Pub Date : 2018-01-01DOI: 10.4172/2165-7939.1000420
Cantu-Leal R, Cantu-Longoria R
Background: The benefits from endoscopic spine surgery are well documented in literature. The use of interspinous spacers remains controversial, but the results reported in the studies just compare open decompression versus indirect decompression with interspinous spacers. Percutaneous cylindrical interspinous spacer portal is recommended at 16 cm from midline and endoscopic transforaminal discectomy from 10-12 cm. The risk of using an extreme lateral portal is greater. The literature recommends general anesthesia for interspinous instrumentation. We hypothesized that patients could benefit from a minimal invasive endoscopic decompression and an indirect decompression using the same portal for endoscopic transforaminal discectomy and the interspinous spacer instrumentation changing the introduction angle. This will reduce the recovery time, reoperation rate, soft tissue damage, anesthetic risk, and the possibility of damage to abdominal and retroperitoneal organs. Methods: We collected data from 152 consecutive patients from January 2008 to June 2016. All patients were candidates for endoscopic transforaminal discectomy and/or foraminoplasty and had surgical indications for interspinous spacer instrumentation. Mild sedation and local anesthesia was used during the endoscopic procedure. The interspinous spacer instrumentation was performed with local or epidural anesthesia. Results: Of the 152 patients that had the minimum 2 years follow up, we lost 10 patients at the end. Another 7 had another surgery. Average age was 49 years old, 80 males and 72 females. A total of 214 lumbar interspinous spacers were used. 84 patients referred their primary problem was axial pain (facets/discs) and 68 radicular pain (with central and/or foraminal stenosis). VAS lumbar pain dropped from 7.2 to 0.8 at 2 years, radicular pain from 6.1 to 0.4. The preoperatory ODI was 54.8 and went down to 12.4 at 24 months. More than 90% of the patients reported excellent or good results. Conclusion: No complications associated with the combination of both procedures. In proper selected cases, the uses of interspinous spacers and endoscopic transforaminal decompression have good results. Minimally invasive procedures can help patients to prevent or retard a greater surgery like fusion or laminectomy. Citation: Cantu-Leal R, Cantu-Longoria R (2018) Uniportal Endoscopic Transforaminal Discectomy Associated with Cylindrical Percutaneous Interspinous Spacer. J Spine 7: 420. doi: 10.0142/2165-7939.1000420
{"title":"Uniportal Endoscopic Transforaminal Discectomy Associated with Cylindrical Percutaneous Interspinous Spacer","authors":"Cantu-Leal R, Cantu-Longoria R","doi":"10.4172/2165-7939.1000420","DOIUrl":"https://doi.org/10.4172/2165-7939.1000420","url":null,"abstract":"Background: The benefits from endoscopic spine surgery are well documented in literature. The use of interspinous spacers remains controversial, but the results reported in the studies just compare open decompression versus indirect decompression with interspinous spacers. Percutaneous cylindrical interspinous spacer portal is recommended at 16 cm from midline and endoscopic transforaminal discectomy from 10-12 cm. The risk of using an extreme lateral portal is greater. The literature recommends general anesthesia for interspinous instrumentation. We hypothesized that patients could benefit from a minimal invasive endoscopic decompression and an indirect decompression using the same portal for endoscopic transforaminal discectomy and the interspinous spacer instrumentation changing the introduction angle. This will reduce the recovery time, reoperation rate, soft tissue damage, anesthetic risk, and the possibility of damage to abdominal and retroperitoneal organs. Methods: We collected data from 152 consecutive patients from January 2008 to June 2016. All patients were candidates for endoscopic transforaminal discectomy and/or foraminoplasty and had surgical indications for interspinous spacer instrumentation. Mild sedation and local anesthesia was used during the endoscopic procedure. The interspinous spacer instrumentation was performed with local or epidural anesthesia. Results: Of the 152 patients that had the minimum 2 years follow up, we lost 10 patients at the end. Another 7 had another surgery. Average age was 49 years old, 80 males and 72 females. A