European Spine Journal最新文献

Purpose: Pedicle subtraction osteotomies (PSOs) are well-established for rigid sagittal deformities, but the efficacy and safety of biplanar PSOs (BiPSOs) remain uncertain. This study aims to evaluate whether BiPSOs compromise sagittal correction or elevate surgical morbidity or complication rates.

Methods: A retrospective analysis of a prospective multicentric adult spinal deformity database included patients who underwent a single Schwab-3/4 PSO with at least two years of follow-up. BiPSOs were defined by segmental angular changes (SAD) greater than 5° in both the sagittal and coronal planes, while uniplanar (UPSOs) had SAD greater than 5° in one plane. Demographic, surgical, and outcome variables were compared.

Results: The study included 33 BiPSOs and 123 UPSOs. No differences were found for baseline demographic characteristics. UPSOs were more common in patients with prior spinal surgery (57.6% vs. 80.5%) with less L4-S1 lordosis (29.5° vs. 22°), meanwhile BiPSOs' patients showed worse preoperative coronal alignment (C7-SVL 37.2 vs. 25.2 mm) and greater Cobb angles (44.6° vs. 24°). Comparable coronal and sagittal alignment were obtained postoperatively according to C7-CSVL (19.1 vs. 17.0 mm) and GAP Score (5.1 vs. 5.6 points, - 48.6% vs. - 43.8%). Comparable surgical aggressiveness including surgical time, blood loss, or hospitalization stays was observed. Neurological complications were comparable between the groups (15.2% BiPSOs vs. 19.5% UPSOs), with no significant differences in motor deficits. Overall complication rates and patient-reported outcomes were comparable, though BiPSOs had higher satisfaction at final follow-up.

Conclusions: BiPSOs effectively treat rigid biplanar deformities, achieving optimal coronal correction without compromising sagittal alignment restoration or increasing surgical morbidity and neurological risks.

Purpose: Surgical treatment of adolescent spinal deformities requires accurate pre-operative planning. Few studies confirmed that sagittal alignment restoration is crucial to reduce the risk of early degeneration, yet sagittal alignment targets are lacking in adolescents. No predictive formula for ideal sacral slope (SS_ideal) based on pelvic incidence (PI) has been developed specifically for surgical planning in adolescents. The aim of the present study is to investigate the relationship between PI and SS in healthy adolescents aged 11-18 years to identify the most accurate model for SS_ideal prediction based on PI.

Methods: Full-spine standing biplanar X-rays were analyzed. PI, SS and pelvic tilt (PT) were measured. Three regression models (linear, polynomial, and logarithmic) were generated to describe the PI-SS relationship. The adult-derived model by Yilgor et al. was also applied to the study cohort. Accuracy and precision of all models were assessed globally and within PI-based subgroups. External validation was performed using a previously published dataset.

Results: A total of 122 patients (mean age 14 years) were included. Logarithmic and polynomial models achieved the best fit within the study cohort (R² = 0.63 and 0.63). The Yilgor et al. model showed substantially lower fit (R² = 0.39) and systematic underestimation of SS in intermediate and high PI subgroups. The linear model performed best within the external validation cohort showing the best goodness-of-fit, accuracy, precision, and robustness. The Yilgor model again showed systematic SS underestimation and higher errors.

Conclusion: Our results suggest that the formula SS_ideal = 0.61 x PI + 11.4 can be reliably employed in the pre-operative planning of adolescent spinal deformities.

Background: Retro-odontoid pseudotumor is a soft tissue mass that compresses cervicomedullary neural structures at the craniovertebral junction, causing severe neurological deficits. Optimal management remains controversial. We report exoscope-assisted intradural far-lateral resection of a retro-odontoid pseudotumor without fusion using the lateral position.

