Coexistence of Neck and Shoulder Disability: Results of a Population-Based Cross-Sectional Study on Normative Scores and Multifactorial Risk Factors for Neck and Shoulder Problems

Koller Juliane,Bismarck Carsten,Krebs Sona,Hitzl Wolfgang,Mayer Michael,Koller Heiko 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.2

Study Design: Cross-sectional population-based study.Purpose: The study objective was to evaluate the coexistence of neck- and shoulder-disability, to establish normative scores for Neck Disability Index (NDI), Visual Analog Scale (VAS)-neck, VAS-arm, Quick Disability of Shoulder and Hand (Quick-DASH), and modified Constant score (mConstant score), and to determine the influence of psychological distress (Hospital Anxiety and Depression Scale [HADS]) on the disability measures. The authors also investigated the distribution of dysphagia across the population and its relation to the NDI scores.Overview of Literature: Several factors can adversely influence the clinical outcomes after cervical surgeries. The interaction of neck and shoulder disability in the perspective of psychological distress is not well understood.Methods: Prospective questionnaire-based assessment was performed for 1,000 participants. Questionnaires consisted of validated generic and disease-specific queries and specific questions. The survey included patients without pathologies of cervical spine/shoulders/upper extremities.Results: Mean age of participants was 39 years. The average neck VAS score was 1.2, NDI% was 7.3, arm VAS score was 0.8, QuickDASH was 6.2, mConstant score was 70.7, HADS-A score was 4.9, and HADS-D score was 3.2. The psychological scores showed a significant correlation with neck- and shoulder-disability (<i>p</i><0.0001, <i>r</i>=0.3 to <i>r</i>=0.5). However, correlations between neck (NDI%, neck VAS score) and shoulder disability (mConstant score, arm VAS score, Quick-DASH) were stronger (<i>p</i><0.0001, <i>r</i>=0.5 to <i>r</i>=0.6). A body mass index >35 kg/m² influenced shoulder-disability (<i>p</i><0.005) and psychological distress (HADS-D score, <i>p</i><0.00001). Limited neck rotation was present in those with higher age, psychological distress, neck and shoulder disability (<i>p</i><0.001).Conclusions: Normative scores for neck and shoulder disability were established. The outcomes of cervical spine surgery can be normalized to these results. A better understanding of the interdependencies of neck and shoulder disability and psychological distress would enable superior decision-making and patient counseling.

SOF System; A New Nomenclature System for the Surgical Techniques of Cervical Spine Deformity

홍재택,Heiko Koller,Kuniyoshi Abumi,Wen Yuan,Asdrubal Falavigna,이호진,이종범,Jean-Charles Le Huec,박종혁,김일섭 대한척추신경외과학회 2020 Neurospine Vol.17 No.3

Although cervical spinal deformity (CSD) can have a profoundly negative impact on an individual’s quality of life and there have been many advances in surgical treatment of CSD in recent years, there exists no comprehensive classification system of surgical treatment that categorizes anterior and posterior surgery separately according to the grade of surgery. The objective of this study is to introduce the new classification system of various surgical treatments for CSD. We developed a new classification system (SOF system) for CSD surgery that describes the sequence of surgical approach (S), the grade of osteotomy (O), and the information of fixation (F) using alphanumeric codes. This new classification system can provide a consistent description of the various osteotomies performed in CSD surgery. Especially, regarding research, there has been a clear benefit to this classification. Having a standardized classification that allows for common frame for cervical deformity correction surgery, communication between surgeons and the evaluation of the CSD surgeries make it possible to conduct global comparative research about surgical outcome.

Analysis of Postoperative Pain at the Anterior Iliac Crest Harvest Site: A Prospective Study of the Intraoperative Local Administration of Ropivacaine

Juliane Zenner,Wolfgang Hitzl,Michael Mayer,Heiko Koller 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.1

Study Design: This was a prospective randomized comparative study. Purpose: The aim of this study was to objectify donor site-related pain following anterior iliac crest graft harvesting, in patients who have undergone multilevel anterior cervical discectomy and fusion with plating (ACDFP); and to assess the effect of an intraoperative local single injection of ropivacaine on postoperative pain. Overview of Literature: Multilevel ACDFP can be associated with a high non-union rate. Autogenous iliac bone has been used to increase union rates, although a high incidence of donor site-related pain has been reported. Methods: Forty consecutive patients who required 3-level or 4-level ACDFP were prospectively assessed for donor site-related pain. Pain levels were assessed daily for five days postoperative using the visual analog scale (VAS). Patients were randomly assigned to group A or B. In group A patients, 7–10 mL of ropivacaine (0.2%) was injected into the iliac crest after iliac crest graft harvesting. Morphine usage via patient controlled analgesia was calculated. At six months postoperative, patient complaints at the harvest site were documented. Results: Patients were randomly assigned to group A or B. In group A, ropivacaine was locally administered at the site of the iliac crest graft harvest after fascia closure. In group B, no additional treatments were administered. The average patient age in group A was 56±7.6 years, whereas the average age of patients in group B was 52.6±10.4 years. Group A had an average of 0.6±0.7 previous surgeries per patient, whereas group B had an average of 0.8±1.0 previous surgeries per patient. The average number of levels fused in group A was 3.6±0.7, whereas the average number of levels fused in group B was 3.7±0.9 (all p >0.05). In group A, the mean ropivacaine volume administered was 8.4±1.5 mL. No patient complaints regarding chronic pain, were reported six months postoperatively. No complications were encountered from the harvest site, and all patients underwent successful 3-level and 4-level ACDFP. Statistical analysis showed significant differences for VAS on postoperative day 1 (p =0.004) and day 2 (p =0.005). Conclusions: VAS assessment showed overall moderate perioperative morbidity in terms of donor site-related pain, which was reduced by administering ropivacaine.

