Journal of neurosurgery. Spine最新文献

Objective: The aim of this study was to compare the predictive efficacy of quantitative CT (QCT)-based endplate volumetric bone mineral density (EP-vBMD) and MRI-based endplate vertebral bone quality (EBQ) score for cage subsidence (CS) after lateral lumbar interbody fusion (LLIF).

Methods: A retrospective study was conducted on patients who underwent single-level LLIF in conjunction with pedicle screw fixation at the authors' institution between January 2019 and April 2023. The volumetric bone mineral density (vBMD) was measured based on preoperative CT using phantom-less QCT software. Measurement of the VBQ score was based on preoperative MRI. CS was defined as a decrease of more than 2 mm in the midpoint height of the intervertebral space. The receiver operating characteristic (ROC) curve of the EP-vBMD and EBQ for predicting CS was drawn, and the predictive efficacy of the two methods was compared using the Delong test. Clinical outcomes, including the visual analog scale for low back pain (VAS-BP), VAS for leg pain (VAS-LP), and Oswestry Disability Index (ODI) scores were assessed preoperatively, postoperatively, and at the 1-year follow-up.

Results: Ninety-seven patients who underwent LLIF were included in this study, including 31 patients with CS and 66 patients with no CS (NCS). No significant differences were observed between the two groups in VAS-BP, VAS-LP, or ODI scores preoperatively, postoperatively, or at the 1-year follow-up (all p > 0.05). The EP-vBMD of the CS group was lower than that of the NCS group, and EBQ was higher than that of the NCS group. The area under the ROC curve (AUC) of EP-vBMD for predicting CS was larger than that of global and segmental vBMD. The AUC of the EBQ for predicting CS was larger than that of global and segmental VBQ, and the AUC of EP-vBMD was larger than that of the EBQ. The combined prediction model of EP-vBMD and EBQ had the largest AUC value (0.899), but it was not significantly different from EP-vBMD alone (p = 0.547).

Conclusions: The regional endplate BMD assessment based on QCT and MRI can effectively predict CS after LLIF, and it has better predictive efficiency than the global or surgical segmental vertebrae BMD measurement. EP-vBMD is superior to EBQ in predicting CS. The prediction efficiency of EP-vBMD combined with EBQ was better than EBQ alone, but not better than EP-vBMD.

Objective: Multipoint pelvic fixation with multirod constructs is increasingly used for long-segment deformity constructs to reduce rates of distal failure. However, more robust distal fixation may negatively impact proximal junction biomechanics, and this potential relationship has not been extensively studied.

Methods: Standard nondestructive flexibility tests (7.5 Nm) were performed on 7 cadaveric specimens (L1-pelvis) to assess intervertebral flexibility (range of motion [ROM]), rod strain, and screw bending moments along a posterior fusion construct (pedicle screw and rod [PSR]) spanning L2-S1, supplemented by bilateral primary S2 alar-iliac (S2AI) fixation (2 S2AI screws and 2 rods), followed by additional S2AI screw placement and bilateral accessory rod placement spanning L4-S2AI (4 S2AI screws and 4 rods). Four conditions were tested for each specimen: 1) intact; 2) L2-S1 PSR; 3) L2-S2AI PSR; and 4) L2-S2AI plus L4-S2AI. Data were analyzed using repeated-measures ANOVA.

Results: Seven cadaveric specimens were included. Proximal rod strain at the L2-3 level did not change across the varying test conditions in the 7 specimens tested (p > 0.05 for all conditions). There was no significant difference detected in proximal screw strain across conditions (p > 0.05). Finally, no significant difference was found in L2-3 ROM (p > 0.05) across instrumented variations, all of which were more rigid than intact specimens.

Conclusions: Pelvic fixation with 2 or 4 screws and 2 or 4 rods, respectively, did not significantly alter proximal junction screw or rod strain in a cadaveric model. Robust pelvic fixation might protect against distal failure without deleterious effects on the proximal junction.

On the screen, Christopher Reeve was Superman. Off-screen, Reeve was an avid equestrian who experienced arguably one of the most famous horse riding accidents to date when a fall from the saddle led to comminuted C1 and C2 fractures with an associated spinal cord injury that left him quadriplegic. Reeve publicly endured a grueling rehabilitation including personalized training plans and experimental treatments coupled with severe depression. With his family and friends by his side, Reeve shocked everyone when he was able to lift a finger on his left hand and feel the hugs of his family several years after being diagnosed with an American Spinal Injury Association grade A injury. He went on to establish the Christopher & Dana Reeve Foundation to advocate for research funding and quality-of-life programs for patients with spinal cord injury. Unfortunately, Christopher Reeve died in 2004. However, his legacy lives on in the lasting impact he made in spinal cord injury awareness and in the continued work of his children through the Christopher & Dana Reeve Foundation. To the authors' knowledge, this is the first comprehensive look at the life, injury, and legacy of Christopher Reeve and his foundation now 30 years after such a fateful accident.

