European Spine Journal最新文献

Purpose: Anterior cervical discectomy and fusion (ACDF) is the most commonly performed surgical procedure for degenerative cervical spine surgery, which has a long learning curve. Surgical technique training is fundamental for spine surgeons, however, there is a lack of techniques for training on ACDF. Virtual reality (VR) has been introduced into spine surgery training within safe environments. So far, no existing studies have comprehensively evaluated the potential benefits of VR in training residents in ACDF field. This study aims to develop the VR based ACDF training system and evaluate the effect of VR on surgical training for residents.

Methods: A VR simulation module for ACDF training was developed, involving 19 interactive operation steps. Residents of postgraduate years (PGY) 1-3 in our spine center were randomly assigned to VR training (VR group) and standard programmatic training (ST group). The test on ACDF surgery knowledge was conducted as cognitive evaluation, attitudes toward training were evaluated with the neurosurgical evaluation of attitudes towards simulation training (NEAT) tool, self-efficacy evaluation by using the general self-efficacy scale (GSES), and a performance questionnaire was used to evaluate the performance of all participants.

Results: A total of 60 residents were included in this study, with 30 in VR group and 30 in ST group. No significant differences were observed in terms of the demographic data such as age, gender, PGY between the two groups. After the training, the knowledge test scores of residents in the VR group (76.91 ± 9.07) were significantly higher than those in ST group (82.23 ± 8.49), MD= -5.32 with 95%CI (-9.87, -0.79), P < 0.05. VR group showed a better NEAT score (38.23 ± 0.59) than ST group (27.83 + 0.62), MD= -10.43 with 95%CI (-12.67, -8.19), P < 0.05; VR group showed a higher GSES (31.11 ± 3.25) than ST group (29.36 + 3.05), MD= -1.73 with 95%CI (-3.20, -0.23), P < 0.05, and better performance questionnaire score (21.15 ± 2.41) compared with ST group (19.38 ± 2.55), MD= -1.77 with 95%CI (-3.12, -0.55), P < 0.05.

Conclusions: This study developed a VR training system of ACDF, which offers an immersive and interactive 3D environment, enabling trainees to actively engage in the entire ACDF surgical process. The VR training can enhance the cognition of knowledge, positively affect attitudes, improve self-efficacy and intraoperative performance in residents compared with traditional training, thereby supporting its potential application as an educational tool for ACDF training in the future.

Aims: To investigate the characteristics of spinal adverse events after non-operative treatment for spinal metastases with intermediate instability and to discuss clinical considerations when selecting non-operative treatment.

Methods: This study included 56 patients with spinal metastases who had Spinal Instability Neoplastic Scores (SINS) of 7-12 and who underwent radiotherapy and intensive rehabilitation without a bed rest period as initial treatment between 2020 and 2023. We evaluated progression of paralysis and changes in spinal alignment before treatment, within 1 month, 1 to 6 months, and more than 6 months after treatment.

Results: Paralysis progressed within 1 month after treatment in 7 of 56 patients (12.5%). Pre-treatment paralysis and SINS ≥ 11 were significantly associated with progression of paralysis. Alignment changes occurred in 18 of 56 patients (32.1%), with a similar incidence in patients with SINS ≥ 11 and ≤ 10. Fifteen of 44 patients (34.1%) without pre-treatment paralysis had alignment changes, but 1 patient (2.3%) experienced progression of paralysis due to increased instability within 1 month. All 3 patients whose paralysis progressed despite no evidence of malignant spinal cord compression before or after treatment had SINS ≥ 11 and showed vertebral height reduction and kyphosis progression within 1 month.

Conclusion: Patients with pre-treatment paralysis and SINS ≥ 11 can progress to paralysis early; therefore, careful observation and imaging examinations are recommended early after treatment. If spinal alignment worsens, the treatment plan should be reconsidered, including restrictions of activity and surgical treatment.

Objective: The aim of this study was to investigate the predictive value of lumbar local fat parameters for osteoporotic vertebral compression re-fracture (OVCRF) after percutaneous kyphoplasty (PKP) and to develop a nomogram that could provide novel strategies for the prevention of OVCRF.

Methods: We included patients who underwent PKP at Zhongda Hospital between January 2012 and December 2021. The cohort was randomly divided into training and validation cohorts in a 7:3 ratio. Data collection encompassed general patient information, lumbar local fat parameters, and additional imaging data. Lumbar local fat parameters included intramuscular fat, subcutaneous fat, and epidural fat. Patients were classified into re-fracture and non-re-fracture groups based on the occurrence of OVCRF within two years post-PKP. A nomogram was developed utilizing LASSO-logistic regression, and model evaluation was performed through receiver operating characteristic curves, calibration curves, and decision curve analysis.

Results: A total of 452 patients were included in this study. LASSO-logistic regression analysis identified age, bone mineral density (BMD), alkaline phosphatase (ALP), the fat infiltration ratio of paravertebral muscle (PVM-FIR), subcutaneous fat thickness (SFT), and the difference in local kyphotic angle (dLKA) between preoperative and postoperative periods as independent predictive factors for OVCRF. The evaluation curves demonstrated that the model exhibited strong predictive ability and clinical utility.

