Global Spine Journal最新文献

Study design: Systematic review.

Objectives: The objective of this review paper was to summarize targeted molecular therapy options for spinal chordoma and chondrosarcoma, and to provide an update on the relevant clinical trials open for recruitment.

Methods: A systematic review of the current literature was performed, according to PRISMA guidelines, to summarize the latest developments in non-surgical molecular treatment options for low grade malignant primary spinal tumours. We also summarize those actively recruiting clinical trials based on clinicaltrials.gov.

Results: A total of 73 studies and completed clinical trials were reviewed. Twenty actively recruiting clinical trials (eight for chordoma and twelve for chondrosarcoma) were identified.

Conclusions: There is a strong need to find new therapeutic options to complement surgical resection and radiation therapy, which remain the cornerstone of management. Targeted therapies against molecular pathways show promise as compared to conventional chemotherapy.

Study design: Narrative Review.

Objective: The management of spinal tumors requires a multi-disciplinary approach including surgery, radiation, and systemic therapy. Surgical approaches typically require posterior segmental instrumentation to maintain long-term spinal stability. Carbon fiber reinforced pedicle screws (CFRP) are increasingly used in the oncologic setting due to reductions in both imaging artifacts and radiotherapy perturbations compared to titanium implants. We performed a review of the literature and highlight advantages and future areas of study for CFRP.

Methods: We performed a systematic review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and identified 10 articles including 573 patients. Across all studies we reviewed patient demographics, tumor types treated, hardware-related features, complication rates, recurrence, survival, and follow-up.

Results: Across 10 studies, a total of 1371 screws placed. Surgical and non-surgical complications were reported in 18.3% of patients. Disease progression at the surgical site was detected in 7.3% of patients. There was no significant difference in clinical or hardware complications between CFRP or titanium implants. The most frequent complication attributable to implanted CFRP hardware included screw breakage in 2.4% and loosening in 1.7% of patients, respectively.

Conclusion: CFRP provide a unique tool in the setting of spinal oncology. With a safety profile comparable to titanium, we review the documented advantages of CFRP posterior implants compared to titanium, while also addressing their current limitations. Additionally, we highlight several areas of future research to identify the optimal patients who will achieve the greatest benefit of CFRP.

Study design: A retrospective study.

Objectives: This study aimed to check how accurately cages were inserted and how they affected the radiological results in oblique lumbar interbody fusion (OLIF) at L2-L5.

Methods: A total of 137 patients diagnosed with lumbar degenerative disease, 184 intervertebral discs were included. We used a new cage deviation classification system on magnetic resonance imaging (MRI) to determine cage insertion accuracy. Cage deviation angles (CDA) were classified into four groups based on the angle formed by the long axis of the cage and the horizontal axis of the vertebral body. Other radiological parameters on plain radiographs and MRI were compared based on this classification.

Results: Among 183 cages, 19 were in zone Ⅰ-Ⅱ (10.32%), 163 were in zone II-III (88.59%), and two were in zone III-IV (1.09%). The median cage deviation was 4.97°. No significant differences (H = 2.479, P = .290 > .05) of CDA were found among different segments. Posterior cage deviation accounted 94.57%. The minimal, mild, moderate, and severe cage deviation was 89 (48.4%), 51 (27.7%), 30 (16.3%), and 14 (7.6%) respectively. No differences in radiological parameter changes were noted among different cage obliquity categories.

Conclusions: Approximately 98.91% of cages were placed in zones I-II and II-III. Most cages deviated posteriorly with CDA ranging minimal to moderate. Minimal to moderate cage deviation did not impact radiological outcomes significantly in OLIF at L2-L5. However, avoiding severe cage deviation is crucial to prevent contralateral traversing nerve root injuries.

Study design: Bioinformatics analysis of Gene Expression Omnibus (GEO).

Objective: Ossification of the ligamentum flavum (OLF) and ankylosing spondylitis (AS) represent intricate conditions marked by the gradual progression of endochondral ossification. This investigation endeavors to unveil common biomarkers associated with heterotopic ossification and explore the potential molecular regulatory mechanisms.

Methods: Microarray and RNA-sequencing datasets retrieved from the Gene Expression Omnibus (GEO) repository were harnessed to discern differentially expressed genes (DEGs) within the OLF and AS datasets. Subsequently, Weighted Gene Co-expression Network Analysis (WGCNA) was implemented to pinpoint co-expression modules linked to OLF and AS. Common genes were further subjected to an examination of functional pathway enrichment. Moreover, hub intersection genes were identified using the Least Absolute Shrinkage and Selection Operator (LASSO) regression, followed by an evaluation of diagnostic performance in external OLF and AS cohorts. Lastly, an analysis of immune cell infiltration was conducted to scrutinize the correlation of immune cell presence with shared biomarkers in OLF and AS.

