European Spine Journal最新文献

Background: CaO-SiO₂-P₂O₅-B₂O₃ bioactive glass-ceramics7 (BGS-7) are known for their strong integration with bone and stability and are commonly used in spinal fusions.

Purpose: This study aimed to compare fusion rates and radiological and clinical outcomes between BGS-7 and allograft spacers with iliac bone grafts (IBG) in multilevel anterior cervical discectomy and fusion (ACDF) surgeries.

Study design/setting: This retrospective study was conducted at BRM Medical Center.

Patient sample: We included patients who underwent multilevel ACDF at BRM Medical Center between January 2012 and December 2023. The patients had symptoms such as cervical radiculopathy and myelopathy due to cervical disc herniation, stenosis, and spondylosis.

Outcome measures: We evaluated the preoperative and postoperative Japanese Orthopedic Association (JOA) scores, neck disability index (NDI), functional rating index (FRI), and visual analog scale (VAS) scores for the neck, shoulder, and upper extremities at 6 months and 1 year after surgery.

Methods: Fusion rates were assessed using dynamic radiography and computed tomography (CT) scans at 1 year postoperatively. Radiological measurements were obtained from preoperative and postoperative plain radiographs.

Results: At the 1-year follow-up, the fusion rates were 89.5% for BGS-7 and 92.2% for the allograft cage on dynamic radiographs (p=0.156) and 93.4% and 90.4%, respectively, on CT scans (p=0.319), confirming both internal and external osseointegration. Subsidence rates were 4% for BGS-7 and 10% for the allograft spacer group. Both groups showed increased cervical lordosis (CL), segmental lordosis (SL), and segmental height postoperatively, with maintained lower segmental height (LSH) in the BGS-7 group than in the allograft spacer group at postoperatively 1 year. No adjacent segmental disease (ASD) occurred in either group. The JOA, NDI, and FRI showed significant improvements in both groups. The VAS scores decreased significantly in both groups, indicating improved clinical outcomes.

Conclusions: In multilevel ACDF, BGS-7 demonstrated fusion rates comparable to those of the allograft spacer with IBG, experiencing fewer instances of subsidence and cage fracture. Therefore, BGS-7 spacer can be safely utilized in multilevel ACDF as a substitute for traditional allograft spacers, without the need for additional IBG.

Purpose: Degenerative spine disease (DSD) is increasingly prevalent due to aging populations, leading to higher surgical interventions and associated complications. This necessitates a comprehensive preoperative assessment, evaluating frailty through tools such as the modified Frailty Index 5 and modified Frailty Index 11 (mFI-5 and mFI-11). Despite the utility of mFI-5 and mFI-11 in predicting postoperative complications, these indices do not account for sarcopenia, a syndrome related to but distinct from frailty, which is associated with higher complication rates. This paper aims to retrospectively evaluate the influence of sarcopenia and frailty on postoperative adverse events in a cohort of patients who underwent posterior spine fusion for degenerative disease of the lumbar spine.

Methods: A retrospective review of 286 patients who underwent posterior lumbar spine fusion for DSD was conducted. Frailty was measured using mFI-5 and mFI-11, while sarcopenia was assessed through Psoas to Lumbar Vertebral Index (PLVI) on magnetic resonance images. Primary outcomes included postoperative complications within 30 days. Statistical analysis involved univariate and multivariate models to determine the predictors of complications.

Results: Higher frailty scores were significantly associated with increased postoperative complications (p < .05). However, sarcopenia showed no significant correlation with postoperative complications rates, except for pneumological complications (p = .031). Multivariate analysis confirmed frailty as a strong independent predictor of postoperative complications, while sarcopenia had limited impact.

Conclusion: Frailty is a robust predictor of postoperative complications in DSD surgeries, while sarcopenia, appears to play a lesser role. The findings suggest that frailty alone provide a more comprehensive assessment of risk than sarcopenia.

Objective: To study the effect of percutaneous kyphoplasty (PKP) combined with microwave ablation (MWA) on pain and clinical outcomes in patients with spinal metastases.

Methods: Eighty-seven patients with spinal metastases were retrospectively collected and divided into the PKP group (40 cases), and PKP + MWA group (47 cases). The postoperative efficacy (Frankel grade classification) was assessed, and the height of the diseased vertebrae, pain indices [visual analogue scale (VAS) and analgesic use score (AUS)], dysfunction in daily activities [Oswestry disability index (ODI)], quality of life (quality of life scores for tumor patients), and physical status score [Eastern Cooperative Oncology Group performance status] were compared. The incidence rate of adverse events and the survival of both groups were also counted.

Results: Postoperatively, the PKP + MWA group had a higher total effective rate than the PKP group (P < 0.05). Versus the PKP group, the PKP + MWA group showed improved recovery of vertebral height, lower VAS, AUS, and ODI scores, higher QLS, and better physical status (all P < 0.05). Postoperative adverse events were not significantly different between the two groups (P > 0.05). The disease-free survival rate and overall survival rate within 1 year were higher in the PKP + MWA group than in the PKP group (P < 0.05).

Conclusion: PKP combined with MWA elevates the height of the diseased vertebrae, alleviates the symptoms of pain and dysfunction, and promotes the quality of life and physical status in patients with spinal metastases.

Purpose: To translate and cross-culturally adapt Fukushima Lumbar Spinal Stenosis Scale into a Simplified Chinese version (FLS-25-SC), and evaluate the reliability and validity of FLS-25-SC in patients with lumbar spinal stenosis.

Methods: Test-retest reliability was assessed by Intra-class correlation coefficient (ICC). Construct validity was analyzed by correlations between FLS-25-SC and the Swiss Spinal Stenosis (SSS) Questionnaire, Visual analogue scale (VAS) as well as the short form (36) health survey (SF-36).

