Clinical Spine Surgery最新文献

Study design: Retrospective cohort study.

Objective: The purpose of this study is to investigate the impact of language-discordant spine care. Specifically, do non-English speakers (NES) experience (1) increased length of stay? (2) increased rates of complications (ie, intra/perioperative complications, revision surgery, reoperation)?

Background: To provide the best care, there exists a growing focus on understanding which patient groups may be at greater risk for poorer outcomes. In the current body of orthopedic and spine literature, there is little data regarding outcomes for patients where there is language discordance between the physician and patient.

Patients and methods: This is a retrospective cohort study. Patients who underwent spine surgery at a single institution between 2017 and 2023 were included. Translator usage was used as a proxy for poor English language proficiency. Patient demographic and outcome data were collected from the electronic medical record. Patients were matched on surgical and demographic factors and analyzed for outcome variables. Multivariable logistic regressions were run to assess variables associated with poor outcomes.

Results: A total of 214 NES and 9217 English speakers (ES) were reviewed. The final matched cohort resulted in 158 NES and 313 ES with no differences in demographic data. NES patients had significantly more postoperative visits (2.19 vs 1.73; P < 0.001) and increased readmission rates (0.96% vs 4.43%; P = 0.033). On multivariable analysis, NES were predictive of readmission (OR = 4.22; P = 0.039).

Conclusion: Patients with low English proficiency experienced significantly higher rates of readmissions following spine surgery. These patients may benefit from increased and more effective preoperative and postoperative communication.

Level of evidence: Level IV.

Study design: Retrospective Cohort Study of National Database.

Objective: This study examines their effect on medical and mechanical complications within 90 days postlumbar spine surgery.

Summary of background data: Patients undergoing spinal procedures increasingly use glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally for type 2 diabetes and now popular for weight loss. The impact of GLP-1 RAs on spinal fusion outcomes is unknown.

Methods: This study used medical records from TriNetX, a national deidentified database, to examine diabetic patients undergoing lumbar spine procedures. Patients receiving GLP-1 RAs within 6 months preoperatively were compared with a propensity-matched control group. Propensity score matching (1:1) controlled for demographic factors and comorbidities, including type I and II diabetes, metformin use, and BMI. The study analyzed 90-day medical and 1-year implant complications using χ 2 exact tests and univariate regression in a propensity-matched cohort.

Results: The GLP-1 RA cohort and control group included 1110 and 151,440 patients, respectively. Of these, 1090 patients were propensity-matched 1:1 in each cohort. Within 90 days postoperatively, the GLP-1 RA group had higher rates of all-cause anemia (9.4% vs. 7.0%, P =0.016), renal failure (4.4% vs. 2.9%, P =0.028), opioid use (94% vs. 89%, P <0.001), emergency room visits (16% vs. 13%, P =0.013), and wound complications (0.5% vs. 0.2%, P <0.001). Other complications, such as infections, myocardial infarction, pulmonary embolism, deep vein thrombosis, hypoglycemic events, stroke, hospitalization, pneumonia, and transfusion, were similar between groups. One year postoperatively, pseudoarthrosis was less frequent in the GLP-1 RA group (12% vs. 16%, P =0.002). There were no significant differences in hospitalization, adjacent segment disease, mechanical loosening, or postlaminectomy syndrome.

Conclusion: This study found that the risk of complications in patients receiving GLP-1 RAs before lumbar spine surgery is comparable to control patients, suggesting GLP-1 RAs do not increase adverse outcomes and should not exclude patients from surgery.

Level of evidence: Level III-therapeutic study.

Study design: Retrospective case series study.

Objective: To evaluate the safety and efficacy of bilateral-contralateral decompression using unilateral biportal endoscopy (UBE) for treating adjacent segment disease (ASD) after lumbar interbody fusion (LIF).

Summary of background data: ASD is a well-documented complication following LIF, often requiring additional surgical interventions. Traditional decompression techniques risk damaging the facet joints, potentially leading to further instability and degeneration. However, our bilateral-contralateral decompression using UBE focuses on minimizing facet joint resection and reducing the risk of postoperative instability.

Methods: This study included 37 patients who underwent bilateral-contralateral UBE decompression for ASD following LIF at the L4-5 level between September 2020 and March 2022. Radiographic evaluations included measurements of vertebral range of motion (ROM), slip distance, disk height, lumbar lordosis, and facet joint preservation. Clinical assessments were performed using the visual analog scale (VAS) for back and leg pain and the Oswestry disability index (ODI).

