteotomy. HWR was performed after a second-look arthroscopy through the previous skin incision. For clinical evaluation, the JOA score, VAS score, and ROM were assessed before and 1year after HWR using the Wilcoxon rank test. Logistic regression analysis was performed to identify the predictors of post-HWR improvement. Of 98 knees examined (91 patients), 80 (73 patients; 39 men and 34 women) were included. At the time of OWHTO, mean age was 64.0 ± 9.7years and body mass index, 25.5 ± 3.1kg/m2; Kellgren-Lawrence (KL) grade 1 was seen in 20 cases, KL-2 in 46, and KL-3 in 14. Mean periods between OWHTO and HWR were 13.4 ± 2.0months, and 11.9 ± 1.2months between HWR and evaluation. The JOA score and flexion angle significantly improved after HWR (The JOA score: p = 0.026 flexion angle: p < 0.001); however, the VAS score and extension angle did not (VAS score: p = 0.162, extension angle: p = 0.934). Hardware irritation was observed in four cases (5%), which improved after HWR. Logistic regression analysis revealed that lower preoperative KL grade and flexion angle were predictors of improvement after HWR [KL grade: p = 0.008; odds ratio 3.244, 95% confidence interval (CI) 1.350-7.794; flexion angle: p < 0.001; odds ratio 1.150, 95% CI 1.062-1.245]. HWR improves flexion angle, clinical outcomes and hardware-related complications after OWHTO. Preoperative KL grade and flexion angle are predictors of improvement after HWR in patients who have undergone OWHTO.

Effect of bone cement-reinforced pedicle screws combined with fusion repositioning therapy on lumbar spine function and postoperative complications in patients with severe lumbar spondylolisthesis

ObjectiveTo retrospectively study the efficacy of bone cement-enhanced pedicle screws combined with interbody fusion reduction in the treatment of severe lumbar spondylolisthesis, its effect on lumbar function and complications. MethodsFrom January 2019 to June 2021, 82 cases of severe lumbar spondylolisthesis in our hospital were analyzed. According to the different treatment plans, the patients were divided into two groups: A and B, in which group A patients were treated with pedicle screws combined with fusion and reduction, and group B patients were treated with bone cement reinforced pedicle screws combined with fusion and reduction. Perioperative indexes, pain severity (VAS), Oswestry dysfunction index (ODI), and low back and leg pain score of Japan Orthopedic Association (JOA), spondylolisthesis reduction, intervertebral space height, intervertebral foramen height, complications, and screw loosening were compared between the two groups. ResultsThere was no significant difference in the amount of intraoperative bleeding between group A and group B (P > 0.05). The operation time of group B was longer than that of group A, and the hospitalization time was shorter than that of group A. The vertebral fusion rate of group B was higher than that of group A (P < 0.05). The VAS, ODI and JOA scores at the last follow-up in both groups were lower than those before surgery, and group B was lower than group A (P < 0.05). Compared with the preoperative period, the postoperative slippage degree grading improved in both groups, while the improvement rate in group B was higher than that in group A (P < 0.05). At the last follow-up, the scores of intervertebral foramen height and intervertebral space height in both groups were higher than those before operation, and those in group B were higher than those in group A (P < 0.05). There was no difference in the incidence of complications and screw loosening between the two groups (P > 0.05). ConclusionCompared with conventional screw treatment, bone cement-reinforced pedicle screws combined with fusion repositioning can further improve the repositioning rate of slipped vertebrae in the treatment of severe LSL, while achieving a better intervertebral fusion rate. Therefore, the treatment of severe LSL with bone cement reinforced pedicle fusion and reduction is a safe and effective method.

