Global Spine Journal最新文献

Study DesignRetrospective legal case review.ObjectiveThe aim of this study is to assess recent trends and risk factors for litigation against U.S. spine surgeons to better understand the current medico-legal landscape and inform future care in spine surgery.MethodsThe LexisNexis legal database was queried for case summaries from January 1, 2020, to October 6, 2024, yielding 432 results. Recent medical malpractice reports involving alleged spine surgeon error causing patient injury were included.ResultsThirty-three cases met inclusion criteria. Most occurred in the South (52%) and Midwest (27%) U.S. All defendants were male spine surgeons (52% orthopedic, 48% neurosurgeons). Plaintiffs were 55% male. Most defendants were in private practice (66%); 30% worked in hospital systems. Surgeries occurred in hospitals in 61% of cases. Pain was the most common alleged surgical indication (42%), with lumbar fusions being the most frequent procedure (61%, lumbar 42%). Alleged injuries included persistent pain or radiculopathy (52%) and paraplegia (24%). The most-cited surgeon errors were failure to inform/obtain consent (21%) and cord damage (18%). Verdicts favored plaintiffs in 55% of cases. No variables were significantly associated with case outcomes (P > 0.05). When plaintiffs prevailed, the median payout was $1.62 million USD (IQR $600,000-$4.5 million USD).ConclusionsThese findings offer a limited snapshot of malpractice litigation themes in U.S. spine surgery, highlighting persistent issues with informed consent and communication. While not necessarily representative of all malpractice claims, these results may offer useful insights into potential areas for clinical and legal risk mitigation.

Study designRetrospective Multicenter Comparative Study.ObjectiveThe population's aging is progressively increasing the number of elderly patients on antiplatelet medications undergoing lumbar fusion procedures. Lateral lumbar interbody fusion (LLIF) has demonstrated valuable clinical and radiological advantages compared to conventional posterior fusion procedures in treating degenerative spine disorders. This study aims to evaluate the safety of continuing antiplatelet drug administration in the perioperative time for patients undergoing single- or multiple-level LLIF for degenerative lumbar disorders.MethodsThis is a multicenter retrospective study on the safety and efficacy of continuing acetyl salicylic acid therapy in patients undergoing single- or multiple-level LLIF. Age, gender, body mass index (BMI), smoking status, presence of diabetes mellitus, and relevant comorbidities were considered as independent variables in influencing clinical-radiological and surgical outcomes and complications.ResultsA total of 421 levels were operated on the 332 patients included in the study. The mean introperative blood loss was 42.3 ± 27.4 cc in the CG, and 47.2 ± 31.8 cc in the TG (P = 0.12). The drainage collected volume in the postoperative 24 h was 21.2 ± 13.9 cc in the CG, and 23.6 ± 11.9 cc in the TG (P = 0.11). No significant differences were reported in clinical, neurological, and radiological outcomes between the 2 groups.ConclusionsOur results suggest that acetylsalicylic acid discontinuation in patients undergoing single- or multiple-level XLIF for degenerative spine disorders is not supported, according to similar blood loss and complications' rate between patients discontinuing and those continuing antiplatelet drugs. Further dedicated clinical trials are needed to confirm our results.

Study DesignRetrospective cohort study.ObjectiveCondoliase is a chemonucleolysis for lumbar disc herniation (LDH) that enzymatically degrades herniated disc material with high specificity for chondroitin sulfate and hyaluronic acid. Few studies have compared condoliase treatment with surgical treatments. We compared the clinical outcomes of condoliase treatment and minimally invasive discectomy.MethodsPatients who received condoliase treatment or minimally invasive discectomy at single institution were included. Propensity score matching was performed to adjust for age and sex. We included 146 patients with LDH (73 per group). The Japan Orthopaedic Association (JOA) score, visual analog scale (VAS) for leg pain, and disc height and degeneration were assessed at baseline and 2 weeks, 3 months, and 1 year after treatment.ResultsThe JOA score and leg pain VAS improved significantly over time (P < .001, Friedman's test). Two weeks after treatment, a marked improvement in JOA score and leg pain VAS was observed in the surgery group compared with the condoliase group (P < .001, mixed-effects model). However, 3 months and 1 year after treatment, the differences were not significant. In contrast, disc height reduction was significantly greater in the condoliase group than in the surgery group at 3 months and 1 year after treatment (P < .001, mixed-effects model). Condoliase treatment was identified as an independent risk factor for progression of disc degeneration (odds ratio, 23.60; P = .001, logistic regression analysis).ConclusionCondoliase treatment demonstrated mid-term efficacy comparable to surgical treatment; however, it required more time for pain relief and was potentially associated with progression of disc degeneration.

