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Clinical and Radiological Outcomes of Intermuscular "Raising Roof" Modified Cervical Laminoplasty for Cervical Spondylotic Myelopathy: A Retrospective Study of at Least 2 Years Follow-Up.
IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-01 DOI: 10.1177/21925682251333285
Xinhang Li, Haosen Wu, Liran Xu, Xueshi Tian, Gengyu Han, Yu Sun, Shengfa Pan, Yanbin Zhao, Feifei Zhou

Study designRetrospective study.ObjectivesThe aim of this study was to evaluate the outcomes of a new modified laminoplasty, intermuscular "raising roof" laminoplasty for patients with cervical spondylotic myelopathy.Methods98 patients with cervical spondylotic myelopathy were involved into the study, including 44 patients underwent intermuscular "raising roof" laminoplasty (RL) and 54 patients underwent unilateral muscle-preserve laminoplasty (UL). The data, including sagittal parameters and clinical scale was collected at preoperative stage and final follow-up (at least 2 years) and compared between RL group and UL group. Multivariable liner regressions were preformed to evaluate the relationship between parameters with significant changes at the final follow-up and changes of CL, postoperative NDI and JOA. The cumulative sum (CUSUM) analysis was used for quantitative assessment of RL learning curve. All cases were divided into the learning phase and the proficiency phase according to the peak of CUSUM curve.ResultsNo significant difference was found between RL group and UL group preoperatively. At final follow-up, patients in RL group showed higher JOA scores and recovery rate (RR) but lower NDI scores. For the cervical alignment, the ROM of RL group was greater significantly than UL group, whereas the T1S of RL group was lower than UL group. For the decompression, the RL group had larger CSA of spinal canal than UL group (C4: 278.16 ± 50.40 vs 233.84 ± 42.71, P < .001; C5: 279.12 ± 63.88 vs 232.41 ± 48.38, P < .001). For the muscle-preserve effect, the CSA of left-side PM in RL group decreased significantly compared to the preoperative stage on C5 level (2.92 ± 0.66 vs 3.16 ± 1.08, P < .05), and RL group showed better postoperative symmetry than UL group. The regression results indicated postoperative CSA of right-side PM on C4 level had positive impact on the change of CL (positive value increasing, P = .023). And the postoperative symmetry of PM at C4 had positively correlation with postoperative NDI (P = .034). However, the ages of patients showed negative correlation (P = .012) with postoperative JOA. Operation time of learning phase was significantly longer than proficiency phase (166 ± 34.78 vs 120.65 ± 20.36, P < .001), and blood loss of learning phase was significantly higher than proficiency phase (251.90 ± 171.27 vs 148.88 ± 82.02, P < .001).ConclusionCompared to UL, RL showed similar recovery of neurological functions, but with better improvement of quality of life, cervical mobility and decompression effect at 2-year follow-up. It provides a new treatment approach for degeneration cervical myelopathy.

{"title":"Clinical and Radiological Outcomes of Intermuscular \"Raising Roof\" Modified Cervical Laminoplasty for Cervical Spondylotic Myelopathy: A Retrospective Study of at Least 2 Years Follow-Up.","authors":"Xinhang Li, Haosen Wu, Liran Xu, Xueshi Tian, Gengyu Han, Yu Sun, Shengfa Pan, Yanbin Zhao, Feifei Zhou","doi":"10.1177/21925682251333285","DOIUrl":"https://doi.org/10.1177/21925682251333285","url":null,"abstract":"<p><p>Study designRetrospective study.ObjectivesThe aim of this study was to evaluate the outcomes of a new modified laminoplasty, intermuscular \"raising roof\" laminoplasty for patients with cervical spondylotic myelopathy.Methods98 patients with cervical spondylotic myelopathy were involved into the study, including 44 patients underwent intermuscular \"raising roof\" laminoplasty (RL) and 54 patients underwent unilateral muscle-preserve laminoplasty (UL). The data, including sagittal parameters and clinical scale was collected at preoperative stage and final follow-up (at least 2 years) and compared between RL group and UL group. Multivariable liner regressions were preformed to evaluate the relationship between parameters with significant changes at the final follow-up and changes of CL, postoperative NDI and JOA. The cumulative sum (CUSUM) analysis was used for quantitative assessment of RL learning curve. All cases were divided into the learning phase and the proficiency phase according to the peak of CUSUM curve.ResultsNo significant difference was found between RL group and UL group preoperatively. At final follow-up, patients in RL group showed higher JOA scores and recovery rate (RR) but lower NDI scores. For the cervical alignment, the ROM of RL group was greater significantly than UL group, whereas the T1S of RL group was lower than UL group. For the decompression, the RL group had larger CSA of spinal canal than UL group (C4: 278.16 ± 50.40 vs 233.84 ± 42.71, <i>P</i> < .001; C5: 279.12 ± 63.88 vs 232.41 ± 48.38, <i>P</i> < .001). For the muscle-preserve effect, the CSA of left-side PM in RL group decreased significantly compared to the preoperative stage on C5 level (2.92 ± 0.66 vs 3.16 ± 1.08, <i>P</i> < .05), and RL group showed better postoperative symmetry than UL group. The regression results indicated postoperative CSA of right-side PM on C4 level had positive impact on the change of CL (positive value increasing, <i>P</i> = .023). And the postoperative symmetry of PM at C4 had positively correlation with postoperative NDI (<i>P</i> = .034). However, the ages of patients showed negative correlation (<i>P</i> = .012) with postoperative JOA. Operation time of learning phase was significantly longer than proficiency phase (166 ± 34.78 vs 120.65 ± 20.36, <i>P</i> < .001), and blood loss of learning phase was significantly higher than proficiency phase (251.90 ± 171.27 vs 148.88 ± 82.02, <i>P</i> < .001).ConclusionCompared to UL, RL showed similar recovery of neurological functions, but with better improvement of quality of life, cervical mobility and decompression effect at 2-year follow-up. It provides a new treatment approach for degeneration cervical myelopathy.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251333285"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prospective Randomized Comparison of Minimally Invasive Tlif versus Open Tlif: Clinical Effectiveness and Restoration of Working Capacity in Railway Workers. 微创 Tlif 与开放 Tlif 的前瞻性随机比较:铁路工人的临床疗效和工作能力恢复。
IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-01 Epub Date: 2024-03-25 DOI: 10.1177/21925682241242039
Vadim A Byvaltsev, Andrei A Kalinin, Yurii Ya Pestryakov, Dmitriy V Hozeev, Rustem A Kundubayev, Mikhail Y Biryuchkov, K Daniel Riew