Posterior paramedian approach combined with a novel inverted V-shaped surgical access for intraspinal schwannomas: a retrospective case series study

ObjectiveTo explore the efficacy and safety of the posterior paramedian approach combined with a novel inverted V-shaped surgical access for the treatment of intraspinal schwannomas.MethodsThis study retrospectively reviewed consecutive patients who underwent surgical resection of the intraspinal schwannomas via the inverted V-shaped approach at our center between January 2016 and May 2021. Changes between the preoperative and postoperative visual analog scale (VAS) scores and neurological function Japan Orthopaedic Association (JOA) scores were assessed. Secondary outcomes such as success rate of tumor resection, operation time, blood loss, spinal stability, and disruption degree of intervertebral joints. Postoperative complications were also investigated.ResultsOf these 36 consecutive patients, there were 6 cases in the cervical spine, 2 cases at the cervical-thoracic junction, 11 cases in the thoracic spine, 4 cases at the thoracic-lumbar junction and 13 cases in the lumbar spine. The average operation time was 99 min, and the average blood loss was 95.4 mL. The tumor removal rate was 100%. Postoperative CT re-examination showed that the spinous processes were intact in all cases, the facet joint surfaces were intact in 32 cases. At the time of last follow-up, the median JOA score was 25 (9–27), which was significantly improved compared to the preoperative median JOA score of 15 (10–22) (P < 0.01). The overall excellent and good rate were 88.9 %. The median VAS score at post-surgery was 0 (0–2), which was significantly improved compared to the preoperative median VAS score of 4 (2–8) (P < 0.01). As for complications, there were no cases of cerebrospinal fluid leakage or spinal instability. Three patients who had a postoperative fever finally recovered after lumbar cistern drainage.ConclusionThe inverted V-shaped surgical access via the posterior paramedian approach is an effective and safe method for the treatment of intraspinal schwannomas.

Comparison of clinical outcomes between cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of single-level cervical spondylosis: a 10-year follow-up study

BACKGROUND CONTEXTThe theoretical advantage of cervical disc arthroplasty includes preserved motion at the cervical level, which may reduce degeneration of the adjacent segments. The long-term follow-up results are still controversial. PURPOSEThe present study aimed to retrospectively study the long-term efficacy and complications of cervical disc arthroplasty using a single commercially-available device in a single center. STUDY DESIGNThis was a propensity-score matched cohort study. PATIENT SAMPLEThis study enrolled 148 single-level cervical degenerative disease patients from January 2009 to March 2012. After 1:1 propensity score matching, 39 patients remained in the ACDF or ACDR groups. OUTCOME MEASURESThe outcome measures were neurological functions (Neck Disability Index (NDI) and Japan Orthopedic Association (JOA) scores), radiographic evaluations (cervical curvature, operative segment range of motion, degenerative condition of adjacent segments, heterotopic ossification (HO) of the surgical segment), and complications. METHODSNDI and JOA scores were used to evaluate patient neurological functions. Cervical curvature (C2-C7 Cobb angle) and operative segment range of motion (ROM) were compared between the two groups. Grading criteria for osteophyte formation were used to evaluate the degenerative condition of adjacent segments. HO after ACDR was graded according to the McAfee grading method. RESULTSThe average follow-up time was 119.3 ±17.2 months. Satisfactory improvements in neurological function were obtained for both the ACDR and ACDF groups. There were no significant differences in VAS or NDI scores between the two groups. In the ACDR group, the ROM of the operative segment increased from 6.7 ±4.3° before the operation to 8.9 ±3.5° on the second day after the operation (p<.001). The ROM of the operative segment was 8.1 ±4.0° at the 1-year follow-up, 7.2 ±3.6° at the 2-year follow-up, 5.7 ±4.5° at the 5-year follow-up and 4.3 ±3.9° at the last follow-up. ASD was more likely to develop in the caudal adjacent segments and progressed with the follow-up time. At the last follow-up, HO was present in 27 patients (69.23%), while high-grade HO (McAfee scores III and IV) was detected in 6 patients (15.38%). CONCLUSIONSThrough nearly 10 years of follow-up, ACDR was as effective as ACDF for treating single-level degenerative cervical disc disease. However, HO and the role of ACDR in the protection of ASD remains to be further observed and followed up.

