Early Clinical Experience with a Fresh Talar Transplant Inlay Allograft for the Treatment of Osteochondral Lesions of the Talus

2010 ◽  
Vol 100 (1) ◽  
pp. 25-34 ◽  
Author(s):  
Leonard Janis ◽  
David B. Kaplansky ◽  
William T. DeCarbo
Keyword(s):  
Stage Iv ◽  
Osteochondral Lesions ◽  
Consecutive Series ◽  
Osteochondral Defects ◽  
Promising Alternative ◽  
Radiographic Outcomes ◽  
Early Results ◽  
Hardware Complications ◽  
Sport And Recreation

Background: Management of osteochondral defects of the talus remains a challenge, and many lesions do not respond to traditional treatments. The use of fresh allografts is a promising alternative. Methods: A freehand inlay surgical technique for reconstructing osteochondral defects of the talus with fresh osteochondral allografts fixated with bioresorbable chondral darts is described. A retrospective review of a consecutive series of 15 patients (eight males and seven females; mean age, 42.2 years) with stage IV osteochondral defects who underwent this procedure is presented. Seven patients reported a history of trauma. The mean lesion diameter was 1.7 cm. Results: Mean follow-up was 1.6 years. The Foot and Ankle Outcome Score subscale mean scores obtained at the most recent follow-up were as follows: 66.0 (pain), 64.8 (other symptoms), 71.2 (activities of daily living), 50.7 (sport and recreation function), and 42.1 (quality of life). Nine lesions had no evidence of lucency, and six demonstrated mild lucency, indicating that no allograft had been absorbed. Most patients exhibited no step-off deformity or arthrosis. No graft-related complications occurred. No subsequent surgical procedures were required. Conclusions: Early results suggest that this technique is a viable option for treating large osteochondral defects of the talus, as evidenced by the favorable patient assessment and radiographic outcomes and the lack of postoperative complications and subsequent procedures. Unlike previous allograft techniques, hardware complications did not occur. Based on these results, this technique will continue to be used. (J Am Podiatr Med Assoc 100(1): 25–34, 2010)

scholarly journals Clinical and Radiographic Outcomes of Revision Total Ankle Arthroplasty Using an Intramedullary Referencing Implant

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0002 ◽  
Author(s):  
Steve Behrens ◽  
Thomas Bemenderfer ◽  
Oliver Schipper ◽  
Robert Anderson ◽  
W. Hodges Davis
Keyword(s):  
Revision Arthroplasty ◽  
Outcome Data ◽  
Total Ankle Arthroplasty ◽  
Consecutive Series ◽  
Implant Survival ◽  
Ankle Arthroplasty ◽  
Radiographic Outcomes ◽  
Early Results ◽  
Patient Reported

