Pub Date : 2024-09-13DOI: 10.1007/s00586-024-08494-1
Dong Li, Jie Li, Yanjie Xu, Chen Ling, Yong Qiu, Zezhang Zhu, Zhen Liu
Purpose
To assess the effectiveness and safety of topical vancomycin powder (VP) in preventing surgical site infections (SSIs) in spinal deformity surgeries.
Methods
A literature search was conducted on Web of Science, PubMed, and Cochrane Library databases for comparative studies of VP in spinal deformity surgeries published before February 2024. Two reviewers independently screened eligible articles based on the inclusion and exclusion criteria, assessed study quality, and extracted data. Data analysis was performed using Review Manager 5.4 software.
Results
Of all 143 papers screened, a meta-analysis was conducted on 10 articles, which included a total of 8,166 surgeries. The results of the meta-analysis indicated that the incidence of deep SSI in VP group was 0.28 times that in non-VP group (p < 0.001). In the subgroup analysis, VP treatment significantly reduced the risk of deep SSI in both adult spinal deformity (ASD) (RR 0.40, 95% CI 0.21–0.77, p = 0.006) and pediatric scoliosis (PS) (RR 0.25, 95% CI 0.16–0.38, p < 0.001) surgeries. However, this effect was not observed in neuromuscular scoliosis (NMS) patients (RR 0.66, 95% CI 0.26–1.66, p = 0.38). Bacterial culture results indicated that VP treatment significantly reduced polymicrobial infections (p = 0.007) and gram-positive infections (p = 0.001).
Conclusion
From the literature available at present, VP was associated with reduced deep SSIs rates in spinal deformity patients. However, particular attention should be paid to the lack of the effectiveness of VP in NMS patients. The current literature did not report local cytotoxicity or renal toxicity related to VP in spinal deformity patients.
{"title":"Topical vancomycin powder for the prevention of surgical site infections in spinal deformity surgery: a systematic review and meta-analysis","authors":"Dong Li, Jie Li, Yanjie Xu, Chen Ling, Yong Qiu, Zezhang Zhu, Zhen Liu","doi":"10.1007/s00586-024-08494-1","DOIUrl":"https://doi.org/10.1007/s00586-024-08494-1","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>To assess the effectiveness and safety of topical vancomycin powder (VP) in preventing surgical site infections (SSIs) in spinal deformity surgeries.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A literature search was conducted on Web of Science, PubMed, and Cochrane Library databases for comparative studies of VP in spinal deformity surgeries published before February 2024. Two reviewers independently screened eligible articles based on the inclusion and exclusion criteria, assessed study quality, and extracted data. Data analysis was performed using Review Manager 5.4 software.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Of all 143 papers screened, a meta-analysis was conducted on 10 articles, which included a total of 8,166 surgeries. The results of the meta-analysis indicated that the incidence of deep SSI in VP group was 0.28 times that in non-VP group (<i>p</i> < 0.001). In the subgroup analysis, VP treatment significantly reduced the risk of deep SSI in both adult spinal deformity (ASD) (RR 0.40, 95% CI 0.21–0.77, <i>p</i> = 0.006) and pediatric scoliosis (PS) (RR 0.25, 95% CI 0.16–0.38, <i>p</i> < 0.001) surgeries. However, this effect was not observed in neuromuscular scoliosis (NMS) patients (RR 0.66, 95% CI 0.26–1.66, <i>p</i> = 0.38). Bacterial culture results indicated that VP treatment significantly reduced polymicrobial infections (<i>p</i> = 0.007) and gram-positive infections (<i>p</i> = 0.001).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>From the literature available at present, VP was associated with reduced deep SSIs rates in spinal deformity patients. However, particular attention should be paid to the lack of the effectiveness of VP in NMS patients. The current literature did not report local cytotoxicity or renal toxicity related to VP in spinal deformity patients.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1007/s00586-024-08492-3
Hiroshi Miyamoto
Background
This study aimed to elucidate the specificity of the radiological features of Dropped head syndrome (DHS) from both reginal and global aspects.
