European Spine Journal最新文献

Purpose: No studies have explored the reliability of the Rigo classification system using surface topography (ST), which would allow optimization without radiation exposure. This study aims to measure and compare the intra- and inter-observer reliability (Kappa values) and accuracy of the Rigo system between ST and X-ray for overall types and subtypes.

Methods: X-ray and ST images of 31 adolescent idiopathic scoliosis patients were selected. Three investigators were blinded to assess images using the Rigo system, twice for each patient on different weeks, with 372 overall image readings. Afterwards, all investigators agreed upon the correct Rigo scores for finalized classifications.

Results: For Rigo types, the average intra-observer Kappa value was slightly better for ST (0.77, p<0.001) than X-ray (0.75, p<0.001). For Rigo subtypes, the average intra-observer Kappa value was again slightly better for ST (0.74, p<0.001) than X-ray (0.65, p<0.001). The inter-observer reliability was expectedly lower than intra-observer, with ST (0.53, p<0.001) comparable to X-ray (0.54, p<0.001) for the type. For subtype inter-observer reliability, ST (0.43, p<0.001) was slightly better than X-ray (0.36, p<0.001). For the type, the overall accuracy of the observers was slightly lower for ST (77.96%) than X-ray (79.57%). For the subtype, the accuracy of observers was slightly higher for ST (70.97%) than X-ray (65.05%).

Conclusion: ST-based Rigo system demonstrates very good intra-rater reproducibility and moderately good inter-rater reproducibility. Surface topography is comparable to X-ray for the Rigo system, and therefore can be considered a reliable alternative in clinical application.

Purpose: Fibrosis of muscle spindles (sensory organs) in back muscles induced by intervertebral disc (IVD) degeneration could limit transmission of muscle stretch to the sensory receptor and explain the proprioceptive deficits common in back pain. Exercise reduces back muscles fibrosis. This study investigated whether targeted muscle activation via neurostimulation reverses or resolves muscle spindle fibrosis in a model of IVD injury.

Methods: In eighteen sheep, lumbar (L)1-2 and L3-4 IVD degeneration was induced by partial thickness anulus fibrosis incision and a neurostimulator was implanted. After IVD-degeneration developed for 3 months, neurostimulation of the L2 nerve root activated multifidus in nine randomly selected animals. Multifidus muscle adjacent to the spinous process of L2 (non-stimulated) and L4 (stimulated) was harvested 3 months after activation. Muscle spindles were identified in Van Giessen's-stained sections. Connective tissue spindle capsule thickness, and cross-sectional area (CSA) of the spindle, its periaxial fluid and sensory elements were measured. Immunofluorescence assays evaluated Collagen-I and -III.

Results: Multifidus muscle spindle capsule thickness and Collagen-1 were significantly less in the neurostimulation animals than IVD-injury animals at L4 (stimulated muscle) (P < 0.05), but not L2 (non-stimulated muscle). Spindle capsule thickness was less in lateral than medial regions. CSA of the muscle spindle and sensory elements was less in neurostimulated animals at L4.

Conclusion: Targeted multifidus activation reverses or prevents accumulation of connective tissue of the multifidus muscle spindle capsule caused by IVD injury. Reduced fibrosis should maintain sensory function of this important muscle mechanoreceptor and might provide an effective solution to resolve the commonly identified proprioceptive deficits in back pain and maintain healthy spine function.

Purpose: The effect of skeletal muscle mass of the trunk and extremities on sagittal imbalance of the spine before and after surgery for adult spinal deformity (ASD) has not been elucidated. The purpose of this study was to examine the correlation between reduced skeletal muscle mass of the trunk and extremities, as well as spinopelvic parameters, preoperatively, postoperatively and at least 2 years after surgery for ASD.

Methods: This retrospective observational study included 140 consecutive patients who had undergone surgery for ASD and were followed-up for at least 2 years and whose skeletal muscle mass could be measured preoperatively using whole-body dual-energy X-ray absorptiometry. Correlations between skeletal muscle mass and spinopelvic parameters were assessed preoperatively, postoperatively, and after 2 years of follow-up.