Category: Ankle Arthritis Introduction/Purpose: Treatment of the failed total ankle arthroplasty (TAA) is challenging, and historically arthrodesis was advocated as the salvage treatment of choice. Currently, there is limited available literature reporting on options and outcomes of revision arthroplasty despite the persistent relatively high failure rate ranging from 10-23% within the first ten years after primary TAA. Early published outcomes of intramedullary-referencing implants for primary TAA have shown improvement in clinical outcomes and radiographic parameters, sustained correction of coronal deformity, and excellent survivorship with few associated complications. The purpose of this study is to report the clinical and radiographic outcomes of revision TAA using an intramedullary-referencing implant. Methods: We reviewed a consecutive series of 24 cases (14 female and 10 male; median age, 57.9 (28.2-74.6) years; median BMI, 31 (19.4-40.2)) between 2008 to 2015 in which a failed TAA underwent revision using InBone, an intramedullary-referencing, fixed-bearing, two-component total ankle system. Demographic, radiographic, and functional outcome data were collected preoperatively, immediately postoperatively, and at the most recent follow up. The primary outcome was implant survival defined by no reoperation for subsidence/loosening or revision of the implant. Secondary outcomes included radiographic (coronal and sagittal component alignment, osteolysis, and subsidence) and functional (American Orthopaedic Foot & Ankle Society [AOFAS] score and foot function index [FFI]) outcome data. Results: Twenty-four patients underwent revision TAA with intramedullary-referencing with 87.5% implant survival at average follow up of 30.4 months. Revision was performed most commonly for aseptic talar subsidence (45.8%) or implant loosening (tibia, 12.5%; talus, 16.7%). Following revision, three (12.5%) patients required reoperation for talar subsidence or loosening at average 37.7 months. Progression of osteolysis of the tibia, talus, and fibula was observed in 14 (58%), 4 (17%), and 6 (25%) of patients, respectively, although osteolysis was present preoperatively in 17 (70.1%), 9 (37.5%), and 10 (41.7%), respectively. Subsidence of the tibial and talar components was observed in 8 (33%) and 9 (38%) patients, respectively. Clinically, the average AOFAS and FFI score were 72 (57-100) and 27.1 (11.8-82.9), respectively. Conclusion: Early results of intramedullary-referencing revision TAA demonstrated improved patient-reported outcomes and maintenance of radiographic outcomes at an average follow-up of 30 months. Additionally, early results of revision arthroplasty after failed TAA were similar to those after primary arthroplasty. Aseptic talar subsidence or loosening were the main postoperative complications which required reoperation. Revision arthroplasty utilizing an intramedullary-referencing implant is a viable option for the failed TAA.

No Difference in Outcomes Following Osteochondral Allograft with Fresh Precut Cores Compared to Hemi-Condylar Allografts

Cartilage ◽  
2021 ◽  
pp. 194760352110219
Author(s):  
Danielle H. Markus ◽  
Anna M. Blaeser ◽  
Eoghan T. Hurley ◽  
Brian J. Mannino ◽  
Kirk A. Campbell ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Knee Injury ◽  
Lesion Size ◽  
Osteochondral Allograft ◽  
Osteochondral Lesions ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Patient Reported ◽  
The Mean

Objective The purpose of the current study is to evaluate the clinical and radiographic outcomes at early to midterm follow-up between fresh precut cores versus hemi-condylar osteochondral allograft (OCAs) in the treatment of symptomatic osteochondral lesions. Design A retrospective review of patients who underwent an OCA was performed. Patient matching between those with OCA harvested from an allograft condyle/patella or a fresh precut allograft core was performed to generate 2 comparable groups. The cartilage at the graft site was assessed with use of a modified Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system and patient-reported outcomes were collected. Results Overall, 52 total patients who underwent OCA with either fresh precut OCA cores ( n = 26) and hemi-condylar OCA ( n = 26) were pair matched at a mean follow-up of 34.0 months (range 12 months to 99 months). The mean ages were 31.5 ± 10.7 for fresh precut cores and 30.9 ± 9.8 for hemi-condylar ( P = 0.673). Males accounted for 36.4% of the overall cohort, and the mean lesion size for fresh precut OCA core was 19.6 mm2 compared to 21.2 mm2 for whole condyle ( P = 0.178). There was no significant difference in patient-reported outcomes including Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and Tegner ( P > 0.5 for each), or in MOCART score (69.2 vs. 68.3, P = 0.93). Conclusions This study found that there was no difference in patient-reported clinical outcomes or MOCART scores following OCA implantation using fresh precut OCA cores or size matched condylar grafts at early to midterm follow-up.

scholarly journals Autologous Matrix-Induced Chondrogenesis With Lateral Ligament Stabilization for Osteochondral Lesions of the Talus in Patients With Ankle Instability

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110074
Author(s):  
Jakob Ackermann ◽  
Fabio A. Casari ◽  
Christoph Germann ◽  
Lizzy Weigelt ◽  
Stephan H. Wirth ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Clinical Outcomes ◽  
Cartilage Repair ◽  
Ankle Instability ◽  
Lesion Size ◽  
Lateral Ligament ◽  
Osteochondral Lesions ◽  
Level Of Evidence ◽  
Radiographic Outcomes

