Pub Date : 2024-09-01Epub Date: 2024-06-23DOI: 10.1007/s00586-024-08368-6
Carol A Mancuso, Roland Duculan, Frank P Cammisa, Andrew A Sama, Alexander P Hughes, Darren R Lebl, Federico P Girardi
Purpose: Surgeons' preoperative expectations of lumbar surgery may be associated with patient-reported postoperative outcomes.
Methods: Preoperatively spine surgeons completed a validated Expectations Survey for each patient estimating amount of improvement expected (range 0-100). Preoperative variables were clinical characteristics, spine-specific disability (ODI), and general health (RAND-12). Two years postoperatively patients again completed these measures and global assessments of satisfaction. Surgeons' expectations were compared to preoperative variables and to clinically important pre- to postoperative changes (MCID) in ODI, RAND-12, and pain and to satisfaction using hierarchical models.
Results: Mean expectations survey score for 402 patients was a 57 (IQR 44-68) reflecting moderate expectations. Lower scores were associated with preoperative older age, abnormal gait, sensation loss, vacuum phenomena, foraminal stenosis, prior surgery, and current surgery to more vertebrae (all p ≤ .05). Lower scores were associated postoperatively with not attaining MCID for the ODI (p = .02), RAND-12 (p = .01), and leg pain (p = .01). There were no associations between surgeons' scores and satisfaction (p = .06-.27). 55 patients (14%) reported unfavorable global outcomes and were more likely to have had fracture/infection/repeat surgery (OR 3.2, CI 1.6-6.7, p = .002).
Conclusion: Surgeons' preoperative expectations were associated with patient-reported postoperative improvement in symptoms and function, but not with satisfaction. These findings are consistent with clinical practice in that surgeons expect some but not complete improvement from surgery and do not anticipate that any particular patient will have markedly unfavorable satisfaction ratings. In addition to preoperative discussions about expectations, patients and surgeons should acknowledge different types of outcomes and address them jointly in postoperative discussions.
{"title":"Associations between surgeons' preoperative expectations of lumbar surgery and patient-reported 2-year outcomes.","authors":"Carol A Mancuso, Roland Duculan, Frank P Cammisa, Andrew A Sama, Alexander P Hughes, Darren R Lebl, Federico P Girardi","doi":"10.1007/s00586-024-08368-6","DOIUrl":"10.1007/s00586-024-08368-6","url":null,"abstract":"<p><strong>Purpose: </strong>Surgeons' preoperative expectations of lumbar surgery may be associated with patient-reported postoperative outcomes.</p><p><strong>Methods: </strong>Preoperatively spine surgeons completed a validated Expectations Survey for each patient estimating amount of improvement expected (range 0-100). Preoperative variables were clinical characteristics, spine-specific disability (ODI), and general health (RAND-12). Two years postoperatively patients again completed these measures and global assessments of satisfaction. Surgeons' expectations were compared to preoperative variables and to clinically important pre- to postoperative changes (MCID) in ODI, RAND-12, and pain and to satisfaction using hierarchical models.</p><p><strong>Results: </strong>Mean expectations survey score for 402 patients was a 57 (IQR 44-68) reflecting moderate expectations. Lower scores were associated with preoperative older age, abnormal gait, sensation loss, vacuum phenomena, foraminal stenosis, prior surgery, and current surgery to more vertebrae (all p ≤ .05). Lower scores were associated postoperatively with not attaining MCID for the ODI (p = .02), RAND-12 (p = .01), and leg pain (p = .01). There were no associations between surgeons' scores and satisfaction (p = .06-.27). 55 patients (14%) reported unfavorable global outcomes and were more likely to have had fracture/infection/repeat surgery (OR 3.2, CI 1.6-6.7, p = .002).</p><p><strong>Conclusion: </strong>Surgeons' preoperative expectations were associated with patient-reported postoperative improvement in symptoms and function, but not with satisfaction. These findings are consistent with clinical practice in that surgeons expect some but not complete improvement from surgery and do not anticipate that any particular patient will have markedly unfavorable satisfaction ratings. In addition to preoperative discussions about expectations, patients and surgeons should acknowledge different types of outcomes and address them jointly in postoperative discussions.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141442413","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 : 2024-09-01Epub Date: 2024-06-24DOI: 10.1007/s00586-024-08358-8
Tariq Z Issa, Omar H Tarawneh, Teeto Ezeonu, Ameer A Haider, Rajkishen Narayanan, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler
Introduction: Revision lumbar fusion is most commonly due to nonunion, adjacent segment disease (ASD), or recurrent stenosis, but it is unclear if diagnosis affects patient outcomes. The primary aim of this study was to assess whether patients achieved the patient acceptable symptom state (PASS) or minimal clinically important difference (MCID) after revision lumbar fusion and assess whether this was influenced by the indication for revision.
