Correlation analysis between preoperative odontoid incidence and clinical outcomes 2 years after anterior cervical discectomy and fusion.

This study presents a novel odontoid parameter, the odontoid incidence (OI), to examine the correlation between OI on preoperative cervical sagittal radiographs and 2-year clinical outcomes following short-segment anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylotic myelopathy (CSM). A retrospective analysis of the clinical data of 87 patients with CSM who underwent ACDF surgery from January 2018 to December 2023 was conducted. The patients were categorized into a larger OI group (44 patients, OI > 12.62°) and a smaller OI group (43 patients, OI ≤ 12.62°) on the basis of the median cervical sagittal OI prior to surgery. The postoperative follow-up duration was 2 years. Cervical sagittal parameters were assessed on lateral cervical spine radiographs both preoperatively and postoperatively. Additionally, the Japanese Orthopedic Association (JOA), neck disability index (NDI), and visual analog scale (VAS) scores were documented for each patient before surgery and at the final 2-year postoperative follow-up. Compared with those in the preoperative period, the T1 slope, C2‒C7 Cobb angle, sagittal segmental angle (SSA), and C0‒C2 Cobb angle significantly improved in 87 patients with cervical spondylosis (P < 0.05). At the 2-year postoperative follow-up, all patients exhibited significant improvements in JOA, NDI, and VAS scores compared with the preoperative values (P < 0.05). No statistically significant difference was observed in the preoperative or baseline data between the larger OI group and the smaller OI group (P > 0.05); however, a statistically significant difference was noted in the postoperative SSA between the two groups (P < 0.05). A statistically significant difference was observed in the VAS score and NDI score at the final follow-up between the two groups (P < 0.05), as well as in the improvement in the JOA score and VAS score (preoperative score minus the final follow-up score), between the two groups (P < 0.05). The results of the Pearson correlation analysis indicated a negative correlation between the preoperative OI score and the VAS and NDI scores at the final postoperative follow-up (P = 0.012, r = - 0.268) (P = 0.028, r = - 0.236). In ACDF, the preoperative OI of patients with CSM was negatively correlated with the VAS and NDI scores at the final postoperative follow-up; Larger preoperative OI corresponded to lower VAS and NDI scores at the final follow-up, leading to comparatively improved 2-year clinical outcomes.

Gong Y ，Liu H ，Gan Y ，He J ，Zhou Z ，Zhuo H ，Liu Y ，Liang D ，Ren H ，Jiang X ，Cheng Z ... -  《Journal of Orthopaedic Surgery and Research》

[Correlation analysis between preoperative C (2) slope and effectiveness at 2 years after short-segment anterior cervical discectomy and fusion].

Cheng Z ，Gong Y ，Gan Y ，He J ，Liang D ，Ren H ，Jiang X ... -  《-》

Zero-profile implant system versus novel plate systems after ACDF for comparison of sagittal balance parameters and clinical efficacy analysis.

The zero-profile implant system (Zero-P) and conventional plates have been widely used in anterior cervical discectomy and fusion (ACDF) to treat cervical spondylosis. The purpose of this study was to compare the effects of the application of Zero-P and new conventional plates (ZEVO, Skyline) in ACDF on the sagittal imaging parameters of cervical spondylosis patients and to analyze their clinical efficacy. We conducted a retrospective study on 119 cervical spondylosis patients from January 2018 to December 2021, comparing outcomes between those receiving the Zero-P device (n = 63) and those receiving a novel conventional plate (n = 56, including 46 ZEVO and 10 Skyline plates) through ACDF. Cervical sagittal alignment was assessed pre- and postoperatively via lateral radiographs. The Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and visual analog scale (VAS) scores were recorded at baseline, after surgery, and at the 2-year follow-up to evaluate patient recovery and intervention success. There were significant differences in the postoperative C0-C2 Cobb angle and postoperative sagittal segmental angle (SSA) between patients in the novel conventional plate group and those in the Zero-P group (P < 0.05). Postoperatively, there were significant changes in the C2‒C7 Cobb angle, C0‒C2 Cobb angle, SSA, and average surgical disc height (ASDH) compared to the preoperative values in both patient groups (P < 0.05). Dysphagia in the immediate postoperative period was lower in the Zero-P group than in the new conventional plate group (0% in the Zero-P group, 7.14% in the novel conventional plate group, P = 0.046), and the symptoms disappeared within 2 years in both groups. There was no statistically significant difference between the two groups in terms of complications of adjacent spondylolisthesis (ASD) at 2 years postoperatively (3.17% in the Zero-P group, 8.93% in the novel conventional plate group; P = 0.252). According to the subgroup analysis, there were significant differences in the postoperative C2‒C7 Cobb angle, C0‒C2 Cobb angle, T1 slope, and ASDH between the ZEVO group and the Skyline group (P < 0.05). Compared with the preoperative scores, the JOA, NDI, and VAS scores of all groups significantly improved at the 2-year follow-up (P < 0.01). According to the subgroup analysis, the immediate postoperative NDI and VAS scores of the ZEVO group were significantly better than those of the Skyline group (P < 0.05). In ACDF, both novel conventional plates and Zero-P can improve sagittal parameters and related scale scores. Compared to the Zero-P plate, the novel conventional plate has a greater advantage in correcting the curvature of the surgical segment, but the Zero-P plate is less likely to produce postoperative dysphagia.