Background: Autologous matrix-induced chondrogenesis (AMIC) has been shown to result in favorable clinical outcomes in patients with osteochondral lesions of the talus (OLTs). Though, the influence of ankle instability on cartilage repair of the ankle has yet to be determined. Purpose/Hypothesis: To compare the clinical and radiographic outcomes in patients with and without concomitant lateral ligament stabilization (LLS) undergoing AMIC for the treatment of OLT. It was hypothesized that the outcomes would be comparable between these patient groups. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-six patients (13 with and 13 without concomitant ankle instability) who underwent AMIC with a mean follow-up of 4.2 ± 1.5 years were enrolled in this study. Patients were matched 1:1 according to age, body mass index (BMI), lesion size, and follow-up. Postoperative magnetic resonance imaging and Tegner, American Orthopaedic Foot & Ankle Society (AOFAS), and Cumberland Ankle Instability Tool (CAIT) scores were obtained at a minimum follow-up of 2 years. A musculoskeletal radiologist scored all grafts according to the MOCART (magnetic resonance observation of cartilage repair tissue) 1 and MOCART 2.0 scores. Results: The patients’ mean age was 33.4 ± 12.7 years, with a mean BMI of 26.2 ± 3.7. Patients with concomitant LLS showed worse clinical outcome measured by the AOFAS (85.1 ± 14.4 vs 96.3 ± 5.8; P = .034) and Tegner (3.8 ± 1.1 vs 4.4 ± 2.3; P = .012) scores. Postoperative CAIT and AOFAS scores were significantly correlated in patients with concomitant LLS ( r = 0.766; P = .002). A CAIT score >24 (no functional ankle instability) resulted in AOFAS scores comparable with scores in patients with isolated AMIC (90.1 ± 11.6 vs 95.3 ± 6.6; P = .442). No difference was seen between groups regarding MOCART 1 and 2.0 scores ( P = .714 and P = .371, respectively). Conclusion: Concurrently performed AMIC and LLS in patients with OLT and ankle instability resulted in clinical outcomes comparable with isolated AMIC if postoperative ankle stability was achieved. However, residual ankle instability was associated with worse postoperative outcomes, highlighting the need for adequate stabilization of ankle instability in patients with OLT.

The use of dual-mobility bearings in patients at high risk of dislocation

2019 ◽  
Vol 101-B (1_Supple_A) ◽  
pp. 41-45 ◽  
Author(s):  
C. W. Jones ◽  
I. De Martino ◽  
R. D’Apolito ◽  
A. A. Nocon ◽  
P. K. Sculco ◽  
...  
Keyword(s):  
Risk Factors ◽  
New York ◽  
High Risk ◽  
High Body Mass Index ◽  
High Volume ◽  
Consecutive Series ◽  
Dual Mobility ◽  
Radiographic Outcomes ◽  
Stable Reconstruction

Aims Instability continues to be a troublesome complication after total hip arthroplasty (THA). Patient-related risk factors associated with a higher dislocation risk include the preoperative diagnosis, an age of 75 years or older, high body mass index (BMI), a history of alcohol abuse, and neurodegenerative diseases. The goal of this study was to assess the dislocation rate, radiographic outcomes, and complications of patients stratified as high-risk for dislocation who received a dual mobility (DM) bearing in a primary THA at a minimum follow-up of two years. Materials and Methods We performed a retrospective review of a consecutive series of DM THA performed between 2010 and 2014 at our institution (Hospital for Special Surgery, New York, New York) by a single, high-volume orthopaedic surgeon employing a single prosthesis design (Anatomic Dual Mobility (ADM) Stryker, Mahwah, New Jersey). Patient medical records and radiographs were reviewed to confirm the type of implant used, to identify any preoperative risk factors for dislocation, and any complications. Radiographic analysis was performed to assess for signs of osteolysis or remodelling of the acetabulum. Results There were 151 patients who met the classification of high-risk according to the inclusion criteria and received DM THA during the study period. Mean age was 82 years old (73 to 95) and 114 patients (77.5%) were female. Mean follow-up was 3.6 years (1.9 to 6.1), with five patients lost to follow-up and one patient who died (for a reason unrelated to the index procedure). One patient (0.66%) sustained an intraprosthetic dislocation; there were no other dislocations. Conclusion At mid-term follow-up, the use of a DM bearing for primary THA in patients at high risk of dislocation provided a stable reconstruction option with excellent radiographic results. Longer follow-up is needed to confirm the durability of these reconstructions.