Results: The average final follow-up period was 14.5±1.9 mo. The average preoperative ROM was 3.0 degrees, which significantly increased to 4.8° at the final follow-up ( P <0.05). Static structure and dynamic stability parameters, including the vertebral slip distance, lumbar lordosis, and disk height, showed no significant differences between the preoperative examination and 1-year postoperative follow-up. The facet joint preservation rate was 97.4±2.1% on average. Significant improvements in VAS scores for leg and back pain and ODI were observed. Despite improvement with conservative treatment in 7 patients with delayed instability, 2 patients required fusion surgery.

Conclusions: Bilateral-contralateral decompression through UBE has proven to be an effective and safe method for treating ASD following LIF. This technique is particularly suitable for patients requiring spinal stability maintenance. The high rates of facet joint preservation and low incidence of reoperation highlight this technique as a compelling alternative treatment for spinal stenosis.

Level of evidence: Level III.

Study design: Retrospective study.

Objective: To investigate the relationship between a number of preoperative cervical foraminal stenoses and postoperative ROM in cervical laminoplasty patients.

Summary of background data: Several concerns exist, such as upper extremity palsy, kyphosis, axial neck pain, and ROM changes after laminoplasty. Preoperative foraminal stenosis is a known risk factor for upper extremity palsy and kyphosis after laminoplasty.

Methods: Open-door laminoplasty patients with cervical myelopathy between January 2007 and September 2021 were included. Foraminal stenosis was evaluated using MRI T2-weighted images of the axial cut. The number of foraminal stenoses was counted among 10 foramina from C3/C4 to C7/T1, and the study population was divided into 2 groups based on the number of foraminal stenoses. Groups A and B comprised individuals with <4 and 4 or more foraminal stenoses, respectively. ROM was measured through flexion and extension view plain lateral radiography using Cobb method. NDI and VAS scores were used to assess clinical symptoms. Cervical spondylosis was assessed with Cervical Degenerative Index (CDI) factor scoring system. Statistical analyses were performed using 2-sample t test, χ 2 test, and linear mixed model.

Results: Sixty-three patients (group A, 27; group B, 36) were analyzed. NDI score after 1 year was 18.33 and 19.29 in groups A and B ( P =0.027). Regarding neck pain, VAS score after 3 years of surgery was 1.55 in group A and 3.94 in group B ( P =0.043). Flexion and total ROM in group A, 3 years post-surgery were 24.59 and 36.2 degrees, and group B had values of 16.04 and 24.98 degrees, respectively ( P =0.014). Three years after surgery, ROM preservation ratio was 89% in group A and 66% in group B ( P =0.013). On the basis of the CDI factor scoring system, difference of average between groups was 1.02 ( P =0.081).

Conclusions: A greater number of foraminal stenoses results in a reduction in ROM after laminoplasty.

Level of evidence: Level III.

Study design: This is a retrospective cohort study.

Objective: To evaluate the combined modified percutaneous short-segment posterior instrumentation technique by reducing and fixating the thoracolumbar burst fracture and checking the efficacy of indirect spinal decompression using intraoperative CT. This study aims to (1) demonstrate that using modified percutaneous short-segment posterior instrumentation is enough to rebuild spinal stability and decompress the spinal stenosis for thoracolumbar burst fracture and (2) prove the effects of spinal canal decompression by intraoperative portable CT with the surgical technique.

Summary of background data: Various posterior instrumentation methods have been used to treat thoracolumbar burst fractures and decompress retropulsed bony fragments through ligamentotaxis, but no studies have assessed the efficacy of combining percutaneous short-segment posterior instrumentation with intraoperative CT.

Methods: Using modified percutaneous short-segment posterior instrumentation to rebuild the spinal stability and ligamentotaxis effect to indirect decompression of the spinal stenosis without laminectomy and check parameters immediately after surgery by real-time intraoperative portable CT.

Results: Fifty-seven patients with thoracolumbar burst fractures underwent modified percutaneous short-segment posterior instrumentation from 2018 to 2023 at a single medical center. Mean injured vertebral canal dimension increased from 90.8±26.3 to 122.1±30.3 mm 2 ( P <0.05) and mean canal encroachment index decreased from 44.8±9.5% to 25.6±4.8% ( P <0.05), the anterior body height increased from 13.9±3.8 to 25.9±3.9 mm ( P <0.01) and kyphotic angle decreased from 27.3±3.2 to 8.6±2.1 degrees ( P <0.01). Neurological function was improved by at least 1 Frankel grade in neurological deficit patients. No significant difference in kyphotic angle between post-op and 6-month follow-up.

