Clinical Spine Surgery最新文献

Study design: Retrospective study.

Objective: To evaluate clinical and radiologic outcomes of fusionless lumbar spine stabilization using a tendon allograft loop through the spinous process, following microsurgical decompression to address procedure-related destabilization.

Summary of background data: The limitations of traditional spinal fusion and decompression surgeries have driven the development of motion-preserving alternatives that maintain natural vertebral mobility while providing structural stability, thereby reducing complications and long-term consequences associated with rigid fixation.

Methods: Twenty patients with low-grade stable degenerative spondylolisthesis who underwent primary lumbar decompression for spinal stenosis and ligamentous stabilization using the trans-spinous tendon allograft technique between 2022 and 2023 were included. The Oswestry disability index (ODI) and visual analog scale (VAS) for back/leg pain were recorded. Radiographs assessed adjacent segment degeneration and spinous process integrity, and MRI scans evaluated decompression and tendon allograft status.

Results: Median ODI improved significantly at all time points compared with baseline: 6-month ODI: 16 points (IQR=4.5-26), P =0.0013; 1-year ODI: 16.5 points (IQR=4-22), P =0.0013, with no significant difference between 6-month and 1-year results ( P =1). Similar trends were observed for scores. One patient required revision surgery due to a facet joint cyst compressing a nerve root. Eleven patients (55%) experienced spinous process fractures, but clinical outcomes did not differ between patients with and without fractures: 6-month ODI: P =0.921, 1-year ODI: P =0.985; 6-month VAS back: P =0.507, 1-year VAS back: P =0.767; 6-month VAS leg: P =0.826, 1-year VAS leg: P =0.747. Patients with fractures were significantly older ( P =0.023).

Conclusion: The trans-spinous process vertebropexy technique with decompressive bilateral laminotomy compromises spinous process integrity, causing high fracture rates. Although these fractures have minimal clinical impact, the current stabilization technique should be abandoned due to inadequate safety and efficacy. Technique refinement, larger prospective studies, and extended follow-up are necessary before clinical implementation.

Level of evidence: Level III-retrospective analysis.

Study design: Retrospective cohort study.

Objective: To understand the strengths of titanium cages for ACDF using a propensity score matched analysis while characterizing radiologic and clinical outcomes associated with graft material.

Summary of background evidence: Structural allografts and synthetic grafts such as titanium cages have been frequently utilized for anterior cervical discectomy and fusion (ACDF). Although the biomechanical properties have been compared between these 2 graft types, there remains limited data on their comparative performance for cervical procedures.

Methods: We assembled a cohort of patients who underwent an ACDF with a structural allograft or titanium cage at a tertiary care medical center and community hospital by a single surgeon. To compare outcomes, 1:1 propensity score matching was performed using optimal pair matching and a generalized linear model.

Results: Of 376 patients, 269 received a structural allograft and 107 a titanium cage [median age: 56 y, 51.6% (n=194) female, 22.9% (n=86) current smokers]. Almost half of ACDFs (161 patients, 42.8%) were multilevel fusions. Across both graft materials, ACDFs had a relatively safe complication profile with a low intraoperative blood loss. There was durable symptom relief, with 94.5% (n=345 of 365) of patients reporting improved to resolved symptoms at last follow-up. Patients with titanium cages had significantly greater cervical Cobb angle change compared with patients with structural allografts (P<0.001). After propensity score matching, patients with titanium cages had a lower estimated blood loss (P=0.03) and shorter hospital length of stay (P<0.001). However, there were no significant differences in rates of fusion, cage subsidence, pseudoarthrosis, or revision surgery.

Conclusions: Titanium cages demonstrate a similar safety and efficacy profile to structural allografts and may enable greater cervical Cobb angle changes. Longer neurosurgical follow-up may be required to assess need for revision procedures and quantitative patient-reported outcomes across cage materials.

Study design: Retrospective review.

Objective: Determine the rate of bony union of an integrated cage/screw polyether-ethyl ketone (PEEK) cervical interbody fusion device with computed tomography (CT) and provide long-term outcomes of patients treated with such.

Summary of background data: Anterior cervical discectomy and fusion (ACDF) is a common treatment option for patients with degenerative cervical conditions that have failed conservative treatment. Stand-alone anchored cages offer the theoretical advantage of decreasing soft tissue dissection off the anterior vertebral body and mitigating risk to surrounding structures while still achieving solid fusion.