Gong Y ，Zhuo H ，Zhou Z ，Cheng Z ，Gan Y ，He J ，Song Z ，Liu H ，Liu Y ，Liang D ，Jiang X ，Ren H ... -  《-》

Correlation between axial symptoms and cervical sagittal alignment parameters in patients with two-level or three-level cervical spondylotic myelopathy: anterior cervcial discectomy and fusion versus hybird surgery.

To comparatively analyze the correlation between axial symptoms (AS) and cervical sagittal alignment parameters after anterior cervical discectomy and fusion (ACDF) and hybrid surgery (HS). From January 2018 to June 2023, 74 patients who underwent ACDF (n = 36) or HS (n = 38) for two-level or three-level cervical spondylotic myelopathy were retrospectively analyzed. The Visual Analogue Scale (VAS), Japanese Orthopedic Association (JOA), Neck Disability Index (NDI) were recorded to assess clinical outcomes. Cervical sagittal alignment parameters (Cobb's angle C2-7, C7 slope [C7S], and C2-7 sagittal vertical axis [C2-7 SVA]) were measured preoperatively, 3 days postoperatively, and at the last follow-up. The range of motion (ROM) of C2-7 and ROM of surgical segment were measured. The occurrence of AS was observed at the last follow-up. Logistic regression was used to analyze the correlation between postoperative AS and cervical sagittal alignment parameters. Both in ACDF group and HS group, VAS, JOA and NDI scores showed significant improvements at 3-day postoperation and at the last follow-up (P < 0.05). However, there was no significant difference between the two groups (P > 0.05). The Cobb's angle C2-7 and C7S were significantly increased at 3 days postoperation compared with pre-operatively in both groups (P < 0.05). C2-7SVA was increased in both groups 3 days after surgery compared with pre-operatively, but there was no significant difference (P > 0.05). At the last follow-up, the ROM of C2-7 in ACDF group was significantly smaller than HS group (P < 0.05). The prevalence of postoperative AS in the ACDF group and HS group was 41.7 and 18.4%, respectively, with statistical difference between the two groups (P < 0.05). When simple Logistic regression analysis was used, the last Cobb's angle C2-7 (β = -0.088), the last C2-7SVA (β = 0.099) in ACDF group and the last C2-7SVA (β = 0.222) in HS group were all correlated with the occurrence of postoperative AS. When multiple Logistic regression analysis was used, only the last C2-7SVA (β = 0.181) in the HS group was positively correlated with the occurrence of postoperative AS. Both ACDF and HS can achieve satisfied clinical outcomes. ACDF and HS can improve cervical sagittal balance to a certain extent, and HS is superior to ACDF in maintaining ROM. The decrease of the last Cobb's angle C2-7 and the increase of the last C2-7SVA may be related to the occurrence of AS after ACDF. The increase of the last C2-7SVA was an independent risk factor for the occurrence of AS after HS.

Qiu Z ，Xiong Y ，Yu X ，Li W ，Ma Y ，Feng N ，Zhou S ，Jiang G ，Zhou Y ... -  《-》

Comparison of Anterior Cervical Decompression and Fusion and Posterior Laminoplasty for Four-Segment Cervical Spondylotic Myelopathy: Clinical and Radiographic Outcomes.

 Although anterior or posterior surgery for cervical spondylotic myelopathy (CSM) has been extensively studied, the choice of anterior or posterior approach in four-segment CSM remains poorly studied and controversial. We compared the clinical and radiographic outcomes of four-segment CSM by posterior laminoplasty (LAMP) and anterior cervical decompression fusion (ACDF) to further explore the merits and demerits of ACDF and LAMP for four-segment CSM in this study.  Patients with four-segment CSM who underwent ACDF or LAMP between January 2016 and June 2019 were retrospectively analyzed. We compared the preoperative and postoperative cervical Japanese Orthopaedic Association (JOA) scores, neck disability index (NDI), neck pain visual analog scale (VAS) score, sagittal vertical axis, cervical lordosis (CL), and range of motion.  There were 47 and 79 patients in the ACDF and LAMP groups, respectively. Patients in the ACDF group had a significantly longer surgical time and lower estimated blood loss and length of stay than those in the LAMP group. There was no significant difference in the JOA, NDI, or neck pain VAS scores between the two groups preoperatively, but the NDI and neck pain VAS scores in the ACDF group were significantly lower than those in the LAMP group at the final follow-up. The preoperative C2-C7 Cobb angle of the ACDF group was significantly lower than that of the LAMP group but there was no significant difference between the two groups postoperatively. The improvement of C2-C7 Cobb angle (∆C2-C7 Cobb angle) in the ACDF group was significantly higher than that in the LAMP group. This indicated that ACDF can improve CL better than LAMP. The linear regression analysis revealed the ∆C2-C7 Cobb angle was negatively correlated with the final follow-up neck pain VAS scores and NDI. This indicated that patients with better improvement of CL may have a better prognosis.  Although both ACDF and LAMP surgeries are effective for four-segment CSM, ACDF can better improve CL and neck pain. For patients with poor CL, we suggest ACDF when both approaches are feasible.

Shi L ，Ding T ，Wang F ，Wu C ... -  《-》