Global Spine Journal最新文献

Study DesignRetrospective Cohort Study.ObjectivesThis study sought to analyze predictors of delayed spine surgery and their impact on postoperative adverse outcomes.MethodsThis retrospective cohort study analyzed patients who underwent spine surgery from the National Surgical Quality Improvement Program database from 2015 to 2020. Delayed spine surgery was defined as the interval from admission to operation exceeding the 95th percentile of the total population or lasting >3 days. Multivariate regression models were used to estimate probabilities of outcomes after adjusting for individual risk factors. The primary outcome included mortality, along with secondary measures including nonroutine discharge, extended length of stay (LOS), major and minor postoperative complications, Clavien-Dindo grade IV complications (CDIV), readmission, and reoperation rates.ResultsOf 362 788 patients, 16 664 (4.59%) experienced a delay in surgery. The adjusted odds ratios for outcomes predicted by delayed surgery were mortality (1.452, 1.251-1.685), nonroutine discharge destination (3.447, 3.285-3.618), extended LOS (3.650, 3.473-3.837), minor postoperative complications (1.462, 1.370-1.559), major postoperative complications (1.607, 1.511-1.709), Clavien-Dindo grade IV complications (1.469, 1.356-1.592), readmission (1.499, 1.401-1.604), and reoperation (1.420, 1.303-1.547). ROC analysis showed that GNRI has an excellent discriminative power (C-statistic = 0.801) for delayed surgery. There is little incremental gain from adding other indices including frailty and perioperative conditions and status to GNRI (C-statistic of the compound index = 0.809).ConclusionsPre-operative delays in spine surgery independently predict increased postoperative morbidity and mortality. Surgical delay was associated with higher GNRI. These findings highlight the importance of timely surgeries to minimize complications and reduce healthcare costs.

Study DesignRetrospective cohort study.ObjectiveReciprocal changes (RCs) in unfused spinal segments can significantly affect the global alignment after corrective surgery. Identifying radiographic thresholds for guiding surgical strategies is critical for optimizing the outcomes.Materials and MethodsNinety-eight ASD patients who underwent staged surgeries, including lateral lumbar interbody fusion (LLIF) and posterior spinal fusion (PSF), were analyzed. According to the final follow-up image, the patients were classified into balanced (BG) and imbalanced (IG) groups, with IG further stratified into proximal junctional kyphosis/failure (IG-PJK/PJF) and non-PJK/PJF (IG-NPJK/PJF). Radiographic and clinical data were collected preoperatively, postoperatively, and at 2-year follow-up.ResultsThe IG exhibited greater RCs in thoracic kyphosis (TK) and PI-LL mismatch from postoperative to follow-up than the BG (P = .030, P = .008). Significant predictors included Age >65.5 y/o (AUC: .672) and Post-PT >17.5° (AUC: .852) for imbalance and Post-TK >34.5° (AUC: .755) for IG-PJK/PJF. IG-PJK/PJF showed poorer ODI scores than BG and IG-NPJK/PJF (P = .021 and P = .022, respectively). IG-PJK/PJF showed poorer total SRS-22 scores than IG-NPJK/PJF (P = .021).ConclusionIncreased RCs in TK was associated with adverse outcomes. Extending the upper instrumented vertebra (UIV) to the upper thoracic spine and addressing excessive TK (>34.5°) may improve alignment and reduce complications. Radiographic thresholds can provide actionable guidance in surgical planning.

Study DesignBiomechanical human cadaveric study.ObjectivesTransforaminal lumbar interbody fusion (TLIF) is a well-established procedure for treating degenerative lumbar spine pathologies. However, posterior fixation has been reported to accelerate adjacent segment degeneration (ASD). Posterior fixation can be omitted in screw-anchored stand-alone anterior lumbar interbody fusion (ALIF). The present study aimed to compare the cranial adjacent segment motion of ALIF vs TLIF in specimens with reduced bone mineral density (BMD).MethodsSixteen fresh-frozen lumbosacral spines with reduced BMD (donors' age 71 ± 13years, BMD 95.7 ± 34.5 mg HA/cm³) were used. Range of motion (ROM) and Neutral Zone (NZ) of the cranial adjacent segment were analyzed in flexion-extension, lateral bending, and axial rotation in native state and after TLIF or stand-alone screwed ALIF instrumentation.ResultsNo significant differences between TLIF and stand-alone screwed ALIF were observed for both absolute ROM and NZ of the cranial adjacent segment in instrumented state across all tested motion directions (P  ≥ .267). Decreased relative ROM of the fused segment - normalized to the corresponding segmental ROM in native state - resulted in compensatory increased relative ROM of the cranial adjacent segment after instrumentation. However, the relative adjacent segment ROM did not differ significantly between TLIF and stand-alone screwed ALIF (P ≥ .172).ConclusionsThis study found no clinically significant difference in adjacent segment motion when comparing TLIF with stand-alone screwed ALIF. Hence, both techniques appear to have a negligible impact on adjacent segment motion in poor bone quality. This suggests that neither TLIF nor stand-alone screwed ALIF increase the risk of ASD due to compensatory motion resulting from an operated adjacent segment.

