Spine最新文献

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 AIS with 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 and 45° randomized to either NT or FT brace group. Follow-up occurred over 2 years, assessing treatment efficacy through radiographs and quality of life using SRS-22 and visual analog scale (VAS) questionnaire scores at baseline, 6 months, and 12 months. Compliance was monitored with thermal sensors every 3 months. Statistical analyses were conducted, with significance set at P < 0.05.

Results: Seventy-eight AIS patients, predominantly females (85.9%), were recruited, including 35 (44.87%) in the FT group and 43 (55.13%) in the NT. Initial Cobb angles were comparable between groups. Nine patients were excluded, and eight required surgery (NT 12.82%, FT 10%). After 2 years, both braces showed similar effectiveness in preventing curve progression. No differences in SRS-22 nor VAS scores were found before treatment. At 6-month follow-up, the NT group reported significantly better outcomes in "self-image" compared with FT ( P =0.047). After 1 year, NT patients reported less pain compared with 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 with NT brace.

Study design: An observational registry-based study.

Objective: We investigated the long-term patterns of sick leave among patients undergoing surgery for lumbar disk herniation using two nationwide databases to study the achievement of postsurgery return to work (RTW).

Summary of background data: The ability to RTW is increasingly recognized as an essential outcome measure for spine surgery.

Materials and methods: The study included 13,698 patients aged 18 to 60 on sick leave undergoing surgery for lumbar disk herniation from January 2007 through January 2019. Data from the Norwegian Registry for Spine Surgery (NORspine) and the Norwegian Labour and Welfare Administration (NAV) were linked. Certified sick leave around the time of surgery was assessed. The patients were further categorized according to the length of presurgery sick leave, and the rate of sustainable RTW for the different groups was compared using survival analysis. The association between successful surgical outcomes, defined by a 30% improvement in Oswestry Disability Index score, and achievement of sustainable RTW was analyzed using a logistic regression model.

Results: Two years after surgery, 76% of the patients had returned to work. Shorter presurgery sick leave was associated with a higher proportion and rate of achieved sustainable RTW: Among patients with sick leave of <30 days, a total of 99% achieved sustainable RTW (median: 46 days); only 40% of patients with longer lasting work assessment allowance achieved the same goal within 2 years. Successful surgical outcomes were associated with sustainable RTW for all patient groups, but the impact of surgical success on RTW declined as sick leave extended beyond 180 days.

Conclusions: Most patients had returned to work 2 years after lumbar disk herniation surgery. Shorter presurgery sick leave was associated with achieving faster and more sustainable RTW. Successful surgical outcomes had less impact on patients with extended sick leave.

Level of evidence: Level III.

Study design: A retrospective chart review was conducted at a single institution.

Objective: The purpose of this study was to investigate the clinical outcomes of cervical disc arthroplasty (CDA) used for the treatment of symptomatic adjacent segment disease (ASD) developed after anterior cervical discectomy and fusion (ACDF).

Background: A major clinical concern following ACDF is the development of ASD. ASD after ACDF is often treated with an additional fusion, but risks include pseudoarthrosis and further ASD. CDA is a motion-preserving alternative that addresses these concerns, and therefore, has been proposed as an alternative treatment for ASD after ACDF.

Materials and methods: Patients who underwent CDA at level(s) adjacent to a prior ACDF (n = 120) were identified from a consecutive series of patients who underwent CDA at one institution. Pre-CDA to post-CDA patient-reported outcome measures were compared using the paired Wilcoxon signed-rank test.

Results: A total of 142 devices were implanted-98 patients underwent a 1-level CDA, and 22 patients underwent a 2-level CDA. The mean follow-up duration after CDA was 32.11 months. Neck pain, arm pain, and Neck Disability Index scores significantly improved from the preoperative to postoperative time point (respectively: 6.14-3.02, 4.42-1.61, 44.28-28.62, all P < 0.001). In total, 7 patients underwent reoperation (5.83%). One of these patients underwent reoperation for pseudarthrosis at the level of ACDF following a hybrid procedure. The indications for index level reoperations (n = 3) were foraminal stenosis, osteolysis, and postoperative hematoma. All patients with an adjacent level reoperation (n = 3) received surgery at levels adjacent to the prior fusion, not the more recent CDA.

