Search

Study Design: Retrospective Cohort Study Objectives: To determine if decreased preoperative symptom duration is associated with greater clinical improvement in function and myelopathic symptoms after posterior cervical decompression and fusion (PCDF). Methods: All patients over age 18 who underwent primary PCDF for cervical myelopathy or myeloradiculopathy at a single institution between 2014 and 2020 were retrospectively identified. Patient demographics, surgical characteristics, duration of symptoms, and preoperative and postoperative patient reported outcomes measures (PROMs) including modified Japanese Orthopaedic Association (mJOA), Neck Disability Index (NDI), Visual Analogue Scale (VAS) Neck, VAS Arm, and SF-12 were collected. Univariate and multivariate analyses were performed to compare change in PROMs and minimum clinically important difference achievement (%MCID) between symptom duration groups (< 6 months, 6 months–2 years, > 2 years). Results: Preoperative symptom duration groups differed significantly by sex and smoking status. Patients with < 6 months of preoperative symptoms improved significantly in all PROMs. Patients with 6 months–2 years of preoperative symptoms did not improve significantly in mJOA, Physical Component Scores (PCS), or NDI. Patients with > 2 years of symptoms failed to demonstrate significant improvement in mJOA, NDI, or Mental Component Scores (MCS). Univariate analysis demonstrated significantly decreased improvement in mJOA with longer symptom durations. Increased preoperative symptom duration trended toward decreased %MCID for mJOA and MCS. Regression analysis demonstrated that preoperative symptom duration of > 2 years relative to < 6 months predicted decreased improvement in mJOA and NDI and decreased MCID achievement for mJOA and MCS. Conclusion: Increased duration of preoperative symptoms (> 2 years) before undergoing PCDF was associated with decreased postoperative improvement in myelopathic symptoms. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort study Objectives: To evaluate the effect of caudal instrumentation level on revision rates following posterior cervical laminectomy and fusion. Methods: A retrospective review of a prospectively collected database was performed. Minimum follow-up was one year. Patients were divided into two groups based on the caudal level of their index fusion construct (Group 1-cervical and Group 2- thoracic). Reoperation rates were compared between the two groups, and preoperative demographics and radiographic parameters were compared between patients who required revision and those who did not. Multivariate binomial regression analysis was performed to determine independent risk factors for revision surgery. Results: One hundred thirty-seven (137/204) patients received fusion constructs that terminated at C7 (Group 1), while 67 (67/204) received fusion constructs that terminated at T1 or T2 (Group 2). The revision rate was 8.33% in the combined cohort, 7.3% in Group 1, and 10.4% in Group 2. There was no significant difference in revision rates between the 2 groups (P =.43). Multivariate regression analysis did not identify any independent risk factors for revision surgery. Conclusion: This study shows no evidence of increased risk of revision in patients with fusion constructs terminating in the cervical spine when compared to patients with constructs crossing the cervicothoracic junction. These findings support terminating the fusion construct proximal to the cervicothoracic junction when indicated. Level of Evidence: III [ABSTRACT FROM AUTHOR]

