Global Spine Journal最新文献

DesignPost-hoc analysis of data from prospective multicenter observational study.ObjectivesAdult spinal deformity (ASD) can have significant impact on various aspects of a patient's social life. This study aims to examine the impact of ASD surgery on the social functioning among elderly patients.MethodsPatients ≥60 years undergoing ≥5 levels of spinal fusion from 12 international centers were enrolled and followed up 2 years post-operatively. The outcome measures of interest in the current report were questions 14 and 18 of the Scoliosis Research Society-22r questionnaire (SRS-22r), and question 9 from the Oswestry Disability Index (ODI).Results219 patients met the inclusion criteria, with a median age of 67.5 and 80.4% being female. More than a third were employed or homemakers, 60.3% were retired and 25.7% showed cognitive impairment. For the SRS-22r Q14, at baseline, 40.6% of patients felt their back condition moderately or severely affected their personal relationships compared to 14.7% at 2-years. For SRS-22r Q18, at baseline, 47.7% of patients felt their back often or very often limited them going out with friends/family compared to 17.1% at 2-years. For the ODI, Q9, 8.7% of patients felt that their social was normal and does not cause them extra pain pre-op compared to 44.1% of patients at 2-years.ConclusionWhile many factors can affect a patient's social function, in this cohort ASD surgery had a positive impact on social function.The ClinicalTrails.gov identifier: NCT02035280.

Study DesignRetrospective Cohort Study.ObjectivesTo evaluate the prognostic value of preoperative increased signal intensity (ISI) grade on T2-weighted magnetic resonance imaging (MRI) and to identify risk factors associated with poor neurological recovery after surgery in adult cervical spinal cord injury without radiographic evidence of trauma (SCIWORET).MethodsA total of 128 consecutive SCIWORET patients who underwent surgical treatment between January 2016 and June 2023 were retrospectively analyzed. Patients were classified into 3 groups (Grade 0, 1, and 2) according to ISI grade on preoperative MRI. Neurological function was assessed using the Japanese Orthopaedic Association (JOA) score and recovery rate (RR). Multivariate logistic regression analysis identified predictors of poor RR (< 50%), and receiver operating characteristic (ROC) analysis determined the optimal age cutoff for prognosis.ResultsSignal intensity alterations were observed in 111 patients (86.7%). Higher ISI grades correlated with lower preoperative JOA scores (r = -0.303, P < 0.001) but not with postoperative RR (r = -0.067, P = 0.450). Multivariate analysis identified age as the only independent predictor of poor RR (OR = 1.10, 95% CI: 1.04-1.16, P < 0.001). ROC curve analysis yielded an optimal age cutoff of 58.5 years.ConclusionsPreoperative ISI grade reflected the severity of spinal cord injury but did not predict postoperative neurological recovery. Older age (> 58.5 years) independently predicted poorer outcomes, highlighting the importance of integrating patient age into prognostic counseling and individualized surgical decision-making in SCIWORET.

Study DesignThis study is a meta-analysis of randomized controlled trials (RCTs) and observational studies.ObjectiveLumbar disc herniation (LDH) often requires surgery, with microdiscectomy (MD) being common. This study compares Unilateral Biportal Endoscopic Discectomy (UBED) to conventional and tubular MD for LDH treatment.MethodsPubMed, Cochrane Central, and ScienceDirect were searched up to May 2025. Mean differences (MDs) and risk ratios (RRs) were pooled with a random effects model using Review Manager. Quality was assessed using the Cochrane risk of bias tool and the Newcastle-Ottawa Scale. Publication bias was evaluated with funnel plots and Egger's regression test.ResultsThirteen studies (11 observational studies and 2 RCTs), pooling 1369 patients, were included. UBED was associated with decreased 1-3 days post-operative (MD: -0.81; 95% CI: [-1.48, -0.14]; P = 0.02) and 12 months post-operative (MD: -0.37; 95% CI: [-0.74, -0.01]; P = 0.04) VAS back pain scores, 12 months post-operative ODI scores (MD: -1.32; 95% CI: [-2.44, -0.19]; P = 0.02), estimated blood loss (MD: -74.42; 95% CI: [-114.11, -34.73]; P = 0.0002), and hospital stay (MD: -1.81; 95% CI: [-2.99, -0.63]; P = 0.003) compared to conventional MD although the operative time was high (MD: 9.07; 95% CI: [1.66, 16.48]; P = 0.02). Concurrently, the 12 months post-operative VAS back pain score (MD: -0.42; 95% CI: [-1.40, 0.56]; P = 0.40) and ODI score (MD: 1.39; 95% CI: [-2.80, 5.58]; P = 0.52) along with the operative time (MD: 21.80; 95% CI: [-26.31, 69.92]; P = 0.37) and hospital stay (MD: 0.02; 95% CI: [-0.30, 0.33]; P = 0.92) were comparable between the UBED and tubular MD. The VAS leg pain scores were comparable between UBED and both conventional and tubular MD.ConclusionUBED may be associated with reduced early and long-term back pain, disability, blood loss, and hospital stays compared to conventional MD, but has longer surgery times, with comparable outcomes to tubular MD. More large-scale RCTs are required to validate these results.

