European Spine Journal最新文献

Purpose: Cervical spine fractures (CSF) have been linked to blunt cerebrovascular injuries (BCVI) due to arterial proximity, but consensus on screening criteria remains elusive. This literature review hypothesises that BCVI rates differ with CSF types and aims to identify predictive CSF patterns for BCVI, enhancing screening accuracy and diagnostics.

Methods: All English literature (2000-2026) was reviewed according to PRISMA guidelines in PubMed and Embase. Inclusion criteria were adults (> 16 years), blunt cervical trauma, and specific CSF patterns associated with BCVI. Exclusion criteria were pediatric patients, penetrating traumas, and no accessible full text. A random-effects meta-analysis was conducted to produce pooled odds ratios with a corresponding 95% confidence interval for each specific fracture pattern. I2-statistics were calculated to assess the proportion of variation attributed to heterogeneity and whether that variation was significant. Leave-one-out analysis was conducted on estimates with significant heterogeneity Calculations were made using Stata18.

Results: Among 717 eligible articles, 7 studies met the criteria. Specific CSF patterns mentioned were isolated C1 and C2 fractures, any C1-C3 and C4-C7 fractures, two-level fractures, subluxation/dislocations, and transverse foramen (TF) fractures. Pooled odds ratio with 95% confidence interval for BCVI and C1 fractures was: 1.38 (0.97-1.94); C2: 1.18 (0.88-1.58); C1-C3: 1.89 (0.99-3.60); C4-C7: 0.98 (0.61-1.59); TF: 3.42 (1.61-7.26); Subluxation/dislocations: 4.41 (2.88-6.76); Two-level: 1.19 (0.78-1.82).

Conclusion: This meta-analysis showed an association between facet dislocations and fractures involving the transverse foramen and increased odds of BCVI. No statistically significant association was identified between BCVI and fractures at specific vertebral levels, although upper cervical fractures were frequently observed among affected patients. Heterogeneity between studies calls for caution when interpreting results.

Objective: Proximal Junctional Failure (PJF) is a known complication of instrumented spine surgery. When a construct ends in the lower thoracic spine, PJF occurring at the suprajacent level can be difficult to adequately correct. Transforaminal Thoracic Interbody Fusion (TTIF) is a posterior-only pedicle-sparring approach that may offer effective correction of thoracic PJF.

Methods: This report details a single-center retrospective review of patients who underwent TTIF for PJF correction from 2014-2020. Demographic data, operative details, and Oswestry Disability Index (ODI) was included for all patients with at least 1 year follow-up. Preoperative and postoperative full-spine radiographs were assessed for correction of proximal junctional kyphosis (PJK). Surgical complications were recorded.

Results: A total of 22 patients underwent TTIF for PJF correction. Average kyphosis correction was 15° ± 10° (range 0° - 40°). All patients achieved correction to their physiologic sagittal alignment goals, except for one patient that experienced neuromonitoring changes during correction. All cases demonstrated arthrodesis. Mean ODI improvement at 1 year was 12.2% ± 20.0% (range -18.0% - 54.7%; p=0.048).

Conclusions: TTIF is a viable and technically reproducible posterior-only approach for the surgical correction of thoracic PJF.

Purpose: To identify patient and intervention factors that moderate the effects of running on intervertebral disc health (IVD) in adults with non‑specific chronic low back pain.

Methods: Pre‑planned secondary analysis of a 12-week parallel-group (1:1) randomised controlled trial of 40 adults with non-specific CLBP (mean [SD] age: 33 [6] years, female: 50%). Participants were allocated to a digitally-delivered progressive run-walk interval exercise training program (3 days/week, 30 min/session) or waitlist control. Magnetic resonance imaging at baseline, six, and 12 weeks quantified primary outcome IVD composition as whole-disc T2 (ms) from T11/T12 to L5/S1. Moderators included baseline degeneration (Pfirrmann grade; aggregated Pfirrmann score), sex, body mass index, and intervention factors (cumulative running volume, mean speed, and dominant surface). Linear mixed models were fitted at the IVD level to estimate group-by-time effects within each moderator-defined subgroup (α = 0.05).

Results: The highest aggregated Pfirrmann scores reflecting greater multi-level degeneration (estimated marginal mean net difference [95%CI]: 3.42 [0.22, 6.62] ms, P = 0.036), cumulative running volumes between 28.6 and 46.1 kms (4.80 [2.51, 7.10] ms, P < 0.001), mean running speeds between 10.5 and 11.7 km/h (2.46 [0.14, 4.79] ms, P = 0.038), and running on grass (2.93 [0.10, 5.76] ms, P = 0.043) positively moderated between-group IVD T2 changes.

Conclusion: In this pre-planned secondary analysis of a randomised control trial of a run-walk program, our data suggest running speed, volume and surface, as well as more multi-level IVD degeneration, may be associated with more favourable 12-week IVD T2 changes. Findings are hypothesis-generating and may inform future trials designed to optimise IVD health.