Anterior Cervical Spondylosis Surgical Interventions are Associated with Improved Lordosis and Neurological Outcomes at Latest Follow up: A Meta-analysis.
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SUBMITTER: Meng Z
PROVIDER: S-EPMC5493671 | biostudies-literature | 2017 Jun
REPOSITORIES: biostudies-literature
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Anterior Cervical Spondylosis Surgical Interventions are Associated with Improved Lordosis and Neurological Outcomes at Latest Follow up: A Meta-analysis.
Meng Zengdong Z Yu Jing J Luo Chong C Liu Xia X Jiang Wei W Yu Lehua L Huang Rongzhong R
Scientific reports 20170630 1
Aim of this study was to evaluate the effect of cervical spondylosis surgery on cervical lordosis and to identify factors affecting the change by latest follow-up. Literature search was carried out in electronic databases and study selection followed a priori eligibility criteria. Random effects meta-analyses were performed to estimate effect size/s of change in lordosis after surgery (at latest follow-up) and metaregression analyses were performed to identify factors affecting this change. Nine ...[more]
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Project description:BackgroundNowadays, anterior cervical artificial disc replacement (ACDR) has achieved favorable outcomes in treatment for patients with single-level cervical spondylosis. However, It is still controversial that whether or not it will become a potent therapeutic alternation in treating 2 contiguous levels cervical spondylosis compared with anterior cervical decompression and fusion (ACDF). Therefore, we conducted a systematic review and meta-analysis to compare the efficacy and safety of ACDR and ACDF in patients with 2 contiguous levels cervical spondylosis.MethodsAccording to the computer-based online search, PubMed, Embase, Web of Science, and Cochrane Library for articles published before July 1, 2017 were searched. The following outcome measures were extracted: neck disability index (NDI), visual analog scale (VAS) neck, VAS arm, Short Form (SF)-12 mental component summary (MCS), SF-12 physical component summary (PCS), overall clinical success (OCS), patient satisfaction (PS), device-related adverse event (DRAE), subsequent surgical intervention (SSI), neurological deterioration (ND), and adjacent segment degeneration (ASD). Methodological quality was evaluated independently by 2 reviewers using the Furlan for randomized controlled trial (RCT) and MINORS scale for clinical controlled trials (CCT). The chi-squared test and Higgin I test were used to evaluate the heterogeneity. A P?<?.10 for the chi-squared test or I values exceeding 50% indicated substantial heterogeneity and a random-effect model was applied; otherwise, a fixed-effect model was used. All quantitative data were analyzed by the Review Manager 5.2 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark).ResultsNine RCTs and 2 CCT studies containing 2715 patients were included for this meta-analysis. The pooled analysis indicated that the ACDR group is superior to ACDF in NDI, VAS neck, PCS score, OCS, PS, DRAE, ASD, and SSI. However, the pooled results indicate that there was no significant difference in the ND, VAS arm and in MCS score.ConclusionsThe present meta-analysis suggests that for bi-level cervical spondylosis, ACDR appears to provide superior clinical effectiveness and safety effects than ACDF. In the future, more high-quality RCTs are warranted to enhance this conclusion.
| S-EPMC5895371 | biostudies-literature
Project description:IntroductionTo analyze the perioperative hidden blood loss (HBL) and its influencing factors in elderly cervical spondylosis patients treated with anterior cervical discectomy fusion (ACDF).Materials and methodsFrom January 2017 to December 2018, 128 elderly cervical spondylosis patients (age > 65 y) treated with ACDF were selected. The patients' height, weight, duration of symptoms, previous medical history and other basic information were routinely recorded. The hemoglobin (Hb), hematocrit (Hct) and blood coagulation function preoperative and the next day postoperative were recorded. The operation time, surgical bleeding, ASA classification, fixation method, total drainage and the time for extraction of drainage tube were recorded. The total blood loss (TBL) was calculated according to the Gross's formula, and HBL was calculated based on TBL, total drainage and surgical bleeding. The statistical analysis of HBL was performed, and then influential factors were further analyzed by multivariate linear regression analysis and t test.ResultsThe mean surgical bleeding was 102.70 ± 46.78 mL and HBL was 487.98 ± 255.96 mL. HBL accounted for 67.61 ± 5.20% of TBL. According to the multiple linear regression analysis, the gender (P = 0.047), operation time (P = 0.000), fixation method (P = 0.014) and international normalized ratio (INR) (P = 0.003) influenced the amount of HBL. Body mass index (BMI) (P = 0.624), hypertension (P = 0.977), diabetes (P = 0.528), blood type (P = 0.577), ASA classification (P = 0.711), duration of symptoms (P = 0.661), preoperative cobb angle (P = 0.152), number of surgical level (P = 0.709), intramedullary hyperintensity (P = 0.967), drainage time (P = 0.294), postoperative drainage volume (P = 0.599), prothrombin time (PT) (P = 0.674), activated partial thromboplastin time (APTT) (P = 0.544) and thrombin time (TT) (P = 0.680) had no correlation with the amount of HBL.ConclusionsThere was obvious HBL during the perioperative period of ACDF in elderly cervical spondylosis patients. The male patients, longer operation time, fusion with titanium plate and cage and high INR were independent risk factors for HBL.
