Spine最新文献

Study design: Preclinical experimental study.

Objective: To explore the use of hydrogels as bioactive scaffolds for encapsulating bone marrow mesenchymal stem cells (BMSCs) to enhance their therapeutic potential in spinal cord injury (SCI). This study further aims to evaluate the added value of a BMP7 nanoparticle delivery system in overcoming the limitations of BMSCs alone for SCI repair.

Summary of background data: SCI leads to significant neuron loss and functional impairment. While BMSC-based stem cell therapies show promise, their efficacy is limited by challenges such as the instability of bone morphogenetic protein (BMP)-7 in inducing neuronal differentiation. High concentrations of BMP7, though effective in promoting neuronal differentiation, may cause inflammation, necessitating the development of a delivery system for sustained and localized release.

Methods: BMSCs were isolated from Sprague-Dawley rats, and BMP-7's effects on neuronal differentiation were assessed via western blotting. BMP7-loaded nanoparticles (NPs) and BMSCs were co-loaded into a gelatin methacrylate (Gel-MA) hydrogel scaffold, with a cell loading density of 1 × 10⁵ cells/μl. BMP7 was encapsulated at a 0.04% (w/V) concentration, corresponding to approximately 0.4 ng BMP7 per μl of hydrogel. Optimization was performed using mechanical, cytotoxicity, and neuronal marker analyses. Scaffold properties, including water absorption, BMP7 release, and BMSC morphology, were characterized. Therapeutic efficacy was evaluated in a rat SCI model using motor function recovery, histological analysis, and molecular assessments.

Results: BMP-7 effectively promoted BMSC differentiation into neurons while suppressing glial cell development. The BMP7-NPs/Gel-MA scaffold ensured sustained BMP7 release, achieving optimal differentiation at a 0.04% (w/V) BMP7 concentration. In vivo, the scaffold combined with BMSCs enhanced neuronal proliferation and differentiation, stimulated myelin regeneration, reduced lesion volume, and significantly improved motor function recovery.

Conclusion: The BMP7-NPs/Gel-MA scaffold provides sustained delivery of BMP-7, effectively directing BMSC differentiation into neuron-like cells while avoiding glial commitment. Combined with BMSCs, it offers a promising therapeutic strategy for SCI repair.

Study design: Systematic Review.

Objective: To determine the incidence of inappropriate or uncertain implementation of the Minimally Important Clinical Difference (MCID) for the Neck Disability Index (NDI).

Summary of background data: The NDI consists of 10 items that yield a total score out of 50, but some users double the scale to report total scores out of 100. The most used MCID for the NDI is 7.5 out of 50. Implementation of the MCID can be problematic if users are not attentive to the scale of the NDI.

Methods: We performed a methodological review of studies that cited the MCID for the NDI. We defined appropriate implementation as congruent magnitude of the scales used for NDI data and the MCID. We evaluated study characteristics associated with appropriate implementation using multivariable logistic regression.

Results: Among 163 included studies, twenty (12%) reported a 0-50 scale for the NDI, 66 (40%) reported a 0-100 scale, and the remaining 77 (47%) did not report which scale was used. Fifty-seven (35%) reported an MCID of 7.5, 37 (23%) reported an MCID of 15, and the remaining 69 (42%) did not report which value of the MCID used. Appropriate implementation of the MCID occurred in 39 studies (24%), while implementation was inappropriate in 16 (10%) and uncertain due to poor reporting in 108 (66%). Studies published more recently (OR 1.20 per year, 95% CI 1.02 to 1.40, P=0.03) and studies that were RCTs (OR 4.85, 95% CI 1.25 to 18.79, P=0.02) had greater odds of being associated with appropriate implementation.

Conclusions: Inappropriate implementation of the MCID for the NDI is problematic and occurs often, and uncertain implementation due to poor reporting is also common. Evidence users should be cautious when interpreting studies that implement the NDI, and should consider whether the magnitude of the scales used for the NDI and the MCID are congruent.

Study design: Global cross-sectional survey.