Methods: We retrospectively identified all 1-3 level revision lumbar fusions at a single institution. Oswestry Disability Index (ODI) was collected at preoperative, three-month postoperative, and one-year postoperative time points. The MCID was calculated using a distribution-based method at each postoperative time point. PASS was set at the threshold of ≤ 22.
Results: We identified 197 patients: 56% with ASD, 28% with recurrent stenosis, and 15% with pseudarthrosis. The MCID for ODI was 10.05 and 10.23 at three months and one year, respectively. In total, 61% of patients with ASD, 52% of patients with nonunion, and 65% of patients with recurrent stenosis achieved our cohort-specific MCID at one year postoperatively with ASD (p = 0.78). At one year postoperatively, 33.8% of ASD patients, 47.8% of nonunion patients, and 37% of patients with recurrent stenosis achieved PASS without any difference between indication (p = 0.47).
Conclusions: The majority of patients undergoing revision spine fusion experience significant postoperative improvements regardless of the indication for revision. However, a large proportion of these patients do not achieve the patient acceptable symptom state. While revision spine surgery may offer substantial benefits, these results underscore the need to manage patient expectations.
{"title":"The attainment of a patient acceptable symptom state in patients undergoing revision spine fusion.","authors":"Tariq Z Issa, Omar H Tarawneh, Teeto Ezeonu, Ameer A Haider, Rajkishen Narayanan, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler","doi":"10.1007/s00586-024-08358-8","DOIUrl":"10.1007/s00586-024-08358-8","url":null,"abstract":"<p><strong>Introduction: </strong>Revision lumbar fusion is most commonly due to nonunion, adjacent segment disease (ASD), or recurrent stenosis, but it is unclear if diagnosis affects patient outcomes. The primary aim of this study was to assess whether patients achieved the patient acceptable symptom state (PASS) or minimal clinically important difference (MCID) after revision lumbar fusion and assess whether this was influenced by the indication for revision.</p><p><strong>Methods: </strong>We retrospectively identified all 1-3 level revision lumbar fusions at a single institution. Oswestry Disability Index (ODI) was collected at preoperative, three-month postoperative, and one-year postoperative time points. The MCID was calculated using a distribution-based method at each postoperative time point. PASS was set at the threshold of ≤ 22.</p><p><strong>Results: </strong>We identified 197 patients: 56% with ASD, 28% with recurrent stenosis, and 15% with pseudarthrosis. The MCID for ODI was 10.05 and 10.23 at three months and one year, respectively. In total, 61% of patients with ASD, 52% of patients with nonunion, and 65% of patients with recurrent stenosis achieved our cohort-specific MCID at one year postoperatively with ASD (p = 0.78). At one year postoperatively, 33.8% of ASD patients, 47.8% of nonunion patients, and 37% of patients with recurrent stenosis achieved PASS without any difference between indication (p = 0.47).</p><p><strong>Conclusions: </strong>The majority of patients undergoing revision spine fusion experience significant postoperative improvements regardless of the indication for revision. However, a large proportion of these patients do not achieve the patient acceptable symptom state. While revision spine surgery may offer substantial benefits, these results underscore the need to manage patient expectations.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141442417","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 : 2024-09-01Epub Date: 2024-07-17DOI: 10.1007/s00586-024-08391-7
Alina Jacob, Maximilian Heumann, Ivan Zderic, Peter Varga, Nicolas Ion, Bogdan Bocea, Daniel Haschtmann, Tamas Fekete, Christian Rainer Wirtz, R Geoff Richards, Boyko Gueorguiev, Markus Loibl
Purpose: Screwed anterior lumbar interbody fusion (SALIF) alleviates the need for supplemental posterior fixation leading to reduction of perioperative morbidity. Specifically, elderly and multimorbid patients would benefit from shorter operative time and faster recovery but tend to have low bone mineral density (BMD). The current study aimed to compare loosening, defined as increase of ROM and NZ, of SALIF versus transforaminal lumbar interbody fusion (TLIF) under cyclic loading in cadaveric spines with reduced BMD.
Methods: Twelve human spines (L4-S2; 6 male 6 female donors; age 70.6 ± 19.6; trabecular BMD of L5 84.2 ± 24.4 mgHA/cm3, range 51-119 mgHA/cm3) were assigned to two groups. SALIF or TLIF were instrumented at L5/S1. Range of motion (ROM) and neutral zone (NZ) were assessed before and after axial cyclic loading (0-1150 N, 2000 cycles, 0.5 Hz) in flexion-extension (Flex-Ext), lateral bending, (LB), axial rotation (AR).
