Global Spine Journal最新文献

Study DesignRetrospective comparative study.ObjectivesOptimal surgical treatment for low-grade L5-S1 isthmic spondylolisthesis (IS) is still subject of debate. While various surgical approaches exist, anchored stand-alone (SA) ALIF has emerged as a promising alternative technique. This study aimed to compare the efficacy, as well as the clinical and radiological outcomes of anchored SA-ALIF and posterior lumbar interbody fusion in the management of low-grade L5-S1 IS.MethodsA total of 53 patients, 26 from the anterior group and 27 from the posterior group, met the inclusion criteria. Intraoperative blood loss, operative time, radiation exposure and postoperative length of hospitalization were retrospectively evaluated. Clinical outcomes were assessed using the ODI and VAS scales. Upright lumbosacral X-ray and lumbosacral CT scan were used to evaluate spinopelvic parameters and intersomatic fusion according to Brantigan-Steffee-Fraser (BSF) scale, respectively.ResultsThe mean postoperative follow-up was 39 months. Intraoperative blood loss, radiation exposure, operative time, and postoperative length of hospitalization were significantly lower in the anterior group. Effective ODI and VAS improvement was achieved in both anterior and posterior groups. No significant differences were observed between the two groups in postoperative spinopelvic parameters assessment. Effective spinal fusion was achieved in 23 patients (88.4%) in the anterior group, and in 21 patients (77.8%) in the posterior group.ConclusionWhile both techniques effectively achieve spinal fusion and symptom relief, anchored SA-ALIF offers significant advantages over posterior fusion techniques in terms of intraoperative blood loss, radiation exposure, operative time, and postoperative length of hospitalization.

Study designProspective cohort study.ObjectivesTreatment for thoracolumbar (TL) burst fractures in neurologically intact patients remains controversial. The goal of this study was to utilize the international equipoise to determine whether surgery leads to a more rapid improvement of disability measured by minimal clinically important difference (MCID) in Oswestry Disability Index (ODI).MethodsThe primary endpoint was time to achieve an improvement in ODI of more than 12.8 points within 1 year after baseline (MCID). A post hoc analysis was conducted to assess time to minimal disability (ODI of <20). Time-to-event analyses were applied, including log rank test for equality of survivor functions, Kaplan Meier survival curves and Cox proportional hazard models.ResultsOne hundred and ninety-eight patients were included (122 surgical and 76 non-surgical patients). Median time to achieve MCID in ODI (12.8 points) from baseline was similar between the two groups (25.0 days vs 25.5 days, P = 0.517). Post hoc analysis showed a potential trend towards a short time to achieve minimal disability for the surgical group (69.0 days vs 82.0 days, P = 0.057). Similar results were obtained when excluding all patients with suspected PLC injury.ConclusionSurgically and non-surgically treated patients with thoracolumbar burst fractures without neurological injury were similar in terms of time to reaching MCID in ODI at 1 year. Surgical patients may reach minimal disability faster than nonsurgical patients, but additional large scale studies are warranted.Level of EvidenceTherapeutic Prospective Comparative Cohort Study Level II.

Study DesignAmbispective study.ObjectivesTo determine the long-term natural history of non-surgically treated patients with myopathy and spinal deformity.MethodsData were analyzed from 118 files from a children's rehabilitation hospital. Seventeen patients were operated on; the remaining 101 patients (86%) were managed conservatively. Retrospective data included demographics, medical history, respiratory and mobility status, Cobb angle (CA), and pelvic obliquity (PO). Prospective data were obtained via telephone interviews and included the Scoliosis Research Society (SRS-22r), World Health Organization Quality of Life (QoL) (WHO-QoL) and Functional Independence Measure for Children (WeeFIM).ResultsOne hundred and one patients with myopathy and scoliosis did not have surgery and were followed for up to 33 years. Their mean age at first visit was 5.45 ± 5.27 years. CA and PO at the first visit were 27.05 ± 27.07 and 7.74 ± 9.81°, worsening to 46.95 ± 39.26 and 15.61 ± 8.57° at last visit. Respiratory data for 67 patients showed 45 who remained stable and 14 who worsened moderately and 5 severely. Mobility status worsened but not significantly. Of the 24 participants who responded to the survey (mean age 17.41 ± 10.84 years), 92% are single or divorced. They reported being generally satisfied with their QoL, although their functional scores indicated limited independence.ConclusionsDespite worsening of scoliosis and limited independence, participants were generally satisfied with their QoL.