Methods
We enrolled 53 patients with DHS (8 men, 45 women; mean age 73.5 years), and captured their lateral spinopelvic radiographs in standing position. We also selected 21 age- and sex-matched controls with cervical spondylosis. Radiological parameters were measured and compared between two groups. Compensatory and decompensatory sites were also listed for each patient.
Results
Radiological factors such as sagittal vertical axis (SVA), clivo-axial angle (CAA), C2–7 angle, C2–7 SVA, anterior slippage of the vertebra, alignment. C1, C2, C3, C4, C5, C6 slopes, and T1 slope-C2–7 angle showed statistically significant differences between the groups. Multivariate logistic regression showed that SVA, C2–7 SVA, T1-slope-C2–7 angle, and C1 slope were the most important factors specific to DHS. Sole cervical spine and involvement of both cervical and thoracic spine accounted for 22% and 29% of the decompensatory sites in DHS respectively. Notably, 24% of the patients did not show decompensation of the cervical spine. While, 93% exhibited compensation at the craniovertebral junction. The thoracic spine contributed 70% to DHS compensation.
Conclusions
This study indicated the radiological features of DHS from both regional and global aspects. Compensatory and decompensatory DHS mechanisms varied among individuals. Compensation was likely to be developed at the neighboring sites, with the craniovertebral and thoracic junctions as the proximal and distal parts for DHS, respectively.
{"title":"Radiological features of dropped head syndrome","authors":"Hiroshi Miyamoto","doi":"10.1007/s00586-024-08492-3","DOIUrl":"https://doi.org/10.1007/s00586-024-08492-3","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>This study aimed to elucidate the specificity of the radiological features of Dropped head syndrome (DHS) from both reginal and global aspects.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We enrolled 53 patients with DHS (8 men, 45 women; mean age 73.5 years), and captured their lateral spinopelvic radiographs in standing position. We also selected 21 age- and sex-matched controls with cervical spondylosis. Radiological parameters were measured and compared between two groups. Compensatory and decompensatory sites were also listed for each patient.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Radiological factors such as sagittal vertical axis (SVA), clivo-axial angle (CAA), C2–7 angle, C2–7 SVA, anterior slippage of the vertebra, alignment. C1, C2, C3, C4, C5, C6 slopes, and T1 slope-C2–7 angle showed statistically significant differences between the groups. Multivariate logistic regression showed that SVA, C2–7 SVA, T1-slope-C2–7 angle, and C1 slope were the most important factors specific to DHS. Sole cervical spine and involvement of both cervical and thoracic spine accounted for 22% and 29% of the decompensatory sites in DHS respectively. Notably, 24% of the patients did not show decompensation of the cervical spine. While, 93% exhibited compensation at the craniovertebral junction. The thoracic spine contributed 70% to DHS compensation.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>This study indicated the radiological features of DHS from both regional and global aspects. Compensatory and decompensatory DHS mechanisms varied among individuals. Compensation was likely to be developed at the neighboring sites, with the craniovertebral and thoracic junctions as the proximal and distal parts for DHS, respectively.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1007/s00586-024-08489-y
Zhixiao Feng,Chenyang Huang,Ziyu Guo,Qi Zhang
{"title":"Letter to the editor concerning \"Unilateral versus bilateral pedicle screw fixation with anterior lumbar interbody fusion: a comparison of postoperative outcomes\" by Levy HA, et al. (Eur Spine J [2024]: https://doi.org/10.1007/s00586-024-08412-5).","authors":"Zhixiao Feng,Chenyang Huang,Ziyu Guo,Qi Zhang","doi":"10.1007/s00586-024-08489-y","DOIUrl":"https://doi.org/10.1007/s00586-024-08489-y","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1007/s00586-024-08461-w
Sadegh Bagherzadeh, Mohsen Rostami, Mohammad Jafari, Faramarz Roohollahi
