Journal of spine surgery最新文献

Background: Long segment fusion for adult spinal deformity (ASD) has a significant rate pseudoarthrosis, which may be in part due to the mechanical forces across the lumbosacral junction (LSJ). Placement of an interbody cage at the L5-S1 disc space and iliac fixation are two strategies to decrease strain at the L5-S1 level. This study assesses the current literature on biomechanics of the LSJ as it pertains to instrumentation in the context of long segment fusion for ASD.

Methods: A systematic review of MEDLINE via the PubMed database and EMBASE was performed by two independent reviewers. Studies were included if they featured human cadaveric studies that had undergone multilevel spinal fusion involving the L5-S1 junction, and studies that measured biomechanical differences with and without iliac fixation and interbody fixation at L5-S1.

Results: From a biomechanical standpoint, anterior lumbar interbody fusion (ALIF) and iliac fixation are similar in their reduction in range of motion (ROM) about the L5-S1 joint as well as S1 screw strain, compared to pedicle screws alone. Iliac fixation appears to reduce screw strain in more directions compared to ALIF. However, iliac fixation significantly increases posterior rod strain. No studies showed statistically significant biomechanical differences with concurrent iliac and interbody fixation, although 4 of 7 studies reported a trend towards decreased L5-S1 ROM.

Conclusions: Both iliac fixation and ALIF cages decrease S1 screw strain and L5-S1 ROM in the setting of multilevel fusion constructs to the LSJ. There is no biomechanical evidence that concurrent iliac fixation and ALIF cages provide significant additional benefit. Larger biomechanical and clinical studies are warranted to better understand the relationship between the two strategies of reduction strain and successful arthrodesis across the LSJ.

Background: The use of social media in spine surgery is becoming increasingly prevalent as patients aim to navigate the complex system of spine surgeons, physician networks, and hospitals. The purpose of this study is to gather data via surveys administered to spine surgery clinic patients in order to assess (I) differences in how often patients who are self-referred versus those who are referred to a spine surgeon by a primary care physician (PCP) or other physician/department use social media to search the spine surgeon prior to their first clinic visit; and (II) how often these searches result in a change in behavior in terms which spine surgeon a patient chooses to see.

Methods: This survey study was performed at an academic tertiary referral center's outpatient orthopedic spine clinics. Surveys were administered to all willing new patients at their first clinic visit with a spine surgeon.

Results: A total of 181 surveys were collected, and 169 surveys were used for final analysis after meeting the inclusion criteria. Average patient age was 59 years (range, 24-87 years), and 86.3% were White. Most patients, whether PCP-referred or self-referred, stated that social media platforms and online search engines played no role in selecting their spine surgeon. Patients who did an online search mostly used Google and the hospital-sponsored physician profile page. One patient in the PCP-referred group requested a different spine surgeon based on their online reading, and one patient in the self-referred group did so. For patients who seek information about their surgeon, Google and the hospital-sponsored physician profile are the most visited.

Conclusions: Social media platforms and online search engines overall played little to no role in selecting a spine surgeon for the vast majority of new spine clinic patients. From the patients who did use online search engines prior to their first clinic visit, Google and the hospital-sponsored physician profile were the most visited.

Background and objective: Anterior column lumbar interbody fusion using an anterior lumbar interbody fusion (ALIF), oblique lumbar interbody fusion (OLIF)/anterior-to-psoas fusion (ATP), lateral lumbar interbody fusion (LLIF), or combination technique allows insertion of a wide-footprint interbody cage and provides immediate segmental stability, indirect neural decompression, lower risk of subsidence, access for disc preparation, the ability to use a large volume of graft, and restoration of coronal and sagittal balance. Blood loss is usually less than with posterior fusion procedures, except for rare cases of severe vascular injury. The objective of this review was to compare the ALIF, OLIF/ATP, and LLIF techniques to provide a contemporary pragmatic guide for spine surgeons.

