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[PMID]:29254308
[Au] Autor:Deng YZ; Xu LG; Chen L; Zhou D; Liu Y
[Ad] Endereço:Department of Acupuncture, The affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China.
[Ti] Título:Effectiveness of acupuncture in the management of cervical spondylosis: a meta-analysis.
[So] Source:J Biol Regul Homeost Agents;31(4):1017-1022, 2017 Oct-Dec.
[Is] ISSN:0393-974X
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:Cervical spondylosis is the most common type of spinal pathology which is more common in middle-aged or senile populations with a high potential to affect physical and mental health. This study evaluates the effectiveness of acupuncture in the management of cervical spondylosis. After a detailed literature search in electronic databases, the required data were acquired from selected research articles and meta-analyses were performed to obtain the percent cure, failure and total effectiveness rates under random effects model. Meta-regression was performed to identify the factors affecting the efficacy. Twenty-seven studies were selected for data acquisition (2,853 patients; average age 46.2±9.5; 51.7±12.5% males). Acupuncture alone had 33.41% (25.50, 41.24) cure rate but in combination with other therapies it rose to 53.36% (41.9, 64.8). Similarly, total effectiveness rate was 87.01% (83.40, 90.62) with acupuncture alone and 93.62% (89.85, 97.38) with acupuncture in combination with other therapies. Age was inversely associated with the percent cure rate and the number of combination therapies with acupuncture was positively associated with the cure rate. In conclusion, acupuncture therapy alone can provide cure and total effectiveness rates of 33% and 87%, respectively, but acupuncture with additional therapies can improve the cure and total effectiveness rates to 53% and 94%, respectively. Age inversely affects efficacy and the number of additional therapies improves the efficacy.
[Mh] Termos MeSH primário: Terapia por Acupuntura/métodos
Terapia Combinada/métodos
Espondilose/terapia
[Mh] Termos MeSH secundário: Pontos de Acupuntura
Adulto
Vértebras Cervicais/patologia
Vértebras Cervicais/fisiopatologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Espondilose/patologia
Espondilose/fisiopatologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE


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[PMID]:29384855
[Au] Autor:Zeng J; Duan Y; Yang Y; Wang B; Hong Y; Lou J; Ning N; Liu H
[Ad] Endereço:Department of Orthopedics.
[Ti] Título:Anterior corpectomy and reconstruction using dynamic cervical plate and titanium mesh cage for cervical spondylotic myelopathy: A minimum 5-year follow-up study.
[So] Source:Medicine (Baltimore);97(5):e9724, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Anterior cervical corpectomy and fusion (ACCF) is an effective surgical technique for cervical spondylotic myelopathy (CSM). However, no data exist regarding long-term outcomes after ACCF with the dynamic cervical plate for CSM. This study aimed to provide minimum 5-year clinical and radiographic outcomes of anterior corpectomy and reconstruction using dynamic cervical plate and titanium mesh cage (TMC) for CSM.Thirty-five patients who underwent single- or 2-level ACCF with dynamic cervical plate and TMC for the treatment of CSM were retrospectively investigated. The Japanese Orthopedic Association (JOA) score was used to assess the clinical outcome. Radiographic evaluations included TMC subsidence, fusion status, cervical lordosis, segmental angle, and segmental height.Twenty-eight patients underwent single-level and 7 patients underwent 2-level corpectomy with a mean follow-up period of 69.5 months. The average preoperative JOA score was 11.3 ±â€Š3.0 and improved significantly to 14.2 ±â€Š2.0 at the last follow-up (P < .001). Both cervical lordosis (P = .013) and segmental angle (P = .001) were significantly increased toward lordosis at the last follow-up. The TMC subsidence rate was 31.4% (n = 11) at the last follow-up. There was no significant difference in JOA recovery rate between subsidence and no subsidence group (P = .43). All patients obtained solid fusion at 1-year follow-up.Anterior corpectomy and reconstruction with dynamic cervical plate and TMC might be an effective method for the treatment of CSM at a minimum 5-year follow-up. It can maintain or restore cervical sagittal alignment. Subsidence of the TMC did not influence the clinical outcome.
