Fumin Pan

Risk factors for cage retropulsion after lumbar interbody fusion surgery: Series of cases and literature review

OBJECTIVEnTo identify the risk factors for cage retropulsion after lumbar interbody fusion surgery.nnnMETHODSn667 patients underwent lumbar interbody fusion surgery between November 2011 to December 2014 were retrospectively reviewed by the medical recording system in our institute. 8 patients experiencing cage retropulsion were included and 2 underwent the initial surgery in other hospitals. The clinical outcomes were evaluated by visual analogxa0scores (VAS) and Oswestry Disability Index (ODI). Plain radiographs and three-dimensional computed tomography scans were used to analyze the incidence of cage retropulsion. Data were analyzed by SPSS 19.0.nnnRESULTSnThe incidence of cage retropulsion was 0.90%(6 out of 665) in our institution. There were 6 male and 2 female with an average age of 45.63xa0±xa015.48(range, 21-60). The average follow-up time was 23.88xa0±xa012.69 months(range, 6-43 months) and average retropulsion onset time was 2.75 months(range,1-6 months). 6 patients experienced cage retropulsion at L5/S1 and 2xa0at L4/5. 6 used bullet-shaped cages and two had kidney-shaped cages. Average bed rest time after the initial surgery was 5.75xa0±xa01.67 days. 6 patients had neurological deficits and underwent revision surgery. Average operation time and blood loss for revision surgery were much higher than those of the initial surgery (Pxa0<xa00.05). All the patients got a good result in VAS and ODI both from initial surgery and revision surgery (Pxa0<xa00.05).nnnCONCLUSIONSnThere were multiple risk factors for cage retropulsion after lumbar interbody fusion surgery, including patient factors, radiological characteristics, surgical techniques and postoperative reasons. In case of retropulsion, revision surgery was essential for the patients who presented neurological deficits and conservative treatment was recommended for asymptomatic patients.

Do the complications increased in the anterolateral right-side approach to treat the cervical degenerative disorders? A retrospective cohort study

The dysphagia and recurrent laryngeal nerve (RLN) palsy are the most common complications of the patients who underwent anterior cervical surgery in the current literature. These morbidities have led to the study of the impact of sidedness in anterior cervical spine surgery. However, many reports documented the left-side was more effective and safe than right-side based on the anatomy. So the right-side approach is more challenging. We retrospectively study 503 patients with cervical degenerative diseases who underwent cervical spinal surgery using anterolateral right-side approach in our spine center from September 1999 to December 2012 and evaluate the efficient and safety of the anterolateral right-side approach to treat the cervical degenerative diseases. The overall mortality rate in our present report was 3.38% (17 of 503 patients). The most common complication which observed in 2.80% of our cases was dysphagia. Postoperatively, there was only one patient with hematoma and died (0.19%) and symptomatic recurrent laryngeal nerve palsy occurred in 0.39% of the cases. The anterolateral right-side anterior approach didnt increase the incidence of the dysphagia and recurrent laryngeal nerve (RLN) palsy.

The potential effect of type 2 diabetes mellitus on lumbar disc degeneration: a retrospective single-center study