Laterality of lumbar disc herniation

BackgroundLumbar disc herniation (LDH) is most common in men aged 20–40 at the L4/5 level; however, left-right differences have not been reported. Improving our understanding of left- and right-side LDH may facilitate the estimation of mechanical load on intervertebral discs. Here, we assessed left-right differences in LDH via a retrospective analysis of LDH cases. MethodsAmong 10,972 surgical cases of LDH identified in the Nagoya Spine Group database, 2899 in which right- and left-LDH sides were observable in a single vertebral segment were identified (mean age 46.3 ± 16.6 years, 2028 males). The following characteristics of patients with right- and left-LDH were compared: age, LDH level, surgical technique, operative time, blood loss, length of hospital stay, preoperative Japan Orthopaedic Association (JOA) score, and JOA recovery rate. ResultsLDH occurred on the right and left sides in 1358 and 1541 patients, respectively, with patients with right-side LDH significantly older than those with left (47.9 ± 16.6 versus 45.0 ± 16.5, respectively; p < 0.001). No between-group differences in sex, age, LDH level, surgical technique, operative time, blood loss, length of hospital stay, preoperative JOA score, or JOA recovery rate were observed. The occurrence of right-side LDH increased with age, occurring in 42.7%, 45.1%, 49.9%, and 54.7% of patients aged 10–29, 30–49, 50–69, and 70–89 years, respectively. ConclusionLeft-side LDH was observed more frequently than right; however, right-side LDH incidence increased with age. No significant between-group differences regarding symptoms, treatments, or outcomes were observed.

Risk factors for contralateral total knee arthroplasty after unilateral total knee arthroplasty

BackgroundLittle attention has been focused on risk factors for undergoing bilateral total knee arthroplasty (TKA) after primary unilateral TKA among patients with knee osteoarthritis (OA). This study investigated the differences in characteristics between groups with and without additional TKA for the contralateral knee among patients with knee OA who underwent primary unilateral TKA. MethodsSeventy-six patients who underwent primary unilateral TKA were included in this study. We defined patients who underwent additional TKA for the contralateral knee within one year of the primary TKA as a bilateral TKA group, and patients who did not undergo bilateral TKA as a unilateral TKA group. Femorotibial angle (FTA), percentage of mechanical axis (%MA), Kellgren–Lawrence (KL) grade, range of motion, Japan Orthopaedic Association (JOA) score, 10 m-walking time, C-reactive protein, estimated glomerular filtration rate, and serum albumin levels were selected as independent variables including covariates of age, sex, and body mass index for predicting bilateral TKA. We compared differences in variables between the two groups using the t-test or Mann–Whitney U-test and general linear models. A multivariate stepwise logistic regression model was also used to determine which variables correlated with bailateral TKA. ResultsIn pairwise comparisons, the KL grade, FTA, %MA, JOA score, and knee flexion angle in the contralateral knee were significantly worse in the bilateral TKA group than in the unilateral TKA group after controlling for covariates (P < 0.01, respectively). A stepwise logistic regression revealed that significant contributors to undergoing the contralateral TKA were FTA (OR = 1.47, P < 0.001) and knee flexion angle (OR = 0.96, P = 0.022) of the contralateral knee. ConclusionsSevere varus deformity and limitations of flexion in the contralateral knee were found to be risk factors for undergoing additional TKA within one year of primary unilateral TKA among patients with knee OA.

Is Anterior Trans‐Intervertebral Space Decompression Important in Treating Cervical Spondylosis with Severe Intervertebral Space Narrowing? A Retrospective Cohort Study

