Spine最新文献

Study design: Experimental Study.

Objective: To create an EOS rabbit model and use a design-based stereological method to quantitatively assess lung structure changes at 24 weeks of age.

Summary of background data: Scoliosis affects thoracic and lung development, impacting children's chest and lung growth.

Methods: EOS was induced via rib tethering in 4-week-old rabbits with ongoing CT scans and weight measures. Lungs were extracted post-fixation for volume estimation and tissue sampling, followed by microscopic analysis of lung morphology.

Results: The mean Cobb angle increased with the rabbits' growth. The EOS group showed significant decreases in total and right lung volumes. Quantitative lung stereology revealed reduced volumes of lung parenchyma and nonparenchymal tissue in all lobes. Alveolar duct volumes decreased significantly in multiple lobes, and alveolar septal volume was notably reduced in the right upper, middle, and lower lobes. Alveolar septal area decreased, and septal thickness increased in the EOS group. Alveoli numbers dropped, with variable changes in mean alveolar volume across lobes. Vascular lumen volume decreased in the right middle and lower lobes, and blood vessel and perivascular tissue volumes were significantly reduced in the right lung. Vessel diameter changes varied across lobes, with significant decreases in the right middle and lower lobes and increases in the left upper and lower lobes. Vascular endothelial surface area decreased in the left lower, right middle, and right lower lobes, with increased vessel and perivascular tissue thickness in the left upper and lower lobes compared to the right lobes.

Conclusion: The EOS rabbit model demonstrated reduced lung volume, impaired alveolarization, septal thickening, and vascular changes, indicating scoliosis's negative impact on thoracic and lung development, especially on the concave lung.

Study design: Retrospective study analysis.

Objective: To explore association between degenerative spinal conditions and paraspinal sarcopenia in patients with severe degenerative lumbar spinal stenosis (DLSS).

Background: Paraspinal muscles plays an essential role in stabilizing the spine. Paraspinal sarcopenia is progressively recognized as a crucial parameter influencing clinical outcomes in the field of spine surgery. The association between degenerative spinal conditions and paraspinal sarcopenia in patients with severe DLSS has been rarely investigated.

Materials and methods: This study was conducted on consecutive patients who underwent posterior lumbar interbody fusion at L4/5 single-level for lumbar spinal stenosis between January 2019 and July 2023. The study assessed paraspinal sarcopenia based on the fatty infiltration and Goutallier classification systems (GCS) of multifidus muscle on preoperative magnetic resonance imaging. The study evaluated the association between demographic/radiographic factors and paraspinal sarcopenia in patients with DSLL. Ordinal logistic regression analysis was then performed to adjust for confounding.

Results: A total of 129 patients were included, including 38 patients with mild paraspinal sarcopenia, 52 patients with moderate paraspinal sarcopenia, and 39 patients with severe paraspinal sarcopenia. Correlation analysis indicated that age (r=0.366, P<0.001), pelvic incidence (PI) (r=0.407, P<0.001), lumbar lordosis (LL) (r=0.362, P=0.023) were positively correlated with paraspinal sarcopenia, while weight (r=-0.422, P<0.001), cross-sectional area (CSA) of psoas (r=-0613, P<0.001), facet joint angle (FA) (r=-0.447, P=0.016), and The Hounsfield Unit values of L1-L4 (L1-4 HU) (r=0.298, P=0.005) were negatively correlated with paraspinal sarcopenia. Ordinal logistic regression showed that the Facet joint osteoarthritis (FJOA) (odds ratio=2.82, P=0.017), PI (odds ratio=1.15, P<0.001), age (odds ratio=1.14, =0.001), and female (odds ratio=5.26, P=0.04) were associated with paraspinal sarcopenia.

Conclusions: Our study demonstrated FJOA, PI, age, and female were associated with paraspinal sarcopenia. The assessments of paraspinal muscles cross-sectional area were not associated with the severity of fatty infiltration.

Study design: Retrospective review.

Objective: To determine the impact of upper lumbar lordosis changes in the fused segment on compensatory kyphotic or lordotic changes in the unfused lower lumbar spine in patients with Adolescent Idiopathic Scoliosis (AIS).

Summary of background data: While the distribution of lordosis and interplay between fused/unfused segments has been studied in adults, less is known about this in AIS. We hypothesize that increased FSLL can result in compensatory kyphosis of the unfused distal segments.