Results: ROM of the SALIF specimens increased significantly in all loading directions (p ≤ 0.041), except for left AR (p = 0.053), whereas for TLIF it increased significantly in left LB (p = 0.033) and Flex (p = 0.015). NZ of SALIF showed increase in Flex-Ext and LB, whereas NZ of TLIF did not increase significantly in any motion direction.
Conclusions: Axial compression loading caused loosening of SALIF in Flex-Ext and LB, but not TLIF at L5/S1 in low BMD specimens. Nevertheless, Post-cyclic ROM and NZ of SALIF is comparable to TLIF. This suggests that, neither construct is optimal for the use in patients with reduced BMD.
{"title":"Cyclic testing of standalone ALIF versus TLIF in lumbosacral spines of low bone mineral density: an ex vivo biomechanical study.","authors":"Alina Jacob, Maximilian Heumann, Ivan Zderic, Peter Varga, Nicolas Ion, Bogdan Bocea, Daniel Haschtmann, Tamas Fekete, Christian Rainer Wirtz, R Geoff Richards, Boyko Gueorguiev, Markus Loibl","doi":"10.1007/s00586-024-08391-7","DOIUrl":"10.1007/s00586-024-08391-7","url":null,"abstract":"<p><strong>Purpose: </strong>Screwed anterior lumbar interbody fusion (SALIF) alleviates the need for supplemental posterior fixation leading to reduction of perioperative morbidity. Specifically, elderly and multimorbid patients would benefit from shorter operative time and faster recovery but tend to have low bone mineral density (BMD). The current study aimed to compare loosening, defined as increase of ROM and NZ, of SALIF versus transforaminal lumbar interbody fusion (TLIF) under cyclic loading in cadaveric spines with reduced BMD.</p><p><strong>Methods: </strong>Twelve human spines (L4-S2; 6 male 6 female donors; age 70.6 ± 19.6; trabecular BMD of L5 84.2 ± 24.4 mgHA/cm<sup>3</sup>, range 51-119 mgHA/cm<sup>3</sup>) were assigned to two groups. SALIF or TLIF were instrumented at L5/S1. Range of motion (ROM) and neutral zone (NZ) were assessed before and after axial cyclic loading (0-1150 N, 2000 cycles, 0.5 Hz) in flexion-extension (Flex-Ext), lateral bending, (LB), axial rotation (AR).</p><p><strong>Results: </strong>ROM of the SALIF specimens increased significantly in all loading directions (p ≤ 0.041), except for left AR (p = 0.053), whereas for TLIF it increased significantly in left LB (p = 0.033) and Flex (p = 0.015). NZ of SALIF showed increase in Flex-Ext and LB, whereas NZ of TLIF did not increase significantly in any motion direction.</p><p><strong>Conclusions: </strong>Axial compression loading caused loosening of SALIF in Flex-Ext and LB, but not TLIF at L5/S1 in low BMD specimens. Nevertheless, Post-cyclic ROM and NZ of SALIF is comparable to TLIF. This suggests that, neither construct is optimal for the use in patients with reduced BMD.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141626525","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 : 2024-09-01Epub Date: 2023-07-15DOI: 10.1007/s00586-023-07841-y
Nicholas S Hernandez, L Daniel Diaz-Aguilar, Martin H Pham
Purpose: Minimally invasive single position lateral ALIF at L5-S1 with simultaneous robot-assisted posterior fixation has technical and anatomic considerations that need further description.
Methods: This is a retrospective case series of single position lateral ALIF at L5-S1 with robotic assisted fixation. End points included radiographic parameters, lordosis distribution index (LDI), complications, pedicle screw accuracy, and inpatient metrics.
Results: There were 17 patients with mean age of 60.5 years. Eight patients underwent interbody fusion at L5-S1, five patients at L4-S1, two patients at L3-S1, and one patient at L2-S1 in single lateral position. Operative times for 1-level and 2-level cases were 193 min and 278 min, respectively. Mean EBL was 71 cc. Mean improvements in L5-S1 segmental lordosis were 11.7 ± 4.0°, L1-S1 lordosis of 4.8 ± 6.4°, sagittal vertical axis of - 0.1 ± 1.7 cm°, pelvic tilt of - 3.1 ± 5.9°, and pelvic incidence lumbar-lordosis mismatch of - 4.6 ± 6.4°. Six patients corrected into a normal LDI (50-80%) and no patients became imbalanced over a mean follow-up period of 14.4 months. Of 100 screws placed in lateral position with robotic assistance, there were three total breaches (two lateral grade 3, one medial grade 2) for a screw accuracy of 97.0%. There were no neurologic, vascular, bowel, or ureteral injuries, and no implant failure or reoperation.
