Spine最新文献

Study design: Retrospective review of prospectively collected data.

Objective: To analyze temporal trends in improvement after minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Summary of background data: Although several studies have shown that patients improve significantly after MIS TLIF, evidence regarding the temporal trends in improvement is still largely lacking.

Methods: Patients who underwent primary single-level MIS TLIF for degenerative conditions of the lumbar spine and had a minimum of 2-year follow-up were included. Outcome measures were: 1) patient reported outcome measures (PROMs) (Oswestry Disability Index, ODI; Visual Analog Scale, VAS back and leg; 12-Item Short Form Survey Physical Component Score, SF-12 PCS); 2) global rating change (GRC); 3) minimal clinically important difference (MCID); and 4) return to activities. Timepoints analyzed were preoperative, 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years. Trends across these timepoints were plotted on graphs.

Results: 236 patients were included. VAS back and VAS leg were found to have statistically significant improvement compared to the previous timepoint up to 3 months after surgery. ODI and SF-12 PCS were found to have statistically significant improvement compared to the previous timepoint up to 6 months after surgery. Beyond these timepoints, there was no significant improvement in PROMs. 80% of patients reported feeling better compared to preoperative by 3 months. >50% of patients achieved MCID in all PROMs by 3 months. Most patients returned to driving, returned to work, and discontinued narcotics at an average of 21, 20, and 10 days, respectively.

Conclusions: Patients are expected to improve up to 6 months after MIS TLIF. Back pain and leg pain improve up to 3 months and disability and physical function improve up to 6 months. Beyond these timepoints, the trends in improvement tend to reach a plateau. 80% of patients feel better compared to preoperative by 3 months after surgery.

Study design: This was a retrospective study combined with attempted prospective patient contact to collect current data.

Objective: The purpose of this study was to investigate the long-term clinical outcomes of patients undergoing lumbar hybrid surgery (total disk replacement (TDR) at one level and fusion at an adjacent level.

Summary of background data: Many patients with symptomatic lumbar disk degeneration are affected at more than one level. Lumbar TDR was introduced as a fusion alternative; however, some disk levels are not amenable to TDR, and fusion is preferable at such levels. Hybrid surgery was introduced as an option to fusing multiple levels.

Methods: A consecutive series of 305 patients undergoing lumbar hybrid surgery was identified, beginning with the first case experience in 2005. Operative and clinical outcome data, including visual analog scales (VAS) assessing back and leg pain, Oswestry Disability Index (ODI), and reoperations, were collected. The mean follow-up duration was 67.1 months.

Results: There were statistically significant improvements ( P <0.01) in the mean values of all three clinical outcome measures: VAS back pain scores improved from 6.7 to 3.3; leg pain improved from 4.3 to 2.0; and ODI scores improved from 45.5 to 24.6. There were no significant differences in pain and function scores for patients with a minimum 10-year follow-up versus those with a shorter follow-up duration. Re-operation occurred in 16.1% of patients, many of which involved removal of posterior instrumentation at the fusion level (6.2% of the study group, 38.8% of re-operations). Reoperation involving the TDR level occurred in 9 patients (2.9%), only 3 of which (1.0%) involved TDR removal/revision.

Conclusion: This study supports that for many patients with multilevel symptomatic disk degeneration, hybrid surgery is a viable surgical option. Significant improvements were demonstrated in pain and function scores, with no diminished improvement in scores among patients with more than 10-year follow-up.

Level of evidence: Level IV.

Study design: Retrospective cohort study.

Objective: To examine how community-level economic disadvantage impacts short-term outcomes following posterior cervical decompression and fusion (PCDF) for cervical spondylotic myelopathy.

Summary of background data: The effects of socioeconomic factors, measured by the Distress Community Index (DCI), on postoperative outcomes after PCDF are underexplored. By understanding the impact of socioeconomic status (SES) on PCDF outcomes, disparities in care can be addressed.

Materials and methods: Retrospective review of 554 patients who underwent PCDF for cervical spondylotic myelopathy between 2017 and 2022. SES was assessed using DCI obtained from patient zip codes. Patients were stratified into quintiles from Prosperous to Distressed based on DCI. Bivariate analyses and multivariate regressions were performed to evaluate the associations between social determinants of health and surgical outcomes, including length of stay, home discharge, complications, and readmissions.

