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Radiographic Indicators of Craniocervical Instability: Analyzing Variance of Normative Supine and Upright Imaging in a Healthy Population. 颅颈不稳的放射学指标:分析健康人群中标准仰卧位和直立位成像的差异。
IF 1.6 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-28 DOI: 10.1097/BSD.0000000000001715
Alan J Gordillo, Matt Magro, Derrick Obiri-Yeboah, Arpan A Patel, Vorster Sarel, Alexander Spiessberger

Study design: Single-institution retrospective review.

Objective: To establish baseline ranges and variability of 7 radiographic measurements of the cervical spine in a healthy patient population as potential diagnostic tools for craniocervical instability.

Summary of background data: Craniocervical instability, common in patients with connective tissue disease such as Ehlers-Danlos Syndrome, often presents with a wide range of symptoms, including neck pain. Current diagnostic methods employ a range of clinical and radiographic features, but diagnostic challenges remain due to missed indications on static imaging and a lack of standardized measurement values and normalized variance.

Methods: Seventy-two healthy patients with cervical imaging were analyzed. Surgimap software was used to annotate supine computed tomography images, flexion, extension, and neutral x-ray images for measurement. These measurements included the atlanto-dental interval, clival-axial angle, basion-dens interval, basion-axis interval, perpendicular basion to the inferior aspect of C2, also known as Grabb Oakes measurement, and the hard palate to C1 and hard palate to C2. Statistical analysis assessed differences among imaging modalities, and coefficients of variation were calculated for each measurement.

Results: Our cohort consisted of a total of 72 patients with a mean age of 64 (SD: 13.54). All measurements except for the basion-axial interval and atlanto-dental interval demonstrated a significant difference between extension and flexion x-ray measurements. clivo-axial angle, hard palate to C1, and hard palate to C2 demonstrated the lowest coefficients of variance across imaging modalities.

Conclusion: Understanding normal variance in cervical measurements is invaluable for accurate CCI diagnosis. Using a cohort of healthy patients, this study delineates the distribution and spread of 7 cervical measurements, delineating reference values and variability in these key measurements and highlighting their potential for use as imaging markers for CCI.

Level of evidence: Level III.

研究设计单个机构回顾性研究:目的:确定健康患者群体中颈椎 7 项放射学测量的基线范围和变异性,作为颅颈不稳的潜在诊断工具:颅颈不稳常见于患有埃勒斯-丹洛斯综合征等结缔组织疾病的患者,通常会出现包括颈部疼痛在内的多种症状。目前的诊断方法采用了一系列临床和影像学特征,但由于静态成像漏诊、缺乏标准化测量值和归一化差异,诊断仍面临挑战:方法:对 72 名健康患者的颈椎成像进行了分析。采用 Surgimap 软件对仰卧位计算机断层扫描图像、屈曲、伸展和中立位 X 光图像进行注释测量。这些测量包括寰齿间距、龈轴角、基底-窦间距、基底-轴间距、垂直基底至 C2 下侧(也称为 Grabb Oakes 测量)、硬腭至 C1 和硬腭至 C2。统计分析评估了不同成像模式之间的差异,并计算了每次测量的变异系数:我们的队列中共有 72 名患者,平均年龄为 64 岁(标准差:13.54)。除基底-轴间隙和寰齿-齿间隙外,其他所有测量值在伸展和屈曲 X 光测量值之间均存在显著差异。在各种成像模式中,基底-轴角、硬腭至 C1 和硬腭至 C2 的变异系数最小:结论:了解颈椎测量的正常差异对于准确诊断CCI非常重要。本研究利用一组健康患者,描述了 7 项颈椎测量值的分布和扩散情况,划定了这些关键测量值的参考值和变异性,并强调了它们作为 CCI 影像标记的应用潜力:证据等级:III 级。
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引用次数: 0
Diagnosis and Management of Thoracolumbar Spinal Disorders Presenting as Cardiac, Gastrointestinal, and Other False Pain Syndromes. 表现为心脏、胃肠道及其他假性疼痛综合征的胸腰椎疾病的诊断与管理》(Diagnosis and Management of Thoracolumbar Spinal Disorders Presenting as Cardiac, Gastrointestinal, and Other False Pain Syndromes)。
IF 1.6 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-25 DOI: 10.1097/BSD.0000000000001644
Nolan J Brown, Cathleen Kuo, Zach Pennington, Angie Zhang, Ashley E Choi, Andrew K Chan, Shane Shahrestani, Nicholas E Bui, Matthew J Hatter, Gaston Camino-Willhuber, Martin H Pham, Michael Y Oh

Summary of background data: Although pseudoangina is most commonly caused by cervical disc herniation, several cases have been described where thoracic herniation produced symptoms of pseudoangina. If thoracic herniation can produce angina-like pain, then it is important to consider whether pathology of the thoracolumbar spine, in general, can trigger false pain syndromes distinct from pseudoangina.

Objective: We seek to provide the most comprehensive study regarding the diagnosis and treatment of spinal conditions causing false pain syndromes.

Study design: Systematic review of the current literature using PRISMA 2020 recommendations.

Methods: We queried the literature and systematically selected relevant studies according to PRISMA guidelines.

Results: Across 22 selected studies, the sample size was 30 patients, and a total of 26 met the criteria for statistical analysis. Seven (26.9%) of these patients presented with a chief complaint of pseudoangina resulting from thoracic disc herniation. 73.1% (19/26) of patients exhibited pain mimicking visceral origin. Overall, 13/19 (68.4%) patients exhibited thoracic spine disease only and 4/19 (21.1%) patients were affected at lumbar levels only, while 2 (10.5%) patients exhibited thoracolumbar herniation. Presentations included abdominal pain (11/19) mimicking appendicitis or pancreatitis, flank pain mimicking renal colic (8/19), and 2 cases of scrotal pain/orchalgia. Symptom durations ranged from acute (<24 h) to 7 years. Treatments were reported for 18/19 patients and all treated patients reported alleviated pain. Seven out of 18 patients were managed conservatively while 11/18 were treated surgically. Misdiagnosis resulted in unnecessary surgery (pancreaticojejunostomy) or other invasive procedures.