Methods: A retrospective review of Lenke 1/2 patients who underwent posterior spinal fusion (PSF) to L1, L2, or L3 with a minimum follow-up of two years. Coronal Cobb angles, thoracic kyphosis, lumbar lordosis, and spino-pelvic parameters (T4PA, L1PA, PT, SS, PI, PI-LL, SVA) were measured. Custom MATLAB scripts were used for 3D segmental lordosis calculations. Statistical analysis including linear regression analyses and interaction models assessed the relationship between fused segment lumbar lordosis (FSLL), LIV, and thoracic kyphosis (TK) on lower lumbar compensatory alignment.

Results: 158 patients met inclusion criteria. Changes in FSLL affected segmental lordosis of unfused segments, including loss of distal lordosis. In the L1 LIV group, increased FSLL increased L1-L2 lordosis (B=0.35 (P=0.003)). In LIV L2, increased FSLL increased L3-4 lordosis (B=0.2 (P=0.001)) and decreased L4-L5 lordosis (B=-0.23 (P=0.012). For LIV L3, increased FSLL caused reduction in lordosis of L4-5 (B=-0.14 (P=0.026)) and L5-S1 (B=-0.14 (P=0.034)). Changes in TK also had varying impacts on the unfused segments. The interaction model with LIV levels reveals that the compensation strategy can vary depending on specific fusion levels, although not significant. Overall sagittal alignment was maintained and PI-LL remained <10°. Pre- and postoperative T4-L1PA had minimal difference to each other indicating maintained sagittal harmony.

Conclusions: In this observational study of segmental changes in lumbar lordosis in AIS, post-operative changes in the fused segments can result in iatrogenic changed in the unfused lower segments to maintain spinal balance. Understanding normal segmental lumbar lordosis distribution is critical in surgical planning (i.e. rod contouring) and in understanding the health of the unfused segments long term.

Study design: Randomized clinical trial.

Objective: To compare the effect on quality of life of night-time (NT) and full-time (FT) brace treatment for adolescent idiopathic scoliosis (AIS).

Summary of background data: Conservative treatment of adolescent idiopathic scoliosis (AIS) with full-time (FT) braces has proven to prevent the risk of progression and the need for surgery, with an inversely proportional relationship to the number of hours worn. However, therapeutic adherence and its effect on quality of life continue to pose a clinical challenge.

Materials and methods: Open-label clinical trial including AIS patients with curves between 25-45 degrees randomized to either NT or FT brace group. Follow-up occurred over two years, assessing treatment efficacy through radiographs and quality of life using SRS-22 and visual analog scale (VAS) questionnaires scores at baseline, 6 months, and 12 months. Compliance was monitored with thermal sensors every three months. Statistical analyses were conducted, with significance set at P < 0.05.

Results: 78 AIS patients, predominantly females (85.9%), were recruited, including 35 (44.87%) in FT group and 43 (55.13%) in NT. Initial Cobb angles were comparable between groups. Nine patients were excluded, and eight required surgery (NT 12.82%, FT 10%). After two years, both braces showed similar effectiveness in preventing curve progression. No differences on SRS-22 nor VAS scores were found before treatment. At six-month follow-up, NT group reported significantly better outcomes in "Self-image" compared to FT (P=0.047). After one year, NT patients reported less pain compared to baseline (P=0.048).

Conclusions: According to our results, both braces are equally effective in avoiding the progression of the deformity and need for surgery. However, FT brace has a higher impact on self-image and pain compared to NT brace.

Study design: Secondary analysis of a prospective single-center study.

Objective: To analyze the prevalence and risk factors for untreated osteoporosis in patients undergoing lumbar spinal fusion surgery (LFS) and its impact on bone mineral density (BMD) and bone turnover markers.

Background: Osteoporosis is a risk factor for mechanical complications in LFS, which can be mitigated by antiosteoporotic treatment. However, there's limited research on factors leading to untreated osteoporosis before LFS and its impact on preoperative bone status.

Methods: A secondary analysis of a prospective study enrolling adults undergoing LFS for degenerative conditions (2014-2024) with preoperative quantitative CT osteoporosis screening was performed. Demographic data and medical history were analyzed for prevalence and risk factors of untreated osteoporosis, while BMD, vitamin D, PTH levels, and bone turnover markers were assessed for the effects of lacking treatment.