Results: Patients living in at-risk/distressed communities were more likely to be Black (53.3%). Patients living in at-risk/distressed communities had the longest hospitalization (6.24 d vs. prosperous: 3.92, P =0.006). Significantly less at-risk/distressed patients were discharged home without additional services (37.3% vs. mid-tier: 52.5% vs. comfortable: 53.4% vs. prosperous: 56.4%, P <0.001). On multivariate analysis, residing in an at-risk/distressed community was independently associated with nonhome discharge [odds ratio (OR): 2.28, P =0.007] and longer length of stay (E:1.54, P =0.017).

Conclusions: Patients from socioeconomically disadvantaged communities experience longer hospitalizations and are more likely to be discharged to a rehabilitation or skilled nursing facility following PCDF. Social and economic barriers should be addressed as part of presurgical counseling and planning in elective spine surgery to mitigate these disparities and improve the quality and value of health care delivery, regardless of socioeconomic status.

Study design: A randomized controlled study.

Objective: To introduce a new pilot hole preparation system for percutaneous pedicle screw placement and investigate its efficiency and safety in comparison with the conventional method.

Summary of background data: Placing screws accurately, rapidly, and safely with less radiation exposure is critical for minimally invasive lumbar interbody fusion (LIF). Optimizing pilot hole preparation instruments has important clinical implications.

Materials and methods: A total of 60 patients (180 screws) were included in this study. All patients were randomized into two groups (new system vs. conventional method) and performed single-level minimally invasive percutaneous fixation, interbody fusion, and unilateral decompression. Basic information, time of pilot hole preparation, time of screw placement, and fluoroscopy time were recorded. Screw placement accuracy was graded based on the Gertzbein-Robbins scale, and the angle between the screw axis and the pedicle axis was collected in postoperative CT.

Results: There was no statistical difference in basic information between the 2 groups. The mean time of single pilot hole preparation was 4.08±1.01 minutes in the new system group and 5.34±1.30 minutes in the conventional method group ( P <0.001). The time of single screw placement was significantly shorter in the new system group (0.82±0.20 vs. 1.72±0.33 min), and the fluoroscopy time was also less in the new system group (13.70±3.42 vs. 19.95±5.50 s) ( P <0.001). Screw placement accuracy assessment showed that there were 85 (94.45%) A-grade screws in the new system group while 76 (84.44%) A-grade screws in the conventional method group ( P =0.027).

Conclusions: The new pilot hole preparation system has shown significant reductions in the time of pilot hole preparation, time of screw placement, and radiation exposure, and has good clinical application value.

Study design: Retrospective cohort study.

Objective: The purpose of this study was to determine whether muscle mass and quality of the lumbar paraspinal muscles was associated with improvements in lumbar lordosis and other sagittal parameters after isolated posterior lumbar decompression surgery for lumbar spinal stenosis.

Summary of background data: Individuals may develop sagittal imbalance over time, either due to degenerative changes or other spinal conditions. In patients with lumbar spinal stenosis, sagittal imbalance can further exacerbate symptoms of pain and radiculopathy. Sarcopenia of paraspinal muscles has been implicated in previous spine research as a variable with influence on surgical outcomes.

Methods: Sagittal parameters were measured on preoperative and postoperative lateral lumbar radiographs and included lumbar lordosis (LL), sacral slope (SS), and pelvic tilt (PT). Preoperative MRI images were evaluated at the base of the L4 vertebral body to assess muscles mass of the psoas muscle and paravertebral muscles (PVM) and the Goutallier grade of the PVM. Patients were divided into three muscle size groups based on PVM normalized for body size (PVM/BMI): Group A (smallest), Group B, and Group C (largest).

