Spine最新文献

Study design: Retrospective cohort study.

Objective: This study aimed to investigate the association of race with morbidity and mortality in acute cervical spinal cord injury (cSCI) patients.

Summary of background data: Racial disparities in spine surgery are associated with adverse outcomes, however, the impact of race on cSCI is understudied.

Methods: We retrospectively reviewed the American College of Surgeons Trauma Quality Programs database to compare outcomes for acute cSCI patients between racial/ethnic identities: non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic/Latino (HIS), and other (OTH). Demographics, comorbidities, injury type, treatment modality, and adverse events (AEs) were assessed. Multivariable logistic regression was used to identify independent predictors of AEs, non-routine discharge (NRD), and in-hospital mortality.

Results: There were 71,048 patients stratified by race/ethnicity: 44,639 (62.8%) NHW, 13,555 (19.1%) NHB, 5,820 (8.2%) HIS, and 7,034 (9.9%) OTH. NHB and HIS-identifying patients had the greatest rates of any AE (NHW: 20.7% vs. NHB: 25.0% vs. HIS: 24.6% vs. OTH: 22.0%, P<0.001) and the longest mean length of stay (NHW: 11.3±13.5 d vs. NHB: 15.5±20.2 d vs. HIS: 15.0±20.5 d vs. OTH: 12.6±17.5 d, P<0.001). NRDs were lowest for HIS-identifying patients (NHW: 74.8% vs. NHB: 75.5% vs. HIS: 69.5% vs. OTH: 75.4%, P<0.001), while in-hospital mortality was lowest for NHB-identifying patients (NHW: 12.8% vs. NHB: 10.1% vs. HIS: 12.4% vs. OTH: 13.4%, P<0.001). On multivariable analyses, NHB (OR: 1.16, P<0.001), HIS (OR: 1.22, P<0.001), and OTH (OR: 1.14, P=0.004) cohorts had significantly increased odds of AEs. The NHB cohort had significantly increased odds (OR: 1.25, P<0.001), while the HIS cohort had significantly decreased odds (OR: 0.78, P=0.001) of NRD. Only the NHB cohort had significantly decreased odds of in-hospital mortality (OR: 0.69, P<0.001).

Conclusion: Our study suggests racial disparities in outcomes and discharge disposition for acute cSCI patients.

Study design/setting: A retrospective cohort study.

Objective: To compare long-term outcomes and complications of cervical disc replacement (CDR) and anterior cervical discectomy and fusion (ACDF) with cage-plate constructs (CPC) and stand-alone (SA) cages in treating degenerative cervical spondylosis.

Summary of background data: ACDF is commonly used for cervical radiculopathy but may increase adjacent segment degeneration (ASD). CDR has gained popularity by preserving motion and potentially reducing ASD, while SA cages offer a simpler alternative to CPC. Despite widespread adoption, further research is needed to clarify the long-term outcomes and associated complications.

Methods: A retrospective analysis was conducted on 1,146 patients who underwent cervical surgery between 2009 and 2012 at three Chinese hospitals, grouped into CDR (n=220), CPC-ACDF (n=540), and SA-ACDF (n=386). Primary outcomes included overall success rate and complications. Secondary measures were JOA, VAS, SF-36 scores, and imaging parameters.

Results: The CDR group exhibited a significantly higher overall success rate compared to CPC-ACDF and SA-ACDF groups. Dysphagia incidence immediately post-surgery was significantly lower in the CDR and SA-ACDF groups compared to CPC-ACDF. At the final follow-up, implant subsidence was lowest in the CDR group. Radiographic-ASD incidence was significantly lower in the CDR and SA-ACDF groups compared to CPC-ACDF, with SA-ACDF having the lowest rate of symptomatic-ASD. The reoperation occurred in 38 (7.0%) CPC-ACDF, 18 (4.7%) SA-ACDF, and 8 (3.6%) CDR patients. Despite a 65.5% incidence of heterotopic ossification (HO), CDR partially preserved angular range of motion. Multivariate logistic regression analysis suggested that SA-ACDF and CDR were protective factors against postoperative radiographic-ASD. Conditional nomograms demonstrated good predictive performance for symptomatic-ASD, supported by receiver operating characteristic and calibration curves.

Conclusion: This study suggests that CDR provides similar clinical outcomes with fewer complications compared to ACDF. However, further research is needed to confirm these findings, particularly considering the variability between different CDR devices and potential for selection bias.

Study design: A retrospective review of a prospective adult spinal deformity data.

Objective: To identify distinct patient clinical profiles and recovery trajectories in patients with adult spinal deformity (ASD).