To evaluate the clinical efficacy and practicality of anterior trans-intervertebral space decompression and fusion (ATIDF) by comparing radiological and clinical outcomes between ATIDF and traditional anterior cervical corpectomy and fusion (ACCF) in cervical spondylosis patients with severe disc space narrowing. Seventy-one cervical spondylosis patients with severe disc space narrowing underwent anterior cervical spine surgery were included in this retrospective study. Thirty-seven patients underwent ATIDF and 34 patients underwent ACCF. The neck disability index (NDI), Japan Orthopaedic Association (JOA) score and the Hirabayashi improvement rate were used to evaluate patient neurological status. Cervical sagittal alignment (C2-C7 Cobb angle), surgical segment sagittal alignment (Cobb angle of surgical segment) and disc space height were also compared between the two groups. There were 39 males and 32 females; mean age was 63.72 ± 6.36 years (range, 39-81 years). Mean follow-up was 22.4 months (range, 6-45 months). All patients achieved an adequate neurological improvement. There were no significant differences in NDI, JOA scores and Hirabayashi improvement rate between the two groups. The change of C2-7 Cobb angle and surgical segment Cobb angle were both greater in the ATIDF group. The average intervertebral height ratio of the patients in the ATIDF group increased significantly after surgery (0.38 ± 0.17 before surgery to 1.13 ± 0.32 after surgery, P < 0.01). The overall complication rate was lower in the ATIDF group than the ACCF group (35.14% and 44.12%). At 6 months follow-up, three patients in the ACCF group presented with subsidence of the titanium mesh cage. ATIDF is an effective technique for treating cervical spondylosis with severe disc space narrowing; it can achieve adequate decompression and improve sagittal alignment while avoiding and reducing the implant-related complications inherent to traditional ACCF.

Zoning laminectomy for the treatment of ossification of the thoracic ligamentum flavum

Spinal cord injury is a common occurrence during spinal surgery. In this study, we proposed a zoning laminectomy, which could reduce the incidence of nerve injury. We also discussed the safety and clinical efficacy of the zoning laminectomy for thoracic ossification of the ligamentum flavum (TOLF). Forty-five patients with TOLF who underwent zoning laminectomy from October 2016 to February 2020 were included in the retrospective analysis. The Japan Orthopedic Association (JOA) score was used to evaluate clinical outcomes. Meanwhile, the occurrence of complications was recorded. All 45 patients underwent the operation successfully, and the mean follow-up period was 25.3 months, the mean operation time was 160.2min, the average blood loss was 474.2ml, and the average hospital time was 8.0 days. At the final evaluation, the JOA score was significantly higher than the preoperative JOA score (P<0.001) and the overall recovery rate of the JOA score averaged 69.6%. Seventeen patients were graded as excellent, twenty-six as good, and two as fair. The complications included dural tears in nine patients (20.0%), cerebrospinal fluid leakage in seven patients (15.6%), deep infection in one patient (2.2%), and epidural hematoma in one patient (2.2%). All patients recovered well after treatment. Besides, there was no neurological deterioration and thoracic kyphosis occurred. Zoning laminectomy adopts a phased resection from "safe zone" to "danger zone" and defines the safe removal range of the lamina, which reduces the risks of spinal cord injury caused by instrument manipulation. Therefore, it is a safe and effective surgical option.

Long-term therapeutic effect of percutaneous kyphoplasty combined with & without back muscle rehabilitation exercise in elderly patients. A comparative study.

Objectives:To know the long-term therapeutic effects and the pain improvement after percutaneous kyphoplasty (PKP) combined with and without back muscle rehabilitation exercises in elderly patients with osteoporotic lumbar compression fractures.Methods:We performed a retrospective analysis using records of elderly patients with osteoporotic lumbar compression fracture treated in our hospital from June 2019 to June 2020. We extracted relevant hospitalization treatment and record of follow-up data after discharge from 45 patients treated with PKP (Group-I) and 56 treated with PKP combined with back muscle rehabilitation exercises (Group-II). We compared the total effective lumbar function rates (number of effective and perfectly effective treatments/total number of patients) and inprovement in pain of the two treatment schemes.Results:The total efficacy in the group receiving treatment in Group-II was 96.43% higher than that of the patients receiving treatment in Group-I (84.44%; P<0.05). The pain VAS scores at one, six and 12 months in patients receiving treatment in Group-II were lower than those patients receiving treatment in Group-I (P<0.05). A year after the operation, the Oswestry disability index (ODI) scores in patients receiving treatment in Group-II were lower than those patients receiving treatment in Group-I (P<0.05). Whereas Japan Orthopaedic Association (JOA) scores were higher in the patient’s receiving treatment in Group-II as compared to Group-I (P<0.05).Conclusion:After elderly patients were treated with PKP combined with back muscle rehabilitation exercise of lumbar and dorsal muscle function, the curative effect was significantly improved, the pain was reduced and the lumbar function was significantly improved.