Results: Patients in group C had greater LL preoperatively (51.5° vs. 47.9° vs. 43.2, P =0.005) and postoperatively (52.2° vs. 48.9° vs. 45.7°, P =0.043). There was no significant difference in the ∆LL values between groups ( P >0.05). Patients in group C had larger SS preoperatively (35.2° vs. 32.1° vs. 30.0°, P =0.010) and postoperatively (36.1° vs. 33.0° vs. 31.7°, P =0.030). Regression analysis showed that PVM/BMI was a significant predictor of LL preoperatively ( P =0.039) and postoperatively ( P =0.031), as well as SS preoperatively ( P =0.001) and postoperatively ( P <0.001).

Conclusions: Muscle mass of the paravertebral muscles significantly impacts lumbar lordosis and sacral slope in patients with lumbar spinal stenosis before and after posterior lumbar decompression. These findings highlight the need to address risk factors for poor muscle quality in patients with sagittal imbalance.

Level of evidence: Level III.

Study design: Survey-based, prospective study.

Objective: Identify age-adjusted baseline neck disability index (NDI) values in the American population.

Background: The NDI is the most widely used tool for assessing self-rated disability in patients with neck pain. Establishing baseline NDI values can aid in understanding the clinical impact of cervical spine pathologies and treatment interventions.

Materials and methods: An internet-based survey was distributed using the Connect ( TM ) platform powered by CloudResearch. Based on the latest U.S. census, this survey was designed to engage a demographically representative sample of the U.S. adult population. We captured 699 individuals, aiming for 100 people per each 10-year age group between 18 and 89. Participants scored their disability using the NDI survey. Mean NDI scores stratified by age group and sex were calculated for each cohort.

Results: A total of 699 participants were included with 352 (50.4%) males and 347 (49.6%) females and an age distribution closely aligning with national demographics. The overall mean NDI for the combined age groups was 16.5 with a 95% CI of 15.5 to 17.5. The 18 to 29 age group had the lowest mean NDI of 12.3 (95% CI: 10.4, 14.2). Mean NDI scores increased until the 60 to 69 age group with a mean of 20.1 (95% CI: 17.3, 23.0) with women having a mean NDI of 22.2 (95% CI: 18.8, 25.7) compared with men with 15.4 (95% CI: 10.3, 20.4). Mean NDI scores decreased in the 70 to 79 and 80 to 89 age groups.

Conclusion: This is the first study to assess age-adjusted baseline values of NDI in the U.S. population. Our findings demonstrate a disproportionate distribution of disability ratings across age groups. These data are important for health care professionals as it provides age and sex-specific levels of disability.

Level of evidence: Level III.

Study design: A prospective nonrandomized controlled study.

Objective: To compare the clinical and radiographic outcomes of anterior cervical corpectomy and fusion (ACCF) using titanium mesh cages (TMCs), nano-hydroxyapatite/polyamide 66 (n-HA/PA66) cages, and three-dimensional-printed vertebral bodies (3d-VBs).

Background: Postoperative subsidence of TMCs in ACCF has been widely reported. Newer implants such as n-HA/PA66 cages and 3d-VBs using biocompatible titanium alloy powder (Ti6Al4V) have been introduced to address this issue, but their outcomes remain controversial.

Patients and methods: We enrolled 60 patients undergoing ACCF using TMCs, n-HA/PA66 cages, or 3d-VBs from January 2020 to November 2021. For each group, there were 20 patients. Follow-up was conducted for a minimum of 2 years. Clinical outcomes, including Japanese Orthopedic Association (JOA) scores, Neck Disability Index, and Visual Analog Scale scores, and radiographic outcomes, including function of spinal unit (FSU) height, fusion rate, and cervical alignment, were collected preoperatively and at each follow-up. A loss of FSU height ≥3mm was deemed implant subsidence. One-way analysis of variance was used for comparisons of mean values at different time points within the same group, with pairwise comparisons performed using the least significance difference method. The Mann-Whitney test was used for comparisons between groups. Categorical data such as sex, smoking status, implant subsidence, and pathology level were analyzed using the χ 2 test.