Conclusion: Single position lateral ALIF at L5-S1 with simultaneous robotic placement of pedicle screws by a second surgeon is a safe and effective technique that improves global alignment and lordosis distribution index.
{"title":"Single position L5-S1 lateral ALIF with simultaneous robotic posterior fixation is safe and improves regional alignment and lordosis distribution index.","authors":"Nicholas S Hernandez, L Daniel Diaz-Aguilar, Martin H Pham","doi":"10.1007/s00586-023-07841-y","DOIUrl":"10.1007/s00586-023-07841-y","url":null,"abstract":"<p><strong>Purpose: </strong>Minimally invasive single position lateral ALIF at L5-S1 with simultaneous robot-assisted posterior fixation has technical and anatomic considerations that need further description.</p><p><strong>Methods: </strong>This is a retrospective case series of single position lateral ALIF at L5-S1 with robotic assisted fixation. End points included radiographic parameters, lordosis distribution index (LDI), complications, pedicle screw accuracy, and inpatient metrics.</p><p><strong>Results: </strong>There were 17 patients with mean age of 60.5 years. Eight patients underwent interbody fusion at L5-S1, five patients at L4-S1, two patients at L3-S1, and one patient at L2-S1 in single lateral position. Operative times for 1-level and 2-level cases were 193 min and 278 min, respectively. Mean EBL was 71 cc. Mean improvements in L5-S1 segmental lordosis were 11.7 ± 4.0°, L1-S1 lordosis of 4.8 ± 6.4°, sagittal vertical axis of - 0.1 ± 1.7 cm°, pelvic tilt of - 3.1 ± 5.9°, and pelvic incidence lumbar-lordosis mismatch of - 4.6 ± 6.4°. Six patients corrected into a normal LDI (50-80%) and no patients became imbalanced over a mean follow-up period of 14.4 months. Of 100 screws placed in lateral position with robotic assistance, there were three total breaches (two lateral grade 3, one medial grade 2) for a screw accuracy of 97.0%. There were no neurologic, vascular, bowel, or ureteral injuries, and no implant failure or reoperation.</p><p><strong>Conclusion: </strong>Single position lateral ALIF at L5-S1 with simultaneous robotic placement of pedicle screws by a second surgeon is a safe and effective technique that improves global alignment and lordosis distribution index.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9782239","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 : 2024-09-01Epub Date: 2024-08-03DOI: 10.1007/s00586-024-08408-1
Tariq Z Issa, Yunsoo Lee, Jeremy Heard, Tyler W Henry, Michael A McCurdy, Nicholas Siegel, Caroline Zaworksi, Julia Dambly, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, John Mangan, Mark Lambrechts, Christopher K Kepler
Purpose: To report the rate of fusion in a sample of patients undergoing lumbar fusion surgery and assess interrater reliability of computed tomography (CT)-based parameters for the assessment of fusion.
Methods: All adult patients who underwent lumbar fusion surgery from 2017 to 2021 were retrospectively identified. Patient demographics and surgical characteristics were collected through chart review of the electronic medical records. CT scans were reviewed independently by two attending spine surgeons and two spine fellows. Fusion was defined as evidence of bone bridging in any one of (1) posterolateral gutters, (2) facets, or (3) interbody (when applicable) on any CT views. Evidence of screw haloing was indicative of nonunion. Interrater reliability was determined using cohen's kappa. Afterwards, a consensus agreement for each component of fusion was reached between participants.
Results: The overall fusion rate among all procedures was 63/69 (91.3%). Overall 22/25 (88.0%) TLIF, 16/19 (84.2%) PLDF, 3/3 (100%) LLIF, and 22/22 (100%) circumferential fusions experienced a successful fusion. Interrater reliability was good for interbody fusion (k = 0.734) and moderate for all other measures (k = 0.561 for posterolateral fusion; k = 0.471 for facet fusion; k = 0.458 for screw haloing). Overall, interrater reliability as to whether a patient had a fusion or nonunion was moderate (k = 0.510).
Conclusion: There was only moderate interrater reliability across most radiographic measures used in assessing lumbar fusion status. Reliability was highest when evaluating the presence of interbody fusion. The majority of fusions occurred across the facet joints.