<h3 data-test="abstract-sub-heading">Objective</h3><p>Paralysis subsequent to spinal cord decompression in the cervical or thoracic region is infrequent, with White Cord Syndrome (WCS) being among its several causes. Due to WCS’s infrequency, there exists a paucity of high-level evidence concerning its manifestations. Our primary objective is to systematically collate all documented WCS cases, discern prevalent risk and prognostic factors, appraise available treatment modalities, and evaluate patient outcomes.</p><h3 data-test="abstract-sub-heading">Methods</h3><p>A systematic review was conducted following PRISMA guidelines. The search included PubMed, Scopus, Embase, and Web of Science databases. Inclusion criteria required studies to be written in English, be case reports, and contain data on clinical features, management, and treatment outcomes. Exclusion criteria excluded meta-analyses, reviews, editorials, letters, books, studies with insufficient clinical data, and studies not in English or with unavailable full texts. Grey literature was not actively pursued due to identification challenges, potentially introducing selection bias. Two authors independently evaluated papers based on criteria. Disagreements were resolved with a third author. Additionally, the included articles’ references were screened for additional relevant articles.</p><h3 data-test="abstract-sub-heading">Results</h3><p>We found a total of 580 articles through our electronic search. After removing duplicates, 399 articles were screened. Out of the remaining 51 studies, 27 were included in the final quantitative analysis. The average age was 54 (3–79 years) with a male-to-female ratio of 2:1, 33% had OPLL, and Common medical histories were hypertension (30%), diabetes mellitus (20%), and previous ACDF surgery (8%). Of all Surgeries, 70% were done with a posterior approach and 30% with the anterior approach. 48% of cases used Intraoperative NeuroMonitoring(IONM), and Loss of Motor Evoked Potentials (MEP) occurred in 37% of cases. Patients received high-dose intravenous steroids. In 26% of cases, additional posterior cervical decompression was performed, and efforts were made to maintain mean arterial pressure above 85 mmHg in 37% of cases. Other medications were administered in 30% of cases. Over an average 26-week follow-up, 37% of patients had good recovery, 40% had partial recovery, and 23% showed no recovery. The average final Nurick grade was 3.2.</p><h3 data-test="abstract-sub-heading">Conclusions</h3><p>WCS is a rare cause of postoperative neurological deficit following spinal cord decompression surgery. Risk factors for WCS include advanced age, extensive surgery, posterior approach for decompression, and the presence of OPLL. Treatment includes high-dose steroids, posterior cervical decompression, maintaining MAP over 85mmHg, rehabilitation, and sometimes neurotrophic drugs. Most patients can walk with or without assistance during follow-up, but around a quarter n
{"title":"“White Cord Syndrome” as clinical manifestation of the spinal cord reperfusion syndrome: a systematic review of risk factors, treatments, and outcome","authors":"Sadegh Bagherzadeh, Mohsen Rostami, Mohammad Jafari, Faramarz Roohollahi","doi":"10.1007/s00586-024-08461-w","DOIUrl":"https://doi.org/10.1007/s00586-024-08461-w","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Objective</h3><p>Paralysis subsequent to spinal cord decompression in the cervical or thoracic region is infrequent, with White Cord Syndrome (WCS) being among its several causes. Due to WCS’s infrequency, there exists a paucity of high-level evidence concerning its manifestations. Our primary objective is to systematically collate all documented WCS cases, discern prevalent risk and prognostic factors, appraise available treatment modalities, and evaluate patient outcomes.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A systematic review was conducted following PRISMA guidelines. The search included PubMed, Scopus, Embase, and Web of Science databases. Inclusion criteria required studies to be written in English, be case reports, and contain data on clinical features, management, and treatment outcomes. Exclusion criteria excluded meta-analyses, reviews, editorials, letters, books, studies with insufficient clinical data, and studies not in English or with unavailable full texts. Grey literature was not actively pursued due to identification challenges, potentially introducing selection bias. Two authors independently evaluated papers based on criteria. Disagreements were resolved with a third author. Additionally, the included articles’ references were screened for additional relevant articles.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>We found a total of 580 articles through our electronic search. After removing duplicates, 399 articles were screened. Out of the remaining 51 studies, 27 were included in the final quantitative analysis. The average age was 54 (3–79 years) with a male-to-female ratio of 2:1, 33% had OPLL, and Common medical histories were hypertension (30%), diabetes mellitus (20%), and previous ACDF surgery (8%). Of all Surgeries, 70% were done with a posterior approach and 30% with the anterior approach. 