Japanese Orthopaedic Association Research Articles

Evaluating single-level vs. multi-level lateral lumbar interbody fusion: Clinical outcomes and complications.

Lateral Lumbar Interbody Fusion (LLIF) treats lumbar degenerative diseases (LDD) with spinal alignment and decompression advantages but can cause sensory and motor disturbances, especially in multilevel procedures. This study compares single-level and multi-level LLIF focusing on sensory and motor disturbances, surgical duration, and quality of life (QOL). A retrospective review of 139 patients (84 males, 55 females; average age 70years) with LDD who underwent LLIF and posterior fixation between May 2018 and January 2023 was conducted. Patients were divided into two groups: 89 patients who underwent single-level LLIF and 50 patients who underwent multi-level LLIF (two or more levels). Data on demographics, surgical details, perioperative complications, and clinical outcomes, including pain scores (Numeric Rating Scales: NRS) and QOL assessments (Japanese Orthopaedic Association Back Pain Evaluation Questionnaire: JOABPEQ), were collected preoperatively and one year postoperatively. Statistical analysis was performed to compare the outcomes between the two groups. Patients who underwent multi-level LLIF had significantly longer operative times (145.1min vs. 98.9min, p<0.001) and higher estimated blood loss (126.5mL vs. 62.9mL, p<0.001) compared with the single-level group. Both groups significantly improved pain intensity and QOL, including NRS and JOABPEQ score, with no significant differences in perioperative complication rates (cage subsidence, motor paralysis, thigh pain/numbness) or revision rates (4% vs. 8%, p=0.396). Short-term clinical outcomes suggested that both single-level and multi-level LLIF effectively improved pain and QOL outcomes in patients with LDD.

Preoperative cervical alignment parameters can predict postoperative disability scores and myelopathy outcomes.

This study aims to investigate the relationship between preoperative cervical spine alignment and changes in postoperative myelopathy after surgery in patients with cervical myelopathy who underwent anterior cervical corpectomy and fusion (ACCF) surgery as treatment. Patients who underwent anterior cervical corpectomy and fusion surgery for the treatment of cervical myelopathy were included in the study. We evaluated various cervical alignment parameters such as T1 sagittal angle, T1 slope, and C2-7 sagittal vertical axis (SVA) before surgery. Postoperative myelopathy outcomes were assessed using the Modified Japanese Orthopedic Association score (mJOA), Neck Disability Index (NDI), and Visual Analog Scale (VAS). Statistical analysis was performed using Pearson correlation coefficient and multiple linear regression to determine the relationship between preoperative radiological parameters and postoperative clinical outcomes. There were no significant differences in age, gender, or BMI between the single-level and multilevel corpectomy groups. Significant differences were observed in postoperative C2-7 Cobb angle, operative time, and blood loss. Patients with higher C2-7 SVA had worse operative outcomes. Preoperative cervical alignment measurements such as T1 slope and C2-7 SVA may be helpful in predicting myelopathy outcomes after ACCF surgery. Predicting the clinical outcomes of the patient after surgery is important for preparing postoperative care and adjusting treatment.

Motion Capture-based 3-Dimensional Measurement of Range of Motion in Patients Undergoing Cervical Laminoplasty.

A prospective study. To measure 3-dimensional cervical range of motion (ROM) by noninvasive optical tracking-based motion-capture technology in patients undergoing laminoplasty, and to elucidate the postoperative effects of laminoplasty on cervical mobility. Cervical laminoplasty is a motion-sparing decompression surgery for degenerative cervical myelopathy. Unlike cervical laminectomy and fusion, the true postoperative impact of laminoplasty on neck motion has not been well studied. Participants comprised 25 patients undergoing double-door cervical laminoplasty for degenerative cervical myelopathy in a single center. Maximum flexion/extension, left/right rotation, and left/right side bending were recorded using the motion-capture device preoperatively and 3 months postoperatively. ROMs in 3 orthogonal axes were calculated. Preoperative differences in C2-7 Cobb angles on lateral flexion/extension x-rays were also measured as the radiologic ROM to assess reliability. Preoperative and 1-year postoperative Japanese Orthopaedic Association score, Neck Disability Index [NDI], and Euro-QOL were recorded, and correlations with ROMs were assessed. Preoperative mean (±SD) ROMs for flexion/extension, rotation, and side bending were 90±17, 107±16, and 53±17 degrees, respectively. Although radiologic sagittal ROM measurement showed a smaller range than motion capture, averaging 36±13 degrees, a moderate to strong correlation between radiologic and motion capture values was observed (R=0.57, P =0.003). Preoperative NDI showed a negative correlation with coronal ROM (rho=-0.547, P =0.02). Postoperative ROM showed a significant reduction in rotation (95±16 degrees, P =0.002) but not in flexion/extension or side bending. Three-dimensional motion-capture analysis allowed reliable measurement of cervical ROM. Rotational ROM was significantly reduced after laminoplasty, showing that cervical kinematics are still significantly altered.

