Objective To establish the mode of anterior cervical surgery in outpatient setting, and evaluate its preliminary effectiveness. Methods A clinical data of patients who underwent anterior cervical surgery between January 2022 and September 2022 and met the selection criteria was retrospectively analyzed. The surgeries were performed in outpatient setting (n=35, outpatient setting group) or in inpatient setting (n=35, inpatient setting group). There was no significant difference between the two groups (P>0.05) in age, gender, body mass index, smoking, history of alcohol drinking, disease type, the number of surgical levels, operation mode, as well as preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale score of neck pain (VAS-neck), and visual analogue scale score of upper limb pain (VAS-arm). The operation time, intraoperative blood loss, total hospital stay, postoperative hospital stay, and hospital expenses of the two groups were recorded; JOA score, VAS-neck score, and VAS-arm score were recorded before and immediately after operation, and the differences of the above indexes between pre- and post-operation were calculated. Before discharge, the patient was asked to score satisfaction with a score of 1-10. Results The total hospital stay, postoperative hospital stay, and hospital expenses were significantly lower in the outpatient setting group than in the inpatient setting group (P<0.05). The satisfaction of patients was significantly higher in the outpatient setting group than in the inpatient setting group (P<0.05). There was no significant difference between the two groups in operation time and intraoperative blood loss (P>0.05). The JOA score, VAS-neck score, and VAS-arm score of the two groups significantly improved at immediate after operation when compared with those before operation (P<0.05). There was no significant difference in the improvement of the above scores between the two groups (P>0.05). The patients were followed up (6.67±1.04) months in the outpatient setting group and (5.95±1.90) months in the inpatient setting group, with no significant difference (t=0.089, P=0.929). No surgical complications, such as delayed hematoma, delayed infection, delayed neurological damage, and esophageal fistula, occurred in the two groups. Conclusion The safety and efficiency of anterior cervical surgery performed in outpatient setting were comparable to that performed in inpatient setting. Outpatient surgery mode can significantly shorten the postoperative hospital stay, reduce hospital expenses, and improve the patients’ medical experience. The key points of the outpatient mode of anterior cervical surgery are minimizing damage, complete hemostasis, no drainage placement, and fine perioperative management.
ObjectiveTo analyze the clinical outcome of anterior cervical discectomy and fusion using a Zero-profile interbody fusion and fixation device (Zero-P) for cervical spondylotic myelopathy. MethodsBetween April 2011 and September 2013, 26 cases of cervical spondylotic myelopathy underwent anterior cervical discectomy and fusion with the Zero-P. Of 26 cases, 12 were male and 14 were female, aged 43-82 years (mean, 58.3 years). The disease duration was from 3 months to 10 years (mean, 5.9 years). The involved segments included C3,4 in 5 cases, C4,5 in 3 cases, C5,6 in 6 cases, and C6,7 in 12 cases. The clinical outcome was evaluated using visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and Neck Disability Index (NDI) score before operation and after operation. ResultsThe operations were successful and the operation time was 75-140 minutes (mean, 105 minutes); and blood loss was 20-150 mL (mean, 45 mL). There was no complications of infection, neural injury, esophageal fistula, prevertebral hematoma, or leakage of cerebrospinal. Dysphagia occurred in 1 case within 1 week after operation,and disappeared after 1 month. All patients were followed up for an average of 15.3 months (range, 12-18 months). The clinical symptoms were relieved after operation. During follow-up, no implant displacement or subsidence, screw breakage, and cervical instability were observed. At 3 and 12 months after operation, the VAS score and NDI reduced significantly (P<0.05); the JOA score increased significantly (P<0.05); and the intervertebral space height and the cervical Cobb angle improved significantly (P<0.05). But there was no significantly difference between at 3 and 12 months (P>0.05). According to JOA evaluation, the results were excellent in 14 cases, good in 10 cases, and fair in 2 cases, with an excellent and good rate of 92.3% at last follow-up. ConclusionThe clinical outcome of anterior cervical discectomy and fusion using a Zero-P is satisfactory and reliable in the treatment of cervical spondylotic myelopathy. It can restore the cervical physiological curve and the intervertebral space height and decrease the incidence of postoperative dysphagia.