Study DesignBibliometric analysis.ObjectivesAnalysis of literature on surgical management of osteoporotic vertebral compression fractures to identify the top contributing authors, countries, collaborators and the trends of research.MethodsA search to identify original articles published in English between 2011 and 2020 was done using specific keywords in the Web of Science database. After screening, 442 articles met the criteria which were analysed using Biblioshiny R software.ResultsThe top contributing authors were Yang HL (first), Wang H (second) and Hao DJ (third). Amongst the universities, the major contributing ones were Soochow University (first), Guangzhou University of Chinese Medicine (second) and University of Toronto (third). China (first), USA (second) and South Korea (third) were the top contributing countries. The maximum articles were published in Spine, Osteoporosis International and European Spine Journal. The most common articles were on comparisons between kyphoplasty and vertebroplasty, the associated complications and newer modalities of investigations of osteoporosis. Major work surrounds the keywords kyphoplasty and vertebroplasty which are significantly clustered as compared to others.ConclusionsThe study identified the most prolific contributing authors (Yang HL, Wang H) and universities (Soochow University, Guangzhou University of Chinese Medicine), the journals where this work is considered more impactful (Spine, Osteoporosis International) and the top contributing countries (China, USA) and collaborations. This study showed that major work is regarding the cement augmentation techniques of kyphoplasty/vertebroplasty and the attempts at establishing newer techniques of diagnosis of osteoporosis. The study also brought out major differences in findings from that of the previously published study on spine trauma bibliometrics.

Study DesignRetrospective observation study.ObjectivesDespite pelvic incidence (PI)-lumbar lordosis (LL) overcorrection, some patients exhibit residual pelvic tilt (PT) malalignment, termed pelvic non-responders (PNRs). We aimed to identify risk factors for PNRS after PI-LL overcorrection and its impact on surgical outcomes.MethodsA retrospective analysis of 181 adult spinal deformity (ASD) patients who underwent fusion of ≥ five levels. PNRs were defined as postoperative PT ≥ 20° despite PI-LL overcorrection. Patient-reported outcomes (PROMs) and mechanical complications, such as proximal junctional failure (PJF), were documented. Logistic regression identified significant risk factors for PNRs.ResultsAmong the 181 patients, 30 (16.6%) were classified as having PNRs. Preoperative PI and postoperative PI-LL mismatch were significantly higher in PNRs than in PRs. Multivariate analysis identified higher preoperative PI, postoperative PI-LL ≥ -2°, lordosis distribution index (LDI) < 53%, and increased postoperative thoracic kyphosis as significant risk factors for pelvic non-response. PJF was significantly higher in PNRs (30.0% vs 10.6%, P < 0.01). At 1 year postoperatively, PNRs had lower SRS-22 scores in activity, pain, appearance, and mental health (P < 0.05), but MCID analysis indicated these differences may not be clinically meaningful.ConclusionsLarger preoperative PI, lower postoperative LDI, and higher postoperative PI-LL are significant risk factors for pelvic non-response in ASD patients with PI-LL overcorrection. PNRs are at increased risk of higher rates of PJF. Surgical strategies should prioritize achieving the target PI-LL and an LDI of ≥53% to optimize alignment and reduce the risk of PNRs and associated mechanical complications.

Study DesignProspective Study.ObjectiveThe objective of this investigation was to explore the abnormal expression of migration inhibitory factor antisense RNA 1 (MIF-AS1) in lumbar disc herniation (LDH) patients and its relationship to the degree of pain and inflammatory response in LDH, as well as the molecular mechanism of its involvement in LDH.MethodsThis study included 50 patients with LDH. The expression levels of MIF-AS1 were detected by RT-qPCR. The LDH model was constructed in SD rats, and the paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) of LDH rats were detected by behavioral experiments. Enzyme-linked immunosorbent assay (ELISA) was used to detect the concentrations of TNF-α, IL-6, and IL-1β. The targeted regulatory relationships between MIF-AS1 and miR-185-5p, miR-185-5p and VEGFA were verified by a dual-luciferase reporter gene assay.ResultThe expression of MIF-AS1 was up-regulated in LDH patients and correlated with the degree of pain in patients. Low expression of MIF-AS1 reduced the degree of pain and inflammation in LDH rats. In addition, MIF-AS1 may regulate pain and inflammation induced by LDH by modulating the miR-185-5p/VEGFA axis.ConclusionMIF-AS1/miR-185-5p/VEGFA axis may be a therapeutic target for LDH.

