Pub Date : 2024-06-01Epub Date: 2024-05-02DOI: 10.14245/ns.2347256.628
Ikchan Jeon, Sung Bae Park, Bong Ju Moon, Miyoung Choi, Sung Uk Kuh, Jongtae Kim
Objective: We investigated the clinical efficacy of anabolic agents compared with bisphosphonates (BPs) for the incidence of new osteoporotic vertebral fracture (OVF) and fracture healing of OVF in the patients with OVF via meta-analyses of randomized controlled trials (RCTs).
Methods: Electronic databases, including PubMed, Embase, and Cochrane Library were searched for published RCTs till December 2022. The RCTs that recruited participants with osteoporosis at high-/very high-risk of fracture (a history of osteoporotic vertebral or hip fracture) or fresh OVF were included in this study. We assessed the risk of bias on every included RCTs, estimated relative risk (RR) for the incidence of new OVF and fracture healing of OVF, and overall certainty of evidence. Meta-analyses were performed by Cochrane review manager (RevMan) ver. 5.3. Cochrane risk of bias 2.0 and GRADEpro/GDT were applied for evaluating methodological quality and overall certainty of evidence, respectively.
Results: Five hundred eighteen studies were screened, and finally 6 eligible RCTs were included in the analysis. In the patients with prevalent OVF, anabolic agents significantly reduced the incidence of new OVF (teriparatide and romosozumab vs. alendronate and risedronate [RR, 0.57; 95% confidence interval, 0.45-0.71; p < 0.00001; high-certainty of evidence]; teriparatide vs. risedronate [RR, 0.50; 95% confidence interval, 0.37-0.68; p < 0.0001; high-certainty of evidence]). However, there was no evidence of teriparatide compared to alendronate in fracture healing of OVF (RR, 1.23; 95% confidence interval, 0.95-1.60; p = 0.12; low-certainty of evidence).
Conclusion: In the patients with prevalent OVF, anabolic agents showed a significant superiority for preventing new OVF than BPs, with no significant evidence for promoting fracture healing of OVF. However, considering small number of RCTs in this study, additional studies with large-scale data are required to obtain more robust evidences.
{"title":"Comparison of the Clinical Efficacy of Anabolic Agents and Bisphosphonates in the Patients With Osteoporotic Vertebral Fracture: Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Ikchan Jeon, Sung Bae Park, Bong Ju Moon, Miyoung Choi, Sung Uk Kuh, Jongtae Kim","doi":"10.14245/ns.2347256.628","DOIUrl":"10.14245/ns.2347256.628","url":null,"abstract":"<p><strong>Objective: </strong>We investigated the clinical efficacy of anabolic agents compared with bisphosphonates (BPs) for the incidence of new osteoporotic vertebral fracture (OVF) and fracture healing of OVF in the patients with OVF via meta-analyses of randomized controlled trials (RCTs).</p><p><strong>Methods: </strong>Electronic databases, including PubMed, Embase, and Cochrane Library were searched for published RCTs till December 2022. The RCTs that recruited participants with osteoporosis at high-/very high-risk of fracture (a history of osteoporotic vertebral or hip fracture) or fresh OVF were included in this study. We assessed the risk of bias on every included RCTs, estimated relative risk (RR) for the incidence of new OVF and fracture healing of OVF, and overall certainty of evidence. Meta-analyses were performed by Cochrane review manager (RevMan) ver. 5.3. Cochrane risk of bias 2.0 and GRADEpro/GDT were applied for evaluating methodological quality and overall certainty of evidence, respectively.</p><p><strong>Results: </strong>Five hundred eighteen studies were screened, and finally 6 eligible RCTs were included in the analysis. In the patients with prevalent OVF, anabolic agents significantly reduced the incidence of new OVF (teriparatide and romosozumab vs. alendronate and risedronate [RR, 0.57; 95% confidence interval, 0.45-0.71; p < 0.00001; high-certainty of evidence]; teriparatide vs. risedronate [RR, 0.50; 95% confidence interval, 0.37-0.68; p < 0.0001; high-certainty of evidence]). However, there was no evidence of teriparatide compared to alendronate in fracture healing of OVF (RR, 1.23; 95% confidence interval, 0.95-1.60; p = 0.12; low-certainty of evidence).</p><p><strong>Conclusion: </strong>In the patients with prevalent OVF, anabolic agents showed a significant superiority for preventing new OVF than BPs, with no significant evidence for promoting fracture healing of OVF. However, considering small number of RCTs in this study, additional studies with large-scale data are required to obtain more robust evidences.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11224729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2024-06-30DOI: 10.14245/ns.2448372.186
Diana Chang, Austin Lui, Alisa Matsoyan, Michael M. Safaee, Henry Aryan, Christopher Ames
Internationally, the United States (U.S.) cites the highest cost burden of low back pain (LBP). The cost continues to rise, faster than the rate of inflation and overall growth of health expenditures. We performed a comprehensive literature review of peer-reviewed and non- peer-reviewed literature from PubMed, Scopus, and Google Scholar for contemporary data on prevalence, cost, and projected future costs. Policymakers in the U.S. have long attempted to address the high-cost burden of LBP through limiting low-value services and early imaging. Despite these efforts, costs (~$40 billion; ~$2,000/patient/yr) continue to rise with increasing rates of unindicated imaging, high rates of surgery, and subsequent revision surgery without proper trial of non-pharmacologic measures and no corresponding reduction in LBP prevalence. Globally, the overall prevalence of LBP continues to rise largely secondary to a growing aging population. Cost containment methods should focus on careful and comprehensive clinical assessment of patients to better understand when more resource-intensive interventions are indicated.
