Global Spine Journal最新文献

Study DesignRandomized controlled trial over one year.ObjectivesBouldering as a popular climbing discipline might have a therapeutic potential in adolescent idiopathic scoliosis (AIS). This trial examined the effectiveness of an innovative program compared to standard care.MethodsPatients suffering from mild AIS (13.1 ± 1.5 yrs, ♀ = 68%) were weekly treated by scoliosis- specific exercises (SSEs) during bouldering therapy (BT: n = 20, Potsdam model) or physiotherapy (PT: n = 21, Schroth-Method). After 12 months, changes in group-blinded max and sum score of Cobb-Angles as well as angle of trunk rotations (ATRs) were mainly analyzed by use of a mixed-ANOVA.ResultsDisregarding group, max Cobb: -1.9° ± 4.9°; sum Cobb: -3.7° ± 8.4° (excl. one outlier/group); max ATR: -1.3° ± 1.5°; sum ATR: -2.6° ± 2.7° were reduced significantly (main time effects: P < 0.001 to 0.021, f = 0.39 to 1.05). Post-hoc tests revealed significance in both groups for max and sum ATR (p_adj < 0.001 to 0.006, d = 0.56 to 1.03). A significant group-by-time interaction (P = 0.039, f = 0.202) was found in sum ATR (BT: -3.48° vs PT: -1.76°). The improvements in ATR but not Cobb-Angle were below measurement error on group level. In each group, 20% improved and 5% deteriorated to a clinically meaningful extent in max Cobb (≥5°). Regarding max ATR, 15% (BT) and 5% (PT) revealed an improvement ≥4°. No clinically relevant deterioration was seen. 85.7% wanted to continue with BT after intervention period. Most (74%) did not interpret it as a kind of treatment.ConclusionsBoth, SSEs during BT and PT over one year can prevent potential progression of mild AIS and partly improve deformity. The BT program is suitable for youth and might improve adherence to specific exercises until or even beyond skeletal maturity.

Study DesignRetrospective cohort study.ObjectiveTo describe the clinical characteristics and surgical outcomes of non-ambulatory patients with thoracic ossification of the posterior longitudinal ligament (T-OPLL), and to identify predictors of independent walking recovery.MethodsThis retrospective study analyzed 70 non-ambulatory T-OPLL patients treated with either circumferential decompression (CD) or posterior decompression with fusion (PDF) surgery at a single center over 10 years (2012-2022). Outcomes included neurological recovery rate, independent walking recovery, and complications.ResultsOverall, 71.4% of patients regained independent walking. The CD group showed superior functional outcomes (90% vs 64% walking recovery, P = 0.030) but higher complication rates (70% vs 38% CSF leakage, P = 0.015). Shorter disease duration (P = 0.018) and lower BMI (P = 0.027) independently predicted better walking recovery.ConclusionsFor non-ambulatory T-OPLL patients, CD surgery provides better functional recovery while PDF surgery offers a safer alternative. Early surgical intervention and individualized approach selection based on disease duration and BMI are critical for optimizing outcomes.

Study DesignRetrospective Cohort Study.ObjectivesSelecting the last substantially touched vertebra (LSTV) or the lastly touched vertebra (LTV) as the lowest instrumented vertebra (LIV) has been shown to prevent distal adding-on (DA) in Lenke 1A and 2A curves or Lenke 1B and 1C curves, respectively. However, DA was still observed in our cohort even when fusing at or distal to STV or LTV when undergoing thoracic curve fusion (TCF). The purposes of this study are (1) to identify factors associated with the occurrence of DA when LIV for TCF is at or distal to LTV/LSTV, and (2) to demonstrate the effectiveness of LIV-index, defined as the summation of the proximity of LIV relative to neutral vertebra (NV) and stable vertebra (SV) as (LIV-NV) + (LIV-SV), in predicting postoperative DA.MethodsA multicenter observational retrospective analysis was conducted on AIS patients who underwent TCF for major thoracic curves (MTCs, Lenke 1&2 curves). Subgroup analysis was performed between the DA and non-DA groups.Results112 patients were included in the study with 10 patients presenting with DA during follow up. All patients in the DA group had an LIV-index < 0, indicating it a significant risk factor for DA (sensitivity = 100%, specificity = 92%, PPV = 55.5%, NPV = 100%, P < 0.001), especially for patients under 15-year-old (sensitivity = 100%, specificity = 94%, PPV = 77%, NPV = 100%, P < 0.001).ConclusionWhen fusing at or distal to LTV/LSTV in surgery for Lenke type 1 and 2 curves, the LIV-index can be used in clinical practice to prevent postoperative DA, particularly in younger patients.

Study designRetrospective cohort study.ObjectivesThis study evaluated the outcomes of radiation therapy (RT) as the initial treatment for Bilsky grade 2 metastatic epidural spinal cord compression (MESCC) and identified the risk factors associated with RT failure.MethodsThis retrospective cohort study enrolled 151 patients diagnosed with Bilsky grade 2 MESCC. Patients were divided into 2 groups, viz. those who initially underwent RT (n = 127) and those treated with surgery at presentation (n = 24). The patient demographics, treatment outcomes, and risk factors for RT failure were analyzed. The Spinal Instability Neoplastic Score (SINS) and clinical outcomes such as ambulatory status and neurological function were compared. Logistic regression was performed to identify factors predictive of RT failure.ResultsRT was successful in 85.8% (109/127) of patients, and only 14.2% (18/127) required surgery due to symptom progression. The SINS were significantly higher in the RT-failure group (9.6 ± 3.2) than in the RT-success group (7.4 ± 2.8, P = 0.003). SINS scores >8 were associated with a higher risk of RT failure. Patients the surgery group were younger and presented more frequently with neurological deficits. No significant differences in final ambulatory status or survival were observed between the RT-success and RT-failure subgroups.ConclusionsRT can be a viable initial treatment option for Bilsky grade 2 MESCC in the absence of neurological deficits or severe mechanical pain. However, patients with greater spinal instability (SINS >8) face a higher risk of RT failure and may benefit from surgical intervention at diagnosis.

Study DesignRetrospective study.ObjectiveThis study aims to identify how CT HU values vary in degenerative lumbar scoliosis (DLS) patients with different scoliotic apexes and in those with different degree of scoliosis.MethodsWe included 222 DLS patients and 140 lumbar spinal stenosis (LSS) patients, dividing the DLS patients into 2 groups based on scoliotic apex location. Patients were further categorized by T scores into osteoporotic and non-osteoporotic groups, and by Cobb angle into mild (<20°) and severe (>20°) scoliosis. We analyzed CT value distribution in these groups and compared the area under the curve (AUC) for predicting osteoporosis based on HU values from different vertebrae.ResultsCT HU values for L1 and L2 were significantly lower in the DLS group compared to LSS group (P < 0.05). The lowest HU values in patients with a scoliotic apex at L2 or L2-3 were observed at the scoliotic apex region, while those with the scoliotic apex at L3, L3-4, and L4 had the lowest values at L3. This pattern was more pronounced in patients with a Cobb angle >20°. In the mild scoliosis group, the lowest CT value was found at L3 when the scoliotic apex was between L2 and L4. Additionally, L4 CT HU thresholds were better at distinguishing osteoporosis than other levels (P < 0.05), swhen the scoliotic apex was located at L2 or L2-3.ConclusionsCT HU values in DLS patients, particularly with a Cobb angle >20°, decrease at the scoliotic apex. Caution is required when using HU values from L1, L2, and L3 to assess osteoporosis in patients with a scoliotic apex at L2 and L2-3.