Global Spine Journal最新文献

Study DesignSystematic Review and Meta-Analysis.ObjectivesTo compare clinical outcomes in degenerative cervical myelopathy (DCM) patients treated with laminectomy alone (LA) vs laminectomy with fusion (LF) and determine post-laminectomy kyphosis incidence.MethodsWe searched PubMed, Scopus, Embase, Web of Science, and MEDLINE from inception-September 2024 for studies comparing LA and LF for DCM. Outcomes assessed included post-laminectomy kyphosis, neurological recovery outcomes, patient-reported outcomes (PROs), and complication rates. Meta-analyses were performed using random-effects models.ResultsTwenty-seven studies including 3286 patients (2272 LA and 1014 LF), met the inclusion criteria. The pooled incidence of post-laminectomy kyphosis in the LA patients was 2.02 events per 100 person-years (95% CI: 1.26-2.78). Post-laminectomy kyphosis declined from 3.67 cases per 100 person-years in pre-2004 studies, to 0.88 cases per 100 person-years in post-2014 studies. No significant differences were observed between LA and LF in neurologic recovery (SMD 0.29, 95% CI 0.02-0.59), pain score improvement (SMD 0.13, 95% CI: -0.38 to 0.64) and complications (OR 0.77, 95 % CI 0.29-2.08), although subgroup analysis demonstrated that the risk of complications in LA may be lower in patients with less than four operative levels.ConclusionsAlthough the annual rate of kyphosis after LA is approximately 2 events per 100 person-years, PROs and complication rates may be similar between LA and LF. These findings should be interpreted with the caveat of considerable heterogeneity between studies and further randomized trials are needed to better delineate the benefits of each approach and to optimize patient selection.

Study DesignSystematic Literature Review.ObjectiveThe aim of this literature review is to examine the results of total disc arthroplasty in the setting of cervical myelopathy.MethodsA systematic review of the relevant literature examining the efficacy of cervical disc arthroplasty (CDA) in patients with cervical myelopathy was conducted using the Medline database.ResultsOur query identified 288 potentially relevant articles. After eliminating duplicate articles and screening by title and abstract 115 articles underwent full-text review. Of these, 15 were deemed relevant to the research questions posed. Evaluation of references identified 2 additional relevant articles.ConclusionEvaluation of outcomes measures, radiographic analysis, and failure due to implant related complications is equivalent in comparing CDA to Anterior Cervical Discectomy and Fusion (ACDF). From the literature available, the outcomes in patients undergoing cervical disc arthroplasty are at least equal to those of ACDF. The concern for persistent symptoms in patients treated with CDA due to the dynamic component on myelopathy is theoretic and not supported by the available literature.

Study DesignSystematic Review.ObjectiveEndoscopic cervical spine surgery (ECSS) has emerged as a minimally invasive alternative to traditional open surgery for certain cervical spine disorders. ECSS may offer potential advantages such as reduced tissue trauma, shorter hospital stays, and accelerated functional recovery. Technological advancements have further enhanced its feasibility. The purpose of this article is to review current ECSS approaches, systematically review ECSS for cervical stenosis, and explore future directions of ECSS.MethodsThe PubMed, Embase, and Google Scholar databases were searched systematically until October 20, 2024, adhering to PRISMA guidelines. We searched keywords associated with cervical stenosis, including "endoscopic cervical surgery", "endoscopic cervical discectomy", "endoscopic cervical foraminotomy", "cervical endoscopic unilateral laminotomy for bilateral decompression", and "unilateral bilateral endoscopy". We excluded duplicate publications, review articles, preprints, and studies without clinical outcomes or incomplete information. Clinical outcomes and complications were collected.ResultsA total of 12 studies were included with 2 studies being reported twice for having two different ECSS approaches. Each study reported postoperative improvement in clinical outcomes compared to preoperative measurements. The most common complications included dural tears, transient hypesthesia, and CSF leakage.ConclusionECSS is an emerging alternative for treating select cases of symptomatic cervical stenosis and other cervical conditions. Complications differed depending on the approach. Advancements in endoscopic instruments, navigational technologies, and artificial intelligence hold promise for improving preoperative planning, surgical precision, and patient outcomes. The true value of ECSS will require carefully conducted prospective, controlled studies with rigorous assessment of outcomes and complications.

Study designRetrospective multicenter cohort study.ObjectivesTreatment of subaxial cervical spine injuries (SCSI) carries high risks of surgical adverse events (SAEs) and revision surgery. While anterior approaches are widely applied, large-scale trauma-specific data remain limited. This study assessed the incidence and predictors of SAEs and revisions after anterior stabilization of SCSI.MethodsAdult patients with acute fractures of C3-C7 treated with single-stage anterior stabilization between 2017-2022 were identified in the German Spine Registry. Demographic, injury, and surgical variables were analyzed using univariate tests and multivariable logistic regression for SAEs and revisions. Model performance was evaluated with ROC curves.ResultsA total of 1486 patients were included. SAEs occurred in 8.5%, most often motor (1.5%) or sensory dysfunctions (1.2%). Revision surgery was required in 4.5%, mainly instrumentation reimplantation (1.9%). Independent predictors of SAEs were male sex (OR 1.69), higher age (OR 1.02/year), AO type C fractures (OR 1.73), and spinal degeneration (OR 1.57). Revision was predicted by fracture type C (OR 2.31). ROC AUCs were 0.65 (SAEs) and 0.70 (revisions). Fracture type C was also linked to neurological deterioration, infection, and implant failure, while age and degeneration predicted implant failure.ConclusionAnterior surgery for SCSI carries notable complication risks. Fracture type C, age, male sex, and degeneration predicted SAEs, while fracture type C independently predicted revisions. Given its association with implant failure, anterior-only stabilization of type C injuries should be considered cautiously. Although individual SAE types were rare, findings underscore the need for vigilant postoperative management in specialized centers.