Methods: A retrospective review was conducted from a single institution's enrollment data during a postmarket surveillance study for the Stalif-C (Centinel Spine, West Chester, PA). Three surgeons independently reviewed CT scans from 1 and 2-year follow-up visits to assess for fusion. The criteria for fusion were the presence of bridging bone in at least one of 5 regions (anterior, posterior, right, left uncovertebral joint, and intracage) on 2 consecutive slices of the CT scan using 1 mm coronal and sagittal reformats. These same surgeons repeated their assessment of the imaging studies at a minimum of 2 weeks after the initial review. The resulting fusion rates were then averaged to provide a mean fusion rate at the 1 and 2-year points.

Results: A total of 34 patients were enrolled in the study with 2 patients withdrawing consent after the procedure. Thirty had completed their 1-year follow-up with imaging studies comprising 32 levels treated. Twenty-three patients (25 levels) completed a 2-year follow-up at the time of this study. The average bony fusion rate at 1 year was 37% (range: 19%-56%) and at 2 years was 50% (range: 40%-60%).

Conclusion: The rate of bony fusion as assessed by CT scans at 1 and 2 years was 37% and 50%, respectively. This is well below previously published fusion rates for standalone constructs.

Level of evidence: Level III.

Study design: Retrospective cohort study.

Objectives: To assess the impact of frailty, using modified 5-item frailty index (mFI-5), and sarcopenia, using temporalis muscle thickness (TMT), on motor and functional outcomes in patients with acute traumatic central cord syndrome (ATCCS).

Summary of background data: Patients who suffer from ATCCS often are elderly patients who may be frail and sarcopenic. It would be useful to know the impact it has on their outcome, to see how they fair and identify the areas that need improvement.

Methods: Receiver operating characteristic analysis determined the optimal cut-off value of TMT at 3.965 mm. Patients were considered sarcopenic if their average TMT value was less than 3.965 mm. Primary outcomes were significant improvement in the American Spinal Injury Association Motor Score (AMS) scores at 6 and 12 months. Secondary outcomes were significant improvement in Functional Independence Measure (FIM) at 6 months, and significant recovery of Modified Japanese Orthopedic Association (mJOA) at 6 months. Logistic regression was performed to assess the influence of mFI-5 and TMT on these outcomes.

Results: A total of 80 patients were used in this study. Significant improvement in AMS improvement (71.4% vs. 90.4%, P=0.028), significant improvement in FIM (42.9% vs. 71.2%, P=0.013), and significant recovery in mJOA (14% vs. 38%, P=0.039) were all significantly lower in sarcopenic patients. Multivariate analysis found that the presence of sarcopenia was inversely related to significant improvement in FIM at 6 months (OR 0.026, 95% CI 0.002-0.414, P=0.010). The MFI score of 0 was positively associated with significant improvement in FIM at 6 months (OR 64.189, 95% CI 2.643-1412.016, P=0.010).

Conclusions: Frailty and sarcopenia have a significant effect on motor and functional outcomes in ATCCS patients.

Study design: Retrospective case series.

Objective: To report on the early clinical safety profile and accuracy of Augmented reality (AR)-assisted pedicle screw placement in patients undergoing minimally invasive spinal surgery.

Summary of background data: While navigation-guided pedicle screw placement has improved accuracy rates to 89-100%, current systems face challenges, including line-of-sight interruptions and attention shift from patient to remote screens. AR technology projects navigation data directly onto the surgical field, potentially overcoming these limitations while maintaining high accuracy.

Methods: A multi-center retrospective analysis was conducted across two institutions, reviewing 31 procedures involving 200 pedicle screws placed using the Xvision AR navigation system (Augmedics Inc.). All procedures were performed by fellowship-trained spine surgeons. Accuracy was assessed using pre- and post-instrumentation CT O-arm imaging according to the Gertzbein and Robbins classification system. Novel angular deviation analysis was performed to evaluate trajectory accuracy. Clinical outcomes, including complications and revision rates, were recorded.

Results: Among 200 pedicle screws analyzed, 84.5% were classified as Gertzbein-Robbins grade A (complete containment), 13.5% as grade B (trivial breach), and 2% as grade C, yielding an overall accuracy rate of 98%. The pedicle breach rate was 15.5%, with no instances of superior endplate or facet joint violations. Mean angular deviation from the ideal trajectory was 0.78±4.56 degrees. No screw revisions, hardware-related complications, or symptomatic nerve encroachment occurred. Two patients experienced non-hardware-related systemic infections.