目的:报告接受腰椎融合手术的样本患者的融合率,并评估基于计算机断层扫描(CT)的融合评估参数的交互可靠性:回顾性识别2017年至2021年接受腰椎融合手术的所有成年患者。通过查阅电子病历收集患者的人口统计学特征和手术特征。两名脊柱外科医生主治医师和两名脊柱研究员独立审查 CT 扫描。融合的定义是在任何 CT 切面上,(1) 后外侧沟、(2) 椎面或 (3) 椎间体(如适用)中的任何一处出现骨桥。螺钉晕的证据表明存在骨不连。使用科恩卡帕(cohen's kappa)确定相互之间的可靠性。之后,参与者之间就融合的各个部分达成一致意见:所有手术的总融合率为 63/69(91.3%)。总的来说,22/25(88.0%)例 TLIF、16/19(84.2%)例 PLDF、3/3(100%)例 LLIF 和 22/22(100%)例环形融合术都取得了成功。椎体间融合的相互间可靠性良好(k = 0.734),所有其他指标的相互间可靠性中等(后外侧融合的 k = 0.561;面融合的 k = 0.471;螺钉晕的 k = 0.458)。总体而言,判定患者是融合还是未愈合的评分者间可靠性为中等(k = 0.510):结论:用于评估腰椎融合状态的大多数放射学测量方法的研究者间可靠性仅为中等水平。结论:大多数用于评估腰椎融合状况的放射学测量方法的相互间可靠性仅为中等水平,而在评估是否存在椎体间融合时可靠性最高。大多数融合发生在面关节上。
{"title":"An evaluation of fusion status following lumbar fusion surgery utilizing multi-planar computed tomography.","authors":"Tariq Z Issa, Yunsoo Lee, Jeremy Heard, Tyler W Henry, Michael A McCurdy, Nicholas Siegel, Caroline Zaworksi, Julia Dambly, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, John Mangan, Mark Lambrechts, Christopher K Kepler","doi":"10.1007/s00586-024-08408-1","DOIUrl":"10.1007/s00586-024-08408-1","url":null,"abstract":"<p><strong>Purpose: </strong>To report the rate of fusion in a sample of patients undergoing lumbar fusion surgery and assess interrater reliability of computed tomography (CT)-based parameters for the assessment of fusion.</p><p><strong>Methods: </strong>All adult patients who underwent lumbar fusion surgery from 2017 to 2021 were retrospectively identified. Patient demographics and surgical characteristics were collected through chart review of the electronic medical records. CT scans were reviewed independently by two attending spine surgeons and two spine fellows. Fusion was defined as evidence of bone bridging in any one of (1) posterolateral gutters, (2) facets, or (3) interbody (when applicable) on any CT views. Evidence of screw haloing was indicative of nonunion. Interrater reliability was determined using cohen's kappa. Afterwards, a consensus agreement for each component of fusion was reached between participants.</p><p><strong>Results: </strong>The overall fusion rate among all procedures was 63/69 (91.3%). Overall 22/25 (88.0%) TLIF, 16/19 (84.2%) PLDF, 3/3 (100%) LLIF, and 22/22 (100%) circumferential fusions experienced a successful fusion. Interrater reliability was good for interbody fusion (k = 0.734) and moderate for all other measures (k = 0.561 for posterolateral fusion; k = 0.471 for facet fusion; k = 0.458 for screw haloing). Overall, interrater reliability as to whether a patient had a fusion or nonunion was moderate (k = 0.510).</p><p><strong>Conclusion: </strong>There was only moderate interrater reliability across most radiographic measures used in assessing lumbar fusion status. Reliability was highest when evaluating the presence of interbody fusion. The majority of fusions occurred across the facet joints.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141878618","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 : 2024-09-01Epub Date: 2024-08-07DOI: 10.1007/s00586-024-08442-z
Jin-Oh Park
{"title":"Answer to the letter to the editor of Zhang D, et al. concerning \"Effect of saline irrigation temperature difference on postoperative acute pain and hypothermia during biportal endoscopic spine surgery\" by Park S-R, et al. (Eur Spine J [2024]; doi: 10.1007/s00586-024-08322-6).","authors":"Jin-Oh Park","doi":"10.1007/s00586-024-08442-z","DOIUrl":"10.1007/s00586-024-08442-z","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897186","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 : 2024-09-01Epub Date: 2024-07-23DOI: 10.1007/s00586-024-08414-3
Jiaqi Zhang, Yinhao Liu, Yan Zeng, Weishi Li, Zhongqiang Chen
Purpose: The aims of this study were to investigate the correlations between Chinese version of Lumbar Stiffness Disability Index (C-LSDI) and other clinical outcomes, and to identify the factors independently affecting stiffness-related disability after long-segment fusion in patients with degenerative lumbar scoliosis (DLS).