Summary of background data: Patients with ASD exhibit a diverse array of symptoms and significant heterogeneity in clinical presentations, posing challenges to precise clinical decision-making. Accurate patient selection may provide further insight to personalized management strategies.

Methods: Latent profile analysis (LPA) was performed to determine possible patient phenotype. Goodness-of-fit indices were used to determine the optimal cluster profiles. Outcome differences were evaluated using Analysis of Variance (ANOVA) and subsequent post hoc Tukey's test, while significant predictors of group membership were identified through multinomial logistic regression.

Results: A total of 204 ASD patients (mean age of 60.3 ± 11.8 years, comprising 62.3% females) with complete 1-year and 2-year follow-up outcome were included. LPA identified three phenotypes: 51 patients in phenotype 1, 73 patients in phenotype 2 and 80 patients in phenotype 3, respectively. Each phenotype exhibited a unique symptom profile and distinct functional recovery trajectories. Patients in phenotype 3, although demonstrated the worst Scoliosis Research Society-22 questionnaire (SRS-22r) domains at baseline, patients in this cluster exhibited the most substantial Δchange in SRS-22r domains except for self-image at both 1-year and 2-year follow-up. Remarkably, a relative large proportion of patients (58.8%) who were dissatisfied at 1-year follow-up transited to satisfied at 2-year follow-up. Advanced age, longer symptom duration, severe preoperative pelvic incidence-lumbar lordosis (PI-LL) mismatch, higher preoperative sagittal vertical axis (SVA), fusion extending to sacrum/pelvis and grade ≥ 3 osteotomy predicted membership in the phenotype 3.

Conclusions: LPA enabled the delineation of three distinct phenotypes among ASD patients, each characterized by unique clinical profiles and distinct long-term recovery trajectories. By pinpointing the crucial variables that uniquely distinguish and predict membership in different phenotypes, the study provides valuable guidance for patient stratification.

Study design: Systematic Review and Meta-analysis.

Objective: This study aims to compare the efficacy and safety of surgical and endovascular treatments for SDAVFs.

Summary of background data: Spinal dural arteriovenous fistulas (SDAVFs) result from an abnormal connection between the radiculomeningeal artery and the radicular vein, leading to venous hypertension and potential neurological damage. The two primary treatment strategies are surgical closure and endovascular obliteration of the fistula.

Methods: PubMed, Scopus, and Web of Science databases were searched from inception to July 2024. We defined the successful treatment as fistula occlusion with sufficient embolic material penetration or obliteration during surgery.

Results: A total of 1192 articles were identified, with 40 studies meeting the inclusion criteria, comprising 1818 patients (surgical: 804, endovascular: 1014). The surgical group demonstrated higher rates of complete occlusion at last follow-up (96.8%, 363/375) compared to the endovascular group (72.5%, 470/648) (OR: 0.16; CI: 0.09 to 0.28, P<0.01). Surgical treatment also had higher successful treatment rates (97.5%, 392/402) compared to endovascular treatment (66.7%, 529/793) (OR: 0.11; CI: 0.06 to 0.19, P<0.01). Recurrence rates were lower in the surgical group (OR: 6.04; CI: 3.45 to 10.57, P<0.01) and retreatment rates were also lower (OR: 7.16; CI: 4.11 to 12.48, P<0.01). Initial treatment failure was significantly higher in the endovascular group (32.2%, 329/1023) compared to the surgical group (2.3%, 19/804) (OR: 8.97; CI: 5.56 to 14.45, P<0.01).

Conclusions: Surgical treatment for SDAVFs achieves higher rates of complete occlusion and successful treatment compared to endovascular treatment, with lower rates of recurrence, retreatment, and initial treatment failure. Although both treatments show similar improvements in neurological status and periprocedural complications, surgery remains the preferred approach for definitive results. Treatment decisions should be individualized based on patient-specific factors and anatomical characteristics. Further research is needed to confirm these results.

Study design: Biomechanical study by using a multi-body simulation approach.

Objective: Objectification of spinal biomechanics after Vertebral Body Tethering with and without Apical Fusion.

Summary of background data: Vertebral body tethering, a motion preserving surgical technique for correction of adolescent idiopathic scoliosis, is increasingly being used for thoracolumbar curves. However, tether breakage remains a common problem with breakage rates up to 60% for TL curves. Therefore, surgeons have begun to adapt their surgical technique by fusing the apex. The short-term clinical studies show a significant reduction of the tether breakage rate to 10%, but little is known about the biomechanical reasons. Therefore, this study analyzes the intervertebral compression and tether force in a tethered spine without apical fusion and in a tethered spine with apical fusion between L1/2.