Results: A total of 1353 and 91 Differentially Expressed Genes (DEGs) were identified in OLF and AS, respectively. Using the Weighted Gene Co-expression Network Analysis (WGCNA), 2 modules were found to be notably significant for OLF and AS. The integrative bioinformatic analysis revealed 3 hub genes (MAB21L2, MEGF10, ISLR) as shared risk biomarkers, with MAB21L2 being the central focus. Receiver Operating Characteristic (ROC) analysis exhibited a strong diagnostic potential for these hub genes. Gene Ontology (GO) analysis indicated their involvement in the positive regulation of myoblast proliferation. Notably, MAB21L2 was singled out as the optimal common biomarker for OLF and AS. Furthermore, an analysis of immune infiltration demonstrated a correlation between MAB21L2 expression and changes in immune cells. Activated CD8 T cells were identified as shared differential immune infiltrating cells significantly linked to MAB21L2 in both OLF and AS.

Conclusion: This study represents the first instance of identifying MAB21L2 as a prospective diagnostic marker for patients contending with OLF associated with AS. The research results indicate that the ECM-receptor interaction and the cell-cell adhesion may play a role in both disease processes. This newfound knowledge not only enhances our understanding of the pathogenesis behind spinal ligament ossification but also uncovers potential targets for therapeutic interventions.

Study design: Narrative Review.

Objective: Machine learning (ML) is one of the latest advancements in artificial intelligence used in medicine and surgery with the potential to significantly impact the way physicians diagnose, prognose, and treat spine tumors. In the realm of spine oncology, ML is utilized to analyze and interpret medical imaging and classify tumors with incredible accuracy. The authors present a narrative review that specifically addresses the use of machine learning in spine oncology.

Methods: This study was conducted in accordance with the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) methodology. A systematic review of the literature in the PubMed, EMBASE, Web of Science, Scopus, and Cochrane Library databases since inception was performed to present all clinical studies with the search terms '[[Machine Learning] OR [Artificial Intelligence]] AND [[Spine Oncology] OR [Spine Cancer]]'. Data included studies that were extracted and included algorithms, training and test size, outcomes reported. Studies were separated based on the type of tumor investigated using the machine learning algorithms into primary, metastatic, both, and intradural. A minimum of 2 independent reviewers conducted the study appraisal, data abstraction, and quality assessments of the studies.

Results: Forty-five studies met inclusion criteria out of 480 references screened from the initial search results. Studies were grouped by metastatic, primary, and intradural tumors. The majority of ML studies relevant to spine oncology focused on utilizing a mixture of clinical and imaging features to risk stratify mortality and frailty. Overall, these studies showed that ML is a helpful tool in tumor detection, differentiation, segmentation, predicting survival, predicting readmission rates of patients with either primary, metastatic, or intradural spine tumors.

Conclusion: Specialized neural networks and deep learning algorithms have shown to be highly effective at predicting malignant probability and aid in diagnosis. ML algorithms can predict the risk of tumor recurrence or progression based on imaging and clinical features. Additionally, ML can optimize treatment planning, such as predicting radiotherapy dose distribution to the tumor and surrounding normal tissue or in surgical resection planning. It has the potential to significantly enhance the accuracy and efficiency of health care delivery, leading to improved patient outcomes.

Study design: Systematic review, expert opinion and Delphi technique, and validity and reliability studies.

Objective: We developed Jakarta Instability Score (JIS) to identify spinal instability and the need of fusion in degenerative lumbar spinal stenosis (LSS).

Methods: This study consisted of systematic review to find predictors of spinal instability, expert opinion and modified Delphi technique to develop JIS, and validity and reliability studies of the newly developed JIS.

Results: A total of 54 studies were included in the systematic reviews to obtain predictors of spinal instability. Through expert opinion and modified Delphi technique, JIS was developed and consisted of the clinical component (back pain), dynamic radiograph component (dynamic translation and angulation), and MRI component (facet joint effusion), each of the component would be scored, and the total scoring would be from 0 to 14. The final scoring would classify patients into three groups: stable group (score of 0 to 4) in which the fusion is not needed, potentially unstable group (score of 5 to 8) in which the decision of fusion is based on surgeon's clinical judgment, and unstable group (score of 9 to 14) in which the fusion is needed. Final step of study concluded that this JIS had a high validity and reliability.

Conclusion: The newly developed JIS was a valid and reliable scoring system that could help to identify the presence of instability in LSS and can be used as a guideline to decide whether spinal fusion will be needed.