Study Design: Systematic review and Meta-analysis. Objective: This systematic review seeks to compare fusion, reoperation and complication rates, estimated blood loss (EBL), and surgical time between multi-level instrumented fusions with LIVs (lowest instrumented vertebra) in the cervical spine and those that extend into the thoracic spine. Summary of Background Data: Several studies address the question of whether to extend a long-segment, posterior cervical fusions, performed for degenerative disease, into the upper thoracic spine. Recommendations for appropriate LIV continue to vary. Methods: A comprehensive computerized literature search through multiple electronic databases without date limits up until April 3rd, 2020 using combinations of key search terms and sets of inclusion/exclusion criteria was performed. Results: Our comprehensive literature search yielded 3852 studies. Of these, 8 articles consisting of 1162 patients were included in the meta-analysis. In 61.2% of the patients, the fusion did not cross the cervicothoracic junction (CTJ) (cervical LIV, CLV). In the remaining 38.8%, the fusion extended into the upper thoracic spine (thoracic LIV, TLV). Overall, mean patient age was 62.5 years (range: 58.8-66.1 years). Our direct analysis showed that odds of fusion were not statistically different between the CLV and TLV groups (OR:.648, 95% CI:.336-1.252, P =.197). Similarly, odds of reoperation (OR: 0.726, 95% CI: 0.493-1.068, P =.104) and complication rates were similar between the 2 groups (OR: 1.214, 95% CI: 0.0.750-1.965, P =.430). Standardized mean difference (SMD) for the blood loss (SMD:.728, 95% CI: 0.554-.901, P =.000) and operative (SMD: 0.653, 95% CI:.479-.826, P =.000) differed significantly between the 2 groups. The indirect analysis showed similar fusion (Effect Size (ES)TLV:.892, 95% CI:.840-.928 vs ESCLV:0.894, 95% CI:0.849-.926); reoperation rate (ESTLV:0.112, 95% CI: 0.075-.164 vs ESCLV:.125, 95% CI:.071-.211) and complication rates (ESTLV:.108, 95% CI:.074-.154 vs ESCLV:0.081, 95% CI:.040-.156). Conclusions: Our meta-analysis showed that fusion, complication, and reoperation rates did not differ significantly between patients in whom multi-level posterior fusions ended in the cervical spine vs those of which was extended into the thoracic spine. The mean blood loss, operative time and length of stay were significantly lower in patients with CLV at C6 or C7, compared to their counterparts. These data suggest that, absent focal, C7-T1 pathology, extension of long, posterior cervical fusions into the thoracic spine may not be necessary. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective Cohort., Objective: To compare the short-term outcomes for Laminoplasty, Laminectomy/fusion, and ACDF., Methods: We utilized a prospectively-collected, multi-center national database with a propensity score matching algorithm to compare the short-term outcomes for laminoplasty, laminectomy/fusion, and multi-level ( > 3) ACDF (with and without corpectomy). Bivariate analyses involved both chi-square/fisher exact test and t-test/ANOVA on perioperative factors. Multivariate analyses were performed to determined independent risk factors for short term outcomes., Results: 546 patients remained after propensity score matching, with 182 patients in each cohort. ACDF required the longest operative time 188 ± 79 versus laminectomy/fusion (169 ± 75, p = 0.017), and laminoplasty (167 ± 66, p = 0.004). ACDF required the shortest hospital stay (LOS ≥ 2: ACDF 56.6%, laminoplasty 89.6%, laminectomy/fusion 93.4%, p < 0.05). ACDF had lower overall complications (ACDF 3.9%, laminoplasty 7.7%, laminectomy/fusion 11.5%, p < 0.05), mortality (ACDF 0%, laminoplasty 0.55%, laminectomy/fusion 2.2%, p < 0.05), and unplanned readmissions (ACDF 4.4%, laminoplasty 4.4%, laminectomy/fusion 9.9%, p < 0.05). No significant differences were seen in the other outcomes including DVT/PT, acute renal failure, UTI, stroke, cardiac complications, or sepsis. In the multivariate analysis, laminectomy/fusion (OR 17, reference: ACDF) and laminoplasty (OR10, reference: ACDF) were strong independent risk factors for LOS ≥ 2 days. Laminectomy/fusion (OR 3.2, reference: ACDF) was an independent predictor for any adverse events 30-days after surgery., Conclusions: Laminectomy/fusion carries the highest risk for morbidity, mortality, and unplanned readmissions in the short-term postoperative period. Laminoplasty and ACDF cases carry similar short-term complications risks. ACDF is significantly associated with the longest operative duration and shortest LOS without an increase in individual or overall complications, readmissions, or reoperations.