Study DesignRandomized Clinical Trial.ObjectiveTo compare the clinical efficacy and restoration of working capacity after MI (minimally invasive)-TLIF and O (open)-TLIF in railway workers with lumbar degenerative disease.Methods83 patients, who were indicated for two-level lumbar decompression and fusion were randomly assigned to one of two groups: group 1 (n = 44) had MI-TLIF procedure and group 2 (n = 39) had O-TLIF procedure. The functional status was assessed using SF-36, ODI and VAS for back and leg pain, preoperatively, at discharge, and at 3, 6, and 12 months postoperatively. MRI and CT were obtained 1-year follow-up. The percentage of patients who returned to work at 1-year, work intensity and the time to return to work post-operatively were analyzed.ResultsAt 1-year follow-up, the MI-TLIF group had significantly better ODI, VAS and SF-36 scores compared to the O-TLIF group. The postoperative MRIs revealed a statistically significantly less multifidus muscle atrophy in the MI group compared to the Open group. At 1-year follow-up, a comparable fusion ratio between MI group and Open group was recorded. After MI-TLIF procedure, depending on the workload, patients had a statistically significantly earlier return to work (P < .05) and statistically significantly higher return to work rate compared with the O-TLIF group (P < .05).ConclusionsThe use of two-level MI-TLIF in railway workers has made it possible to significantly improve long-term clinical results, reduce the risk of surgical complications, muscle atrophy and time to return to work compared to O-TLIF.

研究设计随机临床试验:方法:将 83 名有腰椎两级减压融合手术指征的患者随机分为两组:第一组(44 人)接受 MI-TLIF 手术,第二组(39 人)接受 O-TLIF 手术。术前、出院时、术后3、6和12个月时,采用SF-36、ODI和VAS对背痛和腿痛的功能状态进行评估。术后 1 年进行了 MRI 和 CT 检查。对术后 1 年重返工作岗位的患者比例、工作强度和重返工作岗位的时间进行了分析:结果:随访1年后,MI-TLIF组的ODI、VAS和SF-36评分明显优于O-TLIF组。术后核磁共振成像显示,MI 组的多裂肌萎缩程度明显低于开放组。在一年的随访中,MI 组与开放组的融合率相当。MI-TLIF术后,根据工作量的不同,与O-TLIF组相比,患者重返工作岗位的时间明显提前(P < .05),重返工作岗位率明显提高(P < .05):结论:与O-TLIF相比,在铁路工人中使用两级MI-TLIF可显著改善长期临床效果,降低手术并发症风险,减少肌肉萎缩和重返工作岗位的时间。
{"title":"Prospective Randomized Comparison of Minimally Invasive Tlif versus Open Tlif: Clinical Effectiveness and Restoration of Working Capacity in Railway Workers.","authors":"Vadim A Byvaltsev, Andrei A Kalinin, Yurii Ya Pestryakov, Dmitriy V Hozeev, Rustem A Kundubayev, Mikhail Y Biryuchkov, K Daniel Riew","doi":"10.1177/21925682241242039","DOIUrl":"10.1177/21925682241242039","url":null,"abstract":"<p><p>Study DesignRandomized Clinical Trial.ObjectiveTo compare the clinical efficacy and restoration of working capacity after MI (minimally invasive)-TLIF and O (open)-TLIF in railway workers with lumbar degenerative disease.Methods83 patients, who were indicated for two-level lumbar decompression and fusion were randomly assigned to one of two groups: group 1 (n = 44) had MI-TLIF procedure and group 2 (n = 39) had O-TLIF procedure. The functional status was assessed using SF-36, ODI and VAS for back and leg pain, preoperatively, at discharge, and at 3, 6, and 12 months postoperatively. MRI and CT were obtained 1-year follow-up. The percentage of patients who returned to work at 1-year, work intensity and the time to return to work post-operatively were analyzed.ResultsAt 1-year follow-up, the MI-TLIF group had significantly better ODI, VAS and SF-36 scores compared to the O-TLIF group. The postoperative MRIs revealed a statistically significantly less multifidus muscle atrophy in the MI group compared to the Open group. At 1-year follow-up, a comparable fusion ratio between MI group and Open group was recorded. After MI-TLIF procedure, depending on the workload, patients had a statistically significantly earlier return to work (<i>P</i> < .05) and statistically significantly higher return to work rate compared with the O-TLIF group (<i>P</i> < .05).ConclusionsThe use of two-level MI-TLIF in railway workers has made it possible to significantly improve long-term clinical results, reduce the risk of surgical complications, muscle atrophy and time to return to work compared to O-TLIF.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"1508-1516"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140206644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association of Untreated Pre-surgical Depression With Pain and Outcomes After Spinal Surgery. 未经治疗的术前抑郁与脊柱手术后疼痛和疗效的关系
IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-01 Epub Date: 2024-06-11 DOI: 10.1177/21925682241260642
Jae-Won Shin, Yung Park, Sung-Hoon Park, Joong Won Ha, Woo-Seok Jung, Hak-Sun Kim, Kyung-Soo Suk, Si-Young Park, Seong-Hwan Moon, Byung Ho Lee, Ji-Won Kwon, Jaeun Ahn

Study DesignProspective Cohort Study.ObjectiveUntreated pre-surgical depression may prolong post-surgical pain and hinder recovery. However, research on the impact of untreated pre-surgical depression on post-spinal surgery pain is lacking. Therefore, this study aimed to assess pre-surgical depression in patients and analyze its relationship with post-surgical pain and overall post-surgical outcomes.MethodsWe recruited 100 patients scheduled for lumbar spine surgery due to spondylolisthesis, degenerative lumbar disc diseases, and herniated lumbar disc diseases. Psychiatrists evaluated them for the final selection. We assessed the Beck Depression Inventory (BDI), Japanese Orthopaedic Association (JOA), Oswestry Disability Index (ODI), and EuroQoL 5 Dimensions (EQ-5D) scores, numerical back and leg pain scales, and medication dosage data collected before and at 6 weeks, 3 months, and 6 months after surgery.ResultsNinety-one patients were included in this study; 40 and 51 were allocated to the control and depression groups, respectively. The pre- and post-surgical leg pain, back pain, and functional scores were not different. However, the depression group showed higher ODI and EQ-5D and lower JOA scores than the control group 3 months post-surgery. Partial correlation analysis revealed an inverse correlation between the JOA and BDI scores and a positive correlation between the EQ-5D and BDI scores at 3 months postoperatively.ConclusionUntreated depression can prolong postoperative pain and hinder recovery. Detecting and treating depression in patients before spine surgery may improve their overall quality of life and functional recovery.