total of 214 lumbar interspinous spacers were used. 84 patients referred their primary problem was axial pain (facets/discs) and 68 radicular pain (with central and/or foraminal stenosis). VAS lumbar pain dropped from 7.2 to 0.8 at 2 years, radicular pain from 6.1 to 0.4. The preoperatory ODI was 54.8 and went down to 12.4 at 24 months. More than 90% of the patients reported excellent or good results. Conclusion: No complications associated with the combination of both procedures. In proper selected cases, the uses of interspinous spacers and endoscopic transforaminal decompression have good results. Minimally invasive procedures can help patients to prevent or retard a greater surgery like fusion or laminectomy. Citation: Cantu-Leal R, Cantu-Longoria R (2018) Uniportal Endoscopic Transforaminal Discectomy Associated with Cylindrical Percutaneous Interspinous Spacer. J Spine 7: 420. doi: 10.0142/2165-7939.1000420","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":"07 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7939.1000420","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70770026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2165-7939.1000422
A. Yeung, J. Porter
{"title":"SEP as A Sensory Pathway Integrity Check in Patients Undergoing Lumbar Endoscopic Spine Surgery Using the Yeung Endoscopic Spine System","authors":"A. Yeung, J. Porter","doi":"10.4172/2165-7939.1000422","DOIUrl":"https://doi.org/10.4172/2165-7939.1000422","url":null,"abstract":"","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":"07 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7939.1000422","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70770656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2165-7939.1000426
L. P. Domingos, D. Sá-Caputo, E. Guedes-Aguiar, E. Moreira-Marconi, M. Moura-Fernandes, A. S. Reis, P. Marín, C. Stark, M. Bernardo-Filho
{"title":"Whole Body Vibration Exercises on Physiological and Hemodynamic Parameters of Spinal Cord Injury Individuals: A Systematic Review","authors":"L. P. Domingos, D. Sá-Caputo, E. Guedes-Aguiar, E. Moreira-Marconi, M. Moura-Fernandes, A. S. Reis, P. Marín, C. Stark, M. Bernardo-Filho","doi":"10.4172/2165-7939.1000426","DOIUrl":"https://doi.org/10.4172/2165-7939.1000426","url":null,"abstract":"","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":"07 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7939.1000426","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70770845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2165-7939.1000430
Jeffrey D. Voigt, D. Anderson
Objective: Few studies have evaluated the cost effectiveness associated with lumbar microdiscectomy. The outcome data used in this analysis was from a prior randomized controlled trial (RCT) demonstrating that the use of a cryopreserved amniotic membrane (cAM) reduced the incidence of repeat procedures and improved outcomes vs. the standard of care (SOC). The purpose of this analysis was to cost out the procedural data associated with the outcomes from this RCT for cAM and then to evaluate the cost effectiveness of this alternative compared to every day practice. Methods: The direct costs of care for patients undergoing lumbar microdiscectomy were modeled using Medicare 2017 national average reimbursement. TreeAge Pro 2018 software was used for the decision tree analysis over a 2 year period. The assumed cost of cAM was $500 US. The probabilities of events were derived from the published literature, including repeat surgery from recurrent disc herniation. The effectiveness outcome evaluated was the Ostwestry Disability Index, as evaluated in the RCT and from published literature. One-way sensitivity analysis was conducted along with Monte Carlo simulation. Results: The use of cAM was the least costly alternative over 2 years by $343 vs. SOC ($12,417 vs. $12,760). One-way sensitivity analyses found the following variables had the greatest effect on the decision to use SOC vs. cAM (based on costs alone): incidence of revision surgery due to recurrent disc herniation for cAM (>6.8%) and SOC ( $843); cost of an inpatient repeat procedure of <$8,408. In Monte Carlo simulation, cAM dominated 53% of the time. Conclusion: Based on a lower incidence of repeat procedures and an improved ODI, cAM can be a cost effective alternative when compared to SOC. In today’s environment of US value based reimbursement, the use of cAM may hold promise.