Matrix-Induced Autologous Chondrocyte Implantation (MACI) Grafting for Osteochondral Lesions of the Talus

2020 ◽  
Vol 41 (9) ◽  
pp. 1099-1105 ◽  
Author(s):  
Christopher G. Lenz ◽  
Shu Tan ◽  
Andrew L. Carey ◽  
Kaenson Ang ◽  
Timothy Schneider
Keyword(s):  
Autologous Chondrocyte Implantation ◽  
Treatment Method ◽  
Osteochondral Lesions ◽  
Osteochondral Defects ◽  
Long Term Follow Up ◽  
Chondrocyte Implantation ◽  
The Mean ◽  
Autologous Chondrocyte

Background: Matrix-induced autologous chondrocyte implantation (MACI) is an established treatment method for larger joints and has shown promising results in the ankle as well. We present a series of patients after ankle MACI with long-term follow-up of clinical and radiological outcomes. Methods: We present the follow-up of 15 patients who underwent MACI grafting from August 2003 to February 2006. The mean follow-up was 12.9 years. Clinical evaluations were conducted using the American Orthopaedic Foot & Ankle Society (AOFAS), Foot and Ankle Activity Measurement (FAAM), and visual analog scale (VAS) scoring systems and the magnetic resonance observation of cartilage repair tissue (MOCART) scoring system for radiological evaluation. Results: The mean size of the talar osteochondral defects was 204 mm2. We found a significant improvement in mean AOFAS score from 60 preoperatively to a mean of 84 at 12 years postoperatively. The 12-year FAAM score for Activities of Daily Living was 89% (range, 62%-99%). The mean 12-year MOCART score was 65 points (range, 30-100 points) with significant agreement between assessors ( P < .001). However, the MOCART scores did not correlate with the FAAM scores ( P = .86). Conclusion: Considering our long-term follow-up, we believe MACI is a reliable treatment method for talar osteochondral defects providing lasting pain relief and satisfying clinical results. However, with an equivalent outcome, but at higher costs, and the requirement for 2 operative procedures, the results do not seem to be superior to other established methods. The clinical utility of the MOCART score requires further scrutiny since we were not able to show any correlation between the score and clinical outcome. Level of Evidence: Level IV, case series.

Transaortic Aortic Valve Implantation in 100 Patients: Follow-up to 3 Years

2016 ◽  
Vol 11 (2) ◽  
pp. 106-111
Author(s):  
Riccardo Cocchieri ◽  
Ezra Y. Koh ◽  
Laurens W. Wollersheim ◽  
Paola G. Meregalli ◽  
Abdenasser Bardai ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Promising Alternative ◽  
Femoral Access ◽  
Early Results ◽  
Echocardiographic Examination ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
Preoperative Patient

Objective Transaortic aortic valve implantation (TAo-AVI) through the ascending aorta is a novel technique and is used as an alternative in patients with poor femoral access. Although early results have been promising, no midterm data have been published yet. To determine whether this approach is an acceptable treatment option, we analyzed the first 100 cases performed at our institution with a follow-up to 3 years. Methods Between July 2011 and January 2015, a total of 100 patients with high-risk or inoperable aortic valve stenosis were treated with TAo-AVI. Preoperative patient data were collected and analyzed retrospectively. All surviving patients were seen for clinical and echocardiographic examination for follow-up. Results Median follow-up was 15 months. Device success was accomplished in 94 patients (94%). There were no access site complications. The 30-day mortality rate was 9%. Stroke occurred in a total of six patients (6%). Survival at 1-, 2-, and 3 years was 75%, 62%, and 58%, respectively. Conclusions Our results show that TAo-AVI is a promising alternative to transapical implantation for treating severe inoperable aortic valve stenosis.

