Spine最新文献

Study design: A retrospective cohort study.

Objective: To evaluate the mid-term effect of intervertebral disc degeneration (DD) in patients with adolescent idiopathic scoliosis (AIS) who underwent pedicle screw instrumentation (PSI) and rod derotation (RD) with direct vertebral rotation (DVR).

Summary of background data: Posterior spinal fusion is a mainstay of surgical treatment in AIS, and DVR is considered a main corrective maneuver for vertebral rotation. However, the mid-term effect of intervertebral DD after DVR is still unknown in AIS.

Methods: A total of 336 vertebrae for 48 patients with AIS who underwent PSI and RD with DVR were retrospectively assessed for intervertebral DD. They were divided into two groups based upon intervertebral DD, defined as Pfirmann grade more than IV. The Pfirrmann grade and modic change were evaluated at the disc above the uppermost instrumented vertebra (UIV), the disc below the lowest instrumented vertebra (LIV), and the lumbar disc levels.

Results: With the 11.6 years of mean follow-up, 41.7% (20/48) of patients exhibited DD, while modic changes were observed in 4.2% (2/48) of the included patients. The discs below the LIV, L4-5, and L5-S1 were significantly shown to have an increasing trend of Pfirmann grade. The preoperative thoracic kyphosis was significantly lower in the DD group (22.0°) than in the non-DD group (31.4°) ( P = 0.025) and negatively correlated with DD ( r = -0.482, P = 0.018). The Pfirrmann grade of L5-S1 showed a high level of correlation with DD ( r = 0.604, P < 0.001).

Conclusions: The degenerative change at the disc below the LIV, L4-5, and L5-S1 levels was observed following PSI and RD with DVR. Thoracic hypokyphosis may negatively influence intervertebral discs in patients with AIS required for deformity correction. Therefore, the restoration of thoracic kyphosis is important to prevent long-term DD in AIS.

Study design: A retrospective case-control study.

Objective: To characterize the motor evoked potential (MEP) when the epiconus or conus medullaris is compressed by a fracture of the T12 or L1 vertebra.

Summary of background data: Although the characteristics of compressive cervical and thoracic myelopathy with transcranial magnetic stimulation MEP have been reported, the MEP parameters in compressive disorders of the epiconus and conus medullaris have not yet been characterized.

Methods: Twenty patients with T12 or L1 vertebral fractures who had lower extremity symptoms due to compression of the epiconus or conus medullaris were included. These patients were compared with 28 healthy controls and 32 patients with cervical spondylotic radiculopathy (CSR) without spinal cord compression. MEPs of abductor hallucis muscles were recorded using transcranial magnetic stimulation and electrical stimulation of the tibial nerve. MEP latency, central motor conduction time (CMCT), and peripheral conduction time (PCT) were evaluated.

Results: MEP latency, CMCT, and PCT were significantly longer in patients with fractures than in healthy controls and patients with CSR. MEP latency was most accurate for differentiating patients with fracture from healthy controls (cutoff value, 40.0 ms, sensitivity, 95.0%; specificity, 100%), and CMCT was most accurate for comparing patients with fracture and CSR (cutoff value, 15.5 ms, sensitivity, 80.0%; specificity, 93.8%). In the distinction between patients with fracture and CSR, 16 of the 20 patients with fracture exceeded the cutoff values for any of the parameters, and 12 of them exceeded the cutoff values for all parameters. There was no significant correlation between the linear distance from the most inferior end of the spinal cord to the site of compression and any of the MEP parameters.

Conclusion: Both CMCT and PCT are often prolonged in compressive lesions of the epiconus and conus medullaris, and MEP latency and CMCT are useful in the diagnosis.

Study design: Cross-sectional study.

Objective: To evaluate the structural validity of the Arabic version of the Oswestry Disability Index (ODI) in patients with low back pain (LBP).

Summary of background data: The Arabic ODI is currently used in clinical and research settings to assess disability, but questions remain regarding its structural validity.

