Preservation Of Range Of Motion Research Articles

Temporary halo fixation and radiotherapy as alternative to long-construct spondylodesis in patients with multiple unstable cervical metastases

Background and purposeCurrently no minimally invasive surgical treatment exists to provide immediate stability for unstable cervical/cervicothoracic metastases. Long-construct spondylodesis carries a high complication risk and has severe impact on residual range of motion. This study explores temporary halo fixation and radiotherapy as an alternative to long-construct cervical spondylodesis. Materials and methodsThis retrospective cohort study included twenty patients with multiple unstable cervical metastases treated between 2013–2023. All patients underwent halo fixation for an intended duration of three months to allow for safe reossification of lytic lesions following radiotherapy, with a dose fractionation scheme best suited to the histological origin of the tumor. ResultsImmobilization with halo fixation lasted a median 83 days (range, 41–132 days). Radiotherapy started on average 7 days after halo fixation (range, −35–118 days). The median pain score at baseline was 8, and was 0 at halo removal and at last follow-up. All patients had no or minor neurological deficits at baseline and did not develop new neurological deficits. At halo removal, 17/18 patients showed radiographic evidence of reossification. The majority of patients experienced minor limitations or had full range of motion of the neck at last follow-up. ConclusionPatients with multiple unstable cervical metastases treated with halo fixation and radiotherapy showed complete pain response or substantial pain reduction, reossification of the vertebrae and a, mostly, preserved range of motion. In selected neurologically intact patients, this treatment might be a patient-friendly alternative to fixation. Prospective evaluation of this treatment combination is needed.

Cervical Alignment and Range of Motion Change after Anterior 3-Level Hybrid Surgery Compared with Cervical Laminoplasty: A Matched Cohort Study.

Cervical alignment and range of motion (ROM) changes after cervical spine surgery are related to cervical biomechanical and functions. Few studies compared these parameters between posterior laminoplasty and anterior 3-level hybrid surgery incorporating anterior cervical discectomy and fusion (ACDF) with cervical disc replacement (CDR). This study is aimed to detect the differences of cervical alignment and ROM changes of the two surgeries in a matched-cohort study. From January 2018 and May 2020, 51 patients who underwent 3-level hybrid surgery incorporating ACDF with ACDR were included. A 1:1 match of the patients who underwent cervical laminoplasty based on age, gender, duration of symptoms, body mass index, and cervical alignment type was utilized as control group. General data (operative time, blood loss, etc.), Japanese Orthopaedic Association (JOA) score, VAS (Visual Analog Score), NDI (The Neck Disability Index), cervical sagittal alignment, and cervical range of motion (ROM) were recorded and compared. Both groups gained significant improvement in JOA, VAS, NDI scores postoperatively (p < 0.05). Cervical alignment significantly increased in hybrid group and decreased in control group after surgeries (p < 0.001). ROM decrease was similar in two groups. For cervical lordosis, though cervical alignment angle in control group decreased, the final follow-up cervical alignment and cervical alignment changes were not significantly different between hybrid and control groups. For cervical non-lordosis, cervical alignment decreased in control group while increased in hybrid group. At final follow-up, cervical alignment and the changes between the two groups were significantly different. Both control group and hybrid group had similar ROM decrease after the surgery no matter whether there was cervical lordosis or non-lordosis. Hybrid surgery showed cervical alignments significantly improved and similar ROM preservation compared with control group at final follow-up both for 1-level and 2-level disc replacement subgroups. The hybrid surgery demonstrated advantages of preserving cervical alignment and gaining similar cervical ROM preservation compared with cervical laminoplasty, especially for cervical non-lordosis. Given the importance of restoring lordotic cervical alignment, hybrid surgery may be preferred over laminoplasty to treat multilevel cervical disc herniation.

Homodigital Unipedicled Islanded Neurovascular Pulp Advancement Flap/Colombo Flap for Fingertip Reconstruction: A Case Series with a Novel Technique.

