Japanese Orthopaedic Association Recovery Rate Research Articles

Effects of Preoperative Cervical Range of Motion on Clinical Outcomes Following Posterior Decompression: A Multicenter Study of Patients With Cervical Ossification of the Posterior Longitudinal Ligament

Study Design Retrospective multicenter study. Objectives To investigate the impact of preoperative cervical range of motion (ROM) on clinical outcomes after posterior decompression for cervical ossification of the posterior longitudinal ligament (OPLL). Methods We analyzed data from 156 patients with cervical OPLL who underwent posterior decompression and were followed for at least 2 years. Patients were divided into two groups based on preoperative gap ROM, which was a novel indicator representing the difference between flexion and extension ROM: the gROM <0° and >0° groups, and their outcomes were compared. Results There were no significant differences in patient demographics or surgical details between the gROM <0° and >0° groups. The gROM <0° group exhibited less lordosis in C2-7 angles before and after surgery compared to the gROM >0° group. Cervical ROM significantly decreased following posterior decompression regardless of whether preoperative gROM was <0° or >0°. Meanwhile, the incidence of perioperative complications was similar between the two groups. Furthermore, both groups showed significant improvement in Japanese Orthopaedic Association (JOA) scores postoperatively; however, there were no significant group differences in JOA scores, recovery rates, or visual analog scale for neck pain between the two groups at the preoperation and final follow-up. Conclusions The incidence of perioperative complications and postoperative clinical outcomes were comparable regardless of the magnitude of preoperative cervical gROM. Although cervical ROM decrease postoperatively, posterior decompression for cervical OPLL can offer favorable clinical outcomes irrespective of the preoperative cervical ROM magnitude, consequently.

A More Efficient and Safer Improved Percutaneous Pedicle Screw Insertion Technique-Trajectory DynamicAdjustment Technique, Technical Note, and Clinical Efficacy.

Percutaneous pedicle screw fixation (PPSF) technique requires a very precise entry point of the Jamshidi needle, which leads to repeated adjustments, damaging the pedicle and increasing radiation exposure. This study was designed to propose an improved percutaneous pedicle screw fixation technique-trajectory dynamic adjustment (TDA) technique, and evaluate its feasibility and assess the clinical outcomes. A total of 445 patients with lumbar spondylolisthesis or lumbar spinal stenosis associated with instability from June 2017 to May 2022 were included in the retrospective study. They were randomly separated into two groups. Two hundred thirty-one patients underwent TDA technique (TDA group). Two hundred fourteen patients underwent traditional PPSF technique (PPSF group). All patients underwent postoperative CT to assess the accuracy of screw placement, superior facet joint violation (FJV). The evaluated clinical outcomes were needle insertion time, radiation exposure, blood loss, hospital stay, the Japanese Orthopedic Association (JOA) score, the Visual Analogue Scale (VAS) scores for lower back pain (LBP), and leg pain, lumbar interbody fusion rate, and postoperative complications. The independent-sample t test and paired t-test were used for continuous data. The contingency table and Mann-Whitney U test were used for categorical data. The time of the insertion in TDA group was significantly lower than that in PPSF group (p < 0.05). Similarly, the fluoroscopy frequency in TDA group was significantly lower than that in PPSF group (p < 0.05). There was no difference in intraoperative blood loss and hospital stay between the two groups (p > 0.05). Overall, there was no significant difference in the proportion of clinically acceptable screws between the two groups (p > 0.05). In addition, the lateral screw misplacement in TDA group was higher. Moreover, FJV rate was significantly lower than that in PPSF group (p < 0.05). In both TDA group and PPSF group, postoperative back and leg pain and the JOA score were significantly improved (p < 0.05). However, there were no significant differences in the pre- and postoperative VAS score for back and leg pain and the JOA score, JOA recovery rate, intervertebral fusion rate, and complications rate between the two groups (p > 0.05). Compared to traditional PPSF technique, TDA technique is a safer and more effective procedure which has shorter surgical time, lower radiation exposure, and lower facet joint violation rate.

K-Line Tilt May Influence the Short-Term Surgical Outcomes After Laminoplasty in Patients With Degenerative Cervical Myelopathy.