Results: A total of 445 patients (48% female, median age 64) were included, of which 137 patients (31%) had osteoporosis. Of these, 66 (48%) were untreated and 71 (52%) were treated, with 40 (56%) receiving pharmacological and 31 (44%) non-pharmacologic treatment including vitamin D supplementation and lifestyle modifications. Of the untreated patients, 55 (80%) were identified by preoperative screening. 71% of osteoporotic men versus 35% of osteoporotic women were untreated (P<0.001). Multivariable logistic regression confirmed male sex as an significant contributing factor (OR 4.3, 95% CI 1.9-10.1, P<0.001) for untreated osteoporosis. Treated osteoporotic patients had higher BMD (P<0.001), higher VitD levels P=0.023) and lower levels of bone resorption parameters (P=0.004) than untreated patients.

Conclusion: Untreated osteoporosis is common before LFS, especially in men, with the untreated having lower BMD and higher bone resorption marker levels than treated patients. Identification of osteoporotic cases and subsequent osteological optimization could potentially reduce the risks of adjacent fractures or screw loosening.

Study design: Retrospective Cohort.

Objective: Investigate the disparities between octogenarians and non-octogenarians undergoing cervical spine surgery regarding perioperative, and postoperative outcomes.

Summary of background data: As the population ages, the demand for elective cervical spine surgery among older, more active adults increases. However, concerns remain regarding the optimal management of older patients undergoing cervical surgery, given the potential complexities associated with advanced age, comorbidities, and physiological decline. While the safety and efficacy of cervical spine surgery in younger cohorts have been extensively studied, there is a paucity of literature specifically addressing outcomes in octogenarians.

Methods: Octogenarians undergoing elective cervical spine surgery were propensity matched 3:1 to patients <80 years old by baseline neck and arm pain, surgical approach, and total instrumented levels. Primary outcomes of interest were postoperative complications, unexpected 90-day hospital readmissions and 12-month reoperation. Secondary outcomes were 12-month patient satisfaction and patient reported outcome measures (PROMs) at 3 and 12 months, including EuroQol-5D, modified Japanese Orthopaedic Association, neck disability index, and visual analog scale for neck and arm pain.

Results: There were 29 octogenarians and 87 nonoctogenarians identified. The mean age in each cohort was 82.4±2.2 vs. 59.1±11.1 years, respectively. There was no difference in postoperative complications (10.3% vs. 6.9%, P=0.548), 90-day readmission (10.3% vs. 6.9%, P=0.548), and 12-month reoperation (3.4% vs. 2.3%, P=0.736) between octogenarians and non-octogenarians. Similarly, octogenarians and nonoctogenarians experienced comparable 12-month patient satisfaction (65.2% vs. 55.3%, P=0.393), improvement in 3- and 12- month PROMs and MCID achievement.

Conclusion: Postoperative complications, readmission, reoperation rate, patient satisfaction, and PROMs did not significantly differ between octogenarians and non-octogenarians undergoing cervical spine surgery. These findings suggest that age alone should not be a determining factor in surgical decision-making for elective cervical spine procedures, as octogenarians can achieve comparable outcomes to their younger counterparts.

Study design: Retrospective.

Objective: To explore the value of time-resolved CE-MRA in evaluating and locating the SVM prior to digital subtraction angiography (DSA).

Summary of background data: Spinal vascular malformations (SVM) can be detected with time-resolved contrast-enhanced MRA(CE-MRA).

Materials and methods: 178 patients with suspected SVM who underwent time-resolved CE-MRA examination and DSA were included in this study. DSA served as the reference standard. The type of SVM, feeding arteries, fistula/nidus, and proximal segment of draining veins were evaluated on time-resolved CE-MRA. The diagnostic performance and classification performance of time-resolved CE-MRA in the diagnosis of SVM is summarized in terms of overall accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV). The difference of catheterized vessels during spinal vascular DSA between actual and estimated number was also analyzed.

Results: 147 patients were diagnosed with SVM (20 cervical, 118 thoracolumbar, and 9 deep lumbosacral) and 31 patients were diagnosed with non-SVM according to DSA findings. The diagnostic sensitivity, specificity, PPV, NPV, and accuracy of time-resolved CE-MRA for subtype of SVM were 0.961, 0.961, 0.993, 0.806 and 0.961, respectively. The overall accuracy of time-resolved CE-MRA for the diagnosis of SVM was 0.821, and was 0.783, 0.793, and 0.778 for cervical, thoracolumbar, and deep lumbosacral SVM, respectively. The actual number of catheterized vessels during spinal vascular DSA with time-resolved CE-MRA as the reference was lower than the estimated number of catheterized vessels in both SVM and non-SVM patients (P<0.001).