Perioperative Dysphagia Considerations for Patients With Severe Cervical Spondylotic Myelopathy.

Cohort study with consecutive cases. Dysphagia after anterior cervical spine surgery is a well-known complication. The aim of this study is to identify risk factors for dysphagia in patients with cervical myelopathy requiring surgery. We conducted a prospective analysis of 92 consecutive patients with cervical spondylotic myelopathy (CSM) who underwent anterior cervical spine surgery. All patients underwent a pre- and postoperative swallowing evaluation using the Eating Assessment Tool (EAT-10) and the Hyodo-Komagane (H‒K) score, an endoscopic scoring method used by an examining otolaryngologist to assess dysphagia. None of the patients had dysphagia when assessed using EAT-10; however, 15.2% of patients had H‒K scores indicative of dysphagia. Preoperative latent dysphagia was highly correlated with postoperative dysphagia (r = 0.51, P < 0.0001). No significant difference was found for the presence of dysphagia due to a history of smoking, dialysis, diabetes, asthma, and restrictive and/or obstructive ventilation disorder. The 10-s grip and release test (P < 0.0001) and the upper extremity function (P = 0.004) and bladder function (P = 0.0008) items from the Japanese Orthopaedic Association scores significantly correlated with H‒K scores. This study suggests that advanced age and severe preoperative upper limb and bladder dysfunction are risk factors for dysphagia in patients with cervical myelopathy requiring surgery.

Effect of intervertebral foramen area and width on postoperative pain relief in patients with cervical spondylotic radiculopathy

ObjectiveThis study aims to investigate the relationship between preoperative cervical intervertebral foramen width and area and the persistence of postoperative pain in patients diagnosed with cervical spondylotic radiculopathy (CSR).MethodsPatients were divided into two groups, based on their pain relief at the 6-month postoperative follow-up: the pain relief group and the persistent pain group. We compared various parameters, including age, sex, body mass index (BMI), duration of symptoms, preoperative Japanese Orthopedic Association (JOA) score, Neck Disability Index (NDI) score, postoperative ratio of disc space distraction, preoperative width of the intervertebral foramen (WIVF), and area of the intervertebral foramen (AIVF) between the two groups. Binomial logistic regression analysis was conducted to identify the factors affecting pain relief.ResultsSignificant differences were observed in preoperative WIVF, AIVF, duration of symptoms, preoperative NDI scores, and the ratio of disc space distraction between the two groups (all P < 0.05). Regression models indicated that symptom duration, preoperative NDI score and ratio of disc space distraction were negatively associated with pain relief, whereas preoperative WIVF and AIVF were positively associated with pain relief.ConclusionPreoperative WIVF and AIVF may be linked to persistent postoperative pain in patients with CSR.

Impact of Antiplatelet Medication Continuation on Surgical Outcomes after Minimally Invasive Posterior Lumbar Decompression Surgery: Retrospective Cohort Study.

Retrospective cohort study. Spinal surgeons face a dilemma regarding the continuation or discontinuation of antiplatelet agents during the perioperative period. Guidelines recommend considering the balance between thrombotic and bleeding risks. However, no consensus exists for the use of these agents for patients who undergo minimally invasive lumbar decompression. This study aimed to assess the effect of continued antiplatelet medication on minimally invasive posterior lumbar decompression surgery outcomes, focusing on perioperative outcomes and 1-year postoperative clinical results. This study included 106 patients who underwent minimally invasive posterior lumbar decompression between 2017 and 2022 and were taking antiplatelet medications before spinal surgery. Patient characteristics, antiplatelet medication type, and perioperative data were analyzed. Patients were divided into "continuation" and "discontinuation" groups based on preoperative antiplatelet medication status. Univariate and multivariate linear regression analyses were performed. No significant differences were observed between groups in terms of surgical time, intraoperative blood loss, postoperative drain volume, complication rates, and Japanese Orthopedic Association scores and EuroQoL-5 dimensions 5-level at 1 year postoperatively. Similar results were noted in groups focusing exclusively on patients treated with aspirin. Multivariate linear regression revealed that surgical time per level was significantly associated with total blood loss, whereas antiplatelet medications did not show a significant relationship (operative time per level, P < 0.01; antiplatelet drugs, P = 0.459). This study suggests that minimally invasive posterior lumbar spine decompression can be performed safely and effectively under continuous antiplatelet medication. Further studies with more evidence are required to validate our findings.

Proximal junctional disease 5 years after surgery for L4 degenerative spondylolisthesis: comparing PLIF versus minimally invasive decompression.