Study DesignAn Exploratory Study.ObjectivesTo estimate the prevalence of scoliosis and associated factors among adolescents, and to evaluate the clinical utility of an electronic scoliometer in school screening.MethodsThe scoliosis school screening was conducted in Xinyang City, Henan Province, in 2024. Students' study habits and daily routines were collected via questionnaires. Manual and electronic scoliometers were used for primary screening and compared using receiver operating characteristic (ROC) curves and agreement statistics. Three-dimensional ultrasound provided a provisional diagnosis. Multivariable logistic regression identified factors associated with scoliosis.ResultsA total of 1874 students were enrolled in this study. The positive screening rates using manual and electronic scoliometers were 4.97% and 2.87%, respectively. Among these cases, 102 students were referred for 3D ultrasound examination, with 74 students showing an ultrasound Cobb angle ≥10°. The prevalence of scoliosis was 4.55% in seventh-grade students and 4.04% in eighth-grade students. The prevalence of scoliosis was 2.99% in males and 5.96% in females. In the paired sample (n = 39), the electronic device had an AUC of 0.844 (95% CI 0.718-0.971) vs 0.751 (95% CI 0.596-0.907) for the manual device (ΔAUC = 0.093, P = 0.033). Agreement for continuous ATR showed moderate absolute agreement (ICC(3,1) = 0.614; 95% CI 0.373-0.777). Multinomial regression identified sitting with crossed legs and lack of sports participation as potential risk factors.ConclusionsThe prevalence of scoliosis among seventh and eighth-grade students in Xinyang City, Henan Province, was 4.33%. We recommend ATR ≥5°be triaged with 3D ultrasound before radiography; cases with UCA <20°should be rechecked at 3 months. Schools/parents should promote correct seated posture and more physical activity.

Study DesignProspective Cohort Study.ObjectivesThe rapidly evolving landscape of cancer care alters the prognostic accuracy of established scoring systems for metastatic spinal tumors. This study aimed to provide a contemporary assessment of patient survival and examine the independent and complementary roles of the new Katagiri score (a systemic prognostic tool) and the Spinal Instability Neoplastic Score (SINS, a mechanical instability tool) in predicting 6-month mortality, laying a foundation for future combined prognostic model development.MethodsWe prospectively analyzed 151 patients with metastatic spinal tumors treated between 2021 and 2023. Demographic, clinical, and treatment data, including the new Katagiri score and SINS, were collected. The primary endpoint was 6-month mortality, which was evaluated using trend tests, correlation, and multivariate logistic regression.ResultsThe 6-month mortality rate was 25.17%. Higher scores in both the new Katagiri score and the SINS were significantly associated with an increased risk of 6-month mortality. Notably, no significant correlation was observed between the total Katagiri score and the total SINS. Stratified analyses showed that prognostic factors for early mortality differed across new Katagiri score risk groups, with varying influences from specific Katagiri score items, SINS components, and spinal metastasis levels. SINS-related factors had a significant impact in the high-risk group.ConclusionsThe new Katagiri score and SINS independently predicted 6-month mortality in our cohort. Our findings suggest that considering both complementary measures may further refine prognostic assessment, providing a rationale for future prospective model development and validation.