[Mh] Termos MeSH primário: Placas Ósseas
Vértebras Cervicais/cirurgia
Procedimentos Ortopédicos
Procedimentos Cirúrgicos Reconstrutivos
Doenças da Medula Espinal/cirurgia
Espondilose/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Vértebras Cervicais/diagnóstico por imagem
Feminino
Seguimentos
Seres Humanos
Lordose/diagnóstico por imagem
Lordose/cirurgia
Masculino
Meia-Idade
Complicações Pós-Operatórias
Estudos Retrospectivos
Doenças da Medula Espinal/diagnóstico por imagem
Espondilose/diagnóstico por imagem
Titânio
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
D1JT611TNE (Titanium)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009724


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[PMID]:29382028
[Au] Autor:Wang BY; Wu TK; Liu H; Deng YX; Ding C
[Ad] Endereço:Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
[Ti] Título:Intraoperative conversion of artificial cervical disc replacement to anterior cervical discectomy and fusion for iatrogenic fracture: A rare case report.
[So] Source:Medicine (Baltimore);96(47):e8917, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Artificial cervical disc replacement (ACDR) has been reported to be an effective and safe surgical treatment for cervical spondylosis. However, iatrogenic fracture during ACDR surgery has rarely been reported. Considering its infrequency, we report a rare clinical case, with the aim of sharing our experience and exploring when to convert ACDR to fusion intraoperatively. PATIENTS CONCERNS: A 47-year-old woman felt neck pain with weakness and numbness in both upper limbs for 5 months. DIAGNOSES: The patient had received discectomy and fusion procedure on C3/4 and C5/6 to relieve her radicular pain nearly 4 years prior. Neurologic examination revealed a diminished sensation at the C6-C8 skin areas and level Grade-4 power in the left wrist extensor and grip muscle strength. Magnetic resonance imaging (MRI) showed disc herniation compressing the spinal cord at C6/7. Computed tomography (CT) scans showed intervertebral fusion in both the C3/4 and C5/6 segments. INTERVENTIONS: Surgery was performed to remove the plate and replace C6/7 with an artificial disc, but a transverse cleavage endplate cortical fracture was detected after cutting the blades. Thus, we terminated artificial cervical disc replacement intraoperatively and changed to discectomy and fusion in C6/7. OUTCOMES: The patient's symptoms were remarkably relieved. Postoperative CT scans showed a transverse cleavage fracture in the backside of the C6 caudal endplate. Good fusion was achieved after 6 months. LESSONS: Iatrogenic fracture during ACDR is rare but does occur in clinic practice. Complete examination and an alternative approach determined before surgery are important for operative safety. Anterior cervical discectomy and fusion (ACDF) is recommended as a feasible remedial surgical strategy if ACDR fails intraoperatively.
[Mh] Termos MeSH primário: Vértebras Cervicais/cirurgia
Discotomia/métodos
Fraturas da Coluna Vertebral/cirurgia
Fusão Vertebral/métodos
Substituição Total de Disco/efeitos adversos
[Mh] Termos MeSH secundário: Vértebras Cervicais/lesões
Feminino
Seres Humanos
Doença Iatrogênica
Período Intraoperatório
Meia-Idade
Reoperação/métodos
Fraturas da Coluna Vertebral/etiologia
Espondilose/cirurgia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008917


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Registro de Ensaios Clínicos
[PMID]:27770801
[Au] Autor:Yang F; Li WX; Liu Z; Liu L
[Ad] Endereço:Shaanxi University of Chinese Medicine, Xi'an, 712000, China. yangfengdudu@163.com.
[Ti] Título:Balance chiropractic therapy for cervical spondylotic radiculopathy: study protocol for a randomized controlled trial.
[So] Source:Trials;17(1):513, 2016 10 22.