Conclusions: Indirect decompression of the spinal canal with modified percutaneous short-segment fixation without laminectomy was an effective treatment for thoracolumbar burst fracture, even in selected incomplete neurological deficits patients.

Study design: The reconstruction of the anterior vertebral body using 3D-printed artificial vertebrae after total en bloc spondylectomy for spinal tumors restores spinal stability.

Objective: To investigate the feasibility of using 3D-printed artificial vertebrae for spinal reconstruction after tumor resection.

Summary of background data: Total en bloc spondylectomy is an effective surgical method for treating spinal tumors. However, reconstructing the vertebral body after tumor resection is challenging. 3D-printed artificial vertebrae offer a novel solution to this issue.

Methods: From December 2016 to September 2023, 43 patients with malignant spinal tumors underwent vertebrectomy followed by reconstruction using 3D-printed artificial vertebrae. The cohort included 30 males and 13 females, aged 15-76 years, with a mean age of 58.0 years. Tumor types included 12 primary malignant tumors and 36 metastatic tumors. Clinical outcomes were assessed using preoperative and postoperative VAS scores at 24 hours and 3 months, Frankel grades, and radiologic evaluation of local tumor control and prosthesis subsidence.

Results: Follow-up ranged from 3 to 31 months, with a mean of 10.9 months. There was a statistically significant improvement in VAS scores at 24 hours and 3 months postoperatively compared with preoperative scores ( P <0.01). Of the 43 patients, 42 (97.7%) showed at least one grade improvement in Frankel grade at the last follow-up. During the follow-up period, there were no cases of prosthesis subsidence among the patients who underwent reconstruction with 3D-printed artificial vertebrae.

Conclusion: Porous titanium artificial vertebrae produced by 3D printing technology exhibit good biocompatibility and mechanical stability, making them suitable for reconstruction after vertebrectomy.

Study design: Randomized controlled trials.

Objectives: We conducted this study to compare the clinical efficacy of antiosteoporosis at different starting time points combined with oblique lateral interbody fusion in the treatment of lumbar degenerative disease complicated with patients with osteoporosis.

Background: Seki and colleagues found that perioperative administration of teriparatide was more effective than that of bisphosphonates in preventing complications in osteoporotic females undergoing surgery. Inoue and colleagues found that the injection of teriparatide beginning at least 1 month before surgery was effective in increasing the insertional torque of pedicle screws during surgery in patients with osteoporosis. Ohtori and colleagues concluded that teriparatide improved the quality of the lumbar spine and reduced the incidence of screw loosening.

Materials and methods: Fifty-nine patients were randomly divided into 2 groups: (1) the advanced group (AG; 30 cases) was treated advanced with antiosteoporosis for 3-6 months, followed by surgical treatment, and (2) the simultaneous group (SG; 29 cases) received antiosteoporosis and surgical treatment simultaneously. The primary outcome was cage subsidence rate. Secondary outcomes included screw loosening rate, intervertebral height, Visual Analog Scale, segmental lordosis angle, lumbar lordosis angle, and bone mineral density.

Results: There was no significant difference in the cage subsidence rate ( P = 0.76) and screw loosening rate ( P = 0.98) between the AG and the SG. The immediate postoperative disk height was significantly different from that before surgery, both in the AG and the SG ( P < 0.00001). When compared within the same group at different times, both AG ( P < 0.00001) and SG ( P < 0.00001) had significantly lower Visual Analog Scale scores after surgery than before. Both of the segmental and lumbar lordosis angles after surgery were significantly higher than that of before. At the final follow-up, bone mineral density was significantly higher than that of presurgery in both groups.

Conclusions: Both starting time points of teriparatide treatment were effective in preventing cage subsidence and screw loosening after oblique lateral interbody fusion, without affecting clinical improvement.

Study design: A prospective, randomized study.

Objective: The goal of this study was to evaluate the impact that subcutaneous drains have on patient satisfaction and postoperative recovery after a lumbar fusion surgery.

Summary of background data: The use of drains following lumbar fusion surgery is controversial. Current literature shows that there are both benefits and drawbacks to using deep drains, however, there are no reports on the utility of superficial drains.

Methods: One hundred ten patients undergoing a 1 to 3-level fusion by a single surgeon were randomly selected to receive either a subcutaneous drain (55 patients) or no drain (55 patients). Drain output was collected 1, 3, and 5 days after the procedure. Drains were removed 5 days after the surgery so long as the output was <50 ccs in a 24-hour period. Patient demographics, drain outputs, and questionnaire data from 10, 30, and 60 days after the procedure were compared.