Fingertip injury is the most common type of upper extremity injury. Operative treatment with flap cover is required for tissue loss causing bone exposure and when there is a compelling need to preserve the length, unless microvascular replantation is possible. There are many techniques described for this purpose offering varying degrees of good outcomes. Yet there are limitations and long-term problems. We report a case series with a novel technique named "Colombo flap," which is a neurovascular islanded advancement flap based on a single pedicle. Five fingers of four consented patients were operated using this technique and they were followed up for 2.5 years. All had satisfactory sensory recovery (S3 +/S4), preserved range of motion (ROM) at interphalangeal joints, good grip strengths, and satisfactory outcomes based on Michigan Hand Questionnaire (MHQ). There were no complications such as flap necrosis, infection, and neuroma formation. Hook nail deformity was minimal and none had pain or cold intolerance.

Axial Neck Pain after Cervical Laminoplasty with Preserving C7 Spinous Process Using C7 Arcocristectomy: A Prospective Study.

Single-blinded, randomized, single-center, prospective study. This study aims to compare the radiographical and clinical outcomes between C7 laminoplasty and C7 arcocristectomy, which preserves the C7 spinous process. Laminoplasty is a widely used surgical method that decompresses the cervical spinal cord. However, axial neck pain is one of the major factors of dissatisfaction, and still, it is not clearly solved the reduction method of postoperative axial neck pain. Thirty-one patients with multilevel cervical spondylotic myelopathy who required C6-C7 level decompression surgery were operated and followed up for 24 months. One group (15 patients) received C7 arcocristectomy without laminoplasty, and the other group (16 patients) received C7 laminoplasty. Flexion, neutral, and extension angles were measured using the Cobb method at C2-C7 to evaluate preoperative and postoperative radiographic parameters. Range of motion (ROM), ROM preservation rate of the cervical spine, C2-C7 sagittal vertical axis (SVA), and T1 slope were measured using C-spine lateral X-ray. The Visual Analog Scale (VAS) and modified Japanese Orthopedic Association (JOA) score were used to compare preoperative and postoperative clinical symptoms. Flexion, neutral, extension angles of the cervical spine, C2-C7 SVA, T1 slope, ROM, ROM preservation rate, and modified JOA score were not significantly different between the two groups (p>0.05). In the C7 arcocristectomy group, the average postoperative VAS for axial neck pain was increased in 13.3% (2/15) of the patients, whereas in the C7 laminoplasty group, the average postoperative VAS was increased in 43.8% (7/16) of the patients (p=0.018). C7 arcocristectomy, which preserves the C7 spinous process and posterior structures, is a useful technique for relieving axial neck pain.

Combining Laminoplasty With Artificial Disc Replacement for the Treatment of Cervical Spondylotic Myelopathy With Congenital Cervical Stenosis.

Cervical spondylotic myelopathy (CSM) is a very common and devastating spinal disease. Congenital cervical stenosis (CCS) is the most common cause. We aimed to elucidate the security, effectivity, and feasibility of surgery combining laminoplasty with artificial disc replacement (ADR) to treat CSM patients with radiculopathy, especially for preserving the range of motion (ROM) of the cervical spine. Between August 2008 and April 2019, 39 patients with multiple CSM caused by CCS were enrolled in the present study. All patients received laminoplasty first and then ADR. We used a retrospective collection of data for evaluating the functional and radiologic outcomes, especially regarding preservation of ROM. Each patient underwent at least a 2-year postoperative follow-up. The Japanese Orthopedic Association score showed great improvements at 6 months. The ADR index-level ROM was preserved during follow-up. The subaxial Cobb angle could also be retained in the whole cervical spine, and the spinal canal diameter could be expanded by more than 52.6%. There were no severe complications or side effects, and no patients needed secondary surgery. We aimed to treat multiple levels of CSM with adequate decompression without too many intervertebral disc replacements. We were able to expand the spinal canal directly for these patients with CCS and needed only 1- or 2-level ADR to treat them with associated radiculopathy. This combined surgical strategy was secure, effective, and was able to preserve the ROM of the cervical spine.

Long-term functional and radiological outcomes of cervical disc arthroplasty at a tertiary level spine center in India: A retrospective cohort analysis with minimum 2 years of follow-up.

