Pub Date : 2024-12-01Epub Date: 2024-03-25DOI: 10.1097/BSD.0000000000001607
Nicole J Hung, Robert Trigg McClellan, Wellington Hsu, Serena S Hu, Aaron J Clark, Alekos A Theologis
Study design: Prospective cross-sectional survey.
Objective: To identify timelines for when athletes may be considered safe to return to varying athletic activities after sustaining cervical spine fractures.
Background: While acute management and detection of cervical spine fractures have been areas of comprehensive investigation, insight into timelines for when athletes may return to different athletic activities after sustaining such fractures is limited.
Methods: A web-based survey was administered to members of the Association for Collaborative Spine Research that consisted of surgeon demographic information and questions asking when athletes (recreational vs elite) with one of 8 cervical fractures would be allowed to return to play noncontact, contact, and collision sports treated nonoperatively or operatively. The third part queried whether the decision to return to sports was influenced by the type of fixation or the presence of radiculopathy.
Results: Thirty-three responses were included for analysis. For all 8 cervical spine fractures treated nonoperatively and operatively, significantly longer times to return to sports for athletes playing contact or collision sports compared with recreational and elite athletes playing noncontact sports, respectively ( P < 0.05), were felt to be more appropriate. Comparing collision sports with contact sports for recreational and elite athletes, similar times for return to sports for nearly all fractures treated nonoperatively or operatively were noted. In the setting of associated radiculopathy, the most common responses for safe return to play were "when only motor deficits resolve completely" and "when both motor and sensory deficits resolve completely."
Conclusions: In this survey of spine surgeons from the Association for Collaborative Spine Research, reasonable timeframes for return to play for athletes with 8 different cervical spine fractures treated nonoperatively or operatively varied based on fracture subtype and level of sporting physicality.
{"title":"Timelines for Return to Different Sports Types After Eight Cervical Spine Fractures in Recreational and Elite Athletes: A Survey of the Association for Collaborative Spine Research.","authors":"Nicole J Hung, Robert Trigg McClellan, Wellington Hsu, Serena S Hu, Aaron J Clark, Alekos A Theologis","doi":"10.1097/BSD.0000000000001607","DOIUrl":"10.1097/BSD.0000000000001607","url":null,"abstract":"<p><strong>Study design: </strong>Prospective cross-sectional survey.</p><p><strong>Objective: </strong>To identify timelines for when athletes may be considered safe to return to varying athletic activities after sustaining cervical spine fractures.</p><p><strong>Background: </strong>While acute management and detection of cervical spine fractures have been areas of comprehensive investigation, insight into timelines for when athletes may return to different athletic activities after sustaining such fractures is limited.</p><p><strong>Methods: </strong>A web-based survey was administered to members of the Association for Collaborative Spine Research that consisted of surgeon demographic information and questions asking when athletes (recreational vs elite) with one of 8 cervical fractures would be allowed to return to play noncontact, contact, and collision sports treated nonoperatively or operatively. The third part queried whether the decision to return to sports was influenced by the type of fixation or the presence of radiculopathy.</p><p><strong>Results: </strong>Thirty-three responses were included for analysis. For all 8 cervical spine fractures treated nonoperatively and operatively, significantly longer times to return to sports for athletes playing contact or collision sports compared with recreational and elite athletes playing noncontact sports, respectively ( P < 0.05), were felt to be more appropriate. Comparing collision sports with contact sports for recreational and elite athletes, similar times for return to sports for nearly all fractures treated nonoperatively or operatively were noted. In the setting of associated radiculopathy, the most common responses for safe return to play were \"when only motor deficits resolve completely\" and \"when both motor and sensory deficits resolve completely.\"</p><p><strong>Conclusions: </strong>In this survey of spine surgeons from the Association for Collaborative Spine Research, reasonable timeframes for return to play for athletes with 8 different cervical spine fractures treated nonoperatively or operatively varied based on fracture subtype and level of sporting physicality.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E404-E414"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140293011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-09-06DOI: 10.1097/BSD.0000000000001690
Xinchun Liu
Study design: Technical report.
Objective: This report aimed to describe a 3-step unilateral uniportal interlaminar circum-dural approach for entire spinal canal inspection and bilateral discectomy at L5/S1 level.
Summary of background data: Treatment of lumbar disc herniation with bilateral symptoms at L5/S1 level is complicated in full endoscopic surgeries. Unilateral interlaminar approaches have been used for bilateral discectomy at L5/S1 level through a uniportal ventral dural approach or a biportal dorsal dural approach. Despite the reporting of successful clinical outcomes, inspection and manipulation of the entire spinal canal via a unilateral approach remain challenging.
Methods: The 3-step inspection of the entire spinal canal includes the ipsilateral side, the midline, and the contralateral side. Two typical cases are provided to further demonstrate the technique. In case 1, bilateral symptoms were caused by bilateral multifocal herniations. In case 2, bilateral symptoms were caused by a huge midline herniation.
Results: The surgical purposes were achieved as intended in both of the 2 cases. The herniations were successfully removed and the pain was relieved immediately after surgery.
Conclusions: As indicated by the preliminary application, the present technique, integrating the advantages of both the ventral and the dorsal dural approaches, is probably an ideal choice for bilateral discectomy at L5/S1 level.