Objective: To validate the hierarchical nature of the AO Spine Upper Cervical Spine Injury Classification (UCIC) across AO geographical regions/practice experience.

Summary of background data: In order to create a universally validated scheme with prognostic value, AO Spine established an upper cervical spine injury classification involving three elements: injury morphology (region: I - occipital condyle and craniocervical junction; II - C1 ring and C1-2 joint; III - C2 and C2-3 joint), and (subtype: A - isolated bony injury; B - bony/ligamentous injury; C - displaced/translational injury), neurologic status (N0 - intact; N1 - transient deficit; N2 - radiculopathy; N3 - incomplete spinal cord injury (SCI); N4 - complete SCI, and NX - unable to examine), and case-specific modifiers (M1 - injuries at risk of nonunion; M2 - injuries at risk of instability; M3 - patient specific factors; M4 - vascular injury).

Methods: 151 AO Spine members (orthopaedic and neurosurgery) were surveyed globally regarding the severity (zero - low severity to 100 - high severity) of each UCIC variable. Primary outcomes were differences in perceived injury severity score (ISS) over various geographic/practice settings, level of experience, and subspecialty.

Results: 148 responses were received. There was an increase in median perceived severity as each anatomic region (I-III) progressed from types A to B to C. Neurologic status progressed similarly, except N1 and N2 were perceived similarly. Modifier M2 was perceived more severely than M3. There were no differences in ISS amongst levels of surgeon experience. There were small geographic differences with respondents from North and Central and South America perceiving types IC (P=0.003), IIB (P=0.003), and IIIB (P=0.003) somewhat more severely than other regions. Neurosurgeons perceived types IB (P=0.002) and IIIB (P=0.026) as more severe than orthopaedic spine surgeons.

Conclusions: The AO Spine UCIC has overall excellent hierarchical progression in subtype ISS. These findings are consistent across geographic regions, spine subspecialty training and experience levels.

Study design: Retrospective cohort study.

Objective: To assess the utility of preoperative vertebral bone quality (VBQ) scores in predicting the five-year clinical outcomes following lumbar spine surgery.

Summary of background data: Osteoporosis poses a significant concern in older adults undergoing spinal surgery. The VBQ score, assessed through preoperative magnetic resonance imaging (MRI), is associated with subsequent osteoporotic fractures and postoperative complications. However, previous report on the impact of VBQ score on mid-term clinical outcomes after lumbar spine surgery remains lacking.

Materials and methods: A total of 189 patients who underwent lumbar surgery (≤3 disc levels) for lumbar spinal stenosis between 2010 and 2016 were enrolled. Patients were classified into high (>3.35), middle (2.75-3.35), and low (<2.73) VBQ score groups based on tertiles. Clinical scores, including Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Short Form-36 (SF-36), were recorded preoperatively and one, two, and five years postoperatively.

Results: Comparative analysis showed significant differences among the VBQ groups throughout the study period in low back pain ( P =0.013), walking ability ( P =0.005), social life function ( P =0.010) of JOABPEQ, and physical component summary of the SF-36 ( P =0.018) following lumbar spine surgery. A higher VBQ score was significantly correlated with worse five-year postoperative outcomes for all domains except for lumbar function of the JOABPEQ using multiple linear regression analysis, adjusting for age, sex, BMI, hyperlipidemia, surgical procedures, and each preoperative score.

Conclusion: A high preoperative VBQ score is a risk factor for poor five-year clinical outcomes after lumbar spine surgery. Evaluation of the VBQ score through routine preoperative MRI facilitates osteoporotic screening in lumbar patients without radiation exposure and health care costs, while also demonstrating its potential as a prognostic indicator of postoperative clinical outcomes.

Level of evidence: Level III.

Study design: A genetic case-control study.

Objectives: To investigate the association between AIS progression-associated SNPs reported by GWAS studies and the effectiveness of brace treatment.

Summary of background data: Bracing is the most effective conservative method to treat adolescent idiopathic scoliosis (AIS). Several factors have been reported to be associated with bracing failure in AIS patients. Genetic markers associated with AIS have potential prognostic value.