Conclusions: In spinal disorders manifesting with atypical pain syndromes, delay in proper diagnosis and unnecessary treatments can, unfortunately, cause prolonged patient suffering and increased cost of health care. As a result, some have proposed that spinal screening should be incorporated into clinical examinations involving false pain syndromes.

背景资料摘要:虽然假性心绞痛最常见于颈椎间盘突出症,但也有几例病例描述胸椎椎间盘突出症产生了假性心绞痛症状。如果胸椎椎间盘突出症能产生类似心绞痛的疼痛,那么就有必要考虑胸腰椎的病变是否会引发不同于假性心绞痛的假性疼痛综合征:我们试图就导致假性疼痛综合征的脊柱疾病的诊断和治疗提供最全面的研究:研究设计:采用 PRISMA 2020 建议对现有文献进行系统回顾:我们查询了文献,并根据 PRISMA 指南系统地选择了相关研究:在 22 项选定的研究中,样本量为 30 名患者,共有 26 项符合统计分析标准。其中7例(26.9%)患者的主诉是胸椎间盘突出导致的假性气胸。73.1%(19/26)的患者表现出模仿内脏源性疼痛。总体而言,13/19(68.4%)名患者仅表现为胸椎疾病,4/19(21.1%)名患者仅腰椎水平受到影响,2(10.5%)名患者表现为胸腰椎突出。表现包括腹痛(11/19),类似阑尾炎或胰腺炎,侧腹疼痛,类似肾绞痛(8/19),以及 2 例阴囊疼痛/瘙痒。症状持续时间从急性到慢性不等:对于表现为非典型疼痛综合征的脊柱疾病,延误正确诊断和不必要的治疗可能会延长患者的痛苦并增加医疗费用。因此,有人建议在涉及假性疼痛综合征的临床检查中纳入脊柱筛查。
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引用次数: 0
Influence of Cervical Level Fused on Subsidence of Cage and Allograft in Anterior Cervical Discectomy and Fusion. 前路颈椎椎间盘切除和融合术中融合颈椎水平对固定架和同种异体移植物下沉的影响
IF 1.6 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-25 DOI: 10.1097/BSD.0000000000001721
Zachary P Milestone, Akiro H Duey, Wasil Ahmed, Christopher Gonzalez, Jiwoo Park, Lathan Liou, Pierce Ferriter, Jonathan Markowitz, Jun S Kim, Samuel K Cho

Study design: Retrospective cohort.

Objective: This study aims to evaluate the relationship between the cervical levels fused and the degree of subsidence following anterior cervical discectomy and fusion (ACDF) procedures.

Background: Subsidence following ACDF may worsen clinical outcomes. Previous studies have linked lower cervical levels with higher rates of subsidence, but none have quantified the relative degree of subsidence between levels.

Materials and methods: Patients who underwent ACDF from 2016 to 2021 at a tertiary medical center were included in this study. Lateral cervical radiographs from the immediate postoperative period and the final follow-ups were used to calculate subsidence. Analysis of variance was used to examine the association between cervical levels fused and subsidence. Multivariable linear regression analysis controlled for age, sex, smoking status, osteopenia/osteoporosis, number of fused levels, cage-to-body ratio, and cage type while examining the relationship between the cervical level fused and subsidence.

Results: This study includes 122 patients who underwent 227 levels fused. There were 16 (7.0%) C3-C4 fusions, 55 (24.2%) C4-C5 fusions, 97 (42.7%) C5-C6 fusions, and 59 (26.0%) C6-C7 fusions. There was a significant difference in the degree of anterior subsidence between cervical levels fused (P = 0.013) with a mean subsidence of 1.0 mm (SD: 1.6) for C3-C4, 1.1 mm (SD: 1.4) for C4-C5, 1.8 mm (SD: 1.5) for C5-C6, and 1.8 mm (SD: 1.6) for C6-C7 fusions. Relative to C6-C7 fusions, C4-C5 (P = 0.016), and C3-C4 (P = 0.014) fusions were associated with decreased anterior subsidence, whereas C5-C6 (P = 0.756) fusions were found to have similar degrees of anterior subsidence in the multivariable analysis.

Conclusion: We found upper cervical levels experienced a smaller degree of anterior subsidence than lower levels, after controlling for demographic and implant characteristics. Surgeons can consider using larger cages at lower cervical levels to minimize these risks.

研究设计回顾性队列研究:本研究旨在评估前路颈椎椎间盘切除融合术(ACDF)术后融合的颈椎水平与下沉程度之间的关系:背景:ACDF术后下沉可能会恶化临床效果。背景:ACDF术后的沉降可能会恶化临床预后。以前的研究表明,颈椎水平越低,沉降率越高,但没有研究对不同水平之间的相对沉降程度进行量化:本研究纳入了 2016 年至 2021 年期间在一家三级医疗中心接受 ACDF 治疗的患者。使用术后即刻和最终随访的颈椎侧位X光片计算下沉程度。方差分析用于研究融合的颈椎级别与下沉之间的关系。多变量线性回归分析控制了年龄、性别、吸烟状况、骨质疏松症/骨质疏松症、融合水平数、骨笼与身体比率和骨笼类型,同时研究了颈椎融合水平与下沉之间的关系:这项研究包括122名接受了227个椎间融合术的患者。其中 16 例(7.0%)进行了 C3-C4 融合术,55 例(24.2%)进行了 C4-C5 融合术,97 例(42.7%)进行了 C5-C6 融合术,59 例(26.0%)进行了 C6-C7 融合术。不同颈椎水平融合后的前方下陷程度存在明显差异(P = 0.013),C3-C4融合后的平均下陷程度为1.0毫米(标度:1.6),C4-C5融合后的平均下陷程度为1.1毫米(标度:1.4),C5-C6融合后的平均下陷程度为1.8毫米(标度:1.5),C6-C7融合后的平均下陷程度为1.8毫米(标度:1.6)。与C6-C7融合术相比,C4-C5(P = 0.016)和C3-C4(P = 0.014)融合术与前方下陷减少有关,而C5-C6(P = 0.756)融合术在多变量分析中的前方下陷程度相似:结论:在控制了人口统计学和植入物特征后,我们发现上颈椎水平的前下沉程度小于下颈椎水平。外科医生可以考虑在颈椎下水平使用较大的固定架,以尽量减少这些风险。
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引用次数: 0
Minimally Invasive Transforaminal Versus Lateral Lumbar Interbody Fusion for Degenerative Spinal Pathology: Clinical Outcome Comparison in Patients With Predominant Back Pain. 微创经椎间孔与侧腰椎椎间融合术治疗脊柱退行性病变:主要腰痛患者的临床效果比较。
IF 1.6 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-25 DOI: 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 χ2 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 χ2 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/m2, and the majority of the included cohort were nondiabetic and nonhypertensive. No significant demographic differences were noted
在 12 周的时间点上,背痛和残疾的平均结果评分更倾向于侧向方法,同时在该时间点上,身体功能的 MCID 达标率也更高。
{"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":"https://doi.org/10.1097/BSD.0000000000001631","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;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 &gt; 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 χ2 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 χ2 analysis. Statistical significance was noted as a P value &lt;0.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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/m2, and the majority of the included cohort were nondiabetic and nonhypertensive. No significant demographic differences were noted","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-25","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}
引用次数: 0
Dynamic Instability Is Underestimated on Standing Flexion-Extension Films When Compared With Prone CT Imaging. 与俯卧位 CT 成像相比,站立屈伸位片上的动态不稳定性被低估了。
IF 1.6 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-25 DOI: 10.1097/BSD.0000000000001725
Michael C Chiang, Albert Jiao, Melvin C Makhni, Jacob C Mandell, Zacharia Isaac