Study DesignRetrospective Cohort Study.ObjectivesTo evaluate the prognostic utility of preoperative laboratory values (PLVs) in predicting 30-day postoperative outcomes among patients undergoing single-level vertebral fracture fixation.MethodsThe ACS-NSQIP database (2015-2020) was queried to identify adults who underwent single-level vertebral fracture fusion. Patients were stratified by PLV categories using clinically relevant hypo- and hyper-thresholds. Outcomes included 30-day mortality, major complications, Clavien-Dindo IV complications, non-home discharge (NHD), readmission, reoperation, and extended length of stay. Multivariate logistic regression adjusted for demographics and comorbidities was used to assess associations between PLVs and adverse outcomes.ResultsA total of 4005 patients were identified. Hypoalbuminemia emerged as the strongest independent predictor of poor outcomes, including mortality (OR 4.05, 95% CI 2.14-7.69, P < 0.001), major complications (OR 1.94, 95% CI 1.46-2.57, P < 0.01), and NHD (OR 1.72, 95% CI 1.37-2.17, P < 0.001). Elevated creatinine and leukocytosis were significantly associated with increased mortality (P = 0.047) and Clavien-Dindo IV complications (P < 0.001), while preoperative anemia predicted prolonged hospitalization (P < 0.01).ConclusionsAmong patients undergoing single-level vertebral fixation for fracture, hypoalbuminemia is the most consistent predictor of adverse 30-day outcomes. Elevated creatinine, leukocytosis, and anemia also confer independent risks for specific complications. Incorporating PLVs into preoperative risk stratification may enhance patient counseling, optimize perioperative planning, and identify candidates for targeted prehabilitation.

Study designProspective multicentric study.ObjectiveThoracolumbar fractures without neurologic deficit are challenging situations in terms of treatment decision making. We aimed to analyze the occurrence of adverse events (AEs) after surgical and nonsurgical treatment and its impact on functional outcomes.Methods198 patients from a prospective multicentric database were included. The occurrence of adverse events and treatment failure within 2 years of follow up were recorded. ODI was compared between patients with and without adverse events at six months, 1 year and 2 years follow up. Multivariable regression analysis was conducted to assess the association between post-treatment adverse events and ODI at 1-year follow-up.Results46 adverse events were recorded (23.2%). Higher categories of the Charlson Comorbidity Index (CCI) (P = 0.006), unemployment or retirement (P = 0.027), and current smoking (P = 0.008) were significantly associated with the occurrence of adverse events whereas no significant differences were observed in terms of treatment decision (conservative vs surgical). ODI values were significantly higher in patients with adverse events at the 6-month and 1-year follow-up visits without significant differences at 2 years follow up. Treatment failure was observed in only 5 patients.ConclusionWe found association between the occurrence of AE and higher ODI at 6-months and one-year follow up. Additionally, a higher CCI and smoking status were associated with higher likelihood to develop adverse events in our cohort.

Study DesignProspective Study.ObjectivesDegenerative lumbar central spinal stenosis (DLCCS) commonly affects the elderly, causing back and leg pain that often necessitates surgical intervention. Perioperative tranexamic acid (TXA) effectively reduces blood loss in lumbar instrumented fusion surgeries. Its effectiveness in elderly patients undergoing posterolateral lumbar instrumented fusion and posterior decompression for DLCCS remains insufficiently investigated. This study aims to evaluate the potential benefits of TXA in these surgical interventions.Methods170 patients with DLCCS that underwent posterolateral lumbar instrumented fusion with posterior decompression at two consecutive vertebral levels were included. Patients were divided into two groups: Group A (87) without intravenous TXA and Group B (83) with intravenous TXA 30 minutes preoperatively. Outcomes included intraoperative blood loss, postoperative drainage, transfusion rates, surgical duration, initiation of mobilization and hospital stay.ResultsNo significant differences were found in patients' baseline demographics. Surgical duration was significantly shorter in the TXA group (103.6 ± 9.8 min vs 128.6 ± 8.2 min, P < 0.001). Intraoperative blood loss was lower in the TXA group (462.7 ± 92.0 mL vs 864.4 ± 157.0 mL, P < 0.001), as was postoperative drainage (85.2 ± 47.6 mL vs 207.4 ± 153.5 mL, P < 0.001). Postoperative transfusion was required in 3 TXA patients vs 27 in the non-TXA group (P < 0.001). TXA patients mobilized earlier (7.4 ± 3.4 hours vs 12.1 ± 8.1 hours, P < 0.001) and had a shorter hospital stay (2.1 ± 0.4 days vs 2.6 ± 0.9 days, P < 0.001).ConclusionsPreoperative TXA administration in this spinal surgery improved surgical and postoperative outcomes and should be considered more.

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.