48% of cases used Intraoperative NeuroMonitoring(IONM), and Loss of Motor Evoked Potentials (MEP) occurred in 37% of cases. Patients received high-dose intravenous steroids. In 26% of cases, additional posterior cervical decompression was performed, and efforts were made to maintain mean arterial pressure above 85 mmHg in 37% of cases. Other medications were administered in 30% of cases. Over an average 26-week follow-up, 37% of patients had good recovery, 40% had partial recovery, and 23% showed no recovery. The average final Nurick grade was 3.2.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>WCS is a rare cause of postoperative neurological deficit following spinal cord decompression surgery. Risk factors for WCS include advanced age, extensive surgery, posterior approach for decompression, and the presence of OPLL. Treatment includes high-dose steroids, posterior cervical decompression, maintaining MAP over 85mmHg, rehabilitation, and sometimes neurotrophic drugs. Most patients can walk with or without assistance during follow-up, but around a quarter n","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1007/s00586-024-08470-9
Eva Liu, Sabahat Saeed, Nicole R. Coote, Jack Su, Patrick R. Toyota, Braeden D. Newton, Amit R. Persad, Daryl R. Fourney
Purpose
One of the major advantages of a minimally invasive microdiscectomy is that when CSF leak occurs, there is minimal anatomic dead space for ongoing leakage following removal of the tubular retractor. However, there are no published reports that address the safety and long-term outcomes of same-day discharge for CSF leak after tubular microdiscectomy.
Methods
This is a retrospective compartive study of 30 patients with incidental durotomy during minimally invasive tubular microdiscectomy occurring between January 1, 2009 to August 31, 2023 at our institution.
Results
There were 16 patients (53%) admitted to hospital and 14 (47%) patients discharged home the same day following CSF leak. There were no differences in patient demographics between the two groups at baseline. Twenty-nine out of 30 (97%) of the patients had onlay duraplasty, and one (3%) patient was repaired using sutures through the tubular retractor. None were converted to an open approach. The hospitalized group was kept on bed rest overnight or for 24 h. The discharge group was kept on best rest for 2 h or mobilized immediately after surgery. No patients in either group required readmission or revision surgery for CSF leak. The average length of admission for the hospitalized group was 2.4 ± 4.0 days. Conclusion: Patients with CSF leak during minimally invasive tubular microdiscectomy can be safely discharged home the same day.
{"title":"Incidental durotomy during tubular microdiscectomy does not preclude same-day discharge","authors":"Eva Liu, Sabahat Saeed, Nicole R. Coote, Jack Su, Patrick R. Toyota, Braeden D. Newton, Amit R. Persad, Daryl R. Fourney","doi":"10.1007/s00586-024-08470-9","DOIUrl":"https://doi.org/10.1007/s00586-024-08470-9","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>One of the major advantages of a minimally invasive microdiscectomy is that when CSF leak occurs, there is minimal anatomic dead space for ongoing leakage following removal of the tubular retractor. However, there are no published reports that address the safety and long-term outcomes of same-day discharge for CSF leak after tubular microdiscectomy.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>This is a retrospective compartive study of 30 patients with incidental durotomy during minimally invasive tubular microdiscectomy occurring between January 1, 2009 to August 31, 2023 at our institution.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>There were 16 patients (53%) admitted to hospital and 14 (47%) patients discharged home the same day following CSF leak. There were no differences in patient demographics between the two groups at baseline. Twenty-nine out of 30 (97%) of the patients had onlay duraplasty, and one (3%) patient was repaired using sutures through the tubular retractor. None were converted to an open approach. The hospitalized group was kept on bed rest overnight or for 24 h. The discharge group was kept on best rest for 2 h or mobilized immediately after surgery. No patients in either group required readmission or revision surgery for CSF leak. The average length of admission for the hospitalized group was 2.4 ± 4.0 days. Conclusion: Patients with CSF leak during minimally invasive tubular microdiscectomy can be safely discharged home the same day.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-09DOI: 10.1007/s00586-024-08485-2
Yi Lu, Xiaobing Cai, Juexin Shen, Rengui Luo
Purpose: Short-term efficacy of percutaneous kyphoplasty (PKP) for treating osteoporotic vertebral compression fracture (OVCF) in elderly patients is good, but long-term complications such as vertebral recompression (VRC) and adjacent vertebral fracture (AVF) may arise. Identifying risk factors in patients with poor prognoses, we developed a nomogram model to mitigate these potential complications.
