Seminars in Spine Surgery最新文献

The prevalence of adult spinal deformity is on the rise with an aging population. Spine surgeons will need to optimize preoperative planning and treatment selection for adequate intervention. This review consolidates the current literature regarding clinical indications for adult deformity surgery and the use of diagnostic imaging for pre-surgical planning.

Surgical treatment of adult spinal deformity (ASD) is associated with high resource utilization, high costs, and potential complications. In order to generate consensus for treatment paradigms and to demonstrate value, it is crucial to accurately assess clinical outcomes. Historically, objective assessments in ASD were performed by providers, and in recent decades the use of patient-reported outcome measures (PROMs) have become widely incorporated. Here, we report results of a bibliometric analysis of PROMs in ASD, synthesizing a global view of the topic and mapping trends in the field. In the modern era, enabling advancements in predictive modeling and machine learning, along with technology within smartphones and wearables, may supplement traditional patient-centric outcomes assessments and overcome some of their limitations.

The population aged 65 and over is projected to double by the year 2050. As the population continues to age, the incidence of adult spinal deformity (ASD) will continue to rise. It is estimated that 30–50% of patients older than 65-years develop a degenerative scoliosis. Many of these patients have little to no symptoms as a result of their deformity and continue to lead active and healthy lives. A smaller subset of patients with degenerative scoliosis develops pain and disability as a result of their underlying deformity. The outcomes of surgery in this group are generally favorable but there is significant risk and potential morbidity associated with deformity correction surgery. The pre-operative planning and technical aspects of surgery are important but the peri-operative optimization of modifiable factors to minimize the risk of complications is even more important to achieve optimal outcomes. This paper will review the most up-to-date literature on the peri-operative optimization of patients undergoing adult spinal deformity surgery.

Adult spinal deformity (ASD) continues to increase in tandem with a globally aging population. Advances in technology and surgical techniques have significantly improved the efficacy of surgical treatment for ASD. The medical complexity of patients with ASD in combination with the intensive physiologic demands of deformity surgery accentuates the risk of postoperative complications in this patient population. Therefore, this review sequentially outlines postoperative complications in spinal deformity surgery by timing and prevalence, and describes risk factors and management strategies to improve outcomes in patients undergoing surgical treatment for ASD.

Historically, anterior cervical discectomy and fusion (ACDF) has been the preferred surgical technique to address myelopathy and radiculopathy due to cervical spine intervertebral disc disease. Continued design improvements and theoretical biomechanical advantages to cervical disc arthroplasty over the last decade have made cervical disc arthroplasty an appealing alternative to ACDF, especially in younger patient populations without significant spondylosis who may wish to preserve neck motion. This narrative review will discuss the recent advances in cervical disc arthroplasty in regard to material composition, overall design and resultant degrees of freedom of the devices, the potential sparing of neck range of motion, and the theoretical biomechanical advantages of an arthroplasty compared to an ACDF.

Cervical total disc arthroplasty (CTDA) is an alternative to cervical fusion when addressing single level cervical disc disease and attempts to restore normal disc height and preserve motion, theoretically decreasing rates of adjacent segment disease (ASD) and symptomatic pseudoarthrosis. Although safe and effective, CTDA has a unique complication profile particularly in regard to long-term complications. Approach related complications are similar to anterior cervical discectomy and fusion (ACDF) and include injury to surrounding vascular, digestive, and neurologic structures. To achieve anatomic positioning, CTDA requires vertebral endplate cartilage removal and osseous preparation which can lead to endplate fracture, salvage fusion, or component malpositioning. Long term complications include heterotopic ossification (HO), implant subsidence, ASD requiring surgical intervention, and implant migration or translation. Although HO reduces motion at the prosthesis site, it does not appear to worsen clinical outcomes in most cases. Evidence is still conflicting regarding ASD when comparing ACDF to CTDA, however, the most recent evidence suggests a lower rate of development with CTDA.

Objective

To perform a systematic literature review of the use of cervical disc replacement for cervical myelopathy.

Methods

A systematic literature review was performed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Clinical studies on cervical disc replacement surgery for spondylotic cervical myelopathy were included for analysis.

Results

Out of 524 studies in the original search, a total of 13 studies were included. There were 8 studies related to cervical spondylotic myelpathy(CSM). From a total of 561 patients, 685 levels underwent arthroplasty, with an average of 48.6 months of follow-up. On average, Nurik grading system improved 1.5, JOA improved 4.4, and NDI improved 25.1. Mean VAS neck and arm improved 4.4 and 4.5 respectively. Maintained ROM was noted in all studies with one study showing increased global and segmental lordosis. Reoperation was performed in 5 patients whose initial symptoms were not relieved. Complications include 83 cases of paravertebral ossifications (14.8%), 10 dysphagia (1.8%), and 10 levels with anterior migration of the implant, which were treated non-operatively.

Conclusion

At an average of 4 years follow-up, significant improvements in Nurick grade, NDI. JOA, VAS-neck, and VAS-arm pain scores are seen in myelopathy patients undergoing cervical arthroplasty. Retaining range of motion was reported without causing related neurological complications. A large sample size with long-term follow-up studies may be needed to confirm these findings in the future.

Anterior cervical discectomy and fusion (ACDF) has been considered the mainstay of care for cervical spondylosis despite its association with decreased spinal mobility, altered kinematics, and risk of adjacent segment disease. Cervical disc arthroplasty (CDA) has recently emerged as a potential alternative that allows for preservation of motion and restoration of physiologic load distribution at both the index and adjacent levels. The growing interest and strong clinical evidence supporting the use of CDA has led to several changes in implant design. This review aims to discuss the implementation of CDA as an alternative to ACDF as well as provide an update on advancements in implant design and their influence of spinal biomechanics.

The optimal surgical treatment for multilevel cervical degenerative disc disease is still controversial. The purpose of this article is to review the current evidence of the hybrid cervical surgery, which combines anterior cervical discectomy and fusion and cervical disc arthroplasty, for treating this condition. This fusion-nonfusion hybrid procedure provides favorable biomechanics and promising clinical and radiographic outcomes in both contiguous and skip-level pathologies. However, further high-quality and long-term follow-up studies are required to provide strong evidence and validate the results of the hybrid cervical spine surgery.