Spine Surgery and Related Research最新文献

Introduction: Intramedullary spinal cord tumors (IMSCTs) are rare lesions associated with significant neurological impairment and decreased quality of life. Surgical resection is the primary treatment option; however, postoperative recovery is often limited and functional outcomes vary considerably. Although cigarette smoking is known to adversely affect outcomes in various spinal disorders, its impact on IMSCT surgery remains unclear. This study aimed to determine the influence of cigarette smoking on surgical outcomes and perioperative complications in patients with IMSCTs.

Methods: This retrospective comparative study included 194 consecutive patients with IMSCTs who underwent surgical resection between 2012 and 2022. Participants were categorized into smoker (n=35) and nonsmoker (n=159) groups based on smoking status. Demographic, surgical, and clinical outcomes were compared between the two groups.

Results: The smoker group had significantly lower pre- and postoperative Japanese Orthopaedic Association (JOA) scores for cervical and thoracic lesions than the nonsmoker group, with no significant improvement observed at the final follow-up. However, there were no significant differences between the groups in other demographic data, surgical data, perioperative complications, or postoperative modified McCormick scale grade changes for either cervical or thoracic IMSCTs. In addition, preoperative smoking status (the number of cigarettes smoked/day, years of smoking, total number of smoked cigarettes) showed no significant correlation with pre- or postoperative JOA scores.

Conclusions: Although smoking does not affect the incidence of perioperative complications, it negatively impacts JOA scores in patients with IMSCTs, regardless of the number of cigarettes smoked or the duration of smoking.

Introduction: The application of intraoperative computed tomography (CT) navigation in anterior cervical spine surgery remains limited because of challenges in securing a stable reference frame during supine positioning and the absence of reliable bony landmarks in the anterior cervical region. To overcome these limitations, we propose a novel technique involving reference frame placement on the proximal diaphysis of the clavicle and evaluate its feasibility and navigation accuracy.

Technical note: Five patients (4 males, 1 female; mean age 59±15 years) underwent anterior cervical surgery for cervical ossification of the posterior longitudinal ligament (n=2), cervical disc herniation (n=2), and cervical spondylotic amyotrophy (n=1). The reference frame was affixed to the clavicle contralateral to the operating surgeon. Intraoperative CT scans were obtained using a robotic C-arm angiography system and navigation was performed via an optical surgical navigation system. Navigation accuracy was assessed in 3 planes: mediolateral (x), craniocaudal (y), and anteroposterior (z). Navigation errors (mean±standard deviation) were 0.29±0.24 mm (x), 0.47±0.31 mm (y), and 0.64±0.59 mm (z), all within clinically acceptable limits. No intraoperative or postoperative complications, including clavicle fracture, subclavian vessel injury, or supraclavicular nerve damage, were observed. Compared with previously reported techniques, this method demonstrated favorable accuracy.

Conclusions: Clavicle-based reference frame placement offers high navigation accuracy and technical feasibility in anterior cervical spine surgery. Larger studies are warranted to confirm its clinical utility and safety.

Objective: To present 3 cases of spontaneous cervical epidural hematoma (SCEH) with acute neurological deterioration that achieved excellent functional recovery after surgical decompression, and to evaluate the influence of surgical timing on outcomes through a literature review.

Methods: We report on 3 patients diagnosed with SCEH via cervical magnetic resonance imaging (MRI) following acute-onset neck pain, followed by hemiparesis or hemiplegia. Surgical decompression was performed at 19, 6, and 10 hours after symptom onset, respectively. A comprehensive literature review was also conducted to assess the relationship between surgical timing and neurological outcomes in SCEH.

Literature search strategy: We performed a literature search using PubMed as the primary database, complemented by Google Scholar, covering the period from January 1980 to December 2024. Keywords included "spinal epidural hematoma," "cervical," "spontaneous," and "surgery." Inclusion criteria were case reports, case series, or reviews describing SCEH with surgical or conservative management and reported outcomes.

