European Spine Journal最新文献

Purpose: Cervical laminoplasty is widely used for multilevel cervical stenosis. However, a known complication is C5 palsy, which usually occurs within 1 week postoperatively and is attributed to nerve root traction associated with posterior spinal cord shift. Therefore, we conducted a prospective study to clarify early changes in spinal cord shift within 1 week after cervical laminoplasty.

Methods: The cohort comprised 51 patients who underwent cervical double-door laminoplasty including the C4/5 level. Spinal cord shift and dural expansion were evaluated on MRI obtained on postoperative day 1 and 1 week postoperatively. A spinal cord shift of ≥ 3 mm at C4/5 was defined as a "great shift," and contributing factors were analyzed based on demographic and radiographic data.

Results: The mean spinal cord shift at C4/5 was 1.4 ± 0.9 mm on postoperative day 1 and 0.6 ± 0.6 mm 1 week postoperatively. The shift was significantly greater on postoperative day 1 than at 1 week from C2/3 to C6/7 (p < 0.001). Six patients exhibited a great shift (mean 3.2 ± 0.3 mm). Multivariate analysis showed that the preoperative anteroposterior diameter of the dura mater at C5/6 was significantly associated with a great shift (OR = 0.46, 95% CI = 0.214-0.971, p = 0.04).

Conclusion: Posterior spinal cord shift was significantly greater on postoperative day 1 than at 1 week after cervical laminoplasty. Severe C5/6 stenosis preoperatively contributed to pronounced spinal cord shift at C4/5. These findings reveal early postoperative changes in spinal cord shift and underscore the importance of preoperative MRI assessment to reduce neurological complications.

Purpose: This study aims to investigate the impact of different bone cement distribution patterns on cement leakage in percutaneous curved vertebroplasty (PCVP) versus bilateral percutaneous vertebroplasty (PVP). We hypothesized that anteriorly displaced cement increases leakage risk and that PCVP produces a more anterior distribution than bilateral PVP.

Methods: This retrospective analysis included 55 vertebrae treated with bilateral PVP between November 2021 and March 2023 and 60 vertebrae treated with PCVP between April 2023 and September 2024. Variables included age, gender, BMI, bone mineral density, surgical approach, cement distribution pattern (three-part classification on lateral radiographs), and postoperative cement leakage. We utilized a computer software-assisted radiographic analysis to localize the cement centroid and classify position (anterior/central/posterior). Univariate analyses were followed by logistic regression. Inter-observer reliability for the computer-assisted classification was assessed on a random subset [n = 30] using intraclass correlation coefficients (ICC) and Cohen's κ.

Results: Cement leakage occurred in 28.6% of anterior, 3.8% of central, and 0% of posterior distributions (P < 0.001). Compared with bilateral PVP, PCVP yielded a substantially higher proportion of anterior distributions (56.5% vs. 29.1%) and a lower proportion of central distributions (32.6% vs. 65.5%; P < 0.001). In multivariable logistic regression, central versus anterior distribution was associated with markedly lower odds of leakage (adjusted OR 0.06, 95% CI 0.02-0.20; P < 0.001), whereas PCVP versus bilateral PVP was not significantly associated with leakage after adjusting for cement position (adjusted OR 0.98, 95% CI 0.27-3.52; P = 0.969).

Conclusion: Compared with bilateral PVP, PCVP tended to yield a more anterior cement distribution. An anterior distribution was strongly associated with a higher likelihood of cement leakage. Clinically, centering cement within the middle third-particularly during PCVP-may reduce leakage risk.

Purpose: To describe the surgical technique of Dual Rod Translation (DRT) and evaluate its radiographic and patient-reported outcomes in thoracic adolescent idiopathic scoliosis (AIS), with a focus on sagittal alignment restoration.

Methods: A retrospective review was conducted on patients with AIS who underwent posterior spinal fusion using the DRT technique between July 2020 and December 2023. DRT employs asymmetrically contoured rods and reduction screws with extended tabs. After both rods are positioned, posterior translation is performed on the concave side. The convex rod, fully seated in the screw heads, functions as a mechanical axis for vertebral rotation and hump reduction, enabling simultaneous three-dimensional correction. Radiographic parameters and SRS-22 scores were assessed preoperatively and at follow-up. Mixed-effects models and Pearson's correlation coefficient were used for analysis.

Results: Sixty patients (mean age 16.5 ± 3.9 years; 88% female) were included. The mean follow-up period was 20.5 ± 6.3 months. The main thoracic curve improved from 58° ± 9° to 16° ± 5° (mean correction 76%). Thoracic kyphosis increased by 18° in all, with greater gains (22°) in hypokyphotic patients. Cervical and lumbar lordosis increased significantly, correlating with changes in thoracic kyphosis (r = 0.442 and r = 0.428, respectively). SRS-22 self-image and subtotal scores improved significantly. No intraoperative complications occurred.

Conclusions: The DRT technique may represent a safe and reproducible method for thoracic AIS, achieving favorable coronal correction with notable improvement in sagittal alignment.

