European Spine Journal最新文献

Purpose: This study aims to (1) evaluate whether the endplate bone quality (EBQ) scores can independently predict adjacent segment disease (ASD); and (2) judge the predictive value of EBQ compared to vertebral bone quality (VBQ) for ASD after single-level transforaminal lumbar interbody fusion (TLIF).

Methods: A single-center retrospective analysis was conducted of patients undergoing single-level TLIF for degenerative spinal disease from 2014 to 2020. Demographic, surgery, and radiographic data were collected. Logistic regression was used to identify independent risk factors for ASD. Furthermore, a receiver operating curve (ROC) analysis was conducted to evaluate the predictive efficacy of the EBQ score and VBQ score.

Results: The rate of ASD was 16.4% at a minimum 24-month follow-up. Significant risk factors for ASD were higher VBQ score (OR = 3.418, 95%CI: 1.297-9.008, P = 0.013), higher EBQ score (OR = 2.469, 95%CI: 1.085-5.621, P = 0.031), and higher adjacent segment Pfirrmann grade (OR = 2.866, 95%CI: 1.765-4.653, P<0.001). The diagnostic accuracy of VBQ and EBQ for distinguishing ASD were 0.806 (95%CI: 0.728-0.883) and 0.835 (95%CI: 0.757-0.912). The optimal threshold of VBQ scores was 2.926 (sensitivity: 90.6%, specificity: 62.0%) and of EBQ was 3.511 (sensitivity: 90.6%, specificity: 71.8%).

Conclusion: Higher VBQ and EBQ scores are both independent risk factors of ASD after single-segment TLIF surgery, and EBQ scores perform better in predicting ASD. When EBQ > 3.511, there is a considerable risk of ASD.

Purpose: The objective of this systematic review is to present a comprehensive summary of existing research on the use of 3D printing in spinal surgery.

Methods: The researchers conducted a thorough search of four digital databases (PubMed, Web of Science, Scopus, and Embase) to identify relevant studies published between January 1999 and December 2022. The review focused on various aspects, including the types of objects printed, clinical applications, clinical outcomes, time and cost considerations, 3D printing materials, location of 3D printing, and technologies utilized. Out of the 1620 studies initially identified and the 17 added by manual search, 105 met the inclusion criteria for this review, collectively involving 2088 patients whose surgeries involved 3D printed objects.

Results: The studies presented a variety of 3D printed devices, such as anatomical models, intraoperative navigational templates, and customized implants. The most widely used type of objects are drill guides (53%) and anatomical models (25%) which can also be used for simulating the surgery. Custom made implants are much less frequently used (16% of papers). These devices significantly improved clinical outcomes, particularly enhancing the accuracy of pedicle screw placement. Most studies (88%) reported reduced operation times, although two noted longer times due to procedural complexities. A variety of 3DP technologies and materials were used, with STL, FDM, and SLS common for models and guides, and titanium for implants via EBM, SLM, and DMLS. Materialise software (Mimics, 3-Matic, Magics) was frequently utilized. While most studies mentioned outsourced production, in-house printing was implied in several cases, indicating a trend towards localized 3D printing in spine surgery.

Conclusions: 3D printing in spine surgery, a rapidly growing area of research, is predominantly used for creating drill guides for screw insertion, anatomical models, and innovative implants, enhancing clinical outcomes and reducing operative time. While cost-efficiency remains uncertain due to insufficient data, some 3D printing applications, like pedicle screw drill guides, are already widely accepted and routinely used in hospitals.

Purpose: To investigate the relationship between spinal cord anatomy and the risk of curve progression in mild to moderate adolescent idiopathic scoliosis (AIS).

Methods: We prospectively included patients presenting with mild or moderate AIS (< 40 degrees). Irrespective of curve severity, patients underwent 3-dimensional MRI and were followed until skeletal maturity or surgery. Retrospectively, we measured the true lateral cord space (LCS) ratio on transverse cuts of the curve apex. This is a measure of the lateral displacement of the medulla in the spinal canal. The primary outcome measure was curve progression defined as a Cobb angle increase ≥ 10 degrees at follow-up.

Results: Of the 64 included patients, 18 (28%) progressed more than 10 degrees during follow-up. At baseline, mean age in the progression and non-progression group was 13.1 ± 1.6 vs. 15.8 ± 1.5 years (p < 0.001), and mean Cobb angle was 32 ± 7 vs. 26 ± 9 degrees (p < 0.001). The time from baseline x-ray to MRI was 1.3 ± 3 months vs. 1.7 ± 3.6 months (p = 0.738). LCS ratio was 1.5 (IQR: 1.1-1.7) in the progression group and 1.0 (IQR:0.8-1.3) in the non-progression group (p < 0.001). When matched according to baseline Cobb angle and age, median LCS ratio was 1.5 [1.1, 1.7] and 0.9 [0.7-1.2] in the progression and non-progression group, respectively (p < 0.001).

Conclusions: We found significant displacement of the medulla towards the concavity of the curve in progressive AIS. This finding supports the theory of a neuro-osseous growth mismatch as a part of the etiopathophysiology of AIS and may play a predictive role in prognosis of milder cases of AIS.

Objective: This study systematically assesses the learning curve of Unilateral Biportal Endoscopic (UBE) techniques across various spinal surgeries, focusing on its influence on operative efficiency and complication rates to guide optimized training and practice.

Methods: Systematic searches in PubMed, Web of Science, Embase, Scopus, and Cochrane Library identified studies on UBE learning curves for patients aged 18 or older, comparing early and mastery phases. Two reviewers independently extracted data on surgery type, operative time, and complications. Study quality was assessed using the Newcastle-Ottawa Scale. We performed subgroup analyses based on different UBE surgery types, examining variations in operative time and complication rates across each procedure.

