Journal of neurosurgery. Spine最新文献

Objective: Patient-reported outcome measures (PROMs) are standardized questionnaires used to evaluate patients' quality of life and health status before and after medical procedures. While worse preoperative health is often associated with worse postoperative outcomes, the role of baseline PROMs in predicting postoperative dysphagia following cervical surgery has been unexplored with Eating Assessment Tool-10 (EAT-10) scores. This study aimed to investigate the relationship between baseline PROMs and the incidence of postoperative dysphagia.

Methods: A prospectively collected multi-institutional quality registry of patients undergoing anterior cervical spine surgery was retrospectively reviewed. Eight baseline PROMs were assessed: Neck Disability Index (NDI), modified Japanese Orthopaedic Association scale, EQ-5D questionnaire, EuroQol visual analog scale, visual analog scales for neck pain (NP-VAS) and arm pain, and 10-item Patient-Reported Outcomes Measurement Information System Global Physical Health and Global Mental Health. Including baseline dysphagia as a fixed effect, multivariable logistic regressions were performed to examine the impact of patient-reported baseline PROMs on the incidence of dysphagia.

Results: Baseline PROMs were collected from 1706 patients. When assessing baseline PROMs independently in multivariable analyses, worse baseline NDI score (OR 1.04, p = 0.001) was a significant predictor of dysphagia at 12 months after surgery, while other PROMs were not. When assessing baseline PROMs together in multivariable analysis, worse baseline NDI score (OR 1.07, p < 0.001) and better NP-VAS score (OR 0.88, p = 0.006) were significant predictors of dysphagia at 12 months, while other PROMs were not. Patients in the severe or complete disability NDI categories (NDI score ≥ 25; 465/1466 patients without baseline dysphagia) experienced significantly more new dysphagia at 1 month (65% vs 50%, p < 0.001), 3 months (30% vs 21%, p < 0.001), and 12 months (32% vs 14%, p < 0.001) after anterior cervical spine surgery. These patients also had no significant difference in baseline EAT-10 scores (0.103 ± 0.386 vs 0.115 ± 0.405, p = 0.6), yet experienced significantly worse EAT-10 score changes between baseline and 12 months (3.369 ± 5.954 vs 1.208 ± 3.332, p < 0.001).

Conclusions: Baseline NDI score appears to be the strongest independent predictor of the 8 PROMs in determining whether patients have dysphagia at 12 months after anterior cervical surgery.

Objective: The advanced age and high mortality rate of patients with simultaneous fractures of the atlas and axis complicates decision-making. The aim of this study was to identify clinical and demographic predictors of mortality in this patient population.

Methods: This retrospective cohort study included all patients with simultaneous fractures of the atlas and axis due to ground-level falls treated at a single institution from 2012 to 2022. Multivariable methods were used to identify predictors of mortality.

Results: Eighty-three patients (median age 83 years [IQR 77, 89 years]) with simultaneous C1 and C2 fractures due to ground-level falls were included. The cohort was disproportionately female (61.4%) and had a severe comorbid disease burden (Charlson Comorbidity Index ≥ 5 for 54.2%). Most falls resulted in minor trauma, with 57.7% of patients having no other injuries, while 3.7% of patients had a major trauma (Injury Severity Score ≥ 15). Overall mortality was 11.4% at 30 days, 17.3% at 90 days, 23.5% at 6 months, 28.4% at 12 months, 38.7% at 18 months, and 40.7% at 24 months, which followed a linear trend (R2 = 0.9520, p = 0.0009). In the Cox proportional hazards analysis, mortality was associated with older age (HR 1.048, p = 0.0420), male sex (HR 4.554, p = 0.0009), and dementia (HR 5.419, p = 0.0011). Surgery did not affect mortality (p = 0.8025). Patients with dementia had a higher early mortality rate (40.0% vs. 4.7% at 30 days, p = 0.0011) that converged over time with that of patients without dementia. Male and female patients had a similar mortality rate at 30 days, but mortality rates diverged over time (p = 0.0460). Male sex combined with dementia (n = 10) had a 100% positive predictive value for death by 2 years (p = 0.0039). The observed survival in this cohort was lower than the actuarial expected survival (p = 0.0202).

Conclusions: Patients with simultaneous fractures of the atlas and axis due to falls were typically female octogenarians with severe comorbid disease burdens and only minor associated injuries. Mortality rates were high in this cohort, and the observed survival rate was lower than the actuarial expected survival rate. Surgery was not associated with mortality. The combination of dementia and male sex was associated with mortality. The difference in mortality rates between patients with and without dementia narrowed over time, and the difference in mortality rates between male and female patients widened over time.

Objective: Isthmic spondylolisthesis impacts up to 11.5% of the general population. For patients who have failed conservative therapy, decompression and fusion or decompression alone are options for surgical management. However, there remains debate as to whether reduction of mobile spondylolisthesis is integral to good patient outcomes. The present systematic review and meta-analysis aimed to address this by comparing clinical and radiological outcomes between patients treated with fusion in situ and those undergoing fusion with reduction of isthmic spondylolisthesis.