Poorer Preoperative Function Leads to Delayed Return to Work After Anterior Cervical Discectomy and Fusion for Degenerative Cervical Myelopathy.

The factors that affect return to work (RTW) after anterior cervical discectomy and fusion (ACDF) for degenerative cervical myelopathy (DCM) remain unclear, especially in a non-Workers' Compensation setting. We aimed to (1) identify factors that influence RTW in patients undergoing ACDF (2) determine if early RTW plays a role in functional outcomes, quality of life, and satisfaction. Prospectively collected data of 103 working adults who underwent primary ACDF for DCM were retrospectively reviewed. Patients were stratified into 2 groups: early RTW (≤60 days, n = 42) and late RTW (>60 days, n = 61). The mean time taken to RTW was 34.7 and 134.9 days in the early and late RTW groups, respectively (P < 0.001). The early RTW group had significantly better preoperative Japan Orthopaedic Association (JOA) score and Neck Disability Index (NDI) (P < 0.05) and showed a trend toward higher 36-Item Short Form Physical Component Summary (PCS) (P = 0.071). The early RTW group also had significantly better postoperative JOA, NDI, and PCS at 6 months and less arm pain along with a trend toward better NDI at 2 years (P = 0.055). However, there was no difference in the change in outcome scores and a similar proportion in each group attained the minimal clinically important difference for each metric. At 2 years, 85.7% and 77.0% were satisfied in the early and late RTW groups, respectively (P = 0.275). While working adults that RTW later tend to have poorer function preoperatively and up to 2 years postoperatively, surgeons may reassure them that they will likely experience the same degree of clinical improvement and level of satisfaction after ACDF. Level 3, therapeutic study.

Spinous Process-Splitting Laminectomy Approach for Tumor Excision at Conus Medullaris or Cauda Equina Level Results in Satisfactory Clinical Outcomes Without Affecting Global Spinal Sagittal Alignment.

Retrospective comparative study. The present study investigated radiographical changes in global spinal sagittal alignment (GSSA) and clinical outcomes following tumor resection using spinous process-splitting laminectomy (SPSL) approach without fixation in patients with conus medullaris (CM) or cauda equina (CE) tumor. Forty-one patients with CM or CE tumor (19 males, 22 females, mean age at surgery of 52.9 ± 13.0years) were included in this study. The variations of outcome variables were analyzed in various GSSA profiles using radiographic outcomes. The clinical outcomes were assessed using Japan Orthopaedic Association (JOA) score and JOA back pain evaluation questionnaire (JOABPEQ). In all cases, the various GSSA parameters (sagittal vertical axis, C2-7 lordosis, T1 slope, thoracic kyphosis, T10-L2 kyphosis, lumbar lordosis [LL; upper, middle, and lower], sacral slope, pelvic incidence, and pelvic tilt) did not significantly change in the 2-years postoperative period. Moreover, age at surgery, the number of resected laminae, preoperative T12-L2 kyphosis, or LL did not affect the postoperative changes in T12-L2 kyphosis or LL, and had no statistically significant correlation among them. The scores of each postoperative JOA domain and the Visual Analogue Scale included in the JOABPEQ were significantly improved. There was no statistical significant group difference in each sagittal profile or clinical outcomes between CM and CE groups postoperatively. Tumor resection using SPSL approach did not affected the various GSSA parameters examined and resulted in satisfactory clinical outcomes, indicating that SPSL approach is a suitable surgical technique for patients with CM or CE tumor.

