Global Spine Journal最新文献

Study DesignLiterature review with clinical recommendations.ObjectiveSpinal metastases represent a late complication of cancer and a major factor in decreased quality of life. The role of surgery for specific indications for spinal metastases is well established. Given the significant morbidity associated with spine surgery in this frail population, efforts are ongoing to decrease the surgical footprint. The objective of this study is to provide the readers with a concise curation of the latest spine literature on reducing the surgical footprint for spine metastases and clinical recommendations for how the practicing clinician should interpret and make use of this evidence.MethodsThe latest spine literature in the topic of reducing the surgical footprint for spine metastases was reviewed and clinical recommendations were formulated. The recommendations are dichotomously graded into strong and conditional based on the integration of scientific methodology and content expert opinion. This opinion considers experience and practical issues such as risks, burdens, costs, patient values, and circumstances.ResultsFour high impact studies were selected for review. The findings suggest that surgery plays a key role in improving patients' quality of life, but incidence of adverse events remains high and hence methods to decrease surgical morbidity are necessary. The integration of radiation into the treatment algorithm allows for less extensive surgical procedures and SBRT should be strongly considered after surgery for spine metastases in appropriate patient populations. Implementation of enhanced recovery after surgery (ERAS) protocols reduce perioperative morbidity for both open and minimally invasive surgeries and should be considered on an institutional level. Utilization of minimally invasive surgical stabilization should be considered as it results in fewer post operative complications, lower infection rates, less blood loss during surgery, and a shorter hospital stay compared to open stabilization of unstable pathology thoracolumbar fractures.ConclusionsThe role and benefits of surgery for metastatic spine disease are well established, yet surgery carries significant risk for adverse events which may negatively affect overall cancer care. Methods for reducing the surgical footprint include incorporation of stereotactic radiation allowing less extensive surgery, implementation of ERAS protocols and utilization of minimally invasive surgical strategies.

Study DesignProspective, randomized controlled study.ObjectiveAssess early radiological outcomes in transforaminal lumbar interbody fusion (TLIF) with 3D-printed porous titanium (3DPPT) compared to PEEK.MethodsSingle-blinded prospective, randomized controlled trial comparing 1-2 level TLIF with micro- & nano-textured, 3DPPT vs PEEK cages from 11/2021 to 5/2023. Interbody fusion was assessed on CT at 6 months according to Brantigan and Steffee method, modified to describe the Fraser definition of locked pseudoarthrosis [(BSF) scale]. Primary outcome was radiographic fusion at 6 months. ResultsInitial study protocol included 70 total patients but was ended early given the significance on interim analysis. Amongst 17 patients with 25 interbody levels implanted, 10 3DPPT and 15 PEEK cages were implanted. 3DPPT levels had a significantly higher rate of successful fusion (BSF-3) at 6 months compared with PEEK (100% vs 0.0%, P < 0.001). The posterior probability that 3DPPT increased the odds of fusion versus PEEK was > 99.9%, indicating a near-certain beneficial effect. Using a Bayesian mixed-effects model, the predicted probability of 6-month BSF-3 fusion was 9.0% for PEEK and 91.2% for 3DPPT. There were no significant differences in lumbar pathologies, level of fusion, number of fused levels, cage height, length of hospital stay, surgery duration, postoperative complications, subsidence, or reoperations.ConclusionsThe rate of successful lumbar interbody fusion at 6 months was significantly higher in 3DPPT levels compared to PEEK. 3DPPT may accelerate the rate and quality of bony fusion. Additional studies are needed to further delineate the impact of these radiographical findings on long-term clinical outcomes.

Study DesignModified Delphi study.ObjectivesTelementoring, the practice of providing remote guidance and teaching from a distance using telecommunication technology, has demonstrated feasibility and value in assisting surgeons in remote locations. However, limited evidence exists regarding its effectiveness in improving surgeon performance. This study aimed to develop metrics to assess spine surgeon performance in scoliosis surgery, potentially within the context of a telementoring training program.MethodsTen expert spine surgeons participated in a four-round modified Delphi process including both online and in-person meetings. The resulting metrics were validated for objective assessment by eleven surgeons, who reviewed and rated a video recording using the established rubric.ResultsThe final set of metrics, comprising 50 procedural steps and 28 error categories, was unanimously approved by the panel. Additionally, the panel agreed that utilizing cameras, smart lenses, and output from intraoperative imaging monitors would provide sufficient visibility for assessing both steps and errors.ConclusionsA set of assessment metrics for adolescent idiopathic scoliosis surgery was successfully defined and validated by reviewing example videos. The longer-term research objective is to employ this rubric to assess surgeon's performance throughout a telementoring program, thus assessing its educational impact. The rubric could also be used in other contexts, such as live surgical observation.