Results: All spinopelvic parameters were significantly improved postoperatively compared with preoperatively. Between the postoperative period and two years post-surgery, a significant loss of correction was observed in SVA and GT. Trunk muscles mass showed significant negative correlations with preoperative PT, SS, PI-LL, SVA, GT, and TPA, but there was no significant correlation with postoperative parameters. Through univariate and multivariate regression analysis, lower limb skeletal muscle mass showed a significant negative correlation with SVA at two years postoperatively and the loss of corrected SVA (ΔSVA) over two years.

Conclusion: This study revealed that lower extremity muscle mass was implicated in the loss of corrected SVA 2 years after surgery. This study is clinically meaningful as it suggests that strength training for the lower extremities, performed preoperatively and/or postoperatively, can improve sagittal imbalances of the spine in patients with severe ASD or maintain SVA after corrective surgery.

Level of evidence: 3:

Purpose: To explore the relationship between paraspinal muscle degeneration and cervical spondylosis through cervical spine MRI and lateral X-ray.

Methods: A retrospective study included 83 cervical spondylosis patients as the experimental group, consisting of 28 axial joint pain (Group A), 29 cervical radiculopathy (Group B), and 26 myelopathy (Group C), as well as 29 healthy individuals as the control group (Group D). The cross-sectional area (CSA) of paraspinal muscles at the C3-4, C4-5, and C5-6 segments was measured, including the deep extensor area (DEA), deep flexor area (DFA), and superficial extensor area (SEA). Additionally, fatty infiltration (FI) ratio was calculated, namely the deep extensor fatty infiltration ratio (DEFIR), deep flexor fatty infiltration ratio (DFFIR), and superficial extensor fatty infiltration ratio (SEFIR). Correlations of CSA and FI ratio with age, body mass index, Pfirrmann grading, and Cobb angle were analyzed.

Results: (1) Pfirrmann grading in groups A, B, and C was significantly higher than that in group D (P < 0.001), with group C higher than groups A and B (P < 0.05), but the difference between groups A and B was not statistically significant (P > 0.05). (2) There was no significant difference in the CSA among groups (P > 0.05). For DEFIR and DFFIR, group C > group B > group A > group D, with significant differences (P < 0.05). For SEFIR, groups A, B, and C were significantly higher than group D (P < 0.001), with no significant differences between the other pairs (P > 0.05). (3) The CSA of males was significantly greater than females (P < 0.001), while the difference in FI ratio was not significant (P > 0.05). (4) In the control group, DEFIR and DFFIR were positively correlated with age (r = 0.538, P = 0.003; r = 0.829, P < 0.001) and negatively correlated with Cobb angle (r=-0.523, P = 0.004; r=-0.535, P = 0.003). In the experimental group, DEFIR and DFFIR were positively correlated with age (r = 0.731, P < 0.001; r = 0.741, P < 0.001) and Pfirrmann grading (r = 0.778, P < 0.001; r = 0.812, P < 0.001), and negatively correlated with Cobb angle (r=-0.507, P < 0.001; r=-0.539, P < 0.001). There were no correlations between the other parameters.

Conclusion: In cervical spondylosis patients, the FI ratio of the deep cervical muscle is linked to both worsening disc degeneration and changes in cervical spine alignment. Among the different subtypes, cervical myelopathy shows the highest FI ratio of the deep cervical muscle and disc degeneration, indicating its significant impact on spinal structure and muscular integrity.

Purpose: Although idiopathic scoliosis is a common three-dimensional deformity, there is a lack of studies evaluating the associations between the aortic-vertebral distance (AVD) and spinal deformities in all planes. The study therefore aimed to evaluate how the coronal and sagittal curvature, vertebral rotation and aortic-vertebral angle (AVA) affect the AVD in idiopathic scoliosis.

Methods: The AVD, AVA, vertebral rotation and curve angles were measured on preoperative magnetic resonance imaging and radiographs in 46 patients who underwent posterior spinal fusion with pedicle screw instrumentation for idiopathic scoliosis Lenke types 1 and 2. Associations between variables were examined using correlation and multivariable regression analyses.

