We present the results of a single centre, prospective study to evaluate the clinical and radiographic outcomes of anterior cervical decompression and replacement (ACDR) using the NuNec(tm) Cervical Arthroplasty System (Pioneer Surgical Technology, Marquette, Mich., USA). 36 patients with radiculopathy/myelopathy, who failed to respond to conservative measures, were included. Pain and function were evaluated by Visual Analogue score for Neck pain (VAS-NP) and Arm pain (VAS-AP), Neck disability index (NDI) and SF-36 questionnaires. Radiological assessments include assessing overall range of movement (ROM) and at functional segment unit (FSU). Statistical analysis was completed using SPSS 16.0 statistical package (SPSS Inc, Chicago, IL). Appropriate parametric (A paired t-test) and non parametric tests (Wilcoxon signed-rank test) were used to assess the statistical significance (p<0.05). The average age at operation was 51 years (range 35 - 77years). 8 patients received ACDR at one-level, 15 had 2-level surgery, 12 had 3-level surgery and 1 had a 4-level surgery. At the time of final follow-up (Mean 14.25 months, Range 12- 22.5 months) the mean NDI improved from 49.35; to 33.78 (p< 0.001). There statistically significant improvement note in VAS-NP (Post-op3.65, Pre-op:8.16, p<0.001), VAS-AP (Post-op:3.12, Pre-op:7.32, p<0.001) and SF-36BP (pre-op:29.15, post-op:37.18, p<0.002). The overall global ROM movement was preserved (pre-op:46.80±10.52, post-op:45.04±11.53) and an improvement in ROM at FSU was observed (pre-op:16.60±8.50, post-op:20.22±12.22) at final follow–up.Background
Methodology and Results
This prospective multicentre study was undertaken
to determine segmental movement, disc height and sagittal alignment
after total disc replacement (TDR) in the lumbosacral spine and
to assess the correlation of biomechanical properties to clinical
outcomes. A total of 173 patients with degenerative disc disease and low
back pain for more than one year were randomised to receive either
TDR or multidisciplinary rehabilitation (MDR). Segmental movement
in the sagittal plane and disc height were measured using distortion
compensated roentgen analysis (DCRA) comparing radiographs in active flexion
and extension. Correlation analysis between the range of movement
or disc height and patient-reported outcomes was performed in both
groups. After two years, no significant change in movement in the
sagittal plane was found in segments with TDR or between the two
treatment groups. It remained the same or increased slightly in
untreated segments in the TDR group and in this group there was
a significant increase in disc height in the operated segments.
There was no correlation between segmental movement or disc height
and patient-reported outcomes in either group. In this study, insertion of an intervertebral disc prosthesis
TDR did not increase movement in the sagittal plane and segmental
movement did not correlate with patient-reported outcomes. This
suggests that in the lumbar spine the movement preserving properties
of TDR are not major determinants of clinical outcomes. Cite this article:
Aims. The optimal procedure for the treatment of ossification of the posterior longitudinal ligament (OPLL) remains controversial. The aim of this study was to compare the outcome of anterior cervical ossified posterior longitudinal ligament en bloc resection (ACOE) with posterior laminectomy and fusion with bone graft and internal fixation (PTLF) for the surgical management of patients with this condition. Methods. Between July 2017 and July 2019, 40 patients with cervical OPLL were equally randomized to undergo surgery with an ACOE or a PTLF. The clinical and radiological results were compared between the two groups. Results. The Japanese Orthopaedic Association (JOA) score and recovery rate in the ACOE group were significantly higher than those in the PTLF group during two years postoperatively, provided that the canal occupying ratio (COR) was > 50%, or the K-line was negative. There was no significant difference in JOA scores and rate of recovery between the two groups in those in whom the COR was < 50%, or the K-line was positive. There was no significant difference in the Cobb angle between C2 and C7, sagittal vertical axis, cervical
Study purpose and background. Kinematic variables have been identified as potential biomarkers for low back pain patients; however, an in-depth comparison between chronic (n=22), acute (n=15), and healthy controls (n=136) has not been done. This retrospective data analysis compared intervertebral lumbar
Introduction. Research has suggested baby wearing results in happier healthier babies [1]. Various designs of carrier are available, is there one which has less impact on the biomechanics of the cervical spine?. Methods. 18 volunteers (9 male and female) performed a warm up procedure on the neck (movement through each range of motion), repeated thrice. Measurement of the active cervical