Results: Thirteen studies, including 1217 patients, were included, focusing on lumbar spine surgeries. The average learning curve cutoff for UBE procedures was 32.18 cases, with the mastery phase reducing operative time by an average of 48.14 min (95% CI 35.80, 60.47; p < 0.001), although high heterogeneity observed. In the mastery phase, single-group analysis of 707 patients showed a mean operative time of 92.38 min (95% CI 77.35, 107.41). Complication analysis across 12 studies (1182 patients) revealed a significantly lower rate in the mastery phase (odds ratio, OR = 0.29; p < 0.001). Subgroup analyses revealed significant reductions in both operative time and complications for UBE-LIF and UBE-LD/ULBD during the mastery phase, while no significant changes were observed for UBE-PCF. Additionally, specific complications, such as dural tears and incomplete decompression, were significantly reduced in the mastery phase.

Conclusion: This systematic review confirms a learning curve in UBE surgery, with improvements in operative time and complications. Procedure-specific cutoff points provide guidance for training and future research.

Purpose: This study aimed at comparing the costs of spinal fusion surgery between patients with and without diabetes.

Methods: Following PRISMA guidelines, a systematic search of four databases was conducted. A meta-analysis was performed on comparative studies examining diabetic versus non-diabetic adults undergoing cervical/lumbar fusion in terms of cost. Heterogeneity was assessed using the I2 test. Standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model in the presence of heterogeneity.

Results: Twenty-two studies were included in this meta-analysis. Standardized costs were significantly higher in the diabetic group (SMD 0.02, 95% CI 0.01 to 0.03, p < 0.05). The excess cost per diabetic patient undergoing spinal fusion surgery was estimated to be $2,492 (95% CI: $1,620 to $3,363). The length of stay (LOS) was significantly longer in the diabetes group (MD 0.42, 95% CI 0.24 to 0.60, p < 0.001). No significant difference was observed in intensive care unit admission between the groups (OR 4.15, 95% CI 0.55 to 31.40, p > 0.05). Reoperation showed no significant differences between the groups (OR 1.14, 95% CI 0.96 to 1.35, p > 0.05). However, 30-day and 90-day readmissions were significantly higher in the diabetes group: (OR 1.42, 95% CI 1.24 to 1.62, p < 0.05) and (OR 1.39, 95% CI 1.15 to 1.68, p < 0.001), respectively. Non-routine or non-home discharge was also significantly higher in the diabetes group (OR 1.89, 95% CI 1.67 to 2.13, p < 0.001).

Conclusion: Patients with diabetes undergoing spinal fusion surgery had increased costs, prolonged LOS, increased 30-day/90-day readmission rates, and more frequent non-routine discharges.

Purpose: Synthetic cages are commonly used in posterior and transforaminal lumbar interbody fusion procedures. Using morselized corticocancellous bone from spinous processes and laminae has been suggested as an alternative, especially in low-resource settings where access to synthetic cages is limited. The aim of this study was to compare radiographic and functional outcomes of synthetic cages with those of morselized local autograft.

Methods: MEDLINE and EMBASE database search strategies were created by a medical librarian following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Screening and data extraction were performed in duplicate by two authors using predefined criteria. A meta-analysis of fusion rates, functional scores including Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI), operative time, and blood loss was performed on studies that met the selection criteria. Qualitative appraisal of post-operative disc heights and complication profile was performed. Methodological index for non-randomized studies (MINORS) criteria were used to ascertain the quality of included studies.

Results: 7 cohort studies were included in the finaly analysis, with 284 patients in the morselized local graft group and 276 patients in the synthetic cage group. There was no significant difference in fusion rates between the two cohorts at final follow-up (minimum 1 year; P = 0.21, I² = 30%). Likewise, no difference was seen in any of the secondary outcomes included in this meta-anlysis. Disc height at final follow-up was similar between the two cohorts in all included studies.

Conclusion: Usage of morselized corticocancellous autograft to achieve interbody fusion can be a suitable alternative to synthetic cages, especially in low-resource settings where the cost of synthetic cages can be prohibitive.

Purpose: 5q-spinal muscular atrophy (SMA) is a treatable neuromuscular disorder associated with scoliosis in up to 90% of patients. New SMA therapies could mark a paradigm shift in scoliosis management, but their effects on scoliosis development remain unclear. This study aims to observe scoliosis progression in the current treatment landscape to inform management strategies.

Methods: We conducted a cross-sectional retrospective analysis of 94 SMA patients treated at our center. Scoliosis development was evaluated in 75 patients using spine radiographs and electronic health records. Statistical analysis was performed using Python and GraphPad Prism. One-way ANOVA and Pearson correlation were used for group comparisons and correlation analysis, respectively.

Results: Scoliosis parameters in 5q-SMA patients who had received either nusinersen, onasemnogene abeparvovec, risdiplam, or their combinations showed mean ages at scoliosis detection were 23.94, 55.52, and 168.11 months for SMA types 1, 2, and 3, respectively. Cobb angles at detection showed no significant intergroup differences. The mean ages at scoliosis surgery were 60, 88.43, and 124.8 months. Pelvic obliquity (PO) was highest in type 1 and lowest in type 3. A strong correlation (r = 0.9) was found between PO measurement techniques. HFMSE scores correlated moderately with scoliosis severity (r = -0.38), while CHOP-INTEND showed no correlation.

Conclusion: The observations made in this study suggest that the effects of SMA therapies do not prevent scoliosis development. The improved prognosis may lead to a growing cohort of SMA type 1 and 2 patients with early onset scoliosis who require early growth-friendly surgical interventions.