Results: All 3 patients demonstrated complete neurological recovery despite presenting with severe motor deficits and undergoing surgery at different times. Their recovery periods ranged from 11 to 90 days. Our literature review, which included 158 cases, consistently indicated that surgical timing is a critical factor influencing outcomes. Specifically, 83.2% of patients showed neurological improvement with surgery within 12 hours, while 68.9% improved when operated on between 12 and 24 hours¹⁾. Another study reported 91% favorable outcomes with ultra-early intervention (within 6 hours), compared to 33% when delayed beyond 48 hours²⁾.

Limitations: The proposed treatment algorithm is based on a small number of institutional cases combined with data from a narrative literature review. A formal meta-analysis or quantitative pooled analysis was not performed; therefore, the generalizability of the algorithm should be interpreted with caution.

Conclusions: Prompt surgical decompression, ideally within 12-24 hours, can result in excellent functional recovery in SCEH, even in patients with severe initial neurological deficits. Early recognition of stroke-mimicking symptoms and urgent MRI evaluation are crucial for achieving optimal outcomes.

Introduction: Patients with adolescent idiopathic scoliosis (AIS) frequently have cervical kyphosis, and, although it can be significantly improved by scoliosis correction surgery, cervical kyphosis remains frequent even after surgery. It has been reported that cervical kyphosis can increase the risk of pain, degenerative disc disease, and reduced quality of life, even in patients with AIS. However, it is unclear what indicators we should aim for during scoliosis correction surgery to prevent residual cervical kyphosis after surgery.

Methods: A total of 45 consecutive patients (41 women, 4 men) with Lenke type 1 or 2 AIS who received posterior corrective surgery and were followed up for a minimum of 2 years were included. Data were extracted from our prospectively collected database. The patients were divided into 2 subgroups: those with cervical hyperkyphosis (cervical lordosis ≤-10°) and those without. We investigated the alignment we should aim for during posterior thoracic correction surgery to prevent postoperative cervical hyperkyphosis. According to the previous study, we focused particularly on upper thoracic kyphosis (TK1-5).

Results: The cervical hyperkyphosis group was characterized by a large preoperative cervical kyphosis, a small preoperative and postoperative TK1-5, and a small postoperative T1 slope. In our multivariate logistic regression analysis, we found that postoperative TK1-5 was an independent associated factor for postoperative cervical hyperkyphosis.

Conclusions: We clarified that during posterior correction surgery for Lenke type 1 and 2 curves AIS, formation of kyphosis in the thoracic spine, especially in the upper thoracic spine, is important for preventing postoperative cervical hyperkyphosis.

Introduction: Osteoporotic vertebral fractures (OVFs) are the most common type of fragility fracture in elderly patients with osteoporosis. Bracing is widely used for conservative treatment; however, few studies have objectively assessed patient adherence to prescribed brace usage. This prospective study aimed to evaluate true patient compliance with the Jewett brace for acute OVFs using a temperature logger embedded in the brace.

Methods: Patients aged ≥65 years with an acute OVF diagnosed within two weeks of injury were enrolled between February 2024 and January 2025. After two weeks of bed rest, patients began ambulation while wearing a Jewett brace. A button-type temperature logger was installed on the sternal pad of the brace to record the temperature every 30 minutes for 42 consecutive days. Wearing was defined as temperatures ≥30°C. Based on previous reports, wearing the brace for 15 hours daily was defined as 100% compliance. Compliance was calculated for the entire period, for hospitalization versus post-discharge, and at three 14-day intervals. Correlations between vertebral instability and compliance were also analyzed.

Results: A total of 17 patients were included in the final analysis. The mean overall compliance rate was 85.8%, corresponding to an average wearing time of 12.9 hours per day. Brace compliance was consistently maintained at a high level during hospitalization and after discharge, as well as across the first, second, and last 14-day intervals. The daily wearing rate peaked at approximately 80% around mealtimes and remained above 70% during daytime hours. A significant, moderately positive correlation was observed between vertebral instability and compliance in the last 14 days.

