European Spine Journal最新文献

Background: Patients with atlantoaxial dislocation combined with atlas occipitalization often present with variations in the anatomy of the vertebral artery and bone, posing potential risks during the implantation of the C2 pedicle screws during surgery.

Objective: Based on comprehensive preoperative imaging evaluation, this study investigates the blood supply, course, and relationship with bone of the vertebral artery in patients with atlantoaxial dislocation combined with atlas occipitalization, aiming to provide reference for safe implantation of internal fixation.

Methods: Imaging data of 77 patients with atlantoaxial dislocation combined with atlas occipitalization from October 2015 to December 2023 at the First Affiliated Hospital of the University of Science and Technology of China were collected, including CT, CT angiography, and MRI. The blood supply, course, and relationship with surrounding structure of the vertebral artery were analyzed using PACS and RadiAnt software.

Results: There were 18 males and 59 females, with an average age of 48.5 ± 10.5 years (range: 17-71 years). Forty-one cases (53.2%) were associated with congenital C2-3 fusion(Klippel-Feil syndrome). Vertebral artery blood supply was predominantly unilateral (including single blood supply) in 56 cases (72.7%), with left-sided predominance (62.5%). Segment V3 course variations of the vertebral artery were common, with 47 cases (35.6%) not entering the transverse foramen of C1. High-riding vertebral arteries were present in 36 cases (46.8%), with 22 cases (61.1%) associated with congenital C2-3 fusion. The average width of the axis pedicle on the high-riding side was 2.13 ± 1.2 mm, and the height of the isthmus was ≤ 5 mm, with an average of 2.55 ± 1.07 mm. There was a loose gap on the lateral side of the vertebral artery within the transverse foramen, with an average of 2.1 mm, and the corresponding width of the subarachnoid space on the inner side of the axis pedicle was 3.48 mm.

Conclusion: Comprehensive preoperative imaging evaluation can reduce the risk of vertebral artery injury during surgery in patients with congenital atlantoaxial dislocation combined with atlas occipitalization, and provide feasible and optimized internal fixation solutions.

Purpose: To perform a large-scale assessment of reoperation risk among spine deformity patients undergoing thoracic to pelvis surgery.

Methods: The PearlDiver database was queried for spinal deformity patients (scoliosis, kyphosis, spondylolisthesis, sagittal plane deformity) undergoing at minimum, a T12-pelvis operation (2010-2020). CPT codes identified lumbar arthrodesis procedures that included pelvic fixation and ≥ 7 levels of posterior instrumentation on the same day. Minimum follow-up was 2 years. Reoperations included subsequent arthrodesis, decompression, osteotomy, device insertion, and pelvic fixation procedures. Multivariable regression analysis described associations between variables and reoperation risk.

Results: 7,062 patients met criteria. Overall reoperation rate was 23.2%. Reoperation rate at 2- and 5-year was 16.9% and 22.1% respectively. 10-year reoperation-free probability was 73.7% (95% CI: 72.4-74.9%). Multivariable analysis revealed higher reoperation risk for patients with kyphosis and ≥ 13 levels of posterior instrumentation. Patients who received interbody cages had a lower reoperation risk. No association was found between the presence or absence of osteotomy procedures and reoperation risk. Lastly, linear regression analyses revealed no significant relationship between age or ECI and risk for subsequent operations did not independently influence reoperation.

Conclusions: This study, representing a real-world cohort of over six times the largest current prospective data set, found a 2-year reoperation rate of 17%, similar to previous studies, suggesting study group findings are applicable to a broader population. Preoperative kyphosis and ≥ 13 levels of posterior instrumentation was associated with higher reoperation risk, while the use of interbody cages was protective. Age, medical comorbidities, and osteotomies did not predict reoperations.

Purpose: This study aimed at comparing the costs of spinal fusion surgery between patients with and without diabetes.

Methods: Following PRISMA guidelines, a systematic search of four databases was conducted. A meta-analysis was performed on comparative studies examining diabetic versus non-diabetic adults undergoing cervical/lumbar fusion in terms of cost. Heterogeneity was assessed using the I2 test. Standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model in the presence of heterogeneity.

