European Spine Journal最新文献

Purpose: To evaluate the effect of intraoperative viewing of real-time surgical video and communication among patients on postoperative recovery and satisfaction after percutaneous transforaminal endoscopic discectomy (PTED).

Method: Patients admitted to our medical center from January 1, 2021 to December 1, 2023 who underwent PTED for L4/5 lumbar disc herniation were collected. We finally included 77 patients who met the inclusion and exclusion criteria. Patients were categorized into communication (CM) group (n = 39) and non-communication (NCM) group (n = 38) according to whether they had intraoperative real-time surgical video viewing and communication. Preoperative baseline data, operative time, postoperative hospitalization time, Visual Analogue Scale(VAS) score, lumbar Japanese Orthopaedic Association (JOA) score, surgical complications and patient satisfaction were compared between the two groups.

Result: Patients in the CM group had less pain, faster functional recovery, shorter hospitalization, and higher satisfaction in the early postoperative period. The NCM group had a shorter operative time. However, patients in the CM group had lower VAS scores on the first day after surgery and at 1 month after surgery than those in the NCM group. And JOA scores were better in the communication group at the first week and first month after operation. There was no significant difference between the two groups in terms of VAS scores, JOA scores, and postoperative complications in the third and sixth postoperative months.

Conclusion: Allowing patients to watch real-time surgical videos and engage in intraoperative communication during PTED surgery is a feasible way to reduce early postoperative pain, accelerate functional recovery, and improve patient satisfaction.

Purpose: To compare the utility of the frailty phenotype (FP), the FRAIL scale, and 5-item modified Frailty Index (mFI-5) in predicting postoperative adverse events after enhanced recovery after lumbar fusion surgery in older patients.

Methods: This study prospectively included older patients (> 75 years) who underwent transforaminal lumbar interbody fusion from June 2019 to August 2021. Frailty status was evaluated using FP, the FRAIL scale, and mFI-5. The study investigated the associations between these three frailty tools and total adverse events, complications, and secondary outcomes. Multivariable logistic regression analysis was performed to identify predictors of total adverse events, complications, and secondary outcomes.

Results: Correlation analysis demonstrated that frailty assessed by the FP was significantly associated with an increased incidence of complications (55.7% vs. 41.5%, p =.028) and prolonged hospital stays (29.5% vs. 16.9%, p =.021). Frailty identified using the FRAIL scale was significantly linked to prolonged hospital stays (33.7% vs. 16.2%, p =.002). Additionally, frailty assessed by the mFI-5 was associated with higher rates of 30-day readmission (18.5% vs. 6.3%, p =.003) and 30-day reoperation (7.4% vs. 0.6%, p =.007). Multivariate logistic regression revealed that an FP score of ≥ 3 was an independent risk factor for total adverse events, complications, and secondary outcomes, while a FRAIL score of ≥ 3 was an independent risk factor for secondary outcomes.

Conclusion: Frailty as defined by the FP is an independent risk factor for total adverse events, complications, and secondary outcomes. Frailty as defined by the FRAIL scale is an independent risk factor for secondary outcomes. The mFI-5 has not been demonstrated to be an independent risk factor for any postoperative adverse events.

Purpose: The purpose of the present study was to quantitatively assess the characteristics of lumbar spine motor function in patients with lumbar spinal stenosis (LSS) who experienced falls and to determine the association between falls and lumbar spine motion.

Methods: This cross-sectional study enrolled consecutive patients with clinically and radiologically defined LSS indicated for surgical treatment at a single center. The lumbar motion task consisted of bending forward to the maximum range of motion of the lumbar spine in the standing position, followed by a return to the upright position. The occurrence of falls in the past year was recorded. Binomial logistic regression analysis was performed to evaluate the association between falls and lumbar spine motion while using basic characteristics, general fall risk assessment, and known fall-related factors in patients with LSS as adjustment variables.

Results: A total of 102 participants were analyzed; 43 participants had a history of falls. Binomial logistic regression analysis showed that delayed lumbar spine motion was significantly associated with the occurrence of falls (odds ratio, 2.56; 95% confidence interval, 1.09-6.03).

Conclusion: The results of this study suggest that delayed lumbar motion is an important factor associated with falls in patients with LSS.

Background: This study investigated how machine learning methods can be applied to small sample sizes to enhance prediction of postoperative functional recovery, as measured by the Japanese Orthopedic Association (JOA) score, in cervical spondylotic myelopathy (CSM) patients undergoing laminoplasty, while leveraging existing research and expert knowledge.

Methods: Data from 143 CSM patients who underwent laminoplasty were analyzed. Eleven key imaging parameters related to cervical alignment and paravertebral muscles were measured. Multiple machine learning algorithms were evaluated using different feature engineering approaches. Model performance was assessed through repeated random sampling and confidence intervals.

Results: Increasing the number of random data splits improved stability of performance metrics. Incorporating fat infiltration parameters enhanced predictive performance. The Gaussian Naive Bayes algorithm achieved the best overall performance, with 76.90% accuracy (65.01-88.78% CI) and 75.24% AUC (59.20-91.28% CI) using the optimal feature set. Logistic regression and support vector machines also performed well. Random forests showed high specificity but low sensitivity.

Conclusions: This study demonstrates that machine learning can effectively predict postoperative outcomes in CSM patients using small samples when combined with expert-informed feature engineering and rigorous evaluation methods. Multiple training iterations and confidence interval reporting enhance result reliability. Machine learning's flexibility in feature selection provides advantages over traditional statistical approaches for such predictive tasks in clinical settings.

