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New Clinical Insight on Degenerative Cervical Spine Disorder Treatment

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (30 September 2023) | Viewed by 8452

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Special Issue Editors

Dr. Qiang Zhou

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Guest Editor

Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China
Interests: spine surgery; intervertebral disc degeneration; tissue engineering

Dr. Pei Li

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Guest Editor

Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China
Interests: orthopedics; degenerative intervertebral disc disease; biomarkers discovery; molecular biology; mechanobiology

Special Issue Information

Dear Colleagues,

Degenerative cervical spine disorders (DCSD) are common diseases in spinal surgery clinics and often contribute to the instability, deformity, and stenosis of the spinal segment and even neurological dysfunction. Currently, the most effective treatment for DCSD patients is decompression surgery with or without internal fixation. In the past, the surgery methods for severe DCSD mainly included anterior approach surgery (i.e., anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF)) and posterior approach surgery (i.e., expansive open-door laminoplasty (EOLP)). With the development of engineering technology, minimally invasive cervical surgery is being performed today with the help of endoscopic or working channels. Furthermore, the non-fusion technique (artificial cervical disc replacement, ACDR) focusing on spinal function reconstruction has also been reported with increasing success. Additionally, with the increase in global aging, standardized and scientific perioperative management (i.e., management of nutrition, pain, complications in bed, and muscle function) is gathering increasing interest. Taken together, an update of surgical techniques and improvements to perioperative management strategies will be helpful in the postoperative rehabilitation of DCSD patients. In this Special Issue, we solicit original research articles and review articles focusing on the surgical treatment and/or perioperative management of DCSD We hope this proposal can help foster a standardized surgical treatment and perioperative management of DCSD.

Potential topics to be covered:

Potential topics include, but are not limited to, the following:

Advances in the diagnosis of DCSD;
Novel surgical techniques for DCSD, such as new surgical approaches and interbody fusion methods;
Summary of outcomes of current surgical techniques (i.e., ACDF, ACCF, EOLP, and ACDR) for DCSD;
Comparison between fusion surgery and non-fusion surgery for DCSD;
Standardized perioperative management strategies of DCSD;

Prediction and management of surgical complications in DCSD patients;

Other applications focusing on enhanced recovery after surgery strategy in DCSD patients

Dr. Qiang Zhou
Dr. Pei Li
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

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Keywords

degenerative cervical spine disorders
anterior cervical discectomy and fusion
anterior cervical corpectomy and fusion
expansive open-door laminoplasty
artificial cervical disc replacement
surgical complications
enhanced recovery after surgery

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10 pages, 1475 KiB

Open AccessArticle

Difference between Anterior and Posterior Cord Compression and Its Clinical Implication in Patients with Degenerative Cervical Myelopathy

by Kyung-Chung Kang, Tae Su Jang, Sun-Hwan Choi and Hee-Won Kim

J. Clin. Med. 2023, 12(12), 4111; https://doi.org/10.3390/jcm12124111 - 18 Jun 2023

Cited by 1 | Viewed by 2857

Abstract

In degenerative cervical myelopathy (DCM), the low anteroposterior compression ratio of the spinal cord is known to be associated with a neurologic deficit. However, there is little detailed analysis of spinal cord compression. Axial magnetic resonance images of 183 DCM patients at normal C2–C3 and maximal cord compression segments were analyzed. The anterior (A), posterior (P), and anteroposterior length and width (W) of the spinal cord were measured. Correlation analyses between radiographic parameters and each section of Japanese Orthopedic Association (JOA) scores and comparisons of the patients divided by A (below or above 0, 1, or 2 mm) were performed. Between C2–C3 and maximal compression segments, the mean differences of A and P were 2.0 (1.2) and 0.2 (0.8) mm. The mean anteroposterior compression ratios were 0.58 (0.13) at C2–C3 and 0.32 (0.17) at maximal compression. The A and A/W ratio were significantly correlated with four sections and the total JOA scores (p < 0.05), but the P and P/W ratio did not demonstrate any correlations. Patients with A < 1 mm had significantly lower JOA scores than those with A ≥ 1 mm. In patients with DCM, spinal cord compression occurs mainly in the anterior part and the anterior cord length of <1 mm is particularly associated with neurologic deficits. Full article

(This article belongs to the Special Issue New Clinical Insight on Degenerative Cervical Spine Disorder Treatment)

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13 pages, 2071 KiB

Open AccessArticle

Preoperative Decreased Hounsfield Unit Values of Cervical Vertebrae and the Relative Cross-Sectional Area of Flexion/Extension Paraspinal Muscles Are Novel Risk Factors for the Loss of Cervical Lordosis after Open-Door Laminoplasty

by Wenjun Hu, Shaoguang Li, Huihong Shi, Yong Li, Jincheng Qiu, Jinlang Zhou, Dongsheng Huang, Yan Peng, Wenjie Gao and Anjing Liang

