Neurospine最新文献

Objective: To investigate the ability of radiological parameter canal bone ratio (CBR) to assess bone mineral density and to differentiate between patients with primary and multiple osteoporotic vertebral compression fracture (OVCF).

Methods: A retrospective analysis was conducted on OVCF patients treated at our hospital. CBR was measured through full-spine x-rays. Patients were categorized into primary and multiple fracture groups. Receiver operating characteristic curve analysis and area under the curve (AUC) calculation were used to assess the ability of parameters to predict osteoporosis and multiple fractures. Predictors of T values were analyzed by multiple linear regression, and independent risk factors for multiple fractures were determined by multiple logistic regression analysis.

Results: CBR showed a moderate negative correlation with dual-energy x-ray absorptiometry T values (r = -0.642, p < 0.01). Higher CBR (odds ratio [OR], -6.483; 95% confidence interval [CI], -8.234 to -4.732; p < 0.01) and lower body mass index (OR, 0.054; 95% CI, 0.023-0.086; p < 0.01) were independent risk factors for osteoporosis. Patients with multiple fractures had lower T values (mean ± standard deviation [SD]: -3.76 ± 0.73 vs. -2.83 ± 0.75, p < 0.01) and higher CBR (mean ± SD: 0.54 ± 0.07 vs. 0.46 ± 0.06, p < 0.01). CBR had an AUC of 0.819 in predicting multiple fractures with a threshold of 0.53. T values prediction had an AUC of 0.816 with a threshold of -3.45. CBR > 0.53 was an independent risk factor for multiple fractures (OR, 14.66; 95% CI, 4.97-43.22; p < 0.01).

Conclusion: CBR is negatively correlated with bone mineral density (BMD) and can be a novel opportunistic BMD assessment method. It is a simple and effective measurement index for predicting multiple fractures, with predictive performance not inferior to T values.

Objective: To compare clinical and radiographic outcomes between 2 motion preservation surgeries, cervical disc replacement (CDR) and posterior endoscopic cervical decompression (PECD), for unilateral cervical radiculopathy.

Methods: Between February 2018 and December 2020, 60 patients with unilateral cervical radiculopathy who underwent either CDR or PECD were retrospectively recruited as matched pairs. Clinical outcomes included visual analogue scale (VAS) scores for neck and arm pain, Neck Disability Index (NDI), and satisfaction rates. The radiographic outcome was index level motion. Intraoperative data, complications, and hospital stay were collected. Preoperative and postoperative outcomes were compared.

Results: Patients undergoing CDR or PECD were included, with 30 cases in each group. Matched pairs were compared in terms of demographic data and preoperative measurements. CDR was associated with shorter operative times, whereas PECD resulted in less intraoperative blood loss. The total complication rate was 5%. NDI and VAS for neck and arm were significantly improved in both groups, with no significant differences between the 2 groups. Satisfaction rates of good and excellent exceeded 87% in both groups. CDR was superior to PECD in the restoration of disc height. Early postoperative follow-up showed no significant difference in terms of index level motion. PECD demonstrated significantly shorter hospital stays and quicker return-to-work times (p<0.05).

Conclusion: PECD achieved equivalent clinical and radiologic outcomes compared with CDR when the certain criteria for surgery were met. Both techniques demonstrated the potential to maintain index level motion. Additionally, PECD resulted in less blood loss, shorter hospital stays, and faster return-to-work times. Conversely, CDR offered shorter operative times and better restoration of disc height.

Objective: The main objective of this study was to analyze the efficacy and feasibility of surgical management for patients with thoracic spinal tuberculous spondylitis (STB) by using posterior-only transforaminal debridement and interbody fusion (PTDIF) with preservation of posterior ligamentous complex (PLC) and noninferior of PTDIF compared with conventional posterior-only debridement and interbody fusion (CPDIF).

Methods: From January 2019 to January 2022, a prospective, randomized, controlled trial was conducted in which patients with thoracic STB were enrolled and assigned to undergo either the PTDIF group (group A) or CPDIF group (group B) in a 1:1 ratio. The clinical efficacy was evaluated on average operation time, blood loss, hospitalization durations, visual analogue scale, Oswestry Disability Index scores, erythrocyte sedimentation rate (ESR), C-Reactive protein (CRP), and neurological function recovery using the American Spinal Injury Association's impairment scale and operative complications. Radiological measurements included kyphosis correction, loss of correction. The outcomes were compared between the groups at preoperation, postoperaion, and final follow-up.