{"title":"Full Endoscopic Bilateral Discectomy at L5/S1 Level: Technical Note of a Unilateral Uniportal Interlaminar Circum-dural Approach.","authors":"Xinchun Liu","doi":"10.1097/BSD.0000000000001690","DOIUrl":"10.1097/BSD.0000000000001690","url":null,"abstract":"<p><strong>Study design: </strong>Technical report.</p><p><strong>Objective: </strong>This report aimed to describe a 3-step unilateral uniportal interlaminar circum-dural approach for entire spinal canal inspection and bilateral discectomy at L5/S1 level.</p><p><strong>Summary of background data: </strong>Treatment of lumbar disc herniation with bilateral symptoms at L5/S1 level is complicated in full endoscopic surgeries. Unilateral interlaminar approaches have been used for bilateral discectomy at L5/S1 level through a uniportal ventral dural approach or a biportal dorsal dural approach. Despite the reporting of successful clinical outcomes, inspection and manipulation of the entire spinal canal via a unilateral approach remain challenging.</p><p><strong>Methods: </strong>The 3-step inspection of the entire spinal canal includes the ipsilateral side, the midline, and the contralateral side. Two typical cases are provided to further demonstrate the technique. In case 1, bilateral symptoms were caused by bilateral multifocal herniations. In case 2, bilateral symptoms were caused by a huge midline herniation.</p><p><strong>Results: </strong>The surgical purposes were achieved as intended in both of the 2 cases. The herniations were successfully removed and the pain was relieved immediately after surgery.</p><p><strong>Conclusions: </strong>As indicated by the preliminary application, the present technique, integrating the advantages of both the ventral and the dorsal dural approaches, is probably an ideal choice for bilateral discectomy at L5/S1 level.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"482-488"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-02-20DOI: 10.1097/BSD.0000000000001582
Patrick P Nian, Jayson Saleet, Matthew Magruder, Ian J Wellington, Jack Choueka, John K Houten, Ahmed Saleh, Afshin E Razi, Mitchell K Ng
Study design: Retrospective Observational Study.
Objective: The objective of this study was to assess the utility of ChatGPT, an artificial intelligence chatbot, in providing patient information for lumbar spinal fusion and lumbar laminectomy in comparison with the Google search engine.
Summary of background data: ChatGPT, an artificial intelligence chatbot with seemingly unlimited functionality, may present an alternative to a Google web search for patients seeking information about medical questions. With widespread misinformation and suboptimal quality of online health information, it is imperative to assess ChatGPT as a resource for this purpose.
Methods: The first 10 frequently asked questions (FAQs) related to the search terms "lumbar spinal fusion" and "lumbar laminectomy" were extracted from Google and ChatGPT. Responses to shared questions were compared regarding length and readability, using the Flesch Reading Ease score and Flesch-Kincaid Grade Level. Numerical FAQs from Google were replicated in ChatGPT.
Results: Two of 10 (20%) questions for both lumbar spinal fusion and lumbar laminectomy were asked similarly between ChatGPT and Google. Compared with Google, ChatGPT's responses were lengthier (340.0 vs. 159.3 words) and of lower readability (Flesch Reading Ease score: 34.0 vs. 58.2; Flesch-Kincaid grade level: 11.6 vs. 8.8). Subjectively, we evaluated these responses to be accurate and adequately nonspecific. Each response concluded with a recommendation to discuss further with a health care provider. Over half of the numerical questions from Google produced a varying or nonnumerical response in ChatGPT.
Conclusions: FAQs and responses regarding lumbar spinal fusion and lumbar laminectomy were highly variable between Google and ChatGPT. While ChatGPT may be able to produce relatively accurate responses in select questions, its role remains as a supplement or starting point to a consultation with a physician, not as a replacement, and should be taken with caution until its functionality can be validated.
{"title":"ChatGPT as a Source of Patient Information for Lumbar Spinal Fusion and Laminectomy: A Comparative Analysis Against Google Web Search.","authors":"Patrick P Nian, Jayson Saleet, Matthew Magruder, Ian J Wellington, Jack Choueka, John K Houten, Ahmed Saleh, Afshin E Razi, Mitchell K Ng","doi":"10.1097/BSD.0000000000001582","DOIUrl":"10.1097/BSD.0000000000001582","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Observational Study.</p><p><strong>Objective: </strong>The objective of this study was to assess the utility of ChatGPT, an artificial intelligence chatbot, in providing patient information for lumbar spinal fusion and lumbar laminectomy in comparison with the Google search engine.</p><p><strong>Summary of background data: </strong>ChatGPT, an artificial intelligence chatbot with seemingly unlimited functionality, may present an alternative to a Google web search for patients seeking information about medical questions. With widespread misinformation and suboptimal quality of online health information, it is imperative to assess ChatGPT as a resource for this purpose.</p><p><strong>Methods: </strong>The first 10 frequently asked questions (FAQs) related to the search terms \"lumbar spinal fusion\" and \"lumbar laminectomy\" were extracted from Google and ChatGPT. Responses to shared questions were compared regarding length and readability, using the Flesch Reading Ease score and Flesch-Kincaid Grade Level. Numerical FAQs from Google were replicated in ChatGPT.</p><p><strong>Results: </strong>Two of 10 (20%) questions for both lumbar spinal fusion and lumbar laminectomy were asked similarly between ChatGPT and Google. Compared with Google, ChatGPT's responses were lengthier (340.0 vs. 159.3 words) and of lower readability (Flesch Reading Ease score: 34.0 vs. 58.2; Flesch-Kincaid grade level: 11.6 vs. 8.8). Subjectively, we evaluated these responses to be accurate and adequately nonspecific. Each response concluded with a recommendation to discuss further with a health care provider. Over half of the numerical questions from Google produced a varying or nonnumerical response in ChatGPT.</p><p><strong>Conclusions: </strong>FAQs and responses regarding lumbar spinal fusion and lumbar laminectomy were highly variable between Google and ChatGPT. While ChatGPT may be able to produce relatively accurate responses in select questions, its role remains as a supplement or starting point to a consultation with a physician, not as a replacement, and should be taken with caution until its functionality can be validated.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E394-E403"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-03-27DOI: 10.1097/BSD.0000000000001593
Giovanni Viroli, Alberto Ruffilli, Marco Ialuna, Francesca Barile, Marco Manzetti, Matteo Traversari, Fabio Vita, Cesare Faldini
Study design: Systematic review and meta-analysis of literature.
