Global Spine Journal最新文献

Study DesignRetrospective Cohort Study.ObjectivesThe purpose of this study was to identify the role of lumbar paraspinal muscle fatty infiltration using the Goutallier classification in predicting perioperative outcomes following elective lumbar surgery.MethodsA retrospective review was conducted on patients who underwent elective one- or two-level lumbar decompressions or instrumented fusions for degenerative pathology at a single institution over a 3 year period. Patients were stratified by procedure type. Data included demographics, perioperative outcomes, and the 5-item Modified Frailty Index (MFI-5). Fatty infiltration was graded at L4-5 using the Goutallier classification (intraclass correlation coefficient = 0.908). Opportunistic osteoporosis screening used computed tomography-based Hounsfield units (HU) at L1-2. The relationships between Goutallier grade, demographics, MFI-5 score, and postoperative outcomes were analyzed using Chi-squared analyses, Fisher's exact test, Analysis of Variance, and multivariable logistic and linear regression.ResultsIn total, 314 patients met the inclusion criteria. Mean age was 68.9 ± 8.6 years; mean Goutallier score was 2.2 ± 1.1 and MFI-5 was 1.3 ± 1.0. Goutallier score significantly correlated with age, American Society of Anesthesiologists grade, steroid use, MFI-5, discharge disposition, and 180 day complications and reoperation. Subgroup analyses revealed differing associations between Goutallier score and comorbidities/outcomes across procedure types. Multivariable regression confirmed Goutallier score as predictive of 180 day complications, reoperation, non-home discharge, and frailty.ConclusionGoutallier score is a predictive marker of frailty and postoperative outcomes in lumbar spine surgery. Goutallier classification is an effective tool that can aid in risk stratification for patients undergoing lumbar spinal surgery.

Study DesignCross-Sectional.ObjectivesAdult spinal deformity (ASD) affects 68% of the elderly, with surgical intervention carrying complication rates of up to 50%. Effective patient education is essential for managing expectations, yet high patient volumes can limit preoperative counseling. Language learning models (LLMs), such as ChatGPT, may supplement patient education. This study evaluates ChatGPT-3.5's accuracy and readability in answering common patient questions regarding ASD surgery.MethodsStructured interviews with ASD surgery patients identified 40 common preoperative questions, of which 19 were selected. Each question was posed to ChatGPT-3.5 in separate chat sessions to ensure independent responses. Three spine surgeons assessed response accuracy using a validated 4-point scale (1 = excellent, 4 = unsatisfactory). Readability was analyzed using the Flesch-Kincaid Grade Level formula.ResultsPatient inquiries fell into four themes: (1) Preoperative preparation, (2) Recovery (pain expectations, physical therapy), (3) Lifestyle modifications, and (4) Postoperative course. Accuracy scores varies: Preoperative responses averaged 1.67, Recovery and lifestyle responses 1.33, and postoperative responses 2.0. 59.7% of responses were excellent (no clarification needed), 26.3% were satisfactory (minimal clarification needed), 12.3% required moderate clarification, and 1.8% were unsatisfactory, with one response ("Will my pain return or worsen?") rated inaccurate by all reviewers. Readability analysis showed all 19 responses exceeded the eight-grade reading level by an average of 5.91 grade levels.ConclusionChatGPT-3.5 demonstrates potential as a supplemental patient education tool but provides varying accuracy and complex readability. While it may support patient understanding, the complexity of its responses may limit usefulness for individuals with lower health literacy.

Study DesignRetrospective comparative study.ObjectiveThis multicenter European study aimed to compare the accuracy, complication rates, and incidence of revision surgery associated with three distinct cervical pedicle screw (CPS) insertion techniques: freehand, navigation-assisted (Loop-X/O-arm), and patient-specific 3D-template guided approaches. The primary endpoint was to provide evidence to support decision-making in cervical spine instrumentation.MethodsA retrospective, observational study analyzed prospectively collected data from 97 adult patients who underwent posterior cervical fusion with CPS between January 2019 and August 2024. Screw accuracy was assessed using intraoperative or postoperative CT scans, according to the Gertzbein-Robbins classification. Intraoperative and postoperative complications were systematically evaluated.ResultsA total of 369 CPS were implanted, with an overall accuracy (Grade A/B) of 90.7%. Patient-specific 3D-templates yielded the highest accuracy (97.7% of grade A/B screws), significantly superior to navigation-assisted (85.5%) and freehand (80.0%) techniques (P < .001). The lowest accuracy was observed at the C2 level (79.4%; P < .001). Patients over 60 years of age undergoing surgery at the C2 level had a 4.7-fold increased likelihood of suboptimal (Grade > B) screw placement (P = .016). The overall rate of intraoperative and postoperative complications was significantly higher in the freehand and navigation-assisted groups (P < .05).ConclusionCPSs are safe and effective for cervical fusion, with acceptable complication rates. Patient-specific 3D templates offer superior accuracy and fewer complications, but its applicability is limited in urgent cases. Navigation provides good accuracy, but is associated with higher costs and potential technical inconveniences. Technique selection should consider surgeon expertise, resources, and patient-specific factors.

