Postoperative Japanese Orthopaedic Association Scores Research Articles

Interdisciplinary Surgical Treatments and Long-Term Outcomes of Lumbar Spinal Tumors With Retroperitoneal Involvements: A Retrospective Case Series Study.

PurposeSurgical treatments are technically challenging for lumbar spinal tumor (LST) with extensive retroperitoneal involvements. Our study aimed to report the experience and outcomes concerning interdisciplinary surgical collaborations in managing such LSTs.Patients and MethodsNine patients underwent interdisciplinary surgical treatments which were performed by specialists, namely, spinal, vascular, and urinary surgeries. Data on clinical characteristics were collected, and the Visual Analogue Scale (VAS) and the Japanese Orthopaedic Association Score (JOAS) were used in the evaluation before and after surgery. The postoperative complications and the long-term outcomes were reported as well.ResultsThe interdisciplinary work included double J catheter indwelling (n = 9), nephrostomy (n = 5), replacement of the common iliac vein (n = 2), abdominal aorta repair (n = 3), and vital vessel repair (n = 8). The early-stage complications included complaints of moderate low back pain and slight implant shift (n = 1, 11.1%) and tardive ureterodialysis (n = 1, 11.1%). The 3- and 5-year disease-free survival rates were 76.2 ± 14.8 and 50.8 ± 23.0%, respectively, during the mean follow-up of 34.6 ± 17.9 months (range, 9.5–68.7). Besides this, more blood loss was associated with recurrent and metastatic tumor status (p = 0.043) and surgery time >5 h (p = 0.023). Remarkable pain relief and favorable quality of life were achieved based on the postoperative VAS (3.3 ± 0.9, p < 0.001) and JOAS (16.6 ± 0.5, p < 0.001).ConclusionsThe treatments of LSTs with wide-range retroperitoneal involvements require interdisciplinary surgical collaborations to lower the risks and improve the long-term outcomes. High-quality prospective cohort studies with large samples are warranted to establish general surgical protocols in managing LSTs with extensive retroperitoneal involvements.

Is there any correlation between the recovery rate of JOA and the increasing of cervical spinal cord area after single-door cervical laminoplasty?

ObjectivesThe aim of the study is to investigate the clinical and radiologic factors represented by the increasing of spinal cord area associated with the prognosis of the patients at long-term follow-up by multivariate analysis after single-door cervical laminoplasty (SDCL). MethodsA total of 115 patients who underwent cervical laminoplasty with miniplate fixation were included from November 2008 to June 2018. The average postoperative follow-up period was 17.3 months (range, 12–105 months). The prognosis of the patients following cervical laminoplasty was evaluated by the recovery rate of Japanese Orthopedic Association (JOA) at the final follow-up. The recovery rate of JOA ≤ 50% were classified as poor prognosis group (PP group) whose prognosis is relatively poor, and those> 50% were classified as good prognosis group (GP group) whose have a better prognosis. The clinical factors including gender, age, duration of symptoms, diagnosis type, blood loss, operative time, pre- and post-JOA score, etc. were recorded. The radiologic factors including sagittal canal diameter (SCD), the cervical curvature index (CCI), the range of motion (ROM), the spinal canal area and the increasing of cervical spinal cord area, etc. were collected before and after operation and measured by X-ray plain and computed tomography (CT) scan images. The univariate analysis and multivariate logistic regression analysis were performed. ResultsThere were 62 patients in PP group and 53 patients in GP group. The multivariate analysis showed that the preoperative (OR=6.875, P = 0.001) and postoperative JOA scores (OR=24.000, P = 0.001), preoperative spinal canal area (OR=2.464, P = 0.023) and the increasing of cervical spinal cord area (OR=5.438, P = 0.001) maybe related factors to the recovery rate of JOA at the final follow-up. ConclusionsThe preoperative spinal canal area, the increasing of cervical spinal cord area, preoperative and postoperative JOA scores play important roles in long-term prognosis after SDCL.

A Clinical Study on the Effect of Different Ratios of Recombinant Human Bone Morphogenetic Protein-2 Compound to Autogenous Bone on Cervical Interbody Fusion Based on Smart Healthcare.

With an increasing elderly population worldwide, the incidence of spine degenerative diseases with neck and shoulder pain as the main symptom is rising obviously, which has now become one of the important and difficult problems in sociomedical science. This study was to explore the effects of different ratios of recombinant human bone morphogenetic protein-2 (rhBMP-2) compound to the autogenous bone on cervical interbody fusion. 90 cervical degeneration patients with the need of surgical treatment admitted to our hospital from January 2019 to January 2020 were selected as the research objects and equally divided into group A, group B, and group C according to the order of admission, with 30 cases in each group and the ratios of rhBMP-2 compound to autogenous bone being 2 : 1, 1 : 1, and 1 : 2 respectively, and standard anterior cervical diskectomy and fusion (ACDF) treatment was performed to all patients to compare their surgery-related indexes, the Japanese Orthopaedic Association (JOA) score, the visual analog scale (VAS) score, the effect of cervical interbody fusion, and the postoperative complication rate (CR). Compared with group A and group C, group B achieved the significantly better surgery-related indexes (P < 0.05), significantly higher postoperative JOA scores (P < 0.05), significantly lower postoperative neck and upper limb VAS scores (P < 0.05), significantly better effect of cervical interbody fusion (P < 0.05), and significantly lower postoperative CR (P < 0.05). 1 : 1 is the best ratio of rhBMP-2 compound to the autogenous bone, for it can optimize patients' perioperative indexes, reduce the postoperative pain, lower the possibility of complications, and improve the effect of cervical interbody fusion, which should be promoted and applied in practice.