Conclusion: This study established a nomogram for predicting the occurrence of OVCRF following PKP based on lumbar local fat parameters. The model offers a valuable reference for the prediction and prevention of OVCRF.

Purpose: Image-guided navigation and robotic systems have been introduced in spinal surgery to increase the accuracy of pedicle screws placement and reduce the rate of complications. The objective of this study is to evaluate the different final screw deviation from pre-operative planning and the associated pedicle screw accuracy in spinal fusion surgery assisted by image-guided navigation or robotic systems.

Methods: The systematic literature search was executed using PubMed-Medline, Cochrane Central, and Scopus on 30 April 2023. Studies that explored the deviation between final position and preoperative planning of pedicle screws assisted by image-guide navigation or robotic system were included. The data extracted were surgical approach, surgical aid, number of screws evaluated, spinal levels, accuracy and deviation of screws. The quality of the studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) or the methodological index for non-randomized studies (MINORS) score.

Results: This review included 15 studies, of which 5 used navigation and 10 robotic system. The studies involved 1487 patients, with the evaluation of a total of 7274 pedicle screws, with an assessment of planning and final position. The different methodologies to calculate the deviation include angular deviations in the axial and sagittal plane, 3D angular deviation, and tip and entry point deviation. Regarding screw accuracy, 98.15% of the screws were grade A or B, and 1.85% as category C or D.

Conclusion: Although preoperative planning allows the surgeon to plan the final position of the screw most appropriately, mild deviations from it do not seem to excessively influence the accuracy of the spinal fusion.

Purpose: To radiographically assess the umbilicus' level (i.e. latitude) relative to the anterior lumbar spine based on varying pelvic incidence (PI) magnitudes.

Methods: Pediatric patients (ages 10-18 years) with a previously obtained CT abdomen/pelvis were reviewed. Excluded were patients with prior spine surgery, spinal deformity, and/or underlying lumbar spinal degenerative pathology. On sagittal CT images, 2 radiologists recorded the vertebral level/disc space that corresponded to the umbilicus' latitude level. On the CTs' scout lateral images, two spine surgeons measured the PI. The spinal level corresponding to the umbilicus' latitude was compared between 3 groups based on PI magnitude: low (< 45°), middle (45°-65°), and high (65°).

Results: 107 patients (average age = 14.82.0 years; 62.6% female; average BMI=25.9±10.1) met inclusion criteria. Of all patients, the umbilicus' level ranged from the L3-4 disc to the L5 vertebral body with the L4-5 disc (36.4%) and L4 vertebral body (29.0%) being the most common levels. Average PI was 47.2° 11.9° (Low PI-41.1%; Middle PI-46.7%; High PI-12.1%). The umbilicus' level relative to the spine significantly varied based on PI magnitude (p<0.001). In Low PI, the majority's umbilicus corresponded to the L4-5 disc (50%) or L5 vertebral body (18.2%). In Middle PI, the majority's umbilicus was at the L4 vertebral body (34.0%) and L4-5 disc (34.0%). In High PI, the majority's umbilicus corresponded to the L3-4 disc (38.5%) or L4 vertebral body (46.2%).

Conclusions: The umbilicus' level relative to the lumbar spine significantly varies based on PI magnitude. Patients with lower PIs (low sacral slope) have their umbilicus more commonly located over the distal lumbar spine (L4-5 disc/L5 vertebral body), while high PI patients (high sacral slope) have more superiorly located vertebral levels when referencing the umbilicus. Additional clinical investigations will be beneficial to confirm utility of these findings in guiding location of ALIF incisions.

Purpose: To report the long-term follow-up outcome of a 15-day-old neonate with congenital scoliosis treated with posterior-only hemivertebra bone-disc-bone osteotomy (BDBO) without internal fixation.

Methods: A 15-day-old neonate presented with a lumbar dorsal bulge exhibiting central ulceration and fluid discharge, necessitating emergency hospital admission. The comprehensive imaging study showed a fully segmented right L5 hemivertebra, L3-L4 fusion, and anterior bone bar of T10-T11, syringomyelia at the L2 level, type I diastematomyelia at the L3-L4 level, open spinal meningocele, and tethered cord. Prior to surgery, the patient received a 3-day course of antibiotics to address potential infection concerns. Subsequently, the patient underwent concurrent procedures including repair of the spinal meningocele, resection of the bone crest, release of tethering, and posterior-only hemivertebra type 1 BDBO without internal fixation.

Results: The surgical procedure lasted 165 min, accompanied by an intraoperative blood loss of approximately 50 mL and a blood transfusion of 50 mL. Preoperatively, the patient's hemoglobin level was 159 g/L, which decreased to 138 g/L postoperatively, with no complications. After the operation, the patient achieved a good correction of the spinal curve. The 18-year postoperative follow-up showed further improvement in the correction with good coronal and sagittal balance. The facet joint between the residual L5 hemivertebra and S1, as well as the contralateral facet joint was well preserved, with no pseudoarthrosis formation and a good spinal range of motion.