在国际上,美国是腰背痛(LBP)费用负担最重的国家。其成本持续上升,速度超过了通货膨胀率和医疗支出的总体增长速度。我们对来自 PubMed、Scopus 和 Google Scholar 的同行评议和非同行评议文献进行了全面的文献综述,以了解有关患病率、成本和未来成本预测的当代数据。长期以来,美国的政策制定者一直试图通过限制低价值服务和早期成像来解决腰椎间盘突出症的高成本负担问题。尽管做出了这些努力,但成本(约 400 亿美元;约 2000 美元/患者/年)仍在继续上升,原因是无指征的影像学检查、高手术率以及随后的翻修手术率不断增加,且未对非药物治疗措施进行适当试验,腰椎间盘突出症的患病率也没有相应降低。在全球范围内,腰椎间盘突出症的总体发病率持续上升,这主要是由于人口老龄化的加剧。成本控制方法应侧重于对患者进行仔细、全面的临床评估,以便更好地了解何时需要采取资源密集型干预措施。
{"title":"Comparative Review of the Socioeconomic Burden of Lower Back Pain in the United States and Globally.","authors":"Diana Chang, Austin Lui, Alisa Matsoyan, Michael M. Safaee, Henry Aryan, Christopher Ames","doi":"10.14245/ns.2448372.186","DOIUrl":"10.14245/ns.2448372.186","url":null,"abstract":"<p><p>Internationally, the United States (U.S.) cites the highest cost burden of low back pain (LBP). The cost continues to rise, faster than the rate of inflation and overall growth of health expenditures. We performed a comprehensive literature review of peer-reviewed and non- peer-reviewed literature from PubMed, Scopus, and Google Scholar for contemporary data on prevalence, cost, and projected future costs. Policymakers in the U.S. have long attempted to address the high-cost burden of LBP through limiting low-value services and early imaging. Despite these efforts, costs (~$40 billion; ~$2,000/patient/yr) continue to rise with increasing rates of unindicated imaging, high rates of surgery, and subsequent revision surgery without proper trial of non-pharmacologic measures and no corresponding reduction in LBP prevalence. Globally, the overall prevalence of LBP continues to rise largely secondary to a growing aging population. Cost containment methods should focus on careful and comprehensive clinical assessment of patients to better understand when more resource-intensive interventions are indicated.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11224735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141492830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2024-06-30DOI: 10.14245/ns.2347300.650
Huanbing Liu, Linnan Duan, Zhibin Li, Yuanhao Liu, Yubo Wang
Objective: Epidemiological studies on spinal cord tumors are rare, and studies on primary intramedullary tumors are even rarer. The incidence and survival of patients with primary intramedullary spinal cord tumors have not been well documented. We aimed to study the incidence and survival of patients with primary spinal cord malignant and borderline malignant tumors based on data from the Surveillance, Epidemiology, and End Results (SEER) database and provide information for revealing the epidemiology and exploring the prognosis of patients with primary intramedullary tumors.
Methods: Patients in the SEER database with microscopically diagnosed malignant and borderline malignant primary spinal cord tumors from 2000 and 2019 were included in this study. We analyzed the distribution of patients according to the demographic and clinical characteristics. Then, we extracted the incidence rate and 5-year relative survival for the whole cohort and different subgroups of the cohort. Finally, multivariate Cox proportional hazards models were used to analyze the independent prognostic factors associated with overall survival.
Results: A total of 5,211 patients with malignant and borderline malignant primary spinal cord tumors were included in this cohort study. Ependymoma, astrocytoma (including oligodendrogliomas and glioblastoma), lymphoma and hemangioblastoma were the most common pathological types. The age-adjusted incidence rates of primary spinal cord ependymoma was 0.18 per 100,000. The incidence rate for females was significantly lower than that for males. The incidence rate was highest in Caucasian. The incidence rate of ependymoma was significantly higher than that of other pathological types. The incidence of astrocytoma was highest among people aged 0-19 years, the incidence of ependymoma was highest among people aged 40-59 years, and the incidence of lymphoma was highest among people aged 60 years or older. The 5-year observed survival and relative survival rates for the whole cohort were 82.80% and 86.00%, respectively. Patients diagnosed with ependymoma had significantly better survival than their counterparts. We also found the impact of surgery and chemotherapy on the prognosis of patients with different tumors varies a lot.
