Evaluation of clinical results and quality of life after surgical reconstruction for rheumatoid cervical spine

BACKGROUND CONTEXT: The EuroQol (EQ-5D) is a widely used comprehensive measure of health-related quality of life. There has been no study that has evaluated the health-related quality of life before and after the surgical reconstruction of rheumatoid arthritis (RA) cervical spine lesions using EQ-5D. PURPOSE: The present study aimed to evaluate the improvement of quality of life before and after surgical reconstruction of rheumatoid cervical spine using EQ-5D, and the surgical outcomes of cervical spine affected by RA. STUDY DESIGN: A retrospective study of the patients who underwent surgical reconstruction of cervical disorders in RA. PATIENT SAMPLE: Twenty-five patients (seven men, 18 women, mean age 62.2 years) who underwent surgical reconstruction of cervical disorders in RA were enrolled. OUTCOME MEASURES: Japanese Orthopaedic Association (JOA) score and EQ-5D. METHODS: Clinical symptoms were evaluated before surgery and at 2 years after surgery by measuring the JOA score. We also investigated health-related quality of life before surgery and outcome at 2 years after surgery using the EQ-5D questionnaire. RESULTS: Mean observation period was 46.3 months. Mean JOA score significantly improved from 9.1 +/- 4.5 points before surgery to 12.4 +/- 2.8 at the 2 years after surgery (p=.0001). All the EQ-5D data were improved at the 2 years after surgery, compared with the data before surgery; especially, pain (p=.005), usual activity (p=.005), mobility (p=.008), and anxiety/depression (p=.02) were significantly improved. Utility weight was 0.37 +/- 0.27 before surgery and 0.56 +/- 0.26 at the 2 years after surgery, showing significant improvement at the 2 years after surgery compared to before surgery (p=.002). CONCLUSIONS: The surgical reconstruction of rheumatoid cervical spine has been demonstrated to improve patients' health-related quality of life.ArticleSPINE JOURNAL. 13(4):391-396 (2013)journal articl

Mid-term results of computer-assisted cervical reconstruction for rheumatoid cervical spines

Study design A retrospective single-center study. Summary and background We routinely have used C1-C2 transarticular and cervical pedicle screw fixations to reconstruct highly destructed unstable rheumatoid arthritis (RA) cervical lesions. However, there is little data on midterm results of surgical reconstruction for rheumatoid cervical disorders, particularly, cervical pedicle screw fixation. Objectives The purpose of this study was to evaluate the mid-term surgical results of computer-assisted cervical reconstruction for such lesions. Methods Seventeen subjects (4 men, 13 women; mean age, 61 +/- 9 years) with RA cervical lesions who underwent C1-C2 transarticular screw fixation or occipitocervical fixation, with at least 5 years follow-up were studied. A frameless, stereotactic, optoelectronic, CT-based image-guidance system, was used for correct screw placement. Variables including the Japanese Orthopaedic Association (JOA) score, Ranawat class, EuroQol (EQ-5D), atlantodental interval, and Ranawat values before, and at 2 and 5 years after surgery, were evaluated. Furthermore, screw perforation rates were evaluated. Results The lesions included atlantoaxial subluxation (AAS, n = 6), AAS + vertical subluxation (VS, n = 7), and AAS + VS + subaxial subluxation (n = 4). There was significant neurological improvement at 2 years after surgery, as evidenced by the JOA scores, Ranawat class, and the EQ-5D utility weight. However, at 5 years after surgery, there was a deterioration of this improvement. The Ranawat values before, and at 2 and 5 years after surgery, were not significantly different. Major screw perforation rate was 2.1 %. No neural and vascular complications associated with screw insertion were observed. Conclusions Subjects with rheumatoid cervical lesions who underwent C1-C2 transarticular screw fixation or occipitocervical fixation using a pedicle screw had significantly improved clinical parameters at 2 years after surgery. However, there was a deterioration of this improvement at 5 years post surgery.ArticleJOURNAL OF ORTHOPAEDIC SCIENCE. 18(6):916-925 (2013)journal articl

Myxopapillary Ependymoma of the Cauda Equina in a 5-Year-Old Boy

Myxopapillary ependymoma in childhood typically occurs in the central nervous system. There are few surgical cases of myxopapillary ependymoma of the cauda equina in children. We report a case of myxopapillary ependymoma of the cauda equina in a 5-year-old boy, who presented with leg pain and abnormal gait. Subtotal resection surgery was performed. Following the subtotal tumor resection, follow-up magnetic resonance imaging evaluation showed a recurrent tumor. As a result, we performed a second subtotal tumor resection and followed with postoperative radiation therapy. No further evidence of the disease has been noted elsewhere in the patient in over ten years of follow-up. Myxopapillary ependymoma of the cauda equina in a young boy was improved by subtotal tumor resection and postoperative radiation therapy