Objective To compare the loss of anterior column heightand cervical Cobb angle with three different types of anterior cervical discectomy and fusion(ACDF). Methods A prospective randomized study was performed on 60 patients who had undergone ACDF with the autologous iliac crest graft (group A, n=20), the autogenous bone and the anterior cervical locking plates (group B, n=20), and Syncage-C filled with the local autograft reamings (group C, n=20) from January 1998 to January 2003. The patients diagnosed as having cervical radiculopathy (RP) and cervical spondylotic myelopathy (CSM) were indicated for ACDF. Of the patients, 41 were male and 19 female with a mean age of 57 years (range, 36-68) and their average course of disease was 6.2 months (range, 1-36). There were 36 one-level and 24 two-level fusions from C3,4 to C7,T1. Radiological measurements were performed on the cervical radiographs taken before operation, 7 days and 3 months after operation, and on the last day of the follow-up; then, the height and Cobb angle of the fused segment, functional restoration, and clinical outcome were evaluated in the three groups. Results The followup of more than 2 years (range,2-7) showed that the average loss of anterior column height and Cobb angle of the fused segments in groups A and B, which had not preserved the-endplate, hada greater increase than that in group C, which had preserved the endplate. Of the patients, 12 had autograft collapse, 3 autograft displacement, and 10 postural abnormality between the fused segments, most of which happened in groups A andB. The fusion rate was 93.3% (56 cases) according the strict arthrodesis critera; their excellent and good rate in the functional assessment was 83.3% (RP 90.4%, CSM 79.5%); the overall satisfactory (excellent and good) rates in groups A,B and C were 75%, 85% and 90%, respectively. Conclusion To increase the resistance to graft subsidence, which is a major reason for narrowness of the fused segments, and to maintain normal cervical curvature, we should improve our skills of bone grafting performance, preserve the endplate, carefully evaluate the degree of osteoporosis before operation, and use anterior cervical locking plate and /or fusion with Syncage-C when necessary.
To probe the etiopathogenisis of adjacent-segment disease by analyzing the imageology data and cl inical neurological function in patients with anterior cervical discectomy and fusion (ACDF) harvested by long-term follow-up. Methods A retrospective study was performed on 52 patients who had undergone ACDF with perfect documents from January 1990 to April 2003. Of the patients, 45 were males and 7 were females with a mean age of 48.5 years (range from 25 to 72 years). There was the fusion of 10 one-levels, 38 two-levels and 4 three-levels. The cervical anterior-posterior and lateral X-ray, CT and MRI examination were performed before the operation. Cl inical neurological function was recorded by the Nurick score, and this score at 6 weeks after the operation was compared with the later follow-up. In the radiological examination, the motion of adjacent vertebrae and osteophyte formation were reviewed on X-ray and CT, and were converted to the semi-quantitative degeneration score according to the Goffin method. The correlation between Nurick score or degeneration score and the age at operation or fusion levels was compared by Spearman correlation coefficients. The cervical canal sizes of adjacent level and remote level on MRI were reviewed and compared with each other by t test. Results The follow-up period was 3 to 10 years, 6.9 years on average. There was difference in the Nurick score between the 6th week after operation (1.07 ± 0.84) and the later follow up (1.92 ± 1.28) by rank test (P lt; 0.05). There was no correlation between the Nurick score change and the age at operation (r = 0.21, P gt; 0.05) or fused levels(r = 0.30, P gt; 0.05) by Spearman correlation coefficients. There was obvious difference in degeneration score between the 6th week after operation (0.73 ± 0.67) and the later follow up (1.58 ± 1.06), (P lt; 0.01). There was no correlation between the degeneration score change and the age at operation (r = 0.35, P gt; 0.05) or fusion levels (r = 0.38, P gt; 0.05) by Spearman correlation coefficients. The cervical canal size reductions were (1.7 ± 1.1) mm at superioradjacent level, (1.2 ± 0.6) mm at inferior adjacent level and (0.30 ± 0.68) mm at remote level. There was obvious difference between superior or inferior and remote level by t test (P lt; 0.01). The adjacent level developed prominent degeneration together with nerve function change after the fusion operation and displayed correlation between degeneration and nerve function change(r = 0.41, P lt; 0.05). Conclusion The adjacent-segment disease after interbody fusion is produced by multiple factors. The natural progression in adjacent disc, biomechanical natural change resulting from interbody fusion, destruction to l igament structure in front of cervical vertebrae by operation, and bone graft model are important factors not to be ignored.