Objective: The aim of the presented study is to assess whether the reduction of high-grade spondylolisthesis (HGS) through the correction of lumbosacral kyphosis leads to a decrease in the sagittal spinopelvic compensatory mechanisms.
Summary of background data: HGS is as an anterior translation of a vertebra, >50%. It is also characterized by a kyphotic deformity of the affected level. This combination of translation and kyphosis leads to compensatory mechanisms on the sagittal plane [pelvic retroversion, increased lumbar lordosis (LL), reduction in thoracic kyphosis (TK)].
Methods: A systematic search of electronic databases was conducted. Inclusion criteria were diagnosis of HGS (Meyerding >II, Slip% >50%), partial or complete reduction surgery (with a significant decrease in Slip%), and report of spinopelvic parameters (pelvic incidence, pelvic tilt, or sacral slope). Clinical and radiographic outcomes were extracted and summarized. Meta-analyses were performed to estimate the differences between preoperative and postoperative spinopelvic alignment measures. P <0.05 was considered significant.
Results: Eighteen studies were included. PT showed a statistically significant decrease of -2.1217 (95% CI: -3.4803 to -0.7630), while SS showed a significant increase of 4.8349 (95% CI: 2.7462-6.9236). Conversely, both LL and TK showed nonsignificant changes, -4.7043 (95% CI: -10.4535 to 1.0449) and 6.3881 (95% CI: -0.8344 to 13.6106), respectively. VAS significantly decreased by -3.1950 (95% CI: -4.9462 to -1.4439).
Conclusions: The meta-analysis showed mild, yet statistically significant, decrease of PT and an increase in SS after HGS reduction. Conversely, nonstatically significant decrease in LL and an increase in TK occurred. The clinical significance of these results remains questionable.
{"title":"Restoration of Spinopelvic Alignment After Reduction of High-grade Spondylolisthesis: Myth or Reality? A Systematic Review of the Literature and Meta-analysis.","authors":"Giovanni Viroli, Alberto Ruffilli, Marco Ialuna, Francesca Barile, Marco Manzetti, Matteo Traversari, Fabio Vita, Cesare Faldini","doi":"10.1097/BSD.0000000000001593","DOIUrl":"10.1097/BSD.0000000000001593","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis of literature.</p><p><strong>Objective: </strong>The aim of the presented study is to assess whether the reduction of high-grade spondylolisthesis (HGS) through the correction of lumbosacral kyphosis leads to a decrease in the sagittal spinopelvic compensatory mechanisms.</p><p><strong>Summary of background data: </strong>HGS is as an anterior translation of a vertebra, >50%. It is also characterized by a kyphotic deformity of the affected level. This combination of translation and kyphosis leads to compensatory mechanisms on the sagittal plane [pelvic retroversion, increased lumbar lordosis (LL), reduction in thoracic kyphosis (TK)].</p><p><strong>Methods: </strong>A systematic search of electronic databases was conducted. Inclusion criteria were diagnosis of HGS (Meyerding >II, Slip% >50%), partial or complete reduction surgery (with a significant decrease in Slip%), and report of spinopelvic parameters (pelvic incidence, pelvic tilt, or sacral slope). Clinical and radiographic outcomes were extracted and summarized. Meta-analyses were performed to estimate the differences between preoperative and postoperative spinopelvic alignment measures. P <0.05 was considered significant.</p><p><strong>Results: </strong>Eighteen studies were included. PT showed a statistically significant decrease of -2.1217 (95% CI: -3.4803 to -0.7630), while SS showed a significant increase of 4.8349 (95% CI: 2.7462-6.9236). Conversely, both LL and TK showed nonsignificant changes, -4.7043 (95% CI: -10.4535 to 1.0449) and 6.3881 (95% CI: -0.8344 to 13.6106), respectively. VAS significantly decreased by -3.1950 (95% CI: -4.9462 to -1.4439).</p><p><strong>Conclusions: </strong>The meta-analysis showed mild, yet statistically significant, decrease of PT and an increase in SS after HGS reduction. Conversely, nonstatically significant decrease in LL and an increase in TK occurred. The clinical significance of these results remains questionable.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"489-503"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140293010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-10-25DOI: 10.1097/BSD.0000000000001631
Kevin C Jacob, Madhav R Patel, Timothy J Hartman, James W Nie, Alexander W Parsons, Max A Ribot, Michael Prabhu, Hanna Pawlowski, Nisheka Vanjani, Kern Singh
<p><strong>Study design: </strong>Retrospective review.</p><p><strong>Objective: </strong>To compare perioperative and postoperative clinical outcomes between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and lateral lumbar interbody fusion (LLIF) in patients presenting with predominant back pain.</p><p><strong>Background: </strong>Two popular techniques utilized for lumbar arthrodesis are MIS-TLIF and LLIF. Both techniques have reported high fusion rates and suitable postoperative clinical outcomes. Scarce literature exists, however, comparing these 2 common fusion techniques in a subset population of patients presenting with predominant back pain preoperatively.</p><p><strong>Methods: </strong>A retrospective review of lumbar procedures performed between November 2005 and December 2021 was conducted using a prospectively maintained single-surgeon database. Inclusion criteria were set as primary, elective, single, or multilevel MIS-TLIF or LLIF procedures for degenerative spinal pathology in patients with predominant preoperative back pain [visual analog scale (VAS) back pain preoperative score > VAS leg preoperative score]. Patients undergoing a revision procedure, single-level procedure at L5-S1, or surgery indicated for infectious, malignant, or traumatic etiologies were excluded. In addition, patients with VAS leg preoperative scores ≥ to VAS back preoperative scores were excluded. Patient demographics, perioperative characteristics, postoperative complications, and patient-reported outcome measures (PROMs) were collected. PROMs included VAS for back and leg pain, Oswestry Disability Index (ODI), and Short Form-12 (SF-12) Item Survey Mental (MCS) and Physical (PCS) Composite Scores with all values collected at the preoperative, 6-week, 12-week, 6-month, 1-year, and 2-year follow-up time point. Patients were grouped into 2 cohorts, depending on whether a patient underwent a MIS-TLIF or LLIF. Demographic and perioperative characteristics were compared between groups using χ 2 and Student t test for categorical and continuous variables, respectively. Mean PROM scores were compared between cohorts at each time point utilizing an unpaired Student t test. Postoperative improvement from preoperative baseline within each cohort was assessed with paired samples t test. Achievement of minimum clinical important difference (MCID) was determined by comparing ΔPROM scores to previously established threshold values. MCID achievement rates were compared between groups with χ 2 analysis. Statistical significance was noted as a P value <0.05.