Lumbar lateral interbody fusion (LLIF) has been gaining popularity among the spine surgeons dealing with degenerative spinal diseases while LLIF on L5-S1 is still challenging for its technical and anatomical difficulty. OLIF51 procedure achieves effective anterior interbody fusion based on less invasive anterior interbody fusion via bifurcation of great vessels using specially designed retractors. The technique also achieves seamless anterior interbody fusion when combined with OLIF25. A thorough understanding of the procedures and anatomical features is mandatory to avoid perioperative complications.
Introduction: Postoperative respiratory complications (PRC) are one of the most serious complications. Potentially life-threatening accidents can occur after an anterior cervical discectomy and fusion (ADF), such as airway obstruction and aspiration pneumonia. Despite numerous studies, preoperative predictive and preventive methodology has yet to be established.
As reported in our previous study, the evaluation of preoperative dysphagia using the eating assessment tool (EAT-10) and a flexible endoscopic evaluation of swallowing (FEES) is useful for predicting the incidence and risk factors of dysphagia after ADF.
Methods: This prospective study comprised 60 consecutive patients who underwent ADF. An otolaryngologist and a speech-language-hearing therapist preoperatively and 1 week postoperatively evaluated dysphagia using EAT-10 and Hyodo-Komagane (H-K) scores during FEES. Patient demographics, comorbidities, and pre- and postoperative dysphagia were compared between patients with and without PRC.
Results: Seven of 60 (11.6%) patients had preoperative dysphagia diagnosed using the H-K score. A significant positive correlation existed between the pre- and postoperative H-K scores. Of all 60 cases, eight (13.3%) had PRC. Among them, two required reintubation due to airway obstruction and six had aspiration pneumonia. The PRC (+) group was significantly older and more prone to diabetes and asthma. The preoperative H-K score of the PRC (+) group was significantly higher than that of the PRC (−) group. Postoperatively, but not preoperatively, EAT-10 was significantly higher in the PRC (+) group.
Conclusions: Preoperative dysphagia may potentially exacerbate postoperative dysphagia after ADF. A preoperative evaluation of dysphagia using the H-K score during FEES is a useful method for predicting and reducing the risk of PRC.
Introduction: Delirium after spine surgery is an important complication; identification of risk factors associated with postoperative delirium (PD) is essential for reducing its incidence. Prophylactic intervention for PD has been reported to be effective. This study aimed to identify risk factors for PD and determine the efficacy of a prevention program using a delirium risk scoring system for PD after spine surgery.
Methods: This study was conducted in two stages. First, 294 patients (167 males, 127 females) who underwent spine surgery from 2013 to 2014 were assessed to examine the incidence and risk factors of PD and to establish a novel PD screening tool (Group A). Second, preoperative intervention was performed on 265 patients who underwent surgery from 2016 to 2017 (Group B) for the purpose of preventing PD using a delirium risk scoring system. Outcomes, including PD incidence and rates of adverse events, were compared between Group A and Group B.
Results: A logistic regression analysis revealed that psychiatric disorders (odds ratio [OR] = 10.3, P < 0.001), benzodiazepine use (OR = 4.9, P < 0.001), age > 70 years (OR = 4.2, P < 0.001), hearing loss (OR = 3.7, P = 0.001), and admission to intensive care unit (ICU) (OR = 3.7, P = 0.006) were independent risk factors associated with PD. Based on these results, we established a novel delirium screening tool after spine surgery. PD incidence was significantly higher in Group A than in Group B (22% vs. 13%, P = 0.0008). The occurrence of dangerous behavioral symptoms was significantly higher in Group A than in Group B (66% vs. 40%, P = 0.02). The catheter problem tended to be higher in Group A than in Group B (19% vs. 9%, P = 0.245).
Conclusions: In this study, psychiatric disorders, benzodiazepine use, age > 70 years, hearing loss, and admission to ICU were independent risk factors associated with PD. With the introduction of the delirium risk score, the onset of delirium was delayed, and adverse outcomes of delirium were reduced.
Introduction: The purpose of the present study was to determine, in a mid-term follow-up 5 years or more after surgery, the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and expiratory flow in patients with adolescent idiopathic scoliosis (AIS) who underwent posterior spinal fusion (PSF) with or without thoracoplasty.
Methods: The subjects were 134 patients with AIS who underwent PSF between 2004 and 2013. Forty-five patients agreed to participate in the study. We divided the patients into two groups as follows: 24 patients who underwent PSF with thoracoplasty from 2004 to 2010 in the TP group and 21 patients who underwent PSF without thoracoplasty from 2011 to 2013 in the non-TP group. We evaluated whole spine X-ray imaging and pulmonary function tests (PFTs) in these patients. PFTs measured FVC, FEV1, peak expiratory flow (PEF), maximum expiratory flow at 50% FVC (V50), maximum expiratory flow at 25% FVC (V25), and the ratio of V50 to V25 (V50/V25).