Study design/setting: Single center retrospective cohort study.

Objective: We performed a retrospective study evaluating the incidence and degree of L4-5 anterior spondylolisthesis in patients with standard supine MRI, standing flexion-extension radiographs, and prone CT. We hypothesize that prone CT imaging will provide greater sensitivity for instability compared with conventional flexion extension or supine positions.

Summary of background data: Dynamic lumbar instability evaluated by flexion-extension radiographs may underestimate the degree of lumbar spondylolisthesis. Despite efforts to characterize dynamic instability, significant variability remains in current guidelines regarding the most appropriate imaging modalities to adequately evaluate instability.

Methods: We assessed single-level (L4-5) anterolisthesis between 2014 and 2022 with standing lateral conventional radiographs (CR), flexion-extension images, prone CT images (CT), or supine MRI images (MRI).

Results: We identified 102 patients with L4-5 anterolisthesis. The average translation (±SD) measured were 4.9±2.2 mm (CR), 2.5±2.6 mm (CT), and 3.7±2.6 mm (MRI) (P<0.001). The mean difference in anterolisthesis among imaging modalities was 2.7±1.8 mm between CR and CT (P<0.001), 1.8±1.4 mm between CR and MRI (P<0.001), and 1.6±1.4 mm between CT and MRI (P=0.252). Ninety-two of 102 patients (90.2%) showed greater anterolisthesis on CR compared with CT, 72 of 102 (70.6%) comparing CR to MRI, and 27 of 102 (26.5%) comparing CT to MRI. We found that 17.6% of patients exhibited ≥3 mm anterior translation comparing CR with MRI, whereas 38.2% of patients were identified comparing CR with CT imaging (χ2 test P=0.0009, post hoc Fisher exact test P=0.0006 between CR and CT). Only 5.9% of patients had comparable degrees of instability between flexion-standing.

Conclusions: Prone CT imaging revealed the greatest degree of single L4-5 segmental instability compared with flexion-extension radiographs.

研究设计/设置:单中心回顾性队列研究:我们进行了一项回顾性研究,通过标准仰卧位核磁共振成像、站立屈伸位X光片和俯卧位CT,评估患者L4-5前椎体滑脱的发生率和程度。我们假设,与传统的屈伸位或仰卧位相比,俯卧位 CT 成像对不稳定性的敏感性更高:背景数据摘要:通过屈伸X光片评估腰椎动态不稳定性可能会低估腰椎滑脱的程度。尽管在描述动态不稳定性方面做出了努力,但目前关于最适合充分评估不稳定性的成像模式的指南仍存在很大差异:2014年至2022年期间,我们通过立位侧位常规X光片(CR)、屈伸影像、俯卧位CT影像(CT)或仰卧位MRI影像(MRI)对单水平(L4-5)前椎体滑脱进行了评估:我们确定了 102 名 L4-5 椎体前凸患者。测量到的平均平移量(±SD)分别为 4.9±2.2毫米(CR)、2.5±2.6毫米(CT)和3.7±2.6毫米(MRI)(PC结论:与屈伸位X光片相比,俯卧位CT成像显示L4-5单节段不稳定的程度最大。
{"title":"Dynamic Instability Is Underestimated on Standing Flexion-Extension Films When Compared With Prone CT Imaging.","authors":"Michael C Chiang, Albert Jiao, Melvin C Makhni, Jacob C Mandell, Zacharia Isaac","doi":"10.1097/BSD.0000000000001725","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001725","url":null,"abstract":"<p><strong>Study design/setting: </strong>Single center retrospective cohort study.</p><p><strong>Objective: </strong>We performed a retrospective study evaluating the incidence and degree of L4-5 anterior spondylolisthesis in patients with standard supine MRI, standing flexion-extension radiographs, and prone CT. We hypothesize that prone CT imaging will provide greater sensitivity for instability compared with conventional flexion extension or supine positions.</p><p><strong>Summary of background data: </strong>Dynamic lumbar instability evaluated by flexion-extension radiographs may underestimate the degree of lumbar spondylolisthesis. Despite efforts to characterize dynamic instability, significant variability remains in current guidelines regarding the most appropriate imaging modalities to adequately evaluate instability.</p><p><strong>Methods: </strong>We assessed single-level (L4-5) anterolisthesis between 2014 and 2022 with standing lateral conventional radiographs (CR), flexion-extension images, prone CT images (CT), or supine MRI images (MRI).</p><p><strong>Results: </strong>We identified 102 patients with L4-5 anterolisthesis. The average translation (±SD) measured were 4.9±2.2 mm (CR), 2.5±2.6 mm (CT), and 3.7±2.6 mm (MRI) (P<0.001). The mean difference in anterolisthesis among imaging modalities was 2.7±1.8 mm between CR and CT (P<0.001), 1.8±1.4 mm between CR and MRI (P<0.001), and 1.6±1.4 mm between CT and MRI (P=0.252). Ninety-two of 102 patients (90.2%) showed greater anterolisthesis on CR compared with CT, 72 of 102 (70.6%) comparing CR to MRI, and 27 of 102 (26.5%) comparing CT to MRI. We found that 17.6% of patients exhibited ≥3 mm anterior translation comparing CR with MRI, whereas 38.2% of patients were identified comparing CR with CT imaging (χ2 test P=0.0009, post hoc Fisher exact test P=0.0006 between CR and CT). Only 5.9% of patients had comparable degrees of instability between flexion-standing.</p><p><strong>Conclusions: </strong>Prone CT imaging revealed the greatest degree of single L4-5 segmental instability compared with flexion-extension radiographs.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496367","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}
引用次数: 0
Risk Factors for Adjacent Vertebral Fractures Following Cement Vertebroplasty: The Clinical Significance of Multiple Preexisting Vertebral Compression Fractures. 骨水泥椎体成形术后邻近椎体骨折的风险因素:已有多处椎体压缩性骨折的临床意义。
IF 1.6 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-24 DOI: 10.1097/BSD.0000000000001718
Po-Hao Huang, Chih-Wei Chen, Ming-Hsiao Hu, Shu-Hua Yang, Chuan-Ching Huang