Study Design: Literature review., Objectives: Posterior cervical interfacet cages are an alternative to lateral mass fixation in patients undergoing cervical spine surgery. Recently, a percutaneous, tissue-sparing system for interfacet cage placement has been developed, however, there is limited clinical evidence supporting its widespread use. The aim was to review studies published on this system for patient reported outcomes, radiographic outcomes, intraoperative outcomes, and complications., Methods: Four electronic databases (PubMed, EMBASE, Scopus, and MEDLINE) were queried for original published studies that evaluated the percutaneous, tissue-sparing technique for posterior cervical fusion with interfacet cage placement. All studies reporting on open techniques and purely biomechanical studies were excluded., Results: The extensive literature search returned 7852 studies. After systematic review, a total of 7 studies met inclusion criteria. Studies were independently classified as retrospective or prospective cohort studies and each assessed by the GRADE criteria. Patient reported outcomes, radiographic outcomes, intraoperative outcomes, and complications were extracted from each study and presented., Conclusions: Tissue-sparing, posterior cervical fusion with interfacet cages may be considered a safe and effective surgical intervention in patients failing conservative management for cervical spondylotic disease. However, the quality of evidence in the literature is lacking, and controlled, comparative studies are needed for definitive assessment., Competing Interests: Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Dr Joseph Laratta reports personal fees for consultancy from Spineart, Evolution Spine, and Gerson Lehrman Group, royalties from Spineart and Evolution Spine, intellectual property with Combination Biologic and ICBG/BMAC system, grants from Medtronic, NuVasive, Orthopaedic Science Research Foundation, Orthopaedic Research and Education Foundation, personal fees for travel expenses/meeting accommodations from American Institute of Minimally Invasive Surgery (AIMIS), NuVasive, Stryker, K2M, and Fisher Owen Fund, and is on the editorial board for Spine, Global Spine Journal, and Journal of Spine Surgery. Dr William Smith reports personal fee for consultancy from NuVasive, Spineology, Pediguard, Providence, and Ortho Bio Design, grants from MDT, NuVasive, Providence, and Spineology, ownership interest in NuVasive, Pediguard, and SpineSmith, royalty from NuVasive and Spineology, and is on the speakers’ bureau for NuVasive and Pediguard., (© The Author(s) 2019.)

Study Design: Retrospective case series., Objectives: To evaluate the efficacy and results of minimally invasive posterior cervical fusion with facet cages as an augment to high-risk patients and patients status post multilevel anterior cervical decompression and fusion., Methods: Thirty-five patients with symptomatic cervical stenosis with high risk for pseudoarthrosis underwent circumferential cervical decompression and fusion via staged anterior and posterior approach. Anterior cervical decompression and fusion was performed first by means of the standard anterior approach, with the patient supine on the operating table. The patients were subsequently flipped into a prone position and minimally invasive posterior cervical facet fusion with DTRAX was performed. The patients were then followed in the outpatient clinic for an average of 312.71 days. Postoperative patient satisfaction scores were obtained via the visual analogue scale (VAS). Preoperative VAS scores were compared with postoperative VAS scores in order to evaluate patient outcomes., Results: Of the 35 patients evaluated, minimum follow-up was 102 days, with a maximum follow-up of 839 days. Average preoperative and postoperative VAS scores were 7.6 and 2.8, respectively ( P < .0001), with an average improvement of 4.86 points. This was an average improvement of 64.70% from preoperative to postoperative. Seventeen patients had excellent outcomes, with a postoperative VAS score ≤2. Seven patients achieved a postoperative VAS score of 0, with 100% improvement of preoperative pain and symptoms. Average blood loss was 70.38 mL. Average length of stay was 1.03 days., Conclusions: The results indicate that minimally invasive posterior cervical decompression and fusion with facet cages, when combined with standard anterior cervical decompression and fusion, is an effective means of obtaining circumferential cervical fusion while simultaneously improving patient outcomes., Competing Interests: Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Rahul V. Shah, MD, is a paid consultant for Providence Medical Technologies for Teaching., (© The Author(s) 2020.)