Methods: PubMed and Ovid Medline databases were searched to identify English-language studies published from 2000 to 2024. The search terms were "anterior", "fusion", "interbody", "lateral", "lumbar", and "oblique". We included studies describing the indications, approaches, patient positioning, surgical technique, learning curve, complications, radiation exposure, need for supplemental fixation, and clinical and radiologic outcomes of ALIF, OLIF/ATP, and LLIF procedures.

Key content and findings: This review compared the ALIF, OLIF/ATP, and LLIF techniques regarding patient factors, anesthetic factors, surgical factors, operative efficiency, surgical risks, and economic factors. We focused on differences between techniques to help clinicians choose between procedures and identified the preferred procedure(s) at each spinal level. We supplemented data from the literature with practical information obtained from our substantial clinical experience with these procedures.

Conclusions: ALIF, OLIF/ATP, and LLIF are all effective techniques for anterior interbody fusion, which provide very good long-term clinical outcomes, excellent fusion rates, and low but specific complication rates.

Background and objective: Ankylosing spondylitis (AS) spinal fractures pose unique diagnostic and therapeutic challenges due to the altered biomechanics, rigid ankylosed spine, and risk for extensive neurologic injury. The optimal practice is not established with rising clinical occurrences. This article aims to review the current literature regarding diagnosis, classification, and operative and non-operative treatment paradigms of spinal fractures due to AS in adults and present a cohesive perspective to facilitate evidence-based clinical practice.

Methods: A narrative systematic review was conducted on the basis of the PubMed database, including English-language papers from January 2000 to May 2025. Keywords included "AS", "spinal fracture", "vertebral trauma", "surgical management", and "neurological outcomes". Studies identified were evaluated based on clinical relevance, level of evidence, and representation of evolving concepts in diagnosis and management.

Key content and findings: The review discusses the specific biomechanical frailties of the ankylosed spine, recent classification methods like AO Spine and Denis classifications, and recent imaging modalities for diagnosis. It highlights operative decision-making approaches, posterior-only, anterior, and combination, in fracture morphology, neurologic status, and patient comorbidities. It discusses perioperative concerns such as positioning issues, blood loss, and complications like hardware failure and infection. Four summary tables provide insight into imaging preference, surgical interventions, outcomes, and complication profiles.

Conclusions: Prompt diagnosis and personalized treatment of AS-related spinal fractures are essential to reducing morbidity and mortality. Emerging literature supports the use of posterior-only methods in selected cases, but highly context-specific surgical choices must remain. The review stresses the importance of prospective studies as a guide to standard treatment protocols and improved outcomes for this difficult patient group.

Background: Anchored standalone cages for anterior cervical discectomy and fusion (ASC-ACDF) are easier to implant but have higher subsidence rates compared to anterior plating constructs. Smoking is a known risk factor for subsidence, however, there are conflicting reports on its effect on functional outcomes. This study aims to evaluate the impact of smoking on radiological and functional outcomes of patients undergoing ASC-ACDF.

Methods: Patients who underwent primary single- and double-level ASC-ACDF between 2015-2022 were reviewed. Inclusion: diagnosis of cervical myelopathy, radiculopathy or myeloradiculopathy, age range 40-90 years old. Exclusion: previous cervical spine surgery, diagnosis of tumor or infection. Patients were divided into non-smokers (NS) or current and ex-smokers (CES). Data was collected radiological outcomes [postoperative subsidence rates, Δtotal intervertebral height (TIH), Δlordotic angle] at 1-year and functional outcomes [Japanese Orthopedic Association (JOA) score, Neck Disability Index (NDI), Visual Analogue Scores for Neck Pain (VASNP) and Upper Limb Pain (VASLP)] at 6 months and 2 years postoperatively.

Results: A total of 71 patients were included (CES: 23; NS: 48). CES had higher subsidence rates at 1-year (60.9% vs. 35.4%, P=0.043) with greater TIH loss (ΔTIH -2.4 vs. -1.7 mm, P=0.038). Fusion rates (91.3% vs. 89.5%, P=0.82) and change in lordosis (-4.1° vs. -3.8°, P=0.78) were insignificantly different. Both groups demonstrated significant improvement in all functional scores after surgery (P<0.05) at similar rates (P<0.05). JOA scores were unaffected by smoking. However, CES consistently had higher NDI, VASNP, and VASLP scores at all timepoints.

