Journal of Bone and Joint Surgery, American Volume最新文献

Background: The associations between spine-specific muscle sarcopenia and clinical outcomes after cervical and lumbar spinal surgery have been investigated. However, no study has investigated the associations between cervical multifidus sarcopenia (CMS) and outcomes after laminoplasty for cervical ossification of the posterior longitudinal ligament (OPLL). The aim of the present study was to investigate whether CMS affects cervical sagittal alignment (CSA) and patient-reported outcomes (PROs) in patients with cervical OPLL who underwent laminoplasty.

Methods: A retrospective review of prospectively collected data on patients with cervical OPLL who underwent laminoplasty was conducted from 2015 to 2020. CMS was evaluated on T2-weighted magnetic resonance imaging sequences at the C5-C6 level and graded according to the Goutallier classification. CSA parameters, including the C2-C7 lordosis angle, C2-C7 sagittal vertical axis (SVA), C2 slope, and T1 slope, were measured. PROs, including visual analog scale (VAS) neck and arm pain, Japanese Orthopaedic Association (JOA), and Neck Disability Index (NDI) scores, were recorded. Patients were grouped according to the Goutallier classification of CMS, and their preoperative demographic and OPLL characteristics, preoperative and latest follow-up PROs, and preoperative, immediate postoperative, and latest follow-up CSA parameters were analyzed.

Results: A total of 134 patients with cervical OPLL were enrolled, including 36 patients with mild CMS (Goutallier grade >0 to 1.0), 47 patients with moderate CMS (grade 1.5 to 2.0), and 38 patients with severe CMS (grade 2.5 to 4.0). All patients were Han Chinese. The mean age differed significantly among the groups (p = 0.004), whereas the other demographic characteristics were comparable among the groups. CMS severity was significantly associated with the OPLL occupancy ratio. Significant differences were found in the postoperative changes in C2-C7 lordosis angle, C2-C7 SVA, C2 slope, and T1 slope among the groups. Greater CMS severity was associated with worse NDI and VAS neck pain scores at the latest follow-up.

Conclusions: In a uniform cohort of patients who underwent laminoplasty for cervical OPLL, CMS had a negative impact on CSA and PROs. These findings highlight the potential value of preoperative assessment of CMS in this patient population.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Background: Although total knee arthroplasty (TKA) is known to improve patient-reported outcome measure (PROM) scores in the short term to midterm, the long-term trajectories of both disease-specific and generic PROM scores remain unclear.

Methods: We retrospectively analyzed the prospectively collected registry data of 1,264 patients (mean age, 68.5 years; 93.7% female) who underwent primary TKA for osteoarthritis between 2005 and 2013 and completed PROM assessments at baseline and 10 years postoperatively. Disease-specific PROMs were assessed using the Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Generic PROMs were assessed using the Short Form-36 Health Survey (SF-36). Assessments were performed preoperatively and at 6 months and 1, 2, 5, 10, and 15 years postoperatively. Generalized linear models and linear mixed-effects models were used to evaluate temporal changes and subgroup differences by age and sex.

Results: All PROM scores improved significantly within 6 months after TKA. Thereafter, disease-specific PROMs showed modest changes up to 1 year, with relative stability until 5 years, whereas generic PROMs demonstrated heterogeneous patterns across different domains. Between 5 and 10 years postoperatively, WOMAC pain and stiffness scores did not show significant changes, the KSKS decreased but not significantly so, and WOMAC physical function scores exhibited small but significant deterioration that was not clinically meaningful. SF-36 domains demonstrated varied trajectories: physical and mental component scores declined by more than the minimal clinically important difference after 5 years, whereas the social functioning score showed continuous improvement, although not all changes were significant. Octogenarians demonstrated lower physical functioning scores but higher social functioning scores in the long term compared with younger patients, and female patients demonstrated inferior functional and vitality scores compared with male patients.

Conclusions: Both disease-specific and generic PROM scores after TKA improved significantly and remained superior to baseline scores over a 15-year period, although physical function scores tended to decline in the long term. In this large, predominantly female Korean cohort, the distinct age- and sex-specific trajectories highlight the importance of implementing individualized, time-adapted long-term management strategies to optimize patient outcomes.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Background: Pelvic tilt (PT) is an important sagittal parameter to be restored to the normal range in corrective surgery for spinopelvic malalignment. However, the normal value of PT varies among patients. With the introduction of the pelvic inclination angle (PIA), which is the angle subtended by the vertical axis and the line connecting the anterior pubic tubercle and the anterior superior iliac spine, we aimed to determine whether the PIA could reflect the symptom severity and whether normal PIA values exist.

Methods: The study cohort consisted of patients with spinopelvic malalignment (patient group) and normal healthy adults (normal group). In the patient group, correlation analyses were performed to investigate the relationship between the PIA and other sagittal parameters and between the sagittal parameters and patient-reported outcome measures. In the normal group, correlation analysis was performed to assess the relationship between pelvic incidence (PI) and other sagittal parameters. The radiographic parameters were compared according to PI categories.

Results: There were 162 patients in the patient group, with a mean age of 71.1 years, and 108 in the normal group, with a mean age of 32.1 years. In the patient group, the PIA strongly correlated with the conventional parameters such as PT, PI-lumbar lordosis mismatch, and T1-pelvic angle. The PIA had weak to moderate correlations with all patient-reported outcome measures, of which the correlation coefficients were similar to or greater than those of other sagittal parameters with patient-reported outcome measures. In the normal group, PI showed moderate to strong correlations with all conventional sagittal parameters except for the PIA, which correlated very weakly with PI. Unlike the other sagittal parameters, the PIA did not significantly differ among the PI categories.

Conclusions: The PIA reflected the symptom severity and had a normal value independent of PI. As an alternative to PT, the PIA can be a clinically useful parameter in evaluating and managing patients with spinopelvic malalignment.

Clinical relevance: As the PIA is independent of PI, it will be more useful in differentiating between patients with normal spinopelvic alignment and those with spinopelvic malalignment and in reflecting the clinical symptoms of patients with spinopelvic malalignment. In addition, by providing a cutoff value of 13.6°, the PIA can be used as a surgical target or to predict postoperative outcomes.

➢ The use of multirod constructs (≥3 rods) in complex spine surgery has increased as its utility has been recognized over the past decade.➢ There are multiple different rod configurations that may be utilized on the basis of the desired supplemental rod function, with each type having its own advantages and clinical indications.➢ Literature has continued to demonstrate a reduced incidence of pseudarthrosis, rod fracture, and reoperation when comparing multirod constructs with traditional dual-rod constructs.➢ The use of consistent nomenclature when describing multirod constructs will allow for more productive clinical and biomechanical research.