Purpose: To investigate the surgical outcomes and complications of ACDF among patients taking thiazide diuretics.

Methods: Cervical radiculopathy patients who underwent ACDF from 2010 to 2022 were retrospectively queried through the PearlDiver Database. Patients were included if they underwent ACDF with at least 2 years of follow-up and were on thiazide diuretics within 90 days of their procedure. A control group was created using propensity score matching based on age, gender, and Charlson Comorbidity Index. Univariate analysis using chi squared tests and student t-tests were used to compare demographics and outcomes between groups.

Results: A total of 16,886 cervical radiculopathy patients (8,443 used thiazide diuretics, 8,443 controls) treated with ACDF were identified through the database. The thiazide diuretic group had significantly lower rates of hardware complications compared to the control group (1.16% vs. 2.05%; P = 0.001). Pseudarthrosis rates were not significantly different between the thiazide diuretic group and the control group (3.98% vs. 3.60%; P = 0.371). Furthermore, rates of revision (11.8% vs. 10.5%; P = 0.07) and spondylolisthesis (3.90% vs. 3.60%; P = 0.482) after ACDF were not significantly different.

Conclusion: This large retrospective database study over 12 years found that lower rates of hardware complications were seen in cervical radiculopathy patients who were prescribed thiazide diuretics after ACDF surgery. However, these patients may still be at a similar risk for other postoperative surgical complications, including pseudoarthrosis, revision surgery, and spondylolisthesis.

Purpose: Post-operative epidural hematoma is a rare but devastating complication of spine surgery. The importance of timely decompression for preserving neurologic function has been repeatedly stressed, but the acceptable timescale for decompression remains controversial. The purpose of this study was to propose a diagnosis and treatment flowchart for post-operative epidural hematoma.

Methods: A retrospective chart review from the registry database of 93 patients who underwent epidural hematoma evacuation from January 2007 to December 2021 was conducted. Statistical analysis was performed to assess the correlation between recovery of neurologic function and time to decompression.

Results: Sixty patients were included in the statistical analysis. Time to decompression was significantly associated with recovery of neurologic function in the overall analysis and in subgroup analysis of cases of acute post-operative epidural hematoma. As the time to decompression decreases, there is an improvement in the odds of neurological function recovery. Moreover, a critical threshold for the time to decompression was determined to be < 6 h.

Conclusion: Timely decompression is strongly suggested for post-operative epidural hematoma. We proposed a flowchart as a tool to guide treatment of post-operative epidural hematoma. For acute post-operative epidural hematoma, decompression within 6 h promises better neurologic recovery, and decompression should not be delayed by imaging examination. For delayed post-operative epidural hematoma, decompression should be performed as soon as possible after a definite diagnosis is reached.

Objectives: To determine the prevalence of lumbar spondylolisthesis (LS) and its association with low back pain, walking speed, grip strength, and muscle mass in the general population.

Methods: Participants included 1551 members of the general population from the 2nd ROAD (Research on Osteoarthritis/osteoporosis Against Disability) study conducted in Wakayama Prefecture, Japan, between 2008 and 2010. Lumbar radiography diagnosed LS when the slip was ≥ 3 mm in the lateral views. Logistic regression analysis (adjusted for sex, age, area, and BMI) assessed the association between LS and low back pain, walking speed, grip strength, and appendicular lean mass.

Results: Complete data from 1522 participants (510 men, 1012 women, mean age 65.7 ± 12.2 years) were analyzed. The prevalence of LS increases with age, with an estimated one in five men aged 80 years or older and one in four women aged 70-79 years affected. Logistic regression showed LS was significantly associated with low back pain (OR: 1.36, CI: 1.03-1.80). Walking speed, grip strength, and appendicular lean mass were not significantly associated with LS. The prevalence of LS at any level was 17.4% in the total sample, 13.3% in men, and 19.5% in women (P = 0.005).

Conclusion: LS was prevalent in 17.4% of the general population, with a higher prevalence in women. Patients with LS had more low back pain than those without LS.

Background: Spinal deformity can have a severe impact on the patient's sexual health. Eventually, this can lead to depression and relationship distress. Spinal surgical management is suggested to improve sexual function, however, the literature concerning these aspects is still scarce. This study evaluated which factors predicted improvement in sexual health in patients with adult spinal deformity (ASD) who underwent surgical treatment.

Methods: Multicentric retrospective study based on a prospectively collected ASD database. Data of patients who underwent surgical correction and had a 2-year follow-up were collected. The association between different patient-reported outcome measures and ODI question 8 (Q8, sexual health) was explored with Pearson correlations and Principal Component Analysis (PCA). Improvement in sexual health was evaluated through a 1-point decrease on Q8. Comparisons between improved and non-improved patients and the non-response to the preoperative Q8 were assessed.

Results: Data from 880 patients were collected. Moderate correlations were revealed between ODI and COMI-back, SRS-22, and SF-36 items and confirmed with PCA. The main factors associated to a non-response to Q8 were being of an older age, having worse sagittal imbalance, and having a specific nationality. Patients with an improvement in sexual health at 2 years were the ones with a worse baseline quality of life, older patients with a greater sagittal correction, and a better improvement of the level of physical activity.

Conclusion: Non-response to Q8 was correlated to age and nationality. Long-segment ASD surgery could improve sexual health, which was correlated to physical activity improvement, severe deformity with worse preoperative quality of life, and better postoperative sagittal correction.