Pronostics Factors of Csm; Experience of Military Hospital of Rabat/Maroc about 107 Cases

Background: The surgery outcome of cervical spondylotic myelopathy (CSM) for some authors depend to the clinical signs (obesity, smoking, sex, age, patient’s activity, and the surgery delays). Nevertheless, for others authors it’s depending to the chirurgical approach (anterior or posterior or the levels number of decompression in the cervical spine). There is no consensus although some arguments prevail over to others in the literature. Our study purpose was to determine the important clinical factors predictors of surgical outcome in patients with CSM. It’s a retrospective study of 107 patients admitted to the Mohamed V hospital in Rabat over 06 years from January 2013 to December 2018 for cervical spondylotic myelopathy (CSM) operated and were followed up for 1year. Their neurological status pre and postoperative was assessed using the Japan Orthopedic Association (JOA) score and others prognostics factors such as sex, age, duration of symptoms, Cobbs angle, number of discs compressed, MODIC class signal and, (P&lt;0.05) was statistically significant. Patients were classified into 02 groups, youngers patients in group 1 = G1 (&lt;60 years of age; n = 70) and an elderly patients group = G2 (&gt;/=60 years of age; n = 37). The mean age = 52.72 years [42.27-63.16], male 64.5% against 35.5% of women, a sex ratio = 2/1 in favor of men. In G1, mean age X1= 45.6 years. In G 2, mean age X2 = 61.85 years. The average delays for surgery = 11.28 months [6-18.19]. In G1 it was 10.30 months and 16.34 months in G2. The pre operatory JOA score (JOA PREO) = 9.87 +/- 2.033. JOA PREO score was 11 and 7 respectively in G1 and G2. The prevalence of MODIC (MC) = 52.23% and type 2 of MC was predominant in both groups, with p&gt; 0.05. G1 patients underwent an ACDF in 82% and laminectomy in 18%. In G 2 laminectomy was performed in 50% and the anterior discectomy in 21.73%, corporectomy in 28.27%. After surgery, JOA score passed to severe to moderate 13.48 and 13.27 after 1year of follow-up in G1 and G2. In conclusion those factors such as sex, number of discs involved, and Cobbs angle on prognosis were not statistically significant (P&gt;0.05) but patient’s age and duration of symptoms &lt; 1 year predict to have more neurologic improvement (P&lt;0.05) according to the JOA score.

Prognostic Indices of Surgical Outcome in Cervical Spondylotic Myelopathy: A Clinical Prospective Study

BACKGROUND: One of the most common causes of spinal cord dysfunction is cervical spondylotic myelopathy (CSM) especially in the elderly. Prognostic indices can aid the surgeon preoperatively to detect the patients’ prognosis. AIM: The aim of the work is to better assess patients and to find possible indicators for post-operative improvement or deterioration in CSM patients. METHODS: Forty patients with multiple levels CSM, admitted and operated on in the Neurosurgery Department of Cairo University Hospitals, have been enrolled randomly in this study after fulfilling the criteria for CSM surgical intervention. The patient age, complaint duration, number of levels affected, signal intensity on T1-weighted and T2-weighted magnetic resonance (MR) images, Japan Orthopedic Association (JOA) scoring system, and Nurick’s score were evaluated before surgery and correlated with outcome after 1 year follow-up. RESULTS: About 80% of patients improved after operation with average pre- and post-operative JOA and Nurick scores about 11.23 and 3.12; 14.1 and 1.6, respectively. Patient age, sex, number of levels affected, and signal intensity on T1- weighted and T2-weighted MR images were not significantly associated with post-operative improvement, p &gt; 0.05. However, the only significant prognostic factor was the duration of symptoms if less than 1 year with p &lt; 0.05. CONCLUSION: Short complaint duration coupled with close intra-operative monitoring was directly correlated with good CMS operation outcome while age, sex, number of levels affected, presence of cord signal on MR imaging, and surgical approach appear to have no significant effect on outcome.