Study DesignProspective Cohort Study of 108 cases.ObjectiveProne Transpsoas (PTP) fusion is a minimally invasive surgical technique using a single-position prone lateral approach to augment the anterior column of the lumbar spine. Degenerative spondylolisthesis (DS) is a common pathology where anterior-posterior access can be advantageous. This study aimed to evaluate operative, radiological and functional outcomes of PTP fusion in the management of symptomatic DS.MethodsA multi-centre cohort study was conducted, involving 108 consecutive patients who underwent PTP fusion for low-grade (Grade I-II) DS. Descriptive statistical analysis was used to evaluate clinical, radiological and functional outcomes.ResultsIn all 108 cases, anterior column fusion was combined with posterior percutaneous pedicle screw fixation to optimise spinal realignment. The cohort's average operative time was 115 minutes, and the psoas retraction time was 14 minutes. The cohort had an average slip of 5.9 mm, which was reduced to 0.8 mm (P < 0.001) postoperatively. Statistically significant radiological improvements were observed in lumbar lordosis (Δ5°), segmental lordosis (Δ4°), anterior disc height (Δ 4.2 mm) and posterior disc height (Δ 2.1 mm). No major vascular or visceral complications were encountered. The sustained neurological complication rate was 1.9%, and patients maintained improved functional outcomes through the 1-year follow-up.ConclusionsPTP is a safe approach for managing low-grade DS, showing significant postoperative correction of spinal alignment. These results support the use of PTP fusion for treating spondylolisthesis and add to the growing evidence of its safety and efficacy as a minimally invasive technique.

Study DesignRetrospective Cohort Study.ObjectivesMental health disorders like depression and psychoses are increasingly recognized in surgical populations and may adversely affect outcomes. This study aimed to: (1) evaluate the prevalence of these disorders among patients undergoing single-level lumbar fusion, (2) compare perioperative complications, costs, and discharge disposition; and (3) determine whether psychotic disorders confer greater risk than depression.MethodsA retrospective study of the National Inpatient Sample (2016-2022) identified adults undergoing elective single-level lumbar fusion procedures. Patients were stratified into depression, psychoses, or control cohorts. Multivariable logistic regression was adjusted for demographic, hospital, and clinical covariates and used to assess associations with perioperative complications, non-home discharge, and inpatient mortality. Hospital costs were converted and inflation-adjusted to 2022 United States (U.S.) dollars.ResultsAmong 792 065 weighted admissions, 17.7% had depression and 2.6% had psychotic disorders. Depression was independently associated with increased odds of cardiovascular complications (OR 1.26), mechanical complications (OR 1.25), adverse events (OR 1.26), and non-home discharge (OR 1.17, all P < .001). Psychotic disorders had greater risk, with higher odds of cardiovascular (OR 1.41), mechanical (OR 1.45), any adverse event (OR 1.42), and non-home discharge (OR 1.59; all P < .001). Mean costs ($41 097 vs $39 256 vs $38,117; P < .001) and length of stay (3.72 vs 3.51 vs 3.19 days; P < .001) were greatest in psychoses.ConclusionDepression and psychotic disorders are common in patients undergoing lumbar fusion, and are independently associated with increases in perioperative morbidity, non-home discharge, and costs. Tailored perioperative planning may help mitigate these risks.