| S-EPMC8020224 | biostudies-literature
Project description:To estimate the effectiveness of anterior cervical discectomy with arthroplasty (ACDA) compared to anterior cervical discectomy with fusion (ACDF) for patient-important outcomes for single-level cervical spondylosis.Electronic databases (MEDLINE, EMBASE, Cochrane Register for Randomized Controlled Trials, BIOSIS and LILACS), archives of spine meetings and bibliographies of relevant articles.We included RCTs of ACDF versus ACDA in adult patients with single-level cervical spondylosis reporting at least one of the following outcomes: functionality, neurological success, neck pain, arm pain, quality of life, surgery for adjacent level degeneration (ALD), reoperation and dysphonia/dysphagia. We used no language restrictions. We performed title and abstract screening and full text screening independently and in duplicate.We used random-effects model to pool data using mean difference (MD) for continuous outcomes and relative risk (RR) for dichotomous outcomes. We used GRADE to evaluate the quality of evidence for each outcome.Of 2804 citations, 9 articles reporting on 9 trials (1778 participants) were eligible. ACDA is associated with a clinically significant lower incidence of neurologic failure (RR = 0.53, 95% CI = 0.37-0.75, p = 0.0004) and improvement in the Neck pain visual analogue scale (VAS) (MD = 6.56, 95% CI = 3.22-9.90, p = 0.0001; Minimal clinically important difference (MCID) = 2.5. ACDA is associated with a statistically but not clinically significant improvement in Arm pain VAS and SF-36 physical component summary. ACDA is associated with non-statistically significant higher improvement in the Neck Disability Index Score and lower incidence of ALD requiring surgery, reoperation, and dysphagia/dysphonia.There is no strong evidence to support the routine use of ACDA over ACDF in single-level cervical spondylosis. Current trials lack long-term data required to assess safety as well as surgery for ALD. We suggest that ACDA in patients with single level cervical spondylosis is an option although its benefits and indication over ACDF remain in question.
| S-EPMC3422251 | biostudies-literature
Project description:ObjectiveThe aim of this study was to evaluate the efficacy and safety of anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF) for treating two-adjacent-level cervical spondylosis myelopathy (CSM).DesignA meta-analysis of the two anterior fusion methods was conducted. The electronic databases of PubMed, the Cochrane Central Register of Controlled Trials, ScienceDirect, CNKI, WANFANG DATA and CQVIP were searched. Quality assessment of the included studies was evaluated using the Cochrane Risk of Bias Tool and the Methodological Index for Non-Randomised Studies criteria. Pooled risk ratios of dichotomous outcomes and standardised mean differences (SMDs) of continuous outcomes were generated. Using the ?(2) and I(2) tests, the statistical heterogeneity was assessed. Subgroup and sensitivity analyses were also performed.ParticipantsNine eligible trials with a total of 631 patients and a male-to-female ratio of 1.38:1 were included in this meta-analysis.Inclusion criteriaRandomised controlled trials (RCTs) and non-randomised controlled trials that adopted ACCF and ACDF to treat two-adjacent-level CSM were included.ResultsNo significant differences were identified between the two groups regarding hospital stay, the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) scores for neck and arm pain, total cervical range of motion (ROM), fusion ROM, fusion rate, adjacent-level ossification and complications, while ACDF had significantly less bleeding (SMD=1.14, 95% CI (0.74 to 1.53)); a shorter operation time (SMD=1.13, 95% CI (0.82 to 1.45)); greater cervical lordosis, total cervical (SMD=-2.95, 95% CI (-4.79 to -1.12)) and fused segment (SMD=-2.24, 95% CI (-3.31 to -1.17)); higher segmental height (SMD=-0.68, 95% CI (-1.03 to -0.34)) and less graft subsidence (SMD=0.40, 95% CI (0.06 to 0.75)) compared to ACCF.ConclusionsThe results suggested that ACDF has more advantages compared to ACCF. However, additional high-quality RCTs and a longer follow-up duration are needed.