Clinical Implications of the Epidural Fat Thickness in the Management of Lumbar Spinal Stenosis

Lumbar epidural lipomatosis is a rare condition defined as the excessive accumulation of epidural fat (EF). We herein investigated the indicators of the posterior compression factors, EF and yellow ligament, to identify the clinical features of lumbar epidural lipomatosis. Five hundred consecutive patients who underwent posterior lumbar decompression surgery for lumbar spinal stenosis (LSS) were retrospectively reviewed. The EF/SC-L index (the ratio of the anteroposterior length of the EF to that of the spinal canal [SC]) was evaluated at the spinal level that exhibited maximum dural tube compression. The participants were divided into 3 groups: grade I, EF/SC-L index ≤50%; grade II, EF/SC-L index 51%-74%; grade III, EF/SC-L index ≥75%. EF/SC-A (the ratio of the cross-sectional area of EF to that of SC) and YL/SC-A (the ratio of the cross-sectional area of yellow ligament [YL] to that of SC) were calculated. The clinical outcomes were assessed according to the Japan Orthopaedic Association scale for lumbar disease. EF/SC-L exhibited a significantly positive correlation with EF/SC-A (r= 0.82, P < 0.001), and a negative correlation with YL/SC-A (r=-0.71, P < 0.001). The Japan Orthopaedic Association score recovery rate was 56.7 ± 22.6 in the case-matched control group, 34.5 ± 31.2 in the grade II group (P < 0.001), and 39.6 ± 24.9 in the grade III group (P=0.032). The EF/SC-L index is a simple and reliable indicator to quantitatively evaluate posterior compression in patients with LSS. As the accumulation ofEF is associated with worse operative outcomes, the EF/SC-L index should be considered when planning lumbar decompression surgery for patients with LSS.

Analysis of compliance and efficacy of integrated management of whole process in the choice of percutaneous full-endoscopic surgery for patients with cervical disc herniation

BackgroundPercutaneous spinal endoscopy is a new type of surgery for the treatment of cervical disc herniation. It can avoid the complications of the classic anterior cervical discectomy and fusion (ACDF) approach and the risk of adjacent spondylosis. How can we effectively improve patients’ awareness of spinal endoscopy and their election of endoscopic techniques?ObjectiveTo analyze the compliance and clinical effect of the integrated management of the whole process in the choice of percutaneous full-endoscopic surgery for patients with cervical disc herniation.MethodsRetrospective analysis of 72 patients with cervical disc herniation undergoing surgery in our hospital from August 2015–August 2017 was performed. The whole-process integrated management model was used for all the patients. The 36 patients in the experimental group were treated by percutaneous full-endoscopic cervical discectomy, and the 36 patients in the control group were treated by ACDF. The postoperative feeding time, time to get out of bed, length of hospital stay, compliance, clinical efficacy, and recurrence rate of neck pain were observed. Changes between the preoperative and postoperative pain visual analog scale (VAS) scores and neurological function Japan Orthopaedic Association (JOA) scores were assessed.ResultsThe postoperative feeding time in the experimental group was 8.319 ± 1.374 h, the postoperative time to get out of bed was 16.64 ± 3.728 h, and the hospitalization time was 6.403 ± 0.735 days. The excellent and good clinical efficacy rate was 91.67%, the compliance rate was 88.89%, and the neck pain recurrence rate was 5.56%. The postoperative feeding time in the control group was 26.56 ± 9.512 h, the postoperative time to get out of bed was 45.06 ± 9.027 h, and the length of hospital stay was 8.208 ± 0.865 days. The excellent and good clinical efficacy rate was 88.89%, the compliance rate was 69.4%, and the neck pain recurrence rate was 8.33%. There was no significant difference between the two groups in the excellent efficacy rate and the neck pain recurrence rate, p > 0.05. The compliance rate in the experimental group was better than that in the control group, and the difference was statistically significant, p < 0.05. The hospitalization time of the experimental group was significantly lower than that of the control group, and the difference was statistically significant, p < 0.05. The postoperative VAS scores and JOA scores of the two groups were significantly better than the preoperative scores, and the difference was statistically significant, p < 0.05; there was no significant difference between the two groups, p > 0.05.ConclusionThe integrated management of the whole course can effectively improve the compliance of patients with cervical disc herniation receiving endoscopic treatment, yield the same treatment effect as the classic operation, shorten the hospitalization time, speed up the turnover of hospital beds, and improve satisfaction with medical quality and is worthy of clinical application.