This study aimed to compare the incidence of radiological adjacent segment disease (R-ASD) at L3/4 between patients with L4/5 degenerative spondylolisthesis (DS) who underwent L4/5 posterior lumbar interbody fusion (PLIF) and those who underwent microscopic bilateral decompression via a unilateral approach (MBDU) at L4/5. Our ultimate goal was to distinguish the course of natural lumbar degeneration from fusion-related degeneration while eliminating L4/5 decompression as a confounder. Ninety patients with L4/5 DS who underwent L4/5 PLIF (n = 53) or MBDU (n = 37) and were followed for at least 5 years were retrospectively analyzed. Various radiographic parameters at L3/4 and L4/5 were measured before surgery and at last follow-up. Progression of facet degeneration was measured on computed tomography (Japanese Orthopaedic Association [JOA] classification); disc degeneration and spinal stenosis were measured on magnetic resonance imaging (Pfirrmann and Imagama classifications, respectively). R-ASD on plain radiography (X-ASD) was defined as reported by Okuda et al. [1]. R-ASD on CT or MRI (C/M-ASD) was defined as at least a one-grade progression in the relevant classification. JOA score for low back pain and incidence of reoperation were also evaluated. The mean parameters at L3/4 in the PLIF group were as follows (before surgery/at last follow-up): (1) % slip: 0.8%/1.9%, (2) change in slip: 0.7/0.4mm, (3) segmental lordosis: 11.9°/12.1°, (4) disc arc: 7.7°/7.5°, and (5) disc height: 8.6/7.7mm. Corresponding data in the MBDU group was: (1) % slip: 1.8%/2.4%, (2) change in slip: 0.6/0.5mm, (3) segmental lordosis: 9.6°/10.8°, (4) disc arc: 7.7°/8.7°, and (5) disc height: 7.8/6.5mm. Disc height at last follow-up significantly differed between the groups (p = 0.002). Progression of facet degeneration was detected in 55.1% of PLIF patients and 77.8% of MBDU patients. Progression of disc degeneration and spinal stenosis was observed in 45.2% and 36.8% of PLIF patients, respectively, and 58.9% and 36.0% of MBDU patients, respectively. Overall, the incidence of X-ASD was 17.0% in the PLIF group and 16.2% in the MBDU group. Among the patients who underwent plain radiography plus CT or MRI, the total incidence of R-ASD was 70.6% in the PLIF group and 60.0% in the MBDU group. The above rates did not significantly differ between the groups. The mean improvement rate in the JOA score for low back pain was 52.8% in the PLIF group and 52.1% in the MBDU group (p = 0.867). The incidence of revision surgery at L3/4 was 1.9% in the PLIF group and 5.4% in the MBDU group (p = 0.62). The 5-year incidence of R-ASD at L3/4 after PLIF and MBDU in patients undergoing surgery for L4/5 DS is similar, indicating that naturally occurring lumbar degeneration is probably responsible, not fusion.

A novel posterior decompression technique (anterior sliding decompression osteotomy) for beak-type ossification of the posterior longitudinal ligament in the thoracic spine.

Conventional decompression surgery for beak-type ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine, whether approached anteriorly or posteriorly, poses several challenges, including technical complexity, cerebrospinal fluid leakage, incomplete decompression, and potential neurological deterioration. Therefore, the authors introduce a novel technique, anterior sliding decompression osteotomy (ASDO), for thoracic myelopathy caused by OPLL and evaluate the efficacy and safety of this technique. Six patients (4 men and 2 women) who underwent ASDO surgery for beak-type OPLL in the thoracic spine with a follow-up period of at least 2 years were included in the cohort. Clinical and surgical outcomes, including modified Japanese Orthopaedic Association (mJOA) score, neurological recovery rate, canal occupying ratio, operation time, and blood loss, were evaluated. The mean ± SD follow-up period was 26.5 ± 2.0 months. The mean mJOA score improved from 6.0 to 9.7, with the mean recovery rate reaching 63.6% at 6 weeks postoperatively to 73.9% at 2 years after surgery. Neural decompression was effective in all patients, reducing the mean canal occupying ratio from 70.8% to 29.1% without complications. ASDO surgery achieves sufficient spinal cord decompression for beak-type OPLL in the thoracic spine. It represents an effective, feasible technique, offering surgeons a familiar view from the conventional posterior approach.

THE ROLE OF DYNAMIC CERVICAL MRI IN DETERMINING THE LEVEL OF POSTERIOR DECOMPRESSION IN CERVICAL SPONDYLOTIC MYELOPATHY.