研究设计前瞻性队列研究:未经治疗的术前抑郁症可能会延长手术后疼痛的时间并阻碍康复。然而,有关未经治疗的手术前抑郁对脊柱手术后疼痛的影响的研究尚属空白。因此,本研究旨在评估患者手术前抑郁的情况,并分析其与手术后疼痛及手术后总体预后的关系:我们招募了 100 名因脊椎滑脱症、腰椎间盘退行性疾病和腰椎间盘突出症而计划接受腰椎手术的患者。精神科医生对他们进行了评估,以确定最终人选。我们评估了贝克抑郁量表(BDI)、日本骨科协会(JOA)、Oswestry残疾指数(ODI)、欧洲生活质量5维度(EQ-5D)评分、腰腿痛数字量表以及术前、术后6周、3个月和6个月的药物剂量数据:本研究共纳入 91 名患者,其中 40 人被分配到对照组,51 人被分配到抑郁组。手术前后的腿痛、背痛和功能评分没有差异。然而,与对照组相比,抑郁组在术后 3 个月的 ODI 和 EQ-5D 分数更高,JOA 分数更低。偏相关分析显示,术后3个月时,JOA和BDI评分呈反相关,EQ-5D和BDI评分呈正相关:结论:未经治疗的抑郁症会延长术后疼痛的时间并阻碍术后恢复。在脊柱手术前检测并治疗患者的抑郁症可改善他们的整体生活质量和功能恢复。
{"title":"Association of Untreated Pre-surgical Depression With Pain and Outcomes After Spinal Surgery.","authors":"Jae-Won Shin, Yung Park, Sung-Hoon Park, Joong Won Ha, Woo-Seok Jung, Hak-Sun Kim, Kyung-Soo Suk, Si-Young Park, Seong-Hwan Moon, Byung Ho Lee, Ji-Won Kwon, Jaeun Ahn","doi":"10.1177/21925682241260642","DOIUrl":"10.1177/21925682241260642","url":null,"abstract":"<p><p>Study DesignProspective Cohort Study.ObjectiveUntreated pre-surgical depression may prolong post-surgical pain and hinder recovery. However, research on the impact of untreated pre-surgical depression on post-spinal surgery pain is lacking. Therefore, this study aimed to assess pre-surgical depression in patients and analyze its relationship with post-surgical pain and overall post-surgical outcomes.MethodsWe recruited 100 patients scheduled for lumbar spine surgery due to spondylolisthesis, degenerative lumbar disc diseases, and herniated lumbar disc diseases. Psychiatrists evaluated them for the final selection. We assessed the Beck Depression Inventory (BDI), Japanese Orthopaedic Association (JOA), Oswestry Disability Index (ODI), and EuroQoL 5 Dimensions (EQ-5D) scores, numerical back and leg pain scales, and medication dosage data collected before and at 6 weeks, 3 months, and 6 months after surgery.ResultsNinety-one patients were included in this study; 40 and 51 were allocated to the control and depression groups, respectively. The pre- and post-surgical leg pain, back pain, and functional scores were not different. However, the depression group showed higher ODI and EQ-5D and lower JOA scores than the control group 3 months post-surgery. Partial correlation analysis revealed an inverse correlation between the JOA and BDI scores and a positive correlation between the EQ-5D and BDI scores at 3 months postoperatively.ConclusionUntreated depression can prolong postoperative pain and hinder recovery. Detecting and treating depression in patients before spine surgery may improve their overall quality of life and functional recovery.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"1725-1732"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141305803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Long-Term Outcomes of One-Stage Combined Posteroanterior Procedure and Laminoplasty-Alone for Multilevel Degenerative Cervical Myelopathy With Concomitant Anterior and Posterior Compression: A Propensity Score Matching Analysis of 8-year Follow-Up. 一期后路联合手术和椎板成形术-Alone治疗伴有前后压迫的多级退行性颈椎病的长期疗效:8年随访倾向得分匹配分析》。
IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-01 Epub Date: 2024-07-20 DOI: 10.1177/21925682241265878
Ruomu Qu, Yiyuan Yang, Ben Wang, Zexiang Liu, Xiumao Li, Liang Jiang, Xiaoguang Liu, Zhongjun Liu

Study DesignRetrospective cohort study.ObjectiveThis study aimed to investigate the long-term outcomes of laminoplasty-alone (LP) and combined procedure (CP), consisting of laminoplasty and single-level anterior cervical discectomy and fusion, in comparable patients who had multilevel degenerative cervical myelopathy (MDCM) with concomitant anterior and posterior compression (CAPC).MethodsConsecutive MDCM patients with CAPC underwent LP or CP between 2012 and 2015 from a same surgical group were enrolled and followed up for a minimum of 8 years. Preoperative demographic, radiological, and clinical variables were collected. Propensity score matching (PSM) analysis was performed to match patients with comparable conditions. The outcomes were evaluated by postoperative Japanese Orthopedic Association (JOA) score improvement, JOA recovery rate (JOARR) and complications.ResultsA total of 230 patients were included, of whom 146 underwent LP and 84 underwent CP. After PSM, 84 pairs of comparable patients were matched. The matched groups presented fair comparability in preoperative conditions. The CP group had significantly prolonged surgery time and greater blood loss. At the final follow-up, the postoperative JOA scores of LP and CP groups were 14.51 ± 1.79 and 15.47 ± 1.81 (P < 0.001) and the JOARR were 42.5% ± 53.3% and 68.5% ± 35.4%, respectively (P < 0.001). Three (3.6%) patients in the LP group underwent reoperations because of recurrent symptoms (P = 0.081).ConclusionBoth LP and CP demonstrated considerable long-term neurological recovery in patients with CAPC. The CP showed a significantly higher JOA improvement and JOARR. The combined decompression might be a safe and effective alternative in treating MDCM with CAPC in experienced hands.