Study design: Review article.

Objectives: A review of literature on the epidemiology, natural course, pathobiology and clinical implications of vertebral endplate changes.

Methods: A literature search was performed using the Cochrane Database of Systematic Reviews, EMBASE, and PubMed. Studies published over the last 10 years were analysed. The searches were performed using Medical Subject Headings terms, and the subheadings used were "Vertebral endplate changes", "Modic changes", "Disc Endplate Bone Marrow complex".

Results: The disc, endplate (EP), and bone marrow region of the spine constitute a unified morphological and functional unit, with isolated degeneration of any one structure being uncommon. Disc degeneration causes endplate defects, which result in direct communication and a constant cross-talk between the disc and the vertebral body. This may result in a persistent inflammatory state of the vertebral bone marrow, serving as a major pain generator. This review article focuses on vertebral endplate changes and how the current understanding has progressed from the Modic classification to the Disc Endplate Bone Marrow complex classification. It provides a clear portrayal of the natural course of these alterations and their clinical implications in low back pain.

Conclusions: In light of the heightened interest and current prominence of vertebral endplate changes within the spine community, we must progress beyond the Modic changes to achieve a comprehensive understanding. The DEBM complex classification will play a major part in disc degeneration research and clinical care, representing a considerable advancement in our understanding of the vertebral endplate changes over the classical Modic changes.

Study design: Systematic Literature Review.

Objectives: To address whether TLICS or AOSpine is best used in clinical practice through assessment of interobserver and intraobserver reliability, agreement, and imaging modality performance.

Methods: This systematic literature review was reported in accordance with PRISMA 2020 guidelines. Articles were included based on meeting eligibility criteria: studies evaluating TLICS, AOSpine, and/or TL AOSIS through reliability, agreement, or imaging modality performance with adult patients (≥18) suffering from traumatic thoracolumbar fractures. Articles were acquired in April 2023 from Medline, CINAHL, and Scopus. Risk of bias was assessed through a modified COSMIN checklist. Tabulated results were separated by classification tool (TLICS or AOSpine/TL AOSIS) and reliability, agreement, or imaging modality results.

Results: Twenty-one studies were included in the final review. Interobserver and intraobserver AOSpine morphology reliability was on average superior to TLICS. Increased familiarity with the tool positively influenced both AOSpine and TLICS performance. For surgical treatment recommendation, AOSpine differentiated between stable and unstable burst fractures and guided clinician's more accurately than TLICS. Regarding conservative treatment, both TLICS and AOSpine reported similar clinical accuracy. TLICS performed significantly better when MRI was incorporated compared to CT alone. CT was sufficient as an imaging modality for AOSpine/TL AOSIS performance.

Conclusions: AOSpine outperformed TLICS in surgical reliability, agreement and did not require additional MRI imaging to improve accuracy. Limitations of evidence include low quality of available studies and significant heterogeneity in patient and observer number. Future prospective multicentre research is recommended. This study was not funded and not registered on PROSPERO.

Study design: Prospective analysis of retrospective data.

Objectives: To analyse the clinical and radiological outcomes of thoracic and thoracolumbar TB kyphosis by a posterior-only approach using kyphosis classification.

Methods: Patients with thoracic and thoracolumbar spinal TB who underwent posterior-only surgical correction for kyphotic deformity >30° were categorized into Group: A (Active TB) and Group B (Healed TB). Demographic, clinical and radiological data were collected, and kyphotic deformity was classified according to Rajasekaran classification.

Results: 52 patients with a minimum 2-year follow-up were included. Group A included 25 patients with mean preop kyphosis of 39.5° (31.2°-53.7°), and Group B included 27 patients with mean preop kyphosis of 85° (44.2°-125.2°). Among 25 patients in Group A, 19 were Type IIIA, and 6 were Type IIA kyphosis. In Group B, 18 patients were Type IIIB, 5 were Type III C, 3 were Type IIA, and 1 was IIIA kyphosis. All patients in group A underwent posterior column shortening by Smith-Peterson Osteotomy, with 14 patients requiring additional anterior column reconstruction. Patients in Group B required Closing-Opening Wedge Osteotomy (18), Halo followed by vertebral column resection (6), disc bone osteotomy (2) and pedicle subtraction osteotomy (1). Mean kyphosis at 2 years follow-up was 20.8° (11.2°-32.8°) in Group A and 53.5° (8.1°- 96.4°) in Group B.

Conclusions: Correction of kyphosis in spinal TB involves completely different strategies in active and healed disease. Hence, a posterior-only treatment approach using Rajasekaran's kyphosis classification can help surgeons in appropriate decision-making.