Neurospine最新文献

Various treatments have been developed for treating herniated lumbar discs (HLD), which have been examined by professional associations when composing clinical guidelines that provide structured approaches to treating HLD. This paper aims to gather recent guidelines and summarize their conclusions on nonsurgical and surgical treatment options. PubMed, Web of Science, Scopus, Guidelines International Network, Turning Research into Practice databases, and websites of medical societies were searched for clinical guidelines of HLD. Full-text guidelines published by a professional association in English relevant to HLD were included. Comparisons among guidelines were made based on the treatments evaluated, and recommendation grades were recorded when provided by the guidelines. A total of 12 guidelines were included, with 4 by non-United States (US) or international associations, 3 by US pain societies, 2 by surgical societies, 2 by government agencies, and 1 by a multidisciplinary medical society. Treatments assessed included surgical, invasive nonsurgical, and noninvasive nonsurgical interventions. Three guidelines did not include surgical treatments, and 2 guidelines did not include nonsurgical therapies. Recommendation criteria varied among guidelines due to differences in the intended audience. HLD can be treated with various modalities with specific therapies offering better pain relief. Despite inconsistency in the recommendation grades of most treatments, established surgical techniques and epidural injections were reported with higher confidence in recommendation estimates, while inadequate supporting evidence was shown for noninvasive therapies except cognitive behavioral therapy. Future studies could incorporate and comment on some of the newer methods of treating HLD.

Objective: To explore a surgical technique for completing ventral bone decompression and C1-2 plate-screw fixation in the craniocervical junction (CVJ) through nasal approach by stage I at the imaging and physical anatomy levels, and to evaluate its feasibility.

Methods: Radiographic parameters of 80 patients with basilar invagination (BI) and 56 with normal CVJ anatomy were retrospectively analyzed. Three-dimensional (3D) reconstructions were performed in 31 patients with BI. Key anatomical landmarks, screw entry points, and fixation trajectories were evaluated. Customized plate-screw constructs were designed. Finally, surgical feasibility was tested on a 3D-printed anatomical model and a cadaveric.

Results: In 80 BI patients, the average distances between 4 screw insertion points were 16.04 mm, 21.10 mm, 6.83 mm, and 7.10 mm. C2 lateral mass oblique lengths were 16.81 mm (right) and 17.12 mm (left); C1 lengths were 18.71 mm (right) and 19.07 mm (left), with significant differences between C1 and C2 (p<0.001). A 28.5×14.1-mm titanium plate with 16 mm screws was successfully implanted via the nasal route in the polyether ether ketone 3D-printed BI model and the cadaveric. Radiology indicated that the screws were all in the lateral mass and the plates fit tightly.

Conclusion: In BI, transnasal odontoidectomy and plate-screw fixation of C1-2 are feasible theoretically. This may enable a new alternative approach for nasal minimally invasive decompression and immobilization, following the completion of biomechanics and clinical trials.

Objective: This study aimed to evaluate and compare the structural and functional characteristics of commercially available percutaneous epidural neuroplasty (PEN) catheters. Correlations among catheter properties were also examined to identify potential implications for clinical practice.

Methods: Nine PEN catheter products from different manufacturers were analyzed. Various physical properties were assessed, including catheter diameter, length, lever rotation angle, bending degree, and advancing force. Bending degree was measured at maximal and half-maximal lever rotation angles, with and without the guidewire inserted. Advancing force was determined by measuring pressure generated at the catheter tip upon contact with the electronic scale plate. Wilcoxon signed-rank and Spearman correlation tests were used for statistical analysis.

Results: Catheters exhibited considerable variations in structural and functional properties. The average catheter diameter and length were 2.0±0.6 mm and 287.8±30.3 mm, respectively; the mean lever rotation angle was 57°±21°. When the steering lever was rotated to its maximum allowable angle, proximal bend angle significantly increased in the wire-off state relative to the wire-on state, suggesting a trade-off between flexibility and structural support. Advancing force significantly varied across products; a positive correlation was observed between catheter diameter and advancing force.

Conclusion: This study identified substantial variations in catheter characteristics across different products. Increased catheter flexibility after guidewire removal may lead to positional instability, requiring careful consideration during PEN procedures. Larger catheter diameters were correlated with increased advancing force, which could influence ease of insertion and patient comfort. These findings emphasize the need for standardized PEN catheter specifications to optimize safety and efficacy in clinical practice.