Objective: Anterior cervical discectomy and fusion (ACDF) is an established treatment for cervical degenerative disc disease; however, the procedure can cause loss of cervical spine range of motion and potentially accelerate adjacent segment degeneration. Cervical disc arthroplasty (CDA) seeks to preserve native motion of the cervical spine, which can theoretically reduce the incidence of adjacent level degeneration. The literature regarding the relative efficacy of ACDF versus CDA remains inconsistent. In this study, the authors investigate the difference in outcomes between ACDF and CDA and identify factors contributing to the heterogeneity in the literature.

Methods: The Ovid, Embase, Scopus, Cochrane, and ClinicalTrials.gov databases were systematically searched from inception to September 5, 2023, for randomized controlled trials (RCTs) comparing ACDF and CDA for degenerative disc disease. Studies were extracted by two authors and verified by a third. Random-effects meta-analysis was performed. The primary outcome was the difference in clinical outcomes between the two surgical groups. The secondary outcomes were the differences in radiological outcomes, surgical characteristics, complication rates, and hospital lengths of stay. The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration no. CRD42023469204) and adhered to the PRISMA guidelines.

Results: From 584 articles uploaded to the Covidence platform for screening, 35 studies derived from 25 RCTs were included in this systematic review and meta-analysis. A total of 4530 patients were treated with ACDF (2081) and CDA (2449). Forty-six percent of the patients (2063) were male, and the mean age of the study cohort was 45 ± 3 years. In terms of the primary outcome, CDA showed higher rates of neurological and overall success. Regarding the secondary outcomes, CDA demonstrated a significantly lower rate of adjacent level disease, higher rate of heterotopic ossification, and greater range of motion at the operated level. Additionally, CDA had lower rates of reoperation but significantly longer operative times than ACDF. The inclusion of myelopathic patients and variations in follow-up between the surgical groups contributed to the observed effect heterogeneity among studies.

Conclusions: In this study, CDA showed comparable or potentially greater success in overall and neurological outcomes, along with a lower incidence of adjacent level degeneration and reoperation rates but longer operative times.

Objective: The aim of this retrospective study was to investigate the relationship between postoperative Roussouly sagittal profile changes and patient outcomes.

Methods: From a prospectively collected, single-center database, the authors reviewed the records of patients with adult spinal deformity (ASD) who had clinical and radiographic data from baseline to 2 years after surgery. The patients were stratified by their Roussouly curve type (current sacral slope-based and "theoretical" pelvic incidence-based types). Means comparison tests (ANOVA and chi-square) were used to assess differences among Roussouly groups. Backstep logistic regression analyses were used to analyze associations between Roussouly sagittal profile changes and patient outcomes, including minimum clinically important differences (MCIDs) in functional metrics.

Results: Five hundred twenty-five patients, 79% of whom were female, were included in this study. The mean age of the cohort was 60.8 ± 14.1 years, BMI was 27.2 ± 5.5 kg/m2, and Charlson Comorbidity Index score was 1.72 ± 1.68. According to the Roussouly classification, 8.3% of patients had a Roussouly type 1 (R1) curve, 53.6% type 2 (R2), 26.3% type 3 (R3), and 11.9% type 4 (R4). Overall, 39% of patients had a changed Roussouly shape postoperatively: 59% had R1, 58.5% R2, 48.1% R3, and 26.7% R4 (p < 0.001). Forty-eight percent of patients matched the theoretical Roussouly type postoperatively (41% R1, 41.5% R2, 51.9% R3, and 73.3% R4, p < 0.001). When controlling for baseline clinical and radiographic differences, the Roussouly type changes associated with a higher risk of proximal junctional kyphosis or proximal junctional failure were as follows: R1 to R2 (OR 2.5, 95% CI 1.1-5.6, p = 0.024), R2 to R4 (OR 2.8, 95% CI 1.1-7.7, p = 0.039), and R3 to R4 (OR 2.3, 95% CI 1.1-4.9, p = 0.033). R4 to R3 switches had the highest mechanical complication risks (OR 3.4, 95% CI 1.2-9.4, p = 0.016). R1 to R2 changes had the highest rate of attaining an MCID in the Oswestry Disability Index at 6 weeks (23.5%, p = 0.004). Roussouly type changes were not associated with differences in the MCID on the refined 22-item Scoliosis Research Society patient outcome questionnaire (SRS-22r) up to 2 years after surgery.

