Global Spine Journal最新文献

Study design: Literature review with clinical recommendations.

Objective: To highlight important studies about osteoporotic spinal fractures (OF) that may be integrated into clinical practice based on the assessment of the AO Spine KF Trauma and Infection group key opinion leaders.

Methods: 4 important studies about OF that may affect current clinical practice of spinal surgeons were selected and reviewed with the aim of providing clinical recommendations to streamline the journey of research into clinical practice. Recommendations were graded as strong or conditional following the GRADE methodology.

Results: 4 studies were selected. Article 1: a validation of the Osteoporotic Fracture (OF)-score to treat OF fractures. Conditional recommendation to incorporate the OF score in the management of fractures to improve clinical results. Article 2: a randomized multicenter study comparing romosozumab/alendronate vs alendronate to decrease the incidence of new vertebral fractures. Strong recommendation that the group receiving romosozumab/alendronate had a decreased risk of new OF when compared with the alendronate only group only. Article 3: a systematic literature review of spinal orthoses in the management of. Conditional recommendation to prescribe a spinal orthosis to decrease pain and improve quality of life. Article 4: post-traumatic deformity after OF. A conditional recommendation that middle column injury and pre-injury use of steroids may lead to high risk of post-traumatic deformity after OF.

Conclusions: Management of patients with OF is still complex and challenging. This review provides some recommendations that may help surgeons to better manage these patients and improve their clinical practice.

Study design: Bibliometric analysis.

Objective: The study aims to comprehensively assess the literature related to gait rehabilitation for individuals with spinal cord injury (SCI) to identify significant contributors, and to explore the collaborations and emerging themes in the field.

Methods: Original and review articles in English using relevant keywords were searched in the Clarivate Web of Science database. The data from the selected articles were imported into R software. Bibliometric indicators were assessed to determine author contributions, country affiliations, journal sources, and thematic trends.

Results: A total of 1313 relevant articles were identified. The USA, followed by Canada and Switzerland were the most prolific countries contributing to gait rehabilitation research in SCI. The most relevant journals were Spinal Cord, Archives of Physical Medicine and Rehabilitation, Journal of Spinal Cord Medicine, Journal of NeuroEngineering, and Journal of Neurotrauma. The highest contributions came from Northwestern University, the University of Miami, and the University of Alberta. The analysis revealed an increase in research interest in gait rehabilitation after 2000, with a focus on interdisciplinary approaches and emerging technologies like robotics, exoskeletons, and neuromodulation.

Conclusion: The analysis demonstrates the importance of collaborative and interdisciplinary research in gait rehabilitation. The results indicate a shift in research focus from traditional methods to the integration of technology. The impact of publications from the USA and Europe is a notable finding. The study highlights the growth of articles related to technology-driven approaches and understanding neuroplasticity in gait rehabilitation.

Study design: Retrospective cohort analysis.

Objective: To characterize the impact of COVID-19 on utilization of the ten most common spine procedures and percentages of outpatient procedures.

Methods: The PearlDiver national database was queried from January 2010 to April 2021 for short (<6 segments) and long segment posterior instrumented fusion (≥6 segments), posterior cervical fusion, anterior cervical decompression and fusion (ACDF), cervical laminectomy, laminoplasty, and disc arthroplasty, lumbar laminectomy, microdiscectomy, and interbody fusion. Annual procedure utilization between January 2010 through April 2021 was recorded and compared. Monthly trends were compared to January 2020. Outpatient trends were compared between 2010-2019 and 2019-2021 using segmented linear regression.

Results: Overall, all ten procedures decreased 4.3% in 2020 compared to 2019 and increased 6.3% in 2021 compared to 2019. March and April of 2020 had the largest decreases, with March 2020 decreasing 18.2% and April 2020 decreasing 51.6% compared to January 2020. Despite increasing COVID cases in January 2021, overall procedure utilization decreased only 1.8% compared to January 2020, and increased later in 2021 with April 2021 case volumes increasing by 138% compared to January 2020. Outpatient utilization of short segment posterior lumbar fusion and lumbar interbody fusion significantly increased during this time (P < .001).

Conclusion: The greatest impact on spine surgery volume from the COVID-19 pandemic occurred in March and April 2020. Spine procedure utilization was otherwise similar or increased compared to January 2020. Additionally, the volume of outpatient short segment posterior fusion and lumbar interbody fusions increased during this time period.

Objective: This study aimed to explore the relationship between diffusion tensor imaging (DTI) parameters, cervical spine alignments, and spinal cord morphological parameters in patients with Hirayama disease (HD).

Methods: In this retrospective cohort study, 41 HD patients were recruited from the Huashan hospital from July 2017 to November 2021. Patients received X-rays, conventional magnetic resonance (MR), and DTI scans in flexion and neutral positions. The DTI parameters assessed were calculated using the region of interest (ROI) method. Paired t-tests were performed on the DTI parameters of neck flexion and neutral position. Cervical spine alignments, including flexion and neutral Cobb angles, were measured, and range of motion (ROM) was calculated. Spinal cord morphological parameters were measured, including spinal cord atrophy (SCA) and loss of attachment (LOA). Spearman's correlation analysis between DTI parameters, cervical spine alignments, and spinal cord morphological parameters was performed.