Conclusions: Subsidence rates and functional scores (NDI, VASNP and VASLP) are nearly double in smokers after surgery. In ASC-ACDF, while smokers and NS benefit from surgery, smoking is associated with higher disability and pain scores.

Background: Adolescent idiopathic scoliosis (AIS) often presents with significant spinal curvature and small, anatomically distorted pedicles, particularly in the thoracic spine. These factors make pedicle screw placement technically challenging and elevate the risk of neurovascular injury and poor bone purchase. Intraoperative O-arm navigation has emerged as a promising tool for enhancing screw placement accuracy and minimizing complications. This study aimed to (I) determine the accuracy of pedicle screws placed with intraoperative O-arm guidance at the thoracic and lumbar levels in spinal fusions for AIS; (II) evaluate postoperative curve correction and fusion maintenance; and (III) assess reoperation and complication rates due to screw misplacement.

Methods: A single-institution retrospective review was performed for pediatric patients (<18 years) who underwent posterior spinal instrumentation and fusion (PSIF) for AIS from June 2023 to August 2024. Patients included had Lenke 1AN-6C curves and preoperative Cobb angles >40°. Intraoperative O-arm CT was used for navigation and final assessment of screw positioning. Postoperative X-rays assessed correction and alignment. Chart review identified reoperations and complications attributable to screw malposition.

Results: A total of 227 pedicle screws were placed in 12 AIS patients (mean age: 14 years). All screws (100%) were accurately placed without cortical breach. The Wilcoxon Signed-Rank test showed a large, significant difference between the Pre-Operative Cobb Angles (Mdn =51.5, n=12) and the Post-Operative Cobb Angles (Mdn =19.7, n=12), (W+ =0, P<0.001, r=-1). 0 patients experienced screw-related complications or required reoperation.

Conclusions: In AIS patients with severe curves and narrow pedicles, intraoperative O-arm navigation provides precise, breach-free pedicle screw placement and facilitates safe, durable deformity correction. These results support the use of intraoperative navigation in complex pediatric spinal deformity surgery.

Background: Never before has technology been so universally accepted as the modern-era cell phone, the smartphone. Spine surgeons have noticed a rise in patients in their offices complaining of neck and upper back pain. Many patients are of the younger age group, and one thing they all seem to have in common is prolonged smartphone use. While using a smartphone, the cervical spine demonstrates flexion angles ranging from 15 to 60 degrees, with more pronounced deviations from the neutral position observed during sitting compared to standing, and while texting compared to web browsing or video watching. Nowadays, there is strong evidence that persistent neck pain and radiculopathy are associated with time spent text messaging. While it now seems rather clear that repetitive texting, or similar activity while utilizing a forward flexed neck position, may lead to neck pain or "text neck", what is currently unknown is whether this poses a risk for intervertebral disk degeneration and consequent cervical spondylosis, and if so, at what age the condition will emerge and which levels of the cervical spine will it affect the most. The aim of this study was to evaluate the effects of smartphone texting on cervical spine sagittal alignment in healthy young adults, and to identify which cervical segments are most affected, particularly comparing sitting versus standing postures.

Methods: We took lateral radiographs of the cervical spine of healthy volunteers younger than 40 years old. The radiographs were made while texting on a smartphone and in a neutral position, sitting and standing. Then we measured the disc angles, vertebral angles, and sagittal angles on each radiograph.

Results: When texting while standing, significant (P≤0.05) changes in the intervertebral angles (IVAs) were seen at foramen magnum (FM)-C2, FM-C3, FM-C4, C1-2, C2-4, C2-T1, C3-4, C3-5, C3-6, C3-7 and C3-T1. The significant changes in the interdiscal angles (IDAs) were seen at C3-4, C4-5. No significant changes were seen in the angle of lordosis (AOL). When texting while sitting, the significant (P≤0.05) changes in the IVAs were at IVAs: FM-C2, FM-C3, FM-C4, C1-2, C1-3, C1-4, C2-7, C2-T1, C3-4, C3-5, C3-6 and C5-7. The significant changes in the IDAs were at C3-4, C5-6. No significant changes were seen in the AOL.

