Spine Surgery and Related Research最新文献

Introduction: Intervertebral disc degeneration (IDD) is a primary cause of chronic back pain and disability, highlighting the need for precise detection and grading for effective treatment. This study focuses on developing and validating a convolutional neural network (CNN) with a You Only Look Once (YOLO) architecture model using the Pfirrmann grading system to classify and grade lumbar intervertebral disc degeneration based on magnetic resonance imaging (MRI) scans.

Methods: We developed a deep learning model trained on a dataset of anonymized MRI studies of patients with symptomatic back pain. MRI images were segmented and annotated by radiologists according to the Pfirrmann grading for the datasets. The segmentation MRI-disc image dataset was prepared for three groups: a training set (1,000), a testing set (500), and an external validation set (500) to assess model generalizability without overlapping images. The model's performance was evaluated using accuracy, sensitivity, specificity, F1 score, prediction error, and ROC-AUC.

Results: The AI model showed high performance across all metrics. For Grade I IDD, the model achieved an accuracy of 97%, 95%, and 92% in the training, testing, and external validation sets, respectively. For Grade II, the sensitivity was 100% in both training and testing sets and 98% in the validation set. For Grade III, the specificity was 95.4% in the training set and 94% in both testing and validation sets. For Grade IV, the F1 score was 97.77% in the training set and 95% in both testing and validation sets. For Grade V, the prediction error was 2.3%, 2%, and 2.5% in the training, testing, and validation sets, respectively. The overall ROC-AUC was 97%, 92%, and 95% in the training, testing, and validation sets, respectively.

Conclusions: The AI-based classification model exhibits high accuracy, sensitivity, and specificity in detecting and grading lumbar IDD using the Pfirrmann grading. AI has significantly enhanced diagnostic precision and reliability, providing a powerful tool for clinicians in managing IDD. The potential impact is substantial, although further clinical validation is necessary before integrating this model into routine practice.

Introduction: Minimally invasive surgical treatment of myelopathy caused by central thoracic disc herniation (TDH) is challenging to carry out because reaching the herniation site is difficult and the thoracic spinal cord is fragile. In this study, using the posterior-lateral approach for central TDH with myelopathy, we present a novel procedure of transcostal microendoscopic discectomy (TCMED).

Technical note: The patient was operated in a prone position under general anesthesia. At a preoperatively determined distance from the midline, an 18-mm-long longitudinal incision was conducted, and using a 25-degree microendoscope, the operation was carried out. The endoscope was placed at an inward angle of approximately 50 degrees in the vertical direction. The ribs adjacent to the disc were identified, and the disc was exposed by resecting the ribs using a surgical high-speed drill while preserving the cortical bone of the ribs on the pleural side. The herniation was identified by drilling the ventral side of the disc and was then successfully removed. After discectomy, the dura mater expanded ventrally. Three male patients (mean age, 47.3 years) were treated, with 20 weeks of follow-up on average, 237.7-min mean operative time, and 26.7-mL mean blood loss. The average preoperative modified Japanese Orthopedic Association score was 5.2/11, which improved to 9.5/11 postoperatively, with a 75.6% average recovery rate. The 10-s step test score improved from an average of eight times preoperatively to 20 times postoperatively. No serious perioperative or postoperative complications or residual rib pain were observed.

Conclusions: The proposed TCMED approach for treating central TDH that causes myelopathy allows for safe access to the level of the posterior vertebral wall using the rib as a landmark for resecting the rib head without opening the chest. Using the angled microendoscope and curved surgical instruments, the central TDH, located ventral to the spinal canal, can then be safely and effectively resected without spinal cord retraction.

Introduction: Patients with adult spinal deformity (ASD) lean forward with their trunks when walking, even if they can remain upright during static standing. However, it remains unclear which part of the spinal column is involved in forward trunk tilt and the details of the relationships between sagittal alignment during static standing and changes in dynamic parameters during walking. Therefore, this study aimed to clarify the above by analyzing the walking motion of ASD patients using inertial measurement units (IMUs).

Methods: Preoperative ASD patients were included in this study. Dynamic parameters during gait were measured by IMUs attached on the skin at the T1, T12, and S1 spinous processes, thigh, and lower leg. Walking data were divided into three phases of 10 s each (initial, middle, and final), and the average dynamic parameters at each phase were statistically compared. The relationships between the standing radiographic and dynamic parameters in the final phase were evaluated by linear regression analyses.

Results: A total of 34 patients were included in this study. Their mean age was 72 years. The inclination of IMUs on the T1, T12, and S1 and the flexion angle of T12-S1 IMUs significantly increased over time. Pelvic tilt (PT) of standing radiography was positively correlated with the inclination angles of T12 (r²=0.22, p=0.0048) and S1 (r²=0.16, p=0.0178) and the flexion angle of T12-S1 IMUs (r²=0.29, p=0.0011).

Conclusions: This study showed that anteversion of the trunk in patients with ASD is due to an increase in lumbar forward bending and anterior tilt of the pelvis. Lumbar forward bending was significantly correlated with PT on standing radiography. It is important to consider the presence of poorer posture during gait than during standing when we evaluate patients with high PT.

Introduction: In high-grade spinal osteotomy involving large anterior column resection, restoration of the structural integrity of the posterior column at the osteotomy site can reduce postoperative instrumentation failure (IF). This study aimed to describe our technique of posterior strut bone grafting using an en bloc resected vertebral arch, which is useful for posterior column reconstruction after high-grade osteotomies during surgeries for spinal tumor and deformity in the lower lumbar spine.

