European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Review Meta Analysis
Multi-level cervical disc arthroplasty (CDA) versus single-level CDA for the treatment of cervical disc diseases: a meta-analysis.
Cervical disc arthroplasty (CDA) was developed to treat cervical degenerated disc diseases with the advantages of preserving the kinematics of the functional spinal unit. However, the safety and reliability of multi-level CDA are still controverted when comparing to the single-level CDA. It has shown unclear benefits in terms of clinical results, functional recovery, heterotopic ossification, and the need for secondary surgical procedures. The purpose of this study is to estimate the effectiveness of multi-level cervical arthroplasty over single-level CDA for the treatment of cervical spondylosis and disc diseases. ⋯ The meta-analysis revealed that the outcomes and functional recovery of patients performed with multi-level CDA are equivalent to those with single-level CDA, which suggests the multi-level CDA is as effective and safe as single-level invention for the treatment of cervical spondylosis. Nonetheless, more well-designed studies with large groups of patients are needed to provide further evidence for the benefit and reliability of multi-level CDA in the treatment of cervical disc diseases.
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When a deformity involves more than one area of the spine, it becomes a multifocal deformity; such a deformity could either be extending on two adjacent segments, or be two separated deformities on two non-adjacent segments. ⋯ All these questions about the management of multifocal deformities will be discussed and answered with technical details and concrete examples of the different situations that may be encountered.
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Meta Analysis Comparative Study
Anterior cervical discectomy versus corpectomy for multilevel cervical spondylotic myelopathy: a meta-analysis.
This is a meta-analysis to compare the results between anterior cervical discectomy fusion (ACDF) and anterior cervical corpectomy fusion (ACCF) for the patients with multilevel cervical spondylotic myelopathy (MCSM). ⋯ As compared with ACCF with plate fixation, ACDF with plate fixation showed no significant differences in terms of postoperative JOA score, fusion rate, but better improved cervical lordosis, lower complication and smaller surgical trauma. As the limitations of small sample and short follow-up in this study, it still could not be identified whether ACDF with plate fixation is more effective and safer than ACCF with plate fixation.
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The combination of Massive epidural scarring and spinal deformity represents the ultimate challenge for the spinal deformity surgeon. This is observed more and more as the population is aging and the number of spine surgery is increasing. In assessing the patient with spinal deformity and epidural scarring, one should carry out a thorough medical work up including Dexa scan, comorbidities, and in most cases a Myelo-CT scan that will identify the extent of the previous fusion, the fixed or semi-rigid nature of the deformity with complete anterior fusion or only bone bridges, the evaluation of the previous instrumentation (if present) with possible screw misplacement, or halo around the screws, the extent of the previous laminectomy, the spinal stenosis and possible arachnoiditis and or meningocele. ⋯ During the closing of the osteotomy the dura may not be as giving as a normal dura and too aggressive closure of the osteotomy may not be possible. Instead a closing/opening osteotomy may be preferable, but will require an additional anterior column support. Attention to anterior column reconstruction and solid posterior instrumentation (iliac screws, four rods) should be given to all these revisions to have a long-lasting result.
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Degenerative changes have the potential to greatly disrupt the normal curvature of the spine, leading to sagittal malalignment. This phenomenon is often treated with operative modalities, such as osteotomies, though even with surgery, only one-third of patients may reach neutral alignment. Improvement in surgical outcomes may be achieved through better understanding of radiographic spino-pelvic parameters and their association with deformity. ⋯ Finally, given the importance of sagittal alignment and the role of osteotomies in treatment for deformity, the need for future research becomes apparent. Novel intraoperative measurement techniques and three-dimensional analysis of the spine may allow for vastly improved operative correction. Furthermore, awareness of the relationship between alignment and balance, the soft tissue envelope, and compensatory mechanisms will provide a more comprehensive conception of the nature of spinal deformity and the modalities with which it is treated.