Global Spine Journal最新文献

Study design: Systematic review.

Objective: While the occurrence of sexual dysfunction in patients sustaining traumatic cervical or thoracic injuries is well acknowledged, the evidence regarding its prevalence and outcome in individuals with degenerative cervical myelopathy (DCM) is still limited. The current systematic review was planned to comprehensively evaluate the existing literature regarding the prevalence, patterns, presentation, and outcome of sexual dysfunction in patients presenting with DCM.

Methods: A thorough search of the literature was performed on October 15, 2024, using 5 different databases (Google Scholar, Embase, PubMed, Web of Science and Cochrane Library). Studies on sexual dysfunction in DCM published until 2024 were scrutinized. Narrative or systematic reviews, opinions, letters to the editor, and manuscripts published in non-English languages were excluded.

Results: Overall, the literature search yielded a total of 384 articles of which 7 articles with 910 patients were included in the analysis. The overall prevalence of erectile dysfunction (ED) in CSM ranges between 3 and 6%. 82% of patients with preoperative ED had an abnormal psychogenic erection while the remaining had an abnormal reflexogenic erectile function. The erectile function was reported to improve substantially following decompressive surgery (68% recovery rate; P = 0.05). The presence of preoperative sexual dysfunction has been associated with poorer neurological outcomes (50% recovery rate; including poorer gait recovery). The data regarding ejaculatory disturbances and female sexual dysfunction in DCM patients are still limited.

Conclusion: ED occurs in 3 to 6% of patients with DCM, with a majority of patients suffering from ED from psychogenic origin. Surgical decompression can significantly improve the sexual recovery in these patients. Patients with ED have overall poorer neurological recovery.

Study designs: Retrospective Database Analysis.

Objectives: Pre-operative glycemic control in diabetic patients undergoing lumbar fusion (LF) is essential for evaluating complication risk. However, current thresholds for preoperative HbA1c and same-day-glucose (SDG) are either non-specific or have low predictive power. This study uses HbA1c and SDG to provide data-driven risk stratification for 90-day major and wound complications in LF patients.

Methods: Using a national database, patients undergoing LF from 2013-2022 with a recorded preoperative HbA1c and SDG level were included for analysis. Multiple HbA1c and SDG strata were identified using stratum specific likelihood ratio analysis (SSLR). Each stratum was then propensity-score matched to the lowest strata and compared using risk ratios. Significance level was set at a P-value <0.05.

Results: 12,026 patients met inclusion criteria. For 90-day major complications, SSLR identified 3 predictive HbA1c (4.5-5.4, 5.5-7.9, and 8.0+) and SDG strata (60-159, 160-239, and 240+). Following propensity-matching, the 90-day major complication risk sequentially increased for HbA1c: 5.5-7.9 (1.69; P = 0.001; 95% CI 1.24-2.30), 8.0+(2.31; P < 0.001; 95% CI 1.56-3.43). Following propensity-matching, the SDG strata similarly demonstrated sequentially increasing 90-day major complication risk: 160-239 (1.34; P < 0.001; 95% CI 1.18-1.54), 240+ (1.64; P < 0.001; 95% CI 1.31-2.05). Matched analysis demonstrated a higher relative-risk of 90-day wound complications for the 8.0+ HbA1c strata (2.23; P = 0.001; 95% CI 1.37-3.63) compared to the HbA1c 4.5-5.4 strata. No other strata were identified that predicted differences in 90-day wound complications.

Conclusions: This study identified data-driven HbA1c and SDG strata that better risk-stratify 90-day major complications following LF. Instead of current single-value thresholds, these multiple strata may be utilized for better preoperative guidance.

Study design: Retrospective cohort study.

Objective: To analyze the efficacy and safety of Halo-femoral traction (HFT) following spinal release, and preoperative Halo-gravity traction (HGT) in patients with severe spinal kyphoscoliosis and spinal cord risk classification (SCRC) type 3 at the apex.

Methods: A total of 73 patients (24 males, 49 females, mean age 22.4 ± 6.4 years) and 56 patients (15 males, 41 females, mean age 22.9 ± 10.4 years) were included in the HFT and HGT group, respectively. Radiographic parameters were measured at the initial assessment, post-traction, post-final surgery, and during each follow-up. Neurologic function was assessed using the Frankel score system. IONM alerts and all complications were documented. Quality-of-life was evaluated using the SF-36 questionnaire.