Study DesignProspective multicenter cohort study.ObjectivesTo determine the incidence and risk factors for postoperative complications following cervical spine surgery and to explore their association with long-term clinical outcomes.MethodsA total of 1482 patients with degenerative cervical disorders who underwent surgery at 10 high-volume institutions in Japan were prospectively enrolled. Perioperative complications were defined as events occurring within 30 days postoperatively. Risk factors were analyzed using univariate and logistic regression analyses. Clinical outcomes were assessed using the cervical Japanese Orthopaedic Association (JOA) score and the Physical Component Summary (PCS) of the SF-36 at baseline and 2 years postoperatively.ResultsPerioperative complications occurred in 5.5% of patients: segmental motor paralysis (2.3%), neurological deficit (0.6%), dural tear (0.5%), CSF leakage (0.3%), epidural hematoma (0.9%), and surgical site infection (0.8%). Male sex (OR 3.049; 95% CI 1.045-8.929) and posterior fusion (OR 4.016; 95% CI, 1.518-10.620) were significant risk factors for segmental motor paralysis, while respiratory disease (OR 5.500; 95% CI, 1.462-20.694) was associated with surgical site infection. At 2 years, patients with complications showed variable neurological recovery, with many failing to reach the minimum clinically important difference.ConclusionsMale sex, posterior fusion, and respiratory disease were identified as significant risk factors for major complications. Awareness of these factors may support improved surgical planning and perioperative management. However, interpretation of long-term outcomes should be made with caution because of the limited number of cases and potential selection bias associated with incomplete follow-up.

DesignProspective multicenter observational study.ObjectivesSpinal deformity has a significant impact on health in elderly patients. The appropriate use of multilevel fusion surgery in elderly patients requires information regarding the expected outcomes and complications.MethodsPatients ≥60 years undergoing ≥5 levels of spinal fusion from 12 international centers were enrolled and followed up to 5 years post-operatively.Results219 of 229 enrolled patients met the inclusion criteria. The mean age was 67.5 (range 60-83) years with 80.4% female patients. The mean changes (95% CI) of the subtotal and total SRS-22r scores from baseline to 5-year follow up were 0.88 (0.76;1.00) and 0.90 (0.78;1.02), respectively (P < 0.001). Comparable improvements were observed in the Oswestry Disability Index, Numeric Rating Scale and EQ-5D with maximum improvement noted at 1 year and maintained at the 2- and 5-year follow-ups. Overall, there were 244 adverse events reported in 124 patients during the 2-year follow-up period, and further 25 adverse events reported in 20 patients between 2 and 5 years.ConclusionMultilevel reconstructive surgery in elderly patients with spinal deformity is associated with significant improvement in self-reported outcomes despite a relatively high rate of adverse events. The results of this study provide important information regarding the expected risks and benefits of surgery in these patients, empowering patients and physicians to make informed choices regarding care.

Study designProspective cross-sectional observational study.ObjectiveThis study aimed to develop a novel Physical Performance Test (PPT)-based scoring system by linking PPTs with the radiological severity of Degenerative Cervical Myelopathy (DCM).MethodsThe severity of spinal cord compression in DCM patients was assessed using the cross-sectional area (CSA) at the maximal stenosis, as determined by magnetic resonance imaging (MRI). Functional performance was evaluated with the modified JOA scoring system (mJOA) and PPTs: 10-second-Grip-and-Release-Test (GR), Simple-Foot-Tapping-Test (FTT), 10-second-Step-Test (SST), Nine-hole-Peg-Test (HPT), and 30-meter-Walking-Test (30MWT). Validity was determined by examining correlations between CSA and these metrics, using Pearson's correlation. The Hong Kong Myelopathy Criteria (HKMC) were developed through Principal Component Analysis and K-means clustering to combine PPTs with the highest correlation with CSA.Results269 DCM patients (57% female, mean age 63 ± 9) were studied. 55% had CSA less than 70 mm² (mean CSA 55.92 ± 7.37 mm²), symptoms for 19 ± 6 months, and mJOA of 14.4 ± 2.0. PPTs showed significant correlations with CSA (r = -0.473 to 0.837, p < 0.001), but not with mJOA. The HKMC, combining GR, FTT, and SST (loadings >0.87), with a four-tier scoring system (0-3), showed a strong correlation (r = 0.896, p < 0.001). A cutoff of 4.5 effectively indicates significant cervical stenosis, with 90% sensitivity and 94% specificity.ConclusionThis study is the first to demonstrate a strong association between spinal cord compression and physical performance in DCM. As a novel DCM-specific assessment tool, the HKMC demonstrates bedside utility and superior validity compared to individual PPTs and mJOA to identify individuals with radiologically severe DCM.