Conclusion: The results of this study found that CDA was effective for the treatment of ASD following ACDF. CDA appears to be a viable treatment option for ASD after ACDF in appropriately selected patients.

Study design: Retrospective cohort study.

Objective: Compare outcomes in patients undergoing one-level or two-level anterior lumbar interbody fusion (ALIF) at L4-S1.

Background: Although ALIF may deliver restoration of lumbar lordosis and improvement in clinical outcomes, it also carries risk of complications including major vascular injury. Whether one-level and two-level ALIF offers similar outcomes is not known.

Materials and methods: Adults who underwent one-level L4-L5 or L5-S1 ALIF and two-level L4-S1 ALIF at a single academic institution were identified. Patient demographics, procedural characteristics, improvement in spinopelvic alignment, and one-year postoperative patient-reported outcome measures (PROMs) and complications were compared. Multivariate regression analyses, accounting for age, sex, and Charlson comorbidity index (CCI), were also performed.

Results: In total, 158 ALIF patients (111 one-level and 47 two-level) were included, with mean age of 51.4 years, 57.0% female, mean CCI of 1.2, and mean follow-up of 27.0 months. Surgical time (147.3 vs. 124.6 min, P =0.002) and hospital length of stay (3.5​​​ vs. 2.9 d, P =0.036) were higher for two-level ALIF. One-year postoperatively, two-level ALIF patients had more caudal apex of lordosis ( P =0.016) and 4.1 mm ( P =0.002) and 2.0 mm ( P =0.019) higher L4-L5 anterior and posterior disc heights, respectively. PROMs were not statistically different across groups ( P >0.05). Finally, two-level ALIF patients were 10.9 times more likely to have in-hospital complications ( P =0.040), such as intraoperative vascular injury (11.1% vs. 1.5%, P =0.040) or postoperative ileus (7.4% vs. 0.0%, P =0.027), than one-level ALIF patients.

Conclusion: In this investigation with greater than one-year follow-up, two-level ALIF in the L4-S1 spine had higher procedural time, length of stay, and approach-related complications than one-level ALIF. Although there were minor improvements in alignment with two-level ALIF, PROMs were comparable with improvements from baseline to last follow-up. These findings may help surgeons carefully weigh the risks and benefits of one-level versus two-level ALIF when determining surgical plans for patients.

Level of evidence: Level IV.

Study design: The present study is a scoping review of the literature on Pott disease in ancient human remains.

Objective: Comprehending the origin and history of Pott disease is relevant to assessing this pathologic condition from an evolutionary perspective.

Summary of background data: Tuberculosis (TB) is an ancient pulmonary disease that remains the leading cause of death from a single infectious agent, rating above HIV/AIDS. The disease typically affects the lungs but can also target other anatomic sites. Of those, the most common and characteristic are the skeletal changes involving the spine, such as in Pott disease. Spinal tuberculosis accounts for approximately half of all cases of musculoskeletal tuberculosis. It can lead to loss of function in the lower limbs due to damage to the spinal column. Nevertheless, its origin and evolution are still not fully understood and need further investigation.

Materials and methods: The authors investigated the published studies on Pott disease in ancient human remains, intending to survey the literature, map the evidence and identify gaps and future perspectives on TB in paleopathology. The search strategy was conducted between September 2021 and March 2023 using keywords including the terms "Pott disease" OR "tuberculosis" AND "skeletal remains" in PubMed Biomed Central , Scopus , and Google Scholar search engines and biomedical databases. Five hundred and three records were initially identified, and 66 studies were finally included and assessed for qualitative analysis. Finally, the included records were analyzed in terms of non-narrative data, including the type of publication, country of excavation, dating of the sample, the number of human remains, and their details. Furthermore, the type of bone lesion was indicated as well as the diagnostic method if detailed.