Results: In the HFT vs HGT group, the total correction rates were 39.9 ± 7.2% v.s. 41.3 ± 6.8% for the major Cobb and 36.6 ± 9.3% v.s. 44.4 ± 9.2% for global kyphosis (GK) after final surgery, respectively. The traction contributions were 57.6 ± 11.1% v.s. 52.3 ± 9.3% for major Cobb and 70.1 ± 10.5% v.s. 63.9 ± 11.1% for global kyphosis (GK), respectively. More than half of the total correction can be achieved gradually and safely through preoperative traction with patients in an awake state. No deterioration in neurological function was found post-final surgery. During the last follow-up, SF-36 questionnaire scores improved significantly in both groups (P < .05).

Conclusions: Significant outcomes can be expected in patients with severe kyphoscoliosis, even with spinal cord risk classification (SCRC) type 3 at the apex undergoing HFT and HGT.

Study design: Randomized Controlled Trial.

Objective: Chronic low back pain (CLBP) is a major public health concern that will continue to grow with the expected aging of the population. The purpose of this study was to examine the clinical effect of a personalized, home-based biomechanical intervention compared to traditional physical therapy in patients with CLBP.

Methods: This was a randomized controlled trial. One-hundred and sixty-two patients were randomized in a 2:1 ratio to a home-based biomechanical intervention (HBBI, AposHealth) or traditional physical therapy (TPT), respectively. Patients were assessed at baseline and after 12 weeks and 52 weeks. The primary outcome measure was pain at 52 weeks, using a standard Numeric Rating Scale (NRS). Secondary outcomes included pain and function metrics, quality of life and objective spatio-temporal gait test. A Linear Mixed Model assessed changes over time across all study visits.

Results: A significant reduction in NRS was found after 52 weeks with a superiority effect of the HBBI arm compared to TPT (F = 13.82, P < 0.001). Patients in the HBBI arm demonstrated a marginal mean reduction of 3.5 points, from 6.2 to 2.7 (a 56% reduction), while patients in the TPT arm reported a mean decrease of 1.8 points from 6.9 to 5.1 (a 26% reduction).

Conclusions: A new foot-worn, home-based, biomechanical intervention for patients with chronic non-specific back pain was found to be clinically effective. Given the lack of non-surgical, non-pharmacological interventions for this populations, this treatment might serve as an adjunct to the current standard of care.

Study design: Retrospective cohort study.

Objective: To (1) determine whether preoperative neck pain improves after laminoplasty for cervical myelopathy and identify factors that could predict improvements in neck pain.

Methods: A total of 88 patients with preoperative neck pain visual analogue scale (VAS) of ≥4, who underwent laminoplasty for cervical myelopathy, and were followed-up for >2 years were retrospectively reviewed. Patients demonstrating ≥50% improvement in VAS scores for neck pain 2 years postoperatively compared toㅇ preoperative assessment were included in neck pain improved (NP-improved) group. The remaining patients were assigned to neck pain unimproved (NP-unimproved) group.

Results: Overall, 54 patients (61.4%) were included in NP-improved group and 34 patients (38.6%) were included in NP-unimproved group. NP-unimproved group more frequently underwent C3 laminectomy (P = 0.026) and had lesser degree of preoperative C2-C7 lordosis (P = 0.006) in the extension position compared to that in the NP-improved group. Furthermore, undergoing C3 laminectomy was associated with lower probability of achieving a ≥50% improvement in neck pain VAS scores (P = 0.018), while greater preoperative C2-C7 lordosis in the extension position was associated with a higher possibility of neck pain improvement (P = 0.048). A cut-off value of 20.5° for C2-C7 lordosis in the extension position predicted a ≥50% improvement in neck pain.

Conclusion: Preoperative neck pain should not be considered contraindication for laminoplasty as 61.4% of patients experienced ≥50% improvement in neck pain post-operatively. C3 laminectomy decreases the probability of neck pain improvement after laminoplasty, while greater C2-C7 lordosis in the extension position is associated with neck pain improvement.

Study design: Systematic review.

Objective: Artificial intelligence (AI) and deep learning (DL) models have recently emerged as tools to improve fracture detection, mainly through imaging modalities such as computed tomography (CT) and radiographs. This systematic review evaluates the diagnostic performance of AI and DL models in detecting cervical spine fractures and assesses their potential role in clinical practice.

Methods: A systematic search of PubMed/Medline, Embase, Scopus, and Web of Science was conducted for studies published between January 2000 and July 2024. Studies that evaluated AI models for cervical spine fracture detection were included. Diagnostic performance metrics were extracted and included sensitivity, specificity, accuracy, and area under the curve. The PROBAST tool assessed bias, and PRISMA criteria were used for study selection and reporting.

