European Spine Journal最新文献

Background: This study aimed to evaluate the clinical indications, imaging findings, and structural factors identified on pediatric lumbar MRI, with a specific focus on non-traumatic low back pain and lumbar disc herniation (LDH).

Materials and methods: A retrospective review was conducted of 1,253 lumbar MRI examinations performed in pediatric patients aged 0-18 years between November 2022 and March 2024. Clinical indications were documented for all patients. Imaging findings were systematically analyzed in children presenting with non-traumatic low back pain. In patients diagnosed with LDH, the presence of lumbosacral transitional vertebrae (LSTV), spondylolysis, and spondylolisthesis was reassessed. LSTVs were categorized using the Castellvi classification.

Results: Low back pain was the most common indication for MRI (n=650, 51.9%). Among these children, 62.3% had normal examinations. Disc protrusion (15.1%), degenerative disc or endplate changes (8.9%), spondylolysis (5.5%), and spondylolisthesis (2.8%) were the most frequent abnormalities. LDH predominantly occurred at the L5-S1 level. LSTVs were identified in 52 patients (8%) with LDH, and higher-grade Castellvi types were significantly associated with LDH (p<0.001). Lumbarization of S1 was observed in 10 LDH patients, typically showing squaring of S1 and prominence of the S1-2 disc space.

Conclusion: Although most pediatric lumbar MRI examinations performed for low back pain are normal, MRI remains essential for identifying clinically relevant structural abnormalities. LDH is more common in older adolescents and is associated with anatomical variants such as LSTV and lumbarization. Recognition of these variations, combined with adherence to evidence-based imaging recommendations, is crucial for accurate diagnosis and appropriate clinical management in children with low back pain.

Purpose: This study aimed to analyze adverse events associated with Mazor X surgical guidance robots, focusing on parameters such as root causes, vertebral distribution, surgical delay, robot abandonment, and more.

Methods: 330 adverse events reported within the Manufacturer and User Facility Device Experience (MAUDE) database for the Mazor X (MX) and Mazor X Stealth Edition (MXSE) robot guidance systems were analyzed and categorized based on the root causes, vertebral distribution, surgical delay, robot abandonment, and patient outcomes.

Results: Both the MX and MXSE adverse events were primarily due to external root causes (35% and 52%, respectively), with user error being the most common. Deviations were most likely to affect the L3, L4, and L5 vertebra, and deviate either medially or laterally. Motor deficits were the most common adverse patient outcome for MX, while sensory deficits were the most common for MXSE. There were two deaths associated with the MX, compared to zero deaths with the MXSE.

Conclusion: While the MAUDE database cannot be used to calculate the incidence or prevalence of adverse events, it provides insight into the types of adverse events that tend to occur with medical devices. MAUDE reports suggest that user-related errors account for most of the adverse events that occur, underscoring the need for focused surgeon training. Our study highlights the importance of understanding both the types of adverse events and their root causes to promote patient safety and reduce complication rates.

Introduction: Severe spinal deformities represent rare and complex conditions requiring highly individualized treatment strategies. Among these, the "reverse-folding human" deformity has never before been reported in the medical literature. This study presents the first documented case of this condition, managed successfully through a multidisciplinary team approach and staged posterior spinal instrumentation and fusion. It also establishes the first framework for risk stratification and perioperative management of such extreme deformities.

Methods: Case report.

Case presentation: A 36-year-old woman presented with progressive cervical hyperextension over 26 years and thoracolumbar deformity over 17 years. Clinical and radiological evaluation revealed severe cervical hyperextension, spinal lordosis (Cobb angle: 140.1°), scoliosis (Cobb angle: 87.6°), and severe restrictive pulmonary impairment. The patient underwent a two-stage posterior spinal fusion (C2-S1). Postoperative outcomes included substantial improvement in alignment and gait, with no neurological or mechanical complications over two years of follow-up.

Conclusion: This case demonstrates the feasibility and efficacy of a staged full-spine surgical approach in managing unprecedented spinal deformities. The successful outcome highlights key elements for similar cases: patient-specific surgical planning, staged correction to reduce risks, and coordinated MDT involvement. This report provides a critical clinical reference and treatment framework for managing rare and severe spinal deformities, including the newly defined "reverse-folding human" condition.

Background: The Hoffmann (H-) reflex is a monosynaptic electrophysiological response that reflects S1-root integrity. Although widely used in experimental and in clinical outpatient neurophysiological testing, its intra-operative application during endoscopic lumbar surgery is rarely reported. We present the first real-time documentation of H-reflex normalization immediately after endoscopic decompression of an acute L5-S1 disc herniation.

Case description: A 49-year-old woman presented with acute right-sided S1 radiculopathy (ankle dorsiflexion/plantar-flexion MRC grade III; hallux extension grade I). MRI showed a large, right sub-articular L5-S1 disc extrusion compressing the S1 nerve root. Unilateral biportal endoscopic discectomy was performed under general anesthesia with multimodal intra-operative neuromonitoring (MEPs, free-run EMG, and continuous tibial-nerve H-reflex). Baseline recordings revealed marked side-to-side asymmetry: right-leg MEP amplitudes were depressed, and the right H-reflex was low and unstable. During foraminoplasty and fragment removal, a sudden, sustained 100% surge in right H-reflex amplitude occurred, coincidence with root decompression, while MEPs remained unchanged. Free-run EMG discharges abated after the H-reflex improved. Post-operative recovery was uneventful. At 2 months the patient demonstrated near-complete motor recovery (MRC IV-V) and full pain relief.

Conclusion: Continuous H-reflex monitoring provided an immediate, sensitive marker of S1-root decompression when conventional MEPs failed to reflect functional recovery. This single-case experience supports the feasibility and potential prognostic value of adding H-reflex surveillance to the neuromonitoring toolkit for endoscopic lumbar surgery. Prospective studies in larger cohorts are warranted to validate threshold criteria, refine stimulation parameters, and determine cost-effectiveness.