Neurospine最新文献

Objective: Lesions of the ventral craniovertebral junction are difficult to access owing to their deep location and proximity to critical neurovascular and pharyngeal structures. In this study, we aimed to describe the surgical technique and clinical outcomes of the endoscopic endonasal transnasopharyngeal approach for ventral craniovertebral junction lesions and highlight key considerations regarding approach selection, airway management, and occipitocervical stabilization.

Methods: We retrospectively reviewed 7 patients who underwent the endoscopic endonasal transnasopharyngeal approach for ventral craniovertebral junction lesions. The analysis included preoperative planning for surgical access, intraoperative technique, postoperative management, airway and nutritional strategies, and the need for occipitocervical fixation. One representative case is presented to illustrate key technical steps.

Results: Of the 7 patients, 6 had neoplastic lesions and 1 had basilar invagination. Despite a relatively large mean lesion size of 39.4 mm, subtotal or greater resection was achieved in 5 of the 6 tumor cases. Occipitocervical fixation was performed in 2 cases. Two patients underwent prophylactic tracheostomy because of anticipated airway compromise. Of the 5 orally intubated cases, 3 were extubated immediately and 2 by postoperative day 2. Oral feeding resumed by day 10 in 6 cases. No postoperative infections or cerebrospinal fluid leakage occurred. One patient experienced transient velopharyngeal insufficiency, which resolved spontaneously.

Conclusion: The endoscopic endonasal transnasopharyngeal approach is a safe and effective option for ventral craniovertebral junction lesions when appropriately selected. Careful preoperative evaluation and individualized management of airway and spinal stability are essential for favorable outcomes.

Objective: Anterior odontoid screw fixation (AOSF) has several advantages over posterior C1-2 fusion for Grauer type II and shallow type III odontoid fractures. However, the risk factors for fusion failure, particularly in terms of 3-dimensional (3D) measurements, remain unclear. This study investigated the impact of fracture deficit volume (FDV), a novel 3D measurement, on fusion outcomes in patients undergoing AOSF.

Methods: We enrolled 44 patients with Grauer type II or shallow type III odontoid fractures treated with AOSF at a single institution. Radiological assessments included preoperative and postoperative measurements of the fracture gap and fracture displacement on computed tomography (CT) scans. FDV was calculated through 3D CT reconstruction of preoperative and immediate postoperative CT to quantify the spatial gap between the edges of the fractures. Fusion outcomes were defined as solid union, fibrous union, or nonunion. Logistic regression and a generalized additive model (GAM) were used to identify risk factors for fusion failure after AOSF.

Results: Solid fusion was achieved in 77.3% of patients. A reduction in the FDV with respect to the preoperative value was significantly associated with successful fusion (p=0.028), whereas patients presenting an increased FDV postoperatively were more likely to exhibit fusion failure (p=0.006). Age≥65 years, a fracture gap≥2 mm, and an increased FDV postoperatively were significant risk factors for fusion failure. GAM analysis revealed a linear relationship between a reduced FDV and improved fusion rates (adjusted R2=0.186, p=0.018).

Conclusion: The risk of fusion failure is greater in elderly patients, those with a fracture gap greater than 2 mm, and those with an increased FDV postoperatively. Among the modifiable risk factors, FDV had the greatest impact on fusion outcomes after AOSF.

Objective: To elucidate the clinical outcomes of craniocervical realignment surgery in patients with craniovertebral junction (CVJ) kyphosis accompanied by negative sagittal imbalance, and to identify radiological predictors associated with favorable outcomes.

Methods: A retrospective analysis was performed on 28 patients who underwent craniocervical realignment between 2014 and 2022 for CVJ kyphosis with accompanying negative sagittal imbalance. Clinical outcomes were evaluated using the Neck Disability Index (NDI), visual analogue scale for neck pain, and the Japanese Orthopaedic Association (JOA) score. Radiographic parameters included the C0-2 angle and the C2-7 sagittal vertical axis (SVA). Favorable outcomes were defined as an improvement of more than 20 points in the NDI and a JOA recovery rate exceeding 50%. Multiple linear regression and receiver operating characteristic (ROC) curve analyses were conducted to identify independent predictors and to determine optimal threshold values.

Results: Significant improvements in both clinical outcomes and radiographic alignment were observed in association with craniocervical realignment surgery. Patients who achieved favorable outcomes exhibited greater postoperative changes in the C0-2 angle and the C2-7 SVA. Multivariate analysis identified changesm in the C0-2 angle (p=0.019) and C2-7 SVA (p=0.010) as independent predictors of NDI improvement, while age (p=0.033) and C2-7 SVA change (p=0.037) were independently associated with the JOA recovery rate. ROC curve analysis determined optimal cutoff values of ≥10.65° for C0-2 angle change and ≥19.2 mm for C2-7 SVA change, with corresponding area under the curve values of 0.872 and 0.802, respectively.