Results: Postoperative FSU height loss at 2 years differed significantly among the TMC, n-HA/PA66, and 3d-VB groups, measuring 3.07 ± 1.25mm, 2.11 ± 0.73mm, and 1.46 ± 0.71mm, respectively ( P < 0.001). The rates of implant subsidence were 45%, 20%, and 10%, respectively ( P = 0.031). All patients obtained solid fusion at a 2-year follow-up. We observed statistically significant differences in Visual Analog Scale and JOA scores at 3 months postoperatively, and JOA scores at 2 years postoperatively among the 3 groups. At a 2-year follow-up, the n-HA/PA66 and the 3d-VBs groups exhibited less FSU height loss, lower subsidence rates, and demonstrated better cervical lordosis than the TMC group. No severe postoperative complications were observed in any of the patients, and no patient required reoperation.

Conclusion: At a 2-year follow-up after ACCF, the n-HA/PA66 and the 3d-VBs groups exhibited less FSU height loss, lower subsidence rates, and demonstrated better cervical lordosis than the TMC group. Longer-term observation of implant subsidence in ACCF using TMC, n-HA/PA66, and 3d-VB is necessary.

Level of evidence: Level III-therapeutic.

Study design: A meta-analysis study.

Objective: This meta-analysis evaluates the difference in surgical outcomes between obese and nonobese patients undergoing adult spinal deformity (ASD) corrective surgery.

Background: ASD encompasses a wide range of debilitating spinal abnormalities. Concurrently, obesity is on the rise globally and has been shown to influence the outcomes of ASD management. The relationship between obesity and surgical outcomes in ASD has been the focus of recent studies, yielding various results.

Materials and methods: We conducted a comprehensive search of PubMed, Cochrane, and Google Scholar (pages 1-20) through June of 2024. The surgical outcomes assessed included postoperative complications, revision rates, wound infections, thromboembolic events, implant-related complications, and nonhome discharge. Surgical parameters such as operative time, length of stay (LOS), and estimated blood loss (EBL), as well as functional outcomes like the Oswestry Disability Index (ODI) and pain scores were analyzed.

Results: Nine studies met the inclusion criteria. Nonobese patients exhibited a lower rate of implant-related complications [odds ratio (OR)=0.25; 95% CI: 0.12-0.52, P =0.0002] and nonhome discharge (OR=0.52; 95% CI: 0.32-0.84, P =0.007). In addition, nonobese patients had reduced LOS (MD=-0.29; 95% CI: -0.53 to -0.05, P =0.02) and EBL (SMD=-0.68; 95% CI: -1.19 to -0.18, P =0.008). No statistically significant differences were observed for the remaining outcomes.

Conclusion: Nonobese patients undergoing ASD corrective surgery are associated with fewer implant-related complications, a lower EBL, shorter LOS, and a higher likelihood of being discharged home compared with their obese counterparts.

Study design: Systematic review.

Objective: The primary purpose of this article was to survey the present literature and report on return-to-play (RTP) outcomes in elite athletes after undergoing motion preservation spinal surgery (MPSS).

Background: For elite performance, athletes require adequate mobility throughout the trunk, torso, and spine to achieve maximal force production. Therefore, elite athletes who have failed conservative treatment may seek to undergo motion-preserving surgical options, such as total disc arthroplasty and lumbar microdiscectomy. Individual studies have reported on RTP outcomes following individual motion preservation surgical procedures, but no systematic reviews have formally reported on RTP outcomes, postoperative performance, and reoperation rates on these procedures in elite athletes.

Materials and methods: A systematic review was conducted from inception until February 2024 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. One reviewer queried PubMed for relevant studies that reported on RTP outcomes in elite athletes after MPSS based on title and abstract (n = 1404). After the original search query, an additional reviewer screened full-length articles. A total of 11 studies met the inclusion criteria. Special consideration was given to RTP rates, postoperative performance, and reoperation rates.

Results: A total of 612 elite athletes from the National Basketball Association, Major League Baseball, National Football League, National Hockey League, and other professional sporting organizations underwent cervical and lumbar MPSS to treat various spinal pathologies. Various motion-sparing techniques were used to treat various pathologies. After undergoing MPSS, RTP rates ranged from 75% to 100% for lumbar cases and 83.3% to 100% for cervical cases. Postoperative performance varied with some athletes performing at the same level before surgery and some performing at a decreased level.

Conclusions: MPSS is a feasible option when properly indicated. Future studies are needed to compare return to sport rates, postoperative performance, and reoperation rates between MPSS to spinal arthrodesis.