Conclusion: We conducted a population-based analysis of malignant and borderline malignant primary spinal cord tumors with the aim of revealing the epidemiology and survival of patients with primary intramedullary spinal cord tumors. Despite some shortcomings, this study provides valuable information to help us better understand the epidemiological characteristics of primary intramedullary spinal cord tumors.
{"title":"Incidence and Survival of Patients With Malignant Primary Spinal Cord Tumors: A Population-Based Analysis.","authors":"Huanbing Liu, Linnan Duan, Zhibin Li, Yuanhao Liu, Yubo Wang","doi":"10.14245/ns.2347300.650","DOIUrl":"10.14245/ns.2347300.650","url":null,"abstract":"<p><strong>Objective: </strong>Epidemiological studies on spinal cord tumors are rare, and studies on primary intramedullary tumors are even rarer. The incidence and survival of patients with primary intramedullary spinal cord tumors have not been well documented. We aimed to study the incidence and survival of patients with primary spinal cord malignant and borderline malignant tumors based on data from the Surveillance, Epidemiology, and End Results (SEER) database and provide information for revealing the epidemiology and exploring the prognosis of patients with primary intramedullary tumors.</p><p><strong>Methods: </strong>Patients in the SEER database with microscopically diagnosed malignant and borderline malignant primary spinal cord tumors from 2000 and 2019 were included in this study. We analyzed the distribution of patients according to the demographic and clinical characteristics. Then, we extracted the incidence rate and 5-year relative survival for the whole cohort and different subgroups of the cohort. Finally, multivariate Cox proportional hazards models were used to analyze the independent prognostic factors associated with overall survival.</p><p><strong>Results: </strong>A total of 5,211 patients with malignant and borderline malignant primary spinal cord tumors were included in this cohort study. Ependymoma, astrocytoma (including oligodendrogliomas and glioblastoma), lymphoma and hemangioblastoma were the most common pathological types. The age-adjusted incidence rates of primary spinal cord ependymoma was 0.18 per 100,000. The incidence rate for females was significantly lower than that for males. The incidence rate was highest in Caucasian. The incidence rate of ependymoma was significantly higher than that of other pathological types. The incidence of astrocytoma was highest among people aged 0-19 years, the incidence of ependymoma was highest among people aged 40-59 years, and the incidence of lymphoma was highest among people aged 60 years or older. The 5-year observed survival and relative survival rates for the whole cohort were 82.80% and 86.00%, respectively. Patients diagnosed with ependymoma had significantly better survival than their counterparts. We also found the impact of surgery and chemotherapy on the prognosis of patients with different tumors varies a lot.</p><p><strong>Conclusion: </strong>We conducted a population-based analysis of malignant and borderline malignant primary spinal cord tumors with the aim of revealing the epidemiology and survival of patients with primary intramedullary spinal cord tumors. Despite some shortcomings, this study provides valuable information to help us better understand the epidemiological characteristics of primary intramedullary spinal cord tumors.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11224732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141492834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To evaluate the preoperative and perioperative predictors of persistent leg numbness following lumbar fusion in patients aged ≥ 75 years.
Methods: This single-center retrospective study examined 304 patients aged ≥ 75 years who underwent lumbar fusion for lumbar degenerative disease (102 men, 202 women; mean age, 79.2 [75-90] years). The visual analogue scale (VAS) score for leg numbness was examined preoperatively and at 2 years postoperatively. The persistent leg numbness group included patients with a 2-year postoperative VAS score for leg numbness ≥ 5 points. The demographic data were also reviewed. A multivariate stepwise logistic regression analysis was performed for variables with univariate analysis values of p < 0.2 on univariate analysis.
Results: In total, 71 patients (23.4%) experienced persistent postoperative leg numbness. Multivariate logistic regression analysis revealed that a history of lumbar decompression, longer symptom duration, and a preoperative VAS score for leg numbness ≥ 5 points were associated with greater postoperative persistent leg numbness following lumbar fusion. In contrast, other factors, such as sex, body mass index, vertebral fracture, diabetes mellitus, depression, symptom duration, dural injury, operative time, and estimated blood loss, were not.
Conclusion: A history of preoperative lumbar decompression, longer symptom duration, and greater preoperative VAS scores for leg numbness were preoperative predictors of persistent postoperative leg numbness following lumbar fusion in older patients. Although lumbar fusion is expected to improve leg numbness, surgeons should consider the surgical history, duration, and preoperative numbness intensity and explain the potential postoperative persistent leg numbness in advance.
