Clinical Spine Surgery最新文献

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: 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: 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.

Study design: Descriptive study.

Summary of background data: Patients commonly use online patient education materials (PEM) to learn about anterior cervical discectomy and fusion (ACDF).

Objective: The purpose of this study is to evaluate the readability of patient education materials on anterior cervical discectomy and fusion.

Methods: The Google search engine was queried using the term "Anterior Cervical Discectomy and Fusion patient information." The first 25 websites meeting inclusion criteria for this term were evaluated. Readability scores were automatically calculated by transferring the texts to http://www.readabilityformulas.com . Descriptive statistics were calculated for each measure using SPSS version 28.0.0.

Results: The mean average reading level was 9.2±2.4. The mean readability score out of 100 for the FK Reading Ease Score was 55.2±8.6. The remaining scores were: Gunning Fog, 12.7±2.2; FK Grade Level, 8.9±2.0; The Coleman Liau Index, 11.0±1.7; SMOG Index, 48.1±197.0; Automated Readability Index, 8.1±3.11; Linsear Write Formula, 9.8±2.1. Only 2 of the PEMs were written at or below a sixth grade level and only 7 were written at or below an eighth grade reading level.

Conclusion: Patient readability is an important component of patient care and the current readability level of ACDF PEMs is insufficient. At their current state, PEMs may not allow a significant portion of the population to understand the nature of their condition and procedure properly.

Level of evidence: Level III.

Study design: Prospective survey study.

Objective: To address a gap that exists concerning ChatGPT's ability to respond to various types of questions regarding cervical surgery.

Summary of background data: Artificial Intelligence (AI) and machine learning have been creating great change in the landscape of scientific research. Chat Generative Pre-trained Transformer(ChatGPT), an online AI language model, has emerged as a powerful tool in clinical medicine and surgery. Previous studies have demonstrated appropriate and reliable responses from ChatGPT concerning patient questions regarding total joint arthroplasty, distal radius fractures, and lumbar laminectomy. However, there is a gap that exists in examining how accurate and reliable ChatGPT responses are to common questions related to cervical surgery.

Materials and methods: Twenty questions regarding cervical surgery were presented to the online ChatGPT-3.5 web application 3 separate times, creating 60 responses. Responses were then analyzed by 3 fellowship-trained spine surgeons across 2 institutions using a modified Global Quality Scale (1-5 rating) to evaluate accuracy and utility. Descriptive statistics were reported based on responses, and intraclass correlation coefficients were then calculated to assess the consistency of response quality.

Results: Out of all questions proposed to the AI platform, the average score was 3.17 (95% CI, 2.92, 3.42), with 66.7% of responses being recorded to be of at least "moderate" quality by 1 reviewer. Nine (45%) questions yielded responses that were graded at least "moderate" quality by all 3 reviewers. The test-retest reliability was poor with the intraclass correlation coefficient (ICC) calculated as 0.0941 (-0.222, 0.135).

Conclusion: This study demonstrated that ChatGPT can answer common patient questions concerning cervical surgery with moderate quality during the majority of responses. Further research within AI is necessary to increase response.

Study design: Retrospective cohort study.

Objectives: Identify and compare racial/ethnic disparities in ambulatory versus inpatient surgical care utilization for single-level lumbar spine surgery.

Summary of background data: The proportion of spine surgeries performed in the ambulatory setting has dramatically increased over the past 2 decades. However, few studies have investigated whether this shift has resulted in racial/ethnic disparities in surgical care utilization, particularly for outpatient lumbar spine surgery, compared with the inpatient setting.

Materials and methods: Utilizing the 2019 National Inpatient Sample and Nationwide Ambulatory Surgical Sample discharge, we included patients who had undergone a single-level lumbar discectomy, laminectomy, and/or fusion, were of Black, White, or Hispanic race/ethnicity, were covered under Medicare, Medicaid, or private insurance, and were aged 18 years or above. The primary outcome was the rate ratio (RR) of patients from the aforementioned 3 racial/ethnic groups undergoing lumbar surgical care, in the ambulatory and inpatient settings. US Bureau of Labor Statistics data were utilized to offset the model for population-based variations in sociodemographic factors utilizing nested coefficients.

Results: Among 397,173 cases, 220,250 (55.5%) were inpatient, and 176,923 (44.5%) were ambulatory. Compared with White patients, Black (RR: 0.54, 95% CI: 0.53-0.55) and Hispanic (RR: 0.61, 95% CI: 0.60-0.62) patients had lower utilization rates of ambulatory surgical care. More pronounced patterns were observed for Black (RR: 0.44 95% CI: 0.44-0.45) and Hispanic (RR: 0.55, 95% CI: 0.54-0.56) inpatient surgical utilization; all P < 0.001.

Conclusions: Racial/ethic disparities in single-level lumbar surgical care utilization exist in both the ambulatory and the inpatient setting.

Level of evidence: Level 3.

Study design: Randomized control trial.

Objective: To examine erector spinae plane block on a large, comprehensive scale, and investigate the management of postoperative pain and recovery process after lumbar spine surgery using this block.

Summary of background data: Pain management is a key aspect of a patient's care and overall surgical outcome regarding spinal surgery. While most patients have no issues when undergoing spinal surgery, many have pain that will persist postoperation. Our goal was to evaluate the efficacy of erector spinae plane (ESP) blocks before lumbar arthrodesis in helping manage the persisting pains and opioid consumption postsurgery.

Methods: A single-blinded randomized control trial was designed and executed on patients who were to undergo lumbar spine fusion. Before their surgical intervention, patients were randomly assigned to receive the erector spinae plane block or the normal anesthesia/pain management routine.

Results: Of a total of 49 patients, 23 (47%) underwent a spinal block before their respective lumbar spine procedure. Patients with spinal block required fewer supplemental opioids postoperatively (69.9±6.66 vs. 71.7±5.70, P = 0.0002) while reporting less severe pain on VAS pain scoring throughout the first 3 postoperative days ( P < 0.0001).

Conclusions: The patient population that received the erector spinae block had significantly lower pain scores on days 1-3 postsurgery, showing that the spine block is effective in helping patients recover from spinal surgery quicker and with less persisting pain. In addition, the number of patients who filled their first opioid prescription was approaching significance, with the ESP block group filling those prescriptions less frequently. ESP blocks appear to be efficacious at reducing pain and opioid consumption in the immediate postoperative period. No additional complications or readmissions were apparent between subgroups.