European Spine Journal最新文献

Objectives: To determine the prevalence of lumbar spondylolisthesis (LS) and its association with low back pain, walking speed, grip strength, and muscle mass in the general population.

Methods: Participants included 1551 members of the general population from the 2nd ROAD (Research on Osteoarthritis/osteoporosis Against Disability) study conducted in Wakayama Prefecture, Japan, between 2008 and 2010. Lumbar radiography diagnosed LS when the slip was ≥ 3 mm in the lateral views. Logistic regression analysis (adjusted for sex, age, area, and BMI) assessed the association between LS and low back pain, walking speed, grip strength, and appendicular lean mass.

Results: Complete data from 1522 participants (510 men, 1012 women, mean age 65.7 ± 12.2 years) were analyzed. The prevalence of LS increases with age, with an estimated one in five men aged 80 years or older and one in four women aged 70-79 years affected. Logistic regression showed LS was significantly associated with low back pain (OR: 1.36, CI: 1.03-1.80). Walking speed, grip strength, and appendicular lean mass were not significantly associated with LS. The prevalence of LS at any level was 17.4% in the total sample, 13.3% in men, and 19.5% in women (P = 0.005).

Conclusion: LS was prevalent in 17.4% of the general population, with a higher prevalence in women. Patients with LS had more low back pain than those without LS.

Background: Spinal deformity can have a severe impact on the patient's sexual health. Eventually, this can lead to depression and relationship distress. Spinal surgical management is suggested to improve sexual function, however, the literature concerning these aspects is still scarce. This study evaluated which factors predicted improvement in sexual health in patients with adult spinal deformity (ASD) who underwent surgical treatment.

Methods: Multicentric retrospective study based on a prospectively collected ASD database. Data of patients who underwent surgical correction and had a 2-year follow-up were collected. The association between different patient-reported outcome measures and ODI question 8 (Q8, sexual health) was explored with Pearson correlations and Principal Component Analysis (PCA). Improvement in sexual health was evaluated through a 1-point decrease on Q8. Comparisons between improved and non-improved patients and the non-response to the preoperative Q8 were assessed.

Results: Data from 880 patients were collected. Moderate correlations were revealed between ODI and COMI-back, SRS-22, and SF-36 items and confirmed with PCA. The main factors associated to a non-response to Q8 were being of an older age, having worse sagittal imbalance, and having a specific nationality. Patients with an improvement in sexual health at 2 years were the ones with a worse baseline quality of life, older patients with a greater sagittal correction, and a better improvement of the level of physical activity.

Conclusion: Non-response to Q8 was correlated to age and nationality. Long-segment ASD surgery could improve sexual health, which was correlated to physical activity improvement, severe deformity with worse preoperative quality of life, and better postoperative sagittal correction.

Purpose: This study aims to investigate the relationship between interspinous ligament fluid (ISF) sign and low back pain, and the effect of ISF on the outcome of lumbar interbody fusion (LIF).

Methods: This retrospective analysis evaluated patients who underwent single-level LIF for lumbar degeneration from January 2012 to December 2019. Patients were divided into ISF (+) and ISF (-) groups based on preoperative lumbar MRI. Data collected included demographic information, surgical data, preoperative and postoperative VAS and ODI scores, and surgical satisfaction. Imaging data assessed intervertebral disc degeneration, lumbar spondylolisthesis, and stability of surgical segments. Differences in VAS, ODI, and satisfaction scores before and after surgery were compared, and regression analysis identified imaging factors linked to residual low back pain. Two-sided p < 0.05 was considered statistically significant.

Results: A total of 328 patients participated in the study, with 108 in the ISF (+) group and 220 in the ISF (-) group. There were no significant differences in mean age, BMI, sex ratio, hypertension, or diabetes rates between the groups. However, the ISF (+) group had a significantly longer hospital stay (16.13 ± 6.83 days) compared to the ISF (-) group (14.51 ± 6.59 days) (p = 0.040). No significant differences were found in operative level, operation time, intraoperative blood loss, or complication rates. At 1 and 3 months postoperatively, VAS scores for low back pain were significantly higher in the ISF (+) group than in the ISF (-) group (p < 0.001 for both). ODI scores showed no significant differences at any postoperative time point (p > 0.05). A significant difference was observed in the proportion of patients with residual low back pain at both 1 and 3 months post-surgery, with more patients in the ISF (+) group reporting pain. Residual low back pain at 1 and 3 months post-surgery positively correlated with a positive ISF sign at the preoperative fusion level (R = 0.213, p < 0.001; R = 0.123, p = 0.025). Logistic regression analysis indicated that a positive ISF sign at the preoperative fusion level was an independent risk factor for residual low back pain at both 1 month and 3 months post-surgery [OR (95% CI) = 2.528 (1.552, 4.118), p < 0.001; OR (95% CI) = 2.146 (1.076, 4.277), p = 0.030].

Conclusion: A positive ISF sign observed at the fusion level may significantly influence the outcomes of lumbar fusion procedures. Specifically, the presence of a positive ISF sign is associated with an elevated risk of unfavorable early postoperative results following lumbar fusion. Furthermore, patients exhibiting a positive ISF sign are more likely to experience residual low back pain during the early postoperative phase compared to those with a negative ISF sign.