Conclusion: Craniocervical realignment appears to be a viable surgical option for patients with CVJ kyphosis and negative sagittal imbalance. Postoperative changes in C0-2 angle and C2-7 SVA were found to be associated with favorable clinical and functional outcomes, suggesting their potential role as prognostic factors.

Objective: To evaluate the trends in school-based scoliosis screening programs, with a focus on the impact of coronavirus disease 2019 (COVID-19) pandemic, including its effects on referral numbers and radiological profiles of patients with adolescent idiopathic scoliosis (AIS).

Methods: A total of 298,666 volunteer individuals participated in the school-based scoliosis screening program, classified into 2 groups; prepandemic group (between 2017 and 2019, n=201,160) and postpandemic group (between 2021 and 2023, n=97,506). The data included referral volumes, the prevalence rate of AIS, and trends in both referral patterns and the characteristics of the screened population.

Results: The prevalence rate of AIS among the screened population was significantly higher in the postpandemic group (49.35%; 95% confidence interval [CI], 48.12-50.59) compared to the prepandemic group (41.47%; 95% CI, 40.71-42.24) (p<0.001). The postpandemic group also exhibited significantly younger age (p<0.001), lower body weight (p<0.001), earlier onset of menarche (p<0.001), and a larger Cobb angle in females (p<0.001) compared to the prepandemic group. Additionally, the proportion of individuals not recognizing their AIS was significantly higher in the postpandemic group (99.74%) compared to the prepandemic group (88.87%) (p<0.001).

Conclusion: Lockdown for preventing COVID-19 pandemic negatively affected the school-based scoliosis screening program. While the overall prevalence of AIS remained stable, the detection rate in the screened population increased, accompanied by younger ages, earlier menarche, and higher Cobb angles (in females) following the COVID-19 pandemic.

Objective: Endoscopic spine surgery implies possibly severe complications of the central nervous system, from headache to seizures and autonomic dysreflexia. These adverse events might be due to increased intracranial pressure (ICP), presumably induced by increased spinal intra-/epidural pressure caused by fluid irrigation. This study was designed to perform interlaminar endoscopic lumbar discectomy (IELD) at different irrigation fluid settings while monitoring its effect on intra-/epidural and ICPs, with and without dural tears.

Methods: Spinal intradural pressures were measured by introducing catheters through a sacral approach to human cadavers' lumbar, thoracic, and cervical levels. Additionally, an epidural probe was placed at L3-4. ICP was measured by an intraventricular probe. IELD was performed at L3-4, and the effect of varying irrigation pressures by different endoscopic pump systems and gravity-based irrigation on intra-/epidural and ICP pressures was measured before and after durotomy at L3-4.

Results: Intradural pressure at L3-4 correlated linearly with increasing irrigation pressure, irrespective of the used pump system (median pressure increase at 100-mmHg irrigation pressure: system I: 7 mmHg, r=0.94, p=0.002; system II: 7 mmHg, r=0.89, p=0.017) or gravity (8 mmHg, r=0.93, p=0.242). This effect was also seen intradurally at the thoracic/cervical spine, epidural, and intracranial level, and was even more pronounced with the maneuver of outflow-occlusion and a dural tear present.

Conclusion: While performing IELD, pump pressures correlated linearly to intra-/epidural pressures and ICPs. Pressures did not rise to concerningly high levels without outflow-occlusion, even with increased pump pressures. In the presence of a dural tear, higher pump pressures exacerbated by occlusion may lead to deleterious intradural and ICP elevations.

Postoperative pain is an inevitable consequence of spine surgery, yet there remains no universal consensus on the optimal pain management strategy. The complexity of spine procedures, coupled with patient variability, necessitates a multifaceted approach to pain control. Over time, numerous strategies have emerged, each with varying levels of effectiveness. Pharmacological approaches, including multimodal analgesia, local anesthetic infusions, and gabapentinoids, provide relief for both acute and chronic pain. Additionally, perioperative strategies such as enhanced recovery after surgery (ERAS) protocols have demonstrated benefits in optimizing pain control and recovery outcomes. Beyond pharmacological interventions, physical therapy has become a cornerstone of postoperative pain management, aiding in functional recovery and reducing reliance on medications. For patients with refractory or chronic pain, neuromodulatory techniques such as spinal cord stimulation and intrathecal injections offer alternative solutions. Despite the breadth of evidence-based strategies available, limitations persist, including opioid dependence, the complexity of multimodal regimens leading to suboptimal compliance, and cases of refractory pain. These challenges underscore the importance of tailoring pain management approaches to individual patient needs, ensuring a balance between effectiveness and safety. This narrative review of evidence seeks to explore the multifaceted nature of pain management following spine surgery, highlighting the challenges and evolving strategies in optimizing patient outcomes.