Methods: Patients with OVCFs who underwent PKP had their medical data retrospectively evaluated. Analysis of the sample included their pre- and postoperative conditions. Stepwise logistic regression analyses were conducted to identify independent risk factors for postoperative complications. For forecasting the likelihood of postoperative comorbidities, we offered a nomogram. The prognostic performance was assessed using the receiver operating characteristic curve (ROC), calibration curve, and decision curve analyses (DCA). Internal model validation using the Bootstrap method.
Results: A total of 235 patients were included in this study. Among them, 147 patients were utilized to develop nomograms and for internal validation, while the remaining 88 patients from a different time period were designated as the external validation cohort. The results of stepwise logistic regression analysis showed that thoracolumbar (TL) fracture, posterior wall of vertebral fracture, vertebral compression > 30%, and lack of continuous anti-osteoporosis therapy after surgery as independent risks associated with poor prognosis. The nomogram exhibited outstanding predictive accuracy and clinical utility.
Conclusions: This study identified four independent predictors of poor prognosis following PKP and devised a straightforward yet efficient predictive model. This model offers valuable insights for guiding clinical decision-making in the management of elderly patients with OVCFs.
{"title":"Development and validation of a prediction model for vertebral recompression and adjacent vertebral fracture after kyphoplasty in geriatric patients.","authors":"Yi Lu, Xiaobing Cai, Juexin Shen, Rengui Luo","doi":"10.1007/s00586-024-08485-2","DOIUrl":"https://doi.org/10.1007/s00586-024-08485-2","url":null,"abstract":"<p><strong>Purpose: </strong>Short-term efficacy of percutaneous kyphoplasty (PKP) for treating osteoporotic vertebral compression fracture (OVCF) in elderly patients is good, but long-term complications such as vertebral recompression (VRC) and adjacent vertebral fracture (AVF) may arise. Identifying risk factors in patients with poor prognoses, we developed a nomogram model to mitigate these potential complications.</p><p><strong>Methods: </strong>Patients with OVCFs who underwent PKP had their medical data retrospectively evaluated. Analysis of the sample included their pre- and postoperative conditions. Stepwise logistic regression analyses were conducted to identify independent risk factors for postoperative complications. For forecasting the likelihood of postoperative comorbidities, we offered a nomogram. The prognostic performance was assessed using the receiver operating characteristic curve (ROC), calibration curve, and decision curve analyses (DCA). Internal model validation using the Bootstrap method.</p><p><strong>Results: </strong>A total of 235 patients were included in this study. Among them, 147 patients were utilized to develop nomograms and for internal validation, while the remaining 88 patients from a different time period were designated as the external validation cohort. The results of stepwise logistic regression analysis showed that thoracolumbar (TL) fracture, posterior wall of vertebral fracture, vertebral compression > 30%, and lack of continuous anti-osteoporosis therapy after surgery as independent risks associated with poor prognosis. The nomogram exhibited outstanding predictive accuracy and clinical utility.</p><p><strong>Conclusions: </strong>This study identified four independent predictors of poor prognosis following PKP and devised a straightforward yet efficient predictive model. This model offers valuable insights for guiding clinical decision-making in the management of elderly patients with OVCFs.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: To compare the mechanical properties of human annulus fibrosus obtained by forceps versus bistoury and observe whether the measurement could be affected by forceps sampling method.