Cervical disc arthroplasty (CDA) was developed for the treatment of cervical disc disease with the potential advantages of preservation of physiological motion at a discal level, thereby potentially reducing adjacent level stresses and degeneration, which were a known complication of anterior cervical arthrodesis. The objective of this study was the assessment of long-term functional and radiological outcomes overtime in all the patients who underwent CDA from 2011 to 2019 at our institute. Forty-eight patients who underwent CDA (2011-2019) with a minimum 2-year follow-up were retrospectively evaluated. The functional outcome included the Visual Analog Score (VAS) and Neck Disability Index (NDI). Radiographs were assessed for range of motion (ROM) at the index surgical level, presence of heterotopic ossification (HO), and adjacent segment degeneration. The mean follow-up was 5.79 ± 2.96 (2.16-11.75) years. Significant improvement (P < 0.05) was observed in the VAS (8.91 ± 2.52 [preoperative] to 0.89 ± 1.27 [follow-up]) and NDI (65.5% ±23.06% [preoperative] to 4.79 ± 3.87 [follow-up]) score. Motion at index level increased significantly from 5.53° preoperatively to 7.47°, and 92% of the implanted segments were still mobile (referring to the threshold of ROM > 3°). HOs are responsible for the fusion of 4/50 (8%) levels at the last follow-up. Distal and proximal adjacent disc degeneration occurred in 36% and 28% of patients, respectively. No migration of the implant was observed on the radiograph. Our study showed favorable clinical outcome of CDA with preservation of ROM at the index surgical level. CDA can be a promising alternative to anterior cervical arthrodesis when properly indicated.

CATASTROPHIC ANTIPHOSPHOLIPID SYNDROME: A VICIOUS CIRCLE OF CLOTTING AND BLEEDING

CATASTROPHIC ANTIPHOSPHOLIPID SYNDROME: A VICIOUS CIRCLE OF CLOTTING AND BLEEDING

Subacromial Balloon Spacer: Indications, Rationale, and Technique.

First, a diagnostic arthroscopy is performed. In addition to evaluating the rotator cuff, care is taken to evaluate the tendinous insertion of the subscapularis as well as the long head of the biceps tendon, the labrum, and the articular cartilage of the joint. Synovectomy, bursectomy, and biceps tenodesis or tenotomy are performed as appropriate. For cases with an intact or repairable subscapularis, an acromioplasty is performed. The balloon size is determined with use of a probe through the lateral portal, measured from 1 cm medial to the superior glenoid rim to the lateral border of the acromion. The balloon-insertion device is advanced through the lateral portal, and the balloon is inflated with sterile saline solution after appropriate subacromial positioning. The balloon is then sealed and detached from the insertional device. Most treatment algorithms attempt to reduce pain and dysfunction with initial nonoperative treatment options4. For cases in which nonoperative treatment has failed, several surgical techniques have been described. These include partial rotator cuff repair, graft interposition, graft augmentation, superior capsular reconstruction, tendon transfers, and reverse total shoulder arthroplasty5. Ideal candidates for this procedure are patients with irreparable symptomatic rotator cuff tears. These patients should primarily complain of pain and have a preserved range of motion. Alternatively, if they have reduced range of motion because of pain, then their range of motion should improve after a corticosteroid injection. It is also important that the patient has an intact or repairable subscapularis. The balloon is beneficial in patients with medical comorbidities that would limit the use of other techniques dependent on biologic tissue healing or that would limit the use of arthroplasty. Poor candidates would be patients with pseudoparalysis, axillary nerve palsy, irreparable subscapularis tears, or severe glenohumeral arthritis (Hamada grade ≥3). A recent randomized clinical trial demonstrated the 2-year efficacy, safety, and benefits of the InSpace subacromial balloon spacer6. The authors reported significant early clinical benefit that was maintained over 2 years. Additionally, this benefit was equivalent or superior to the partial-repair control group at all included time points. The multiyear clinical efficacy of the subacromial balloon spacer in that study was similar to that reported by Familiari et al. and Senekovic et al. at 3 and 5 years postoperative, respectively1,7. Together, these studies would suggest that the initial benefit of the subacromial balloon spacer lasts beyond its biodegradation at 12 months postoperatively. Proper placement of the lateral portal should be made parallel to the supraglenoid tubercle. Such placement allows easy insertion and orientation of the balloon at the midpoint of the supraglenoid tubercle.Arthroscopic evaluation of the subscapularis must be performed. For cases with a torn subscapularis, partial or complete repair is recommended to maximize anteroposterior coupling forces that are critical to the function of the balloon.Preservation of the medial bursa and coracoacromial ligament will provide structural constraints against medial migration of the balloon into the supraspinatus fossa.Acromioplasty can be performed to create a smooth articulating surface and minimize friction on the implant, but should only be done in cases in which there is an intact or repairable subscapularis to minimize the risk of anterior escape.Adequate debridement, with acromioplasty as needed, will provide full visualization of the subacromial space to allow proper sizing of the spacer. Proper implant sizing will reduce the risk of subsequent balloon displacement postoperatively.If the measurement of the balloon is between 2 sizes, the larger spacer can be selected to limit displacement.Overinflation of the balloon can cause excessive tension on the deltoid. Underinflation increases the risk of escape. To optimize inflation of the balloon, the senior author prefers to fill the balloon to the recommended maximum volume and then remove saline solution until the balloon reaches the recommended final volume.If there is partial tearing of the long head of the biceps, a tenotomy or tenodesis is recommended. ROM = range of motionRCT = randomized clinical trialTSA = total shoulder arthroplastySCR = superior capsular reconstructionRC = rotator cuffISP = infraspinatusSSP = supraspinatusSSC = subscapularisRI = rotator intervalCAL = coracoacromial ligamentCA = coracoacromialC = coracoidMRI = magnetic resonance imagingSAD = subacromial decompressionPRO = patient-reported outcomeFDA = U.S. Food and Drug Administration.