Results: A significant weak to strong correlation was found between the AVD and AVA, and the AVD and vertebral rotation (r = 0.315 to 0.712) within the thoracic curve. The sagittal kyphosis and coronal Cobb angles showed weak correlations with the AVD (r = -0.311 to 0.338). The regression model for the apical vertebral level, which included the four variables, explained 40% (R²=0.40) of the variation in AVD. AVA and vertebral rotation were significantly associated with AVD (p < 0.01 for each), together accounting for 34% (R²=0.34) of the variation.

Conclusion: The shortest distance from the aortic wall to the vertebral body wall is primarily influenced by vertebral rotation and the AVA within the thoracic curve. Thus, these factors need to be taken into consideration when planning pedicle screw placement especially in freehand techniques.

Objective: This study aimed to compare the use of the endoscopic drill (ED) with the extra-endoscopic trephine (EET) in treating lumbar disc herniations with regard to efficiency, safety, and clinical outcomes.

Methods: From January 2022 and June 2023, 136 patients who had the single-level LDH and received the transforaminal endoscopic surgery were divided into two groups according to the foraminoplasty technique: the EET group (n = 69) and the ED group (n = 67). Surgery-related parameters, complications, Visual Analogue Scale (VAS, 0-10), and Oswestry Disability Index (ODI, 0-100%) were assessed and compared among two groups.

Results: The mean operation time and the foraminoplasty time of the EET group was significantly shorter than that of the ED group (P < 0.05). Patients in ED group reported less back pain on the VAS during foraminoplasty than EET group. Although the total complication rate was similar between two groups, the incidence of neural irritation in ED group was significantly lower than that in the EET group. There were no significant differences in VAS or ODI scores at each follow-up visit between two groups.

Conclusions: The application of EET and ED were both effective for full-endoscopic foraminoplasty, and have achieved good clinical outcomes. Although the efficiency of EET is higher than that of ED, it faces some problems during use, such as a high risk of neural irritation, intense intraoperative pain, and the trephine displacement. The ED technique is safe and controllable, which can be used as an ideal method for supplementary foraminoplasty.

Introduction: In asymptomatic subjects, variations of sagittal alignment parameters according to age and pelvic incidence (PI) has been reported. The aim of this observational study was to describe thoraco-lumbar sagittal alignment in patients with degenerative scoliosis and to compare them to asymptomatic individuals, seeking for the specific effect of deformity in similar age and PI groups.

Materials and methods: Full spine radiographs of 235 asymptomatic subjects and 243 scoliosis patients were analyzed: cervico-thoracic inflexion point (CTIP), thoraco-lumbar inflexion point (TLIP), lumbar lordosis (LL) L1-S1, LL (TLIP-S1), LL superior arch (TLIP-lumbar apex), LL inferior arch (lumbar apex-S1), PI, thoracic kyphosis (TK) T5-T12, TK T1-T12, number of vertebrae CTIP-TLIPandTLIP-S1. The distribution of parameters was analyzed using a Bayesian inference (significant when Pr > 0.975 or Pr < 0.025). Comparisons between reference (R) and pathologic (P) groups were matched according to age (40-60 years; >60 years) and PI (< 45°; 45-60°; >60°).

Results: LL L1-S1 was significantly lower in the P-group (Pr = 1.0), decreased with age (Pr > 0.99) and increased with PI (Pr < 0.001). In contrast, there was no significant decrease with age for LL (TLIP-S1) or LL (superior arch) (respectively Pr < 0.92 and Pr > 0.19). LL in the inferior arch was significantly lower in the P-group (Pr = 1.0) and decreased with age (Pr = 0.99). The number of vertebrae TLIP-S1 was significantly lower in the P-group compared to the reference group (Pr < 0.001).Thoracic kyphosis T1-T12 was significantly lower in the P-group (Pr < 0.001), without significant influence of age or PI. The number of vertebrae CTIP-TLIP increased significantly in the P-group (Pr < 0.001) and with PI (Pr < 0.004).

Conclusion: This observational study highlights specific thoraco-lumbar sagittal alignment adaptations in degenerative scoliosis, matched on age and PI. Beyond the decrease in LL due to aging, degenerative scoliosis leads to a distal migration of the TLIP, an increase in the number of vertebrae in TK and a decrease in LL. This phenomenon was linked to kyphosis at the thoraco-lumbar junction due to scoliosis and was more important in high PI.

