Risk factor analysis of hinge fusion failure after plate-only open-door laminoplasty.
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ABSTRACT:
SUBMITTER: Lee S
PROVIDER: S-EPMC4303478 | biostudies-other | 2015 Feb
REPOSITORIES: biostudies-other
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Project description:ObjectiveTo investigate and evaluate the biomechanical behaviour of tension-band-reconstruction (TBR) and ordinary titanium plates in open-door laminoplasty by finite element (FE) analysis.MethodsTBR titanium plate and ordinary titanium plate were implanted into a validated finite element model of healthy adult cervical vertebrae. Among them, 5 ordinary titanium plate were used in model A, 2 TBR titanium plates and 3 ordinary titanium plates were used in model B, and 5 TBR titanium plates were used in model C. The same loading conditions was applied identically to all models. Range of motion (ROM) of the vertebral body, stress distribution of the titanium plate and intradiscal pressure (IDP) were compared in flexion, extension, lateral bending and rotation.ResultsThe ROM of model B and C was similar in flexion and extension, and both were smaller than that of model A. The highest von Mises stress in the titanium plate appears is in model C. The IDP in C2/3 was significantly higher than that in other segments in flexion. There was no significant difference in IDP among three models in left lateral bending and left axial rotation.ConclusionApplication of TBR titanium plate in open-door laminoplasty can reduced ROM in flexion, extension and axial rotation of the cervical vertebrae. But the increase of stress in TBR titanium plate could lead to higher risk of adverse events such as titanium plate deformation. Moreover, compared with complete TBR titanium plate, the combination of TBR titanium plate for C3 and C7 with ordinary titanium plate for the other vertebrae largely reduce the stress of the titanium plates by ensuring stability. The proposed FE model (C2-T1) exhibits a great potential in evaluating biomechanical behaviour of TBR titanium plate for open-door laminoplasty.
| S-EPMC9454233 | biostudies-literature
Project description:Objective To demonstrate that preservation of all posterior structures during open-door laminoplasty (ODL) is associated with a significant preservation of motion. Methods Fifteen patients underwent cervical ODL by one surgeon for treatment of cervical spondylotic myelopathy. An open-door technique was employed, and the laminae on the open side were reconstructed using miniplates with allograft strut bone graft. All spinous processes and interspinous and supraspinous ligaments were preserved within the operative levels and between supra- and subjacent levels in all patients. Postoperative radiographs were obtained 1.5, 3, 6, and 12 months. Computed tomography scans were obtained at 12 months. Results There were no significant intraoperative or perioperative complications. Postoperatively, the neutral angle was 6.8 ± 11.5 degrees (95% confidence interval: 0.5 to 13.1), representing a loss of lordosis of 3 degrees (not significant). The difference between the preoperative and postoperative arc range of motion was 5.96 ± 11.9 degrees (confidence interval: -0.62 to 12.5). The average percent loss of motion was 3.5% ± (0.1 to 6.9%). Four patients had an increased range of motion postoperatively. Conclusion Open-door laminoplasty with preservation of all posterior structures provides greater preservation of motion than has been previously described.