Incidence of Cranial Adjacent Segment Disease after Posterior Lumbar Interbody Fusion Using the Cortical Bone Trajectory Technique for the Treatment of Single-Level Degenerative Lumbar Spondylolisthesis; More than a 2-Year Follow-Up

Introduction Posterior lumbar interbody fusion (PLIF) is a widely used effective, safe, and established treatment for degenerative spinal disorders. Adjacent segment disease (ASD) is one of the serious concerns governing the clinical results following spinal fusion surgery. Cortical bone trajectory (CBT) is an alternative and less-invasive technique for lumbar pedicle screw placement. Its unique medial and caudal entry point has the potential to prevent an iatrogenic facet joint violence leading to the ASD; however, the incidence of ASD following PLIF using the CBT technique (CBT-PLIF) remains unknown. Methods Among patients surgically treated with CBT-PLIF in our institute, 52 consecutive patients (13 males, 39 females) with single-level degenerative lumbar spondylolisthesis (DLS) who were followed up for at least 24 months were exclusively enrolled. Their clinical and radiological features, including the incidence of radiographical and symptomatic ASD and significantly associated factor for the developing radiographical ASD, were retrospectively measured. Results In the present study, we could confirm significant neurological improvement and reduction of the spondylolisthesis with mean follow-up period of 43 months. Radiographical and symptomatic ASD was observed in 14 (27%) and 2 (3.8%) cases, respectively. We compared these two groups and found that the latest lumbar lordosis was significantly different between the two groups, but not in age, body mass index, and Japan Orthopaedic Association score. Two patients with symptomatic ASD required additional surgical treatment around 1 year following the initial surgery. Conclusions The present study, even though it is preliminary, revealed that CBT-PLIF can achieve a neurological improvement and an effective reduction of spondylolisthesis for the treatment of single-level DLS. The CBT technique is capable of reducing the incidence of ASD compared with the traditional technique; however, we must keep in mind that appropriate postoperative lumbar lordosis should be achieved. Larger, longer-term follow-up studies are required to elucidate the clinical output of CBT-PLIF.

Acupotomy Treatment for Lumbar Disc Herniation

Background: The aim of this study was to examine whether the effects of acupotomy therapy were beneficial for the treatment of protrusion of lumbar intervertebral disc.&lt;br/&gt;Methods: The number of patients (n = 80) were equally assigned into treatment group and control group. Treatment group was given acupotomy therapy twice a week, and control group was given acupuncture 3 times a week, for 4 weeks. The beneficial effect and changes in score of the Japan Orthopedic Association (JOA) for low back pain were observed.&lt;br/&gt;Results: Among 40 cases in the treatment group, there were 25 (62.5%) with an excellent effect, 13 (32.5%) with good effect, 1 (2.5%) with a medium effect and 1 (2.5%) with poor effect, with the total experiencing an excellent/good effect of 95.0%. Among 40 cases in the control group, there were 11 (27.5%) with an excellent effect, 17 (42.5%) with good effect, 10 (25.0%) with a medium effect, and 2 (5.0%) with poor effect, with an excellent/good rate of 70.0%. The result of the rank sum test showed Z = -4.923, p &lt; 0.05 in the comparison, indicating a significantly better outcome following acupotomy compared with acupuncture. JOA scores increased in both groups after treatment (p &lt; 0.05), which was more significant in the acupotomy treatment group (p &lt; 0.05).&lt;br/&gt;Conclusion: Acupotomy therapy has a beneficial effect on protrusion of lumbar intervertebral disc.