Methods: A multi-body simulation approach was chosen to analyze the biomechanical effects of two surgical techniques during different physiological movements. The tether and intervertebral compression forces in the different instrumented segments are once analyzed for a T10-L3 tethered spine and once for a T10-L3 tethered with additional L1/2 fusion using an intervertebral cage.

Results: VBT with apical fusion reduces the prevailing tether forces not only at the fused level by nearly 861 N, but also at the adjacent spinal segments by around 100 N. However, a significant increase in intervertebral compression force of approximately 706 N can be observed, especially at the adjacent spinal segments.

Conclusion: L1/2 fusion in a tethered spine reduces tether forces in adjacent segments and thus might decrease the rate of tether breakage. However, fusion results in increased intervertebral compression forces by up to 31% compared to an unfused spine. Long-term clinical studies are needed to further analyze and evaluate the biomechanical consequences.

Study design: Retrospective Cohort Study.

Objective: This study aimed to compare outcomes in AIS patients that underwent PSF using either freehand with occasional fluoroscopic assistance (FOFA), computer assisted surgery/navigation (CAS), or technique and technology (T&T).

Summary of background data: Pedicle screw insertion in scoliosis is challenging due to abnormal pedicle morphology. Fluoroscopic guidance was frequently utilized, until technological advancements led to the adaptation of computer assisted screw insertion. While improvement in screw accuracy has been documented, an increase in radiation exposure, surgical time, and blood loss can occur. This institution adopted a T&T, or technique and technology, approach that combines freehand technique with CT-based navigation technology for confirmation and navigation for challenging pedicles.

Methods: This was a two-part retrospective review of 573 AIS patients that underwent PSF.Part I: 304 were operated in FOFA. 63 patients were operated on with solely CT-based navigation technology (CAS Group). 206 patients were in T&T. Perioperative outcomes were compared.Part II: 206 T&T patients were compared to 326 AIS patients from the NSQIP database that were operated on using computer-assisted navigation (CAN). Operative time and 30-day complications were compared.All data is presented as medians, IQR, frequencies, and percents. Fisher's Exact, Chi-squared, Kruskal-Wallis, and Wilcoxon rank-sum tests were used.

Results: FOFA radiation dose was 2.3 mGy and radiation time was 20.4 seconds compared to 22.2 mGy and 21.6 seconds for CAS, and 15.0 mGy and 18.6 seconds for T&T (P<0.001, P<0.001). Operative time was shorter for the T&T patients when compared to FOFA and CAS (P<0.001).Part II: T&T had an operative time of 233.0 minutes compared to 323.0 minutes for CAN (P<0.001).

Conclusion: T&T optimizes screw accuracy while reducing the increased radiation burden and operative time associated with CAS. The T&T approach incorporates CT-based navigation technology as confirmation, while maintaining surgeon's skill.

Study design: Cohort study.

Objective: Validate the Surgical Apgar Score (SAS) as a means of predicting perioperative major complications occurring within 30 days after scoliosis surgery in pediatric patients with cerebral palsy (CP).

Summary of background data: A patient's SAS, which is composed of three commonly recorded intraoperative variables, predicts postoperative complications after various types of spine surgery. This has not; however, been studied in pediatric patients with scoliosis and CP, a population that experiences a high incidence of complications after corrective spinal surgery.

Methods: Pediatric CP patients who underwent spinal correction surgery were included in this study. Patient background, surgical variables, and perioperative complications occurring within 30 days after surgery were collected. Patients were divided into 4 groups based on their SAS: SAS 0 to 4, SAS 5 to 6, SAS 7 to 8, and SAS 9 to 10. The incidences of perioperative complications for each group were compared using a receiver operating characteristic analysis. The area under the curve (AUC) is reported.

Results: A total of 111 patients met the inclusion criteria. There were no death cases. There were 44 (39.6%) perioperative major complications in 37 (33.3%) patients that occurred within 30 days after spine surgery. The most frequent perioperative complications were pulmonary issues (13.5%). The incidence of perioperative major complication in each SAS group was as follows: SAS 0 to 4; 51.6%, SAS 5 to 6; 30.2%, SAS 7 to 8; 18.5%, SAS 9 to 10; 0/0. When the SAS 7 to 8 group was set as the reference, there was no significant difference compared to SAS 5 to 6 ( P =0.34), while the incidence rate was significantly increased in SAS 0 to 4 ( P =0.02). The AUC was 0.65 (95% CI: 0.54-0.75).

Conclusions: Overall, there were 37 (33.3%) patients with CP who had a major complication within 30 days after spinal surgery. Lower SAS, with the 0 to 4 group being the cutoff, were associated with significantly higher complication rates than higher SAS groups.