Study design: A retrospective cohort study.

Objective: The study retrospectively analyzed the factors associated with the development of adjacent vertebral fractures.

Summary of background data: Adjacent vertebral fractures (AVF) may occur following cement vertebroplasty, and several risk factors have been reported with controversies.

Methods: A total of 123 patients, with a mean age of 79.2 years, who underwent single-level vertebroplasty were included in the investigation. We systematically collected data encompassing baseline demographics, osteoporosis parameters, surgical details, radiologic measurements, and Hounsfield unit (HU) values in the lumbar spine. Subsequently, univariable, followed by multivariable logistic regression analyses, were employed to identify the risk factors of AVFs.

Results: Thirty of 123 patients had AVFs within 6 months following vertebroplasty. The AVF group exhibited a higher percentage of multiple preexisting vertebral compression fractures (P=0.006), a greater volume of injected cement (P=0.032), and a more pronounced reduction in local kyphosis (P=0.007). Multivariable logistic regression analysis revealed multiple preexisting vertebral compression fractures and a reduction in local kyphosis exceeding 8 degrees were independent risk factors for AVFs (P=0.008 and 0.003, respectively), with odds ratios of 3.78 (95% confidence interval: 1.41-10.12) and 4.16 (95% CI: 1.65-10.50), respectively. Subgroup analysis showed that patients with multiple preexisting vertebral compression fractures (VCFs) had significantly lower bone mineral density Z-score, T-score, and HU values compared with those without preexisting VCFs (P<0.05). Conversely, there were no significant differences in T-score or HU values between patients with no VCFs and those with a single VCF.

Conclusion: This study demonstrated that both bone strength and local alignment are key factors associated with adjacent vertebral fractures. Specifically, having multiple preexisting vertebral compression fractures and a reduction in local kyphosis exceeding 8 degrees are independent risk factors. The presence of more than one previous vertebral compression fracture serves as a significant clinical indicator of advanced bone density reduction in patients with osteoporosis, offering a quick and straightforward method for identifying high-risk patients. Patients exhibiting these risk factors should be monitored more closely for favorable clinical outcomes.

Level of evidence: Level III-retrospective nonexperimental study.