Cervical spondylotic myelopathy (CSM) is a leading cause of spinal cord dysfunction in adults, often progressing silently. Static MRI is the standard imaging tool but may miss compression caused by neck movement. Dynamic MRI, by capturing flexion and extension views, provides a clearer picture of spinal cord compression, aiding surgical planning and improving outcomes. However, its use is limited due to higher costs and specialized requirements, making its clinical value essential to assess. Eighty-two CSM patients undergoing posterior decompression surgery were divided into two groups: static MRI-based planning (n=43) and combined static and dynamic MRI-based planning (n=39). Neurological outcomes were evaluated using modified Japanese Orthopaedic Association (mJOA) and Visual Analog Scale (VAS) scores pre- and postoperatively. Compression levels identified on static and dynamic MRI were compared. Demographic characteristics were similar between groups. Dynamic MRI identified additional compression levels, mainly at C5-C6 and C6-C7, in 18 patients. Patients in the dynamic MRI group showed significantly greater improvements in mJOA scores (mean: 15.8 ± 1.6 vs. 14.5 ± 1.8, p=0.01) and VAS scores (mean: 3.2 ± 1.4 vs. 4.5 ± 1.8, p=0.01) compared to the static MRI group. Dynamic cervical MRI enhances the identification of compression levels overlooked by static MRI, improving surgical precision and postoperative outcomes in CSM patients. Incorporating dynamic MRI into routine preoperative evaluations may be particularly beneficial for complex, multilevel cases.

Atlantodentoplasty using the anterior retropharyngeal approach for treating irreducible atlantoaxial dislocation with atlantodental bony obstruction: a retrospective study.

This was a retrospective study. The current study aimed to investigate the clinical efficacy of atlantodentoplasty using the anterior retropharyngeal approach against irreducible atlantoaxial dislocation with atlantodental bony obstruction. In cases of atlantoaxial dislocation with atlantodental bony obstruction, owing to the presence of an osteogenic mass between the atlas and odontoid process, reduction is challenging to complete using the posterior approach. Transoral odontoidectomy is technically demanding and is associated with several risks. The clinical data of 26 patients diagnosed with irreducible atlantoaxial dislocation complicated by atlantodental bony obstruction were analyzed retrospectively. All patients underwent anterior retropharyngeal atlantodentoplasty, followed by posterior occipitocervical fusion. Details including surgical duration and blood loss volume were recorded. Radiographic data such as the anterior atlantodental interval, O-C2 angle, space available for the cord, clivus-canal angle, and cervical medullary angle, and clinical data including the Japanese Orthopedic Association (JOA) score were assessed. The fusion time of the grafted bone and the development of complications were examined. In patients undergoing anterior retropharyngeal atlantodentoplasty, the surgical duration and blood loss volume were 120.1±16.4 minutes and 100.6±33.5 mL, respectively. The anterior atlantodental interval decreased significantly after the surgery (p <0.001). The O-C2 angle, space available for the cord, clivus-canal angle, and cervical medullary angle increased significantly after the surgery (p <0.001). The JOA score during the latest follow-up significantly increased compared with that before the surgery (p <0.001). The improvement rate of the JOA score was 80.8%±18.1%. The fusion time of the grafted bone was 3-8 months, with an average of 5.7±1.5 months. In total, 11 patients presented with postoperative dysphagia and three with irritating cough. However, none of them exhibited other major complications. Anterior retropharyngeal atlantodentoplasty can anatomically reduce the atlantoaxial joint with a satisfactory clinical outcome in patients with irreducible atlantoaxial dislocation with atlantodental bony obstruction.

Correlation between anxiety, depression, and social stress in young patients with thoracolumbar spine fractures.

Traumatic injuries, such as falling, car accidents, and crushing mostly cause spinal fractures in young and middle-aged people, and > 50% of them are thoracolumbar fractures. This kind of fracture is easily combined with serious injuries to peripheral nerves and soft tissues, which causes paralysis of the lower limbs if there is no timely rehabilitation treatment. Young patients with thoracolumbar fractures find it difficult to recover after the operation, and they are prone to depression, low self-esteem, and other negative emotions. To investigate the association between anxiety, depression, and social stress in young patients with thoracolumbar spine fractures and the effect on rehabilitation outcomes. This study retrospectively analyzed 100 patients admitted to the orthopedic department of Honghui Hospital, Xi'an Jiaotong University who underwent thoracolumbar spine fracture surgery from January 2022 to June 2023. The general data of the patients were assessed with the Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD), life events scale, and social support rating scale (SSRS) to identify the correlation between anxiety, depression scores, and social stress and social support. The Japanese Orthopedic Association (JOA) was utilized to evaluate the rehabilitation outcomes of the patients and to analyze the effects of anxiety and depression scores on rehabilitation. According to the scores of HAMD and HAMA in all patients, the prevalence of depression in patients was 39% (39/100), and the prevalence of anxiety was 49% (49/100). Patients were categorized into non-depression (n = 61) and depression (n = 39), non-anxiety (n = 51), and anxiety (n = 49) groups. Statistically significant differences in gender, occupation, Pittsburgh Sleep Quality Index (PSQI) score, and monthly family income were observed between the non-depression and depression groups (P < 0.05). A significant difference in occupation and PSQI score was found between the non-anxiety and anxiety groups. Both depression (r = 0.207, P = 0.038) and anxiety scores (r = 0.473, P < 0.001) were significantly and positively correlated with negative life events. The difference in negative life event scores as well as SSRS total and item scores was statistically significant between patients in the non-depression and depression groups (P < 0.05). The difference between the non-anxiety and anxiety groups was statistically significant (P < 0.05) in the negative life event scores as well as the total SSRS scores. Additionally, JOA scores were significantly lower in both anxious and depressed patients. Young patients with thoracolumbar fractures are prone to anxiety and depression. Patients' anxiety and depression are closely associated with social pressure, which reduces the life pressure of young patients with thoracolumbar fractures, enhances social support, and improves the psychology of anxiety and depression., which affects patients' recovery.

