European Spine Journal最新文献

Purpose: CT is considered the gold standard to assess bone morphology, whereas MRI is the imaging modality of choice to assess soft tissue. To reduce the ionising radiation exposure of the patient from CT, new MRI technologies have been developed to obtain images of bone. Two promising methods include MRI-based synthetic CT (sCT) and T1-weighted isotropic MRI.

Methods: A prospective study including twenty-four adult patients receiving lumbar or sacral spine stabilisation surgery was performed. For each patient, two scans were acquired: a 3D dual echo T1-weighted gradient image, from which a sCT was reconstructed, and a 3D isotropic T1-weighted MRI sequence. Three observers assessed the sCT images for adequate visualisation of relevant vertebral anatomies and confidence using sCT in preoperative planning compared to the isotropic MRI based on a series of statements scored using a Likert-scale. Summary statistics and intraclass correlation coefficients were calculated.

Results: All observers agreed that the sCT provided adequate visualization (94% of cases). Compared to the isotropic MRI, the sCT provided added value (89% of cases) and improved confidence (92% of cases) for the preoperative planning stage. No unexpected poor intraclass correlations were identified. The observers diagnosed patients with spondylolysis, scoliosis, arthrosis, spina bifida occulta, various Castellvi classifications, or without pathology.

Conclusions: sCT adequately visualised vertebral structures relevant for surgical spine planning with good confidence and added value for sCT compared to 3D T1-weighted isotropic MRI is shown. sCT could be a valuable method to reduce the radiation exposure associated with CT.

Purpose: To evaluate the effectiveness of an evidence-based pre-, peri- and postoperative rehabilitation pathway (i.e. the REACT rehabilitation pathway) on disability in patients undergoing lumbar fusion surgery (LFS), compared to usual care.

Methods: A prospective, nonrandomized controlled trial included 72 patients scheduled for one- or two-level LFS for degenerative conditions or adult isthmic spondylolisthesis. Participants were allocated to usual care (N = 36) or the REACT rehabilitation pathway (N = 36). The REACT rehabilitation pathway includes prehabilitation, early mobilization and avoidance of unsubstantiated postoperative restrictions, early postoperative physiotherapy, patient empowerment, case manager guidance, and support towards an early return to activity. The primary outcome was disability; key secondary outcomes were back and leg pain intensity, and return-to-work rate. Additional secondary outcomes included fear of movement, pain catastrophizing, negative emotional states, sit-to-stand performance, analgesic use, length of stay, and adverse events. Data were collected preoperatively and at five time points up to one year postoperatively.

Results: Participants in the REACT group demonstrated significantly greater improvements in disability (p = 0.003), back pain intensity (p = 0.007), and return-to-work rates (88% vs 56%, p = 0.34) compared to the control group. The REACT group also showed greater improvements in fear of movement (p = 0.038), pain catastrophizing (p < 0.001), combined negative emotional states (p = 0.007), sit-to-stand performance (p = 0.021), and reduced analgesic use (p = 0.001). No significant differences were observed in leg pain intensity (p = 0.042), length of hospital stay (p = 0.095) or adverse events (p = 1.00).

Conclusion: The REACT rehabilitation pathway significantly reduced disability in the first postoperative year after LFS compared to usual care. The most promising result is the significantly higher return-to-work rate in the REACT group.

Purpose: Spondylodiscitis is a serious condition requiring prolonged antibiotic therapy. Relevant pharmacokinetic tissue understanding of antibiotics in a spondylodiscitis setting is limited. The study aimed to investigate cefuroxime concentrations in the L4/L5 intervertebral disc, lumbar bone, paravertebral muscle and subcutaneous tissue using microdialysis.

Methods: Eight pigs received 1,500 mg of cefuroxime by intravenous bolus infusion over 10 min. Prior to cefuroxime administration, microdialysis catheters were placed in the L4/L5 intervertebral disc, lumbar bone, paravertebral muscle and adjacent subcutaneous tissue for sampling across an 8-h dosing interval. Plasma samples were obtained for reference. Based on prior time-kill modelling for cefuroxime, 40% of the dosing interval with concentrations above the minimum inhibitory concentration (40% T > MIC) for Staphylococcus aureus was chosen as the primary endpoint.