BackgroundDiabetes mellitus (DM) and low back pain which is mainly caused by degeneration of the intervertebral discs (IVDs) both are major public health problem worldwide. The present study was designed to investigate the association between type 2 diabetes mellitus (T2D) and severity of lumbar disc degeneration (LDD).MethodsWe retrospectively reviewed patients with low back pain visiting our spine clinic in 2014. Low back pain patients all have the lumbar MRI imaging and no previous treatment. One hundred fifty patients without T2D (group A) and 622 patients with T2D meeting the criteria were included. Sex, age, body mass index (BMI), high blood pressure (HBP), history of smoking, alcohol use, and duration of T2D were recorded. Patients with T2D were assigned to a well-controlled group (group B, nu2009=u2009380) and a bad-controlled group (group C, nu2009=u2009242). In group B, T2D duration of 148 patients was ≤u200910xa0years (group B1) and 232 patients >u200910xa0years (group B2). In group C, T2D duration of 100 patients was ≤u200910xa0years (group C1) and 142 patients >u200910xa0years (group C2). The severity of LDD was evaluated using the five-level Pfirrmann grading system. Data were analyzed using SPSS 19.0.ResultsDemographic data except age showed no difference among groups (Pu2009>u20090.5). Compared to patients without T2D, patients with T2D showed more severe disc degeneration after removal of age effects (Pu2009<u20090.05). From L1/2 to L5/S1, the average Pfirrmann scores between groups A and B1 showed no difference(Pu2009>u20090.05); groups B2, C1, and C2 showed higher average Pfirrmann scores than group A (Pu2009<u20090.05). Groups B2 and C2 showed higher average Pfirrmann scores than groups B1 and C1 (Pu2009<u20090.05). Groups C1 and C2 showed higher average Pfirrmann scores than groups B1 and B2 (Pu2009<u20090.05). From L1/2 to L5/S1, the severity of LDD was highly positively related to T2D duration both in groups B and C (Pu2009<u20090.05).ConclusionsT2D duration >u200910xa0years and a bad control of T2D were risk factors for LDD. The longer T2D duration was, the more severe disc degeneration would be.

C5 nerve root palsy after posterior cervical spine surgery: A review of the literature

Background: C5 palsy is a serious complication after cervical decompression surgery in which the patient shows a deterioration in power of the deltoid or biceps brachii by at least one grade in the manual muscle test without aggravation of lower extremity function. Although there are several hypotheses regarding the etiology of C5 palsy, the pathogenesis and preventive measures remain unidentified and many other controversies remain. Objective: To systematically review the clinical features, risk factors, mechanism, and preventive measures of C5 palsy after posterior cervical decompression surgery. Materials and methods: PubMed was searched to identify eligible studies that contained more than 10 cases and focused on C5 palsy. Microsoft Excel was used to analyze the data. Statistical comparisons were made when appropriate. Results: Out of 718 papers involving C5 palsy, 28 met the inclusion criteria. The average incidence rate was 7.8% (range, 1.4–23.0%). Risk factors for C5 palsy included age, male gender, ossification of the posterior longitudinal ligament, and stenosis of the C4–C5 intervertebral foramen. C5 palsy occurred from immediately to 2 months after surgery, and recovery time ranged from 48 h to 41 months. Hypotheses for the mechanism of C5 palsy included root involvement and spinal cord impairment. Foraminotomy and intraoperative neuromonitoring were the two main methods used to prevent C5 palsy. Conclusion: C5 palsy is a serious complication occurring at the early stage after cervical decompression surgery. Foraminotomy and intraoperative neuromonitoring were the two main methods to prevent C5 palsy. The incidence of C5 palsy is low, but it can place a serious burden on the patients’ quality of life and finances. The risk factors and mechanism of C5 palsy are still controversial. However, under conservative therapy, the prognosis is usually good. Higher quality studies are necessary for drawing more reliable and convincing conclusions about this disease.

Percutaneous endoscopical transforaminal approach versus PLF to treat the single-level adjacent segment disease after PLF/PLIF: 1–2 years follow-up

BACKGROUNDnAdjacent segment disease (ASD) is a common complication after lumbar decompression and fusion surgery. Traditional revision-surgery, including posterior lumbar decompression and posterolateral fusion (PLF) or interbody fusion (PLIF) is traumatic. The percutaneous endoscopic transforaminal procedure (PE-TF) has been widely used in patients with lumbar disc disease. However, there are no reports about using PE-TF procedure to treat ASD in the current literature.nnnOBJECTIVEnTo compare the clinical outcomes between PE-TF and PLF for single-level ASD after PLF or PLIF.nnnSTUDY DESIGNnA retrospective study.nnnSETTINGnDepartment of Spine Surgery.nnnMETHODSnThere were 64 patients diagnosed with single-level ASD and accepted revision surgery. 33 patients accepted PE-TF (Group A) and 31 underwent PLF (Group B). Oswestry Disability Index (ODI) and Japanese Orthopedic Association (JOA) scores were used to evaluate clinical outcomes. Complications, length of skin incision, hospitalization time and blood loss were investigated according to patient records.nnnRESULTSnAll symptoms had improved at the final follow-up. The improvement rate was 82.75% in group A and 86.28% in group B. The satisfactory clinical outcomes were similar in both groups with no recurrence in all cases. PE-TF procedure had significant advantages in the following items: traumatization, cosmetology, hospitalization time and blood loss.nnnCONCLUSIONSnClinical outcomes of using PE-TF procedure to treat single-level ASD were similar to those of PLF approach, but PE-TF was less invasive and could shorten hospitalization time.