ProDisc-C versus anterior cervical discectomy and fusion for the surgical treatment of symptomatic cervical disc disease: two-year outcomes of Asian prospective randomized controlled multicentre study.

Our study aimed to evaluate non-inferiority of ProDisc-C to anterior cervical discectomy and fusion (ACDF) in terms of clinical outcomes and incidence of adjacent segment disease (ASD) at 24-months post-surgery in Asian patients with symptomatic cervical disc disease (SCDD). This multicentre, prospective, randomized controlled trial was initiated after ethics committee approval at nine centres (China/Hong Kong/Korea/Singapore/Taiwan). Patients with single-level SCDD involving C3-C7-vertebral segments were randomized (2:1) into: group-A treated with ProDisc-C and group-B with ACDF. Assessments were conducted at baseline, 6-weeks, 3/6/12/18/24-months post-surgery and annually thereafter till 84-months. Primary endpoint was overall success at 24-months, defined as composite of: (1) ≥ 20% improvement in neck disability index (NDI); (2) maintained/improved neurologic parameters; (3) no implant removal/revision/re-operation at index level; and (4) no adverse/severe/life-threatening events. Of 120 patients (80ProDisc-C,40ACDF), 76 and 37 were treated as per protocol (PP). Overall success (PP) was 76.5% in group-A and 81.8% in group-B at 24-months (p = 0.12), indicating no clear non-inferiority of ProDisc-C to ACDF. Secondary outcomes improved for both groups with no significant inter-group differences. Occurrence of ASD was higher in group-B with no significant between-group differences. Range of motion (ROM) was sustained with ProDisc-C but lost with ACDF at 24-months. Cervical TDR with ProDisc-C is feasible, safe, and effective for treatment of SCDD in Asians. No clear non-inferiority was demonstrated between ProDisc-C and ACDF. However, patients treated with ProDisc-C demonstrated significant improvement in NDI, neurologic success, pain scores, and 36-item-short-form survey, along with ROM preservation at 24-months. Enrolment difficulties resulted in inability to achieve pre-planned sample size to prove non-inferiority. Future Asian-focused, large-scale studies are needed to establish unbiased efficacy of ProDisc-C to ACDF.