Mid-term Clinical and Radiographic Outcomes of the Actis Total Hip System: A Retrospective Study.

Introduction Implant technology for total hip arthroplasty (THA) was developed to improve hip function and patient satisfaction. Actis (DePuy Synthes, Warsaw, IN, USA) is a short fit-and-fill titanium stem, with a medial-collared and triple-taper (MCTT) geometry, that is fully coated with hydroxyapatite (HA). We evaluated the radiographic and clinical outcomes of the Actis Total Hip System during a mean follow-up of five years. Patients and methods We retrospectively analyzed data from 80 patients (14 male and 66 female, mean age: 65 ± 8.4 years) who underwent primary THA using Actis stems (anterolateral approach, 60 hips; posterior approach, 20 hips). Radiographs were obtained postoperatively and at the time of the final examination. Radiographic assessments included the alignment of the femoral stem, spot welds, stress shielding, cortical hypertrophy, subsidence (>2 mm), radiolucent line, pedestal formation, Dorr type, canal fill ratio (CFR), and stem fixation. Clinical evaluation included the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ) and Harris Hip Score (HHS). Results The mean follow-up period was 64.0 ± 6.0 months. No significant differences were observed in the alignment of the femoral components between approaches. Of the 80 hips, 53 (66.3%) showed radiographic signs of stem osseointegration, predominantly in the mid-distal region of the stem at the final follow-up. Multiple logistic regression analysis revealed that younger age and a higher CFR (20 mm proximal to the lesser trochanter) were associated with the presence of spot welds. Mild stress shielding occurred in 25 hips (31.3%), and no patient experienced severe stress shielding. All stems were fixed by bone on growth. The JHEQ and HHS significantly improved at the final assessment. Conclusion At the five-year follow-up, patients who received the Actis Total Hip System during THA had good radiographic and clinical outcomes.

S8 Navigation system combined with an ultrasonic osteotome for three-dimensional real-time dynamic visualization decompression to reduce postoperative neurological deterioration in thoracic ossification of the ligamentum flavum.

Posterior laminectomy is a standard treatment for thoracic ossification of the ligamentum flavum (TOLF), but it often leads to neurological deterioration during surgery. This study aimed to reduce iatrogenic neurological deterioration by using an S8 navigation system combined with an ultrasonic osteotome for three-dimensional real-time dynamic visualization decompression. A retrospective analysis was conducted on patients who underwent laminectomy and internal fixation for TOLF in our centre from January 2016 to January 2023. Patients were divided into a visualization group (S8 navigation + ultrasonic bone scalpel) and a control group (ultrasonic bone scalpel) based on the use of three-dimensional real-time dynamic visualization decompression technology. Intraoperative multimodal neuroelectrophysiological monitoring (IONM) was used to collect somatosensory evoked potential and motor evoked potential data. We compared the incidence of intraoperative neurological deterioration indicated by IONM alarms between the two groups. Neurological and motor functions were assessed via the American Spinal Injury Association (ASIA) classification system and the modified Japanese Orthopaedic Association (m-JOA) score for thoracic myelopathy. Follow-ups were conducted at 1, 3, 6, and 12months postsurgery, and the data from both groups were compared. Other clinical indicators included decompression time per laminectomy segment, intraoperative blood loss, intraoperative dural ossification, hospitalization duration, and drainage tube placement time. We also analysed intraoperative and postoperative complications. A total of 91 patients with thoracic ossification of the ligamentum flavum were included, with a follow-up period of 12-18months. The visualization group consisted of 41 patients, and the control group included 50 patients. The incidence of neurological deterioration indicated by IONM in the visualization group (9.8%) was significantly lower than that in the control group (30.0%) (P = 0.014). The immediate postoperative ASIA grade change value ≤ - 1 was lower in the visualization group (9.8%) than in the control group (34.0%) (P = 0.006); A similar trend was observed at the 12month follow-up (2.4% vs. 20.0%, P = 0.022). The m-JOA scores at 1, 3, 6, and 12months postsurgery were higher in the visualization group than in the control group (P < 0.05). The visualization group also had shorter lamina decompression times per segment and less intraoperative blood loss (P < 0.05). The incidence of nondural ossification cerebrospinal fluid leakage was lower in the visualization group (2.4%) than in the control group (18.0%) (P = 0.018). Additionally, nerve root injury was lower in the visualization group (0%) than in the control group (10.0%) (P = 0.037). Postoperative CT scans revealed no ossification residue in the visualization group, whereas 7 cases (14.0%) were observed in the control group (P = 0.013). The S8 navigation system combined with an ultrasonic osteotome for three-dimensional real-time dynamic visualization decompression significantly reduces the incidence of intraoperative neurological deterioration, improves postoperative motor function recovery, and reduces decompression time per vertebral segment, intraoperative bleeding, and complications such as cerebrospinal fluid leakage. This technology is safe and reliable and offers a promising option for spinal surgeons in treating thoracic ossification of the ligamentum flavum.