scholarly journals The stability of outcomes of cancellous autografts with acellular membrane for extended osteochondritis of the knee. Outcomes for 22 AMIC® grafts at an average follow-up of 4 years

2021 ◽  
Vol 9 (2_suppl) ◽  
pp. 2325967121S0002
Author(s):  
Adrien Pauvert ◽  
Caroline Vincelot Chainard ◽  
Xavier Buisson ◽  
Henri Robert
Keyword(s):  
Stage Iv ◽  
Osteochondral Lesions ◽  
Collagen Membrane ◽  
Functional Scores ◽  
Single Operator ◽  
Extensive Lesion ◽  
The Mean ◽  
Student’S T ◽  
The Stability

Objectives: Loss of osteochondral substances resulting from osteochondritis dissecans (OCD) of the knee are arthrogenic in the long term. When they exceed 2 cm2, the Autologous Matrix Induced Chondrogenesis (AMIC®) technique is one of the methods used in France. The objective of this study was to evaluate the medium-term results of the AMIC® technique. Methods: This was a consecutive, prospective, single-center, single-operator series of 22 patients (13 men, 9 women, mean age 28 years (15-51)) treated by AMIC® (spongy bone graft + sutured collagen membrane) between September 2011 and November 2016. Previous surgery had been performed on 17 patients. According to the ICRS classification, the lesion was stage IV in 21 cases and stage III in 1 case. The sites were: condylar: 19 cases, patellar: 2 cases and trochlear: 1 case. The mean surface area was 3.6 cm2 (2-8) and the depth was 0.5 mm (0.4-0.8). All the patients were functionally assessed by an independent examiner using validated functional scores for these indications (KOOS, subjective IKDC). Student’s T tests were used. Results: At a mean follow-up of 4 years (minimum 2 years) all but 2 patients had significantly improved (In preop. IKDC: 44±14 and KOOS: 56±17). In these 2 cases, the postoperative scores remained unchanged over the years: one patient had had several surgeries before the graft and a 51-year-old female patient had an extensive lesion of 6.9 cm2. The mean IKDC and KOOS scores were 73±18 and 78±15 and then 77±16 and 81±14 respectively, at 1 and 4 years (p> 0.05 for IKDC and KOOS). Regrettably there were 2 complications: 1 arthrolysis 1 year after surgery and 1 algodystrophy. Conclusion: Few techniques are available in France for extensive symptomatic osteochondral lesions. AMIC® is a reliable, one-step, reproducible, inexpensive technique for loss of substance due to OCD with stable results as of 1 year after surgery.

scholarly journals Satisfactory mid-term outcomes of condylar-constrained knee implants in primary total knee arthroplasty: clinical and radiological follow-up

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Fabio Mancino ◽  
Ivan De Martino ◽  
Aaron Burrofato ◽  
Carmine De Ieso ◽  
Maristella F. Saccomanno ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Consecutive Series ◽  
Radiographic Outcomes ◽  
First Choice ◽  
Total Knee ◽  
The Mean ◽  
Primary Total Knee