Methods: Adult patients with LBP were recruited from physical therapy departments of two hospitals in Saudi Arabia. Participants completed the Arabic ODI and the Numeric Pain Rating Scale. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were conducted to examine the factor structure of the ODI. Maximum likelihood extraction and parallel analysis were used in the EFA, and the goodness-of-fit indices (Chi-square statistics (χ2), Tucker-Lewis index (TLI), comparative-fit index (CFI), root mean square error of approximation (RMSEA) and standardized root mean residual (SRMR)) were assessed in the CFA to confirm the factor structure.

Results: A total of 113 patients (47.8% Male, 52.2% Female) participated. The EFA identified a unidimensional structure for the Arabic ODI, with one factor explaining 45.8% of the total variance. All items had significant factor loadings, with loadings ranging from 0.48 (sleeping) to 0.84 (sex life and social life). The CFA confirmed this unidimensional structure, yielding good fit indices (χ²=49.53, P<0.04; TLI=0.96; CFI=0.97; RMSEA=0.06 (90% CI=0.07-0.10), SRMR=0.04). All ODI items exhibited significant positive loadings consistent with the expected correlation between the single latent variable (LBP-related disability) and the ODI items. A high error covariance was observed between items related to walking and standing.

Conclusion: The Arabic Oswestry Disability Index demonstrates sufficient structural validity as a unidimensional measure of disability in Arabic-speaking patients with low back pain. These findings support the continued use of the Oswestry Disability Index for disability assessment in clinical and research settings and support the validity of using one total score representing the single underlying latent construct.

Level of evidence: 3.

Study design: This retrospective study compared unilateral pedicle screw combined with contralateral translaminar facet joint screw (UPS+TFS) fixation with bilateral pedicle screw (BPS) fixation in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for single-segment lumbar degenerative disease.

Objective: To assess the long-term clinical efficacy of UPS+TFS fixation and BPS fixation in MIS-TLIF.

Summary of background data: Limited research exists on the long-term clinical outcomes of UPS+TFS fixation in MIS-TLIF. This study addresses this gap by comparing UPS+TFS with the more common BPS fixation technique.

Methods: A retrospective analysis of 151 patients with single-segment lumbar degenerative disease treated with MIS-TLIF at XXX Hospital (March 2011-December 2012) was conducted. Propensity score matching (1:1) resulted in 32 patients per group (UPS+TFS and BPS). Basic demographic characteristics, preoperative functional scores, perioperative indicators, and postoperative complications were compared between the groups. Lumbar and leg Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores up to 10 years postoperatively were also compared. The surgical outcomes of both groups were evaluated using the MacNab criteria at the final follow-up.

Results: The UPS+TFS group had significantly lower lumbar VAS scores at three months postoperatively (P<0.05) with less intraoperative blood loss, shorter surgery time, and reduced hospital stay compared to the BPS group (P<0.05). No significant differences were found in the JOA or ODI scores between the two groups at 3 months and 1, 3, 5, and 10 years post-surgery (P>0.05).

Conclusion: UPS+TFS and BPS fixation during MIS-TLIF can achieve favorable clinical outcomes with no difference in long-term clinical efficacy. UPS+TFS demonstrates perioperative advantages such as reduced intraoperative blood loss, shorter operation time, reduced postoperative hospital stay, and less iatrogenic injury. Therefore, MIS-TLIF with UPS+TFS fixation is a reliable treatment for single-segment lumbar degenerative disease.

Study design: Retrospective cohort.

Objective: To evaluate the impact of adjunctive gabapentinoid therapy on postoperative opioid consumption following 1-3 levels anterior lumbar interbody fusion (ALIF) with posterior fixation.

Summary of background data: Gabapentin and pregabalin are analogues of the inhibitory neurotransmitter Gamma-Aminobutyric Acid (GABA) and are frequently employed as adjuncts in multimodal anesthesia strategies for managing acute pain. However, the opioid-sparing effect of gabapentinoids in the context of spine surgery has yet to be consistently demonstrated.

Methods: The PearlDiver Database was queried from 2010 to 2021 for patients who underwent primary 1-3 levels ALIF with posterior fixation. Patients with opioid or gabapentinoid use within 6 months prior to index surgery were excluded. Patients with both gabapentinoid and opioid treatment were propensity score-matched to patients with opioid-only treatment.

