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- 저자 : Joshua Heller (검색결과 2 건)
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Biomechanics of Circumferential Cervical Fixation Using Posterior Facet Cages: A Cadaveric Study
Bernardo de Andrada Pereira,Joshua E. Heller,Jennifer N. Lehrman,Anna G.U. Sawa,Brian P. Kelly 대한척추신경외과학회 2021 Neurospine Vol.18 No.1
Objective: Anterior cervical discectomy and fusion (ACDF) is a common procedure for the treatment of cervical disease. Circumferential procedures are options for multilevel pathology. Potential complications of multilevel anterior procedures are dysphagia and pseudarthrosis, whereas potential complications of posterior surgery include development of cervical kyphosis and postoperative chronic neck pain. The addition of posterior cervical cages (PCCs) to multilevel ACDF is a minimally invasive option to perform circumferential fusion. This study evaluated the biomechanical performance of 3-level circumferential fusion with PCCs as supplemental fixation to anteriorly placed allografts, with and without anterior plate fixation. Methods: Nondestructive flexibility tests (1.5 Nm) performed on 6 cervical C2–7 cadaveric specimens intact and after discectomy (C3–6) in 3 instrumented conditions: allograft with anterior plate (G+P), PCC with allograft and plate (PCC+G+P), and PCC with allograft alone (PCC+G). Range of motion (ROM) data were analyzed using 1-way repeated-measures analysis of variance. Results: All instrumented conditions resulted in significantly reduced ROM at the 3 instrumented levels (C3–6) compared to intact spinal segments in flexion, extension, lateral bending, and axial rotation (p<0.001). No significant difference in ROM was found between G+P and PCC+G+P conditions or between G+P and PCC+G conditions, indicating similar stability between these conditions in all directions of motion. Conclusion: All instrumented conditions resulted in considerable reduction in ROM. The added reduction in ROM through the addition of PCCs did not reach statistical significance. Circumferential fusion with anterior allograft, without plate and with PCCs, has comparable stability to ACDF with allograft and plate.
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Panya Luksanapruksa,Paul William Millhouse,Victor Carlson,Thanase Ariyawatkul,Joshua Heller,Christopher Keppel Kepler 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.3
Study Design: Retrospective cohort study. Purpose: To evaluate surgical outcomes and complications of cervical spine fractures in ankylosing spondylitis (CAS) patients who were treated using either the posterior (P) or combined approach (C). Overview of Literature: Ankylosing spondylitis typically causes progressive spinal stiffness that makes patients susceptible to spinal fractures. CAS is a highly unstable condition. There is contradictory evidence regarding which treatment option, the posterior or the combined approach, yields superior clinical results. Methods: A single institution database was reviewed for data in the period 1999 to 2015. All CAS patients who underwent posterior or combined instrumented fusion were enrolled. We analyzed demographic data, radiographic results, perioperative complications, and postoperative results. Results: Thirty-three patients were enrolled (23 in the P group, 10 in the C group). All patients presented with neck pain after a fall. In the P group, mean operative time was 161.1 minutes (100–327 minutes), and mean estimated blood loss (EBL) was 306.4 mL (50–750 mL). In the C group, 90% of patients underwent a staged procedure, typically with posterior surgery first. Mean EBL was 124 mL (25–337 mL). For posterior surgery, mean EBL was 458.3 mL (400–550 mL). EBL of posterior surgery in the C group was higher but this difference was not significant (p=0.16). Postoperative complication rate was higher in the C group but this difference was not significant (50% vs. 17.4%, p=0.09). In the follow-up period, no late reoperations were performed. Patients who underwent C surgery had a higher rate of neurological improvement but this difference was not significant (p=0.57). Conclusions: Both P and C provided good clinical results. P surgery had lower EBL, lower postoperative complication rate, and shorter length of stay than C surgery; none of these differences were statistically significant.
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