Methods: The Scopus, EMBASE, Medline, and Cochrane databases were systematically queried on the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies comparing treatment outcomes in patients with isthmic spondylolisthesis after in situ fusion or fusion with spondylolisthesis reduction. Endpoints of interest included Oswestry Disability Index (ODI) score, hospitalization duration, operative morbidity, and rates of surgical revision. Data from individual studies were aggregated using random-effects models to assess combined effects.

Results: Of 277 identified studies, 7 studies were included with an aggregate 308 patients (143 underwent fusion in situ and 165 underwent reduction). Patients who underwent reduction for isthmic lumbar spondylolisthesis had significantly lower rates of pseudarthrosis at last follow-up (OR 0.22, p = 0.03). Estimated blood loss, operative time, hospitalization duration, change in ODI score, change in back pain (visual analog scale [VAS]), and reoperation rate did not differ significantly between groups.

Conclusions: For patients with isthmic spondylolisthesis, the present data suggest that fusion with reduction of spondylolisthesis may lower rates of pseudarthrosis as compared to in situ fusion. However, operative morbidity and improvement in patient-reported outcomes were similar between strategies.

Objective: Global and regional spinal compensatory alignment changes are well documented, but segmental compensation/reciprocation remain poorly understood. The purpose of this study was to provide a detailed analysis of adjacent segment behavior after single-level reconstruction.

Methods: Inclusion criteria were adult patients who underwent L5-S1 anterior lumbar interbody fusion for nonnormative preoperative segmental lordosis (SL), demonstrated a ≥ 5° SL increase by intradiscal angle (IDA) or motion segment angle (MSA), and had normal preoperative lumbar lordosis (LL; pelvic incidence [PI]-LL < 10°). IDA; MSA; anterior disc height (ADH) and posterior disc height (PDH) at the index, adjacent, and supra-adjacent levels; and LL, PI, and L1 pelvic angle, were measured preoperatively and at 1 month and 1 year postoperatively.

Results: A total of 100 patients met the inclusion criteria. The fusion levels increased IDA and MSA at 1 month (IDA: 11.12°, p < 0.001; MSA: 9.26°, p < 0.001) and 1 year (IDA: 11.45°, p < 0.001; MSA: 9.13°, p < 0.001). There was a reciprocal decrease in L4-5 SL at 1 month for MSA and IDA (-3.58° and -2.01°, p < 0.001) and 1 year (-3.03° and -1.91°, p < 0.001). PDH increased at 1 month (1.16 mm, p < 0.001) and 1 year (0.92 mm, p = 0.002). The L3-4 level showed postoperative reciprocal decrease in MSA and IDA at 1 month (-1.30°, p < 0.001; -0.99°, p < 0.001) and IDA reciprocation was maintained at 1 year (-1.01°, p < 0.001). ADH and PDH showed commensurate increases at 1 month (0.80 mm, p = 0.015; 0.91 mm, p < 0.001) and 1 year (0.83 mm, p = 0.049; 0.79 mm, p = 0.006). LL increased at 1 month (5.541°, p < 0.001) and 1 year (7.069°, p < 0.001). Changes in IDA and MSA at the index level showed a significant positive correlation with changes in LL at 1 month (p = 0.001, p = 0.002) and 1 year (p = 0.009, p = 0.010). At the 1-year follow-up, the reciprocal decrease in IDA at the adjacent level can be estimated using the equation -0.195(∆1-year IDA at the index level) + 0.332, while the reciprocal decrease in MSA at the adjacent level can be calculated as -0.440(∆1-year IDA at the index level) + 2.023.

Conclusions: The postoperative reciprocation of the adjacent levels implies a preoperative segmental compensatory mechanism. Normative restoration of the surgical level lordosis may therefore have a preventative impact on the otherwise negative consequences of ongoing compensation mechanisms at the adjacent segmental levels in the lumbar spine. This could relate to the risk of adjacent segment disease and deserves further long-term analysis.

Objective: Surgical site infection (SSI) is a leading cause of morbidity following posterior spine surgery. The optimal choice of skin closure technique depending on patient- and procedure-specific characteristics remains to be elucidated.

Methods: The Neurosurgery Enterprise Registry (NER) at Mayo Clinic was queried for patients who underwent posterior spine surgery from 2017 to 2023. Propensity matching was performed to match patients on the basis of the development of SSI and baseline characteristics, including age, sex, race, and comorbidities. Perioperative outcomes were analyzed using data from the NER and medical records.

