OBJECTIVE: Anterior cervical discectomy and fusion (ACDF) is a choice of surgical procedure for cervical degenerative diseases associated with radiculopathy or myelopathy. However, the patients undergoing ACDF still have problems. The purpose of the present study is to evaluate the radiologic results of 3 different methods in single-level ACDF. METHODS: We conducted a retrospective collection of radiological data from January 2011 to December 2014. A total of 67 patients were included in this study. The patients were divided into 3 groups by operation procedure: using stand-alone cage (group cage, n=20); polyether-ether-ketone (PEEK)-titanium combined anchored cage (group AC, n=21); and anterior cervical cage-plate (group CP, n=26). Global cervical lordosis (C2-C7 Cobb angle), fused segment height, fusion rate, and cervical range of motion (ROM) were measured and analyzed at serial preoperative, postoperative, 6-month, and final 1-year follow-up. RESULTS: Successful bone fusion was achieved in all patients at the final follow-up examination; however, the loss of disc height over 3 mm at the surgical level was observed in 6 patients in group cage. Groups AC and CP yielded significantly better outcomes than group cage in fused segment height and cervical ROM(p=0.01 and p=0.02, respectively). Furthermore, group AC had similar radiologic outcomes to those of group CP. CONCLUSION: The PEEK-titanium combined anchored cage may be a good alternative procedure in terms of reducing complications induced by plate after ACDF.
Animals ; Cervical Vertebrae ; Diskectomy* ; Female ; Follow-Up Studies ; Humans ; Lordosis ; Methods* ; Postoperative Complications ; Radiculopathy ; Radiography ; Range of Motion, Articular ; Retrospective Studies ; Spinal Cord Diseases ; Spinal Fusion

OBJECTIVE: The aim of this study was to compare the clinical and radiological outcomes associated with the use of hydroxyapatite (HA) spacer and allogeneic bone (AB) spacer in laminoplasty. METHODS: From January 2006 to July 2014, 79 patients with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament underwent cervical laminoplasty. The radiologic parameters were obtained from plain radiography and three-dimensional computed tomography. All images were taken before and after surgery. Cervical lordosis, spinal canal dimension, fusion between lamina and spacer, and resorption of spacer were checked. Clinical outcomes were assessed using visual analog scale and Japanese Orthopedic Association. RESULTS: Double-door laminoplasty was performed on 280 levels : 182 in the HA group and 98 in the AB group. The mean follow-up was 23.1 months (range : 4–69 months). Similar fusion rates were found in these groups (p=0.3). The resorption rate between lamina and spacer was lower in the HA group (p<0.001). During the immediate postoperative period, the canal dimension of both groups increased compared with the results in the preoperative period. However, the canal dimension of the AB group decreased over time compared with that of the HA group (p<0.001). CONCLUSION: Double-door laminoplasty improved the clinical outcomes of both groups. However, the spinal canal dimension in the AB group showed a greater degree of reduction than in the HA group at the final postoperative follow-up. Therefore, we suggest that surgeons consider the use of larger-sized AB spacers in double-door laminoplasties.
Allografts ; Animals ; Asian Continental Ancestry Group ; Durapatite* ; Follow-Up Studies ; Humans ; Hydroxyapatites ; Laminoplasty* ; Longitudinal Ligaments ; Lordosis ; Orthopedics ; Ossification of Posterior Longitudinal Ligament ; Postoperative Period ; Preoperative Period ; Radiography ; Spinal Canal ; Spinal Cord Diseases ; Spinal Fusion ; Surgeons ; Visual Analog Scale

OBJECTIVETo investigate effect of Activ L total lumbar disc replacement on lumbar sagittal alignment.