Results: Patients receiving a superficial drain were significantly less likely to have incisional drainage ( P <0.01) and tended to be less anxious about their wound healing ( P =0.06). There was no difference between drain and no drain groups in terms of postoperative complications, wound care satisfaction, level of independence, or need for outside medical assistance. Body mass index (BMI) and wound thickness did not impact the volume of drain output or other results.

Conclusions: Subcutaneous drains significantly decrease incisional leakage and tend to decrease patient anxiety regarding wound healing. The presence of a postoperative drain does not diminish patient satisfaction with wound healing.

Study design: Single-institution retrospective cohort study.

Objective: Determine the impact of graft height and material on radiographic pseudarthrosis, pseudarthrosis requiring reoperation, and patient-reported outcome measures (PROMs).

Summary of background data: The success of an anterior cervical discectomy and fusion (ACDF) depends on obtaining solid bony fusion to achieve stability and restore disc height. While various interbody graft options exist, the impact of graft height and material on fusion rate remains an area of ongoing investigation.

Methods: Patients who underwent 1-3 level primary ACDF between 2010 and 2021 were studied. Graft height and material (structural allograft vs. prosthetics) were the primary independent variables. The primary outcome was pseudarthrosis, defined as interspinous motion >2 mm on flexion-extension lateral x-rays at 1-year postoperatively. PROMs included Numeric Rating Scale-Arm/Neck and Neck Disability Index. Multivariable logistic regression was performed. A subanalysis was conducted for prosthetic submaterial (PEEK vs. titanium).

Results: One hundred fifty-three patients were included (mean age: 51.8±11.0 y; 42.5% male). Most patients had 1-2 levels operated on and 33.3% had structural allograft as the interbody implant. Prosthetic implants were used in 66.7% of patients, with PEEK being the most common (80.4%). At 1-year postoperatively, 11.1% of patients developed pseudarthrosis, and 2.0% underwent reoperation. There were no significant differences in graft height, material, or prosthetic submaterial between patients with and without pseudarthrosis. Multivariable logistic regression also did not show any significant associations between graft height, material, or prosthetic submaterial with pseudarthrosis, reoperation, or PROMs (all P >0.05).

Conclusion: This study found that graft height and material did not significantly affect pseudarthrosis, reoperation, or PROMs in patients undergoing primary ACDF. While graft height and composition alone may not be critical determinants for fusion success in ACDF, Other factors, such as patient-specific characteristics and surgical technique may contribute to the risk of pseudarthrosis and should be explored in future studies.

Level of evidence: Level III.

Study design: Retrospective cohort study.

Objective: To analyze national trends in the management of acute traumatic central cord syndrome.

Summary of background data: Acute traumatic central cord syndrome (ATCCS) is the most common incomplete spinal cord injury. Initial management involves decompression and stabilization of the cervical spinal cord. On the basis of mixed literature regarding operative timing for ATCCS, we aimed to evaluate trends in early, late, and delayed surgery over the last 5-10 years and compare their respective outcomes.

Methods: Data were obtained from the National Inpatient Sample (NIS) using specific ICD-10 codes. Baseline demographics, comorbidities, and outcomes were evaluated. These patients were grouped based on whether central cord syndrome (CCS) operative treatment was early (within 24h of admission), late (between 24 and 48h of admission), or delayed (after 48h of admission).

Results: A total of 21,265 patients underwent operative management for ATCCS; 16.7% received early operative management, 35.6% received late operative management, and 47.6% received delayed operative management. Compared with the total cohort, the delayed operative management group was more likely to contain patients with obesity (7.1% vs. 6.3%, P <0.001), chronic obstructive pulmonary disease (COPD) (12.9% vs. 11.1%, P <0.001), and diabetes mellitus (28.1% vs. 26.1%, P <0.001). Early operative management was more likely in patients with plegia (24.7% vs. 17%, P <0.001) and bowel/bladder dysfunction (14.6% vs. 9.5%, P <0.001) and was independently associated with lower rates of prolonged length of stay (LOS) (OR=0.71) and acute kidney injury (AKI) (OR=0.696).

Conclusions: Our analysis of the trends in operative timing for ATCCS demonstrated an overall increase in the rate of early operative management and a decrease in the rate of delayed operative management. These findings mirror the current evolution of the literature on the topic. Nuances in early versus late outcomes should be used to help decision making related to operative timing in ATCCS.

Level of evidence: Level III.