- Email: [email protected]
Adjacent Segment Pathology Correlated with HRQOL following Cervical Laminoplasty versus Posterior Cervical Decompression and Fusion
Proceedings of the NASS 30th Annual Meeting / The Spine Journal 15 (2015) 87S–267S ADLS spine surgery. These results show that poor preoperative and postoperative glucose control are independently associated with wound complications. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
105S
43. Berry’s Ligament and the Inferior Thyroid Artery as Reliable Anatomical Landmarks for the Recurrent Laryngeal Nerve (RLN): A Fresh Cadaveric Study Relevant to the Cervical Spine Ali Rajabian, FRCSEd1, Nasir A. Quraishi, MD2; 1The Centre for Spinal Studies and Surgery, Nottingham, UK; 2Queens Medical Centre, Nottingham, UK
http://dx.doi.org/10.1016/j.spinee.2015.07.058
Wednesday, October 14, 2015 2:05 – 3:05 pm Cervical Spine Treatments 42. Adjacent Segment Pathology Correlated with HRQOL following Cervical Laminoplasty versus Posterior Cervical Decompression and Fusion Virginie Lafage, PhD1, Themistocles S. Protopsaltis, MD1, Amir Amitai2, Anthony J. Boniello, BS1, Matthew Spiegel, BS, MD3, Renaud Lafage1, Vincent Challier, MD4, Yuriy Trimba, BA1, Emmanuelle Ferrero, MD5, Michael Smith, MD5, Peter G. Passias, MD1,6, Yong H. Kim, MD7, Afshin E. Razi, MD1, Ronald Moskovich, MD1; 1New York University Hospital for Joint Diseases, New York, NY, US; 2Moshav Rinnatia, Israel; 3Woodmere, NY, US; 4Spine Research Institute, New York, NY, US; 5New York, NY, US; 6 New York University School of Medicine, New York, NY, US; 7Madison Avenue Orthopedic Associates, New York, NY, US BACKGROUND CONTEXT: Adjacent segment degeneration (ASD) has been described after anterior cervical fusion surgeries though ASD is not always clinically relevant. Hilibrand et al described a grading system for ASD after anterior cervical fusion. We expand the ASD definition with an analysis of radiographic adjacent segment pathology (RASP) by also assessing the progression of kyphotic alignment, and spondylolisthesis at adjacent segments in patients following cervical laminoplasty (LP) and posterior cervical decompression and fusion (CDF). PURPOSE: To assess radiographic adjacent segment pathology by analyzing adjacent segment degeneration, and the progression of kyphotic alignment and spondylolisthesis at segments adjacent to operated levels for LP and CDF surgery. STUDY DESIGN/SETTING: Retrospective analysis of cervical radiographs in patients undergoing prior LP and CDF surgery. PATIENT SAMPLE: 64 patients undergoing prior LP and CDF surgery. OUTCOME MEASURES: NDI and mJOA. METHODS: Preoperative and postoperative radiographs were analyzed for ASD, progression of adjacent level kyphosis and spondylolisthesis at proximal, distal or any other segments. The RASP was determined by combining proximal and distal ASD, and the adjacent level kyphosis and spondylolisthesis into one spectrum of disease. The presence and rate of development of adjacent segment pathology was compared for LP and CDF. HRQOLs included NDI and mJOA. RESULTS: 64 patients were included (24 LP and 40 CDF) with mean age 59.9 years (46.9% female) and 30.2 months mean follow-up. Spondylolisthesis at the adjacent segment was more prevalent in CDF (29.2% vs 4.5%). Both LP and CDF demonstrated a similar rate of RASP (LP 40.9%, CDF 44%). NDI correlated with proximal adjacent level degeneration (r 5 0.34, p 5 0.024) and kyphosis (r 5 0.36 p 5 0.017). CONCLUSIONS: Both cervical laminoplasty and posterior cervical decompression and fusion are associated with adjacent level degeneration. However, there is a higher rate of adjacent segment spondylolisthesis after CDF. Motion preservation procedures may have less of a role in preventing adjacent level degeneration than previously thought. Adjacent segment degeneration correlated with NDI disability in these patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.060
BACKGROUND CONTEXT: Whilst most cadaveric studies of the recurrent laryngeal nerve (RLN) have focused on course variations as a suitable guide for right versus left RLN, they have mostly been done on preserved (fixed) cadavers which renders the RLN immobile. PURPOSE: Our aim was to perform anterior cervical exposures from C2 to T2-3 with particular attention to the course of the RLN on right- and left-sided exposures in fresh cadaveric specimens. In addition, we aimed to expose the entire course of the RLN. Finally, we wanted to show the position of the RLN in relation to the trachea-oesophageal groove, inferior thyroid artery and Berry’s ligament. STUDY DESIGN/SETTING: Eight fresh cadavers had extensive layer by layer