A retrospective study. To explore the relationship between K-line tilt and short-term surgical outcomes following laminoplasty in patients with multilevel degenerative cervical myelopathy (DCM), and to evaluate the potential of K-line tilt as a reliable preoperative predictor. A retrospective analysis was performed for 125 consecutive patients who underwent laminoplasty for multilevel DCM. The radiographic parameters utilized in this study encompassed T1 slope (T1S), C2-C7 lordosis (CL), C2-C7 sagittal vertical axis (cSVA), T1 slope minus C2-C7 lordosis (T1S-CL), C2-C7 range of motion (ROM), and K-line tilt. The neurological recovery was evaluated using the Japanese Orthopaedic Association (JOA) score. Pearson correlation coefficients were calculated to assess the relationship between K-line tilt and other classical cervical parameters. Logistic regression analysis was employed to examine the association between K-line tilt and surgical outcomes. Of the 125 patients, 89 were men. The mean age of the patients was 61.74 ± 11.31 years. The results indicated a correlation between the K-line tilt and the cSVA (r = 0.628, P < 0.001), T1S (r = 0.259, P = 0.004), and T1S-CL (r = 0.307, P < 0.001). The K-line tilt showed an association with the failure of the JOA recovery rate (RR) to reach the minimal clinically important difference (MCID) and the occurrence of postoperative kyphotic deformity. We identified cutoff values for the K-line tilt which predict the failure of the JOA RR to reach the MCID and postoperative kyphotic deformity as 10.13° and 9.93°, respectively. The K-line tilt is an independent preoperative risk factor associated with both the failure of the JOA RR to reach the MCID and the occurrence of postoperative kyphotic deformity in patients with multilevel DCM after laminoplasty.

Anterior decompression and posterior total laminectomy with fusion for ossification of the cervical posterior longitudinal ligament.

Surgical approaches to cervical ossification of the posterior longitudinal ligament (OPLL) remain controversial. The purpose of the present study was to analyze and compare the long-term neurological recovery following anterior decompression with fusion (ADF) and posterior laminectomy and fusion with bone graft and internal fixation (PLF) based on > ten-year follow-up outcomes in a single centre. Included in this retrospective cohort study were 48 patients (12 females; mean age 55.79 years (SD 8.94)) who were diagnosed with cervical OPLL, received treatment in our centre, and were followed up for 10.22 to 15.25 years. Of them, 24 patients (six females; mean age 52.88 years (SD 8.79)) received ADF, and the other 24 patients (five females; mean age 56.25 years (SD 9.44)) received PLF. Clinical data including age, sex, and the OPLL canal-occupying ratio were analyzed and compared. The primary outcome was Japanese Orthopaedic Association (JOA) score, and the secondary outcome was visual analogue scale neck pain. Compared with the baseline, neurological function improved significantly after surgery in all patients of both groups (p < 0.001). The JOA recovery rate in the ADF group was significantly higher than that in the PLF group (p < 0.001). There was no significant difference in postoperative cervical pain between the two groups (p = 0.387). The operating time was longer and intraoperative blood loss was greater in the PLF group than the ADF group. More complications were observed in the ADF group than in the PLF group, although the difference was not statistically significant. Long-term neurological function improved significantly after surgery in both groups, with the improvement more pronounced in the ADF group. There was no significant difference in postoperative neck pain between the two groups. The operating time was shorter and intraoperative blood loss was lower in the ADF group; however, the incidence of perioperative complications was higher.

Impact of congenital spinal stenosis on the outcome of three-level anterior cervical discectomy and fusion in patients with cervical spondylotic myelopathy: a retrospective study.

To investigate whether congenital cervical spinal stenosis (CCSS) affects the outcome of three-level anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylotic myelopathy (CSM). One hundred seventeen patients with CSM who underwent three-level ACDF between January 2019 and January 2023 were retrospectively examined. Patients were grouped according to presence of CCSS, which was defined as Pavlov ratio ≤ 0.75. The CCSS and no CCSS groups comprised 68 (58.1%) and 49 (41.9%) patients, respectively. The Japanese Orthopaedic Association (JOA) score did not significantly differ between the two groups at any postoperative time point (p > 0.05). The JOA improvement rate was lower in the CCSS group 1 month after surgery (41.7% vs. 45.5%, p < 0.05), but showed no difference at any follow-up time point after one month. Multivariate logistic regression identified preoperative age (OR = 10.639), JOA score (OR = 0.370), increased signal intensity (ISI) in the spinal cord on T2-weighted MRI (T2-WI) (Grade 1: OR = 6.135; Grade 2: OR = 29.892), and degree of spinal cord compression (30-60%: OR = 17.919; ≥60%: OR = 46.624) as independent predictors of a poor oneyear outcome (JOA recovery rate < 50%). Although early JOA improvement is slower in the CCSS group, it does not affect the final neurological improvement at 1 year. Therefore, CCSS should not be considered a contraindication for three-level ACDF in patients with CSM. The main factors influencing oneyear outcome were preoperative age, JOA score, ISI grade, and degree of spinal cord compression.