Conclusion: Posterior-only hemivertebra BDBO without internal fixation might be a simple, safe, effective and feasible surgical procedure for managing lumbosacral hemivertebra in very young children.

Purpose: This prospective, single-arm, multicentre study evaluated the effectiveness of 10 kHz spinal cord stimulation (SCS) in relieving pain and improving function and quality of life in patients with chronic intractable leg pain in routine clinical practice.

Methods: Patients with leg pain refractory to conservative therapy and scoring ≥ 5 cm on a 10-cm visual analog scale (VAS) were enrolled at 12 centres. Those who achieved ≥ 50% leg pain relief during a temporary trial underwent permanent implantation and were followed for 12 months. Outcomes collected included the proportion of patients who achieved ≥ 50% reduction in leg pain VAS score, health-related quality-of-life (EQ-5D-5 L, functional disability [ODI]), opioid use, sleep quality (PSQ-3), global impression of change (GIC), and patient satisfaction.

Results: Of 121 patients trialed, 118 completed the trial and 95 proceeded to implant. At 3 months, 61/95 (64.2%) of all implanted patients were responders to therapy (≥ 50% VAS reduction), which remained stable at 64.2% through 12 months. EQ-5D-5 L, ODI, and PSQ-3 showed clinically important and sustained improvement over 12 months (repeated measures ANOVA, p < 0.001). Patients also reduced opioid dosage on average (p = 0.022). The safety profile was consistent with previous reports using 10 kHz SCS.

Conclusion: This study supports 10 kHz SCS as an effective and safe therapeutic option to reduce pain and disability while improving health-related quality of life in patients with chronic intractable leg pain. 10 kHz SCS appears to be effective in significantly improving the severe disability and poor quality of life experienced by patients with chronic intractable leg pain.

Study registered: ISRCTN Registry - ISRCTN11180496.

Purpose: To describe the incidence of stroke in the first year after surgery for lumbar spinal stenosis (LSS).

Methods: The study included 64,179 Swedish National Spine Register (Swespine) patients who underwent surgery for LSS between 2001 and 2020. The primary outcome was the diagnosis of stroke within the first year after surgery, as documented in the Swedish Stroke Register. The incidence was quantified as the number of strokes per 1,000 surgeries within a defined period, inclusive of the incidence rate (number of strokes/100,000 person-years). An adjusted Cox regression model was used to analyse whether age, sex, smoking, or surgery with implants further increased the risk of stroke.

Results: In the first year after surgery, 426 patients (0.66%) developed a stroke. The risk of stroke was highest during the first 30 days (n=72, 0.11%). Stroke incidence was 1.1/1,000 surgeries during the first 30 days and 6.6/1,000 surgeries during the first year after surgery. The incidence rate during the initial 30 days was 1,394 strokes per 100,000 person-years, while the incidence rate during the first year was 660 strokes per 100,000 person-years. Smoking (hazard ratio [HR], 1.82; 95% confidence interval [CI], 1.31-2.52), age 65-74 years (HR, 2.65; 95% CI, 1.91-3.67), and age ≥75 years (HR, 6.04; 95% CI, 4.42-8.25) further increased the risk of stroke.

Conclusion: The incidence of stroke after LSS surgery was the highest during the first 30 days. However, the absolute number of strokes was small. The risk of stroke could be of minor concern for most of the patients even if older age and smoking were identified as risk factors.

Objective: To investigate the epidemiology and the association with lumbar degeneration of lumbar schmorl's node (SN) subtypes in the general population using abdominal CT scans.

Methods: Patients underwent abdominal CT scans from Jan, 2023 to December, 2023 with all lumbar levels included were retrospectively reviewed. Presence or absence of SNs was scored. The SNs were further classified into SN of primarily developmental cause (SNd) and SN of primarily acquired cause (SNa) according to their image features by two independent readers. Lumbar degeneration of patients with SNs and 150 controls without SNs was evaluated using an existed grading system. Interreader agreement, epidemiologic features of SN subtypes and their association with lumbar degeneration were analyzed.

Results: A total of 2262 patients (45 ± 16 years, 1534 men) were included. Four hundred and forty patients (440/2262, 19%) had 975 SNs, 446 were classified as SNd, and 529 were classified as SNa. The prevalence of SNa increased with age (from 3 to 52%, p < 0.001), while the prevalence of SNd was similar among age groups (from 7 to 10%, p = 0.230). Sex difference was not observed for both SNa (p = 0.585) and SNd (p = 0.167). The most commonly affected lumbar level was L4 and L5 for SNa and L2 for SNd. SNa was independently associated with higher lumbar degeneration scores (p < 0.001) while SNd was not (p = 0.297). The interreader κ value was 0.67.

Conclusion: The SN subtypes differ in their predilected lumbar levels, the relationship with age and lumbar degeneration and should be analyzed as different entities.