Conclusions: AR-assisted navigation demonstrates high accuracy for pedicle screw placement with minimal angular deviation and low complication rates. This technology offers promising potential for improving surgical precision while maintaining workflow efficiency.

Level of evidence: Level IV.

Odontoid fractures comprise 10%-15% of all cervical fractures in adults, of which Anderson and D'Alonzo type II odontoid fractures are the most common subtype. Anterior screw fixation for type IIB odontoid fractures is a safe and effective treatment option in the properly selected patient. This less invasive technique preserves the C1-C2 motion while stabilizing the dens and yields a high union rate with minimum morbidity in appropriately indicated patients. Younger patients and nonosteoporotic patients with anterior superior to posterior inferior (type IIB) fracture patterns are ideal candidates. The authors recommend using a noncannulated system with a single fully threaded screw and a lag technique to achieve bicortical fixation across the fracture. This paper presents an anterior odontoid screw fixation for type II odontoid fractures with a detailed technical guide in written and accompanying video format. We also discuss appropriate indications, contraindications, complications, and technical pearls. The full video illustrating this surgical technique and approach can be found at: https://www.youtube.com/watch?v=HKW4JO3HBxo&list=PL_UtVTe4NFuIYo3BabDnWtCiInnkelbJy&index=6.

Study design: A retrospective study using the TriNetX Research Network.

Objective: Evaluate the prevalence of malnutrition and its impact on postoperative complications in patients undergoing posterior cervical spinal instrumentation.

Summary of background data: Malnutrition, commonly identified by serum albumin <3.5 g/dL, has been linked to surgical site infections (SSI) and wound dehiscence (WD). However, data specific to posterior cervical spine surgery remain limited.

Methods: Using TriNetX, adult patients who had single- or multilevel posterior cervical spine instrumentation with diagnoses including stenosis, myelopathy, disc disorder, radiculopathy, spondylosis, or spondylolisthesis, and a preoperative albumin measurement within 30 days, were identified. Patients grouped by albumin <3.5 g/dL or ≥3.5 g/dL. Propensity score matching controlled for age, sex, race, and comorbidities. Primary outcomes were SSI and WD, with reoperation as a secondary outcome, identified within 90 days postsurgery.

Results: Of 7607 patients (mean age: 61.8±12.6 y, 54.8% male), 1790 (23.5%) had albumin <3.5 g/dL. Before matching, malnourished patients had higher odds of SSI/WD (OR=1.400, 95% CI: 1.105-1.775) and reoperation (OR=1.472, 95% CI: 1.241-1.745) compared with patients with adequate nutritional status. After matching (1785 patients/group), malnourished patients showed elevated odds of SSI/WD (OR=1.377, 95% CI: 1.016-1.866) and reoperation (OR=1.380, 95% CI: 1.111-1.716) within 90 days.

Conclusion: In this large retrospective matched analysis, malnutrition (albumin <3.5 g/dL) was present in 23.5% of adults undergoing posterior cervical spinal instrumentation. Malnourished patients had ∼40% higher odds of postoperative SSI, WD, and reoperation within 90 days compared with those with albumin ≥3.5 g/dL. These complications prolong hospitalization, increase health care costs, and negatively affect patient outcomes. Minimizing them is critical, and malnutrition is a modifiable risk factor. Our findings underscore the importance of routine nutritional evaluation and interventions before posterior cervical spine surgery. Further studies should explore nutritional supplementation and its impact on reducing postoperative morbidity in malnourished patients.

Level of evidence: Level III.

Study design: A retrospective cohort study.

Objective: To identify factors associated with minimally invasive surgery (MIS) utilization and compare inpatient outcomes between MIS and open fusion for traumatic thoracic vertebral fractures using a multicenter trauma registry.

Summary of background data: MIS is increasingly utilized in spine surgery due to its potential to reduce perioperative morbidity. However, its role in managing traumatic thoracic vertebral fractures remains unclear, and large-scale comparisons of MIS versus open fusion in this setting are limited.

Methods: Adult patients (≥18 y) who underwent thoracic fusion for traumatic thoracic fractures between 2019 and 2021 were identified from the American College of Surgeons Trauma Quality Program database using ICD-10 codes. Patients were stratified by surgical approach (MIS vs. open), and demographic, injury, and clinical characteristics-as well as inpatient outcomes-were compared using chi-squared and t-tests. Multivariable logistic regression was performed to identify patient and injury factors associated with MIS utilization. A P-value < 0.05 was considered statistically significant.