{"title":"Predictors of Persistent Postoperative Numbness Following Lumbar Fusion in Patients Older Than 75 Years: A Minimum 2-Year Follow-up.","authors":"Takeru Tsujimoto, Masahiro Kanayama, Shotaro Fukada, Fumihiro Oha, Yukitoshi Shimamura, Yuichi Hasegawa, Tomoyuki Hashimoto, Kenichiro Kakutani, Takashi Yurube, Yoshiki Takeoka, Kunihiko Miyazaki, Norimasa Iwasaki","doi":"10.14245/ns.2347312.656","DOIUrl":"10.14245/ns.2347312.656","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the preoperative and perioperative predictors of persistent leg numbness following lumbar fusion in patients aged ≥ 75 years.</p><p><strong>Methods: </strong>This single-center retrospective study examined 304 patients aged ≥ 75 years who underwent lumbar fusion for lumbar degenerative disease (102 men, 202 women; mean age, 79.2 [75-90] years). The visual analogue scale (VAS) score for leg numbness was examined preoperatively and at 2 years postoperatively. The persistent leg numbness group included patients with a 2-year postoperative VAS score for leg numbness ≥ 5 points. The demographic data were also reviewed. A multivariate stepwise logistic regression analysis was performed for variables with univariate analysis values of p < 0.2 on univariate analysis.</p><p><strong>Results: </strong>In total, 71 patients (23.4%) experienced persistent postoperative leg numbness. Multivariate logistic regression analysis revealed that a history of lumbar decompression, longer symptom duration, and a preoperative VAS score for leg numbness ≥ 5 points were associated with greater postoperative persistent leg numbness following lumbar fusion. In contrast, other factors, such as sex, body mass index, vertebral fracture, diabetes mellitus, depression, symptom duration, dural injury, operative time, and estimated blood loss, were not.</p><p><strong>Conclusion: </strong>A history of preoperative lumbar decompression, longer symptom duration, and greater preoperative VAS scores for leg numbness were preoperative predictors of persistent postoperative leg numbness following lumbar fusion in older patients. Although lumbar fusion is expected to improve leg numbness, surgeons should consider the surgical history, duration, and preoperative numbness intensity and explain the potential postoperative persistent leg numbness in advance.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11224755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141492840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2024-06-30DOI: 10.14245/ns.2347330.665
Weishi Liang, Yihan Yang, Bo Han, Duan Sun, Peng Yin, Yong Hai
Objective: Cervical hybrid surgery optimizes the use of cervical disc arthroplasty (CDA) and zero-profile (ZOP) devices in anterior cervical discectomy and fusion (ACDF) but lacks uniform combination and biomechanical standards, especially in revision surgery (RS). This study aimed to investigate the biomechanical characteristics of adjacent segments of the different hybrid RS constructs in ACDF RS.
Methods: An intact 3-dimensional finite element model generated a normal cervical spine (C2-T1). This model was modified to the primary C5-6 ACDF model. Three RS models were created to treat C4-5 adjacent segment degeneration through implanting cages plus plates (Cage-Cage), ZOP devices (ZOP-Cage), or Bryan discs (CDA-Cage). A 1.0-Nm moment was applied to the primary C5-6 ACDF model to generate total C2-T1 range of motions (ROMs). Subsequently, a displacement load was applied to all RS models to match the total C2-T1 ROMs of the primary ACDF model.
Results: The ZOP-Cage model showed lower biomechanical responses including ROM, intradiscal pressure, maximum von Mises stress in discs, and facet joint force in adjacent segments compared to the Cage-Cage model. The CDA-Cage model exhibited the lowest biomechanical responses and ROM ratio at adjacent segments among all RS models, closely approached or lower than those in the primary ACDF model in most motion directions. Additionally, the maximum von Mises stress on the C3-4 and C6-7 discs increased in the Cage-Cage and ZOP-Cage models but decreased in the CDA-Cage model when compared to the primary ACDF model.
Conclusion: The CDA-Cage construct had the lowest biomechanical responses with minimal kinematic change of adjacent segments. ZOP-Cage is the next best choice, especially if CDA is not suitable. This study provides a biomechanical reference for clinical hybrid RS decision-making to reduce the risk of ASD recurrence.
