Cervical Spine Deformity—Part 1: Biomechanics, Radiographic Parameters, and Classification

Tan, Lee A.; Riew, K. Daniel; Traynelis, Vincent C.

doi:10.1093/neuros/nyx249

Cited by 85 publications

(71 citation statements)

References 26 publications

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“…12 The anterior approach is generally considered to be more tolerable and still effective in achieving significant deformity correction, whereas posterior and combined approaches offer greater mechanical advantage but higher morbidity risks. 1,3,6,[13][14][15] As each approach has particular strengths, understanding potential complications associated with each approach is also essential for spine surgeons and their patients. Here, the present study set out to determine complications and short-term quality outcomes in a large, comparative sample of patients undergoing each of the 3 approach types.…”

Section: Discussionmentioning

confidence: 99%

“…Irrespective of the etiology, it is associated with high morbidity rates, and its correction is generally resource intensive. [1][2][3] If left untreated, patients with ACD frequently suffer from debilitating pain, poor health-related quality of life, and patients' risk to progressively lose function in case of associated myelopathy and neurological deficits. Severe forms of ACD, such as chin-on-chest deformities, can even lead to the inability to chew, swallow, or speak.…”

Section: Introductionmentioning

confidence: 99%

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A Comparative Analysis of Patients Undergoing Fusion for Adult Cervical Deformity by Approach Type

Varshneya

Medress

Stienen

et al. 2020

Global Spine Journal

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Study Design: Retrospective cohort study. Objective: To provide insight into postoperative complications, short-term quality outcomes, and costs of the surgical approaches of adult cervical deformity (ACD).Methods: A national database was queried from 2007 to 2016 to identify patients who underwent cervical fusion for ACD. Patients were stratified by approach type-anterior, posterior, or circumferential. Patients undergoing anterior and posterior approach surgeries were additionally compared using propensity score matching. Results: A total of 6575 patients underwent multilevel cervical fusion for ACD correction. Circumferential fusion had the highest postoperative complication rate (46.9% vs posterior: 36.7% vs anterior: 18.5%, P < .0001). Anterior fusion patients more commonly required reoperation compared with posterior fusion patients (P < .0001), and 90-day readmission rate was highest for patients undergoing circumferential fusion (P < .0001). After propensity score matching, the complication rate remained higher in the posterior, as compared to the anterior fusion group (P < .0001). Readmission rate also remained higher in the posterior fusion group; however, anterior fusion patients were more likely to require reoperation. At index hospitalization, posterior fusion led to 1.5Â higher costs, and total payments at 90 days were 1.6Â higher than their anterior fusion counterparts. Conclusion:Patients who undergo posterior fusion for ACD have higher complication rates, readmission rates, and higher cost burden than patients who undergo anterior fusion; however, posterior correction of ACD is associated with a lower rate of reoperation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Comparative Analysis of Patients Undergoing Fusion for Adult Cervical Deformity by Approach Type

Varshneya

Medress

Stienen

et al. 2020

Global Spine Journal

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“…Se sabe incluso que no es la técnica más utilizada por grupos de neurocirujanos en el mundo, principalmente debido a los elevados costos, aunque se tiene proyección que esta situación se revertirá en los próximos años, ante la evidencia de los buenos resultados en el corto, mediano y largo plazo (20,21) . Por otro lado, la motilidad segmentaria o el alineamiento cervical general es afectado por la artroplastía de un nivel, por ende, los implantes discales cervicales deben tener la característica de simular la fisiología del movimiento cervical, lo que justifica la realización de pruebas de movimientos de flexión antero-posterior, extensión antero-posterior, flexión lateral, así como de tolerancia a la sobrecarga axial (22,23) . Por ello, los resultados obtenidos por el FCI, en las pruebas realizadas en columna cervical de porcino, revisten especial importancia ya que corroboran la naturaleza flexible del implante probado.…”

Section: Discussionunclassified

Desarrollo mecánico y experimental de un implante discal cervical flexible

Álvarez¹,

Lean

Rodrı́guez³

et al. 2019

An Fac med

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Introducción: La artroplastía cervical es una cirugía que implica el uso de implantes discales con la capacidad de conservar el movimiento del segmento. Constituye un reto para paises como el nuestro desarrollar alternativas a los altos costos de los mencionados implantes, con diseños patentado, elaborado viables de manufacturar, con biocompatibilidad, seguridad, y que simule lo máximo posible los movimientos cervicales fisiológicos. Objetivo: Desarrollar la geometría y mecánica de un diseño discal patentado, elaborado, sea por manufactura aditiva de titanio ELI, así como verificar su compatibilidad con la fisiología de los movimientos cervicales. Métodos: El diseño del estudio tuvo tres etapas iterativas: la primera, el desarrollo de la geometría del implante y el estudio de elementos finitos utilizando como referencia normas internacionales; en segundo lugar, se desarrollaron estudios de metalografía, caracterización del material incluyendo pruebas de fatiga del implante; finalmente, se utilizó un modelo animal cadavérico para confirmar la compatibilidad del implante con los movimientos cervicales. Resultados: Se demostró que el implante elaborado sea por manufactura aditiva o por forja, fue compatible con las normas internacionales. Se realizaron 84 estudios de rayos X en 18 cuellos de porcino. En el 100% de las columnas cervicales de los porcinos, el rango en flexión fue menor que el de extensión. Existió mayor rango de movimiento cuando se utilizaron dos implantes y cuando el implante fue más grande. Conclusiones: El implante cervical flexible elaborado por forja o por manufactura aditiva de titanio ELI presentó resultados prometedores, por lo que podría postularse su uso experimental en pacientes tributarios de artroplastía cervical.

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“…Surgical strategies include direct decompression of the spinal cord, correction of the deformity, or both, using anterior, posterior, or combined circumferential approaches. [2][3][4][5][6] In this review article, the rationale behind complex revision surgery for cervical deformity secondary to several etiologies are discussed using illustrative cases (Table 1).…”

Section: Introductionmentioning

confidence: 99%

Complex Revision Surgery for Cervical Deformity or Implant Failure

Shimokawa¹,

Sato²,

Matsumoto³

et al. 2020

Neurospine

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Postoperative cervical deformity sometimes occurs in the short or long term after primary surgery for cervical disorders related to the degenerative aging spine, neoplastic etiologies, hemodialysis, infection, inflammation, trauma, etc. Cervical kyphosis after posterior decompression surgery, such as laminectomy or laminoplasty, is a common problem for spine surgeons. However, revision surgery for cervical deformity is definitely one of the most challenging areas for spine surgeons. There is no doubt that surgery for cervical deformity carries a high risk of surgery-related complications that might result in aggravation of healthrelated quality of life. Revision surgery is even more challenging. Hence, spine surgeons need to assess carefully the overall severity of the underlying condition before revision surgery, and try to refine the surgical strategy to secure safe surgery. Needless to say, spine surgeons are now facing great challenges in making spine surgery a much more reliable and convincing entity.

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Cervical Spine Deformity—Part 1: Biomechanics, Radiographic Parameters, and Classification

Cited by 85 publications

References 26 publications

A Comparative Analysis of Patients Undergoing Fusion for Adult Cervical Deformity by Approach Type

A Comparative Analysis of Patients Undergoing Fusion for Adult Cervical Deformity by Approach Type

Desarrollo mecánico y experimental de un implante discal cervical flexible

Complex Revision Surgery for Cervical Deformity or Implant Failure

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