This is a meta-analysis of controlled trials.To assess the overall condition of adjacent segment of cervical disk arthroplasty (CDA) compared with anterior cervical discectomy and fusion (ACDF).With the increase in CDA and ACDF, surgeons are taking more attention to adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis). There are more and more meta-analyses comparing the efficacy of CDA with ACDF, however, there are few meta-analyses referring to adjacent segment parameters, and investigators are still unable to arrive at the same conclusion.Several important databases were searched for controlled trials comparing CDA and ACDF before February 2016 according to PRISMA guidelines. The analysis parameters included follow-up time, operative segments, cervical range of motion (ROM), adjacent segment motion, ASDeg, ASDis and adjacent segment reoperation. The risk of bias scale and Newcastle-Ottawa Scale were used to assess the papers. Subgroup analysis and sensitivity analysis were used to analyze the reason for high heterogeneity.Forty-one controlled trials fulfilled the inclusion criteria, including 36 English papers and 5 Chinese. The average follow-up time of all included patients was 39 months. Compared with ACDF, the rate of adjacent segment reoperation in the CDA group was significantly lower (P<0.01), and the advantage of CDA group increased with the increasing of follow-up time according to subgroup analysis. The rate of ASDeg in CDA was significantly lower than that of ACDF (P<0.01). There was no statistical difference between upper and lower ASDeg using the same surgical method (P>0.05). CDA provided a greater cervical ROM than did ACDF (P<0.01). There was a lower adjacent segment ROM and the rate of ASDis in CDA compared with ACDF (P<0.05).Compared with ACDF, the advantages of CDA were lower ASDeg, ASDis, adjacent segment reoperation and adjacent segment motion; and higher cervical ROM. However, there was no statistical difference between upper and lower adjacent segment ROM/ASDeg using the same surgery.
Background Cavernous malformations are common vascular abnormalities of the central nervous system, but cavernous malformations of the cerebral aqueduct are rare. The choice of treatment is influenced by various factors. Case Description We report two cases of midbrain cavernous malformations. Both cases involved midbrain lesions obstructing the cerebral aqueduct, leading to obstructive hydrocephalus. The primary symptoms and complaints of the patients were related to hydrocephalus. Prior to surgery, patients underwent comprehensive imaging evaluations and received endoscopic third ventriculostomy rather than tumor resection. Both patients had favorable recoveries. We also reviewed the literature and discussed the choice of treatment strategies. Conclusion Cavernous malformations are slow-progressing central nervous system lesions with a relatively benign natural course. When selecting a treatment strategy, clinicians should carefully consider the underlying cause of the patient’s primary symptoms and the specific objectives of the surgery. Avoiding overly aggressive resection that fails to address the main symptoms and potentially causes irreversible damage is crucial.
Abstract Local and general anesthesia are the main techniques used during percutaneous kyphoplasty (PKP); however, both are associated with adverse reactions. Monitored anesthesia with dexmedetomidine may be the appropriate sedative and analgesic technique. Few studies have compared monitored anesthesia with other anesthesia modalities during PKP. Our aim was to determine whether monitored anesthesia is an effective alternative anesthetic approach for PKP. One hundred sixty-five patients undergoing PKP for osteoporotic vertebral compression fractures (OVCFs) were recruited from a single center in this prospective, non-randomized controlled study. PKP was performed under local anesthesia with ropivacaine (n = 55), monitored anesthesia with dexmedetomidine (n = 55), and general anesthesia with sufentanil/propofol/sevoflurane (n = 55). Perioperative pain was assessed using a visual analogue score (VAS). Hemodynamic variables, operative time, adverse effects, and perioperative satisfaction were recorded. The mean arterial pressure (MAP), heart rate, VAS, and operative time during monitored anesthesia were significantly lower than local anesthesia. Compared with general anesthesia, monitored anesthesia led to less adverse anesthetic effects. Monitored anesthesia had the highest perioperative satisfaction and the lowest VAS 2 h postoperatively; however, the monitored anesthesia group had the lowest MAP and heart rate 2 h postoperatively. Based on better sedation and analgesia, monitored anesthesia with dexmedetomidine achieved better patient cooperation, a shorter operative time, and lower adverse events during PKP; however, the MAP and heart rate in the monitored anesthesia group should be closely observed after surgery.
Objective
To observe the curative effects of cervical paravertebral nerve block under ultrasound guidance combined with nerve stimulator localization for cervical spondylosis of nerve-root type.
Methods
One hundred and twenty patients with cervical spondylosis of nerve-root type were enrolled and treated by cervical paravertebral nerve block under ultrasound guidance combined with nerve stimulator localization. Visual analogue scale (VAS) was observed before treatment and at 1 day, 1 week and 3 months after the treatment. The effects were assessed by modified MacNab method at 3 months after the treatment.
Results
The VAS decreased significantly at 1 day (2.3±0.6) , 1 week (2.2±0.4) , and 3 months (1.9±0.4) after the treatment as compared with pre-treatment (7.2±0.5) (P 0.05) . Sixty-five patients (54.2%) showed excellent effect, 44 patients (36.7%) good effect, 8 patients (6.7%) acceptable effect and 3 patients (2.5%) poor effect. The excellent and good rate was 90.8% (109/120 cases) and the CASCS increased at 3 months after the treatment as compared with pre-treatment (P<0.05) , without adverse reaction.