Methods: In this study, the mechanical properties of the the extracellular matrix (ECM) of human annulus fibrosus, including elastic modulus and stiffness, were investigated using atomic force microscope (AFM). Tissue was obtained from patients during operation using a bistoury or nucleus pulposus forceps. Tissues obtained with the nucleus pulposus forceps were considered as the forceps group and those obtained with a bistoury were considered as the bistoury group.
Results: There was no significant difference observed between the forceps and bistoury group according to histological staining. The elastic modulus of the forceps group was 0.41 ± 0.08 MPa, and that of bistoury group was 0.53 ± 0.13 MPa, and the difference between the two groups was statistically significant (p < 0.05). The stiffness of the forceps group was 0.024 ± 0.003 N/m, and that of the bistoury group was 0.037 ± 0.003 N/m, and the difference between the two groups was statistically significant (p < 0.05).
Conclusion: The results indicate that the forceps sampling method has a substantial negative effect on the micromechanical properties of the ECM of the annulus fibrosus. Bistoury sampling method is recommended as the experimental subject for exploring the micromechanics mechanisms of cervical degenerative disease.
{"title":"The mechanical properties measurement could be affected by forceps: a technical note on sampling human annulus fibrosus.","authors":"Tianchi Zhou, Bowei Xiao, Juying Huang, Tianhua Rong, Bingxuan Wu, Baoge Liu","doi":"10.1007/s00586-024-08438-9","DOIUrl":"https://doi.org/10.1007/s00586-024-08438-9","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the mechanical properties of human annulus fibrosus obtained by forceps versus bistoury and observe whether the measurement could be affected by forceps sampling method.</p><p><strong>Methods: </strong>In this study, the mechanical properties of the the extracellular matrix (ECM) of human annulus fibrosus, including elastic modulus and stiffness, were investigated using atomic force microscope (AFM). Tissue was obtained from patients during operation using a bistoury or nucleus pulposus forceps. Tissues obtained with the nucleus pulposus forceps were considered as the forceps group and those obtained with a bistoury were considered as the bistoury group.</p><p><strong>Results: </strong>There was no significant difference observed between the forceps and bistoury group according to histological staining. The elastic modulus of the forceps group was 0.41 ± 0.08 MPa, and that of bistoury group was 0.53 ± 0.13 MPa, and the difference between the two groups was statistically significant (p < 0.05). The stiffness of the forceps group was 0.024 ± 0.003 N/m, and that of the bistoury group was 0.037 ± 0.003 N/m, and the difference between the two groups was statistically significant (p < 0.05).</p><p><strong>Conclusion: </strong>The results indicate that the forceps sampling method has a substantial negative effect on the micromechanical properties of the ECM of the annulus fibrosus. Bistoury sampling method is recommended as the experimental subject for exploring the micromechanics mechanisms of cervical degenerative disease.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.1007/s00586-024-08484-3
Ronny Meisterfeld, Anne Queck, Alexander Carl Disch, Marius Distler, Hanns-Christoph Held, Janusz von Renesse, Klaus-Dieter Schaser, Jürgen Weitz, Konrad Kamin
Purpose: In patients with traumatic, infectious, degenerative, and neoplastic surgical indications in the cervical spine, commonly the anterior approach is used. Often these patients require a tracheostomy necessary due to prolonged mechanical ventilation. The limited spinal mobility and proximity to the surgical site of anterior cervical spine fixation (ACSF) could pose an increased risk for complications of percutaneous dilational tracheostomy (PDT.) Importantly, PDT might raise wound infection rates of the cervical spine approach. The aim of this study is to prove safety of PDT after ACSF.
Methods: We performed a retrospective, single-center study comparing patients with and without ACSF who underwent Ciaglia-single step PDT. After propensity score matching using logistic regression, we compared intra- and postprocedural complication rates. Furthermore, surgical site infections were evaluated. Putensen's definitions of complications and Clavien-Dindo's classification were used.