Postoperative Complications and Survival Rate in Hemodialysis-Dependent Patients Undergoing Cervical Spine Surgery.

Introduction Spine surgery is challenging in hemodialysis (HD)-dependent patients owing to their poor general condition. However, postoperative complications and the mortality and survival rates have not been specifically evaluated in a wide series. This study aimed to elucidate postoperative complications and the survival rate in cervical spine surgery in HD patients. Methods This study included 109 HD patients (70 men, 39 women) who had undergone cervical spine surgery between July 1996 and May 2018. Based on radiological diagnosis, we divided them into the destructive spondyloarthropathy (DSA) and non-DSA groups. We investigated the causes of hemodialysis, postoperative complications, postoperative inpatient mortality rate, and survival rate. Results The DSA and non-DSA groups included 100 surgeries in 89 patients and 21 surgeries in 20 patients, respectively. The mean age at surgery was 62.9 years for the DSA and 55.9 years for the non-DSA group (P=0.97). The DSA group had a shorter hemodialysis period at surgery compared with the non-DSA group (21.7 vs. 26.5 years, P<0.05). The two most common causes of HD in both groups were chronic glomerulonephritis (DSA, 45%; non-DSA, 57.1%) and diabetes (DSA, 11%; non-DSA, 14.5%). Postoperative complications were observed in 23% (23/100) and 19% (4/21) of surgeries in the DSA and non-DSA groups, respectively (P=0.782). The total in-hospital mortality rate was 2.5% (3/121). The 1-, 3-, 5-, and 10-year postoperative survival rates of all patients were 89.6%, 75.5%, 67.1%, and 44.7%, respectively. The survival rates did not depend on the group (DSA vs. non-DSA), pre- and postoperative Japanese Orthopedic Association score for cervical myelopathy, hemodialysis period, sex, and age (P>0.05). However, significantly low survival rates were observed in HD caused by diabetes compared with that by chronic glomerulonephritis (P<0.001) and other causes (P<0.001). Conclusions Cervical spine surgery in HD patients is associated with postoperative complications. The postoperative survival rate was found to be low if the cause of hemodialysis was diabetes.

Percutaneous Transforaminal Endoscopic Diskectomy for Lumbar Disk Herniation: Young (Age

We compare the differences in the efficacy of percutaneous transforaminal endoscopic diskectomy (PTED) between the younger (age <60 years) and older (age ≥60 years) patients with lumbar disk herniation (LDH). From December 2016 to December 2017, 128 patients with symptomatic LDH underwent PTED and were followed up. Forty-four 60 years old and above, including 19 males and 25 females with an average age of 68.7 (61-82) years, were classified as the elderly age group. Eighty-four patients younger than 60 years were classified as the young age group, which included 48 males and 36 females with an average age of 44.7 (16-58) years. The visual analog scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores, and satisfaction rates of the two groups before and after surgery were compared. The operation was completed successfully in both groups. The average follow-up times of the elderly and young age groups were 18.47 ± 2.62 (12-23) and 17.90 ± 3.27 (12-23) months, respectively. One patient in the young age group had recurrence 7 months after surgery, and the symptoms were relieved after PTED was performed again. Two patients with nerve root injury after surgery in the young age group completely recovered after 2 months of conservative treatment. There were no significant surgical complications in the elderly age group. There was no significant difference in postoperative VAS, JOA, and MacNab scores between the two groups. The MacNab scores in the elderly age group were excellent for 28 patients, good for 10 patients, and fair for 6 patients; the satisfaction rate was 86.3%. In the young age group, scores were excellent for 63 patients, good for 14 patients, fair for 5 patients, and poor for 2 patients; the satisfaction rate was 91.7%. The clinical effectiveness of PTED for treatment of LDH in both elderly and young patients is satisfactory. Age is not a predictor of poor outcomes of PTED.

Radiological Changes in Adjacent and Index Levels after Cervical Disc Arthroplasty.