{"title":"Biomechanical Analysis of Hybrid Artificial Discs or Zero-Profile Devices for Treating 1-Level Adjacent Segment Degeneration in ACDF Revision Surgery.","authors":"Weishi Liang, Yihan Yang, Bo Han, Duan Sun, Peng Yin, Yong Hai","doi":"10.14245/ns.2347330.665","DOIUrl":"10.14245/ns.2347330.665","url":null,"abstract":"<p><strong>Objective: </strong>Cervical hybrid surgery optimizes the use of cervical disc arthroplasty (CDA) and zero-profile (ZOP) devices in anterior cervical discectomy and fusion (ACDF) but lacks uniform combination and biomechanical standards, especially in revision surgery (RS). This study aimed to investigate the biomechanical characteristics of adjacent segments of the different hybrid RS constructs in ACDF RS.</p><p><strong>Methods: </strong>An intact 3-dimensional finite element model generated a normal cervical spine (C2-T1). This model was modified to the primary C5-6 ACDF model. Three RS models were created to treat C4-5 adjacent segment degeneration through implanting cages plus plates (Cage-Cage), ZOP devices (ZOP-Cage), or Bryan discs (CDA-Cage). A 1.0-Nm moment was applied to the primary C5-6 ACDF model to generate total C2-T1 range of motions (ROMs). Subsequently, a displacement load was applied to all RS models to match the total C2-T1 ROMs of the primary ACDF model.</p><p><strong>Results: </strong>The ZOP-Cage model showed lower biomechanical responses including ROM, intradiscal pressure, maximum von Mises stress in discs, and facet joint force in adjacent segments compared to the Cage-Cage model. The CDA-Cage model exhibited the lowest biomechanical responses and ROM ratio at adjacent segments among all RS models, closely approached or lower than those in the primary ACDF model in most motion directions. Additionally, the maximum von Mises stress on the C3-4 and C6-7 discs increased in the Cage-Cage and ZOP-Cage models but decreased in the CDA-Cage model when compared to the primary ACDF model.</p><p><strong>Conclusion: </strong>The CDA-Cage construct had the lowest biomechanical responses with minimal kinematic change of adjacent segments. ZOP-Cage is the next best choice, especially if CDA is not suitable. This study provides a biomechanical reference for clinical hybrid RS decision-making to reduce the risk of ASD recurrence.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11224737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141492824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2024-06-30DOI: 10.14245/ns.2448140.070
Jordan J Levett, Miltiadis Georgiopoulos, Simon Martel, Wissam Al Mugheiry, Nikolaos A Stavropoulos, Miguel Vega-Arroyo, Carlo Santaguida, Michael H Weber, Jeff D Golan, Peter Jarzem, Jean A Ouellet, Georgios Klironomos, Andreas K Demetriades
Degenerative cervical myelopathy (DCM) is the leading cause of spinal cord dysfunction in adults, representing substantial morbidity and significant financial and resource burdens. Typically, patients with progressive DCM will eventually receive surgical treatment. Nonetheless, despite advancements in pharmacotherapeutics, evidence for pharmacological therapy remains limited. Health professionals from various fields would find interest in pharmacological agents that could benefit patients with mild DCM or enhance surgical outcomes. This review aims to consolidate all clinical and experimental evidence on the pharmacological treatment of DCM. We conducted a comprehensive narrative review that presents all pharmacological agents that have been investigated for DCM treatment in both humans and animal models. Riluzole exhibits effectiveness solely in rat models, but not in treating mild DCM in humans. Cerebrolysin emerges as a potential neuroprotective agent for myelopathy in animals but had contradictory results in clinical trials. Limaprost alfadex demonstrates motor function improvement in animal models and exhibits promising outcomes in a small clinical trial. Glucocorticoids not only fail to provide clinical benefits but may also lead to adverse events. Cilostazol, anti-Fas ligand antibody, and Jingshu Keli display promise in animal studies, while erythropoietin, granulocyte colony-stimulating factor and limaprost alfadex exhibit potential in both animal and human research. Existing evidence mainly rests on weak clinical data and animal experimentation. Current pharmacological efforts target ion channels, stem cell differentiation, inflammatory, vascular, and apoptotic pathways. The inherent nature and pathogenesis of DCM offer substantial prospects for developing neurodegenerative or neuroprotective therapies capable of altering disease progression, potentially delaying surgical intervention, and optimizing outcomes for those undergoing surgical decompression.