Case description: A 69-year-old male presented with progressive motor weakness and gait disturbance. MRI showed a retro-odontoid pseudotumor with severe spinal cord compression and intramedullary high signal intensity at C1-C2. Radiographs showed minimal atlantoaxial instability. We performed pseudotumor resection through the left intradural far-lateral approach with the patient in the right lateral decubitus position. Head fixation without rotation maintained consistent surgical orientation. This positioning allowed gravity-assisted spontaneous spinal cord displacement, avoiding active neural retraction. The exoscope provided clear oblique visualization of the ventral spinal cord from the posterolateral corridor. We sectioned the dentate ligaments and the left C2 posterior nerve root to expand operating space. The ventral dura was incised and internal debulking achieved partial resection with adequate decompression. Neuroendoscopic examination confirmed sufficient decompression. The patient was discharged without complications. Histopathology confirmed inflammatory tissue consistent with retro-odontoid pseudotumor. At three-month follow-up, neurological function improved significantly. At two years postoperatively, no symptom recurrence was noted.

Conclusion: Partial resection achieved effective neural decompression with favorable neurological recovery while preserving spinal mobility. The combination of lateral positioning for gravity-assisted minimal retraction, head fixation without rotation, and exoscopic visualization enabled precise joint-sparing tumor debulking. This strategy offers a viable option for symptomatic retro-odontoid pseudotumors without significant instability.

Study design: Retrospective multicenter study.

Objectives: To evaluate the safety and efficacy of adult spinal deformity (ASD) surgery in patients aged ≥ 80 years compared to their younger counterparts.

Methods: Patients who underwent posterior fusion involving ≥ 5 spinal levels for ASD between 2017 and 2023 at two institutions were included. Patients were stratified into the three groups categorized by age: super-elderly (≥ 80 years), elderly (65-79 years), and middle-aged (50-64 years). Demographics, surgical details, radiographic parameters, patient-reported outcomes, satisfaction at two years, 30-day complications, and rates of proximal junctional failure (PJF) were compared.

Results: A total of 151 patients (44 super-elderly, 79 elderly, and 28 middle-aged) were analyzed. Super-elderly patients had higher ASA scores and a higher rate of osteoporosis than the other groups. Surgical extent and duration were similar, but blood loss was lower in the super-elderly group. Pre-operative PT and SVA as well as post-operative PT were significantly greater in the super-elderly and elderly groups than in the middle-aged group. Leg pain and ODI were significantly worse pre-operatively in the elderly group; however, all post-operative outcomes, satisfaction, short-term complication rates were similar across the three groups. The incidence of PJF increased stepwise across age categories (36% vs. 29% vs. 12%, p = 0.09), while a multivariate analysis revealed super-elderly status was not independently associated with PJF.

Conclusions: Despite greater pre-operative deformity, patients aged ≥ 80 years achieved comparable functional and radiographic outcomes to patients aged 65-79 and 50-64. Careful patient selection and pre-operative counseling are essential for optimizing outcomes in this growing surgical population.

Purpose: To assess and compare the preoperative healthcare costs associated with single-level cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF), with additional evaluation across cost categories and insurance types.

Methods: Patients who underwent CDA or ACDF between 2010 and 2022 were queried from the PearlDiver Mariner database. Preoperative expenditures - including office visits, imaging (X-ray, MRI, CT), opioid prescriptions, steroid injections, and physical therapy - were quantified. Patients were stratified by insurance type, and statistical comparisons were performed using t-tests with significance set at P < 0.05.

Results: CDA was associated with significantly higher preoperative costs compared to ACDF. The mean total preoperative cost for CDA was $10,967.98 versus $9,463.64 for ACDF (P < 0.001), driven by greater expenditures on physical therapy, imaging, and office visits. Among Medicare beneficiaries, CDA patients had preoperative costs of $9,517.83 versus $9,178.40 for ACDF (P < 0.001), with significant differences in imaging. In the commercial insurance cohort, CDA patients incurred $11,062.86 compared to $9,226.20 for ACDF (P < 0.001), with larger differences in physical therapy, imaging, and office visits.

Conclusion: CDA incurs higher preoperative costs than ACDF across both Medicare and commercial insurance groups, with notable differences in physical therapy and imaging expenditures. These findings underscore the importance of evaluating cost drivers in the preoperative setting and highlight the potential for cost-optimization strategies, particularly in patients undergoing CDA.