Methods: A retrospective cohort of AIS patients undergoing brace treatment was enrolled in this study and divided into success and failure groups based on treatment outcome. Clinical characteristics of AIS patients were documented. Candidate SNPs were selected from previous GWAS studies of AIS, which were known to be associated with curve progression and validated across diverse populations. Genotype and allele frequencies between the success and failure groups were compared using χ 2 analysis.

Results: A total of 259 female AIS patients were included in this study, 30.5% of the well-braced patients had curve progression exceeding 5° and 69.5% of the patients undergo an improvement or progression of <5°. Allele C of rs10738445 ( BNC2 ) could significantly add to the risk of bracing failure, with odds ratio of 1.59. No significant association with bracing outcomes was found for rs12946942 ( SOX9/KCNJ2 ), rs1978060 ( TBX1 ), rs1017861 ( CHD7 ), and rs35333564 ( MIR4300HG ).

Conclusions: SNP rs10738445 were significantly associated with brace treatment effectiveness. The other four SNPs were not significantly associated with the outcome of bracing. More SNPs and predictors should be included in future study to develop a more accurate predictive model for clinical application.

Study design: A retrospective, observational study.

Objective: To evaluate the ability and value of metagenomic next-generation sequencing (mNGS) in detecting pathogens from spinal infections.

Background: The pathogenic diagnosis of primary spinal infection is challenging. The widespread application of mNGs in clinical practice makes it particularly useful in detecting rare, emerging, and atypical complex infectious diseases.

Methods: From January 2019 to December 2023, 120 samples were retrospectively collected from patients suspected of spinal infections and undergoing treatment. Pairwise comparisons between traditional laboratory tests and mNGS were conducted for all cases.

Results: Among the 120 cases, 95 were diagnosed as spinal infections, while 25 were classified as noninfectious. Microbiological evidence was found in 59 cases, while 36 cases were clinically diagnosed as spinal infections without definitive microbiological evidence. Rare microorganisms such as Aspergillus fumigatus , Taifanglania major , and Coxiella burnetii were detected by mNGS. The positive rate of mNGS was significantly higher at 88.42% compared with microbiological culture (43.16%), P <0.001. At the genus level, mNGS exhibited a consistency rate of 86.44% (51/59) with confirmed microorganisms. MNGS demonstrated very good agreement with clinically confirmed microorganisms at the genus level (κ=0.833). The sensitivity, specificity, positive predictive value, and negative predictive value of mNGS were 86.44%, 92.00%, 96.23%, and 74.19%, respectively.

Conclusions: The mNGS test exhibits rapidity, efficiency, and accuracy, rendering it of immense diagnostic and therapeutic value in the realm of spinal infection diseases.

Study design: Retrospective cohort study.

Objective: To elucidate the factors related to the progression of scoliosis in patients with rheumatoid arthritis (RA) using longitudinal cohort data.

Background: Of patients, 30% with RA have lumbar scoliosis. However, the effectiveness of current treatment methods in preventing the progression of scoliosis is not well understood due to a lack of longitudinal studies.

Patients and methods: We enrolled 180 patients with RA who were followed up for over 2 years, all of whom underwent standing spinal x-rays. These patients were categorized based on their disease activity score-28 with erythrocyte sedimentation rate into 2 groups: (1) those in remission (n = 76) and (2) those in nonremission (n = 104). We evaluated various radiographic measures, including C7 center sacral vertical line, pelvic obliquity, major Cobb angle, and curve location.

Results: Fifty-three (29.4%) patients presented progression of scoliosis during a mean follow-up period of 4.8 years. Patients in the nonremission showed larger Cobb angle at baseline and final follow-up, compared with those in remission. The annual progression rate of the curve was also greater in the nonremission group (1.04°/yr) than in the remission group (0.59°/yr, P = 0.001). There was no difference in the incidence of new vertebral fractures. The presence of a baseline Cobb angle of 10° or more [odds ratio (OR): 3.14; 95% CI: 1.38-7.13; P = 0.006], glucocorticoid use (OR: 2.88; 95% CI: 1.18-7.06; P = 0.021), and nonremission at baseline (OR: 2.83; 95% CI: 1.25-6.41; P = 0.012) were significant risk factors for progression of scoliosis.