Results: Twenty-two studies were included in this meta-analysis. Standardized costs were significantly higher in the diabetic group (SMD 0.02, 95% CI 0.01 to 0.03, p < 0.05). The excess cost per diabetic patient undergoing spinal fusion surgery was estimated to be $2,492 (95% CI: $1,620 to $3,363). The length of stay (LOS) was significantly longer in the diabetes group (MD 0.42, 95% CI 0.24 to 0.60, p < 0.001). No significant difference was observed in intensive care unit admission between the groups (OR 4.15, 95% CI 0.55 to 31.40, p > 0.05). Reoperation showed no significant differences between the groups (OR 1.14, 95% CI 0.96 to 1.35, p > 0.05). However, 30-day and 90-day readmissions were significantly higher in the diabetes group: (OR 1.42, 95% CI 1.24 to 1.62, p < 0.05) and (OR 1.39, 95% CI 1.15 to 1.68, p < 0.001), respectively. Non-routine or non-home discharge was also significantly higher in the diabetes group (OR 1.89, 95% CI 1.67 to 2.13, p < 0.001).

Conclusion: Patients with diabetes undergoing spinal fusion surgery had increased costs, prolonged LOS, increased 30-day/90-day readmission rates, and more frequent non-routine discharges.

Objective: This study aimed to compare the use of the endoscopic drill (ED) with the extra-endoscopic trephine (EET) in treating lumbar disc herniations with regard to efficiency, safety, and clinical outcomes.

Methods: From January 2022 and June 2023, 136 patients who had the single-level LDH and received the transforaminal endoscopic surgery were divided into two groups according to the foraminoplasty technique: the EET group (n = 69) and the ED group (n = 67). Surgery-related parameters, complications, Visual Analogue Scale (VAS, 0-10), and Oswestry Disability Index (ODI, 0-100%) were assessed and compared among two groups.

Results: The mean operation time and the foraminoplasty time of the EET group was significantly shorter than that of the ED group (P < 0.05). Patients in ED group reported less back pain on the VAS during foraminoplasty than EET group. Although the total complication rate was similar between two groups, the incidence of neural irritation in ED group was significantly lower than that in the EET group. There were no significant differences in VAS or ODI scores at each follow-up visit between two groups.

Conclusions: The application of EET and ED were both effective for full-endoscopic foraminoplasty, and have achieved good clinical outcomes. Although the efficiency of EET is higher than that of ED, it faces some problems during use, such as a high risk of neural irritation, intense intraoperative pain, and the trephine displacement. The ED technique is safe and controllable, which can be used as an ideal method for supplementary foraminoplasty.

Purpose: Spine surgery, particularly deformity correction, is associated with a high risk of peri-operative or post-operative complications, and these complications can lead to catastrophic consequences. This case report will present the etiology and treatment process of the peri-operative cardiac arrest during scoliosis correction surgery.

Method: In this report, we present a case of cardiac arrest during posterior correction surgery in a 17-year-old female patient with adolescent idiopathic scoliosis.

Results: The patient was successfully treated using extracorporeal membrane oxygenation and an intra-aortic balloon pump. We have discussed the potential causes of peri-operative cardiac arrest, including thromboembolism (VAE/PE), electrolyte imbalance (Hyper/Hypokalemia or Acidosis), hypovolemia, hypothermia, and cardiogenic shock related to neurogenic-stunned myocardium.

Conclusion: There are many etiologies should be considered in peri-operative cardiac arrest during posterior correction spine surgery, such as venous air embolism and electrolyte imbalance. Stress cardiomyopathy, which occurs after stressful conditions, such as surgery should also be considered. Surgeons must consider these etiologies when faced with critical situations, and the successful treatment of such cases relies on team collaboration and prompt intervention.

Purpose: To evaluate incidental lumbar durotomy incidence and risk-factors, and the association of durotomy with perioperative metrics and patient-reported outcomes.

Methods: A total 3140 cases of 1-3 level elective decompressive surgery from 2008 to 2023 at a single centre were included. Multivariable analysis was performed on literature derived variables to identify independent risk-factors for durotomy. Absolute difference or absolute risk increase (ARI) between durotomy and non-durotomy perioperative metrics was calculated. The association between durotomy and 3-month or 12-month patient-reported outcome measures was assessed.

Results: All-procedure durotomy incidence was 4.5% (142/3140). Durotomy risk-factors were age (odds ratio (OR) 1.016, 95% confidence intervals (95% CI) 1.011-1.020), female (OR 1.48, 95% CI 1.26-1.74), number of operative levels (two-level OR 1.81, 95% CI 1.48-2.21; three-level OR 3.18, 95% CI 2.14-4.72), multiple versus no previous operation (OR 1.85, 95% CI 1.11-3.07), and fusion with discectomy versus discectomy (OR 2.36, 95% CI 1.90-2.93). Durotomy was associated with longer length of stay (∆2.4 days, p < 0.001), longer operative time (∆21 min, p < 0.001), and higher rate of iatrogenic nerve injury (ARI 4.3%, p < 0.001), 30-day return to theatre (ARI 5.7%, p < 0.001), and 30-day readmission (ARI 4.4%, p = 0.002). Durotomy was not associated with poorer patient-reported outcomes.