Methods: We performed a retrospective study of 118 consecutive surgically treated DLS cases at a single institute. Pre- and post-operative radiological parameters and postoperative health related quality of life (HRQOL) were examined to determine their correlation coefficients with postoperative C-LSDI. Patients were divided into two groups by the medium number of postoperative C-LSDI: low-stiffness group (C-LSDI < 48 points) and high-stiffness group (C-LSDI ≥ 48 points). Subsequently, differences between the two groups were assessed, and the presumed factors affecting C-LSDI evaluation were further analyzed.
Results: Coronal parameters and global sagittal parameters showed significant correlations with postoperative C-LSDI. The correlation coefficients between C-LSDI and Oswestry Disability Index (ODI), Japanese Orthopedic Association-29 (JOA-29), the Scoliosis Research Society-22 questionnaire (SRS-22) Function, and the Short Form-36 Health Survey (SF-36) Physical Component Scores were over 0.5. In multiple linear regression, postoperative sagittal vertical axis (β = 0.084, p = 0.025), fusion levels (β = 2.13, p = 0.012), and body mass index (β = 0.867, p = 0.022) were independent related factors for C-LSDI.
Conclusion: This study showed that all HRQOLs demonstrated the varying degree of correlations with C-LSDI, of which the ODI, JOA-29, SRS-22 Function, and SF-36 PCS were most relevant, with moderate strength of associations.Moreover, longer fusion levels, higher BMI, and greater postoperative SVA independently affect C-LSDI after long segmental posterior instrumentation and fusion for DLS.
{"title":"Stiffness-related disability following long segmental posterior instrumentation and fusion: is it influenced by postoperative spinopelvic alignment?","authors":"Jiaqi Zhang, Yinhao Liu, Yan Zeng, Weishi Li, Zhongqiang Chen","doi":"10.1007/s00586-024-08414-3","DOIUrl":"10.1007/s00586-024-08414-3","url":null,"abstract":"<p><strong>Purpose: </strong>The aims of this study were to investigate the correlations between Chinese version of Lumbar Stiffness Disability Index (C-LSDI) and other clinical outcomes, and to identify the factors independently affecting stiffness-related disability after long-segment fusion in patients with degenerative lumbar scoliosis (DLS).</p><p><strong>Methods: </strong>We performed a retrospective study of 118 consecutive surgically treated DLS cases at a single institute. Pre- and post-operative radiological parameters and postoperative health related quality of life (HRQOL) were examined to determine their correlation coefficients with postoperative C-LSDI. Patients were divided into two groups by the medium number of postoperative C-LSDI: low-stiffness group (C-LSDI < 48 points) and high-stiffness group (C-LSDI ≥ 48 points). Subsequently, differences between the two groups were assessed, and the presumed factors affecting C-LSDI evaluation were further analyzed.</p><p><strong>Results: </strong>Coronal parameters and global sagittal parameters showed significant correlations with postoperative C-LSDI. The correlation coefficients between C-LSDI and Oswestry Disability Index (ODI), Japanese Orthopedic Association-29 (JOA-29), the Scoliosis Research Society-22 questionnaire (SRS-22) Function, and the Short Form-36 Health Survey (SF-36) Physical Component Scores were over 0.5. In multiple linear regression, postoperative sagittal vertical axis (β = 0.084, p = 0.025), fusion levels (β = 2.13, p = 0.012), and body mass index (β = 0.867, p = 0.022) were independent related factors for C-LSDI.</p><p><strong>Conclusion: </strong>This study showed that all HRQOLs demonstrated the varying degree of correlations with C-LSDI, of which the ODI, JOA-29, SRS-22 Function, and SF-36 PCS were most relevant, with moderate strength of associations.Moreover, longer fusion levels, higher BMI, and greater postoperative SVA independently affect C-LSDI after long segmental posterior instrumentation and fusion for DLS.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141747892","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}
Objective: This study aims to investigate the potential of preoperative blood supply condition measured by dynamic susceptibility contract (DSC) MRI in prediction of postoperative outcomes for patients with cervical spondylotic myelopathy (CSM).
Materials and method: Thirty-nine patients (Age: 61 ± 7, male: 23, female: 16) with CSM who underwent laminoplasty were enrolled. All patients received DSC MRI before the operation. Five parameters include Enhance, rEnhance, full width at half maxima (FWHM), Slope1 and Slope2 in DSC MRI, were calculated at all the compressed spinal cord segments. Clinical outcomes were evaluated by modified Japanese Orthopaedic Association (mJOA) scores. Patients were divided into two groups based on mJOA recovery rate of 5 years: good recovery (> 50%) or poor recovery (≤ 50%). The difference between two groups were compared. The value of DSC MRI to CSM was evaluated by logistic and receiver operating characteristic (ROC) curve analysis.