Objective: To evaluate the impact of the K-line and canal-occupying ratio (COR) on surgical outcomes in patients with multilevel cervical ossification of the posterior longitudinal ligament (OPLL).

Methods: Patients with cervical myelopathy due to multilevel OPLL who underwent decompression surgery (anterior or posterior) from 2013 to 2022, with 2-year minimum follow-up, were enrolled. Radiological evaluations included K-line, COR, OPLL type/level, and cervical parameters (C2 slope [C2S], T1 slope [T1S], K-line tilt). Clinical outcomes included Japanese Orthopaedic Association (JOA) score and neck-pain visual analogue scale. Patients were categorized by K-line status (+/-) and COR (<50% or ≥50%).

Results: Among 575 patients, JOA recovery was significantly better in the K-line (+) and in low COR (<50%). In high COR (≥50%), K-line (-) was associated with poorer recovery. In low COR, outcomes were similar regardless of K-line. Anterior decompression with fusion (ADF) yielded the best outcomes. Laminoplasty (LP) was optimal for COR ≥50% and/or K-line (+), while laminectomy with fusion (LF) was better for COR ≥50% and K-line (-). In high COR, K-line was influenced by cervical alignment, C2S, and T1S, while in low COR, it was mainly affected by COR percentage.

Conclusion: Combining K-line and COR is essential for surgical planning in multilevel OPLL. When COR is high, K-line plays a significant role in predicting neurological recovery. ADF led to superior recovery, whereas for patients with K-line (-) and high COR, LF offered better results than LP. Cervical parameters at high COR influence the K-line more.

Objective: This study aimed to compare the clinical outcomes of patients with AOSpine A3 or A4 thoracolumbar fractures presenting with neurological deficits treated with endoscopic decompression combined with percutaneous pedicle screws fixation (endoscopic minimally invasive surgery, EMIS) or conventional open surgery (OS).

Methods: Data of patients with AOSpine A3 or A4 thoracolumbar fractures with neurological deficits who were treated with EMIS or OS between June 2019 and July 2021 were extracted from the electronic database. Various clinical outcomes were compared between the 2 cohorts.

Results: Among the 231 patients who were followed up for more than 2 years, 107 were in the EMIS cohort and 124 were in the OS cohort. Compared with the OS cohort, the EMIS cohort had longer operative time (p<0.05), but the intraoperative blood loss, incision length and hospital stay were significantly reduced (p<0.05). At both postoperative and final follow-up assessments, the EMIS cohort demonstrated significantly better visual analogue scale and Oswestry Disability Index outcomes compared to the OS cohort (p<0.05). Both cohorts maintained similar correction of spinal canal erosion rate, percentage of anterior vertebral height and sagittal Cobb angle after surgery and at the last follow-up (p>0.05). According to American Spinal Injury Association classification, the 2 cohorts had similar neurological recovery at the last follow-up (p>0.05).

Conclusion: In comparison to OS, EMIS treatment for AOSpine A3 or A4 thoracolumbar fractures with neurological deficits has shown comparable clinical efficacy while significantly reducing surgical trauma.

Objective: In this study, we aimed to develop evidence-based clinical practice guidelines (CPGs) for the treatment of lumbar disc herniation (LDH) with radiculopathy, tailored to South Korean clinical settings.

Methods: The guideline development process used followed the evidence-based medicine principles. Literature searches were conducted across databases, including MEDLINE (PubMed), Cochrane, Embase, and KoreaMed, using predefined search strategies. Titles and abstracts were reviewed to identify the best research evidence. Data extraction and quality assessment were performed using the Cochrane risk of bias tool and the GRADE method. Quantitative meta-analyses or qualitative synthesis were conducted based on data heterogeneity. Recommendations were assigned strength grades (A, B, C, D, I) reflecting evidence reliability.

Results: In these guidelines, comprehensive recommendations for managing LDH with radiculopathy in clinical settings were provided. International evidence and multidisciplinary expert opinions were integrated. Four key clinical questions were identified and divided into sections: surgical treatment, interventional treatment, and physical treatment/exercise. The recommendations for these questions are summarized in this article.

Conclusion: The aim of establishing these CPGs was to enhance treatment outcomes, reduce healthcare costs, and promote public health. By recognizing limitations in domestic data and the dynamic healthcare circumstances, the need for continuous revision was emphasized in these guidelines. Nonetheless, in future updates, the guidelines will be refined to improve their quality and applicability in clinical practice.