Results: A total of 1175 patients underwent PDT between 2009 and 2021. Fifty-seven patients underwent PDT following ACSF and were matched to fifty-seven patients without ACSF. The mean interval between ACSF and PDT was 11.3 days. The overall complication rate was 19.3% in the ACSF group and 21.1% in the non-ACSF group. The mean follow-up was 388 days (± 791) in the ACSF group and 424 days (± 819) in the non-ACSF group. Life-threatening complications (Clavien-Dindo IV to V) were found in 1.8% of ACSF patients and 3.5% of non-ACSF patients. There were no significant differences in complication rates. No surgical site infection of the anterior spine access was detected.
Conclusion: PDT is a feasible and safe procedure in patients after ACSF. Complication rates are comparable to patients without ACSF. Surgical site infections of ACSF are very rare.
{"title":"Percutaneous dilational tracheostomy following anterior cervical spine fixation - a retrospective propensity-matched cohort study.","authors":"Ronny Meisterfeld, Anne Queck, Alexander Carl Disch, Marius Distler, Hanns-Christoph Held, Janusz von Renesse, Klaus-Dieter Schaser, Jürgen Weitz, Konrad Kamin","doi":"10.1007/s00586-024-08484-3","DOIUrl":"https://doi.org/10.1007/s00586-024-08484-3","url":null,"abstract":"<p><strong>Purpose: </strong>In patients with traumatic, infectious, degenerative, and neoplastic surgical indications in the cervical spine, commonly the anterior approach is used. Often these patients require a tracheostomy necessary due to prolonged mechanical ventilation. The limited spinal mobility and proximity to the surgical site of anterior cervical spine fixation (ACSF) could pose an increased risk for complications of percutaneous dilational tracheostomy (PDT.) Importantly, PDT might raise wound infection rates of the cervical spine approach. The aim of this study is to prove safety of PDT after ACSF.</p><p><strong>Methods: </strong>We performed a retrospective, single-center study comparing patients with and without ACSF who underwent Ciaglia-single step PDT. After propensity score matching using logistic regression, we compared intra- and postprocedural complication rates. Furthermore, surgical site infections were evaluated. Putensen's definitions of complications and Clavien-Dindo's classification were used.</p><p><strong>Results: </strong>A total of 1175 patients underwent PDT between 2009 and 2021. Fifty-seven patients underwent PDT following ACSF and were matched to fifty-seven patients without ACSF. The mean interval between ACSF and PDT was 11.3 days. The overall complication rate was 19.3% in the ACSF group and 21.1% in the non-ACSF group. The mean follow-up was 388 days (± 791) in the ACSF group and 424 days (± 819) in the non-ACSF group. Life-threatening complications (Clavien-Dindo IV to V) were found in 1.8% of ACSF patients and 3.5% of non-ACSF patients. There were no significant differences in complication rates. No surgical site infection of the anterior spine access was detected.</p><p><strong>Conclusion: </strong>PDT is a feasible and safe procedure in patients after ACSF. Complication rates are comparable to patients without ACSF. Surgical site infections of ACSF are very rare.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-05DOI: 10.1007/s00586-024-08482-5
Wei-Zhen Tang, Wen-Xin Deng, Tai-Hang Liu
{"title":"Letter to the editor concerning \"Impact of preoperative back pain severity on PROMIS outcomes following minimally invasive lumbar decompression\" by Anwar FN, et al. (Eur Spine J [2024]: doi: 10.1007/s00586-024-08275-w).","authors":"Wei-Zhen Tang, Wen-Xin Deng, Tai-Hang Liu","doi":"10.1007/s00586-024-08482-5","DOIUrl":"https://doi.org/10.1007/s00586-024-08482-5","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-04DOI: 10.1007/s00586-024-08411-6
Xiao-Nan Tian, Sheng-Nan Li, Bao-Gen Zhao, Ning Wang, Ting Gao, Li Zhang
Purpose: To investigate the clinical application of zonally magnified oblique multislice (ZOOM) imaging technology in patients with degenerative cervical myelopathy (DCM) and compare it with T2WI imaging.