Results: The propensity score-matching resulted in two equal groups of 2,617 patients with and without adjunctive gabapentinoid treatment for pain management. Adjunctive use of gabapentinoids was associated with a modest 2.9% reduction in average Morphine Milligram Equivalent (MME) per day (Standardized Mean Difference (SMD) -1.33, 95% Confidence Interval (CI) [-2.657, -0.002], P=0.050). However, this was accompanied by a 37.1% increase in the total duration of opioid prescriptions (SMD 94.97, 95% CI [56.976, 132.967], P<0.001) and a 41.7% increase in total MME consumption per patient (SMD 4817.23, 95% CI [1864.410, 7770.044], P=0.001). Additionally, gabapentinoid use was associated with an increased risk of readmission due to pain (Relative Risk (RR) 1.10, 95% CI [1.002, 1.212], P=0.050) and the development of drug abuse (RR 1.37, 95% CI [1.016, 1.833], P=0.046).

Conclusion: Despite the modest daily opioid-sparing effect observed, adjunctive gabapentinoid treatment appears to increase total opioid consumption due to prolonged opioid use and may compromise pain management in the context of ALIF with posterior fixation.

Study design: Register-based cohort study based on linked data from multiple national registries.

Objective: To describe the sociodemographic and health characteristics of individuals in Denmark with osteoporotic vertebral fractures (OVF) and analyze time trends. The study compares labor market participation and comorbidities between OVF patients and a matched control group without these fractures.

Summary of background data: The incidence and characteristics of OVF patients in Denmark are not well-documented. Multiple national health and economic registries enable linking of individual patient data, providing new insights.

Methods: We identified individuals with hospital-diagnosed vertebral compression fractures from 2010 to 2018 using the Danish National Patient Register. A control group was matched by sex, age, and municipality. Work status prior to OVF was categorized as employed, on paid sickness benefit, in early retirement, or on old-age pension. Comorbidities were analyzed based on hospital diagnoses within 10 years prior to the fracture.

Results: During 2010 to 2018, 20.262 individuals had a hospital contact with an OVF. Sixty-four percent were women and the mean age was 73.6 (SD 12.4) years. OVF incidence increased from 86 in 2010 to 142 per 100,000 persons in 2018. In 2018, the regional incidence ranged from 120 to 154 per 100,000. More than a fifth of the patients were working prior to the fracture, while 77% were in early retirement or old-age pension. The population with OVF had more comorbidities than the matched comparison group.

Conclusion: The incidence of hospital-diagnosed OVFs has risen over the last decade, with regional differences. Notably, over 20% of OVF patients were still employed, highlighting the socioeconomic impact of this condition.

Study design: Retrospective cohort study.

Objective: To evaluate the outcomes and reoperation rates in patients with adolescent idiopathic scoliosis undergoing lumbar anterior vertebral body tethering (AVBT).

Background: AVBT is a viable option for growing children. The benefit of motion preservation must be balanced by a higher reoperation rate. A paucity of reports has addressed lumbar AVBT.

Materials and methods: A single-center retrospective study was conducted to identify all patients who underwent lumbar AVBT (lowest instrumented vertebra L3 or L4) with a minimum of 2 years of follow-up. Clinical and radiographic parameters, including complications and reoperations, were also collected. Statistical analysis was performed using the Student t test for qualitative variables.

Results: From a data set of 551 patients, we identified 106 patients (89% female) who underwent a lumbar AVBT (33 lumbar only, 73 bilateral thoracic/lumbar) with a mean follow-up of 4.1 ± 1.6 years at which point 85% (90/106) had reached skeletal maturity. Preoperatively, these patients were skeletally immature (age: 12.8 ± 1.3 yr, Sanders: 3.3 ± 0.8, R = 0.6 ± 0.9) with a lumbar coronal curve angle of 49.6° ± 11.2° which corrected to 19.9° ± 11.2° ( P < 0.0001) at most recent follow-up. At the latest follow-up, 76.4% (81/106) of the patients harbored a coronal curve angle of <30°. Twenty patients (18.9%) underwent 23 reoperations, with overcorrection being the most common (10/23, 43%). Broken tethers led to reoperation in 3 instances (3/23, 13%). Six patients in the cohort needed a posterior spinal fusion (6/106, 5.4%).