Study DesignRetrospective Cohort Study.ObjectiveThe aim of this study was to evaluate the efficacy of our proposed surgical procedure named unilateral exposure channel-assisted (UCA) laminoplasty in treating degenerative cervical myelopathy (DCM), and the postoperative volume changes of cervical paraspinal muscles.MethodsFrom January 2020 to January 2022, 104 patients with DCM underwent unilateral open-door laminoplasty, among which, 63 patients underwent UCA laminoplasty (UCA group) and 41 patients underwent traditional laminoplasty (LP group). The radiological and clinical parameters as well as postoperative complications were recorded and analyzed before operation and during the follow-up.ResultsThe operation was completed successfully for all patients from both groups, who showed significant but comparable improvement in clinical outcome indicators including mJOA score, Neck pain VAS score, NDI score and radiological indicators including spinal canal diameter and area at the final follow-up compared to pre-operation. When conducting the intra-group comparison, less intraoperative time consumption and blood loss, less postoperative drainage and lower incidence of axial symptoms were observed in patients from UCA group than LP group. Furthermore, we found better preservation of C2-7 cobb angle, cervical curvature index (CCI) and cervical paraspinal muscle on the hinge side in patients underwent UCA laminoplasty than traditional laminoplasty.ConclusionThe UCA laminoplasty showed similar efficacy on alleviating clinical symptoms, and priority on maintaining cervical sagittal balance, minimizing intraoperative invasion, speeding up postoperative rehabilitation, reducing paraspinal muscle atrophy and postoperative axial symptoms when compared with traditional unilateral open-door laminoplasty.

Study DesignRetrospective cohort study.ObjectivesHypothyroidism is associated with increased perioperative risks across various surgical specialties and has recently been linked to hematologic and short-term complications following spinal fusion. However, its impact on long-term mechanical complications remains unclear. This study aims to evaluate short-term (45-day) and long-term (2-year) medical and mechanical complications in hypothyroid patients undergoing primary lumbar fusion.MethodsA retrospective analysis was conducted using the TriNetX database to identify patients who underwent lumbar fusion between 2002 and 2022 with at least 2 years of follow-up. Patients with preoperative hypothyroidism (n = 3,348, identified via ICD-10-CM code E03.9) were propensity score-matched 1:1 to euthyroid controls based on demographic and clinical risk factors.ResultsAfter matching (n = 2850 per cohort), hypothyroid patients had higher rates of sepsis at 45 days (2.1% vs 1.3%; P = 0.019; RR: 1.62, 95% CI [1.08-2.44]). At 2 years, they had increased risks of chronic device-related infection (0.7% vs 0.3%; P = 0.019; RR: 2.27, 95% CI [1.12-4.61]), wound disruption (3.6% vs 2.7%; P = 0.031; OR: 1.35, 95% CI [1.03-1.75]), and proximal junctional kyphosis (3.2% vs 2.3%; P = 0.017; RR: 1.42, 95% CI [1.06-1.90]). No significant differences were observed in readmissions, revision surgery, or pseudoarthrosis rates.ConclusionsHypothyroidism is a risk factor for early and late postoperative complications in patients undergoing primary lumbar fusion. Appropriate preoperative optimization with thyroid hormone supplementation to achieve euthyroid status could potentially minimize the incidence of developing notable postoperative medical and mechanical complications.