Results: A total of 18,842 cases of posterior spine surgery were identified in the NER, and SSI was observed in 154 cases (0.8%). Of these patients, 308 patients were included in the 1:1 propensity score-matched cohort analysis, with 154 patients included in each group. Sutures were used in 224 patients (72.7%) and staples in 84 patients (27.3%) (p < 0.01). Female patients comprised 45.1% of the sutures group and 46.4% of the staples group (p = 0.8). The mean ± SD age was 59.8 ± 15.4 years in the sutures group and 60.8 ± 11.9 years in the staples group (p = 0.6). Fusion was performed in 27.2% of patients in the sutures group and 44% in the staples group (p < 0.01). Multilevel fusion comprised 68.9% of fusion cases in the sutures group and 67.6% in the staples group (p = 0.8). Comorbidities, such as diabetes (p = 0.6), hypertension (p = 0.1), and the use of disease-modifying antirheumatic drugs (DMARDs) (p = 0.5) and immunosuppressants (p = 0.2), did not differ between groups. Univariate analysis performed in the propensity score-matched cohort showed that SSI was observed in 53.6% of patients in the sutures group and 40.5% in the staples group (p = 0.04). No significant differences were noted regarding 30-day (p = 0.3), 90-day (p = 0.2), and 1-year (p = 0.3) readmissions and 30-day (p = 0.7), 90-day (p = 0.8), and 1-year (p = 0.8) reoperations. On multivariable logistic regression, SSI was not significantly associated with the choice of skin closure technique (p = 0.3).

Conclusions: After adjustment for spinal fusion, number of fused levels, the use of immunosuppressants, and other risk factors, SSI development was not significantly associated with the use of sutures versus staples following posterior spine surgery in our institution. Additionally, no significant differences were observed regarding baseline characteristics and other perioperative outcomes. The authors' analysis shows that skin closure technique did not significantly affect SSI rates and other outcomes in these patients.

Objective: This study examined the extent to which preoperative depression predicts dysphagia after cervical spine surgery.

Methods: A prospectively collected multi-institutional quality registry was retrospectively reviewed. Patients undergoing cervical surgery were categorized based on preoperative depression, and correlations with pre- and postoperative Eating Assessment Tool-10 (EAT-10) dysphagia questionnaire scores were assessed. Mixed-effects logistic regressions were performed to assess the impact of preoperative depression on the incidence of dysphagia.

Results: Of 2002 patients meeting inclusion criteria, 524 (26%) reported having preoperative depression. Depression was associated with a higher incidence of dysphagia at baseline (25% vs 12%, p < 0.001) and at 1 (62% vs 54%, p = 0.038), 3 (36% vs 26%, p < 0.001), and 12 months (36% vs 22%, p < 0.001) postoperatively. Including baseline dysphagia as a fixed effect, multivariable analysis revealed that depression is not a significant independent predictor of postoperative dysphagia at 1 (OR 1.14, p = 0.5), 3 (OR 1.09, p = 0.6), or 12 months (OR 1.27, p = 0.2). Patients with depression and no baseline dysphagia (395 of 524) were significantly more likely to report new dysphagia at 12 months (26% vs 18%, p = 0.006), but not at 1 (53% vs 52%, p = 0.7) or 3 months (28% vs 22%, p = 0.06). The average change in EAT-10 scores between baseline and 12 months was significantly worse in patients with preoperative depression and no baseline dysphagia (2.552 [SD 5.041] vs 1.634 [SD 4.095], p < 0.001). Post hoc multivariable analyses excluding those with baseline dysphagia did not significantly affect the results.

Conclusions: Although patients with preoperative depression report dysphagia more often at baseline and at 1, 3, and 12 months after cervical surgery, preoperative depression is not an independent predictor of postoperative dysphagia. Preoperative depression may be valuable to consider as a risk factor for developing dysphagia after cervical surgery, but the heightened dysphagia risk in patients with depression may be attributed to secondary factors associated with depression such as comorbid conditions.

Objective: The goal of this study was to investigate the patterns of functional connectivity (FC) in patients with asymptomatic cervical spinal cord compression and determine how the patterns differ from those in healthy controls and correlate with spinal compression and Neck Disability Index (NDI) scores.

Methods: This cross-sectional study consisted of 45 patients with asymptomatic spinal cord compression (ASCC) and 35 healthy controls (HCs) with resting-state functional MRI (rs-fMRI) scans. The patients with ASCC also had sagittal and axial T2-weighted cervical spine MRI scans. The rs-fMRI scans were used for region of interest to region of interest analyses that generated brain networks of FC that could be compared between and within groups.

Results: The patients with ASCC had stronger FC between visual and motor regions than the HCs, with the intracalcarine cortex (occipital cortex) as the largest hub of connection strength differences. Within the ASCC cohort, the cerebellar region associated with attention (multi-domain task battery [MDTB] region 5) was the hub of functional changes related to the severity of spinal compression. However, the NDI scores of patients covaried most with functional connections of the left superior parietal lobule.

Conclusions: This study indicated that functional brain changes are evident before neurological symptoms appear. These alterations in FC patterns reflect a systematic reorganization of neural dynamics, suggesting that the brain adaptively reconfigures its computational architecture to compensate for compromised signal transmission through the compressed spinal cord. Patients with ASCC appear to rely more on visual information to maintain normal sensorimotor function, as proprioception information is likely compromised due to spinal compression. Their functional changes in the subregion of the cerebellum involved in attention indicate possible strain on multitasking and working memory. Finally, connectivity differences related to NDI scores support the idea that the superior parietal lobule helps to compensate for motor difficulties. These early adaptations in brain computation could serve as crucial biomarkers for disease progression, potentially enabling more precise timing of clinical interventions in this challenging patient population.