Clinical Spine Surgery最新文献

Study design: Retrospective case series.

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

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

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

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

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

Level of evidence: Level IV.

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

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

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

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

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

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

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

Level of evidence: Level III.

Study design: A retrospective cohort study.

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

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

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

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

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

Study design: Retrospective cohort study.

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

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

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

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

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

Level of evidence: Level III.

Study design: Retrospective cohort study.

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

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

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

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

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

Study design: Retrospective cohort study.

Objective: The purpose of our study is to identify CT characteristics of unilateral cervical spine facet fractures that are predictive of instability on MRI.

Summary of background data: Management of isolated subaxial cervical spine facet fractures is typically based on the neurological status of the patient and perceived stability of the injury. It has been shown that the degree of ligamentous instability can help predict instability and need for surgery, and MRIs are increasingly being used to evaluate these injuries, but not always. While there are studies that evaluate radiographic characteristics of facet fractures on CT, there are few that specify which CT findings predict instability on MRI.

Methods: A retrospective review of 49 patients with unilateral cervical facet fractures during a 7-year period from a level I trauma center was performed. All patients had a CT and an MRI performed. Measurements of fracture fragments were obtained from CT scans. MRIs were examined by an independent radiologist and assigned an instability score. CT measurements were compared with MRI instability scores to determine which parameters were predictive of the need for operative stabilization.

Results: Forty-nine patients were identified with unilateral cervical spine facet fractures. Thirty patients initially were treated nonoperatively, and 19 patients underwent surgical stabilization. One patient failed nonoperative management, having neurological deficits and pain at follow-up, and underwent a C6-C7 ACDF later. The average instability score in the operative group was 3.34, versus 1.06 in the conservative treatment group ( P <0.001). Fracture displacement ( P =0.013), multifragmentary fractures ( P <0.001) and MRI instability score ( P <0.001) were correlated with a statistically significant increased likelihood of operative necessity.

Conclusions: Fracture size did not directly correlate with ligamentous injury. Displacement and multifragmentary fractures on CT scan were had the highest correlation with instability scores on MRI. This suggests that patients with subaxial cervical facet fractures that are comminuted or have significant displacement may require operative stabilization.

Level of evidence: Level III.

Study design: Retrospective study design.

Study objectives: To assess the prevalence and severity of sleep disturbances among patients with idiopathic scoliosis in Saudi Arabia. To evaluate the impact of surgical intervention on sleep quality in IS patients, comparing preoperative and postoperative sleep patterns.

Background: Idiopathic scoliosis (IS) is a complex spinal deformity that may impact sleep quality due to pain, breathing difficulties, and psychological factors. Surgical intervention is the primary treatment for severe cases, yet its effect on sleep quality remains unclear.

Methods: A retrospective cohort study was conducted on 70 patients who underwent scoliosis surgery at a tertiary center in Riyadh, Saudi Arabia, between 2019 and 2024. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) before and 6 months after surgery.

Results: The prevalence of poor sleep quality decreased significantly postoperatively from 64.2% to 44.2% (P = 0.018). Significant improvements were observed in sleep latency (P = 0.031), duration (P = 0.002), efficiency (P = 0.004), and daytime dysfunction (P = 0.002).

Conclusions: Surgical correction of idiopathic scoliosis significantly improves sleep quality by enhancing sleep parameters and reducing sleep disturbances. Further research is warranted to optimize postoperative care and improve patient quality of life.

Study design: Review.

Objective: To provide an overview of outcome measures used to evaluate cervical spondylotic myelopathy (CSM) and degenerative cervical myelopathy (DCM), emphasizing their diagnostic utility, prognostic value, and limitations.

Summary of background data: DCM and CSM lead to spinal cord compression and neurological impairment. Effective outcome measures are essential for disease monitoring and clinical decision-making.

Methods: A comprehensive literature review was conducted.

Results: The modified Japanese Orthopaedic Association scale (mJOA) and Nurick grading remain standard provider assessments for DCM and CSM but have limitations. The patient-derived mJOA (P-mJOA) is a patient-reported outcome measure (PROM) similar to the European Myelopathy Score (EMS), whereas PROMs such as the Neck Disability Index, Short Form-36, and EuroQol-5D lack disease specificity. Advances in imaging, including diffusion tensor imaging (DTI) and diffusion basis spectrum imaging (DBSI), electrophysiological assessments, and wearable sensors, may enhance diagnostic precision in the future.

Conclusions: Integrating subjective and objective outcome measures can enhance DCM/CSM assessment. A multimodal approach may improve diagnosis, prognostication, and guide treatment recommendations through traditional clinical assessments, evolving patient-reported outcome measures, advanced imaging techniques, and wearable sensor data. Large data sets made possible by these advancements can leverage the power of predictive analytics and artificial intelligence.

Study design: Single-center retrospective cohort study.

Objective: The primary objective was to evaluate the incidence of proximal facet joint violation (FJV) in lumbar and sacral pedicle screw placement, comparing robotic-assisted navigation (RAN) versus augmented reality (AR) guidance systems. Secondary objectives examined risk factor assessment across demographic characteristics, surgical variables, and analysis of vertebral level-specific violation patterns.

Summary of background data: Proximal FJV is a recognized complication of pedicle screw placement, with reported rates ranging from 2% to 42%. Although robotic-assisted techniques are associated with reduced FJV risk, direct comparisons between modern RAN and AR systems remain limited and warrant further investigation.

Methods: Postoperative imaging was analyzed for proximal FJV in patients who underwent either RAN (Mazor X) or AR-guided (Xvision) pedicle screw placement. Patient demographics, surgical characteristics, and FJV rates were compared between groups.

Results: Among 175 patients, a total of 350 proximal facet joints were evaluated, with an FJV rate of 5.8% (n = 11) in the RAN group and 9.4% (n = 15) in the AR group. The highest violation rates occurred at L5 (RAN: 13.2%, n=5; AR: 35.3%, n=12), without reaching statistical significance. Most violations were modified Park grade I (RAN: 6.3%, n=9; AR: 4.4%, n=7) or grade II (RAN: 1.6%, n=2; AR: 5.6%, n=8), with no grade III violations observed. Demographic factors showed no significant association with FJV rates. No revision surgeries were required for screw malposition or FJV.

Conclusions: RAN demonstrated lower proximal FJV rates compared with AR guidance in lumbar and sacral pedicle screw placement, particularly at L5; however, this difference was not statistically significant. Although demographic factors showed no significant association with FJV occurrence, the absence of severe violations in both cohorts demonstrates the overall safety profile of these navigation systems.