METHODSThe imaging data of patients with degenerative disc disease received Activ L total lumbar disc replacement at Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University from March 2009 to March 2013 were retrospectively analyzed. The average age was 45.6 years(range, 35-60 years)and the surgery levels were as follows: L3-4 2 cases, L4-5 15 cases, L5/S1 5 cases, L3-4+ L4-5 3 cases, L4-5+ L5/S1 7 cases. All patients were followed up for 15 to 63 months(average, 32 months). Radiographic parameters such as lumbar lordosis angle(LL), segment lordosis angle(SL) and sacral slope angle(SS) were recorded. All the radiographic parameters were compared using one-way ANOVA at different stage. Lumbar lordosis angle of the two-level was compared with the one of one-level by using independent sample t-test before and after the operation. A partial correction test was carried out to determine the corrections between the parameters preoperatively, one month after the operation and at final follow-up.

RESULTSOne month after the operation, the lumbar lordosis angle decreased by an average of 1.8°, but there was no statistically significant(P>0.05). Compared with one month postoperation, the lumbar lordosis angle increased by an average of 6.8°(P<0.05), which also increased a lot compared with preoperation(P<0.05). The value of segment lordosis angle was rising up from preoperation to the final follow-up(P<0.05), so was the value of sacral slope angle, but there was no statistically significant between different stage(P>0.05). The lumbar lordosis angle showed no significant difference between double-level ones and single-level ones at different stage(P<0.05). The lumbar lordosis angle showed positive correlation with the sacral slope(P<0.001), however, the lumbar lordosis angle showed no corrected with the segment angle all the time(P>0.05).

CONCLUSIONSThe total lumbar disc replacement with Activ L prosthesis had contributed to maintain and improve the lumbar alignment in the short and medium term. Double- or single-level total lumbar disc replacement had no significant effect on the value of lumbar lordosis angle. The lumbar lordosis angle showed positive correlation with the sacral slope all the time with no correlation between lumbar lordosis angle and sacral slope.

Diagnostic Imaging ; Humans ; Intervertebral Disc Degeneration ; surgery ; Lordosis ; diagnostic imaging ; Lumbar Vertebrae ; surgery ; Lumbosacral Region ; surgery ; Postoperative Period ; Prostheses and Implants ; Radiography ; Retrospective Studies ; Total Disc Replacement

OBJECTIVE: To investigate the relationship between bone mineral density (BMD) and sagittal spinal balance in the Korean elderly population. METHODS: The retrospective study included subjects aged 60 years and above, who had whole-spine lateral radiography and dual-energy X-ray absorptiometry (DEXA) within a year's gap between each other. Sagittal vertical axis (SVA) for evaluation of sagittal spinal balance and five spinopelvic parameters were measured through radiography. The presence of compression fracture was identified. Correlations of BMD T-scores with SVA and with the spinopelvic parameters were assessed using Pearson correlation coefficient (PCC). Linear regression analyses were performed between SVA and the clinical and radiologic variables. RESULTS: One hundred twenty-two subjects (42 males and 80 females; mean age, 69.93+/-5.5 years) were included in the study. BMD, femur or spine, was not correlated with SVA or any spinopelvic parameters in both genders (PCC<+/-0.2), except that spine BMD in men was associated with sacral slope. Univariate regression analysis revealed association between SVA and lumbar lordosis, pelvic tilt, and compression fractures in both genders; it was also associated with age and pelvic incidence in females and with sacral slope in males. Multivariate linear regression model showed lumbar lordosis and compression fracture as variables affecting SVA in both sexes; pelvic incidence was another factor affecting SVA in women only. CONCLUSION: BMD was not associated with sagittal spinal balance in the aged. Sagittal spinal balance was explained partly by lumbar lordosis and compression fracture. Further study is warranted to understand progression of sagittal imbalance with age.
Absorptiometry, Photon ; Aged ; Animals ; Axis, Cervical Vertebra ; Bone Density* ; Female ; Femur ; Fractures, Compression ; Humans ; Incidence ; Linear Models ; Lordosis ; Male ; Radiography ; Retrospective Studies ; Spine