The aim of this study was to assess the accuracy of pedicle screw placement, as well as intraoperative factors, radiation exposure, and complication rates in adult patients with degenerative disorders of the thoracic and lumbar spines who have undergone robotic-navigated spinal surgery using a contemporary system. The authors reviewed the prospectively collected data on 196 adult patients who had pedicle screws implanted with robot-navigated assistance (RNA) using the Mazor X Stealth system between June 2019 and March 2022. Pedicle screws were implanted by one experienced spinal surgeon after completion of a learning period. The accuracy of pedicle screw placement was determined using intraoperative 3D fluoroscopy.Aims
Methods
Postoperative complication rates remain relatively high after adult spinal deformity (ASD) surgery. The extent to which modifiable patient-related factors influence complication rates in patients with ASD has not been effectively evaluated. The aim of this retrospective cohort study was to evaluate the association between modifiable patient-related factors and complications after corrective surgery for ASD. ASD patients with two-year data were included. Complications were categorized as follows: any complication, major, medical, surgical, major mechanical, major radiological, and reoperation. Modifiable risk factors included smoking, obesity, osteoporosis, alcohol use, depression, psychiatric diagnosis, and hypertension. Patients were stratified by the degree of baseline deformity (low degree of deformity (LowDef)/high degree of deformity (HighDef): below or above 20°) and age (Older/Younger: above or below 65 years). Complication rates were compared for modifiable risk factors in each age/deformity group, using multivariable logistic regression analysis to adjust for confounders.Aims
Methods
Background and objectives. Numerous approaches are recommended for the management of non-specific neck pain (NS-NP). However, the extent to which approaches are used is unclear. This survey investigated current UK physiotherapists' measurement and management of patients with NS-NP. Methods and results. Physiotherapists were invited to participate in an online survey if they were practicing in the UK and had experience of managing NS-NP. 2101 responses were received. Analysis of the results indicated the overall popularity of active treatment approaches with 84% and 61% of respondents employing exercise and patient education respectively. 48% of respondents reported using a multimodal approach (that is, combination of exercise and manual therapy with/without patient education). Over a third of respondents reported not using outcome measures (OMs) for NS-NP. Of the two-thirds who reported using OMs, the majority reported using pain and
Purpose and background. Static plain radiographs at the end of uncontrolled bending are the current standard of care for measuring translatory slip in back pain patients. Quantitative fluoroscopy systems (QF) that employ standardised bending protocols have been found to improve precision and reduce dose, but comparative data are lacking. We compared 4 QF methods with static radiographs in a control population, calculating ranges, population variation and measurement errors over 6 weeks. Methods. Fifty-four healthy controls (F=22, M=23) received passive recumbent and active weight bearing QF screenings during controlled motion, plus still fluoro imaging in neutral, flexion and extension. The translatory slip of all levels from L2-S1 was determined for each condition using bespoke image tracking codes (Matlab) and pooled to provide means and ranges of variation (+/-1.96SD). The pooled measurement error, or minimal detectable change (MDC. 95. ), reflecting the intra subject repeatability over 6 weeks was calculated. Ranges of translation for each level (L2-S1), for each type of motion were also calculated. Results. Static radiographs at the end of uncontrolled flexion gave the greatest variation and the worst repeatability, while QF recumbent passive and active weight bearing motion with flexion recorded during the motion had ¼ less variation and twice the repeatability. For individual levels, L2-3 had significantly higher flexion
Purpose and Background:. To compare static and dynamic lumbar intervertebral
Objective. To compare the effectiveness of the Aspen, Aspen Vista, Philadelphia, Miami-J and Miami-J Advanced collars at restricting cervical spine movement in the sagittal, coronal and axial planes. Methods. Nineteen healthy volunteers (12 female, 7 male) were recruited to the study. Collars were fitted by an approved physiotherapist. Eight ProReflex (Qualisys, Sweden) infra-red cameras were used to track the movement of retro reflective marker clusters placed in predetermined positions on the head and trunk. 3D kinematic data was collected during forward flexion, extension, lateral bending and axial rotation from uncollared and collared subjects. The physiological