目的:很少有研究评估与腰椎微椎间盘切除术相关的成本效益。本分析中使用的结果数据来自先前的随机对照试验(RCT)，该试验表明，与标准护理(SOC)相比，使用冷冻保存羊膜(cAM)减少了重复手术的发生率，并改善了结果。该分析的目的是计算出与该随机对照试验cAM结果相关的程序数据，然后与日常实践相比，评估该替代方案的成本效益。方法:采用2017年医疗保险全国平均报销模型对腰椎微椎间盘切除术患者的直接护理成本进行建模。使用TreeAge Pro 2018软件进行为期2年的决策树分析。假定cAM的成本为500美元。事件的概率来源于已发表的文献，包括复发性椎间盘突出的重复手术。评估的有效性结果是Ostwestry残疾指数，根据随机对照试验和已发表的文献进行评估。单因素敏感性分析与蒙特卡罗模拟相结合。结果:使用cAM是2年内成本最低的替代方案，比SOC低343美元(12,417美元对12,760美元)。单向敏感性分析发现，以下变量对使用SOC和cAM的决定影响最大(仅基于成本):由于复发性椎间盘突出而进行翻修手术的发生率对于cAM (bb0 6.8%)和SOC(843美元);住院病人重复手术的费用< 8408美元。在蒙特卡罗模拟中，cAM占了53%的优势。结论:基于较低的重复手术发生率和改善的ODI，与SOC相比，cAM是一种经济有效的替代方案。在当今美国基于价值的报销环境中，cAM的使用可能会带来希望。
{"title":"Cost Effectiveness Analysis-Cryopreserved Amniotic Membrane?s (cAM) Use in Lumbar Micro Discectomy-A Modeling of the Costs and Outcomes from a Randomized Controlled Trial","authors":"Jeffrey D. Voigt, D. Anderson","doi":"10.4172/2165-7939.1000430","DOIUrl":"https://doi.org/10.4172/2165-7939.1000430","url":null,"abstract":"Objective: Few studies have evaluated the cost effectiveness associated with lumbar microdiscectomy. The outcome data used in this analysis was from a prior randomized controlled trial (RCT) demonstrating that the use of a cryopreserved amniotic membrane (cAM) reduced the incidence of repeat procedures and improved outcomes vs. the standard of care (SOC). The purpose of this analysis was to cost out the procedural data associated with the outcomes from this RCT for cAM and then to evaluate the cost effectiveness of this alternative compared to every day practice. Methods: The direct costs of care for patients undergoing lumbar microdiscectomy were modeled using Medicare 2017 national average reimbursement. TreeAge Pro 2018 software was used for the decision tree analysis over a 2 year period. The assumed cost of cAM was $500 US. The probabilities of events were derived from the published literature, including repeat surgery from recurrent disc herniation. The effectiveness outcome evaluated was the Ostwestry Disability Index, as evaluated in the RCT and from published literature. One-way sensitivity analysis was conducted along with Monte Carlo simulation. Results: The use of cAM was the least costly alternative over 2 years by $343 vs. SOC ($12,417 vs. $12,760). One-way sensitivity analyses found the following variables had the greatest effect on the decision to use SOC vs. cAM (based on costs alone): incidence of revision surgery due to recurrent disc herniation for cAM (>6.8%) and SOC ( $843); cost of an inpatient repeat procedure of <$8,408. In Monte Carlo simulation, cAM dominated 53% of the time. Conclusion: Based on a lower incidence of repeat procedures and an improved ODI, cAM can be a cost effective alternative when compared to SOC. In today’s environment of US value based reimbursement, the use of cAM may hold promise.","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":"07 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7939.1000430","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70771326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2165-7939.1000425
H. Ribeiro, R. Teixeira, P. Fernandes, A. Nunes, J. Sousa, R. Almeida
{"title":"Thoracic Fracture-Dislocations without Neurologic Injury: 2 Cases Report and their Literature Review","authors":"H. Ribeiro, R. Teixeira, P. Fernandes, A. Nunes, J. Sousa, R. Almeida","doi":"10.4172/2165-7939.1000425","DOIUrl":"https://doi.org/10.4172/2165-7939.1000425","url":null,"abstract":"","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":"07 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7939.1000425","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70770901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2165-7939.s7-009
Jian Shen
Surgical decompression via an anterior or posterior approach is the treatment of choice for patients with cervical spinal stenosis/cord compression and cervical myelopathy. Traditional open and tubular approaches for treatment of central and lateral recess spinal stenosis involve laminotomy or laminectomy with removal of overgrown ligamentum flavum and a portion of the medial facet joints in order to decompress the central canal and lateral recess. Posterior minimally invasive compression techniques allow preservation of motion segment and neural decompression without fusion. Microendoscopic laminotomy (MED) patients have significantly less postoperative axial pain and improved subaxial cervical lordosis when compared with traditional laminoplasty patients [1].