Objective To evaluate the cl inical outcomes of primary anterior focus debridement, bone autograft, and internal fixation via transperitoneal approach in treating tuberculosis of the lumbosacral junction. Methods From February 2002 to April 2007, 16 patients with tuberculosis of the lumbosacral junction underwent anterior radical debridement, autologous il iac bone graft (two pieces of il iac bone, 5 cm × 3 cm in size), and internal fixation via transperitoneal approach, including 4 males and 12 females aged 27-63 years old (average 38 years old). The course of the disease ranged from 6 to 18 months (average 10 months). All patients experienced various degrees of pain in the lumbosacral area and toxic symptoms of thetuberculosis. Nine cases were compl icated with radicular pain in the lower extremities, and 3 cases had saddle area anaesthesia. Two cases were initially diagnosed as lumbar intervertebral disc protrusion and treated accordingly. The segments involved by the tuberculosis were L5-S1 level in all cases. The average erythrocyte sedimentation rate (ESR) was 61 mm/hour. Imaging examination confirmed the diagnosis of spinal tuberculosis. All cases received four antitubercular drugs and nutrition support for nerve before operation. Operation was performed when hepatorenal function was normal, and the toxic symptom of the tuberculosis was under control or ESR was decreased. Results Operation was performed safely in all cases without injuries of abdominal viscera, major blood vessel, cauda equina nerve and ureter. All wounds healed by first intention. No recurrence of tuberculosis and formation of sinuses occurred. All cases were followed up for 12-37 months (average 21 months). No such compl ications as tuberculous peritonitis and intestinal obstruction occurred. No postoperative erectile dysfunction and retrograde ejaculation occurred in the 4 male patients. ESR was recovered to normal 3-6 months after operation, and regular X-ray and CT exams showed no displacement of grafted bone. All patients achieved bony fusion 12 months after operation without the occurrence breakage and loosening of titanium plate and screw. The radical pain in the lower extremities and the saddlearea anaesthesia disappeared. Four patients had pain in the il iac donor site, 2 patients had mild pain in the lumbosacral area, and the pain was el iminated after symptomatic treatment. The therapeutic effect was graded as excellent in 14 cases and good in 2 cases according to the therapeutic effect evaluation criteria of Chen and co-workers. Conclusion The surgical treatment of tuberculosis of the lumbosacral junction with primary anterior focus debridement, bone autograft, and internal fixation via transperitoneal approach can achieve satisfying bony fusion and reconstruct spinal stabil ity.
ObjectiveTo systematically review the efficacy and safety of the anterior and posterior approach for the treatment in ossification of the posterior longitudinal ligament (OPLL) of the cervical spine.MethodsAn electronical search was conducted in PubMed, EMbase, The Cochrane Library, Web of Science, WanFang Data and CNKI from inception to December 2016 to collect studies which compared the anterior cervical approach with posterior approach for OPLL. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies and then RevMan 5.3 software was used to perform meta-analysis.ResultsA total of 20 studies involving 1 263 patients were included. The results of meta-analysis showed that: compared with the posterior approach group, the anterior approach group had higher postoperative JOA score (MD=0.98, 95%CI 0.52 to 1.44, P<0.000 1), higher improvement (MD=12.18, 95% CI 6.65 to 17.71, P<0.000 1), higher re-operation rate (OR=3.21, 95%CI 1.70 to 6.08, P=0.000 3), longer operation time (MD=53.43, 95%CI 12.77 to 94.09, P=0.01) and more bleeding (MD=122.88, 95%CI 39.56 to 206.20, P=0.004), respectively. There was no significant difference in the incidence of complications between two groups (OR=1.49, 95%CI 0.88 to 2.51, P=0.14).ConclusionThe anterior approach for the treatment in OPLL of the cervical spine can achieve better postoperative neurological improvement and lower neurological deterioration, while the posterior approach for the treatment in OPLL has lower re-operation rate, less blood loss and shorter operation time. The incidence of complications between two groups is similar. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