研究设计回顾性队列研究:本研究旨在探讨单纯椎板成形术(LP)和联合术(CP)(包括椎板成形术和单水平颈椎前路椎间盘切除术和融合术)在多水平退行性颈椎脊髓病(MDCM)合并前后压迫(CAPC)患者中的长期疗效:方法: 2012年至2015年期间,同一手术组连续对接受LP或CP治疗的多椎间孔变性颈椎病(MDCM)合并前后压迫症(CAPC)患者进行了登记和至少8年的随访。收集术前人口统计学、放射学和临床变量。进行倾向评分匹配(PSM)分析,以匹配病情相似的患者。通过术后日本骨科协会(JOA)评分改善情况、JOA恢复率(JOARR)和并发症对结果进行评估:结果:共纳入 230 名患者,其中 146 人接受了 LP,84 人接受了 CP。经过 PSM,84 对具有可比性的患者进行了配对。配对组在术前条件方面具有相当的可比性。CP 组的手术时间明显延长,失血量增加。最终随访时,LP 组和 CP 组的术后 JOA 评分分别为(14.51 ± 1.79)和(15.47 ± 1.81)(P < 0.001),JOARR 分别为(42.5% ± 53.3%)和(68.5% ± 35.4%)(P < 0.001)。LP组有3名(3.6%)患者因症状复发而再次手术(P = 0.081):结论:LP和CP均可使CAPC患者的神经功能得到显著的长期恢复。结论:LP 和 CP 对 CAPC 患者的长期神经恢复都很明显,CP 的 JOA 改善和 JOARR 明显更高。在治疗伴有 CAPC 的 MDCM 时,经验丰富的医生可能会将联合减压作为一种安全有效的替代方法。
{"title":"Long-Term Outcomes of One-Stage Combined Posteroanterior Procedure and Laminoplasty-Alone for Multilevel Degenerative Cervical Myelopathy With Concomitant Anterior and Posterior Compression: A Propensity Score Matching Analysis of 8-year Follow-Up.","authors":"Ruomu Qu, Yiyuan Yang, Ben Wang, Zexiang Liu, Xiumao Li, Liang Jiang, Xiaoguang Liu, Zhongjun Liu","doi":"10.1177/21925682241265878","DOIUrl":"10.1177/21925682241265878","url":null,"abstract":"<p><p>Study DesignRetrospective cohort study.ObjectiveThis study aimed to investigate the long-term outcomes of laminoplasty-alone (LP) and combined procedure (CP), consisting of laminoplasty and single-level anterior cervical discectomy and fusion, in comparable patients who had multilevel degenerative cervical myelopathy (MDCM) with concomitant anterior and posterior compression (CAPC).MethodsConsecutive MDCM patients with CAPC underwent LP or CP between 2012 and 2015 from a same surgical group were enrolled and followed up for a minimum of 8 years. Preoperative demographic, radiological, and clinical variables were collected. Propensity score matching (PSM) analysis was performed to match patients with comparable conditions. The outcomes were evaluated by postoperative Japanese Orthopedic Association (JOA) score improvement, JOA recovery rate (JOARR) and complications.ResultsA total of 230 patients were included, of whom 146 underwent LP and 84 underwent CP. After PSM, 84 pairs of comparable patients were matched. The matched groups presented fair comparability in preoperative conditions. The CP group had significantly prolonged surgery time and greater blood loss. At the final follow-up, the postoperative JOA scores of LP and CP groups were 14.51 ± 1.79 and 15.47 ± 1.81 (<i>P</i> < 0.001) and the JOARR were 42.5% ± 53.3% and 68.5% ± 35.4%, respectively (<i>P</i> < 0.001). Three (3.6%) patients in the LP group underwent reoperations because of recurrent symptoms (<i>P</i> = 0.081).ConclusionBoth LP and CP demonstrated considerable long-term neurological recovery in patients with CAPC. The CP showed a significantly higher JOA improvement and JOARR. The combined decompression might be a safe and effective alternative in treating MDCM with CAPC in experienced hands.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"1813-1822"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Positive Side Effect of Anterior Cervical Decompression and Fusion on Axial Neck Pain. 颈椎前路减压融合术对轴性颈痛的积极副作用
IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-01 Epub Date: 2024-05-10 DOI: 10.1177/21925682241254036
Andrea Redaelli, Pablo Bellosta-López, Francesco Langella, Paolo Lepori, Francesca Barile, Riccardo Cecchinato, Domenico Compagnone, Marco Damilano, Daniele Vanni, Claudio Lamartina, Pedro Berjano

Study DesignObservational Cohort Study.ObjectivesThis study aims to comprehensively assess the outcomes of anterior cervical spine surgery in patients who have undergone surgical intervention for radiculopathy or myelopathy, with a specific focus on the surgery's impact on axial neck pain.MethodsData from an institutional spine surgery registry were analyzed for patients who underwent anterior cervical spine surgery between January 2016 and March 2022. Patient demographics, clinical variables, and outcome measures, including the Neck Disability Index (NDI), numeric rating scales for neck and arm pain (NRS-Neck and NRS-Arm), and 36-Item Short Form Health Survey (SF-36) scores, were collected. Statistical analysis included paired t-tests, chi-squared tests, and multivariate linear regression.ResultsOf 257 patients, 156 met the inclusion criteria. Patients showed significant improvement in NDI, NRS-Neck, NRS-Arm, SF-36 (Physical and Mental components), and all changes exceeded the minimum clinically important difference. Multivariate regression revealed that lower preoperative physical and mental component scores and higher preoperative NRS-Neck predicted worse NDI scores at follow-up.ConclusionsThis study underscores that anterior cervical fusion not only effectively alleviates arm pain and disability but also has a positive impact on axial neck pain, which may not be the primary target of surgery. Our findings emphasize the potential benefits of surgical intervention when neck pain coexists with neurologic compression. This contribution adds to the growing body of evidence emphasizing the importance of precise diagnosis and patient selection. Future research, ideally focusing on patients with isolated neck pain, should further explore alternative surgical approaches to enhance treatment options.