Comparison of anterior and posterior approaches for the treatment of cervical ossification of the posterior longitudinal ligament: a meta-analysis of 28 cohort studies.

At present, the choice of approach for the surgical treatment of cervical ossification of the posterior longitudinal ligament (OPLL) remains controversial. We performed this meta-analysis to compare the efficacy of the anterior and posterior approaches in the treatment of cervical OPLL. PubMed, EMBASE and the Cochrane Library were systematically searched for all eligible articles as of August 3, 2023, without any publication date restrictions. We used the random effects model to pool standardized mean differences (SMDs) or odds ratios (ORs) with 95% confidence intervals (CIs). We conducted subgroup analyses to explore the potential sources of heterogeneity, and sensitivity analyses were used to evaluate the robustness of the findings via the leave-one-out procedure. In addition, we evaluated publication bias by observing the symmetry of the funnel plot and using Egger's test, and the trim-and-fill method was employed to A total of 28 studies including 6,324 participants met the inclusion criteria. The meta-analysis revealed that, compared with the posterior approach, the anterior approach was significantly associated with a superior recovery rate (SMD, 0.83; 95% CI, 0.41 to 1.25), a greater number of patients with a recovery rate ≥ 50% (OR, 2.13; 95% CI, 1.16 to 3.92), higher Japanese Orthopaedic Association (JOA) scores (SMD, 0.62; 95% CI, 0.31 to 0.94), and better recovery of cervical lordosis (SMD, 1.83; 95% CI, 0.95 to 2.72). Furthermore, the results revealed that the complication rate (OR, 1.45; 95% CI, 1.01 to 2.09) with the anterior approach was significantly greater than that with the posterior approach. However, our study revealed no significant differences between the two surgical groups in terms of the postoperative visual analogue scale (VAS) score, postoperative space available for the spinal cord, postoperative range of motion of the cervical spine, duration of symptoms, operation time, blood loss, or length of stay. The anterior approach is superior to the posterior approach in terms of the postoperative recovery rate, the number of patients with a recovery rate ≥ 50%, JOA scores, and recovery of cervical lordosis. Combined with the results of the above outcome and subgroup analysis, we advocate for the anterior approach in patients with a canal-occupying ratio exceeding 50% or 60%.

Correlation analysis between preoperative odontoid incidence and clinical outcomes 2 years after anterior cervical discectomy and fusion

ObjectiveThis study presents a novel odontoid parameter, the odontoid incidence (OI), to examine the correlation between OI on preoperative cervical sagittal radiographs and 2-year clinical outcomes following short-segment anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylotic myelopathy (CSM).MethodsA retrospective analysis of the clinical data of 87 patients with CSM who underwent ACDF surgery from January 2018 to December 2023 was conducted. The patients were categorized into a larger OI group (44 patients, OI > 12.62°) and a smaller OI group (43 patients, OI ≤ 12.62°) on the basis of the median cervical sagittal OI prior to surgery. The postoperative follow-up duration was 2 years. Cervical sagittal parameters were assessed on lateral cervical spine radiographs both preoperatively and postoperatively. Additionally, the Japanese Orthopedic Association (JOA), neck disability index (NDI), and visual analog scale (VAS) scores were documented for each patient before surgery and at the final 2-year postoperative follow-up.ResultsCompared with those in the preoperative period, the T1 slope, C2‒C7 Cobb angle, sagittal segmental angle (SSA), and C0‒C2 Cobb angle significantly improved in 87 patients with cervical spondylosis (P < 0.05). At the 2-year postoperative follow-up, all patients exhibited significant improvements in JOA, NDI, and VAS scores compared with the preoperative values (P < 0.05). No statistically significant difference was observed in the preoperative or baseline data between the larger OI group and the smaller OI group (P > 0.05); however, a statistically significant difference was noted in the postoperative SSA between the two groups (P < 0.05). A statistically significant difference was observed in the VAS score and NDI score at the final follow-up between the two groups (P < 0.05), as well as in the improvement in the JOA score and VAS score (preoperative score minus the final follow-up score), between the two groups (P < 0.05). The results of the Pearson correlation analysis indicated a negative correlation between the preoperative OI score and the VAS and NDI scores at the final postoperative follow-up (P = 0.012, r = − 0.268) (P = 0.028, r = − 0.236).ConclusionIn ACDF, the preoperative OI of patients with CSM was negatively correlated with the VAS and NDI scores at the final postoperative follow-up; Larger preoperative OI corresponded to lower VAS and NDI scores at the final follow-up, leading to comparatively improved 2-year clinical outcomes.