{"title":"Fully Endoscopic Bilateral Cervical Laminotomy with Unilateral Approach for Cervical Spinal Stenosis and Myelopathy: A Case Series","authors":"Jian Shen","doi":"10.4172/2165-7939.s7-009","DOIUrl":"https://doi.org/10.4172/2165-7939.s7-009","url":null,"abstract":"Surgical decompression via an anterior or posterior approach is the treatment of choice for patients with cervical spinal stenosis/cord compression and cervical myelopathy. Traditional open and tubular approaches for treatment of central and lateral recess spinal stenosis involve laminotomy or laminectomy with removal of overgrown ligamentum flavum and a portion of the medial facet joints in order to decompress the central canal and lateral recess. Posterior minimally invasive compression techniques allow preservation of motion segment and neural decompression without fusion. Microendoscopic laminotomy (MED) patients have significantly less postoperative axial pain and improved subaxial cervical lordosis when compared with traditional laminoplasty patients [1].","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":"01 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7939.s7-009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70776123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-31DOI: 10.4172/2165-7939.1000404
T. Funayama, T. Tsukanishi, T. Abe, H. Kumagai, Shigeo Izawa, H. Noguchi, Kengo Fujii, Y. Shibao, M. Koda, M. Yamazaki
Purpose: To elucidate the association between computed tomography (CT)/magnetic resonance imaging (MRI) and radiographic findings of fractured vertebral body instability in patients with osteoporotic vertebral fractures and to clarify whether resistance to conservative treatment can be evaluated on the basis of dynamic loading radiography.Methods: Seventy-eight patients aged ≥ 65 years who underwent conservative treatment for osteoporotic single vertebral fractures of the thoracolumbar junction were divided into the conservative treatment-resistant group (18 patients) and control group (60 patients). We evaluated the accuracy of the prediction of resistance to conservative treatment on the basis of the CT/MRI findings and the difference in compression rates between standing and supine positions at the time of the first visit. The differences in compression rates (%) were compared between the two groups. In addition, a receiver operating characteristics (ROC) curve was drawn to evaluate the accuracy of the prediction of resistance to conservative treatment.Results: In patients without (47 cases) and with CT findings (31 cases), the mean differences in compression rates (%) was 8.9% and 19.1%, respectively (p=0.0029). The mean differences in compression rates (%) of patients without (60 cases) and with MRI findings (18 cases) was 9.7% and 24.0%, respectively (p=0.0043). The mean differences in compression rates (%) in the conservative treatment-resistant group was 26.3%, while that in the control group was 9.0 (p=0.0066). In addition, according to the ROC curve of the difference in compression rate was 0.93 (95% confidence interval: 0.87–1), and when a 20% difference in compression rate was considered as the threshold value.Conclusion: Dynamic loading radiography is useful for the evaluation of resistance to conservative treatment in patients with osteoporotic vertebral fractures, and that a compression rate difference of ≥ 20% predicts resistance to conservative treatment.
{"title":"Prediction of Treatment Resistance in Conservative Treatment of Osteoporotic Vertebral Fractures Using Lateral Plain Dynamic Loading Radiographs","authors":"T. Funayama, T. Tsukanishi, T. Abe, H. Kumagai, Shigeo Izawa, H. Noguchi, Kengo Fujii, Y. Shibao, M. Koda, M. Yamazaki","doi":"10.4172/2165-7939.1000404","DOIUrl":"https://doi.org/10.4172/2165-7939.1000404","url":null,"abstract":"Purpose: To elucidate the association between computed tomography (CT)/magnetic resonance imaging (MRI) and radiographic findings of fractured vertebral body instability in patients with osteoporotic vertebral fractures and to clarify whether resistance to conservative treatment can be evaluated on the basis of dynamic loading radiography.Methods: Seventy-eight patients aged ≥ 65 years who underwent conservative treatment for osteoporotic single vertebral fractures of the thoracolumbar junction were divided into the conservative treatment-resistant group (18 patients) and control group (60 patients). We evaluated the accuracy of the prediction of resistance to conservative treatment on the basis of the CT/MRI findings and the difference in compression rates between standing and supine positions at the time of the first visit. The differences in compression rates (%) were compared between the two groups. In addition, a receiver operating characteristics (ROC) curve was drawn to evaluate the accuracy of the prediction of resistance to conservative treatment.Results: In patients without (47 cases) and with CT findings (31 cases), the mean differences in compression rates (%) was 8.9% and 19.1%, respectively (p=0.0029). The mean differences in compression rates (%) of patients without (60 cases) and with MRI findings (18 cases) was 9.7% and 24.0%, respectively (p=0.0043). The mean differences in compression rates (%) in the conservative treatment-resistant group was 26.3%, while that in the control group was 9.0 (p=0.0066). In addition, according to the ROC curve of the difference in compression rate was 0.93 (95% confidence interval: 0.87–1), and when a 20% difference in compression rate was considered as the threshold value.Conclusion: Dynamic loading radiography is useful for the evaluation of resistance to conservative treatment in patients with osteoporotic vertebral fractures, and that a compression rate difference of ≥ 20% predicts resistance to conservative treatment.","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":" ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2017-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7939.1000404","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48561155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-16DOI: 10.4172/2165-7939.1000400