[Is] ISSN:1745-6215
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Cervical spondylosis is a very common disorder and cervical spondylotic radiculopathy (CSR) is the most common form of spinal degenerative disease. Its clinical manifestations focus on pain and numbness of the neck and arm as well as restricted movement of the neck, which greatly affect the patient's life and work. The orthopedic of traditional Chinese medicine (TCM) theory holds that the basic pathologic change in spinal degenerative diseases is the imbalance between the dynamic system and the static system of the cervical spine. Based on this theory, some Chinese physicians have developed a balance chiropractic therapy (BCT) to treat CSR, which has been clinically examined for more than 50 years to effectively cure CSR. The purpose of this study is to evaluate the therapeutic effect and safety of BCT on CSR and to investigate the mechanism by which the efficacy is achieved. METHODS/DESIGN: We propose a multicenter, parallel-group, randomized controlled trial to evaluate the efficacy and safety of BCT for CSR. Participants aged 18 to 65 years, who are in conformity with the diagnostic criteria of CSR and whose pain score on a Visual Analog Scale (VAS) is more than 4 points and less than 8 points, will be included and randomly allocated into two groups: a treatment group and a control group. Participants in the treatment group will be treated with BCT, while the control group will receive traction therapy (TT). The primary outcome is pain severity (measured with a VAS). Secondary outcomes will include cervical curvature (measured by the Borden Index), a composite of functional status (measured by the Neck Disability Index, NDI), patient health status (evaluated by the SF-36 health survey) and adverse events (AEs) as reported in the trial. DISCUSSION: If BCT can relieve neck pain without adverse effects, it may be a novel strategy for the treatment of CSR. Furthermore, the mechanism of BCT for CSR will be partially elucidated. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT02705131 . Registered on 9 March 2016.
[Mh] Termos MeSH primário: Protocolos Clínicos
Manipulação Quiroprática/métodos
Radiculopatia/terapia
Espondilose/terapia
[Mh] Termos MeSH secundário: Vértebras Cervicais
Seres Humanos
Tamanho da Amostra
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE


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[PMID]:29305455
[Au] Autor:Peng B; Yang L; Yang C; Pang X; Chen X; Wu Y
[Ad] Endereço:General Hospital of Armed Police Force, 69 Yongding Road, Beijing 100039, China.
[Ti] Título:The effectiveness of anterior cervical decompression and fusion for the relief of dizziness in patients with cervical spondylosis: a multicentre prospective cohort study.
[So] Source:Bone Joint J;100-B(1):81-87, 2018 Jan.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: Cervical spondylosis is often accompanied by dizziness. It has recently been shown that the ingrowth of Ruffini corpuscles into diseased cervical discs may be related to cervicogenic dizziness. In order to evaluate whether cervicogenic dizziness stems from the diseased cervical disc, we performed a prospective cohort study to assess the effectiveness of anterior cervical discectomy and fusion on the relief of dizziness. PATIENTS AND METHODS: Of 145 patients with cervical spondylosis and dizziness, 116 underwent anterior cervical decompression and fusion and 29 underwent conservative treatment. All were followed up for one year. The primary outcomes were measures of the intensity and frequency of dizziness. Secondary outcomes were changes in the modified Japanese Orthopaedic Association (mJOA) score and a visual analogue scale score for neck pain. RESULTS: There were significantly lower scores for the intensity and frequency of dizziness in the surgical group compared with the conservative group at different time points during the one-year follow-up period (p = 0.001). There was a significant improvement in mJOA scores in the surgical group. CONCLUSION: This study indicates that anterior cervical surgery can relieve dizziness in patients with cervical spondylosis and that dizziness is an accompanying manifestation of cervical spondylosis. Cite this article: 2018;100-B:81-7.