Results: Of 8999 patients undergoing thoracic fusion, 370 (4.1%) received MIS. MIS utilization was associated with older age, lower Injury Severity Scores, and less severe neurological impairment. The number of vertebral levels fused did not differ by approach. MIS patients had significantly shorter length of stay, higher home discharge rates, and lower rates of complications, intensive care unit admission, and mechanical ventilation.

Conclusion: This multicenter cohort study identifies key patient and injury characteristics associated with MIS utilization in thoracic trauma. While MIS was associated with some favorable inpatient outcomes, this may be due to selection bias rather than procedural effect. Further prospective studies are needed to clarify appropriate indications and long-term outcomes.

Study design: Retrospective cohort study.

Objective: To evaluate the impact of patient age on complication rates, radiographic alignment, and patient-reported outcomes (PROs) following anterior cervical discectomy and fusion (ACDF).

Summary of background data: ACDF is one of the most common and effective spinal procedures in the United States. However, as a rising number of elderly patients undergo ACDF, age-related differences in outcomes such as subsidence, adjacent segment disease, and PROs remain poorly defined.

Methods: A retrospective review was conducted on 302 patients who underwent ACDF between 2020 and 2022 at a single academic institution. Patients were stratified into 4 age groups: younger than 50, 50-59, 60-69, and 70 years or older. Univariate regression analyses compared cervical sagittal alignment and PROs, while multivariate analyses assessed perioperative characteristics and complications.

Results: Compared with the younger-than-50 cohort, patients aged 50-59 exhibited a significantly higher rate of subsidence (29.6% vs. 13.7%, P=0.001). The 60-69 group showed a similar outcome (24.6%, P=0.033) and a significantly longer length of stay (1.34 vs. 0.96 d, P=0.023). Patients aged 70 years or older experienced the most pronounced changes: subsidence occurred in 42.1% (P=0.044), LOS increased to 1.74 days (P=0.001), and SVA increased by an average of 0.83 cm preoperatively, unlike younger cohorts, in whom SVA stabilized. In addition, patients aged 70 years or older reported a significant resurgence of neck pain at 1- and 2-year follow-ups. In contrast, this group also exhibited the greatest improvement in brief resilience scale scores, ultimately reporting the highest resilience at 1 year postoperatively (P=0.0162).

Conclusions: Advanced age is associated with increased subsidence, sagittal imbalance, longer hospitalization, and recurrence of neck pain following ACDF. These findings are important to consider when planning ACDF, particularly in patients aged 70 years or older. Nonetheless, improvements in resilience among older patients highlight their capacity for meaningful recovery.

Level of evidence: Level III.

Study design: Retrospective cohort study.

Objective: To compare the advantages and disadvantages of two different foraminoplasty methods.

Summary of background data: Foraminoplasty is one of the most important steps in FELD surgery. In recent years, different surgical instruments for foraminoplasty have been invented, mainly, including reamer/trephine and bone drill. Different foraminoplasty methods have different effects and limitations on the surgical outcome.The aim of this study was to compare surgical outcomes, anesthesia satisfaction, and learning curves between two different foraminoplasty procedures.

Patients and methods: A total of 109 patients with lumbar disc herniation (LDH) treated with full endoscopic lumbar discectomy (FELD) by the same group of physicians from October 2020 to February 2022. Patients underwent foraminoplasty with bone drill were divided into group A, while foraminoplasty with trephine as group B. Back and leg visual analogue scale (VAS), Oswestry disability index (ODI) were evaluated at different time follow-up for evaluating surgical outcomes. Different types of anesthesia were recorded, and patients' intraoperative pain assessment was evaluated. Learning curve was presented with operation time in chronological order.

Results: There were statistically differences between VAS-back postoperative (P=0.0077) on 6 months. There was also a statistical difference in back pain symptom scores under the interaction between groups and time (P=0.147). The intraoperative VAS score of group A was significantly higher group B (P=0.008). Migration herniated discs and foraminoplasty method were the main factors affecting intraoperative pain. The operation time of group A was shorter than that of group B, while there was no statistical difference (P=0.782).

Conclusions: Both surgical techniques can achieve good curative effect (excellent rate: 87.7% vs. 89.1%). Patients in group A recovered faster on postoperative function. Patients in group B had better intraoperative experience.