European Spine Journal最新文献

Purpose: This work aimed to investigate the risk factors for fractures in sandwich vertebrae (SDV; an unfractured vertebra located between 2 cemented vertebrae) formed after percutaneous vertebral augmentation (PVA) and to construct a predictive model from this.

Methods: This study retrospectively analyzed patients who underwent PVA with the formation of SDV from July 2018 to July 2023 at Affiliated Banan Hospital of Chongqing Medical University. Patients were divided into a fracture group and a control group according to the presence or absence of fracture of the SDV during the 1-year postoperative follow-up period. Independent predictors were confirmed using the least absolute shrinkage and selection operator (LASSO) method, and the nomogram was constructed and transformed into an online calculator. The discrimination, calibration, and clinical applicability of the model were assessed by Area under the receiver operating characteristic curve (AUC), calibration curve analysis, and Decision curve analysis (DCA). Finally, the model was externally validated using data from another centre and internally validated using Bootstrap.

Results: A total of 259 patients were enrolled in this study, and 36 patients had fractures of SDV within one year. Multifactorial analyses showed that low bone mineral density (BMD) (OR = 4.264, 95% CI: 2.245-8.098, P < 0.001), number of PVA > 3 (OR = 3.703, 95% CI: 1.399-9.801, P = 0.008), lack of anti-osteoporosis (OR = 4.051, 95% CI: 1.573-10.430, P = 0.004), postoperative kyphosis angle of sandwich fracture segments (PKASFS) > 10° (OR = 8.273, 95% CI: 2.991-22.881, P < 0.001), and lumbar lordosis minus thoracic kyphosis (LL-TK) < 0° (OR = 3.701, 95% CI: 1.523-8.994, P = 0.004) were screened as independent risk factors. The AUC of the model constructed based on this was 0.881 (95% CI: 0.829-0.933). The calibration curves and DCA verified that the model had satisfactory practical consistency and clinical applicability. The externally validated AUC was 0.859 (95% CI: 0.788-0.930), validating the stability of the model.

Conclusions: BMD, number of PVA, anti-osteoporosis, PKASFS, and LL-TK are independent influencing factors for fractures in SDV within one year, and a model based on this had excellent predictive efficacy.

Background context: The incidence of bone metastases is increasing due to advancements in cancer treatment, making it essential to monitor patients' health-related quality of life (HRQOL). Patients diagnosed with spinal metastases often experience persistent pain and functional decline. The use of specific patient-reported outcome measures in spinal tumors can help assess quality of life and treatment outcome.

Purpose: This study aims to cross-culturally adapt and validate the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ) into Hungarian to accurately assess the HRQOL of patients diagnosed with spinal metastases.

Study design/setting: A prospective study was conducted at a tertiary referral hospital among patients treated for spinal metastases.

Patient sample: 50 patients with spinal metastases were included into the study. The median age of the study population was 52 years, ranging from 30 to 82 years. The gender distribution was 27 men and 33 women. The most common primary tumor was breast cancer, followed by lung cancer and prostate cancer.

Outcome measures: SOSGOQ, EuroQol-5D index and EuroQol-VAS.

Methods: After translation and cross-cultural adaptation of SOSGOQ, the validity of the SOSGOQ was assessed by correlating it with the EQ-5D index and VAS using Spearman's rank correlation. Reliability was evaluated with the calculation of intraclass correlation coefficient (ICC) and standard error of measurement (SEM), from which the minimal detectable change (MDC95%) was calculated (2.77*SEM). Responsiveness was expressed by the change in group mean scores from pre-surgery to three months post-surgery and the effect size (Cohen's d). Receiver operating characteristic (ROC) analysis was also performed considering different dimensions of clinical outcome.

Results: No significant floor or ceiling effect was observed for the total SOSGOQ score. The Spearman rank correlation between the SOSGOQ and the EQ-5D index showed a strong association (rho = 0.887, p < 0.001), as did the correlation between the SOSGOQ and the EQ-VAS (rho = 0.653, p < 0.001). Hungarian SOSGOQ proved to be a highly reliable PROM characterized by ICC = 0.95 SEM = 3.9 points, and MDC95 = 11 points. The responsiveness analysis indicates that the SOSGOQ can detect clinical changes in patients with spinal tumors performing better in this context than EQ-5D.

Conclusions: The Hungarian SOSGOQ is a reliable and valid tool for assessing the quality of life in patients diagnosed with spinal metastases. The outstanding responsiveness of this condition-specific PROM was also demonstrated in our study.

Background: Spinal cord injury (SCI) is a disabling condition. While conventional rehabilitation provides benefits, its effects are often limited. This study aimed to evaluate the efficacy and safety of blood flow restriction (BFR) training combined with routine rehabilitation in SCI patients after decompression surgery.