Conclusion: Dural tears are often under-reported and are associated with longer hospital stay, increased operative time, and rare perioperative complications which increase healthcare costs. Dural tears did not, however, detrimentally affect patient-reported disability or pain outcomes.

Purpose: To translate and cross-culturally adapt Fukushima Lumbar Spinal Stenosis Scale into a Simplified Chinese version (FLS-25-SC), and evaluate the reliability and validity of FLS-25-SC in patients with lumbar spinal stenosis.

Methods: Test-retest reliability was assessed by Intra-class correlation coefficient (ICC). Construct validity was analyzed by correlations between FLS-25-SC and the Swiss Spinal Stenosis (SSS) Questionnaire, Visual analogue scale (VAS) as well as the short form (36) health survey (SF-36).

Results: The original version of the FLS-25 was cross-culturally adapted and translated into Simplified Chinese. FLS-25-SC was indicated to have excellent reliability (Cronbach's alpha = 0.941, ICC = 0.952). FLS-25-SC had almost perfect correlation with Physical Functioning (r = -0.870, P < 0.001) subscale of SF-36. Moderate to substantial correlations between FLS-25-SC and Symptom severity (r = 0.542, P < 0.001), Physical function (r = 0.604, P < 0.001) subscales of Swiss Spinal Stenosis (SSS) Questionnaire, VAS (r = 0.613, P < 0.001), as well as Role Physical (r = -0.537, P < 0.001) and Bodily Pain (r = -0.474, P < 0.001). It was observed that the loading of the 3 factors explained 63.108% of the total variance: [Kaiser-Mayer-Olkin (KMO) = 0.903, C2 = 1769.491, p < 0.001].

Conclusion: FLS-25-SC has been shown to have acceptable reliability and validity in patients with degenerative lumbar spinal stenosis and may be recommended for patients in Chinese mainland.

Objective: To explore the efficacy and safety of the direct inferior endplate approach in percutaneous endoscopic interlaminar discectomy (PEID) for the treatment of L5-S1 disc herniation.

Methods: This was a retrospective analysis of 116 patients with L5-S1 disc herniation treated with PEID; 74 patients underwent surgery via the direct inferior endplate approach (group A), and 42 patients underwent surgery via the indirect approach (group B). The number of intraoperative fluoroscopy exposures, establishment channel time, operation time, postoperative visual analogue scale (VAS) score, and Oswestry Disability Index (ODI) were compared between the 2 groups.

Results: Compared with those in Group B, the channel establishment time, number of fluoroscopy exposures, and operation time in Group A were significantly lower (P < 0.05). There was no significant difference in the VAS score or ODI between the two groups (P > 0.05).

Conclusions: Compared with the indirect approach, the direct inferior endplate approach can allow the exposed target to be reached more quickly, shorten the operation time, and reduce the degree of radiation exposure of doctors and patients, resulting in a high safety profile.

Objective: To assess the efficacy and safety of subcutaneous perispinal infiltration of low dose of triamcinolone and lidocaine indicated for pain control in patients with cervical osteoarthritis (COA).

Methods: Patients with symptomatic COA resistant to conventional treatment including anti-inflammatory drugs, analgesics, and physical therapy were included. Technetium-99 m pyrophosphate (99mTc-PYP) scintigraphy and computerized tomography (CT) fusion scans images were used for diagnosis of COA and as a guide for level(s) of infiltration(s). Infiltration consisted of subcutaneous administration of 1 cc of a mixture of triamcinolone (6 mg/0.7 cc) and 2% lidocaine (6 mg/0.3 cc) into the posterior central interspinal area, at the levels where the greatest uptake of the radiotracer was observed. Response was assessed using a pain analogue scale (PAS) (range 0-10 with 10 representing worst pain).

Results: Forty-two patients were included. Thirty-six (85.7%) were women. The mean age was 59.2 years. Three months after infiltration clinical improvement was confirmed by a decrease in the PAS value: before and after infiltrations was 7.26 (range 4-10, SD:1.48) and 1.97 (range 0-6, SD:1.24), respectively. This difference being statistically significant (P < 0.05). No patient presented local or systemic adverse effects.

Conclusions: Low dose subcutaneous perispinal injection of triamcinolone and lidocaine may offer clinical benefits for patients with symptomatic COA refractory to conventional treatments. 99mTc-PYP/CT fusion scans images were useful as a guide for localization of infiltrations.