Machine-learning-based prediction by stacking ensemble strategy for surgical outcomes in patients with degenerative cervical myelopathy

BackgroundMachine learning (ML) is extensively employed for forecasting the outcome of various illnesses. The objective of the study was to develop ML based classifiers using a stacking ensemble strategy to predict the Japanese Orthopedic Association (JOA) recovery rate for patients with degenerative cervical myelopathy (DCM).MethodsA total of 672 patients with DCM were included in the study and labeled with JOA recovery rate by 1-year follow-up. All data were collected during 2012–2023 and were randomly divided into training and testing (8:2) sub-datasets. A total of 91 initial ML classifiers were developed, and the top 3 initial classifiers with the best performance were further stacked into an ensemble classifier with a supported vector machine (SVM) classifier. The area under the curve (AUC) was the main indicator to assess the prediction performance of all classifiers. The primary predicted outcome was the JOA recovery rate.ResultsBy applying an ensemble learning strategy (e.g., stacking), the accuracy of the ML classifier improved following combining three widely used ML models (e.g., RFE-SVM, EmbeddingLR-LR, and RFE-AdaBoost). Decision curve analysis showed the merits of the ensemble classifiers, as the curves of the top 3 initial classifiers varied a lot in predicting JOA recovery rate in DCM patients.ConclusionsThe ensemble classifiers successfully predict the JOA recovery rate in DCM patients, which showed a high potential for assisting physicians in managing DCM patients and making full use of medical resources.

Does Spinal Cord-Canal Mismatch Adversely Affect the Clinical Outcomes of Anterior Cervical Discectomy and Fusion for the Treatment of Cervical Myelopathy?

Retrospective cohort study. To clarify whether clinical outcomes of anterior cervical discectomy and fusion (ACDF), is affected by presence of spinal canal-cord mismatch (SCCM). SCCM is considered a factor that would moderately influence surgeons to perform posterior surgery since it could widen the spinal canal, while an anterior approach could only remove degenerative pathologies grown into the spinal canal. We retrospectively reviewed 186 patients who underwent ACDF and had been followed-up for >2 years. Patients with spinal cord occupation ratio (SCOR) of ≥0.7 were classified into the SCCM group, while those with a SCOR of <0.7 were included in the no-SCCM group. Patient demographics, cervical sagittal parameters, neck pain visual analog scale (VAS), arm pain VAS, and Japanese Orthopedic Association (JOA) score were assessed. JOA score was the primary outcome of the study. One-hundred and forty-seven patients (79.0%) were included into the no-SCCM group, while 39 patients (21.0%) were classified into the SCCM group. Postoperative radiographic parameters including C2-C7 lordosis, C2-C7 sagittal vertical axis, and range of motion did not significantly differ between the two groups. Neck pain VAS, arm pain VAS, and JOA score (no-SCCM group, from 13.7±2.5 to 14.6±2.3, P<0.001; SCCM group, from 13.8±1.6 to 15.0±2.0, P<0.001) significantly improved after the operation in both groups, and results were not significantly different between the two groups. Furthermore, SCOR was not significantly associated with JOA recovery rate at 2 years postoperatively in linear regression analysis. Clinical and radiographic outcomes of ACDF were not affected by the presence of SCCM. Furthermore, SCOR was not significantly associated with neurologic recovery at 2 years of follow-up. Therefore, ACDF can be safely and effectively applied for treating cervical myelopathy, regardless of the presence of SCCM, when other factors favor the anterior approach. 3.

Changes in Intramedullary Increased Signal Intensity on Axial T2-weighted MRI After Laminoplasty for Cervical Spondylotic Myelopathy: A 10-year Follow-up Study.

A retrospective study. To investigate whether the preoperative classification and changes in the intramedullary increased signal intensity (ISI) on axial T2-weighted magnetic resonance imaging (MRI) reflect the postoperative functional outcome in patients after laminoplasty for cervical spondylotic myelopathy (CSM). Although patients with CSM exhibit ISI on axial MRI, the association between ISI (preoperative classification and changes) and surgical outcomes has not been investigated. We retrospectively included patients with CSM who underwent MRI preoperatively and at least 10 years postoperatively after laminoplasty between January 2009 and December 2010. According to axial images for the cervical compressive myelopathy (Ax-CCM) system, the ISI on axial images was classified as follows: type 0, normal; type 1, diffuse; type 2, fuzzy focal; and type 3, discrete focal. Functional outcomes, as measured by the Japanese Orthopaedic Association (JOA) score and JOA recovery rate, were evaluated based on the Ax-CCM classification. Forty-three patients were enrolled. The mean follow-up time was 11.0±1.0 years. At the final follow-up, postoperative changes in the type of ISI were observed in 62.8% of patients. The type of ISI improved in 5 patients (11.6%), remained unchanged in 16 patients (37.2%), and worsened in 22 patients (51.2%). Patients with preoperative type 2 ISI had worse postoperative JOA scores and JOA recovery rates than those with other types. A worse ISI type was related to a lower postoperative JOA score and a lower recovery rate at the final follow-up. Type 2 ISI was associated with poor postoperative symptoms and low postoperative function improvement. ISI changed after laminoplasty in 27 patients (62.8%), and worsened ISI was related to poor surgical outcomes.

Long-Term Outcomes of One-Stage Combined Posteroanterior Procedure and Laminoplasty-Alone for Multilevel Degenerative Cervical Myelopathy With Concomitant Anterior and Posterior Compression: A Propensity Score Matching Analysis of 8-year Follow-Up.