Results: In comparing DTI parameters, segments of the C3/4, C4/5, C6/7, and lower cervical spine were significantly different, while segments of C5/6 were not significantly different. In Spearman's correlation analysis, the flexion Cobb angle was significantly correlated with the fractional anisotropy (FA) value (R² = .111, P = .033) and apparent diffusion coefficient (ADC) value (R² = .119, P = .027). Flexion FA values were correlated with SCA in C4/5 (R² = .211, P = .003), C5/6 (R² = .454, P < .001), and C6/7 (R² = .383, P < .001) while flexion ADC values were correlated with SCA in the C4/5 (R² = .178, P = .006), C5/6 (R² = .388, P < .001) and C6/7 segments (R² = .187, P = .005).

Conclusion: The DTI parameters were correlated with the flexion Cobb angle and the SCA. These data support the dynamic cervical flexion compression hypothesis and indicate that the degree of SCA may be used to assess the condition of HD patients quantitatively.

Study design: Retrospective, matched case-control study.

Objective: To investigate the risk factors of reoperation after percutaneous endoscopic lumbar discectomy (PELD) due to recurrent lumbar disc herniation (rLDH) and to establish a set of individualized prediction models.

Methods: Patients who underwent PELD successfully from January 2016 to February 2022 in a single institution were enrolled in this study. Six methods of machine learning (ML) were used to establish an individualized prediction model for reoperation in rLDH patients after PELD, and these models were compared with logistics regression model to select optimal model.

Results: A total of 2603 patients were enrolled in this study. 57 patients had repeated operation due to rLDH and 114 patients were selected from the remaining 2546 nonrecurrent patients as matched controls. Multivariate logistic regression analysis showed that disc herniation type (P < .001), Modic changes (type II) (P = .003), sagittal range of motion (sROM) (P = .022), facet orientation (FO) (P = .028) and fat infiltration (FI) (P = .001) were independent risk factors for reoperation in rLDH patients after PELD. The XGBoost AUC was of 90.71%, accuracy was approximately 88.87%, sensitivity was 70.81%, specificity was 97.19%. The traditional logistic regression AUC was 77.4%, accuracy was about 77.73%, sensitivity was 47.15%, specificity was 92.12%.

Conclusion: This study showed that disc herniation type (extrusion, sequestration), Modic changes (type II), a large sROM, a large FO and high FI were independent risk factors for reoperation in LDH patients after PELD. The prediction efficiency of XGBoost model was higher than traditional Logistic regression analysis model.

Study design: Retrospective cohort study.

Objective: Spinal metastasis from hepatocellular carcinoma is rapidly progressive and predisposes to spinal disability, cord compression and further neural injury, leading to poor prognosis. Currently, it is still challenging to look for a treatment strategy that can improve the quality of life of patients and even directly prolong the survival time. This study attempts to evaluate the clinical efficacy of separation operation combined with postoperative stereotactic radiotherapy (SRT/SRS) in the treatment of hepatocellular carcinoma patients developing spinal metastasis and epidural spinal cord compression.

Methods: Patients with metastases spinal cord compression from hepatocellular carcinoma were studied retrospectively and divided into two groups, the SO group (who undergo separation operations combined with postoperative SRS, n = 32) and RT group (who received only SRS, n = 28). The visual Analogue Scale (VAS) pain score, Frankel grade, Karnofsky performance score, and Quality of Life (SF-36) score were comparatively analyzed between the two groups.

Results: Significantly higher VAS pain scores, Frankel grades, Karnofsky performance scores and Quality of Life (SF-36) scores were demonstrated in patients with combination treatment than in patients with SRS alone.

Conclusion: Separation operations are effective surgical procedure for the treatment of spinal metastatic tumor from hepatocellular carcinoma with spinal cord compression. The combination with postoperative SRS can significantly improve the quality of life in this patient population via spinal canal decompression and spinal stability reconstruction.

Study design: This was a retrospective cohort radiographic study.

Objective: To determine the age- and gender-related normative values and correlation of cervical sagittal parameters in asymptomatic Chinese adults, and to explore the changes and compensating mechanisms across different age groups.

Methods: The asymptomatic subjects were divided into 6 groups according to age and then one-way analysis of variance was used to compare the multiple sets of cervical sagittal parameters among the different age groups. Independent t-tests were performed to compare the sagittal parameters among different gender and different cervical spine alignments. Relationships between each parameter were tested by Pearson's correlation. Linear regression analysis based on T1 slope (T1S) and C2 slope (C2S) was used to provide an equation to predict normal cervical alignment.