J. Clin. Med. 2023, 12(6), 2119; https://doi.org/10.3390/jcm12062119 - 8 Mar 2023

Cited by 4 | Viewed by 3203

Abstract

Open-door laminoplasty is widely used for patients with cervical spondylotic myelopathy (CSM). However, the loss of cervical lordosis (LCL) seems to be unavoidable in the long-term follow-up after surgery, which may affect the clinical outcomes. The risk factors for this complication are still unclear. In this study, patients who underwent open-door laminoplasty between April 2016 and June 2021 were enrolled. Cervical X-rays were obtained to measure the C2–7 Cobb angle, C2–7 sagittal vertical axis (SVA), T1 slope (T1S) and ranges of motion (ROM). Cervical computed tomography (CT) scans and magnetic resonance imaging (MRI) were collected to evaluate the cervical Hounsfield unit values (HU) and the relative cross-sectional area (RCSA) of paraspinal muscles, respectively. A total of 42 patients were included and the average follow-up period was 24.9 months. Among the patients, 24 cases (57.1%) had a LCL of more than 5° at a 1-year follow-up and were labeled as members of the LCL group. The follow-up JOA scores were significantly lower in the LCL group (13.9 ± 0.6 vs. 14.4 ± 0.8, p = 0.021) and the mean JOA recovery rate was negatively correlated with LCL (r = −0.409, p = 0.007). In addition, LCL was positively correlated to the preoperative T1S, flexion ROM, flexion/extension ROM and the RCSA of flexion/extension muscles, while it was negatively correlated to extension ROM and the HU value of cervical vertebrae. Furthermore, multiple linear regression showed that preoperative T1S, mean HU value of cervical vertebrae, flexion/extension ROM and the flexion/extension RCSA were independent risk factors for LCL. Spine surgeons should consider these parameters before performing open-door laminoplasty. Full article

(This article belongs to the Special Issue New Clinical Insight on Degenerative Cervical Spine Disorder Treatment)

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19 pages, 2903 KiB

Open AccessSystematic Review

Is It Necessary to Cross the Cervicothoracic Junction in Posterior Cervical Decompression and Fusion for Multilevel Degenerative Cervical Spine Disease? A Systematic Review and Meta-Analysis

by Honghao Yang, Jixuan Huang, Yong Hai, Zhexuan Fan, Yiqi Zhang, Peng Yin and Jincai Yang

J. Clin. Med. 2023, 12(8), 2806; https://doi.org/10.3390/jcm12082806 - 11 Apr 2023

Cited by 3 | Viewed by 1912

Abstract

Background: Posterior cervical decompression and fusion (PCF) is a common procedure for treating patients with multilevel degenerative cervical spine disease. The selection of lower instrumented vertebra (LIV) relative to the cervicothoracic junction (CTJ) remains controversial. This study aimed to compare the outcomes of PCF construct terminating at the lower cervical spine and crossing the CTJ. Methods: A comprehensive literature search was performed for relevant studies in the PubMed, EMBASE, Web of Science, and Cochrane Library database. Complications, rate of reoperation, surgical data, patient-reported outcomes (PROs), and radiographic outcomes were compared between PCF construct terminating at or above C7 (cervical group) and at or below T1 (thoracic group) in patients with multilevel degenerative cervical spine disease. A subgroup analysis based on surgical techniques and indications was performed. Results: Fifteen retrospective cohort studies comprising 2071 patients (1163 in the cervical group and 908 in the thoracic group) were included. The cervical group was associated with a lower incidence of wound-related complications (RR, 0.58; 95% CI 0.36 to 0.92, p = 0.022; 831 patients in cervical group vs. 692 patients in thoracic group), a lower reoperation rate for wound-related complications (RR, 0.55; 95% CI 0.32 to 0.96, p = 0.034; 768 vs. 624 patients), and less neck pain at the final follow-up (WMD, −0.58; 95% CI −0.93 to −0.23, p = 0.001; 327 vs. 268 patients). However the cervical group also developed a higher incidence of overall adjacent segment disease (ASD, including distal ASD and proximal ASD) (RR, 1.87; 95% CI 1.27 to 2.76, p = 0.001; 1079 vs. 860 patients), distal ASD (RR, 2.18; 95% CI 1.36 to 3.51, p = 0.001; 642 vs. 555 patients), overall hardware failure (including hardware failure of LIV and hardware failure occurring at other instrumented vertebra) (RR, 1.48; 95% CI 1.02 to 2.15, p = 0.040; 614 vs. 451 patients), and hardware failure of LIV (RR, 1.89; 95% CI 1.21 to 2.95, p = 0.005; 380 vs. 339 patients). The operating time was reasonably shorter (WMD, −43.47; 95% CI −59.42 to −27.52, p < 0.001; 611 vs. 570 patients) and the estimated blood loss was lower (WMD, −143.77; 95% CI −185.90 to −101.63, p < 0.001; 721 vs. 740 patients) when the PCF construct did not cross the CTJ. Conclusions: PCF construct crossing the CTJ was associated with a lower incidence of ASD and hardware failure but a higher incidence of wound-related complications and a small increase in qualitative neck pain, without difference in neck disability on the NDI. Based on the subgroup analysis for surgical techniques and indications, prophylactic crossing of the CTJ should be considered for patients with concurrent instability, ossification, deformity, or a combination of anterior approach surgeries as well. However, long-term follow-up outcomes and patient selection-related factors such as bone quality, frailty, and nutrition status should be addressed in further studies. Full article

(This article belongs to the Special Issue New Clinical Insight on Degenerative Cervical Spine Disorder Treatment)

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