研究设计回顾性队列研究:研究回顾性分析了邻近椎体骨折发生的相关因素:骨水泥椎体成形术后可能会发生邻近椎体骨折(AVF),有报道称几种风险因素存在争议:调查对象包括 123 名接受单层椎体成形术的患者,平均年龄 79.2 岁。我们系统地收集了包括基线人口统计学、骨质疏松症参数、手术细节、放射学测量和腰椎的 Hounsfield 单位(HU)值在内的数据。随后,研究人员采用单变量和多变量逻辑回归分析来确定动静脉瘘的风险因素:结果:123 例患者中有 30 例在椎体成形术后 6 个月内出现 AVF。AVF组患者在术前存在多发性椎体压缩骨折的比例更高(P=0.006),注入的骨水泥量更大(P=0.032),局部椎体后凸的减少更明显(P=0.007)。多变量逻辑回归分析显示,既往多发性椎体压缩骨折和局部后凸减少超过8度是AVFs的独立风险因素(P=0.008和0.003),几率比分别为3.78(95%置信区间:1.41-10.12)和4.16(95% CI:1.65-10.50)。亚组分析显示,与没有椎体压缩性骨折(VCFs)的患者相比,有多处椎体压缩性骨折(VCFs)的患者的骨矿物质密度 Z 值、T 值和 HU 值明显较低(结论:该研究表明,骨强度和骨密度均可影响椎体压缩性骨折(VCFs)的发生:本研究表明,骨强度和局部排列是与邻近椎体骨折相关的关键因素。具体来说,既往存在多处椎体压缩性骨折和局部后凸减少超过 8 度是独立的风险因素。曾有过一次以上的椎体压缩性骨折是骨质疏松症患者骨密度降低晚期的一个重要临床指标,为识别高危患者提供了一种快速、直接的方法。应更密切地监测有这些风险因素的患者,以获得良好的临床结果:III级--回顾性非实验研究。
{"title":"Risk Factors for Adjacent Vertebral Fractures Following Cement Vertebroplasty: The Clinical Significance of Multiple Preexisting Vertebral Compression Fractures.","authors":"Po-Hao Huang, Chih-Wei Chen, Ming-Hsiao Hu, Shu-Hua Yang, Chuan-Ching Huang","doi":"10.1097/BSD.0000000000001718","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001718","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cohort study.</p><p><strong>Objective: </strong>The study retrospectively analyzed the factors associated with the development of adjacent vertebral fractures.</p><p><strong>Summary of background data: </strong>Adjacent vertebral fractures (AVF) may occur following cement vertebroplasty, and several risk factors have been reported with controversies.</p><p><strong>Methods: </strong>A total of 123 patients, with a mean age of 79.2 years, who underwent single-level vertebroplasty were included in the investigation. We systematically collected data encompassing baseline demographics, osteoporosis parameters, surgical details, radiologic measurements, and Hounsfield unit (HU) values in the lumbar spine. Subsequently, univariable, followed by multivariable logistic regression analyses, were employed to identify the risk factors of AVFs.</p><p><strong>Results: </strong>Thirty of 123 patients had AVFs within 6 months following vertebroplasty. The AVF group exhibited a higher percentage of multiple preexisting vertebral compression fractures (P=0.006), a greater volume of injected cement (P=0.032), and a more pronounced reduction in local kyphosis (P=0.007). Multivariable logistic regression analysis revealed multiple preexisting vertebral compression fractures and a reduction in local kyphosis exceeding 8 degrees were independent risk factors for AVFs (P=0.008 and 0.003, respectively), with odds ratios of 3.78 (95% confidence interval: 1.41-10.12) and 4.16 (95% CI: 1.65-10.50), respectively. Subgroup analysis showed that patients with multiple preexisting vertebral compression fractures (VCFs) had significantly lower bone mineral density Z-score, T-score, and HU values compared with those without preexisting VCFs (P<0.05). Conversely, there were no significant differences in T-score or HU values between patients with no VCFs and those with a single VCF.</p><p><strong>Conclusion: </strong>This study demonstrated that both bone strength and local alignment are key factors associated with adjacent vertebral fractures. Specifically, having multiple preexisting vertebral compression fractures and a reduction in local kyphosis exceeding 8 degrees are independent risk factors. The presence of more than one previous vertebral compression fracture serves as a significant clinical indicator of advanced bone density reduction in patients with osteoporosis, offering a quick and straightforward method for identifying high-risk patients. Patients exhibiting these risk factors should be monitored more closely for favorable clinical outcomes.</p><p><strong>Level of evidence: </strong>Level III-retrospective nonexperimental study.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496371","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}
引用次数: 0
Evaluation of the Efficacy and Safety of FFX Facet Cages Compared With Pedicle Screw Fixation in Patients With Lumbar Spinal Stenosis: A Long-Term Study. 腰椎管狭窄症患者使用 FFX 椎板面固定架与椎弓根螺钉固定术的疗效和安全性评估:一项长期研究
IF 1.6 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-15 DOI: 10.1097/BSD.0000000000001704
Omar Houari, Arnaud Douanla, Mehdi Ben Ammar, Mustapha Benmekhbi, Jihad Mortada, Gabriel Lungu, Cristian Magheru, Jimmy Voirin, Pablo Ariel Lebedinsky, Mariano Musacchio, Federico Bolognini, Robin Srour

Study design: Hybrid retrospective/prospective study.

Objective: The study evaluated the long-term safety and efficacy of the FFX facet cage versus pedicle screw (PS) fixation in patients with lumbar spinal stenosis (LSS).

Summary of background data: A previous single-arm study reported on the safety, fusion rate, and patient outcomes associated with the use of the FFX facet cage in patients with lumbar spinal stenosis. There are no long-term studies reporting outcomes with this device compared with the use of pedicle screw fixation.

Methods: Following a medical records review, subjects meeting the inclusion and exclusion criteria were consented to and enrolled in the prospective arm of the study. CT scans and dynamic X-rays were performed to assess fusion rates, range of motion, and translation. Adverse events during the 2-year post-index procedure were also analyzed. Preoperative and 2+ year Visual Analogue Scale (VAS) back and leg scores and Oswestry Disability Index (ODI) were also obtained.

Results: A total of 112 subjects were enrolled with 56 patients included in the PS and FFX groups. Mean age was 63.1±11.2 and 67.1±10.9 years and the mean number of levels operated was 1.8±0.8 and 2.3±1.0, respectively, for the PS and FFX groups. There was no difference between the 2 groups for the primary composite fusion endpoint assessed with the FFX group achieving a 91% bony facet fusion rate. There was also no difference in postoperative complications or adverse events during the 2-year follow-up period. A higher percentage of patients in the PS group (10.7%) required reoperation compared with the FFX group (3.6%). Although both groups experienced significant improvements in VAS and ODI scores versus preoperative assessment, there was no difference between the 2 groups.

Conclusion: The present study documents the long-term safety and efficacy of the FFX device in patients with LSS with a reduction in reoperation rate when compared with PS fixation.

Level of evidence: Level III.