Patient-reported outcome trajectories the first 24 months after surgery for cervical spondylotic myelopathy: a Quality Outcomes Database study.

Cervical spondylotic myelopathy (CSM) shows varying levels of improvement after surgical treatment. While some patients improve soon after surgery, others may take months to years to show any signs of improvement. The goal of this study was to evaluate postoperative improvement, patient-reported outcomes, and patient satisfaction up to 2 years after surgical treatment for CSM, which will help optimize the current treatment strategies and effectively manage patient expectations. This was a retrospective study of prospectively collected data using the Quality Outcomes Database. The primary outcomes of interest were achievement of the minimal clinically important difference (MCID) for the numeric rating scale for neck and arm pain, modified Japanese Orthopaedic Association, Neck Disability Index, and EQ-5D scores and postoperative satisfaction (North American Spine Society scale). Early and sustained improvement was defined as MCID achievement in at least one patient-reported outcome measure (PROM) at the 3-, 12-, and 24-month follow-ups. Transient improvement was defined as MCID achievement only at the 3-month and/or 12-month follow-up but not at the 24-month follow-up. Late improvement was defined as MCID achievement in at least one PROM only at the 24-month follow-up. There were 630 patients included in the comparative analysis. A total of 463 (73.5%) patients achieved early and sustained improvement, 105 (16.7%) patients experienced transient improvement with subsequent decline, 25 (4.0%) patients reported late improvement, and 37 (5.9%) patients did not report any clinically meaningful improvement after surgery. Patients with an anterior approach were more likely to be in the early and sustained improvement group. African American patients (OR 2.98, 95% CI 1.14-7.76; p = 0.03) were more likely to report late improvement when compared with White patients. The overall satisfaction rate at the 24-month follow-up was 87.8%. These findings indicate that 73.5% of patients achieve early and sustained improvement, and 87.8% of patients are satisfied with surgery 24 months postoperatively.

T1 mapping using MP2RAGE in degenerative cervical myelopathy: a longitudinal study.

Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord (SC) dysfunction. In routine clinical practice, SC changes are well depicted using conventional MRI, especially T2-weighted imaging. However, this modality usually fails to provide satisfactory clinico-radiological correlations. In this context we assessed the potential value of quantitative changes measured with a T1 MP2RAGE sequence. 18 patients diagnosed with chronic onset of DCM and 17 healthy controls (HC) were enrolled in the study. Clinical presentation was assessed using the modified Japanese Orthopaedic Association (mJOA) scale. Sagittal cervical SC T2-w 3D SPACE imaging and T1 MP2RAGE mapping were performed at baseline and 3-months postoperatively. Data were processed using Matlab and the SC Toolbox. mJOA score increased from 13.3 ± 2.1 preoperatively to 14.4 ± 1.9 at follow-up (p = 0.027). Site of maximum compression (Cmax) was at C3-C4 cervical levels in 4 patients, C4-C5 in 8 patients, C5-C6 in 5 patients and C6-C7 in 1 patient. SC compression was multi-level in 7 patients and single-level in 11 patients. T2-w hyperintensity was present in 15 patients. Mean SC T1 values in the whole SC in the DCM group at baseline showed significant difference as compared to mean SC T1 values in HC group (962.2 ± 62 vs. 924.9 ± 34 ms, respectively (p < 0.0001)) but no differences could be observed between baseline and 3-month follow-up (962.4 ± 59 ms (p = 0.86)). Z-scores at baseline were - 0.05 ± 1 for mild, 1.2 ± 1.9 for moderate and 2.5 ± 1.2 for severe. Mean baseline and 3-month follow-up SC T1 values were weakly but significantly correlated to preoperative (R2 = 0.33 (p = 0.013) and postoperative mJOA (R2 = 0.29 (p = 0.024). Baseline T1 value at C2 level was significantly correlated with mJOA at 3-month follow-up (p = 0.048). T1-MP2RAGE mapping in patients with DCM demonstrated both focal and diffuse cervical SC alteration. It could thus be a biomarker for patients with DCM managed surgically.

Comparative clinical efficacy of acupuncture combined with manipulation and other non-pharmacological interventions in the treatment of lumbar disc herniation: a prospective, multi-arm, randomized, open-label, blinded endpoint trial.