Study DesignCross sectional.ObjectiveSpin bias, where authors distort findings to overstate efficacy, is prevalent in the medical literature. The comparative superiority of polyetheretherketone (PEEK) and titanium (Ti) cages in spinal fusion remains controversial. This study aims to assess the prevalence of spin bias in meta-analyses and systematic reviews comparing PEEK vs Ti cages in spinal fusion.MethodsThe PubMed, Embase, and Web of Science databases were searched to identify meta-analyses and systematic reviews comparing PEEK and titanium cages in spinal fusion. Included studies were assessed for the presence of the 9 most severe types of spin bias. This study also graded the quality of these articles using A Measurement Tool to Assess systematic Reviews 2 (AMSTAR 2) criteria.ResultsThe search resulted in 2352 articles, of which 13 met the inclusion criteria. Spin bias was identified in 8/13 (61.54%) of the included studies, with the most prevalent types being Type 3 (38.46%) and Type 5 (30.77%). Using AMSTAR 2, 1/13 (7.69%) studies were rated as critically low quality, 4/13 (30.77%) as low, 8/13 (61.54%) as moderate, with none rated as high.ConclusionsSpin was found in 61.54% of the reviews comparing PEEK and Ti cages in spinal fusion, with none achieving a high-quality rating. Surgeons must critically evaluate these articles for bias prior to utilizing them in clinical decision making.

Study DesignA comparative analysis of AI-generated vs human-authored personal statements for spine surgery fellowship applications.ObjectiveTo assess whether evaluators could differentiate between ChatGPT- and human-authored personal statements and determine if AI-generated statements could outperform human-authored ones in quality metrics.Summary of Background DataPersonal statements are key in fellowship admissions, but the rise of AI tools like ChatGPT raises concerns about their use. While previous studies have examined AI-generated residency statements, their role in spine fellowship applications remains unexplored.MethodsNine personal statements (4 ChatGPT-generated, 5 human-authored) were evaluated by 8 blinded reviewers (6 attending spine surgeons and 2 fellows). ChatGPT-4o was prompted to create statements focused on 4 unique experiences. Evaluators rated each for readability, originality, quality, and authenticity (0-100 scale), determined AI authorship, and indicated interview recommendations.ResultsChatGPT-authored statements scored higher in readability (65.69 vs 56.40, P = 0.016) and quality (63.00 vs 51.80, P = 0.004) but showed no differences in originality (P = 0.339) or authenticity (P = 0.256). Reviewers could not reliably distinguish AI from human authorship (P = 1.000). Interview recommendations favored ChatGPT-generated statements (84.4% vs 62.5%, OR: 3.24 [1.08-11.17], P = 0.045).ConclusionChatGPT can produce high quality, indistinguishable spine fellowship personal statements that increase interview likelihood. These findings highlight the need for nuanced guidelines regarding AI use in application processes, particularly considering its potential role in expanding access to high-quality writing assistance and editing.

