European Spine Journal最新文献

Study design: Prospective single-center observational cohort study.

Objectives: To assess whether prior arthroscopic experience is associated with a shorter learning curve in uniportal interlaminar endoscopic lumbar discectomy (IELD), primarily in terms of operative efficiency, and to descriptively evaluate perioperative complications and patient-reported outcomes.

Methods: In accordance with STROBE guidelines, 240 consecutive patients with single-level lumbar disc herniation (MSU A/B, non-calcified, symptom duration ≤ 3 months) underwent IELD between 2021 and 2023 at a single academic orthopedic center. Procedures were performed by three spine surgeons without prior endoscopic experience; one surgeon had performed more than 300 shoulder arthroscopies. Operative time was analyzed using cumulative sum (CUSUM) methodology and linear regression. Missing outcome data were handled using last observation carried forward. Complications were recorded descriptively and stratified by learning phase and surgeon. Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores for back and leg pain were assessed preoperatively and at 3 and 12 months.

Results: All surgeons demonstrated a three-phase learning curve consisting of learning, improvement, and stabilization phases. Operative efficiency stabilized after approximately 50 cases across surgeons. The surgeon with prior arthroscopic experience reached the CUSUM inflection point earlier (case 12) compared with the other surgeons (cases 24-26). The overall major complication rate was 9.2% and was highest during the initial learning phase. ODI and VAS scores improved significantly at 3 and 12 months (all p < 0.001), with no statistically significant between-surgeon differences at final follow-up.

Conclusions: Prior arthroscopic experience was associated with earlier adaptation during the initial learning phase of IELD, as measured by operative time. Following procedural stabilization, no statistically significant differences were detected in operative efficiency, major complication rates, or patient-reported outcomes between surgeons. These findings suggest that arthroscopic experience may facilitate early adaptation to endoscopic visualization and workflow but does not independently determine long-term clinical outcomes.

Level of evidence: III.

Purpose: Collagen integrity is essential for connective tissue maintenance, and its deterioration may contribute to postoperative complications. Dermal ultrasound (US) echogenicity has been associated with collagen quality, with changes in echogenicity reflecting alterations in collagen composition. These changes may indicate increased susceptibility to revision surgery in lumbar fusion patients, particularly due to adjacent segment disease (ASD). However, no study has established a specific cutoff value for skin US echogenicity to predict the need for ASD-related revision surgery. This single-center prospective cohort study aimed to evaluate the association between dermal echogenicity and ASD revision, and to determine echogenicity cutoff values that could help identify patients at higher risk of requiring revision surgery.

Methods: Patients undergoing posterior lumbar fusion from 2014 to 2023 were included. US measurements were conducted at two standardized locations on the lumbar back. Echogenicity values for the average dermal (AD), upper dermal (UD), and lower dermal (LD) layers were calculated using our institution's PACS imaging software. Statistical significance set at p < 0.05.

Results: Among 383 patients (51% female, median age 63), those undergoing ASD revision were significantly older (median age 66.8 vs. 62 years, p = 0.012). Higher echogenicity in the LD (OR = 1.03, p = 0.008), UD (OR = 1.03, p = 0.027), and AD (OR = 1.03, p = 0.005) layers was associated with increased ASD risk. The optimal LD echogenicity cutoff was 124.3 (AUC = 0.654, sensitivity = 0.6, specificity = 0.69).

Conclusion: We identify echogenicity cutoff values that correlate with an increased risk of revision surgery for ASD. Higher dermal US echogenicity may reflect alterations in collagen, contributing to poorer tissue quality. These findings support the use of dermal US parameters as a potential biomarker for high-risk lumbar fusion patients.