[Mh] Termos MeSH primário: Vértebras Cervicais/cirurgia
Descompressão Cirúrgica/métodos
Tontura/etiologia
Fusão Vertebral/métodos
Espondilose/complicações
Espondilose/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Discotomia/métodos
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Cervicalgia/etiologia
Estudos Prospectivos
Índice de Gravidade de Doença
Resultado do Tratamento
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180107
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.100B1.BJJ-2017-0650.R2


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[PMID]:27771787
[Au] Autor:Ma Z; Ma X; Yang H; Guan X; Li X
[Ad] Endereço:Department of Orthopaedics, Shanxi Academy of Medical Sciences & Shanxi DaYi Hospital, No. 99 Long Cheng Street, Taiyuan, 030032, Shanxi Province, China.
[Ti] Título:Anterior cervical discectomy and fusion versus cervical arthroplasty for the management of cervical spondylosis: a meta-analysis.
[So] Source:Eur Spine J;26(4):998-1008, 2017 Apr.
[Is] ISSN:1432-0932
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The aim of this study was to compare the efficacy and safety of anterior cervical discectomy and fusion (ACDF) and cervical arthroplasty for patients with cervical spondylosis. METHODS: PubMed, Embase, and Cochrane Library were used to search for relevant articles published prior to April 2016 to identify studies comparing ACDF and cervical arthroplasty involving patients with cervical spondylosis. Relative risks (RR) and mean differences (MD) were used to measure the efficacy and safety of ACDF and cervical arthroplasty using the random effects model. RESULTS: The meta-analysis of 17 studies involved 3122 patients diagnosed with cervical spondylosis. Patients undergoing ACDF showed lower overall success rate (RR 0.84; 95 % CI 0.77-0.92; P < 0.001), higher VAS score (MD 0.36; 95 % CI 0.08-0.64; P = 0.011), and shorter mean surgical duration (MD -1.62; 95 % CI -2.80 to -0.44; P = 0.007) when compared with cervical arthroplasty. However, the association between ACDF therapy and the risk of mean blood loss (MD -0.16; 95 % CI -0.34 to 0.02; P = 0.082), mean hospitalization (MD 0.02; 95 % CI -0.31 to 0.36; P = 0.901), patient satisfaction (RR 0.96; 95 % CI 0.92-1.00; P = 0.066), neck disability index (MD 0.20; 95 % CI -0.05 to 0.44; P = 0.113), reoperation (RR 1.25; 95 % CI 0.64-2.41; P = 0.514), or complication (RR 1.17; 95 % CI 0.90-1.52; P = 0.242) was not statistically significant. CONCLUSIONS: Patients undergoing ACDF therapy tended to exhibit lower overall success rate, higher VAS score, and decreased mean surgical duration when compared with patients treated with cervical arthroplasty.
[Mh] Termos MeSH primário: Artroplastia/métodos
Vértebras Cervicais/cirurgia
Discotomia/métodos
Fusão Vertebral/métodos
Espondilose/cirurgia
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Cervicalgia/etiologia
Satisfação do Paciente
Reoperação
Espondilose/complicações
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180112
[Lr] Data última revisão:
180112
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE
[do] DOI:10.1007/s00586-016-4779-7


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[PMID]:28926393
[Au] Autor:Arrojas A; Jackson JB; Grabowski G
[Ad] Endereço:1Department of Orthopaedic Surgery, University of South Carolina, Columbia, South Carolina.
[Ti] Título:Trends in the Treatment of Single and Multilevel Cervical Stenosis: A Review of the American Board of Orthopaedic Surgery Database.
[So] Source:J Bone Joint Surg Am;99(18):e99, 2017 Sep 20.