</p><p><strong>Results: </strong>Eligible study cohort included 153 patients, split into 106 patients in the MIS-TLIF cohort and 47 patients in the LLIF cohort. The mean age was 55.9 years, the majority (57.5%) of patients were males, the mean body mass index was 30.8 kg/m 2 , and the majority of the included cohort were nondiabetic and nonhypertensive. No significant demographic differences were n
{"title":"Minimally Invasive Transforaminal Versus Lateral Lumbar Interbody Fusion for Degenerative Spinal Pathology: Clinical Outcome Comparison in Patients With Predominant Back Pain.","authors":"Kevin C Jacob, Madhav R Patel, Timothy J Hartman, James W Nie, Alexander W Parsons, Max A Ribot, Michael Prabhu, Hanna Pawlowski, Nisheka Vanjani, Kern Singh","doi":"10.1097/BSD.0000000000001631","DOIUrl":"10.1097/BSD.0000000000001631","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review.</p><p><strong>Objective: </strong>To compare perioperative and postoperative clinical outcomes between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and lateral lumbar interbody fusion (LLIF) in patients presenting with predominant back pain.</p><p><strong>Background: </strong>Two popular techniques utilized for lumbar arthrodesis are MIS-TLIF and LLIF. Both techniques have reported high fusion rates and suitable postoperative clinical outcomes. Scarce literature exists, however, comparing these 2 common fusion techniques in a subset population of patients presenting with predominant back pain preoperatively.</p><p><strong>Methods: </strong>A retrospective review of lumbar procedures performed between November 2005 and December 2021 was conducted using a prospectively maintained single-surgeon database. Inclusion criteria were set as primary, elective, single, or multilevel MIS-TLIF or LLIF procedures for degenerative spinal pathology in patients with predominant preoperative back pain [visual analog scale (VAS) back pain preoperative score > VAS leg preoperative score]. Patients undergoing a revision procedure, single-level procedure at L5-S1, or surgery indicated for infectious, malignant, or traumatic etiologies were excluded. In addition, patients with VAS leg preoperative scores ≥ to VAS back preoperative scores were excluded. Patient demographics, perioperative characteristics, postoperative complications, and patient-reported outcome measures (PROMs) were collected. PROMs included VAS for back and leg pain, Oswestry Disability Index (ODI), and Short Form-12 (SF-12) Item Survey Mental (MCS) and Physical (PCS) Composite Scores with all values collected at the preoperative, 6-week, 12-week, 6-month, 1-year, and 2-year follow-up time point. Patients were grouped into 2 cohorts, depending on whether a patient underwent a MIS-TLIF or LLIF. Demographic and perioperative characteristics were compared between groups using χ 2 and Student t test for categorical and continuous variables, respectively. Mean PROM scores were compared between cohorts at each time point utilizing an unpaired Student t test. Postoperative improvement from preoperative baseline within each cohort was assessed with paired samples t test. Achievement of minimum clinical important difference (MCID) was determined by comparing ΔPROM scores to previously established threshold values. MCID achievement rates were compared between groups with χ 2 analysis. Statistical significance was noted as a P value <0.05.</p><p><strong>Results: </strong>Eligible study cohort included 153 patients, split into 106 patients in the MIS-TLIF cohort and 47 patients in the LLIF cohort. The mean age was 55.9 years, the majority (57.5%) of patients were males, the mean body mass index was 30.8 kg/m 2 , and the majority of the included cohort were nondiabetic and nonhypertensive. No significant demographic differences were n","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E441-E447"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-05-29DOI: 10.1097/BSD.0000000000001647
Tyler K Williamson, Ezekial J Koslosky, Jordan Lebovic, Stephane Owusu-Sarpong, Peter Tretiakov, Jamshaid Mir, Pooja Dave, Andrew J Schoenfeld, Bassel G Diebo, Heiko Koller, Renaud Lafage, Virginie Lafage, Peter G Passias
Background: The association of Hounsfield units (HU) and junctional pathologies in adult cervical deformity (ACD) surgery has not been elucidated.
Objective: Assess if the bone mineral density of the LIV, as assessed by HUs, is prognostic for the risk of complications after ACD surgery.
Study design/setting: Retrospective cohort study.
Methods: HUs were measured on preoperative CT scans. Means comparison test assessed differences in HUs based on the occurrence of complications, linear regression assessed the correlation of HUs with risk factors, and multivariable logistic regression followed by a conditional inference tree derived a threshold for HUs based on the increased likelihood of developing a complication.
Results: In all, 107 ACD patients were included. Thirty-one patients (29.0%) developed a complication (18.7% perioperative), with 20.6% developing DJK and 11.2% developing DJF. There was a significant correlation between lower LIVs and lower HUs ( r =0.351, P =0.01), as well as age and HUs at the LIV. Age did not correlate with change in the DJK angle ( P >0.2). HUs were lower at the LIV for patients who developed a complication and an LIV threshold of 190 HUs was predictive of complications (OR: 4.2, [1.2-7.6]; P =0.009).