| S-EPMC4120428 | biostudies-literature
Project description:The older adult population in developed countries is rapidly increasing, as is the number of older adults with cervical spondylosis. Previous studies on the surgical outcomes of older adults with cervical spondylosis have reported contradictory results. This study aimed to compare the surgical outcomes in adults with cervical spondylosis who were <80 and ≥80 years old. We retrospectively investigated data from adults who underwent surgical treatment for cervical spondylosis between 2006 and 2016. The clinical outcomes and postoperative complications of patients who were <80 years old were compared to those of patients who were ≥80 years old. Of the 108 patients included in the study, 14 (13.0%) were ≥80 years old. The preoperative neurosurgical cervical spine score was significantly different between patients who were <80 (9.1 ± 2.4) and ≥80 (6.1 ± 2.1) years old (p < .001). The recovery rate was 58.2 ± 30.0% and 41.3 ± 24.7% in patients who were <80 and ≥80 years old, respectively (p = .05). However, the number of recovery points scored was 2.8 ± 2.0 and 3.4 ± 2.3 in patients who were <80 and ≥80 years old, respectively, which was not significantly different. Although 12 patients had medical comorbidities, they had no surgical complications. This study clarifies the benefits of surgical treatment for older adults with cervical spondylosis. Generally, older adults have lower recovery rates and are unlikely to experience full recovery; however, surgery for cervical spondylosis appears to improve patients' quality of life.
| S-EPMC6594602 | biostudies-literature
Project description:BackgroundCervical spondylotic myelopathy (CSM) is a common indication for cervical spine surgery. Surgical options include anterior, posterior, or combined procedures each with specific advantages and disadvantages.Questions/purposesThis article will provide a description of the various anterior alternatives and discuss the available evidence used in guiding the surgical decision making process with the aim of answering the following questions: (1) What anatomical/disease related factors favor anterior over posterior surgeries? (2) What are the common anterior procedures and how safe and effective are they? (3) What are the most effective options for multilevel CSM? (4) Is there a role for motion preservation? An additional objective is to discuss technical advances that have improved success rates for anterior procedures.MethodsThe PubMed database was searched. Keywords were CSM and anterior surgery. Three hundred eighty two articles were found one hundred three were reviewed. Articles describing anterior cervical techniques were selected along with studies describing the various anterior techniques or comparisons of anterior to posterior techniques.ResultsAnterior decompression and fusion procedures are more effective than posterior procedures for patients with primarily ventrally located compression especially in the presence of cervical kyphosis. ACDF, ACCF, and hybrid combinations are safe and effective treatment options for multilevel CSM. Anterior procedures may be more cost effective and result in significantly improved postoperative quality of life and health-related quality of life measures compared to posterior procedures.ConclusionAnterior cervical decompression techniques are safe and effective in the treatment of CSM. Anterior surgeries may be preferable to posterior approaches, when considering health-related quality of life measures and cost effectiveness.
| S-EPMC4342400 | biostudies-literature
Project description:ObjectivesAnterior neck soft tissue thickness, usually measured by ultrasound, is increasingly being investigated to predict difficult laryngoscopy, but the results have not been validated. Considering the conflicting measurement data, different measuring body positions and lack of a standard ultrasound procedure, we used MRI to verify the efficacy of these popular ultrasonographic parameters.DesignProspective cohort study.SettingA tertiary hospital in Beijing, China.MethodsWe enrolled 315 adult patients who underwent cervical spinal surgery in Peking University Third Hospital from April to October 2016. We analysed MRI data to predict difficult laryngoscopy. Cormack-Lehane scales were assessed during intubation, and patients with a class III or IV view were assigned to the difficult laryngoscopy group.ResultsUnivariate analysis showed that male sex (p<0.01), older age (p=0.03) and body weight (p=0.02) were associated with difficult laryngoscopy. MRI data consisted of five common ultrasonographic variables used to predict difficult laryngoscopy, but none was a valuable predictor: skin to hyoid (p=0.18), skin to midpoint of epiglottis (p=0.72), skin to thyroid cartilage at the level of the vocal cords (p=0.10), skin to vocal cords (p=0.44) or skin to anterior to the trachea at the level of suprasternal notch (p=0.92). Adjusted by sex, age and body weight, none of the five MRI indicators had predictive value (p>0.05).ConclusionThe five most commonly studied ultrasonographic indicators of anterior soft tissue thickness appeared unreliable to predict difficult laryngoscopy in patients with cervical spondylosis. Further study is needed to validate the most valuable indicator to predict difficult laryngoscopy.Trial registration numberChiCTRROC-16008598; Pre-results.