[Is] ISSN:1535-1386
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In order to identify any changes in the utilization of new and old techniques, we investigated trends in the operative management of cervical stenosis by orthopaedic surgeons applying for board certification. METHODS: We queried the American Board of Orthopaedic Surgery database from 1998 to 2013 to identify all of the cervical spine procedures for stenosis that had been performed by candidates taking Part II of the licensing examination. Longitudinal trends were determined for the utilized approach, the individual procedures that had been performed, and whether a motion-preserving technique had been employed. RESULTS: There were 5,068 cervical spine procedures performed by 1,025 candidates. Procedure totals remained relatively constant until 2011, when a sudden increase of 280% (202 to 768 procedures) was noted. This trend continued, reaching a 460% increase (202 to 1,131 procedures) compared with 2010. The number of candidates only rose by 150% (42 to 105) over the entire study period. The proportion of procedures performed via an anterior approach saw a bimodal distribution; early on, this approach predominated over posterior procedures and was largely driven by the number of corpectomies that were performed. From 2004 to 2011, posterior procedures became more prevalent, but there was a sharp decline in 2011, driven by the large number of anterior cervical discectomies and fusions that were performed. This remained constant through 2013. Lastly, motion-preserving techniques, which included total disc replacement and laminoplasty, had modest increases in utilization from 2005 to 2007. This increased prevalence was short-lived, and it steadily declined through 2014 to <5% utilization. CONCLUSIONS: The number of candidates performing cervical spine procedures increased more than twofold over a 16-year period. This reflects a larger proportion of the orthopaedic graduates who subspecialize in spine surgery. While the number of surgeons performing spine surgery has increased, the sheer number of procedures that each surgeon performed greatly outpaced the increased number of surgeons. Motion-preserving techniques had their peak utilization in 2007, and have since decreased to <5%, in contrast to fusion techniques, which predominate, comprising >90% of the performed procedures.
[Mh] Termos MeSH primário: Vértebras Cervicais/cirurgia
Procedimentos Ortopédicos/tendências
Ortopedia/tendências
Padrões de Prática Médica/tendências
Estenose Espinal/cirurgia
Espondilose/cirurgia
[Mh] Termos MeSH secundário: Discotomia/tendências
Seres Humanos
Fusão Vertebral/tendências
Substituição Total de Disco/tendências
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170922
[Lr] Data última revisão:
170922
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170920
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.16.01082


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[PMID]:28869390
[Au] Autor:Zeitoun R; Hussein M
[Ad] Endereço:Department of Diagnostic and Interventional Radiology, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt.
[Ti] Título:Approach to interpret images produced by new generations of multidetector CT scanners in post-operative spine.
[So] Source:Br J Radiol;90(1079):20170082, 2017 Nov.
[Is] ISSN:1748-880X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To reach a practical approach to interpret MDCT findings in post-operative spine cases and to change the false belief of CT failure in the setting of instruments secondary to related artefacts. METHODS: We performed observational retrospective analysis of premier, early and late MDCT scans in 68 post-operative spine patients, with emphasis on instruments related complications and osseous fusion status. We used a grading system for assessment of osseous fusion in 35 patients and we further analysed the findings in failure of fusion, grade (D). RESULTS: We observed a variety of instruments related complications (mostly screws medially penetrating the pedicle) and osseous fusion status in late scans. We graded 11 interbody and 14 posterolateral levels as osseous fusion failure, showing additional instruments related complications, end plates erosive changes, adjacent segments spondylosis and malalignment. CONCLUSION: Modern MDCT scanners provide high quality images and are strongly recommended in assessment of the instruments and status of osseous fusion. In post-operative imaging of the spine, it is essential to be aware for what you are looking for, in relevance to the date of surgery. Advances in knowledge: Modern MDCT scanners allow assessment of instruments position and integrity and osseous fusion status in post-operative spine. We propose a helpful algorithm to simplify interpreting post-operative spine imaging.