研究设计观察性队列研究:本研究旨在全面评估因根性颈椎病或脊髓病而接受手术治疗的患者接受颈椎前路手术的结果,尤其关注手术对轴向颈痛的影响:对2016年1月至2022年3月期间接受颈椎前路手术的患者进行分析。收集了患者的人口统计学特征、临床变量和结果测量,包括颈部残疾指数(NDI)、颈部和手臂疼痛数字评分量表(NRS-Neck 和 NRS-Arm)以及 36 项简表健康调查(SF-36)得分。统计分析包括配对 t 检验、卡方检验和多变量线性回归:结果:在 257 名患者中,156 人符合纳入标准。患者的 NDI、NRS-颈部、NRS-手臂、SF-36(身体和心理部分)均有明显改善,所有变化均超过最小临床重要差异。多变量回归显示,术前较低的身体和精神部分评分以及术前较高的 NRS-Neck 预测了随访时较差的 NDI 评分:本研究强调,颈椎前路融合术不仅能有效缓解手臂疼痛和残疾,还能对轴向颈部疼痛产生积极影响,而轴向颈部疼痛可能并不是手术的主要目标。我们的研究结果强调了当颈部疼痛与神经压迫同时存在时,手术干预的潜在益处。越来越多的证据强调了精确诊断和患者选择的重要性,我们的研究为这些证据增添了新的内容。未来的研究最好以孤立性颈部疼痛患者为重点,进一步探索替代性手术方法,以提高治疗效果。
{"title":"The Positive Side Effect of Anterior Cervical Decompression and Fusion on Axial Neck Pain.","authors":"Andrea Redaelli, Pablo Bellosta-López, Francesco Langella, Paolo Lepori, Francesca Barile, Riccardo Cecchinato, Domenico Compagnone, Marco Damilano, Daniele Vanni, Claudio Lamartina, Pedro Berjano","doi":"10.1177/21925682241254036","DOIUrl":"10.1177/21925682241254036","url":null,"abstract":"<p><p>Study DesignObservational Cohort Study.ObjectivesThis study aims to comprehensively assess the outcomes of anterior cervical spine surgery in patients who have undergone surgical intervention for radiculopathy or myelopathy, with a specific focus on the surgery's impact on axial neck pain.MethodsData from an institutional spine surgery registry were analyzed for patients who underwent anterior cervical spine surgery between January 2016 and March 2022. Patient demographics, clinical variables, and outcome measures, including the Neck Disability Index (NDI), numeric rating scales for neck and arm pain (NRS-Neck and NRS-Arm), and 36-Item Short Form Health Survey (SF-36) scores, were collected. Statistical analysis included paired t-tests, chi-squared tests, and multivariate linear regression.ResultsOf 257 patients, 156 met the inclusion criteria. Patients showed significant improvement in NDI, NRS-Neck, NRS-Arm, SF-36 (Physical and Mental components), and all changes exceeded the minimum clinically important difference. Multivariate regression revealed that lower preoperative physical and mental component scores and higher preoperative NRS-Neck predicted worse NDI scores at follow-up.ConclusionsThis study underscores that anterior cervical fusion not only effectively alleviates arm pain and disability but also has a positive impact on axial neck pain, which may not be the primary target of surgery. Our findings emphasize the potential benefits of surgical intervention when neck pain coexists with neurologic compression. This contribution adds to the growing body of evidence emphasizing the importance of precise diagnosis and patient selection. Future research, ideally focusing on patients with isolated neck pain, should further explore alternative surgical approaches to enhance treatment options.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"1608-1613"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140903588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Does Elevated Mean-Arterial Pressure Lead to Better Outcomes in Degenerative Cervical Myelopathy?- A Prospective, Pilot Randomized Control Trial. 升高平均动脉压是否能改善退行性颈椎病的治疗效果?
IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-01 Epub Date: 2024-05-27 DOI: 10.1177/21925682241256350
Ayush Sharma, Ajay Jaiswal, Nandan Marathe, Vijay Singh, Akash Shakya, Nilesh Mangale, Pauras Mhatre

Study designRandomized Control Trial.ObjectiveDCM refers to compression of spinal cord either due to static/dynamic causes or commonly, a result of combination of both. Number of variables exist, which determine prognosis post-surgery. Role of intra-operative blood pressure has not been analyzed in depth in current literature. Elevating MAP post SCI is widely practiced and forms a recommendation of AANS/CNS Joint Committee Guidelines. This led us to investigate role played by elevated MAP during surgery for DCM, in order to optimize outcomes.MethodsThis prospective randomized comparative pilot study was conducted at a tertiary care spine centre. 84 patients were randomly divided in two groups. Group 1 had intra-operative MAP in normal range. Group 2, had intra-operative BP 20 mmHg higher than preoperative average MAP with a variation of + 5 mmHg. Outcomes were recorded at 3 months, 6 months and 1 year by mJOA, VAS and ASIA scale.ResultsNeurological improvement was documented in 19/30 (63.3%) patients of hypertensive group compared to 16/30 (53.3%) patients of normotensive group. Improvements in mJOA scores were better for hypertensive group during the 1-year follow-up. Improvement in VAS scores were comparable between two groups, but at 1-year follow-up the VAS score of hypertensive groups was significantly lower.ConclusionMAP should be individualized according to preoperative average blood pressure assessment of patient. Keeping intraoperative MAP at higher level (preoperative MAP + 20 mmHg) during surgery for DCM can result in better outcomes.