Effects of Zembrin® (Sceletium tortuosum) Supplementation on Mood, Soreness, and Performance Following Unaccustomed Resistance Exercise: A Pilot Study

The purpose of this study was to investigate acute Zembrin® (Sceletium tortuosum) supplementation on muscle soreness, markers of muscle damage, mood, and exercise performance following unaccustomed resistance exercise. Untrained females (n = 16) were divided into two groups with a different three-day treatment regimen: (1) placebo (PL) and (2) Zembrin® (ZEM). During the initial visit, baseline perceived soreness, range of motion (ROM), mood state (profile of mood states (POMS) questionnaire), and plasma lactate dehydrogenase concentrations (LDH) were measured followed by the performance of an eccentric bicep curl protocol with their non-dominant arm. The total repetitions and rate of perceived exertion (RPE) were recorded throughout the exercise. The participants then supplemented with the corresponding treatment immediately following, the subsequent day, and 30 min prior to completing a 48 h follow-up visit. For the 48 h visit, all procedures were repeated and comparisons were drawn for perceived soreness, ROM, LDH, mood scores, total repetitions, and RPE. The findings indicate that short-term ZEM supplementation resulted in lower perceived soreness (p = 0.020) and a greater preservation of ROM (p = 0.028) at 48 h versus the PL group. Mood worsened from the baseline to 48 h regardless of the treatment (p = 0.043) but the decrements were exacerbated in the PL group compared with the ZEM group (p &lt; 0.001). LDH levels (p = 0.019) and RPE (p = 0.008) were higher and total repetitions were lower (p &lt; 0.001) at 48 h irrespective of the treatment. Although short-term dietary enrichment with ZEM did not alter the exercise performance or biomarkers of muscle damage, the current results suggest ZEM supplementation may be effective in reducing the markers of soreness and preserve mood following unaccustomed eccentric exercise.

C1-C2 Wiring With Timed Self-Obsolescence for Complex C2 Body Fracture.

Fractures of C2 are typically managed nonoperatively with good rates of healing. Management decisions are complicated, however, when there are additional fractures in the axis possibly leading to increased instability. Additionally, the techniques used for treating these unstable axis fractures can have either significant complications or permanent loss of range of motion. Here, we present a novel technique for the reduction and stabilization of complex C2 body fracture. A 34-yr-old woman with a complex C2 body fracture, which included a right pars and left lateral mass fracture, presented after a water slide accident. It was felt that this fracture was both unstable and would not heal in an anatomically acceptable way so an open surgical reduction was needed. After consideration of more traditional fusion and osteosynthesis techniques, we chose to perform a C1-C2 internal stabilization with C1 sublaminar and C2 spinous process wiring. The patient was then instructed to wear a Miami J collar for 3 mo. The outcome was favorable with good approximation and healing with preserved range of motion.

Single-Level Cervical Arthroplasty with a Keel-less Prosthesis: Results in a Series of 35 Patients Operated on for Soft Disk Herniation with a Minimum of 3 Years of Follow-Up.

Cervical arthroplasty with artificial cervical disks has gained popularity as an alternative to anterior discectomy and fusion. The main advantages of disk arthroplasty include maintenance of the range of movement, restitution of disk height and spinal alignment, and reduction of adjacent segment degeneration (ASD). In this article, we aimed to assess the outcomes of the use of a keel-less prosthesis. We included all the patients who underwent single-level cervical arthroplasties with the Discocerv Cervidisc Evolution for "soft" disk herniation. Clinical assessment included Neck Disability Index (NDI) and visual analog scale (VAS) for neck and arm pain. Radiologic studies investigated the occurrence of ASD and system failure or subsidence. The reoperation rate was also recorded. The study included 35 patients (14 men and 21 women; mean age: 42.5 years; mean follow-up: 57.8 months). There was a significant decrease in VAS neck and VAS arm scores, which went from 7.2 and 6.9 preoperatively to 2.2 and 1.7 postoperatively, 2.2 and 1.6 at 6 months, 2.0 and 1.8 at 1 year, and 2.1 and 1.3 at the last follow-up, respectively. The mean NDI score was 58.0 preoperatively, 19.4 postoperatively, 17.0 at 6 months, 16.1 at 1 year, and 16.2 at the last follow-up. Radiologic studies revealed a preserved range of motion in 33 of 35 patients. No ASD occurred and no reoperation was required. Cervical disk arthroplasty with a keel-less prosthesis can be a safe and effective alternative to fusion for degenerative disk disease in selected patients, with a possible reduction of ASD.