PurposeThe purpose of this retrospective study was to evaluate radiological and clinical outcomes in patients undergoing cervical disc arthroplasty (CDA) for cervical degenerative disc disease. The results may assist in surgical decision-making and enable more effective and safer implementation of cervical arthroplasty.Materials and MethodsA total of 125 patients who were treated with CDA between 2006 and 2019 were assessed. Radiological measurements and clinical outcomes included the visual analogue scale (VAS), the Neck Disability Index (NDI), and the Japanese Orthopaedic Association (JOA) myelopathy score assessment preoperatively and at ≥2 years of follow-up.ResultsThe mean follow-up period was 38 months (range, 25–114 months). Radiographic data demonstrated mobility at both the index and adjacent levels, with no signs of hypermobility at an adjacent level. There was a non-significant loss of cervical global motion and range of motion (ROM) of the functional spinal unit at the operated level, as well as the upper and lower adjacent disc levels, compared to preoperative status. The cervical global and segmental angle significantly increased. Postoperative neck VAS, NDI, and JOA scores showed meaningful improvements after one- and two-level CDA. We experienced a 29.60% incidence of heterotrophic ossification and a 3.20% reoperation rate due to cervical instability, implant subsidence, or osteolysis.ConclusionCDA is an effective surgical technique for optimizing clinical outcomes and radiological results. In particular, the preservation of cervical ROM with an artificial prosthesis at adjacent and index levels and improvement in cervical global alignment could reduce revision rates due to adjacent segment degeneration.

Intervertebral Foramen Width Is an Important Factor in Deciding Additional Uncinate Process Resection in ACDF-a Retrospective Study.

Background: Anterior cervical discectomy and fusion (ACDF) has been established as a classic procedure for the management of cervical radiculopathy. However, it is unclear whether combined uncinate process resection (UPR) is necessary for treating cervical radiculopathy. Here, we investigated the clinical outcome of ACDF combined with UPR compared to ACDF alone to determine the necessity of UPR in treating cervical radiculopathy.Hypothesis: Uncinate process resection may be necessary in certain patients along with ACDF to achieve better clinical outcomes of cervical radiculopathy.Patients and Methods: Fifty-five patients underwent ACDF with UPR, and 126 patients without UPR were reviewed. The width and height of the intervertebral foramen were measured by 45° oblique X-rays. We also measured the Japanese Orthopedic Association (JOA) score and visual analog scale (VAS) score. C2–C7 Cobb angles were obtained from all patients pre- and post-operatively. Meanwhile, linear regression analysis was used to evaluate the relationship between the clinical outcomes and the intervertebral foramen width before surgery.Results: Linear regression analysis indicated that the improvement in the JOA and VAS scores was irrelevant to both the pre-operative width of the intervertebral foramen (wIVF) and the height of the intervertebral foramen (hIVF) in the ACDF+UPR group. However, pre-operative wIVF was associated with post-operative JOA and VAS scores in the ACDF alone group. Those with pre-operative wIVF <3 mm in the ACDF group had the least improvement in post-operative clinical symptoms due to the change in wIVF (P > 0.05). The ACDF group whose wIVF was over 3 mm showed similar clinical outcomes to the ACDF + UPR group, and wIVF significantly increased post-operatively (P < 0.05). The fusion rate and C2–C7 Cobb angles did not show significant differences between the two groups (P > 0.05).Discussion: Our current findings suggest that UPR should be considered when wIVF is <3 mm pre-operatively. However, there is no need to sacrifice the uncovertebral joint in ACDF when the pre-operative wIVF is over 3 mm.Level of Evidence: Level III.

Influence of Intervertebral Level of Stenosis on Neurological Recovery and Reduction of Neck Pain After Posterior Decompression Surgery for Cervical Spondylotic Myelopathy: A Retrospective Multicenter Study with Propensity Scoring.

Retrospective multicenter study. To identify the impact of the intervertebral level of stenosis on surgical outcomes of posterior decompression for cervical spondylotic myelopathy (CSM). As the upper affected cervical levels in elderly patients result from degenerative changes in the lower cervical levels with aging, it is usually difficult to determine the influence of the upper affected cervical levels on surgical outcomes after posterior decompression for CSM in older age. This study involved 636 patients with CSM who underwent posterior decompression. According to the most stenotic intervertebral level, patients were divided into upper (n = 343, the most stenotic intervertebral level was C2/3, C3/4, or C4/5) and lower (n = 293, the most stenotic intervertebral level was C5/6, C6/7, or C7/T1) cervical stenosis groups. Propensity score matching of the baseline factors (characteristics, comorbidities, and neurological function) was performed to compare surgical outcomes, the Japanese Orthopaedic Association (JOA) scores, and visual analog scale (VAS) for neck pain between the upper (n = 135) and lower (n = 135) cervical stenosis groups. Before propensity score matching, age at surgery was older and pre- and postoperative JOA scores were lower in the upper cervical stenosis group (P < 0.001, P < 0.001, and P < 0.001, respectively). Following matching, baseline factors were comparable between the groups. Postoperative JOA scores, preoperative-to-postoperative changes in the JOA scores, and the JOA score recovery rate were not significantly different between the groups (P = 0.866, P = 0.825, and P = 0.753, respectively). No differences existed in postoperative VAS for neck pain and preoperative-to-postoperative changes in VAS for neck pain between the groups (P = 0.092 and P = 0.242, respectively). The intervertebral level of stenosis did not affect surgical outcomes after posterior decompression for CSM.Level of Evidence: 3.