Conclusion: Time-resolved CE-MRA could accurately evaluate SVM and reduce the number of catheterized vessels during spinal vascular DSA.

Study design: Retrospective cohort.

Objective: To explore the relationship between symptomatic pseudoarthrosis requiring revision after lumbar fusion and antidepressant use.

Summary of background data: Approximately 25% of patients undergoing spine surgery are taking antidepressants. Pseudoarthrosis is a significant complication of spinal fusion surgery that can lead to debilitating pain and revision surgery. Animal models have identified selective serotonin reuptake inhibitors/serotonin and norepinephrine reuptake inhibitors (SSRIs/SNRIs) as detrimental to bone healing, and one database study identified antidepressants as associated with lumbar pseudoarthrosis. However, no single-institution study has replicated these findings.

Methods: A structured query language search identified patients from 2017-2022 with pseudoarthrosis after lumbar fusion-this was verified by pseudoarthrosis listed as the indication for revision surgery in operative notes and by reviewing preoperative computed tomography imaging. Patients were counted as taking antidepressants if an antidepressant was an active medication at their preoperative and first postoperative appointments. Control patients who had no radiographic indication of pseudoarthrosis at their last clinical follow-up were matched 3:1 with pseudoarthrosis patients requiring revision based on smoking status, levels fused, levels decompressed, and procedure type. Statistical analysis was performed to compare the two groups.

Results: 36 patients were identified that had revision for symptomatic pseudoarthrosis after primary, elective lumbar fusion. These patients were compared to 108 patients who had lumbar fusion without pseudoarthrosis. Patients with pseudoarthrosis had higher rates of diagnosed depression (P=0.019), anxiety (P=0.007), and antidepressant use (P=0.001). Logistic regression identified SSRI/SNRI use as an independent predictor of requiring revision surgery for symptomatic lumbar pseudoarthrosis (OR 3.95, CI 1.66-9.45, P=0.002).

Conclusions: Patients requiring revision surgery for lumbar pseudoarthrosis had a higher rate of depression, anxiety, and antidepressant use. SSRI/SNRI use was identified as an independent predictor of requiring revision surgery for lumbar pseudoarthrosis. Future, prospective studies are needed to further evaluate this association.

Level of evidence: III.

Study design: Secondary analysis of prospective study.

Objective: To analyze the impact of prior total knee arthroplasty (TKA), total hip arthroplasty (THA), or both on the Oswestry Disability Index (ODI) two years after elective lumbar surgery.

Background: Degenerative conditions that cause pain and mobility loss significantly reduce quality of life. The rising prevalence of total joint arthroplasties (TJA) and spinal surgeries complicates treatment and may result in persistent postoperative symptoms. Understanding how these surgeries interact and how surgical history and underlying conditions influence postoperative outcomes is crucial.

Methods: A secondary analysis was performed on a prospective study of patients undergoing lumbar surgery for degenerative conditions. Patients with a two-year ODI follow-up were included. ODI was prospectively assessed pre- and postoperatively. Patients without ODI-assessment were excluded. Differences in pre- and postoperative ODI were evaluated, and patients were categorized based on ODI-improvement. Statistical analyses included Mann-Whitney-U-test, univariable logistic regression, and multivariable logistic regression adjusted for age, sex, and BMI.

Results: Overall, 385 patients (57% female, 65±10 y) were included. 46 patients (12%) had prior THA, 34 (9%) patients had prior TKA, and 11 (3%) patients had both. ODI-improvement was achieved in 91%. After adjusting for covariates, combined TKA and THA was significantly associated with postoperative ODI non-improvement (OR9.96, 95%CI 2.53-38.3, P=0.001). Prior TKA also tended to be a risk factor for ODI non-improvement, although not statistically significant (P=0.052) after adjusting for covariates.

Conclusion: Patients with prior concomitant TKA and THA have higher odds of ODI non-improvement two years postoperatively, suggesting that concurrent musculoskeletal degeneration of the spine and lower extremities may negatively impact improvement after lumbar surgery. These results highlight the connection not only between the hip but also the knee and spine.