Methods: A total of 111 patients diagnosed with DCM were recruited. According to mJOA, patients with DCM were divided into ND + group with neurological dysfunction and ND- group without neurological dysfunction. Routine MRI and ZOOM-DWI were performed on 3.0 T MRI to obtain sagittal T2WI and apparent diffusion coefficient (ADC) diagram. ADC values of the narrow segment and its adjacent upper and lower segments were measured, and compared between the ND + and ND- groups. The correlation between ADC value of cervical spinal cord and mJOA score was analyzed. Additionally, ROC curves were plotted to calculate the AUC values.
Results: The comparison between ND + and ND- groups shows that there are significant differences in mJOA score, T2WI, anteroposterior diameter of spinal canal, ADC values of narrow, upper and lower segment (P < 0.05). In ND + group, there is a significant difference between ADC values of the narrow and its upper and lower segments (P < 0.001), while with no significant difference in ADC values of the upper and lower segments (P > 0.05). Results of correlation analysis indicate that in the ND + group, neurological dysfunction evaluated by mJOA scores is correlated with increased ADC values of the narrow segment (r = -0.52, P < 0.001), but not significantly correlated with ADC values of the upper and lower segments. Furthermore, T2WI, anteroposterior diameter of the spinal canal, and cervical cord ADC values all has diagnostic efficacy in evaluating neurological dysfunction in DCM (AUC > 0.5, P < 0.05), with the ADC value of the narrow segment being optimal.
Conclusion: The ADC value of spinal cord obtained by small-field ZOOM-DWI can be used to evaluate neurological dysfunction in DCM, and is superior to traditional T2WI.
{"title":"The apparent diffusion coefficient based on small-field DWI is superior to T2-weighted imaging in evaluating neurological dysfunction of degenerative cervical myelopathy.","authors":"Xiao-Nan Tian, Sheng-Nan Li, Bao-Gen Zhao, Ning Wang, Ting Gao, Li Zhang","doi":"10.1007/s00586-024-08411-6","DOIUrl":"https://doi.org/10.1007/s00586-024-08411-6","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the clinical application of zonally magnified oblique multislice (ZOOM) imaging technology in patients with degenerative cervical myelopathy (DCM) and compare it with T2WI imaging.</p><p><strong>Methods: </strong>A total of 111 patients diagnosed with DCM were recruited. According to mJOA, patients with DCM were divided into ND + group with neurological dysfunction and ND- group without neurological dysfunction. Routine MRI and ZOOM-DWI were performed on 3.0 T MRI to obtain sagittal T2WI and apparent diffusion coefficient (ADC) diagram. ADC values of the narrow segment and its adjacent upper and lower segments were measured, and compared between the ND + and ND- groups. The correlation between ADC value of cervical spinal cord and mJOA score was analyzed. Additionally, ROC curves were plotted to calculate the AUC values.</p><p><strong>Results: </strong>The comparison between ND + and ND- groups shows that there are significant differences in mJOA score, T2WI, anteroposterior diameter of spinal canal, ADC values of narrow, upper and lower segment (P < 0.05). In ND + group, there is a significant difference between ADC values of the narrow and its upper and lower segments (P < 0.001), while with no significant difference in ADC values of the upper and lower segments (P > 0.05). Results of correlation analysis indicate that in the ND + group, neurological dysfunction evaluated by mJOA scores is correlated with increased ADC values of the narrow segment (r = -0.52, P < 0.001), but not significantly correlated with ADC values of the upper and lower segments. Furthermore, T2WI, anteroposterior diameter of the spinal canal, and cervical cord ADC values all has diagnostic efficacy in evaluating neurological dysfunction in DCM (AUC > 0.5, P < 0.05), with the ADC value of the narrow segment being optimal.</p><p><strong>Conclusion: </strong>The ADC value of spinal cord obtained by small-field ZOOM-DWI can be used to evaluate neurological dysfunction in DCM, and is superior to traditional T2WI.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}