| S-EPMC3864484 | biostudies-other
Project description:BACKGROUND:For patients with spinal canal stenosis in the upper cervical spine who undergo C3-7 laminoplasty alone, it remains impossible to achieve full decompression due to its limited range. This study explores the extension of expansive open-door laminoplasty (EODL) to C1 and C2 for the treatment of cervical spinal stenosis of the upper cervical spine and its effects on cervical sagittal parameters. METHODS:A retrospective analysis of 33 patients presenting with symptoms of cervical spondylosis myelopathy (CSM) and ossification in the posterior longitudinal ligament (OPLL) of the upper cervical spine from February 2013 to December 2015 was performed. Furthermore, the changes in the C0-2 Cobb angle, C1-2 Cobb angle, C2-7 Cobb angle, C2-7 SVA, and T1-Slope in lateral X-rays of the cervical spine were measured before, immediately after, and 1 year after the operation. JOA and NDI scores were used to evaluate spinal cord function. RESULTS:The C0-2 and C1-2 Cobb angles did not significantly increase (P?=?0.190 and P?=?0.081), but the C2-7 Cobb angle (P?=?0.001), C2-7 SVA (P?<?0.001), and T1-Slope (P?<?0.001) significantly increased from preoperative to 1?year postoperative. In addition, C2-7 SVA was significantly correlated with the T1-Slope (Pearson?=?0.376, P?<?0.001) and C0-2 Cobb angle (Pearson?=?0.287, P?=?0.004), and the C2-7 SVA was negatively correlated with the C2-7 Cobb angle (Pearson?=?-?0.295, P?<?0.001). The average preoperative and postoperative JOA scores were 8.3?±?1.6 and 14.6?±?1.4 points, respectively, indicating in a postoperative neurological improvement rate of approximately 91.6%. The average preoperative and final follow-up NDI scores were 12.62?±?2.34 and 7.61?±?1.23. CONCLUSIONS:The sagittal parameters of patients who underwent EODL extended to C1 and C2 included loss of cervical curvature, increased cervical anteversion and compensatory posterior extension of the upper cervical spine to maintain visual balance in the field of vision. However, the changes in cervical spine parameters were far less substantial than the alarm thresholds reported in previous studies. We believe that EODL extended to C1 and C2 for the treatment of patients with spinal canal stenosis in the upper cervical spine is a feasible and safe procedure with excellent outcomes.
| S-EPMC7003532 | biostudies-literature
Project description:STUDY DESIGN: Retrospective cohortObjective: To determine if there are differences in important clinical outcomes between patients treated with a "preservation of the unilateral posterior muscular-ligament complex (PMLC) procedure" and a "hinge side anchoring procedure (HSAP)" for the treatment of cervical spondylotic myelopathy (CSM). METHODS: Nine hundred and forty-six patients underwent the above procedures for treatment of CSM between January 2006 and December 2009. Five hundred and fifty-two (58%) subjects met study criteria and 136 were analyzed (76% unavailable for follow-up). One group (70 patients) received a "preservation of unilateral PMLC procedure" and another group (66 patients) received an HSAP. The rate and severity of postoperative axial symptoms were assessed, and the changes of cervical-spine curvature and postoperative decompression were measured. RESULTS: The mean time to follow-up in the preservation of unilateral PMLC group was 6.9 months (range, 6-8 months) and the HSAP group was 6.4 months (6-8 months). The overall rate of any axial symptoms (AS) among all subjects was 35%. No AS was reported in 45.7% of the preservation of unilateral PMLC group and 23.8% of the HSAP group (P = .008). Severe AS was reported in 4.3% and 11.1% of patients per group, respectively (P = .14). Cervical spinal lordosis was improved in the unilateral PMLC group and decreased in the HSAP group. The risk of losing lordosis was more than two times higher in the HSAP group compared with the unilateral PMLC group (70% and 34%, respectively; P < .001). CONCLUSION: Differences were observed between the two groups; however, a high loss to follow-up rate weakens the findings. Cervical expansive laminoplasty with preservation of unilateral PMLC may have the advantage of a lower rate of postoperative AS and maintenance of cervical spinal lordosis compared with the HSAP group.
| S-EPMC3427960 | biostudies-other
Project description:BackgroundUnilateral biportal endoscopy (UBE) is a newly developed technique for spine surgery. Owing to the convenience of nerve decompression and compatibility with open surgical instruments under endoscopic guidance, this technique has seen widespread global use. In this study, we first used modified UBE with suture anchor fixation for cervical laminoplasty in a 65-year-old female patient with good clinical outcomes.MethodsWe used bilateral biportal endoscopy (BBE) for cervical laminoplasty with suture anchor fixation in a patient with cervical stenosis. Under endoscopic guidance, a bilateral approach was used to make the gutter and lift the lamina door. After the lamina doors were opened, sutures were tied tightly using facia cannula and knot pusher. After confirming the solidarity of the open-door status, the drainage tube was inserted and the incisions were closed. The patient's pre- and postoperative radiological and clinical results were evaluated.ResultsPostoperative Japanese Orthopaedic Association (JOA) and Neck Disability Index (NDI) scores were improved clinically, and cervical canal was decompressed radiologically.ConclusionsBBE laminoplasty combined with suture anchor fixation showed a favorable clinical and radiological result and appears to be a safe and effective technique for cervical stenosis.
