European Spine Journal最新文献

Purpose: This study aimed to evaluate the potential for changes in pelvic incidence (PI) as a secondary outcome following lumbar or lumbosacral fusion surgery, to identify preoperative factors-particularly sacroiliac joint (SIJ) degeneration-associated with such changes, and to analyze their subsequent impact on postoperative clinical outcomes.

Methods: This retrospective study included 472 patients (mean age 64.8 ± 8.5 years; 46% male) who underwent lumbar or lumbosacral fusion surgery between February 2020 and February 2023. Patients were divided into two groups based on postoperative changes in PI at 6 months: the PI-change group (ΔPI ≥ 5°) and the no-change group (ΔPI < 5°). Preoperative and 6-month postoperative spinopelvic parameters were assessed using standardized standing whole-spine lateral radiographs. Clinical outcomes were assessed at 6 months postoperative using the Visual Analog Scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and EuroQol-5 Dimension (EQ-5D). The clinical outcomes of the two groups were compared to evaluate the impact of PI change on functional recovery.

Results: Ninety patients (19.1%) exhibited significant PI changes postoperatively. The PI change group had higher intraoperative blood loss (711.8 ± 508.8 mL vs. 558.7 ± 464.8 mL), higher preoperative SI joint degeneration scores (7.1 ± 3.0 vs. 5.4 ± 3.7), and less frequent use of OLIF (5.6% vs. 16.0%). Multivariable logistic regression identified preoperative SI joint degeneration as an independent factor predicting PI change (odds ratio: 2.903, 95% confidence interval: 1.444-5.837). Functional outcomes at 6 months were significantly worse in the PI change group, reflected by higher ODI scores (29.5 ± 20.4 vs. 18.3 ± 16.3) and lower EQ-5D scores (0.7 ± 0.2 vs. 0.8 ± 0.1).

Conclusions: PI, traditionally considered a constant parameter, may be altered following lumbar or lumbosacral fusion, particularly in patients with preoperative SI joint degeneration, emphasizing the importance of SI joint assessment in preoperative planning and postoperative management.

Purpose: This study aimed to address the challenges and explore potential solutions for improving IONM utilization. Posterior endoscopic cervical decompression (PECD) relieves pressure on the exiting nerve root and spinal cord, potentially leading to improvements in patient symptoms. The routine use of intraoperative neuromonitoring (IONM) currently remains debatable, despite its ability to provide additional real-time neurological observation beyond standard practice.

Methods: In this retrospective cohort study, we investigated the clinical data of 140 patients with single-segment cervical spondylotic radiculopathy (CSR) or herniated nucleus pulposus (HNP) from 2020 to 2023. Seventy patients underwent PECD with IONM (IONM group), whereas the remaining 70 patients did not undergo IONM. For both groups, neurological status, IONM data, duration of surgery, and complications were recorded. The curative effect was assessed based on the Neck Disability Index (NDI), visual analog scale (VAS) for arm and neck discomfort, and the modified MacNab criteria.

Results: One hundred and forty patients diagnosed with unilateral single-segment CSR or HNP were included; 70 patients underwent PECD with IONM, 60 showed IONM changes, whereas 10 did not. Despite this, all 140 patients in both groups experienced postoperative neurological improvement without deficits, with significant enhancements in the VAS, NDI, and modified MacNab criteria scores, notably at the 12-month mark.

Conclusion: IONM enhances surgical decision-making and strengthens surgeon confidence despite its limited predictive ability for postoperative deficits. IONM alarms swiftly identify and address potential complications, thereby supporting patient safety. Continued advancements in IONM technology hold promise for further optimization of orthopedic surgical outcomes.