Zihao Chen, Bin Liu, Jianwen Dong, Feng Feng, Ruiqiang Chen, Peigen Xie, Liangming Zhang and Limin Rong
The purpose of this study was to compare the effectiveness and safety of anterior corpectomy and fusion (ACF) with laminoplasty for the treatment of patients diagnosed with cervical ossification of the posterior longitudinal ligament (OPLL).
The authors searched electronic databases for relevant studies that compared the use of ACF with laminoplasty for the treatment of patients with OPLL. Data extraction and quality assessment were conducted, and statistical software was used for data analysis. The random effects model was used if there was heterogeneity between studies; otherwise, the fixed effects model was used.
A total of 10 nonrandomized controlled studies involving 819 patients were included. Postoperative Japanese Orthopaedic Association (JOA) score (p = 0.02, 95% CI 0.30–2.81) was better in the ACF group than in the laminoplasty group. The recovery rate was superior in the ACF group for patients with an occupying ratio of OPLL of ≥ 60% (p < 0.00001, 95% CI 21.27–34.44) and for patients with kyphotic alignment (p < 0.00001, 95% CI 16.49–27.17). Data analysis also showed that the ACF group was associated with a higher incidence of complications (p = 0.02, 95% CI 1.08–2.59) and reoperations (p = 0.002, 95% CI 1.83–14.79), longer operation time (p = 0.01, 95% CI 17.72 –160.75), and more blood loss (p = 0.0004, 95% CI 42.22–148.45).
For patients with an occupying ratio ≥ 60% or with kyphotic cervical alignment, ACF appears to be the preferable treatment method. Nevertheless, laminoplasty seems to be effective and safe enough for patients with an occupying ratio < 60% or with adequate cervical lordosis. However, it must be emphasized that a surgical strategy should be made based on the individual patient. Further randomized controlled trials comparing the use of ACF with laminoplasty for the treatment of OPLL should be performed to make a more convincing conclusion.
Jianwen Dong, Limin Rong, Feng Feng, Bin Liu, Yichun Xu, Qiyou Wang, Ruiqiang Chen and Peigen Xie
Treatment of patients with single-segment degenerative lumbar instability using unilateral pedicle screw fixation can achieve stability and fusion rates similar to those of bilateral pedicle screw fixation. The aim of this study was to analyze the clinical outcome of using unilateral pedicle screw fixation through a tubular retractor via the Wiltse approach to treat single-segment degenerative lumbar instability.
Thirty-nine consecutive patients with single-segment, low-grade, degenerative lumbar instability were randomly assigned to treatment with either unilateral (n = 20) or bilateral (n = 19) pedicle screw fixation. In the unilateral group, patients underwent unilateral posterior lumbar interbody fusion (PLIF) and ipsilateral pedicle screw fixation through a tubular retractor via the Wiltse approach. In the bilateral group, patients underwent modified bilateral PLIF with bilateral pedicle screw fixation via the posterior midline approach. During follow-up, patients were evaluated using a visual analog scale (VAS), the Japanese Orthopaedic Association (JOA) score, and the Oswestry Disability Index.
The unilateral group had a shorter operative duration (p < 0.05) and less blood loss (p < 0.001). All patients completed more than 2 years of follow-up (mean 36 months). In general, the time trends in improvement on the VAS and JOA differed slightly between the groups through 2 years, but no significant difference in back pain VAS score or leg pain VAS score was found between these 2 groups at the 2-year follow-up. Complete bone fusion was shown on CT in all patients at the 2-year follow-up.
Unilateral pedicle screw fixation through a tubular retractor via the Wiltse approach appears to be as safe and effective as bilateral pedicle screw fixation for the treatment of single-segment degenerative lumbar instability.
Zihao Chen, Liangming Zhang, Jianwen Dong, Peigen Xie, Bin Liu, Qiyou Wang, Ruiqiang Chen, Feng Feng, Bu Yang, Tao Shu, Shangfu Li, Yang Yang, Lei He, Mao Pang and Limin Rong
A prospective randomized controlled study was conducted to clarify whether percutaneous transforaminal endoscopic discectomy (PTED) results in better clinical outcomes and less surgical trauma than microendoscopic discectomy (MED).
In this single-center, open-label, randomized controlled trial, patients were included if they had persistent signs and symptoms of radiculopathy with corresponding imaging-confirmed lumbar disc herniation. Patients were randomly allocated to the PTED or the MED group by computer-generated randomization codes. The primary outcome was the Oswestry Disability Index (ODI) score 1 year after surgery. Secondary outcomes included scores of the Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain and physical function scales, EuroQol Group’s EQ-5D , and the visual analog scales for back pain and leg pain. Data including duration of operation, in-bed time, length of hospital stay, surgical cost and total hospital cost, complications, and reoperations were recorded.
A total of 153 participants were randomly assigned to 2 treatment groups (PTED vs MED), and 89.5% (137 patients) completed 1 year of follow-up. Primary and secondary outcomes did not differ significantly between the treatment groups at each prespecified follow-up point (p > 0.05). For PTED, there was less postoperative improvement in ODI score in the median herniation subgroup at 1 week (p = 0.027), 3 months (p = 0.013), 6 months (p = 0.027), and 1 year (p = 0.028) compared with the paramedian subgroup. For MED, there was significantly less improvement in ODI score at 3 months (p = 0.008), 6 months (p = 0.028), and 1 year (p = 0.028) in the far-lateral herniation subgroup compared with the paramedian subgroup. The total complication rate over the course of 1 year was 13.75% in the PTED group and 16.44% in the MED group (p = 0.642). Five patients (6.25%) in the PTED group and 3 patients (4.11%) in the MED group suffered from residue/recurrence of herniation, for which reoperation was required.
Over the 1-year follow-up period, PTED did not show superior clinical outcomes and did not seem to be a safer procedure for patients with lumbar disc herniation compared with MED. PTED had inferior results for median disc herniation, whereas MED did not seem to be the best treatment option for far-lateral disc herniation.
Clinical trial registration no.: NCT01997086 (clinicaltrials.gov).