Conclusions: Our observation shows that the most significant changes in the cervical spine while texting occur in the upper segments of the cervical spine, more pronounced while sitting.

Background: Anterior cervical discectomy and fusion (ACDF) is a widely used approach for cervical pathologies. However, achieving optimal sagittal alignment with static implants remains challenging. Expandable titanium cages (ETC) may offer the advantage of precise alignment adjustments. This study presents our early clinical experience with ETC in ACDF.

Methods: Between 2019 and 2023, we performed a retrospective analysis at Weill Cornell Medicine, Department of Neurosurgery, New York-Presbyterian Hospital, examining patients who underwent ACDF with ETC. Hospital records, imaging, and pre- and post-operative visits were reviewed. We assessed clinical outcomes using the numeric rating scale (NRS) for arm and neck pain and the neck disability index (NDI). Radiological outcomes included cervical and segmental lordosis, disc height, cage subsidence, and fusion status. For data analysis, we used R Studio, with GraphPad Prism, for data visualization.

Results: Forty-four patients (mean age 53±13 years, 52.3% female) with 77 treated levels were analyzed. C5-6 (39%) was the most treated level, and 61.4% underwent two-level fusions. The median follow-up was 12 months (interquartile range, 11-13 months). Clinical outcomes showed significant improvement: NRS-Arm pain (2 to 0), NRS-Neck pain (6 to 2), and NDI (35 to 9). Radiographically, cervical lordosis improved from 4.4° to 9.0°, segmental lordosis from -0.9° to 2.4°, and anterior disc height from 4.0 to 8.5 mm, all sustained at follow-up. Fusion occurred in 69 of the 77 treated levels (fusion rate: 89.6%). Among 29 patients (65.9%) who completed approximately 12 months of follow-up (range, 11.6-41.2 months) with 53 treated levels, fusion occurred in 51 levels (fusion rate: 96.2%). Subsidence was observed in 16/77 segments (20.8%) overall, and in 10/53 segments (18.9%) within the subgroup with approximately 12-month follow-up. The overall rate of new subsidence decreased significantly over time. There were no revision surgeries or neurological complications.

Conclusions: This study highlights the effectiveness and safety of ETC in achieving sagittal alignment and disc height restoration in ACDF.

Background: Subaxial cervical spine injuries are commonly managed in cervical collars but these may not provide sufficient support for some injuries. Surgical stabilisation carries both immediate and longer-term risks. Halo vest immobilisation (HVI) has been widely documented in the management of upper cervical spine injuries but there is less data regarding its use for subaxial injuries. The objective of this study was to investigate complications and outcomes associated with HVI for subaxial cervical spine injuries.

Methods: A retrospective review of patients with subaxial cervical spine injuries, treated with HVI between 2016 and 2021, and followed-up in a dedicated "halo clinic", was performed. Data relating to demographics, injury and follow-up were collected. Patients in whom HVI was used as an adjunct to surgical management for upper cervical or isolated thoracic injuries were excluded.

Results: 46 patients (67% male) with a median age of 33 years were included. Four (9%) were lost to follow-up. Median time of HVI was 80 days. Three patients (6.5%) underwent subsequent surgery. Two, with multi-level injuries, underwent a single and two-level anterior cervical discectomy and fusion for ongoing instability. One patient underwent multi-level posterior fusion due to early loss of alignment with HVI. Other complications included four pin site infections (9%) and seven pin loosening (15%).

Conclusions: HVI can be utilised to manage subaxial cervical spine injuries with careful follow-up. There may be a role in reducing the requirement for multi-level fusion in multi-level injuries, however, future prospective trials are required to elucidate this. Further investigation is required to ascertain patient reported outcomes comparing HVI to surgical management for subaxial cervical spine injuries in the long term.