Retrospective cohort study. This study aimed to investigate the long-term outcomes of laminoplasty-alone (LP) and combined procedure (CP), consisting of laminoplasty and single-level anterior cervical discectomy and fusion, in comparable patients who had multilevel degenerative cervical myelopathy (MDCM) with concomitant anterior and posterior compression (CAPC). Consecutive MDCM patients with CAPC underwent LP or CP between 2012 and 2015 from a same surgical group were enrolled and followed up for a minimum of 8years. Preoperative demographic, radiological, and clinical variables were collected. Propensity score matching (PSM) analysis was performed to match patients with comparable conditions. The outcomes were evaluated by postoperative Japanese Orthopedic Association (JOA) score improvement, JOA recovery rate (JOARR) and complications. A total of 230 patients were included, of whom 146 underwent LP and 84 underwent CP. After PSM, 84 pairs of comparable patients were matched. The matched groups presented fair comparability in preoperative conditions. The CP group had significantly prolonged surgery time and greater blood loss. At the final follow-up, the postoperative JOA scores of LP and CP groups were 14.51 ± 1.79 and 15.47 ± 1.81 (P < 0.001) and the JOARR were 42.5% ± 53.3% and 68.5% ± 35.4%, respectively (P < 0.001). Three (3.6%) patients in the LP group underwent reoperations because of recurrent symptoms (P = 0.081). Both LP and CP demonstrated considerable long-term neurological recovery in patients with CAPC. The CP showed a significantly higher JOA improvement and JOARR. The combined decompression might be a safe and effective alternative in treating MDCM with CAPC in experienced hands.

Risk factors for poor neurological recovery after anterior cervical discectomy and fusion: imaging characteristics

BackgroundPoor neurological recovery in patients after anterior cervical discectomy and fusion has been frequently reported; however, no study has analyzed the preoperative imaging characteristics of patients to investigate the factors affecting surgical prognosis. The purpose of this study was to investigate the factors that affect the preoperative imaging characteristics of patients and their influence on poor neurologic recovery after anterior cervical discectomy and fusion.MethodsWe retrospectively analyzed the clinical data of 89 patients who met the criteria for anterior cervical discectomy and fusion for the treatment of single-level cervical spondylotic myelopathy and evaluated the patients’ neurological recovery based on the recovery rate of the Japanese Orthopaedic Association (JOA) scores at the time of the final follow-up visit. Patients were categorized into the “good” and “poor” groups based on the JOA recovery rates of ≥ 50% and < 50%, respectively. Clinical information (age, gender, body mass index, duration of symptoms, preoperative JOA score, and JOA score at the final follow-up) and imaging characteristics (cervical kyphosis, cervical instability, ossification of the posterior longitudinal ligament (OPLL), calcification of herniated intervertebral discs, increased signal intensity (ISI) of the spinal cord on T2-weighted imaging (T2WI), and degree of degeneration of the discs adjacent to the fused levels (cranial and caudal) were collected from the patients. Univariate and binary logistic regression analyses were performed to identify risk factors for poor neurologic recovery.ResultsThe mean age of the patients was 52.56 ± 11.18 years, and the mean follow-up was 26.89 ± 11.14 months. Twenty patients (22.5%) had poor neurological recovery. Univariate analysis showed that significant predictors of poor neurological recovery were age (p = 0.019), concomitant OPLL (p = 0.019), concomitant calcification of herniated intervertebral discs (p = 0.019), ISI of the spinal cord on T2WI (p <0.05), a high grade of degeneration of the discs of the cranial neighboring levels (p <0.05), and a high grade of discs of the caudal neighboring levels (p <0.05). Binary logistic regression analysis showed that ISI of the spinal cord on T2WI (p = 0.001 OR = 24.947) and high degree of degeneration of adjacent discs on the cranial side (p = 0.040 OR = 6.260) were independent risk factors for poor neurological prognosis.ConclusionISI of the spinal cord on T2WI and high degree of cranial adjacent disc degeneration are independent risk factors for poor neurological recovery after anterior cervical discectomy and fusion. A comprehensive analysis of the patients’ preoperative imaging characteristics can help in the development of surgical protocols and the management of patients’ surgical expectations.

Clinical and Radiological Outcomes in C2 Recapping Laminoplasty for the Pathologies in the Upper Cervical Spine.