研究设计随机对照试验:脊髓压迫症是指由于静态/动态原因导致的脊髓压迫,通常是两者共同作用的结果。决定术后预后的变量很多。目前的文献尚未深入分析术中血压的作用。提高 SCI 术后血压是一种广泛的做法,也是 AANS/CNS 联合委员会指南的一项建议。这促使我们研究 DCM 手术期间血压升高的作用,以优化手术效果:这项前瞻性随机对比试验研究在一家三级脊柱治疗中心进行。84 名患者被随机分为两组。第一组患者术中血压在正常范围。第二组,术中血压比术前平均血压高 20 mmHg,变化幅度为 + 5 mmHg。通过 mJOA、VAS 和 ASIA 量表记录 3 个月、6 个月和 1 年的结果:结果:19/30(63.3%)名高血压组患者的神经功能得到改善,而 16/30(53.3%)名正常血压组患者的神经功能得到改善。在为期一年的随访中,高血压组患者的 mJOA 评分改善幅度更大。两组患者的 VAS 评分改善情况相当,但随访 1 年后,高血压组的 VAS 评分明显降低:结论:应根据术前对患者平均血压的评估结果对血压进行个体化调整。结论:应根据患者术前的平均血压评估结果对 MAP 进行个体化调整,在 DCM 手术中将术中 MAP 保持在较高水平(术前 MAP + 20 mmHg)可获得更好的疗效。
{"title":"Does Elevated Mean-Arterial Pressure Lead to Better Outcomes in Degenerative Cervical Myelopathy?- A Prospective, Pilot Randomized Control Trial.","authors":"Ayush Sharma, Ajay Jaiswal, Nandan Marathe, Vijay Singh, Akash Shakya, Nilesh Mangale, Pauras Mhatre","doi":"10.1177/21925682241256350","DOIUrl":"10.1177/21925682241256350","url":null,"abstract":"<p><p>Study designRandomized Control Trial.ObjectiveDCM refers to compression of spinal cord either due to static/dynamic causes or commonly, a result of combination of both. Number of variables exist, which determine prognosis post-surgery. Role of intra-operative blood pressure has not been analyzed in depth in current literature. Elevating MAP post SCI is widely practiced and forms a recommendation of AANS/CNS Joint Committee Guidelines. This led us to investigate role played by elevated MAP during surgery for DCM, in order to optimize outcomes.MethodsThis prospective randomized comparative pilot study was conducted at a tertiary care spine centre. 84 patients were randomly divided in two groups. Group 1 had intra-operative MAP in normal range. Group 2, had intra-operative BP 20 mmHg higher than preoperative average MAP with a variation of + 5 mmHg. Outcomes were recorded at 3 months, 6 months and 1 year by mJOA, VAS and ASIA scale.ResultsNeurological improvement was documented in 19/30 (63.3%) patients of hypertensive group compared to 16/30 (53.3%) patients of normotensive group. Improvements in mJOA scores were better for hypertensive group during the 1-year follow-up. Improvement in VAS scores were comparable between two groups, but at 1-year follow-up the VAS score of hypertensive groups was significantly lower.ConclusionMAP should be individualized according to preoperative average blood pressure assessment of patient. Keeping intraoperative MAP at higher level (preoperative MAP + 20 mmHg) during surgery for DCM can result in better outcomes.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"1653-1661"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparison of Surgical Outcomes After Posterior Decompression by Junior or Senior Surgeons for Patients With Cervical Ossification of the Posterior Longitudinal Ligament: Results From Retrospective Multicenter Cohort Study. 初级或高级外科医生对颈椎后纵韧带骨化患者进行后路减压术后的手术效果比较:回顾性多中心队列研究结果。
IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-01 Epub Date: 2024-06-03 DOI: 10.1177/21925682241260725
Toshiki Okubo, Narihito Nagoshi, Hitoshi Kono, Yoshiomi Kobayashi, Osahiko Tsuji, Ryoma Aoyama, Norihiro Isogai, Shinichi Ishihara, Kazuki Takeda, Masahiro Ozaki, Satoshi Suzuki, Morio Matsumoto, Masaya Nakamura, Kota Watanabe, Ken Ishii, Junichi Yamane

Study DesignRetrospective multicenter study.ObjectivesTo investigate surgical outcomes following posterior decompression for cervical ossification of the posterior longitudinal ligament (OPLL) when performed by board-certified spine (BCS) or non-BCS (NBCS) surgeons.MethodsWe included 203 patients with cervical OPLL who were followed for a minimum of 1 year after surgery. Demographic information, medical history, and imaging findings were collected. Clinical outcomes were assessed preoperatively and at the final follow-up using the Japanese Orthopedic Association (JOA) score and the visual analog scale (VAS) for the neck. We compared outcomes between BCS surgeons, who must meet several requirements, including experience in more than 300 spinal surgeries, and NBCS surgeons.ResultsBCS surgeons performed 124 out of 203 cases, while NBCS surgeons were primary in 79 cases, with 73.4% were directly supervised by a BCS surgeon. There was no statistically significant difference in surgical duration, estimated blood loss, and perioperative complication rates between the BCS and NBCS groups. Moreover, no statistically significant group differences were observed in each position of the C2-7 angle and cervical range of motion at preoperation and the final follow-up. Preoperative and final follow-up JOA scores, VAS for the neck, and JOA score recovery rate were comparable between the two groups.ConclusionsSurgical outcomes, including functional recovery, complication rates, and cervical dynamics, were comparable between the BCS and NBCS groups. Consequently, posterior decompression for cervical OPLL is considered safe and effective when conducted by junior surgeons who have undergone training and supervision by experienced spine surgeons.

研究设计回顾性多中心研究:调查获得脊柱委员会认证的外科医生(BCS)或未获得脊柱委员会认证的外科医生(NBCS)对颈椎后纵韧带骨化(OPLL)进行后路减压术后的手术效果:我们纳入了 203 名颈椎 OPLL 患者,对他们进行了术后至少 1 年的随访。我们收集了人口统计学信息、病史和影像学检查结果。使用日本骨科协会(JOA)评分和颈部视觉模拟量表(VAS)对术前和最终随访的临床结果进行评估。我们比较了BCS外科医生和NBCS外科医生的疗效,BCS外科医生必须满足多项要求,包括具有300例以上脊柱手术经验:结果:在203例手术中,BCS外科医生完成了124例,而NBCS外科医生主要完成了79例,其中73.4%由BCS外科医生直接指导。BCS 组和 NBCS 组在手术时间、估计失血量和围手术期并发症发生率方面没有明显的统计学差异。此外,在术前和最终随访时,C2-7 角的各个位置和颈椎活动范围在统计学上也没有明显的组间差异。两组患者术前和最终随访时的JOA评分、颈部VAS评分和JOA评分恢复率相当:结论:BCS组和NBCS组的手术效果(包括功能恢复、并发症发生率和颈椎动态变化)相当。因此,由接受过培训的初级外科医生在经验丰富的脊柱外科医生的指导下进行颈椎OPLL后路减压术是安全有效的。
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引用次数: 0
Efficacy and Safety of Ultrasound Guided Inter-semispinal Plane Block for Postoperative Analgesia in Posterior Cervical Laminectomy - A Prospective Randomised Controlled Study. 超声引导下椎间孔平面阻滞用于颈椎后路切除术术后镇痛的有效性和安全性--一项前瞻性随机对照研究。
IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-01 Epub Date: 2024-05-10 DOI: 10.1177/21925682241254327
Karthik Ramachandran, Madhanmohan Chandramohan, Ajoy Prasad Shetty, Balavenkat Subramanian, Rishi Mugesh Kanna, Shanmuganathan Rajasekaran

