Global Spine Journal最新文献

Study design: systematic review.

Objective: To evaluate risk factors associated with failure of non-operative management of isolated unilateral facet fractures of the subaxial cervical spine in neurologically intact patients.

Methods: A systematic review of the PubMed, Embase, LILACS, and Cochrane Library databases was conducted in order to determine risk factors associated with failure of non-operative management in isolated unilateral facet fractures of the subaxial cervical spine without facet and/or vertebral displacement, in neurologically intact patients. Our research was in line with the PRISMA Statement and registered on PROSPERO (CRD42023405699).

Results: A total of 1639 studies were identified through a database search on May 5, 2023. In total, 7 studies from the databases were included, along with 1 study found through a manual citation search. The evidence showed high clinical heterogeneity, a serious risk of bias according to the ROBINS-I tool, and a predominance of retrospective cohort studies. In comparison to less complex facet fractures, lateral floating mass fractures were found to have 5.41 times higher odds of failure of non-operative management (OR = 5.41; 95% CI = 1.32, 22.19). We calculated the potential association between lower absolute fracture height and non-operative treatment success [Fracture height (percentage) Mean Difference = -17.51 (-28.22, -6.79 95% CI); Absolute height Mean Difference: -0.46 (-0.60, -0.31 95% CI)]. Other risk factors were not included in the meta-analysis due to lack of data. The level of certainty was rated as "very low".

Conclusions: Lateral floating mass cervical facet fractures and larger fracture fragment size (measured either in absolute terms or as a percentage) are significant risk factors for failure of non-operative treatment.

Study design: Case-control study.

Objectives: Degenerative Cervical Myelopathy (DCM) is a progressive neurological condition caused by mechanical stress on the cervical spine. Surgical exposure in the preceding months to a DCM diagnosis is a common theme of Patient and Public Involvement (PPI) discussions. Such a relationship has biological plausibility (e.g. neck positioning, cord perfusion) but evidence to support this association is lacking.

Methods: We analysed UK Hospital Episode Statistics (HES) data for participants in the UK BioBank cohort. We defined cases as those episodes with a primary diagnosis of DCM and generated controls using non-DCM HES episodes. Cases and controls were propensity score-matched by age, sex and date of episode, and a directed acyclic graph was used to robustly control for confounders. We defined the exposure as any surgical procedure under general or regional anaesthetic occurring within the 6-24 months prior to the episode.

Results: We analysed 806 DCM and 2287432 non-DCM hospital episodes. On multivariable logistic regression analysis, the odds ratio (95% CI) for the effect of a binarised (0 vs ≥ 1) exposure on risk of developing DCM was 1.20 (1.02-1.41), and for categorised (0 vs 1 and 0 vs ≥ 2) exposure was 1.11 (0.882-1.39) & 1.33 (1.075-1.65).

Conclusions: This study supports the patient narrative of surgery as a risk factor for the development of DCM. The association displays temporality, dose-response relationship, and biological plausibility. Further work is needed to confirm this in other cohorts, explore mediating mechanisms, and identify those at greatest risk.

Study design: Retrospective cohort study.

Objective: Decompression for the treatment of lumbar spinal stenosis (LSS) has shown excellent clinical outcomes. In patients with symptomatic single level stenosis and asymptomatic adjacent level disease, it is unknown whether decompressing only the symptomatic level is sufficient. The objective of this study is to compare outcomes between single level and dual level minimally invasive (MIS) decompression in patients with adjacent level stenosis.

Methods: The current study is a retrospective review of patients undergoing primary single or dual level MIS decompression for LSS. Radiographic stenosis severity was graded using the Schizas grading. Patients undergoing single level decompression (SLD) with moderate stenosis at the adjacent level were compared with patients undergoing dual level decompression (DLD) for multi-level LSS. Clinical outcomes, complications, and reoperations were compared. Subgroup analysis was performed on patients with the same Schizas grade at the adjacent level in the SLD group and the second surgical level in the DLD group.

Results: 148 patients were included (126 SLD, 76 DLD). There were no significant differences in patient reported outcomes between the two groups at any timepoint up to 2 years postoperatively, including in the matched stenosis severity subgroups. Operative time was longer in the DLD cohort (P < 0.001). There were no significant differences in complications or reoperation rates.

Conclusion: In patients with single level symptomatic LSS and adjacent level stenosis, decompression of only the symptomatic level provided equivalent clinical outcomes compared to dual level decompression. The additional operative time and potential incremental risk of dual level surgery may not be justified.

Study design: Retrospective cohort study.

Objectives: Using propensity match score to remove those confounding bias and focuses on age factor to compare clinical outcomes and perioperative complications following spinal surgery in cohort of Korean octogenarians treated at a single tertiary hospital.

Methods: We classified patients of 80s as the octogenarian group (group O), those 65 and older, and under 80 as the elderly group (group E). We strategically employed the Propensity Score Matching (PSM) analysis as a method to counteract potential confounding variables. 1: 1 nearest-neighbor PSM for fusion level, estimated blood loss (EBL), transfusion, body mass index (BMI), American society of anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI) surgical method and operation time was performed. After PSM, 98 patients are categorized each group evenly (group O, n = 49 vs group E, n = 49). Demographics, clinical, radiologic and postoperative complications were analyzed.

