The spine journal : official journal of the North American Spine Society
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In select patients, posterior cervical foraminotomy (PCF) and anterior cervical discectomy and fusion (ACDF) result in similar clinical outcomes when used to treat cervical radiculopathy. Nonetheless, ACDF is performed more frequently, in part because of surgeon perception that PCF requires operative revisions more frequently. The present study investigates the rate of ACDF reoperation at the index level after initial PCF. ⋯ This is the first study to determine conversion to ACDF after PCF. The present study demonstrates that PCF is associated with a low reoperation rate, similar to the historical reoperation for ACDF. Accordingly, spine surgeons can operate via a PCF approach without a significant increased risk for ACDF revision surgery at the index level.
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Observational Study
Early outcomes and complications of posterior vertebral column resection.
Hyperkyphosis confers a significant risk for neurologic deterioration as well as compromised cardiopulmonary function. Posterior vertebral column resection (PVCR) is a challenging but effective technique for spinal cord decompression and deformity correction that even under the setting of limited resources can be performed to reduce the technical difficulties, the operating time, and possibly the complications of the traditional two-staged vertebral column resection (VCR). ⋯ Posterior vertebral column resection was successfully undertaken for the management of thoracic and thoracolumbar hyperkyphosis, demonstrating improvements in overall kyphosis and clinical outcome. Neuromonitoring provided the required safety to perform these challenging complex spine deformity procedures.
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Adverse events (AEs) with significant resultant morbidity are common during the acute hospital care of patients with traumatic spinal cord injury (TSCI). The Rick Hansen SCI Registry (RHSCIR) collects Canada-wide data on patients with TSCI, such as sociodemographic, injury, diagnosis, intervention, and health outcome details. These data contribute to an evidence base for informing best practice and improving SCI care. As the RHSCIR captures data on patients from prehospital to community phases of care, it is an invaluable resource for providing information on health outcomes resulting from TSCI, including outcomes related to AEs. ⋯ This prospective study found that more than 77% of patients with TSCI sustain an AE during acute hospital care, significantly higher than previously reported. We demonstrate the utility of a dedicated AE collection system and the effect of these events on health status.
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Reconstructive surgeries at the occipitocervical (OC) junction have been studied in treating degenerative conditions. There is a paucity of data for optimal fixation for a traumatically unstable OC joint. In clinical OC dislocations, segmental fixation may be impossible because of vertebral artery injury or fracture. Segmental fixation of the occiput, C1, and C2 demonstrated maximum biomechanical stability in fixation of an unstable craniocervical dislocation. A biomechanical study comparing various points of cervical posterior screw fixation after recreating traumatic injury would illuminate relative advantages between the various techniques. ⋯ All fixation constructs significantly reduced motion in all loading modes and CC translations, compared with intact and injury. The construct with the greatest stability against craniocervical dislocation included SPF with instrumentation at the occiput, C1, and C2. By skipping C1 using the EPF, FE and cephalad-caudal translations significantly increased compared with posterior fixation at every level. The addition of a cross-connector increased the stability but was not statistically significant.
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The frequency of anterior cervical fusion (ACF) surgery and total hospital costs in spine surgery have substantially increased in the last several years. ⋯ This study highlights the patient comorbidities associated with increased hospital costs after one- or two-level ACFs and the potential drivers of these costs.