Background: Intervertebral disc (IVD) degeneration is the main cause of neck pain. Although conventional magnetic resonance imaging can detect morphological changes in intervertebral disc degeneration, it cannot provide accurate and objective evaluations. Magnetic resonance diffusion tensor imaging (DTI) reflects the microstructural changes in tissues by describing the diffusion of water molecules. It was initially applied to the evaluation of lumbar disc degeneration; however, no study has used DTI to evaluate cervical disc degeneration.

Objective: To conduct a prospective study to evaluate the efficacy and feasibility of DTI in quantifying cervical disc degeneration by correlating the main parameters of axial DTI of intervertebral discs, namely fractional anisotropy (FA) and mean diffusivity (MD) values, using the Pfirrmann grade.

Methods: The cervical discs of 30 symptomatic volunteers with neck pain and 20 asymptomatic volunteers were assessed using a 3.0 T magnetic resonance scanner. We evaluated intervertebral discs from C3/4 to C6/7 in each volunteer. The Pfirrmann grades, FA value, and MD value on the conventional magnetic resonance imaging were evaluated. The Kruskal-Wallis test and Wilcoxon rank-sum test were used to compare the FA and MD values of subjects with different degeneration levels.

Results: Statistical analysis showed that the FA value of the nucleus pulposus in patients group was significantly higher than that in the asymptomatic volunteers, and the MD value of the nucleus pulposus was significantly lower than that in the asymptomatic volunteers, and the difference was significant (P < 0.05). In the study group, with an increase in cervical intervertebral disc grade, the FA value of the nucleus pulposus also showed a gradual upward trend, and this difference was significant (P < 0.05). The MD value of the nucleus pulposus showed a gradual downward trend, except between grades I and II, which indicates that the axial FA value can better show the early pathological changes of the cervical intervertebral disc.

Conclusions: The FA and MD values of the cervical intervertebral disc can quantitatively evaluate the degree of degeneration of the cervical intervertebral disc; axial DTI imaging technology can provide a good theoretical basis for the imaging diagnosis of cervical intervertebral disc degeneration and has important clinical application value.

Purpose: Spinal epidural abscesses are rare yet serious conditions, often necessitating emergency surgical intervention. Holospinal epidural abscesses (HEA) extending from the cervical to the lumbosacral spine are even rarer and present significant challenges in management. This report aims to describe a case of HEA with both ventrally-located cervical and dorsally-located thoracolumbar epidural abscesses treated with a combination of anterior keyhole decompression and posterior skip decompression surgeries.

Methods: A 73-year-old woman with diabetes and hypertension presented with severe neck and back pain, fever, and a marked increase in leukocytes (29980/µL) and C-reactive protein (CRP; 24.26 mg/dL) levels. Magnetic resonance imaging revealed epidural abscesses extending from the cervical to lumbar spine, confirming the diagnosis of HEA. At the cervical lesion, spinal cord was compressed by ventrally-located epidural abscess. Due to the patient's poor general condition, conservative treatment was initially pursued, followed by surgical intervention targeting the most severely compressed spinal segments. Managing ventrally-located epidural abscesses poses greater challenges. In this patient, a novel anterior keyhole decompression surgery was employed to evacuate the ventrally-located cervical epidural abscess while preserving intervertebral discs and endplates.

Results: Posterior skip decompression surgery was performed, successfully reducing thoracolumbar epidural abscesses. Subsequently, anterior keyhole decompression was performed to evacuate ventrally-located epidural abscess, preserving intervertebral discs and endplates. Postoperatively, the patient's symptoms improved, and leukocyte count and CRP gradually normalized. Follow-up imaging showed resolution of the abscesses and bone remodeling within the keyhole without evidence of spinal instability and postoperative kyphosis.

Conclusion: Management of HEA poses significant challenges, particularly in cases with ventrally-located cervical epidural abscesses. Our case highlights the efficacy of a combined surgical approach involving anterior keyhole decompression and posterior skip decompression in achieving abscess drainage and preserving spinal stability. This novel technique offers advantages over existing methods by preserving intervertebral motion and minimizing the risk of postoperative kyphosis. Further studies are warranted to validate the long-term outcomes and generalizability of this approach.