Comparison of Spinous Process-Splitting Laminectomy versus Conventional Laminectomy for Lumbar Spinal Stenosis

Study DesignSeventy-five patients who had been treated for lumbar spinal stenosis (LSS) were reviewed retrospectively.PurposeInvasion into the paravertebral muscle can cause major problems after laminectomy for LSS. To address these problems, we performed spinous process-splitting laminectomy. We present a comparative study of decompression of LSS using 2 approaches.Overview of LiteratureThere are no other study has investigated the lumbar spinal instability after spinous process-splitting laminectomy.MethodsThis study included 75 patients who underwent laminectomy for the treatment of LSS and who were observed through follow-ups for more than 2 years. Fifty-five patients underwent spinous process-splitting laminectomy (splitting group) and 20 patients underwent conventional laminectomy (conventional group). We evaluated the clinical and radiographic results of each surgical procedure.ResultsJapanese Orthopaedic Association score improved significantly in both groups two years postoperatively. The following values were all significantly lower, as shown with p-values, in the splitting group compared to the conventional group: average operating time (p=0.002), postoperative C-reactive protein level (p=0.006), the mean postoperative number of days until returning to normal body temperature (p=0.047), and the mean change in angulation 2 years postoperatively (p=0.007). The adjacent segment degeneration occurred in 6 patients (10.9%) in the splitting group and 11 patients (55.0%) in the conventional group.ConclusionsIn this study, the spinous process-splitting laminectomy was shown to be less invasive and more stable for patients with LSS, compared to the conventional laminectomy

Mini Open Foraminotomy for Cervical Radiculopathy: A Comparison of Large Tubular and TrimLine Retractors

Study DesignRetrospective chart review.PurposeA comparison of mini open foraminotomy (MOF) for cervical radiculopathy using either large tubular (LT) or TrimLine (TL) retractors.Overview of LiteraturePosterior foraminotomy relieves compression of the cervical nerve root in radiculopathy patients. However, invasion of the paravertebral muscle may cause major problems in these patients. To address these problems, we performed MOF.MethodsTwenty cervical radiculopathy patients (16 male and 4 female) who underwent MOF between May 2004 and August 2011 were assigned to LT and TL groups. Each group contained 10 subjects. Surgical and clinical outcomes were compared.ResultsThe average operating time in the TL group was significantly shorter than that in the LT group. The final follow-up mean neck disability indices significantly improved compared to the preoperative values (LT group, 12.0±7.8 vs. 28.0±9.4; TL group, 6.0±5.9 vs. 21.9±10). The final follow-up neck pain visual analog scale (VAS) scores also decreased significantly from the preoperative of 8.0±1.5 and 2.5±2.5 to the final follow-up values of 2.2±2.2 and 1.0±2.5 in the LT and TL groups, respectively. The recovery rate for the neck pain VAS score was 70.0±31.9 in the LT group and 87.0±32.0 in the TL group, thus suggesting no significant difference between the two groups.ConclusionsMOF with the TL retractor is an easy and safe procedure. Furthermore, the use of the TL retractor allows for a minimally invasive and effective surgical treatment of cervical radiculopathy patients

Comparison of Clinical and Radiological Results of Posterolateral Fusion and Posterior Lumbar Interbody Fusion in the Treatment of L4 Degenerative Lumbar Spondylolisthesis