Results: Among articles identified, most were classified as original articles, and were published between 2011 and 2020. Close to 77% of the reported records are excavations in Europe and the Near East. Included studies considered a total of 3388 human remains, mostly excavated in archeological sites and necropoles. Interestingly, the reported prevalence was higher among young males and adults.

Conclusions: Although most of the findings are consistent with the literature, since the majority of the human remains were from Europe and the Near Middle East, more research is necessary in other sectors of the world. The suggestion of a male predominance needs to be confirmed and questions about the possible pathognomic role of rib lesions as well Serpes endocranica symmetrica (SES) represent further areas of research that need to be explored.

Study design: Retrospective controlled cohort.

Objective: To evaluate the effect of intraoperative liposomal bupivacaine (LB) through erector spinae plane block (ESPB) on patients with postoperative adolescent idiopathic scoliosis (AIS) with and without patient-controlled analgesia (PCA).

Background: Pain control after posterior spinal fusion (PSF) for AIS includes opioids and other modalities. The goal of these modalities is to reduce pain and opioid consumption. Two new modalities for pain control include LB and ESPB. There are scant studies on these modalities tested in concert on patients undergoing PSF for AIS.

Patients and methods: Seventy-two consecutive patients with AIS who underwent PSF were separated into patients who had a PCA (group A) as part of their postoperative pain management and those who did not (group B). Opioid consumption was measured through morphine milligram equivalents. Pain scores were measured through the visual acuity score (Visual Analog Scale). Patient mobility was measured by steps taken. These were measured by the function of postoperative days from surgery.

Results: Group B had significantly lower morphine milligram equivalents at every point after surgery, most notably throughout the entire hospital stay (99.8 vs . 200.7). Postoperative pain scores in group B were the same if not better than group A. There was no difference in mobility between the cohorts. Group B had lower LOS (3.7 vs . 4.1).

Conclusion: In postoperative PSF for patients with AIS receiving LB through ESPB, those who did not receive a PCA had lower opioid consumption without worse pain scores or mobility and had a lower LOS. Adding LB through ESPB to postoperative pain regimens effectively replaces a PCA by providing the same pain control and reducing overall opioid consumption and LOS.

Study design: Retrospective study.

Objectives: To investigate the effect of lumbar stiffness on patient-reported outcomes (PROs) and satisfaction in patients undergoing adult spinal deformity (ASD) surgery.

Summary of background data: Lumbar stiffness following pan-lumbar arthrodesis may impair the activities of daily living. However, the effect lumbar stiffness on the PROs and patient satisfaction in Asian populations remains unclear.

Methods: Patients who underwent ≥ 5-level fusion including the sacrum were selected for the study. Radiographic and clinical outcomes were evaluated at postoperative 2 years. Lumbar stiffness was evaluated using the modified lumbar stiffness disability index (M-LSDI), which comprises 10 questionnaires with higher scores indicating greater disability. The PRO measures included the visual analog scale (VAS), Oswestry Disability Index (ODI), Scoliosis Research Socitey-22 (SRS-22), Short Form-36 (SF-36) physical component score (PCS), and SF-36 mental component score (MCS). Patients were divided into two groups based on their 2-year SRS-22 satisfaction scores: high satisfaction (≥ 4.0) and low satisfaction (< 4.0).

Results: A total of 194 patients were included in the study (female, 87.6%; mean age, 69.1 years; and mean fusion length, 8.0). All PROs significantly improved after surgery with regard to VAS, ODI, SRS-22, and SF-36. The M-LSDI score was worsened significantly from 22.3 preoperatively to 26.6 postoperatively. Correlation analysis showed that the 2-year M-LSDI scores were negatively associated PRO measures, including VAS, ODI, SRS-22, SF-36 PCS, and SF-36 MCS. Multivariate regression analysis revealed that the 2-year M-LSDI score did not affect patient satisfaction status; the 2-year SRS-22 score was an independent factor for high satisfaction.