| S-EPMC9209651 | biostudies-literature
Project description:Despite their prevalent use as a surrogate for partitioning of pharmacologically active solutes across lipid membranes, the mechanism of transport across water/octanol phase boundaries has remained unexplored. Using molecular dynamics, graph theoretical, cluster analysis, and Langevin dynamics, we reveal an elegant mechanism for the simplest solute, water. Self-assembled octanol at the interface reversibly binds water and swings like the hinge of a door to bring water into a semi-organized second interfacial layer (a "bilayer island"). This mechanism is distinct from well-known lipid flipping and water transport processes in protein-free membranes, highlighting important limitations in the water/octanol proxy. Interestingly, the collective and reversible behavior is well-described by a double well potential energy function, with the two stable states being the water bound to the hinge on either side of the interface. The function of the hinge for transport, coupled with the underlying double well energy landscape, is akin to a molecular switch or shuttle that functions under equilibrium and is driven by the differential free energies of solvation of H2O across the interface. This example successfully operates within the dynamic motion of instantaneous surface fluctuations, a feature that expands upon traditional approaches toward controlled solute transport that act to avoid or circumvent the dynamic nature of the interface.
| S-EPMC8179308 | biostudies-literature
Project description:Microplate readers are foundational instruments in experimental biology and bioengineering that enable multiplexed spectrophotometric measurements. To enhance their accessibility, we here report the design, construction, validation, and benchmarking of an open-source microplate reader. The system features full-spectrum absorbance and fluorescence emission detection, in situ optogenetic stimulation, and stand-alone touch screen programming of automated assay protocols. The total system costs less than $3500, a fraction of the cost of commercial plate readers, and can detect the fluorescence of common dyes at concentrations as low as ?10 nM. Functional capabilities were demonstrated in the context of synthetic biology, optogenetics, and photosensory biology: by steady-state measurements of ligand-induced reporter gene expression in a model of bacterial quorum sensing and by flavin photocycling kinetic measurements of a LOV (light-oxygen-voltage) domain photoreceptor used for optogenetic transcriptional activation. Fully detailed guides for assembling the device and automating it using the custom Python-based API (Application Program Interface) are provided. This work contributes a key technology to the growing community-wide infrastructure of open-source biology-focused hardware, whose creation is facilitated by rapid prototyping capabilities and low-cost electronics, optoelectronics, and microcomputers.
| S-EPMC7144579 | biostudies-literature
Project description:ObjectiveCervical sagittal alignment changes (CSACs) influence outcomes and health-related quality-of-life. Anterior cervical discectomy and fusion (ACDF), laminectomy with fusion (LCF), and laminoplasty (LP) are common treatments for multisegmental cervical spondylotic myelopathy; however, these approaches need to be compared.MethodsOur study included 167 patients who underwent ACDF, LCF, or LP. Patients were divided into four groups according to C2-C7 Cobb angle (CL): kyphosis (CL < 0°), straight (0° ≤ CL < 10°), lordosis (10° ≤ CL < 20°), and extreme lordosis (20° ≤ CL) groups. CSACs consist of two parts. CSAC from the preoperative period to the postoperative period is surgical correction change (SCC). CSAC from the postoperative period to the final follow-up period is postoperative lordosis preserving (PLP). Outcomes were evaluated using the Japanese Orthopaedic Association score and the neck disability index.ResultsACDF, LCF, and LP had equivalent outcomes. ACDF had greater SCC than LCF and LP. During follow-up, lordosis decreased in the ACDF and LCF groups but increased in the LP group. For straight alignment, ACDF had greater CSAC and greater SCC than the LCF and LP groups but similar PLP. For lordosis alignment, ACDF and LP had positive PLP, and LCF had negative PLP. For extreme lordosis, ACDF, LP, and LCF had negative PLP; however, cervical lordosis in the LP group was relatively stable during follow-up.ConclusionsACDF, LCF, and LP have different CSAC, SCC, and PLP according to a four-type cervical sagittal alignment classification. Preoperative cervical alignment is an important consideration in deciding the type of surgical treatment in CSM.