Four-level anterior cervical discectomy and fusion for cervical spondylotic myelopathy

Purpose To review the outcome of 32 consecutive patients who underwent 4-level anterior cervical discectomy and fusion (ACDF) with cages and plates and were followed up for at least 5 years. Methods Records of 19 men and 13 women aged 48 to 69 years who underwent 4-level ACDF with cages and plates for myelopathy (n=11) or myeloradiculopathy (n=21) at C3 to C7 by a single surgeon and were followed up for a minimum of 5 years were reviewed. Clinical outcome was assessed using the visual analogue scale (VAS), Neck Disability Index (NDI), and modified Japanese Orthopaedic Association (JOA) score for pain or myelopathic symptoms. Radiographic evaluation included fusion rate, range of motion, cervical lordosis (C2-to-C7 Cobb angle), and disc height. Results The mean follow-up was 66 months. All patients had good recovery of muscle strength and resolution of limb sensory disturbance, except for 4 who still had some numbness. The mean VAS for neck and arm pain improved from 14.2 to 6.84 (p=0.012); the mean NDI improved from 31.62 to 12.17 (p<0.01); and the mean JOA score improved from 10.1 to 13.9 (p=0.027). The mean percentage of recovery was 62.9. The mean Cobb angle improved from 10.24° to 1.28° (p=0.019); the mean disc height improved from 4.12 to 6.58 mm (p<0.01). 30 (94%) patients achieved solid fusion. Conclusion Multilevel ACDF using PEEK cages and plates is safe and effective for multilevel cervical spondylotic myelopathy and achieves satisfactory mid-term outcome.

Transforaminal endoscopic system technique for discogenic low back pain: A prospective Cohort study

OBJECTIVEnTo investigate the clinical outcomes of transforaminal endoscopic system(TESSYS) for discogenic low back pain(DLBP).nnnMETHODSn62 consecutive patients with one-level DLBP applying to the including criteria underwent TESSYS from January 2010 to December 2013. These patients included 38 males and 24 females with a mean age of 42.7xa0±xa05.4 years (range, 18-73xa0yr) and a mean follow-up of 26.8xa0±xa04.2 months (range, 12-48 months). The visual analog scale (VAS) were used for back pain, the Oswestry Disability Index (ODI) for lumbar function, and the modified MacNab criteria for clinical global outcomes.nnnRESULTSn24 patients showed only inflammatory granuloma on annulus tear tissues(Group A), 16 patients showed no annulus tear but adhesion and inflammatory granuloma among the intracanal annulus fibrous(AF), posterior longitudinal ligament(PLL) and the abdomen side of the dura sac(Group B) and 22 patients showed both(Group C). Concordant pain could be triggered by touching the inflammation with the bipolar radiofrequency probe. The success rate (excellent and good) of group C was much higher than A and B(Pxa0<xa00.05). The whole success rate was 75.8%. Of the 4 patients with poor result, 2 refused further surgical treatment and showed either no improvement or worsening. The remaining 2 patients had spinal fusion surgery and achieved better results. VAS and ODI had significantly improved after surgery (Pxa0<xa00.01). No unexpected complications were seen.nnnCONCLUSIONnTEEYS is an effective method in treating DLBP and the complete management of the inflammatory granuloma was the key point in achieving better results.