{"title":"Pharmacological Treatment of Degenerative Cervical Myelopathy: A Critical Review of Current Evidence.","authors":"Jordan J Levett, Miltiadis Georgiopoulos, Simon Martel, Wissam Al Mugheiry, Nikolaos A Stavropoulos, Miguel Vega-Arroyo, Carlo Santaguida, Michael H Weber, Jeff D Golan, Peter Jarzem, Jean A Ouellet, Georgios Klironomos, Andreas K Demetriades","doi":"10.14245/ns.2448140.070","DOIUrl":"10.14245/ns.2448140.070","url":null,"abstract":"<p><p>Degenerative cervical myelopathy (DCM) is the leading cause of spinal cord dysfunction in adults, representing substantial morbidity and significant financial and resource burdens. Typically, patients with progressive DCM will eventually receive surgical treatment. Nonetheless, despite advancements in pharmacotherapeutics, evidence for pharmacological therapy remains limited. Health professionals from various fields would find interest in pharmacological agents that could benefit patients with mild DCM or enhance surgical outcomes. This review aims to consolidate all clinical and experimental evidence on the pharmacological treatment of DCM. We conducted a comprehensive narrative review that presents all pharmacological agents that have been investigated for DCM treatment in both humans and animal models. Riluzole exhibits effectiveness solely in rat models, but not in treating mild DCM in humans. Cerebrolysin emerges as a potential neuroprotective agent for myelopathy in animals but had contradictory results in clinical trials. Limaprost alfadex demonstrates motor function improvement in animal models and exhibits promising outcomes in a small clinical trial. Glucocorticoids not only fail to provide clinical benefits but may also lead to adverse events. Cilostazol, anti-Fas ligand antibody, and Jingshu Keli display promise in animal studies, while erythropoietin, granulocyte colony-stimulating factor and limaprost alfadex exhibit potential in both animal and human research. Existing evidence mainly rests on weak clinical data and animal experimentation. Current pharmacological efforts target ion channels, stem cell differentiation, inflammatory, vascular, and apoptotic pathways. The inherent nature and pathogenesis of DCM offer substantial prospects for developing neurodegenerative or neuroprotective therapies capable of altering disease progression, potentially delaying surgical intervention, and optimizing outcomes for those undergoing surgical decompression.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11224758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141492838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sungjae An, Woo-Keun Kwon, Il Choi, Jang-Bo Lee, Joohyun Kim, Junseok W. Hur
Objective To demonstrate the non-inferiority of the novel hemostatic agent, Hemofence® (BMI Korea Co. Ltd., Jeju Korea, thrombin cross-linked sodium hyaluronate gel matrix) compared to the established agent, Floseal Hemostatic Matrix (Baxter, thrombin-gelatin matrix) in achieving hemostasis for spinal surgeries, with secondary objectives to assess additional efficacy and safety. Methods This clinical trial was a multicenter, randomized, subject-blinded, active-controlled, parallel-group, phase 3 study. Investigational drugs were administered to the first and second bleeding sites of each participant (or only to the first site if a second site was absent), evaluating hemostasis success rate within 10 minutes and the time to achieve hemostasis. Subsequent visits were conducted for safety assessments. For non-inferiority test, a 97.5% one-sided confidence interval was used; the test group was deemed non-inferior if the lower limit exceeded -10%. Results This trial showed a 97.10% success rate in the test group and 96.05% in the control group for primary efficacy. The 95% confidence interval (-4.90%, 7.44%) confirmed the test drug's non-inferiority. Time to hemostasis showed no significant difference between groups. All adverse events, adverse drug reactions, and serious adverse events were statistically similar between groups (p=1.0000, p=0.2427, and p=0.9663, respectively). Conclusion A novel hemostatic agent, Hemofence®, demonstrated an efficacy and safety profile comparable to that of Floseal.
{"title":"Evaluating the Efficacy and Safety of Hemofence (Thorombin Cross-linked Sodium Hyaluronate Gel Matrix) in Hemostasis for Intractable Exudative Bleeding in Spinal Surgery: A Multicenter, Randomized, Phase III Clinical Trial.","authors":"Sungjae An, Woo-Keun Kwon, Il Choi, Jang-Bo Lee, Joohyun Kim, Junseok W. Hur","doi":"10.14245/ns.2448024.012","DOIUrl":"https://doi.org/10.14245/ns.2448024.012","url":null,"abstract":"Objective\u0000To demonstrate the non-inferiority of the novel hemostatic agent, Hemofence® (BMI Korea Co. Ltd., Jeju Korea, thrombin cross-linked sodium hyaluronate gel matrix) compared to the established agent, Floseal Hemostatic Matrix (Baxter, thrombin-gelatin matrix) in achieving hemostasis for spinal surgeries, with secondary objectives to assess additional efficacy and safety.