Study DesignA cross-sectional retrospective study.ObjectivesThis study aims to analyze the correlation between cervical disc degeneration grade and cervical imaging parameters and improve grade assessment objectivity and accuracy under the Miyazaki disc degeneration grading system.MethodsCervical disc degeneration was graded using the Miyazaki disc degeneration grading system. Cervical imaging parameters included the disc height index (DHI) and segmental range of motion (sROM) in the lateral X-ray view. Correlation, subgroup analysis, and linear regression analysis were conducted to analyze the relationships between cervical disc degeneration grades, DHI, and sROM, respectively. The kappa value for the Miyazaki disc degeneration grading system was analyzed before and after considering imaging parameters.ResultsA total of 98 patients (47 males and 51 females, age from 29 to 85 years ) with 490 discs were included in the analysis. Correlation analysis revealed that cervical disc degeneration grade related to DHI (ρ = -0.543, P < 0.001) and sROM (ρ = -0.309, P < 0.001) across different cervical segments, age, sex, and body mass index groups (majority of P < 0.05). Linear regression analysis illustrated a negative impact of the cervical disc degeneration grade on DHI (B = -0.058, P < 0.001) and sROM (B = -0.903, P < 0.001). Regarding the regression coefficients, the kappa value for the Miyazaki disc degeneration grading system increased from 0.626 to 0.812.ConclusionsCervical disc degeneration grade was associated with DHI and sROM in adult patients, and reference to cervical imaging parameters could improve the objectivity and accuracy of the Miyazaki disc degeneration grading system.

Study designRetrospective cohort study.ObjectivesWound complications and suboptimal pelvic correction remain significant challenges in posterior spinal fusion to the pelvis for neuromuscular scoliosis. We describe and evaluate the Rocket incision, a novel modification of the posterior midline approach designed to redistribute closure tension and enhance access for soft tissue release.MethodsThis retrospective cohort study included 16 paediatric patients with neuromuscular scoliosis who underwent long posterior spinal fusion to the pelvis using the Rocket incision between 2020 and 2022. Radiographic parameters included Cobb angle and pelvic obliquity, measured pre- and postoperatively. Wound complications and readmissions were documented. Surgical exposure, instrumentation, and closure were standardised. Statistical analysis was performed using paired t-tests (significance set at P < .05).ResultsThe mean Cobb angle improved from 81.5° (95% CI: 72.5-90.5) to 21.0° (95% CI: 15.0-27.1), representing a 74% mean correction (P < .001). Pelvic obliquity, a primary outcome, improved from 19.8° to 3.2° (mean correction: 16.6°, P < .0001), with 81.3% of patients achieving <5° tilt. There were no early wound infections, wound breakdowns, or readmissions within 90 days. One patient (6.25%) developed a late superficial infection treated non-operatively. No patients experienced radiographic decompensation or loss of correction.ConclusionThe Rocket incision appears to be a safe and effective modification to the posterior spinal approach in neuromuscular scoliosis, with promising early results in deformity correction and wound morbidity. These preliminary findings, derived from a small retrospective cohort, should be interpreted as hypothesis-generating and require further validation in comparative or prospective studies.

Study DesignSystematic Review.ObjectivesTo detail every historical classification system of the sacrum and pelvis and their resultant integration into the encompassing AO Spine Sacral Injury Classification System.MethodsA systematic review of MEDLINE, EMBASE and Cochrane Databases was performed in keeping with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.Results49 studies were included in the systematic review. Historical systems fail to provide clinicians with a rational method of determining whether operative or non-operative management is appropriate. Fracture morphologies are presented in a non-hierarchical manner without considering crucial treatment changing factors such as degree of neurological injury or associated anterior pelvic injury. The AO Spine Sacral Injury Classification System introduces sacrum and pelvic fractures in a clinically meaningful manner ranging from the usually stable type A bony injures of the lower sacrococcygeal region, to the type B posterior pelvic injuries potentially involving the sacral foramina, and finally the type C unstable spino-pelvic injuries.ConclusionsThe sacrum and pelvis are biomechanically related structures and should be evaluated as a unified entity rather than separately as has been historically suggested. The AO Spine Sacral Injury Classification System achieves this by considering the integrity of the spino-pelvic bony as well as supporting ligamentous structures, whilst simultaneously providing a graded framework to guide whether surgical or non-surgical management is most appropriate.

Study DesignProspective multicenter cohort study.ObjectivesAlthough surgery for degenerative cervical myelopathy (DCM) often improves neurological function, predicting clinically meaningful recovery remains challenging. To identify preoperative predictors of achieving the minimum clinically important difference (MCID) in the Japanese Orthopaedic Association (JOA) score and to evaluate its association with patient-reported outcomes.MethodsWe prospectively analyzed 762 patients with moderate to severe DCM (defined by preoperative JOA score <15) who underwent surgery at 10 high-volume centers in Japan, with a 2-year follow-up. MCID was defined as a ≥2.5-point improvement in JOA score. Logistic regression identified independent predictors. Outcomes included JOA score, Visual Analog Scale (VAS), the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and the 36-Item Short Form Health Survey (SF-36).ResultsMCID was achieved in 63.0% of patients. Independent predictors included younger age (Odds ratio = 0.973 [95% confidence interval: 0.956-0.990]; P = 0.002), absence of cerebrovascular (0.466 [0.224-0.960]; P = 0.039) and cardiac disease (0.510 [0.285-0.912]; P = 0.023), greater cervical lordosis (1.021 [1.004-1.037]; P = 0.013), lower baseline JOA score (0.547 [0.485-0.617]; P < 0.001), and higher JOACMEQ scores for upper extremity function (1.011 [1.000-1.022]; P = 0.044) and QOL (1.021 [1.009-1.033]; P < 0.001). MCID achievement was associated with significantly greater improvements in VAS, most JOACMEQ domains, and all SF-36 subscales.ConclusionsYounger age, absence of cerebrovascular and cardiac disease, greater cervical lordosis, lower baseline JOA score, and higher preoperative JOACMEQ scores for upper extremity function and QOL were associated with achieving MCID in JOA score.