[Mh] Termos MeSH primário: Placas Ósseas/efeitos adversos
Parafusos Ósseos/efeitos adversos
Tomografia Computadorizada Multidetectores
Fusão Vertebral/instrumentação
Coluna Vertebral/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adolescente
Adulto
Artefatos
Criança
Pré-Escolar
Feminino
Seres Humanos
Masculino
Meia-Idade
Tomografia Computadorizada Multidetectores/instrumentação
Tomografia Computadorizada Multidetectores/métodos
Dor Pós-Operatória
Período Pós-Operatório
Estudos Retrospectivos
Espondilose/diagnóstico por imagem
Falha de Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171017
[Lr] Data última revisão:
171017
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170905
[St] Status:MEDLINE
[do] DOI:10.1259/bjr.20170082


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[PMID]:28862572
[Au] Autor:Lau D; Winkler EA; Than KD; Chou D; Mummaneni PV
[Ad] Endereço:Department of Neurological Surgery, University of California, San Francisco; and.
[Ti] Título:Laminoplasty versus laminectomy with posterior spinal fusion for multilevel cervical spondylotic myelopathy: influence of cervical alignment on outcomes.
[So] Source:J Neurosurg Spine;27(5):508-517, 2017 Nov.
[Is] ISSN:1547-5646
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE Cervical curvature is an important factor when deciding between laminoplasty and laminectomy with posterior spinal fusion (LPSF) for cervical spondylotic myelopathy (CSM). This study compares outcomes following laminoplasty and LPSF in patients with matched postoperative cervical lordosis. METHODS Adults undergoing laminoplasty or LPSF for cervical CSM from 2011 to 2014 were identified. Matched cohorts were obtained by excluding LPSF patients with postoperative cervical Cobb angles outside the range of laminoplasty patients. Clinical outcomes and radiographic results were compared. A subgroup analysis of patients with and without preoperative pain was performed, and the effects of cervical curvature on pain outcomes were examined. RESULTS A total of 145 patients were included: 101 who underwent laminoplasty and 44 who underwent LPSF. Preoperative Nurick scale score, pain incidence, and visual analog scale (VAS) neck pain scores were similar between the two groups. Patients who underwent LPSF had significantly less preoperative cervical lordosis (5.8° vs 10.9°, p = 0.018). Preoperative and postoperative C2-7 sagittal vertical axis (SVA) and T-1 slope were similar between the two groups. Laminoplasty cases were associated with less blood loss (196.6 vs 325.0 ml, p < 0.001) and trended toward shorter hospital stays (3.5 vs 4.3 days, p = 0.054). The perioperative complication rate was 8.3%; there was no significant difference between the groups. LPSF was associated with a higher long-term complication rate (11.6% vs 2.2%, p = 0.036), with pseudarthrosis accounting for 3 of 5 complications in the LPSF group. Follow-up cervical Cobb angle was similar between the groups (8.8° vs 7.1°, p = 0.454). At final follow-up, LPSF had a significantly lower mean Nurick score (0.9 vs 1.4, p = 0.014). Among patients with preoperative neck pain, pain incidence (36.4% vs 31.3%, p = 0.629) and VAS neck pain (2.1 vs 1.8, p = 0.731) were similar between the groups. Similarly, in patients without preoperative pain, there was no significant difference in pain incidence (19.4% vs 18.2%, p = 0.926) and VAS neck pain (1.0 vs 1.1, p = 0.908). For laminoplasty, there was a significant trend for lower pain incidence (p = 0.010) and VAS neck pain (p = 0.004) with greater cervical lordosis, especially when greater than 20° (p = 0.011 and p = 0.018). Mean follow-up was 17.3 months. CONCLUSIONS For patients with CSM, LPSF was associated with slightly greater blood loss and a higher long-term complication rate, but offered greater neurological improvement than laminoplasty. In cohorts of matched follow-up cervical sagittal alignment, pain outcomes were similar between laminoplasty and LPSF patients. However, among laminoplasty patients, greater cervical lordosis was associated with better pain outcomes, especially for lordosis greater than 20°. Cervical curvature (lordosis) should be considered as an important factor in pain outcomes following posterior decompression for multilevel CSM.
