Background Anterior cervical discectomy fusion (ACDF) is a surgical procedure used to treat cervical spondylosis with anterior spinal cord compression. However, there are limitations to traditional ACDF and posterior indirect decompression when the anterior source lesion is in the center of the cervical vertebra. Case Presentation On June 8, 2022, our department treated a patient with cervical spondylotic myelopathy—whose high posterior longitudinal ligament (OPLL) occupied the central position of the vertebral body—with modified ACDF. The preoperative surgical plan was designed based on the relevant imaging data and assay index. Also, the visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) scores, and imaging parameters of neck pain were recorded and compared. Postoperative imaging data showed that cervical curvature was recovered and spinal canal compression was relieved. The VAS score for neck pain decreased from 7 preoperatively to 1.5 at the last follow‐up, while the JOA score increased from 10 preoperatively to 29 at the last follow‐up. The volume of the spinal canal was restored. Simultaneously, the patient's extremity muscle strength improved and muscle tension decreased. Conclusions Modified ACDF may be an effective surgical method for resolving spinal cord compression in a specific location when bone mineral density is good. We can effectively avoid iatrogenic nerve injury and symptom recurrence by removing the vertebral body and the lesion directly.
Background Modified anterior cervical discectomy and fusion (Mod ACDF) can effectively address ossification of the posterior longitudinal ligament (OPLL), which is difficult to remove directly from the posterior edge of the vertebral body, with considerably lesser damage as compared to anterior cervical corpectomy and fusion (ACCF). We compared the static mechanics of different anterior approaches by using an ideal finite element model. Methods A complete finite element model was established and classified into the following three surgical models according to different model cutting operations: ACDF, ACCF, and Mod ACDF. Three different bone volume situations (normal bone mineral density, osteopenia, and osteoporosis) were simulated. After fixing the lower surface of C5 or C6, a load was applied to the upper surface of C4, and the stress distribution and displacement of the upper surface of C5 or C6 were observed and the related values were recorded. Results The average Von Mises Stress and displacement levels of Mod ACDF were between those of ACDF and ACCF; with the peak Von Mises Stress occurring on the posterior side of the vertebral body (Points 1–4). The change in Von Mises Stress of the vertebral body is not significant during bone loss. However, the degree of displacement of the vertebral body surface and risk of vertebral collapse are increased (100 N: 13.91 vs. 19.47 vs. 21.62 μm; 150 N: 19.60 vs. 29.30 vs. 31.64 μm; 200 N: 28.53 vs. 38.65 vs. 44.83 μm). Conclusions The static biomechanical effects caused by Mod ACDF are intermediate between ACDF and ACCF, and the risk of vertebral body collapse is lower than that by ACCF. Therefore, Mod ACDF may be an effective solution when targeting OPLL with poorly positioned posterior vertebral body edges.
Background Modified Krackow, Bunnell, and Kessler sutures under different suture incisions can be used to directly suture ruptured Achilles tendons, but different suture techniques have various advantages and disadvantages. This study aimed to discuss the clinical effects of different suture techniques with different incision sizes. Methods This study retrospectively recruited and classified 159 patients with acute Achilles tendon injuries into minimally invasive surgery (MIS) and open surgery (OS) following operation incision size. Patients were subdivided into MIS-Krackow, MIS-Bunnell, MIS-Kessler, OS-Krackow, OS-Bunnell, and OS-Kessler. Age, sex, length of stay, creatine kinase levels (CK) pre- and postoperatively, incision length, operation time, intraoperative bleeding, AOFAS ankle-hindfoot scale, ATRS score, and range of ankle dorsalis and plantar flexion were collected and statistically compared, as well as motion, bilateral calf circumference difference, heel-rise repetition ratio, heel-rise height ratio, blood flow velocity in Achilles tendon, and complications. Results Length of stay, postoperative CK levels, surgical bleeding, and pain medication dosage demonstrated significant differences between the MIS and OS groups (P < 0.001). Operative time demonstrated significant differences between the MB:OKa, MB:OB, MKs:MKa, MKs:OKa, MKs:OB, MKs:OKs, and OKa:Oks groups (P < 0.05). Incision length demonstrated significant differences between the MB:MKa and MIS:OS groups (P < 0.05). The mean systolic blood flow velocity of the MB:MKa, MB:OKa, MB:OB, MKs:OKa, MKa:OB, MKa:OKs, OKa:OB, and OKa:OKs groups were different at 1 week postoperatively (P < 0.05). MB:MKs, MB:MKa, MB:OKa, MKs:OB, MKa:OKs, OKa:OB, and OKa:OKs groups demonstrated significant differences at 8 weeks postoperatively (P < 0.05). The dorsiflexion range of motion of MIS:OS was significantly different at 6 weeks postoperatively (P < 0.05). AOFAS demonstrated significant differences between the MIS and OS groups, except for the MKs:OKa and MKs:OB groups (P < 0.05). Only the AOFAS of the MB:OKs, MB:OB, MKa:OB, and MKa:OKs groups were significantly different at 24 postoperatively (P < 0.05). All indexes demonstrated no difference at 48 postoperatively (P > 0.05). Complications included Achilles tendon adhesion in 7 cases (1, 3, 1, and 2 cases in the OKa, OKs, OB, and MKs groups, respectively). Nerve injury occurred in two cases (MKa and MB groups, respectively). Incision infection occurred in 6 patients (3, 2, and 1 in the OKa, OB, and OKs groups, respectively). Achilles tendon re-rupture occurred in 7 cases (5 in the MKs group and 2 in the OKs group). The excellent and good rates of MKa, MB, MKs, Oka, OB, and OKs were 92.0%, 100%, 87.0%, 96.3%, 100%, and 93.1% as assessed by Arnerlind-holm, with no significant differences between the six groups. Conclusions Both OS and MIS are safe and effective in treating Achilles tendon rupture. Among them, MIS caused less secondary trauma and better ankle ROM and AOFAS scores in the previous period, but this difference was not significant at 24 and 48 weeks of follow-up. Krackow’s operation time was longer and the intensity was higher compared with the three suture methods of the two surgical methods, but the local blood flow rate of the Achilles tendon was significantly worse than Bunnell and Kessler. Additionally, Kessler was easier to operate and had better blood transport than Krackow, but the intensity was poor and the probability of complications was higher than the other two groups. Bunnell has better overall performance, less blood flow impact, and fewer complications, and is recommended as the choice of suture method for percutaneous surgery.
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