Study DesignRetrospective cohort study.ObjectivesThe SpineJack®-system represents a new generation of kyphoplasty for the treatment of traumatic and osteoporotic fractures. The aim of this study was to analyze the usage, safety and efficacy of the SpineJack®-system, in both osteoporotic and non-osteoporotic fractures.Methods310 patients with vertebral fractures treated with the SpineJack®-system between November 2014 and December 2022 were analyzed. Demographics, intraoperative parameters and outcomes were assessed. A subgroup analysis was performed for traumatic vertebral fractures (tVCFs) and osteoporotic vertebral fractures (oVCFs).ResultsSpineJack®-kyphoplasty was performed for 157 (47.4%) oVCFs and 153 (46.2%) tVCFs. Stand-alone SpineJack®-kyphoplasty was performed in 128 patients, while 182 patients underwent combined procedures. The mean pain reduction from admission to discharge was 3.8 (range 3-10, SD 2.7). Opioids were administered for an average of 4.6 days (range 0-72 days, SD 7.2 days). The overall mean hospital length of stay was 6.1 days, significantly shorter for patients undergoing stand-alone SpineJack® procedures at 4.8 days (SD 6.9 days). The most common complication observed was cement extravasation in 29 patients (8.8%), followed by neurological symptoms in 8 patients (2.4%) and surgical site infections in 4 patients (1.2%). Notably, no surgical site infections were recorded in the stand-alone SpineJack®-group.ConclusionPercutaneous stent-kyphoplasty (SpineJack®-system) appears to be a safe and effective therapeutic option, whether used as a stand-alone procedure or in combination with other interventions, for osteoporotic and non-osteoporotic vertebral fractures.

Study DesignRetrospective study.ObjectivesTo investigate the prevalence of cervical kyphosis, identify factors influencing cervical sagittal alignment and analyze its relationship with spino-pelvic parameters in asymptomatic children and adolescents.Methods410 asymptomatic children and adolescents aged 4-18 years were included. Cervical sagittal alignment types and radiographic parameters were measured in the full-length spine X-ray. Three groups were assigned according to Toyama method: lordotic group, straight and sigmoid group, kyphotic group. Participants were stratified by gender and age, and differences in spinal parameters were analyzed. To determine factors influencing cervical sagittal alignment, a multinomial logistic regression was conducted.ResultsAmong the 410 participants, 119 (29.0%) were classified as lordotic, 170 (41.5%) as straight, 5 (1.2%) as sigmoid, and 116 (28.3%) as kyphotic of the cervical sagittal alignment. Females exhibited a higher prevalence of kyphosis compared to males (35.8% vs 19.0%). Furthermore, kyphosis prevalence increased with age, from 0% in the 4-6-year-old group to 39.2% in the 16-18-year-old group. Strong positive correlations were observed between T1 slope and C2-C7 Cobb angle (r = 0.667, P < 0.01), as well as between lumbar lordosis and sacral slope (r = 0.758, P < 0.01). Age and C2-C7 Cobb angle were identified as predictors of cervical sagittal alignment via multinomial logistic regression analysis.ConclusionsThis study revealed that cervical kyphosis prevalence was comparable to lordosis in asymptomatic pediatric population, which challenged the traditional view of kyphosis as pathological. Additionally, cervical sagittal alignment showed significant gender- and age-related differences. These findings contribute to understanding pediatric cervical morphology and refining surgical strategies.

Study DesignScoping Literature Review.ObjectiveThe aim of this literature review is to examine the results of both skip laminectomy and oblique corpectomy in the setting of degenerative cervical myelopathy (DCM).MethodsA scoping review of the relevant literature examining the efficacy of cervical skip laminectomy and oblique corpectomy in patients with DCM was conducted using the Medline database. Our review strategy aimed at answering two research questions. #1: Do clinical outcomes differ between patients undergoing cervical laminoplasty vs skip laminectomy in the setting of myelopathy. #2: Which outcomes can oblique corpectomy provide, and how its related complication profile differs from other motion preserving procedures? What is the incidence of persistent myelopathy requiring reoperation following oblique corpectomy?ResultsOur query identified 43 potentially relevant articles. For questions 1, 3 were deemed relevant to the research question posed. For question 2, 6 articles were deemed relevant to the research question posed. Both cervical skip laminectomy and cervical oblique corpectomy are viable options for the treatment of DCM. Skip laminectomy compared to laminoplasty resulted in at least equivalent results in regard to functional outcomes and retained range of motion. Oblique corpectomy in appropriately indicated patients results in improved functional outcomes. It carries the unique increased risk of temporary and permanent Horner's syndrome compared to other motion preserving cervical procedures.ConclusionAdditional well designed comparative studies are required to draw firm conclusions in the treatment of cervical myelopathy with these alternative motion preserving techniques.