Results: The main thoracic curves were 53.6 ± 10.1° before surgery, 19.8 ± 7.6° 1 week after surgery, 22.3 ± 8.3° 2 years after surgery, and 23.3 ± 7.6° at the most recent observation. Compared with preoperative values, FVC, FEV1, and % FEV1 were improved significantly at the most recent observation. No significant difference was observed between % FVC before surgery and at the most recent observation. Compared with preoperative values, PEF, V50, and V25 were improved significantly at the most recent observation. V50/V25 did not change significantly. The changes in PFT values in the TP group and the non-TP group were compared. No significant differences were observed in FVC, % FVC, FEV1, % FEV1, PEF, V50, or V25.
Conclusions: Regardless of whether thoracoplasty was performed or not, FVC, FEV1, and expiratory flow were improved 5 years or later after PSF.
Introduction: Due to the increase in osteoporosis accompanying the aging society in Japan, osteoporotic vertebral fractures (OVFs) are increasing. Percutaneous vertebral augmentation (PVA) has been widely used for OVFs because it reduces pain immediately with less invasiveness. Re-collapse of vertebral body after PVA is a rare, but important, complication. Once the re-collapse has occurred, patients should undergo an additional invasive salvage surgery.
Methods: We treated 5 patients with re-collapse after PVA in our hospital. For re-collapse after PVA, we performed anterior column reconstruction with video-assisted thoracoscopic surgery (VATS), posterior fixation with percutaneous pedicle screws (PPSs) and minimally invasive spine stabilization (MISt).
Results: The mean postoperative follow-up was at 62.8 months. At the final follow-up, the patients were free of low back pain, and bony union was achieved in all cases. The postoperative correction loss was 6 degrees. Perioperative complications included aspiration pneumonia in one patient and bone fracture of an adjacent vertebral body in two patients. There were no reoperation cases.
Conclusions: We perform minimally invasive combined anterior and posterior surgery with VATS for re-collapse after PVA. This procedure is useful in elderly patients with less reserve capacity.
Introduction: The specific morphology and differences between patients with cervical spondylotic myelopathy (CSM) and those with normal spines remain unclear. This study aimed to evaluate and determine the features of cervical spine morphology on reconstructive CT.
Methods: We investigated that axial reconstructive CT scans of the cervical spine at C3 to C7 were obtained from 309 individuals (97 CSM patients and 212 controls). Those of the optimal pedicle diameter were selected, and the following parameters were measured: (a) sagittal diameter of the spinal canal (b) transverse diameter of the spinal canal, (c) pedicle width, (d) lateral mass thickness, (e) transverse diameter of the foramen, (f) sagittal diameter of the vertebral body, and (g) transverse diameter of the vertebral body. The following ratios were calculated using these values: the sagittal-transverse ratio and the canal-body ratio.
Results: Most parameters differed significantly between the sexes in both groups. The parameters without the mean sagittal diameter of the spinal canal were significantly larger in men than in women. However, the mean sagittal diameter of the spinal canal did not differ significantly between the sexes in CSM patients. The sagittal-transverse ratio and canal-body ratio were significantly smaller in the CSM patients at all levels. According to relative operating characteristic curves of the sagittal diameter of the spinal canal, sagittal-transverse ratio, and canal-body ratio, the sensitivity from C3 to C7 in both sexes was > 60% at the threshold. In men, the specificity from C3 to C7 was also >60% at the threshold.
Conclusions: The morphometry of the sagittal diameter of the spinal canal, sagittal-transverse ratio, and canal-body ratio on axial reconstructive CT images appears useful for distinguishing cervical spinal canal stenosis involving myelopathy.
Introduction: Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are widely performed to resolve anterior cervical spine compression. The main purpose of the different surgical techniques is to obtain an adequate decompression of the spinal cord and nerve roots, preserving spinal stability like in oblique corpectomy or leading to a final solid construct to achieve arthrodesis.
Technical Note: We describe a surgical procedure for treating cervical spondylotic myelopathy (CSM) with ossification of the posterior longitudinal ligament (OPLL) at the level of C3-C4 and C4-C5. A double level discectomy C3-C4 and C4-C5 and selective posterior wedge corpectomy of C3, C4, and C5 were performed. Two cages (Zero-P VA) at C3-C4 and C4-C5 were positioned to obtain segmental stability and arthrodesis. An extended anterior cervical canal decompression was obtained and confirmed by postsurgical CT scan. At 15 months, dynamic X-ray showed fusion, and cervical magnetic resonance imaging (MRI) showed evidence of spinal canal decompression.
Conclusions: Anterior cervical discectomy followed by selective wedge corpectomy appears to be a safe and effective technique for anterior spinal cord compression extending above and below the intervertebral disc space.