Conclusions: While a significant portion of patients matched their postoperative theoretical Roussouly type, many of those matched at baseline were prone to become unmatched postoperatively. Postoperative Roussouly shape changes influence patient outcomes and should be accounted for when planning ASD surgery.

Objective: The Spinal Laminectomy Versus Instrumented Pedicle Screw trial reported the superiority of fusion compared to laminectomy alone for patients with grade 1 degenerative spondylolisthesis. However, it remains unclear if the advantages of fusion extend to using minimally invasive surgical (MIS) techniques. This study compared 60-month outcomes following minimally invasive transforaminal lumbar interbody fusion (TLIF) versus decompression for grade 1 spondylolisthesis.

Methods: The authors analyzed patients who underwent single-segment MIS TLIF or MIS tubular decompression for grade 1 degenerative lumbar spondylolisthesis from the prospective Quality Outcomes Database's 12 highest enrolling sites (SpineCORe team). Uni- and multivariable analyses compared outcomes including the Oswestry Disability Index (ODI), numeric rating scale (NRS) for back pain (NRS-BP), NRS for leg pain (NRS-LP), EuroQol-5D (EQ-5D), North American Spine Society (NASS) satisfaction score, and cumulative related reoperation rate.

Results: Of 608 total patients, 143 underwent MIS TLIF (n = 72, 50.3%) or MIS decompression (n = 71, 49.7%). The overall study cohort's 60-month follow-up rate was 86.8%. The MIS TLIF cohort was significantly younger (mean 62.1 ± 10.6 vs 72.3 ± 9.7 years), had lower rates of diabetes (9.7% vs 22.5%), higher rates of private insurance utilization (65.3% vs 26.8%), was more likely to be employed preoperatively (54.2% vs 23.9%), and had higher baseline NRS-BP scores (mean 6.9 ± 2.6 vs 5.6 ± 3.2, p < 0.05). Otherwise, the cohorts were similar in baseline characteristics. Sixty months postoperatively, both cohorts had significant mean improvements in ODI, NRS-LP, NRS-BP, and EQ-5D scores compared to their respective baselines (p < 0.05). MIS TLIF had a significantly lower reoperation rate (2.8% vs 15.5%, p = 0.008). The minimal clinically important difference rates for the ODI, NRS-LP, NRS-BP, and EQ-5D were equivalent (p > 0.05). MIS TLIF demonstrated significantly larger reductions in NRS-BP scores (-4.0 ± 3.5 vs -2.2 ± 3.4) and higher rates of satisfaction (NASS score 1 or 2 = 87.7% vs 74.5%; p < 0.05) but similar absolute 60-month ODI, NRS-LP, NRS-BP, and EQ-5D scores (p > 0.05). On multivariable analyses, fusion significantly reduced the odds of reoperation (OR 0.07, 95% CI 0.008-0.39; p = 0.006), but fusion status was neither a significant predictor of ODI, NRS-LP, NRS-BP, or EQ-5D scores, nor NASS satisfaction scores.

Conclusions: Regardless of the surgical approach, a dorsal-based MIS technique was associated with clinical benefits in patients with grade 1 spondylolisthesis. These 60-month results demonstrate that MIS TLIF and MIS decompression are associated with similar patient-reported outcomes. However, MIS TLIF is associated with significantly fewer reoperations.

Objective: The MRI-based vertebral bone quality (VBQ) score has emerged as a safe, convenient alternative to dual energy x-ray absorptiometry (DEXA) and CT for preoperative bone health assessment, which correlates with the outcomes of spine surgery. In this study, the authors aimed to systematically review the literature characterizing the utility of the VBQ score in predicting postoperative complications to inform operative planning and patient management.

Methods: This systematic review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration no. CRD42024542755) and adhered to PRISMA guidelines. PubMed, Embase, and Cochrane databases were searched for all original research published between January 1, 2020, and May 20, 2024, that had analyzed the VBQ score as a predictor of postoperative complications following spine surgery including pedicle screw loosening (PSL), cage subsidence (CS), adjacent segment disease (ASD), proximal junctional kyphosis (PJK) or proximal junctional failure (PJF), distal junctional kyphosis (DJK) or distal junctional failure (DJF), vertebral refracture, and need for reoperation. Applications of the VBQ score and its derivatives were characterized across methods, demographics, and outcomes. The Newcastle-Ottawa Scale was used for study quality assessment.

