European Spine Journal最新文献

Objectives: To evaluate 30-day mortality and survival up to five years post injury in surgically treated adults with traumatic sub-axial cervical spine injuries at a South African tertiary centre.

Methods: We performed a retrospective observational study of adults who underwent surgery between 2018 and 2022. Mortality data were obtained from the South African Medical Research Council death registry. Primary outcomes were 30-day mortality and survival up to five years post injury. Univariable logistic regression was used to evaluate factors associated with 30-day mortality, and categorical ASIA-based logistic models were constructed to minimise overfitting. Cox proportional hazards analysis was used to evaluate predictors of survival during follow-up.

Results: Eighty-six patients were included. Thirty-day mortality was 12%. Kaplan-Meier estimated overall survival was 83.7% at 1 year and 80.0% at 5 years. Seventeen patients died during follow-up. Univariable analysis identified spinal shock, ASIA grade, Injury Severity Score, and lower respiratory tract infection as factors associate with 30-day mortality. In time-to-event analysis, ASIA grade on arrival was the only factor independently associated with survival. Respiratory failure caused all but one death.

Conclusion: ASIA grade strongly predicted survival in traumatic sub-axial cervical spine injuries. Despite high mortality among patients with severe neurological injury, many patients survive, underscoring the importance of rehabilitation and community reintegration.

Background: Osteogenesis imperfecta (OI) is a rare genetic disorder characterized by bone fragility and severe spinal deformities, with scoliosis affecting up to 80% of patients and often progressing despite bracing. Surgical management is challenging due to poor bone quality and high complication risk. Advances in pedicle screw-based constructs and multimodal strategies, including traction and bisphosphonates, have improved outcomes and enabled the successful correction of deformities. This review analyzes radiographic and surgical results of modern posterior spinal fusion (PSF) in OI-associated spinal deformity.

Methods: A systematic search of PubMed, Scopus, Embase, Cochrane Library, and Google Scholar (inception to May 2025) was performed using search terms such as "osteogenesis imperfecta", "brittle bone disease", "posterior spinal fusion", "spinal arthrodesis", "scoliosis" and "spinal deformity". Extracted data covered demographics, OI type, traction techniques, instrumentation, radiographic and surgical outcomes, complications, and patient-reported outcome measures (PROMs). The risk of bias was assessed using the MINORS tool, and reporting followed PRISMA guidelines.

Results: The initial search identified 264 articles, of which 8 met the inclusion criteria, including 149 patients with OI (mean age 15.5 years). All studies were retrospective case series (level IV evidence). Cement augmentation was used in 31.5% of cases and apical osteotomies in 37.5%. Preoperative main curves ranged from 75.5° to 96°, with a mean correction rate of 49.5% after PSF. Both coronal and sagittal radiographic parameters improved postoperatively. The mean operative time was 410.6 minutes, blood loss averaged 1,375 mL, and hospital stay was 7.9 days. The overall complication rate was 27.5%, with 10.7% requiring unplanned reoperation.

Conclusion: Modern pedicle screw-based constructs appear to provide more consistent radiographic correction in OI-associated scoliosis compared to earlier in situ fusion techniques. Although these procedures still entail significant blood loss and long operative times, their complication rates remain acceptable given patient complexity. Future multicenter high-quality studies should focus on optimizing implant density, screw augmentation, rod material, osteotomies, and integrating navigation and new biomaterials to standardize treatment strategies.

Purpose: Lumbosacral fusion (LSF) is the standard approach in adult spinal deformity (ASD) surgery but is frequently associated with proximal junctional kyphosis. Floating fusion (FF) has been proposed as an alternative approach. This study examined factors influencing the selection of FF and identified postoperative adverse factors associated with each surgical approach.

Methods: This multicenter study retrospectively reviewed the records of patients who underwent surgery for ASD. They were divided into FF and LSF groups and compared by baseline patient characteristics and radiological parameters. Each group was further divided and compared according to mechanical complications (MC).

Results: The number of fusion levels (odds ratio [OR] = 0.50, 95% confidence interval [CI]: 0.41-0.61, P < 0.01), thoracic kyphosis (OR = 1.03, 95% CI: 1.00-1.06, P = 0.045), and lower lumbar lordosis (LL) (OR = 1.07, 95% CI: 1.03-1.10, P < 0.01) were independently associated with FF. In FF, the correction amounts for LL and PI - LL were lower in the MC subgroup (LL: no MC, 9.3 ± 12.5; MC, 2.1 ± 16.1, P = 0.04 and PI - LL: no MC, - 10.6 ± 12.3; MC, - 2.1 ± 14.1, P = 0.02). In LSF, the preoperative SVA was higher in the MC subgroup (no MC, 82.5 ± 55.4; MC, 103.1 ± 46.7; P = 0.049).

Conclusion: FF outcomes were more favorable in patients undergoing short-segment fusion who retained TK or lower lumbar lordosis. Various procedural demands influenced postoperative MC: FF requires LL proportional to the PI, whereas LSF focuses on global alignment correction.