Abstract Background The purpose of this study was to evaluate (1) the reoperation rates and survivorship for septic and aseptic causes, (2) radiographic outcomes, and (3) clinical outcomes of condylar-constrained knee (CCK) implants used in primary total knee arthroplasty (TKA) with severe coronal deformity and/or intraoperative instability. Materials and methods A consecutive series of CCK implants in primary TKA was retrospectively evaluated in patients with severe coronal deformities. Forty-nine patients (54 knees) were included with a mean follow-up of 9 years (range 6–12). All patients were treated with a single-design, second-generation CCK implant. The primary diagnosis was osteoarthritis in 36 knees, post-traumatic arthritis in 7 knees, and rheumatoid arthritis in 4 knees. Preoperatively, standing femorotibial alignment was varus in 22 knees and valgus in 20 knees. Results At a mean follow-up of 9 years, overall survivorship was 93.6%. Two knees (4.3%) required revision for periprosthetic joint infection. One knee (2.1%) required subsequent arthroscopy due to patellar clunk syndrome. At final follow-up, no evidence of loosening or migration of any implant was reported, and the mean Knee Society knee scores improved from 43 to 86 points (p < 0.001). The mean Knee Society function scores improved to 59 points (p < 0.001). The average flexion contracture improved from 7° preoperatively to 2° postoperatively and the average flexion from 98° to 110°. No knees reported varus–valgus instability in flexion or extension. Conclusion CCK implants in primary TKA with major coronal deformities and/or intraoperative instability provide good midterm survivorship, comparable with less constrained implants. In specific cases, CCK implants can be considered a viable option with good clinical and radiographic outcomes. However, a higher degree of constraint should be used cautiously, leaving the first choice to less constrained implants. Level of evidence Therapeutic study, level IV.

scholarly journals Intermediate to Long-Term Clinical and Radiographic Results of Deltoid Ligament Reconstruction with Tendon Graft

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0018
Author(s):  
Jonathan H. Garfinkel ◽  
Cesar de Cesar Netto ◽  
Harry G. Greditzer ◽  
Andrew Roney ◽  
Carolyn M. Sofka ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Stage Iv ◽  
Tendon Graft ◽  
Deltoid Ligament ◽  
Foot And Ankle ◽  
Ankle Arthritis ◽  
Radiographic Outcomes ◽  
Talar Tilt

Category: Ankle, Hindfoot, Flatfoot Introduction/Purpose: Adult acquired flatfoot deformity (AAFD) is a complex deformity characterized by hindfoot valgus, medial longitudinal arch collapse, midfoot abduction, and forefoot supination. In its most advanced stages (stage IV), the deltoid ligament is compromised, which leads to valgus talar tilt at the tibiotalar joint. This talar tilt puts patients at high risk of developing ankle arthritis necessitating ankle arthrodesis or arthroplasty. Tendon graft reconstruction of the deltoid ligament has previously demonstrated good clinical and radiographic outcomes at short to intermediate-term follow-up but controversy over efficacy of the procedure remains. The goal of the current study was to present the intermediate to long-term clinical and radiographic outcomes of the largest series to date of patients undergoing this procedure. Methods: Data from a prospectively collected Foot and Ankle Registry was reviewed. All consecutive patients undergoing deltoid ligament reconstruction with tendon allograft or autograft as part of their flatfoot surgery by the senior author prior to 1/1/2015 were eligible for inclusion. Patients with radiographic follow-up of <3 years were asked to return for follow-up under an IRB- approved study protocol. Patients missing preoperative radiographs or unable to complete follow-up were excluded from radiographic analysis. Measurements of talar tilt were performed on AP ankle x-rays by two observers (Figure 1). Reliability analysis was performed using intraclass correlation. Preoperative Foot and Ankle Outcome Scores (FAOS) were obtained from the registry. Patients were contacted to complete postoperative FAOS and PROMIS surveys. Paired t-tests were used to evaluate changes in talar tilt and clinical outcomes. P-values of less than 0.05 were considered significant. Results: 35 feet/34 patients were eligible. Two feet/patients failed treatment (one ankle fusion, one deep infection and amputation). Three patients were deceased, two unable to follow-up due to unrelated medical problems, one missing preoperative imaging, and five unwilling to return for long-term follow-up. None of these patients failed treatment at last follow-up. 21 feet/20 patients (7/7 female) underwent radiographic analysis. Mean age at surgery was 58.4 (43.8-80.9) years. Interobserver agreement assessing change in talar tilt was excellent (ICC=.892). At mean radiographic follow-up of 10.3 (4.1-18.3) years, talar tilt improved significantly from an average of 9.71 +/- 6.22 degrees preoperatively to 3.63 +/- 3.27 degrees valgus postoperatively (p<.001). All FAOS subscores improved significantly pre to postoperatively. Postoperative PROMIS scores were comparable to or better than population means. Conclusion: Our findings demonstrate that deltoid ligament reconstruction with tendon graft enables radiographic correction, though not always complete, in patients with stage IV AAFD over the medium to long-term. Although limited by the sample size, our study demonstrates overall good clinical outcomes with few treatment failures. Though accessory procedures performed routinely at the time of flatfoot reconstruction present possible confounding variables, untreated ankle valgus likely leads to worsening deformity and ankle arthritis. Although the correction is not necessarily full, surgical reconstruction of the ligament may preclude patients from requiring joint sacrificing procedures such as ankle fusion or replacement over the long-term.