Conclusions: Low bone mineral density at the lowest instrumented vertebra, as assessed by a threshold lower than 190 Hounsfield units, may be a crucial risk factor for the development of complications after cervical deformity surgery. Preoperative CT scans should be routinely considered in at-risk patients to mitigate this modifiable risk factor during surgical planning.
Level of evidence: Level-III.
背景:在成人颈椎畸形(ACD)手术中,Hounsfield单位(HU)与交界处病变的关系尚未阐明:研究设计/设置:回顾性队列研究:方法:通过术前 CT 扫描测量 HUs。均值比较检验评估了基于并发症发生情况的 HUs 差异,线性回归评估了 HUs 与风险因素的相关性,多变量逻辑回归后的条件推理树根据并发症发生可能性的增加得出了 HUs 的阈值:共纳入 107 例 ACD 患者。31名患者(29.0%)出现了并发症(18.7%为围术期并发症),其中20.6%出现了DJK,11.2%出现了DJF。较低的 LIV 与较低的 HU 之间存在明显的相关性(r=0.351,P=0.01),年龄与 LIV 时的 HU 也存在明显的相关性。年龄与 DJK 角的变化无关(P>0.2)。出现并发症的患者在 LIV 时的 HU 值较低,LIV 临界值为 190 HU 可预测并发症的发生(OR:4.2,[1.2-7.6];P=0.009):结论:以低于190 Hounsfield单位的阈值评估最低器械椎体的低骨质密度,可能是颈椎畸形手术后出现并发症的关键风险因素。在制定手术计划时,应常规考虑对高危患者进行术前 CT 扫描,以降低这一可改变的风险因素:证据等级:三级。
{"title":"Lower Hounsfield Units at the Planned Lowest Instrumented Vertebra Is an Independent Risk Factor for Complications Following Adult Cervical Deformity Surgery.","authors":"Tyler K Williamson, Ezekial J Koslosky, Jordan Lebovic, Stephane Owusu-Sarpong, Peter Tretiakov, Jamshaid Mir, Pooja Dave, Andrew J Schoenfeld, Bassel G Diebo, Heiko Koller, Renaud Lafage, Virginie Lafage, Peter G Passias","doi":"10.1097/BSD.0000000000001647","DOIUrl":"10.1097/BSD.0000000000001647","url":null,"abstract":"<p><strong>Background: </strong>The association of Hounsfield units (HU) and junctional pathologies in adult cervical deformity (ACD) surgery has not been elucidated.</p><p><strong>Objective: </strong>Assess if the bone mineral density of the LIV, as assessed by HUs, is prognostic for the risk of complications after ACD surgery.</p><p><strong>Study design/setting: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>HUs were measured on preoperative CT scans. Means comparison test assessed differences in HUs based on the occurrence of complications, linear regression assessed the correlation of HUs with risk factors, and multivariable logistic regression followed by a conditional inference tree derived a threshold for HUs based on the increased likelihood of developing a complication.</p><p><strong>Results: </strong>In all, 107 ACD patients were included. Thirty-one patients (29.0%) developed a complication (18.7% perioperative), with 20.6% developing DJK and 11.2% developing DJF. There was a significant correlation between lower LIVs and lower HUs ( r =0.351, P =0.01), as well as age and HUs at the LIV. Age did not correlate with change in the DJK angle ( P >0.2). HUs were lower at the LIV for patients who developed a complication and an LIV threshold of 190 HUs was predictive of complications (OR: 4.2, [1.2-7.6]; P =0.009).</p><p><strong>Conclusions: </strong>Low bone mineral density at the lowest instrumented vertebra, as assessed by a threshold lower than 190 Hounsfield units, may be a crucial risk factor for the development of complications after cervical deformity surgery. Preoperative CT scans should be routinely considered in at-risk patients to mitigate this modifiable risk factor during surgical planning.</p><p><strong>Level of evidence: </strong>Level-III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E503-E511"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141161170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-05-31DOI: 10.1097/BSD.0000000000001637
Bould Lauren, Kooner Paul, Beckman Lorne, Maroun Rizkallah, Thomas Steffen, Jan van Loon, Ahmed Aoude, Jean Ouellet, Robert-Jan Kroeze, Maarten Spruit
Study design: We performed a comprehensive cadaveric biomechanical study to compare the fixation strength of primary screws, screws augmented with bone allograft, and screws augmented with polymethylmethacrylate cement.
Objective: To evaluate a novel technique for screw augmentation using morselized cortico-cancellous bone allograft to fill the widened screw track of failed pedicle screws.
Background: To date, there are no known biological methods available for failed pedicle screw augmentation or fixation.
Materials and methods: Biomechanical tests were performed using 2 different testing modalities to quantify fixation strength including axial screw pullout and progressive cyclic displacement tests.
Results: Fifty vertebrae were instrumented with pedicle screws. Our study showed that bone allograft augmentation using the same diameter screw was noninferior to the fixation strength of the initial screw. In the axial pullout test, screws undergoing bone allograft repair failed at 25% lower loads compared with native screws, and screws augmented with cement showed approximately twice as much strength compared with native screws. In the cyclic displacement test, screws fixed with cement resisted loosening the best of all the groups tested. However, screws augmented with bone graft were found to have an equal strength to native screw purchase. our study did not find a correlation with bone mineral density as a predictor for failure in axial pullout or cyclic displacement tests.
Conclusion: Bone allograft augmentation for pedicle screw fixation was noninferior to the initial screw purchase in this biomechanical study. This bone allograft technique is a viable option for screw fixation in the revision setting when there is significant bone loss in the screw track.