Results: There were 26 patients in good recovery group and 13 patients in poor recovery group. The baseline characteristics, including age, gender, preoperative mJOA score, and smoking status showed no significant difference between the two groups (all p > 0.05). The FWHM was significantly higher in the poor recovery group (9.77 ± 2.78) compared to the good recovery group (6.64 ± 1.65) (p = 0.002). Logistic regression analysis indicated that an increased FWHM was a significant risk factor for poor prognosis recovery (p = 0.013, OR = 0.392, 95%CI: 0.187-0.822). The AUC of FWHM for ROC was 0.843 (95% CI: 0.710-0.975) with a p value of 0.001. In addition, an FWHM greater than 5.87, with a sensitivity of 92.3% and specificity of 69.2%, was found to be an independent risk factor for poor postoperative recovery in patients with CSM.
Conclusion: In this study, we successfully quantified the spinal cord blood supply condition by DSC MRI technique. We found that an increase in FWHM was an independent risk factor for poor postoperative recovery in CSM patients. Specifically, patients with FWHM > 5.87 have a poor postoperative recovery.
{"title":"Pre-operative spinal cord perfusion quantified by DSC MRI as a predictor of post-operative prognosis in patients with cervical spondylotic myelopathy.","authors":"Qingpeng Song, Chunyao Wang, Wen Jiang, Jinchao Wang, Jiuheng Li, Hua Guo, Huijun Chen, Xiao Han","doi":"10.1007/s00586-024-08417-0","DOIUrl":"10.1007/s00586-024-08417-0","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to investigate the potential of preoperative blood supply condition measured by dynamic susceptibility contract (DSC) MRI in prediction of postoperative outcomes for patients with cervical spondylotic myelopathy (CSM).</p><p><strong>Materials and method: </strong>Thirty-nine patients (Age: 61 ± 7, male: 23, female: 16) with CSM who underwent laminoplasty were enrolled. All patients received DSC MRI before the operation. Five parameters include Enhance, rEnhance, full width at half maxima (FWHM), Slope1 and Slope2 in DSC MRI, were calculated at all the compressed spinal cord segments. Clinical outcomes were evaluated by modified Japanese Orthopaedic Association (mJOA) scores. Patients were divided into two groups based on mJOA recovery rate of 5 years: good recovery (> 50%) or poor recovery (≤ 50%). The difference between two groups were compared. The value of DSC MRI to CSM was evaluated by logistic and receiver operating characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>There were 26 patients in good recovery group and 13 patients in poor recovery group. The baseline characteristics, including age, gender, preoperative mJOA score, and smoking status showed no significant difference between the two groups (all p > 0.05). The FWHM was significantly higher in the poor recovery group (9.77 ± 2.78) compared to the good recovery group (6.64 ± 1.65) (p = 0.002). Logistic regression analysis indicated that an increased FWHM was a significant risk factor for poor prognosis recovery (p = 0.013, OR = 0.392, 95%CI: 0.187-0.822). The AUC of FWHM for ROC was 0.843 (95% CI: 0.710-0.975) with a p value of 0.001. In addition, an FWHM greater than 5.87, with a sensitivity of 92.3% and specificity of 69.2%, was found to be an independent risk factor for poor postoperative recovery in patients with CSM.</p><p><strong>Conclusion: </strong>In this study, we successfully quantified the spinal cord blood supply condition by DSC MRI technique. We found that an increase in FWHM was an independent risk factor for poor postoperative recovery in CSM patients. Specifically, patients with FWHM > 5.87 have a poor postoperative recovery.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758124","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 : 2024-09-01Epub Date: 2024-08-07DOI: 10.1007/s00586-024-08437-w
Mürsel Ekinci
{"title":"Answer to the letter to the editor of Q. Zhou, et al. concerning \"Surgical vs ultrasound-guided lumbar erector spinae plane block for pain management following lumbar spinal fusion surgery\" by Kaciroglu A, et al. (Eur Spine J [2024]: doi 10.1007/s00586-024-08347-x).","authors":"Mürsel Ekinci","doi":"10.1007/s00586-024-08437-w","DOIUrl":"10.1007/s00586-024-08437-w","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897185","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}
Aims: This research aims to construct and verify an accurate nomogram for forecasting the 3-, 5-, and 7-year outcomes in pediatric patients afflicted with spinal cord injury (SCI).