研究设计回顾性/前瞻性混合研究:该研究评估了腰椎管狭窄症(LSS)患者使用 FFX 椎面骨架与椎弓根螺钉(PS)固定的长期安全性和有效性:之前的一项单臂研究报告了腰椎管狭窄症患者使用 FFX 椎板骨架的安全性、融合率和患者预后。与使用椎弓根螺钉固定相比,目前还没有关于该设备疗效的长期研究报告:经过病历审查,符合纳入和排除标准的受试者同意并加入前瞻性研究。通过 CT 扫描和动态 X 光检查评估融合率、活动范围和平移。此外,还对指标术后两年内的不良事件进行了分析。此外,还获得了术前和术后2年以上的视觉模拟量表(VAS)背部和腿部评分以及Oswestry残疾指数(ODI):结果:共有 112 名受试者参加,其中 PS 组和 FFX 组共有 56 名患者。PS 组和 FFX 组的平均年龄分别为(63.1±11.2)岁和(67.1±10.9)岁,平均手术层数分别为(1.8±0.8)层和(2.3±1.0)层。两组的主要复合融合终点评估结果无差异,FFX 组的骨面融合率达到 91%。在为期两年的随访期间,两组在术后并发症或不良事件方面也没有差异。PS 组需要再次手术的患者比例(10.7%)高于 FFX 组(3.6%)。尽管与术前评估相比,两组患者的VAS和ODI评分均有明显改善,但两组之间并无差异:本研究证实了FFX装置在LSS患者中的长期安全性和有效性,与PS固定相比,FFX装置降低了再手术率:证据等级:三级。
{"title":"Evaluation of the Efficacy and Safety of FFX Facet Cages Compared With Pedicle Screw Fixation in Patients With Lumbar Spinal Stenosis: A Long-Term Study.","authors":"Omar Houari, Arnaud Douanla, Mehdi Ben Ammar, Mustapha Benmekhbi, Jihad Mortada, Gabriel Lungu, Cristian Magheru, Jimmy Voirin, Pablo Ariel Lebedinsky, Mariano Musacchio, Federico Bolognini, Robin Srour","doi":"10.1097/BSD.0000000000001704","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001704","url":null,"abstract":"<p><strong>Study design: </strong>Hybrid retrospective/prospective study.</p><p><strong>Objective: </strong>The study evaluated the long-term safety and efficacy of the FFX facet cage versus pedicle screw (PS) fixation in patients with lumbar spinal stenosis (LSS).</p><p><strong>Summary of background data: </strong>A previous single-arm study reported on the safety, fusion rate, and patient outcomes associated with the use of the FFX facet cage in patients with lumbar spinal stenosis. There are no long-term studies reporting outcomes with this device compared with the use of pedicle screw fixation.</p><p><strong>Methods: </strong>Following a medical records review, subjects meeting the inclusion and exclusion criteria were consented to and enrolled in the prospective arm of the study. CT scans and dynamic X-rays were performed to assess fusion rates, range of motion, and translation. Adverse events during the 2-year post-index procedure were also analyzed. Preoperative and 2+ year Visual Analogue Scale (VAS) back and leg scores and Oswestry Disability Index (ODI) were also obtained.</p><p><strong>Results: </strong>A total of 112 subjects were enrolled with 56 patients included in the PS and FFX groups. Mean age was 63.1±11.2 and 67.1±10.9 years and the mean number of levels operated was 1.8±0.8 and 2.3±1.0, respectively, for the PS and FFX groups. There was no difference between the 2 groups for the primary composite fusion endpoint assessed with the FFX group achieving a 91% bony facet fusion rate. There was also no difference in postoperative complications or adverse events during the 2-year follow-up period. A higher percentage of patients in the PS group (10.7%) required reoperation compared with the FFX group (3.6%). Although both groups experienced significant improvements in VAS and ODI scores versus preoperative assessment, there was no difference between the 2 groups.</p><p><strong>Conclusion: </strong>The present study documents the long-term safety and efficacy of the FFX device in patients with LSS with a reduction in reoperation rate when compared with PS fixation.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459728","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}
引用次数: 0
Removal of Retro-Corporeal Compressive Pathology Using Guttering Osteotomy During Anterior Cervical Discectomy and Fusion. 在前路颈椎椎间盘切除和融合术中使用沟槽截骨术清除后路压迫性病变
IF 1.6 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-02 DOI: 10.1097/BSD.0000000000001679
Dong-Ho Lee, Chang Ju Hwang, Jae Hwan Cho, Sehan Park

Study design: A retrospective cohort study.

Objective: Guttering is a technique that creates a tunnel through the vertebral body adjacent to the endplate to remove compressive pathologies behind the vertebral body during anterior cervical discectomy and fusion (ACDF). In this study, we investigated cases of patients who underwent gutter-shaped osteotomy (guttering) to decompress retro-corporeal compressive lesions.

Summary of background data: Retro-corporeal pathologies causing cord compression cannot be removed using conventional ACDF.

Materials and methods: A total of 217 patients who underwent ACDF to treat cervical myelopathy and were followed up for ≥1 year were retrospectively reviewed. The fusion rate, subsidence, neck pain visual analog scale (VAS), arm pain VAS, and neck disability index (NDI) were assessed. Results were compared between the guttering (patients for whom guttering was performed) and nonguttering (patients for whom guttering was not performed) groups.

Results: Thirty-five patients (16.1%) were included in the guttering group, while 182 patients (83.8%) were included in the nonguttering group. Fusion rates assessed by interspinous motion (P=0.559) and bone bridging on computed tomography (CT) (P=0.541 and 0.715, respectively) were not significantly different between the 2 groups at 1 year after surgery. Furthermore, neck pain VAS (P=0.492), arm pain VAS (P=0.099), and NDI (P=1.000) 1 year after surgery did not demonstrate significant intergroup differences. All patients in the guttering group exhibited healed guttering on 1-year postsurgery CT.

Conclusions: Guttering as an adjunct to ACDF could provide a more expansive workspace for complete decompression when compressive pathology extends retrocorporeal. This additional bone resection is not associated with increased pseudarthrosis or subsidence or related to aggravation of patient symptoms.

Level of evidence: Level III.