{"title":"Bone Allograft Pedicle Screw Augmentation: A Biomechanical Study.","authors":"Bould Lauren, Kooner Paul, Beckman Lorne, Maroun Rizkallah, Thomas Steffen, Jan van Loon, Ahmed Aoude, Jean Ouellet, Robert-Jan Kroeze, Maarten Spruit","doi":"10.1097/BSD.0000000000001637","DOIUrl":"10.1097/BSD.0000000000001637","url":null,"abstract":"<p><strong>Study design: </strong>We performed a comprehensive cadaveric biomechanical study to compare the fixation strength of primary screws, screws augmented with bone allograft, and screws augmented with polymethylmethacrylate cement.</p><p><strong>Objective: </strong>To evaluate a novel technique for screw augmentation using morselized cortico-cancellous bone allograft to fill the widened screw track of failed pedicle screws.</p><p><strong>Background: </strong>To date, there are no known biological methods available for failed pedicle screw augmentation or fixation.</p><p><strong>Materials and methods: </strong>Biomechanical tests were performed using 2 different testing modalities to quantify fixation strength including axial screw pullout and progressive cyclic displacement tests.</p><p><strong>Results: </strong>Fifty vertebrae were instrumented with pedicle screws. Our study showed that bone allograft augmentation using the same diameter screw was noninferior to the fixation strength of the initial screw. In the axial pullout test, screws undergoing bone allograft repair failed at 25% lower loads compared with native screws, and screws augmented with cement showed approximately twice as much strength compared with native screws. In the cyclic displacement test, screws fixed with cement resisted loosening the best of all the groups tested. However, screws augmented with bone graft were found to have an equal strength to native screw purchase. our study did not find a correlation with bone mineral density as a predictor for failure in axial pullout or cyclic displacement tests.</p><p><strong>Conclusion: </strong>Bone allograft augmentation for pedicle screw fixation was noninferior to the initial screw purchase in this biomechanical study. This bone allograft technique is a viable option for screw fixation in the revision setting when there is significant bone loss in the screw track.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E472-E479"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141183777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-06-17DOI: 10.1097/BSD.0000000000001634
Yunsoo Lee, Delano Trenchfield, Emily Berthiaume, Alexa Tomlak, Rajkishen Narayanan, Parker Brush, Jeremy Heard, Krisna Maddy, Tariq Issa, Mark Lambrechts, Ian David Kaye, John Mangan, Giovanni Grasso, Jose Canseco, Alexander Vaccaro, Christopher Kepler, Gregory Schroeder, Alan Hilibrand
Study design: Retrospective Cohort.
Objective: To compare patient-reported outcomes and surgical outcomes after anterior cervical discectomy and fusion (ACDF) versus cervical laminoplasty for multilevel cervical spondylotic myelopathy.
Background: Treatment options for multilevel cervical spondylotic myelopathy include ACDF and cervical laminoplasty. Given that the literature has been mixed regarding the optimal approach, especially in patients without kyphosis, there is a need for additional studies investigating outcomes between ACDF and cervical laminoplasty.
Methods: A retrospective review was conducted of adult patients undergoing 3 or 4-level surgery. Patients with preoperative kyphosis based on C2-C7 Cobb angles were excluded. The electronic medical record and institutional databases were reviewed for baseline characteristics, surgical outcomes, and patient-reported outcomes.
Results: A total of 101 patients who underwent ACDF and 52 patients who underwent laminoplasty were included in the study. The laminoplasty cohort had a higher overall Charlson Comorbidity Index (3.10 ± 1.43 vs 2.39 ± 1.57, P = 0.011). Both groups had a comparable number of levels decompressed, C2-C7 lordosis, and diagnosis of myelopathy versus myeloradiculopathy. Patients who underwent laminoplasty had a longer length of stay (2.04 ± 1.15 vs 1.48 ± 0.70, P = 0.003) but readmission, complication, and revision rates were similar. Both groups had similar improvement in myelopathy scores (∆modified Japanese Orthopedic Association: 1.11 ± 3.09 vs 1.06 ± 3.37, P = 0.639). ACDF had greater improvement in Neck Disability Index (∆Neck Disability Index: -11.66 ± 19.2 vs -1.13 ± 11.2, P < 0.001), neck pain (∆Visual Analog Scale-neck: -2.69 ± 2.78 vs -0.83 ± 2.55, P = 0.003), and arm pain (∆Visual Analog Scale-arm: -2.47 ± 3.15 vs -0.48 ± 3.19, P = 0.010). These findings persisted in multivariate analysis except for Neck Disability Index.
Conclusion: ACDF and cervical laminoplasty appear equally efficacious at halting myelopathic progression. However, patients who underwent ACDF had greater improvements in arm pain at 1 year postoperatively. Longitudinal studies evaluating the efficacy of laminoplasty to mitigate adjacent segment disease are indicated to establish a robust risk-benefit assessment for these 2 procedures.
Level of evidence: III.