Conclusions: After surgery, significant improvements were observed in all RROs. Although the postoperative increase in M-LSDI scores were significant, the changes were small. The degree of lumbar stiffness negatively influenced all PRO measures but did not affect patient satisfaction at 2 years postoperatively.

Study design: Systematic review and meta-analysis.

Objective: To evaluate the impact of posterior ligamentous augmentation (PLA) on proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) in adult spinal deformity (ASD) surgery.

Summary of background data: Adult spinal deformity (ASD) surgery is frequently complicated by PJK and PJF, with reported rates ranging from 17% to 61.7%. Techniques such as PLA, which involves spinous process or sublaminar tethering at the upper instrumented vertebra (UIV) +1 or +2, have been investigated as potential methods to mitigate these complications.

Methods: A systematic literature review and meta-analysis was performed according to the PRISMA guidelines. Most studies defined PJK as an increase of ≥10° or ≥20° in the sagittal Cobb angle from UIV to UIV+2 compared to preoperative measurements. PJF was defined as PJK necessitating revision surgery.

Results: Eight comparative studies comprising 1,333 patients (PLA: 579; no PLA: 754) were included. The mean age ranged from 55 to 68.6 years across studies, with a mean follow-up period of 17.6 to 31.2 months. There were no significant differences between the PLA and no PLA groups in terms of age (MD 2.53; 95% CI -0.28 to 5.34, I²: 64.8%), BMI (MD 1.03; 95%CI -0.87 to 2.93, I²:69%), or sagittal vertical axis (SVA) preoperatively (MD 3.92; 95% CI -1.90 to 9.75, I²:73.1%) and postoperatively (MD -1.54; 95%CI -4.10 to 1.01, I²: 56.2%). However, the PLA group demonstrated significantly lower odds of developing PJK compared to the no PLA group (PLA: 25.8%; no PLA: 28.8%; OR: 0.54; 95%CI 0.34 to 0.85, I²: 37.4%). Furthermore, PLA was associated with significantly lower odds of PJF (PLA: 3.3%; no PLA: 12.3%; OR: 0.23; 95%CI 0.12 to 0.47, I²: 17.9%).

Conclusions: PLA in ASD surgery is associated with reduced odds of developing PJK and PJF over a follow-up period of 17.6 to 31.2 months.

Study design: Retrospective analysis of prospectively collected data.

Objective: This study will evaluate whether the presence of pelvic fusion can affect this PI modification.

Background: In Adult spinal deformity (ASD), restoring sagittal spinal alignment can positively modify the quality of life in patients post-operatively. Restoring this alignment is based on the measurement of the pelvic incidence (PI) which was postulated to be a constant value specific to each person. However, the literature has recently shown that this pelvic parameter can change after ASD surgery.

Methods: This is a retrospective multicenter study of 290 patients who have undergone ASD surgery between 2012 and 2022. These patients were divided into two groups, group A who received pelvic fusion, and group B who did not. Post-operative PI change was defined by an absolute difference of ≥ 6° between pre- and post-operative values. Furthermore, patients were divided into 3 groups pre-operatively based on their PI: low (<40°), medium (40°-60°), and high (>60°).

Results: Of the patients in group A, 80.0% had a change in PI compared to 12.8% in group B (Odds-Ratio=27.2 [13.8; 53.5], P<.001). Furthermore, this change occurred more frequently in males when compared to females (P=0.02). In addition, a logistic regression model controlling for gender, pre-operative PI groups, the change in lumbar lordosis and sacral slope, and pelvic fixation showed that only the latter predicted the post-operative change in PI with an adjusted odd-ratio of 26.3.

Conclusion: In our cohort, 32.1% of the patients operated for ASD had a post-operative change of PI of ≥ 6° which was well within the reported range in the literature. Moreover, pelvic fusion was found to be the only independent risk factor for PI change with an adjusted OR of 26.3.