Surgical management of symptomatic lumbar degenerative disc disease (DDD) currently consists of fusion or implantation of a first generation total disc replacement (TDR). This study is the first to evaluate an elastomeric one-piece TDR in a 50-patient European study. Fifty patients with single-level, symptomatic lumbar DDD at L4-S1 who were unresponsive to at least 6-months of non-operative therapy were enrolled in a clinical trial of a viscoelastic TDR (VTDR) at three European sites. Patients were assessed clinically and radiographically at 6 weeks, 3 and 6 months, and 1 and 2 years. Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) were used to assess clinical outcomes. Twenty-eight males and twenty-two females were enrolled in the study. The average age of patients was 39.7 (23 to 61). The operative level was L4/L5 in 13 patients and L5/S1 in 37 patients. There were no intra-operative complications. Quantitative radiographic assessment indicates that the VTDR restores and maintains a physiologically appropriate disc height and angle, while providing
Statement of Purpose. The purpose of this experiment was to characterize the biomechanical properties of a minimally-invasive flexion-restricting stabilization system (FRSS) developed to address flexion instability. Background. Lumbar flexion instability is associated with degenerative pathology such as degenerative spondylolisthesis (DS) as well as resection of posterior structures during neural decompression. Flexion instability may be measured by increased total flexion/extension
Purpose of the study. To compare safety and efficacy of cervical disc replacement (CRD) in single and multilevel DDD. Patients were followed up at 1, 3, 6, 12 and 24 months. Methods. 249 patients were enrolled. 171 patients were treated at 1-level, 41 treated at 2 levels and 2 patients were treated at 3 levels. Implant was also used adjacent to a fusion with a cage in 35 patients. The diagnosis was cervical degenerative disc disease between C3 and C7 with symptomatic DH. Population was 106 male 143 female, average age 46 (25-71). Clinical assessment included VAS scores for arm and neck pain and Neck Disability Index (NDI).
Statement of Purpose. It is well known that individuals with a history of low back pain (hLBP) exhibit altered movement patterns that are caused by changes in neuromuscular control. Postural disturbance provides an effective method for creating these differentiable movement patterns. This study has explored the response of the lower limb and spine to a translational perturbation similar to that experienced on public transport in healthy volunteers and those with hLBP. Methods. Healthy volunteers (n=16) and subjects with hLBP (n=10) were subjected to 31 identical postural disturbances at varying time intervals while standing atop a moving platform. Skeletal kinematics and muscle activation were recorded using a 10-camera Vicon system (Oxford, UK) and Myon electromyography (EMG) at the trunk (lumbar, lower thoracic, and upper thoracic segments), pelvis, thigh, calf, and foot. Joint angles were calculated using Body Builder (Vicon) and a unilateral seven-segment custom model. Results. Examination of the total
Many studies have investigated the kinematics of the lumbar spine and the morphological features of the lumbar discs. However, the segment-dependent immediate changes of the lumbar intervertebral space height during flexion-extension motion are still unclear. This study examined the changes of intervertebral space height during flexion-extension motion of lumbar specimens. First, we validated the accuracy and repeatability of a custom-made mechanical loading equipment set-up. Eight lumbar specimens underwent CT scanning in flexion, neural, and extension positions by using the equipment set-up. The changes in the disc height and distance between adjacent two pedicle screw entry points (DASEP) of the posterior approach at different lumbar levels (L3/4, L4/5 and L5/S1) were examined on three-dimensional lumbar models, which were reconstructed from the CT images.Objectives
Methods
The objective of this study was to assess the association between whole body sagittal balance and risk of falls in elderly patients who have sought treatment for back pain. Balanced spinal sagittal alignment is known to be important for the prevention of falls. However, spinal sagittal imbalance can be markedly compensated by the lower extremities, and whole body sagittal balance including the lower extremities should be assessed to evaluate actual imbalances related to falls. Patients over 70 years old who visited an outpatient clinic for back pain treatment and underwent a standing whole-body radiograph were enrolled. Falls were prospectively assessed for 12 months using a monthly fall diary, and patients were divided into fallers and non-fallers according to the history of falls. Radiological parameters from whole-body radiographs and clinical data were compared between the two groups.Objectives
Methods
To evaluate the neck strength of school-aged rugby players, and
to define the relationship with proxy physical measures with a view
to predicting neck strength. Cross-sectional cohort study involving 382 rugby playing schoolchildren
at three Scottish schools (all male, aged between 12 and 18 years).
Outcome measures included maximal isometric neck extension, weight,
height, grip strength, cervical range of movement and neck circumference.Objectives
Methods