To evaluate C2 muscle preservation effect and the radiological and clinical outcomes after C2 recapping laminoplasty. Fourteen consecutive patients who underwent C2 recapping laminoplasty around C1-2 level were enrolled. To evaluate muscle preservation effect, the authors conducted a morphological measurement of extensor muscles between the operated and nonoperated side. Two surgeons measured the cross-sectional area (CSA) of obliquus capitis inferior (OCI) and semispinalis cervicis (SSC) muscle before and after surgery to determine atrophy rates (ARs). Additionally, we examined range of motion (ROM), sagittal vertical axis (SVA), neck visual analogue scale (VAS), Neck Disability Index (NDI), and Japanese Orthopaedic Association (JOA) score to assess potential changes in alignment and consequent clinical outcomes following posterior cervical surgery. We measured the CSA of OCI and SSC before surgery, and at 6 and 12 months postoperatively. Based on these measurements, the AR of the nonoperated SSC was 0.1% ± 8.5%, the AR of the operated OCI was 2.0% ± 7.2%, and the AR of the nonoperated OCI was -0.7% ± 5.1% at the 12 months after surgery. However, the AR of the operated side's SSC was 11.2% ± 12.5%, which is a relatively higher value than other measurements. Despite the atrophic change of SSC on the operated side, there were no prominent changes observed in SVA, C0-2 ROM, and C2-7 ROM between preoperative and 12 months postoperative measurements, which were 11.8 ± 10.9 mm, 16.3° ± 5.9°, and 48.7° ± 7.7° preoperatively, and 14.1 ± 11.6 mm, 16.1° ± 7.2°, and 44.0° ± 10.3° at 12 months postoperative, respectively. Improvement was also noted in VAS, NDI, and JOA scores after surgery with JOA recovery rate of 77.3% ± 29.6%. C2 recapping laminoplasty could be a useful tool for addressing pathologies around the upper cervical spine, potentially mitigating muscle atrophy and reducing postoperative neck pain, while maintaining sagittal alignment and ROM.

The preservation of cervical flexibility helps maintain cervical sagittal alignment after laminoplasty

BACKGROUND CONTEXTCervical spine range of motion (ROM) is a critical factor in changes in cervical sagittal alignment (CSA) and clinical outcomes after cervical laminoplasty (LMP). However, the impact of postoperative cervical ROM on CSA after cervical LMP is still unclear. PURPOSEEvaluating the imaging and symptomatic data from patients with cervical spondylotic myelopathy (CSM) to identify the influence of postoperative cervical ROM on post-LMP CSA and surgical outcomes. STUDY DESIGNRetrospective study. PATIENT SAMPLEEighty-six patients undergoing LMP due to multilevel CSM OUTCOME MEASURESRadiographic parameters were measured before surgery and at follow-up: cervical lordosis (CL), T1 slope (T1S), cervical sagittal vertical axis (cSVA), CL in flexion (Flex CL), CL in extension (Ext CL), total cervical spine range of motion (ROM), cervical spine range of flexion (Flex ROM), and cervical spine range of extension (Ext ROM). Japanese Orthopedic Association (JOA) and visual analog score (VAS) were used to assessed clinical outcomes. Other parameters included age, gender, body mass index (BMI), follow-up time, number of surgical segments, proximal level, distalis level, and collar wear time. METHODSWe divided patients according to the changes in CSA (loss of cervical lordosis (LCL)>10°, or ≤10°; an increase in cervical sagittal vertical axis (I-cSVA) >10mm, or ≤10mm). A receiver-operating characteristic curve (ROC) analysis was constructed to identify the optimal cut-off value to discriminate the patients with and without postoperative deterioration of CSA. RESULTSThe postoperative total and Flex ROM were significantly lower in the LCL>10° and I-cSVA>10mm groups. Multivariate logistic regression analysis showed that low post-Flex ROM was significant risk factor for postoperative deterioration of CSA. ROC showed that the cut-off value for postoperative Flex ROM was 15.60°. Improvements in JOA recovery rate and neck pain were more significant in the flexibility group (post-Flex ROM ≥15.6°) after surgery. Patients in the stiffness group (post-Flex ROM <15.6°) wore a collar longer. CONCLUSIONSThe preservation of cervical flexibility can maintain CSA after cervical LMP. Postoperative cervical stiffness is related to poor surgical outcomes because significant cervical kyphotic change and sagittal imbalance are likely to occur after surgery. Prolonged wearing of cervical collar is correlated with cervical stiffness following cervical LMP.

Evaluation of the Bone Union Occurring Subsequent to C1-2 Fusion Combined With C1 Laminectomy for the Surgical Treatment of Retro-Odontoid Pseudotumor.

Introduction Surgical treatments for retro-odontoid pseudotumors (ROPs) include C1 laminectomies and C1-2 and occipitocervical (OC) fusions. When a C1 laminectomy is combined with a C1-2 fusion, concerns arise regarding an increased risk of pseudarthrosis due to decreased bone grafting space. Extension of the fusion area to the OC region may be considered to ensure an adequate bone graft bed. However, this procedure is associated with a risk of complications. Thus, in this study, we investigated the bone fusion and clinical outcomes of C1-2 fusion combined with a C1 laminectomy. Methods Between January 2017 and December 2022, seven patients with ROPs who had undergone C1-2 fusion combined with a C1 laminectomy were included in the study. All patients were followed up for >1 year. Bone fusion was evaluated by computed tomography (CT) at one year postoperatively, while implant failure was assessed by radiography at the final follow-up. Clinical evaluations included preoperative and one-year postoperative Japanese Orthopaedic Association (JOA) scores and recovery rates. Results This study included five male and two female patients, with an average age of 71.9 years. The average follow-up duration was 3.3 years. The primary anchor choices included the C1 lateral mass screw and the C2 pedicle screw. In one case, the transarticular screw was utilized unilaterally, and in another case, a lamina screw was utilized unilaterally. One year postoperatively, CT revealed bone fusion in three of the seven patients. Fusion occurred at the lateral and median atlantoaxial joints in two cases and one case, respectively. Screw loosening was observed in one case. None of the patients required reoperations. The average JOA recovery rate was 34.6%. Conclusion This surgical technique is useful for stabilizing and decompressing the C1-2 region while preserving mobility at the OC joint. However, further long-term follow-up studies are required.