Results: All 65 patients were completely cured during the follow-up. The intraoperative blood loss and operation time in group B were more than that in group A. All patients were pain-free at the final follow-up visit. ESR, CRP returned to normal limits in all patients 3 months after surgery. All patients had improved neurological signs. No significant difference was found in kyphosis angle correction, loss of correction between the 2 groups.

Conclusion: PTDIF, with preservation of PLC, achieved debridement, decompression, and reconstruction of the spine's stability, similar to CPDIF in the surgical treatment of thoracic STB. PTDIF has less surgical trauma with less intraoperative blood loss and operation time.

Objective: To evaluate the degeneration patterns of paraspinal muscles in double-level degenerative lumbar spondylolisthesis (dl-DLS) versus single-level degenerative lumbar spondylolisthesis (sl-DLS).

Methods: A total of 67 dl-DLS and 73 sl-DLS patients were included. Multifidus (MF), erector spinae (ES), and psoas major (PM)'s fatty infiltration (FI) and relative cross-sectional area (rCSA) were measured. Sagittal parameters such as lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) were also assessed. Comparisons and correlation analysis were performed between the 2 groups.

Results: MF atrophy is worse in dl-DLS patients from L3-4 to L5-S1, with higher FI from L1-2 to L5-S1 compared to sl-DLS patients. ES atrophy and FI are more pronounced in dl-DLS patients from L1-2 to L5-S1. PM atrophy is more significant in dl-DLS patients at L2-3 to L5-S1, with heavier FI from L1-2 to L3-4, though no difference in FI from L4-5 to L5-S1. The rCSA and FI of MF and ES show significant differences between adjacent segments in both groups, except for MF rCSA between L3-4 and L4-5 in dl-DLS. In dl-DLS, PM rCSA negatively correlates with PT from L4-5 to L2-3, while FI of MF and ES in L5-S1 positively correlates with LL. In sl-DLS, PM FI in L4-5 and L5-S1 negatively correlates with LL.

Conclusion: Degeneration of MF, ES, and PM is more severe in dl-DLS patients, particularly at the spondylolisthesis level. Severe paraspinal muscle degeneration can lead to spinal force imbalance and progression from sl-DLS to dl-DLS. The degradation of PM and ES correlates negatively with PT and SVA, indicating a link to pelvic decompensation and SVA abnormalities, potentially causing disproportionate degenerative changes in dl-DLS patients.

Recent advances in robotics technology and artificial intelligence (AI) have sparked increased interest in humanoid robots that resemble humans and social robots capable of interacting socially. Alongside this trend, a new field of robot research called human-robot interaction (HRI) is gaining prominence. The aim of this review paper is to introduce the fundamental concepts of HRI and social robots, examine their current applications in the medical field, and discuss the current and future prospects of HRI and social robots in spinal care. HRI is an interdisciplinary field where robotics, AI, social sciences, design, and various disciplines collaborate organically to develop robots that successfully interact with humans as the ultimate goal. While social robots are not yet widely deployed in clinical environments, ongoing HRI research encompasses various areas such as nursing and caregiving support, social and emotional assistance, rehabilitation and cognitive enhancement for the elderly, medical information provision and education, as well as patient monitoring and data collection. Although still in its early stages, research related to spinal care includes studies on robotic support for rehabilitation exercises, assistance in gait training, and questionnaire-based assessments for spinal pain. Future applications of social robots in spinal care will require diverse HRI research efforts and active involvement from spinal specialists.

Objective: Poor bone quality is a risk factor for postoperative complications after degenerative lumbar fusion surgery. The magnetic resonance imaging-based vertebral bone quality (VBQ) score is a good tool for assessing bone quality, and this is the first meta-analysis performed to summarize the predictive value of the VBQ score for cage subsidence and screw loosening in patients undergoing degenerative lumbar surgery.

Methods: Studies were comprehensively searched in electronic databases. The quality of the studies was assessed. The pooled sensitivity, specificity and summary receiver operating characteristic curve were calculated. Publication bias was assessed and meta-regression was conducted.