K. Yücesoy, K. Yüksel, Idiris Altun, Murvet Yuksel, O. Kalemci
Background context: Synergy disc is a new cervical disc prosthesis that incorporates alignment restoration while providing full intervertebral disc kinematics.Purpose: This follow-up study with 40 Synergy Disc patients with 24-month follow-up compared cervical alignment changes with a retrospective cohort of 30 single level anterior cervical discectomy and fusion (ACDF) patients.Study design/setting: The pilot trial was a multi-center, prospective, consecutive patient enrollment study using the Synergy Disc for the treatment of single and two-level degenerative disc disease of the cervical spine.Patient sample: The procedure was performed on 43 patients (45 implants) with follow-up on 40 patients (42 implants). For the historical cohort ACDF arm, 30 patients with similar follow-up with single level anterior discectomy, fusion and plating were used for segmental lordosis measurements.Outcome measures: For the Synergy Disc group, the kinematic parameters included: range of motion (ROM), shell angle (SA), disc height (DH), sagittal plane translation and center of rotation (COR) in the X and Y direction. Standard assessments of clinical outcomes were also measured (Neck Disability Index, Visual Analog Scale). For the fusion arm, only functional spinal unit (FSU) angle was recorded using a single pre-operative and post-operative standing lateral cervical radiograph.Methods: In the Synergy Disc group, static and dynamic radiological assessments were performed in 43 consecutive patients prior to the placement of the Synergy Disc. Forty patients were studied for the course of the study protocol (3 patients lost to follow-up). For the Synergy Disc group, all kinematic parameters were examined at a minimum of 24 months follow-up. Neck Disability Index and Visual Analog Scale for arm and neck pain were collected and analyzed. For the fusion group, standing lateral radiographs were reviewed.Results: At a mean of 28 months with all patients having a minimum of 24-month follow-up (40 patients, 42 implants), the average SA of the Synergy Disc was maintained at 6 ± 2.7˚ of lordosis. There was significant improvement in all clinical outcome measures. In the fusion group, with a similar follow-up period, there was a 4˚ increase in lordosis of the FSU.Conclusion: The Synergy Disc had an endplate angle of 6 ± 2.7˚ at 2 years following surgery. This was comparable to the lordotic correction provided by an anterior cervical discectomy with interbody fusion and plating.
{"title":"Can Cervical Arthroplasty Impact Alignment? A Comparison of the Synergy Disc with Cervical Fusion","authors":"K. Yücesoy, K. Yüksel, Idiris Altun, Murvet Yuksel, O. Kalemci","doi":"10.4172/2165-7939.1000400","DOIUrl":"https://doi.org/10.4172/2165-7939.1000400","url":null,"abstract":"Background context: Synergy disc is a new cervical disc prosthesis that incorporates alignment restoration while providing full intervertebral disc kinematics.Purpose: This follow-up study with 40 Synergy Disc patients with 24-month follow-up compared cervical alignment changes with a retrospective cohort of 30 single level anterior cervical discectomy and fusion (ACDF) patients.Study design/setting: The pilot trial was a multi-center, prospective, consecutive patient enrollment study using the Synergy Disc for the treatment of single and two-level degenerative disc disease of the cervical spine.Patient sample: The procedure was performed on 43 patients (45 implants) with follow-up on 40 patients (42 implants). For the historical cohort ACDF arm, 30 patients with similar follow-up with single level anterior discectomy, fusion and plating were used for segmental lordosis measurements.Outcome measures: For the Synergy Disc group, the kinematic parameters included: range of motion (ROM), shell angle (SA), disc height (DH), sagittal plane translation and center of rotation (COR) in the X and Y direction. Standard assessments of clinical outcomes were also measured (Neck Disability Index, Visual Analog Scale). For the fusion arm, only functional spinal unit (FSU) angle was recorded using a single pre-operative and post-operative standing lateral cervical radiograph.Methods: In the Synergy Disc group, static and dynamic radiological assessments were performed in 43 consecutive patients prior to the placement of the Synergy Disc. Forty patients were studied for the course of the study protocol (3 patients lost to follow-up). For the Synergy Disc group, all kinematic parameters were examined at a minimum of 24 months follow-up. Neck Disability Index and Visual Analog Scale for arm and neck pain were collected and analyzed. For the fusion group, standing lateral radiographs were reviewed.Results: At a mean of 28 months with all patients having a minimum of 24-month follow-up (40 patients, 42 implants), the average SA of the Synergy Disc was maintained at 6 ± 2.7˚ of lordosis. There was significant improvement in all clinical outcome measures. In the fusion group, with a similar follow-up period, there was a 4˚ increase in lordosis of the FSU.Conclusion: The Synergy Disc had an endplate angle of 6 ± 2.7˚ at 2 years following surgery. This was comparable to the lordotic correction provided by an anterior cervical discectomy with interbody fusion and plating.","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":"6 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2017-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41729386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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