OBJECTIVE: Cervical spine encompasses a bridge role between the head and the lower parts of the spine and therefore has unique properties. Our aim in this study was to evaluate the cervical sagittal alignment parameters in pediatric and adult non-surgical patients and to find any differences in respect of age, sex and admission type. METHODS: All patients who were admitted to emergency and neurosurgery clinics of Diyarbakir Bismil State Hospital due to cervical spine problems (trauma, radiculopathy, paraspinal pain) in 2014 were enrolled retrospectively into the study. Cervical anterior-posterior and lateral X-rays were obtained. Our exclusion criteria were cervical coronal deformity, multitrauma, Glasgow Coma Scale <15, traumatic disruption of the cervical spine, history of malignancy, spinal infection, metabolic or rheumatologic diseases. RESULTS: There were 44 female and 55 male patients (n=99) in the study. Thirty-five (35.35%) of the patients were younger than 18 years of age. Mean cervical spinal alignment parameters were as follows: -42.81+/-11.23degrees (OC2), -17.15+/-11.48degrees (C2-C7), -29.82+/-7.60degrees (T1 slope), -3.62+/-3.05degrees (C3), -3.14+/-3.05 (C4), -3.80+/-2.74degrees (C5), -3.12+/-2.36degrees (C6), -3.43+/-2.53degrees (C7). Positive correlations were observed between age-C2C7 angle, C2C7 angle-T1 slope, C3 angle-C4 angle, C4 angle-OC2 angle, C4 angle-T1 slope, C4 angle-C5 angle. The one only negative correlation was between OC2 angle-C2C7 angle. CONCLUSION: In this regional study, it has been observed that global cervical lordosis increases as age increases. C4 vertebra is in the middle of this evaluation as it has many correlations with other cervical segments, which should be kept in mind when making surgical plans for this delicate spine region.
Adult ; Animals ; Congenital Abnormalities ; Emergencies* ; Female ; Glasgow Coma Scale ; Head ; Hospitals, State* ; Humans ; Lordosis ; Male ; Neurosurgery* ; Radiculopathy ; Radiography ; Retrospective Studies ; Spine ; Turkey*

OBJECTIVE: To investigate the effect of different pillow heights on the slope of the cervicothoracic spine segments. METHODS: A prospective analysis of data from 16 asymptomatic adults (aged 20 to 30 years) was carried out. Exclusion criteria were history of injury or accident to the cervicothoracic spine, cervicothoracic spine surgery, or treatment for neck symptoms. We used three different pillow heights: flat (0 cm), 10-cm, and 20-cm pillows. Cervical sagittal parameters, measured with radiography, included; C2-7 Cobb's angle, T1 slope (T1S), thoracic inlet angle (TIA), and neck tilt (NT). Statistical analyses were performed using Spearman correlation coefficients. RESULTS: As the height of the pillow increased, the T1S & C2-7 Cobb's angle increased while the NT values tended to decrease. The TIA values, however, remained constant. Additionally, there was a statistically significant sex difference in T1S with the 0-cm pillow (p=0.01), and in NT with the 20-cm pillow (p=0.01). CONCLUSION: From the data obtained in this study, we recommend that the most suitable pillow height is 10 cm, considering the normal cervical lordosis.
Adult ; Animals ; Bays ; Humans ; Lordosis ; Neck ; Prospective Studies ; Radiography ; Sex Characteristics ; Spine*