\u0000\u0000\u0000Methods\u0000This clinical trial was a multicenter, randomized, subject-blinded, active-controlled, parallel-group, phase 3 study. Investigational drugs were administered to the first and second bleeding sites of each participant (or only to the first site if a second site was absent), evaluating hemostasis success rate within 10 minutes and the time to achieve hemostasis. Subsequent visits were conducted for safety assessments. For non-inferiority test, a 97.5% one-sided confidence interval was used; the test group was deemed non-inferior if the lower limit exceeded -10%.\u0000\u0000\u0000Results\u0000This trial showed a 97.10% success rate in the test group and 96.05% in the control group for primary efficacy. The 95% confidence interval (-4.90%, 7.44%) confirmed the test drug's non-inferiority. Time to hemostasis showed no significant difference between groups. All adverse events, adverse drug reactions, and serious adverse events were statistically similar between groups (p=1.0000, p=0.2427, and p=0.9663, respectively).\u0000\u0000\u0000Conclusion\u0000A novel hemostatic agent, Hemofence®, demonstrated an efficacy and safety profile comparable to that of Floseal.","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140744026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The landscape of spine surgery has undergone a remarkable transformation with the emergence of advanced technologies. While robotics in spine surgery made its debut in the early 2000s, the past decade has seen a resurgence of interest in robotic-assisted procedures, likely driven by improved technology and refinements in technique. 1 The integration of robotics into spine surgery promises numerous opportunities. One of its foremost advantages lies in its capacity to guide pedicle screw insertion with real-time navigation based on preoperative planning. This precision not only minimizes tissue trauma but also reduces radiation. 2 Additionally, it has been used to complement lateral inter-body fusion surgery, percutaneous iliac screw fixation, spinal endoscopy, and sacroiliac joint fusion, further enhancing its applicability across various spinal procedures. 3,4 In the March special issue of Neurospine , Hwang et al. 5 conducted a comprehensive comparative analysis of 3 pedicle screw fixation methods in their article titled “A Propensity Score-Matched Cohort Study Comparing 3 Different Spine Pedicle Screw Fixation Meth-ods: Freehand, Fluoroscopy-Guided, and Robot-Assisted Techniques”. To date, most studies have been single-or double-arm studies, with few clinical outcomes reported. 6,7 This article sheds more light through a deeper comparative analysis. The authors performed a retrospective cohort study utilizing propensity score matching to compare the efficacy of robotic-assisted surgery with conventional techniques. Specifically, they analyzed C-arm guided minimally invasive transforaminal lumbar interbody fusion and freehand open posterior lumbar interbody fusion involving 162 patients with lumbar degenerative disease. Each group comprised 54 patients after propensity score matching. The study evaluated various parameters, including surgical accuracy, radiological outcomes, clinical improvement, and complications for
随着先进技术的出现,脊柱外科的格局发生了显著变化。虽然脊柱手术中的机器人技术在本世纪初才首次亮相,但在过去的十年中,人们对机器人辅助手术的兴趣再次高涨,这很可能是由于技术的改进和技术的完善。1 将机器人技术融入脊柱手术有望带来众多机遇。其最重要的优势之一在于能根据术前规划实时导航,引导椎弓根螺钉的插入。这种精确性不仅能最大限度地减少组织创伤,还能减少辐射。2 此外,它还被用于辅助侧方椎体间融合手术、经皮髂骨螺钉固定、脊柱内窥镜检查和骶髂关节融合术,进一步提高了其在各种脊柱手术中的适用性。3,4 在《神经脊柱》(Neurospine)三月特刊中,Hwang 等人5 在题为 "比较 3 种不同脊柱椎弓根螺钉固定方法的倾向得分匹配队列研究"(A Propensity Score-Matched Cohort Study Comparing 3 Different Spine Pedicle Screw Fixation Meth-ods)一文中对 3 种椎弓根螺钉固定方法进行了全面的比较分析:自由操作、透视引导和机器人辅助技术 "一文中。迄今为止,大多数研究都是单臂或双臂研究,很少有临床结果报告。6,7本文通过更深入的对比分析揭示了更多信息。作者利用倾向得分匹配法进行了一项回顾性队列研究,比较了机器人辅助手术与传统技术的疗效。具体来说,他们分析了 C 臂引导下的微创经椎间孔腰椎椎体间融合术和徒手开放式后路腰椎椎体间融合术,共涉及 162 名腰椎退行性疾病患者。经过倾向评分匹配后,每组由 54 名患者组成。研究评估了各种参数,包括手术准确性、放射学结果、临床改善和并发症。
{"title":"Commentary on “A Propensity Score-Matched Cohort Study Comparing 3 Different Spine Pedicle Screw Fixation Methods: Freehand, Fluoroscopy-Guided, and Robot-Assisted Techniques”","authors":"J. Oh","doi":"10.14245/ns.2448240.120","DOIUrl":"https://doi.org/10.14245/ns.2448240.120","url":null,"abstract":"The landscape of spine surgery has undergone a remarkable transformation with the emergence of advanced technologies. While robotics in spine surgery made its debut in the early 2000s, the past decade has seen a resurgence of interest in robotic-assisted procedures, likely driven by improved technology and refinements in technique. 1 The integration of robotics into spine surgery promises numerous opportunities. One of its foremost advantages lies in its capacity to guide pedicle screw insertion with real-time navigation based on preoperative planning. This precision not only minimizes tissue trauma but also reduces radiation. 2 Additionally, it has been used to complement lateral inter-body fusion surgery, percutaneous iliac screw fixation, spinal endoscopy, and sacroiliac joint fusion, further enhancing its applicability across various spinal procedures. 3,4 In the March special issue of Neurospine , Hwang et al. 5 conducted a comprehensive comparative analysis of 3 pedicle screw fixation methods in their article titled “A Propensity Score-Matched Cohort Study Comparing 3 Different Spine Pedicle Screw Fixation Meth-ods: Freehand, Fluoroscopy-Guided, and Robot-Assisted Techniques”. To date, most studies have been single-or double-arm studies, with few clinical outcomes reported. 