Midterm Patient-Reported Outcomes in Wrist Denervation for Post-Traumatic Arthritis

To analyze patient-reported outcomes and range of motion in a cohort of patients who underwent wrist denervation for advanced wrist osteoarthritis. We hypothesized that improvements in pain and function would be seen with preserved range of motion. Thirty patients underwent wrist denervation for symptomatic stage 1-4 scapholunate advanced collapse (SLAC) arthritis. Patient-Rated Wrist Evaluation, Quick Disabilities of the Arm, Shoulder, and Hand score, and range of motion measurements were assessed preoperatively and at final follow-up. The mean follow-up duration was 47 months (range, 24-92 months). The mean age at surgery was 65 years, and 96% of the patients were men. The dominant hand was involved in 66% of cases. The SLAC grades of patients involved were as follows: 10% (n = 3) grade 1, 27% (n = 8) grade 2, 60% (n = 18) grade 3, and 3% (n = 1) grade 4. Two patients required conversion to a wrist fusion and were considered failures. In the remaining 28 patients, the mean Patient-Rated Wrist Evaluation total score decreased 22 points (82.4 to 60.9) and the mean Quick Disabilities of the Arm, Shoulder, and Hand score decreased 8 points (32.4 to 24.8). Total arc of wrist flexion-extension showed an average 5° improvement. This method of wrist denervation was a viable salvage option for patients with symptomatic SLAC wrist osteoarthritis to preserve motion, decrease pain, and increase function with a low absolute failure rate at mid- to long-term follow-up. Therapeutic, Level IV.

Need to Perform Rehabilitation Exercises at Home by Parents of Children with Neurological Diseases to Maintain Performance During COVID-19 Lockdown.

With the outbreak of the novel pandemic coronavirus disease 2019 worldwide, numerous pediatric rehabilitation clinics have closed to support social and physical distancing, and therapists similar to other individuals are staying at their homes. There is a common concern of parents and caregivers that how and with what quality children’s rehabilitation exercises should proceed. Most children with neurological diseases have problems, such as muscle spasticity, range of motion (ROM) limitation, muscle shortening, balance loss, and mobility and movement impairments. The normalization of muscle tone, preservation of ROM, muscle stretch, and improvement of fine and gross motor skills and balance are essential activities that need to be considered. Therefore, this study aimed to summarize the necessities of a home-based rehabilitation exercise program during the quarantine period.

The use of Integra® for abdominal reconstruction after a necrotizing fasciitis in a child

Abstract Necrotizing fasciitis is a rare infection, often requiring large debridement's due to its rapid spread in the soft tissues. Reconstruction is always a challenge. We report the successful use of Integra® Dermal Regeneration Template, combined with Negative Pressure Wound Therapy and thin skin grafts, and a local flap, to reconstruct the abdominal skin in a 7-year-old boy who developed a necrotizing fasciitis after a trauma with his scooter. Stable coverage was achieved, without skin retraction and with a preserved range of motion at 1-year post-operatively.

The Feasibility of Optimal Surgical Result Prediction according to the Center of Rotation Shift after Multilevel Cervical Total Disc Replacement