Study Design: Retrospective trends analysis., Objectives: Cervical fusion is a common adjunctive surgical modality used in the treatment of cervical spondylotic myelopathy (CSM). The purpose of this study was to quantify national trends in patient demographics, hospital characteristics, and outcomes in the surgical management of CSM., Methods: This was a retrospective study that used the National Inpatient Sample. The sample included all patients over 18 years of age with a diagnosis of CSM who underwent cervical fusion from 2003 to 2013. The outcome measures were in-hospital mortality, length of stay, and hospital charges. Chi-square tests were performed to compare categorical variables. Independent t tests were performed to compare continuous variables., Results: We identified 62 970 patients with CSM who underwent cervical fusion from 2003 to 2013. The number of fusions performed per year in the treatment of CSM increased from 3879 to 8181. The average age of all fusion patients increased from 58.2 to 60.6 years ( P < .001). Length of stay did not change significantly from a mean of 3.7 days. In-hospital mortality decreased from 0.6% to 0.3% ( P < .01). Hospital charges increased from $49 445 to $92 040 ( P < .001)., Conclusions: This study showed a dramatic increase in cervical fusions to treat CSM from 2003 to 2013 concomitant with increasing age of the patient population. Despite increases in average age and number of comorbidities, length of stay remained constant and a decrease in mortality was seen across the study period. However, hospital charges increased dramatically., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Study Design: Retrospective analysis of prospectively collected data., Objectives: Few studies have investigated the role of preoperative anemia on postoperative outcomes of posterior cervical fusion. This study looked to investigate the potential relationship between preoperative anemia and postoperative outcomes following posterior cervical spine fusion., Methods: Data from patients undergoing elective posterior cervical fusions between 2005 and 2012 was collected from the American College of Surgeons National Surgical Quality Improvement Program database using inclusion/exclusion criteria. Multivariate analyses were used to identify the predictive power of anemia for postoperative outcomes., Results: A total of 473 adult patients undergoing elective posterior cervical fusions were identified with 106 (22.4%) diagnosed with anemia preoperatively. Anemic patients had higher rates of diabetes ( P = .0001), American Society of Anesthesiologists scores ≥3 ( P < .0001), and higher dependent functional status prior to surgery ( P < .0001). Intraoperatively, anemic patients also had higher rates of neuromuscular injuries ( P = .0303), stroke ( P = .013), bleeding disorders ( P = .0056), lower albumin ( P < .0001), lower hematocrit ( P < .0001), and higher international normalized ratio ( P = .002). Postoperatively, anemic patients had higher rates of complications ( P < .0001), death ( P = .008), blood transfusion ( P = .001), reoperation ( P = .012), unplanned readmission ( P = .022), and extended length of stay (>5 days; P < .0001)., Conclusions: Preoperative anemia is linked to a number of postoperative complications, which can increase length of hospital stay and increase the likelihood of reoperation. Identifying preoperative anemia may play a role in optimizing and minimizing the complication rates and severity of comorbidities following posterior cervical fusion., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Study Design Systematic literature review and meta-analysis. Objective This study is a meta-analysis assessing the fusion rate and the clinical outcomes of cervical pseudarthrosis treated with either a posterior or a revision anterior approach. Methods A literature search of PubMed, Cochrane, and Embase was performed. Variables of interest included fusion rate and clinical success. The effect size based on logit event rate was calculated from the pooled results. The studies were weighted by the inverse of the variance, which included both within- and between-study error. The confidence intervals were reported at 95%. Heterogeneity was assessed using the Q statistic and I (2), where I (2) is the estimate of the percentage of error due to between-study variation. Results Sixteen studies reported fusion outcomes; 10 studies reported anterior and/or posterior results. The pooled fusion success was 86.4% in the anterior group and 97.1% in the posterior group (p = 0.028). The anterior group demonstrated significant heterogeneity with Q value of 34.2 and I (2) value of 73.7%; no heterogeneity was seen in the posterior group. The clinical outcomes were reported in 10 studies, with eight reporting results of anterior and posterior approaches. The pooled clinical success rate was 77.0% for anterior and 71.7% for posterior (p = 0.55) approaches. There was significant heterogeneity in both groups (I (2) 16.1; 19.2). Conclusions Symptomatic cervical pseudarthrosis can be effectively managed with either an anterior or a posterior approach. The posterior approach demonstrates a significantly greater fusion rate compared with the anterior approach, though the clinical outcome does not differ between the two groups.