| S-EPMC6549676 | biostudies-literature
Project description:BACKGROUND:Advanced cervical spondylosis (CS) can cause structural damage to the spinal cord resulting in long-term neurological impairment including neck pain and motor weakness. We hypothesized long-term structural reorganization within the brain in patients with CS. OBJECTIVE:To explore the associations between cortical thickness, subcortical volumes, neurological symptoms, and pain severity in CS patients with or without myelopathy and healthy controls (HCs). METHODS:High-resolution T1-weighted structural magnetic resonance imaging (MRI) scans from 26 CS patients and 45 HCs were acquired. Cortical thickness and subcortical volumes were computed and compared to the modified Japanese Orthopedic Association (mJOA) and the Neck Disability Index (NDI) scores. RESULTS:Cortical thinning within the superior frontal gyrus, anterior cingulate, precuneus, and reduction in putamen volume were associated with worsening neurological and pain symptoms. Among the strongest associations were cortical thickness within the left precuneus (R2 = 0.34) and left and right putamen (R2 = 0.43, 0.47, respectively) vs mJOA, and the left precuneus (R2 = 0.55), insula (R2 = 0.57), and right putamen (R2 = 0.54) vs NDI (P ? .0001 for all). Cortical thickness along Brodmann areas 3a, 4a, and 4p were also moderately associated with mJOA. Preliminary evidence also suggests that patients with CS may undergo cortical atrophy at a faster rate than HCs. CONCLUSION:Patients with CS appear to exhibit cortical thinning and atrophy with worsening neurological and pain symptoms in specific brain regions associated with sensorimotor and pain processing.
| S-EPMC6500881 | biostudies-literature
Project description:Sagittal cervical alignment is a clinically related feature in patients suffering from chronic cervical spondylotic radiculopathy (CSR). We designed this randomized trial to explore the effects of cervical lordosis (CL) correction in thirty chronic lower CSR patients with CL < 20°. Patients were assigned randomly into two equal groups, study (SG) and control (CG). Both groups received neck stretching and exercises and infrared radiation; additionally, the SG received cervical extension traction. Treatments were applied 3× per week for 10 weeks after which groups were followed for 3 months and 2 years. The amplitude of dermatomal somatosensory evoked potentials (DSSEPS), CL C2−C7, and pain scales (NRS) were measured. The SG had an increase in CL post-treatment (p < 0.0001), this was maintained at 3 months and 2 years. No statistical improvement in CL was found for the CG. A significant reduction in NRS for SG after 10 weeks of treatment with non-significant loss of change at 3 months and continued improvement at 2 years was found. CG had less significant improvement in post-treatment NRS; the 3-month and 2-year measures revealed significant worsening in NRS. An inverse linear correlation between increased CL and NRS was found (r = −0.49; p = 0.005) for both groups initially and maintained in SG at the final 2-year follow-up (r = −0.6; p = 0.01). At 10 weeks, we found significant improvements in DSSEPS for both groups (p < 0.0001). We identified a linear correlation between initial DSSEPs and CL for both groups (p < 0.0001), maintained only in the SG at the final follow-up for all levels (p < 0.0001). Improved CL in the SG correlated with significant improvements in nerve root function and pain rating in patients with CSR at short and long-term follow-up. These observed effects indicate that clinicians involved in the treatment of patients with symptoms of cervical degenerative disorders should add sagittal curve correction to their armamentarium of rehabilitation procedures for relevant patient populations.
| S-EPMC9658907 | biostudies-literature
Project description:Study Design Retrospective cross-sectional study. Clinical Question What is the prevalence of cervical spondylosis (CS) and thoracolumbar (TL) spinal deformity in an administrative database during a 4-year study period? Is the prevalence of CS or TL deformity higher in patients who have the other spine diagnosis compared with the overall study population? Are patients with both diagnoses more likely to have undergone spine surgery? Patients and Methods An administrative claims database containing 53 million patients with either Medicare (2005-2008) or private payer (2007-2010) insurance was used to identify patients with diagnoses of CS and/or TL deformity. Disease prevalence between groups was compared using a χ (2) test and reported using prevalence ratios (PR). Results The prevalence of CS was higher in patients with TL deformity than without TL deformity, for both Medicare (PR = 2.81) and private payer (PR = 1.79). Similarly, the prevalence of TL deformity was higher in patients with CS than without CS for both Medicare (PR = 3.19) and private payer (PR = 2.05). Patients with both diagnoses were more likely to have undergone both cervical (Medicare, PR = 1.44; private payer, PR = 2.03) and TL (Medicare, PR = 1.68; private payer, PR = 1.74) spine fusion. All comparisons were significant with p < 0.0001. Conclusions Patients with either CS or TL deformity had a higher prevalence of the other spinal diagnosis compared with the overall disease prevalence in the study population. Patients with both diagnoses had a higher prevalence of having spine surgery compared with patients with only one diagnosis. More studies to identify a causal mechanism for this relationship are warranted.
| S-EPMC3969428 | biostudies-literature