研究设计回顾性队列研究:比较患者报告的结果和颈椎前路椎间盘切除融合术(ACDF)与颈椎板成形术治疗多椎间孔型颈椎病的手术结果:背景:多层次颈椎病的治疗方法包括 ACDF 和颈椎板成形术。鉴于有关最佳方法的文献报道不一,尤其是对无脊柱后凸的患者,因此需要对 ACDF 和颈椎板成形术的疗效进行更多研究:对接受3或4级手术的成年患者进行了回顾性研究。方法:对接受3或4级手术的成年患者进行了回顾性研究,排除了术前有C2-C7 Cobb角畸形的患者。对电子病历和机构数据库中的基线特征、手术结果和患者报告的结果进行了回顾性分析:研究共纳入了101名接受ACDF手术的患者和52名接受椎板成形术的患者。椎板成形术组患者的夏尔森综合指数(Charlson Comorbidity Index)较高(3.10 ± 1.43 vs 2.39 ± 1.57,P = 0.011)。两组患者的减压层数、C2-C7 椎体前凸以及脊髓病与脊髓脊膜病的诊断结果相当。接受椎板成形术的患者住院时间较长(2.04 ± 1.15 vs 1.48 ± 0.70,P = 0.003),但再入院率、并发症和翻修率相似。两组患者的脊髓病评分改善情况相似(∆日本骨科协会修订版:1.11 ± 3.09 vs 1.48 ± 0.70):1.11 ± 3.09 vs 1.06 ± 3.37,P = 0.639)。ACDF 对颈部残疾指数(∆颈部残疾指数:-11.66 ± 19.2 vs -1.13 ± 11.2,P < 0.001)、颈部疼痛(∆颈部视觉模拟量表:-2.69 ± 2.78 vs -0.83 ± 2.55,P = 0.003)和手臂疼痛(∆手臂视觉模拟量表:-2.47 ± 3.15 vs -0.48 ± 3.19,P = 0.010)的改善更大。除颈部残疾指数外,这些结果在多变量分析中依然存在:结论:ACDF和颈椎板成形术在阻止脊髓病变进展方面似乎同样有效。结论:ACDF 和颈椎椎板成形术在阻止髓核病变进展方面的疗效相同,但术后 1 年接受 ACDF 的患者手臂疼痛的改善程度更大。对椎板成形术缓解邻近节段疾病的疗效进行纵向评估研究,可为这两种手术建立健全的风险效益评估:证据等级:III。
{"title":"A Comparison of Clinical Outcomes Between Anterior Cervical Discectomy and Fusion Versus Posterior Cervical Laminoplasty for Multilevel Cervical Myelopathy.","authors":"Yunsoo Lee, Delano Trenchfield, Emily Berthiaume, Alexa Tomlak, Rajkishen Narayanan, Parker Brush, Jeremy Heard, Krisna Maddy, Tariq Issa, Mark Lambrechts, Ian David Kaye, John Mangan, Giovanni Grasso, Jose Canseco, Alexander Vaccaro, Christopher Kepler, Gregory Schroeder, Alan Hilibrand","doi":"10.1097/BSD.0000000000001634","DOIUrl":"10.1097/BSD.0000000000001634","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Cohort.</p><p><strong>Objective: </strong>To compare patient-reported outcomes and surgical outcomes after anterior cervical discectomy and fusion (ACDF) versus cervical laminoplasty for multilevel cervical spondylotic myelopathy.</p><p><strong>Background: </strong>Treatment options for multilevel cervical spondylotic myelopathy include ACDF and cervical laminoplasty. Given that the literature has been mixed regarding the optimal approach, especially in patients without kyphosis, there is a need for additional studies investigating outcomes between ACDF and cervical laminoplasty.</p><p><strong>Methods: </strong>A retrospective review was conducted of adult patients undergoing 3 or 4-level surgery. Patients with preoperative kyphosis based on C2-C7 Cobb angles were excluded. The electronic medical record and institutional databases were reviewed for baseline characteristics, surgical outcomes, and patient-reported outcomes.</p><p><strong>Results: </strong>A total of 101 patients who underwent ACDF and 52 patients who underwent laminoplasty were included in the study. The laminoplasty cohort had a higher overall Charlson Comorbidity Index (3.10 ± 1.43 vs 2.39 ± 1.57, P = 0.011). Both groups had a comparable number of levels decompressed, C2-C7 lordosis, and diagnosis of myelopathy versus myeloradiculopathy. Patients who underwent laminoplasty had a longer length of stay (2.04 ± 1.15 vs 1.48 ± 0.70, P = 0.003) but readmission, complication, and revision rates were similar. Both groups had similar improvement in myelopathy scores (∆modified Japanese Orthopedic Association: 1.11 ± 3.09 vs 1.06 ± 3.37, P = 0.639). ACDF had greater improvement in Neck Disability Index (∆Neck Disability Index: -11.66 ± 19.2 vs -1.13 ± 11.2, P < 0.001), neck pain (∆Visual Analog Scale-neck: -2.69 ± 2.78 vs -0.83 ± 2.55, P = 0.003), and arm pain (∆Visual Analog Scale-arm: -2.47 ± 3.15 vs -0.48 ± 3.19, P = 0.010). These findings persisted in multivariate analysis except for Neck Disability Index.</p><p><strong>Conclusion: </strong>ACDF and cervical laminoplasty appear equally efficacious at halting myelopathic progression. However, patients who underwent ACDF had greater improvements in arm pain at 1 year postoperatively. Longitudinal studies evaluating the efficacy of laminoplasty to mitigate adjacent segment disease are indicated to establish a robust risk-benefit assessment for these 2 procedures.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E529-E535"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141330532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-07-22DOI: 10.1097/BSD.0000000000001667
Matthew H Meade, Mark Michael, Jamie Henzes, Ruchir Nanavati, Barrett Woods
The abstract of a research paper functions to attract readers and highlight the clinical significance of a research project in a broadly appealing manner. Abstract structure is commonly dictated by the target journal, however, a basic style typically follows the "Introduction, Methods, Results and Discussion" structure of introduction, materials/methods, results, and discussion/conclusion. The abstract itself is commonly the initial accessible portion of a research paper, so writing in an engaging while informative manner is imperative for increasing manuscript views and citations. Overall, an abstract is a to-the-point synopsis of a research project that succinctly describes the entirety of your work.
{"title":"How to Write an Abstract.","authors":"Matthew H Meade, Mark Michael, Jamie Henzes, Ruchir Nanavati, Barrett Woods","doi":"10.1097/BSD.0000000000001667","DOIUrl":"10.1097/BSD.0000000000001667","url":null,"abstract":"<p><p>The abstract of a research paper functions to attract readers and highlight the clinical significance of a research project in a broadly appealing manner. Abstract structure is commonly dictated by the target journal, however, a basic style typically follows the \"Introduction, Methods, Results and Discussion\" structure of introduction, materials/methods, results, and discussion/conclusion. The abstract itself is commonly the initial accessible portion of a research paper, so writing in an engaging while informative manner is imperative for increasing manuscript views and citations. Overall, an abstract is a to-the-point synopsis of a research project that succinctly describes the entirety of your work.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"504-505"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Evaluate the influence of observer variability on the measurements of both thoracic kyphosis (TK) and lumbar lordosis (LL) obtained with anatomic and functional spinal segmentation methods.