To compare the clinical efficacy and safety of four intervention methods-traditional Chinese manipulation combined with acupuncture, acupuncture alone, manipulation alone, and traction-for the treatment of lumbar disc herniation (LDH). A prospective, multi-arm, randomized, parallel-controlled clinical trial was conducted between July 2021 and June 2024. A total of 240 eligible LDH patients were randomized into four groups (60 patients per group) in a 1:1:1:1 ratio: manipulation combined with acupuncture group, manipulation group, acupuncture group, and traction group. Each treatment lasted for 3 weeks. Changes in Visual Analog Scale (VAS) and Japanese Orthopedic Association (JOA) scores were recorded before treatment, at 1 and 3 weeks during treatment, and at 1 and 3 months post-treatment. Adverse events were also monitored. A total of 210 patients completed the follow-up. At the 3-week (day 21) and 3-month (day 111) follow-ups, the acupuncture + manipulation group showed the most significant improvements, with VAS scores decreasing by 63.34% and 68.30% and JOA scores increasing by 55.17% and 58.33%. The acupuncture group showed VAS score reductions of 55.04% and 59.29% and JOA score increases of 44.52% and 48.29%. The manipulation group reported VAS score reductions of 51.73% and 55.02% and JOA score increases of 41.16% and 45.27%. The traction group demonstrated the least improvement, with VAS scores decreasing by 43.25% and 45.73% and JOA scores increasing by 30.55% and 33.97%. Statistical analysis indicated that the acupuncture + manipulation group had significantly better improvements in VAS and JOA scores than the other three groups during treatment and follow-up periods (P < 0.05). There were no significant differences between the acupuncture and manipulation groups (P > 0.05), while the traction group showed significantly less improvement compared to the other groups (P < 0.05). This study demonstrates that acupuncture combined with spinal manipulation significantly reduces pain and improves lumbar function in LDH patients compared to other tested interventions. The symptom relief rate was significantly higher in the acupuncture + manipulation group compared to the acupuncture, manipulation, and traction groups. https://www.chictr.org.cn/index.aspx, identifier ChiCTR2200058598.

What is the Best Strategy for C3 in Open-Door Laminoplasty: Laminectomy versus Laminoplasty - A Systematic Review and Meta-analysis.

Conventional open-door laminoplasty is commonly used to treat multilevel cervical disorders but often leads to complications such as loss of cervical lordosis, limited neck motion, and axial symptoms. These issues stem from the extensive disruption of musculature and structural alterations involved in conventional methods. To address these shortcomings, the modified open-door laminoplasty with C3 laminectomy technique has been developed as a modification of conventional open-door laminoplasty, with the aims to preserve the semispinalis cervicis muscle attached to the C2 spinous process, potentially improving postoperative outcomes by maintaining muscle integrity and stability of the cervical spine. This study seeks to evaluate the clinical benefits of modified open-door laminoplasty with C3 laminectomy in comparison to conventional open-door laminoplasty approaches. Patient Sample: patients undergoing open-door laminoplasty OUTCOME MEASURES: The outcome measures assessed were categoried into self-report Measure including pain indices, physiologic measures including complications, and functional measures including operative time, Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) scores, length of hospital stay, and cervical range of motion (ROM). We conducted a comprehensive search across multiple databases, including PubMed, Scopus, EMBASE, Web of Science, and the Cochrane Library, to identify randomized controlled trials (RCTs), cohort studies, and case-control studies that compare the clinical outcomes of conventional open-door laminoplasty and modified open-door laminoplasty with C3 laminectomy. Statistical analyses were performed using RevMan software to evaluate the differences between the two surgical techniques. Our analysis included 11 studies encompassing 873 participants. The meta-analysis revealed no significant differences between patients undergoing conventional open-door laminoplasty and modified open-door laminoplasty with C3 laminectomy regarding operation time (mean difference, MD: 5.08, 95% confidence interval, CI: -3.04 to 13.21), length of hospital stay (MD: -0.33, 95% CI: -1.43 to 0.77), JOA scores (MD: 0.18, 95% CI: -0.03 to 0.40), NDI scores (MD: -0.14, 95% CI: -4.00 to 3.72), and complication rates (risk difference, RD: 0.01, 95% CI: -0.03 to 0.04). However, participants in the group that underwent modified open-door laminoplasty with C3 laminectomy exhibited a significantly greater range of motion (MD: 4.13, 95% CI: 0.07 to 7.20) and lower postoperative pain scores (standard mean difference, SMD: -0.57, 95% CI: -1.05 to -0.10). Our study suggests that modified open-door laminoplasty with C3 laminectomy improves range of motion and reduces pain compared to conventional open-door laminoplasty, with no differences in other clinical outcomes. Further studies are needed to confirm these results.

Morbidity and Mortality of Adult Spinal Deformity Surgery Using the Japanese Orthopedic Association National Registry/Japanese Society for Spine Surgery and Related Research Database (JOANR/JSSR-DB)

Morbidity and Mortality of Adult Spinal Deformity Surgery Using the Japanese Orthopedic Association National Registry/Japanese Society for Spine Surgery and Related Research Database (JOANR/JSSR-DB)