The CT Classification of Multilevel Cervical Ossification of the Posterior Longitudinal Ligament to Guide Hybrid Anterior Controllable Antedisplacement and Fusion vs. Posterior Laminoplasty.

For precise and minimally invasive treatment of ossification of the posterior longitudinal ligament of the cervical spine, the lifting segment is minimized, anterior controllable antedisplacement and fusion (ACAF) was refined and improved. In addition, the development of appropriate surgical procedures for the ossification of each segment was rarely reported. Therefore, this study aimed to compare the efficacy and safety of hybrid anterior controlled antedisplacement fusion (Hybrid ACAF) with laminoplasty for multilevel ossification of the posterior longitudinal ligament (OPLL). Between May 2018 and May 2021, 70 patients with multilevel OPLL were divided into a hybrid ACAF group and a laminoplasty group according to surgical methods. All patients were followed up for at least 1 year. Japanese Orthopaedic Association (JOA) score and recovery rate (JOARR), (VAS, NDI) score and C2-C7 Cobb angle, the sagittal vertical axis of the neck (SVA), and complications (cerebrospinal fluid leakage, C5 paralysis, etc.) were compared between the two groups by t test or non-parametric test. The operation time of hybrid ACAF was longer. C5 paralysis and axial pain were more common in the laminoplasty group, while dysphagia and hoarseness were more common in the hybrid ACAF group. At the last follow-up, the hybrid ACAF group had better recovery and maintenance of cervical lordosis and sagittal plane balance and a higher JOA score and recovery rate than the laminoplasty group. Hybrid ACAF can reduce the number of vertebral bodies and expand the decompression range, which is safe, effective, and tailored to local conditions. Compared with laminoplasty, hybrid ACAF is a precise alternative for patients with OPLL.

Change of cervical flexion range of motion influences postoperative sagittal alignment of the cervical spine after laminoplasty

ObjectiveThe relationships between preoperative cervical spine range of motion (ROM) and postoperative cervical sagittal alignment (CSA), and clinical outcomes after laminoplasty (LMP) have been widely studied. However, the impact of ROM changes on postoperative CSA and clinical outcomes after LMP remains unclear. Herein, patients with cervical spondylotic myelopathy (CSM) were retrospectively analyzed to explore the association between postoperative cervical ROM changes and CSA and surgical outcomes.MethodsPatients who underwent cervical LMP at our hospital between January 2019 to June 2022 were retrospectively reviewed. CSA parameters were measured before the surgery and at the final follow-up. Loss of cervical lordosis (LCL) was defined as preoperative cervical lordosis (CL) - postoperative CL. An increase in the cervical sagittal vertical axis (I-cSVA) was defined as postoperative cervical sagittal vertical axis (cSVA) - preoperative cSVA. We defined the changes in cervical flexion range of motion (△Flex ROM, preoperative Flex ROM minus postoperative Flex ROM) > 10° as L- Flex ROM group, and △Flex ROM ≤ 10° as S- Flex ROM group. Japanese Orthopedic Association (JOA) score and visual analog score (VAS) were used to assess the surgical outcomes.ResultsThe study comprised 74 patients and the average follow-up period was 31.83 months. CL, total ROM, and Flex ROM decreased and cSVA increased after cervical LMP. LCL and I-cSVA were positively correlated with △Flex. Multiple linear regression analysis showed that a decrease in the Flex ROM was a risk factor for LCL and I-cSVA after LMP. LCL and I-cSVA were higher in the L-Flex ROM group than in the S-Flex ROM group. Postoperative JOA and the JOA recovery rate were worse in the L-Flex ROM group than in the S-Flex ROM group.ConclusionsCervical total and Flex ROM decreased after cervical LMP. The reduction of Flex ROM was associated with LCL and I-cSVA after surgery. The preservation of cervical Flex ROM helps maintain CSA after LMP. Therefore, more attention should be paid to maintaining cervical ROM to obtain good CSA and surgical effects after cervical LMP.

Evaluating the Efficacy of Antibiotic Therapy in Non-responsive Sacroiliitis: A Comparative Study.