Conclusion: RA disease activity is linked to the progression of scoliosis in patients with RA. Patients with RA who present with initial scoliosis of ≥10°, require glucocorticoids for treatment and are in nonremission at baseline may be at high risk for scoliosis progression.

Level of evidence: Level III.

Study design: Unblinded single-arm prospective clinical trial.

Objective: Evaluate safety and accuracy of navigation for placement of posterior cervicothoracic instrumentation.

Summary of background data: Computer-assisted stereotactic navigation for placement of spinal instrumentation has been widely studied and implemented in the thoracic and lumbar spine. However less literature exists regarding the use of computer-assisted navigation for posterior cervical instrumentation, particularly with lateral mass fixation. Here we present the first prospective study of navigated cervical lateral mass screw placement for cervicothoracic fusion.

Methods: Patients who met indications for posterior cervical fusion were screened, consented, and enrolled preoperatively for instrumentation with medtronic infinity occipital-cervical-thoracic implants, with use of intraoperative O-arm and stereotactic Stealth navigation. Postoperative CTs of the instrumented levels were obtained during the same hospital admission. Primary outcome of the trial was safety. Secondary outcomes were screw accuracy assessed by Gertzbein-Robbins grade, neurologic exams, and patient reported outcomes on the PROMIS 29 questionnaire.

Results: A total of 50 patients underwent surgery, and 557 screws were placed. There were no adverse events related to the use of navigation or screw malposition. Gertzbein-Robbins grade A or B placement comprised 95% of navigated screws. There was a decrease in positive Hoffmann sign rate postoperatively, and sensory and motor exams remained stable. There was improvement in patient reported pain and sleep domains.

Conclusions: Navigation for cervicothoracic instrumentation is safe overall and leads to high rates of accurately placed screws. Longer term follow-up could provide more insight to whether the use of this technology results in durable improvement in spinal alignment parameters and patient reported outcomes.

Level of evidence: Level III.

Study design: A systematic review and meta-analysis.

Objective: To conduct a meta-analysis of studies that compared surgery with or without radiotherapy to radiotherapy alone for patients with malignant spinal cord compression, and a subgroup analysis of patients stratified by hematologic and solid malignancies.

Summary of background data: Two previous meta-analyses showed that surgery with or without radiotherapy was better than radiotherapy alone in patients with malignant spinal cord compression. Nevertheless, there was no stratification by tumor type, leading to uncertainty regarding the best approach for patients with hematologic malignancies.

Materials and methods: We searched PubMed, Scopus, and Web of Science, for studies comparing surgery with or without radiotherapy to radiotherapy alone in patients with malignant spinal cord compression. The primary outcomes were improvement in ambulatory status and survival at 12 months. For neurological outcomes, we included studies involving both locally advanced primary malignancies of the spine and metastatic tumors. We restricted our analysis to studies on metastases for survival outcomes.

Results: We included 2536 patients from 18 studies. Surgery was performed in 890 (35%) patients. The pooled analysis of all studies revealed that improvement in ambulatory status [odds ratio (OR): 2.65; 95% CI: 1.60-4.39] and survival at 12 months (OR: 1.66; 95% CI: 1.10-2.52) were significantly higher in patients who underwent surgery with or without radiotherapy. Improvement in ambulatory status (OR: 1.92; 95% CI: 1.19-3.09) and survival at 12 months (OR: 4.24; 95% CI: 2.35-7.66) were significantly higher in patients with hematologic malignancies in the surgical arm. The primary outcomes were not significantly different between patients with solid malignancies.

Conclusion: Surgical intervention demonstrates superior neurological outcomes and increased survival compared with radiotherapy alone. Subgroup analysis revealed that patients with hematologic malignancies in the surgery group experienced superior primary outcomes; however, the high risk of bias of the included studies precludes definitive changes in standard care based on this data. These findings underscore the need for further research regarding the efficacy of surgical versus radiotherapeutic approaches for specific tumor types.

Level of evidence: Level II.