Study designProspective, randomized controlled study.ObjectiveTo assess the safety and efficacy of an ultrasound-guided ISP block for postoperative analgesia in posterior cervical laminectomy.Methods88 patients requiring posterior cervical laminectomy were randomized into two groups, those who underwent ISP block with multimodal analgesia (ISPB group) and those with only multimodal analgesia (control group). Demographic details, intraoperative parameters (blood loss, duration of surgery, perioperative total opioid consumption, muscle relaxants used), and postoperative parameters (numeric rating scale, satisfaction score, mobilization time, and complications) were recorded.ResultsThe total opioid consumption (128.41 + 39.65vs 284.09 + 140.92mcg; P < .001), muscle relaxant usage (46.14 + 6.18 mg vs 59.32 + 3.97 mg; P < .001), surgical duration (128.61 + 26.08/160.23 + 30.99mins; P < .01), and intra-operative blood loss (233.18 + 66.08 mL vs 409.77 + 115.41 mL; P < .01) were significantly less in the ISPB group compared to the control. In the postoperative period, the control group's pain score was significantly higher (P < .001) in the initial 48 hours. The Modified Observer Alertness/Sedation Score (MOASS) score and satisfaction scores were significantly better in the ISPB compared to the control (P < .001). The mean time required to ambulate was statistically less in ISPB (4.30 + 1.64hours) when compared to controls (9.48 + 3.07hours) (P < .001).ConclusionIn patients undergoing posterior cervical laminectomy, ISP block is a safe and effective technique with better outcomes than standard multi-modal analgesia alone, in terms of reduced intra-operative opioid requirements and blood loss, better postoperative analgesia, and early mobilization.

研究设计前瞻性随机对照研究:方法:将88例需要进行颈椎后路椎板切除术的患者随机分为两组,即接受ISP阻滞和多模式镇痛的患者(ISPB组)和仅接受多模式镇痛的患者(对照组)。记录了两组患者的详细人口统计学资料、术中参数(失血量、手术时间、围手术期阿片类药物总用量、肌肉松弛剂用量)和术后参数(数字评分量表、满意度评分、活动时间和并发症):结果:阿片类药物总用量(128.41 + 39.65vs 284.09 + 140.92mcg;P < .001)、肌肉松弛剂用量(46.14 + 6.18 mg vs 59.32 + 3.97 mg;P < .001)、手术持续时间(128.61 + 26.08/160.23 + 30.99mins; P < .01)、术中失血量(233.18 + 66.08 mL vs 409.77 + 115.41 mL; P < .01),ISPB 组均显著少于对照组。术后最初 48 小时内,对照组的疼痛评分明显更高(P < .001)。与对照组相比,ISPB 组的改良观察者警觉性/镇静评分(MOASS)和满意度评分明显更高(P < .001)。与对照组(9.48 + 3.07小时)相比,ISPB患者所需的平均行走时间(4.30 + 1.64小时)在统计学上更短(P < .001):在接受颈椎后路椎板切除术的患者中,ISP阻滞是一种安全有效的技术,在减少术中阿片类药物需求量和失血量、改善术后镇痛和早期活动能力方面,其效果优于单纯的标准多模式镇痛。
{"title":"Efficacy and Safety of Ultrasound Guided Inter-semispinal Plane Block for Postoperative Analgesia in Posterior Cervical Laminectomy - A Prospective Randomised Controlled Study.","authors":"Karthik Ramachandran, Madhanmohan Chandramohan, Ajoy Prasad Shetty, Balavenkat Subramanian, Rishi Mugesh Kanna, Shanmuganathan Rajasekaran","doi":"10.1177/21925682241254327","DOIUrl":"10.1177/21925682241254327","url":null,"abstract":"<p><p>Study designProspective, randomized controlled study.ObjectiveTo assess the safety and efficacy of an ultrasound-guided ISP block for postoperative analgesia in posterior cervical laminectomy.Methods88 patients requiring posterior cervical laminectomy were randomized into two groups, those who underwent ISP block with multimodal analgesia (ISPB group) and those with only multimodal analgesia (control group). Demographic details, intraoperative parameters (blood loss, duration of surgery, perioperative total opioid consumption, muscle relaxants used), and postoperative parameters (numeric rating scale, satisfaction score, mobilization time, and complications) were recorded.ResultsThe total opioid consumption (128.41 + 39.65vs 284.09 + 140.92mcg; <i>P</i> < .001), muscle relaxant usage (46.14 + 6.18 mg vs 59.32 + 3.97 mg; <i>P</i> < .001), surgical duration (128.61 + 26.08/160.23 + 30.99mins; <i>P</i> < .01), and intra-operative blood loss (233.18 + 66.08 mL vs 409.77 + 115.41 mL; <i>P</i> < .01) were significantly less in the ISPB group compared to the control. In the postoperative period, the control group's pain score was significantly higher (<i>P</i> < .001) in the initial 48 hours. The Modified Observer Alertness/Sedation Score (MOASS) score and satisfaction scores were significantly better in the ISPB compared to the control (<i>P</i> < .001). The mean time required to ambulate was statistically less in ISPB (4.30 + 1.64hours) when compared to controls (9.48 + 3.07hours) (<i>P</i> < .001).ConclusionIn patients undergoing posterior cervical laminectomy, ISP block is a safe and effective technique with better outcomes than standard multi-modal analgesia alone, in terms of reduced intra-operative opioid requirements and blood loss, better postoperative analgesia, and early mobilization.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"1625-1634"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140903485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Long-Term Incidence of Adjacent Segmental Pathology After Minimally Invasive vs. Open Transforaminal Lumbar Interbody Fusion. 微创与开放经椎间孔腰椎椎体融合术后相邻节段病变的长期发生率。
IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-01 Epub Date: 2024-05-13 DOI: 10.1177/21925682241254800
Jae-Won Shin, Yung Park, Sang-Ho Kim, Sung-Ryul Choi, Joong-Won Ha, Hak Sun Kim, Kyung-Soo Suk, Sung-Hwan Moon, Si-Young Park, Byung-Ho Lee, Ji-Won Kwon, Hee-Min Choi