Results: Twenty-seven studies comprising 4068 patients, 60.5% of whom were female, with a mean age of 58.5 ± 17.0 years were eligible for study inclusion. Sixteen studies used the traditional VBQ score calculation (L1-4/L3); alternatives included C3-6/C2 (5 studies), C3-6/C5 (1 study), L1-5/L3 (1 study), L4-5/L3 (1 study), and S1/L3 (3 studies). The VBQ score significantly predicted PSL (ranges: thresholds 2.9-3.175, areas under the curve [AUCs] 0.72-0.77, ORs 1.02-5.778), CS (thresholds 2.68-4.10, AUCs 0.785-0.99, ORs 1.513-23.158), ASD (thresholds 2.91-2.95, AUCs 0.934-0.963, ORs 1.509-1.601), PJK or PJF (thresholds 2.715-3.205, AUCs 0.721-0.943, ORs 1.745-26.49), DJK or DJF (threshold 2.66, AUC 0.935, OR 1.46), refracture (combined T1- and T2-weighted VBQ nomogram threshold 0.73, and ratio of adjacent to injured vertebral levels VBQ score < 1.4; AUCs 0.753-0.838, ORs 0.32-2.239), and reoperation (threshold 2.6 to > 3, AUCs 0.702-0.808, ORs 1.569-2.096).

Conclusions: The data suggested that the VBQ score serves as a safe, convenient measure to predict complications after spine surgery. The lowest thresholds reported across all complications were 2.66 in the cervical spine and 2.6 in the lumbar spine, which may serve as rough cutoffs for prompting further patient testing. However, methodological heterogeneity limits guideline development. Future research with consistent methodology is necessary. Systematic review registration no.: CRD42024542755 (www.crd.york.ac.uk/prospero).

Objective: Artificial intelligence (AI) is increasingly capable of academic writing, with large language models such as ChatGPT showing potential to assist or even generate scientific manuscripts. However, concerns remain regarding the quality, reliability, and interpretive capabilities of AI-generated content. The authors' study aimed to compare the quality of a human-written versus an AI-generated scientific manuscript to evaluate the strengths and limitations of AI in the context of academic publishing.

Methods: Two manuscripts were developed using identical titles, abstracts, and tables of a simulated analysis: one authored by a physician with multiple publications, and the other generated by ChatGPT-4o. Three independent and blinded reviewers-two human and one AI-assessed each manuscript across five domains: clarity and readability, coherence and flow, technical accuracy, depth, and conciseness and precision. Each category was scored on a 10-point scale, and qualitative feedback was collected to highlight specific strengths and weaknesses. Additionally, all reviewers were asked to deduce authorship of the manuscripts.

Results: The AI-generated manuscript scored higher in clarity and readability (mean 9.0 vs 7.2), but lower in technical accuracy (mean 6.3 vs 9.3) and depth (mean 5.5 vs 7.5). However, reviewers noted that the AI version lacked depth, critical analysis, and contextual interpretation. All reviewers accurately identified the authorship of each manuscript and tended to rate the version more favorably when it aligned with their own origin (human or AI); i.e., human reviewers assigned higher scores to the human-written manuscript, while the AI reviewer scored the AI-generated manuscript higher.

Conclusions: Although AI models can improve some aspects of scientific writing, particularly clarity and readability, they fall short in critical reasoning and contextual understanding. This reinforces the importance of human authorship and oversight in maintaining the critical analysis and scientific accuracy essential for academic publishing. AI may be used as a complementary tool to support, rather than replace, human-led scientific writing.

Objective: Complex locoregional closure of back wounds following spine surgery via muscle flap closure, as opposed to traditional layer-by-layer approximation, decreases rates of complications such as seroma, infection, and dehiscence. However, the impact of barbed suture use on operative time, surgical cost, and patient outcomes for these cases remains unknown. In this study, the authors aimed to evaluate the complication profile, time, and cost savings of barbed suture in complex flap closure of back wounds following the placement of spinal instrumentation.

Methods: An IRB-approved retrospective analysis was conducted on the medical records of all patients who underwent spine surgery followed by locoregional muscle flap complex closure at the authors' institution between January 2016 and July 2021. Patients were in either the barbed or conventional suture cohort. Odds ratios and 95% confidence intervals were computed using multivariable logistic regression with Firth's correction. Estimated cost savings were calculated using literature-reported figures.

Results: A total of 110 patients with comparable baseline demographics were included. Rates of seroma (p > 0.99), infection (p = 0.21), and dehiscence (p = 0.66) were statistically similar between groups. After adjusting for the length of surgical closure, the mean times were 3.1 mins/cm and 4.6 mins/cm for the barbed and conventional suture cohorts, respectively, resulting in a time savings of 1.5 mins/cm (p < 0.001). The calculated time savings for muscle flap closure of an average incision length was 34.5 minutes (95% CI 18.6-50.4 minutes), and the overall financial savings were calculated to be $1094.10 (95% CI $513.75-$1674.45) per case.

Conclusions: Knotless barbed suture use in complex closure of back wounds results in decreased operative time and hospital cost while conferring similar complication rates to conventional suture.