The Effect of Rod Pattern, Outrigger, and Multiple Screw-Rod Constructs for Surgical Stabilization of the 3-Column Destabilized Cervical Spine - A Biomechanical Analysis and Introduction of a Novel Technique

Sebastian Hartmann,Claudius Thomé,Anto Abramovic,Sara Lener,Werner Schmoelz,Juliane Koller,Heiko Koller 대한척추신경외과학회 2020 Neurospine Vol.17 No.3

Objective: Anterior-only reconstructions for cervical multilevel corpectomies are prone to fail under continuous mechanical loading. This study sought to define the mechanical characteristics of different constructs in reducing a range of motion (ROM) of the 3-column destabilized cervical spine, including posterior cobalt-chromium (CoCr)-rods, outrigger-rods (OGR), and a novel triple rod construct using lamina screws (6S3R). The clinical implications of biomechanical findings are discussed in depth from the perspective of the challenges surgeons face cervical deformity correction. Methods: Three-column deficient cervical spinal models were produced based on reconstructed computed tomography scans. The corpectomy defect between C3 and C7 end-level vertebrae was restored with anterior titanium (Ti) mesh-cage. The ROM was evaluated in a customized 6-degree of freedom spine tester. Tests were performed with different rod materials (Ti vs. CoCr), varying diameter rods (3.5 mm vs. 4.0 mm), with and without anterior plating, and using different construct patterns: bilateral rod fixation (standard-group), OGRgroup, and 6S3R-Group. Construct stability was expressed in changes and differences of ROM (°). Results: The largest reduction of ROM was noticed in the 6S3R-group compared to the standard- and the OGR-group. All differences observed were emphasized with an increasing number of corpectomy levels and if anterior plating was not added. For all simulated 1-, 2-, and 3-level corpectomy constructs, the OGR-group revealed decreased ROM for all motion directions compared to the standard-group. An increase of construct stiffness was also recorded for increased rod diameter (4.0 mm) and stiffer rod material (CoCr), though these effects lacked behind the more advanced construct pattern. Conclusion: A novel reconstructive technique, the 6S3R-construct, was shown to outperform all other constructs and might resemble a new standard of reference for advanced posterior fixation.

Feasibility of the Far Lateral Suboccipital Approach to the Retroodontoid Region. How Much Bone Removal Is Truly Needed?

Gergely Boon,Kristof Kiraly,Tamas Ruttkay,Bernhard Hirt,Koller Heiko 대한척추신경외과학회 2020 Neurospine Vol.17 No.4

Objective: The posterolateral extradural suboccipital approach can be used to reach the anterior epidural space and the retro-odontoid regions. The extent of necessary bone removal of the atlas vertebra (C1) has not yet been defined. We studied the changes in the size of the horizontal and vertical surgical windows using stepwise bone removal of C1. A representative case is shown. Methods: The anatomical study was performed bilaterally on five Thiel-fixed human cadavers (mean age, 83.7 years). The surgical window (horizontal×vertical) required to access the retro-odontoid region via a posterolateral approach was measured for an intact C1 posterior arch, after a semicircular inferior partial resection of the C1 arch, after resection of the unilateral hemiarch of C1, and finally after drilling approximately 3 mm from the medial aspect of the lateral mass of C1. Results: The intact C1 resulted in a very narrow surgical window of 6.3 mm×9.7 mm (horizontal×vertical). The vertical window increased to a 13 mm after the semicircular inferior partial resection of the C1 arch and to 17.3 mm in the case of removal of the ipsilateral C1 posterior arch. The bone removal from the medial aspect of the C1 lateral mass resulted in a widening of the horizontal surgical window to 10.3 mm. The final size of the surgical window was 10.3 mm×17.3 mm. The patient with severe kyphoscoliosis of the craniocervical spine was successfully operated on using odontoid and C1–2 facet osteotomies. Conclusion: If only the anterior epidural space or the base of the odontoid needs to be reached, the semicircular inferior partial resection of the C1 arch allows for an adequate surgical window. The tip of the odontoid could only be reached if the ipsilateral posterior arch is resected.