Results: We ultimately included 9 studies with a total of 1,404 patients with a mean age of 60.4 years and a percentage of females of 57.0%. According to the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool to assess methodological quality, the quality of the included studies was relatively low and risks of bias might exist. Results showed that a high VBQ was significantly associated with cage subsidence and screw loosening, and risk factor analysis revealed that the merged odds ratio was 5.37 for cage subsidence and 3.87 for screw loosening. With a VBQ cutoff value of 3.34±0.45, the pooled sensitivity and specificity for the diagnosis of postoperative complications were 0.75 and 0.75, respectively, and the area under the curve was 0.82 (95% confidence interval, 0.78-0.85).

Conclusion: A high VBQ was associated with a high risk of cage subsidence and screw loosening in patients who underwent degenerative lumbar surgery. The VBQ score could be considered for identifying high-risk patients for further evaluation.

Objective: The study aimed to investigate the role of N6-methyladenosine (m6A) modification in spinal cord injury (SCI) and its underlying mechanism, focusing on the interplay between m6A methyltransferase-like 3 (METTL3), miR-30c, and autophagy-related proteins.

Methods: An SCI model was established in rats, and changes in autophagy-related proteins, m6A methylation levels, and miR-30c levels were analyzed. Hydrogen peroxide (H2O2)-stimulated spinal cord neuron cells (SCNCs) were used to assess the impact of METTL3 overexpression. The effects of STM2457, an antagonist of METTL3, were evaluated on cell viability, apoptosis, and autophagy markers in H2O2-stimulated SCNCs.

Results: In the SCI model, decreased levels of autophagy markers and increased m6A methylation, miR-30c levels, and METTL3 were observed. Overexpression of METTL3 in SCNCs led to reduced cell viability, increased apoptosis, and suppressed autophagy. Conversely, co-overexpression of autophagy-related protein 5 (ATG5) or miR-30c inhibition reversed these effects. Knocking out METTL3 yielded opposite results. STM2457 treatment improved cell viability, reduced apoptosis, and upregulated autophagy markers in SCNCs, which also enhanced functional recovery in rats as measured by the Basso-Beattie-Bresnahan score and inclined plate test.

Conclusion: STM2457 alleviated SCI by suppressing METTL3-mediated m6A modification of miR-30c, which in turn induces ATG5-mediated autophagy. This study provides insights into the role of m6A modification in SCI and suggests a potential therapeutic approach through targeting METTL3.

Objective: Readmission rates after posterior cervical fusion (PCF) significantly impact patients and healthcare, with complication rates at 15%-25% and up to 12% 90-day readmission rates. In this study, we aim to test whether machine learning (ML) models that capture interfactorial interactions outperform traditional logistic regression (LR) in identifying readmission-associated factors.

Methods: The Optum Clinformatics Data Mart database was used to identify patients who underwent PCF between 2004-2017. To determine factors associated with 30-day readmissions, 5 ML models were generated and evaluated, including a multivariate LR (MLR) model. Then, the best-performing model, Gradient Boosting Machine (GBM), was compared to the LACE (Length patient stay in the hospital, Acuity of admission of patient in the hospital, Comorbidity, and Emergency visit) index regarding potential cost savings from algorithm implementation.

Results: This study included 4,130 patients, 874 of which were readmitted within 30 days. When analyzed and scaled, we found that patient discharge status, comorbidities, and number of procedure codes were factors that influenced MLR, while patient discharge status, billed admission charge, and length of stay influenced the GBM model. The GBM model significantly outperformed MLR in predicting unplanned readmissions (mean area under the receiver operating characteristic curve, 0.846 vs. 0.829; p < 0.001), while also projecting an average cost savings of 50% more than the LACE index.

Conclusion: Five models (GBM, XGBoost [extreme gradient boosting], RF [random forest], LASSO [least absolute shrinkage and selection operator], and MLR) were evaluated, among which, the GBM model exhibited superior predictive performance, robustness, and accuracy. Factors associated with readmissions impact LR and GBM models differently, suggesting that these models can be used complementarily. When analyzing PCF procedures, the GBM model resulted in greater predictive performance and was associated with higher theoretical cost savings for readmissions associated with PCF complications.