Browsing by Subject "Cervical spondylosis"

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  • Hirvonen, Tuomas; Siironen, Jari; Marjamaa, Johan; Niemelä, Mika; Koski-Palkén, Anniina (2020)
    Background Context Anterior cervical discectomy and fusion (ACDF) procedures is thought to lead to accelerated degeneration of the adjacent cervical discs and in some cases can be symptomatic (adjacent segment disease, or ASD). The occurrence of ASD is of particular interest when treating young individuals, as the cumulative disease burden may become increasingly significant during their expectedly long lifetime. However, the overall impact of a surgical intervention on the lifetime prognosis of ASD remains unclear. Purpose Our goal was to study the long-term outcomes of ACDF surgery among those members of the young adult population who have been operated on between the ages of 18 and 40. Study design Retrospective study. Patient Sample All patients between 18 and 40 years of age at the time of surgery who underwent ACDF due to degenerative cervical disorders at Helsinki University Hospital between the years of 1990 and 2005 (476 patients). Outcome Measures Cervical reoperation rate, satisfaction with the surgery, employment status, Neck Disability Index (NDI) Methods We retrospectively analyzed the medical records of all patients between 18 and 40 years of age at the time of surgery who underwent ACDF due to degenerative cervical disorders at Helsinki University Hospital between the years of 1990 and 2005. We sent questionnaires to all available patients at the end of the follow-up (median 17.5 years) to assess their current neck symptoms, general situations, and levels of satisfaction with the surgery. Furthermore, we compared the results for different types of ACDF surgeries (i.e., discectomy only versus synthetic cage or bone autograft implantation for fusion) in propensity-score-matched groups. Results Of the 476 patients who were included in the study, surgery was performed in 72% of the cases due to intervertebral disc herniation and in 28% due to spondylotic changes. The total reoperation rate during the entire follow-up (median 17.5 years) was 24%, and 19.5% if early reoperations (
  • Rissanen, Anni (Helsingin yliopisto, 2020)
    Background: Cervical spondylotic myelopathy (CSM) is a severe degenerative disease of the spine and can lead to significant functional deterioration. Multilevel disease is generally approached with a posterior surgery by either decompressive laminectomy with or without fusion or laminoplasty. Published long-term follow up studies of laminectomy without fusion are scarse. Objective: To retrospectively analyse clinical data of three cohorts of patients who have undergone cervical laminectomy without fusion for CSM at the Department of Neurosurgery in Helsinki University Hospital between years 2000-2011 (n=340 patients) and evaluate the incidence of further cervical surgeries and risk for cervical misalignment as well as current functional status, neck symptoms and quality of life. Results: The subjective clinical outcome was reported good or excellent on the Likert scale by 72 % of the patients in short term clinical follow up. 41 (12.1%) patients had later underwent another cervical surgery. 10 (24 %) of these surgeries were wound revisions, 21 (51 %) early re-decompressions within a year from initial laminectomy and 10 (24 %) decompressions due to further stenosis later during the follow-up of mean 8.5 years (maximum follow-up 17.5 years). The most common indication for further surgery was residual stenosis on adjacent or other cervical levels (14 patients, 34 %). Only 5 (1 %) patients required a further surgery for correction of a sagittal balance problem, namely for olisthesis developing in the area of the laminectomy. In X-ray studies the mean change in sagittal alignment was 4.0 towards lordotic posture and a newly developed kyphosis was found in 3 of 40 (7.5 %) patients median 9.4 years after index laminectomy. The mean Neck Disability Index percentage was 28 % median 9.0 years after laminectomy indicating mild self-rated disability. The mean EQ-5D index score was 58.8 and the mean EQ-VAS 61.1 indicating reduced health related quality of life when compared to a control cohort from the general population selected by propensity matched scoring and also to population norms. Nurick score below 3 before laminectomy or at the follow-up visit (mean 83 days after laminectomy) were statistically significant factors for both, better EQ-5D index score and EQ-VAS. Conclusions: As CSM is a progressive condition, some degree of progression even after surgical treatment might occur and therefore need for further interventions may be necessary. However, the development of post-laminectomy kyphosis and need for correction of sagittal alignment problems is rare. Large randomized studies comparing different approaches would be needed to determine the optimal treatment for multilevel CSM. However, the very low incidence of kyphosis development after laminectomy and in particularly the low rate of corrective surgery needed for alignment issues per se well justifies the role of simple laminectomy in treatment of multilevel CSM.