Objective To explore the anatomical parameters of the cervical uncinate process “inflection point” through cervical CT angiography (CTA) and MRI measurements, offering a reliable and safe anatomical landmark for anterior cervical decompression surgery. Methods A retrospective analysis was conducted on the cervical CTA and MRI imaging data of normal adults who met the selection criteria between January 2020 and January 2024. The CTA dataset included 326 cases, with 200 males and 126 females, aged 22-55 years (mean, 46.7 years). The MRI dataset included 300 cases, with 200 males and 100 females, aged 18-55 years (mean, 43.7 years). Based on the CTA data, three-dimensional models of C3-C7 were constructed, and the following measurements were obtained from the superior view: uncinate process “inflection point” to vertebral artery distance (UIVD), uncinate process tip to vertebral artery distance (UTVD), uncinate process “inflection point” to “inflection point” distance (UID), uncinate process long-axis to sagittal angle (ULSA), and uncinate process “inflection point” to transverse foramen-sagittal angle (UITSA). From the anterior view, the anterior uncinate process to sagittal angle (AUSA) was measured. From the posterior view, the posterior uncinate process to sagittal angle (PUSA) was measured. Based on the MRI data, uncinate process “inflection point” to dural sac distance (UIDD) and dural sac width (DSW) were measured. The trends in measurement parameters of C3-C7 were observed, and the differences in measurement parameters between genders and between the left and right sides of the same segment were compared, as well as the difference in UID and DSW within the same segment was compared. Results The measurement parameters from C3 to C7 in the CTA data showed a general increasing trend, with no significant difference between the left and right sides within the same segment (P>0.05). The UIVD, UTVD, and UID were greater in males than in females, with significant differences observed in the UIVD and UTVD at C3 and C6 and UID at C3, C6, and C7 (P<0.05). The MRI measured DSW showed a general increasing trend from C3 to C7, and the DSW at C6 was greater in females than in males, with a significant difference (P<0.05). The UIDD showed a gradual decreasing trend, with the smallest value at C6. There was no significant difference between males and females or between the left and right sides within the same segment (P>0.05). The UID was greater than the DSW at C3-C7, and the differences were significant (P<0.05). ConclusionThe uncinate process “inflection point” is a constant anatomical structure located at the anteromedial aspect of the uncinate process tip and laterally to the dural sac. It maintains a certain safe distance from the vertebral artery. As a decompression landmark in anterior cervical spine surgery, it not only ensures surgical safety but also guarantees complete decompression.
ObjectiveTo evaluate the effectiveness of anterior lumbar interbody fusion (ALIF) with self-locked Cage in the treatment of central type lumbar intervertebral disc protrusion and recessive lumbar segmental instability. MethodsBetween March 2010 and February 2012, 31 patients with central type lumbar intervertebral disc protrusion and recessive lumbar segmental instability were treated with decompression and ALIF assisted by self-locked Cage through the mini-incision and retroperitoneal approach. There were 20 males and 11 females with the mean age of 46 years (range, 34-58 years). And the disease duration ranged from 5 to 32 months (mean, 16 months). The lesion located at the L3,4 level in 2 cases, L4,5 in 20 cases, and L5, S1 in 9 cases. The operation time, intraoperative blood loss, bedridden time, hospitalization time, and complications were recorded. The effectiveness was evaluated by Oswestry disability index (ODI) and visual analogue scale (VAS). Lumbar X-ray films and three-dimensional CT scan were taken to evaluate the fusion and the variation of the height and Cobb angle of intervertebral space. ResultsThe mean operation time was 102 minutes; the mean intraoperative blood loss was 121 mL; the mean bedridden time was 5 days; and the mean hospitalization time was 11 days. Intraoperative peritoneum tear and ascending lumbar vein tear, postoperative cerebrospinal fluid leakage, pain at donor site, and asymmetric elevated skin temperature of the lower extremity occurred in 2 cases, 1 case, 1 case, 4 cases, and 2 cases respectively, which were relieved after symptomatic treatment. All cases were followed up 12-28 months (mean, 20 months). No infection, recurrence, deep venous thrombosis, or retrograde ejaculation was observed after operation. MRI showed complete decompression at 3 months after operation. At last follow-up, the scores of ODI, VAS of lumbars and lower limbs, the intervertebral height, and Cobb angle were significantly improved when compared with preoperative ones (P<0.05); CT scan showed bone fusion in all cases. ConclusionThe clinical outcome of ALIF with self-locked Cage through mini-incision and retroperitoneal approach is satisfactory in treatment of central type lumbar intervertebral disc protrusion and recessive lumbar segmental instability. It can retain the posterior spinal construction and has the advantages of less trauma and bleeding, immediate stability, high bone fusion rate, and so on.