Results: The 40% T > MIC target exposure was surpassed in all investigated compartments in 5/8 pigs at the lowest MIC-target of 1 [Formula: see text]g/mL. None of the pigs achieved the 40% T > MIC at the clinical breakpoint MIC for S. aureus of 4 [Formula: see text]g/mL. Mean %T > MIC was comparable across the spondylodiscitis relevant tissues at MICs of 1 (range: 43-60%), 2 (range: 30-38%)[Formula: see text] and 4 [Formula: see text]g/mL (range: 16-26%).

Conclusion: Short-infused cefuroxime dosing standards may under-treat S. aureus spondylodiscitis, increasing the risk of inadequate bacterial killing and resistance development. Given the severity of spondylodiscitis, alternate clinical dosing strategies for cefuroxime may be necessary, such as shorter dosing intervals or prolonged/continuous infusion.

Purpose: To investigate the factors affecting indirect dural sac expansion on MRI in single-level Lateral Lumbar Interbody Fusion (LLIF) for degenerative lumbar spondylolisthesis. The focus was on identifying preoperatively selectable and intraoperatively modifiable factors that contribute to or detract from successful indirect decompression, as evidenced by dural sac expansion.

Methods: A retrospective review of 88 consecutive patients who underwent single-level LLIF surgery for degenerative lumbar spondylolisthesis at a single academic institute from January 2013 to December 2022 was conducted. Parameters measured included preoperative and postoperative slip distance, disc height (DH), cage position, and the canal cross-sectional area (CSA) of the dural sac using MRI. Multivariable regression analysis was conducted to identify factors affecting the change in CSA and segmental disc angle (SDA).

Results: The study included patients with an average age of 68.1, primarily undergoing L4-5 LLIF. Significant improvements were noted postoperatively in CSA and disc heights. Multivariable regression showed that smaller preoperative posterior DH and more posterior cage positions significantly increased CSA, whereas smaller anterior DH and more anterior cage positions increased SDA. There was no significant correlation between the change in slip distance and CSA.

Conclusions: Factors contributing to indirect decompression following LLIF for lumbar degenerative spondylolisthesis are primarily associated with an increase in posterior intervertebral height. However, an excessive increase due to posterior placement of the interbody cage may negatively impact the local lordotic angle. The study also suggests that a focus on slip correction may not significantly influence the efficacy of indirect decompression.

Background: Since objective stifness measures are not consistent with the patients' perception and its correlation with the clinical severity of neck pain is not clear, novel studies assessing the clinical relevance of muscle stiffness are needed.

Objectives: To analyze the correlation among psychological factors, clinical severity indicators, and muscle stiffness in neck muscles in patients with chronic mechanical neck pain, and compare these factors with asymptomatic controls.

Methods: A cross-sectional observational study was conducted. Participants included cases with chronic neck pain and asymptomatic controls, assessed for muscle stiffness using shear wave elastography, psychological health (anxiety and kinesiophobia), and clinical severity. Data analysis involved correlation matrices and comparison between groups.

Results: Although no significant differences in levator scapulae stiffness were observed between groups (p > 0.05), patients exhibited significantly increased stiffness in the anterior scalene and cervical multifidus muscles (p = 0.009 and p = 0.040, respectively). STAI scores were significantly higher in patients for both subscales (STAI-S p = 0.002 and STAI-T p < 0.001), but no kinesiophobic behaviors differences were found (p > 0.05). Significant correlations between pain chronicity, intensity, disability, and psychological factors were confirmed. Notably, the levator scapulae stiffness was positively associated with disability, anxiety, and kinesiophobia (all p < 0.01). However, the anterior scalene and cervical multifidus stiffness, even if significantly associated with demographic factors (p < 0.05), were not associated with clinical or psychological outcomes.