Technical note: Using a posterior approach, en bloc resection of the targeted vertebral arch was performed in accordance with the surgical technique for total en bloc spondylectomy (TES). The posterior elements in the upper and lower adjacent vertebrae were separated by a significant space after vertebral body resection followed by cage insertion in TES or anterior column osteotomy followed by correction in deformity surgery. To create a new posterior column, the en bloc resected vertebral arch was placed at 90° rotation to bridge the upper and lower vertebral arches. Using this technique, an abundant amount of bone chips made from the resected vertebral elements were placed over the en bloc resected posterior arch as an additional bone graft. The technique was used in three patients who underwent TES for spinal tumors and in one patient who underwent grade 4 osteotomy for adult spinal deformity in the lower lumbar spine. One year after surgery, computed tomography showed that the structural integrity of bony fusion was successfully achieved between the en bloc resected arch and the posterior elements of the adjacent vertebrae in all patients and showed no postoperative IFs.

Conclusions: This bone graft technique created new continuity of the posterior column after high-grade osteotomies in the lower lumbar spine. Bone fusion was achieved in the posterior elements to prevent IF after surgery.

Introduction: Adult spinal Langerhans cell histiocytosis (LCH) presents a treatment challenge due to ongoing controversies. Traditional approaches such as curettage with bone grafting and internal fixation are preferred for severe cases involving mechanical instability, neurological deficits, or deformity. This study aimed to explore the efficacy of a customized approach involving simple posterior instrumentation without curettage or bone grafting in treating adult spinal LCH.

Methods: This retrospective study analyzed a prospectively maintained database of all spine surgeries conducted at our institute from April 2013 to December 2020. Adult patients (age≥20) diagnosed with LCH were included. We assessed surgical methods, adjuvant therapy, and clinical results, such as perioperative progression of disease, symptoms, and recurrence.

Results: Four male patients aged between 21 and 28, each with a single spinal LCH lesion (T6, T5, and C5) except one case (T5 and T7), were treated. Diagnoses were confirmed via biopsy (two open, two needle biopsies). Whole-body computed tomography or bone scintigraphy revealed no additional LCH lesions in any patient, except in one patient with a small lung nodule. All patients presented with severe back or neck pain and pathological fractures at the affected vertebra. Thoracic LCH cases received percutaneous pedicle screw fixation, while the cervical case was managed with conventional posterior instrumentation using lateral mass screws. After surgery, all patients experienced significant pain relief, halted bone lysis, and rapid new bone formation. One patient underwent chemotherapy postsurgery. Over 3 years of follow-up, imaging studies revealed no recurrences of the disease.

Conclusions: Posterior instrumentation, without the need for curettage or bone grafting, is a promising surgical treatment for adult spinal LCH. This method may effectively halt lesion progression, prevent spinal deformity, and avert neurological deficits in the patients with progressive spine lesion where conservative treatment may not adequately prevent vertebral fractures.

Introduction: This study aimed to standardize perioperative interruption of antiplatelet agents in patients undergoing cervical spinal surgery and investigate the incidence of epidural hematoma and thrombotic complications.

Methods: A total of 153 patients, consisting of 85 men and 68 women, were included in this study. Their mean age was 65.5 years. They were divided into two groups: Groups A and B. Group A (139 patients) did not receive preoperative antiplatelet agents, and Group B (14 patients) resumed antiplatelet agents from 7 or 14 days presurgery to 3 days postsurgery. Our analysis encompassed demographic data before surgery, postoperative magnetic resonance image-based assessment of radiological epidural hematoma (EH), and complications such as symptomatic hematoma, blood transfusion, stroke, and venous thromboembolism after surgery.

Results: The frequency of medical conditions, such as hypertension, diabetes, and hyperlipidemia, was significantly higher in Group B than in Group A. The CHADS2 scores, which serve as a clinical prediction rule for estimating stroke risk, were significantly higher in Group B than in Group A. In contrast, the intraoperative blood loss was significantly lower in Group B than in Group A. There was no significant difference in radiologically severe EH, hemorrhage, and thrombotic complications between the two groups. Interestingly, none of the patients in Group B had hemorrhagic and thrombotic complications.

Conclusions: Our standardized perioperative management of antiplatelet agents did not affect the incidence of radiological EH, hemorrhage, and thrombotic complications in patients undergoing cervical spinal surgery.

Introduction: Disc degeneration is a risk factor of pyogenic spondylitis. However, its degree in patients with pyogenic spondylitis is unknown. This study aimed to determine differences in disc degeneration between patients with pyogenic spondylitis and those with noninfectious lumbar spondylosis.

Methods: A total of 85 patients with lumbar pyogenic spondylitis (the infected group) and 156 with lumbar spondylosis who underwent posterior lumbar interbody fusion (the noninfected group) were retrospectively evaluated. Patients with a previous history of spinal fusion, tuberculous spondylitis, and multilevel infection and those receiving dialysis were excluded. Magnetic resonance imaging of the lumbar spine was conducted. Each disc at the L1/2-L5/S levels was graded. The total score of the four discs, excluding the affected disc, was used as the modified disc degenerative disease (DDD) score. Propensity score matching was performed using independent variables such as age, sex, diabetes mellitus, cancer, and steroid use. The modified DDD scores at all and each disc level were compared between the two matched groups.

Results: After matching, 48 patients in the infected group and 88 in the noninfected group were finally included in the study. The mean modified DDD scores of the infected and noninfected groups were 7.63 and 5.40, respectively. The modified DDD scores at all and each disc level were higher in the infected group than in the noninfected group.

Conclusions: The incidence of disc degeneration at all and each disc level was higher in patients with pyogenic spondylitis than in those with noninfectious lumbar spondylosis.