Study DesignRetrospective case series.ObjectiveThe single-position prone lateral lumbar interbody fusion (P-LLIF), which eliminates the need to change patient decubitus during the procedure, represents a modification of the traditional lateral lumbar interbody fusion (LLIF). This pioneering study aims to investigate the positional shifts of retroperitoneal organs and changes in lumbar lordosis angle across different decubitus, providing novel insights into the biomechanics of LLIF.MethodsEighteen patients scheduled for LLIF were included. CT scans were performed in 3 positions: prone, right lateral, and oblique decubitus. Measurements included the anatomical positions of the psoas major, abdominal aorta, left common iliac artery, and left kidney at intervertebral disc levels, as well as changes in lumbar lordosis angle across the 3 positions.ResultsIn the prone decubitus compared to the lateral decubitus: The thickness of the psoas major increased by 4.07 ± 3.41 mm. The abdominal aorta shifted laterally by 2.29 ± 2.79 mm. The left common iliac artery shifted laterally by 1.98 ± 3.54 mm. The kidney moved anteriorly by 6.97 ± 5.84 mm. The lumbar lordosis angle increased by 7.73 ± 3.76°. In the oblique decubitus compared to the lateral decubitus: The thickness of the psoas major increased by 3.14 ± 3.36 mm. The abdominal aorta shifted laterally by 1.59 ± 2.82 mm. The left common iliac artery shifted laterally by 2.45 ± 4.51 mm. The kidney moved anteriorly by 3.92 ± 4.70 mm. The lumbar lordosis angle increased by 3.04 ± 3.55°.ConclusionP-LLIF induces significant positional changes in retroperitoneal organs and increases lumbar lordosis angle compared to traditional LLIF. These findings offer critical insights for preoperative planning and underscore the importance of optimizing safety protocols in P-LLIF procedures.

Study DesignScoping review.ObjectiveTo review the literature on complications related to uniportal and unilateral biportal endoscopic techniques for lumbar spinal stenosis, identify areas needing further clarification, and enhance the understanding of these techniques.MethodologyA scoping review was conducted in September 2024 across five databases (Google Scholar, Medline, Embase, PubMed, and Web of Science) on complications related to uniportal and unilateral biportal interlaminar endoscopic decompression for lumbar spinal stenosis. Descriptive characteristics, trends, and regional distribution of studies were summarized. Study types, findings, and complications for each technique were tabulated. A comparison of complication rates was performed between the two techniques to assess their relative safety and outcomes.ResultsA total of 38 studies involving 2426 patients (17 Uniportal, 17 Biportal, 4 comparing both) were analyzed, with L4-L5 being the most common level operated. The overall complication rate was 2.7% for uniportal and 2.2% for biportal, with reporting inconsistencies noted. Persistent symptoms after surgical decompression were more common in the uniportal group (P = 0.003), while postoperative headaches were higher in the biportal group (P = 0.007). However, the number of studies reporting these complications was limited.ConclusionBoth uniportal and unilateral biportal endoscopic techniques are effective for lumbar spinal canal decompression, with no significant difference in complication rates. However, inconsistent reporting across studies limits meaningful meta-analyses. Future research should standardize the reporting of complications to ensure more reliable results and improve research quality.

Study DesignRetrospective Cohort Study.ObjectivesThis study sought to analyze predictors of delayed spine surgery and their impact on postoperative adverse outcomes.MethodsThis retrospective cohort study analyzed patients who underwent spine surgery from the National Surgical Quality Improvement Program database from 2015 to 2020. Delayed spine surgery was defined as the interval from admission to operation exceeding the 95th percentile of the total population or lasting >3 days. Multivariate regression models were used to estimate probabilities of outcomes after adjusting for individual risk factors. The primary outcome included mortality, along with secondary measures including nonroutine discharge, extended length of stay (LOS), major and minor postoperative complications, Clavien-Dindo grade IV complications (CDIV), readmission, and reoperation rates.ResultsOf 362 788 patients, 16 664 (4.59%) experienced a delay in surgery. The adjusted odds ratios for outcomes predicted by delayed surgery were mortality (1.452, 1.251-1.685), nonroutine discharge destination (3.447, 3.285-3.618), extended LOS (3.650, 3.473-3.837), minor postoperative complications (1.462, 1.370-1.559), major postoperative complications (1.607, 1.511-1.709), Clavien-Dindo grade IV complications (1.469, 1.356-1.592), readmission (1.499, 1.401-1.604), and reoperation (1.420, 1.303-1.547). ROC analysis showed that GNRI has an excellent discriminative power (C-statistic = 0.801) for delayed surgery. There is little incremental gain from adding other indices including frailty and perioperative conditions and status to GNRI (C-statistic of the compound index = 0.809).ConclusionsPre-operative delays in spine surgery independently predict increased postoperative morbidity and mortality. Surgical delay was associated with higher GNRI. These findings highlight the importance of timely surgeries to minimize complications and reduce healthcare costs.