Clinical Spine Surgery最新文献

Study design: Retrospective study.

Objectives: The objectives were to determine whether vertebral bone quality (VBQ) scores are associated with interbody cage subsidence following transforaminal (TLIF) and posterior (PLIF) lumbar interbody fusions and whether there is a clinically sensitive threshold for subsidence.

Background: Interbody cage subsidence following lumbar fusion is a complication that can generate poor surgical outcomes. Prior research has correlated cage subsidence with bone mineral density. VBQ scores derived from magnetic resonance imaging (MRI) have been proposed as a tool for measuring bone mineral density, offering a potential new and convenient preoperative risk assessment tool for subsidence.

Methods: The study involved patients undergoing single-level PLIF or TLIF between 2007 and 2022. Exclusions were for nondegenerative diagnoses, multilevel/revision surgeries, inadequate radiographs, missing immediate postoperative radiographs, and preoperative MRI studies older than 1 year. VBQ was calculated at L1-L4 from preoperative T1-weighted MRI images. Subsidence was assessed by changes in disc height (DH; >2 mm difference) and segmental lordosis (SL; >5 degrees difference) between immediate weight-bearing postoperative and latest postoperative lateral radiographs. Statistical analysis included descriptive and inferential statistics.

Results: Subsidence was observed in 27% (SL parameter) and 47% (DH parameter) of 51 total patients. VBQ scores were significantly associated with cage subsidence based on both SL (odds ratio = 7.750, P = 0.012; correlation coefficient = 0.382, P = 0.006) and DH (odds ratio = 4.074, P = 0.026; correlation coefficient = 0.258, P = 0.057) in the combined TLIF/PLIF cohorts. In the cohort of 36 patients undergoing TLIF, a VBQ of 2.70 yielded 100.0% sensitivity and 46.2% specificity in detecting subsidence with SL measurement (area under the curve = 0.812, P < 0.001) and 86.7% sensitivity and 47.6% specificity with the DH measurement (area under the curve = 0.692, P = 0.033).

Conclusions: We found that MRI-based VBQ scores are effective predictors of cage subsidence following TLIF surgery. A VBQ score of 2.70 demonstrated a reliable model and high sensitivity for doing so, identifying a potential clinical threshold for preoperative subsidence risk assessment.

Level of evidence: Level III.

Background: Cervical disc arthroplasty is a well-established alternative to anterior cervical fusion but requires precise placement for optimal outcomes. We present the case of a 2-level cervical disc arthroplasty with suboptimal implantation of the interbody devices, requiring revision corpectomy. Supplemental video, Supplemental Digital Content 1 (http://links.lww.com/CLINSPINE/A358) content of the revision surgery is also provided. This report highlights the importance of proper implant sizing and position and reviews the nuances of surgical revision.

Methods: A retrospective review of the clinical and radiographic data was performed from prior to the index operation through the 3-month postoperative period after the surgical revision.

Results: The patient presented approximately 2 years post-cervical arthroplasty with increasing neck pain and early cervical myelopathy. An imaging workup revealed severe cervical stenosis at the caudal level with cord compression and concern for device failure. Intraoperatively, the core of the caudal device was found to have ejected into the spinal canal. A cervical corpectomy of the intervening vertebra with the removal of both devices was performed. The patient had a complete neurologic recovery.

Conclusion: Although failure of a cervical disc arthroplasty device is rare, the likelihood can be significantly increased with poor sizing (over or under sizing), asymmetric placement, endplate violation, or poor patient selection. In the case presented herein, early device failure was unrecognized, and the patient went on to develop progressive cervical myelopathy requiring revision corpectomy.

Camptocormia, also known as bent spine syndrome, primarily affects individuals with Parkinson disease (PD). This review provides an overview of camptocormia in PD, covering its definition, epidemiology, causes, diagnosis, and treatment. In the epidemiology section, we delve into its prevalence, gender disparities, and ongoing genetic research. Regarding diagnosis and assessment, we discuss evolving diagnostic criteria and measurement techniques, as well as new diagnostic tools. For management and treatment, a wide array of options is available, from conservative methods such as physical therapy and botulinum toxin injections to surgical interventions such as spinal orthopedic surgery and deep brain stimulation. We stress the significance of personalized care and multidisciplinary collaboration. This comprehensive review aims to provide clinicians, researchers, and healthcare professionals with a comprehensive understanding of camptocormia in PD, highlighting its clinical features, diagnostic strategies, management approaches, and future perspectives.

Study design: A retrospective chart review.

Objective: The authors aim to investigate the role of clinical and radiographic parameters in patients who underwent posterior cervical surgery, and their association with C5 palsy severity and time to recovery.

Background: Postoperative C5 palsy affects 1%-30% of patients undergoing posterior decompression, with or without fusion. Causation and avoidance of this complication remain widely debated.

Materials and methods: A single institution review of patients who underwent posterior cervical spine surgery was focused on using specific Common Procedural Technology codes associated with the patient population of interest. Patients were excluded if they had inadequate pre and postoperative imaging, as well as a history of prior cervical spine surgery, concurrent anterior surgery, intradural pathology, spinal tumor, or spinal trauma. Radiographic measurements of the pre and postoperative images were completed with subsequent intraclass correlation coefficient analysis to confirm the precision of measurements.

Results: Out of 105 total patients, 35 (33%) patients developed a C5 palsy. Twenty-four (69%) of those palsies completely resolved, with a median time to recovery of 8 months. Preoperative demographics and radiographic parameters demonstrated heterogeneity among those patients who did and did not have a resolution of palsy. Patients with increased change in C2-C7 lordosis (P = 0.011) after surgery were associated with decreased likelihood of recovery. Patients without a smoking history (P = 0.009) had an increased likelihood of recovering from C5 palsy.

Conclusions: The degree of increased lordosis in the treatment of degenerative cervical disease plays a role in the rate of recovery from C5 palsy. This should be considered during preoperative planning in determining the amount of lordosis desired. In addition, patients without a smoking history were associated with a higher rate of recovery.

Level of evidence: Level IV.

Objective: To describe 2 cases with pathologic expansion of lumbosacral dura mater exerting compression on lumbosacral nerves treated with placement of lumboperitoneal shunt (LPS). Although dural ectasia (DE) is asymptomatic in most cases, a systematic review of the literature was performed focusing on the management when it causes symptoms.

Methods: Pubmed/Medline and Embase databases were searched for the surgical management of DE. Both pediatric and adult patients were included. The presence of a cerebrospinal fluid leak was considered an exclusion criterion. An additional search was performed to provide a more complete picture of the DE spectrum considering meningoceles as a severe form of dural expansion.

Results: Differentiating DE from meningocele, only 20 patients were treated for symptomatic DE. Surgical management varied according to presentation and etiopathogenesis: blood patch or fibrin glue were attempted in case of intracranial hypotension, followed eventually by LPS or marsupialization or dura reduction in cases of failure, whereas LPS or spinal decompression were proposed in cases of radiculopathy or cauda equina syndrome.

Conclusion: DE is a rare condition mostly associated with connective tissue disorders. The different etiopathogenesis may explain how it causes symptoms in specific conditions. Treatments should be chosen according to this and may be proposed at the appearance of symptoms since dural expansion is a self-sustained mechanism.