Does the longus colli have an effect on cervical vertigo?: A retrospective study of 116 patients

Abstract The aim of the study was to evaluate the role of the longus colli muscles in cervical vertigo. We retrospectively analyzed 116 adult patients who underwent anterior cervical discectomy and fusion (ACDF) during 2014 in our department. Patients were assigned to the vertigo group or the nonvertigo group. Demographic data were recorded. Inner distance and cross-sectional area (CSA) of longus colli were measured using coronal magnetic resonance imaging (MRI). The vertigo group (nu200a=u200a44) and the nonvertigo group (nu200a=u200a72) were similar in demographic data. Mean preoperative Japanese Orthopaedic Association (JOA) score was higher in the vertigo group than in the nonvertigo group (Pu200a=u200a0.037), but no difference postoperatively. Mean JOA scores increased significantly postoperatively in both groups (Pu200a=u200a0.002 and Pu200a=u200a0.001). The mean vertigo score decreased significantly from pre- to postoperatively in the vertigo group (Pu200a=u200a0.023). The mean preoperative Cobb angle was significantly smaller in the vertigo group than in the nonvertigo group (P <0.001), but no significant difference postoperatively. After ACDF, the mean Cobb angle increased significantly in the vertigo group (P <0.001). The instability rates of C3/4 and C4/5 were significantly higher in the vertigo group (P <0.001 and P <0.001). The inner distance of longus colli was significantly shorter (Pu200a=u200a0.032 and Pu200a=u200a0.026) and CSA significantly smaller (Pu200a=u200a0.041 and Pu200a=u200a0.035), at C3/4 and C4/5 in the vertigo group than in the nonvertigo group. Mean Miyazaki scores were significantly higher in the vertigo group at C3/4 and C4/5 (Pu200a=u200a0.044 and Pu200a=u200a0.037). Moreover, a shorter inner distance and smaller CSA were related to a higher Miyazaki score. Inner distance and cross-sectional area (CSA) of longus colli are associated closely with cervical vertigo. Shorter inner distance and smaller CSA of the longus colli muscles might be risk factors for cervical vertigo. ACDF provided a good resolution of cervical vertigo.

Manual preoperative tracheal retraction exercise decreases the occurrence of postoperative oropharyngeal dysphagia after anterior cervical discectomy and fusion

Objective: Preoperative tracheal retraction exercise (TRE) to minimize the occurrence of postoperative oropharyngeal dysphagia after anterior cervical spine surgery. Methods: A total of 220 patients admitted for elective anterior cervical spine surgery from January 2013 to December 2014 were retrospectively reviewed. The patients were allocated into two groups: TRE group and control group (without TRE). Modified dysphagia scoring system (MDSS) was used for evaluating the presence and severity of dysphagia symptoms at 1 week and 1, 3, and 6 months after surgery. Demographics such as age, gender, smoking, type of procedure, number of levels operated, duration of surgery, intraoperative blood loss, and instrumentation were analyzed. The clinical outcomes in both groups were compared with Neck Disability Index (NDI), Visual Analogue Scale (VAS) for arm and neck pain, and Odom’s criteria for global outcome. Results: In the first week postoperatively, 86 patients (39.1%) developed dysphagia, which decreased to 72 (32.7%), 5 (2.3%), and 4 (1.8%) after 1, 3, and 6 months, respectively. The patients who received the TRE prior to surgery had significantly better MDSS scores (p = 0.032 for second-level, 0.022 for third-level, and 0.009 for fourth-level fusions) than control group patients who did not receive TRE at the first week of surgery. At the 1-month follow-up, the followed-up patients for second- to fourth-level fusions in the TRE group had improved MDSS scores than those in the control group (p = 0.041 for second-level, 0.025 for third-level, and 0.0011 for fourth-level fusions). MDSS scores showed no significant difference between both the groups at 1 and 3 months postoperatively for single level anterior cervical fusion. NDI and VAS scores didn’t yield any significant difference. Global outcome by Odom’s criteria was 88.6%. Conclusion: Preoperative TRE can significantly reduce the occurrence of postoperative dysphagia after ACDF surgery. During follow-up, the incidence of postoperative dysphagia was significantly lower and had resolved at 3 months in all patients.