Study DesignRetrospective design/spine clinic and tertiary referral hospital.PurposeThis study investigated the association between shifted location of center of rotation (COR) and subsequent surgical outcomes and identified radiological parameters that corresponded to COR change after multilevel cervical total disc replacement (MCTDR).Overview of LiteratureCervical total disc replacement (TDR) maintains normal cervical kinematics after surgery. However, there is a paucity of literature analyzing the relationship between radiological shifts of COR and subsequent clinical success, especially when it comes to the issue of MCTDR switch.MethodsThis study included 24 consecutive patients treated with MCTDR following the diagnosis of multilevel cervical disc herniation or stenosis. Numeric rating scale, range of motion (ROM) at both C2–7 segment and TDR implanted levels, and location of COR at TDR level were evaluated pre- and post-MCTDR. These parameters were compared between patients who experienced successful and unsuccessful pain relief.ResultsThe inherent CORs relatively at ventrocranial coordinates demonstrated significant migrations to dorsocaudal location, more prominent shifts for the successful group, after MCTDR switch. The unsuccessful group showed markedly reduced C2–7 ROM and reduced angular improvement at C2–7 segment and MCTDR level compared with the successful group. Postoperative C2–7 ROM was related to postoperative COR along the x-axis.ConclusionsAside from ROM preservation at both C2–7 and TDR levels, COR restoration from ventrocranial location close to normal coordinates by posterior and inferior shifts was marked as a clinical success after MCTDR. The COR position along the x-axis after MCTDR was an important factor to determine maintenance of C2–7 ROM.

Does Heterotopic Ossification in Cervical Arthroplasty Affect Clinical Outcome?

To investigate the occurrence and progression of heterotopic ossification (HO) in patients treated by anterior cervical discectomy with arthroplasty. It was evaluated if HO affects clinical outcome and range of motion (ROM). Risk factors of HO was studied as well. Patients who underwent anterior cervical discectomy with arthroplasty for a cervical radiculopathy because of a herniated disc from the NECK and PROCON trial were analyzed for HO at 12 and 24 months postoperatively. HO was scored according to the McAfee-Mehren classification. The index ROM was defined by a custom developed image analysis tool, and global cervical ROM was measured by Cobb's angle. Clinical outcome was evaluated by means of the Neck Disability Index and the 36-Item Short Form Health Survey. The occurrence of HO was 60% at 1 year, and it increased to 76% at 2-year follow-up. A total of 31% of patients were scored as high-grade HO at 1-year follow-up, and this percentage increased to 50% at 2-year follow-up. Clinical outcome does not correlate to HO grade, and no risk factor for high-grade HO could be identified. The ROM at the index level was significantly higher in low-grade HOgroup than those patients with high-grade HO, but in 15%-38% HO grade does not correspond to ROM. HO occurs in three fourths of the patients at 2 years after surgery, but does not necessarily correspond to clinical outcome, nor loss or preservation of ROM. The McAfee-Mehren classification should be combined with ROM evaluation to properly study HO.

Short-Term Outcomes of Anterior Fusion–Nonfusion Hybrid Surgery versus Posterior Cervical Laminoplasty in the Treatment of Multilevel Cervical Spondylotic Myelopathy

To compare short-term clinical and radiologic outcomes of anterior fusion-nonfusion hybrid surgery (cervical discectomy or corpectomy and fusion combine with cervical disc replacement) and posterior cervical laminoplasty for multilevel cervical spondylotic myelopathy. From January 2014 to December 2015, 105 patients who underwent anterior fusion-nonfusion hybrid surgery (AHS group, n= 48) or posterior cervical laminoplasty (n= 57) for ≥3 disc levels cervical spondylotic myelopathy were included. The Japanese Orthopedic Association (JOA) score, complications, and radiologic results including cervical curvature and cervical range of motion (ROM) were compared between the 2 groups of patients. The complications that occurred within 1 month after the surgery were recorded as early complications, otherwise they were considered late complications. Both groups gained significant JOA scores improvement (P < 0.05). No significant difference in JOA improvement was found between the 2 groups (P > 0.05). The cervical curvature increased significantly in the AHS group (P= 0.024), whereas it decreased significantly in the posterior cervical laminoplasty group (P= 0.002). Cervical ROM of both groups significantly decreased after the surgery (P < 0.05). The preoperative and final follow-up cervical ROM, together with the total cervical ROM preservation rate were not significant different between the 2 groups (P>0.05). The AHS group had a significant higher early complication rate (22/48 vs. 15/57; P= 0.037) and a lower late complication rate (9/48 vs. 21/57; P= 0.041). Both anterior fusion-nonfusion hybrid surgery and cervical laminoplasty could gain satisfied neurological recovery. The anterior hybrid surgery may preserve cervical curvature with a higher early complication rate and a lower late complication rate than cervical laminoplasty.

