Neurospine最新文献

Objective: Hoarseness can occur after spinal surgery under general anesthesia, which has been assessed through self-report measures based on questionnaires. Given the inherent biases associated with self-report instruments, there is a need for more objective measures to assess hoarseness.

Methods: Single institute, a prospective observational study was planned to include 427 patients after spine surgery. This interim analysis was planned to include 215 patients who met the inclusion criteria. All subjects included in this study submitted a questionnaire of Korean Voice Handicap Index (KVHI)-10. Voice analysis including low or high pitch (Herz), frequency variation rate (jitter), amplitude variation rate (Shimmer), and noise-to-harmonic ratio (NHR) was performed with a software of Pratt.

Results: This interim report enrolled a total of 215 patients who met the inclusion criteria, and among them, 162 patients (75.5%) were subjected to interim analysis after excluding those with data loss (8 patients), operation cancellation (3 patients), and loss to follow-up (42 patients). The incidence of hoarseness was 35.0% on postoperative day (POD)0 and 5.5% on POD30. In the acoustic parameters analyzed, hertz and jitter were significantly positively correlated with the KVHI-10 scores on POD0, while only the jitter value significantly correlated with POD30. The optimal cutoff values of the acoustic parameter on POD30 from the receiver operating characteristic curve were 0.65% in jitter, 4.67% in shimmer, and 16.96 dB in NHR.

Conclusion: This study revealed a correlation between objective acoustic parameters obtained from voice analysis and subjective questionnaire scores for hoarseness.

This study aimed to elucidate the efficacy and safety of mesenchymal stromal cell (MSC) therapy for chronic discogenic low back pain (LBP). A systematic literature search was conducted on PubMed/Medline, Scopus, Cochrane, and ClinicalTrials.gov following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. Eligible studies included published and ongoing clinical trials assessing intradiscal MSC injections in patients with chronic discogenic LBP unresponsive to conservative treatment. Risk-of-bias (RoB) assessment was performed through MINORS (Methodological Index for Non-randomized Studies) and RoB 2 tools. Within- and between-group differences were expressed as means and 95% confidence intervals. Effect sizes were calculated through Cohen d and g. Data from 10 published clinical studies (n=736; 470 in treatment and 266 in control groups) revealed a mean age of 41.5 years and an average follow-up of 21.6 (range, 6-72) months. Various MSC sources were employed, including autologous and allogeneic bone marrow-derived MSCs and adipose-derived MSCs, with doses ranging from 6×10⁶ to over 50×10⁶ cells/disc. Visual analogue scale, Oswestry Disability Index, and quality-of-life questionnaires indicated modest improvements in pain, disability, and functional status. Additionally, magnetic resonance imaging assessments occasionally demonstrated increased disc hydration and stabilization or improvement of Pfirrmann grade. Data from 8 ongoing trials (n=498 participants; 276 treatment, 222 control) with follow-up periods ranging 6-24 months further corroborate the feasibility and safety of MSC-based interventions. MSC therapy is a biologically-driven approach for managing chronic discogenic LBP. While preliminary data support its potential to alleviate pain and improve disc integrity, further high-quality, standardized trials are necessary to optimize treatment protocols and confirm long-term clinical benefits.

Objective: Implant fixation in osteoporotic bone presents substantial challenges due to reduced bone mass and compromised microarchitecture. This study investigated whether romosozumab, a sclerostin inhibitor, improves osseointegration and mechanical stability of cancellous bone screws in glucocorticoid-induced osteoporosis.

Methods: Fifty-five New Zealand white rabbits were enrolled. Osteoporosis was induced via either bilateral ovariectomy or weekly intramuscular glucocorticoid injections (4-8 mg/kg). Based on bone mineral density results, glucocorticoid injection was selected for experimental induction. Rabbits were divided into 5 groups: control, untreated osteoporosis, parathyroid hormone (PTH), PTH combined with denosumab, and romosozumab. Cancellous bone screws (4.0-mm diameter, titanium alloy) were bilaterally inserted into the iliac bones. Antiosteoporosis treatments were administered for 3-week postimplantation. Histomorphometric evaluation of bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO) was performed using nondecalcified sectioning and Goldner trichrome staining. Biomechanical pull-out testing measured resistance at 1-mm displacement using a standardized setup on the MTS system.

Results: The romosozumab-treated group exhibited superior outcomes. BIC reached 21.2%±18.1%, and BAFO was 56.9%±9.9%. Pull-out strength significantly increased to 275±55 N in the romosozumab group, outperforming PTH (184±61 N), PTH+denosumab (202±23 N), and untreated osteoporosis (120±33 N). Enhanced collagen structure and neobone formation were observed histologically around implants.

Conclusion: Romosozumab significantly enhances cancellous bone screw fixation strength and osseointegration in glucocorticoid-induced osteoporotic bone. These findings suggest its clinical potential as an adjuvant therapy in improving spinal implant outcomes in osteoporotic patients.

Objective: Traumatic vertebral artery injuries (tVAIs) are uncommon but potentially devastating if missed. While computed tomography angiography (CTA) is routinely used for diagnosis, data on the number needed to image (NNI) remain limited. We hence analyzed tVAI epidemiology and imaging practices at a major Scandinavian level 1 trauma center.

Methods: A retrospective study (2013-2020) was performed based on a single-center trauma registry. Patients were grouped based on CTA imaging protocol used; selective screening (2013-2017) and universal screening (2018-2020). Imaging protocols, treatment strategies, and outcomes were analyzed.

Results: Among 2,843 patients admitted with level 1 trauma and receiving CTA imaging, 62 had a tVAI (2.2%) yielding a NNI of 46 patients to diagnose 1 tVAI. Twenty-five of these patients (40.3%) were found to have a posterior circulation stroke, resulting in an incidence of 0.9%, and a NNI of 114 to diagnose 1 stroke on CTA. NNIs for both tVAI and stroke detection increased with adoption of universal screening (tVAI: 35→65; stroke: 90→149). However, the detection rate of tVAI during the universal screening period was not significantly higher than during the selective screening period (p=0.261).

Conclusion: In our level 1 trauma cohort, the incidence of tVAI was 2.2% and stroke rate 0.9%. The NNI rose with universal screening, yet detection rates did not improve. These findings suggest that selective screening based on risk factors may be more efficient than a universal approach. Further research is needed to balance diagnostic accuracy with resource use in trauma care.