Conclusion: The findings underscore the intertwined nature of psychological factors and muscle stiffness in chronic neck pain, suggesting the need for integrated approaches in treatment that consider both physical and psychological dimensions.

Purpose: Split cord malformations represent a small group among tethered cord syndromes. This paper presents the largest series of adult patients with this disorder reported to date. Neuroradiological features, clinical symptoms, surgical management and data on short- and long-term outcomes are analyzed.

Methods: 94 adults (mean age 54.7 ± 15 years) presented with split cord malformations between 1991 and 2024 and were evaluated (follow-up of 64 ± 84 months). Radiological features, intraoperative findings, and neurological examinations before and after surgery were analyzed. Long-term outcomes were evaluated with Kaplan-Meier statistics.

Results: 35 patients presented with a split cord separated in two dural tubes (type I), 59 patients demonstrated a split cord type II with both hemicords in a single dural sac. 79 patients featured a low positioned conus and 10 patients a dermal sinus. In 31 patients (33%), the malformation was combined with a hamartoma, i.e. lipoma or dermoid, epidermoid, neurenteric or neuroepithelial cyst. The commonest clinical course consisted of radicular pain and slowly progressive neurological deficits. 51 patients underwent 59 operations with untethering the split cord, transection of the filum terminale, and hamartoma removal if applicable. There was no permanent surgical morbidity except for patients requiring a revision in split cords type I combined with a hamartoma. 61% considered their postoperative condition improved. Radicular pain responded best with only marginal neurological changes after surgery. Postoperative progression-free courses for 10 years corresponded to the complexity of the malformation: 83.3% experienced 10 year progression-free outcomes after first operation on any split cord without associated hamartoma. If a hamartoma accompanied the split cord, this figure dropped to 59.3%.

Conclusion: The natural history of split cord malformations in adults is benign with slow neurological progression. Surgery should be reserved for symptomatic patients and provide untethering of all structures involved in the split as well as transection of the filum terminale. Associated dysraphic cysts require complete resection, while lipomas may be resected subtotally. The overall prognosis for patients requiring a revision is considerably reduced. Therefore, referral of these patients to appropriate centers is advisable.

Purpose: To report all complications that occurred during the 2 to 5-year postoperative period, describe reoperations during this time period, and compare patients who did and did not have major, surgery-related complications and/or reoperations during this time period.

Methods: The Scoli-RISK-1 study enrolled 272 ASD patients undergoing surgery from 15 centers. Inclusion criteria were Cobb angle of > 80°, corrective osteotomy for congenital/revision deformity, and/or 3-column osteotomy. At each follow-up visit, any neurologic or non-neurologic adverse event(AE) was documented & categorized.

Results: 77 patients had a minimum 5-year follow-up. 35 surgery-related AE's occurred during the 2 to 5-year period in 25(32.5%) patients. 23/35(65.7%) major, surgery-related complications occurred in 17 patients, 22/35(62.9%) requiring reoperations in 16 patients. Rod fracture and/or pseudarthrosis was the most common complication. The most common minor, surgery-related complication was asymptomatic rod fractures with no alignment changes. Four neurological complications were reported, one of which did not require reoperation. One death occurred at 6.1 years postoperative after multiple reoperations for mechanical complications. 14/17(82.4%) patients with major, surgery-related complication had a preceding AE during the initial 2-year postoperative period. 53 non-surgery-related AEs occurred in 21(27.3%) patients with musculoskeletal(37.7%) occurring most often. No differences were observed in ODI or SRS-22r in those with/without major surgery-related complications or those with/without reoperation.

Conclusion: During the study period, 25(32.5%) patients experienced 35 surgery-related complications, of which 23(65.7%) were major. Rod fracture with pseudarthrosis was the most common major, surgery-related complication. Neurologic complications were not found to be major drivers of reoperation. Surprisingly, PROs were similar in those with/without a major, surgery-related complication during the study period. This work has been presented as a podium presentation at the 55th Scoliosis Research Society annual meeting, Sep 9-13, 2020.