Conclusions: This study objectively demonstrated a remarkably high patient compliance rate of 85.8% (12.9 hours per day) with Jewett braces for OVFs during the 42-day period following the initial two-week hospitalized bed rest.

Background: Low back pain (LBP) in children of school age has become an increasingly recognized health concern. Moreover, poor posture among children has emerged as a significant problem. However, large-scale studies evaluating the relationship between LBP prevalence and objectively measured spinal alignment using Spinal Mouse technology remain limited. This study aimed to determine the prevalence of LBP in children of school age and identify associated factors.

Methods: This cross-sectional study included 899 children (451 males, 448 females, mean age 10.6 years) who participated in the 2023 Katsuragi Integrated Defense for Locomotive Syndrome in Children (KID Locomo) study. LBP was assessed through questionnaires. Body composition and spinal alignment parameters including lumbar lordosis and sacral inclination were measured using Spinal Mouse. Associations between these parameters and LBP were evaluated considering age, sex, physical activity time, muscle mass, and postural awareness. Statistical analysis was performed using Student's t-test.

Results: LBP was present in 45 children (5.0%), with no significant sex difference (p=0.17). The LBP group showed significantly higher values for age (12.6 vs. 10.5 years), longer weekly physical activity time (385.5 minutes vs. 219.3 minutes), appendicular skeletal muscle mass (16.0 kg vs. 12.6 kg), trunk muscle mass (18.3 kg vs. 14.9 kg), and skeletal muscle index (all p<0.05). In addition, the LBP group had significantly higher rates of neck stiffness (46.7% vs. 7.5%), parental awareness of poor posture (75.6% vs. 52.9%), student awareness of poor posture (77.8% vs. 51.3%), and lower sitting sacral inclination (14.1° vs. 16.5°) (p<0.05).

Conclusions: The prevalence of LBP in children of school age was 5.0%. Associated factors included older age, longer weekly physical activity time, increased muscle mass, decreased sacral inclination in sitting position, and awareness of poor posture. LBP may increase owing to growth-related changes, lifestyle factors, and postural influences.

Introduction: Chronic low back pain (CLBP) is a complex condition significantly impacting global health. While non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for treatment, factors influencing their efficacy remain poorly understood. This study investigated the therapeutic effects of systemically acting diclofenac sodium patches in patients with CLBP and factors influencing their efficacy, focusing on psychiatric factors and neuropathic pain components in short-term (4 weeks) and long-term (12 weeks) outcomes.

Methods: This multicenter retrospective observational study included 196 patients with CLBP treated with diclofenac sodium patches (150 mg/day). The visual analog scale (VAS) evaluated the intensity of LBP. Psychiatric factors were assessed using the Brief Scale for Psychiatric Problems in Orthopedic Patients (BS-POP), and neuropathic pain was evaluated using the short form of the Spine painDETECT questionnaire (SF-SPDQ). Multiple regression analyses were performed to identify predictive factors.

Results: LBP VAS scores significantly improved from baseline (72.4±15.4) to 12 weeks (42.6±23.5). Among the participants, 112 (57.1%) had comorbid pain, defined as chronic musculoskeletal pain in sites other than low back and radiating leg pain. Multiple regression analysis revealed that psychiatric factors (BS-POP score; regression coefficient=-1.10, p=0.026) and presence of comorbid pain (regression coefficient=-9.50, p=0.021) were significant negative predictors at 4 weeks, with their impact increasing at 12 weeks (BS-POP score: regression coefficient=-2.51, p<0.001; comorbid pain: regression coefficient=-11.73, p=0.020). Neuropathic pain components negatively affected only short-term outcomes.

Conclusions: Psychiatric factors and comorbid pain significantly influence the efficacy of diclofenac sodium patches in CLBP treatment, with their impact increasing over time. These findings emphasize the importance of comprehensive patient assessment before initiating NSAID treatment and suggest the need for early multifaceted intervention in patients with psychiatric factors and comorbid pain.