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Reoperations Following Cervical Disc Replacement
Branko Skovrlj,이동호,John Michael Caridi,Samuel Kang-Wook Cho 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.3
Cervical disc replacement (CDR) has emerged as an alternative surgical option to cervical arthrodesis. With increasing numbers of patients and longer follow-ups, complications related to the device and/or aging spine are growing, leaving us with a new challenge in the management and surgical revision of CDR. The purpose of this study is to review the current literature regarding reoperations following CDR and to discuss about the approaches and solutions for the current and future potential complications associated with CDR. The published rates of reoperation (mean, 1.0%; range, 0%–3.1%), revision (mean, 0.2%; range, 0%–0.5%), and removal (mean, 1.2%; range, 0%–1.9%) following CDR are low and comparable to the published rates of reoperation (mean, 1.7%; range; 0%–3.4%), revision (mean, 1.5%; range, 0%–4.7%), and removal (mean, 2.0%; range, 0%–3.4%) following cervical arthrodesis. The surgical interventions following CDR range from the repositioning to explantation followed by fusion or the reimplantation to posterior foraminotomy or fusion. Strict patient selection, careful preoperative radiographic review and surgical planning, as well as surgical technique may reduce adverse events and the need for future intervention. Minimal literature and no guidelines exist for the approaches and techniques in revision and for the removal of implants following CDR. Adherence to strict indications and precise surgical technique may reduce the number of reoperations, revisions, and removals following CDR. Long-term follow-up studies are needed, assessing the implant survivorship and its effect on the revision and removal rates.
Jun Sup Kim,Zoe Beatrice Cheung,Varun Arvind,John Caridi,Samuel Kang-Wook Cho 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.1
Study Design: Cadaveric biomechanical study. Purpose: The purpose of this study was to biomechanically evaluate the effect of preserving or augmenting the interspinous ligament (ISL) and supraspinous ligament (SSL; ISL/SSL) complex between the upper instrumented vertebra (UIV) and UIV+1 using a cadaveric model. Overview of Literature: Adult spinal deformity is becoming an increasingly prevalent disorder, and proximal junctional kyphosis (PJK) is a well-known postoperative complication following long spinal fusion. Methods: Pure moments of 4 and 8 Nm were applied to the native and instrumented spine, respectively (n=8). The test conditions included the following: native spine (T7–L2), fused spine (T10–L2), fused spine with a hand-tied suture loop through the spinous processes at T9–T10, and fused spine with severed T9–T10 ISL/SSL complex. Results: The flexion range of motion (ROM) at T9–T10 of the fused spine loaded at 8 Nm increased by 62% compared to that of the native spine loaded at 4 Nm. The average flexion ROM at T9–T10 for the suture loop and severed ISL/SSL spines were 141% (p =0.13) and 177% (p =0.66) of the native spine at 4 Nm, respectively (p -values vs. fused). Conclusions: Transection of the ISL/SSL complex did not significantly change flexion ROM at the proximal junctional segment following instrumented spinal fusion. Furthermore, augmentation of the posterior ligamentous tension band with a polyester fiber suture loop did not mitigate excessive flexion loads on the proximal junctional segment. We postulate that the role of the posterior ligamentous tension band in mitigating PJK is secondary to the anterior column support provided by the vertebral body and intervertebral disc.