PURPOSE: Anterior cervical discectomy and fusion (ACDF) has become a common spine procedure, however, there have been no previous studies on whole spine alignment changes after cervical fusion. Our purpose in this study was to determine whole spine sagittal alignment and pelvic alignment changes after ACDF. MATERIALS AND METHODS: Forty-eight patients who had undergone ACDF from January 2011 to December 2012 were enrolled in this study. Cervical lordosis, thoracic kyphosis, lumbar lordosis, sagittal vertical axis (SVA), and pelvic parameters were measured preoperatively and at 1, 3, 6, and 12 months postoperatively. Clinical outcomes were assessed using Visual Analog Scale (VAS) scores and Neck Disability Index (NDI) values. RESULTS: Forty-eight patients were grouped according to operative method (cage only, cage & plate), operative level (upper level: C3/4 & C4/5; lower level: C5/6 & C6/7), and cervical lordosis (high lordosis, low lordosis). All patients experienced significant improvements in VAS scores and NDI values after surgery. Among the radiologic parameters, pelvic tilt increased and sacral slope decreased at 12 months postoperatively. Only the high cervical lordosis group showed significantly-decreased cervical lordosis and a shortened SVA postoperatively. Correlation tests revealed that cervical lordosis was significantly correlated with SVA and that SVA was significantly correlated with pelvic tilt and sacral slope. CONCLUSION: ACDF affects whole spine sagittal alignment, especially in patients with high cervical lordosis. In these patients, alteration of cervical lordosis to a normal angle shortened the SVA and resulted in reciprocal changes in pelvic tilt and sacral slope.
Adult ; Aged ; Cervical Vertebrae/physiopathology/radiography/*surgery ; Cross-Sectional Studies ; *Diskectomy ; Female ; Humans ; Lordosis/etiology/*surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neck/surgery ; Retrospective Studies ; Spinal Diseases/complications/physiopathology/radiography/*surgery ; Spinal Fusion/*methods ; Spine ; Treatment Outcome ; Young Adult

OBJECTIVETo analyze the clinical manifestations, bone X-ray findings and genetic analysis results of three short-limb inherited short stature diseases: achondroplasia (ACH), hypochondroplasia (HCH) and pseudoachondroplasia (PSACH).

METHODSThe clinical manifestations, bone X-ray findings, and genetic analysis results of 10 children with genetically confirmed short-limb inherited short stature diseases, including 4 cases of ACH 3 cases of HCH, and 3 cases of PSACH, were analyzed.

RESULTSThe 10 patients had a mean body height of -3.69±1.79 SD, a mean sitting height/standing height ratio of 0.65±0.03, and a mean finger spacing/body height ratio of 0.93±0.04. Four ACH cases and 3 PSACH cases showed typical bone X-ray findings; one HCH case showed a smaller sciatic notch, and another HCH case showed no widening of interpedicular distance. G380R mutation in FGFR3 gene was detected in 3 of 4 ACH cases, and Y278C mutation in the other ACH case, N540K mutation in FGFR3 gene was detected in 3 HCH cases, and heterozygous mutations in COMP gene were detected in 3 PSACH cases.

CONCLUSIONSChildren with ACH and PSACH have severer short stature and skeletal deformities than children with HCH, who have mild, atypical clinical manifestations. Bone X-ray and genetic analysis are helpful for the diagnosis and differential diagnosis of the three diseases. The mutational hotspots in two genes are involved in the three diseases, which is conducive to clinical genetic diagnosis.

Achondroplasia ; diagnostic imaging ; genetics ; Bone and Bones ; abnormalities ; diagnostic imaging ; Child ; Child, Preschool ; Dwarfism ; diagnostic imaging ; genetics ; Female ; Humans ; Limb Deformities, Congenital ; diagnostic imaging ; genetics ; Lordosis ; diagnostic imaging ; genetics ; Male ; Mutation ; Radiography ; Receptor, Fibroblast Growth Factor, Type 3 ; genetics