Results: Mean values of each cervical sagittal parameter were presented based on age and gender. There were positive correlations between age and cervical lordosis (CL) (r = -.278, P < .001), T1S (r = .271, P < .001), cervical sagittal vertical axis (cSVA) (r = .218, P < .001), C2-C4 Cobb angle (r = -.283, P < .001), horacic inlet angle (TIA) (r = .443, P < .001), and neck tilt (NT) (r = .354, P < .001). Older groups (aged >50 years) had greater T1 Slope, C2S, and TIA. The C2-C4 Cobb angle maintained a steadily increasing trend and significantly increased in the older adult groups (P < .05), while the C5-C7 Cobb angle was relatively constant. Mean values of parameters were larger in males (P > .05). Linear regression analysis indicated a strong association between T1S and CL (R2 = .551, standard error 1.16°), T1S and C5-7 (R2 = .372; P < .001), and C2S and C2-4 (R2 = .309; P < .001).

Conclusions: Normative values of cervical sagittal parameters vary by age and sex. The CL, cSVA, and T1S, C2-4 Cobb angle changed with increasing age, and it can influence the recruitment of compensation mechanism. Normative CL of Chinese adults was predicted by the equation CL = T1S-14.7° ± 1.2°, which could serve as a reference when planning for cervical surgery.

Study design: A systematic review and meta-analysis comparing the outcomes of Anterior Cervical Discectomy and Fusion (ACDF) vs Anterior Cervical Corpectomy and Fusion (ACCF) in treating adjacent two-segment cervical spondylotic myelopathy.

Objective: To assess the clinical effectiveness and safety of ACDF compared to ACCF.

Methods: A literature search was conducted in Cochrane Library, Web of Science, PubMed, and Embase up to December 2023. Studies included were prospective and observational involving ACDF or ACCF for adjacent two-segment cervical spondylotic myelopathy. Data were analyzed using RevMan 5.4 software.

Results: Ten studies (nine case-control and one RCT) were included. ACDF showed a shorter hospital stay (SMD = -0.29, 95% CI: -0.53 to -0.04, P < 0.05), better Cobb angle (SMD = 0.52, 95% CI: 0.31 to 0.74, P < 0.01), and improved T1S (SMD = 0.54, 95% CI: 0.28 to 0.80, P < 0.01). No significant differences were found in upper limb VAS, neck VAS, JOA scores, NDI, fusion rates, C2-7 SVA, total complications, blood loss, and operation time.

Conclusions: ACDF and ACCF are both effective for adjacent two-segment cervical spondylotic myelopathy, with ACDF offering advantages in hospitalization duration and cervical curvature restoration, making it the preferred surgical approach. Further research is needed to validate these findings.

Study design: Narrative review.

Objectives: The objectives of this study were to answer the following questions: (1) What is the quality of informed consent in spine surgery, including both neurosurgery and orthopaedic spine surgery? (2) What limitations impede the ability of surgeons to engage in effective shared decision-making (SDM) and obtain adequate informed consent? (3) What strategies and solutions may improve the quality of informed consent and SDM? (4) What factors decrease the incidence of litigation in spine surgery?

Methods: N/A.

Results: SDM is a collaborative process where patients are involved in their treatment choices through open communication about risks, alternatives, and postoperative expectations. Informed consent is a vital component of this process, ensuring that patients are fully informed and empowered to make decisions based on their values and preferences. This review highlights the current state of informed consent within the context of SDM in spine surgery and explores how enhancing this process can improve patient outcomes, reduce dissatisfaction, and decrease litigation. By emphasizing patient autonomy and improving the quality of risk communication, SDM fosters better physician-patient relationships and more positive clinical outcomes.

Conclusions: Orthopaedic surgery and neurosurgery are highly litigated specialties, with failure to obtain informed consent frequently cited in lawsuits. These legal challenges are costly and time-consuming for both physicians and patients. Integrating SDM into the informed consent process can help mitigate these issues, leading to improved patient satisfaction and fewer legal disputes.

Study design: Retrospective cohort study.

Objectives: To evaluate whether different radiographic clusters of adult spinal deformity identified using artificial intelligence-based clustering are associated with distinct surgical outcomes.

Methods: Patients were classified based on the results of a previously conducted analysis that examined clusters of deformity, including Moderate Sagittal (Mod Sag), Severe Sagittal (Sev Sag), Coronal, and Hyper-Thoracic Kyphosis (Hyper-TK). The surgical data, HRQOL, and complication outcomes of these clusters were then compared.

Results: The final analysis included 1062 patients. Similar to published results on a different patient sample, Mod Sag and Sev Sag patients were older, more likely to have a history of previous spine surgery, and more disabled. By 2-year, all clusters improved in HRQOL and reached a similar rate of minimal clinically important difference (MCID).The Sev Sag cluster had the highest rate major complications (53% vs 34-40%), and complications leading to reoperation (29% vs 17-23%), implant failures (20% vs 8-11%), and operative complications (27% vs 10-17%). Coronal patients had the highest rate of pulmonary complications (9% vs 3-6%) but the lowest rate of X-ray imbalance (10% vs 19-21%). No significant differences were found in neurological complications, infection rate, gastrointestinal, or cardiac events (all P > .1). Kaplan-Meier survival curves demonstrated a lower time to first complications for the Sev Sag cluster.

Conclusions: All clusters of adult spinal deformity benefit similarly from surgery as they all achieved similar rates of MCID. Although the rates of complications varied among the clusters, the types of complications were not significantly different.