6,7 This article sheds more light through a deeper comparative analysis. The authors performed a retrospective cohort study utilizing propensity score matching to compare the efficacy of robotic-assisted surgery with conventional techniques. Specifically, they analyzed C-arm guided minimally invasive transforaminal lumbar interbody fusion and freehand open posterior lumbar interbody fusion involving 162 patients with lumbar degenerative disease. Each group comprised 54 patients after propensity score matching. The study evaluated various parameters, including surgical accuracy, radiological outcomes, clinical improvement, and complications for","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140357690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clinical medicine is a constantly changing field. However, no change is perhaps as drastic as the integration of machine learning (ML) and artificial intelligence (AI) into clinical practice. This rapid adaptation has recently been stretched with the introduction of the chat generative pre-trained transformer (ChatGPT) in 2022. Unlike many other complex tools for ML, ChatGPT is a large language model (LLM) developed with the intent for rapid use by the lay audience. The tremendously low barrier to entry—namely involving generation of an account—has led to expansive interest in the use of ChatGPT in nearly every subfield of surgery, including spine surgery and low back pain. The goal of the study by Mejia et al. 1 was to assess the ability of ChatGPT to provide accurate medical information regarding the care of patients with lumbar disk herniation with radiculopathy. The research team developed a series of questions related to lumbar disk herniation, us-ing the 2012 North American Spine Society (NASS) guidelines as a gold standard. 2 They then collected responses from both ChatGPT-3.5, and ChatGPT-4.0. They quantified several metrics for each response. A response was considered accurate if it did not contradict the NASS guidelines. It was considered overconclusive if it provided a recommendation when the NASS guidelines did not provide sufficient evidence. A response was supplementary if it included additional relevant information for the question. Finally, a response was considered incomplete if it was accurate but omitted relevant information included within the NASS guidelines. Both ChatGPT-3.5 and -4.0 provided accurate responses to just over 50% of questions. Nearly half of all responses were also overconclusive, providing recommendations without direct
{"title":"Commentary on “Use of ChatGPT for Determining Clinical and Surgical Treatment of Lumbar Disc Herniation With Radiculopathy: A North American Spine Society Guideline Comparison”","authors":"A. Seas, Muhammad M. Abd-El-Barr","doi":"10.14245/ns.2448248.124","DOIUrl":"https://doi.org/10.14245/ns.2448248.124","url":null,"abstract":"Clinical medicine is a constantly changing field. However, no change is perhaps as drastic as the integration of machine learning (ML) and artificial intelligence (AI) into clinical practice. This rapid adaptation has recently been stretched with the introduction of the chat generative pre-trained transformer (ChatGPT) in 2022. Unlike many other complex tools for ML, ChatGPT is a large language model (LLM) developed with the intent for rapid use by the lay audience. The tremendously low barrier to entry—namely involving generation of an account—has led to expansive interest in the use of ChatGPT in nearly every subfield of surgery, including spine surgery and low back pain. The goal of the study by Mejia et al. 1 was to assess the ability of ChatGPT to provide accurate medical information regarding the care of patients with lumbar disk herniation with radiculopathy. The research team developed a series of questions related to lumbar disk herniation, us-ing the 2012 North American Spine Society (NASS) guidelines as a gold standard. 2 They then collected responses from both ChatGPT-3.5, and ChatGPT-4.0. They quantified several metrics for each response. A response was considered accurate if it did not contradict the NASS guidelines. It was considered overconclusive if it provided a recommendation when the NASS guidelines did not provide sufficient evidence. A response was supplementary if it included additional relevant information for the question. Finally, a response was considered incomplete if it was accurate but omitted relevant information included within the NASS guidelines. Both ChatGPT-3.5 and -4.0 provided accurate responses to just over 50% of questions. Nearly half of all responses were also overconclusive, providing recommendations without direct","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140360267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Expanding the Scope of Robotic Spinal Surgery With Bone Decompression: Commentary on “Advancements and Challenges in Robot-Assisted Bone Processing in Neurosurgical Procedures”","authors":"Stephen Ryu","doi":"10.14245/ns.2448210.105","DOIUrl":"https://doi.org/10.14245/ns.2448210.105","url":null,"abstract":"","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140358738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}