BACKGROUND: Detection of postoperative spinal cord level change can provide basic information about the spinal cord status, and electrophysiological studies regarding this point should be conducted in the future. METHODS: To determine the changes in the spinal cord level postoperatively and the possible associated factors, we prospectively studied 31 patients with scoliosis. All the patients underwent correction and posterior fusion using pedicle screws and rods between January 2008 and March 2009. The pre- and postoperative conus medullaris levels were determined by matching the axial magnetic resonance image to the sagittal scout image. The patients were divided according to the change in the postoperative conus medullaris level. The change group was defined as the patients who showed a change of more than one divided section in the vertebral column postoperatively, and the parameters of the change and non-change groups were compared. RESULTS: The mean pre- and postoperative Cobb's angle of the coronal curve was 76.80degrees +/- 17.19degrees and 33.23degrees +/- 14.39degrees, respectively. Eleven of 31 patients showed a lower conus medullaris level postoperatively. There were no differences in the pre- and postoperative magnitude of the coronal curve, lordosis and kyphosis between the groups. However, the postoperative degrees of correction of the coronal curve and lumbar lordosis were higher in the change group. There were also differences in the disease entities between the groups. A higher percentage of patients with Duchene muscular dystrophy had a change in level compared to that of the patients with cerebral palsy (83.3% vs. 45.5%, respectively). CONCLUSIONS: The conus medullaris level changed postoperatively in the patients with severe scoliosis. Overall, the postoperative degree of correction of the coronal curve was higher in the change group than that in the non-change group. The degrees of correction of the coronal curve and lumbar lordosis were related to the spinal cord level change after scoliosis correction.
Adolescent ; Adult ; Cerebral Palsy/complications ; Child ; Female ; Humans ; Kyphosis/radiography ; Lordosis/radiography ; Lumbar Vertebrae/radiography/surgery ; *Magnetic Resonance Imaging ; Male ; Muscular Dystrophy, Duchenne/complications ; Prospective Studies ; Scoliosis/complications/radiography/*surgery ; Severity of Illness Index ; Spinal Cord/*pathology ; Thoracic Vertebrae/radiography/surgery ; Young Adult

BACKGROUND: To evaluate the clinical efficacy of three-level anterior cervical arthrodesis with polyethyletherketone (PEEK) cages and plate fixation for aged and osteoporotic patients with degenerative cervical spinal disorders. METHODS: Twenty one patients, who had undergone three-level anterior cervical arthrodesis with a cage and plate construct for degenerative cervical spinal disorder from November 2001 to April 2007 and were followed up for at least two years, were enrolled in this study. The mean age was 71.7 years and the mean T-score using the bone mineral density was -2.8 SD. The fusion rate, change in cervical lordosis, adjacent segment degeneration were analyzed by plain radiographs and computed tomography, and the complications were assessed by the medical records. The clinical outcomes were analyzed using the SF-36 physical composite score (PCS) and neck disability index (NDI). RESULTS: Radiological fusion was observed at a mean of 12.3 weeks (range, 10 to 15 weeks) after surgery. The average angle of cervical lordosis was 5degrees preoperatively, 17.6degrees postoperatively and 16.5degrees at the last follow-up. Degenerative changes in the adjacent segments occurred in 3 patients (14.3%), but revision surgery was unnecessary. In terms of instrument-related complications, there was cage subsidence in 5 patients (23.8%) with an average of 2.8 mm, and loosening of the plate and screw occurred in 3 patients (14.3%) but there were no clinical problems. The SF-36 PCS before surgery, second postoperative week and at the last follow-up was 29.5, 43.1, and 66.2, respectively. The respective NDI was 55.3, 24.6, and 15.9. CONCLUSIONS: For aged and osteoporotic patients with degenerative cervical spinal disorders, three-level anterior cervical arthrodesis with PEEK cages and plate fixation reduced the pseudarthrosis and adjacent segment degeneration and improved the clinical outcomes. This method is considered to be a relatively safe and effective treatment modality.
Aged ; Aged, 80 and over ; Biocompatible Materials ; *Bone Plates/adverse effects ; Bone Screws/adverse effects ; Cervical Vertebrae/radiography/*surgery ; Diskectomy ; Female ; Follow-Up Studies ; Humans ; Ketones ; Lordosis/pathology ; Male ; Radiculopathy/surgery ; Severity of Illness Index ; Spinal Cord Diseases/surgery ; Spinal Diseases/*surgery ; Spinal Fusion/adverse effects/*methods ; Treatment Outcome