研究设计回顾性队列研究:在颈椎前路椎间盘切除与融合术(ACDF)中,开槽术是一种在椎体邻近终板处开凿隧道以清除椎体后压迫性病变的技术。在这项研究中,我们调查了接受椎间沟形截骨术(椎间沟截骨术)对椎体后压迫性病变进行减压的患者病例:背景资料概要:传统的 ACDF 无法去除导致脊髓压迫的体腔后病变:回顾性分析了217例接受ACDF治疗颈椎病并随访≥1年的患者。评估了融合率、沉降、颈部疼痛视觉模拟量表(VAS)、手臂疼痛视觉模拟量表(VAS)和颈部残疾指数(NDI)。比较了开槽组(进行了开槽手术的患者)和未开槽组(未进行开槽手术的患者)的结果:结果:35 名患者(16.1%)被纳入开槽组,182 名患者(83.8%)被纳入未开槽组。术后1年,两组患者通过棘突间运动(P=0.559)和计算机断层扫描(CT)骨桥接(分别为P=0.541和0.715)评估的融合率无明显差异。此外,术后 1 年的颈部疼痛 VAS(P=0.492)、手臂疼痛 VAS(P=0.099)和 NDI(P=1.000)也未显示出明显的组间差异。在术后1年的CT检查中,所有沟槽组患者的沟槽均已愈合:结论:当压迫性病理延伸至体外时,作为 ACDF 的辅助手段,开槽术可为完全减压提供更广阔的工作空间。这种额外的骨切除与假关节增加或下沉无关,也与患者症状加重无关:证据等级:三级。
{"title":"Removal of Retro-Corporeal Compressive Pathology Using Guttering Osteotomy During Anterior Cervical Discectomy and Fusion.","authors":"Dong-Ho Lee, Chang Ju Hwang, Jae Hwan Cho, Sehan Park","doi":"10.1097/BSD.0000000000001679","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001679","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cohort study.</p><p><strong>Objective: </strong>Guttering is a technique that creates a tunnel through the vertebral body adjacent to the endplate to remove compressive pathologies behind the vertebral body during anterior cervical discectomy and fusion (ACDF). In this study, we investigated cases of patients who underwent gutter-shaped osteotomy (guttering) to decompress retro-corporeal compressive lesions.</p><p><strong>Summary of background data: </strong>Retro-corporeal pathologies causing cord compression cannot be removed using conventional ACDF.</p><p><strong>Materials and methods: </strong>A total of 217 patients who underwent ACDF to treat cervical myelopathy and were followed up for ≥1 year were retrospectively reviewed. The fusion rate, subsidence, neck pain visual analog scale (VAS), arm pain VAS, and neck disability index (NDI) were assessed. Results were compared between the guttering (patients for whom guttering was performed) and nonguttering (patients for whom guttering was not performed) groups.</p><p><strong>Results: </strong>Thirty-five patients (16.1%) were included in the guttering group, while 182 patients (83.8%) were included in the nonguttering group. Fusion rates assessed by interspinous motion (P=0.559) and bone bridging on computed tomography (CT) (P=0.541 and 0.715, respectively) were not significantly different between the 2 groups at 1 year after surgery. Furthermore, neck pain VAS (P=0.492), arm pain VAS (P=0.099), and NDI (P=1.000) 1 year after surgery did not demonstrate significant intergroup differences. All patients in the guttering group exhibited healed guttering on 1-year postsurgery CT.</p><p><strong>Conclusions: </strong>Guttering as an adjunct to ACDF could provide a more expansive workspace for complete decompression when compressive pathology extends retrocorporeal. This additional bone resection is not associated with increased pseudarthrosis or subsidence or related to aggravation of patient symptoms.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361235","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}
引用次数: 0
Does Epidural Corticosteroid Application During Spinal Surgery Reduce Postoperative Pain?: An Adjunct to Multimodal Analgesia. 脊柱手术中硬膜外皮质类固醇的应用能减轻术后疼痛吗?多模式镇痛的辅助手段。
IF 1.6 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-03-05 DOI: 10.1097/BSD.0000000000001586
Hyun Song, Charles Edwards, Ryan Curto, Alejandro Perez, Cailin Cruess, Adam Schell, Justin Park

Study design: A prospective, randomized, placebo-controlled, double-blinded study.

Objective: To examine the effect of intraoperative epidural administration of Depo-Medrol on postoperative back pain and radiculitis symptoms in patients undergoing Transforaminal Lumbar Interbody Fusion (TLIF).

Summary of background data: Postoperative pain is commonly experienced by patients undergoing spinal fusion surgery. Adequate management of intense pain is necessary to encourage early ambulation, increase patient satisfaction, and limit opioid consumption. Intraoperative steroid application has been shown to improve postoperative pain in patients undergoing lumbar decompression surgeries. There have been no studies examining the effect of epidural steroids on both back pain and radicular pain in patients undergoing TLIF.

Method: In all, 151 patients underwent TLIF surgery using rh-BMP2 with 3 surgeons at a single institution. Of those, 116 remained in the study and were included in the final analysis. Based on a 1:1 randomization, a collagen sponge saturated with either Saline (1 cc) or Depo-Medrol (40 mg/1 cc) was placed at the annulotomy site on the TLIF level. Follow-up occurred on postoperative days 1, 2, 3, 7, and postoperative months 1, 2, and 3. Lumbar radiculopathy was measured by a modified symptom- and laterality-specific Visual Analog Scale (VAS) regarding the severity of back pain and common radiculopathy symptoms.

Results: The patients who received Depo-Medrol, compared with those who received saline, experienced significantly less back pain on postoperative days 1, 2, 3, and 7 ( P <0.05). There was no significant difference in back pain beyond day 7. Radiculopathy-related symptoms such as leg pain, numbness, tingling, stiffness, and weakness tended to be reduced in the steroid group at most time points.

Conclusion: This study provides Level 1 evidence that intraoperative application of Depo-Medrol during a TLIF surgery with rh-BMP2 significantly reduces back pain for the first week after TLIF surgery. The use of epidural Depo-Medrol may be a useful adjunct to multimodal analgesia for pain relief in the postoperative period.