Study DesignTranslational rodent study.ObjectivesTo investigate (1) chemokine-mediated mesenchymal stem cell mobilization and homing to the intervertebral disc and (2) using this technique to mitigate intervertebral disc degeneration in a rat model.Methods(1) Recruitment of mesenchymal stem cells (MSCs) to intervertebral discs (IVD) was investigated using intradiscal chemokines. Hydrogel containing SDF-1, RANTES, MCP-1, or empty control was injected intradiscally, followed by near-infrared (NIR) imaging to observe MSC localization. (2) A rat IVD degeneration model was induced by annular puncture. Intradiscal RANTES injection and/or systemic AMD3100 injection was performed. Longitudinal imaging and histological analyses including Rutges Score (histologic degeneration) assessed IVD degeneration mitigation post-treatment up to 12-weeks. Statistical analyses included ANOVA and mixed-effects models to evaluate recruitment, retention, and regenerative potential of MSCs.Results(1) 24 rats were included in the investigation of MSC recruitment. In vivo NIR signal on 1-day post-intervention was highest with RANTES (P < .05). Ex vivo NIR signal at 14-days post-intervention was highest with RANTES (P < .05). (2) 36 IVD degeneration model rats underwent intradiscal RANTES and/or AMD3100 injection. AMD3100-treated groups showed larger nucleus pulposus (NP) volumes and reduced histologic damage, with lower Total Rutges scores (P = .004). RANTES treatment alone reduced Total Rutges scores (P = .009) and protected against IVD height loss at 6 weeks.ConclusionsIntradiscal delivery of RANTES/CCL5 promotes a sustained and targeted recruitment of MSCs to the IVD. In a rat model of IVD degeneration, administration of systemic AMD3100 and intradiscal RANTES mitigates IVD degeneration.

Study DesignSystematic review with meta-analysis.ObjectiveThis study aimed to assess the diagnostic accuracy of USG for detecting PLC injuries.MethodsA systematic search was conducted in PubMed, EMBASE, and Web of Science. Studies evaluating USG images compared with MRI or intraoperative findings for PLC injuries were included. Pooled sensitivity, specificity, and area under the ROC curve (AUC) were calculated using a bivariate model. Methodological quality was assessed using QUADAS-C, and publication bias was evaluated via Deeks' test.ResultsSix studies comprising 140 patients were included. The pooled sensitivity and specificity of USG were 0.86 (95% CI: 0.73-0.93) and 0.95 (95% CI: 0.81-0.99), respectively, with an AUC of 0.91 (95% CI: 0.88-0.93). Moderate heterogeneity was observed in specificity (I² = 51.89%), and publication bias was detected (Deeks' test, P < 0.001).ConclusionsUltrasonography shows good diagnostic performance for detecting thoracolumbar PLC, particularly involving the supraspinous and interspinous ligaments. However, its role in assessing deeper structures such as the ligamentum flavum and facet joint capsules remains inadequately validated. Therefore, USG should be considered a complementary tool, especially where MRI is unavailable or contraindicated, and further studies are required to broaden its clinical applicability.

Study designprospective study.ObjectivesThe hematogenous spread of pathogens from a distant infected area is the main route of primary spinal infections. It is expected that blood metagenomic next-generation sequencing (mNGS) has potential in the pathogen detection of primary spinal infections. The aim of this study is to compare the diagnostic performance of blood and tissue mNGS in primary spinal infections.MethodsA total of 21 patients with primary spinal infections were analyzed. The results of mNGS and culture of blood and spinal specimens were used to calculate the diagnostic efficiency-related parameters.ResultsThe positive rate, sensitivity and specificity of blood mNGS were significantly lower than those of tissue mNGS (42.86% vs 90.48%, 9.52% vs 95%, 12.5% vs 100%). The positive rate and sensitivity of blood mNGS were higher (42.86% vs 4.76, 9.52% vs 5%) than those of blood pathogen culture. Also, the sensitivity and specificity of blood mNGS were lower than tissue pathogen culture (9.52% vs 45%, 12.5% vs 100%). Moreover, the specificity of blood mNGS was the lowest among the 4 pathogen identification techniques.ConclusionsThe diagnostic performance of blood mNGS is worse than tissue mNGS in primary spinal infections. The application prospects of blood mNGS in pathogen identification of primary spinal infections are limited. Further studies will be required to investigate the diagnostic values of blood mNGS in other types of spinal infections or in subpopulations of spinal infections.