Application of Triggered EMG in the Intraoperative Neurophysiological Monitoring of Posterior Percutaneous Endoscopic Cervical Discectomy.

ObjectiveTo describe the rationale and application of triggered EMG (T‐EMG) in intraoperative neurophysiological monitoring, and to explore the efficacy and safety of posterior percutaneous endoscopic cervical discectomy (PPECD) in the treatment of cervical spondylotic radiculopathy (CSR) under multimodal intraoperative neurophysiological monitoring (IOM).MethodsThis study was a retrospective cohort control study. The clinical data of 74 patients with single‐segment CSR from June 2015 to August 2018 were analyzed retrospectively, of whom 35 underwent IOM‐assisted PPECD with triggered EMG (T‐EMG group), while 39 were subjected to IOM‐assisted PPECD alone (IOM group). Operation time, hospital stay, and complications were recorded for both groups. The curative effect was evaluated according to the Visual Analog Scale (VAS) of neck and arm pain, Japanese Orthopaedic Association (JOA) score, and modified MacNab scale.ResultsOperations were successful and all patients were followed up for at least 24 (average 31.77 ± 9.51) months with no patient lost to follow‐up. No significant difference was found in preoperative baseline data between the T‐EMG and the IOM group (P > 0.05). Also, no significant difference was found in the operation time between the T‐EMG (108.29 ± 11.44 min) and the IOM (110.13 ± 12.70 min) (P > 0.05) group, but the difference in hospital stay (T‐EMG: 5.66 ± 0.99 days; IOM: 7.10 ± 1.43 days) was statistically significant (P < 0.05). The VAS for the neck and upper limbs in the two groups at 1 month post‐operation (T‐EMG: 2.09 ± 1.07, 2.26 ± 0.92; IOM:2.18 ± 1.05, 2.31 ± 0.77) and the last follow‐up (T‐EMG: 0.83 ± 0.62, 0.86 ± 0.55; IOM: 0.90 ± 0.50, 0.87 ± 0.61) were significantly different from the preoperative scores (T‐EMG: 6.14 ± 1.09, 7.17 ± 1.04; IOM: 6.18 ± 1.28, 7.15 ± 1.23) (P < 0.05). However, no significant difference was found between the two groups (P > 0.05). The 1‐month postoperative JOA scores for the two groups (12.69 ± 0.76; 12.59 ± 0.82) and those at the last follow‐up (14.60 ± 0.77; 14.36 ± 0.78) were significantly different from the preoperative scores (11.09 ± 0.98; 11.05 ± 0.89) (P < 0.05), but the difference between the two groups was not significant (P > 0.05). One patient in the T‐EMG group developed a transient aggravation of symptoms on the first day after surgery. In the IOM group, three patients had intraoperative cerebrospinal fluid leakage, and symptoms of C5 nerve root paralysis were presented in four patients following surgery. Compared with the IOM group, the T‐EMG group had fewer complications (1/35; 7/39, P < 0.05). At the last follow‐up, the modified MacNab criteria were 91.43% (32/35) and 89.7% (35/39) for the T‐EMG group and IOM group, respectively.ConclusionsTriggered EMG prevents the occurrence of neurological complications, which not only aids PPECD for CSR treatment in achieving satisfactory results, but also reduces average hospital stay and complication rates.

Percutaneous Full-Endoscopic Anterior Transcorporeal Cervical Discectomy for the Treatment of Cervical Disc Herniation: Surgical Design and Results

Studies that focus on percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) have rarely been reported. Therefore, the available data on the surgical design of PEATCD and related clinical outcomes are very limited. To design a surgical plan for PEATCD and to evaluate its clinical efficacy in clinical application. A retrospective cohort study. A center for spine surgery, rehabilitation department and pain medicine. Based on the size and precise location of the disc protrusions on magnetic resonance imaging (MRI), the diameter and direction of the bone channel were designed to make a surgical plan for PEATCD. A total of 26 patients with central/paracentral cervical disc herniation (CDH) who underwent PEATCD through the designed surgical plan from October 2015 to September 2016 were enrolled in the retrospective study. Clinical outcome evaluations included Visual Analog Scale (VAS) scores, Japanese Orthopedic Association (JOA) scores, and the modified Macnab criteria. Radiologic follow-up included cervical computerized tomography (CT) and MRI evaluations. The diameter of the designed bone channel was about 7.5 mm, and the direction was from the upper edge of the lower endplate obliquely toward the disc protrusion. Through the designed surgical plan, 26 cases of discectomy were successfully completed. The average operation time was 91.50 ± 16.80 min, and the average hospital stay was 4.07 ± 0.84 days. All patients were followed for an average of 19.61 ± 4.04 months. The postoperative VAS and JOA scores were significantly improved compared with the preoperative scores (P < 0.0001). Clinical efficacy at the final follow-up was evaluated by the modified Macnab criteria, and the excellent and good rate was 92.31%. Postoperative MRI showed that the disc protrusion was completely removed, and CT showed no collapse of the vertebral body. This study has several limitations, including the lack of a control group, the small sample size, and the unavoidable nature of the single-center study design. Based on the size and location of the disc protrusion on MRI, the diameter and direction of the bone channel are designed, which is conducive to have enough space under the full-endoscopic field of view to completely expose and remove the disc protrusion, to avoid residuals, and to ensure that PEATCD achieves good therapeutic results. The study was registered at Chinese Clinical Trial Registry (ChiCTR1900027820).