Study DesignMulticenter analysis of two groups of patients surgically treated for degenerative L4 unstable spondylolisthesis.PurposeTo compare the clinical and radiographic outcomes of posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) for degenerative L4 unstable spondylolisthesis.Overview of LiteratureSurgery for lumbar degenerative spondylolisthesis is widely performed. However, few reports have compared the outcome of PLF to that of PLIF for degenerative L4 unstable spondylolisthesis.MethodsPatients with L4 unstable spondylolisthesis with Meyerding grade II or more, slip of >10° or >4 mm upon maximum flexion and extension bending, and posterior opening of >5 degree upon flexion bending were studied. Patients were treated from January 2008 to January 2010. Patients who underwent PLF (n=12) and PLIF (n=19) were followed-up for >2 years. Radiographic findings and clinical outcomes evaluated by the Japanese Orthopaedic Association (JOA) score were compared between the two groups. Radiographic evaluation included slip angle, translation, slip angle and translation during maximum flexion and extension bending, intervertebral disc height, lumbar lordotic angle, and fusion rate.ResultsJOA scores of the PLF group before surgery and at final follow-up were 12.3±4.8 and 24.1±3.7, respectively; those of the PLIF group were 14.7±4.8 and 24.2±7.8, respectively, with no significant difference between the two groups. Correction of slip estimated from postoperative slip angle, translation, and maintenance of intervertebral disc height in the PLIF group was significantly (p<0.05) better than those in the PLF group. However, there was no significant difference in lumbar lordotic angle, slip angle and translation angle upon maximum flexion, or extension bending. Fusion rates of the PLIF and PLF groups had no significant difference.ConclusionsThe L4–L5 level posterior instrumented fusion for unstable spondylolisthesis using both PLF and PLIF could ameliorate clinical symptoms when local stability is achieved

Long-Term Surgical Results of Skip Pedicle Screw Fixation for Patients with Adolescent Idiopathic Scoliosis: A Minimum-Ten-Year Follow-Up Study

Skip pedicle screw fixation for adolescent idiopathic scoliosis (AIS) requires fewer screws and can reduce the risk of neurovascular injury as compared with segmental pedicle screw fixation. However, the long-term impact of screw number reduction on correction and clinical results is unclear. This study examined the 10-year post-operative outcomes of skip pedicle screw fixation for patients with AIS. We reviewed the outcomes of 30 patients who underwent skip pedicle screw fixation for AIS. Radiological and clinical findings were assessed before and immediately, 2 years, and 10 years after surgery in the remaining 25 patients. The mean Cobb angle of the main curve preoperatively and immediately, 2 years, and 10 years post-operatively was 59.4&deg;, 23.4&deg;, 25.8&deg;, and 25.60&deg;, respectively, and was significantly improved at all post-surgical time points (all p &lt; 0.001). The mean correction rate immediately after surgery was 60.8%, and the correction loss rate at the observation end point was 4.8%. The Cobb angle of the lumbar curve was significantly improved immediately after surgery, and the correction persisted until 10 years post-operatively. Remarkable gains were observed for most Scoliosis Research Society-22 patient questionnaire sub-scores at the final follow-up versus preoperative assessments. In conclusion, good correction of the AIS deformity by skip pedicle screw fixation was well maintained over a long follow-up period of 10 years, with clinically meaningful gains in Society-22 patient questionnaire sub-scores

Comparison of fusion versus non-fusion surgery for retro-odontoid pseudotumor with atlanto-axial subluxation

Background: Due to the limited number of reports comparing posterior fusion with posterior decompression alone for retro-odontoid pseudotumor, there remains no consensus on treatment preference, especially in older patients. This study compared posterior fusion (with or without additional decompression) with posterior decompression alone for treating spinal cord pressure from non-inflammatory retro-odontoid pseudotumor with atlanto-axial subluxation (AAS). Methods: Forty-one patients (27 male and 14 female; mean age, 73.0 ± 11.4 years) who underwent either posterior cervical fusion or decompression alone for the treatment of non-inflammatory retro-odontoid pseudotumor with AAS and were observed for more than 1 year between September 2009 and July 2019 were enrolled. Thirty-two patients (23 male and 9 female; mean age: 71.8 ± 10.9 years) received posterior fusion surgery (fusion group) and 9 patients (4 male and 5 female; mean age: 77.2 ± 12.5 years) underwent decompression alone (non-fusion group). We compared pre- and postoperative Japanese Orthopaedic Association (JOA) scores and preoperative cervical alignment parameters between the groups. Results: In the fusion group, the mean preoperative JOA score was significantly improved from 9.0 ± 3.2 points to 11.7 ± 3.2 points at the final follow-up (p = 0.0002). Similarly in the non-fusion group, the mean preoperative and final follow-up JOA scores were 8.2 ± 3.5 points and 11.7 ± 3.8 points, respectively (p = 0.003). The recovery rate at the final follow-up was 22.6% in the fusion group and 43.4% in the non-fusion group, which were statistically comparable (p = 0.23). We observed no remarkable correlations between cervical sagittal spinal alignment parameters and JOA score recovery rate in the cohort, nor was any significant subluxation progression seen. Conclusion: Compared with fusion surgery, surgical decompression alone may be a suitable and less invasive option for the treatment of non-inflammatory retro-odontoid pseudotumor with AAS, especially in elderly patients