| S-EPMC10007737 | biostudies-literature
Project description:BackgroundIn treating patients with cervical ossification of the posterior longitudinal ligament (COPLL), a novel surgery technique - anterior controllable antedisplacement and fusion (ACAF) suggested promising clinical benefits in recent exploratory studies.MethodsThis is a multicentre, randomized, open-label, parallel-group, active controlled trial that will compare the clinical benefits of ACAF versus conventional posterior laminoplasty (LAMP) in severe COPLL patients. A total of 164 patients will be enrolled and randomized in a 1:1 ratio to either ACAF or LAMP group. The primary efficacy measure is cervical- Japanese Orthopaedic Association (C-JOA) recovery rate at 12 months post operation, which is to be derived by Hirabayashi's method from JOA data (range, 0 [worst] to 17 [normal condition]). Other important secondary efficacy endpoints include visual analogue scale (VAS) pain score (range, 0 [no pain] to 10 [most severe]), 10-item neck disability index (NDI, a total range of 0 to 50 points, the highest index the worst) and 6-level Nurick disability grade (range, 0 [mild] to 5 [severe]). Safety endpoints including adverse events, perioperative complications, and adverse events of special interest will also be assessed in this study. Full analysis set for baseline and efficacy data analyses according to the intention-to-treat principle will be established as the primary analysis population. Analysis of covariance (ANCOVA) will be used to analyze the C-JOA recovery rate, with random stratification factors (if appropriate) and the treatment group as fixed factors, and the baseline level of C-JOA score as covariate.DiscussionThis study is designed to demonstrate the clinical benefits of ACAF as compared to conventional LAMP in COPLL patients. It will provide clinical evidence that the novel surgery technique - ACAF might be more favorable in treating patients with severe cervical ossification of the posterior longitudinal ligament. (Words: 290).Trial registrationClinicalTrials.gov number, NCT04968028 .
| S-EPMC8425037 | biostudies-literature
Project description:BackgroundAnterior plate fusion is an effective procedure for the treatment of cervical spinal diseases but is accompanied by a high incidence of postoperative dysphagia. A zero profile (Zero-P) spacer is increasingly being used to reduce postoperative dysphagia and other potential complications associated with surgical intervention. Studies comparing the Zero-P spacer and anterior plate have reported conflicting results.MethodologyA meta-analysis was conducted to compare the safety, efficacy, radiological outcomes and complications associated with the use of a Zero-P spacer versus an anterior plate in anterior cervical spine fusion for the treatment of cervical spinal disease. We comprehensively searched PubMed, Embase, the Cochrane Library and other databases and performed a meta-analysis of all randomized controlled trials (RCTs) and prospective or retrospective comparative studies assessing the two techniques.ResultsTen studies enrolling 719 cervical spondylosis patients were included. The pooled data showed significant differences in the operation time [SMD = -0.58 (95% CI = -0.77 to 0.40, p < 0.01)] and blood loss [SMD = -0.40, 95% CI (-0.59 to -0.21), p < 0.01] between the two groups. Compared to the anterior plate group, the Zero-P group exhibited a significantly improved JOA score and reduced NDI and VAS. However, anterior plate fusion had greater postoperative segmental and cervical Cobb's angles than the Zero-P group at the last follow-up. The fusion rate in the two groups was similar. More importantly, the Zero-P group had a lower incidence of earlier and later postoperative dysphagia.ConclusionsCompared to anterior plate fusion, Zero-P is a safer and effective procedure, with a similar fusion rate and lower incidence of earlier and later postoperative dysphagia. However, the results of this meta-analysis should be accepted with caution due to the limitations of the study. Further evaluation and large-sample RCTs are required to confirm and update the results of this study.
| S-EPMC4466022 | biostudies-literature