Relationship between cervical curvature and spinal cord drift distance after laminectomy via lateral mass screw fixation and its effect on clinical efficacy.

Background:Laminectomy with lateral mass screw fixation (LCS) is considered an effective surgical procedure for cervical spondylotic myelopathy. However, varying degrees of loss of the cervical curvature were noted in some patients postoperatively. The aim of this study was to observe the relationship between cervical curvature and spinal drift distance after LCS and to determine its effect on neurological function, axial symptoms, and C5 palsy.Methods:A total of 117 consecutive cervical spondylotic myelopathy patients with normal cervical curvature underwent LCS from April 2015 to May 2017 in our institution. Of these patients, 90 patients who accepted to undergo an integrated follow-up were enrolled in this study. The patients were divided into 3 groups based on their postoperative cervical curvature. In group A (28 patients), the cervical curvature became straight postoperatively (0°≤cervical spine angle≤5°); in group B (36 patients), the cervical curvature decreased (5°<cervical spine angle≤16.5°); and in group C (26 patients), the cervical curvature remained normal (cervical spine angle>16.5°). Spinal drift distance, neurological recovery, axial symptoms, and C5 palsy in the patients were recorded and analyzed.Results:Postoperative measurements showed that there was no significant difference in laminectomy width between the groups (P > .05). The cervical spine angle was 2.7° ± 0.5° in group A, 11.2° ± 2.6° in group B, and 20.8° ± 4.1° in group C (P < .05), while the spinal drift distance was 1.2 ± 0.2 mm, 1.8 ± 0.4 mm, and 3.0 ± 0.5 mm, respectively (P < .05). The postoperative Japanese Orthopedic Association score was significantly increased in all groups (P < .05), and there was no significant difference between the groups at different time points (P > .05). However, significant differences were noted between the groups in axial symptoms (P < .05), which were analyzed via the visual analog scale score. The occurrence of C5 palsy in groups A, B, and C was 7.1% (2/28), 8.3% (3/36), and 11.5% (3/26), respectively (P > .05).Conclusion:In LCS, the cervical curvature should be maintained at the normal angle to obtain a good spinal cord drift distance and a lower incidence of axial symptoms.

Factors Affecting Incomplete L5/S Posterior Lumbar Interbody Fusion, Including Spinopelvic Sagittal Parameters.

Study DesignRetrospective observational study.PurposeIn this study we identify risk factors, including patient demographics, sagittal parameters, and clinical examinations, affecting incomplete L5/S posterior lumbar interbody fusion (PLIF).Overview of LiteratureThe lumbosacral spine is considered to have an interbody fusion rate lower than that of the lumbar spine, but few studies have investigated the cause, including investigating the pelvis. We believe that pelvic morphology can affect L5/S interbody fusion of the lumbosacral spine.MethodsWe observed 141 patients (61 men, 80 women; average age, 65.8 years) who had undergone PLIF and checked for the presence of L5/S interbody fusion. We investigated factors such as age, gender, the presence of diffuse idiopathic skeletal hyperostosis (DISH), fusion level, and grade 2 osteotomy, as well as pre-, post-, and post–preoperative L5/S disk height and angle, lumbar lordosis, Visual Analog Scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and pelvic incidence (PI), comparing those with and without L5/S interbody fusion. In addition, we analyzed the patients classified into short-level (n=111) and multi-level fusion groups (n=30).ResultsOverall, the L5/S interbody fusion rate was 70% (short-level, 78%; multi-level, 40%). Age and pre- and post–preoperative L5/S disk angle were significantly different in each fusion level group. DISH presence, grade 2 osteotomy, and postoperative VAS and JOA scores were significantly different in the short-level fusion group, whereas PI was significantly different in the multi-level fusion group.ConclusionsIncomplete union after L5/S PLIF correlates with advanced age, many fusion levels, and a large value of preoperative and a small value of post–preoperative L5/S disk angles.