Study designRetrospective cohort study.ObjectiveTo compare the incidence of adjacent segmental pathology (ASP) following minimally invasive (MI) vs open transforaminal lumbar interbody fusion (TLIF) and to identify factors linked to ASP requiring reoperation.MethodsThis retrospective study reviewed the outcomes of patients who underwent MI-TLIF or open TLIF. Radiographic ASP (RASP) was evaluated using X-ray imaging to distinguish between degenerative changes, spondylolisthesis, and instability in the adjacent spinal segment. Clinical ASP (CASP) was assessed with the visual analog scale score for leg and back pain and the Oswestry disability index. Patient data were collected 1, 2, 5, and 10 years postoperatively. The timing and frequency of ASP reoperation were analyzed.ResultsFive years postoperatively, the RASP rate was 35.23% and 45.95% in the MI-TLIF and open TLIF groups. The frequency of CASP differed significantly between the MI-TLIF and open TLIF groups at 1 year postoperatively. The rates of RASP, CASP, and ASP necessitating reoperation were not significantly different 10 years postoperatively. Cranial facet violation significantly affected ASP in both groups. In the open TLIF group, preoperative adjacent segment disc degeneration significantly influenced ASP.ConclusionThe RASP rate at 5 years postoperatively and the CASP rate at 1 year postoperatively differed significantly between groups. There was no difference in the rate of ASP requiring reoperation. Cranial facet violation is a crucial driving factor for ASP after both surgical procedures.

研究设计回顾性队列研究:比较微创(MI)与开放经椎间孔腰椎椎体融合术(TLIF)后邻近节段病变(ASP)的发生率,并确定与需要再次手术的 ASP 相关的因素:这项回顾性研究回顾了接受微创腰椎椎间融合术(MI-TLIF)或开放式腰椎椎间融合术(TLIF)患者的治疗效果。通过X光成像评估放射学ASP(RASP),以区分退行性病变、脊柱滑脱和邻近脊柱节段的不稳定性。临床 ASP(CASP)通过腿部和背部疼痛的视觉模拟量表评分以及 Oswestry 残疾指数进行评估。收集了患者术后1年、2年、5年和10年的数据。对 ASP 再次手术的时间和频率进行了分析:结果:术后五年,MI-TLIF组和开放式TLIF组的RASP率分别为35.23%和45.95%。MI-TLIF 组和开放式 TLIF 组术后 1 年发生 CASP 的频率差异显著。术后 10 年,RASP、CASP 和需要再次手术的 ASP 发生率无明显差异。颅骨面侵犯对两组的 ASP 均有明显影响。在开放式TLIF组中,术前邻近节段椎间盘退变对ASP有明显影响:结论:两组患者术后 5 年的 RASP 率和术后 1 年的 CASP 率差异显著。结论:术后 5 年的 RASP 发生率和术后 1 年的 CASP 发生率在各组间存在明显差异,而需要再次手术的 ASP 发生率则没有差异。颅骨面侵犯是导致两种手术后ASP的关键驱动因素。
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引用次数: 0
Post-Operative Hyperextension Bracing Has the Potential to Reduce Proximal Junctional Kyphosis: A Propensity Matched Analysis of Braced versus Non-braced Cohorts. 术后过伸支撑有可能减少近端交界性脊柱后凸:支撑与非支撑队列的倾向匹配分析。
IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-01 Epub Date: 2024-06-06 DOI: 10.1177/21925682241260278
Pratyush Shahi, Robert K Merrill, Anthony Pajak, Justin T Samuel, Izzet Akosman, John C Clohisy, Jerry Du, Bo Zhang, Jonathan Elysee, David N Kim, Yusef Jordan, Rachel L Knopp, Francis C Lovecchio, Han Jo Kim

Study DesignRetrospective cohort.ObjectiveDetermine effects of bracing on proximal junctional kyphosis (PJK) after adult deformity correction.MethodsPatients were identified from a single-surgeon dataset of posterior-only fusions for ASD (pelvis to UIV of T9-12) with a minimum of 1-year follow up. Starting in 2021, all lower thoracic fusions were braced using a hyperextension brace. Patients wore the brace at all times (unless in bed) for the first 6 weeks after surgery. A 1:1 propensity-match was performed based on age, number of levels, 3 column osteotomies, and magnitude of correction to identify a comparative non-braced cohort.Results141 patients (113 non-brace, 28 brace) were evaluated. After matching, 56 patients were identified to form similar cohorts. Non-matched and matched groups had no statistically significant differences in demographics, comorbid conditions, surgical characteristics (except shorter operative time and lower EBL in the braced group), and preoperative radiographic parameters. For the overall cohort, the change in proximal junctional angle at 1-year was higher in the non-braced group (7.6° vs 8.1°, P = .047), and non-braced patients had a higher incidence of PJK at 1-year in both the overall cohort (36% vs 14%, P = .045) and matched cohort (43% vs 14%, P = .038). There was no difference in proximal junctional failure between groups.ConclusionThis pilot study shows that our protocol for extension bracing may reduce rates of PJK. These findings can form the basis for future multi-center trials examining the effect of extension bracing on junctional complications.

研究设计回顾性队列:确定支撑对成人畸形矫正后近端交界性脊柱后凸(PJK)的影响:从单个外科医生的后路融合治疗 ASD(骨盆至 T9-12 的 UIV)数据集中确定至少随访 1 年的患者。自2021年起,所有下胸椎融合术均使用过伸支架进行支撑。患者在术后的前 6 周内(除非卧床)始终佩戴支撑架。根据年龄、水平数、3柱截骨术和矫正幅度进行1:1倾向匹配,以确定非支撑架对比队列:共评估了 141 名患者(113 名无支架患者,28 名有支架患者)。经过配对后,56 名患者被确定为相似队列。非配对组和配对组在人口统计学、合并症、手术特征(除了支撑组的手术时间更短和 EBL 更低)和术前放射学参数方面没有统计学意义上的显著差异。在总体队列中,无支具组近端交界角度在 1 年后的变化更大(7.6° vs 8.1°,P = .047),在总体队列(36% vs 14%,P = .045)和匹配队列(43% vs 14%,P = .038)中,无支具组患者在 1 年后的 PJK 发生率更高。各组间近端连接失败率无差异:这项试点研究表明,我们的伸展支具方案可降低 PJK 的发生率。结论:这项试验研究表明,我们的伸展支撑方案可以降低 PJK 的发生率,这些研究结果可以作为未来多中心试验的基础,以检验伸展支撑对交界处并发症的影响。
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引用次数: 0
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Global Spine Journal
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