Comparison of Clinical and Radiographic Results Between Posterior Pedicle-Based Dynamic Stabilization and Posterior Lumbar Intervertebral Fusion for Lumbar Degenerative Disease: A 2-Year Retrospective Study.

To compare outcomes between K-rod dynamic stabilization system (KDSS) and posterior lumbar intervertebral fusion (PLIF) for lumbar degenerative disease. This study retrospectively reviewed 98 patients who underwent lumbar surgery from March 2012 to June 2014, including 48 in the KDSS group and 50 in the PLIF group. All patients were followed up for at least 2 years. Duration of operation, blood loss, hospital stay, complications, and patient satisfaction were recorded and analyzed. Clinical outcomes were evaluated by visual analog scale and Oswestry Disability Index. Radiographic results including disk height index, foraminal height, and range of motion (ROM) were compared between groups. Compared with PLIF group, KDSS group had shorter duration of operation and less blood loss (P<0.001). There were no differences in hospital stay, complications, and patient satisfaction. Both groups demonstrated significant improvement in visual analog scale back and leg pain and Oswestry Disability Index. No significant difference was found between groups at any time point (P > 0.05). Postoperative disk height index and foraminal height increased significantly compared with preoperatively (P < 0.05). Although disk height index and foraminal height in KDSS group were smaller than PLIF group values, there were no significant differences between groups. ROM of total lumbar and implanted segment was decreased compared with preoperative ROM in both groups (P < 0.05), but the 2 values were higher in KDSS group (P < 0.05). Both KDSS and PLIF can improve clinical and radiographic outcomes for early-stage lumbar degenerative disease. Compared with PLIF, KDSS has better operative time, less blood loss, and better preservation of ROM, but prospective, randomized, controlled trials with larger sample size and longer follow-up are required.

Guidance value of TOI classification for treatment of traumatic T-type atlantoaxial dislocation

Objective To investigate the guidance value of TOI classification in treating traumatic T-type atlantoaxial dislocation (ADD). Methods A retrospective case series study was made on 32 cases of traumatic TOI T-type ADD treated between January 2012 and December 2015. There were 19 males and 13 females, aged (38.4±14.7)years. Fifteen cases of T1-type underwent external fixation or internal fixation without fusion, while 17 cases of T2-type underwent internal fixation with fusion. Symon-Lavender clinical standard, Japanese orthopedic association score (JOA), visual analogue scale (VAS), atlas-dens interval (ADI) and space available for the cord (SAC) were used to evaluate the therapeutic effect. Results Patients were followed up for 6-54 months (mean, 32.4 months). At final follow-up, ADI was decreased to (2.3±1.4)mm from preoperative (5.6±1.6)mm, but SAC was increased to (15.4±1.9)mm from preoperative (12.0±2.9)mm (P<0.01). At final follow-up, cervical axial rotation range of motion was 102°-154° in T1-type cases and 57°- 93° in T2-type cases. Range of motion for atlantoaxial joint was preserved in T1-type cases, but lost in T2-type cases. According to the Symon-Lavender clinical standard, there were 14 cases of mild disability, nine moderate disability, eight severe disability and one extremely severe disability before operation; there were 21 cases of mild disability, nine moderate disability and two severe disability at last follow-up. Significant difference was observed in the grades according to the Symon-Lavender clinical standard before operation and at last follow-up (P<0.05). At last follow-up, JOA score was increased to (14.6±2.9)points from preoperative (9.9±3.2)points, and VAS was decreased to (2.7±1.3)points from preoperative (6.0±1.6)points (P<0.01). Conclusions By using TOI classification, reconstruction of stability and improved neurological function can be achieved in treatment of traumatic T-type atlantoaxial dislocation. Non-fusion treatment of T1-type atlantoaxial dislocation can preserve range of motion for atlantoaxial joint. Key words: Atlanto-axial joint; Dislocations; Classification