Use of a nano-hydroxyapatite/polyamide composite in anterior cervical subtotal corpectomy and fusion

This study aimed to explore the safety and efficacy of using nano-hydroxyapatite/polyamide (N-HA/PA) composite in anterior cervical vertebral body subtotal corpectomy and interbody fusion. Total 50 patients with cervical spondylotic myelopathy were enrolled to undergo anterior cervical spondylectomy. Bone graft pedicles were compounded with N-HA/PA and intervertebral body fusion was performed. Study outcomes included surgical efficacy and the degree of fusion. Patients in whom vertebral body fusion was performed with N-HA/PA composite pedicles had significantly improved symptoms. The postoperative Japanese Orthopaedic Association scores increased to 18.56±4.37 from 11.37±3.52, reflecting an improvement rate of 87.3%. The composite pedicle fusion rate was 96.4%. Therefore, N-HA/PA composite pedicle as a bone graft material in fusion surgery provides significant therapeutic efficacy. Moreover, the composite pedicle fusion rate is high, making it ideal for anterior cervical vertebral body subtotal corpectomy and fusion.

Does fusion status following posterolateral lumbar fusion in the treatment for stable lumbar degenerative spondylolisthesis affect the long-term surgical outcomes? A propensity score-weighted analysis of consecutive patients

BackgroundThe surgical strategy of lumbar degenerative spondylolisthesis (LDS) is controversial, especially regarding whether or not fusion should be used. Although some reports have indicated that decompression combined with fusion may be better than decompression alone in the treatment of LDS, the effect of fusion status after uninstrumented posterolateral lumbar fusion (PLF) on the outcomes of patients with stable LDS remains unknown. This study aimed to evaluate the surgical outcomes of uninstrumented PLF for stable LDS and clarify whether radiographic fusion status could affect surgical outcomes. MethodsA total of 93 consecutive patients who had undergone single-level uninstrumented PLF for Meyerding grade I LDS without preoperative dynamic instability with a minimum follow-up period of 5 years were retrospectively studied. Patients were divided into two groups: nonunion (52 patients) and union (41 patients). The primary outcomes were the 5-year percent recovery of postoperative Japanese Orthopaedic Association (JOA) scores, Oswestry Disability Index (ODI), Visual analog scale (VAS) scores, and reoperation rate. The outcome scores were compared between the groups using the inverse probability weighting method using propensity scores. ResultsThe union and nonunion groups had comparable weighted means of the 5-year postoperative clinical score for the percent recovery of the JOA score (70.2% vs. 71.1%, P = 0.86), ODI (14.5 vs.14.6, P = 0.98), VAS of low back pain (20.3 vs. 18.7 mm, P = 0.72), and VAS of leg pain (24.0 vs. 19.4 mm, P = 0.43). The reoperation rate was 2.4% (one case of adjacent segment pathology) in the union group and 0% in the nonunion group (P = 0.44). ConclusionThe fusion status following uninstrumented PLF had no significant effect on the 5-year postoperative clinical outcomes and reoperation rate in patients with Meyerding grade I LDS without dynamic instability.

Impact of various MRI signal intensity changes on radiological parameters, the neurological status, and surgical outcomes in degenerative cervical myelopathy

Study designA retrospective study of prospectively collected date. PurposeThe present study aimed to identify patient characteristics, radiological factors, the neurological status, and postoperative outcomes associated with MRI signal intensity changes in degenerative cervical myelopathy (DCM). Material and methodOne hundred and fourteen DCM patients who underwent posterior decompression surgeries were enrolled. Pre- and postoperative (12 months) Japanese Orthopedic Association (JOA) scores, cervical alignment and balance on X rays, the cross-sectional area of the spinal cord (CSA) in kinematic CT myelography (CTM). The recovery rate (RR) of the total JOA score and those specific for the upper and lower limb items were evaluated. MRI included T1-weighted imaging (WI) and T2WI. Patients were classified into two groups for a univariate analysis according to the presence or absence of a high signal intensity (HIS) in the sagittal view on T2WI, a low signal intensity (LSI) in the sagittal view on T1WI, the distribution of HSI at a single or multiple levels, and the presence or absence of the snake eye appearance. A multiple logistic regression analysis (MLRA) was performed to identify factors associated with signal intensity changes on MRI. ResultsNinety-six patients (84.3%) were classified into HIS changes in the sagittal view on T2WI. The group with multilevel HSI showed significantly lower RR specific for the lower extremity JOA score (30.8% vs 47.7%; P = 0.016). The snake eye-positive group showed a significantly inferior RR specific for the upper extremity JOA score (40.1% vs 53.2%; P = 0.04).In MLRA, LSI changes on T1WI revealed small CSAF (P = 0.02, Odds ratio; 0.77, 95%CI:0.61–0.97), while HSI changes on T2WI revealed a small CSAF (P = 0.008, Odds ratio;1.36, 95%CI:1.08–1.72) and large C2–7 angle during extension (P = 0.009, Odds ratio;0.73, 95%CI:0.58–0.92). CSAF correlated with multilevel HSI changes (P = 0.006, Odds ratio;0.78, 95%CI:0.66–0.93). The snake eye appearance correlated with CSAF (P = 0.006, Odds ratio;0.78, 95%CI:0.66–0.93) and the duration of disease (P = 0.05, Odds ratio;1.01, 95%CI:1.0–1.03). ConclusionSevere and poorly compensated spinal cord compression during neck flexion may cause signal intensity changes. The snake eye appearance may be useful as a sign of the inferior postoperative recovery of upper limb function, and multilevel HSI as a sign of the inferior postoperative recovery of lower limb function.