Conclusions: Vertebral body tethering is a viable treatment option for skeletally immature patients with idiopathic scoliosis. This report is the largest to date for lumbar AVBT, highlighting that 84% of patients harbored a curve <35° at the latest follow-up but with an 18.9% reoperation rate.

Level of evidence: 3.

Study design: Predictive study utilized retrospectively collected data.

Objective: The primary objective was to evaluate the predictive association between the Spine Instability Neoplastic Score (SINS) and Skeletal-related events (SREs). Secondary objectives included examining characteristics of cases with SINS ≤ 6 among those who developed SRE and evaluating the impact of additional predictors on prediction accuracy.

Summary of background data: Advances in cancer treatment have prolonged the lives of cancer patients, emphasizing the importance of maintaining quality of life. SREs from metastatic spinal tumors significantly impact the quality of life. However, currently, there is no scientifically established method to predict the occurrence of SRE. SINS, developed by the Spine Oncology Study Group, assesses spinal instability using six categories. Therefore, the predictive performance of SINS for SRE occurrence is of considerable interest to clinicians.

Methods: This predictive study utilized retrospectively collected data from a single-center registry comprising over 1000 patients with metastatic spinal tumors. SINS and clinical data were collected. Logistic regression was used to create a prediction equation for SRE using SINS. Additional analyses explored factors associated with SRE in patients with SINS ≤ 6.

Results: The study included 1041 patients with metastatic spinal tumors. SRE occurred in 121 cases (12%). The prediction model for SRE using SINS demonstrated an area under the curve (AUC) of 0.832. Characteristics associated with SRE included lower female prevalence, surgeries to primary sites, bone metastases to nonspinal sites, and metastases to other organs. A post hoc analysis incorporating additional predictors improved the AUC to 0.865.

Conclusions: The SINS demonstrated reasonable predictive performance for SRE within one month of the initial visit. Incorporating additional factors improved prediction accuracy. The study emphasizes the need for a comprehensive clinical prediction model for SRE in metastatic spinal tumors.

Study design: Retrospective review.

Objective: The purpose of this study was to evaluate disparities in patient-reported outcome measures (PROM) completion rates and baseline function scores among newly presenting spine patients.

Summary of background data: Prior studies have demonstrated that minority patients and those of low socioeconomic status may present with worse physical and mental health on PROMs. As PROMs are increasingly used in clinical care, research, and health policy, accurate assessment of health status among populations relies on the successful completion of PROM instruments.

Methods: A retrospective review of 10,803 consecutive new patients presenting to a single multidisciplinary spine clinic from June 2020 to September 2022 was performed. Univariate statistics were performed to compare demographics between patients who did and did not complete PROMs. Multivariable analysis was used to compare PROM instrument completion rates by race, ethnicity, and Social Vulnerability Index (SVI) and baseline scores among responders.

Results: A total of 68.4% of patients completed PROMs at the first clinic visit. After adjusting for age, sex, body mass index, and diagnosis type, patients of non-White race (OR=0.661, 95% CI=0.599-0.729, P <0.001), Hispanic ethnicity (OR=0.569, 95% CI=0.448-0.721, P <0.001), and increased social vulnerability (OR=0.608, 95% CI=0.511-0.723, P <0.001) were less likely to complete PROMs. In the multivariable models, patients of non-White race reported lower levels of physical function (β=-6.5, 95% CI=-12.4 to -0.6, P =0.032) and higher levels of pain intensity (β=0.6, 95% CI=0.2-1.0, P =0.005). Hispanic ethnicity (β=1.5, 95% CI=0.5-2.5, P =0.004) and increased social vulnerability (β=1.1, 95% CI=0.4-1.8, P =0.002) were each associated with increased pain intensity.

Conclusions: Among newly presenting spine patients, those of non-White race, Hispanic ethnicity, and with increased social vulnerability were less likely to complete PROMs. As these subpopulations also reported worse physical function or pain intensity, additional strategies are needed to better capture patient-reported health status to avoid bias in clinical care, outcomes research, and health policy.

Level of evidence: 4.