Results: The clinical outcomes showed no significant differences in the VAS and ODI preoperatively or postoperatively. And most of hospitalization related factors shows no differences between 2 groups. However, follow-up period was longer in group E (1053.37 ± 684.14 days) than group O (640.29 ± 496.68, P = 0.001) and group O has higher incidences of medical complication (38.77% vs 16.32%, P = 0.013), especially in delirium (34.69% vs 6.12%, P = 0.001) than group E.

Conclusions: With the preparation for the prevention and treatment of postoperative delirium, age itself should not be a reason to hesitate in performing the spinal surgery.

Study design: Retrospective Cohort Study.

Objective: This study aimed to explore the association between cervical disc degeneration and disease progression in patients with Hirayama disease, with a particular focus on changes in the cervical intervertebral disc space height and potential compensatory mechanisms.

Methods: This retrospective study included 35 patients diagnosed with Hirayama disease (HD), who were compared with 35 healthy control subjects matched for age and sex. This study focused on collecting and analyzing cervical disc grades and intervertebral space heights from C2 to C7, aiming to assess the extent of cervical disc degeneration between HD patients and the control group. The analysis used independent sample t tests and Mann‒Whitney U tests for demographic data and Spearman's correlation coefficient to explore the relationship between disc degeneration and age.

Results: Compared with the control group, patients with Hirayama disease presented significant reductions in intervertebral disc height (P < .01) and increased disc degeneration. Within the HD group, most patients displayed multisegment degeneration (30 out of 35), and more than half presented with full-segment disc degeneration (20 out of 35), which was significantly different from the normal population (P < .01).

Conclusion: Patients with Hirayama disease exhibit disc degeneration and reduced intervertebral space height, which may represent a compensatory response.

Study design: A prospective observational study.

Objectives: To explore the potential utility of the Coin Test as a valuable tool for assessing and diagnosing cervical spondylotic myelopathy (CSM).

Methods: In the first cohort, 36 patients with balance issues were assessed for CSM using the new Coin Test. In the second cohort, the Coin Test and mJOA scores were compared in 36 CSM patients before and 6 weeks after surgery.

Results: Among the 36 patients with balance problems who failed tandem gait test, 15 out of 16 (94%) CSM patients failed the Coin Test. The other 20 patients (56%) without CSM completed the Coin Test successfully but failed the tandem gait test for various reasons. The Coin Test demonstrated high specificity (100%) and sensitivity (94%) for diagnosing CSM in patients who failed tandem gait test. In the second cohort, the mJOA score improved significantly from 12 to 15 6 weeks postoperatively, and the Coin Test completion time decreased from 29.5 seconds to 16.4 seconds postoperatively (P < 0.0001). Higher mJOA scores correlate with better performance (shorter time) on the Coin Test, both at baseline and 6 weeks post-surgery.

Conclusion: The Coin Test is a useful tool for evaluating hand fine motor and sensory function in CSM patients with high specificity. It also can serve as a tool for assessing surgical outcomes in patients with CSM.

Study design: Retrospective cohort study of a prospectively collected single-center database.

Objective: Distal Junctional Kyphosis (DJK) is one of the most common complications in adult cervical deformity (ACD) correction. The utility of radiographic alignment alone in predicting and minimizing DJK occurrence warrants further study. To investigate the impact of post-operative radiographic alignment on development of DJK in ACD patients.

Methods: ACD patients (≥18 yrs) with complete baseline (BL) and two-year (2Y) radiographic data were included. DJF was defined as DJK greater than 15° (Passias et al) or DJK with reop. Multivariable logistic regression (MVA) identified 3-month predictors of DJK. Conditional inference tree (CIT) machine learning analysis determined threshold cutoffs. Radiographic predictors were combined in a model to determine predictive value using area under the curve (AUC) methodology. "Match" refers to ideal age-adjusted alignment.

Results: 140 cervical deformity patients met inclusion criteria (61.3 yrs, 67% F, BMI: 29 kg/m², CCI: 0.96 ± 1.3). Surgically, 51.3% had osteotomies, 47.1% had a posterior approach, 34.5% combined approach, 18.5% anterior approach, with an average 7.6 ± 3.8 levels fused and EBL of 824 mL. Overall, 33 patients (23.6%) developed DJK, and 11 patients (9%) developed DJF. MVA controlling for age, and baseline deformity, followed by CIT found 3M cSVA <3.7 cm (OR: .2, 95% CI:.06-.6), and TK T4-T12 <50 (OR:.17, 95% CI:.05-.5, both P < .05) were significant predictors of a lower likelihood of DJK. Receiver operator curve AUC using age, T1S match, TS-CL match, LL-TK match, cSVA <3.7 cm, and T4-T12 <50 predicted DJK with an AUC of .91 for DJK by 2Y, and .88 for DJF by 2Y.