Methods: Pediatric patients with SCI from multiple hospitals in China, diagnosed between Jan 2005 and Jan 2020, were incorporated into this research. Half of these patients were arbitrarily chosen for training sets, and the other half were designated for external validation sets. The Cox hazard model was employed to pinpoint potential prognosis determinants related to the American Spinal Injury Association (ASIA) and Functional Independence Assessment (FIM) index. These determinants were then employed to formulate the prognostic nomogram. Subsequently, the bootstrap technique was applied to validate the derived model internally.
Results: In total, 224 children with SCI were considered for the final evaluation, having a median monitoring duration of 68.0 months. The predictive nomogram showcased superior differentiation capabilities, yielding a refined C-index of 0.924 (95% CI: 0.883-0.965) for the training cohort and a C-index of 0.863 (95% CI: 0.735-0.933) for the external verification group. Additionally, when applying the aforementioned model to prognostic predictions as classified by the FIM, it demonstrated a high predictive value with a C-index of 0.908 (95% CI: 0.863-0.953). Moreover, the calibration diagrams indicated a consistent match between the projected and genuine ASIA outcomes across both sets.
Conclusion: The crafted and verified prognostic nomogram emerges as a dependable instrument to foresee the 3-, 5-, and 7-year ASIA and FIM outcomes for children suffering from SCI.
目的:本研究旨在构建并验证一个准确的提名图,用于预测小儿脊髓损伤(SCI)患者3年、5年和7年的预后:研究对象为2005年1月至2020年1月期间在中国多家医院确诊的脊髓损伤小儿患者。其中一半患者被任意选作训练集,另一半患者被指定为外部验证集。采用 Cox 危险模型找出与美国脊柱损伤协会(ASIA)和功能独立性评估(FIM)指数相关的潜在预后决定因素。然后利用这些决定因素制定预后提名图。随后,应用引导技术对得出的模型进行内部验证:共有 224 名 SCI 患儿接受了最终评估,中位监测持续时间为 68.0 个月。预测提名图显示了卓越的区分能力,训练组的精炼 C 指数为 0.924(95% CI:0.883-0.965),外部验证组的 C 指数为 0.863(95% CI:0.735-0.933)。此外,当将上述模型应用于根据 FIM 分类的预后预测时,该模型显示出很高的预测价值,C 指数为 0.908(95% CI:0.863-0.953)。此外,校准图显示,两组预测结果与真正的 ASIA 结果一致:结论:经过精心设计和验证的预后提名图是预测 SCI 患儿 3 年、5 年和 7 年 ASIA 和 FIM 预后的可靠工具。
{"title":"Development and validation of a nomogram for predicting the prognosis in children with spinal cord injuries.","authors":"Bo Wang, Liukun Xu, Pengfei Zheng, Yapeng Zhang, Wangmi Liu, Yuntao Wang, Zhiqun Zhang","doi":"10.1007/s00586-024-08208-7","DOIUrl":"10.1007/s00586-024-08208-7","url":null,"abstract":"<p><strong>Aims: </strong>This research aims to construct and verify an accurate nomogram for forecasting the 3-, 5-, and 7-year outcomes in pediatric patients afflicted with spinal cord injury (SCI).</p><p><strong>Methods: </strong>Pediatric patients with SCI from multiple hospitals in China, diagnosed between Jan 2005 and Jan 2020, were incorporated into this research. Half of these patients were arbitrarily chosen for training sets, and the other half were designated for external validation sets. The Cox hazard model was employed to pinpoint potential prognosis determinants related to the American Spinal Injury Association (ASIA) and Functional Independence Assessment (FIM) index. These determinants were then employed to formulate the prognostic nomogram. Subsequently, the bootstrap technique was applied to validate the derived model internally.</p><p><strong>Results: </strong>In total, 224 children with SCI were considered for the final evaluation, having a median monitoring duration of 68.0 months. The predictive nomogram showcased superior differentiation capabilities, yielding a refined C-index of 0.924 (95% CI: 0.883-0.965) for the training cohort and a C-index of 0.863 (95% CI: 0.735-0.933) for the external verification group. Additionally, when applying the aforementioned model to prognostic predictions as classified by the FIM, it demonstrated a high predictive value with a C-index of 0.908 (95% CI: 0.863-0.953). Moreover, the calibration diagrams indicated a consistent match between the projected and genuine ASIA outcomes across both sets.</p><p><strong>Conclusion: </strong>The crafted and verified prognostic nomogram emerges as a dependable instrument to foresee the 3-, 5-, and 7-year ASIA and FIM outcomes for children suffering from SCI.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140174094","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}