dissections performed by two surgeons (one of whom has extensive experience as an anatomy demonstrator and dissector). The RLNs were exposed in their entire length and relationship to different landmarks recorded. Photographs were taken at each stage of the exposure. METHODS: Fresh cadaveric dissection relevant to cervical spine ACDF. RESULTS: In all specimens, we were able to demonstrate the entire course of both RLNs from origin to insertion. The RLNs were consistently associated with the inferior thyroid artery and Berry’s ligament bilaterally with the RLNs passing at almost perpendicular to these structures. CONCLUSIONS: The near horizontal direction of the Berry’s ligament in the cervical tissue planes exposed during anterior cervical exposures enables the surgeon to reliably identify the expected position of RLN at its medial end and hence avoid it prior to visual observation of the nerve on either side. We found that the most reliable anatomical landmark bilaterally for the RLN was the inferior thyroid artery and Berry’s ligament both of which would be encountered in anterior surgical exposure prior to the nerve itself. We believe that this will help spinal surgeons refine their surgical technique to identify this nerve where necessary and thus reduce the incidence of iatrogenic injury. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.061
44. Does Age Affect Surgical Outcomes in Patients with Degenerative Cervical Myelopathy? Results from the Prospective, Multicenter AOSpine International Study on 479 Patients Michael G. Fehlings, MD, PhD, FRCSC1, Hiroaki Nakashima, MD2, Lindsay Tetreault3, Branko Kopjar, MD, PhD4, Narihito Nagoshi, MD5, Aria Nouri, BA, MD5, Paul M. Arnold, MD6; 1Toronto Western Hospital, Toronto, ON, Canada; 2Nagoya University Graduate School of Medicine, Department of Orthopedic Surgery, Nagoya, Japan; 3 University of Toronto, Oakville, ON, Canada; 4University of Washington, Seattle, WA, US; 5University of Toronto, Toronto, ON, Canada; 6University of Kansas Medical Center Department of Neurosurgery, Kansas City, KS, US BACKGROUND CONTEXT: Studies have identified age as a significant predictor of surgical outcome in patients with cervical spondylotic myelopathy (CSM). In general, older patients have lower recovery potential following surgery due to comorbidities, reduced physiological reserves and age-related changes to the spinal cord. The elderly may also require a more complex surgery due to more substantial degenerative pathology.
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.
105S
43. Berry’s Ligament and the Inferior Thyroid Artery as Reliable Anatomical Landmarks for the Recurrent Laryngeal Nerve (RLN): A Fresh Cadaveric Study Relevant to the Cervical Spine Ali Rajabian, FRCSEd1, Nasir A. Quraishi, MD2; 1The Centre for Spinal Studies and Surgery, Nottingham, UK; 2Queens Medical Centre, Nottingham, UK
http://dx.doi.org/10.1016/j.spinee.2015.07.058
Wednesday, October 14, 2015 2:05 – 3:05 pm Cervical Spine Treatments 42. Adjacent Segment Pathology Correlated with HRQOL following Cervical Laminoplasty versus Posterior Cervical Decompression and Fusion Virginie Lafage, PhD1, Themistocles S. Protopsaltis, MD1, Amir Amitai2, Anthony J. Boniello, BS1, Matthew Spiegel, BS, MD3, Renaud Lafage1, Vincent Challier, MD4, Yuriy Trimba, BA1, Emmanuelle Ferrero, MD5, Michael Smith, MD5, Peter G. Passias, MD1,6, Yong H. Kim, MD7, Afshin E. Razi, MD1, Ronald Moskovich, MD1; 1New York University Hospital for Joint Diseases, New York, NY, US; 2Moshav Rinnatia, Israel; 3Woodmere, NY, US; 4Spine Research Institute, New York, NY, US; 5New York, NY, US; 6 New York University School of Medicine, New York, NY, US; 7Madison Avenue Orthopedic Associates, New York, NY, US BACKGROUND CONTEXT: Adjacent segment degeneration (ASD) has been described after anterior cervical fusion surgeries though ASD is not always clinically relevant. Hilibrand et al described a grading system for ASD after anterior cervical fusion. We expand the ASD definition with an analysis of radiographic adjacent segment pathology (RASP) by also assessing the progression of kyphotic alignment, and spondylolisthesis at adjacent segments in patients following cervical laminoplasty (LP) and posterior cervical decompression and fusion (CDF). PURPOSE: To assess radiographic adjacent segment pathology by analyzing adjacent segment degeneration, and the progression of kyphotic alignment and spondylolisthesis at segments adjacent to operated levels for LP and CDF surgery. STUDY DESIGN/SETTING: Retrospective analysis of cervical radiographs in patients undergoing prior LP and CDF surgery. PATIENT SAMPLE: 64 patients