Conclusion: These findings suggest post-operative radiographic alignment is strongly associated with distal junctional kyphosis. When utilizing age-adjusted realignment in addition to newly developed thresholds, a suggested post-operative cSVA target of 3.7 cm and thoracic kyphosis less than 50, it is possible to substantially reduce the occurrence of distal junctional kyphosis and distal junctional failure.

Study design: Retrospective study.

Objectives: The current study compares the ability of the modified Frailty Index (mFI), the American Society of Anesthesiologists (ASA) classification, the modified Charleston Comorbidity Index (mCCI), the American College of Surgeons Surgical Risk Calculator (SRC), and the Fusion Risk Score (FRS) to predict perioperative outcomes.

Methods: Comorbidity indices were calculated for patients undergoing elective thoracic and lumbar spinal fusion at a single institution and assessed for their discriminative ability in predicting the desired outcomes using an area under the curve (AUC) analysis.

Results: 393 patients met the inclusion and exclusion criteria. Patients being treated for adult spinal deformity (ASD) had the highest rate of complications (44.4%). The FRS had acceptable discrimination (AUC >0.7) and the highest ability among the methods studied to predict any adverse effects, new neurological deficit, return to OR within 90 days, and surgical site infection. It had good discrimination ability (AUC >0.8) predicting durotomy, respiratory failure (RF) requiring intubation, hemodynamic instability, and sepsis. The SRC had acceptable discrimination and highest ability to predict deep venous thrombosis (DVT). The mCCI had excellent and the highest ability to predict acute renal failure (ARF). For the other outcomes, the indices had either poor predictive ability (AUC 0.6-0.7) or no discriminative ability (AUC <0.6).

Conclusions: The FRS had a better ability than the ASA, mCCI, mFI, and SRC to predict the most perioperative adverse events and reoperation. Further study is needed to develop preoperative indices with better predictive ability of postoperative outcomes.

Study design: Retrospective comparative cohort.

Objective: (1) Describe the prevalence of the basivertebral vessel (BVV) in a cohort of spinal epidural abscesses (SEA) at lumbar or thoracic (2) correlate the presence of BVV to the risk of conservative treatment failure (CTF).

Methods: Twenty-six patients successfully managed without surgery were compared to 26 who required surgical management due to failed conservative management (lumbar and thoracic). Two observers sought the BVV on the sagittal T1 with contrast sequences of the initial MRI in a blinded fashion for Kappa score calculation. BVV-/BVV+: absence/presence. Demographic, radiological, and laboratory parameters, as well as functional scores, were recorded.

Results: For both observers, 29/52 patients had a BVV+ (55.7%); the agreement was 84% (Kappa: 0.80 CI 95% [0.70-0.90]). 5/23 (21.7%) BVV- patients had a successful medical treatment, while the proportion was 21/29 (72%) for BVV+ (P = .0003). The positive predictive value for BVV+, predicting successful conservative treatment, was 81%. The negative predictive value for BVV- predicting CTF was 69%. BVV- was predictive of CTF in multivariable logistic regression: OR = 40, CI 95% [5-880], P = .02, for agreed observations between observers. For both observers, the proportion of dorsal abscess was the highest for BVV+ (P = .01).

Conclusion: The BVV is part of the epidural network. The absence of BVV was strongly correlated with an increased risk of CTF, leading to the need for subsequent surgical treatment. SEA's location pattern varied according to BVV detection. Although the spinal vascular anatomy has been well-known for over 100 years, there are still very few studies on its pathophysiological implications.

Study design: Cross-sectional Cohort Study.

Objective: To determine the cervicothoracic inflection point in an asymptomatic, adult population.

Introduction: The cervicothoracic inflection point (CTIP) is an important sagittal marker to understand for patients with cervical deformities. We aimed to identify the CTIP and understand the relationship to other sagittal alignment markers.

Methods: 468 adult asymptomatic volunteers (18-80 years) from 5 countries (United States, France, Japan, Singapore, Tunisia). All volunteers underwent standing full body, low dose stereo radiographs. The CTIP was identified by measuring the cervical sagittal angle (CSA) and thoracic kyphosis maximum angle (TK_Max), using the end vertebra concept. The CTIP was defined as the vertebra or disc between the lower end vertebra of the CSA and upper end vertebra of TK_Max. A correlation matrix was utilized to identify the relationship between the CTIP and spinopelvic sagittal parameters of interest.

Results: The most common CTIP value was the T1 vertebra. CTIPs ranged from C5 to T4, respectively. CTIP showed a weak positive correlation to age (r = 0.10, P = 0.03) and negative correlation to BMI (r = -0.11, P = 0.04). Additionally, CTIP had a minor positive correlation with OC2-CL, C7 slope, T1 slope, T1PA, T1-T12 TK, and T4-T12 TK, all statistically significant. Linear regression demonstrated increased cervical lordosis and increased TK was associated with more caudal CTIP segments.

Conclusion: CTIP segments ranged from C5 to T4, with the most common segment being T1. Understanding the relationship of the CTIP to other sagittal variables is critical to patients with CD.