Results: The original version of the FLS-25 was cross-culturally adapted and translated into Simplified Chinese. FLS-25-SC was indicated to have excellent reliability (Cronbach's alpha = 0.941, ICC = 0.952). FLS-25-SC had almost perfect correlation with Physical Functioning (r = -0.870, P < 0.001) subscale of SF-36. Moderate to substantial correlations between FLS-25-SC and Symptom severity (r = 0.542, P < 0.001), Physical function (r = 0.604, P < 0.001) subscales of Swiss Spinal Stenosis (SSS) Questionnaire, VAS (r = 0.613, P < 0.001), as well as Role Physical (r = -0.537, P < 0.001) and Bodily Pain (r = -0.474, P < 0.001). It was observed that the loading of the 3 factors explained 63.108% of the total variance: [Kaiser-Mayer-Olkin (KMO) = 0.903, C2 = 1769.491, p < 0.001].

Conclusion: FLS-25-SC has been shown to have acceptable reliability and validity in patients with degenerative lumbar spinal stenosis and may be recommended for patients in Chinese mainland.

Purpose: The purpose of this study was to investigate threshold values for classifying bone as normal or osteoporotic based on Computed Tomography (CT) Hounsfield Units (HU) and to determine if clinically applicable values could be derived to aid spine surgeons evaluating bone quality using CT.

Methods: This literature review was completed using PubMed and Ovid (MedLine), using syntax specific to bone quality and CT. The included articles were original clinical studies assessing bone quality and utilized composite L1-L4 HU values compared against dual-energy X-ray absorptiometry (DEXA) values. Extracted data study descriptors, CT measurement technique, and CT threshold values. CTs were measured from L1-L4 using either axial or sagittal images, and must classify their bone quality findings for any of the following 3 categories: normal, osteopenia, or osteoporosis.

Results: This review located 34 studies measuring bone density using CT with threshold values, of which, 10 were included in the final review. Number of patients ranged from 74 to 283 and cohort ages from 20s to 70.6 years. CT threshold values for assessing normal and osteoporotic bone quality ranged from 150 to 179 and 87 to 155, respectively. From combining values across studies, a HU value of ≥ 170 HU was associated with normal bone and ≤ 115 HU with osteoporosis.

Conclusion: There is variation in HU values used to differentiate normal from compromised bone quality, even after limiting studies. For patients with HU values between or near 170 or 115 HU, a DEXA scan may be warranted for further evaluation. With ongoing investigation in this area, threshold values for classifying bone quality using CT will be continually refined.

Purpose: We aimed to validate and cross-culturally adapt the Core Outcome Measures Index (COMI) neck for use in Portuguese patients with cervical spine degenerative disease and define the minimal clinically important change score (MCIC) for this questionnaire and population.

Methods: The COMI translation and cross-cultural adaptation was done following published guidelines. Patients awaiting surgery in a neurosurgical centre completed the COMI, Neck Disability Index (NDI) and EQ-5D questionnaires, a pain visual analog scale (VAS) twice within a 5-to-15-day period, and a Global Treatment Outcome (GTO) question evaluating whether a clinical status change had occurred during that period. The MCIC was obtained through an anchor method by analysis of changes in pre- to postoperative total COMI scores and GTO dichotomized answers.

Results: The COMI first assessment was completed by 101 patients and 72 patients completed both assessments. The questionnaire showed good construct validity (n = 72 patients) as predefined hypotheses were confirmed: scores on each COMI domain correlated with a Spearman ρ > 0.4 with scores for the corresponding domain on other questionnaires and COMI total score displayed good correlation with total NDI score (ρ = 0.67) and EQ-5D total score (ρ = 0.55). Test-retest reliability (n = 72 patients) was confirmed through high intraclass correlation coefficients. The MCIC (n = 76 patients) was calculated as 2 points.

Conclusion: The COMI (neck) psychometric qualities were confirmed, such that it can be considered a valid and reliable questionnaire to be applied in the European Portuguese population with surgical cervical spine degenerative disease, with an MCIC of 2 points.

Purpose: This research is intended to evaluate the correlations of serum IL-6 and TGF-β1 concentrations with bone density and turnover markers as well as their diagnostic value in elderly male patients with osteoporosis (OP).

Methods: A retrospective analysis was conducted on 335 elderly men (≥ 60 years; 90 with normal bone mass, 120 osteopenia cases, and 125 OP cases). Lumbar spine/femoral neck BMD values were measured using dual-energy X-ray absorptiometry. Correlations of serum IL-6 and TGF-β1 concentrations with bone density and bone turnover markers in OP patients were analyzed utilizing Pearson or Spearman correlation coefficients. Independent influencing factors for OP were identified by logistic multivariate regression analysis. The diagnostic value of serum IL-6 and TGF-β1 was assessed with ROC curves and MedCalc software.

Results: Smoking history, drinking history, lumbar spine BMD, femoral neck BMD, PINP, and β-CTX markedly differed among the normal bone mass, osteopenia, and OP groups. Elevated IL-6 and reduced TGF-β1 concentrations were observed in serum samples of OP. Serum IL-6 concentrations was inversely associated with bone density markers but positively lined to bone turnover markers. Conversely, serum TGF-β1 was positively related to bone density markers but negatively associated with bone turnover markers. Smoking history, PINP, and IL-6, were identified as independent risk factors while lumbar spine BMD, femoral neck BMD, and TGF-β1 were independent protective markers for OP. The combined assessment of serum IL-6 and TGF-β1 showed superior diagnostic performance for OP.

Conclusion: Serum IL-6 in combination with TGF-β1 exhibits good diagnostic performance for OP.

Level of evidence: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.