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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The kinematical properties of C5/C6 segments in axial rotation are evaluated before and after total disc arthroplasty (TDA) with PRESTIGE®-and BRYAN® Cervical Disc (Medtronic) under flexion/extension as parameters and compared with those of C3/C4. ⋯ Due to the configuration of the vertebral joints and their interaction with the intervertebral disc, the IHA migrates during the axial rotation within a distinct domain of each C5/C6-segment. Implantation of the PRESTIGE® and BRYAN® prostheses significantly alters these kinematical properties by dorsal displacements of the domains. Statistically TDA of C3/C4 and of C5/C6 are not correlated. Under axial rotation of the cervical spine, additional lateral and/or ventral/dorsal displacements are produced by TDA. Consequently, adjacent level disease (ALD) may be mechanically stimulated.
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Comparative Study
Which salvage fixation technique is best for the failed initial screw fixation at the cervicothoracic junction? A biomechanical comparison study.
The pedicle screw construct is the most widely used technique for instrumentation at cervicothoracic junction (CTJ) because of its high biomechanical stability. However, we may need salvage fixation options for it as there might be a situation when pedicle screw is not available or it initially fails in order to obviate the need to instrument an additional motion segment. We aimed to evaluate the ability of using salvage screw fixations at CTJ (C7, T1, T2), when the initial fixation method fails. ⋯ Laminar screws appear to provide stronger and more reproducible salvage fixation than lateral mass screws for C7 fixation, if pedicle screw should fail. If failure of initial pedicle screw is verified at the upper thoracic spine, both laminar screw and pedicle screw with different trajectory could be an option of salvage fixation. Our results suggest that pedicle screws and laminar screw similarly provide a strong fixation for salvage applications in the cervicothoracic junction.
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Review Meta Analysis
Locking stand-alone cages versus anterior plate constructs in single-level fusion for degenerative cervical disease: a systematic review and meta-analysis.
To conduct a meta-analysis to compare the clinical and radiological outcomes in single-level anterior cervical discectomy and fusion (ACDF) surgery for degenerative cervical disease performed by either single-level locking stand-alone cage (LSC) or anterior plate construct (APC). ⋯ LSC and APC have similar clinical and radiological outcomes. Further blinded randomised trials are required to establish conclusive evidence in favour of LSC with regards to minimising post-operative dysphagia. We also encourage future studies to make use of formalised dysphagia outcome measures in reporting complications.
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Comparative Study
Comparison of intraoperative neurophysiologic monitoring outcomes between cervical and thoracic spine surgery.
The objective is to compare the intraoperative monitoring (IOM) outcomes between degenerative cervical and thoracic spine decompression surgery. ⋯ The IOM loss between CCM and TCM patients present obvious difference and the sudden MEPs loss associated with spinal decompression need to be taken seriously especially in TCM.
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The aim of this study was to assess the potential role of diffusion tensor imaging (DTI) as a predictor of surgical outcomes in patients with cervical compressive myelopathy (CCM). Surgical decompression is often recommended for symptomatic CCM. It is important to know the prognosis of surgical outcomes and to recommend appropriate timing for surgery. ⋯ FA in spinal cord DTI can moderately predict surgical outcomes. DTI can serve as a supplementary tool for decision-making to guide surgical intervention in patients with CCM.