Purpose: This study aimed to incorporate cartoon visuals into nursing instructions for degenerative disc herniation surgery and test whether cartoon visuals in preoperative nursing instructions can help improve patients ' knowledge, satisfaction, and anxiety during hospitalization.

Methodology: The experimental study was conducted from January to June 2024 and involved 84 patients undergoing surgery for degenerative disc herniation. Participants were randomly assigned by computer into two groups, and preoperative and postoperative tests were conducted to understand the patients' anxiety, self-care knowledge, and satisfaction: the "traditional group" received standard paper-based nursing instructions, while the "experimental group" received cartoon visual nursing instructions.

Results: The study results were statistically significant differences in self-care knowledge (P = .02) and satisfaction (p < .001) among the experimental and traditional groups. There were no statistical differences in situational and trait anxiety, but the experimental group scores decreased. Another unexpected finding was a statistically significant difference (P = .02) in the experimental group, where the number of days of hospital stay was lower than that in the traditional group.

Conclusion: This study showed patients could improve their self-knowledge, reduce situational anxiety, increase satisfaction through cartoon visuals, and reduce the number of hospitalized days. Therefore, the engaging content of cartoon visuals can relieve patients' nervousness about surgery, increase their trust and cooperation, and further improve the effect of doctor-patient communication.

Background: Spinal tumors constitute approximately 15% of all primary central nervous system neoplasms, with extradural tumors accounting for the majority. Ganglioneuromas are rare, benign tumors of neural crest origin, most often located in the posterior mediastinum or retroperitoneum. Involvement of the spinal column from a benign tumor is uncommon and poses significant diagnostic and therapeutic challenges.

Case presentation: We present the case of 25-year-old woman who was admitted with progressive dyspnea, stridor dysphagia, and chest pain. A thoracic CT and MRI scans revealed a 12 × 8 × 6 cm contrast-enhancing mass in the mid-posterior mediastinum. There was no invasion of adjacent mediastinal structures, except for the destruction of the anterior parts of T2-T3 vertebral bodies. Neurological examination showed preserved motor strength. A multidisciplinary surgical approach involving thoracic and neurosurgical teams was planned. At operation, the anterior, superior and middle mediastinal components of the tumor were initially mobilized via a partial median sternotomy. The tumor was then completely excised alongside a partial corpectomy involving the anterior portions of the T2-T3 vertebrae trough an additional left posterior thoracotomy incision. Despite the anterior portions of the vertebral bodies were partially respected at two levels, the spinal column was not intentionally stabilized. Histopathological evaluation confirmed a cavernous ganglioneuroma. Apart from retention of secretions leading to left lower lobe atelectasis which resolved with intensive chest physiotherapy, the patient made an uneventful recovery and was discharged home on eighth postoperative day. She remains asymptomatic with no evidence of recurrence on thoracic CT imaging at two-year follow-up.

Conclusion: This case demonstrates the successful management of a rare spinal cavernous ganglioneuroma via a multidisciplinary surgical approach. Notably, the absence of stabilization following limited anterior column resection did not result in spinal instability or recurrence during the follow-up period. Therefore, we propose that anterior resections involving less than one-third of the vertebral bodies may not require reconstruction of the spinal column in carefully selected cases, although further evidence is needed to validate this observation.

Purpose: Some cases of isolated unstable Jefferson's fracture of the Atlas verbebra require surgical fixation. Historical constructs with occipitocervical fixation or C1C2 posterior Harms-Goel fixation remain associated with functional impairment owing to limited postoperative cervical range of motion. Since 2004, motion-preserving C1 ring lateral mass screws with transverse rod (C1 LMF) has emerged as a possible technical alternative.

Methods: Retrospective multicentric study of patients operated on for isolated unstable Jefferson's fracture of the Atlas vertebra using C1 LMF in two tertiary referral hospitals from South France.

Results: Since 2022, 9 patients (mean age 52.2 ± 20.5, male/female 7/2) were operated on by 5 different senior spine surgeon for Jefferson type 3 (6 cases) or type 4 (3 cases), with 8 cases of transverse ligament injury. Seven patients were treated in the acute setting (mean 2.9 ± 1.2 days), two patients were treated for chronic pseudarthrosis (mean 157.5 ± 116.7 days). Mean operative time was 108.7 ± 45.3 min with intraoperative blood loss of 233.3 ± 106.1, guided either by fluoroscopy (6 cases) or spinal navigation (3 cases). One patient had both screws misplaced medially without clinical consequence, requiring revision surgery. After a mean follow-up of 15.7 ± 7.8, self-assessed clinical outcome was excellent (VAS 1.3 ± 1.2, NDI 17.6 ± 8.9) with good cervical motion (rotation 57.8 ± 12.5°) and 66.7% of return-to-work. Bone fusion was achieved in 77.8%, with lateral mass distance reduction from 11.1 ± 3.6 mm down to 6.8 ± 3.3 mm.

Conclusion: This small patient series suggests the long-term efficacy as well as the operative safety of C1 LMF for isolated unstable Jefferson's fracture.