Quantitative Evaluation of the Trauma of CT Navigation PELD and OD in the Treatment of HLDH: A Randomized, Controlled Study

More evidence is required to support that computerized tomography navigation percutaneous spinal endoscopy in the treatment of highly migrated lumbar disc herniation is a more minimally invasive surgery than open discectomy . To quantitatively evaluate the efficacy and minimal invasiveness of computerized tomography navigation percutaneous spinal endoscopy and open discectomy in highly migrated lumbar disc herniation. A prospective randomized study. First Affiliated Hospital of Gannan Medical College. From August 2016 to February 2020, 68 patients with highly migrated lumbar disc herniation had undergone discectomy. Thirty-five of them randomly received computerized tomography (CT) navigation percutaneous spinal endoscopy at the pain department (CT navigation percutaneous spinal endoscopy group), and 33 patients received open discectomy at the orthopedics department (open discectomy group). The Visual Analog Scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and modified MacNab criteria were applied to evaluate the clinical situations pre- and post-operation. The serum concentrations of IL-6, TNF-alpha, creatine phosphokina (CPK), and C-reactive protein (CRP) in the 2 groups were quantitatively measured. The postoperative VAS scores of the back and lower extremity were lower than those pre-operation in both groups, while the VAS score of back pain in the open discectomy group was significantly higher than that in the CT navigation percutaneous spinal endoscopy group at one week post-operation (P < 0.01). The postoperative JOA scores were significantly higher than those pre-operation in both groups. The serum concentrations of IL-6, TNF-alpha, CPK, and CRP in the open discectomy group were higher than those in the computerized tomography navigation percutaneous spinal endoscopy group postoperatively (P < 0.01). This is a single-center randomized study and with the limitation of the sample size. CT navigation percutaneous spinal endoscopy is a more minimally invasive surgery than open discectomy.Certificate number for the medical institution conducting the clinical trials for humans in China: 934.

The Influence of Diabetes Mellitus on Rotator Cuff Repair: A Systematic Review and Meta-Analysis.

Clinical outcomes after rotator cuff repair associated with diabetes mellitus (DM) are generally favorable, but no study has attempted to establish the influence of DM on outcomes after rotator cuff repair. To conduct a meta-analysis of clinical studies evaluating patient outcomes between people with DM and people without DM after rotator cuff repair. Meta-analysis. A literature search of the Embase, PubMed, and Cochrane Library databases was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Cohort studies and case-control studies about clinical outcomes after rotator cuff repair comparing people with DM and people without DM were included. Statistical analysis was performed with RevMan (v 5.3.3). Nine clinical studies that met the inclusion criteria were identified and included a total of 314 patients treated with DM and 1092 patients without DM. The failure rate was significantly higher in the DM group than in Non-DM group (23.97% compared with 16.60%, OR: 2.39; 95% CI, 1.69-3.37; p < 0.001). The postoperative retear rate and showed a significant difference between the two groups (24.5% and 13.7%; OR: 2.41; 95% CI, 1.57-3.71; p<0.001). The DM group showed a higher rate of postoperative unhealed cuff than the Non-DM group(41.81% and 25.23%; OR: 2.14; 95% CI, 1.69-3.37; p=0.01).Postoperative Range of motion(ROM) at 12 months after surgery show a significant difference in the range of external rotation between two groups (WMD: -6.02; 95% CI, -7.54 to -4.50; p<0.001). The preoperative Japanese Orthopaedic Association (JOA) score, the comparison of pre- and post-operative JOA scores showed a significant difference in the DM and Non-DM group(p<0.001). The postoperative JOA score, the pre- and post-operative muscle strength, the pre- and post-operative visual analog scale (VAS) show significant difference between the DM and Non-DM group(p<0.001). The postoperative infection rates, the rates of postoperative shoulder stiffness, the preoperative ROM, the postoperative ROM at 6 months, the postoperative ROM at 12 months of forward flexion and abduction, the American Shoulder and Elbow Surgeons score, the University of California, Los Angeles scores, and the preoperative Constant-Murley scores show no significant difference between the two groups. This meta-analysis indicates that DM may be relative to a higher rate of shoulder retear and cuff unhealing. However, patients with DM can achieve great clinical outcomes after cuff repair, compared to patients without DM.

Surgery Can Improve Locomotive Syndrome Due to Lumbar Spinal Canal Stenosis and Loco-Check Can Predict Best Timing of Surgery to Avoid Progress of Locomotive Syndrome.