Sacroiliitis, characterized by inflammation of the sacroiliac joints, poses significant challenges in management, especially in patients unresponsive to standard therapies like non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy. This study aimed to evaluate the efficacy of antibiotic therapy in such patients, addressing a critical gap in the current treatment approach. A total of 360 patients with lower back pain who presented to the outpatient department (OPD) of the Department of Orthopedics of a medical college in Northern India for six months were included in this study. With meticulous history taking, clinical examination, and radiological evaluation, 59 patients were diagnosed with sacroiliitis, out of which 31 were males and 28 were females, aged between 20 and 40 years, and were enrolled in this cross-sectional comparative study.Patients were divided into two groups: a control group (21 patients) receiving conventional treatment without antibioticsand a study group (38 patients) receiving conventional treatment plus antibiotics (who gave consent for treatment with antibiotics). The primary outcome was assessed using the Japanese OrthopaedicAssociation (JOA) score, with evaluations conducted at baseline, one month, and three months. Recovery rates were also calculated. SPSS trial software version 27 (IBM Corp., Armonk, NY) was used for statistical analysis. Both groups exhibited improvement in JOA scores over time. At the one-month and three-month follow-ups, the mean JOA scores and recovery rates showed no statistically significant difference between the control and study groups (p-values > 0.05). Adverse effects related to antibiotic use were not significant. The study concludes that the addition of antibiotics to the conventional treatment regimen for sacroiliitis does not provide significant benefit in terms of functional recovery or pain relief in patients non-responsive to NSAIDs and/or physical therapy. These findings underscore the importance of a targeted treatment approach based on the specific etiology of sacroiliitis and caution against unnecessary antibiotic use.

Safety and efficacy of day anterior cervical discectomy and fusion procedure for degenerative cervical spondylosis: a retrospective analysis

ObjectiveOur study aimed to develop a day anterior cervical discectomy and fusion (ACDF) procedure to treat degenerative cervical spondylosis (DCS). The goal was to analyze its clinical implications, safety, and early effects to provide a better surgical option for eligible DCS patients.MethodsA retrospective analysis was performed to identify DCS patients who underwent day ACDF from September 2022 to August 2023. The operative time, intraoperative blood loss, postoperative drainage, preoperative and postoperative visual analog scale (VAS) scores, neck disability index (NDI) scores, Japanese Orthopedic Association (JOA) scores, JOA recovery rate (RR), incidence of dysphagia-related symptoms, 30-day hospital readmission rate, and incidence of other complications were recorded to evaluate early clinical outcomes. Radiography was performed to assess the location of the implants, neurological decompression, and cervical physiological curvature.ResultsAll 33 patients (23 women and 10 men) underwent successful surgery and experienced significant symptomatic and neurological improvements. Among them, 26 patients underwent one-segment ACDF, 5 underwent two-segment ACDF, and 2 underwent three-segment ACDF. The average operative time was 71.1 ± 20.2 min, intraoperative blood loss was 19.1 ± 6.2 mL, and postoperative drainage was 9.6 ± 5.8 mL. The preoperative VAS and NDI scores improved postoperatively (7.1 ± 1.2 vs. 3.1 ± 1.3 and 66.7% ± 4.8% vs. 24.1% ± 2.5%, respectively), with a significant difference (P < 0.01). Moreover, the preoperative JOA scores improved significantly postoperatively (7.7 ± 1.3 vs. 14.2 ± 1.4; P < 0.01) with an RR of 93.9% in good or excellent. Postoperative dysphagia-related symptoms occurred in one patient (3.0%). During the follow-up period, no patient was readmitted within 30 days after discharge; however, an incisional hematoma was reported in one patient on the 6th day after discharge, which was cured by pressure dressing. The postoperative radiographs revealed perfect implant positions and sufficient nerve decompression in all patients. Furthermore, the preoperative cervical physiological curvature improved significantly after the operation (14.5° ± 4.0° vs. 26.3° ± 5.4°; P < 0.01).ConclusionsDay ACDF has good safety and early clinical efficacy, and it could be an appropriate choice for eligible DCS patients.

Mid-Term Results of Single-Level Posterior Lumbar Interbody Fusion in Patients with Pelvic Incidence Minus Lumbar Lordosis Mismatch

BackgroundRecent literature suggests that sagittal imbalance is a risk factor for adjacent segment disease (ASD) following fusion surgery. This study explored the influence of pelvic incidence minus lumbar lordosis (PI-LL) mismatch on the mid-term results and reoperation rate after single-level posterior lumbar interbody fusion (PLIF). MethodsThe participants of this study included 253 patients (80 men and 173 women; mean age 68.2 years) who underwent L4-5 single-segment PLIF. Preoperative PI-LL mismatch was defined as a PI-LL of 30° or greater. The patients were divided into two groups according to the presence or absence of PI-LL mismatch (PI-LL mismatch group; group M, Control group; group C), and the clinical outcomes and radiographic parameters were compared. ResultsOf the 253 cases, 25 were classified in group M and 228 in group C. The Japanese Orthopaedic Association (JOA) score at five years postoperatively was 23.0±3.6 in group M and 23.5±5.1 in group C, and the recovery rate was 66.2±32.6% in group M and 64.6±21.4% in group C and there was no significant difference in the recovery rate between the two groups. All radiographic parameters except SS were significantly worse in group M. One patient (4.3%) in Group M and 18 patients (7.8%) in Group C required revision surgery at 2.4 years (range 0.0–5.0) and there was no significant difference in the revision rate between the two groups. ConclusionsThe mid-term results of L4-5 single-level PLIF were compared with and without PI-LL mismatch, with the threshold defined as 30°; however, there were no significant differences in both the JOA recovery and reoperation rates between the two groups.