  • Hirvonen, Tuomas; Marjamaa, Johan; Siironen, Jari; Koskinen, Seppo; Niemelä, Mika; Koski-Palken, Anniina (2021)
    BACKGROUND CONTEXT: The leading surgical treatment of cervical radiculopathy is anterior cervical discectomy and fusion (ACDF). However, it has been suggested that ACDF procedures could lead to accelerated degeneration of the adjacent cervical discs (adjacent segment disease, or ASD) and the effect of ACDF surgery on neck symptoms and quality of life in the long term is not fully understood. Patients operated on at young ages generally have a long life expectancy and a long number of working years ahead of them. Thus, this patient group is of special interest when considering the accumulation of cervical problems due to possible ASD, the overall progressive nature of cervical degeneration in the long term, and their effects on related quality of life. PURPOSE: Our goal was to study the health-related quality of life in the long-term follow-up after ACDF surgery in the young adult population between the ages of 18 and 40. STUDY DESIGN: A retrospective cohort study with propensity matched controls. PATIENT SAMPLE: All patients between 18 and 40 years of age at the time of the surgery who underwent ACDF due to degenerative cervical disease at Helsinki University Hospital between the years 1990 and 2005 who had filled in the quality of life questionnaires 12 to 28 years after the surgery (281 patients), and a propensity matched control cohort of the general population selected based on age, sex, and smoking status. OUTCOME MEASURES: Quality of life measured by the EuroQol questionnaire (EQ-5D-3L and EQ-VAS). METHODS: The medical records of all patients who underwent ACDF due to degenerative cervical disease at the age of 18 to 40 years at Helsinki University Hospital between 1990 and 2005 were analyzed retrospectively. The EuroQol questionnaire was sent to all patients whose contact information could be obtained (443 patients) at the end of the follow-up (median 17.5 years) to assess their current quality of life. A total of 281 patients returned the questionnaires and were included in this study. Quality of life was compared to that in the general Finnish population using a similar sized control cohort selected through propensity matching. RESULTS: The patients who had undergone ACDF surgery reported significantly more problems than the general population cohort in three out of five dimensions that were assessed in the EQ-5D questionnaire, including mobility, usual activities, and pain/discomfort. Similarly, the overall EQ-5D-3L index calculated from the dimensional values was lower (0.74 vs. 0.83, p=.000), depicting a generally decreased health-related quality of life among patients. Spondylosis as a primary diagnosis, clinical myelopathy, and further cervical surgeries were associated with lower quality of life in the subgroup analyses of the patients. Similarly, in the EQ-VAS assessment, patient subgroups with spondylosis as a primary diagnosis, at least one reoperation, operation on more than one level, and clinical myelopathy were associated with lower scores and lower quality of life. The mean EQ-VAS score among patients was 73%. Regardless of the decreased health-related quality of life, there was no statistically significant difference in the concurrent employment status between the patient and control groups. CONCLUSIONS: The health-related life quality measured by the EQ-5D-3L was lower in the patient population than in the general population. Patients had more problems with mobility and usual activities and more pain/discomfort. However, satisfaction with the surgery was very high, and there was no significant difference in employment status between the patients and the control population. Patients with spondylosis as a primary diagnosis had lower quality of life compared to patients with disc herniation. Also, clinical myelopathy and further cervical surgeries during follow-up were associated with lower quality of life in the subgroup analyses of the patients. It must also be kept in mind that we do not know what the situation could have been without surgery and with conservative treatment only. (C) 2021 The Authors. Published by Elsevier Inc.