Background: Parametric analysis for spinal surgery planning typically relies on anatomic parameters. However, incorporating functional parameters that consider the vertebrae orientation is important to minimizing surgical calculation errors.
Methods: The authors developed parametric analysis software that integrates traditional and functional methodologies. The proposed method included functional thoracic kyphosis and functional lumbar lordosis calculated from the lines normal to the inflection points of the spine model. Using a synthetic lateral X-ray, the observer variability was computer-simulated generating 20 landmark sets that replicate the annotations of 20 observers. The analysis also included 10 clinical X-rays, annotated twice by 3 judges with a minimum 1-week interval. The spinal curvature angles were derived using the anatomic and functional methods. Statistical analysis were performed for comparison.
Results: For the synthetic X-ray, the proposed method presented significantly less variability: TK (<±2.5 degrees, P =0.00023) and LL (<±5 degrees, P =0.00012). For the clinical X-rays, the interobserver reliability analysis yielded higher intraclass correlation coefficients (ICC) for functional TK (ICC>0.97) and functional LL (ICC>0.87) than for TK (ICC<0.91) and LL (ICC<0.89). Statistically significant differences were observed for both TK ( P =0.001) and LL ( P =0.030). Under the traditional method, observer variability led to measurement differences surpassing ±19 degrees, whereas differences with the proposed method were within ±10 degrees for both parameters.
Conclusion: The vertebral endplate is not the most suitable place to measure spinal sagittal curvatures. Small changes in landmark position significantly alter the measured Cobb angle. The proposed method offers a substantial advantage regarding the influence of observer variability, in addition to the more individualized analysis.
研究设计探索性描述研究:评估观察者变异性对采用解剖和功能性脊柱分割方法测量胸椎后凸(TK)和腰椎前凸(LL)的影响:背景:脊柱手术规划的参数分析通常依赖于解剖参数。背景:脊柱手术规划的参数分析通常依赖于解剖参数,然而,纳入考虑椎体方向的功能参数对于最大限度地减少手术计算误差非常重要:作者开发的参数分析软件融合了传统方法和功能方法。所提出的方法包括根据脊柱模型拐点的法线计算出的功能性胸椎后凸和功能性腰椎前凸。使用合成的侧位 X 光片,通过计算机模拟观察者的变异性,生成 20 个地标集,复制 20 个观察者的注释。分析还包括 10 张临床 X 光片,由 3 位评委进行两次标注,间隔至少 1 周。脊柱弯曲角度是通过解剖和功能方法得出的。比较结果进行了统计分析:结果:对于合成 X 光片,拟议方法的变异性明显较小:结果:对于合成 X 光片,所建议的方法的变异性:TK(0.97)和功能性 LL(ICC>0.87)明显小于 TK(ICCC):椎体终板并不是测量脊柱矢状曲的最合适位置。地标位置的微小变化都会显著改变所测量的 Cobb 角。除了更个性化的分析外,所提出的方法在观察者变异性的影响方面具有很大的优势。
{"title":"Strategies for Minimizing the Effects of Observer Variability on Sagittal Parameter Measurements of the Spine.","authors":"Adimilson Dos Santos Delgado, Bruna Souza Morais, Helton Luiz Aparecido Defino, Arlindo Neto Montagnoli","doi":"10.1097/BSD.0000000000001642","DOIUrl":"10.1097/BSD.0000000000001642","url":null,"abstract":"<p><strong>Study design: </strong>Exploratory-descriptive study.</p><p><strong>Objective: </strong>Evaluate the influence of observer variability on the measurements of both thoracic kyphosis (TK) and lumbar lordosis (LL) obtained with anatomic and functional spinal segmentation methods.</p><p><strong>Background: </strong>Parametric analysis for spinal surgery planning typically relies on anatomic parameters. However, incorporating functional parameters that consider the vertebrae orientation is important to minimizing surgical calculation errors.</p><p><strong>Methods: </strong>The authors developed parametric analysis software that integrates traditional and functional methodologies. The proposed method included functional thoracic kyphosis and functional lumbar lordosis calculated from the lines normal to the inflection points of the spine model. Using a synthetic lateral X-ray, the observer variability was computer-simulated generating 20 landmark sets that replicate the annotations of 20 observers. The analysis also included 10 clinical X-rays, annotated twice by 3 judges with a minimum 1-week interval. The spinal curvature angles were derived using the anatomic and functional methods. Statistical analysis were performed for comparison.</p><p><strong>Results: </strong>For the synthetic X-ray, the proposed method presented significantly less variability: TK (<±2.5 degrees, P =0.00023) and LL (<±5 degrees, P =0.00012). For the clinical X-rays, the interobserver reliability analysis yielded higher intraclass correlation coefficients (ICC) for functional TK (ICC>0.97) and functional LL (ICC>0.87) than for TK (ICC<0.91) and LL (ICC<0.89). Statistically significant differences were observed for both TK ( P =0.001) and LL ( P =0.030). Under the traditional method, observer variability led to measurement differences surpassing ±19 degrees, whereas differences with the proposed method were within ±10 degrees for both parameters.</p><p><strong>Conclusion: </strong>The vertebral endplate is not the most suitable place to measure spinal sagittal curvatures. Small changes in landmark position significantly alter the measured Cobb angle. The proposed method offers a substantial advantage regarding the influence of observer variability, in addition to the more individualized analysis.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E494-E502"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}