Introduction The loco-check is a simple tool for evaluating locomotive syndrome (LS), and a previous report suggested that it can be used to identify patients with stage 2 LS. The purpose of this study was to investigate the improvement in LS stage after surgery based on the loco-check in elderly patients with lumbar spinal stenosis (LSS) and to clarify the characteristics associated with improvement to non-stage 2 LS. Methods We reviewed 40 elderly patients with LSS who underwent surgery at our institution. We compared the pre- and postoperative Japanese Orthopaedic Association score, loco-check, Oswestry Disability Index, EuroQoL-5 dimension utility values, and the EuroQoL-visual analog scale. We divided patients according to the presence or absence of stage 2 LS after surgery and compared their preoperative clinical findings and assessment measures. Results Ninety percent of all patients had been preoperatively diagnosed with stage 2 LS according to the loco-check. After surgery, patients showed a decreased number of affirmative answers on the loco-check, according to which only 65% were postoperatively diagnosed with stage 2 LS. The receiver operating characteristic curve analysis identified less than four affirmative answers on the loco-check before LSS as predictive of improvement to non-stage 2 LS. Conclusions Surgical treatment for elderly patients with LSS could improve LS. In patients with less than four affirmative answers on the loco-check preoperatively, improvement to non-stage 2 LS status may be possible.

Optimal Time Period of Wearing Protective Collar after Anterior Cervical Discectomy and Fusion

Objective: There is still no consensus on the time period of wearing protective collar after Anterior Cervical Discectomy and Fusion (ACDF). We aim to investigate the optimal time period of wearing collar after ACDF. Methods: We retrospectively reviewed patients with cervical spondylosis who underwent one or two segment ACDF during January 2016 and December 2017, and included 97 patients who met inclusion and exclusion criteria. Patients were divided into three groups, 1-4 week group, 5-8 week group and 9-12 week group, according to the actual time period of wearing collar after ACDF. We analyzed Japanese Orthopedic Association (JOA) score, Axial Symptom (AS) score and Neck Disability Index (NDI) before surgery and at post-operative 3 months to investigate the optimal time period of wearing collar after ACDF procedure. Results: 1) JOA score: All three groups have a better post-operative JOA score compared with that before surgery (paired t test, p&lt;0.05). There is no significant difference among the three groups with respect to post-operative JOA (ANOVA, p&gt;0.05). 2) AS score: The post-operative AS scores of 1-4 week group and 5-8 week group were significantly better than that before surgery (paired t test, p&gt;0.05). While the post-operative AS score of 9-12 week group was significantly worse than preoperative AS score (paired t test, p&lt;0.05). 3) NDI: All three groups have a better post-operative NDI compared with that before surgery (McNemar test, p&lt;0.05). Of note, in 5-8 weeks group, the percentage of no deficit increased by 45%, and the percentage of mild deficit decreased by 45% accordingly. That percentage is 26% and 31% in 1-4 week group and 9-12 week group, respectively. There was significant difference among these three groups (Fisher’s exact probability test, p&lt;0.05). Conclusion: For cervical spondylosis patients who underwent 1 or 2 segment ACDF, the optimal time period of wearing protective is 5-8 weeks. This time period results in comparable neurological outcome, least risk of axial symptoms, and highest chance of no deficit with neck function.

Ligamentum-preserved/Temporary Preserved Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Spondylolisthesis: Technical Note and 2-year Follow-up.

Prospective study. The aim of this study was to prospectively assess the clinical outcomes of modified minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for the treatment of singlesegment lumbar spondylolisthesis. MIS-TLIF is a safe and effective procedure in the treatment of lumbar degenerative disease. To avoid durotomy and nerve root injury, we modified the surgical order of MIS-TLIF such that the interbody fusion procedure was performed before the decompression procedure. One hundred thirty-nine patients with single-segment lumbar spondylolisthesis were separated into two groups. Sixty-seven patients underwent modified MIS-TLIF (group A). In group B, 72 patients underwent routine MIS-TLIF. The Japanese Orthopedic Association (JOA) score and the visual analogue scale (VAS) scores for lower back pain (LBP) and leg pain were assessed during the postoperative follow-up, and the lumbar interbody fusion rate was evaluated by CT scanning. The mean operative time, incision length, average blood loss, and incision pain level were not significantly different (P > 0.05) between the two groups. No nerve root or dural injuries were observed in group A. In group B, there were two cases of dural injury and three cases of nerve root injury. One patient experienced temporary numbness and weakness on dorsiflexion of the foot, which recovered in 3 months. No differences were identified between the two groups when postoperative JOA scores, back pain, leg pain VAS scores, or the lumbar interbody fusion rate. Both methods are effective in the treatment of lumbar degenerative disease. Modified MIS-TLIF is a safe and effective procedure that can significantly reduce the occurrence of injury to the dura and nerve root during decompression and the interbody fusion procedure.Level of Evidence: 3.