[Mh] Termos MeSH primário: Vértebras Cervicais/cirurgia
Laminectomia
Laminoplastia
Fusão Vertebral
Espondilose/cirurgia
[Mh] Termos MeSH secundário: Perda Sanguínea Cirúrgica
Vértebras Cervicais/diagnóstico por imagem
Feminino
Seguimentos
Seres Humanos
Incidência
Laminectomia/métodos
Laminoplastia/métodos
Masculino
Meia-Idade
Cervicalgia/diagnóstico por imagem
Cervicalgia/epidemiologia
Cervicalgia/cirurgia
Medição da Dor
Complicações Pós-Operatórias/epidemiologia
Estudos Retrospectivos
Índice de Gravidade de Doença
Fusão Vertebral/métodos
Espondilose/diagnóstico por imagem
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171103
[Lr] Data última revisão:
171103
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170902
[St] Status:MEDLINE
[do] DOI:10.3171/2017.4.SPINE16831


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[PMID]:28858129
[Au] Autor:Cai RZ; Wang YQ; Wang R; Wang CH; Chen CM
[Ad] Endereço:Department of neurosurgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
[Ti] Título:Microscope-assisted anterior cervical discectomy and fusion combined with posterior minimally invasive surgery through tubular retractors for multisegmental cervical spondylotic myelopathy: A retrospective study.
[So] Source:Medicine (Baltimore);96(35):e7965, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This study aimed to investigate the clinical efficacy and outcome of combined microscope-assisted anterior cervical discectomy and fusion (ACDF) with posterior minimally invasive surgery through tubular retractors for patients with multisegmental cervical spondylotic myelopathy (MCSM).This retrospective study included 28 patients (19 males and 9 females) with multisegmental cervical spondylotic myelopathy, who underwent combined microscope-assisted ACDF with posterior minimally invasive surgery through tubular retractors in our single center between January 2012 and December 2016. The evaluated postoperative clinical outcomes were operation time, length of hospitalization, blood loss, levels of creatine phosphokinase isoenzyme MM (CPK-MM), Japanese Orthopedic Association (JOA) scores, visual analogue scale (VAS) scores, Cobb angle of C2-C7, and radiological assessments (included X-rays, computed tomography scans, and magnetic resonanceimaging images).The mean surgery time was 198.42 ±â€Š17.53 minutes, the average hospitalization length of hospital was 7.59 ±â€Š1.38 days, and the mean follow-up time was 13 ±â€Š2.45 months. On average, about 36.42 ±â€Š10.15 mL of blood was lost and CPK-MM increased to 331.75 ±â€Š23.15 IU/mL postoperatively (P < .001). The mean modified JOA scores increased from 8.21 ±â€Š0.69 preoperatively to 13.96 ±â€Š1.57 postoperatively (P < .001), whereas the mean VAS scores decreased from 6.64 ±â€Š1.28 preoperatively to 0.39 ±â€Š0.50 postoperatively (P < .001). Cobb angle of C2-C7 increased from 13.86°â€Š±â€Š5.69° preoperatively to 14.10°â€Š±â€Š5.56° postoperatively (P = .16).In conclusion, combined microscope-assisted ACDF with posterior minimally invasive surgery through tubular retractors appears to be a safe and effective treatment for patients with MCSM.
[Mh] Termos MeSH primário: Vértebras Cervicais/cirurgia
Discotomia/métodos
Procedimentos Cirúrgicos Minimamente Invasivos
Fusão Vertebral/métodos
Espondilose/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Perda Sanguínea Cirúrgica
Vértebras Cervicais/diagnóstico por imagem
Creatina Quinase Forma MM/sangue
Discotomia/efeitos adversos
Feminino
Seres Humanos
Imagem Tridimensional
Tempo de Internação
Imagem por Ressonância Magnética
Masculino
Microscopia
Meia-Idade
Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos
Duração da Cirurgia
Estudos Retrospectivos
Fusão Vertebral/efeitos adversos
Espondilose/diagnóstico por imagem
Tomografia Computadorizada por Raios X
Resultado do Tratamento
Escala Visual Analógica
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
EC 2.7.3.2 (Creatine Kinase, MM Form)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170901
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007965



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