undergoing prior LP and CDF surgery. OUTCOME MEASURES: NDI and mJOA. METHODS: Preoperative and postoperative radiographs were analyzed for ASD, progression of adjacent level kyphosis and spondylolisthesis at proximal, distal or any other segments. The RASP was determined by combining proximal and distal ASD, and the adjacent level kyphosis and spondylolisthesis into one spectrum of disease. The presence and rate of development of adjacent segment pathology was compared for LP and CDF. HRQOLs included NDI and mJOA. RESULTS: 64 patients were included (24 LP and 40 CDF) with mean age 59.9 years (46.9% female) and 30.2 months mean follow-up. Spondylolisthesis at the adjacent segment was more prevalent in CDF (29.2% vs 4.5%). Both LP and CDF demonstrated a similar rate of RASP (LP 40.9%, CDF 44%). NDI correlated with proximal adjacent level degeneration (r 5 0.34, p 5 0.024) and kyphosis (r 5 0.36 p 5 0.017). CONCLUSIONS: Both cervical laminoplasty and posterior cervical decompression and fusion are associated with adjacent level degeneration. However, there is a higher rate of adjacent segment spondylolisthesis after CDF. Motion preservation procedures may have less of a role in preventing adjacent level degeneration than previously thought. Adjacent segment degeneration correlated with NDI disability in these patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.060
BACKGROUND CONTEXT: Whilst most cadaveric studies of the recurrent laryngeal nerve (RLN) have focused on course variations as a suitable guide for right versus left RLN, they have mostly been done on preserved (fixed) cadavers which renders the RLN immobile. PURPOSE: Our aim was to perform anterior cervical exposures from C2 to T2-3 with particular attention to the course of the RLN on right- and left-sided exposures in fresh cadaveric specimens. In addition, we aimed to expose the entire course of the RLN. Finally, we wanted to show the position of the RLN in relation to the trachea-oesophageal groove, inferior thyroid artery and Berry’s ligament. STUDY DESIGN/SETTING: Eight fresh cadavers had extensive layer by layer dissections performed by two surgeons (one of whom has extensive experience as an anatomy demonstrator and dissector). The RLNs were exposed in their entire length and relationship to different landmarks recorded. Photographs were taken at each stage of the exposure. METHODS: Fresh cadaveric dissection relevant to cervical spine ACDF. RESULTS: In all specimens, we were able to demonstrate the entire course of both RLNs from origin to insertion. The RLNs were consistently associated with the inferior thyroid artery and Berry’s ligament bilaterally with the RLNs passing at almost perpendicular to these structures. CONCLUSIONS: The near horizontal direction of the Berry’s ligament in the cervical tissue planes exposed during anterior cervical exposures enables the surgeon to reliably identify the expected position of RLN at its medial end and hence avoid it prior to visual observation of the nerve on either side. We found that the most reliable anatomical landmark bilaterally for the RLN was the inferior thyroid artery and Berry’s ligament both of which would be encountered in anterior surgical exposure prior to the nerve itself. We believe that this will help spinal surgeons refine their surgical technique to identify this nerve where necessary and thus reduce the incidence of iatrogenic injury. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.061
44. Does Age Affect Surgical Outcomes in Patients with Degenerative Cervical Myelopathy? Results from the Prospective, Multicenter AOSpine International Study on 479 Patients Michael G. Fehlings, MD, PhD, FRCSC1, Hiroaki Nakashima, MD2, Lindsay Tetreault3, Branko Kopjar, MD, PhD4, Narihito Nagoshi, MD5, Aria Nouri, BA, MD5, Paul M. Arnold, MD6; 1Toronto Western Hospital, Toronto, ON, Canada; 2Nagoya University Graduate School of Medicine, Department of Orthopedic Surgery, Nagoya, Japan; 3 University of Toronto, Oakville, ON, Canada; 4University of Washington, Seattle, WA, US; 5University of Toronto, Toronto, ON, Canada; 6University of Kansas Medical Center Department of Neurosurgery, Kansas City, KS, US BACKGROUND CONTEXT: Studies have identified age as a significant predictor of surgical outcome in patients with cervical spondylotic myelopathy (CSM). In general, older patients have lower recovery potential following surgery due to comorbidities, reduced physiological reserves and age-related changes to the spinal cord. The elderly may also require a more complex surgery due to more substantial degenerative pathology.
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.