Results: Eleven studies published between 2021 and 2024 were included in the review. AI models demonstrated variable performance, with sensitivity ranging from 54.9% to 100% and specificity from 72% to 98.6%. Models applied to CT imaging generally outperformed those applied to radiographs, with convolutional neural networks (CNN) and advanced architectures such as MobileNetV2 and Vision Transformer (ViT) achieving the highest accuracy. However, most studies lacked external validation, raising concerns about the generalizability of their findings.

Conclusions: AI and DL models show significant potential in improving fracture detection, particularly in CT imaging. While these models offer high diagnostic accuracy, further validation and refinement are necessary before they can be widely integrated into clinical practice. AI should complement, rather than replace, human expertise in diagnostic workflows.

Study design: Retrospective Cohort Study.

Objectives: Flexibility radiographs such as traction or bending radiographs are essential in preoperative imaging to assess for curve flexibility and to estimate the amount of operative correction in order to determine the type and length of instrumentation in growth-accompanying scoliosis treatment. Both traction and bending radiographs are controversially discussed in the literature. The predictability of flexibility radiographs of postoperative main curve correction specifically in patients treated with magnetically controlled growing rods (MCGR) has not yet been studied.

Methods: Juvenile patients with idiopathic or neuromuscular scoliosis that were surgically treated with a primary MCGR implant with pedicle screw fixation between 2018-2022 were retrospectively registered. Patients that underwent prior spine surgery, with supine lying-down radiograph and patients with missing traction or bending radiographs available were excluded. Image analysis was conducted using Surgimap® software. For statistical analysis, t test and ANOVA analysis were used to compare the means between groups with a significance level set at P < 0.05.

Results: A total of 50 patients, 34 diagnosed with idiopathic scoliosis (IS) and 16 diagnosed with neuromuscular scoliosis (NMS), were included. Globally, main curve Cobb angles were significantly higher in supine traction compared to fulcrum bending images (44.8° vs 39.6°; P < 0.001) and in the IS subgroup (42.4° vs 37.3°; P < 0.001). Compared to postoperative images, significant differences of supine traction but not fulcrum bending radiographs were detected in total (P < 0.001; P = 0.20) as well as IS (P < 0.001; P = 0.32) and NMS (P < 0.001; P = 0.44) subgroups. Fulcrum bending images displayed significantly higher flexibility rates (FR) and flexibility index (FI) compared to traction images in total (FR: 42.9 vs 35.2, P < 0.001; FI: 1.08 vs 1.58, P = 0.024) and the IS subgroup (FR: 44.2 vs 35.8, P < 0.001; FI: 1.19 vs 1.43, P = 0.033).

Conclusions: Fulcrum bending radiographs showed better flexibility and prediction of operative main curve correction compared to supine traction radiographs in total and IS subgroup. Fulcrum bending might be more precise for predicting the postoperative main curve correction potential of primary MCGR surgery in IS patients.

Study design: Retrospective Cohort Study.

Objectives: The current recommended treatment for Giant Cell Tumour (GCT) of the spine is en bloc excision. Denosumab is a monoclonal antibody reducing osteoclast activity that shows promising results when used as a neo - adjuvant treatment. However, the current literature remains limited. The purpose of this study was to assess the effect of denosumab on tumour characteristics and symptom relief in the acute phase of treatment of spinal GCT.

Methods: We performed a retrospective review of 16 patients treated with denosumab as neo-adjuvant and stand - alone treatment. MRI and PET tumour characteristics were taken before and after treatment and patients were interviewed for subjective pain responses.

Results: Following treatment, all patients showed improvement of pain, of which 68.7% of patients were pain free with 43.75% noting improvement within 48 hours. Mean relative volumetric reduction in tumour volume was 37.3% (P < .001). Eight patients showed high grade of Bilsky classification (Epidural spinal cord compression scale - ESCC) with seven of them showing significant improvement to low grade of ESCC (P = .016). Median baseline PET Standardised Uptake Value (SUV)max was 14.57 and post treatment was 4.8 (P < .001).

Conclusions: This study provides necessary insight to the limited literature on the use of denosumab for spinal GCT in the acute phase. The clinical and radiographic responses observed demonstrate the critical role that neo-adjuvant denosumab has by reducing the tumour burden around critical adjacent neurovascular structures before eventual resection, significant pain improvement even with presence of fractured vertebra.