Preoperative Cervical Range of Motion in Flexion as a Risk Factor for Postoperative Cervical Sagittal Imbalance After Laminoplasty.

Retrospective study. To investigate factors associated with cervical sagittal imbalance (CSI) after cervical laminoplasty (LMP). Preoperative dynamic cervical sagittal alignment is an important predictor for changes in cervical sagittal alignment and clinical outcomes after LMP. However, the impact of preoperative dynamic cervical sagittal alignment on postoperative changes in the cervical sagittal vertical axis (cSVA) after LMP remains unclear. We hypothesized that preoperative cervical flexion and extension function are associated with the changes in cSVA and clinical outcomes and found potential risk factors for post-LMP CSI. Patients undergoing LMP at a single institution between January 2019 and December 2021 were retrospectively reviewed. The average follow-up period was 19 months. The parameters were collected before the surgery and at the final follow-up. We defined the changes in cSVA (△cSVA) ≤ -10 mm as the improvement group, -10 mm < △cSVA ≤ 10 mm as the stable group, and △cSVA > 10 mm as the deterioration group. Multivariate logistic regression was used to evaluate factors associated with postoperative CSI. The χ 2 test was used to compare categorical data between groups. T tests, analysis of variance, Kruskal-Wallis tests, and Mann-Whitney Wilcoxon tests were used to assess the differences between radiographic and clinical parameters among groups. A receiver operating characteristic curve analysis was used to identify optimal cutoff values. The study comprised 102 patients with cervical spondylotic myelopathy. The Japanese Orthopedic Association recovery rate was better in the improvement group and a significant aggravation in neck pain was observed in the deterioration group after surgery. Cervical Flex range of motion (ROM; spine range of flexion) was significantly higher in the deterioration group. The multivariate logistic regression model suggested that greater Flex ROM and starting LMP at C3 were significant risk factors for postoperative deterioration of cervical sagittal balance. Receiver operating characteristic curves showed that the cutoff value for preoperative Flex ROM was 34.10°. Preoperative dynamic cervical sagittal alignment influences postoperative cervical sagittal balance after LMP. Cervical LMP should be carefully considered for patients with a preoperative high Flex ROM, as CSI is likely to occur after surgery. Level 3.

Favorable cervical extension capacity preventing loss of cervical lordosis after laminoplasty due to spontaneous restoration of initial lordosis

Background ContextCervical laminoplasty is a common approach for the treatment of multilevel cervical spondylotic myelopathy (CSM). Postoperative loss of cervical lordosis (LCL) was associated with lower extension motion of the cervical spine before laminoplasty. PurposeTo analyze the possible causes of preoperative cervical extension capacity affecting LCL after laminoplasty by evaluating the changes in cervical lordosis (CL) at different stages. Study Design/SettingRetrospective study. Patient SampleSeventy-two patients undergoing laminoplasty due to multilevel CSM. Outcome MeasuresRadiographic parameters included CL, extension CL (eCL), flexion CL (fCL), range of motion (ROM), extension ROM (eROM), flexion ROM (fROM) and LCL. Clinical outcomes were assessed using the Japanese Orthopedic Association (JOA) and neck disability index (NDI) score. MethodsThe data were recorded before surgery and at 3- and 24-month follow-up. All patients completed a cervical extension test preoperatively. A receiver operating characteristic (ROC) curve of eROM was constructed to discriminate the patients with and without postoperative kyphotic deformity. ResultsAccording to the optimal cut-off value of eROM, the patients were divided into two groups: extension group (eROM≥9.3°) and control group (eROM<9.3°). The radiographic outcomes demonstrated no significant differences in CL, eCL, fCL and ROM between the two groups. Both eROM and fROM were significantly different in the two groups. There was a significant change in CL in the extension group at 3-month follow-up and in the control group at 24-month follow-up. The extension group exhibited significantly lower LCL compared with the control group at follow-up. No significant difference between the two groups was noted in the JOA recovery rate, while the NDI score was significantly different at 24-month follow-up. The positivity ratio of the extension test was significantly greater in the extension group than that in the control group. ConclusionseROM in patients with favorable preoperative cervical extension capacity (eROM≥9.3°) consisted of the actual extension capacity and compensatory flexion. The cervical alignment would be spontaneously restored to its initial lordosis in the short term after laminoplasty. These patients had no substantial LCL at 24-month follow-up and would be good candidates for laminoplasty.