Crossing the Cervicothoracic Junction During Posterior Cervical Fusion for Myelopathy Is Associated With Superior Radiographic Parameters But Similar Clinical Outcomes

Neurosurgery ◽  
2020 ◽  
Vol 87 (5) ◽  
pp. 1016-1024
Author(s):  
Andrew K Chan ◽  
Ryan K Badiee ◽  
Joshua Rivera ◽  
Chih-Chang Chang ◽  
Leslie C Robinson ◽  
...  
Keyword(s):  
Neck Pain ◽  
Reoperation Rate ◽  
Consecutive Series ◽  
Cervicothoracic Junction ◽  
Arm Pain ◽  
T1 Slope ◽  
Radiographic Outcomes ◽  
Radiographic Parameters ◽  
Patient Reported

Abstract Background For laminectomy and posterior spinal fusion (LPSF) surgery for cervical spondylotic myelopathy (CSM), the evidence is unclear as to whether fusions should cross the cervicothoracic junction (CTJ). Objective To compare LPSF outcomes between those with and without lower instrumented vertebrae (LIV) crossing the CTJ. Methods A consecutive series of adults undergoing LPSF for CSM from 2012 to 2018 with a minimum of 12-mo follow-up were identified. LPSF with subaxial upper instrumented vertebrae and LIV between C6 and T2 were included. Clinical and radiographic outcomes were compared. Results A total of 79 patients were included: 46 crossed the CTJ (crossed-CTJ) and 33 did not. The mean follow-up was 22.2 mo (minimum: 12 mo). Crossed-CTJ had higher preoperative C2-7 sagittal vertical axis (cSVA) (33.3 ± 16.0 vs 23.8 ± 12.4 mm, P = .01) but similar preoperative cervical lordosis (CL) and CL minus T1-slope (CL minus T1-slope) (P &gt; .05, both comparisons). The overall reoperation rate was 3.8% (crossed-CTJ: 2.2% vs not-crossed: 6.1%, P = .37). In adjusted analyses, crossed-CTJ was associated with superior cSVA (β = –9.7; P = .002), CL (β = 6.2; P = .04), and CL minus T1-slope (β = –6.6; P = .04), but longer operative times (β = 46.3; P = .001). Crossed- and not-crossed CTJ achieved similar postoperative patient-reported outcomes [Visual Analog Scale (VAS) neck pain, VAS arm pain, Nurick Grade, Modified Japanese Orthopedic Association Scale, Neck Disability Index, and EuroQol-5D] in adjusted multivariable analyses (adjusted P &gt; .05). For the entire cohort, higher postoperative CL was associated with lower postoperative arm pain (adjusted Pearson's r –0.1, P = .02). No postoperative cervical radiographic parameters were associated with neck pain (P &gt; .05). Conclusion Subaxial LPSF for CSM that crossed the CTJ were associated with superior radiographic outcomes for cSVA, CL, and CL minus T1-slope, but longer operative times. There were no differences in neck pain or reoperation rate.

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