Objectives: To compare the prevalence and distribution characteristics of the grade of cervical facet joint degeneration (FJD) among patients with cervical spondylotic myelopathy without/with instability (CSM/CSMI), and ossification of the posterior longitudinal ligament (OPLL). Furthermore, to compare the differences in sagittal parameters and preoperative clinical symptoms between patients with mild and severe FJD.

Methods: The study enrolled 253 patients who underwent surgical treatment at our institution (90 CSM, 79 CSMI, 84 OPLL). A 5-grade computed tomography classification was used to assess bilateral cervical facet joint degeneration from C2/3 to C6/7, with higher grades indicating more severe degeneration. Patients in CSM, CSMI, and OPLL groups were divided into two subgroups separately according to the sum of bilateral FJD grades from C2/3 to C6/7: mild group and severe group. The sagittal parameters of the cervical spine on X-ray, as well as the preoperative Japanese Orthopaedic Association (JOA) score and visual analogue scale (VAS) for neck pain, were compared between the subgroups.

Results: The prevalence of grade 1 to 5 FJD in CSM, CSMI, and OPLL patients was: 77.5%, 17.8%, 3.6%, 1.1%, and 0% for CSM; 62.0%, 25.2%, 7.7%, 3.0%, and 2.1% for CSMI; and 72.4%, 24.4%, 2.2%, 0.3%, and 0.7% for OPLL. The grade of FJD at C2-6 was significantly higher in the CSMI group than the CSM and OPLL groups (P < 0.05). The grade of FJD was highest at C4-C5 in CSM and CSMI groups, while it gradually increased from C3-C4 to C6-C7 in the OPLL group. Patients in severe subgroup exhibited pronounced cervical lordosis, T1 slope, cervical sagittal vertical axis (cSVA), and neck pain (P < 0.05).

Conclusions: The grade of FJD is more severe in patients with CSMI than others. The grade of FJD in CSM and CSMI patients was most severe at C4-C5 level, while OPLL patients had increasingly severe FJD from C3-C7 levels, with maximal degeneration observed at C6-C7. Patients with severe cervical FJD in CSM, CSMI and OPLL groups exhibited pronounced cervical lordosis, increased T1 slope, elevated cSVA, and heightened neck pain.

Purpose: Pyogenic spondylodiscitis is a significant health concern, particularly in older individuals. Minimally invasive surgical techniques, such as posterior fixation, are promising for infection control; however, their mechanisms remain unclear. This study aimed to clarify how posterior fixation promotes infection control in an animal model.

Methods: Thirty female Wistar rats were used to create a pyogenic spondylodiscitis model by injecting methicillin-sensitive Staphylococcus aureus into the intervertebral space between the 6th and 7th coccygeal vertebrae. Three days post-injection, rats were divided into fixation and control groups. The fixation group underwent posterior fixation with an external fixator, whereas the control group underwent screw insertion alone. Bone destruction was assessed via microcomputed tomography on postoperative days (POD) 7, 14, and 21. Immunohistochemistry for cathepsin K and receptor activator of nuclear factor-kappa B ligand (RANKL) was performed on POD 7 samples to assess osteoclast activity.

Results: The fixation group showed less bone destruction than the control group at POD 14 (35% vs. 56%, p = 0.0007) and POD 21 (30% vs. 52%, p < 0.0001). The cathepsin K-positive area was significantly reduced in the fixation group (p = 0.027). RANKL expression was localized within the intervertebral disc in the fixation group, whereas RANKL was strongly expressed on the bone surface adjacent to the disc in control. The RANKL-positive area was also reduced in the fixation group (p = 0.041).

Conclusions: Our combined model of pyogenic spondylodiscitis and posterior fixation supports the theory that posterior fixation stability suppresses RANKL and osteoclast expression, promoting infection control.

Purpose: The small pedicle widths, the thin lateral cortical shell next to the vertebral artery (VA), and the strongly tilted pedicle axis anteromedially narrow the safety margin for cervical pedicle screw (CPS) placement against vertebral artery (VA) injury. We have studied whether the minimally invasive surgery (MIS) of a posterolateral approach with a table-mounted, surgeon-controlled mode of robotic assistance (group R) improves the VA safety compared to C-arm fluoroscopy-guided conventional open technique (group F).

Methods: Group R consisted of 165 screws in 37 patients and group F, 199 screws in 52 patients. The two groups covered a broad range of vertebral levels from C2 to C7 with comparable distribution (p = 0.0512) for treating a similar variety of diseases (p = 0.6958).

Results: Group R, compared with group F, showed a greater lateral-to-medial CPS inclination (p ≤ 0.0004) that even exceeded the obliquity of corresponding pedicle axis, leading to a higher rate of acceptable CPS placement (93.4% vs. 85.4%; p = 0.0164) with a lower rate of lateral breach (1.2% vs. 10.1%; p = 0.0004).

Conclusion: For CPS placement, robot-assisted MIS obviously eliminates morbidity-prone soft-tissue dissection, radiation exposure to the surgical team, and human manual errors. The current study revealed its additional benefit of better safety against VA injury by allowing us to place CPS with a steep lateral-to-medial angulation owing to (1) a lack of counter pressure from the paravertebral muscles and (2) minimizing a navigation pitfall of untracked pressure-induced vertebral rotation.