Study DesignObservational study.ObjectiveTo evaluate representation of countries and gross national income (GNI) at major international spine conferences.MethodsThe 50 most attended spine conferences were identified via ChatGPT. Conferences were excluded if they (1) reference/are held in a single country, (2) emphasize one technique, (3) emphasize neurosurgery or orthopaedic spine, (4) have <2 years of conference programs available. Programs were reviewed (2022-2024) to identify invited speakers/award recipients, executive board members, and committee members and their country of practice. Countries were assigned GNI/capita from World Bank data.ResultsEurospine, GSC, IMAST, ISASS, NASS, and SRS met inclusion criteria (1462 unique invited speakers/awardees). Other than Eurospine, board members were predominantly from Northern America. Speakers were most commonly from Northern America (56.2%), with no representation from Southern Africa and Central Asia. Speakers were overwhelmingly from high-income countries (89.7%) with none from low-income countries. Speakers at GSC were the most globally representative, with 68.8% from countries diverse from GSC's executive board. GSC and NASS had the greatest representation from lower-middle (9.7%) and upper-middle income countries (30.4%), respectively. USA and Germany had 867 (59.4%) invitees, while all of Africa had four. Committee members followed similar trends compared to invited speakers for region, country, and GNI/capita representation.ConclusionsAmongst major international conferences, a preponderance of invited speakers and committee members were from a small number of regions, particularly Northern America and Western Europe. Most speakers and committee members practice in high-income countries, with no representation from low-income countries.

Study DesignRetrospective Cohort Study.ObjectivesTo determine if 3D printed porous titanium (Ti) cages compared to non-porous polyetheretherketone (PEEK) cages predicted improved fusion rate or clinical outcomes after transforaminal lumbar interbody fusion (TLIF).MethodsAll adult patients who underwent one- and two-level TLIF for degenerative conditions by a single surgeon at an academic center between 2017-2021 were retrospectively identified. Patients were dichotomized into porous Ti and non-porous PEEK interbody cage groups. Fusion status was assessed by at 6-months and 1-year postoperatively by CT Bridwell scale and flexion/extension X-Rays. Postoperative complications (CT-based subsidence, adjacent segment disease, reoperation rates) and interval changes in lumbar radiographic alignment at short- and long-term follow-up were determined. Univariate and multivariate analysis compared patient and surgical factors, fusion rates, alignment, and complications across interbody groups.ResultsA total of 136 patients with 169 unique fusion levels (125 Ti cages, 44 PEEK cages) met the inclusion/exclusion criteria. Ti relative to PEEK interbodies had significantly decreased surface area and increased height and lordosis. Ti cage use was associated with greater subsidence (P < 0.001) but did not independently predict maximum subsidence on regression (P = 0.109). In the overall cohort, there were no significant differences in fusion rates or lumbopelvic alignment between interbody groups. Reoperation (Ti: 10.9% vs PEEK: 28.6%, P = 0.026) and reoperation for pseudoarthrosis (Ti: 2.0% vs PEEK: 11.4%, P = 0.038) was significantly more likely in the PEEK relative to the Ti group.ConclusionsUse of 3D printed porous Ti cages relative to non-porous PEEK cages may mitigate pseudoarthrosis related reoperation after TLIF.

Study DesignRetrospective cohort study.ObjectivesThe risk factors for proximal junctional kyphosis (PJK) in adult spinal deformity (ASD) are well established, but their association with onset timing remains unclear. This study aims to identify distinct risk factors for early-onset and late-onset PJK.MethodsThis study included 96 ASD patients who underwent corrective surgery (fusion ≥5 levels, UIV: T1-L1, LIV: L5/S1) with ≥2 years of follow-up. Patients were categorized into Non-PJK, Early-Onset PJK (≤6 months), and Late-Onset PJK (>6 months) groups. Clinical characteristics were compared to identify potential risk factors (P < .10). Multinomial logistic regression was used to evaluate the independent effects of these variables on early-onset and late-onset PJK.ResultsAmong 96 patients, 44 (45.8%) developed PJK (31 early-onset, 13 late-onset), and 7 (7.3%) developed PJF, including 6 cases in the Early-Onset group (19.4%, P = .005). After initial screening and addressing multicollinearity, preoperative PI, UIV location, and postoperative PI-LL and L1PA were finally included in regression analysis. Lower thoracic UIV (T7-L1) increased the risk of Early-Onset PJK (OR = 5.27, P = .015). Higher preoperative PI was associated with Late-Onset PJK, with a 9% increased risk per degree (OR = 1.09, P = .027).ConclusionsMost PJK cases occur within 6 months and have a higher risk of PJF. Lower thoracic UIV increases Early-Onset PJK risk, while higher preoperative PI predisposes to Late-Onset PJK. Strategies should focus on preventing Early-Onset PJK in lower thoracic UIV cases and long-term monitoring for Late-Onset PJK in high-PI patients.