Conclusion
The cervical paravertevral nerve block under ultrasound guidance combined with nerve stimulator localization is a safe and effective method in the treatment of cervical spondylosis of nerve-root type.
Key words:
Ultrasound guidance; Nerve stimulator; Nerve-root type cervical spondylosis
The purpose of this study was to analyze the cervical range of motion (ROM) after revised C1-C2 pedicle screw fixation for pediatric patients with atlantoaxial instability.17 pediatric patients (age range 5-14 years; mean 8.3 years) underwent the revised C1-C2 pedicle screw technique. Pre- and postoperative cervical ROM during flexion/extension, rotation and lateral bending were measured using a head-mounted motion goniometer. Plain radiographs, CT scans and MRI were performed to assess spinal cord compression, the accuracy of screw placement, and bone fusion. The American Spinal Injury Association classification was used to evaluate neurological function.Revised atlantoaxial pedicle screw fixation was successfully performed in all 17 pediatric patients. There were no perioperative complications. All cases showed evidence of bone fusion 6 months after surgery by CT scan. During the follow-up period (24-92 months), of 6 patients with preoperative myelopathy, 3 improved from grade D to grade E and 3 from grade C to grade D. The final follow-up cervical ROM was significantly greater than the preoperative and 6-month postoperative ROM. There was a statistically significant difference between preoperative and 6-month postoperative ROM for flexion, extension, and left and right axial rotation movements.As a short-segmental fixation technique, revised C1-C2 pedicle screw fixation can provide effective biomechanical stability. Final follow-up cervical ROM is significantly increased through alleviating cervical pain and symptoms of myelopathy after surgery and possible subaxial compensation.
Since February 1982, 23 patients with scoliosis were treated by releasing the soft tissues on the concave side and plaster spinal fusion jacket. Of these patients, 13 had congenital scoliosis and 10 idiopathic scoliosis. Follow-up for 1 to 8.5 years showed that the results of correction were satisfactory. The maximum degree of correction of the main curve in this series was from 74 degrees (Cobb method) before treatment to 3 degrees after treatment. The maximum rate of correction was 97.3%.
Many doctors ignored the possibility that there is still a spinal cord compression (SCC) need for decompression after atlantoaxial reduction. Reduction can be achieved on kinematic magnetic resonance imaging (MRI); thus, we want to analyze the role of kinematic MRI in reducible atlantoaxial dislocation and make a preoperative decision whether to perform decompression.36 patients with atlantoaxial reduction on preoperative kinematic MRI in extension postures were enrolled retrospectively. Grouping was based on the condition of SCC after atlantoaxial reduction preoperatively. Group A: patients with SCC after atlantoaxial reduction on dynamic cervical MRI were treated with C1 laminectomy for decompression and atlantoaxial fixation. Group B: patients with no significant SCC, according to dynamic MRI, underwent only atlantoaxial fixation. Clinical outcomes were evaluated using JOA score for spinal cord function. Radiological outcomes were assessed by measuring spinal cord diameter on MRI.The mean follow-up time was 17.1 months. Postoperative JOA score and percentage of SCC in both groups were significantly better than its preoperative score. There were no significant statistical differences in the JOA score at 12 months after surgery and the JOA improvement rate between two groups. All patients in the two groups had a lower percentage of SCC on preoperative extension MRI, compared with neutral MRI. No significant statistical differences in the spinal decompression improvement rate were observed between the two groups.Decompression should be performed in patients who still have significant SCC on preoperative kinematic MRI. Kinematic MRI could be used to assess SCC and decide whether to perform decompression preoperatively.
Abstract Summary Refracture of cemented vertebral body is a complication after vertebroplasty in treatment of osteoporotic compression fractures (OVCF). The cemented vertebra refracture incidence was compared between PCVP and PKP and the results showed that PCVP had lower refracture incidence, and entailed less fluoroscopy and operation time than bilateral PKP. Introduction The purpose of this study is to compare the refracture incidence of the cemented vertebral body of percutaneous curved vertebroplasty (PCVP) and bilateral percutaneous kyphoplasty (PKP) in the treatment of OVCF. Methods Ninety-four patients with single segment thoracolumbar OVCF were randomly divided into two groups (47 patients in each) and underwent PCVP or bilateral PKP surgery respectively. The refracture of cemented vertebral body, bone cement injection volume and cement pattern, cement leakage rate, the total surgical time, intraoperative fluoroscopy time, preoperative and postoperative Cobb angles and anterior vertebral height, Oswestry disability index questionnaire (ODI) and visual analog scales (VAS) were recorded. Results The PCVP group had significantly lower refracture incidence of the cemented vertebral than the bilateral PKP group (p<0.05). There was a significant postoperative improvement in the VAS score and ODI in both group (p<0.01), and no significant difference was found between two groups. The operation time and intraoperative fluoroscopy times were significantly less in the PCVP group than the bilateral PKP group (p<0.01). The mean kyphosis angle correction and vertebral height restoration in the PCVP group was significantly less than that in the bilateral PKP group (p<0.01). Conclusion Both PCVP and PKP were safe and effective treatment for OVCF. The PCVP had lower refracture incidence of the cemented vertebral than the bilateral PKP group, and PCVP entailed less exposure to fluoroscopy and shorter operation time than bilateral PKP.
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