研究设计前瞻性、随机、安慰剂对照、双盲研究:研究目的:探讨术中硬膜外注射甲泼尼龙(Depo-Medrol)对接受经椎间孔腰椎椎体融合术(TLIF)患者术后背痛和根管炎症状的影响:接受脊柱融合手术的患者通常会出现术后疼痛。有必要对剧烈疼痛进行适当处理,以鼓励患者尽早下床活动,提高患者满意度,并限制阿片类药物的用量。有研究表明,术中应用类固醇可改善腰椎减压手术患者的术后疼痛。目前还没有研究探讨硬膜外类固醇对接受 TLIF 患者的腰痛和根性疼痛的影响:方法:共有 151 名患者在一家医疗机构接受了由 3 名外科医生使用 rh-BMP2 进行的 TLIF 手术。其中,116 名患者仍留在研究中,并被纳入最终分析。根据 1:1 随机分配原则,在 TLIF 水平的瓣环切开部位放置饱和生理盐水(1 毫升)或 Depo-Medrol(40 毫克/1 毫升)的胶原海绵。术后第 1、2、3、7 天和术后第 1、2、3 个月进行了随访。腰椎病通过改良的症状和侧位特异性视觉模拟量表(VAS)来测量背痛和常见神经根病症状的严重程度:结果:与接受生理盐水治疗的患者相比,接受Depo-Medrol治疗的患者在术后第1、2、3和7天的背痛明显减轻:本研究提供了 1 级证据,证明在使用 rh-BMP2 的 TLIF 手术中,术中应用 Depo-Medrol 可明显减轻 TLIF 术后第一周的背痛。使用硬膜外去羟肌苷可能是术后缓解疼痛的多模式镇痛的有效辅助手段。
{"title":"Does Epidural Corticosteroid Application During Spinal Surgery Reduce Postoperative Pain?: An Adjunct to Multimodal Analgesia.","authors":"Hyun Song, Charles Edwards, Ryan Curto, Alejandro Perez, Cailin Cruess, Adam Schell, Justin Park","doi":"10.1097/BSD.0000000000001586","DOIUrl":"10.1097/BSD.0000000000001586","url":null,"abstract":"<p><strong>Study design: </strong>A prospective, randomized, placebo-controlled, double-blinded study.</p><p><strong>Objective: </strong>To examine the effect of intraoperative epidural administration of Depo-Medrol on postoperative back pain and radiculitis symptoms in patients undergoing Transforaminal Lumbar Interbody Fusion (TLIF).</p><p><strong>Summary of background data: </strong>Postoperative pain is commonly experienced by patients undergoing spinal fusion surgery. Adequate management of intense pain is necessary to encourage early ambulation, increase patient satisfaction, and limit opioid consumption. Intraoperative steroid application has been shown to improve postoperative pain in patients undergoing lumbar decompression surgeries. There have been no studies examining the effect of epidural steroids on both back pain and radicular pain in patients undergoing TLIF.</p><p><strong>Method: </strong>In all, 151 patients underwent TLIF surgery using rh-BMP2 with 3 surgeons at a single institution. Of those, 116 remained in the study and were included in the final analysis. Based on a 1:1 randomization, a collagen sponge saturated with either Saline (1 cc) or Depo-Medrol (40 mg/1 cc) was placed at the annulotomy site on the TLIF level. Follow-up occurred on postoperative days 1, 2, 3, 7, and postoperative months 1, 2, and 3. Lumbar radiculopathy was measured by a modified symptom- and laterality-specific Visual Analog Scale (VAS) regarding the severity of back pain and common radiculopathy symptoms.</p><p><strong>Results: </strong>The patients who received Depo-Medrol, compared with those who received saline, experienced significantly less back pain on postoperative days 1, 2, 3, and 7 ( P <0.05). There was no significant difference in back pain beyond day 7. Radiculopathy-related symptoms such as leg pain, numbness, tingling, stiffness, and weakness tended to be reduced in the steroid group at most time points.</p><p><strong>Conclusion: </strong>This study provides Level 1 evidence that intraoperative application of Depo-Medrol during a TLIF surgery with rh-BMP2 significantly reduces back pain for the first week after TLIF surgery. The use of epidural Depo-Medrol may be a useful adjunct to multimodal analgesia for pain relief in the postoperative period.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11421561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140048962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
AM-PAC Mobility Score <13 Predicts Development of Ileus Following Adult Spinal Deformity Surgery. AM-PAC 移动能力评分<13 分可预测成人脊柱畸形手术后发生回肠梗阻。
IF 1.6 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-03-14 DOI: 10.1097/BSD.0000000000001599
Jarod Olson, Kevin C Mo, Jessica Schmerler, Andrew B Harris, Jonathan S Lee, Richard L Skolasky, Khaled M Kebaish, Brian J Neuman

Study design: Retrospective review.

Objective: To determine whether the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" score is associated with the development of postoperative ileus.

Summary of background data: Adult spinal deformity (ASD) surgery has a high complication rate. One common complication is postoperative ileus, and poor postoperative mobility has been implicated as a modifiable risk factor for this condition.

Methods: Eighty-five ASD surgeries in which ≥5 levels were fused were identified in a single institution database. A physical therapist/physiatrist collected patients' daily postoperative AM-PAC scores, for which we assessed first, last, and daily changes. We used multivariable linear regression to determine the marginal effect of ileus on continuous AM-PAC scores; threshold linear regression with Bayesian information criterion to identify a threshold AM-PAC score associated with ileus; and multivariable logistic regression to determine the utility of the score thresholds when controlling for confounding variables.

Results: Ten of 85 patients (12%) developed ileus. The mean day of developing ileus was postoperative day 3.3±2.35. The mean first and last AM-PAC scores were 16 and 18, respectively. On bivariate analysis, the mean first AM-PAC score was lower in patients with ileus than in those without (13 vs. 16; P< 0.01). Ileus was associated with a first AM-PAC score of 3 points lower (Coef. -2.96; P< 0.01) than that of patients without ileus. Patients with an AM-PAC score<13 had 8 times greater odds of developing ileus ( P= 0.023). Neither the last AM-PAC score nor the daily change in AM-PAC score was associated with ileus.

Conclusions: In our institutional cohort, a first AM-PAC score of <13, corresponding to an inability to walk or stand for more than 1 minute, was associated with the development of ileus. Early identification of patients who cannot walk or stand after surgery can help determine which patients would benefit from prophylactic management.

Level of evidence: Level-III.

研究设计回顾性研究:确定急性期后护理活动测量(AM-PAC)"6-Clicks "评分是否与术后回肠梗阻的发生有关:成人脊柱畸形(ASD)手术的并发症发生率很高。背景数据摘要:成人脊柱畸形(ASD)手术的并发症发生率很高,其中一种常见的并发症是术后回肠梗阻,而术后活动度差被认为是导致这种情况的一个可改变的风险因素:方法:在一个单一机构的数据库中确定了85例融合≥5个层面的ASD手术。理疗师/物理治疗师收集了患者术后的每日AM-PAC评分,我们对其首次、最后一次和每日的变化进行了评估。我们使用多变量线性回归确定回肠对连续 AM-PAC 评分的边际效应;使用贝叶斯信息标准进行阈值线性回归确定与回肠相关的 AM-PAC 评分阈值;使用多变量逻辑回归确定在控制混杂变量时评分阈值的效用:85名患者中有10人(12%)出现回肠梗阻。发生回肠梗阻的平均天数为术后第 3.3±2.35 天。首次和最后一次 AM-PAC 评分的平均值分别为 16 分和 18 分。双变量分析显示,有回肠的患者首次AM-PAC平均得分低于无回肠的患者(13 vs. 16;PC结论:在我们医院的队列中,AM-PAC 首次评分的证据等级为三级:三级。
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引用次数: 0
期刊
Clinical Spine Surgery
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