Methods: A retrospective analysis was conducted on 80 patients with SCI who underwent decompression surgery and received rehabilitation treatment at our hospital between January 2023 and January 2024. Based on treatment records, patients were categorized into a control group (routine rehabilitation only) and a combination group (BFR plus routine rehabilitation). Treatment lasted for 12 weeks. Outcomes assessed included muscle strength, Lower Extremity Motor scores (LEMS), Activity of daily living (ADL), lower limb muscle circumference, hemodynamic parameters, and adverse events.

Results: At 3-month follow-up, patients in the combination group exhibited greater improvements in hip, knee, and ankle muscle strength, LEMS scores, ADL scores, and lower limb muscle circumference compared to both baseline and the control group (P < 0.05). No significant intergroup differences were observed at baseline or at 1-month follow-up. Heart rate, blood pressure, and adverse event incidence remained similar between the two groups throughout the observation period (P > 0.05).

Conclusion: BFR training combined with routine rehabilitation may enhance motor function, gait performance, and daily living abilities in SCI patients after decompression surgery without increasing adverse events. These findings support its clinical feasibility, but further prospective studies are warranted to confirm the results.

Purpose: Spinal deformity surgery carries a high risk of intraoperative neuromonitoring (IONM) signal loss and neurological complications. The Cobb angle has traditionally been used to assess spinal deformity severity, but the Deformity Angular Ratio (DAR) has been proposed as a potentially more precise predictor of surgical risks. This systematic review and meta-analysis aimed to compare the preoperative DAR to the Cobb angle to predict the loss of IONM signal and the presence of postoperative neurological complications in spinal deformity correction.

Methods: A systematic literature search followed PRISMA guidelines across PubMed, Scopus, Embase, and Web of Science from their inception to August 2024. Studies were included if they reported Cobb angles, DAR values, IONM signal loss, and/or neurological complications in spinal deformity patients. The Newcastle-Ottawa Scale (NOS) was used for quality assessment. Random-effects meta-analysis was performed to assess the association between Cobb angles, DAR, IONM signal loss, and neurological complications, with Trim and Fill correction applied to adjust for publication bias.

Results: Seven high-quality retrospective cohort studies (1,074 patients) were included. Sagittal Cobb (S-Cobb), Coronal Cobb (C-Cobb), and Total Cobb (T-Cobb) angles were significantly associated with IONM signal loss. Sagittal DAR (S-DAR > 12°) and Total DAR (T-DAR > 22°) were strongly correlated with IONM signal loss, while Coronal DAR (C-DAR) showed no significant association after publication bias correction. T-DAR greater than 39° was the only parameter significantly associated with postoperative neurological complications.

Conclusions: DAR demonstrates greater predictive value than the Cobb angle for identifying patients at high risk for IONM signal loss, with T-DAR showing the strongest correlation. The greater impact of sagittal imbalance (S-DAR, S-Cobb) on IONM signal loss is likely due to spinal cord vascular and mechanical factors.

Background: Posterior pedicle screw instrumentation is usually used for patients with thoracolumbar burst fractures. Some scholars have suggested that pedicle fixation at the level of the fracture to improve stability, prevent postoperative loss of correction and reduce the risk of internal fixation failure. However, for patients with a load sharing classification (LSC) score ≤ 6, whether additional screws are needed in the fractured vertebra is unknown, and there is no standard treatment plan. In this prospective randomized controlled study, the imaging parameters and clinical outcomes before surgery were compared with those after surgery and during the follow-up period.

Methods: In this study, patients were randomly divided into the posterior short-segment pedicle fixation with injured vertebra fixation (PSPFI) group and the posterior short-segment pedicle fixation (PSPF) group using a digital randomization sequence. Clinical and radiographic parameters were evaluated before surgery, after surgery and at the follow-up. The imaging parameters included intervertebral disc height (IDH), anterior vertebra height (AVH), the Cobb angle (Cobb), and loss of the corrected AVH (AVH loss) and Cobb angle (Cobb loss). The Oswestry Disability Index (ODI) score and visual analog scale (VAS) score were recorded as parameters for evaluating clinical outcomes.

Results: A total of 150 patients met the inclusion criteria (75 patients each in the PSPFI and PSPF groups). There were no significant differences in the demographics between the two groups. PSPFI was superior to PSPF in the level of correction maintained. PSPF was superior to PSPFI in terms of short-term postoperative correction. However, there was no significant difference between the groups. Moreover, the differences in the VAS and ODI scores were not significant. But the PSPF group had a shorter operation time (P 0.001) and a lower blood loss (P 0.002).

Conclusion: The effect of posterior pedicle screw internal fixation for thoracolumbar fractures is good, with or without the use of intermediate screws, and there is no significant difference in the long-term follow-up data. Owing to its short operation time and low intraoperative blood loss, short-segment pedicle fixation without injured vertebra fixation is worthy of widespread application in clinical practice.